I am pleased to open the debate on the general principles of the Patient Safety Commissioner for Scotland Bill, which will establish an independent public advocate focused on ensuring that patients’ voices are heard.
We know from the testimony of countless patients, gathered by Baroness Cumberlege in the independent medicines and medical devices safety review, that, too often, patients, their families and members of the public do not feel listened to when they raise concerns about the safety of healthcare. As a result, they doubt that their feedback will lead to change and their relationship with healthcare providers may break down, causing them to lose trust in the healthcare system. At worst, as the cases highlighted by Baroness Cumberlege starkly demonstrate, that can lead to patients suffering serious avoidable harm.
We need to address that. Good healthcare is a fundamental right for everyone. It is essential that patients have confidence that, every time they access part of the healthcare system, not only will they receive the best available treatment without fear of harm but any concerns that they raise will be listened to. A culture of openness and learning enables everyone to feel able to share not only what has gone well but what has gone wrong or could have gone better. We must ensure that learning and improvement happen when things go wrong, so that we continue to make healthcare better.
In her report, Baroness Cumberlege recommended:
“The appointment of a Patient Safety Commissioner who would be an independent public leader with a statutory responsibility. The Commissioner would champion the value of listening to patients and promoting users’ perspectives in seeking improvements to patient safety around the use of medicines and medical devices.”
The bill will create a patient safety commissioner who will be directly accessible to patients, their families and members of the public to hear their concerns and will bring their stories together with quantitative safety data from across the healthcare system to spot trends and make healthcare safer for us all. The commissioner will be independent of the Scottish Government and NHS Scotland, which will allow them to challenge the healthcare system, and they will be free to consider any issue pertaining to the safety of patients in healthcare settings throughout Scotland. The bill demonstrates that we have taken Baroness Cumberlege’s work and the views of patients seriously.
The commissioner’s remit will be wider than Baroness Cumberlege recommended: it will not be restricted to consideration of medicines and medical devices but will be able to look at patient safety more widely. That is because patients have told us that there is the potential for harm in many other areas of healthcare and we want the commissioner to be able to look at the things that patients tell them are important.
I am grateful to the Health, Social Care and Sport Committee for its support for the general principles of the bill and to committee members for their detailed and careful consideration of the issues. I thank my predecessor, the Minister for Public Health, Women’s Health and Sport, Maree Todd, for her leadership of the bill. Most importantly, I also thank the various people and organisations who have participated by giving evidence on the bill since it was introduced, including the patients and family members who showed great courage in telling their stories once again and in advocating tenaciously for the creation of the post. It was powerful evidence.
I am pleased that the committee has agreed to the general principles of the bill, although I recognise that it has requested further clarity and changes in some areas. The Government recognises the importance of listening to a wide variety of views to ensure that the patient safety commissioner role, once created, is as effective as possible in being able to freely and independently advocate for the views and interests of patients to improve the safety of care.
It is particularly encouraging that the committee has backed the general principles of the bill unanimously and that it reported strong support for the patient safety commissioner’s role from the patients and patient representatives from whom it heard. The committee emphasised the importance of ensuring that the role is clearly defined and that the commissioner helps to foster a culture of openness, learning and collaboration.
I am also pleased that the committee recognises how vital it is that the patient safety commissioner role is underpinned by robust powers that allow the commissioner to find out what has gone on, make meaningful recommendations to improve patient safety and then work with other organisations to achieve positive change.
The committee has asked for further clarity on how the commissioner’s formal investigations will work and, in particular, on the collaborative approach that we expect the patient safety commissioner to take when engaging with other organisations. That element of collaboration in the commissioner’s ways of working will be crucial, given the complexity of the patient safety landscape. Baroness Cumberlege also emphasised that point in her findings, and I agree that it is important that we get it right.
There will be instances in which it is important that the commissioner is able to share confidential information that is obtained in the course of their investigations with certain other bodies, to enable them to exercise their statutory functions. The bill seeks to strike a balance between enabling that, while also encouraging a broad approach of collaboration, openness and learning, instead of taking a punitive approach.
I agree with the committee on the importance of the commissioner being able to hear the views of staff when that supports the overall purpose of amplifying the patient voice. It is important that the commissioner functions as a listening ear in the whole healthcare system. I have asked my officials to explore how that can be clarified at stage 2.
The committee has also emphasised how important it is that the commissioner carries out thorough and meaningful consultation during the development of their principles and strategic plan, particularly with those whom they seek to represent—the patients. I agree that that will be key.
Parliament will also have a crucial role. Patients and the public have made it very clear that they want someone other than the Government to scrutinise what is going on in the healthcare system. The patient safety commissioner’s freedom to determine their own priorities, informed at all times by the views of patients, as well as the office’s distinctness from other parts of the safety system—in that it will report directly to Parliament and, therefore, to the people of Scotland—will help to maintain trust in the role.
It is clear from the stage 1 report that the committee’s view is that the patient safety commissioner for Scotland will make the views of patients heard, ensure learning and improvement when things go wrong, and help to make healthcare in Scotland safer for us all.
In reaching this milestone in the development of the bill, I thank the patients and families who have helped us to shape the draft legislation. They have taken time to tell us their stories and share their experiences. We have listened and, I hope, have reflected their concerns in the draft bill that we are debating today.
I also thank the many other people and organisations who, along with patients, worked with us on the consultation and bill advisory groups, sharing their expertise and collaborating in just the way that we hope that they will with the patient safety commissioner, to foster a culture of learning and improvement.
I look forward to listening closely to members’ views and having the opportunity to engage with them on the bill. I again thank the committee for its work during stage 1 and in the weeks to come.
That the Parliament agrees to the general principles of the Patient Safety Commissioner for Scotland Bill.
I refer members to my entry in the register of members’ interests. I am a registered mental health nurse, with current Nursing and Midwifery Council registration.
In September 2020, the Parliament debated the independent medicines and medical devices safety review—the Cumberlege review—and the then Cabinet Secretary for Health and Sport, Jeane Freeman, set out how its recommendations would be implemented in Scotland. Those recommendations included establishing a patient safety commissioner.
As the convener of the Health, Social Care and Sport Committee, I am pleased to speak to our stage 1 report on the Patient Safety Commissioner for Scotland Bill. The committee unanimously supports the bill and believes that the role has the potential to improve patient safety across healthcare services.
I was not the committee’s convener when it took evidence on the bill, so I thank Gillian Martin for her leadership during the bill’s scrutiny. I also record our thanks to the committee clerks, the Scottish Parliament information centre researchers and everyone else who has supported the committee’s work on the bill so far.
Before commenting on the committee’s recommendations, I will take a moment to reflect on the evidence that those who engaged with the committee provided. I thank everyone who assisted the committee with its scrutiny—those who responded to our call for views and those who gave evidence in person or online.
I particularly thank Charlie Bethune, Marie Lyon, Fraser Morton and Bill Wright, who spoke about their experiences of serious patient safety issues. They told us that their voices were repeatedly ignored by a system that was meant to provide care and support for them and their families, and by those who were meant to regulate that system. They told us that their fights were not over and that their issues were still not resolved—some are still not resolved after more than 70 years. They told us about investigations that are still needed and support that is still required. In some cases, there has been no resolution; grief has been compounded by the way in which people have been treated, and families have had no closure.
We are grateful for those people’s testimony. We know how difficult it must be to keep recounting their experiences. I commend their passionate campaigns on behalf of others in similar situations who do not have that opportunity or voice. Their experiences emphasise the vital role that a patient safety commissioner can play. A patient safety commissioner cannot change what they have been through, but the role could make a difference to how cases like theirs are managed in the future, by providing a voice for patients and their families and championing their causes.
The commissioner could use their powers to make sure that no one else has the same experiences. Crucially, they could ensure that lessons are learned and that other such incidents are prevented from happening. They could identify patient safety issues that require investigation but which the system is not yet aware of.
Our report concentrates on areas where the bill might need to be clarified to make sure that it can achieve the intended outcomes. The committee supports widening the remit of the role beyond medicines and medical devices to include patient safety more broadly. Although the committee recognises the complex systems for patient safety, governance and regulation that are already in place, we believe that the voice of patients is missing from those systems. The commissioner can fill that gap by amplifying patients’ voices and advocating for systemic improvements that draw on patient experiences.
The committee welcomes the independence of the role as set out in the bill. It endorses the proposal that the commissioner should have the freedom to define and establish the principles that will underpin their work and the remit and scope of that work.
We believe that patients should be given an opportunity to provide input into the process of establishing the office of commissioner and informing its strategic direction. That will ensure that patients’ concerns are addressed and that their voices are heard as the commissioner embarks on their important work.
During its scrutiny, the committee heard a range of views about the scope of the commissioner’s role—some argued that it was too wide and others argued that it did not go far enough. Issues were raised about how safety concerns in social care would be dealt with, especially given that, as one witness noted,
“People do not experience primary care, secondary care, social care or nursing care; they experience care.”—[
Health, Social Care and Sport Committee
, 21 February 2023; c 18.]
Some people suggested that the commissioner should have an additional role in taking on individual cases. On the whole, the committee believes that the bill strikes the right balance by defining a remit that is broad but manageable. However, we would like the Scottish Government to confirm that the commissioner will be empowered to investigate, to make recommendations and to act as the voice of patients on issues that intersect with or transcend health and social care.
The committee does not want to interfere with the commissioner’s independence, but it calls for a commitment that the principles that underpin the commissioner’s work will include an explicit commitment to listen to and support underrepresented voices. The committee believes that that is important particularly because of the specific patient safety issues that gave rise to the Cumberlege review and the circumstances of those affected by them—notably women.
The committee considers that it is vital for the commissioner to have the necessary capabilities to compel evidence from all organisations that are involved in providing healthcare, including private companies that supply medicines and medical devices. The commissioner should also have the power to follow up on the implementation of any recommendations.
Public confidence in the role of the commissioner is of paramount importance. Given the patient experiences that the Cumberlege review highlighted—many people felt that they were not listened to and felt frustrated by the time that it took for their problems to be acknowledged—work will need to be done to raise public awareness of the new role but, equally, to manage expectations. Crucially, the role will need to be sufficiently resourced to fulfil its functions.
The committee recommends robust monitoring and evaluation to ensure that patients’ voices are effectively amplified through the commissioner’s work and that there is on-going public confidence in the role and in the wider system for reviewing and addressing patient safety issues.
In conclusion, the committee is content to support the general principles of the bill and considers that it will be a crucial addition to the patient safety landscape in Scotland that should help to ensure that patients’ voices are consistently heard and acted on. I am grateful to the minister for having provided such a quick response to the committee’s stage 1 report. We look forward to seeing further improvements to the bill at stage 2, as set out in that response, to reflect our key recommendations.
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.
Labour will support the bill at stage 1, as we are supportive of its general principles, although we have some reservations about the detail and we will look to engage with the Government on amendments before stage 2.
As has been outlined, the bill seeks to establish the office of patient safety commissioner for Scotland, as described in section 1. The patient safety commissioner will have two primary functions:
“to advocate for systemic improvement in the safety of health care, and ... to promote the importance of the views of patients and other members of the public in relation to the safety of health care.”
Both provisions are warmly welcome.
As deputy convener of the Health, Social Care and Sport Committee, I echo the comments of the convener, the member for Rutherglen, about the committee’s excellent stage 1 report, which was published at the end of April. I would also like to take a moment to thank the clerks and officials for their work on the report. It is a great summary, and I recommend that all members take some time to digest it.
The bill is supported by a wide array of stakeholders, including Valproate Scotland, Haemophilia Scotland and the Association for Children Damaged by Hormone Pregnancy Tests, all of which gave evidence to the committee, and I am incredibly grateful for that.
The establishment of a patient safety commissioner for Scotland is long overdue. At present, the voice of patients and NHS service users is all too often forgotten, which frequently leads to situations where we do not learn from systemic mistakes that have been made and failures that have occurred in the past, and run the risk of repeating them.
The committee highlighted that issue in our report. It is safe to say that there was a large body of concern among stakeholders that the proposed commissioner will not have a remit to investigate individual complaints and that there will be no locus for the commissioner in matters that pertain to systemic issues in social care.
Given the inherently intertwined nature of health, the NHS and social care—something that the Government seemingly recognises, given the National Care Service (Scotland) Bill—it would be helpful for some thought to be given to how we expand, whether immediately or in the future, the commissioner’s role to include social care.
My colleague Paul O’Kane, a member for West Scotland, raised that point in committee. I know that the minister disagrees with the idea of extending the remit to include social care; however, we know how complex the policy and regulatory landscape currently is and I would hate for us to be back here again in just a few years doing something similar for social care when we could deal with it here and now, in this bill.
As the Scottish Public Services Ombudsman said in its evidence to the lead committee,
“Given the potentially seismic changes in the health and social care landscape in Scotland, it is evident to the SPSO that a legislative separation between health and social care, which is embedded in this bill (which focuses solely on healthcare), may be becoming outpaced by other developments.”
We, in the Scottish Labour Party, have some concerns, too, around the resourcing of the commissioner’s office. Currently, we are looking at a budget of around £644,000 per annum. Although I appreciate that that is a significant sum of money, we are talking about a role that is tasked with investigating extremely complex, deep-rooted issues, and I worry that it risks becoming a public relations exercise instead of a substantive mechanism for delivering justice and positive outcomes for patients.
I would like to clarify, too, that it is not only Labour that has that concern. The Royal College of General Practitioners Scottish patient forum has raised it, too, and it emphasised the disappointment that it would feel should future budgetary decisions cause the commissioner’s office to fold. It suggested that funding levels should be confirmed by parliamentary procedure. I would like to see the Government consider whether the budget is adequate; I would welcome further engagement and dialogue on that particular point as we progress through the legislative process.
On a positive note, we agree with the Government that a patient champion is required, although we might have slightly different views on exactly what that looks like in practice. We are also grateful to the Government for its commitment to the committee that the commissioner should be able to hear from staff about patient safety concerns as flagged by the Royal College of Nursing Scotland.
On a more general point—I am conscious of the time—I want to assure the Government that Labour will work with it to ensure that we end up in a place where we are all in agreement and can wave the bill through unanimously.
There are plenty of policy areas where we have disagreements, but I genuinely do not think that this has to be one of them. We are all looking for the same outcome here: to improve the voices of patients and to ensure that the systemic issues that many have experienced and have been adversely affected by do not come to pass ever again.
I commit to working constructively with the Government. I know that I speak for my Labour colleagues when I say that they also want to work positively with it, and we have heard from a wide variety of stakeholders that they want to do so, too.
I will conclude on that note. I look forward to the bill’s progression through its subsequent stages.
Before I start, I express my apologies to the chamber for having to leave the debate early this afternoon for an unavoidable reason.
I rise to offer my support and that of the Scottish Liberal Democrats for the general principles of the bill and I thank the committee for its work up to this point.
The NHS, as we often rehearse, is one of the finest and best-loved national treasures that these isles have ever produced. It emerged as a Liberal brainchild, which was delivered by the Labour Party as a universal system designed to give remedy to patients in need and to support the hard-working staff administering it.
That system is now in crisis. We have said that many times in the chamber, but it bears repeating. The Government is routinely failing patients and staff alike.
The NHS’s most basic principle is that people can access healthcare at their time of need. For too many Scottish people, that principle is no longer being fulfilled. Figures from last month revealed that cancer waiting times are the worst on record for the fifth quarter in a row. Meanwhile, one in 10 people had to wait longer than eight hours to be seen in our accident and emergency departments. Our healthcare staff go above and beyond the call of duty every single day, but instability and a lack of resource are having a deleterious effect on patient safety.
For the past decade healthcare has been mired in scandal, and we have heard much about that in the exchanges in the chamber. Tens of thousands of women have been afflicted with an excruciating and debilitating life-changing pain because of mesh implants that went wrong. There have been multiple deaths, including of two children, linked to sanitation problems at the flagship Queen Elizabeth university hospital. Those are only two of the multiple scandals that Scottish healthcare has faced in recent times.
It is clear that structural change is required, including safeguards that ensure patient safety, and there is an urgent need for a powerful independent figure—a canary in the mine, if you like—who champions the rights of patients and secures improvements in treatments.
The establishment of a patient safety commissioner in Scotland could aid the course of such a change. Although the Scottish Liberal Democrats have been calling for the creation of that position for more than three years, there are several elements of concern with regard to the road to its delivery. Scotland was the first nation to start talking about a patient safety commissioner in all these islands. However, as a result of the dithering and delay that has become characteristic of this SNP-Green Government, we are still only in the early stages of its inception.
Meanwhile, not only has England appointed a patient safety commissioner, but it filled the post more than eight months ago. The delay is causing real harm, as was evidenced by an excellent article written by Marion Scott of the
. She spoke to Victoria from Ayrshire, a woman whose three-year-old tragically died at the Queen Elizabeth university hospital. Victoria said:
“One of the promises I held on to ... was that the government would be appointing a commissioner to do everything possible to prevent health scandals ... But here we are. Nobody has been appointed ... and I feel betrayed all over again.”
I am sure that there are many people across Scotland like Victoria who feel similarly let down.
Furthermore, the patient safety commissioner is designed to listen to patients’ invaluable insights into our NHS and, thus, to be a platform for their voices. Therefore, as others have said, it is somewhat confusing that the commissioner is expected to amplify patients’ concerns if they are not given the ability to listen directly to individual patients. It is worth noting the concern among stakeholders that, under the bill as proposed, the patient safety commissioner would not be able to listen to individual complaints.
Elaine Holmes, the founder of Scottish Mesh Survivors, expressed concern that that barrier to patient access
“flies in the face of everything a Patient Safety Commissioner should be.”
It is vital that lived experience is at the heart of the patient safety commissioner’s job and their mission, and patients’ having clear access to the commissioner is fundamental. I remind the chamber that there is precedent for that, because we empowered the Children and Young People’s Commissioner Scotland to listen directly to individual voices and take up individual cases through their investigative powers.
We must also remember the key role that our NHS staff play in ensuring patient welfare. With their expertise and experience, our staff are often best placed to identify problems in patient care. Despite that, in its latest report, the RCN noted that members do not always feel listened to when they raise concerns regarding the wellbeing of their patients.
I thank the member for taking an intervention. Does he also acknowledge that the work of the patient safety commissioner should be seen not only as a stick but as a learning opportunity for staff and health boards more widely in order to change policy and go forward in a positive manner?
I absolutely agree with Gillian Mackay’s intervention. Yes, of course, there should be investigative powers, but there should also be an opportunity for the commissioner to disseminate best practice and bring it to the fore and to celebrate success in our health service. Staff, too, should have the ability to properly voice these concerns.
I look forward to further clarification from the minister about how these avenues will be put in place.
Staff safety and patient safety are inextricably linked. Right now, NHS staff are having to endure mammoth workloads to the detriment of their own wellbeing. In advocating and pushing for patient safety, we must not forget the importance of staff safety. As I indicated at the beginning of my speech, the NHS is an integral and lifesaving institution. Its value to our country cannot be overstated, and it is incumbent on us as policy makers to fight tooth and nail to preserve it. In order to do so, we must introduce real structural change. That starts with this commissioner. The introduction of that office could play a significant role in the reform that we need to see, but only if it is introduced properly. That means everyone and anyone with concerns or experience of patient safety having access to it.
I am very happy to speak in the stage 1 debate on the
Patient Safety Commissioner for Scotland Bill. I thank those who engaged with the committee and gave evidence—it is very much appreciated. I think that a patient safety commissioner is much needed, and I will outline why.
Hundreds of thousands of people have been fitted with transvaginal mesh, which was once considered the gold standard and billed as a simple procedure. Although many people are symptom free, for thousands the negative side effects have been profoundly life altering. Yet, despite the widespread negative impacts, Elaine Holmes and Olive McIlroy, founders of Scottish Mesh Survivors, were both told that they were unique—that the extreme and constant pain that they were living with had not been seen in anyone else. They believed that until they met each other. Their symptoms were not unique.
As we have heard, the patient safety commissioner was recommended by the independent medicines and medical devices safety review. Speaking of that review, Baroness Cumberlege said:
“we have never encountered anything like this, the intensity of suffering, the fact that it has lasted for decades. And the sheer scale. This is not a story of a few isolated incidents. No one knows the exact numbers affected ... but it is in the thousands. Tens of thousands.”
Despite the variety of issues covered, the review found several common themes. Those patients were not listened to. When the healthcare system would not support them, they—like Elaine and Olive—turned to each other. Despite the fact that they raised their concerns again and again, the problems that they faced were not acknowledged, sometimes for years. For those years, many patients lived in pain and uncertainty. We cannot let that happen again.
Transvaginal mesh, sodium valproate in pregnancy and Primodos all have something in common: their adverse effects impact women, a group who have historically been, and continue to be, dismissed and patronised in medical settings. I know and can relate to that experience, and I am sure that many others in the chamber can, too. It is of the utmost importance that those barriers are acknowledged and are at the heart of the legislation.
We clearly have some way to go. Recently, the Young Women’s Movement found that young women in Scotland are not taken seriously in healthcare settings. They are often dismissed and their experiences are minimised. They are often left with no further offer of support or follow-up. Age, gender, living in rural areas, being part of an ethnic minority, being disabled, being trans, and body type and weight compounded those issues. That is why, as a committee, we recommended that the commissioner be given powers to undertake follow-ups in order to ensure that patients have been listened to and that safety issues have been addressed. In addition, the committee has called for the principles underpinning the work of the patient safety commissioner to include an explicit commitment to listening to and supporting underrepresented voices.
Several witnesses described an existing cluttered landscape for patient safety. It is not only cluttered but siloed, allowing patient safety issues to be missed and to slip through the cracks. With the bill, we have an opportunity to connect those silos, with the role of the PSC acting as a golden thread, as Tess White alluded. The commissioner will have a clear responsibility for patient safety and will be in a position to join the dots and identify systemic problems.
As a committee, we are dedicated to ensuring that patients are listened to. The commissioner will be required to establish an advisory group, 50 per cent of the members of which will have to be drawn from patients and their representatives. It is vital that barriers to participation on the advisory group are minimised as far as possible. We have recommended that all representatives on the advisory group be entitled to reimbursement, regardless of their employment status. That is especially important given the links between long-term sickness and unemployment. In addition, travel expense calculations should take into account the higher costs that people who have to travel from rural or less well-connected areas may face.
The English PSC is already in post and making a difference, and we can learn from her appointment. I am pleased that the Scottish Government has agreed with the vast majority of our recommendations. Above all, the patient safety commissioner must be a voice for patients, and people must finally be listened to and have back-up when things go wrong. We have an opportunity here, which experts have said could
“fundamentally alter the landscape of patient safety for the better.”—[
Official Report, Health, Social Care and Sport Committee
, 21 February 2023; c 3.]
Let us get on with making that happen.
I am pleased to have the opportunity to speak in the stage 1 debate on the Patient Safety Commissioner for Scotland Bill. I, too, add my thanks to the Health, Social Care and Sport Committee, and especially to the witnesses, campaigners and experts who contributed to its report.
As my colleague Tess White said, we recognise the need for a patient safety commissioner for Scotland. What has been said in the speeches so far really resonates with what I want to say about the experience of a constituent. I will use my time to illustrate the need for a commissioner by highlighting a rather harrowing case that I was involved with early on in my political career, which ended up dragging on for several years and has still to reach a resolution.
I was contacted by a couple—Fraser Morton, whom Clare Haughey mentioned, and his partner June—who tragically lost their son Lucas in childbirth. The official report stated that he was stillborn, but the couple struggled to accept that, as the process was rushed through and any questions that they had were shut down and went nowhere. Fraser and June were sure that Lucas had been alive right up until the point of birth, and they requested a significant adverse event review. That was denied because it was insisted that Lucas was stillborn and that, therefore, an SAER was not needed.
By the time the couple approached me, they had already established an anomaly in baby deaths at Crosshouse hospital, with statistics showing that there was an unusually high level of such losses at the hospital over a number of years. I attended various meetings with Fraser and June, at which they met hospital officials, board members, Healthcare Improvement Scotland and even the then cabinet secretary. It was obvious from those early meetings that they were being fobbed off in the hope that they would eventually give up.
However, the participants in those meetings did not realise how persistent Fraser and June were. They went about reading many case reviews from across the UK, as a result of which they built up a knowledge that it would be very difficult to argue against. They joined with other families who had similar concerns, who, coincidentally, had been labelled as “troublemakers” by some who were under scrutiny. An attempt was even made to blame some members of staff for the tragedy. Everything was done bar accepting the need to review the case and to learn.
Eventually, HIS agreed to instigate an investigation. At the same time, a BBC investigative journalist began her own scrutiny. The upshot of those investigations was that serious flaws were highlighted, not least that the neonatal unit at Crosshouse was 24 staff short and that staff there were under far too much pressure as a result. I would say that Fraser and June are directly responsible for the neonatal unit in Crosshouse
being fully staffed. They continue to support other couples around the UK in similar circumstances and they even raise money for cuddle cots, to help parents to deal with their grief.
I tell that story because, if we were able to wind the clock back and put a patient safety commissioner in place prior to that all transpiring, perhaps that loss and other losses could have been avoided. That is not least because statistics indicating a problem such as an increased number of baby deaths would, I hope, have been noticed, investigated and corrected way before it got to that stage. Having identified a problem, the safety commissioner would have been able to monitor the hospital to ensure continuous improvement—I think that Evelyn Tweed made that point.
What that case highlighted to me is that there seems to be no accountability—no place for patients to go where there is no self-interest in the outcome. It has highlighted to me that it is nearly always the system that is at fault, not the healthcare professionals—who, incidentally, seem to carry the can far too often. Serious adverse event reviews are measured, and health boards do want them against their records, and they vary widely from health board to health board. We need to look at the criteria for investigating a serious adverse event review.
We often talk about what must be learned and changes that must be made to prevent similar things from happening again, as Gillian Martin highlighted in her intervention on Alex Cole-Hamilton. How can lessons be learned if the issues that caused the incident are not properly investigated and discussed without prejudice or blame? That is why I, along with many of my colleagues in the Scottish Conservatives, will be supporting the bill.
A patient safety commissioner should be able to have an overview and oversight of health boards, be able to spot potential warning signs, and carry out and make impartial investigations and recommendations. The position’s remit has to be very clearly defined. We need to look at cases such as the one that I have highlighted and ask the question: what would the commissioner have to be able to do to improve such a situation? Real life—that is where the difference must be felt.
I know that the concern is that the commissioner’s remit could become too wide and that the real impact that they could make could become diluted. I would appreciate it if, in her summing up, the minister could assure the chamber about what considerations are being given to making the commissioner’s remit as tight as is needed to make them as effective as they can possibly be. After all, the position is about supporting our NHS and making our patients’ journey as safe as it can possibly be.
As a member of the Health, Social Care and Sport Committee, I am pleased to speak in this debate on stage 1 of the Patient Safety Commissioner for Scotland Bill, and I remind Parliament that I am a registered nurse with a current Nursing and Midwifery Council registration.
As colleagues have said, the bill was introduced in response to the recommendations of the Cumberlege review. It is a direct response to patient-led campaigns on use of the hormonal pregnancy test Primodos, sodium valproate in pregnancy and transvaginal surgical mesh. Each of those products is associated with significant patient harms and injury, and one of the main findings of the Cumberlege review was that patients were not being listened to.
We took direct evidence at committee from Charlie Bethune, whom I subsequently met, as he is a constituent of mine. He and his wife Lesley have championed the cause of children who have been impacted on by the anti-epilepsy medication sodium valproate, because of the impact that it had on their adopted daughter. Many others have been affected—the number across the UK is estimated to be 20,000.
As colleagues have said, a patient safety commissioner should be created to listen to and amplify the voices of patients, in order to drive systemic improvements in care, with a focus on medicines and medical devices. The patient safety commissioner, or PSC, will be an independent champion for everyone who receives healthcare, and will work alongside healthcare bodies such as NHS Education for Scotland and Healthcare Improvement Scotland. The Scottish Government places high importance on the patient voice and the patient experience.
During the committee’s stage 1 scrutiny, many of the questions were on the remit of the PSC, because the proposed remit is wider than that of the Patient Safety Commissioner for England. The remit of the commissioner will include bringing together patient feedback and safety data that is shared by NHS boards and Healthcare Improvement Scotland, in order to identify concerns and recommend actions.
The commissioner will also, where necessary, lead formal investigations into potential systemic safety issues, with powers to require that information be shared in order to ensure that every investigation is fully informed.
I believe that the remit of the PSC is directly relevant to issues in Dumfries and Galloway, in my South Scotland region, that I have been raising as a result of my work with constituents. I believe that the PSC could play a part in specific aspects, including a focus on cancer treatment and cancer pathways, and travel reimbursement.
Geographically, Dumfries and Galloway is in the south-west of Scotland, but it is aligned with the south-east Scotland cancer network. Nowhere in D and G are people closer to services in Edinburgh than they are to services in Glasgow. In many cases—particularly for people in Stranraer and Wigtownshire—a trip to Edinburgh can mean a 260-mile round trip for treatment. Constituents have been campaigning about unnecessary travel for more than 20 years now, and I know from my engagement with constituents that the trip can often exacerbate already poor health and cause more anxiety and unnecessary stress. Perhaps a patient safety commissioner will help to amplify the voices of my constituents in order to address that.
In addition, patients in D and G are means tested for reimbursement for journeys of more than 30 miles for medical appointments, despite the fact that people who live in other similarly rural parts of Scotland are not. Other travel reimbursement schemes exist in the Highlands and Islands, for instance.
I know that those issues are not overtly safety related, but, considering the specific issues and the evidence that has been presented that care and compassion should also be taken into account, they are worth noting. I therefore seek assurances from the minister that a future commissioner will consider the issues that I have just highlighted, in order to pursue real change.
I welcome the minister’s response to the committee report that was issued this morning. In particular, I welcome the minister’s agreement with our committee’s recommendation
“that the wording in Section 16(4)(c) ... should be amended to specify that” members of the proposed advisory group who represent patients
“must actively demonstrate a commitment to representing the voice of patients, rather than simply appearing to the Patient Safety Commissioner to be representative of patients.”
That is an important recommendation, because it ensures that those who are receiving care are being represented by someone who has an acute understanding of the impact of their circumstances and who is committed to improving processes in the future. I therefore welcome that appointments to the advisory group will be the subject of oversight by the Scottish Parliamentary Corporate Body, which will function as an external check on their appropriateness.
It is clear that the bill will make sure that the voices of people who are using health services are heard and that their concerns are acted on, with the creation of a champion who is independent of the NHS and of Government and who will focus on the safety of people who are receiving healthcare in Scotland. It is vitally important that patients have a voice and a place to turn to if they have safety concerns, and the bill will help to ensure that that happens.
I look forward to continued scrutiny of the bill as we move forward to stage 2. Brian Whittle’s retelling of the experience of Fraser and June at University hospital Crosshouse was a powerful statement of the need for a patient safety commissioner, so I welcome his comments today.
In closing, I welcome the minister’s comment that the PSC “will work collaboratively with” healthcare bodies, and I thank all those, including the many people who have demonstrated great courage, who have helped us to get to this point today. I, too, support the general principles of the bill.
I start by apologising to fellow members, as I will not be able to remain in the chamber for the entire debate. I have been granted permission by you, Presiding Officer, to leave before its conclusion, so I thank you for that.
I thank my colleagues on the Health, Social Care and Sport Committee for their work on the bill. I was not on the committee at that time, but I know how hard they worked. I also thank the committee clerks for their guidance.
As my colleague Paul Sweeney mentioned, Labour will support the bill at stage 1. We agree with the general principles and, as such, we support the establishment of a patient safety commissioner to ensure that patients have a champion and a voice to protect their interests.
For too long, patient safety has not been prioritised by the Government. We have heard some clear examples from members today of the tragedy that has been experienced by families who, for too long, were made to suffer in silence. If the minister truly wishes the establishment of a commissioner to lead to real and meaningful change, she must listen to committee recommendations on ensuring that lived experience is heard and considered at every stage of the appointment process.
Moreover, the Scottish Government must agree to Labour’s calls for the commissioner, when appointed, to be well resourced with funding, as colleagues have mentioned, and to have the power to stand up for patients’ rights and to advocate for the safe treatment and care that they should receive. We want the bill to be successful, but we also want it to be meaningful. The appointment of a commissioner is the first step, but there will be a long way to go afterwards to deliver for patients across the country.
In her response to the committee’s recommendations addressing calls to define “patient safety”, the minister noted that she believed that
“the meaning of ‘safety’ is well understood by patients and the public.”
That may well be true, but we do not know whether it is well understood by the Scottish Government. Despite safe staffing legislation having been passed years ago, health and social care staff are still waiting for implementation of the legislation to improve conditions.
We know from trade unions such as Unison that low staffing levels is one of the many issues that staff face, which is dangerous to staff and patients. Given that it took the Government four years to confirm when it would implement legislation that has a particular focus on improving staff and patient safety, how can people have confidence that things will be any different in this case? Patient safety cannot be improved without significant improvements to staff safety—they go hand in hand. Indeed, on that point, the minister might wish to consider whether the bill should provide clarity on the commissioner’s role in taking forward the concerns of staff who raise patient safety issues.
Therefore, we need a commitment that the bill will be meaningful and will positively impact patients. Scottish Labour will continue to call for existing challenges in staffing safety to be addressed in order to ensure that the bill does not fail to achieve the aims that have been set out.
Furthermore, as has been mentioned, we know that the commissioner’s initial remit will not include social care, and the committee supports that position. However, I note from the minister’s letter to the committee that she acknowledges that that requires flexibility. Although I stress the importance of considering the committee’s recommendation regarding giving the commissioner the ability to have a role in issues that intersect and transcend health and social care, the minister raises an important point.
The new patient safety commissioner will have their work cut out for them if they are to address issues linked to patient safety with the gravity that they deserve, but concerns around funding levels are real and must not be ignored. I hope that the minister will work constructively at future stages—as, I am sure, she will—to ensure that the bill is as strong as possible. From what we are hearing from members across the chamber, that is where we want to be.
However, we cannot suggest for a moment that a patient safety commissioner alone will produce significant improvements to patient safety. As we have seen in recent times, confidence has eroded due to scandals that have been linked to patient safety. They have often, as we have heard, been linked to women’s health, including the use of mesh and, more recently, the provision of endometriosis care.
Although the bill is welcomed, the Scottish National Party has overseen long-term decline in the running of public services, and, although clinicians and staff go above and beyond for patients, confidence is not where we want it to be and people are demanding real and tangible change.
In conclusion, the bill has our support at stage 1. The bill is well intentioned and is similar to the Health and Care (Staffing) (Scotland) Act 2019. If it is implemented effectively and with purpose, and if it is supported by financial resources and the freedom of the commissioner to stand up for patients’ rights and to advocate for safe treatment and care, it can be successful. It is important that we reverse the trend and work towards delivering positive patient experiences and improved patient safety. I thank members for the debate.
I am pleased to speak in the debate as a member of the Health, Social Care and Sport Committee. I, too, thank all those who generously gave their time to provide evidence to the committee, and I thank committee clerks and my colleagues for their hard work and commitment. A special thanks goes to Brian Whittle for speaking with such passion and compassion about his constituent’s experience.
The health and wellbeing of Scotland’s people lies at the heart of the Scottish Government’s responsibilities, and the Patient Safety Commissioner for Scotland Bill is an important step that helps to ensure that good-quality, accessible and patient-centric healthcare services are available to all of us.
The independent medicines and medical devices safety review—known as the Cumberlege review—drew attention to significant changes that were needed for health-related quality and safety and highlighted major disparities in how different groups of patients and service users experience healthcare services, which is an imbalance that must be addressed.
We heard that a patient commissioner would act as an advocate for patients by directly representing their interests in healthcare and drawing on their feedback and experiences to enhance the safety and quality of care. The bill’s primary purpose is to give patients a voice—especially the patients who are least likely to be heard in our healthcare system.
Despite the Scottish Government’s good progress on patient safety in recent years, some patients have been let down, and the consequences of not listening have been extensive and damaging. For example, we heard about vaginal mesh, which is still an issue many years on.
The Cumberlege review and the evidence to the committee highlight that women still experience a lack of understanding of their symptoms. I am sure that we can agree that it is wrong and harmful for women who are experiencing excruciating chronic pain not to be taken seriously. Too many women are told that these are just women’s issues. I thank Carol—I cannot remember her surname—
I thank Carol for also bringing up endometriosis.
The situation is a clear impediment to securing a correct diagnosis and the right support for people. Irene Oldfather from the Health and Social Care Alliance Scotland spoke for many women when she said:
“To say that they felt that they were not being listened to is an understatement—they were banging their heads against brick walls.”—[
Health, Social Care and Sport Committee
, 7 February 2023; c 8]
I welcome the minister’s recent response to the committee, which recognised our call for the patient safety commissioner’s work to include an explicit commitment to listening to and supporting underrepresented voices and agreed about the need for follow-up and for work with organisations to ensure that recommendations really do bring positive change. Patient trust must be strengthened and early intervention is critical. That is exactly what the commissioner will ensure.
Further to that, the bill recognises the key role that data analytics will play in effectively supporting the patient safety commissioner to amplify the voices of patients. We have heard today that sodium valproate can be an essential medicine for those with epilepsy or bipolar disorder, but we are now aware of the imposed physical and neurodevelopmental risk to babies if it is prescribed during pregnancy and also of the trauma and guilt that Tess White described so well. Substantial evidence reaffirming those risks has emerged since the early 2000s, yet Valproate Scotland has noted that there is still no exact figure for how many people in Scotland have been impacted—there is only an estimate of about 2,000. If prevalence is not understood, those who are affected will suffer in silence and go unsupported. Thanks to fierce campaigning by Valproate Scotland, that data is now being collected.
However, we should not be reliant on campaigners to bring such issues to the forefront. We must be proactive—not reactive—in data collection, to identify trends early and minimise harms. It is good to have the minister’s reassurance that the commissioner will have access to the data analytics that they require to implement robust and evidence-based systematic improvements. We simply cannot afford to allow another surgical vaginal mesh or sodium valproate event to unfold.
Today, we have heard much about patient experiences that highlight the need for the bill and about the importance of creating a patient safety commissioner role that is independent of the Government to champion patients’ rights. We have heard that the patient safety commissioner needs the authority to investigate and report on patient safety matters and the power to make recommendations to healthcare providers, professional regulatory bodies and the Government.
The bill should matter to every Scottish citizen, because any one of us might unexpectedly face a situation that goes beyond an individual complaint and appreciate having a patient commissioner who is on our side. I stand by the bill’s aims, and I hope and trust that members will support its general principles.
I, too, welcome the bill’s introduction, and I thank all those who gave evidence to the Health, Social Care and Sport Committee, the committee clerks and the organisations that provided briefings for today’s debate.
This is one of the rare occasions when we do not disagree on an issue and can have a genuine discussion about how to get the best out of the bill for patients. The committee heard a wide range of views from those who gave evidence. We heard varying opinions on how the commissioner should respond to individual cases. When I asked her about that in committee, Baroness Cumberlege said that the commissioner will need to take an overall system-wide view in order to identify trends and that other organisations can support individuals.
We heard from Haemophilia Scotland that people do not always know where to go when they have complaints and that a culture of defensiveness in the NHS may prevent their complaints from being addressed. Haemophilia Scotland made the powerful point that the infected blood inquiry has resulted in the issuing of the apologies that some people have been waiting 20 years for and that there would be value in the commissioner being the first point of contact rather than the last. However, there was largely a consensus among those who gave evidence that the commissioner should not take on and solve individual cases, although they should certainly listen to individual concerns and identify where they form a pattern.
The commissioner’s role in relation to individual cases must be clearly defined as the bill progresses through Parliament so that it can be clearly communicated to the public. As the committee report states, given the on-going issues around
“patients feeling they were not listened to and the length of time taken for their problems to be acknowledged ... raising public awareness, as well as managing expectations, in relation to the role of Patient Safety Commissioner” will be essential, and the Government must plan for that accordingly.
Alongside excellent communication about the role and responsibilities of the commissioner, there must be an early focus on the building of relationships. It was stressed to the committee that patients will need to see the commissioner as someone who is on their side when they may have struggled to be heard for some time.
The commissioner must take a person-centred approach to complaints that recognises the individual who is behind the complaint. Those with lived and living experience of patient safety issues should also have a meaningful role in the recruitment process. That will be essential in establishing patient trust and confidence in the commissioner. Consulting people with lived experience and other stakeholders should be an on-going process and not a one-off event.
The committee’s report calls for the commissioner to consult stakeholders on the principles that will underpin the role and says that these should
“include an explicit commitment to listening to and supporting under-represented voices”.
The commissioner needs to be keenly aware that not all complaints are treated equally and that existing inequalities will impact the experiences of patients when things go wrong. The Cumberlege review examined themes that specifically affected women and found a culture of silence about women’s pain and discomfort, which are often dismissed or ignored by the very system that is meant to keep patients healthy and well.
The commissioner must take an intersectional approach. The MBRRACE-UK report in 2022 revealed that, in the UK, black women were 3.7 times more likely to die from complications from pregnancy than white women were, Asian women were 1.8 times more likely to die than white women were and mixed ethnicity women were 1.3 times more likely to die than white women were.
The General Medical Council has suggested that the commissioner should adopt an explicit focus on addressing and mitigating healthcare inequalities that have the potential to impact on patient safety. I fully support that call.
On the relationship between NHS staff and the commissioner, I appreciate the comments from the then Minister for Public Health, Women’s Health and Sport during her evidence session. She was clear that there should be communication between NHS staff and the commissioner and that that could be clarified in the bill.
The Royal College of Nursing has welcomed that commitment and has highlighted that, although policies and procedures are in place for staff to raise concerns, staff do not always feel that those concerns are heard. Given the pressure that staff are under at the moment, it will be essential to build positive relationships from the beginning, so that staff are not reluctant to raise issues because of fears about punishment. Staff and the commissioner will share a commitment to patient safety, so we need to create an environment where they can work towards that common goal.
The commissioner will need to work co-operatively and not just be seen to be wielding a big stick. As the committee report notes, the complex governance structures that are in place, with responsibility for the safety of patient care shared among several organisations, not only create the risk of overlap and duplication of effort but can make things confusing for patients and lead to them having to tell their stories over and over to different agencies.
That is one example of how raising complaints can be traumatic for patients. More detail is needed on how the commissioner will work with other agencies in a way that will ensure that there is no meaningful duplication or overlap. I look forward to that clarification being added to the bill.
Although the establishment of a commissioner will, I hope, help to alleviate some of the aforementioned trauma that has been experienced by patients who are raising complaints, the need for emotional and practical support is still clear. As we have seen from the infected blood inquiry, seeking resolution for complaints can be an extremely lengthy, drawn-out process that can reinforce trauma for patients. The support that is available to patients and how they can access it while their complaints are being investigated need to be made clear.
The appointment of a patient safety commissioner is a vital step towards improving patient safety and will reassure people that, when things go wrong, their voices will be listened to and lessons will be learned. The Scottish Greens will support the bill at stage 1.
It is well established that health is a fundamental human right, and it should be treated as such. Although our healthcare system has faced unprecedented challenges in recent years, my view is that it is essential to use this time as an opportunity to learn and do better for the safety of patients and the foundation of our healthcare system.
We are faced with unique circumstances in this period of post-pandemic rebuilding in implementing the changes needed to put patient safety at the heart of our healthcare. I therefore very much welcome the Patient Safety Commissioner for Scotland Bill, which intends to establish a patient safety commissioner in order to ensure that patients’ voices are heard, amplified and carefully considered.
The bill proposes that the patient safety commissioner would have two key functions:
“to advocate for systemic improvement in the safety of health care, and ... to promote the importance of the views of patients and other members of the public in relation to the safety of health care.”
As a member of the Health, Social Care and Sport Committee, I have had the privilege of taking verbal and written evidence from a range of stakeholders and experts across the sector. Their views have been invaluable in informing the committee. In addition, we have heard from a range of patients and patient representatives, many of whom strongly supported the establishment of a patient safety commissioner for Scotland and told us about the difference that such a role could have made in their cases.
I am incredibly pleased that the committee has unanimously backed the bill. It was introduced in response to the recommendations of the UK Government-commissioned Cumberlege review. The committee was pleased to welcome Baroness Cumberlege to our first evidence session on the bill, earlier this year. The review was established to examine how the health system responds to reports from patients about patient safety concerns that are related to medicines and medical devices.
Our committee has heard on numerous occasions that the Patient Safety Commissioner for Scotland Bill goes further than the corresponding legislation in England. Under the bill as currently drafted, the patient safety commissioner for Scotland would have the power to make it publicly known if an organisation had failed to co-operate. However, it goes further than that. The commissioner would have the power to compel the organisation to act.
It is reassuring to hear that the Patient Safety Commissioner for England has already made remarkable progress. If the bill is passed, I look forward to seeing even better results in Scotland.
I thank the individuals and members of the public who volunteered their time to speak to the committee at an evidence session. Many of them spoke about their personal experiences, and I know that all members who were present were incredibly moved by their stories.
Patients need to feel safe in the hands of our medical professionals. I cannot fathom the unimaginable pain and mental distress that patients across the country and their families have faced. The harm that has been caused to patients and their families is often avoidable, and I appreciate and recognise that many continue to fight for answers.
Safety lies at the heart of delivering our health services, and it will be essential for the commissioner to instil trust and confidence in our communities and to be a clear and strong voice for patients.
We are debating the bill thanks to the tireless work of campaigners and individuals who have been massively affected by the issue. I am absolutely certain that future generations will benefit from safer healthcare thanks to their incredible efforts.
We cannot talk about healthcare without discussing the universal and entrenched inequalities that patients face. During the committee’s evidence sessions, we heard time and again about how marginalised groups bear the brunt of patient safety issues and about how the establishment of a patient safety commissioner could ensure that marginalised patients’ voices are heard and that their concerns are picked up and acted upon.
Patient safety is incredibly gendered. Experts told the committee that women and children are overwhelmingly the groups that have been affected by medicines and medical devices that are thought to have jeopardised patient safety. Women across Scotland have been let down by ingrained prejudice within the medical system. Research has shown that the healthcare system seems to be poor at listening to women and taking seriously their concerns about their health and wellbeing and the outcomes of the procedures that they have had.
Based on the evidence that we have heard, it is clear that there is a requirement for the system to act more coherently for the public interest. The establishment of a patient safety commissioner is an effective mechanism to ensure that.
In response to the consultation, the Health and Social Care Alliance Scotland—the ALLIANCE—set out a number of considerations, many of which I welcome. They included the importance of a fully transparent appointment process for the commissioner and of clearly explaining the role and remit to the general public through accessible and inclusive messaging. With that in mind, and as the bill progresses to its later stages, a clear focus should be given to the following points.
First, the patient safety commissioner’s remit and scope need to be clarified to ensure a clear definition of roles across the medical system. The medical system is a complex landscape, and it is essential that the commissioner’s role is clearly defined so that there is no overlap with current governance systems and so that patients know who they can contact for support.
Secondly, the commissioner needs to be independent of the Government and the NHS and to have the resources to carry out their role properly. That will help to restore public confidence in our healthcare system and encourage patients to come forward to report any cases of medical wrongdoing.
Thirdly, a person-centred approach is necessary and critical. Patient voices, particularly those from marginalised or underrepresented groups, need to be at the heart of the work. A diversity of voices is paramount for patient safety, and people with lived experiences should play a meaningful
role in the process of establishing a patient safety commissioner for Scotland.
I am confident that, throughout the process, the Scottish Government will continue to work with the relevant organisations to ensure an outcome that is robust and comprehensive.
I once again thank those who gave evidence to the committee in the run-up to the debate, and I look forward to the bill progressing through its upcoming stages.
I add my thanks to the members and clerks of the Health, Social Care and Sport Committee for the work that they did on the stage 1 report and to everyone who took the time to give evidence to the committee to shape that report.
It is clear from reading the evidence to the committee that there is widespread support for the establishment of a patient safety commissioner. Crucially, the commissioner should be independent of Government, to provide a strong voice for patients and champion their interests.
Patient safety must be a non-negotiable aspect of our health and social care service but, too often, patients in Scotland feel that they have been failed. From the chemotherapy dosing scandal for breast cancer patients in Tayside and the pelvic mesh surgery scandal to the infected blood scandal and the tragic death of Milly Main at the Queen Elizabeth university hospital in Glasgow due to contaminated water, it is clear that Scotland needs an independent body with the power and resources to shed light on such mistakes and, crucially, ensure that lessons are learned for the future.
Too often, patients feel that they are not being heard and that they do not have the information to make the right decision about their care. Too often, they do not trust the answers that they are given and do not believe that the system prioritises their health and that of their families.
Take the example from Parkinson’s UK. It highlighted in its evidence to the committee the time-critical nature of the administration of Parkinson’s medicine. If people with Parkinson’s do not get their medication on time, even a delay of 30 minutes can seriously impact their health.
Through its get it on time campaign, Parkinson’s UK and the wider Parkinson’s community have been raising significant concerns about missed and late medicines in hospitals since 2006. That is almost two decades. However, Parkinson’s UK estimates that there are still around 100,000 incidents a year in Scotland in which Parkinson’s medication is administered more than half an hour late—in breach of clinical guidelines—or, on occasions, missed altogether, often with tragic consequences. As we have heard in relation to sodium valproate damage, the Parkinson’s community feels that calls from patients too often fall on deaf ears at a systemic level.
In evidence to the committee, some people argued that there were already established organisations—such as Healthcare Improvement Scotland, the Scottish Public Services Ombudsman and the Health and Safety Executive—to do the job, as well as initiatives such as the NHS Scotland patient safety programme, and they expressed concerns about overlapping responsibilities. Of course, as the committee has highlighted, we need to avoid duplication, but it is clear that the scandals that we have heard about were not properly addressed by the current organisations and the systems that we have in place. That is devastating for patients, but it is also devastating for clinicians and other staff, the overwhelming majority of whom go above and beyond every single day.
Concerns were also raised by the Finance and Public Administration Committee about the increasing number of commissioners and the resource challenges that that brings to the Scottish Parliamentary Corporate Body. However, that is not an argument against having new commissioners; it is an argument that the Health, Social Care and Sports Committee rightly makes to properly resource the Parliament’s corporate body to support the work of the patient safety commissioner and any other commissioners that might be proposed, and to properly resource the commissioners themselves. There are strong arguments for the role that commissioners can play in independently scrutinising Government and providing a voice to people with lived experience, not least in health.
There is currently a petition before Parliament from Dr Gordon Baird, who is a retired general practitioner in my region. It urges the Government to establish independent advocacy in health, specifically for rural areas, to ensure that health service provision is fair and reasonable. Dr Baird has cited the successful model of Australia’s rural health commissioner.
Dr Baird took up the cause after his former music teacher—a woman in her 80s with terminal cancer—had to spend nearly nine hours travelling back from Edinburgh to her home in Sandhead each time she received palliative therapy, for no other reason than the historical convenience of consultants, which led to Dumfries and Galloway being made part of the South East Scotland Cancer Network instead of the West of Scotland Cancer Network. That means that patients from the region have to travel primarily to Edinburgh—
Absolutely. He has been working on that and many other issues in our rural communities.
Concerns that patients have raised about the lack of services in areas have just not been tackled. In this case, that means that patients from the region have to travel to Edinburgh for specialist cancer care and not Glasgow, which is far closer for residents in the west. As Emma Harper highlighted, the health board has promised action to realign those services to the west of Scotland since 2006, but there has been no progress from the board or from Government to deliver that.
Since 2018, we have also seen the maternity unit at Galloway community hospital in Stranraer closed—temporarily, we were told—because of a shortage of midwives. That means that mums-to-be in Wigtownshire have to travel up to 90 miles to Dumfries to give birth.
One of my constituents—Claire Fleming—lives in Glenluce, which is 15 miles from Stranraer. Her first pregnancy was with Abbey, who was, sadly, stillborn. Despite the tragic end to that pregnancy, Claire had to drive herself to the hospital in Dumfries to deliver Abbey. That was 60 miles away. Since then, she has had three children—Molly, Andrew and James—which is wonderful. However, along with her husband, Richard, she has had to clock up more than 7,500 miles between her home and Dumfries for maternity appointments because, even before the maternity unit in Stranraer closed, services had been scaled back.
Claire suffered from hyperemesis during pregnancy, which meant that she had to stop on the journey to Dumfries every 15 minutes to be sick. She told me that she was aware of women in Wigtownshire who had decided not to get pregnant because they were “so scared” of having to make that journey in a rush if they went into labour. They feared that they would have to give birth in a lay-by at the side of the road. Claire has chosen to be sterilised because she says that she could not face that journey again. That is not putting patient safety first.
I have no doubt that, had we had a rural health commissioner shining a light on those scandals and independently holding Government to account, we would have seen progress on ending them before now. I also have no doubt that a patient safety commissioner who is properly resourced, has the proper powers and, crucially, is backed by safe staffing levels in our hospitals could play an important role in standing up for patients’ rights and advocating for the safe treatment and care that we should all be receiving.
My apologies for the short delay, Presiding Officer. I was kicked out and had to log myself in again.
Across the chamber, there is not a member who puts themselves forward to stand for election without believing that their work can improve and protect the lives and wellbeing of the constituents they represent. The health and safety of each and every one of us, and of every one of the people in our constituencies, our cities and across Scotland are, above all else, at the heart of all the work that we do as MSPs.
As we often reflect on, the NHS is one of the finest institutions in the world. The care and dedication of the staff and practitioners are second to none, and I am always in awe at the levels of diligence that they show when carrying out such complex and challenging care.
However, it would be remiss of me not to admit that one of the more difficult parts of our job as members is dealing with complaints and concerns about the NHS. In my experience, our office has usually found NHS Greater Glasgow and Clyde to be extremely helpful when it comes to difficult issues. However, there have been and will be times when issues fall outwith its remit and we are left with patients frustrated and issues unresolved.
I have recently been in discussion with constituents who are mesh survivors and members of groups supporting patients who were treated with transvaginal mesh, and I was flabbergasted and horrified by their shocking stories of discomfort and pain and the wider impact that it has had in their life. The Parliament has had many debates on the subject, and we, as members, have learned so much from the various testimonies that have been proffered to us by the brave woman who have campaigned so hard for patients to have correctional treatment where possible, and for steps to be taken to support those involved. With the launch of the Cumberlege review, I was delighted to see that transvaginal mesh was one of the cases that highlighted the need for the introduction of the patient safety commissioner.
Healthcare and innovation have worked hand in hand for ever. However, as we move into an ever-changing world of artificial intelligence and tech-led healthcare, human beings must always be at the centre of all our care provision. I was recently speaking to a type 1 diabetic patient who, within a few years, has gone from monitoring their sugar levels with a manual prick of the finger and using difficult mathematical calculations and insulin pens to deliver insulin, to using a monitor that can be scanned with a smartphone, and having insulin delivered through a micropump that is attached to the patient’s body. That not only ensures that the patient has more accurate and cohesive regulation of insulin in the body but could mean a massive improvement to their life and a reduction in the other difficult side effects that come with poor diabetic management.
However, it was very interesting to hear that the technology, although transformative, is not without flaws. For example, if the Bluetooth signal from the smartphone to the pump fails, insulin will cease to be delivered, resulting in a spike in blood glucose levels. That very specific example shows that, even when medical technology is transformative, it is not without its difficulties. The patient safety commissioner’s office would be the perfect place for somebody who wishes to raise an issue that could affect people besides themselves but who does not want to seem as if they are complaining about a particularly good service. Hopefully, the patient safety commissioner would be able to take that on and see whether anything could be done about it. That is a very good step in the bill.
One of the key areas that I am really pleased about is that the commissioner role is designed to improve communications with patients and members of the public. During the Cumberlege review, I saw the evidence that recommended that a patient’s lived experience should no longer be considered as anecdotal and should not be downgraded, as it presently is, when weighted against scientific and evidence-based medicine.
The Scottish Government has recognised public calls for patients to have a new voice, and continued engagement with the people of Scotland has confirmed that it should be a priority to fulfil the recommendations of the Cumberlege review, which the bill clearly seeks to do. When it comes to public safety and health, the best outcome for patients will be achieved only if there is strong partnership working.
NHS procurement, run by National Services Scotland, is a prime example of partnership working. Clinicians and management work together to ensure that the needs of the organisation and, ultimately, the service users are met in the most efficient, safe and cost-effective way. Therefore, it is great that although the commissioner will be independent, they will work closely with professionals such as clinicians, lawyers and advocates to ensure that a wholly rounded service is delivered to the people of Scotland.
I am confident that patient complaints are dealt with to the best of each individual health board’s ability, but organisations such as Healthcare Improvement Scotland and others are doing all that they can to ensure the safety of people using healthcare facilities, both public and private, across Scotland. However, the Scottish Government is right to take on the recommendation of the committee report to follow the guidance of the Cumberlege review and the evidence that will ensure that the voices of service users are not lost among the many others.
Although the commissioner will not be advocating in individual cases of patients, it is good that there will be advocacy for safety and health across Scotland and that the voices of patients and service users are central to that. Patients will benefit greatly from streamlined advocacy and guidance when it comes to their safety and care in the healthcare system. The overwhelming public support during the consultation period for the bill is proof that it is absolutely the right implementation to make.
I am therefore delighted to support the Patient Safety Commissioner for Scotland Bill at stage 1.
I am pleased to have the opportunity to close the debate on behalf of Scottish Labour. I begin by welcoming Jenni Minto to her place as minister. This is the first occasion on which I have been across from her in the chamber in this context and, quite possibly, it is the last as, obviously, I am speaking as the former deputy convener of the Health, Social Care and Sport Committee—of course, I was referring to my change of shadow roles and not to the minister.
However, I am pleased to be speaking, to look back at my time on the Health, Social Care and Sport Committee and to follow on from colleagues on that committee in speaking about the bill.
The committee scrutinised the proposals carefully and thoughtfully. It was clear from all the evidence sessions that there is a consensus that a patient safety commissioner can play an important role in improving public confidence in the healthcare system and serving as a powerful advocate for patients. As my colleagues have articulated—most notably Paul Sweeney in his opening remarks—Scottish Labour supports the establishment of a patient safety commissioner to champion the rights of patients and defend their interests. However, as we have said, we want the bill to be as robust as possible and to go as far as possible to ensure that those interests are defended robustly.
It is, of course, a positive step that the Government is implementing a key recommendation of the Cumberlege review. As we have heard from members from across the chamber, in recent years we have witnessed too many scandals, often with fatal consequences, affecting too many families. The stark reality is that we cannot afford the cost—either the economic cost or, critically, the human cost—of unsafe care. It is estimated that, globally, unsafe care in health settings significantly contributes to more than 3 million deaths per year, which is clearly a sobering and significant figure. It is estimated that the financial cost of unsafe care here in Scotland is around £2 billion. In that respect, the importance of legislation is self-evident.
As I said, the crucial aspect is that the bill is well crafted and well implemented. As we have heard, pieces of well-intentioned legislation have often failed to have an impact on improving patient safety or patient care. We heard from my colleague Carol Mochan about the passing of the Health and Care (Staffing) (Scotland) Act 2019, which was hailed as a landmark piece of legislation that would improve patient safety, as well as the safety of the workforce, by ensuring safe staffing levels on wards. However, four years on since that legislation was supported by members across the Parliament, there has been a failure to properly implement it and to meet the standards. I think that everyone is keen to raise that issue once more and to see progress in that space.
Alex Cole-Hamilton and Colin Smyth rightly raised the scandals that have impacted patients across the country, most notably at the Queen Elizabeth university hospital. Those harrowing stories are part of the reason why we need to ensure that the bill goes as far as possible. Scottish Labour has advocated for many years for better and more robust systems to be in place to ensure that the voices of the victims of poor care are at the heart of any inquiries into tragedies. Of course, most notable among those stories is that of Milly Main and the advocacy for Milly’s law to put families at the heart of such inquiries. We need the patient safety commissioner to take a strong role in that regard.
Evelyn Tweed spoke powerfully about the importance of the barriers that are experienced in healthcare, particularly by women, and she acknowledged that those barriers have to be broken down. I am sure that we all want the barriers to be broken down, which is why the recommendations of the committee that Evelyn Tweed referenced about following up with patients, giving them holistic support and representing the underrepresented in this space are vital.
Brian Whittle and Emma Harper brought to the Parliament’s attention the personal cost of the experiences that people have had across Scotland. People have experienced unthinkable pain, both physical and mental, and have had to live with that for many years before progressing towards an outcome. Those members’ contributions were particularly important in helping us to focus on what we want the patient safety commissioner to do. The system, at its heart, needs to be about transparency, accountability and, crucially, safety. I think that we all want those values to underpin the proposal.
As the bill moves to stage 2, it is critical that the Government works with members from across the chamber to iron out some of the issues that the committee raised at stage 1. I welcome what the minister said in her opening speech about the Government being in listening mode, which is really important.
The issues in the committee’s report that stood out to me have already been covered. We need to explore how healthcare staff can raise patient safety concerns freely, without fear of repercussions, with the commissioner. I appreciate what the minister said about working with officials to see what can be done in that regard.
We should provide greater clarity on the powers of the commissioner in relation to compelling private companies that provide devices and medicines to submit evidence during investigations. We should ensure that the commissioner has the teeth to push companies to do that.
Paul Sweeney mentioned investigations into individual cases. That is an important point that merits consideration. It is also important, as he said, to clarify the commissioner’s remit in relation to social care and how that remit will interact with the proposals for a national care service, because the significant safety issues relating to social care that came to light during the pandemic and throughout the period since then need to be addressed. There is an opportunity to do that through the bill.
I join others in thanking my former colleagues on the committee for all their work, and I thank the clerks and those who gave evidence. As I said, Scottish Labour will support the bill because it is evident that there is consensus on the need for a patient safety commissioner. All parties in the Parliament recognise that need. As the bill moves to its subsequent stages, it is critical that the Government gets it right and delivers, because patients have already waited too long and need a champion.
I am grateful to all members for their extremely thoughtful contributions to what has been a constructive and helpful debate. It is welcome that the chamber recognises that there is more to do to ensure that patients are listened to when they have concerns about the safety of healthcare and agrees that the creation of an independent patient safety commissioner is an important step that will promote the patient voice and make healthcare in Scotland safer for us all.
I will, of course, carefully consider all the points that have been raised today before stage 2.
The range of suggestions that have been put forward to ensure that the patient safety commissioner is as effective as possible are very welcome and are doubtless testament to the commitment of the members of this Parliament to the safety of their constituents and all who need to access the healthcare system in Scotland, irrespective of whether that healthcare is provided by the NHS or through another route.
Clearly, some of the issues that we have debated today will need to be considered further, but I am pleased that there appears to be support across the chamber for the general principles of the bill. I will turn to some of the contributions that were made.
I thank Paul O’Kane for his kind words. I have really reflected on what he said about the thoughtful consideration of the committee under Gillian Martin’s convenership. The evidence sessions that I watched were very powerful—especially those with people who had been impacted by previous circumstances. The member referred to the bill being well crafted, and I thank my bill team for that.
I echo the words of Sandesh Gulhane about thanking the healthcare staff who work in our NHS. He also noted that Jeane Freeman first introduced the idea of a patient safety commissioner to the Parliament as a result of Baroness Cumberlege’s review. The member raised various other points that I will touch on if I have time.
I thank Clare Haughey, who raised points about evidence, social care and unrepresented voices, specifically the voices of women—a point that was also raised by Tess White. Tess White also emphasised the importance of collaboration, which is a word that I have used a lot.
Paul Sweeney talked about individual cases and the healthcare around those, and he offered to have further dialogue with me, which I would very much appreciate.
With regard to Alex Cole-Hamilton’s comments, it is important to emphasise that the establishment of our commissioner will be done through stand-alone primary legislation, not, as Sandesh Gulhane mentioned, through an add-on to another bill. We are giving our commissioner statutory powers. We have also taken much time to listen to individuals, which is something that patients wanted.
I have taken the decision to review staffing and the contribution that staff can make to the work of the commissioner, but it will be the commissioner who decides their priorities. However, I certainly note Tess White’s point.
I thank Brian Whittle very much for bringing to the chamber the experience of Fraser and June Morton. I was particularly moved by Fraser Morton’s evidence to the committee and his selfless actions. Mr Whittle pointed to what we need to review and learn from in order to move on positively on the basis of their terrible, traumatic experience.
I reaffirm, as I said to Mr Whittle’s colleague Tess White, that I have responded to that in my letter. It is important that we review that side of things, including the implications for staff.
Emma Harper talked about the importance of listening to and amplifying patients’ voices and, along with Colin Smyth, talked about travel from rural communities, which is an issue that I recognise because I represent Argyle and Bute. Although I am happy to look at that, again, the patient safety commissioner will make decisions as to whether he or she reviews that.
Carol Mochan talked about lived experience, the power to stand up for patients’ rights and this being a first step.
Stephanie Callaghan talked about how patient trust must be strengthened. To me, that is one of the core points of the bill—and that we are proactive, not reactive.
Gillian Mackay talked about building relationships and taking a person-centred approach.
David Torrance talked about trust and confidence in our communities.
I am sorry—how much time have I got?
Okay. I will touch on some of the other points that were raised.
I feel strongly that the safety commissioner’s focus must be on the safety of healthcare, and I am pleased that the committee agrees with that. The commissioner’s remit covers the safety of healthcare irrespective of where it is delivered, which I believe means that there will have to be requisite scope to examine issues at the intersection of health and social care, which the committee has looked at.
With regard to the issue of underrepresented voices, which a number of members raised, it will be for whoever is appointed as the patient safety commissioner to determine on that. However, I agree that a firm commitment to underrepresented voices must sit at the heart of the role.
Tess White talked about women, and I am very proud to be the women’s health minister. This is a key priority of the Scottish Government, and the women’s health plan sets out actions that are designed to achieve long-term success. I hope that, if it is appropriate, there will be collaboration and overlap between the two areas.
I also agree that we need to get resourcing right. It needs to be transparent and accountable.
We discussed individual cases, and I have already offered to have a separate conversation with Paul Sweeney.
I underline the fact that we will have an independent process to hold the patient safety commissioner correct through Parliament, regardless of whether we have that through the committee as well.
Carol Mochan talked about the definition of patient safety, and there are a number of definitions of patient safety, whether the World Health Organization’s or NHS England’s. I suggest that the commissioner may perhaps wish to look at that.
The bill will establish an independent public advocate for patients in Scotland regarding the safety of healthcare who is accountable to this Parliament and thereby to the people of Scotland. The patient voice will be at the heart of the patient safety commissioner role. The commissioner will be informed at all times by the views of patients when deciding what they focus on and which issues they wish to investigate. Crucially, they will be accessible to patients in order to hear their stories directly. People sharing their views and experiences will be key to making the role work and to improving the safety of healthcare for us all.
This will be a significant step forward for patient safety in Scotland and will build on the extensive suite of rights that already enable patients to give feedback. I believe that the bill is an important and positive step in making Scotland’s healthcare system more responsive to the needs of patients and the wider public. Let us work together to take this step and show the people of Scotland that we are committed to ensuring that their healthcare system is as safe as possible. As Stephanie Callaghan said, it matters to every single one of us.
I call on Parliament to support the general principles of the bill.