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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.

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.