 Felly, wrth gwrs, fel《Fourth Meeting of the Health, Social Care and Sport Committee in 2023. I have not received any apologies for today's meeting. The first item on our agenda is to decide whether to take item 5 in private. Does everyone agree? We agree. Thank you very much. The next item on our agenda is our first oil evidence session on the patient safety commissioner for Scotland bill. Today we will take evidence from Baroness Cumberlidge, who led the independent medicines and medical devices safety I welcome to the committee joining us remotely Lady Cumberlage, the chair and Simon Whale, the review member and communications lead for the independent medicines and medical devices safety review. I'll move straight on to asking Baroness Cumberlage a question on that review. One of the recommendations of the review was the need for a patient safety commissioner. Obviously, that's happening in the English NHS and the Scottish Government are proposing in this bill that we have a patient safety commissioner for Scotland as well. What was it in that review that led you to conclude that a patient safety commissioner is a good way forward in addressing any public issues with the patient safety? Come on to start by thanking you very much for this opportunity. We do welcome it very much indeed and to say that I'm accompanied by Simon Whale. Simon Whale, Sosirachantla and I were the panel that went around England looking at safety issues. In fact, we came to Scotland, went to Northern Ireland and went to Wales but our review was really, we were commissioned to look at England. We were so concerned what we heard from patients and the suffering that had gone on and they were heartbreak stories and we thought something must be done. We thought a lot about it and we thought that if we could have somebody and we named it as the patient safety commissioner, this person whose whole remit was to talk with patients to relisten to them and then to act to try and ensure that services were much safer in the future. I don't know if Simon wants to come in, Simon. I would echo what Baroness Cumbidge has said. What we found was that the healthcare system was disjointed, it was styled food, it was too often defensive, it too often didn't listen to patients who had suffered avoidable harm. We saw the patient safety commissioner, as Baroness Cumbidge put it in forward to the report, the golden thread that would link the system together and hold it to account. But they need to be independent of the system, they need to have the resources to do the job properly but their remit, their focus needs to be on patient safety, detecting trends of concern and getting the system to act promptly where the patient safety commissioner detects such trends. My colleagues will come in later about the difference to what is happening in the English NHS with regards to the remit of the patient safety commissioner there, as opposed to the proposals for the Scottish patient safety commissioner. In terms of other deliberations ahead of you deciding on the patient safety commissioner, were there any other discussions about alternatives to that? Was there anything that was discounted or in the mix of what you might have thought might be a way forward that wasn't going down this route? Of course, our review was very comprehensive in what we've spent two and a half years going around the country, listening to people, listening to professionals as well as users of the service. We really felt that, as Simon said, it was this very disjointed system. We needed somebody who would pull it all together to be the golden thread but would ensure that safety was on the top of everyone's agenda. Having appointed the patient safety commissioner for England, Henrietta Hughes, has made a remarkable progress already. We have been hugely encouraged by the way that she has embraced this new role because it is the first for us in England. In fact, I'm not sure that there are many across the world. I haven't done the research, but certainly she has taken this really seriously. Of course, we had a very comprehensive system in order to appoint a patient safety commissioner and it was competitive. We felt that the patient safety commissioner was the only way of ensuring that the system could be held to account. We didn't believe that an organisation or a person sitting within the existing system would be able to do the job in the way that an independent patient safety commissioner could. That's why we came to that view that recommended the establishment of the patient safety commissioner. That's really helpful. That's a really helpful starting point because I think that the independence of the commissioner seems to be the absolute paramount reason for taking them out of the system and being the watchdog of the system on behalf of patients. It's very helpful to know that process and that's why you came to that conclusion. I hand over to my colleague Emma Harper. Good morning to you both. I'm interested in the remit of the patient safety commissioner and comparing it to England. We have lots of commissioners in Scotland. In my notes, we've got equality in older persons commissioner, a veterans commissioner, a children and young people's commissioner. I'm interested in how that would work with all the commissioners and how would it be different? We also have commissioners, children's commission and so on, but this is the first one that we've had within the health system. Certainly, we felt it really, really important, as Simon has said, that we had somebody who was independent and out with the system. We didn't want somebody who was just a creature of the Department of Health, for instance. We wanted the independence that the patient safety commissioner would bring. We felt that the role was really important not only to hold the system to account, but we wanted to ensure that the role was a statutory authority role. That wasn't just a good idea. That had to be in legislation and, of course, it is. We also felt that the patient safety commissioner really would have to have a very broad remit. I have to say that one of our concerns, even now, is the question of resources that are allocated to the commissioner, because it's a big job. It's the first time on our Henrietta Hughes, who is the commissioner, is still having to recruit staff and to set up the systems that she wants. Clearly, it is outwith the usual Department of Health or other systems that are around. This is somebody who is very independent, and that is critical. Just another quick question regarding the remit. Originally, we were looking at mesh harm, or issues of sodium valparate, and that potentially could be expanded. I'm interested in your opinion about whether the patient safety commissioner should go beyond medicines and medical devices and look at wider issues in our bill. It talks about forensic medical services, but I also have concerns about rural issues and rural safety when it comes to a population of people who are engaging with health service in more in-distance travel than urban settings, for instance. Married to a farmer, I couldn't but agree with you that rural issues are really important. But we just felt, to begin with, because there is so much suffering, there is so much to do in the three areas that we examined, we wanted to start with those. One was Primodos, a medication that was given to women with poor results for the baby. The other is sodium valparate, which we are still struggling with, because doctors are still prescribing and pharmacists dispensing sodium valparate, so we know it's damaging. We're still struggling with that. The first one, of course, is mesh, which is such a huge issue and has caused such terrible, terrible tragedies to women and their families and babies. First, we recommended that the English Patient Safety Commission should focus on medicines and medical devices, including the three that we examined in our review, but not limited just to those three, but to all. Henry Oethe-Hugh's remit covers all medicines and all medical devices. It doesn't go further than that. The reason we originally said it doesn't go further than that was because we felt that that scope was huge enough in its own right. We didn't, in our report, rule out the prospects of the Patient Safety Commission in England taking on a wider and wider remit as she gets established and her resources come on the stream. That is perfectly feasible. To your point, there are plenty of other aspects of healthcare beyond medicines and devices themselves that have safety concerns around them or safety implications. In principle, the Patient Safety Commission in England and in Scotland should have the power and the opportunity to examine all those different aspects of healthcare, not just one or two aspects of healthcare. Tess White has a question on this. I had to add two questions, but the second one has just been answered, so thank you for that. Baroness, my understanding is the approach taken in Scotland would mean that the commissioner would not consider individual cases but would instead monitor systemic issues as you've talked about the golden thread. The First Do-No-Harm report emphasised that a patient safety commissioner should be a public leader with a statutory responsibility to champion the value of listening to patients. Are you satisfied that the approach taken in Scotland satisfies that recommendation? Yes, I do. I have read the proposed bill that you are going to be putting before the Scottish Parliament. I must say that I agree with all of it. I think that it's extremely well got together. It's much more detailed and prescriptive than what we have been doing. I think that what you have done is actually extremely helpful to us. Individual cases are quite difficult if you get bogged down in individual cases, you get into inquiries and all the rest of it. We saw the patient safety commissioners having a broader role. We wanted this person to look across the whole piece. Of course, cases she will come across and already cases have been referred to her, but they are used really to assess trends and to see what is happening across the piece, but it's not for her to investigate individual cases. We've got the ombudsman and various other organisations and individuals, so we really saw it in a different role from what we already have. Thank you, Tess, and a question on the remit from Paul Sweeney. Thank you, Baroness, for your comments so far on this. It was quite clear to me in reading the background on your report and the report itself about the gendered aspects of the complaints in particular and the harmful side effects that seem to be disproportionately affecting women. How would you suggest that a specialised gendered consideration of complaints is not overlooked, given the otherwise vast remit that the commissioner will no doubt be undertaking and the volume of complaints that will be received? I may pass that on to Simon. I do believe that the healthcare system has to deal with everybody. It's quite difficult if you start to divide it up into different genders and so on. I'm not sure that's a really good idea, don't you, Simon? I think that what we found, as you have seen in the report, is that women and children were the people that were affected by the medicines and devices that we looked at overwhelmingly. What we found was that the healthcare system seems to be particularly poor at listening to women and taking their concerns about their own health, well-being and the outcomes of their procedures seriously. Many women that we met around the country, including in Scotland, told us time after time that their doctors and other healthcare professionals and other system participants just did not listen to them, sometimes didn't believe them, told them that the pain that they were experiencing was in their head, really quite worrying and disturbing responses from the system, and sometimes no response at all. I think that you're right to be concerned that women suffer particularly in that regard, but I think that it's for the patient safety commissioner, Earl himself, once appointed in Scotland, to work out how best to engage with women and how to ensure that the women who sadly have a track record of not being listened to and not being taken seriously are indeed taken seriously by the commissioner, so that the commissioner can advocate on their behalf and address their concerns with the system. I don't think that you need a separate mechanism. We would argue that it's for the commissioner themselves to make sure that those people who are isolated and often overlooked, be they women or indeed others, need to be heard. I would just like to add that I do think that it's a family concern, and often we have partners who have come and told us what they felt that women have been suffering. That has also been very helpful. We have taken evidence from men and women who are partners in those women. A few members want to come in on the back. I think that they are picking up a very short questions space because we've got quite a lot of themes to get through in the hour that's going to go very fast, I feel. Emma, and then Stephanie, quick question before I move on to the next theme. The rural commissioner in Australia listens to people and advocates so that their voices are heard. In your report, it was pretty clear that some people have been campaigning for decades. Regarding your view on how firm advocacy and listening to people needs to be for the patient safety commissioner, I would just like to hear your thoughts on how firm this advocacy role needs to be. Well, I just say that we have the most brilliant researcher who still actually works with us, and she did a lot of work on Australia and other countries as well. That was really helpful for us to see what other people were doing, but we felt in the end that the obligation, the responsibility, was ours. In our case it was for England, but Simon, do you want to come in? I think that the firmness is a very important point. The patient safety commissioner needs to be robust. They need to be clear, and if necessary, they need to be instructing the system to act. Where there is a genuine concern about the safety of the medicine advice or other aspects of healthcare, the patient safety commissioner needs to have the clarity and the strength of voice to compel the system to act. The legislation needs to provide for that. Just touching back on the gender aspect of it as well, I know that my daughter was really ill when she was small. One of the bits of advice that I would give to other parents was to make sure that they took a meal with them because they tend to be listened to much more. Is there scope for the commissioner to make that an overarching issue? The fact that women do not seem to be listened to and make it something that they look for in all the evidence that they are looking at across all the issues that they are covering? Is that something that they are able to do? We made it very clear that the commissioner could call people to account. Because the commissioner was independent and because she had powers in legislation, it was possible for our commissioner that we appointed to call people to account, where she felt that they were failing and failing particularly our users of the service. I am going to move on to questions from Sandesh Gohani on the English patient safety commissioner. I was just asking, we had a private session here where we were asking questions to our bills team and one of the questions that I would like to ask about the English model. Baroness, you just said that there was powers in legislation. What are those powers if bodies do not respond to Henrietta in the timely fashion that she would like? It is in our legislation and I am sorry that I should have brought the act with me and I have not because it has been through Parliament. It is very clear that she has the power to call people to account. I saw in your act that you are proposing at the end. Is it today, I think that is January? I thought that that was really interesting that you have include powers because I think that that is essential. It is no good just having somebody who can talk but they must have the legislation behind them that will enable them to act as they think fit. Of course, you are proposing that which I think is excellent. I think that the English legislation does not go quite as far as your bill does. The patient safety commission in England has the power to make it publicly known if an organisation is failing to co-operate with her. She does not have the power to compel them to do something. She can, as it were, name and shame them but the legislation stops short of saying that she can absolutely compel them. They have a duty to co-operate with her and that is built into the legislation. Do you feel that having powers such as maybe being able to find public organisations would be something that would be useful? In your proposed bill that you are putting forward, you do have the power to require information. I think that is a very good power to have because information is absolutely essential. As you will know in your profession, you need the information and you have put that into your patient safety commission of Scotland bill. I think that is extremely good. Of course, you bring in the question of confidentiality of information, which is part and parcel of that. However, I think that power and require information in a formal investigation. That is very powerful. That is, I think, a very good way forward. I do like your advisory group. Of course, our patient safety commissioner, Henrietta, is now forming her advisory group because that was also in our legislation. Thank you. Just finally, were there any lessons that you learned and have learned in what is going on that you would say to us that we need to maybe add in to our bill or anything that we could do to improve it and not have to learn the same lessons that you have? I think that your bill is very comprehensive. It is really good. It has a pick-box system with it. There is a duty to have a plan. That is a very good start. I think that very often people feel that they do not have a plan that everybody can sign up to and see what the purpose is. You have all that in your bill, so I congratulate you. It is a really good idea. We move on to questions about clinical governance. They have been led by Evelyn Tweed. Written Evidence highlighted a cluttered scrutiny landscape in terms of patient safety. Do you see potential for a patient safety commissioner to add some clarity and what would be required for it to do so? You are absolutely right that the landscape is cluttered. Whilst it is cluttered, it is also siloed. That leads to increased risk around patient safety and increased risk of avoidable harm. We felt that the patient safety commissioner's role is to encourage and, if not encourage, require the system to act in a more coherent way. Because its focus purely is patient safety, it does not have anything else to distract it from that. The patient safety commissioner can encourage the system to act in a more coherent way. We absolutely accepted when we were considering this role that the risk is that you just place yet another mechanism into an already crowded arena. I think that because of its independence, the fact that, as Van Escambridge has said, it is out with the system, the patient safety commissioner can orchestrate and require people to act in a concerted, coordinated manner in a way that does not happen, certainly does not happen in England prior to the patient safety commissioner's appointment. Can I just start one thing? I think that it is critical that the patient safety commissioner that you appoint has sufficient resources to do the job. I think that we did not pay enough attention to that. Indeed, the person that we have appointed is very good at negotiating. She is actually managing to get more resources and more staff because, at the moment, she has only got four members of staff. You picked up the four members of staff, but I think that this role needs a great deal more because people do have to look at the data, examine what is going on, and they have to look across the whole piece. That is going to require some more people of great talent of integrity who are going to be doing that. I just say to you, just the word of caution, make sure that there is enough resource. Just for clarity, you are not worried about any sort of potential overlap with other Government bodies in terms of the patient safety commissioner's role? I do not think that we are concerned about that. As has already been discussed, there are other commissioners that children's new young persons commissioners. There is an obvious possibility of overlap there. I think that it is for the commissioners themselves to co-operate, talk to each other, keep open lines of communication, share information between them to avoid that duplication. From our perspective, we felt that that was perfectly possible. They do have clear instinct remits. Yes, there are occasions where they could overlap, but that overlap could actually be quite powerful in the public interest. Thank you everyone. I will test you with a question on this. Thank you, convener. Baroness, in Scotland we have the Scottish patient safety programme, the NHS incident reporting and investigation centre, the healthcare improvement Scotland, professional regulatory bodies such as the GMC, the Patients Rights Scotland Act 2011, a patient advice and support service provided by Citizens Advice Scotland, and a Scottish Public Services Ombudsman. The question is, how do you envisage that a patient safety commissioner will fit into a seemingly saturated landscape without duplicating the work of existing bodies? Is there any evidence of that occurring in England? I am sure that we can match the number of organisations that you have already mentioned, and perhaps we have got more. I do not know. I think that it is terribly important that all those organisations know what each other is doing for a start. Secondly, they talk to each other that there is a coherence about it all, and the way that you describe it, it certainly is a big task. We have some questions about your appointment process. They are going to be led by David Torrance. David. Thank you, convener, and good morning. Baroness, what is your opinion on the different approaches being taken in England and Scotland with respect to the appointment of a patient safety commissioner? In which approach does the Baroness think that it would be better for achieving the ambition that she has for a role? I think that the appointment process is really, really important. We advertised it very widely, and to be perfectly frank, we were quite disappointed about how few people of the calibre that we were seeking applied for the job. Unfortunately, we did appoint Henrietta Hughes, and she has made a tremendous impact already. Of course, setting up a whole new organisation takes a lot of time and energy and effort and resource and everything else. So she has had to lay down the different, well really, the architecture, the foundations, everything in order to get this position in a strong position, and she is doing that. In fact, she is having on Thursday a very big meeting where she is involving voluntary organisations, of course people working in the NHS and beyond. That is really important because the thing that Henrietta has done has made people aware who she is, what her remit is, and how she is going to go about it. Thank you for that. Baroness, would you agree that there is a risk to the Scottish patient safety commissioner who is not sponsored by an relevant Scottish Government department would be easily overlooked because of this? Well, I think that it is quite careful. As we understand it, the commissioner will be accountable to you in the Parliament, and actually I think that underlines their independence from the healthcare system. We include in the healthcare system the Government sets healthcare policy, so it is part of the system. I think that what we want the commissioner in Scotland just as we want in England to be a clear, strong voice for patients, someone who does not have to look over their shoulder and worry about who they might upset within the system, someone who says it as they see it and is constantly thinking about the best interest of patients. Reporting into the Parliament means that they are accountable, that it is transparent. I think that that is a good way forward. I do not think that we have any concerns about that. I will move on to questions around individual complaints and how you are managing that aspect of things from Gillian Mackay. How would the Baroness respond to those who argue that the patient safety commissioner should have a role in dealing with individual cases and complaints? We have shied away from that because we have other organisations that can deal with individual cases, but I think that it is absolutely critical that she has an organisation that examines the data of what is coming forward, sees the whole system, sees the whole scene because she needs to see the trends and what is happening. I do not think that the patient safety commissioner should get involved in trying to sort out individual cases. How can the expectations of the public be suitably managed in terms of the public safety commissioner's role in promoting the voice of patients without taking on those individual cases and complaints? There is a communication job to do for the patient safety commissioner, both here and in England and in Scotland, which is to make it very clear what their role is and what their role is not so that the public has some understanding. It is not that the patient safety commissioner would not receive concerns from individuals. The job of the patient safety commissioner is to receive those concerns, analyse them and consider whether they amount to a trend and or a systemic problem. If an individual case does not amount to a trend but is still a legitimate concern on the part of the patient, then we would expect the commissioner, certainly here in England, and I would imagine in Scotland, to signpost that individual, that person to appropriate alternative organisations so that they can look into the case. It is not that the patient safety commissioner should ignore individuals. It is quite the opposite. The patient safety commissioner is there to listen to individuals, but he or she is there to try and understand whether it is a big picture problem or whether it is just one individual isolated case of poor outcomes. In terms of what you said about the communication piece for the public safety commissioner, what do you believe is the most effective way of being able to communicate some of those changes that have been made as a result of issues where there are trends and things need to be changed either within individual health boards or within the system as a whole? It is a point that may provide redress and some comfort to some of those who have raised concerns. How do you think that that should most effectively be done? Well, hardly by the patient safety commissioner themselves, so they should be communicating clearly and strongly using all the appropriate channels to make the public aware that they have detected a trend or a systemic problem that they have recommended or compelled the system to change practice, to change whatever needs to be changed, and that that is resulting in harm being avoided. The patient safety commissioner has a role, but we would argue that the system itself has a role alongside the commissioner to say that the commissioner has helped us to understand that there is a problem here, and we have acted and here is how we have acted. So it shouldn't be a confrontational relationship, it should be a co-operative relationship, because we would expect and you would expect the healthcare system to be dedicated to safety just as the patient safety commissioner is. Thank you, Gillian. Number of members want to ask questions on this issue. Everyone, Tweed? You do not have a question. Paul Sweeney. Thank you for the comments so far. I was curious by the information from the Scottish Public Service ombudsman showing that complaints of the complaints and inquiries they receive are around 64 per cent related to clinical treatment and diagnosis, and of those cases approximately 60 per cent were upheld. Does the baroness think that noting that the public, the patient safety commissioner, is not responsible for dealing with those individual cases, that there is an argument for the PSE to focus heavily on specific areas of healthcare and patient safety, such as clinical treatment, because, for example, of the 278 compensation payments paid out by NHS Scotland in the last year, that was £60 million of expenditure? So surely if we can get to the root cause of why so many complaints are being made regarding clinical treatment and diagnosis, maybe we'll be in a better position in the longer term, not just to improve the patient journey, but also to achieve great cost avoidance as well. Yes, I think we would completely agree with that. The patient safety commissioner has the opportunity to reduce the risk of harm and in the process reduce the likelihood of litigation, of litigation costs as well. So their role is about helping the system, helping the taxpayer ultimately, because it's the taxpayer that funds that, that redress, that compensation, as well as ensuring that people don't suffer a avoidable harm. The commissioner has to have the ability to understand the picture in front of them, to interpret it, and to draw conclusions on what needs to happen. And then the system needs to act. And if all of that happens, then the outcomes that you're suggesting will be delivered. And certainly with Henrietta, I know she's had a lot of talk with NHS resolution, who are involved in litigation, and that they have been very helpful towards her. So I think the more that these different silos are breached, and she is there, she is working with a lot of the different organisations. Because of her background, she knows the NHS and healthcare very, very well indeed, and that actually was a great asset, and is a great asset for her, and also for the role. And that was one of the reasons why we appointed her, actually. Thank you. Now we have questions from Paul O'Kane on social care inclusion. Thank you very much, convener. A number of submissions to the consultation on the Scottish bill felt that the patient safety commissioner should also cover social care, and indeed social care is very topical given the challenges in that sector. I think also coming out of Covid, there has been a renewed focus perhaps on safety in social care. So I wonder if the Baroness thinks that there is a case for including social care within the remit of the patient safety commissioner. Well, I think at this moment, the person who is appointed has a huge role, and certainly once your bill is passed, and I presume it will become an act, that person who is appointed is going to have to set an awful lot of things in train, and I am thinking about ensuring that they recruit the right people, that they have got the right premises, that they have got their independence. It is a very complex role, really. I think that to take on social care at the moment, well, certainly for us, I think that she really would not want to do that, though of course one has to appreciate how much it does build into or, in fact, the reverse with a health care. I think that it is something for the future, but I would not put it on the shoulders of somebody who is newly appointed. I was keen to understand the challenges that might exist in doing that. So it was useful that you followed on that. Is there any sense that later down the line, and I appreciate that this is a kind of known unknown, but there might be a distinct and separate commissioner around social care? Is your sense that it would be better to try and separate out the two and have maybe cross-cutting issues, but not necessarily the same person doing it all? I think you're right. I just think of the time that I was very involved in the NHS sort of much more on the ground than I am now, and I also chaired social services for England, and it was very, very important to ensure that we were all working together. But I do think at the very beginning, let's get a robust system working, let's get a good person who will actually manage these difficult issues. Of course, there's always the opportunity to talk and to have meetings together and so on, to unpack some of the issues that clearly involve both social care and health service. You've raised a little bit throughout the morning about resourcing. Does she have a complex role and a service that the Patient Safety Commission is going to provide? I will hand it over to my colleagues, Stephanie Callaghan, to leave questions on resourcing. Thank you very much, convener. It is certainly good to hear, Simon, in your response to my colleague, you talking about reducing the risk of harm and possibly reducing the litigation costs as well. However, the Scottish Public Services Ombudsman has shown some concern that the resources set out in the financial memorandum actually fall short of the ambition for the post, so I'm just wondering what your comments around that would be. Well, I think that Ernest Cumbus has already suggested that you need to be paid particular attention on ensuring that the commissioner has the right resources to do the job. It is a brand new role. This person will be starting with a blank sheet of paper, or at least with the legislation, but nothing more than that. The financial memorandum, as we understand it, suggests that the commissioner will have four members of staff and will have, I think, a total budget of £500,000, which would include commissioners' own costs and their own salary. That is fairly modest, our opinion, given the scale of the task that this commissioner will be taking on, not just the task of getting things going, of setting themselves up and creating a momentum around their role, but just the day-to-day requirements of the role going forward are really going to stretch the staff of only four. I think that Ernest Cumbus has mentioned the importance of data and data analysis. Amongst those four staff, if that's all it is, there needs to be a real capability to receive, interpret, analyse data, draw conclusions from it. Each step of that data processing is complicated and quite significant. Just collecting data, to how does the patient safety commissioner's office go about collecting data? Where do they get it from? How do they get it? How do they process it in a way that is compliant with data protection legislation? All of those sorts of things, let alone the interpretation of it, require quite a significant amount of resource. Our advice, respectfully, would be make sure that you are satisfied that they will have sufficient resource and that it is only a staff for very competent people who will work very, very hard, because there's going to be an awful lot for people to do. How would that compare with the resources that we're looking at in England? Do you have a view on the size of the team that you think would actually be required in reality in Scotland? I'm not quite sure how this has come into the picture because this is the first straw that the patient safety commissioner in England has done. I mean, she has recruited four people. She will be recruiting a whole lot more and it may be possible that some of the data collection and all that, she would want to put out to other organisations who are experts in these fields and would be reliable sources of information. It's really difficult at this moment to say how many, what the budget would be and so on, but I do know that already the patient safety commissioner in England has negotiated a bigger budget than she was first allocated. She has put it over very strongly of why she needs more resources and so far the department has actually agreed and she is now able to do more than she was first set up to do. I mean, she knows the remit of the job and the person you appointed for Scotland will know the remit of the job and we'll, I'm sure, find that they need a great deal more support and a resource in order to do the sort of job that they're expected to do. Very interesting and helpful. Thank you very much. And a final question for Paul Sweeney. Thank you, convener, and thank you for those comments so far about the budget constraints and resource constraints. I think there has been comments made in the bill consultation about this would effectively leave the patient safety commissioner with an inability to practice, to dedicate resources to any kind of investigative work in anything other than an exceptional basis. Is this a concern that you do share given the current budget of around £644,000 per annum? And is there a danger that this could end up becoming just a PR exercise rather than actually a substantive mechanism to deliver justice for patients or deliver good outcomes for patients? Is there an opportunity to perhaps build greater collaboration with adjacent organisations, perhaps working more collaboratively and deeper with parliamentary committees, for example, to extend the resource and practice available? Is this potentially an opportunity that you see rather than simply sitting as a separate silo within the bureaucracy? That's a very helpful comment because Henrietta and I, we meet at least on a sort of formal basis once every month, so we keep in touch with what's happening, but it's her show. It's not my show. I'm just there, she wants advice, but you are absolutely right that that is the way forward, that actually it is really important that enough resources is given. People always want more and you, I'm sure, have experienced that in other areas, so there has to be a reign on it to ensure that it doesn't go out of control, but there must be enough resource to make the job doable and effective and that people will respect what's going on. Henrietta has certainly has been negotiating that and she has certainly, she's been on a lot of platforms, she's been going round England, I think she's been to Scotland, so there is a communication issue that is absolutely critical to the world. Thank you, I want to thank Bernice Cumberlidge and Simon Whale for the time this morning, and also thank you for the tremendous work that you've undertaken so far on your review and pass on our best wishes to Henrietta and our posters as we start our process and hopefully getting a patient safety commissioner in Scotland, so I want to thank you very much for your time this morning, it's been extremely helpful. Thank you, we're now going to suspend the meeting for the short break. Welcome back, our third item today is consideration of an affirmative instrument, which is the community care, personal care and nursing care Scotland amendment regulations 2023. The purpose of this instrument is to increase the value of payments for free personal care and nursing care by 9.5%. This is an annual increase. The policy note states that emerging evidence in recent years shows that the cost of providing personal and nursing care has increased significantly and the payment made to providers by local authorities for self-funding residents has not kept pace with that. The Delegated Powers and Law Reform Committee considered this instrument its meeting on 24 January 2023, and they made no recommendations in relation to this instrument. We're now going to have an evidence session with the Minister for Mental Well-being and Social Care and supporting officials on the instrument. Once we've had all our questions answered, we'll proceed to a performative debate on the motion. I welcome to the committee Kevin Stewart, the Minister for Mental Well-being and Social Care, and accompanying the minister, we have Marianne Baker, the unit head of adult social care charging, and Claire Thomas, the policy manager of adult social care charging for the Scottish Government. Thank you for joining us today, and I invite the minister to make a statement. Thank you very much, convener, and good morning to the committee. Convener, thank you for the opportunity to speak to the committee today regarding a proposed amendment to the community care, personal care and nursing care Scotland regulations 2002. The draft regulations before the committee today make routine annual increases to the rates for free personal and nursing care. Those payments help to cover the costs of those services for self-funding adults in residential care. Historically, those payments have increased in line with inflation using the GDP deflator. However, emerging evidence, including from the Scottish care home census, shows that the cost of providing care has increased. To help redress that, in the past two years, we have made above GDP deflator increases of 7.5 per cent and 10 per cent, respectively, to the rates of payment, a significant increase on the inflation rate previously used. We again feel that it is appropriate to make an above GDP deflator increase to the rates this year. The regulations before the committee propose a 9.5 per cent uplift for 2003 to 2024. That will mean that the weekly payment rates for personal care for self-funders will rise from £212.85 a week to £233.10 per week, and the nursing component will rise from £95.80 to £104.90. It is estimated that that will cost around £15 million in the next financial year. That will be fully funded by additional provision within the local government settlement, as I outlined in the recent 23-24 Scottish budget. The most recent official statistics show that over 10,000 self-funders receive free personal and nursing care payments. They should all benefit from those changes, convener, and I am happy to take any questions from the committee. Members, do anyone have any questions for the minister? We have Paul. I just want to ask the minister if he is giving any consideration to giving this as an annual sort of manual exercise to uplift, whether there was a formula that could be introduced that would make it a more of an automatic stabiliser that would increase immediately. The same system has been used since the inception of free personal care in 2002. We have made adjustments in the past three years, as I have indicated, taking cognisance of the pressures that are out there and to ensure that we are asking people not to pay too much in terms of their care. There are some things that I think could be improved in all of this, convener. One of the things that I think could be improved upon is the UK Government reintroducing the attendance allowance payments that were given to Scotland prior to the inception of free personal and nursing care. If we look at attendance allowance, if that came back into play, there are around 10,000 people receiving free personal and nursing care. If we take those 10,000 people and take an average of £80, which is not the highest rate for attendance allowance, if that money was restored, that would be £41.6 million extra that we would have to play with. If there is any analysis undertaken by Government about the extent to which profit is extracted from the care system, it is important to undertake expenditure to ensure that care is provided, but there may well be instances where there are profits being generated as a result, as the Government maintains an oversight of the profit that is being generated to ensure that it is not excessive. The committee is well aware that we are undertaking a huge amount of exercises in terms of our work for the formation of the national care service. Ethical procurement is at the heart of all that. Of course, we will look at all aspects of the care system, including profit. We now move on to agenda item 4, which is the formal debate on the affirmative instrument, on which we have just taken evidence. I remind the committee that members should not put questions to the minister during the formal debate, and officials may not speak in the debate, but minister, before I invite you to move on, is there anything further that you wish to say in relation to motion S6M-07494? I move motion S6M-07494 in my name, which seeks that the Health and Sport Committee recommends that the Community Care, Personal Care and Nursing Care Scotland amendment regulations 2022-23 be approved. The question is that motion S6M-07494 be approved. Are we all agreed? We are all agreed.