Seòmar agus comataidhean

I am asking about when GPs take out-of-hours calls for NHS 24. What vacancy percentages have you had during the months of November and December, when things get really busy?

Yes.

I am sorry—I mean in the call centre where GPs go to take phone calls for NHS 24.

Thank you. My final question is about the future. You referenced how challenging and difficult the last winter period was, and my concern is that the one coming might be even worse, because we had a bit of a mild winter for a lot of respiratory diseases. Are you confident that we will see improved performance times and performance data compared to last time? What contingencies are you looking to put into place now to mitigate any other issues that might arise?

I disagree. What we have in the bill at the moment is a strategic plan, which looks at where the commissioner wants to go, and we have some annual reporting. It seems to me to be very sensible that a public body should say what its plan for a year is, and that it should then report against that plan. That is what I would expect most public bodies to do, and I think that the public expect public bodies to do that, so that people are aware of where their money is being spent and how the body—in this case, the commissioner—is going about their job.

I therefore press amendment 12.

We are happy to work with the minister, so I will not move amendment 19.

Amendment 19 not moved.

Section 3 agreed to.

After section 3

Amendment 20 moved—[Sandesh Gulhane].

Amendments 12, 13 and 20, on reviewing the commissioner’s work, are all related. The main amendment is amendment 20, which would insert a new section on performance monitoring. It would require the commissioner to consult the Scottish Parliamentary Corporate Body, the advisory group that is outlined in the bill, as well as the most appropriate parliamentary committee, on a set of performance standards against which the commissioner believes their performance should be judged. Amendment 12 requires that a review of the commissioner’s performance as assessed against those standards be included in the annual report that is to be laid before the Scottish Parliament.

Amendment 13 requires that the most appropriate parliamentary committee must propose a debate on the annual report.

When the minister’s predecessor came before the committee to give evidence on the bill, I inquired how the commissioner will be evaluated to ensure that the office-holder is doing what we expect them to be doing. Let us not forget that it came across loud and clear during stage 1 that the public will have high expectations of the commissioner. The minister and her official said that

“There will be a strong role for Parliament in scrutinising what the commissioner does”

and that Parliament will be

“the primary means of holding the commissioner to account through its responsibility to the people of Scotland.”—[Official Report, Health, Social Care and Sport Committee, 14 March 2023; c 3-6.]

I welcome that the commissioner will be independent of Government, and that the line of accountability for the role will be to the Scottish Parliament. However, I would like to see a tangible set of standards to better facilitate scrutiny of the commissioner’s performance by parliamentarians. In so doing, we will not just be ensuring that the patient safety commissioner serves the public interest to the highest possible standard; we will be looking at the effectiveness and value of the commissioner as part of a system that is likely to expand in the future.

Amendment 32 requires that an appropriate parliamentary committee must examine how the commissioner and the existing patient safety landscape are working together. As Baroness Cumberlege emphasised in her evidence to the committee during stage 1, the patient safety commissioner is supposed to be the “golden thread” running through a patient safety landscape that is already saturated. That is the intention, but is it possible to deliver that? Organisations such as the Scottish Public Services Ombudsman have raised concerns about the potential for duplication.

Once the office-holder has had time to bed in, it will be appropriate to review how the relationship is working in practice. I should add that the proposed new section includes a provision that examines how patient safety organisations have implemented the commissioner’s recommendations, which is an issue that was highlighted during stage 1.

Very little evaluation or research has been carried out on commissioners. The Scottish Conservatives support the creation of a patient safety commissioner, but we also want to consider the detail carefully, especially that which relates to the relationship between the commissioner and the Scottish Parliament. I would be happy to work with the minister and her team to ensure that we get the approach right.

I move amendment 12.

Amendments 17, 18 and 19, in the name of Tess White, relate to the statement of principles, which is currently not clearly defined, in section 3 of the bill.

Amendment 17 would require that the commissioner must include the principle that they

“will seek the views of staff working in the National Health Service Scotland on ... safety concerns”.

That responds to the point that was raised by the Royal College of Nursing that, even though pathways are already established for NHS staff to raise concerns about safety within their health board, they do not always feel that those concerns are heard or addressed. The Scottish Government undertook to review the bill to ensure that the commissioner could hear from staff, but it is not clear from the minister’s amendments that that has been carried out. I would appreciate some clarity from the minister on that specific point.

I note that amendment 16, in the name of Paul Sweeney, includes the principle that people who are underrepresented in healthcare will be involved in the commissioner’s work. The Scottish Conservatives fully support that amendment.

Amendment 18 provides more detail about what the statement of principles should include. It does not seek to be prescriptive, as I agree that the commissioner should have the freedom to establish their own principles. That is reflected in the drafting of amendment 18. Amendment 18 would provide more detail in the bill about the areas that the commissioner should consider when drafting those principles.

Amendment 19 would create a duty to consult on the principles with

“stakeholders ... the Parliamentary corporation ... the advisory group”

and, crucially, the relevant committee of the Scottish Parliament. I note that the Scottish Government has lodged a similar amendment about consulting on the principles, which covers the strategic plan as well. I do not have an issue with that approach, but the minister’s amendment 5 does not include in its list of consultees a parliamentary committee. I would like clarity from the minister as to whether she would consider including that in the bill ahead of stage 3.

Amendment 21 creates a duty on the commissioner to have an annual work programme. That is not designed to be onerous, as I appreciate that the commissioner must also produce a strategic plan and the statement of principles. The key point, though, is that the principles will inform the way that the commissioner works and the strategic plan will set out objectives and priorities for a period of as long as four years. The work programme is intended to be far more agile—an agile document that is produced every year—and to give the commissioner the opportunity to consider the resources that are required for carrying out their work. It is worth reflecting on the Patient Safety Commissioner for England’s recognition, after a short period in post, that more resources will be required to support her work.

I have shared with the minister the possibility of pooling human, financial and legal resources among commissioners to mitigate the costs of office-holders, where possible. As we look at the underpinnings of the commissioner at stage 2, and as we move into stage 3, it is worth considering how we can facilitate value for money in the commissioner system.

I will speak briefly on amendment 27, and I thank the General Medical Council for its input on this subject.

Amendment 27, in the name of Tess White, would amend section 15, which deals with the confidentiality of information, and permits a disclosure of information to “professional healthcare regulatory bodies”. That would further enhance patient safety, because there might be circumstances in which such information points towards a potential risk but in which it is only through further investigation and/or correlation with other information that is held by the regulator that the scale of the risk becomes apparent.

I note that Carol Mochan’s amendment 26 takes a similar approach to Tess White’s amendment 27 in adding the Health and Safety Executive to the list of bodies. Our amendment 27 uses the term “professional healthcare regulatory bodies”, which is a phrase that includes all regulators that are overseen by the Professional Standards Authority for Health and Social Care, including the Health and Safety Executive. Our amendment therefore covers the Health and Safety Executive.

I draw members’ attention to my entry in the register of members’ interests, which states that I am a practising national health service general practitioner.

Amendment 11, in the name of Tess White, is a probing amendment to facilitate debate about the length of time that a commissioner should serve in a single term. The amendment would reduce that period from eight years, which is currently in the bill, to five years. As a point of comparison, the Patient Safety Commissioner for England is appointed for a term of three years, with the possibility of a second term.

I note from the bill’s policy memorandum that the period of appointment was chosen because it is in line with the terms and conditions of other parliamentary commissioners. Those were standardised 13 years ago by the Scottish Parliamentary Commissions and Commissioners etc (Scotland) Act 2010. In the intervening period, the commissioner system has not been substantively evaluated. Meanwhile, as the Finance and Public Administration Committee and the Scottish Parliamentary Corporate Body have highlighted, the number of commissioners could rise from seven to as many as 14. That would be a significant and expensive extension of the public sector. It should follow that the tenure in office is considered as a question of good governance.

I recognise that the bill includes provision for early termination and gives the SPCB some flexibility in the area. Nevertheless, the period in post that is provided in statute matters, because commissioners need to consistently demonstrate that they are serving the public interest as well as the public purse. I will welcome input from the minister and other members on that point.

I move amendment 11.