Mesh Working Group, Interim report from the NHS England8th December 2015
BSUG wishes to make members aware of the Mesh Working Group, Interim report from the NHS England (https://www.england.nhs.uk/ourwork/qual-clin-lead/mesh). The BSUG board have worked with NHS England on this committee and all three working parties representing its members.
We draw your attention to point 2.4 which states:
2.4 Points of agreement
While there has been much debate and some disagreement amongst members, there is consensus between patients, clinicians, policymakers and regulator that there is significant scope for improving care. This can be achieved by focusing on clinical practice, improving data and information, and reviewing procedures for obtaining informed consent.
Overall the document places emphasis on appropriate decision making with documented training of clinicians and adherence to NICE guidance. The role of appraisal is also considered in the document. It states uncertainty regards complications of procedures and places emphasis on the consent process and the collection of data. There is reference to the current optional collection of data and suggestions that a national registry should be considered. This would be supported by BSUG but requires DOH funding to occur. In the meantime we would recommend members to submit all data onto the BSUG database.
There is also a need for a registry of surgeons with experience of mesh removal. Hopefully the recent RCOG questionnaire in this regard to members will help this to be achieved. It is essential that any mesh complications are reported to MRHA so an accurate picture can be obtained. To date it would appear that the complications are under-reported.
Finally the report does separate out mesh procedures for prolapse from those used to treat urinary incontinence. It also make recommendations that NICE should review its current guidance and update in line with the most recent data available.
We would recommend our members to read this report.