Chamber and committees

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?

In its submission to the consultation, COSLA said:

“We do not think that a centralised approach will deliver higher quality social care services. Indeed, we know that there is significant variation across NHS services which continue to face many of the same pressures as those experienced in social care.”

Do you disagree with COSLA? Have you attempted to address COSLA’s concerns about centralisation?

Thank you. Is this in relation to the financial memorandum, convener?

Fine. I will wait until we get to the financial memorandum.

I will ask two questions, if I may, minister.

We have just mentioned the Finance and Public Administration Committee, which asked whether you could get back to it by 12 May with a revised financial memorandum. I understand why you will not be able to do that. However, you have talked about the differences from one region to another in the terms and conditions of social workers. Harmonising those terms and conditions has huge cost implications. I just looked at “The Scottish Approach to Service Design”. It says on page 10 that it is important to be able to define what “good” would look like, so will you be including the cost of harmonising terms and conditions in your consideration at this stage?

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?