I thank the Chairman and members for inviting us to update the committee on vaginal mesh implants and the services we put in place to support people affected by complications in the use of implants. As the Chair mentioned, I am joined by Dr. Clíona Murphy, Ms Catherine Donohoe, and Dr. Suzanne O’Sullivan.
Mesh is a medical product used in a range of surgical specialties, and our focus today relates to mesh used in two urogynaecological procedures for women - the treatment of stress urinary incontinence, SUI, and pelvic organ prolapse, POP. In November 2017, following the experiences of many women who had mesh implants that were causing pain, infection or other complications, the then Minister for Health, Deputy Simon Harris, requested the Chief Medical Officer, CMO, to review the clinical issues involved. In July 2018, the HSE paused the use of vaginal mesh implants for the treatment of SUI and POP.
The CMO’s report, The Use of Uro-gynaecological Mesh in Surgical Procedures, was published in November 2018. The report gave a comprehensive history of vaginal mesh implants and their purpose, and detailed the problems experienced by some women, which led to the pause in use of such implants. The report contained 19 recommendations covering two broad areas: responding to the needs of women experiencing vaginal mesh implant complications and consideration of how clinical practice in the use of vaginal mesh might operate should the pause be lifted. To date, 11 recommendations have been completed, five are ongoing and three are no longer deemed clinically appropriate to progress. The five ongoing recommendations are prospective clinical recommendations and will be implemented if vaginal mesh implants are used again in the future.
I will outline the work done to meet the needs of women and people affected by problems with mesh implants. In order to initially identify and assist the patients who needed support, assessments or had questions about their care or experience, a dedicated page on the HSE website was created with detailed patient information and guidance. The information was promoted in news reports and on social media, and it was ensured that the page was easy to access on search engines. Each hospital group identified specific contact details for its patients, and these were provided on the HSE site. Communications from approximately 70 women were received, and all of the women who made contact were offered appointments either at the time or subsequently.
A new national mesh complications service was established, with a centre in Cork and in Dublin, that has the option to refer people for specialist care abroad if needed. The HSE put in place a three-tiered response to mesh complications to ensure that women always have a pathway of care. First, women experiencing post-mesh complications are advised to contact either their GP or the consultant who inserted the implant, for a clinical assessment. Next, if specialist care is needed, they can then be referred to the national mesh complications service. This service is delivered across two centres and provides expert specialist care to women requiring mesh removal.
The mesh complications service has a multidisciplinary team in place with a range of medical specialties involved. The two hospitals providing this complications service are recognised urogynaecology centres with subspecialist expertise. These centres have extensive experience in dealing with complex pelvic-floor problems, including mesh complications. An additional HSE investment of €1.3 million was provided specifically for this service in 2021. The consultants involved in the care of patients with mesh complications have specialist and subspecialist training, most of which was done abroad in the UK, US and Australia. In addition to this, an internationally renowned subspecialist training programme in urogynaecology has been established in Ireland.
The national mesh complications service, which is a HSE public service, does not make a distinction between women who had a vaginal mesh implanted in a private or public facility. Information on how to access the national mesh complications service is published on the dedicated HSE web page, and is available from all acute hospitals, GPs and patient representative groups.
Both centres have full diagnostics services available, including translabial scanning. In November 2021, a consultant urogynaecologist from the UK led a translabial and transvaginal teaching day and clinic in the urogynaecology department in Cork. Feedback obtained from the women who attended the clinic was positive. There is an identified lead consultant within each centre for this service. To date, the centre in Cork has seen approximately 40 patients and currently has no waiting list. It has a designated mesh clinic that is held every six weeks. The centre in Dublin has seen approximately 69 patients and has a waiting list of 16. We anticipate that all patients will be seen by October 2022.
The third tier of the pathway is the availability of treatment abroad. For some patients who have defined clinical complexities, access to treatment abroad gives an additional pathway when the level of complexity requires it. An application for treatment abroad can be supported by the HSE national mesh complication service. The care of a patient reverts to the referring consultant upon return to Ireland, through whom all follow-up care is organised.
I will conclude by once again acknowledging the difficult experience of the significant number of women who have and are suffering serious complications from the use of vaginal mesh implants. The HSE hopes that the significant investment made in developing the dedicated services to support women will have a positive impact and outcome for people affected. We take this opportunity to encourage people who may be suffering with mesh complications to contact their GP or the HSE for care and support.
