Seòmar agus comataidhean

Liz Smith has raised a pertinent and interesting point specifically about Dr Eljamel and the concerns that were raised about that case.

If you look back at the origins of the patient safety commissioner and the Cumberlege review, you will see that three main issues were looked at: mesh, sodium valproate and Primodos. Those issues were raised by patients—almost exclusively women. They raised issues relating to the effects that those medical devices and medications were having on them and their children.

We need to ensure that there is a mechanism for such issues to be raised and investigated. It was felt that a patient safety commissioner would be able to be the vehicle for doing that, and that a patient safety commissioner would be able to look at broader systems issues and issues with medication and medication devices, and to raise those issues. Perhaps individual patient voices were not being listened to. That was what the committee heard, and certainly that is what the Cumberlege review heard.

I agree with Audrey. I welcome the committee’s inquiry into this. When I saw that you were looking at the issue, I thought that the exercise was certainly timely and worth while.

I would add only that you should scrutinise what organisations, stakeholders and the general public think that a commissioner will do that will improve or advocate more for their particular cause, issue or concern. That is my challenge to the committee. I will leave it at that.

I would not disagree with you, Mr Marra, that that is absolutely our role as elected representatives. I am sure that you have been representing your constituents in issues relating to what they perceive as medical negligence, issues accessing healthcare or just concerns about the impact that medication or medical devices have had on them.

The landscape of patient safety is complex. We have clinical governance structures, we have royal colleges that look at issues, and we have United Kingdom-wide oversight of some medications and issues relating to those. It is important that we ensure that the public are confident and have trust in the healthcare system, so it is absolutely key for the commissioner to have a clear purpose and role of advocating for system-wide improvements in the safety of healthcare and promoting the importance of the views of patients and members of the public.

I referred earlier to what stakeholders described as the golden thread to bring together all those systems and structures. Obviously, we do not yet have a patient safety commissioner in that role, but that is what the committee anticipated would be the outcome from having a commissioner. Ultimately, Parliament passed the legislation that introduced the commissioner, so parliamentarians agreed that that was required.

Given the history and the UK-wide review, and the acceptance from the Scottish Government—obviously I cannot speak for it—of all the review’s recommendations, creating the post of a patient safety commissioner certainly made sense. I understand that there is an argument for commissioners for various other issues and I am sure that many more proposals will come to Parliament. I say from a personal point of view, rather than from a committee point of view, that we need to ensure that there is a good and sound rationale for new commissioners and that they will add value to the public landscape, public conversation and advocacy for individual groups. That is why the committee is looking into the issue.

Certainly, with the patient safety commissioner, the evidence was there as to why we required to appoint one.

Certainly, it is absolutely key to ensure that the complex landscape that we have for patient safety is pulled together, that the public has trust and confidence in the healthcare that is provided, that they are listened to and that their concerns are responded to. However, from the written and oral evidence that we received, and from the previous report, we can see that that is not the case. That has to be remedied, and having a commissioner in place to pull all of that together is one remedy for that.

The committee considered the evidence that was put in front of it, and the overwhelming evidence from stakeholder and stakeholder groups was that they supported the commissioner. In terms of exploration of other models, I can again write to this committee if that was explored more widely. As I said, I was not the convener of the Health, Social Care and Sport Committee at the time that it took evidence, so I certainly was not privy to any of the private discussions. I have seen only the public papers and the report recommending that the general principles of that bill be approved.

Thank you very much, convener, for inviting me along this morning. I apologise for not being able to be there in person.

It is important to note where the idea of a patient safety commissioner came from: it came from the United Kingdom-wide independent medicines and medical devices safety review, more commonly known as the Cumberlege review, which looked at the issues around mesh, sodium valproate and Primodos. It highlighted that patients did not feel that they had been listened to as well as the length of time that it took for their problems to be acknowledged.

One of the review’s nine recommendations was that a patient safety commissioner be appointed as an independent public leader with a statutory responsibility, to champion listening to patients, promoting service users’ perspectives and seeking improvements to patient safety with regard to the use of medicines and medical devices. As a direct consequence, the Patient Safety Commissioner for England and Wales was appointed in September 2022.

I was not a member of the committee when it took evidence on the Patient Safety Commissioner for Scotland Bill, but I know that it had the advantage of being able to seek guidance and information from the commissioner for England and Wales. The Scottish Government also gave a commitment to implementing all the recommendations from the review, including the creation of a patient safety commissioner for Scotland, which was done via primary legislation.

It is fair to acknowledge that, in Scotland, the regulatory landscape around patient safety was already complex prior to the bill. Some of the issues that Audrey Nicoll has highlighted were also considered by my committee, but members felt that the role had the potential to improve patient safety across health services in Scotland and ultimately supported the bill’s general principles at stage 1.

You are absolutely right. We have to ensure that positive outcomes come from the creation of any commissioner. I welcome this inquiry, given the number of commissioners and proposed commissioners. There has to be evaluation.

The patient safety commissioner will lay before Parliament a report annually. That does not preclude them from doing that in relation to other investigations that they carry out or other areas that they investigate.

It is really important that we ensure that, with all commissioners, there is value for money and that the roles that they carry out are not duplicated, there is not unnecessary overlap, and there is collaboration between them so that resources are used effectively. If commissioners have good working relationships, the duplication of work should be reduced.

In case I strayed into any issues this morning that might raise this as a concern, I refer members to my entry in the register of members’ interests, which states that I hold an NHS Greater Glasgow and Clyde bank staff nurse contract. I have nothing else to add, and I thank you for the opportunity to contribute today.

I will come at the question from a slightly different angle, given the origins of the proposals for a patient safety commissioner. The issues that were raised were from the 1960s, the 1970s, the 1980s and up to the 2000s. We are looking at a different landscape, and those were the foundations for the need for a patient safety commissioner. In written and oral evidence, people consistently said that patients’ voices were not being heard, with patients perhaps feeling that they were not being believed. People wanted the commissioner to be an advocate for those voices and to raise concerns about issues relating to medication side effects, medication devices and so on. In Scotland, the patient safety commissioner’s remit will be wider than the remit of the commissioner in England and Wales.

Deprivation and austerity will play a part, but the issues that have resulted in the patient safety commissioner have a much deeper history.