Chamber and committees

The context is the severe budgetary pressures that are being faced by healthcare, so it is not just about demand. The mental health budget has, in effect, been frozen in cash terms this year, with the cut to mental health being restored to bring it back to the level that it was at last year. What impact has that had on your services? Have you been able to offer an alternative interface or are you feeling the pressure as well?

Thank you for joining us today. I have a question regarding the codes that were mentioned in your submission. You indicated that red and purple are assigned to emergency calls, but, despite those emergency markers, I understand that red or purple call patients can still wait hours to get a response. I am familiar with one constituency case in which a red call patient waited six hours and 50 minutes for a response. Paramedics and your team are trying exceptionally hard in impossible circumstances. What can the Scottish Government do to support the service and improve response times to such critical calls, and how can the system improve the flow of returns?

You mentioned that flow navigation is implemented in one form or another across all territorial boards. You are in a fairly unique position in that you sit across all those boards and have that perspective. How dynamic and adaptive are the territorial boards in sharing best practice? Are you able to indicate where approaches are doing well elsewhere that could be adapted across the nation as a whole and bring everyone up to a higher performance level?

I want to pick up an issue that is frequently raised by police officers, which is the amount of time that they spend dealing with cases that they do not feel qualified to address or capable of dealing with. The number of calls made to Police Scotland in which a mental health crisis or a suicide risk was cited increased by almost 10,000, from 14,540 in 2018 to 23,406 in 2022.

You mentioned the pilot of triage cars, three of which are operating in Scotland at the moment. Do you feel that there is an opportunity to look at a business case to expand that model if it is shown to be a more effective and more cost-effective solution, given the huge costs that are incurred by the police in responding to incidents involving people who have a known history of calling the police on such issues or incidents with which they are not qualified to deal when they arrive at the scene?

Sections 10 and 11 of the bill as drafted outline the requirement for the commissioner to prepare a report following any formal investigation, as well as the requirement for a person to respond to any recommendations made to them in a commissioner’s report.

Amendment 22 would give the commissioner the power to make a special report if it were to appear that recommendations made in their initial investigation report had not been, or would not be, implemented. A special report would be sent to the persons to whom the formal investigation report was sent in the first instance, and a copy would be laid before the Scottish Parliament. Further, the report could also be made public if the commissioner considered that to be appropriate.

In committee evidence, patient groups cited a need for accountability. Marie Lyon, from the Association for Children Damaged by Hormone Pregnancy Tests, said that, up to now,

“people have tended to get away with it. There has never been accountability and there have never been consequences.”—[Official Report, Health, Social Care and Sport Committee, 7 February 2023; c 22.]

Where there is a concern about patient safety, and where changes need to be made, bodies cannot be left to mark their own homework. The commissioner can be effective only if they have the ultimate option of escalating matters if recommendations are dismissed or ignored by the relevant authorities, and I believe that my proposed amendment would give the commissioner the teeth that they need in order to ensure that necessary changes are implemented. I believe that that would be a proportionate enhancement of the commissioner’s powers.

I move amendment 22.

Amendment 24, in my name, would ensure that private companies supplying medicines and medical devices are captured in the category of person who would be required to provide information under section 12 to inform investigations undertaken by the commissioner. There is a lack of clarity over whether the commissioner’s proposed powers to require organisations to provide information will apply to private companies, given that section 12 refers only to “persons” or “healthcare providers”. Amendment 24 seeks to insert a definition that ensures that, for the purposes of this section, the term “health care provider” also includes companies in the private sector that provide medicines and medical devices. I think that that is a reasonable definition.

I should also say that we will support the Government’s technical amendments to the language in section 12. We would therefore be eager for the minister to at least consider revising her position on amendment 24, as I think it entirely reasonable that we clear up the definition.

This proposed amendment applies to the definition of “health care” in section 21 and seeks to include social care services as part of that definition in the text of the bill. We know that the social care system is facing a crisis in relation to workforce and rising costs. As a result, capacity is stretched, with social care workers stressing the difficulty, under the current circumstances, of providing the level of care that they would like to provide.

Amendment 33 would not seek to widen the commissioner’s remit to include social care as a whole. Instead, it would merely enable the commissioner to consider the interface with social care as part of their investigation only where those services “intersect with” the defined elements of healthcare in the commissioner’s remit, in relation to

“services provided ... in connection with ... illness, and ... forensic medical examinations”.

Amendment 33 is in line with the committee’s recommendations in its stage 1 report, and I encourage the minister to support it.

I move amendment 33.

I welcome the minister’s comments to clarify that point. The clarification is welcome with regard to amendment 33’s intention, which is in line with the committee’s recommendations. With that assurance, I am content not to press the amendment.

Amendment 33, by agreement, withdrawn.

I note the minister’s comments, but a critical point of discussion at stage 1 was about the fundamental principle that reports are often simply ignored because there is no method for sanction or accountability. Amendment 22 was lodged in that spirit. Other public sector bodies—most notably, the Health and Safety Executive—have powers of compulsion to ensure that recommendations are implemented, and therefore have the capacity to sanction organisations or authorities that do not comply.

Although that might be thought to be overly onerous in this instance—perhaps it would have a chilling effect on health boards and others co-operating with the commissioner—my amendment 22 is an effort to strike a balance. It would not provide the commissioner with the sort of punitive powers that the Health and Safety Executive might have to shut premises down, for example, but it would give the commissioner the capacity to highlight areas in which the recommendations were merely ignored or simply noted by authorities and not actioned. By offering a method of naming and shaming authorities that do not comply or co-operate with the commissioner, my amendment would give the commissioner some degree of leverage to ensure that recommendations are implemented.

I note the minister’s point about the risk of defamation actions. That is a judgment that would be made on a case-by-case basis, based on legal advice. I do not think that the commissioner would knowingly prejudice or expose themselves in that way, so it is an unnecessary overreach to suggest that my amendment 22 would create such a liability. We are all subject to that liability because of the lack of parliamentary privilege in the Scottish Parliament. Improvement across the board is necessary in that respect.

Therefore, I press amendment 22, which I think is entirely reasonable.

Amendment 16 would require that the commissioner’s statement of principles included a commitment to involving underrepresented groups in the commissioner’s work.

In committee evidence, the patient safety issues that were raised, such as valproate and mesh, were issues that disproportionately impacted on women. The mesh scandal is perhaps one of the most commonly known examples of an issue regarding which a group—in this case, a group of brave and unrelenting women, many of whom had to seek recourse through the Citizen Participation and Public Petitions Committee—had to try exceptionally hard to have their voices heard.

Dr Arun Chopra of the Mental Welfare Commission for Scotland told the committee that, despite marginalised groups being predominantly affected by patient safety events, groups such as ethnic minorities are not well represented in patient safety data. By including underrepresented groups in the statement of principles, amendment 16 would ensure that marginalised groups remain visible in consideration of patient safety issues, and would, I hope, give everyone equal recourse to advocacy, so that having their voice heard was a right and not a privilege.

Amendment 16 proposes to insert, at the end of line 11 on page 2:

“The statement of principles must include the principle that the Commissioner will seek to involve categories of people that the Commissioner considers to be under-represented in health care in the Commissioner’s work.”

I move amendment 16.