Health, Social Care and Sport Committee

Meeting date: Tuesday, March 14, 2023

Official Report 703KB pdf

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Patient Safety Commissioner for Scotland Bill: Stage 1

The second item on our agenda is our final evidence session on the Patient Safety Commissioner for Scotland Bill, at stage 1. Today, we will take evidence from the Minister for Public Health, Women’s Health and Sport, Maree Todd, who is joined by Scottish Government officials. Annalena Winslow is safety, openness and learning unit head and Will Wood is the Patient Safety Commissioner for Scotland Bill team leader. I welcome all of you.

I believe that the minister has an opening statement to make.

Yes, convener—I have a brief one.

I thank the committee for inviting me to give evidence, and I pay tribute to the work of Baroness Cumberlege and her team and the patients, healthcare staff and professionals who have worked hard to contribute to development of the bill. I am certain that future generations will benefit from safer care because of their efforts.

It will be helpful to make some brief opening remarks to summarise the intention behind the bill.

Patients, their families and the wider public have told us that, too often, they do not feel listened to when they raise concerns about the safety of their care. The patient safety commissioner for Scotland will be an independent public advocate whose primary focus will be on ensuring that the patient voice is heard in the healthcare system, in order to make care safer for all. Patients told us that the commissioner must be independent of both Government and the national health service. That is why we are proposing that the commissioner be answerable to Parliament directly and, therefore, to the people of Scotland. The commissioner will be directly accessible to patients in order to hear about their experiences and about what could have been better. People sharing their stories will be the key to making the role work and to making healthcare safer for all of us.

The commissioner will focus their attention on the concerns that patients tell them matter most, and will listen to patients’ accounts of their experiences and combine those with data from other organisations to identify systemic safety issues and to recommend improvements.

The commissioner will not necessarily be the person who is best placed to investigate every concern that patients raise with them, and they are not intended to take on and resolve individual complaints. There are already well-established processes for those functions, which are delivered by other organisations, including health boards and the Scottish Public Services Ombudsman. The commissioner will hand over to them, where that is appropriate, but we propose that the commissioner has substantial information-gathering and investigative powers for situations in which they wish to look further into an issue that other organisations, such as Healthcare Improvement Scotland and the Scottish Public Services Ombudsman, are not better placed to take on.

I look forward to answering questions from the committee and to the discussion.

Thank you, minister. In your opening statement, you talked about what the patient safety commissioner will not do: they will not handle individual cases. You mentioned other avenues that patients might go down to have their concerns met. Why is there a need for a patient safety commissioner, given that there are all those other bodies that patients could go to if they have concerns? Can you articulate the overarching need for a commissioner?

It is clear, particularly from the Cumberlege review but also from experiences prior to that, that the patient’s voice has not been heard. There are some very obvious examples of that, such as the mesh-injured women, the families injured by sodium valproate and those who were given infected blood. Those people made representations for many years as they tried to have their voices heard, but were not heard by the system. So, there is clearly a role for a commissioner who will ensure that the patient’s voice is heard and that when concerns, particularly systemic ones, are raised, those are picked up and acted on.

That will give all of us confidence in safety. There is lots of work going on across the NHS on safety and on quality improvement, but having a commissioner will give us all confidence that patients’ concerns are being heard and acted on.

I am interested in how Government will evaluate the success of the patient safety commissioner, once that person is in place.

There will be a strong role for Parliament in scrutinising what the commissioner does. As I said in my opening statement, patients have been clear that they want a role that is distinct from the NHS and from Government. They want someone other than Government to scrutinise what is happening in the NHS. There will be a strong role for Parliament and therefore for the people of Scotland.

We can look at other commissioner roles to see how they function. A similar role, with a slightly narrower remit, is also being developed in England and we will look at how that works, in order to find the best way forward for our patient safety commissioner in Scotland.

The committee heard from the Patient Safety Commissioner for England. It was useful to hear from her and from Baroness Cumberlege. They told us about some of what they learned in setting up that role. My colleagues may speak about that later.

Tess White has some questions.

Some submissions that the committee received in response to its call for views emphasised that patient safety would be better served by investing in safe staffing levels. We explored that idea in some detail. For example, doctors undertake twice as many patient contacts each day as is recommended, which is caused by poor workforce planning.

Do you envisage the commissioner having a role in safe staffing, given the implications for patient safety?

A lot of work is going on in Government and in the NHS to establish safe staffing levels. There is work to ensure that our workforce is developing sustainably.

That issue is slightly separate from the work of the patient safety commissioner. Staffing can be a contributory factor to safety. However, in the examples that I gave in my earlier response—the mesh-injured women, the valproate-injured families and those who were given infected blood—safe staffing was not an issue; the problem was that those injuries happened and the system did not listen to people. The primary function of the safety commissioner will be to ensure that the patient’s voice and concerns are heard.

My colleagues may want to say more about safe staffing.

If patients felt that staffing had an impact on safety and were raising that issue with the commissioner, it would be within the scope of the commissioner’s role to look at that, if they wanted to. It would be up to whoever is appointed to decide whether to take that on.

I will have to read out my second question, because the list is quite long. In Scotland, we have the Scottish patient safety programme, the NHS incident reporting and investigation centre, Health Improvement Scotland, professional regulatory bodies such as the General Medical Council, the Patients Rights (Scotland) Act 2011, the patient advice and support service provided by Citizens Advice Scotland and the Scottish Public Services Ombudsman. In your view, will the commissioner create duplication in the saturated patient safety landscape?

That actually illustrates just why it is a valuable thing to develop the role of a patient safety commissioner. It is a complex landscape with lots of people working in the area. I have personal experience of working with the Scottish patient safety programme when I was a clinician. That has a very different role to the ombudsman, but patients do not necessarily understand that complex landscape.

The role of the commissioner will be to help patients to navigate that complex landscape and make sure that their story is heard by the right people who can act on it. There have been enough incidents where that has not happened to need to recognise that. Patient safety is of vital importance: first do no harm.

Patient safety is absolutely crucial, so it is understandable that there are quite so many systems designed to ensure that care is delivered in a safe way, and to investigate when things go wrong. That is perfectly reasonable, but patients find it quite bewildering and disempowering. That is the bit that we want to make sure is not the case going forward. I and all of you on the committee will have heard stories directly from patients who have been harmed by the system and we want to make sure that that does not happen again.

We want to learn the lessons each time. Therefore, the role of the patient safety commissioner is very much unlike that of the GMC and other professional regulators, who will sometimes take action. The focus of the patient safety commissioner will be different. That role will be very much about establishing what happened and trying to help the system to learn from that, rather than punishing or taking action against individuals within the system.

Sandesh Gulhane has a question on that, before we move on.

I want to pick up on something that the convener asked you, which was about evaluation. How will you evaluate whether, in year 1, 2 or 3, the patient safety commissioner is doing what we would expect them to be doing?

Do either of my colleagues want to come in on that, if my earlier answer was not sufficient?

I just reiterate the point that the minister made about one of the things that was repeated again and again when we consulted with patients and the public, and in the engagement thereafter, which was the importance of the separation between the commissioner and the Scottish Government.

That is absolutely true, but how will you evaluate that? The question was about evaluation. We understand the concept and the people who have spoken, but how will we evaluate whether the PSC is doing what they are supposed to be doing?

Part of that will come through looking at the reports that the commissioner lays before Parliament about their work. It is difficult to be very specific as to how we will do that because of the commissioner’s independence. There is a really important element, which is the commissioner deciding what their priorities are based on what patients tell them and using that to inform how they will carry out their role.

Therefore, I suppose that there will be an element of looking to see what the commissioner sets out as their priorities in the early days of their job, and there will probably be something for the Scottish Government to look at after that. That being said, I reiterate what the minister said about seeing Parliament as the primary means of holding the commissioner to account through its responsibility to the people of Scotland.

It speaks to the independence of the commissioner, does it not? In effect, Parliament will be the main judge of how that is going. That is quite fundamental to the whole idea of the patient safety commissioner.

It is absolutely fundamental. The idea is that Parliament will scrutinise the reports that the commissioner produces. Such reports will, of course, be of interest to the Government and there will be action points for us to take note of, but the intention is that Parliament will scrutinise the information that the commissioner produces. That is much the same in relation to the children’s commissioner; when I worked as the Minister for Children and Young People, the children’s commissioner was very clear about his role: he was appointed by Parliament and he was accountable to Parliament. The patient safety commissioner will be independent from the Government—that is what patients are asking for.

09:15  

We heard from Dr Henrietta Hughes, the Patient Safety Commissioner for England, who produced a report reflecting on her first 100 days in the role, which considered what the remit could be and what could be explored more widely. Could that approach be used as a way to measure how we take the role of the patient safety commissioner forward in Scotland? The report could be made to Parliament.

Certainly. I would expect the committee to be involved in how the role develops, and to meet and speak to the commissioner. The Government will undoubtedly be interested in what the commissioner has to say and their early thoughts on how the role should develop, the remit of the role and the priorities that they want to set. I think that we will find that, as the role evolves, each commissioner will bring a different flavour. However, it is important that the Scottish people hold that commissioner to account.

I am sure that the role will evolve, because different projects will be undertaken and problems will be solved. For instance, an approach that works in one session of Parliament might be different to what works in another session.

Undoubtedly. We will be watching. I imagine that our commissioner will be looking very closely at what is happening in England and will work very closely with that commissioner to see exactly how they are working and how that role is developing. Our commissioner will have a slightly broader remit than the commissioner for England, who is focused largely on medicines. Is that right?

Yes. They also focus on medical devices and medical safety.

Our commissioner will have a slightly broader role. It is a new role and the commissioner will learn in the job. However, the point of the role is to listen to patients, hear what they are saying and ensure that the healthcare system is able to pick up and act on safety concerns that have been raised by patients because we know that that has not happened in the past or has not happened fast enough.

Let us move on to talk about the remit, which we have mentioned a bit already.

Given that, as you have just mentioned, minister, the remit is slightly wider than that of the Patient Safety Commissioner for England, do you have any concerns about duplications on the medicine side of things and between the roles of the two commissioners? Do you think that the role for the new commissioner for Scotland is realistic, given its breadth and potential workload?

I absolutely appreciate the challenge and the tension there. It will be tricky to get that right. However, our ambition should be to be as broad as possible to ensure that we can deal with all of the concerns that patients raise. As I have said before, it is a complex landscape with many people operating in different ways. It is really important to have a patient safety commissioner who will help to draw all the information together.

I do not think that it will be the norm for the patient safety commissioner to have to carry out inquiries themselves, so I do not think that there will be duplication of effort. I would still expect bodies such as HIS or the ombudsman to carry out inquiries when issues are raised with them. However, I would expect the commissioner to be looking at the evidence that those organisations find and pull it together, in order to help patients navigate that complex landscape and to pick up on systemic issues given that opportunities to identify those have been missed in the past.

To what extent are you sympathetic to extending the PSC’s remit to include acting as the voice of staff? Do you agree that widening the remit could enable the PSC to get a clearer picture of patient safety concerns, given the different ways in which such concerns are raised, or do you think that it would risk adding duplication or potentially streamlining the remit across all those different ways?

It should be perfectly possible for staff to raise concerns and for the patient safety commissioner to listen to those concerns. I expect the patient safety commissioner to be an ear in the system and listening to staff would be an important part of that.

We need to make clear that staff can raise their concerns. We are at stage 1 of the legislation and I am open to ideas about how we can make sure that that is clear. Essentially, however, the commissioner should be a listening ear. It would seem odd to me if they were not listening to staff.

Good morning, minister and witnesses. Could you expand a wee bit further on where the remit might go. Social care is obviously a very hot topic that is of significant interest to the committee. Dame Sue Bruce’s on-going work is on social care and its regulation. Have you factored that view into your planning? Given all that is going on in social care, might the PSC have a regulatory role in that context?

I guess there is the tension; are they patients when they are in social care? The patient safety commissioner will be very focused on patient safety.

As social care develops, people are looking very carefully at how to build in some of the systems that are focused on safety that are used in the NHS. At the moment, however, the focus of the remit should be on healthcare. It should not cover social care. If it was to be broadened to cover social care, the role might well be too broad initially and we could lose the essence of what the patient safety commissioner is about. That would be the concern.

I am detecting an openness to consider the matter, as social care and the role of the PSC develop, and that there can be a conversation on that.

There will be a conversation as we go on. I have already mentioned the Scottish patient safety programme, which uses a really effective quality improvement methodology in the NHS to empower coalface clinicians to improve the system in which they work. That is such an effective method of improving patient safety that I think we would be crazy if we did not use it in all sorts of other systems.

When I was Minister for Children and Young People, we started to use similar methodology in care of children and young people. As we build a new national care service, we need to think about safety and quality and how to build that in with the bricks so that the system can improve itself continuously. However, I am not sure that the role of the patient safety commissioner applies to social care at the moment because it is essentially about ensuring that when people are harmed and when the system is harming people, their voices are heard.

Emma Harper also wants to ask about the remit.

The minister will know that I am interested in the remit of the patient safety commissioner as far as it covers advocating for people and groups of people. For 20 years now, people in the south-west corner of Scotland have had to get radiotherapy in Edinburgh instead of going to Glasgow, and that means unnecessary travel. I am interested to know whether that might be something that a patient safety commissioner could pick up on by advocating for and listening to people who are really upset after 20 years of asking, “Why am I driving past the Beatson and going to Edinburgh for my radiotherapy treatment?” Could a patient safety commissioner advocate for, listen to and support a specific group of people such as the one that I have just described?

The main focus of the patient safety commissioner will need to be patient safety. I think that what you are describing is perhaps systems lacking patient-centredness. I am very passionate that our NHS should be person centred. Sometimes, however, we find that people are having to travel long distances, past other services that they could use. That does not make sense to them, but it does not necessarily introduce a safety risk. Our patient safety commissioner will have to be very focused on safety. It is fundamental to the role.

There are perhaps other ways that we can ensure that there is patient-centredness in the system. All the work that happened on realistic medicine, which is essentially about getting high-quality person-centred care in the right place at the right time, with the patient being a sharer of decision making in their care, is absolutely what we are striving to deliver in our NHS.

In a previous evidence session, Matthew McClelland talked about direct links between safety, care and compassion, and thought that the patient safety commissioner could play a role in encouraging grown-up conversations about the risks and benefits of medical interventions and so on. At the same session, Dr Chris Williams from the Royal College of General Practitioners said that safety needs to be the focus of the commissioner, at least initially, so that we can target the safety issues rather than the issues that I have described.

You are right about care and compassion. We brought in a duty of candour in 2018. That duty does what it says on the tin. It is about trying to remove the defensiveness and hostility that sometimes comes across when patients are trying hard to understand what has happened and why outcomes have been the way that they are. We very much want the role of the patient safety commissioner to be on inquiry and helping the system to learn. We want them to look honestly and openly at what has occurred and try to learn the lessons compassionately to ensure that that does not happen to patients in the future. It is about care and compassion. There is probably also a role for helping people who have been bereaved to understand what has gone on. I can see that that would be a powerful role for the patient safety commissioner.

We are interested in the appointment process and what alternatives were considered. In evidence from the English commissioner, we heard that the role is a department of Government, which, it was thought, allowed it not to be overlooked. However, the converse of that, with regard to the bill, is the importance of the independence of the role. What is your rationale for choosing that direction?

When we asked that question, the answer that came loud and clear from people who had been affected by safety issues was that they wanted the role to be independent, and that a different organisation that was either part of the NHS or part of Government would not cut it. What would cut it is someone who is there primarily for them and is accountable to the people of Scotland. I can absolutely understand that. I can see the pros and cons of all sides, but I agree about the importance of independence from the Government and from the NHS itself. As MSPs, we will all have mailboxes full of people saying, “They’re marking their own homework,” and who do not have trust in the system.

It is important that people who come to the patient safety commissioner can trust and have confidence in the process. That independence from both the Government and the NHS will help that.

09:30  

We would certainly recognise that from the evidence that we have heard.

To what extent do you feel that the commissioner, sitting where it does, will have the right powers? People want to see a resolution, which will very often involve some end point of action. Are there enough powers in relation to exerting pressure on the Government, pushing for changes to policy in the NHS or the important learning that has to happen where there have been issues?

I am bound to say that I think that we have got the balance right. I can understand where Paul O’Kane’s questions are coming from, as it is difficult to get that right. However, as I have mentioned, a key point is that we do not want it to become another organisation that is looking to apportion blame. That is the last thing that we want. The two absolutely key things that we want from the patient safety commissioner role is for the patient’s voice to be heard and for the system to learn lessons. Those are really key.

I think that there are enough powers to make sure that the commissioner can inquire and take action, that Government has to listen to them and that there is an accountability to Parliament. However, as with any new role, there will be lessons learned and evolution as we go along.

I will push a little further on that.

Everybody wants to work in a collegiate fashion and ensure that there is encouragement in relation to change and learning lessons. However, that does not always happen; for example, in large organisations, it can often be difficult to get to that end point of a change in process or taking the learning on board. Although I know that “enforce” is not always a word that we like to use, because we want to see that collegiate approach, is there enough ability to enforce? In social care, for example, we would recognise enforcement as happening in the care home sector or other such places. Is there enough power, or any power, to enforce, if that is required?

There are powers to enforce in other parts of the system. The professional regulatory bodies can take action and the police can take action if there is a police concern. A number of different bodies other than the commissioner can ensure that enforcement occurs, should it be needed. The key point in relation to the commissioner is for the system to learn lessons. We have a responsibility there.

If we think of the big issues that have been raised with us—for example, by mesh-injured women, the valproate families and infected blood people—those people were asking for a long time for their story to be heard and for inquiries and explanations to be made. They did not necessarily want blame to be apportioned; in fact, the infected blood people were very keen simply to have an apology and an acknowledgement. Ensuring that the system learns, and that issues are picked up and dealt with, is really very powerful, because we can see so many examples of where that has not happened in the past.

A number of colleagues want to ask questions on powers. May I bring them in?

Yes, of course.

Good morning, minister and witnesses.

In evidence to the committee, witnesses expressed that the patient safety commissioner should have additional and regulatory powers. The minister just said that she does not think that it should. Will people take heed of the commissioner’s recommendations if it does not have those powers?

Yes. The commissioner will have power to require organisations to provide evidence. Those are robust powers.

If I may explain, it is a role that is really about encouraging a culture of openness and inquiry, and it is absolutely in the system’s best interests to adopt that culture. That is how we will give the best patient care.

If we do not learn when mistakes happen or when safety issues arise, mistakes will be repeated, which is not in the interests of patients or the system. Therefore, I think that there will be enough power, but I am open to suggestions, if you think that some powers need to be strengthened. I am listening and I am open to that, but it is very clear how the concept of this role has evolved, so I would like to think that there is a wish and a will in the system to learn those lessons to prevent further harm.

I was wondering whether the patient safety commissioner role would evolve into having such powers.

We need to be careful that we do not duplicate existing powers. Regulators can take action against individual professionals, there are the police and there is the potential to take action in various ways, so we need to ensure that we are not duplicating effort. The fundamental role of the patient safety commissioner is to ensure that the voices of patients are heard and that that open learning culture is fostered so that the system learns and prevents further harm, rather than these things going on for far too long and harm continuing while those issues unfold.

During our evidence-taking session with Dr Henrietta Hughes, the Patient Safety Commissioner for England, we discussed the issue of escalation. She was emphatic about the need for collaboration and a culture of openness, rather than for an inquisitor who would come in and berate people for failures. That is an important insight to note.

However, where there have been egregious problems, there will need to be very clear recommendations that ought to be implemented. In situations in which there is an area of injustice or an issue that needs to be urgently addressed and which could not simply be left to collegiate encouragement, perhaps there is a need for an escalation process. In responding to my question about that, Dr Hughes said that it was quite early days and that she would not necessarily be clear about what the next step of escalation would be in that instance. Obviously, the reporting line in this case is to Parliament rather than to ministers. Does the minister have a view on how the bill might better define that process of potential escalation, if there is such a lack of co-operation in the future?

I am open to proposals on that issue, and as the role beds in, it might be an area that evolves, if it becomes a challenge for the patient safety commissioner to ensure that organisations take account of what the commissioner is saying, report accurately and take achievable actions. Therefore, I am open to the idea that more might be required. As introduced, the bill allows for dialogue on the best way forward. There is potential for collegiate working, which is generally the best way to enable such openness and learning. However, I understand that there is concern.

I genuinely believe that a patient safety commissioner would add something to the landscape. There are lots of people and organisations that are able to take action—including punitive action—and to hold organisations to account, but I think that the patient safety commissioner offers something different. The big tragedies when patients’ voices were not listened to, their stories were not heard and action was not taken soon enough are an example of the kind of systemic issues that I am absolutely certain that the patient safety commissioner will be able to pick up on.

Dr Hughes said that “Multiple paths already exist” in the healthcare system. Earlier, you cited the police as an example. Dr Hughes also said:

“It is partly about understanding the powers that others have, but it is also for others to understand the powers that exist in the system and to work collaboratively”—[Official Report, Health, Social Care and Sport Committee, 21 February 2023; c 36.]

to achieve the common goal.

Bearing in mind that the reporting line is to Parliament rather than to ministers, is there provision in the bill for there to be an assessment period after a certain time to see how the PSC works with other organisations and, if necessary, to define further through secondary legislation those interactions and interfaces? Is that something that the committee could consider in its report?

That is certainly something that the committee can consider. It is a really complex landscape, which is almost impossible for patients to understand—it is quite hard even for health professionals and those who work in the system to understand it. There is an issue around making all the slightly different organisations that have a keen interest in safety work together to get the best possible outcome. We are always open to the idea of going back to look at whether we have achieved our aim and whether legislation is working as intended and delivering the best possible results. There is always the opportunity to look again at that.

We turn to questions on the resourcing of the post and the office, on which Evelyn Tweed will lead.

Good morning. Are you confident that the resources that are proposed will be sufficient for the commissioner to carry out their functions effectively?

We think so. We think that the budget is appropriate for the commissioner’s proposed remit. The commissioner will be an advocate for patient safety and the patient voice, and that role will be underpinned by formal information-gathering powers. We are not intending them to be a new regulator or to have a primarily investigative role. We would say that, largely, other organisations will do the investigations and the patient safety commissioner will work collaboratively with them. We developed the costs that are set out in the financial memorandum on that basis.

As Parliament scrutinises the commissioner’s work, it will take decisions on whether the remit of the role and its accompanying funding need to change.

That leads me on to my next question. In the evidence session with the Patient Safety Commissioner for England, the committee heard that it is already expanding its office and bidding for more resource, although Dr Hughes felt that it was better to start small and to be agile while having a

“plan for future expansion and growth.”—[Official Report, Health, Social Care and Sport Committee, 21 February 2023; c 38.]

Does the minister have a plan for expansion and growth?

I am open to that. The Patient Safety Commissioner for England is right: we should start small and be agile with the role. It is a brand-new role and we need to think carefully about how it evolves.

I think that we have gone for about the same size of budget in Scotland as the UK Government did for the role in England, and there will be similar numbers working in the team, yet there are 10 times as many people living in England. That reflects our slightly broader remit.

I am certain that we are adequately resourcing the role as it starts out. As we have all said, the role is likely to evolve and we might need to look at that in the future. However, I am certain that we are starting out in the right place.

I would like to look more specifically at the issue of data analytics. The chief of staff to the Patient Safety Commissioner for England highlighted the importance of the team having the capacity to provide data analytics. You have already said that you will look at the data that comes from other organisations that carry out investigations, but surely there is a need to pull all that together and look underneath it. Where does that role sit at the moment?

That is certainly possible. I am somebody who loves data. Data does not lie, so if you can get your analysis correct, it will tell you a lot about what is going on.

09:45  

I am not closed to the idea that there may need to be a role for somebody with data analysis expertise. However, in my view, we already have the best data analysts in Scotland in Healthcare Improvement Scotland, and we need to take care not to replicate roles. We need to understand how the organisations that might already be looking into issues are able to gather and analyse data and come up with understanding and insights into how situations evolve. I am not sure that we need another organisation with that capacity checking the numbers from those organisations.

As I said, however, I am not totally closed to the idea. The role will evolve as time goes on, and there is hardly a role in any part of Government—or in public life, because this role will be independent from Government—that would not benefit from a bit of data analysis.

So we will be evaluating and monitoring what is going on and seeing what the needs are as we move forward. Is that right?

Yes. There are people with that type of expertise who do a lot of independent consultancy work, so an individual role may not be needed. It may simply be that expertise is needed in one situation, and there might be capacity to think about using individuals with specific expertise as the role develops.

That is interesting.

We have a further question on resourcing, from Sandesh Gulhane.

I want to pick up on what Stephanie Callaghan talked about. In my initial question, I asked about the need for evaluation with regard to resources. You were very clear, minister, that we need to start small and agile; the Patient Safety Commissioner for England and others who have come before the committee have agreed with that.

Without evaluating whether the patient safety commissioner is doing well, however, it will be difficult to say whether they will need more or fewer resources. Will we be able to ask the patient safety commissioner, once they come into post, to set out, as one of their first actions, the criteria on which they will be evaluated?

Absolutely. That will be part of the dialogue when that person is in post. We will undoubtedly be interested to hear what the commissioner thinks that their priorities are and how they intend to measure the outcomes and demonstrate robustly to Parliament and to other interested parties that they are doing the job that we intended them to do.

That is fantastic.

You said that you want the patient voice to be heard. I am fully aware that it is not intended that the patient safety commissioner will take up individual cases, and you made it clear that the commissioner will not be doing investigative work.

However, to pick up on Emma Harper’s questions, should the patient safety commissioner and their team listen to individual patients when they have a story to tell or something to talk about, in order to collate and catalogue each case and look for the golden thread?

Yes, absolutely—I think that that is clear.

It is not that the commissioner will never do investigations; we have given them some investigative powers because we think that there may be occasions on which it would be useful for them to do that. By and large, however, other organisations will do that work.

Nevertheless, I think that listening to individuals is important. Awareness of the big tragedies that I have mentioned a couple of times this morning started with one patient speaking up and then grew. It is important that the patient safety commissioner is able to listen to patients and pick up on the noise from the system. It seems to me that we do not currently have an organisation that is able to do that.

When such issues have arisen before, that has occurred as the result of an individual situation—nobody has been able to put it together. The patient safety commissioner will be able to put together that picture and listen to the noise from the system.

That is fantastic to hear, but it brings me to the question of resource. After all, it is very labour intensive to listen to someone’s story, pull out the thread, catalogue it and then get it checked to see whether there are any other such threads. As knowledge of the patient safety commissioner grows and people start to go to them, might we see a significant expansion of their budget simply to deal with those patients?

We might, and as I have said, I am open to that possibility. As the role develops and is evaluated by Parliament, that might well be an issue that we as parliamentarians will need to consider.

However, the commissioner might develop a really slick way of working with all the other organisations that do such jobs and be able to help individuals to navigate the system. It is very clear, for instance, that individual patients do not know how to get their issues investigated or how to get an appropriate resolution from the healthcare system. The commissioner might therefore develop in a very slick way and help patients to navigate the system and ensure that their voices are heard, as well as picking up on those systemic issues that we have not been fast enough or slick enough at picking up on in the past.

That will depend on how well the commissioner works with all the organisations in this space. That collaboration will be absolutely key.

I have a very quick final question about the extra cost. What would you say to those people who are very concerned about the cost—full stop—given that there are lots of patient safety commissioners?

I would say that the need is well established. We have shown and demonstrated that such a role is currently absent and that it would help to prevent harm.

The types of harm that I would envisage the patient safety commissioner picking up on and preventing are not only devastating for patients but often very costly to the system. Therefore, I think that this is a reasonable investment to prevent harm. We have established that the current system is not managing to prevent harm in the way that we would have hoped that it would.

Thank you.

Paul Sweeney has a question on this issue.

I raised the point about data with the English commissioner and asked her about the

“huge risk of data inundation”

and having to make sense of large streams and volumes of information that might have been collected for completely different purposes, might not be comparable, might not have the same baselines and might as a result have accuracy risks. In response to being asked how “meaningful conclusions” could be drawn from the different streams of data being fed into her office and how they would be processed, the commissioner said:

“Having a data and digital function in my team so that we can use and manipulate that data in a way that can bring fresh insight that will help the system to attend and listen to things that it may not have been aware of in the past is key.”

Moreover, Dr Duncan, the chief of staff, said that the commissioner was

“right to say that, without a data analytics function, the novel insights that a commissioner could have would be limited.”—[Official Report, Health, Social Care and Sport Committee, 21 February 2023; c 39.]

Do you agree with that assessment?

It seems reasonable to me. We do not want the patient safety commissioner to be picking up noise from the system and dismissing it as something anecdotal rather than an evidence-based concern. Sometimes having the data is the only way of dispelling concerns about whether what you are picking up is genuine or just some incorrect signal.

There will have to be a robust capacity for data analysis, but I am not going to write the job descriptions for the various job roles in the team now. I should say, though, that there is a lot of data analysis expertise already in the system, and that will have to complement the work that is being done, but I get what was said last week about being able to crunch the data and develop fresh insights.

You mentioned the opportunity of collaboration across the system, which was also mentioned by the commissioner. She mentioned that partnership working would have value here. Is there an opportunity to further define that in the bill to say that there are obligations or say where we would expect interfaces to work in the system?

That is a reasonable aim for us to have, and if it is not clearly spelled out or well understood, it is probably worth reflecting on that and seeing whether we can refine it any further. Will Wood might want to say something on that. It certainly seems reasonable that if there are concerns that it is not clear how the commissioner and organisations would collaborate, we would want to make sure that the bill is clear.

From memory, I think that the bill sets out at least a couple of instances in which the commissioner and organisations such as HIS are expected to co-operate with each other. As the minister said, we will consider whether that can be further elaborated on and clarified.

Thanks for that. Minister, the point that you hinted at earlier was important. We often hear qualitative insights from patients, as we did in relation to the mesh scandal. The Public Petitions Committee unpacked a lot of that because the system did not respond. Doctors were dismissing patients saying that it was psychosomatic or imagined. A data signal was not being transmitted through the healthcare system to illustrate that there was a problem. That sort of case might be an opportunity for the commissioner to instruct the gathering of data.

However, the mesh scandal has changed the way that medical devices are monitored and information is gathered about them, so there are much tighter and better systems in place. On medication, the yellow card system will pick up signals, but there was not the same level of robustness in picking up on issues related to medical devices.

I am the minister for women’s health, and there a reason why that post exists. Women face health inequalities because of our inequality in power, status and wealth. Many of the issues that we are talking about are because women are not listened to when we come forward with concerns. We absolutely need to recognise that that is the case and make sure that the system is picking up on that. A great deal of work has been put in to improve the post-surveillance of devices once they have been implanted.

You touched on something in your line of questioning that troubles me about how the system currently listens to people raising concerns, who we find easy to ignore and dismiss and who we pay attention to. The patient safety commissioner role will undoubtedly be key to making that more equitable.

To go back to the point about powers, will there be an appropriate element of compulsion for the commissioner to exercise when it is instructing, for example, health boards to gather certain types of data based on complaints that have been picked up that we cannot verify through data? Is there a mechanism whereby the commissioner could say that people should start assessing the issue at primary or secondary care interfaces, to enable us to gain a greater understanding of the issue? Could that be defined?

That is reasonable. That may be something that the commissioner asks health boards to provide evidence on or try to improve the system around.

Focusing on the positive, could there be a role for the patient safety commissioner in spreading good practices in one part of the Scottish NHS across the whole of the NHS?

I hope so. There are pockets of brilliant practice all over Scotland in many areas. One of our challenges is making sure that that practice is the same all over Scotland and making sure that the same quality and safety focus happens everywhere. That would be a good outcome, but I do not see it as being a primary one, because, remember, this role is absolutely focused on the voice of the patient. Where the commissioner finds good practice, that might be one way of improving the situation if they found a safety concern in one part of the country.

10:00  

We will move on to the views of the Finance and Public Administration Committee.

It was interesting to read that the Scottish Parliamentary Corporate Body said:

“The process is complicated, but we are moving into a period in which it is becoming regarded as a casual thing to suggest and implement the establishment of another commissioner”.—[Official Report, Finance and Public Administration Committee, 10 January 2023; c 20.]

That is not the language that I would have used, because I think that ensuring patient safety and addressing and preventing harm are absolutely reasonable. I say that as a former nurse who worked in situations in which there were issues in operating theatres. I am interested in knowing what you would say about the evidence that was submitted to the Finance and Public Administration Committee about the establishment of a new parliamentary commissioner or new commissioners becoming “a casual thing” that takes insufficient account of the associated budgetary consequences for the Scottish Parliamentary Corporate Body. I ask that on behalf of the Finance and Public Administration Committee.

I am bound to say that I personally feel passionately about the area, not simply because of my role as the minister for public health and women’s health but because of my professional background. I can see the need for such a role. I can see the need for somebody who is independent of the systems that already exist. There is a powerful need for the role and for the commissioner to be accountable to Parliament. I will not comment on all the other commissioners, but I think that there is an undeniable need for a patient safety commissioner.

On the concerns about the budget, that is a worry for the Scottish Parliamentary Corporate Body. One of the reasons for starting small and trying to be agile is to allay the concerns about its taking on a huge resource and to ensure that the Parliament will not have to become a regulatory body with a vast web of actions throughout the NHS. The role is a specific one that is very focused on the voice of the patient and patient safety, and we will see how it evolves, with careful evaluation as time goes on.

Okay. We have six commissioners and an ombudsman. With the potential for future commissioners, does the Scottish Government need to look at how we can ensure that a more strategic approach is taken to resourcing and establishing additional commissioners? Is work being done now to look at that?

The commissioner’s role came from the Cumberlege report. It was not the Government that came up with it, and it was not the Parliament that suggested it, as has happened with many other commissioners. There were really solid reasons to bring forward the commissioner’s role.

There probably is a need to look at the commissioners as a whole strategically. There is always room to look at where the whole Government’s focus is and what resources are going where—that often happens around budget time—as opposed to the individual commissioner whom we are discussing.

We have asked all the questions that we wanted to ask. We thank the minister and her officials for their time this morning.

I suggest that, next, we take item 4 on our agenda, which is consideration of subordinate legislation, before we have a break in advance of taking evidence from our panel on women and girls in sport, if members are happy to do that.

Members indicated agreement.