A new NHS Scotland contract will continue specialist pelvic mesh removal treatment for women living with complications from procedures that were halted in Scotland eight years ago. The £100,000 agreement maintains access to independent treatment alongside the national specialist service in Glasgow.
NHS Scotland has awarded a new £100,000 contract for specialist pelvic mesh removal services, continuing treatment for women affected by complications from implants used for stress urinary incontinence and pelvic organ prolapse.
The contract award was published by Public Service Delivery Scotland on 15 September 2026. It covers clinically led assessment, treatment and mesh removal procedures for eligible NHS Scotland patients and was awarded to Spire Healthcare and Vaginal Surgery & Urogynecology LLC in St Louis, Missouri. The contract was concluded on 18 August and has a stated value of £100,000 excluding VAT.
The arrangement sits alongside Scotland’s national Complex Mesh Surgical Service in Glasgow. National Services Scotland says most women who undergo surgery choose the Glasgow service, although patients can also be referred to independent providers in Bristol or St Louis after specialist assessment. For women using the independent route, the NHS pays for treatment as well as travel and accommodation, with arrangements also made for a companion.
The existence of a new contract in 2026 reflects the continuing consequences of a medical procedure that was once routinely used in Scotland but became the subject of sustained concern over serious complications, patient experience and the ability of the health service to recognise and treat women who had been harmed.
What pelvic mesh was designed to do
Transvaginal mesh was used principally in the treatment of stress urinary incontinence and pelvic organ prolapse.
Stress urinary incontinence can cause urine leakage when pressure is placed on the bladder through activities such as coughing, exercising or lifting. Pelvic organ prolapse occurs when weakened muscles and supporting tissue allow pelvic organs to move from their normal position.
Synthetic mesh was introduced as a means of reinforcing weakened tissue. In procedures for urinary incontinence, strips of polypropylene mesh could be used to support the urethra. Other forms of mesh were used in operations intended to repair pelvic organ prolapse.
For many women the surgery produced the intended result. Scotland’s independent review of transvaginal mesh later emphasised that serious complications did not occur in the majority of patients. But the review also concluded that mesh procedures carried risks which, for some women, were life-changing and could not always be corrected.
Concerns began to intensify as women reported chronic pain and other problems after surgery. The Scottish Government’s review was established against growing concern over serious complications, poor understanding of why some had occurred and under-reporting of adverse events. The review also recorded that some women felt that their concerns had not been heard.
The complications associated with mesh could include pain, infection, exposure or erosion of the implant into surrounding tissue, urinary difficulties and further surgery. Mesh removal itself could also be technically difficult because implanted material could become incorporated into tissue.
By the time Scotland’s final independent review was published in March 2017, the issue had developed beyond the safety of a single surgical technique. The review examined patient experiences, adverse-event reporting, clinical governance, consent, available NHS data and the treatment of women who developed complications.
It concluded that long-term evidence remained insufficient, that information systems needed improvement and that some women who experienced adverse events felt they had not been believed. The review said that this could add to their distress and delay remedial treatment. It called for better clinical awareness, stronger reporting, improved consent and clear pathways for women suffering complications.
For pelvic organ prolapse, the review found no evidence of additional benefit from routine use of transvaginal mesh compared with repair using the patient’s own tissue and concluded that such procedures should not routinely be offered.
Scotland halted the procedures
In September 2018, the Scottish Government instructed health boards to stop the use of transvaginal mesh for both stress urinary incontinence and pelvic organ prolapse.
The halt was introduced while a restricted-use system was considered, with ministers saying any future procedure would have to be confined to exceptional circumstances and subject to stricter approval and informed-consent requirements. Other forms of surgical mesh were treated separately and remained subject to their own clinical assessment.
The decision prevented continued routine use of the procedures at the centre of the controversy. It did not remove mesh that had already been implanted in women across Scotland.
For some patients, symptoms could be treated without further surgery. For others, partial or complete removal became an option, although removal is itself specialised surgery and does not automatically resolve every complication.
Scotland subsequently developed a national service specifically for women experiencing complex problems after mesh surgery.
The Complex Mesh Surgical Service in Glasgow, hosted by NHS Greater Glasgow and Clyde, now provides multidisciplinary assessment involving specialist surgeons, doctors, nurses, physiotherapists and psychologists. Treatment can include non-surgical care or partial or full removal of mesh depending on the individual case.
Women are referred through local urogynaecology services and are assessed before treatment decisions are made. The Glasgow centre forms part of a UK network of specialist mesh services.
The development of that pathway followed years in which some Scottish women sought treatment privately or travelled outside Scotland because they did not believe the available NHS options could provide the surgery they wanted.
In 2022, Scotland introduced a statutory reimbursement scheme for women who had paid privately for mesh removal before the new NHS-funded arrangements were established. The scheme allowed eligible patients to recover the cost of surgery and associated expenses. It subsequently closed to new applications in March 2024, but the NHS-funded referral pathway to independent providers remained in place.
Treatment now extends beyond Scotland
The current NHS pathway gives women who require surgery a choice between the national service in Glasgow and independent treatment elsewhere.
National Services Scotland says the two independent providers currently used are in Bristol and St Louis. Women choosing those providers have surgery and travel funded by the NHS, with accommodation organised for the patient and a companion.
The new procurement continues that arrangement.
Public Service Delivery Scotland says the contract is intended to provide specialist mesh-removal services according to clinical need. The contract was awarded under the procurement regime applying to health services, with clinical quality accounting for 80 per cent of the award criteria and price for 20 per cent.
The £100,000 contract does not establish how many women will require surgery during its term and should not be read as evidence that the number of women affected by mesh complications is either rising or falling.
What it does establish is that NHS Scotland still considers independent specialist provision necessary in 2026.
The treatment system is now markedly different from the one that existed when women first began reporting serious problems. Routine use of the transvaginal procedures at the centre of the controversy was halted. Scotland established a national specialist service, developed dedicated referral routes and created mechanisms for women to seek treatment outside Scotland at NHS expense.
The clinical legacy nevertheless remains.
Women who were implanted years ago can continue to experience complications and can still require specialist assessment or surgery. National Services Scotland’s current guidance specifically provides for patients whose previous non-surgical treatment or earlier surgery has failed to resolve their problems.
Eight years after Scotland halted the procedures, the new contract published this week continues the system created to deal with their consequences.
Sources
NP69726 Pelvic Mesh Removal Services
Public Contracts Scotland, 15 September 2026
Public Contracts Scotland contract award notice
Complex Mesh Removal Surgery Service
National Services Scotland, 13 February 2026
National Services Scotland
Independent Providers — Complex Mesh Removal Surgery Service
National Services Scotland, 8 July 2026
National Services Scotland
Transvaginal mesh implants independent review: final report
Scottish Government, 27 March 2017
Scottish Government
Halt in use of transvaginal mesh
Scottish Government, 12 September 2018
Scottish Government
Mesh reimbursement fund opens in June
Scottish Government, 19 May 2022
Scottish Government
Women urged to apply for historic mesh removal expenses
Scottish Government, 10 March 2024
Scottish Government
