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Thank you, both, for attending. What you have said so far is interesting. You said earlier that you would publish best practice, for example, against which health authorities could benchmark and perhaps implement recommendations. Do you feel that there should be some sort of mechanism for escalation, if there is something so egregious, or some area of injustice, that you feel needs to be urgently addressed, which cannot merely be left to collegiate discussion or recommendation?

It would not necessarily be you issuing an enforcement order, as the Health and Safety Executive does, for example. Perhaps, in your case, it might be a recommendation to the minister that they should use a statutory instrument to implement changes, or, in the case of the proposed commissioner, it might be a recommendation to Parliament to do that. While bearing in mind that there is a need to foster openness and inclusivity to avoid people shutting down and feeling as though they will be attacked if they dare to raise issues openly, do you feel that a potential mechanism for escalation is important? Do you feel that there is a balance to be struck in terms of escalation?

As a former member of the Citizen Participation and Public Petitions Committee, I recall sitting in the session on 8 June 2022 with Gordon Baird and others in which we took evidence on four petitions covering rural healthcare. It quickly developed into a much more effective and quality discussion. It did not just home in on the idea of an agency but took in the broader issue of the agency of patients to advocate for themselves and for clinicians to advocate on their behalf. In particular, it focused on the power imbalance between health boards and other stakeholders in the system.

In that respect, the petition remains relevant, so there is scope for the committee to consider how we take those legitimate and sincere concerns forward. Although it is inevitable that inequalities will exist by virtue of geography in any healthcare system, because you cannot have a fully functioning neurosurgical department in a town of 100 people, we nonetheless need to look at ways in which we can mitigate those issues effectively.

Where changes to service provision are occurring, are we effectively ensuring that ambulance provision, travel allowances and protocols are in place to reduce the risks of, for example, going into labour in a way that means that someone is dangerously far from a maternity department? We should be cognisant of all those issues, which I do not think are necessarily being fed back into the healthcare decision-making system through health boards. Perhaps that is where this committee would have a locus in helping to further the petitioners’ concerns. That would be my suggestion.

Thank you.

My view is that we are not bound to the petitioners’ specific ask, and an inquiry would give us a useful basis on which to roll the issues forward. We can still retreat from that. In my view, it is not a binary thing, in that we have to agree whether there should be an agency or not. We can certainly take on board—

It is proposed that the patient safety commissioner for Scotland will be a parliamentary commissioner—in other words, they will be appointed by the Scottish Parliament, not by the Scottish Government. Is it preferable that the proposed line of accountability is to Parliament rather than to Government or the national health service as an institution?

I will bring in the front-line representatives on that, starting with Mr McClelland.

I have nothing to add.

When we had the discussion at the Citizen Participation and Public Petitions Committee, the petitioners were not committed hard and fast to the idea of an agency. They were happy to row back from that opening gambit. I do not know whether there are technical rules around this, but I would be content to keep the petition open with an understanding that we could look beyond the simple ask for an agency, because the issue is the concept of who has agency in the system.

If the impact of the petition is that the committee holds a related inquiry, it will have done its job in a way. In that sense, perhaps whether or not the petition is kept open is not such a big deal. I would be content to rest on that.

Issues have been raised about the budget—the £500,000 per annum budget has been described as “a bit light”. On the discussion about the heaviness and the sheer volume of the data, we know that most data is useless, because it is not necessarily reliable. It has not necessarily been collected in the same way or in a rational way, and it may be biased. Are there any critical competences or skills in process or technology that you would like the office to have for it to be meaningful and to give it best effect?

I open that up to anyone who might have a view.

Those were really important points about anticipating problems. Service design is done in the context of resource constraints. There is a finite resource that cannot neatly match increasing demand. Inevitably, decisions that are made will have safety implications. A recent example is that the Glasgow health and social care partnership has advised that, under the current settlement for local government, it will not be able to meet its statutory requirement for service delivery in Glasgow. There is clearly a patient safety consideration there.

Is there scope for the commissioner to have a role in assessing decisions within different public bodies about the potential impact on patient safety, and perhaps making a recommendation to Parliament on what the commissioner thinks is the optimum balance or solution in that context? It is not necessarily a patient referring an issue that they are reacting to; rather, it is anticipating the allocation of constrained resources in a difficult environment, such as the one that we are looking at now, in the budgets, and considering the impact of such decisions. The impact, for example, on discharges from mental health estates into more appropriate settings, is that patients might have to stay in hospital as opposed to being discharged.