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I hope so. There are pockets of brilliant practice all over Scotland in many areas. One of our challenges is making sure that that practice is the same all over Scotland and making sure that the same quality and safety focus happens everywhere. That would be a good outcome, but I do not see it as being a primary one, because, remember, this role is absolutely focused on the voice of the patient. Where the commissioner finds good practice, that might be one way of improving the situation if they found a safety concern in one part of the country.

That actually illustrates just why it is a valuable thing to develop the role of a patient safety commissioner. It is a complex landscape with lots of people working in the area. I have personal experience of working with the Scottish patient safety programme when I was a clinician. That has a very different role to the ombudsman, but patients do not necessarily understand that complex landscape.

The role of the commissioner will be to help patients to navigate that complex landscape and make sure that their story is heard by the right people who can act on it. There have been enough incidents where that has not happened to need to recognise that. Patient safety is of vital importance: first do no harm.

Patient safety is absolutely crucial, so it is understandable that there are quite so many systems designed to ensure that care is delivered in a safe way, and to investigate when things go wrong. That is perfectly reasonable, but patients find it quite bewildering and disempowering. That is the bit that we want to make sure is not the case going forward. I and all of you on the committee will have heard stories directly from patients who have been harmed by the system and we want to make sure that that does not happen again.

We want to learn the lessons each time. Therefore, the role of the patient safety commissioner is very much unlike that of the GMC and other professional regulators, who will sometimes take action. The focus of the patient safety commissioner will be different. That role will be very much about establishing what happened and trying to help the system to learn from that, rather than punishing or taking action against individuals within the system.

The main focus of the patient safety commissioner will need to be patient safety. I think that what you are describing is perhaps systems lacking patient-centredness. I am very passionate that our NHS should be person centred. Sometimes, however, we find that people are having to travel long distances, past other services that they could use. That does not make sense to them, but it does not necessarily introduce a safety risk. Our patient safety commissioner will have to be very focused on safety. It is fundamental to the role.

There are perhaps other ways that we can ensure that there is patient-centredness in the system. All the work that happened on realistic medicine, which is essentially about getting high-quality person-centred care in the right place at the right time, with the patient being a sharer of decision making in their care, is absolutely what we are striving to deliver in our NHS.

That is certainly something that the committee can consider. It is a really complex landscape, which is almost impossible for patients to understand—it is quite hard even for health professionals and those who work in the system to understand it. There is an issue around making all the slightly different organisations that have a keen interest in safety work together to get the best possible outcome. We are always open to the idea of going back to look at whether we have achieved our aim and whether legislation is working as intended and delivering the best possible results. There is always the opportunity to look again at that.

Certainly. I would expect the committee to be involved in how the role develops, and to meet and speak to the commissioner. The Government will undoubtedly be interested in what the commissioner has to say and their early thoughts on how the role should develop, the remit of the role and the priorities that they want to set. I think that we will find that, as the role evolves, each commissioner will bring a different flavour. However, it is important that the Scottish people hold that commissioner to account.

Undoubtedly. We will be watching. I imagine that our commissioner will be looking very closely at what is happening in England and will work very closely with that commissioner to see exactly how they are working and how that role is developing. Our commissioner will have a slightly broader remit than the commissioner for England, who is focused largely on medicines. Is that right?

I absolutely appreciate the challenge and the tension there. It will be tricky to get that right. However, our ambition should be to be as broad as possible to ensure that we can deal with all of the concerns that patients raise. As I have said before, it is a complex landscape with many people operating in different ways. It is really important to have a patient safety commissioner who will help to draw all the information together.

I do not think that it will be the norm for the patient safety commissioner to have to carry out inquiries themselves, so I do not think that there will be duplication of effort. I would still expect bodies such as HIS or the ombudsman to carry out inquiries when issues are raised with them. However, I would expect the commissioner to be looking at the evidence that those organisations find and pull it together, in order to help patients navigate that complex landscape and to pick up on systemic issues given that opportunities to identify those have been missed in the past.

I guess there is the tension; are they patients when they are in social care? The patient safety commissioner will be very focused on patient safety.

As social care develops, people are looking very carefully at how to build in some of the systems that are focused on safety that are used in the NHS. At the moment, however, the focus of the remit should be on healthcare. It should not cover social care. If it was to be broadened to cover social care, the role might well be too broad initially and we could lose the essence of what the patient safety commissioner is about. That would be the concern.

You are right about care and compassion. We brought in a duty of candour in 2018. That duty does what it says on the tin. It is about trying to remove the defensiveness and hostility that sometimes comes across when patients are trying hard to understand what has happened and why outcomes have been the way that they are. We very much want the role of the patient safety commissioner to be on inquiry and helping the system to learn. We want them to look honestly and openly at what has occurred and try to learn the lessons compassionately to ensure that that does not happen to patients in the future. It is about care and compassion. There is probably also a role for helping people who have been bereaved to understand what has gone on. I can see that that would be a powerful role for the patient safety commissioner.

I am bound to say that I think that we have got the balance right. I can understand where Paul O’Kane’s questions are coming from, as it is difficult to get that right. However, as I have mentioned, a key point is that we do not want it to become another organisation that is looking to apportion blame. That is the last thing that we want. The two absolutely key things that we want from the patient safety commissioner role is for the patient’s voice to be heard and for the system to learn lessons. Those are really key.

I think that there are enough powers to make sure that the commissioner can inquire and take action, that Government has to listen to them and that there is an accountability to Parliament. However, as with any new role, there will be lessons learned and evolution as we go along.