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Mesh campaigners are dismayed by minister’s blunder over NICE guidance

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4879 (Published 20 October 2017) Cite this as: BMJ 2017;359:j4879
  1. Zosia Kmietowicz
  1. The BMJ

Campaigners have said that they feel betrayed by a government minister who led them to believe that guidelines from the National Institute for Health and Care Excellence (NICE) for treating stress incontinence and pelvic organ prolapse would be published before the end of the year.

Jackie Doyle-Price, England’s social care minister, was speaking at the end of a debate on surgical mesh implants in the House of Commons on 18 October, at which MPs relayed stories about how their constituents had been left in pain and unable to work or look after their families, with broken relationships, ruined sex lives, and post-traumatic stress disorder, after being fitted with mesh implants for stress incontinence, vaginal prolapse, or hernia repair.

Doyle-Price rejected MPs’ calls for a public inquiry into the number of people harmed after surgery to fit mesh implants, saying that a ban on the use of mesh implants was unnecessary.

“With regard to the evidence, we expect to produce the NICE guidelines before the end of 2017,” she said. “We will bring them forward as soon as possible. I am sure that honourable members will want to review those guidelines, to see whether they are satisfied that they have moved forward.

“The advice I have received from the MHRA [Medicines and Healthcare Products Regulatory Agency] is that mesh is still the best product for treating stress incontinence, but the evidence regarding prolapse is more mixed. I can give that advice to honourable members today, but we await the NICE guidelines before the end of the year.”

Although MPs were disappointed that the minister quashed calls for a public inquiry or a ban on implants, they gave an audible sigh of relief that the government was taking some action by expediting the NICE guidelines.

However, inquiries by The BMJ to NICE found that Doyle-Price had been referring to interventional procedures guidance for stress incontinence and prolapse, the last of which is due to be published in December.12345678 The clinical guidelines on treating stress incontinence and prolapse are scheduled for February 2019 and are not being brought forward.9

NICE procedural guidelines do not have the legal weight of clinical guidelines, meaning that their recommendations do not have to be implemented.

A Department of Health spokeswoman told The BMJ that “amendments will be made to Hansard” to clear up the confusion over Doyle-Price’s comments.

After Doyle-Price’s announcement Owen Smith, who chairs the All Party Parliamentary Group on Surgical Mesh Implants, issued a statement welcoming the decision to fast track the NICE guidelines, which he assumed were the clinical guidelines. “Women who have been treated with mesh, or who are contemplating such treatment, will be pleased that the government has agreed to bring forward new guidelines as soon as is possible,” he said.

But, after it was pointed out to him that this was not the case, Smith said in a statement to The BMJ, “I’m incredibly disappointed that Jackie Doyle-Price’s comments on NICE guidelines during yesterday’s debate on mesh did not refer to guidelines to treat POP [pelvic organ prolapse] and SUI [stress urinary incontinence].

“We were all led to believe that the central guidelines that govern clinicians in the treatment for POP and SUI were being brought forward, but instead they will not be published until 2019. That just isn’t good enough.

“I would repeat my earlier calls for the government and NICE to urgently prioritise these guidelines and bring them forward as quickly as possible.”

David Golten, a solicitor representing over 400 women in England and Wales in liability claims against the NHS and mesh manufacturers, told The BMJ, “I was present during the debate. It was clear that when the minister said that the ‘guidelines’ would be published before the end of the year, everyone understood her to be referring to the clinical guidelines, which are due to be published in February 2019.

“It is those guidelines which Emma Hardy [the MP who organised the debate], Owen Smith, and others had been referring to during the debate. It is extremely disappointing that the Department of Health has now said that the guidelines to which the minister was referring are the interventional procedures guidelines.”

Kath Sansom, from the campaign group Sling the Mesh, told The BMJ, “Hansard records must not be amended, as they are a record of what is said, not what a person should have said. She should remain on record forever in history as the woman who did not give enough interest about other women suffering horrendous, life changing injuries from vaginal mesh implants.”

Jackie Harvey, from the group Meshed Up Northern Ireland, said, “This shows that the minister has no interest whatsoever in the plight of women.”

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