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I would not disagree with you, Mr Marra, that that is absolutely our role as elected representatives. I am sure that you have been representing your constituents in issues relating to what they perceive as medical negligence, issues accessing healthcare or just concerns about the impact that medication or medical devices have had on them.

The landscape of patient safety is complex. We have clinical governance structures, we have royal colleges that look at issues, and we have United Kingdom-wide oversight of some medications and issues relating to those. It is important that we ensure that the public are confident and have trust in the healthcare system, so it is absolutely key for the commissioner to have a clear purpose and role of advocating for system-wide improvements in the safety of healthcare and promoting the importance of the views of patients and members of the public.

I referred earlier to what stakeholders described as the golden thread to bring together all those systems and structures. Obviously, we do not yet have a patient safety commissioner in that role, but that is what the committee anticipated would be the outcome from having a commissioner. Ultimately, Parliament passed the legislation that introduced the commissioner, so parliamentarians agreed that that was required.

Given the history and the UK-wide review, and the acceptance from the Scottish Government—obviously I cannot speak for it—of all the review’s recommendations, creating the post of a patient safety commissioner certainly made sense. I understand that there is an argument for commissioners for various other issues and I am sure that many more proposals will come to Parliament. I say from a personal point of view, rather than from a committee point of view, that we need to ensure that there is a good and sound rationale for new commissioners and that they will add value to the public landscape, public conversation and advocacy for individual groups. That is why the committee is looking into the issue.

Certainly, with the patient safety commissioner, the evidence was there as to why we required to appoint one.

To answer a difficult and complex question, we need to look at what has got us to this point. The historical issue is that those less-represented voices were not heard and the women who were raising issues about medications and medical devices such as mesh were not listened to or were dismissed.

I will turn the question around. If we do not have a patient safety commissioner, how will we ensure that those patient voices are heard and that those concerns are responded to promptly and are believed? What is the cost not only financially but emotionally and physically of not listening early to those people who say that there are issues and that we need to change how things are prescribed or how treatments are actioned?

I was not on the Health, Social Care and Sport Committee at the time, so I find that a really difficult question to answer from the evidence that it took. As I said, the commissioner will have to lay before Parliament an annual report. Parliament will therefore have the opportunity to scrutinise that, and committees will have the opportunity to invite in the patient safety commissioner for evidence sessions, as they do with all other commissioners.

Liz Smith has raised a pertinent and interesting point specifically about Dr Eljamel and the concerns that were raised about that case.

If you look back at the origins of the patient safety commissioner and the Cumberlege review, you will see that three main issues were looked at: mesh, sodium valproate and Primodos. Those issues were raised by patients—almost exclusively women. They raised issues relating to the effects that those medical devices and medications were having on them and their children.

We need to ensure that there is a mechanism for such issues to be raised and investigated. It was felt that a patient safety commissioner would be able to be the vehicle for doing that, and that a patient safety commissioner would be able to look at broader systems issues and issues with medication and medication devices, and to raise those issues. Perhaps individual patient voices were not being listened to. That was what the committee heard, and certainly that is what the Cumberlege review heard.

I agree with Audrey. I welcome the committee’s inquiry into this. When I saw that you were looking at the issue, I thought that the exercise was certainly timely and worth while.

I would add only that you should scrutinise what organisations, stakeholders and the general public think that a commissioner will do that will improve or advocate more for their particular cause, issue or concern. That is my challenge to the committee. I will leave it at that.

There is certainly the opportunity for the patient safety commissioner to ensure that there is accountability. One of the things that struck me when reading through the evidence was that stakeholders, professional organisations, professional regulators and individuals described the commissioner as potentially being the golden thread that could unify and unite patient safety and clinical governance structures, as there are numerous clinical governance structures, oversight organisations, professional regulators and so on. It struck me that, if patient groups and patient representatives felt that a patient safety commissioner would help to amplify their voice, it would be worth their while to have such a commissioner.

There absolutely must be reviews and accountability, because we are talking about public money. We want the commissioner to succeed in allowing people’s voices to be heard—particularly voices that are heard less often—in ensuring that all healthcare providers are accountable for their practice and for the care that they deliver, and in ensuring that issues, particularly those relating to medicine and medication devices, are highlighted at the earliest opportunity, because, as was reflected in the Cumberlege review, that is not happening at the moment.

One of the key things is the independence of the role. The commissioner has the freedom to define and establish the principles underpinning their work, and the scope and remit of their work. One of the committee’s recommendations was that patients should be given the opportunity to provide input into the scope and remit of that work. Perhaps that is not as evident in other commissioner roles that involve looking at patient safety or in other bodies that look at assessing medical devices and medicines. It was generally accepted by stakeholders that there was a need for the role, and that was certainly reflected in the written evidence that the committee received and in its evidence sessions.

I will come at the question from a slightly different angle, given the origins of the proposals for a patient safety commissioner. The issues that were raised were from the 1960s, the 1970s, the 1980s and up to the 2000s. We are looking at a different landscape, and those were the foundations for the need for a patient safety commissioner. In written and oral evidence, people consistently said that patients’ voices were not being heard, with patients perhaps feeling that they were not being believed. People wanted the commissioner to be an advocate for those voices and to raise concerns about issues relating to medication side effects, medication devices and so on. In Scotland, the patient safety commissioner’s remit will be wider than the remit of the commissioner in England and Wales.

Deprivation and austerity will play a part, but the issues that have resulted in the patient safety commissioner have a much deeper history.

I do not think that there has been any further correspondence with the committee, but I am certainly happy to check with clerks and update Mr Marra and other members on that.