Meeting of the Parliament

Meeting date: Wednesday, September 27, 2023

Official Report 1256KB pdf

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Patient Safety Commissioner for Scotland Bill: Stage 3

The next item of business is a debate on motion S6M-10594, in the name of Jenni Minto, on the Patient Safety Commissioner for Scotland Bill.

16:40  

I stand to speak conscious that there is nothing that I can say about why the bill is important that some people, sadly, do not already know—those who have been harmed and those who have lost loved ones, even a child.

Our responsibility now is to do all that we can to make sure that healthcare is made as safe as possible and that, in the future, when patients and their families have concerns about the safety of care, they will not have to struggle to make their voices heard. Colleagues across the chamber have worked hard on the bill for that very purpose—to make healthcare safer and to ensure that patients and their families are heard—and I am grateful to them all. Colleagues reached out to us with suggestions to make the bill stronger, and we have worked with them. I believe that the measures that we are proposing will make significant changes for the better.

When the concerns of patients and families are not listened to, it can lead to serious harm that could have been prevented. Crucially, it can also mean that the healthcare system misses opportunities to identify and learn from past mistakes, running the risk of repeating them and causing further harm to patients, instead of ensuring that such mistakes do not happen again.

In Scotland’s patient safety commissioner, patients and their families will, for the first time, have a powerful independent figure to amplify their voice and ensure that it is heard throughout the healthcare system in Scotland. The commissioner will support organisations throughout the healthcare system to identify systemic safety issues, and they will work collaboratively to make improvements.

The bill is the culmination of years of campaigning by patients and their families on the issue of patient safety, and I recognise that that tireless campaigning has been vital in getting us to where we are today. Throughout the bill’s development, we have listened to the stories of patients and their families and have taken them on board in designing the patient safety commissioner role.

The many stories that were shared in Baroness Cumberlege’s report, “First Do No Harm: The report of the Independent Medicines and Medical Devices Safety Review”, demonstrate powerfully how important it is that, when patients raise concerns about their care, they have confidence that they will be listened to. I take this opportunity once again to pay tribute to Baroness Cumberlege and her team, in whose work the creation of the patient safety commissioner role originates; the many patients who shared their experiences with her; and the patients, families and organisations that gave evidence on the bill and advocated the creation of the patient safety commissioner role.

I thank Clare Haughey, the convener of the Health, Social Care and Sport Committee, her predecessor, Gillian Martin, and the committee’s current and past members for their scrutiny of the bill and their thoughtful consideration of the complex issues that are involved. The evidence that they gathered during their scrutiny was powerful.

I was pleased that members unanimously supported the general principles of the bill at stage 1. However, the Health, Social Care and Sport Committee made a number of detailed recommendations in its stage 1 report as to how the bill could be strengthened to make the patient safety commissioner as effective as possible. The engagement that I have had subsequently, during stages 2 and 3, with members across the chamber has been open and constructive, and I very much welcome that.

Although we might not all agree on every detail of the final bill, as Paul Sweeney rightly said during the stage 1 debate,

“We are all looking for the same outcome here: to improve the voices of patients and to ensure that the systemic issues that many have experienced and have been adversely affected by do not come to pass ever again.”—[Official Report, 10 May 2023; c 35.]

During the bill’s development, the engagement and co-operation of all members and the level of debate have been consistent with that shared desire to achieve the best for patients, and it is my belief that the bill and the creation of the patient safety commissioner will go a considerable way towards making healthcare safer for us all.

I will briefly remind members of the key points of the bill. It will create a patient safety commissioner for Scotland with statutory powers who is entirely independent of Government and the national health service. The patient safety commissioner will be a parliamentary commissioner who is accountable to this Parliament and, thereby, the people of Scotland. The commissioner will champion the value of listening to patients and others about the safety of healthcare.

Although the Cumberlege report focused primarily on the significant harm caused to women by three particular medicines and medical devices—Primodos, sodium valproate and pelvic mesh—those we heard from during the development of the bill made it clear that it is important that the scope of the role is as broad as possible: no patient must be denied the chance to have their concerns heard. Therefore, the patient safety commissioner will be completely free to consider any issue that relates to the safety of healthcare in Scotland, whether that care is provided by the NHS or privately.

Crucially, the patient safety commissioner will be directly accessible to patients, their families and the wider public to listen to their stories and concerns. Patients have made it clear that that is of the utmost importance. The commissioner will work collaboratively with other organisations to take a system-wide view of patient safety. They will have a role to identify systemic safety issues and work with others to achieve positive change. They will be supported by robust statutory powers to allow them to access the information that they need when they wish to find out more about an issue that patients raise with them. They will be able to undertake formal investigations when they consider that to be necessary, and, where they uncover areas where improvements can be made, they will be able to make recommendations to which organisations are required to respond.

As we rightly continue to focus on supporting the NHS’s recovery from the Covid-19 pandemic, it is more important than ever that we ensure that the views and safety of patients are paramount. Patients must have confidence that the care that they receive is person centred, effective and safe. They must be sure that, when they have concerns, their voices will be heard and their experiences recognised so that the same mistakes are not repeated and safety is improved for everyone.

If the bill is passed, we will have a patient safety commissioner who will amplify the voices of those who, for too long, have not been listened to, working collaboratively across Scotland’s healthcare system to ensure that the patient voice is at its heart. The commission will act solely for safe healthcare, guided by the views of patients themselves to look impartially and thoroughly into patient safety concerns.

Once again, I thank members for their constructive engagement, which has enabled us to get to this stage.

I move,

That the Parliament agrees that the Patient Safety Commissioner for Scotland Bill be passed.

16:47  

Three years on from the recommendation of the Cumberlege review to appoint a patient safety commissioner, I can confirm that the Scottish Conservatives will support the bill at stage 3.

Most medical interventions are safe, but things can and do go wrong. Diagnostic and medication errors, unsafe surgical procedures and infections in healthcare settings can all result in preventable harm. It is how the healthcare system responds to those cases that is so critical. However, for women affected by Primodos, sodium valproate and pelvic mesh implants, the system failed to respond for far too long and, when it did, it was defensive and doubtful.

For two years, the Cumberlege review shone a light on the horrendous experiences of the women who were affected as they tried to get help. Sadly, their stories will ring true for so many women who are trying to access healthcare. They described being “fobbed off” and “gaslighted” by clinicians. They were told, “It’s all in your head,” and that they were experiencing “women’s issues”. Their pain was normalised, and they felt that their concerns were belittled by the healthcare professionals whom they trusted to treat them.

I want to pay tribute to those women and their families. Their long-standing campaigns have highlighted the injustices of a healthcare system in which the patient is not always listened to or believed. Their bravery and tenacity have brought us to this point today, and I know that many feel that the creation of a patient safety commissioner for Scotland is long overdue.

More generally, we need a sea change in the way in which women are treated by the healthcare system. I sincerely hope that that will be the wider outcome of the Cumberlege review.

Patient safety is not just about the way in which the healthcare system works; it is about the culture of that system. Culture change is one of the three priority areas for the Patient Safety Commissioner for England, Dr Henrietta Hughes.

In the shocking cases of the disgraced brain surgeon Sam Eljamel, who left dozens of patients in NHS Tayside with life-changing injuries, and the Queen Elizabeth university hospital scandal in Glasgow, in which two children died of waterborne infections and many more fell ill, the health boards doubled down and prioritised public relations over protecting patient safety. Warning signs were ignored and opportunities to intervene were overlooked. In such cases, who guards the guards? That question is all too familiar in the context of puberty blockers for children, which have been banned in England following the interim Cass report but are still prescribed in Scotland. The Scottish National Party-Green Government keeps saying that it will review the report’s findings, but what about the potential harm to children in the meantime?

At stages 2 and 3 of the bill’s progress, members have tried to improve it on the basis of valuable input from witnesses and the Health, Social Care and Sport Committee’s recommendations at stage 1. I appreciated the opportunity to discuss my amendments with the minister prior to stage 3, but I regret that she was unwilling to support them.

As I said earlier, the commissioner system in Scotland continues to expand from seven commissioners to as many as 14, but very little evaluation or research has been carried out on them. It is said that we cannot manage what we do not measure. That is why the Scottish Conservative amendments at stages 2 and 3 attempted to strengthen the oversight and accountability of the commissioner to Parliament. I urge the Scottish Parliamentary Corporate Body to reflect on that point for the future.

Early detection of patient safety concerns and action to address them could be life changing and, in some cases, life saving. At a time when the national health service is in crisis under the SNP-Green Government and capacity is at breaking point, the establishment of an independent patient safety advocate is particularly welcome. That is why the commissioner’s appointment needs to be made at pace. We cannot have a repeat of the process surrounding the recruitment of a women’s health champion, which was repeatedly promised but belatedly delivered by the minister and her predecessor.

The role of the commissioner comes with sky-high expectations, finite resources and a much wider remit than that of the equivalent commissioner in England. The independence of the role does not mean the absence of accountability. It will be up to the Parliament to monitor the commissioner’s work and the outcomes for patients. In that regard, I wish the commissioner every success.

16:53  

I thank the minister, the Scottish Government bill team, the Scottish Parliament legislation team and the Health, Social Care and Sport Committee and its clerks for all their work on the bill.

Scottish Labour has long supported the establishment of a patient safety commissioner to champion the rights of patients and to defend their interests. However, we have been clear that we want the bill to be as robust as possible when it comes to defending those rights and interests, and that the rights of bereaved families must be clearly stated in it. Recent patient scandals on the Scottish Government’s watch have, in many instances, eroded confidence in the operation and accountability of our NHS. That is bad for patients and for clinicians and staff, and, ultimately, it reduces trust in health board governance structures.

The amendments that Scottish Labour members lodged presented an opportunity to reset the balance between patients, whistleblowers, families and powerful public bodies. I am therefore genuinely dismayed that the Scottish Government has not adopted the full package of amendments that make up Milly’s law. Those amendments could have ensured that bereaved families were very much at the heart of the response to disasters and public scandals in the bill.

Although I am grateful for the Scottish Government’s co-operation on two of my nine amendments regarding the provision of a patient safety charter in the bill, I am sorely disappointed that the SNP and the Greens have once again voted down amendments that would have delivered Milly’s law in full. That is a betrayal of the very people to whom this bill was supposed to give voice. That includes people such as Louise Slorance, a grieving widow who lost her husband in the Queen Elizabeth hospital infection scandal, and whom Greater Glasgow and Clyde health board paid a private company to spy on. It includes people such as the families who lost their loved ones in the Clostridium difficile scandal at the Vale of Leven hospital, and who had to fight tooth and nail for years to get justice out of this Government. It includes people such as Professor John Cuddihy, whose daughter Molly nearly died after she fell ill at the Queen Elizabeth university hospital and went into septic shock. It includes the patients in NHS Tayside who were operated on by Sam Eljamel, and the women who were affected by the problems with mesh. The minister could have done more.

The NHS in Scotland is in crisis. The Scottish Government is routinely failing patients and staff alike. The state of crisis and the lack of resource that the NHS is facing have an undeniable effect on patient safety. My amendments sought to ensure that the patient safety commissioner for Scotland would have a duty to advocate for those who are affected by a major incident in relation to the safety of healthcare. The amendments would have provided patients and family members with information relating to sources of support, including information on accessing legal support and details of any investigations or inquiries, placing them at the heart of the fight for justice and ensuring that they were never left in the dark again. However, the Government did not accept those amendments.

I have said this before, but it is worth repeating. Milly Main’s mother, Kimberly Darroch, said:

“Right now, the system is stacked against those who have questions about what happened to their loved ones—that can’t be right ... We are looking to our parliament to put measures in place so that nobody has to go through what we went through ever again.”

I fear that, when Kimberly, Louise, John and others look at what was voted on in the chamber tonight, they will feel that the system still remains stacked against families, and whistleblowers, who have to fight to be heard. The bill was an opportunity to reset the balance and to put the interests of patients and families first—what a shame that the SNP has turned its back on doing that.

In addition, it is inexplicable that, although the First Minister would express his support for Milly’s law in public, on the record, his Government simply does not vote for it, given the opportunity. Was he even voting today, or has he run away?

Although Scottish Labour will vote for the Patient Safety Commissioner for Scotland Bill, because it is a step in the right direction, we do so with regret that the SNP has chosen not to truly champion the rights and defend the interests of patients—shame on it.

16:58  

It is my pleasure to speak, on behalf of the Scottish Liberal Democrats, in favour of the bill that is before us. We are rightly incredibly proud of our national health service. The United Kingdom’s decision to create a system of universal healthcare free at the point of need was perhaps the brightest light to emerge from the ashes of two world wars. The doctors, nurses and healthcare professionals who staff our nation’s hospitals, general practices and a range of other settings do an incredible job, often under incredibly difficult circumstances, and they all deserve our utmost thanks.

However, we can always improve it, and sometimes issues, and very occasionally bad actors, in the system can result in significant and often life-changing harm to patients, and even, in some cases—as we have heard today—loss of life. We should all give our thanks, as many members have done, for the colossal amount of work that went into the Cumberlege review, and for the work of the Health, Social Care and Sport Committee in bringing forward the bill.

It has been more than four years since we learned of the serious safety and cleanliness issues at the Queen Elizabeth university hospital, which, in large part, fed into the inquiry. Those problems ranged from the grime-damaged facilities to contaminated supplies, and they had a catastrophic impact on the health of some patients.

We have heard the stories of some of the victims of the scandal at that hospital. Andrew Slorance was a father of five and a dedicated public servant. Andrew’s widow, Louise, has had to campaign to find out the full, unvarnished facts about her husband’s death. Of course, Milly Main was just 10 years old when she passed away in the paediatric hospital.

I have spoken in several debates about the injuries caused by the use of transvaginal mesh, which is a subject that has brought together members across the chamber. Transvaginal mesh is a product that has caused significant harm and injury to many patients, many of whom have—as we have heard—had to fight even to be believed. The Parliament rightly legislated to have those patients compensated for costs related to the removal of that mesh, but that provides cold comfort for the thousands of women who have had their lives devastated, many of whom are still struggling to obtain financial recompense.

Those harms should never have been inflicted in the first place. As members of this Parliament, it is our duty to ensure that we do everything in our power to prevent unnecessary tragedy. It is of vital importance that people who put their trust in our healthcare system—sometimes at the most vulnerable moments of their life—are confident that that trust is well placed.

Scottish Liberal Democrats believe that the bill before us represents an important and necessary milestone in ensuring that everyone who accesses healthcare in Scotland does so safely and has confidence in the champion that we create today. My party also believes that the role of patient safety commissioner is necessary in promoting the views and concerns of patients and the general public and in addressing issues in the system before they can result in harm.

I thank my friend Jackie Baillie for her attempts to include provisions for a patient safety charter in the bill and thereby strengthen it. I do not think that we have fully met the test that was set to us by those who have campaigned tirelessly for Milly’s law. There will be disappointment about the amendments that have been rejected today.

Far too many families have faced barriers in their search for the truth about what happened when tragedy occurred at the QEUH. Those families needed answers but, all too often, doors were closed in their faces. The people who were meant to serve them in their time of need acted, instead, as a barrier to the truth and justice that they rightly deserve. Families who find themselves in the most distressing and vulnerable situations imaginable are entitled to complete transparency, right from the beginning and at every stage of investigation. With the Patient Safety Commissioner for Scotland Bill, I fervently hope that we are able to fully recognise and address the systemic problems in our institutions and prevent further tragedies from occurring. It will have our support tonight.

We move to the open debate.

17:02  

As a member of the Health, Social Care and Sport Committee and as a nurse with a current registration, I am pleased to speak in today’s stage 3 debate on the Patient Safety Commissioner for Scotland Bill.

The bill was introduced in response to the recommendation of the Cumberlege review and in direct response to patient-led campaigns on the use of the hormone pregnancy test Primodos, sodium valproate in pregnancy and transvaginal surgical mesh. Each of those products was associated with significant patient harms and injury, and one of the main findings of the Cumberlege review was that patients were not listened to. As I said when I moved amendments 1 and 2, it is crucial that we ensure that we get the bill right, so that the public can have trust in the commissioner.

The bill proposes the creation of a patient safety commissioner who will be nominated by, and accountable to, the Scottish Parliament. That is important, as parliamentary commissioners are perceived to be more independent of Government.

The bill proposes that the PSC would have two key functions:

“to advocate for systemic improvement in the safety of health care”—

I will touch on that again later—

“and ... to promote the importance of the views of patients”.

Working alongside healthcare providers such as NHS Education for Scotland and Healthcare Improvement Scotland, the patient safety commissioner will be an independent champion for everyone who receives healthcare. The Scottish Government places high importance on the patient voice and the patient experience.

During the stage 1 scrutiny process and in the stage 1 debate, a lot of my interest was on the remit of the Scottish PSC. The remit of the commissioner will include bringing together patient feedback and safety data shared by NHS boards and Healthcare Improvement Scotland to identify concerns and recommend actions. The commissioner will also, when necessary, lead formal investigations into potential systemic safety issues and will have powers to require information to be shared to ensure that every investigation is fully informed.

I believe that the remit of the patient safety commissioner is directly relevant to the constituency work that I have been raising in Dumfries and Galloway, in my South Scotland region. The specific areas involved are cancer treatment, pathways and travel reimbursement.

As colleagues will know, Dumfries and Galloway is geographically located in the south-west of Scotland, but it is aligned with the South East Scotland Cancer Network. Nowhere in D and G is closer to Edinburgh than it is to Glasgow. In many cases, particularly in Stranraer and Wigtownshire, that means a 260-mile round trip for treatment, including radiotherapy. Constituents have been campaigning for that unnecessary travel to be addressed for more than 20 years now. I hear from constituents that the trip can often exacerbate poor health and cause anxiety and additional stress at the very time when people with a diagnosis of cancer should be supported most.

In D and G, patients are currently means tested to be reimbursed for journeys for medical appointments that are more than 30 miles, despite the fact that people living in other rural parts of Scotland are not means tested. Other travel reimbursement schemes exist, such as in the Highlands and Islands. Wigtownshire Women and Cancer and my constituents report that means testing and the journeys travelled lead to worse health outcomes and potentially impact on people’s safety.

I have raised those matters with the Scottish Government on numerous occasions, and I welcome the fact that the language in the bill on the functions of the PSC, under section 2, will allow the commissioner to pick up on those issues.

I welcome the fact that we are moving forward with the Patient Safety Commissioner for Scotland Bill. I also welcome the minister’s commitment to continue to work with me on those issues, and I look forward to hearing more about how we can address cancer pathways in Galloway. The bill is a crucial move that will improve patient safety as we recover from the Covid pandemic. I welcome the fact that we are moving at pace to ensure that we get the bill right for everyone in Scotland.

17:06  

I would like to make two points. The first is that I think that I have not felt the loss of my former colleagues Alex Neil and Neil Findlay more than I do this afternoon. Those of us who, over three parliamentary sessions, were involved in highlighting the torturous and disgraceful way in which women were harmed in the mesh scandal will feel today that we have fallen short. I say that with enormous regret.

Many of those women might even be in tears this afternoon, because they gave so much to the inquiry that was led by Professor Alison Britton—whom we have not mentioned this afternoon, and who expressed frustration about being unable to get information or to hold people to account during her inquiry—and the inquiry that resulted in the recommendations in the Cumberlege report. They might feel that, when we got to the high-wire act today and had to fall either on the side of cynical gritty caution or on the side of slightly more well-wishing hope, we fell on the well-wishing hope side of the argument rather than the gritty caution side.

That is a missed opportunity, and I hope that it does not come back to haunt Parliament at a later date. If it does, many members will be quite ashamed that, when the opportunity to give the commissioner the strongest possible teeth was right before us, and after everything that we had learned over the previous decade, we just did not do it. I am very sorry about that.

I welcome the fact that there will be a commissioner. That is progress, as Jackie Baillie said. Amendments from Tess White, Carol Mochan, Paul Sweeney and Jackie Baillie all advocated for things that we had agreed to in previous debates in the chamber. I do not understand why, having got to the journey’s end and having the chance to vote for what we all agreed to, we did not do so. There we go.

The second point that I want to make is that, although I am a member of the Scottish Parliamentary Corporate Body, I am not speaking on its behalf. When I was in my first session in Parliament, from 2007 to 2011, I was put on a committee that was looking at the principle of commissioners and the extent and growth of their numbers. That cohort of MSPs was concerned because there were five commissioners and they wanted to see that number being reduced. We made recommendations that were supported by MSPs until the recommendations went out to public consultation. The voice of the public in saying, “We want to keep that commissioner,” was so strong that we abandoned, as a Parliament, the courage of our convictions.

The moral of that for me is that, when we create a commissioner, there is no going back. Therefore, I am concerned not about the principle of the patient safety commissioner, which I wholly support, but that we, as parliamentarians, are embracing commissioners loosely and not as part of a coherent plan. In moving from seven to 14 commissioners—or 15, potentially—we would be creating by stealth a new level of Government in Scotland. In a way, we are devolving responsibilities away from ourselves as parliamentarians—responsibilities that I thought the Parliament was, in the first place, established for us to pursue and have responsibility for. We should be very cautious about the overall effect of that.

I agree with Mr Carlaw. Although I hope that we can all support the patient safety commissioner as a one-off, there is a wider issue. How does he think the matter should be taken forward? The Finance and Public Administration Committee has been looking at it. Should that committee be considering the matter, or do we need another way of looking at the bigger question?

I can speak only personally, but I think that there needs to be a point at which Parliament holistically debates the principle of what we do. I do not want to single out by exception, and I do not want to stray away from the debate, Presiding Officer; I am conscious of that. I am sure that everything that I am saying is a consequence of the creation of the patient safety commissioner, but I think that there is a danger that we will find it difficult not to agree to creating a raft of other commissioners after this, because there will be parallels with those that we have approved. That is a concern.

The SPCB has a responsibility for funding the Parliament’s decisions on commissioners but not for deciding whether they are a good thing. Our responsibility is to fund the commissioners that Parliament decides it wants. The commissioners that we have were previously estimated to cost around £3.5 million; they now cost more than £10 million. The total budget for officeholders in the past year was 8.1 per cent of our overall budget. Were we to double the number of commissioners, a thumping big piece of the Parliament’s budget would be going towards that purpose. Therefore, we have to consider not just the financial costs but the fact that, in my experience, no commissioner has ever downsized their office; they have all expanded their offices considerably.

I come back to the purpose of commissioners and my first point. If we are going to create commissioners, they must be given the greatest degree of latitude and power that we can give them. If we are going to create them, let them do what we said they would do. That is why I regret that the patient safety commissioner’s responsibility and authority has been slightly truncated from what I had thought that it would be.

17:12  

I thank my colleagues on the Health, Social Care and Sport Committee for their work on the bill, and I express my equal gratitude to the committee clerks and the legislation team for their on-going assistance.

We must thank the families and patients who engaged closely with us in what were often very difficult times for them. Jackson Carlaw put that important point eloquently. Those families and patients rightly expect much from us, and they deserve every bit of the time that we have put into getting maximum effect from the bill.

My party supports the bill. We are long-standing advocates of the general principles of the bill and we view reform in the area as a top priority. Patient safety is of paramount importance for the future of our NHS, and we are long overdue tangible changes that reflect that.

We all know of a great many examples across Scotland in which a failure to consider the overall state of patient safety has led to loss of life and incalculable damage to families. The bill is a step forward in giving the issue the attention that it deserves, but it is only a step: it is by no means a fix-all, but it provides formal recognition of a change in the direction of travel, which we can all welcome.

Others have made this point: if the Government truly wished to continue along that path, it would have had to give proper status to all aspects of Milly’s law, which would have given bereaved families much-needed new rights. It is unfortunate that, at stage 2, the SNP and the Greens voted down my party’s reasonable attempts to introduce such measures. They should have taken the opportunity today to deliver those much-needed amendments and to back Scottish Labour’s proposals. Their doing so would have given the bill a long-term legacy that could have been a touchstone for serious reform across our health service in respect of how patients interact with powers in the NHS, as a public body.

We must also reflect on the overwhelming pressure that is being placed on staff, which, in turn, hinders patient safety. The two things are entirely linked, so there has to be much greater openness to allow staff to raise serious patient safety issues, including their views when wards are seriously understaffed.

At this juncture, I thank the minister for accepting my stage 2 amendment, which improved co-ordination between safe staffing legislation and patient safety legislation. I thank the minister for acknowledging that in today’s debate. Patient safety and staff safety go hand in hand; we cannot have one without the other, so as we debate the bill this evening, I urge members to be aware that we still await the implementation of safe staffing legislation. Patient safety cannot be fully secured until such issues in our healthcare settings are recognised and addressed.

We cannot suggest for a moment that a patient safety commissioner alone will produce significant improvements to patient safety. As we have seen in recent times, confidence has been eroded due to scandals, and our NHS continues to be seriously underfunded. As we have noted, those scandals are often linked to women’s health—including use of mesh, and more recently, provision of endometriosis care. Although I will not focus over much on that point, it must be made and we must continue to address the issue.

We need to redress the balance of power. Some of my amendments sought to do that, so it is disappointing that the Government seemed to be scared to accept them.

The bill is welcome, but it is a stepping stone. We must never forget that this is the beginning, and we must always strive to do more.

17:16  

As other members are, I am very pleased that the bill has reached stage 3, so I follow others by thanking all those who have put work into the bill.

The Scottish Greens have supported the appointment of a patient safety commissioner throughout the process because we believe that that will lead to an improvement in patient care. It will also help to rebuild relationships between patients and the health service, where there has been a breakdown of trust. Patients must have confidence in our health system, its safety and its ability to respond quickly when problems arise. They need to know that, if they raise concerns, they will be heard and that they will not be left with sometimes life-changing injuries with no means of redress.

The patient safety commissioner will have oversight of the entire system and will be able to promote system-wide improvements while amplifying the voices of patients and their families. That will mean that trends and patterns will be identified more quickly and that widespread issues will be addressed.

There has been discussion about whether the commissioner should look at individual complaints. I support the commissioner taking a systematic approach to identifying trends and areas for improvement, although that process should be based on clear evidence, with protection of vulnerable people being prioritised.

There might be some confusion among members of the public about the specific role of the commissioner—especially in the first few years after they have been appointed. We need to ensure that the role of the commissioner is well understood and that any materials that explain the role use inclusive and accessible language. The Health and Social Care Alliance Scotland has called for inclusive communication processes to be incorporated into the functions of the commissioner at the earliest opportunity, in order to ensure that communication and information provision is inclusive for all. I second that call. That cannot be seen as separate or as an add-on to the appointment of the commissioner; it should be embedded from day 1 so that people do not feel disheartened when they attempt to contact the commissioner only to be informed later that their individual complaint will not be considered.

Alongside excellent communication about the role and responsibilities of the commissioner, there must be an early focus on building relationships. The public should see the commissioner as someone who is on their side and who is working to make health services safer, rather than as an official who serves to protect the NHS and make problems go away.

It is vital that human rights are at the heart of the patient safety commissioner’s work, and that the commissioner fulfils their functions while upholding equalities legislation. As I mentioned during my stage 1 speech, the commissioner must be aware that not all complaints are treated equally and that existing inequalities such as those related to gender, race and economic status will impact on the experience of patients when things go wrong. As I said then, I fully support the commissioner adopting a focus on addressing and mitigating existing health inequalities and on how they can compound system-wide problems.

Following on from the point about equalities, I say that the appointment of the commissioner must be fully transparent, with people who have lived and living experience of patient safety issues playing a meaningful role in the recruitment process. Consulting people with lived experience should be an on-going process, not a one-off event, so I welcome the requirement that half of the advisory group be made up of people who are representative of patients.

I agree with the Health and Social Care Alliance Scotland’s statement that the commissioner’s strategic plan should be explicitly co-produced with people with lived experience of patient safety issues, and with unpaid carers. That will ensure that engagement with lived experience is not tokenistic but is embedded in the work of the commissioner from the beginning.

The appointment of a patient safety commissioner is a vital step towards improving patient safety and demonstrating that, when mistakes are made, patients will be listened to and complaints will be taken seriously. The Greens will therefore support the bill at stage 3.

17:21  

I am very pleased to speak in the stage 3 debate, as I did at stage 2, as a member of the Health, Social Care and Sport Committee. I believe that this legislation is much needed. As we have heard from the minister, the role of patient safety commissioner was recommended by the Independent Medicines and Medical Devices Safety Review. I shared this quote at stage 2, and I will share it again now because it gets to the heart of why the legislation is needed.

Speaking of the issues highlighted by that review, Baroness Cumberlege said:

“we have never encountered anything like this, the intensity of suffering, the fact that it has lasted for decades. And the sheer scale. This is not a story of a few isolated incidents. No one knows the exact numbers affected ... but it is in the thousands. Tens of thousands.”

The Cumberlege review focused on three patient safety issues—transvaginal mesh, sodium valproate in pregnancy, and Primodos. Those all have something in common: their adverse effects impact women, a group who are often not listened to in medical settings.

Patient safety issues range from those resulting from active intervention, such as transvaginal mesh, to those that come about from small, cumulative errors. To illustrate the other end of the scale, there is an issue that has recently been highlighted to the Patient Safety Commissioner for England. Research has found that time-sensitive medicines are being administered late.

For people with diabetes, Parkinson’s disease or HIV, late medication can cause deterioration that is sometimes irreversible. It is estimated that, each year in Scotland’s hospitals, more than 100,000 Parkinson’s medications are given more than 30 minutes outside their prescribed time, or are missed. Only a handful of incidents and complaints are reported, despite the harm that those errors can cause.

In the past, tens of thousands of people were dismissed, ignored and left to suffer. That cannot continue. It is of the utmost importance that the social context is acknowledged. I welcome the agreement today to amendment 13 from Paul Sweeney, which sets out the need for the commissioner to give particular consideration to underrepresented groups. As the Patient Safety Commissioner for England, Dr Henrietta Hughes, told us:

“If we get it right for those who are most vulnerable, we make it better for everybody.”—[Official Report, Health, Social Care and Sport Committee, 21 February 2023; c 28.]

If we create a culture of openness, patients can share not only what has gone well but also where things could have gone better. Patients should have confidence that not only will they receive the best treatment without fear of harm, but any concerns that they raise will be listened to and acted upon.

The bill ensures that the commissioner will be independent of Government and the NHS and will be accountable to the Scottish Parliament and the people of Scotland, and that the commissioner will have complete freedom to consider or investigate any issue that they believe has a significant bearing on patient safety in health care.

As England’s PSC says:

“There are pockets of excellent practice from which we must learn.”

We can learn from her work. Already, she is working with stakeholders internationally, forging connections with those who are leading towards positive change on a global level.

I look forward to seeing our Scottish patient safety commissioner be a voice for patients who, too often, go unheard.

17:25  

I am pleased to contribute to the debate on behalf of the Finance and Public Administration Committee. As Jackson Carlaw pointed out, should the Parliament pass the bill, the patient safety commissioner will join seven other commissioners that the Parliament has established since 1999, with more being proposed. The Finance and Public Administration Committee has a responsibility to scrutinise the Scottish Parliamentary Corporate Body’s budget each year, an increasing proportion of which supports the functioning of commissioners. The set-up costs for the patient safety commissioner are expected to be around £150,000 this and next financial year, with annual running costs thereafter estimated to be around £645,000 at this year’s prices.

As Tess White pointed out in relation to her amendment 22, those costs will add to the £16.6 million that the SPCB required for the seven existing commissioners in 2023-24. That is an 8.1 per cent increase on the previous year, and, as Jackson Carlaw pointed out, the total budget for officeholders is 8.1 per cent of the SPCB’s budget. It alarmed the committee that this year, one commissioner was hiring 7.4 additional members of staff on an average salary of £57,000 at a time when front-line services were under real pressure.

The Finance and Public Administration Committee did not receive any submissions to our call for views on the Patient Safety Commissioner for Scotland Bill, but, in view of the number of commissioners, both current and planned, we wrote to the Health, Social Care and Sport Committee asking it to explore with the Scottish Government the financial impact of establishing the body on the SPCB’s officeholder responsibilities. We are also keen to know whether a more strategic approach to the establishment and resourcing of future potential officeholders might be considered in the future. We otherwise expressed no views as to the merits of the patient safety commissioner, and thank the lead committee for acknowledging our concerns in its stage 1 report.

We note that, in her response, the minister said:

“While it would not be right for me to make funding commitments now, based on hypothetical developments in the future, I can commit that the Scottish Government will engage constructively with the SPCB to ensure that all parliamentary commissioners are funded appropriately, including the Patient Safety Commissioner.”

Although that may be welcome, it somewhat misses the point. As the SPCB told us during budget scrutiny,

“we could be looking at having 14 commissioners”—[Official Report, Finance and Public Administration Committee, 10 January 2023; c 20.]

That is based on current proposals for Government and members bills, as well as recent consultations.

The SPCB 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, despite its being an expensive extension to our public sector.”—[Official Report, Finance and Public Administration Committee, 10 January 2023; c 20.]

Indeed, at the most recent convener’s group meeting, I commented on the plethora of organisations that we already have in the public sector and how crowded it is.

The patient safety commissioner is of particular concern to the Finance and Public Administration Committee in the context of our work on the sustainability of Scotland’s finances now and in the years to come, as well as the Government’s public service reform programme. It also raises important questions about how, collectively, the roles and governance of commissioners function alongside the roles and accountability of public bodies and the Government. The committee considers that it is now time for a more strategic approach to establishing and financing commissioners.

Does the committee have a view on who should take that work forward and who should be leading on it?

The Scottish Government should be looking at that, to be perfectly honest. I think that the SPCB and the Finance and Public Administration Committee have a role, but the Scottish Government will have to grasp the nettle on it.

We need a fundamental look at how the overall landscape of commissioners has continued to develop since devolution. Watch this space: the committee will be looking at some of those issues in the months ahead. That will include something that I have raised and other colleagues have commented on, which is the possibility that some commissioners, after they have achieved the mission that they were originally set up to achieve, can become self-perpetuating. We should perhaps look at a sunset clause for some commissioners, otherwise we will simply have more and more as years pass by.

We will continue to draw our concerns to the attention of the relevant lead committee, where appropriate, when considering future financial memoranda for bills that propose new officeholders, and continue our scrutiny of the SPCB budget, including that for commissioners.

In closing, Presiding Officer—and I thank you for your indulgence—subject to the Parliament’s decision tonight, I hope that the new patient safety commissioner will make a valuable contribution and be a source of support for patients across the country.

17:30  

I am pleased to close the debate on the Patient Safety Commissioner for Scotland Bill on behalf of Scottish Labour. During the Health, Social Care and Sport Committee’s evidence on the bill, colleagues and I heard accounts of where patient safety had failed—quite egregiously in some cases, including in the cases of women who were impacted by transvaginal mesh and hormone pregnancy tests. Such cases dent public confidence in critical healthcare services, and the establishment of a patient safety commissioner is, therefore, an essential opportunity to ensure that people have a champion when patient safety has failed and who seeks to prevent further failure in the system.

Some of the more high-profile cases of patient safety failings disproportionately impact women, and I am therefore grateful to the minister for working with me to bring back my stage 2 amendment to ensure that underrepresented voices are consulted on the development of the commissioner’s principles, strategic plan and charter.

However, I am disappointed that the Government has chosen not to support my other amendments, particularly amendment 14, which would have given the commissioner the power to make a special report in line with the powers of the Scottish Public Services Ombudsman. That was a critical juncture in the legislative process and the Government has been found wanting. I thought that the member for Eastwood in particular spoke powerfully on that point. We should be giving the commissioner the ultimate power of recourse to highlight where implementation has not taken place or is not being taken seriously. We need to think carefully about the commissioner’s capacity to exercise their power appropriately.

We have heard, powerfully, through the convener of the Citizen Participation and Public Petitions Committee, how critical the patient voice was through that committee. That voice should not be stymied when a commissioner is able to undertake such investigations. I hope that the minister will give some comfort to those who are concerned by that lack of support for amendment 14. Patient safety groups were clear to me that there must be accountability, and opposing amendment 14 is a missed opportunity to empower the commissioner with an escalation route.

I understand that the minister had concerns about my stage 2 amendments that sought to give the commissioner the power to compel private medical providers to share information and to clarify the remit on social care. I took those amendments away and worked on the drafting to address the minister’s concerns, which led me to lodge amendments 15 and 19. I am disappointed that her position has not changed in that regard.

I pay tribute to my colleagues on the Health, Social Care and Sport Committee, the clerks, and the legislation team for its constructive and collaborative approach throughout in helping to try to get the bill in the best place possible to serve the people of our country.

My colleague the member for Dumbarton, in particular, has spoken very powerfully to her amendments today, which sought to reset the balance between public bodies and bereaved families, particularly in memory of Milly Main, who died after contracting an infection at the Queen Elizabeth university hospital in Glasgow while recovering from leukaemia.

Although Government support for some of those amendments is welcome and will go some way toward giving bereaved families such as Milly’s a voice when patient safety is not upheld, it is, indeed, regrettable that the Government was not able to fully support all those amendments to give full effect to a Milly’s law. That remains unfinished business, sadly. We will continue to advocate persistently to fully address the intent of Milly’s law in this Parliament.

Labour supports the legislation. We have sought to engage constructively with the Government throughout the legislative process to strengthen the power of the commissioner through our amendments, although we note the important point that a number of members made in the debate this afternoon about the general planning of this Parliament with regard to the scope and remit of commissioners in the round.

Although Labour is supportive of the establishment of a patient safety commissioner, it is regrettable that the minister has not supported some of our key proposals to improve the bill. However, we will continue in our efforts to ensure that bereaved families are never an afterthought in the medical establishment.

17:34  

I draw members’ attention to my entry in the register of members’ interests: I am a practising NHS GP.

The Scottish Conservative and Unionist Party members are highly supportive of the bill, which will introduce a patient safety commissioner for Scotland, three years on from the Cumberlege report and its key recommendations.

For years, we have debated long and hard the SNP’s poor stewardship of our NHS, highlighted concerns about patient safety and advocated for systemic improvements. The bill should help to address injustices in our healthcare system and deliver the improvement in patient safety that Scotland desperately needs.

My colleague, Jackson Carlaw, made strong representation in favour of giving our commissioners real teeth to allow them to deliver, but we fell short of doing so. Jackie Baillie spoke of two awful cases of tainted water supply and Clostridioides difficile. Those are just two of the reasons why I believe that a patient safety commissioner is required, but we must be cognisant of what Tess White said, in relation to some amendments, about the potential for the number of commissioner roles to expand.

Despite that, I genuinely do not understand why the minister would not back Tess White’s amendment 11. The patient safety commissioner will be involved because something has gone wrong. For something to go wrong, staff—clinical, clerical or managerial—must be involved, so surely it is common sense for us to enshrine into law a provision for the views of NHS staff to be heard.

Although Tess White did not move amendment 22, we are concerned about the cost of our commissioners, which was £10 million-plus for last year alone. We do not object to or oppose our individual commissioners, and each group that asks for a commissioner is perfectly valid in doing so and worthy of having one, but it is taxpayers’ money, so we must be able to get value for that money. If we can combine back-room work for duties such as human resources or for lawyers, we might be able to save money overall. We must not continue to create commissioners in such a way and in such numbers that, as Jackson Carlaw said, we end up creating another level of government. I urge careful consideration of costs and that we should try to save as much as we can through as much innovation as possible. I feel that we have cross-party support for that.

I agree with Baroness Cumberlege that the role of the patient safety commissioner is to find the “golden thread” that runs through the story of harm. I hope that our patient safety commissioner is able to do that, and I look forward to their first report, through which they can start making healthcare safer.

Independence from the Scottish Government is important and, on this side of the chamber, we support that position, because it will allow for an agile commissioner who, I hope, will follow data and stories and the “golden thread” that I spoke about.

Before I end my remarks, I will touch on a point that Tess White made. I say to everyone who interacts with our fantastic staff and fantastic NHS that the vast majority of interaction is safe. I want patients to feel reassured, but culture is an issue and we need to make sure that, if something does go wrong, we have someone who is able to look carefully at that and make healthcare safer.

We support the motion and wish our future commissioner well.

I call Jenni Minto to wind up the debate.

17:38  

I am grateful to members for their contributions to this afternoon’s debate, which has been thoughtful and constructive, and I am pleased that there is support for the bill across the chamber. It has been clear that the bill’s overall purpose—the establishment of a patient safety commissioner for Scotland—has enjoyed strong cross-party support from the start. Members on all sides of the chamber share the common goal of making Scotland’s healthcare system as safe for patients as it can be. That is only right, given the challenges that the NHS has faced in recent times, and it will continue to be of the utmost importance as we continue to recover from the pandemic.

We have had a useful debate today, and it has explored a range of issues. I would like to reflect on a couple of visits and events that I have attended in the past 24 hours. One was today at Children’s Hospice Association Scotland’s Rachel house, in Kinross, and the other was the neuroblastoma event last night in Parliament.

There are important issues for us to consider when we are in this chamber. I have met—we have all met—brave parents and families who have shared their experiences. We all draw on such occasions to put the people of Scotland at the heart of what we do and to work together to improve healthcare in Scotland. I believe that, as a number of members have said, the introduction of the patient safety commissioner is a key part of that.

I note that a number of members used the words “trust” and “confidence”. That is absolutely the nub of where we have to get to, so I appreciate those comments. With the fantastic role of commissioner, we also need to achieve openness, learning and co-operation.

Jackson Carlaw commented on the latitude and power to make decisions. I believe that the commissioner will have that under the statutory powers in the bill. Carol Mochan said that patient safety is paramount to the survival of the NHS, and I agree. She recognised that the bill is a step on the path and she also recognised the importance of staff being involved.

Gillian Mackay commented on system-wide improvements, and she mentioned the importance of our being clear about the commissioner’s role. I agree that we need to ensure that the people of Scotland understand the roles and responsibilities of the commissioner.

Evelyn Tweed commented that if we get it right for the most vulnerable, we get it right for us all. That is why I reflected back to the neuroblastoma event that I was at last night.

Kenneth Gibson raised the importance of the strategic approach. From the Scottish Government’s perspective, we would always be willing to talk to the corporate body, and I think that he raised some important points.

I note that the minister refers to talking to the corporate body. Does she agree with Mr Gibson that the Government needs to lead on that, or should it be Parliament that leads on that?

I think that the corporate body and the Scottish Government need to talk about that. That is important, because it is a strategic approach.

Paul Sweeney talked about the patient safety commissioner being a champion for underrepresented voices. I was pleased to work with him to ensure that we got the amendment worded correctly.

I point out to Sandesh Gulhane and Tess White that there is nothing to preclude the commissioner hearing from staff. It is important to reflect on that.

I am grateful to the many members who have contributed to the progress of the bill in the weeks and months leading up to today. A number of people have raised specific matters. For example, Emma Harper raised the issue of the care of cancer patients in her constituency. Katy Clark also spoke to me about hernia mesh, and I am pleased to be able to meet her and some of her constituents shortly.

As I have said previously, I welcome the clear support for the bill across the chamber. It will create a new and independent patient safety commissioner who will gather feedback on the safety of healthcare in Scotland, make recommendations for systemic improvements and work collaboratively with other bodies to achieve those improvements and make healthcare safer.

Although the patient safety commissioner will report to Parliament, they will hear the stories of patients, their families and the wider public directly—the lived experience that has been noted by a number of members—and their priorities will be informed by the importance of patient views and safe healthcare. They will be a commissioner for patients and the public, not politicians. I know that the Parliament wants to ensure that the bill builds on the rights that enable patients to give feedback, raise concerns and make complaints in Scotland. We must continue to listen to patients and learn from their experiences. I trust that members are satisfied that the bill strengthens our commitment to doing that.

The wording of the bill will allow the commissioner to consult widely on their statement of principles and strategic plan and, as was agreed to today, the charter, ensuring that the views of patients can be built into the way in which the commissioner functions from the outset of the role.

As I mentioned earlier, although the bill arose out of the specific issues outlined in the Cumberlege report, I believe that it is right that the scope of the commissioner has been kept intentionally broad. That is crucial to ensuring that no voice in Scotland is left unheard. I cannot stress enough the importance of that. Members do not need me to remind them that the patient safety landscape is complex. The patient safety commissioner will collaborate instead of duplicate, and they will leverage their influence to work with other organisations to track trends, identify problems and make positive improvements.

I thank all those members who, I know, have worked hard on making the bill as effective as possible in achieving its aims of improving patient safety. A moment ago, I mentioned some of the earlier work that has gone into the bill, but I particularly thank Jackie Baillie, Paul Sweeney and Tess White. As I alluded to earlier, even if there has not always been complete agreement on every intricacy in this piece of legislation, I recognise and am grateful for the fact that every single amendment has been proposed with the constructive aim in mind of making the patient safety commissioner as effective as possible to achieve the maximum benefit for the safety of patients. I hope that Opposition members recognise that same spirit in the way that the Scottish Government has engaged in the process.

I thank again the Health, Social Care and Sport Committee for its effective scrutiny of the bill, as well as all those who gave evidence—often powerfully. I also thank the bill team for its diligence, and my predecessor, Maree Todd.

The title of Baroness Cumberlege’s report, which first recommended the creation of a patient safety commissioner, was “First Do No Harm”. I believe that, by listening to the voices of patients and their families, investigating further without fear or favour, and working with others to achieve positive change, Scotland’s patient safety commissioner will reinforce the foundation of trust in our healthcare system that it does no harm to those in its care. Indeed, I believe that in creating the patient safety commissioner for Scotland, Parliament will be doing right by Scotland’s patients and their families. I commend the motion in my name, and I very much hope that members will vote for it unanimously.

That concludes the stage 3 debate on the Patient Safety Commissioner for Scotland Bill.