Chamber and committees

Amendment 11 requires that the “statement of principles” must consider ways of engaging with NHS staff to seek

“their views on patient safety concerns”.

A similar amendment that, as the minister will remember, I lodged at stage 2 sought to place a duty on the commissioner to “seek the views” of NHS staff in relation to patient safety. In her response at the time, the minister raised concerns that the commissioner is

“already empowered to do so”—[Official Report, Health, Social Care and Sport Committee, 13 June 2023; c 16.]

and that such an approach could detract from “patients’ voices”. As such, I have softened the approach of the amendment at stage 3 to focus it on how the commissioner can engage with NHS staff, instead of creating a requirement for them to do so.

I am revisiting the amendment, because, in the period between stages 2 and 3, the trial of former neonatal nurse Lucy Letby reached its horrifying conclusion. That deeply distressing case has shocked the public and has shaken the foundations of the healthcare system. Lessons can and must be learned by healthcare providers, especially given that other NHS staff raised the alarm but were overruled by their managers. I know that recourse exists for NHS staff to raise red flags about safety, but, as the Royal College of Nursing has argued, staff do not always feel that their concerns are heard or addressed, as in Lucy Letby’s case.

The minister suggested that the commissioner’s hearing from NHS staff could cut across patients’ voices, but I would counter that, in many cases, such processes could be concurrent and complementary. It would, of course, be at the commissioner’s discretion how to amplify the voice of patients while engaging with NHS staff, but the amendment is designed to facilitate that process.

I move amendment 11.

I will press the amendment. I am deeply disappointed that the minister has not considered the case of Lucy Letby or the recommendations by the RCN.

I will press amendment 12. I am deeply disappointed that the minister has not heard what I have said. The parliamentary committees have huge resources at their disposal for research and holding inquiries. I think that the minister’s decision is a big mistake, and I hope that, if the amendment is rejected, the commissioner, when he or she is in post, will use that facility to his or her advantage for patient safety. I press amendment 12.

Amendment 12 would create a duty for the commissioner to consult the Health, Social Care and Sport Committee, or whichever parliamentary committee is concerned with patient safety, on the principles and on the strategic plan.

Amendment 12 is another amendment that I lodged at stage 2 and have brought back at stage 3. I thank the minister for the opportunity to discuss it with her earlier this month. At the time, the minister shared with me her concerns that amendment 12 would compromise the independence of the commissioner by specifying that they must consult parliamentary committees. She added that the role is first and foremost for patients and their representatives, as she said earlier in the debate.

The commissioner must have the freedom to define their own principles. However, I do not believe that the independence of the commissioner should preclude their consulting parliamentary committees, especially when committees can—and do—act as a bridge between the public and policy makers. The Health, Social Care and Sport Committee is uniquely placed to understand the healthcare system in Scotland and so can support the work of the commissioner.

More widely, members of the Scottish Parliament regularly advocate at health boards on behalf of patients, and provide assistance in complex cases in which a patient’s safety might have been jeopardised. The cases of patients who have experienced use of surgical mesh are cases in point.

The Scottish Conservatives will support Paul Sweeney’s amendment 13, which he has brought forward from stage 2. The Health, Social Care and Sport Committee’s stage 1 report called for the principles to include

“an explicit commitment to listening to and supporting under-represented voices”,

especially in the context of women having been badly let down by the healthcare system. The Cumberlege report made for difficult and distressing reading in that regard.

I move amendment 12.

I will speak briefly on amendment 22. It is a probing amendment to facilitate debate on the resources that the commissioner will require to carry out their work, and to enable Parliament to consider whether those resources could be shared with other commissioners.

The SNP convener of the Finance and Public Administration Committee, Kenneth Gibson, wrote to the Health, Social Care and Sport Committee in January to express concerns about

“the increasing number of commissioners with their associated costs”.

For 2023-24, those costs amount to £16.6 million, which is £1.2 million more than was budgeted for in the previous year and 5.4 per cent more than was forecast. The finance committee convener added that a

“more strategic approach to the ... resourcing”

of the commissioner system

“might be considered in future.”

Amendment 22 suggests a way in which such a strategic approach could be implemented.

Although I will withdraw my amendment, I urge the Scottish Government and the Scottish Parliamentary Corporate Body to consider value for money for the taxpayer if the commissioner system continues to expand and the number of commissioners increases from seven to 14. Commissioners can be very valuable, especially as they are operationally independent of the Scottish Government. However, the system cannot keep growing so significantly without formal review or evaluation of its effectiveness.

I move amendment 22.

I lodged amendment 23 as an alternative approach to the stage 2 amendment that would have required the Health, Social Care and Sport Committee, or the committee concerned with patient safety, to propose a debate in Parliament on the commissioner’s annual report. Amendment 23 softens that requirement such that the committee must instead “consider” that report once it has been laid before the Scottish Parliament.

The minister’s predecessor and her official told the Health, Social Care and Sport Committee at stage 1 that

“There will be a strong role for Parliament in scrutinising what the commissioner does.”—[Official Report, Health, Social Care and Sport Committee, 14 March 2023; c 3.]

However, at stage 3, we still have questions about what that role will look like. I appreciate that the relevant committee may propose a debate about the commissioner’s work at any time. The minister has raised that point with me. I also appreciate that the committee has the autonomy to decide on its work programme. However, the reality is that, in politics, the protagonists change and priorities become refocused.

That is what the amendment says—it is just a reminder, and an important one. It would create an opportunity to ensure that scrutiny does not fall through the net and that the work of the patient safety commissioner has adequate oversight. I encourage members to support it.

I move amendment 23.

I will press the amendment; I will not withdraw it, because it is important as a check-in point. The amendment is just a guidance note. I sit on the Health, Social Care and Sport Committee, and, if the amendment is not agreed to, I will ensure that we address the commissioner’s report in the first year. However, I will be disappointed if the provision is not included in the bill.

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.

To ask the Scottish Government whether it will provide an update on the work of its international offices. (S6O-02521)