 driver should cast their votes now. The vote is closed. The result of the vote on amendment 10 in the name of Jackie Baillie is ... Sorry. I have all sorts of problems, so it's now tell me today the vote is closed, but it did not let me vote, and I would have voted no. We can record that, but I encourage members to let us know as soon as possible, where Y dduch i dynol. Rŵr yn gwêl o'n gyflym allyf, yn y cyfan oedd 47, r Clone Minister, 50, 59 yn gwneud hwn i ddechrau defnyddio'r tyfnwyr. Ond nid dim ond, mae'r cyffin iawn yn cyfan o'r cyfan o'r cyfan i ddechrau jocgol, ac rôl yr Cwla Thysglaoedd A11 yn nów Tess White, a rwy'n gwybod i'r cyfan i ddechrau a'r cyfan o'r cyfan i ddechrau jocglaoedd A11. MIrdd, Rŵr Oedon, ryef o'n gyffin iawn ar hynny yn cyffin iawn i ddechrau of engaging with NHS staff to seek their views on patient safety concerns. I lodged a similar amendment at stage 2, the Minister will remember, which placed a duty on the commissioner to seek the views of NHS staff in relation to patient safety. In her response at the time, the minister raised concerns that the commissioner is, and I quote, already empowered to do so, and that such an approach could detract from patients voices. As such, I've softened the approach at stage 3 to focus on how the commissioner can engage with NHS staff rather than creating a requirement to do so. I want to revisit this amendment because in the intervening period between stage 2 and stage 3, former neonatal nurse Lucy Letby's trial reached its horrifying conclusion. This deeply distressing case has shocked the public and shaken the foundations of the healthcare system. Lessons can and must be learned by healthcare providers, especially when other NHS staff raised an alarm but were overruled by their managers. There are existing recourses for NHS staff to raise red flags about safety, but as the Royal College of Nursing has argued, NHS staff don't always feel these concerns are being heard or addressed, as in Lucy Letby's case. The minister suggested that the commissioner hearing from NHS staff could cut across patients voices, but I would counter that in many cases, these processes could be concurrent and complementary. It would, of course, be at the discretion of the commissioner to decide how to amplify the voice of the patient while engaging with NHS staff. The amendment is designed to facilitate that process. As I laid out during my discussion with Tess White at stage 2 and further when we met in September, I don't support the amendment. While I agree that, as part of investigating and monitoring potential patient safety issues, the commissioner will wish to hear from staff, there is nothing in the bill that precludes them from doing so. Placing a requirement on the commissioner by way of a principle that the commissioner will seek the views of staff risks cutting across the focus on hearing and amplifying the patient voice. Separate channels and procedures are already in place through which NHS staff can raise concerns about patient safety, including whistleblowing, and I also wish to avoid the commissioner cutting across those. Thank you. I now call on Tess White to wind up the debate. Press or withdraw amendment 11. I press it, Presiding Officer, and I'm deeply disappointed that the minister hasn't considered the case of Lucy Letby and the recommendations by the RCN. Therefore, I press. I recognize White. The question is that amendment 11 be agreed to. Are we all agreed? No. Parliament's not agreed. There'll be a division and members should cast their votes now. That's the vote closed. This time, and last time, but this isn't working and I would have voted no. Thank you. Thank you, Mr Kidd. I'll make sure that vote is recorded. The result of the vote on amendment 11 in the name of Tess White is yes, 48, no, 50. There were no abstentions. The amendment is therefore not agreed. We now move to group 3 charter. I call amendment 3 in the name of Jackie Bailey, grouped with amendments 3A and 4. Jackie Bailey, to move amendments 3 and 3A and speak to all the amendments in the group. Ms Bailey. Thank you, Presiding Officer. I wish to speak to and move amendments 3, 3A and 4, all in my name, and I will first cover 3A and 3. Amendment 3 sets out in the bill the requirement for the commissioner to produce a charter for the benefit of patients and their representatives and ensure that there is consultation on the charter, including with patients, and that it takes their views into account. I am grateful to Ms Minto and the Government for carefully considering the issues that I have raised at stages 1 and 2 and for working with me to ensure that provision for a charter is included in the bill. Amendment 3 will place on the commissioner a duty to produce a charter that would set out what the commissioner considers to be best practice and appropriate standards expected of all healthcare providers, particularly in relation to the importance of engaging with patients and families. The commissioner would be required to take the expectations set out in the charter into account when considering a healthcare provider's handling of any incident. Critically, the charter will send an important signal to patients and families and to healthcare providers that the requirement to act is on NHS boards and other healthcare providers and not on patients and families. Those who have been harmed or bereaved should not have to push for answers from healthcare providers, nor is it acceptable that in times of pain or grief, patients, families and loved ones should have to struggle to have their experiences acknowledged and their voices heard. That is why it is so important that this amendment makes particular reference to engagement with patients and families. Engagement means more than simply passing on information, though that is important. It is vitally important to me, as I know it is, to all of us in this chamber, that providers of healthcare listen to and engage meaningfully with families and their representatives about their experiences, that they engage in a two-way dialogue with patients and families rather than simply deliver information and that they use the insights gained from that engagement to strengthen patient safety and continuously improve their services so that mistakes are not repeated and harm is prevented. I turn now to amendment 3A, which is in addition to amendment 3. That was not agreed with the minister, but on reflection I thought that it was sensible to add. It is important that the commissioner has available to them powers of accountability in ensuring that private companies that supply medicines and medical devices are captured in the category of person required to provide information in an investigation. Amendment 3A would allow the commissioner to prepare and publish a report on the compliance of a healthcare provider with the patient safety charter in so far as such compliance impacts on the safety of healthcare. This is a further attempt to ensure transparency and accountability is actually hardwired into the bill. Amendment 3A does not seek to instruct or bind the commissioner but will provide the option to carry out a report where they feel it would be necessary, and I therefore urge members to support this amendment. Let me touch briefly on amendment 4. The reasons for this amendment have already been set out, so I would urge members to vote for amendment 3, amendment 3A and amendment 4, which will ensure that the commissioner consults on the charter with patients, members of the advisory group and others in the same way that they consult on the principles and strategic plan. I move amendment 3A in my name. I would like to thank Jackie Baillie for introducing amendments 3 and 4. Patient safety is an issue that she is deeply committed to and has campaigned on for many years. I am grateful for her continued work within and outwith this Parliament to ensure that those who have suffered harm and their loved ones remain at the heart of this bill. I am delighted that Jackie Baillie and I have been able to work together to find common ground and to bring these important amendments to stage 3. Together, amendments 3 and 4 will place on the commissioner a duty to produce a charter that will set out what the commissioner considers to be best practice and appropriate standards expected of all healthcare providers. The commissioner would be required to take the expectation set out in the charter into account when considering a healthcare provider's handling of any incident. The charter will send a powerful signal to healthcare providers that the requirement to act is on them and not on patients and families. I share Jackie Baillie's determination that those who have been harmed or bereaved should not have to push for answers from healthcare providers. Those amendments will underscore the need for meaningful engagement with patients and families, and that means much more than just the passing on of information, although that in itself is important. The commissioner will be able to use the charter to set out in particular what is expected of healthcare providers when engaging with patients and families. That emphasises the importance of healthcare providers listening carefully to what patients and families are saying and using the insights gained from that dialogue to strengthen patient safety and continuously improve their services. Jackie Baillie has spoken powerfully, and we have heard her. I know that we share the same goal, and I am very grateful that we have been able to work together to get here. I urge members to support amendments 3 and 4. However, I cannot support amendment 3A, because, after very careful consideration, I believe that amendment 3, which Jackie Baillie has brought forward and which I fully support, is more effective without this further amendment. Amendment 3 already provides that the commissioner is required to look at healthcare providers actions against the expectations set out in the charter when considering how the provider has handled an incident. It does so in stronger terms, setting out that the commissioner must take the expectations set out in the charter into account when considering a healthcare provider's handling of an incident. We can expect that the commissioner will consider the extent to which healthcare providers have met those expectations of standards and good practice and cover them in their reports of any investigation. Amendment 3A is weaker by comparison, stating only that the commissioner may prepare and publish a report on the compliance of a healthcare provider with the charter, so far as it impacts on the safety of healthcare. The second reason I cannot support amendment 3A is more closely connected with our shared aim of ensuring that healthcare providers engage meaningfully with patients and their representatives. The amendment states that reports could only cover compliance with the charter in so far as there has been an impact on the safety of healthcare. Arguably, that would include scrutiny of the quality of a healthcare provider's engagement with patients and families in the report. This is because engagement is a step removed from the actual provision of healthcare where safety issues may arise. This is something that is covered by amendment 3 and which is something that Jackie Baillie and I both recognise to be an important element of the commissioner's role. I do not see the merit of a further amendment that may not be relied upon to allow the commissioner to report on issues of poor communication and inadequate engagement. I therefore urge members not to support amendment 3A on the basis that its broad aims are achieved more effectively in Jackie Baillie's amendment 3. I look forward in future to being talked about in the terms that the minister has spoken about me and very warm they are indeed, so I welcome the engagement. You would think then if she thought so highly of me, she would think highly of my amendments too, but I live for that possibility another day, so let me join with her in warmly welcoming the support for amendments 3 and 4, but I cannot help but say that without the previous amendments, this is a watered down version of Millie's law and whilst it is absolutely a move in the right direction, it will not on its own reset the balance between patients, their families and health board administrators. I have seen health board administrators, not all of them, but many of them who are already defensive, who are already in denial, health board administrators who dissemble rather than admit fault to patients, so simply passing this bill will not resolve that overnight. Can I say in relation to amendment 3A, many of us in this chamber and I am looking at Jackson Carlaw in particular campaigned, witnessed, but campaigned for women that were caught up in the transvaginal mesh scandal. Very few of us will forget some of the stories we were told. The Patient Safety Commissioner Bill has its origins because a UK Government decided that patients' voices need to be better heard and they cited cases of women with transvaginal mesh. Now, the makers of that transvaginal mesh haven't really been held to account, so the purpose of the amendment is to make sure that they are included in any consideration and whilst I hear what the minister says, this amendment puts that beyond doubt, it's not optional, it is bait in to the bill. So whilst I welcome the SNP's support for amendments 3 and 4, I regret that it's not far enough in terms of the overall package and I do hope that members across the chamber will pause and reflect on our experience of the women who have suffered as a result of mesh complications and past amendment 3A. Thank you, Ms Bailey. The question is that amendment 3A be agreed. Are we all agreed? Parliament is not agreed. There will be a division and members should cast their votes now. The vote is closed. The result of the vote on amendment number 3A in the name of Jackie Bailey is yes, 49, no, 58. There were no abstentions. The amendment is therefore not agreed. I call on Jackie Bailey to press a withdrawal. Amendment 3 is bill. Thank you. The question is that amendment 3 be agreed. Are we all agreed? Parliament is agreed. We move on to group 4, duty to consult, I call amendment 12, in the name of Tess White, group with amendment 13, Tess White to move amendment 12 and speak to all amendments in the group. Ms White. Thank you, Presiding Officer. Amendment 12 would create a duty for the commissioner to consult with the Health, Social Care and Sport Committee or whichever parliamentary committee is concerned with patient safety on both the principles and the strategic plan. This was another amendment at stage 2 that I brought back at stage 3 and I thank the minister for the opportunity to discuss this with her earlier this month. At the time the minister shared with me her concerns that this amendment would compromise the independence of the commissioner by specifying that they must consult with parliamentary committees. She added that the role is first and foremost for patients and their representatives as the minister has said earlier today. The commissioner must have the freedom to define their own principles however I do not believe that the independence of the commissioner precludes them from consulting with parliamentary committees especially when these can and do act as the bridge between the public and policymaking. The health committee is uniquely placed to understand the healthcare system in Scotland and this can help to support the work of the commissioner. More widely MSPs advocate regularly for patients with health boards and provide assistance in complex cases where a patient's safety might have been jeopardised. Surgical mesh is a case in point. The Scottish Conservatives will support Paul Sweeney's amendment 13 which he's brought back from stage 2. The Health, Social Care and Sport Committee's stage 1 report called for the principles to include an explicit commitment to listening to and supporting underrepresented voices, especially in the context of women who have been badly let down by the healthcare system. The Cumberlage report made for difficult and distressing reading in this regard. Therefore I move amendment 12 in my name. Thank you. Thank you Ms White. I now call Paul Sweeney to speak to amendment 13 and other amendments in the group. Mr Sweeney. Thank you Deputy Prime Minister. I rise to speak to amendment 13 in my name and thank Ms White for indicating that her party will be supporting this amendment. I was keen at stage 2 to ensure that the work of the commissioner took into account the voices and concerns of those groups of people who have perhaps not always been listened to by the healthcare establishment in the way that they should have been. As I highlighted at stage 2, the stage 1 evidence heard at committee about the valparate and mesh patient safety issues which disproportionately affected women were particularly striking. Dr Aaron Chopra of the Mental Welfare Commission for Scotland gave evidence at stage 1 that despite marginalised groups being predominantly affected by patient safety events, people from groups or communities such as ethnic minorities are not well represented in patient safety data. In that regard, I am grateful to the minister for offering to work with me on my amendment to address those concerns at stage 3. Amendment 13 in my name therefore reflects this collaborative work and would require the commissioner to give particular consideration to groups whose needs are, in the commissioner's opinion, underrepresented or given insufficient weight in discourses around healthcare when consulting on the formulation of the principles which are to inform how the commissioner carries out their functions. The strategic plan sets the course and focus of the commissioner's work in order to redress the clear imbalance. I move amendment 13 in my name. Tess White, as she mentioned, and I discussed the intention behind amendment 12 when we met on 4 September. I explained then that I do not believe that it adds value to the role of the commissioner. The commissioner's role is first and foremost for patients and their representatives. The current wording of the bill already provides for the commissioner to consult and engage widely on the draft statement of principles and strategic plan. In doing that, the commissioner is to have regard to the importance of those documents reflecting patients' concerns. If considered appropriate, consultees may include committees of the Scottish Parliament. Of course, I recognise that committee members have a deep understanding of the healthcare system, and that is representatives of their constituents. They may also hear of experiences from patients and families related to safety, both of which could be helpful to the work of the commissioner. The commissioner's consultation powers are already set out or broad enough to consult with those that the commissioner deems appropriate. It is also worth noting that a duty to consult with a relevant committee is not placed on other commissioners in Scotland. I remain strongly committed to the independence of the commissioner, which was a clear message during the bill's consultation, and I do not want to compromise that by specifying that they must, in the course of their work, consult with specific parliamentary committees. It is for those reasons that I do not support amendment 12. I do, however, support Paul Sweeney's amendment 13 on ensuring that underrepresented groups are heard. A similar amendment was tabled at stage 2, which I supported in principle. Since then, I am pleased to have been able to work with Paul Sweeney on the wording of this amendment. I am content that that will now have the intended effect, which we all agree on, of ensuring that the commissioner gives particular consideration to groups whose perspectives are often less heard or not given sufficient weight in discourse on healthcare. Thank you, Presiding Officer. I will press this point. I am deeply disappointed that the minister has not heard what I have said. The parliamentary committees have huge resources at their disposal for research, holding inquiries, and I think that this is a big mistake. I do hope that, if this amendment is rejected, I do hope that, when the commissioner is in place, he or she will actually use this facility to his or her advantage for patient safety. I press this amendment. Thank you. The question is that amendment 12 be agreed to. Are we all agreed? Parliament is not agreed. There will be a division and members should cast their votes now. The vote is closed. The result of the vote on amendment number 12 in the name of Tess White is yes, 48. No, 58. There were no abstentions. The amendment is therefore not agreed. I call the amendment 13 in the name of Paul Sweeney, already debated with amendment 12. Paul Sweeney to move or not move. The question is that amendment 13 be agreed to. Are we all agreed? Parliament is agreed. I call amendment 4 in the name of Jackie Baillie, already debated with amendment 3. Jackie Baillie to move or not move. The question is that amendment 4 be agreed to. Are we all agreed? Parliament is agreed to be moved to group 4, special report. I call amendment 14 in the name of Paul Sweeney, in a group of its own. Paul Sweeney to move and speak to amendment 14. I rise to speak to amendment 14 in my name. My proposed amendment would give the commissioner the power to create a special report in the event that it appears that recommendations made in the initial formal investigation report have not been or will not be implemented. A special report would be sent to the persons or organisations who the formal investigation report was sent to in the first instance and a copy would also be laid before the Scottish Parliament. Further, the report can also be made public if the commissioner considers this to be appropriate. Bodies cannot be left to mark their own homework on patient safety. There must be an option to escalate this if recommendations are dismissed or ignored. That would seem obvious to me and other members in this chamber. All we need to do is listen to those with experience. Marie Lyon from the Association for Children Damaged by Hormone Pregnancy told the health committee that up to now people have tended to get away with it. There has never been accountability and there has never been consequences. At stage 2, the minister suggested that the proposed amendment was superfluous as the bill as drafted allows for the commissioner to publish information on implementation, but I would argue that the publishing of information and the producing of a special report are two different things. Deputy Presiding Officer, this amendment is not a radical one. It seeks to bring the powers of the patient safety commissioner broadly in line with that of the Scottish Public Service Ombudsman, who under section 16 of the Scottish Public Services Ombudsman Act 2002 can lay a special report before Parliament if, following the making of a formal report, it appears to the ombudsman that the injustice of hardship has not been or will not be remedied. The minister also cited at stage 2 her concerns that the commissioner could be at risk of defamation claims should a special report be created about recommendations that they believe would not be implemented. However, the language of this amendment is in line with that in the Scottish Public Service Ombudsman Act. I would therefore note that, further under section 18 of the patient safety commissioner bill as drafted, there are a number of protections from actions of defamation, including any statement in the commissioner's report on an investigation has absolute privilege and that any other statement made by the commissioner has qualified privilege. In committee evidence, patient safety groups were absolutely clear that there must be accountability and the option to escalate. I move the amendment in my name and urge all members and the minister to please support this, to give the commissioner the necessary teeth and capacity to ensure that recommendations are implemented. Thank you. I do not support this amendment, which would allow the commissioner to make a special report on any recommendations from a previous report they feel have not been or will not be implemented. As I said at stage 2, the bill expressly gives the commissioner power to publish information on a person's response to recommendations that the commissioner has made in an investigation report or indeed any failure to respond. This amendment is therefore unnecessary. At stage 2, I noted my concern that requiring the commissioner to lay before Parliament a report about actions that it appears to the commissioner will not be implemented could leave them open to actions of defamation as it anticipates or speculates about wrongdoing by others. Therefore, I ask members not to vote for amendment 14. I invite Paul Sweeney to wind up the press of a straw amendment 14. It is very disappointing, Deputy Presiding Officer, that the minister, having listened to the points that she is trying to make to clarify this proposed amendment, that she is not minded to accept it. It is clear that simply allowing the commissioner to publish information on implementation is insufficient and that has been broadly recognised. I hear the point that she is trying to make. I have considered her position, but I do not think that it is sufficient. I think that other stakeholders and other groups who have communicated with us on the process of this bill's passage through Parliament are in agreement with that. That is why I have brought this amendment back at stage 3, and I am minded to continue to press it. The question is that amendment 14 be agreed to. Are we all agreed? We are not agreed. There will be a division and members who cast their votes now. Amendment 14, in the name of Paul Sweeney, is yes, 48, no, 58. There were no abstentions. The amendment is therefore not agreed. We move to group 6, information gathering and use. I call amendment 15, again in the name of Paul Sweeney, grouped with amendments 5, 6 and 8. Paul Sweeney, to move amendment 15 and speak to all the other amendments in the group. Thank you, Deputy Presiding Officer. I rise to speak to amendment 15 and my name in to address other amendments in the group. This proposed amendment seeks to find a solution to the lack of clarity in section 12 around whether the powers of the commissioner to compel persons or healthcare providers to provide information will apply to private companies too. I brought a similar amendment at stage 2, which the minister was not able to support due to concerns about the broader regulation of medicines and medical devices being a reserved matter, despite agreeing with me that manufacturers and suppliers of such items should be included. With the minister's concerns in mind, I have brought back a revised amendment that would allow for Scottish ministers to add or modify the description of people to the list of those who the commissioner can require information from under section 12 of the proposed act. Further, section 3C, within my amendment, expressly draws attention to providers of medicine or medical devices within the text. That would allow the Scottish Government time to consider how best to include manufacturers and suppliers in the remit of the information compelling powers of the commissioner within devolved competence. Those benches will also support Ms Mockins amendment 6 in this group, which seeks to add the professional regulator and the health and safety executive to the list of bodies in which the commissioner can compel to share information. I can also confirm that Labour will support the technical changes set out in amendments 5 and 8 in the name of the minister. I hope that the revisions made to my own amendment 15 will provide ample assurance to the minister regarding devolved competence and would welcome support from the Government and across the chamber in exercising this amendment on the face of the bill. I move the amendment in my name. Thank you, Mr Sweeney, and I call the minister to speak to amendment 5 and other amendments in the group minister. Thank you, Presiding Officer. Amendments 5 and 8 in my name relate to wording that was inserted into the bill at stage 2 by Carol Mockin, where the wording currently sits following stage 2 in section 12A of the bill. It is among provisions about investigations by the commissioner. That provision relates instead to amending the Health and Care Staffing Scotland Act 2019 to require health boards and the common services agency, or as it is more widely known, NHS National Services Scotland, to provide information to the patient safety commissioner in addition to Scottish ministers about the steps that they have taken to comply with the guiding principles for health and care staffing. Amendment 5 in my name removes the provision from the body of the bill and amendment 8 inserts it into schedule 2, which deals with similar modifications to other legislation. The substantive effect of the wording inserted by Carol Mockin's amendment at stage 2 is unchanged by this. These amendments simply move it to a more appropriate part of the bill for the benefit of those using the legislation. I have advised Carol Mockin of those changes and I thank her for her contribution to this improvement to the bill. I urge members to support amendments 5 and 8. I now turn to amendment 15 in Paul Sweeney's name. At stage 2, I was unable to support a similar amendment lodged by Paul Sweeney. As I indicated then, medicines and medical devices is a reserved matter and it is complex. The reservation includes matters relating to the regulation and control of medicines such as their manufacture, distribution, importation, licensing and marketing. I undertook that my officials would look into this further and we have carefully reconsidered the information gathering powers in the bill. Our conclusion is that amendment is not required. Section 12 of the bill is a general power to seek information and section 13 is a wider power for more focused inquiries as part of a formal investigation. The general power to seek information from healthcare providers allowed by section 12 is appropriate because the patient safety commissioner is fundamentally about the safety of healthcare being provided to patients by those providers. The healthcare providers are the direct interface to patients. Pharmaceutical companies and a whole range of others are one step removed from that, so it is appropriate that they are covered by the power in section 13. Information can be compelled from them if and when it becomes necessary during the course of an investigation. If, for example, the commissioner were to instigate a formal investigation into hernia mesh, a subject that I know is of particular interest to Katie Clark, then she or he would be able to require information from manufacturers and suppliers of hernia mesh if that information may be relevant to their investigation. Amendment to section 12 is not required. The commissioner's power in section 13 to require information that may be relevant to a formal investigation extends to any person. That would include manufacturers and suppliers of medicines or medical devices, subject to the general limitations contained in the reservation of medicines and medical supplies. We consider that the power in section 13 as part of a formal investigation is the appropriate context to empower the commissioner to require information that may be relevant to that formal investigation from such manufacturers and suppliers. The bill already provides that, so amendment is not required. Therefore, I urge members not to support amendment 15. I am also unable to support amendment 6 in the name of Carol Mochan. As my predecessor Marie Todd said in her evidence to committee, professional regulators such as the general medical council do not have the same purpose as the patient safety commissioner. They uphold professional standards and will, where needed, take action against individuals rather than having a primary focus of promoting learning and systemic improvement. I do not want to create a situation in which the bill may impede the willingness of healthcare professionals to be frank and open with the commissioner, and I believe that amendment 6 risks doing just that. It is also important to note that there is nothing in the bill that prevents the commissioner working with regulators for the benefit of patient safety. I urge members not to support amendment 6. I call Carol Mochan to speak to amendment 6 and other amendments in the group. Thank you, Presiding Officer. I am pleased to speak to amendment 6 in my name and others in the group. Amendment 6 adds two additional bodies to the information sharing requirements. Although I understand that the minister was not in favour of amendment 6 stage 2, I believe similar to my other amendments that it merely attempts to improve relationships and co-operation in the sharing of information. At the evidence-taking stage and indeed in the stage 1 report, professional regulators, although understanding that that may not always be appropriate, were of the view that the lists that I outlined in section 15 to D could have been extended to include professional regulators to allow information sharing in situations where, and I quote, there is a concern that would be suitable for them to follow through on and investigate. They do recognise that it is where appropriate. As I said at stage 2, I found that suggestion to be very reasonable and I maintain that position. I would like to urge the minister to think about the point that allows the broader scope of the provision of what we want in terms of information sharing if it was included in the amendment. As we know, the Scottish Public Services Ombudsman stated that the current list is fairly narrow. I have said before that it is not our intention to extend this list beyond any manageable levels nor extend it in a way that might impede healthcare professionals' willingness to be frank and open with the commissioner, as the minister has suggested, would be her difficulty with this amendment. I think that it takes solid steps towards ensuring information sharing and duty of co-operation, and I had hoped that the minister would accept the amendment in the way that it was offered in an enhancement of the ability for information sharing. I would suggest also that the minister reconsider this point. The Scottish Conservatives lodged an amendment in relation to information sharing at stage 2 with input from the GMC, which the minister said she would not support since it was unsuccessful. I understand that the minister has provided assurances to the GMC about how the commissioner and regulatory bodies will work in practice and share information. As the minister will not support Carol Mocken's amendment 6, I would like to seek clarity from the minister on assurances on this point. The Scottish Conservatives will support all amendments in this group. I call on Paul Sweeney to wind up Presorwithdraw amendment 15. Whilst Labour is minded to support the Government amendments in this group, it is disappointing that the Government is not minded to reciprocate on what I think are very reasonable and rational and logical adjustments to the bill, which will make it clear and provide reassurance to a number of stakeholders who are deeply concerned about the potential for their genuinely held sense of injustice to be redressed. Members not just of the health committee but also of the public petitions committee in the chamber will be alive to these concerns. Certainly in the case of mesh implants, the very nature of the concern and complaint is the manufacture and testing of the product. Therefore, by placing that on the face of the bill, that provides great reassurance to those individuals who are affected that there will be capacity to look at this. Whilst the minister seems to have stood back from our points about devolved competence, and has provided some degree of reassurance that there will be that scope to draw in these individual organisations, et cetera, in the course of investigations, when the primary focus of those investigations will pertain to manufacturers and that instance of mesh manufacturer, for example, it would seem obvious and logical to me to have that on the face of the bill. Similarly, where there are clear interfaces with regulatory bodies such as the GMC, similarly, to have that explicitly stated on the face of the bill would be reasonable. In that respect, I am minded to press amendment 15 and it should stand part of the bill. Thank you, Mr Sweeney. The question is amendment 15, be agreed. Are we all agreed? Parliament has not agreed. There will be a division. The member should cast her votes now. And the vote is closed. The result of the vote on amendment 15 in the name of Paul Sweeney is yes, 49, no 58. There were no abstentions. The amendment is therefore not agreed. I call amendment 5 in the name of the minister. Already debated with amendment 15, minister, to move formally. The question is that amendment 5 be agreed to. Are we all agreed? Parliament has agreed. I call amendment 6 in the name of Karl Mocken. Already debated with amendment 15, Karl Mocken, to move or not move. The question is that amendment 6 be agreed. Are we all agreed? No. Parliament has not agreed. There will be a division and members should cast their votes now. And the vote is closed. The result of the vote on amendment 6 in the name of Karl Mocken is yes, 49, no 58. There were no abstentions. The amendment is therefore not agreed. We move to group 7, co-operation with other bodies. I call amendment 7 in the name of Karl Mocken. Group with amendment 16, Karl Mocken, to move amendment 7 and speak to the other amendments in the group. Thank you, Presiding Officer. I am pleased to move amendment 7 and speak to amendment 16 in this group also in my name. I think it's important to note that these amendments are brought to achieve a common goal, which I do think the minister and I share of ensuring that there is a strong co-operation between the patient safety commissioner for Scotland and other bodies. In moving amendment 7, I do so, as I did at stage 2, to express my view that the extent of the co-operation between the patient safety commissioner for Scotland and other bodies must be far-reaching and ensure that duties exist both ways. Having said that, I understand that the minister had concerns at stage 2 and to allow further protections to be put in place in the event said that concerns are still held. I have brought forward amendment 16, so I have tried to bring forward amendment 16 to help to allay any fears about amendment 7, which I believe separates the Scottish bodies from section 15 to D and apply the duty to co-operate just to them. I hope that that may allay any fears surrounding competence. As I did at stage 2, I refer the minister to the stage 1 report, which highlighted the Scottish Public Service Ombudsman's comments with regard to the clarity within the bill on the relationship between the patient safety commissioner for Scotland and the broader landscape. I think that the amendments that I have brought forward today assist the bill in addressing such concerns. I repeat my point that amendment 16 in particular has been drafted to overcome the minister's concerns at stage 2, while maintaining that same spirit of ensuring strong co-operation and the exercise of functions that I know we both hope to achieve. Amendment 7 and 16 from Carol Malkin seek to add a duty on certain organisations to co-operate with the commissioner in exercise of their functions and for the commissioner to reciprocate. As I explained during the bill's stage 2 debate, this Parliament does not have legislative competence to impose the statutory duty on the commissioner for patient safety in England, and this is still the case. When viewed in conjunction with Ms Malkin's amendment 6 and group 6, amendment 7 also opposes a legislative competence risk since the health and safety executive is reserved and we cannot impose a duty on it. For that reason, I cannot support amendment 7. With regard to amendment 16, which appears to be an evolution of amendment 7, so I thank Carol Malkin for explaining that. I consider that specifying certain bodies carries a risk of limiting the current intentionally broad expectation that all public authorities with responsibilities and functions relating to the delivery of healthcare in Scotland will co-operate in the exercise of the commissioner's functions. I believe that amendment 7 risks creating confusion rather than clarity. Therefore, I ask members not to support those amendments. It is disappointing that the minister won't accept amendment 16, which was brought to make sure that we could allay fears about competency. We have been assured that that could be the position should the minister choose to accept the amendments. With that in mind, I would choose to press the amendments. The question is that amendment 7 be agreed to. Are we all agreed? The Parliament is not agreed. Therefore, we will move to a vote, and members should cast their votes now. The vote is closed. The result of the vote on amendment 7, in the name of Carol Malkin, is yes, 46, no, 62. There were no abstentions. The amendment is therefore not agreed. I call amendment 16, in the name of Carol Malkin, already debated with amendment 7. Carol Malkin, to move or not move. The question is that amendment 16 be agreed to. Are we all agreed? The Parliament is not agreed. Therefore, we will move to a vote, and members should cast their votes now. The vote is closed. The result of the vote on amendment 16, in the name of Carol Malkin, is yes, 49, no, 58. There were no abstentions. The amendment is therefore not agreed. I call amendment 17, in the name of Jackie Baillie, already debated with amendment 9. Jackie Baillie, to move or not move. The question is that amendment 17 be agreed to. Are we all agreed? The Parliament is not agreed. Therefore, we will move to a vote, and members should cast their votes now. The vote is closed. Point of order, Gillian Martin. My app didn't reload. I would have voted no. Thank you, Ms Martin. We'll ensure that it's recorded. Michael Matheson, for a point of order. Thank you, Presiding Officer. My app wouldn't work as well, and I would have voted no. Thank you. We'll ensure that it's recorded. The result of the vote on amendment 17, in the name of Jackie Baillie, is yes, 50, no, 58. There were no abstentions. The amendment is therefore not agreed. I call amendment 18, in the name of Jackie Baillie, already debated with amendment 9. Jackie Baillie, to move or not move. The question is that amendment 18 be agreed to. Are we all agreed? The Parliament is not agreed. Therefore, we'll move to a vote, and members should cast their votes now. The vote is closed. The result of the vote on amendment 18, in the name of Jackie Baillie, is yes, 50, no, 58. There were no abstentions. The amendment is therefore not agreed. We move to group 8, meaning of healthcare. I call amendment 19, in the name of Paul Sweeney, in a group on its own. Paul Sweeney, to move and speak to amendment 19. Thank you, Presiding Officer. I rise to speak to amendment 19, in my name. This amendment seeks to include social care services as part of the definition of healthcare under section 21. I brought a similar amendment at stage 2. I made clear that this amendment would not seek to widen the commissioner's remit to include social care in its entirety. Instead, it would enable the commissioner to consider social care as part of their investigations only when these services intersect with the elements of healthcare within the commissioner's remit. The minister could not support my amendment at stage 2, instead confirming on the record that there's nothing in the bill that would prevent the commissioner from dealing with healthcare that is provided in a social care context. I did welcome that clarification at stage 2 and withdrew, but, on reflection, I think that it is important, particularly having consulted with stakeholders, that this clarification is on the face of the bill for the avoidance of any doubt. The minister previously suggested that this amendment may cause doubt about whether the bill's reference to healthcare includes healthcare provided in context other than social care. I have worked on the amendment to try to ensure that it has addressed her concerns, validly made, and we would welcome, in light of that effort, the support of the Government in clarifying the remit of the commissioner on the face of the bill. I move the amendment in my name. I am not able to support amendment 19. Members will recall that, in its stage 1 report, the Health, Social Care and Support Committee called on the Scottish Government to confirm that the commissioner would be able to address matters arising at the intersection of health and social care. At stage 2, I was very happy to confirm that the commissioner can look at patient safety issues wherever healthcare is being provided, including in social care setting. I reiterate that today in the chamber. The commissioner's role is about safety in healthcare. To be absolutely clear, there is nothing in the bill that would prevent the commissioner dealing with healthcare provided in a social care setting or any other setting. I therefore urge members not to support amendment 19, which, rather than clarifying that point, risks creating doubt about whether the reference to healthcare includes healthcare provided in context other than social care, such as schools or prisons or, indeed, anywhere. Paul Sweeney to wind up and press or withdraw amendment 19. I am not persuaded at all on the point that the minister is making. We, for example, named the committee in this prominent health and social care for very good reason because it reflects that span in which these activities are carried out. Indeed, particular focus on these interfaces, which are critical to patient safety, reflecting just on my own casework, a recent example being elderly patient who was subject to delayed discharge from an acute hospital into a social care setting, jeopardising their safety to the point where, unfortunately, a hospital inquired infection caused premature death. Those are examples where there is an issue of patient safety as pertaining to the interface of acute hospitals and social care settings, which should be clarified on the face of the bill. In that spirit, the amendment is benign in its intent, and the idea is to ensure that it will simply clarify that definition. I do not think that it confuses, but I think that it clarifies. In that sense, I will continue to press the amendment and hope that members will support it. Thank you. The question is that amendment 19 be agreed to. Are we all agreed? The Parliament is not agreed to. Therefore, we will move to vote and members should cast their votes now. The vote is closed. The result of the vote on amendment 19, in the name of Paul Sweeney, is yes, 49. No 58. There were no abstentions. The amendment is therefore not agreed. I call amendment 20, in the name of Jackie Baillie, already debated with amendment 9. Jackie Baillie, to move or not move, moved. The question is that amendment 20 be agreed to. Are we all agreed? The Parliament is not agreed, therefore, we will move to vote and members should cast their votes now. The vote is closed. Point of order, Gillian Martin. Can I just ask you to repeat that, Ms Martin? I can confirm that your vote was recorded. The result of the vote on amendment 20, in the name of Jackie Baillie, is yes, 50. No 58. There were no abstentions. The amendment is therefore not agreed. I call amendment 21, in the name of Jackie Baillie, already debated with amendment 9. Jackie Baillie, to move or not move. Amendment 20 is not moved. Therefore, we move on to the next group, group 9, appointment of... Sorry, my apologies. Thank you, Mr Carlaw. You are wholly correct. It is indeed amendment 21 that is not moved, as we have already just voted on amendment 20. We move on to group 9, appointment of the commissioner. Amendment 1, in the name of Emma Harper, grouped with amendment 2. Emma Harper, to move amendment 1 and speak to both amendments in the group. Thank you, Presiding Officer. I am pleased to move amendments 1 and 2, which are grouped together. Those are concerning the appointment of the Patient Safety Commissioner. From the outset of my remarks, I want to be clear that it is crucially important, particularly given the reasons that have led to the creation of the commissioner post, that patients and their families have trust in the commissioner, and that trust may be undermined if the office were held by someone with a strong, and I emphasise a strong, financial interest in healthcare. That includes those currently or very recently employed in healthcare or who have a control and interest or influence over, for example, a pharmaceutical company. However, paragraph 5 of schedule 1 of the bill may go too far, as it is currently worded. The current wording would disqualify those with any financial interest in a healthcare provider from being appointed as a commissioner. That current wording would exclude someone who, for example, has a smaller number of shares in a pharmaceutical company. It seems like a very blanket, using fixed, strict wording approach that could exclude otherwise a very suitable, competent and qualified candidate. I am grateful to the minister for working with me to bring forward those amendments that remove the current disqualification criteria and replace it with a more nuanced approach. Amendment 1 would require Parliament to be able to inquire whether a person who is to be nominated for the appointment as a commissioner has a relevant financial interest. It would then be for the Parliament to exercise judgment about candidates, additionally enhancing the role of Parliament and Parliament's accountability over the appointment of a commissioner. That means that good candidates will not be excluded from the outset on account of a minimal and or indirect financial interest. Indeed, such an interest could include those who are part of a pension scheme that happens to have shares in a pharmaceutical company, which appears to be relatively common in practice. It is my view that amendment 1 will increase the pool and diversity of candidates applying for the position of patient safety commissioner, which in turn will deliver the best possible outcome for patients. Amendment 2 is simply asking to leave out D in paragraph 5, as I have explained already in my amendment 1. I urge members to support amendments 1 and 2. I have just a couple of reservations that amendments 1 and 2 would pave the way to allow past cabinet secretaries and ministers to be appointed as the patient safety commissioner. I would be grateful if the minister and indeed Emma Harper could confirm in summing up whether it is their intention to exclude former health ministers and cabinet secretaries from the patient safety commissioner role, because in many cases decisions made in office in the past may have an impact on matters relating to patient safety now, and that would constitute a clear conflict of interest. Clarity on this point would be most welcome. On a related point, the Nolan principles of public life have a period of two years from leaving office to taking up a public appointment. Why has this been reduced in the amendments to one year? Minister, if I just go to Jackie Baillie's point, first schedule 1, paragraph 5, still excludes those persons that Ms Baillie referenced. I would like to thank Emma Harper for working with me on those amendments. As Emma Harper has said, it is critical that we do not enhase disqualify any otherwise suitable individual based on a minimal financial interest such as shares and a pension plan. This amendment therefore puts forward a more sensible approach that will not lead to the automatic exclusion of an individual but, importantly and rightly, allows the Parliament to exercise its judgment on suitable candidates. I fully support this amendment and urge the chamber to do the same. I welcome that the Parliament would then exercise judgment about the candidates that would be chosen, and I am not seeking to amend further issues around disqualification of members of the Parliament or other areas that are described in the bill. At the moment, I urge members to support my amendments and I move them today. Thank you. The question is that amendment 1 be agreed to. Are we all agreed? We are agreed. I call amendment 2, in the name of Emma Harper, already debated, with amendment 1. Emma Harper, to move or not move. The question is that amendment 2 be agreed to. Are we all agreed? We are agreed. We move on to group 10, resource sharing. I call amendment 22, in the name of Tess White, in a group on its own. Tess White, to move and speak to amendment 22. I will speak briefly on this amendment. Amendment 22 is a probing amendment to facilitate debate around the resources that the commissioner will require to carry out their work and to consider whether these resources could be shared with other commissioners. The SNP convener of the Finance and Public Administration Committee, Kenneth Gibson, wrote to the Health, Social Care and Sport Committee in January to express concerns about the increasing number of commissioners with their associated costs. For 2023-2024, these costs amount to a total of £16.6 million, £1.2 million higher than the budget for the previous year, and 5.4% more than was forecast. The committee added that a more strategic approach to the resourcing of the commissioner system might be considered in future. Amendment 22 suggests a way in which this strategic approach could be implemented. While I will not move it today, I urge the Scottish Government and the Scottish Parliament's corporate body to consider value for money to the taxpayer if the commissioner system continues to expand from 7 to 14. Commissioners can be very valuable, especially as they are operationally independent from the Scottish Government, but the system cannot keep growing so significantly without formal review or evaluation of its effectiveness. To confirm, I will not move amendment 22. I very much welcome Tess White's comments, because I understand that the SPCB considers resources for commissioners as a matter of course each year. Those decisions are also subject to scrutiny by the Finance Committee of this Parliament, and although I have sympathy with the amendment, I do not believe that it is necessary to have it on the face of the bill. For that reason, we will not be supporting it, but if it is withdrawn, that is a matter of record. However, I understand the wider point that Tess White is making. I have discussed with Tess White the basis for the Scottish Government's opposition to this amendment. The amendment seeks to create a duty for the patient safety commissioner to consider whether it would be effective for resources to be shared with other parliamentary commissioners. I hope that members agree that requiring the commissioner to proactively consider resource sharing in this way would not be an effective use of their time. I am strongly of the view that the commissioner should be focused solely on patient safety. Resourcing for parliamentary commissioners, as has been pointed out, is a matter for the Scottish Parliament's corporate body. Section 19 of the bill already provides that the commissioner must comply with any direction given to them by the Scottish Parliamentary Corporation in relation to the sharing of premises, staff, services or other resources. The amendment is therefore unnecessary and would create a distraction, so I appreciate the withdrawal. I believe that the member had completed her contribution. Moving on, I understand from Tess White's previous contribution that the member wishes to withdraw amendment 22. Does any member object? Therefore, we move on to group 11, reviewing the commissioner's work. I call amendment 23, in the name of Tess White, in a group on its own. Tess White, to move and speak to amendment 23. Presiding Officer, I have brought this amendment back from stage 2 as an alternative approach to the original requirement that the Health, Social Care and Sport Committee, or the Committee concerned with patient safety, must propose a debate on the commissioner's annual report. This amendment softens that requirement so that the committee must consider that report instead once it has been laid before the Scottish Parliament. The Minister's predecessor and her official told the Health, Social Care and Sport Committee at stage 1, and I quote, there will be a strong role for Parliament in scrutinising what the commissioner does. But we still have questions at stage 3 about what the role looks like. I appreciate that the relevant committee can propose a debate about the commissioner's work at any time, and the Minister did raise this point with me, and that they have the autonomy to decide their own work programme. But the reality is that the protagonist's simple politics change, and priorities refocus. Yes, Mr Whitefield. I'm very grateful to Tess White to give way on this point, and it's really just a point of clarification, which I'm sure I'm correct with. There is no implicit criticism of the committee system not following through on pursuing commissioner's annual report contained within this amendment, and it's merely a helpful guidance to remind the commissioner of what will happen with their annual report. Tess White. Thank you, Mr Whitefield. That is what this amendment says. It's just a reminder, and an important reminder. So this amendment is an opportunity to ensure that scrutiny does not fall through the net, and I thank Mr Whitefield for his intervention, and that the work of the patient safety commissioner has adequate oversight. I encourage members to support it. Thank you. Discussed with Tess White why the Scottish Government will not be supporting this amendment today, and I thank her for her engagement. The amendment seeks to create a duty for the parliamentary committee with patient safety in its remit, currently the health, social care and sport committee, to consider the commissioner's annual report once it's laid before Parliament. As set out in schedule 1, part 5 of the bill, annual reports on the commissioner's activity will be produced and made publicly available. It is therefore open to any parliamentary committee or indeed anyone to consider these annual reports. It is not the role of this bill to legislate for how future parliamentary committees and by extension Parliament as a whole spend their time. I strongly believe that attempting to do so would create an unwelcome precedent. I do not see that this amendment makes Parliament's ability to consider or scrutinise the activities of the commissioner any more effective. Indeed, in seeking to dictate how the committee may spend its time in the future, I believe that this amendment risks inadvertently hindering Parliament's vital scrutiny functions, so I urge members not to support this amendment. Thank you, and I call Tess White to wind up and press or withdraw amendment 23. Thank you, Presiding Officer. I will press this point and I won't withdraw it. I think that it's really important as a check-in point. It's just a guidance note, so if it doesn't go through, then I sit on the health and social care committee and I'll make sure that in the first year we do address it, but I'm disappointed that it's not in the bill. Thank you. The question is that amendment 23 be agreed to. Are we all agreed? The Parliament is not agreed, therefore we'll move to vote. Members should cast their votes now. The vote is closed. Point of order, Mary McCallan. Thank you, Presiding Officer. My phone wouldn't connect. I would have voted no. Thank you, Ms McCallan. We'll ensure that's recorded. I call Bill Kidd for a point of order. Thank you, Presiding Officer. Issues with my machine, it's not working, so I would have voted no. Thank you, Mr Kidd. We'll ensure that's recorded. Point of order, Alexander Stewart. Thank you, Presiding Officer. My phone seems to have stalled, so I would have voted yes. Thank you, Mr Stewart. We'll ensure that's recorded. The result of the vote on amendment 23, in the name of Tess White, is yes, 48, no, 59. There were no abstentions. The amendment is therefore not agreed. I call amendment 8, in the name of the minister. Already debated with amendment 15. Minister, to move formally. And the question is that amendment 8 be agreed to. Are we all agreed? We are agreed, and that ends consideration of amendments. And, as members will be aware, at this point in the proceedings, I'm required understanding orders to decide whether or not, in my view, any provision of the Bill relates to a protected subject matter, that is, whether it modifies the electoral system and franchise for Scottish parliamentary elections. In the case of this Bill, in my view, no provision of the patient safety commissioner for Scotland Bill relates to a protected matter. Therefore, the Bill does not require a supermajority to be passed at stage 3. The next item of business is a debate on motion 10594, in the name of Jenny Minto, on patient safety commissioner for Scotland Bill. And I would ask all members who wish to speak in the debate please press their request to speak buttons now. And I call on Jenny Minto to speak to and move the motion up to seven minutes, minister. Thank you, Presiding Officer. I stand to speak conscious that there is nothing I can say this afternoon about why this Bill is important, that sadly some people don't already know. Those who have been harmed, who have lost loved ones, or even lost a child. Our responsibility now is to do all we can to make sure that healthcare is made as safe as possible. And that in the future, when patients and families have concerns about the safety of their care, they do not have to struggle to make their voices heard. Colleagues right across this chamber have worked hard on this Bill for that very purpose, to make healthcare safer and ensure that patients and their families are heard. And I'm so grateful to them all. We have heard those colleagues who have reached out to us with suggestions to make the Bill stronger. We have worked with them, and I believe that the measures we are proposing today will make significant changes for the better. When the concerns of patients and families are not listened to, it can lead to serious harm that could have been prevented. And crucially, it can also mean that the healthcare system misses opportunities to identify and learn from past mistakes, running the risk of repeating them and causing further harm to patients, instead of ensuring that these mistakes do not happen again. In Scotland's patient safety commissioner, patients and their families will, for the first time, have a powerful independent figure to amplify their voices and ensure that it is heard throughout the healthcare system in Scotland. And the commissioner will support organisations throughout the healthcare system to identify systemic safety issues and work collaboratively to make improvements. The Bill is the culmination of years of campaigning by patients and families on the issue of patient safety. I recognise that this tireless campaigning has been vital in getting us to where we are today. And throughout the development of this Bill, we have listened to the stories of patients and families and taken them on board in designing the patient safety commissioner role. The many stories shared as part of Baroness Cumberlidge's independent medicines and medical devices safety review First Do No Harm demonstrate powerfully how important it is that when patients raise concerns about their care, they have confidence that they will be listened to. I would like to take this opportunity once again to pay tribute to Baroness Cumberlidge and her team in whose work the creation of the patient safety commissioner originates. The many patients who shared their experiences with her and the patients, families and other organisations who gave evidence on this Bill and advocated for the patient safety commissioner's creation. I would also like to thank Clare Holly and her predecessor Gillian Martin and the current and past members of the Health, Social Care and Sport Committee for their scrutiny of the Bill and their thoughtful consideration of the complex issues involved. The evidence they gathered during their scrutiny was powerful. I was pleased that members supported the general principles of the Bill unanimously in stage 1. The Health, Social Care and Sport Committee did however make a number of detailed recommendations in its stage 1 report as to how the Bill could be strengthened to make the patient safety commissioner as effective as possible. The engagement that I have had subsequently during stages 2 and 3 from members across the chamber has been open and constructive and I very much welcome that. While we may not all agree on every single detail of the final Bill, as Paul Sweeney rightly said during the stage 1 debate, we are all looking for the same outcome here, to improve the voices of patients and to ensure that the systemic issues that many have experienced and been adversely affected by do not come to pass ever again. The engagement, co-operation and debate from all members during this Bill's development has been consistent with that shared desire to achieve the best for patients. And it is my belief that this Bill and the creation of the patient safety commissioner will go a considerable way towards making healthcare safer for us all. I will briefly remind members of the key points of the Bill. It will create a patient safety commissioner for Scotland with statutory powers who is entirely independent of government and the NHS. The patient safety commissioner will be a parliamentary commissioner. They will be accountable to this Parliament and thereby the people of Scotland. They will champion the value of listening to patients and others in relation to the safety of healthcare. While the Cumberlidge report focused primarily on the significant harm caused to women by three particular medicines and medical devices, primidus, sodium valproate and pelvic mesh, those we have heard from during the development of the patient safety commissioner Bill have made it clear that it is important that the scope of the role is kept as broad as possible. No patient must be denied the chance to have their concerns heard. Therefore, the patient safety commissioner will be completely free to consider any issue relating to the safety of healthcare in Scotland, whether to do with care provided by the NHS or privately. Crucially, the patient safety commissioner will be directly accessible to patients, their families and the wider public to listen to their stories and concerns. That is something that patients have made clear is of utmost importance. The patient safety commissioner will work collaboratively with other organisations to take a system-wide view of patient safety. They will have a role to identify systemic safety issues and work with others to achieve positive change. They will be supported by robust statutory powers to allow them to access the information they need when they wish to find out more about an issue that patients raise with them. They will be able to undertake formal investigations where they consider that necessary and where the uncover areas where improvements can be made they will be able to make recommendations to which organisations are required to respond. As we continue to focus rightly on supporting the NHS recovery from the Covid-19 pandemic, it is more important than ever that we ensure that the views and safety of patients are paramount. Patients must have confidence that the care they receive is person-centred, effective and safe. And they must be sure that when they have concerns their voices will be heard and their experiences recognised so that the same mistakes are not repeated and safety is improved for everyone. If this bill is passed, we will have a patient safety commissioner who will amplify the voices of those who for too long have not been listened to, working collaboratively across Scotland's healthcare system to ensure that the patient voice is put at its heart. They will act solely for safe healthcare guided by the views of patients themselves to look impartially and thoroughly into patient safety concerns. I thank members once again for their constructive engagement that has enabled us to get to this stage. I move that the Parliament agrees that the patient safety commissioner for Scotland Bill be passed. Thank you minister. I now call Tess White. Thank you, Presiding Officer. Three years on from the recommendation of the Cumbillage Review to appoint a patient safety commissioner, I can confirm that the Scottish Conservatives will support the Bill at stage three. Most medical interventions are safe. But things can and do go wrong. Diagnostic medication errors, unsafe surgical procedures and infections in healthcare settings can all result in preventable harm. It's how the healthcare system responds to these cases that is so critical. But for women affected by primados, sodium valparate and pelvic mesh implants, the system failed to respond for far too long. When it did, it was defensive and doubtful. For two years, the Cumbillage Review shone a light on the horrendous experiences of these women as they tried to get help. Sadly, their stories will ring true for so many women trying to access healthcare. They described being fobbed off and gaslighted by clinicians. They were told it's all in your head and that they were experiencing women's issues. Their pain was normalized and they felt their concerns were belittled by the healthcare professionals they trusted to treat them. I want to pay tribute to these women and their families. Their longstanding campaigns have highlighted the injustices of a healthcare system in which the patient isn't always listened to or believed. Their bravery and tenacity have brought us to this point today and I know many feel the patient safety commissioner for Scotland is long overdue. More generally, Presiding Officer, we need a sea change in the way women are treated by the healthcare system and I sincerely hope that there will be a wider outcome of the Cumbillage Review. Presiding Officer, patient safety isn't just about the way the healthcare system works it's about the culture of that system and for the Patient Safety Commissioner for England Dr Henrietta Hughes culture change is one of her three priority areas. In the shocking cases of disgraced brain surgeon Sam Eljamel who left dozens of patients in NHS Tayside with life changing injuries and the Queen Elizabeth University Hospital scandal in Glasgow where two children died of waterborne infection and many more fell ill. The health boards doubled down and prioritised their PR over protecting patient safety. Warning signs were ignored. Opportunities to intervene were overlooked and in such cases Presiding Officer who guards the guards. This is all too familiar in the context of puberty blockers for children which have been banned in England following the interim CAS report but are still prescribed in Scotland. The SNP green government keeps saying it will review the findings but what about the potential harm to children in the meantime? At stages 2 and 3 MSPs have tried to improve the bill based on valuable input from witnesses and the health, social care and sport committees recommendations at stage 1. I appreciated the opportunity to discuss my amendments with the minister prior to stage 3 but I regret that she was unwilling to support my amendments. The commissioner system in Scotland continues to expand from 7, as I've said earlier today, to as many as 14 but very little evaluation or research has been carried out on commissioners. You can't imagine what you don't you can't manage what you don't measure which is why Scottish Conservative amendments at stage 2 and 3 attempted to strengthen the oversight and accountability of the commissioner to parliament. I urge the SPCB to reflect on this point going forwards. Presiding Officer, early detection of patient safety concerns and action to address them could be life changing and in some cases potentially life saving. At a time when the NHS is in crisis under this SNP green government and capacity is at breaking point an independent patient safety advocate is particularly welcome. That's why the appointment needs to be made at pace. We cannot have a repeat of the recruitment of the women's health champion which was repeatedly promised but belatedly delivered by the minister and her predecessor. And finally, Presiding Officer, the role of the commissioner comes with sky high expectations, finite resources and a much wider remit than the equivalent in England. The independence of this role does not mean the absence of accountability and it's up to this parliament to monitor the commissioner's work and the outcome for patients and in this regard I wish them every success. Thank you. Thank you Ms White and I now call on Jackie Baillie. Thank you Presiding Officer. Can I begin by thanking the minister, the Scottish Government bill team, the Scottish Parliament legislation team and the health and social care committee and their clerks for all the work on the bill. Scottish Labour has long supported the establishment of a patient safety commissioner to champion the rights of patients and defend their interests. However, we have been clear that we wanted the bill to be as robust as possible when it comes to defending those rights and interests and that the rights of bereaved families are clear within the bill. Recent patient scandals under the Scottish Government watch have in many instances eroded confidence in the operation and accountability of our NHS. That's bad for patients, is bad for clinicians and staff and ultimately it reduces trust in health board governance structures. The amendments that Scottish Labour brought forward today presented an opportunity to reset the balance between patients, whistleblowers, families and powerful public bodies. So I am genuinely dismayed that the Scottish Government have not adopted the full package of amendments that make up Millie's law. Those amendments could have ensured that bereaved families were very much at the heart of the response to disasters and public scandals within the bill. And whilst I am grateful for the co-operation of the Scottish Government on two out of nine of my amendments around the provision of a patient safety charter within the bill, I have to say I am sorely disappointed that the SNP and the Greens have once again voted down amendments that would have delivered Millie's law in full. This is a betrayal of the very people that this bill was supposed to give voice to. People like Louise Lawrence a grieving widow who lost her husband in the Queen Elizabeth Hospital infection scandal and who greater Glasgow and Clyde health board paid a private company to spy on. People like the families of those who lost their loved ones in the C.Diff scandal at the Vale of Leven hospital who had to fight tooth and nail for years to get justice out of this government. And people like Professor John Cudahy whose daughter Molly died after she fell ill at the Queen Elizabeth University Hospital and she went into septic shock. The patients at NHS Tayside operated on by Sam Eljamill the women affected by the problems with mesh the minister could have done more. The NHS in Scotland is in crisis. The Scottish Government is routinely failing patients and staff alike. The state of crisis and the lack of resource that the NHS is facing has an undeniable effect on patient safety. My amendments sought to ensure that the patient safety commissioner for Scotland has a duty to advocate for those affected by a major incident in relation to the safety of healthcare. They would have provided patients and family members with information relating to sources of support including information on accessing legal support and details of any investigations or inquiries placing them at the very heart of the fight for justice and ensuring that they are never left in the dark again but the government didn't accept them. Millie Mayne's mother Kimberly Dyrex said and I've said this before but it's worth repeating. Right now the system is stacked against those who have questions about what happened to their loved ones. That can't be right. We're looking to our Parliament to put measures in place so that nobody has to go through what we went through ever again. I fear that when Kimberly, Louise, John and others look at what was voted on here tonight that they will feel that the system still remains stacked against families and whistleblowers who have to fight to be heard. This was an opportunity to reset the balance, to put the interests of patients and families first. What a shame the SNP have turned their back on doing that. Can I say, Presiding Officer, it is also inexplicable that the First Minister would express his support for Millie's law in public on the record but that his government simply does not vote for it given the opportunity. Was he even voting today or has he run away? While Scottish Labour will vote for the Patients Safety Commissioner Bill because it is a step in the right direction, we do so with regret that the SNP chose not to truly champion the rights of patients and defend their interests. Shame on them. Thank you Ms Bailey and I now call on Alex Cole-Hamilton. Thank you very much indeed, Presiding Officer. It is my pleasure to speak in favour of tonight's bill before us on behalf of the Scottish Liberal Democrats. Presiding Officer, we are rightly incredibly proud of our national health service. The UK's decision to create a system of universal healthcare free at the point of need was perhaps the brightest light to emerge from the ashes of two world wars. The doctors, nurses, healthcare professionals who staff our nation's hospitals, clinics, GP surgeries and a range of other settings do an incredible job often under incredibly difficult circumstances and they all deserve our utmost thanks. However, we can always improve it and sometimes issues and very occasionally bad actors within the system can result in significant and often life changing harm to patients and even in some cases as we've heard today loss of life. We should all give our thanks as many have done already to the colossal amount of work that went into the Cumberland's review and then the work of the committee in bringing forward this bill that has been over four years now since we learned of the serious safety and cleanliness issues at the Queen Elizabeth University Hospital which fed in large part into this inquiry. His problems ranged from the grime damage facilities to contaminated supplies. They had a catastrophic impact on the health of some patients. We've heard the stories of some of the victims of the scandal of that hospital including Andrew Slorence who was a father of five and a dedicated public servant. Andrew's widow Louise has had to campaign to hear the full unvarnished facts about her husband's death. And of course Millie Mayne who was just 10 years old when she passed away in the paediatric hospital. Presiding Officer I've also spoken in several debates in this chamber about the injuries caused by transvaginal mesh. I think it is a subject that has brought these benches together. It's a product that has caused significant harm and injury to many patients often many of whom having to fight to even be believed as we've heard several times this afternoon. Is Parliament rightly legislated to have those patients compensated for costs related to the removal of that mesh? But that provides cold comfort for thousands of women who've had their lives devastated and many still who are still struggling to find financial recompense. Because Presiding Officer these harms should never have been inflicted in the first place. So it's our duty in this place to ensure we do everything within our power to prevent unnecessary tragedy. It is vital, it is vital importance that those putting their trust in our healthcare system sometimes at the most vulnerable moments of their life are confident that trust is well placed. Scottish Liberal Democrats believe that the bill before us today represents an important and necessary milestone in ensuring that everyone accessing healthcare in Scotland does so safely and has the confidence in the champion that we create today. My party also believed that the role of that patient safety commissioner is necessary in promoting the views and concerns of both patients and the general public and in addressing issues within the system before they can possibly result in harm. I'd like to thank my friend Jackie Baillie for the work she's done to try to include provisions for a patient safety charter within the bill and give strength to those. But I don't think we have fully reached the test set to us by those who have campaigned tirelessly from Millie's law. There is disappointment in the amendments that were rejected today. Presiding Officer far too many families faced barriers in their search for the truth and when tragedy occurred at the QEUH. Those families needed answers but all too often doors were closed in their face. Those who were meant to serve them in their time of need acted instead as a barrier to the truth and justice they rightly deserve. Families who find themselves in the most distressing and vulnerable situations imaginable are entitled to complete transparency right from the beginning and at every stage of the investigation. I fervently hope that with this bill we are now able to fully recognise and address the systemic problems in our institutions and prevent further tragedies from occurring. It will have our support tonight. Thank you Mr Cole-Hamilton. We will now move to the open debate and I call Emma Harper to be followed by Jackson Carlaw. Ms Harper. Thank you Presiding Officer. As a member of the health committee and as a nurse with a current registration I'm pleased to speak in this debate on stage 3 of the Patient Safety Commissioner Bill. This bill was introduced in response to the recommendation of the Cumberledge review and it is in direct response to patient-led campaigns on the hormonal pregnancy test Primaedos sodium valpoe in pregnancy and transvaginal surgical mesh. Each of these products was associated with significant patient harms and injury and one of the main findings of the Cumberledge review was that patients were not listened to. As I said when moving amendments 1 and 2 it is crucial to ensure that we get this bill right so that the public can have trust in the commissioner. Presiding Officer the bill is proposing the creation of a patient safety commissioner who would be nominated by and accountable to Scottish Parliament. This is important as parliamentary commissioners are perceived as being more independent of government. The bill proposes that the PSE would have two key functions to advocate for systemic improvement in the safety of healthcare which I will touch on again later and to promote the importance of the views of patients. The patient safety commissioner will be an independent champion for everyone receiving healthcare working alongside healthcare providers like NES and Health Improvement Scotland. The Scottish Government places high importance on the patient voice and the patient experience. And during stage 1 scrutiny at the committee and during the stage 1 debate a lot of my interest was around the remit of the Scottish patient safety commissioner. The remit of the commissioner will include bringing together patient feedback and safety data shared by NHS boards and Healthcare Improvement Scotland to identify concerns and recommend actions. The commissioner will also when necessary lead formal investigations into potential systemic safety issues with powers to require information to be shared to make sure every investigation is fully informed. And I believe the remit of the patient safety commissioner is directly relevant to the constituency work that I've been raising in Dumfries and Galloway in my South Scotland region. The specific areas are cancer treatment, pathways and travel reimbursement. As colleagues will know, Dumfries and Galloway is geographically located in the south west of Scotland but it is aligned with the east of Scotland cancer network. Nowhere in D&G is closer to Edinburgh than it is to Glasgow. In many cases, particularly in Stranraer and Wyddenshire this means a 260 mile round trip for treatment which includes radiotherapy. Constituents have been campaigning regarding this unnecessary travel to be addressed for more than 20 years now. And I hear from constituents that this trip can often exacerbate poor health, cause anxiety and additional stress at the very time when people with the diagnosis of cancer should be supported most. In D&G, patients are currently means tested to be reimbursed for journeys for medical appointments which are over 30 miles despite the fact that people living in other rural parts of Scotland are not means tested. Other travel reimbursement schemes exist like in the Highlands and Islands. And Wyddenshire women and cancer and my constituents report that means testing and the journeys travelled do lead to worse health outcomes and potentially impact on their safety. I've raised these matters with the Scottish Government on numerous occasions and I welcome that the language in the bill under section 2 of the functions of the PSC does potentially allow the commissioner to pick these issues up. So I welcome that we are moving forward with this patient safety commissioner bill. I also welcome the minister's commitment to continue to work with me on these issues and I look forward to hearing further about how we can address cancer pathways in Galloway. So presiding officer and in closing this bill is a crucial move which will improve patient safety including as we recover from the Covid pandemic and I welcome that we move at pace to ensure we get the bill right for everyone in Scotland. Thank you. Thank you, Ms Harper. I now call Jackson Carlaw to be followed by Carol Mawkin. Mr Carlaw. Thank you, Deputy Presiding Officer. There are two points that I'd like to make. The first is really to say I don't think I've felt the loss of my former colleagues Alec Neill and Neil Findlay more than I do this afternoon because those of us who over three parliaments were involved in the torturous and disgraceful way in which women were harmed by the mesh scandal. Will I feel today that we have fallen short? I say that with enormous regret. Many of those women I think may even be in tears this afternoon because they have given so much to inquiries led by Professor Alison Britten who we've not mentioned this afternoon and whose frustration getting information or being able to hold people to account during her own inquiries or as a consequence of the recommendations in the Cumballage report will feel that when we got to the High Wire Act today and had to fall on the side of cynical gritty caution or on the side of slightly more well-wishing hope we'll feel that we fell on that well-wishing hope side of the argument rather than the gritty caution. And I think that's a missed opportunity. I hope it's not one that comes back to haunt Parliament at a later date because I think if it does then many will be quite ashamed that when the opportunity was right before us today after everything we've learned over all that decade to have gone for the strongest possible teeth for the commissioner in this regard we'll feel that we just didn't do it and I'm very sorry about that but I do welcome the fact that the commissioner is going to be there it is progress as Jackie Baillie has said and I thought the amendments from Tess White from Carol Malkin from Paul Sweeney from Jackie Baillie all were actually advocating things which in this chamber's previous debates I thought we'd all kind of agreed and so I don't understand when we get to the journey end when we have the chance to vote for the things we said we all agreed we kind of didn't and I just well there we go the second point I want to make and I want to stress that while a member of the corporate body I am not speaking on behalf of the corporate body here but when I was in my first parliament 2017-11 I was put on a committee which was to look at the extent and the growth of commissioners as a principle then the cohort of MSPs were concerned I think that there were five commissioners and they wanted to see it reduced and we made recommendations which were supported by MSPs until in fact they went out to public consultation and then the role of the public in saying oh no we want to keep the commission I was so strong that we kind of abandoned as a parliament our courage of our convictions and the moral of that for me is that when we create a commissioner there's no going back and therefore I am concerned not with the principle today of the patient commission which I wholly support but that we are kind of loosely embracing commissioners generally not within a coherent plan as parliamentarians because it does seem to me that if we move from 7 to 14 or even 15 I think potentially we are creating a whole new level of government in Scotland by stealth and that in many respects I just thought I might make this point Mr Mason and that in a certain way we are devolving responsibilities away from us as parliamentarians that I thought this parliament was established in the first place for us to pursue and to have a responsibility for and I think we should be very cautious about the overall effect of what we're doing Mr Mason John Mason I thank Mr Carslaw for giving way and I very much agree with what he says that while hopefully we can all support today's commissioner as a one-off there is a wider issue can he say anything about how he thinks that should be taken forward I mean the finance committee has been looking at it should it be the finance committee or do we need some other way of looking at this bigger question Well again I can only speak personally but I do think that there needs to be a point at which parliament debates holistically the principle of what we're doing because it seems to me that and I don't want to single out by exception at all that someone I don't want to stray away from the debate either presiding officer I'm conscious I'm sure that everything I'm saying is a consequence of this commission there as well that there is a danger that we will find it very difficult not to agree to a whole raft of other commissioners again after that because you know there will be a parallel association with the ones we've approved so I think there is a concern there the corporate body has a responsibility for funding the parliament's the parliament's decisions and relation to commissioners not for deciding whether they're a good thing or not our responsibility is to fund the commissioners that parliament decides it wants I should say that the commissioners we have just now were estimated to cost about three and a half million they now cost over 10 the total budget for office holders in the last in the last year was 8.1% of our overall budget where we to double the number of commissioners is becoming a thumping big piece of money that this parliament's budget is going towards that purpose and therefore I think there is a consideration we have to have not just about the financial cost that we're associating with this but that the fact in my experience no commissioner has ever downsized their office they've all expanded their office considerably and therefore now come back to the purpose and my first point as I conclude that is that if we are going to create commissioners they must be given the greatest degree of latitude and power that we have and we're going to cremate them let them do what we said we thought we would do and that's why I do regret that the patient safety commissioners responsibility and authority is slightly truncated from where I thought it would be Thank you Mr Carlaw I now call Carol Malkin to be followed by Jolene Mackay Miss Malkin Thank you Presiding Officer I thank my colleagues on the health social care and sport committee for their work in the bill and I would like to equally express my gratitude to the committee clerks and the legislation team for their on-going assistance and I think as we all do we have to thank the families and the patients who have engaged so closely with all of us and what can often be very difficult times for them and I think Jackson Carlaw put that so eloquently for us it is often difficult for these families and patients and they quite rightly expect so much from us and they do deserve every bit of the time that we put into this to get the maximum from any bill so it's an important point that Jackson made before me my party as you know are supporting this bill we are long standing advocates of the general principles held within it and view reform in the area as a top priority patient safety is a paramount importance for the future of our NHS and we are long overdue tangible changes that reflect this we all know of a great many examples where a fewer to consider the overall state of patient safety has led to loss of life and the uncalculable damage to families across Scotland and this is a step forward in giving that the attention it deserves but it is only a step it is by no means a fix all but it does provide formal recognition of a change in the direction of travel that we can all welcome if the government truly wish to continue I think others have made this point along that path however they had to come today and give proper status to all aspects of Millie's law which would have given bereaved families much needed new rights at stage 2 the SNP and the Greens unfortunately did vote together and voted down my party's reasonable attempts to introduce these measures there was however still an opportunity to deliver on this much needed amendments and back Scottish Labour's proposals today and they should really have taken that opportunity don't doing so would have given this bill a long term legacy that could really be a touchstone for a serious reform across our health service and how patients interact with powers in the NHS as a public body Presiding Officer we must also reflect on the overwhelming pressure being placed on staff which in turn hinders patient safety the two things are entirely linked and there has to be much greater openness for staff today's serious patient safety issues including their views when words are seriously understaffed therefore at this juncture I would like to thank the minister for accepting my amendment at stage 2 which improved co-operation between safe staffing and patient safety legislation and again I thank the minister for acknowledging that in the debate earlier today patient safety and staff safety go hand in hand we cannot have one without the other and so as we debate this legislation this evening I urge members to be aware of the fact that we still wait the implementation of safe staffing legislation and patient safety cannot be fully secured until the issues within our healthcare settings are recognised and addressed we cannot suggest for a moment that a patient safety commissioner alone will produce significant improvements to patient safety as we've seen in recent times confidence has eroded due to scandals and our NHS continues to be seriously underfunded those scandals have often been linked to women's health as we've noted including the use of mesh and more recently the provision of endometriosis care and whilst I will not overly focus on that point it is a point that must be made it is one that we must continue to address we need to re-address the balance of power and some of my amendments earlier sought to do this and it is disappointing that the Parliament seemed or the Government seemed scared to accept these amendments I am concluding Presiding Officer this bill is welcome but it is a stepping stone and we must never forget that this is the beginning and we must always try to do more thank you Presiding Officer thank you Ms Mocken I now call Gillian Mackay to be followed by Evelyn Tweet Ms Mackay thank you Deputy Presiding Officer I like others I'm very pleased to see this bill reach stage 3 and can I follow others by thanking all of those who have put work into the bill the Scottish Greens have supported the appointment of a patient safety commissioner throughout this process as we believe it will lead to an improvement in patient care it will also help to rebuild relationships between patients in the health service where there has been a breakdown of trust patients must have confidence in a health system in its safety and its ability to respond quickly when problems do arise they need to know that if they raise concerns these will be heard and that they won't be left with sometimes life-changing injuries with no means of redress the patient safety commissioner will have oversight of the entire system and will be able to promote system-wide improvement while amplifying the voices of patients and their families this will mean that trends and patterns will be identified more quickly and widespread issues will be addressed there has been discussion about whether the commissioner should look at individual complaints I support the commissioner taking a systematic approach to identifying trends and areas for improvement although this process should be based on clear evidence with protection of vulnerable people prioritised there may be some confusion about the specific role of the commissioner among members of the public particularly in the first few years after they have been appointed we need to ensure that the role of the commissioner is well understood in that any materials explaining this use inclusive and accessible language the health and social care alliance has called for inclusive communication processes to be incorporated into functions of the commissioner at the earliest opportunity to ensure communication and information provision is inclusive for all and I second this call this cannot be seen as separate or as an add-on to the appointment of the commissioner it should be embedded from day one so that people do not feel disheartened when they attempt to contact the commissioner only to be informed later that their individual complaint will not be considered alongside excellent communication about the role and responsibilities of the commissioner there must be an early focus on the building of relationships the public should see the commissioner as someone who's on their side someone who's working to make health services safer rather than an official who serves to protect the NHS and make problems go away it's vital that human rights are at the heart of the patient safety commissioner's work and that they fulfil their functions while upholding equality's legislation as I mentioned during my stage one speech the commissioner must be aware that not all complaints are treated equally and that existing inequalities such as those related to gender race and economic status will impact the experience of patients when things do go wrong as I said then I fully support the commissioner adopting a focus on addressing and mitigating existing health inequalities and how those can compound system-wide problems following on from the point about equalities the appointment of the commissioner must be fully transparent with those with lived and living experience of patient safety issues playing a meaningful role in the recruitment process consulting people with lived experience should be an on-going process and not a one-off event and I welcome the requirement for half the advisory group to be made up of people who are representative of patients I agree with the alliance's statement that the commissioner's strategic plan should be explicitly co-produced with people with lived experience of patient safety issues and unpaid carers this will ensure that engagement with lived experience is not tokenistic but is embedded in the work of the commissioner from the beginning I will conclude by saying that the appointment of a patient safety commissioner is a vital step towards improving patient safety and demonstrating that when mistakes are made patients will be listened to and complaints will be taken seriously The Greens will therefore support this bill at stage 3 Thank you Ms Mackay I now call Evelyn Tweed to be followed by Kenneth Gibson Ms Tweed Thank you Presiding Officer I am very pleased today to speak in this stage 3 as I did at stage 2 as a member of the health committee I believe that this legislation is much needed As we have heard from the minister the patient safety commissioner was recommended by the independent medicines and medical devices safety review I shared this quote at stage 2 and will share it again now because it gets to the heart of why this legislation is needed Speaking of the issues highlighted by that review Baroness Cumballage said we have never encountered anything like this the intensity of suffering the fact that it lasted decades and the sheer scale this is not a story of a few isolated incidents no one knows the exact numbers affected but it is in the thousands the tens of thousands The Cumballage review focused on three patient safety issues transvaginal mesh sodium valparate and pregnancy and penmodos These all have something in common their adverse effects impact women a group who are often not listened to in medical settings patient safety issues range from those resulting from active intervention such as transvaginal mesh to those that come about from small cumulative errors To illustrate the other end of the scale is an issue recently highlighted to the English patient safety commissioner research has found that time sensitive medicines are being administered late for those with diabetes Parkinson's HIV late medication can cause deterioration that is sometimes irreversible it is estimated that more than a hundred thousand Parkinson's medications are given more than 30 minutes outside their prescribed time or missed each year in Scotland's hospitals Only a handful of incidents and complaints are reported despite the harm that these errors can cause In the past tens of thousands of people were dismissed ignored and left to suffer This cannot continue it's of the utmost importance that the social context is acknowledged and I welcome the agreement today to amendment 13 from Paul Sweeney which sets out the need for the commissioner to give particular consideration to underrepresented groups As patient safety commissioner for England Dr Henrietta Hughes told us if we get it right for those who are the most vulnerable we make it better for everyone If we create a culture of openness patients can share not only what has gone well but also where things could have gone better Patients should have the confidence not only to look at receive the best treatment without fear of harm but any concerns that they raise will be listened to and acted upon The bill ensures the commissioner is independent of government and the NHS and will be accountable to the Scottish Parliament and to the people of Scotland and they will have complete freedom to consider or investigate any issue they believe has a significant bearing on patient safety and healthcare As England's PSC says there are pockets of excellent practice from which we must learn and we can learn from her work Already she is working with stakeholders internationally forging connections with those leading towards positive change on a global level To conclude, Presiding Officer I look forward to seeing our Scottish Patient Safety Commissioner be a voice for patients who too often go unheard Thank you, Ms Tweed and I now call Kenneth Gibson Mr Gibson Thank you, Presiding Officer and I'm pleased to contribute to this debate on behalf of the Finance and Public Administration Committee As Jackson Carlaw pointed out just a few minutes ago should Parliament pass this bill today then the Patient Safety Commissioner will join seven other commissioners this Parliament has established since 1999 and there are more being proposed The Finance and Public Administration Committee has a responsibility to scrutinise the SPCB budget each year an increasing proportion of which supports the functioning of commissioners The set up costs for the Patient Safety Commissioner are expected to be around £150,000 this financial year and next with annual running costs thereafter estimated to be around £645,000 at this year's prices and as Tess White pointed out in her amendment 22 these costs will add to the £16.6 million that the SPCB required for the seven existing commissioners in 2023-24 This is a 8.1% increase on the previous year and it's now 8.1% of the SPCB budget as Jackson Carlaw pointed out One of the increases this year which alarmed the committee was that one of the commissioners was hiring 7.4 additional members of staff on an average salary of £57,000 at a time when front-line services are under real pressure Now, as a committee we didn't receive any submissions to our call for views on the Patient Safety Commissioner Bill but in view of the number of commissioners both current and planned we wrote to the lead committee asking it to explore with the Scottish Government the financial impact of establishing this commissioner on the SPCB office holder responsibilities We're also keen to know whether a more strategic approach to the establishment of and resourcing for future potential office holders might be considered in the future We express no views as to the merits otherwise of the Patient Safety Commissioner and we thank the lead committee for acknowledging our concerns in its stage 1 report We also note the minister's response to it and I quote it would not be right to make funding commitments now based on hypothetical developments in the future The Scottish Government will engage constructively with the SPCB to ensure that all parliamentary commissioners are funded appropriately including the patient safety commissioner Well, this may be welcome it somewhat misses the point Is it SPCB told us during budget scrutiny LSU and I quote we could be looking at having 14 commissioners in the years ahead close quote So based on current proposals that's based on current proposals in government and members' bills as well as the recent consultations The SPCB suggested that the process is complicated but we are moving into a period in which it's becoming a casual thing to suggest and implement the establishment of another commissioner despite it being an expensive extension to our public sector and indeed I commented on at today's conveners committee the plethora of organisations that we already have in the public sector and how crowded that already is So this matter is a particular concern to committee in the context of our work on the sustainability of Scotland's finances now and in the years to come and on the government's public service reform programme It also raises important questions about how collectively the roles and governance of commissioners function alongside the roles and accountability of public bodies and government The committee considers it now is the time for a more strategic approach to establishing and financing commissioners I'm happy to give way to my John Mason Committee call I thank the member for giving way Does the committee have a view as to who should take this forward and who should be kind of leading on it? Kenneth Gibson I think it should really be the Scottish Government actually should be looking at this to be perfectly honest with you I think the SPCB and of course our own committee has a role but I think the Scottish Government itself will have to grasp the nettle on this So we need a fundamental look at how the overall landscape of commissioners has continued to develop since devolution So what's this space? The committee will be looking at some of these issues in the months ahead and not least one of the issues which I personally have raised and other colleagues have commented on is that perhaps some commissioners after they have achieved the mission they were originally set up to achieve become self-perpetuating and so perhaps we should look at a sunset clause with regard to some commissioners otherwise we will simply have more and more as years pass by So we'll continue to draw concerns where appropriate to the relevant league committee when considering future financial memoranda for bills that propose new offsolders and continue our scrutiny of the SPCB budget including that for commissioners So in closing Presiding Officer and I thank you for your indulgence Subject to the decision of the Parliament tonight I hope the new patient safety commissioner will make available contribution and be a source of support for patients across the country Thanks Thank you Mr Gibson and we will now move to closing speeches and I call Paul Sweeney Mr Sweeney Thank you Deputy Presiding Officer I'm pleased to be closing the debate for Labour on the patient safety commissioner bill today During the health committee's evidence on the bill myself and colleagues from across the committee heard accounts where patient safety had failed quite egregiously in some cases including in the cases of women impacted by transvaginal mesh and hormone pregnancy tests Cases like this denting public conference in critical healthcare services and a patient safety commissioner is therefore an essential opportunity to ensure people have a champion in cases where patient safety has failed and to prevent further failure in the system Some of these more high profile cases of patient safety failings disproportionately impact women and I'm therefore grateful to the minister for working with me to bring back my amendment at stage 2 to ensure that underrepresented voices are consulted on the development of the commissioner's principles strategic plan and charter I am however disappointed that the Government have chosen not to support my other amendments particularly amendment 14 which would give the commissioner the power to make a special report in line with the powers of the Scottish Public Service Ombudsman I think that this was a critical juncture in the legislative process where the Government has been found wanting and I thought particularly the member for Eastwood spoke very powerfully on that point that we should be giving the commissioner that ultimate power recourse to highlight where implementation has not been taken place or taken seriously and we need to think very carefully about the capacity for the commissioner to exercise their power appropriately and I think we've heard very powerfully through the convener of the citizen participation and public petitions committee how critical the patient voice was through that committee but it shouldn't then be stymied when a commissioner is able to undertake these investigations and I hope the minister will give some comfort to those who are concerned by that lack of support for amendment 14 patient safety groups were clear certainly to me that there has to be accountability and I believe opposing amendment 14 is a missed opportunity to empower the commissioner with an escalation route I understand that the minister had concerns at stage 2 about my amendments 15 and 19 to look at how the commissioner can compel private medical providers to share information and how we can clarify the remit on social care respectively I took those amendments away and worked on the drafting to address the minister's concerns so I'm also disappointed that her position has not changed in that regard but I do want to pay tribute to my committee colleagues to the clerks of the health committee and indeed to the legislation team for their constructive and collaborative approach throughout and to help try and get the bill in as best a place possible to serve the people of our country My colleague the member for Dumbarton in particular has spoken very powerfully to her amendments today which sought to reset the balance between public bodies and bereaved families and particularly in memory of Millie Mayne who died after contracting an infection at the Queen Elizabeth University Hospital in Glasgow whilst recovering from leukemia Whilst Government support on some of those amendments is indeed welcome and will go some way in giving bereaved families like Millie's a voice when patient safety is not upheld it is indeed regrettable that they were not able to fully support all those amendments to give full effect to Millie's law and it remains unfinished business sadly but we will continue to advocate persistently to fully address the intent of Millie's law in this Parliament Deputy Presiding Officer Labour supports this legislation we have sought to engage constructively with the Government throughout the legislative process to strengthen the power of the commissioner throughout our amendments though we note certainly the general comments made by a number of members about the general planning of this Parliament with regards to the scope and remit of commissioners in the round and I think that was an important point that was made in the debate this afternoon whilst those benches are supportive of the establishment of a patient safety commissioner it is regrettable that the minister has not supported some of our key proposals to improve the bill but we will continue in our efforts to ensure that bereaved families are never an afterthought in the medical establishment thank you thank you Mr Sweeney I now call on Sandish Gohani Dr Gohani thank you Deputy Presiding Officer and I wish to draw members' attention to my register of interest as a practicing NHS GP the Scottish Conservative and Unionist party members are highly supportive of this bill which will introduce a patient safety commissioner for Scotland three years on from the Cumbulage report with its key recommendations we have debated long and hard for years the SNP's poor stewardship of our NHS and have highlighted concerns around patient safety and advocated for systemic improvements this bill should help address injustices in our healthcare system and deliver the improvements in patient safety that Scotland desperately needs my colleague Jackson Carwell made strong representation to giving our commissioners real teeth to allow them to deliver but I think we fell short Jackie Baillie spoke of two awful cases around tainted water supply and seadiff and these are just two of the reasons why I believe the patient safety commissioner is required but we must be cognisant of what Tess White said that some amendments could be expansive of the role at despite this I do genuinely genuinely not understand why the minister would not back Tess White's amendment 11 so something's gone wrong and that's why the patient safety commissioner is involved now for something to go wrong staff must have been involved clinical, clerical or managerial so surely enshrining into law the views of NHS staff to be heard makes common sense whilst Tess White did not move amendment 22 we are concerned about the cost 10 million plus for last year alone and individually we do not object or oppose our commissioners and each group asking for a commissioner is perfectly valid in doing so and worthy to have one but this is tax payers money we must be able to get value for money and if we can combine backroom work for duties such as HR or lawyers then we might be able to save money overall we must not continue to create commissioners in such a way and in such numbers that as Jackson Carlaw said we end up creating another level of government I would urge careful consideration of cost and try to save as much possible by innovation as possible and I do feel that we have cross-party support for this I agree with Baroness Cymbridge that the role of the patient safety commissioner is to find the golden thread that runs through the story of harm this I hope our patient safety commissioner is able to do and I look forward to their first report where they can start making healthcare safer independence from Scottish government is important and we on this side support this position to allow an agile commissioner who I hope will follow data and stories and the golden thread I'd spoke about now I want to touch on a point made by Tess White before I end my remarks to everyone who interacts with our fantastic staff and our fantastic NHS the vast vast majority of interaction is safe I want patients to feel reassured but culture is an issue and we need to make sure that if something does go wrong we have someone who is able to carefully look at it and make healthcare safer we support this motion and wish our future commissioner well Thank you Dr Gohani and I now call on Jenny Munto Minister to wind up the debate Minister Thank you Presiding Officer I am grateful to members for their contributions to this afternoon's debate which has been thoughtful and constructive and I am pleased that there is support across the chamber it's been clear that this bill's overall purpose the establishment of the patient safety commissioner for Scotland has enjoyed strong cross party support from the start I know that members on all sides of this chamber share the common goal of making Scotland's healthcare system as safe for patients as it can possibly be That is only right given the challenges the NHS has faced in recent times and it will continue to be of the utmost importance as we continue to recover from the pandemic We've had a very useful debate today which has explored a range of issues but if I may I'd just like to reflect on a couple of visits and events that I've attended in the last 24 hours One was today at Chaz Rachel House in Conross and then also the Neuroblastoma event last night in Parliament These are important things for us to consider when we are in this chamber I've met and we've all met brave parents and families sharing their experiences and it is occasions like these that I think we all have drawn putting people the people of Scotland at the heart of what we do and working together to improve healthcare in Scotland and I believe as a number of members have said the introduction of the patient safety commissioner is a key part of this I noted that a number of members have used the word trust the words trust and confidence and I think that is absolutely the nub of where we have to get to so I appreciate these comments openness, learning and co-operation is where we need to get to with this fantastic role of commissioner Jackson Carlaw commented on the latitude and power to make decisions and I believe that this is what we have within this bill under the statutory powers that we've given it Carol Malkin patient safety is paramount to the survival of the NHS yes it is and I you recognise that this is a step on the path and also the importance of staff involved in this and I recognise that Gillian Mackay made a couple of comments about system wide improvements but also the importance that we are clear on what the role is and I agree that we need to listen to how we ensure that the people of Scotland understand the roles and responsibilities of the role Evelyn Tweed commented about getting it right for the most vulnerable we get it right for all of us and I think that's why I reflected back to the neuroblastoma event I was at last night Kenneth Gibson important importantly raised the strategic approach and from the Scottish Government's perspective we would always be willing to talk to the corporate body and I think he raised some important points yes of course John Mason I thank her for giving way I note the point she says talking to the corporate body does she agree with Mr Gibson that the government needs to lead on this or should somehow it be Parliament that leads on this Minister so I think that the corporate body and the Scottish Government need to talk about this and I think that that's important because it is the strategic approach Paul Swerie talked about the champion the patient commissioner patient safety commissioner being a champion for underrepresented voices I was very pleased to work with them to ensure that we got that amendment correct correctly worded and I would just point out to Sandesh Gohani and also Tess White that there is nothing precluding the commissioner hearing from staff and I think that's important to reflect on so I'm grateful to the many members who've contributed to the progress of this bill in the weeks and months leading up to today a number of people have raised specific things, Emma Harper for example for the care of cancer patients in her own constituency Katie Clark also spoke to me about hernia mesh and I'm pleased to be able to be meeting with her and some of her constituents shortly and I as I've said before I welcome the clear support for the bill across the chamber it will create a new an independent patient safety commissioner who will gather feedback on the safety of healthcare in Scotland making recommendations for systemic improvements and work collaboratively with other bodies to achieve those improvements and make healthcare safer While the patient safety commissioner will report to parliament they will hear the stories of patients and it's that lived experience that has been noted by a number of members their families and wider public directly and their priorities will be informed by the importance of patient views and safe healthcare they will be a commissioner for patients and the public not politicians I know that parliament wants to ensure that the bill builds on the rights that already enable patients to give feedback raise concerns and make complaints in Scotland we must continue to listen to patients and learn from their experiences I trust that members are satisfied that this bill strengthens our commitment to do that the wording of the bill will allow the commissioner to consult widely on both their statement of principles and strategic plan and as was passed today the charter ensuring that the views of patients can be built into the way the commissioner functions from the very outside of the role As I mentioned earlier although the bill arose out of the specific issues outlined in the Cumberlidge report I believe it is right that the scope of the commissioner has been kept intentionally broad this is crucial to ensuring that no voice in Scotland is left unheard I cannot stress the importance of that enough As members do not need me to remind them the patient safety landscape is a complex one the patient safety commissioner will collaborate rather than duplicate leveraging their influence to work with the other organisations to track trends identify problems and make positive improvements I would like to thank all those members who I know have worked hard on making this bill as effective as possible in achieving its aims of improving patient safety I mentioned a moment ago some of the earlier work that's gone into this but I'd like to particularly thank Jackie Baillie, Paul Sweeney and Tess White as I alluded to earlier even if there's not always been complete agreement on every single intricacy in this piece of legislation I recognise and am grateful for the fact that every single amendment proposed has been made with that constructive aim in mind of making the patient safety commissioner as effective as possible in order to achieve the maximum possible benefit for the safety of patients I hope that opposition members will recognise that same constructive spirit in the way the Scottish Government has engaged in this process I would again like to thank the health, social care and sport committee for their effective scrutiny of the bill and all those who gave evidence often powerfully I would also like to thank the bill team for their diligence and also my predecessor Marie Todd Presiding Officer The title of Baroness Cumberlidge's report which first recommended the creation of a patient safety commissioner was first do no harm in listening to the voices of patients and their families investigating further without fear or favour and working with others to achieve positive change I believe Scotland's patient safety commissioner will reinforce that fundamental foundation of trust in our healthcare system that it does no harm to those in its care Indeed, Presiding Officer I believe that in creating the patient safety commissioner for Scotland this Parliament will be doing the right will be doing right by Scotland's patients and their families I commend the motion in my name and I very much hope that members will vote for it unanimously Thank you