Chamber and committees

Thank you. I hope that we will monitor the situation closely.

I thank Emma Harper for raising that matter. Anything that can prevent livestock worrying is to be applauded. The behaviour of dog walkers is also important—they must keep dogs on leads at this time of year.

We must continue to break down the barriers, including loneliness, that might prevent farmers and the agricultural community from accessing help.

It is good that—as we have heard today—young farmers are doing a lot of good work. They are piloting the “Thrive” mental wellbeing app, which provides live access to qualified therapists who can give advice on many things, especially mental health. We need to look more closely at such initiatives.

I will make two final comments. Access to appropriate NHS services to support their mental health can be challenging for people who reside in rural and remote communities. We know that, sadly, there is a shortage of general practitioners and other clinicians in rural areas. The Scottish Government urgently needs to address that in order to prevent the collapse of rural healthcare.

It is good that Mairi Gougeon MSP is here to hear my next comment, because Angus mental health patients have also been badly let down by the closure in 2018 of the Mulberry unit at Stracathro hospital, which means that patients have had, and still have, to travel miles to a facility in Dundee where, as the Strang report has revealed, there are serious systemic issues with mental health services. Residents in Angus feel deeply let down by that decision.

I hope that the minister will address those points in her closing speech.

I thank Rachael Hamilton for bringing such an important topic to the chamber—for shining a light on an epidemic that is often hidden. Both Rachael Hamilton and I represent areas that have large remote and rural populations. More than half of the population of Aberdeenshire live in rural areas, compared with around 17 per cent of the population of the rest of Scotland.

However, mental health interventions have often been developed through the lens of urban populations, but what works in Glasgow will not necessarily work in Glenbervie. It is vital that policy makers recognise the unique nature of mental health in rural and farming communities, so that we can respond better. That is why advocacy by organisations such as NFU Scotland, the Farm Safety Foundation and the Countryside Alliance, as well as the work of academic institutions such as Robert Gordon University, which is in my region, are so important.

In the north-east, more than 22,000 people are employed in the food, drink and agriculture sectors. However, the awful reality is that suicide rates for agriculture workers are among the highest in the United Kingdom. Sadly, one farmer a week dies by suicide.

As we have heard, farmers often work in isolation. Loneliness frequently affects their mental health. Financial worries, especially given input-price inflation, can weigh heavily on their minds. The 2021 documentary “Unearthing Farming Lives”, which was conceived by several organisations in the north-east of Scotland, thoughtfully examines those issues.

The north-east has also suffered from the recent avian flu outbreak, which has resulted in the deaths of thousands of hens. That is a devastating loss for businesses.

In addition, although spring heralds the lambing and calving season, there are associated pressures and stresses for farmers. Livestock worrying, for example, can have a devastating impact on their mental health. Recently, there have been the horrendous cases of one dog mauling 17 lambs to death in Fife, and four lamb deaths in Moray.

As we have heard, farming can be both physically and psychologically tough.

I am pleased to open on behalf of the Scottish Conservatives in this stage 1 debate on the Patient Safety Commissioner for Scotland Bill. I pay tribute to the Health, Social Care and Sport Committee clerks, to our present and former conveners, and especially to the witnesses, campaigners and experts who contributed their insights and lived experience.

As a starting point, we must recognise why a patient safety commissioner is needed. In the report of the United Kingdom-wide independent medicines and medical devices safety review, Baroness Cumberlege pointed to the avoidable harm that patients—mostly women—have experienced as a result of the hormone pregnancy test Primodos, the use of sodium valproate in pregnancy and pelvic mesh implants. She described the truly

“heart wrenching stories of acute suffering, families fractured, children harmed and much else”.

The adverse effects of hormone pregnancy tests included congenital anomalies and, tragically, miscarriage, stillbirth and baby deaths. If taken by mothers during pregnancy, sodium valproate can cause physical and neurodevelopmental effects in children. Many of the MSPs who are in the chamber this afternoon have been contacted by mesh-injured women about the life-changing and distressing symptoms that the surgery has caused. It is alarming that Baroness Cumberlege found that the patient voice was dismissed, that patients blamed themselves for the harm to their children that was caused by medicines that they took in good faith, and that patients struggled to navigate a complex healthcare landscape in order to advocate for themselves.

It was against that background that Baroness Cumberlege’s report called for a

“public spokesperson with the necessary authority and standing to talk about and report on, to influence and cajole where necessary without fear or favour on matters related to patient safety”,

which brings us to the bill that we are debating. The debate is consensual and the bill has cross-party support. The Scottish Conservatives are pleased to support its general principles at stage 1. However, support does not mean the absence of scrutiny.

The patient safety commissioner must be an effective champion for patients, so it is vital to get the approach and the role’s powers right. As the Royal College of Nursing emphasises, the views of staff on patient safety must be heard and the commissioner must have the power to follow up on the implementation of recommendations.

In her evidence to the committee, Baroness Cumberlege said that she was “satisfied” with the bill. She said that she agreed “with all of it” and that it is “extremely well put together.” She described the patient safety commissioner as the “golden thread” running through a complex patient safety and clinical governance landscape and helping to tie it all together.

The patient safety landscape is, indeed, saturated. Alongside regional health boards, we have the Scottish Public Services Ombudsman, Healthcare Improvement Scotland, the Scottish patient safety programme, the national health service incident reporting and investigation centre, a patient advice and support service that is provided by Citizens Advice Scotland, professional regulatory bodies such as the General Medical Council, and legislation including the Patient Rights (Scotland) Act 2011. That list is not exhaustive.

The patient safety commissioner can help to unify those organisations and create more coherence in a cluttered landscape, but there is also a risk of duplication. What works well on paper does not always work in practice, and there will need to be relationship building on both sides to effectively support and advocate for patients.

When the former health secretary first announced the creation of a patient safety commissioner, she indicated that the role would focus on improvements to patient safety in relation to the use of medicines and medical devices. However, the Scottish Government’s approach has since changed considerably, and the bill widens the patient safety commissioner’s remit to cover patient safety more generally.

A wider remit has implications for resourcing. The committee explored that issue in some depth after the Finance and Public Administration Committee raised a red flag about commissioners being an

“expensive extension of our public sector”,

which is a cause for concern.

In his evidence to the Health, Social Care and Sport Committee, Dr Gary Duncan, chief of staff to the Patient Safety Commissioner for England—who has a much narrower remit—emphasised that

“We would need expanded resources if we wanted to take on further work.”—[Official Report, Health, Social Care and Sport Committee, 21 February 2023; c 38.]

That suggests that more resources for the role in Scotland will need to be available sooner rather than later.

In her evidence, the then Minister for Public Health, Women’s Health and Sport responded to resourcing concerns by pointing to the collaborative approach that the commissioner is expected to adopt by working with existing patient safety bodies, organisations and regulators. She indicated that that way of working would reduce the burden of work on the PSC. However, there is still insufficient clarity on that dynamic in the bill, and that needs to be addressed at stage 2.

It is important to get the resourcing right, because there are already high expectations about what the role will achieve for patients whose voices have too often been ignored. It is also important because public funds are being used, and the process should involve transparency and accountability from the outset. To that end, after the bill completes its parliamentary passage, the Health, Social Care and Sport Committee should be involved in the oversight and monitoring of the patient safety commissioner’s performance.

Notwithstanding those comments, it is clear that there is significant support for the bill. My colleagues and I look forward to strengthening it at stage 2.

The RCN raised a really important point about safe staffing being integral to patient safety. In her new role, does the minister see that as a key principle, and will she be looking into it at stage 2?

Okay, thank you.

Okay. Thank you.

Okay. I have a follow-up question on that. Do you accept, though, Ms Bell, that those costs could go into billions of pounds?

So, you do not know the costs yet.

I will move on to my second question. In October, Michelle Thomson said that the financial memorandum showed that the bill does not represent any value for money at all to the taxpayer. Kenny Gibson added that it was like

“using a sledgehammer to crack a nut”—[Official Report, Finance and Public Administration Committee, 25 October 2022; c24.]

Have you taken on board the concerns of your colleagues with regard to the revised financial memorandum and what are you, as the new minister, going to do differently?

Minister, you recognise that many people want clarity, and you are working towards consensus, which is commendable. The design principles that the Scottish Government and you are following say that it is important to know what good looks like. However, you would not buy a car or a house if you did not know what it looked like.

Too many stakeholders are nervous about the use of secondary legislation, which is set out by the bill. Scottish Borders Council said:

“We have a concern over the sweeping powers proposed by the draft primary legislation without a clear expression of what is actually being proposed, and the further ability to make further radical but as yet unspecified change to the Health and Social care system. Through secondary legislation.”

I accept that you will have 15 consultations over the summer and through to mid-September, but what are you actually going to do differently to put some “meat on the bones”, to use your words?