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We are seeing a hugely worrying situation and we are doing a number of strands of work in the area. Just last week, at a round-table event that was co-hosted by Lorna Slater, there was a discussion, from an environmental perspective, on the impact of single-use vapes. I also have a meeting this Saturday with young children. At the round-table meeting, there was real strength of feeling that we need to consult younger people more about the best thing to do.

We are building on regulations that are already in place and we are reviewing promotion and sale of vapes to under-18s to ensure that we have the right processes in place. We consulted in, I think, 2022 on restrictions on advertising and promotions, and we are looking at that as well. Much work is on-going, and I am working closely with my officials to ensure that we make the proportionate and right response to the current situation with regard to vapes.

I would be really interested to get the read-out from the meeting that you chaired yesterday. There was quite a bit in that question. Ideally, the approach would be through prescriptions, but there are currently no such products that are approved by the Medicines and Healthcare products Regulatory Agency. However, we are looking into the matter and I am working with my officials in pharmacy and suchlike.

We were clear that payment reform was the first step on the journey towards looking at dentistry services. We will collaborate with the BDA and more widely with other dentists on further work on governance and workforce.

I have asked for, and we are arranging, a meeting on dentistry with representatives from the other four UK nations. The issue affects not only Scotland; there are problems with dentistry services across the whole of the UK, partly as the result of a reduction in the number of new dentists coming in. That has happened for two reasons. About 160 student dentists lost a whole year of study because of the pandemic, and then Brexit left us asking how we could encourage dentists from across the world to come to the UK, and to Scotland in particular. A lot of work is being done on that.

I am pleased to say that 183 or 184 students are studying dentistry this year and that will help to move things forward. A lot of work has been done with the directors of dentistry in each of the health board areas to find ways to support dentists who are coming in, specifically in rural health board areas where work similar to that designed to attract GPs is being done. All that work is incredibly positive. My officials and I are engaging with dentists to make progress on it.

That is a good suggestion, Ms Harper, and I will take it away.

I lodged amendment 2 in response to the committee’s recommendation to remove section 4 of the bill as drafted on the basis that it is already provided for in the Equality Act 2010.

I move amendment 2.

I do not support amendment 22, which would allow the commissioner to make a special report on any recommendations from a previous report that they felt had not been, or would not be, implemented. The bill expressly gives the commissioner power to publish information on the implementation, or not, of their recommendations. The amendment is therefore superfluous.

I am also concerned that requiring the commissioner to lay before Parliament a report about actions that they felt would not be implemented could leave them open to defamation actions, as it anticipates or speculates about wrongdoing by others.

I urge members not to vote for amendment 22.

I do not support amendment 11. The commissioner will need sufficient time in post to understand the patient safety landscape, gather sufficient information, carry out any investigations that they feel are necessary and see their recommendations lead to change. Eight years is the standard period of office for all Scottish parliamentary commissioners. A commitment has been made to the Presiding Officer that the patient safety commissioner will be as consistent as possible with existing procedures to reduce the burden on the Scottish Parliament. I therefore ask Sandesh Gulhane not to press amendment 11.

I thank Jackie Baillie for her powerful words. None of us should ever forget in these discussions that the bill is about ensuring that people and their families can benefit from safer care in the future. That is at the forefront of my mind every day and I know that the same will be true for everyone around the table. I know how much of an advocate Jackie Baillie has been for patients and I thank her again for that.

We all want the patient safety commissioner to amplify the voice of patients and drive improvements in safety, and it is important that they have the freedom to do that however they see fit. I would absolutely expect that the commissioner would wish to hear from bereaved families as well as affected patients when they wished to raise an issue relating to patient safety, including in the sorts of circumstances that Jackie Baillie has mentioned.

It is critical that we do not inadvertently tie the commissioner’s hands in that respect. Everything that we are doing with the bill is intended to ensure that the commissioner has the freedom, scope and authority to set their own agenda without fear or favour, to speak up for patients and to drive improvements. Writing very specific steps for the commissioner into the bill would risk getting in the way of their doing that kind of work and working to prevent major patient safety issues from developing in the first place.

The key functions of the commissioner’s role are set out in section 2(1) of the bill. In particular, they are:

“(a) to advocate for systemic improvement in the safety of health care, and

(b) to promote the importance of the views of patients and other members of the public in relation to the safety of health care.”

I am concerned that the amendments in this group would limit the commissioner’s ability to do that. They risk clouding the public’s understanding of the commissioner’s role and would represent a significant departure from the extent of their current remit and from what was agreed at stage 1. Indeed, the committee agreed at stage 1 that it was appropriate for the commissioner not to become involved in resolving individual cases, as avenues for that already exist. It is critical to let the commissioner be guided by patients and families, not by politicians, on what action they need to take.

Following a major incident, the commissioner would have an important role in gathering information from people who were affected and investigating whether a systemic issue had led to it. There is nothing to prevent the commissioner from doing that through the powers and functions that exist in the bill. I therefore urge members not to agree to the amendments.

I am very sorry to hear that some patients have reported complications after having received a hernia mesh implant. I am grateful to Katy Clark for all her efforts in this area and to the patients who have raised concerns, including those who have petitioned the Parliament. Officials and ministers, including the former First Minister, have heard directly from patients, and we have listened carefully and taken their concerns very seriously.

In the chamber a couple of weeks ago, Katy Clark asked me for a meeting. I believe that my officials have been in touch about their meeting her. Once that has happened, we can review the situation.

As a result of what patients have told us, the Government commissioned the Scottish Health Technologies Group to produce two reports on use of hernia mesh. The reports, which are based on current published evidence, support the continued use of mesh in abdominal wall and groin hernia repairs. The reports stress the importance of shared decision making and informed consent, and they emphasise the importance of choice and the availability of alternative treatments for people who want them. We have discussed the findings with professional bodies, including the relevant royal colleges and the British Hernia Society. We will continue to work with them on this important issue.

The chief medical officer has asked medical directors to consider the development of local clinical groups and broader clinical networks for the management of complex cases. Furthermore, there is work on-going with regard to establishing registries to encourage better data collection, which will provide important surveillance and outcome information in the future.

It is therefore clear that the Government is listening and acting on the concerns that have been expressed. However, it is important that the action that we take is proportionate. There seemed to be broad consensus on that point when the Parliament debated the issue in January. The Government is thus of the opinion that further review is not warranted.

I am unable to support amendment 23, but I am happy to discuss the issue further, perhaps in the lead-up to stage 3. By legislating for a particular strand of work, the amendment risks undermining the independence of the commissioner. The commissioner should be able to decide their own priorities based on the concerns that patients raise with them. It is important that the commissioner is forward facing and uses their time to gather information and horizon scan for potential patient safety issues.

I urge members not to vote for amendment 23.

Amendments 6 to 9, in my name, are intended to ensure that the commissioner can require relevant information from all relevant health bodies, and not only those that directly provide healthcare services to patients.

I am not able to support amendment 24. The regulation of medicines and medical devices is a reserved matter, and it is complex. I agree that it would be desirable to bring manufacturers and suppliers of medicines and medical devices into information-gathering provisions. I have asked my officials to look into that further, with a view to lodging an amendment at stage 3, and to keep Paul Sweeney informed of progress. I therefore ask Paul Sweeney not to move amendment 24.

I support Carol Mochan’s amendment 25. Transparency and information sharing are crucial to the success of the commissioner’s role, and I do not think that the amendment would place an unreasonable burden on the commissioner, health boards, the Common Services Agency or NHS National Services Scotland.

Amendment 10 is a technical amendment that clarifies that an offence is committed recklessly or knowingly by a person. The amendment will bring the offence into line with offences in data protection legislation, recognising that information may contain sensitive personal data relating to healthcare treatment, which must be treated with the utmost confidentiality.

I cannot support amendments 26 and 27. As my predecessor Maree Todd said in her evidence to the committee, professional regulators such as the General Medical Council are not like the patient safety commissioner, taking action against individuals instead of promoting learning and improvement. I do not want, with this bill, to create a situation that might impede healthcare professionals’ willingness to be frank and open with the commissioner. It is that spirit of openness and co-operation that I feel will drive improvement, and I do not want to risk that.

I therefore urge members not to vote for amendments 24, 26 and 27, and I move amendment 6.