On 23 August 2023 the Director-General of Health endorsed a pause in the use of surgical mesh to treat stress urinary incontinence (SUI), following a recommendation from the Surgical Mesh Round Table (SMRT). This precautionary measure was taken to reduce harm and ensure patient safety.
Four safety conditions for lifting the pause
Before the pause can be reconsidered, four key safety conditions must be met:
- Mandatory credentialling of clinicians under the National Credentialling Framework
- Structured informed consent using a patient decision aid.
- Patient case discussion at a multi-disciplinary meeting (MDMs)
- Establishment of a mesh registry for female pelvic floor procedures involving mesh.
Progress over the past two years
Significant progress has been made, with three of the four safety steps now completed.
Credentialling
By the end of March 2025, four rounds of credentialling had been completed.
Credentialling is now led by Health New Zealand.
Credentialling is a structured process that confirms a surgeon's competence to perform specific procedures to a specified standard. Surgeons are credentialled against the National Framework for pelvic floor reconstructive, urogynaecological, and mesh revision and removal procedures.
Informed consent
Structured patient decision guides were published on 6 September 2024.
These guides support patients in making informed decisions by outlining treatment options, potential benefits, and risks. They cover both surgical and non-surgical approaches to managing SUI and are designed to be discussed collaboratively between patients and their healthcare providers.
The guides were co-developed with clinicians and independent consumers, including individuals with lived experience of SUI.
Multi-disciplinary meetings (MDMs)
Regional MDMs have been implemented in several districts; however in some regions MDMs can't be sustained due to workforce shortages. Work is underway to evaluate surgeons in these districts. A review of the situation will take place as part of an audit in October 2025.
MDMs are regular, structured meetings where health professionals from various specialties come together to discuss and plan the best treatment options for individual patients.
Mesh registry
The fourth and final safety condition, the establishment of a national mesh registry, is currently underway, led by Health New Zealand. A contract to establish the registry will be in place by the end of September 2025, allowing the development and implementation of the registry to begin.
Once the registry is operational, all four safety conditions will be met, enabling SMRT to consider recommending that the Director-General lift the pause.
Background: Surgical Mesh Work Programme
In 2019, the Ministry of Health initiated a restorative justice process to hear directly from individuals harmed by surgical mesh. This led to recommending 19 actions to improve safety and rebuild public trust. These recommendations formed the foundation of the Surgical Mesh Work Programme, overseen by SMRT.
To date, 17 of the 19 actions have been implemented, meaning systems and processes are now embedded into routine practice.
Actions still in progress
Two actions remain underway.
Action 10
This action focuses on interdisciplinary education and building technical capability to prevent future harm and support removal surgery.
The medical colleges, Royal Australasian College of Surgeons (RACS) and Royal Australian & New Zealand College of Obstetricians and Gynaecologists (RANZCOG), are leading the work required to develop interdisciplinary education packages.
Action 19
Actions and supports are needed to foster a collaborative approach to safety systems and culture. This will be met with the publication of the Health Quality Safety Commission's System Safety Strategy which is due for publication by the end of 2025.
The Ministry of Health acknowledges the dedication of all partners involved in this work and remains committed to ensuring safe, informed, and patient-centered care in surgical mesh procedures.
