The Ministry of Health, in collaboration with other health sector agencies, is continuing to progress work on the actions agreed in the report Hearing and Responding to the Stories of Survivors of Surgical Mesh published in December 2019.
Progress since the previous update
Specialist multi-disciplinary centre(s) are required – a group will meet in January 2020 to advise the number of specialist centres required to ensure equity of access, the model of care, and team required.
Status: In progress
Proposals have been received from Canterbury and Waitemata District Health Boards (DHBs) on co-designed national mesh complications service models, including options for delivery of that model.
Further information is currently being sought to support these proposals, following which the Ministry will work with ACC, and other stakeholders to finalise the model and seek the resources required to deliver the new service.
A combined implementation approach to establishment of the service will follow.
Due to the impacts of COVID-19, it is now likely services will be incrementally established from early 2022, remains dependent on factors such as recruitment of specialist workforce and an appropriate funding model.
Credentialing for mesh removal will need to be completed prior to commencement of the service.
Establish a credentialing committee by the end of January 2020 to recommend national standards for individual practitioners and services commencing with urogynaecology procedures – minimum standards for insertion, renewal, repair, and removal of surgery and native tissue repair will be included.
Status: In progress
The Ministry secured specialist gynaecologist support to assist with the completion of the credentialing framework, which will be done alongside the group who developed the draft framework in late 2020.
A final draft of the credentialing framework will be delivered to the Ministry in early October.
A new national credentialing committee will be established to implement the framework and undertake the initial credentialing of the workforce.
Work is on track to have the final framework published and credentialing undertaken of the subspecialist workforce prior to the establishment of the national mesh complications service.
The Ministry of Health will lead, supported by ACC, interdisciplinary education and build the capability of the required technical skills to prevent future harm and reduce the severity of existing harm.
This action intends to also support the provision of removal surgery.
Status: In progress
Work continues on developing interdisciplinary education for primary, secondary and tertiary prevention and care.
Two workshops have been held with steering group members to support the development of the primary prevention resources.
These workshops outlined the details of the learning resources, platforms and systems that will need to be developed in order to deliver it.
Co-design workshops are scheduled in early October to finalise primary prevention education specifications.
The secondary care workstream remains on hold while the HealthPathway is finalised and published, while the tertiary care workstream is dependent on finalising the credentialing framework.
ACC will partner with consumer representatives to design an approach for looking back through declined mesh-related treatment injury claims.
Recognising those claim outcomes may not change; the process will also aim to learn where improvements can be made to the consumer experience.
ACC have recently updated their website in regard to reassessing declined surgical mesh claims.
National information resources for mesh-related procedures should be created with consumers and include informed consent processes.
Information should incorporate the product safety profile, outcomes and risks, alternative treatments available, and the informed consent process.
The Health and Disability Commission wrote to DHB Chief Executives in August 2021 asking for an update on surgical mesh procedures in in their hospitals, and what resources are used to support informed consent processes.
Responses are still being collated, however indicatively of the DHBs where surgical mesh procedures are being performed, all but one are routinely using the national patient resource.
A similar letter has been sent to private surgical hospitals, and responses are currently being received.