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There will be a conversation as we go on. I have already mentioned the Scottish patient safety programme, which uses a really effective quality improvement methodology in the NHS to empower coalface clinicians to improve the system in which they work. That is such an effective method of improving patient safety that I think we would be crazy if we did not use it in all sorts of other systems.

When I was Minister for Children and Young People, we started to use similar methodology in care of children and young people. As we build a new national care service, we need to think about safety and quality and how to build that in with the bricks so that the system can improve itself continuously. However, I am not sure that the role of the patient safety commissioner applies to social care at the moment because it is essentially about ensuring that when people are harmed and when the system is harming people, their voices are heard.

When we asked that question, the answer that came loud and clear from people who had been affected by safety issues was that they wanted the role to be independent, and that a different organisation that was either part of the NHS or part of Government would not cut it. What would cut it is someone who is there primarily for them and is accountable to the people of Scotland. I can absolutely understand that. I can see the pros and cons of all sides, but I agree about the importance of independence from the Government and from the NHS itself. As MSPs, we will all have mailboxes full of people saying, “They’re marking their own homework,” and who do not have trust in the system.

It is important that people who come to the patient safety commissioner can trust and have confidence in the process. That independence from both the Government and the NHS will help that.

We think so. We think that the budget is appropriate for the commissioner’s proposed remit. The commissioner will be an advocate for patient safety and the patient voice, and that role will be underpinned by formal information-gathering powers. We are not intending them to be a new regulator or to have a primarily investigative role. We would say that, largely, other organisations will do the investigations and the patient safety commissioner will work collaboratively with them. We developed the costs that are set out in the financial memorandum on that basis.

As Parliament scrutinises the commissioner’s work, it will take decisions on whether the remit of the role and its accompanying funding need to change.

It is absolutely fundamental. The idea is that Parliament will scrutinise the reports that the commissioner produces. Such reports will, of course, be of interest to the Government and there will be action points for us to take note of, but the intention is that Parliament will scrutinise the information that the commissioner produces. That is much the same in relation to the children’s commissioner; when I worked as the Minister for Children and Young People, the children’s commissioner was very clear about his role: he was appointed by Parliament and he was accountable to Parliament. The patient safety commissioner will be independent from the Government—that is what patients are asking for.

I am open to proposals on that issue, and as the role beds in, it might be an area that evolves, if it becomes a challenge for the patient safety commissioner to ensure that organisations take account of what the commissioner is saying, report accurately and take achievable actions. Therefore, I am open to the idea that more might be required. As introduced, the bill allows for dialogue on the best way forward. There is potential for collegiate working, which is generally the best way to enable such openness and learning. However, I understand that there is concern.

I genuinely believe that a patient safety commissioner would add something to the landscape. There are lots of people and organisations that are able to take action—including punitive action—and to hold organisations to account, but I think that the patient safety commissioner offers something different. The big tragedies when patients’ voices were not listened to, their stories were not heard and action was not taken soon enough are an example of the kind of systemic issues that I am absolutely certain that the patient safety commissioner will be able to pick up on.

I am open to that. The Patient Safety Commissioner for England is right: we should start small and be agile with the role. It is a brand-new role and we need to think carefully about how it evolves.

I think that we have gone for about the same size of budget in Scotland as the UK Government did for the role in England, and there will be similar numbers working in the team, yet there are 10 times as many people living in England. That reflects our slightly broader remit.

I am certain that we are adequately resourcing the role as it starts out. As we have all said, the role is likely to evolve and we might need to look at that in the future. However, I am certain that we are starting out in the right place.

That is certainly possible. I am somebody who loves data. Data does not lie, so if you can get your analysis correct, it will tell you a lot about what is going on.

I am not closed to the idea that there may need to be a role for somebody with data analysis expertise. However, in my view, we already have the best data analysts in Scotland in Healthcare Improvement Scotland, and we need to take care not to replicate roles. We need to understand how the organisations that might already be looking into issues are able to gather and analyse data and come up with understanding and insights into how situations evolve. I am not sure that we need another organisation with that capacity checking the numbers from those organisations.

As I said, however, I am not totally closed to the idea. The role will evolve as time goes on, and there is hardly a role in any part of Government—or in public life, because this role will be independent from Government—that would not benefit from a bit of data analysis.

However, the mesh scandal has changed the way that medical devices are monitored and information is gathered about them, so there are much tighter and better systems in place. On medication, the yellow card system will pick up signals, but there was not the same level of robustness in picking up on issues related to medical devices.

I am the minister for women’s health, and there a reason why that post exists. Women face health inequalities because of our inequality in power, status and wealth. Many of the issues that we are talking about are because women are not listened to when we come forward with concerns. We absolutely need to recognise that that is the case and make sure that the system is picking up on that. A great deal of work has been put in to improve the post-surveillance of devices once they have been implanted.

You touched on something in your line of questioning that troubles me about how the system currently listens to people raising concerns, who we find easy to ignore and dismiss and who we pay attention to. The patient safety commissioner role will undoubtedly be key to making that more equitable.

There are powers to enforce in other parts of the system. The professional regulatory bodies can take action and the police can take action if there is a police concern. A number of different bodies other than the commissioner can ensure that enforcement occurs, should it be needed. The key point in relation to the commissioner is for the system to learn lessons. We have a responsibility there.

If we think of the big issues that have been raised with us—for example, by mesh-injured women, the valproate families and infected blood people—those people were asking for a long time for their story to be heard and for inquiries and explanations to be made. They did not necessarily want blame to be apportioned; in fact, the infected blood people were very keen simply to have an apology and an acknowledgement. Ensuring that the system learns, and that issues are picked up and dealt with, is really very powerful, because we can see so many examples of where that has not happened in the past.

I think that people should have confidence that that work is on-going. It cannot happen overnight, and nobody has a magic wand, but it is on-going. The thing to try to communicate is that we are in a very different place from where we were at the start of the pandemic, in that we have a really effective vaccine. I am a pharmacist. It is perhaps a little hard for people to understand that, despite the fact that the vaccine does not prevent transmission, it is really effective. It does not prevent you from catching the illness but it has taken away the death and serious illness. We are not seeing the level of hospitalisation that we had, and we are certainly not seeing the level of mortality that we had. The vaccine is incredibly effective and has transformed the situation.

The people who are not responding well to the vaccine are largely people whose immune systems do not make antibodies when they are vaccinated. That is why there is the evolution in the groups who are particularly at risk. It is why people who we thought were at risk pre-vaccine, such as people with COPD, are less likely to be in the high-risk groups now, because their immune systems work well. People’s immune systems are less effective at 81 years old, but they are not immunosuppressed in the same way as people who have had organ transplants are, for example.

The other tool that we have in the box that has transformed things is antiviral medications. People who are eligible for those medications know who they are and how to get them. Wherever those people are in the country, they know that there is information on NHS Inform. They can find the phone number of their health board and telephone if they test positive. As long as they are in that eligible group and within the first five days of illness, they can get the antiviral drugs. Even for the people for whom we know the vaccine is less effective, we have treatments that can reduce the risks from the virus.

We are not in the same situation that we were in before, and none of us has forgotten about the people who are severely impacted. One challenge is communicating to that particular group how important it is for them to protect themselves and keep safe. Using words such as “vulnerable” makes people feel ill and vulnerable, but it had to be communicated in that way—there is a tension. When I used to work in mental health, I had to work hard with the patients whom I worked with to help them to understand that they were ill. Once they understood that they were ill, they were motivated to take their medication.

It is a good and healthy thing if we feel healthy, and the understanding that you are not healthy, or that you are at risk or vulnerable, has quite a profound impact on people. We find that people are struggling a little to recover from that feeling of vulnerability, which is perfectly understandable. I think that nearly all of us—every human being in Scotland—has felt more vulnerable, and it is hard to remind ourselves that the situation today is very different from the situation that we faced in March 2020.