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I would say that the need is well established. We have shown and demonstrated that such a role is currently absent and that it would help to prevent harm.

The types of harm that I would envisage the patient safety commissioner picking up on and preventing are not only devastating for patients but often very costly to the system. Therefore, I think that this is a reasonable investment to prevent harm. We have established that the current system is not managing to prevent harm in the way that we would have hoped that it would.

Absolutely. That will be part of the dialogue when that person is in post. We will undoubtedly be interested to hear what the commissioner thinks that their priorities are and how they intend to measure the outcomes and demonstrate robustly to Parliament and to other interested parties that they are doing the job that we intended them to do.

Yes, absolutely—I think that that is clear.

It is not that the commissioner will never do investigations; we have given them some investigative powers because we think that there may be occasions on which it would be useful for them to do that. By and large, however, other organisations will do that work.

Nevertheless, I think that listening to individuals is important. Awareness of the big tragedies that I have mentioned a couple of times this morning started with one patient speaking up and then grew. It is important that the patient safety commissioner is able to listen to patients and pick up on the noise from the system. It seems to me that we do not currently have an organisation that is able to do that.

When such issues have arisen before, that has occurred as the result of an individual situation—nobody has been able to put it together. The patient safety commissioner will be able to put together that picture and listen to the noise from the system.

I am bound to say that I personally feel passionately about the area, not simply because of my role as the minister for public health and women’s health but because of my professional background. I can see the need for such a role. I can see the need for somebody who is independent of the systems that already exist. There is a powerful need for the role and for the commissioner to be accountable to Parliament. I will not comment on all the other commissioners, but I think that there is an undeniable need for a patient safety commissioner.

On the concerns about the budget, that is a worry for the Scottish Parliamentary Corporate Body. One of the reasons for starting small and trying to be agile is to allay the concerns about its taking on a huge resource and to ensure that the Parliament will not have to become a regulatory body with a vast web of actions throughout the NHS. The role is a specific one that is very focused on the voice of the patient and patient safety, and we will see how it evolves, with careful evaluation as time goes on.

That is a reasonable aim for us to have, and if it is not clearly spelled out or well understood, it is probably worth reflecting on that and seeing whether we can refine it any further. Will Wood might want to say something on that. It certainly seems reasonable that if there are concerns that it is not clear how the commissioner and organisations would collaborate, we would want to make sure that the bill is clear.

That is reasonable. That may be something that the commissioner asks health boards to provide evidence on or try to improve the system around.

Do either of my colleagues want to come in on that, if my earlier answer was not sufficient?

It is clear, particularly from the Cumberlege review but also from experiences prior to that, that the patient’s voice has not been heard. There are some very obvious examples of that, such as the mesh-injured women, the families injured by sodium valproate and those who were given infected blood. Those people made representations for many years as they tried to have their voices heard, but were not heard by the system. So, there is clearly a role for a commissioner who will ensure that the patient’s voice is heard and that when concerns, particularly systemic ones, are raised, those are picked up and acted on.

That will give all of us confidence in safety. There is lots of work going on across the NHS on safety and on quality improvement, but having a commissioner will give us all confidence that patients’ concerns are being heard and acted on.

There will be a strong role for Parliament in scrutinising what the commissioner does. As I said in my opening statement, patients have been clear that they want a role that is distinct from the NHS and from Government. They want someone other than Government to scrutinise what is happening in the NHS. There will be a strong role for Parliament and therefore for the people of Scotland.

We can look at other commissioner roles to see how they function. A similar role, with a slightly narrower remit, is also being developed in England and we will look at how that works, in order to find the best way forward for our patient safety commissioner in Scotland.

A lot of work is going on in Government and in the NHS to establish safe staffing levels. There is work to ensure that our workforce is developing sustainably.

That issue is slightly separate from the work of the patient safety commissioner. Staffing can be a contributory factor to safety. However, in the examples that I gave in my earlier response—the mesh-injured women, the valproate-injured families and those who were given infected blood—safe staffing was not an issue; the problem was that those injuries happened and the system did not listen to people. The primary function of the safety commissioner will be to ensure that the patient’s voice and concerns are heard.

My colleagues may want to say more about safe staffing.