Chamber and committees

To go back to the point about powers, will there be an appropriate element of compulsion for the commissioner to exercise when it is instructing, for example, health boards to gather certain types of data based on complaints that have been picked up that we cannot verify through data? Is there a mechanism whereby the commissioner could say that people should start assessing the issue at primary or secondary care interfaces, to enable us to gain a greater understanding of the issue? Could that be defined?

I do not know whether there is a collective noun for Pauls.

I want to touch on the addictive aspects of unhealthy body image, social media and role models.

You mentioned the education context. A traumatic incident in school could really damage a person’s self-confidence and create destructive behaviours in terms of addictions. I do not necessarily mean addictions to substances, but addictions with regard to creating unattainable goals in terms of physical image. Do you have a view on the reinforcing mechanisms of social media algorithms, and whether they can lead to the real harm that you have identified?

You mentioned earlier that there were some good examples, so can you elaborate on that? Are they examples that we could reinforce from a public policy perspective, through public health advertising to push things in the right direction?

Thanks. That is really helpful.

Dr Hughes said that “Multiple paths already exist” in the healthcare system. Earlier, you cited the police as an example. Dr Hughes also said:

“It is partly about understanding the powers that others have, but it is also for others to understand the powers that exist in the system and to work collaboratively”—[Official Report, Health, Social Care and Sport Committee, 21 February 2023; c 36.]

to achieve the common goal.

Bearing in mind that the reporting line is to Parliament rather than to ministers, is there provision in the bill for there to be an assessment period after a certain time to see how the PSC works with other organisations and, if necessary, to define further through secondary legislation those interactions and interfaces? Is that something that the committee could consider in its report?

I want to pick up on the point about resourcing. Budget and head count are one thing, but understanding the competences that you need in the team is critical. There is a huge risk of data inundation and having to make sense of large volumes of information. Have you given much thought to how you can build a process that is resilient enough to draw meaningful conclusions from what is being fed into your office and how you process that? We have a major concern about how that can be managed by what is, initially, such a small team.

That is helpful. It is a help to know about the line to the select committee, which is something that we can reflect on.

I am thinking about the need for a combination of powers and the capacity to gather meaningful insights. Let us take, for example, the transvaginal mesh scandal, where the patient voice was ignored and not heard by the data collecting mechanisms in the Scottish national system, which meant that patients found themselves at a loss to express their concerns beyond petitioning Parliament—it was only then that an inquiry was pursued. Do you see the need to advise change in the way in which data is collected and managed? If you were hearing qualitative insights from patients, but you did not have the quantitative information to verify whether there was a wider national issue, would you be able to recommend that such information would have to start being collected at a certain point in the patient journey in order for us to understand over time whether there was a wider concern? Would you consider such a mechanism necessary?

The Department of Health and Social Care in England has put forward the argument that being appointed by Government would give the commissioner a powerful role in the system and that

“A commissioner which is entirely removed from the policy department can be more easily overlooked by government.”

Do you agree? Do you think that that is a potential risk?

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?