 The next item of business is a debate on motion 8869 in the name of Jenny Minto on patient safety commissioner for Scotland Bill at stage 1. I invite members wishing to participate in the debate to press the request to speak buttons now or as soon as possible. I call on Jenny Minto to speak to and move the motion minister around 10 minutes please. Presiding Officer, I am pleased to be opening this debate on the general principles of the patient safety commissioner for Scotland Bill, which will establish an independent public advocate focused on ensuring patients' voices are heard. We know from the testimony of countless patients gathered by Baroness Cumberlidge in the independent medicines and medical devices safety review that too often patients, their families and members of the public do not feel listened to when they raise concerns about the safety of healthcare. As a result, they doubt that their feedback will lead to change and the relationship with healthcare providers may break down, causing them to lose trust in the healthcare system and at worst, as the cases highlighted by Baroness Cumberlidge so starkly demonstrate, this can lead to patients suffering serious avoidable harm. We need to address this. Good healthcare is a fundamental right for everyone. It is essential that patients have confidence that every time they access part of the healthcare system not only will they receive the best available treatment without fear of harm but also that any concerns that they raise will be listened to. A culture of openness and learning enables everyone to feel able to share what has gone well but also what has gone wrong or could have gone better. We must ensure that learning and improvement does happen when things go wrong to continue to make healthcare better. In her report, Baroness Cumberlidge recommended the appointment of a patient safety commissioner who would be an independent public leader with a statutory responsibility. The commissioner would champion the value of listening to patients and promoting users' perspectives in seeking improvements to patient safety around the use of medicines and medical devices. This bill will create a patient safety commissioner who will be directly accessible to patients, their families and members of the public to hear their concerns, bringing their stories together with quantitative safety data from across the healthcare system to spot trends and make healthcare safer for us all. They will be independent of the Scottish Government and NHS Scotland, allowing them to challenge the healthcare system and they will be free to consider any issue pertaining to the safety of patients in healthcare settings throughout Scotland. I believe that this bill demonstrates that we have taken Baroness Cumberlidge's work and the views of patients seriously. This commissioner's remit is wider than Baroness Cumberlidge recommended. It will not be restricted to the consideration of medicines and medical devices but will be able to look at patient safety more widely. This is because patients have told us that there is a potential for harm in many other areas of healthcare and we want the commissioner to be able to look at the things that patients tell them are important. I am very grateful to the Health, Social Care and Sport Committee for its support for the general principles of the bill and to committee members for their detailed and careful consideration of the issues. I thank my predecessor as Minister for Public Health and Women's Health Marie Todd for her leadership of the bill. Most importantly, I would also like to thank the various people and organisations who have participated by giving evidence on the bill since it was introduced, including the patients and family members who showed great courage in telling their stories once again and in advocating tenaciously for the creation of this post. This was very powerful evidence. I am pleased that the committee has agreed to the general principles of the bill, while recognising that they have requested further clarity and changes in some areas. The Government recognises the importance of listening to a wide variety of views to ensure that the patient's safety commissioner role, once created, is as effective as possible in being able to freely and independently advocate for the views and interests of patients to improve the safety of care. It is particularly encouraging that the committee has backed the general principles of the bill unanimously and that they reported strong support for this role from the patients and patient representatives that they heard from. The committee emphasised the importance of ensuring that the patient's safety commissioner's role is clearly defined and that the commissioner helped foster a culture of openness, learning and collaboration. I am also pleased that the committee recognises how vital it is that the patient's safety commissioner role is underpinned by robust powers that allow the commissioner to find out what has gone on, make meaningful recommendations to improve patient safety and then work with other organisations to achieve positive change. The committee has asked for further clarity on how the commissioner's formal investigations work and, in particular, on the collaborative approach that we expect the patient's safety commissioner to take when engaging with other organisations. That element of collaboration in the commissioner's ways of working is something that will be crucial given the complexity of the patient's safety landscape and that is something that Baroness Cymorlige also emphasised in her findings and I agree that it is important that we get that right. There will be instances where it is important that the commissioner is able to share confidential information obtained in the course of their investigations with certain other bodies to enable them to exercise their statutory functions. The bill seeks to strike a balance between enabling that while also encouraging a broad approach of collaboration, openness and learning rather than taking a punitive approach. I agree with the committee about the importance of the commissioner being able to hear the views of staff where that supports the overall purpose of amplifying the patient voice. It is important that the commissioner functions as a listening ear in the whole healthcare system. I have asked my officials to explore how that can be clarified at stage 2. The committee has also emphasised how important it is that the commissioner carries out thorough and meaningful consultation during the development of their principles and strategic plan, particularly with those that they seek to represent the patients. I agree that that will be key. This Parliament will also have a crucial role. Patients in the public have made it very clear that they want someone else other than Government to scrutinise what is going on in the healthcare system. The patient's safety commissioner's freedom to determine their own priorities informed at all times by the views of patients and the office's distinctiveness from other parts of the safety system in reporting directly to Parliament, and therefore the people of Scotland will help to maintain trust in the role. It is clear from the stage 1 report that the committee's view is that the patient's safety commissioner for Scotland will make the views of patients heard, ensure learning and improvement when things go wrong, and help to make healthcare in Scotland safer for us all. In reaching this milestone, the development of the bill, I would like to thank those patients and families who have helped us to shape the draft legislation. They have taken time to tell us their stories and share their experiences. We have listened and I hope reflected their concerns in the draft bill that we debate here today. I would also like to thank the many other people and organisations who, along with patients, worked with us on the consultation and bill advisory groups, sharing their expertise and collaborating in just the way that we hope they will with the patient's safety commissioner to help to foster a culture of learning and improvement. I look forward to listening closely to members' views and also to the opportunity to engage with them on the bill. I again thank the committee for its work during stage 1 and in the weeks to come. I move that the Parliament agrees to the general principles of the patient's safety commissioner for Scotland, Bill. I now call Claire Hoggy on behalf of the Health, Social Care and Sport Committee. Ms Hoggy, around nine minutes, please. Thank you, Presiding Officer. Before I begin, I refer members to my entry in the register of interests. I'm a registered mental health nurse with current NMC registration. In September 2020, we, as a Parliament, debated the independent medicines and medical devices safety review, the cumberledge review, and the then cabinet secretary for health and sport, Jean Freeman, set out how its recommendations would be implemented in Scotland. Those included establishing a patient's safety commissioner for Scotland. As the convener of the Health, Social Care and Sport Committee, I am pleased to speak today to our stage 1 report on the patient's safety commissioner for Scotland, Bill. The committee unanimously supports this bill, and we believe that this role has the potential to improve patient's safety across healthcare services in Scotland. I wasn't the convener of the committee as it took evidence on the bill, so firstly I'd like to thank Gillian Martin for her leadership during the scrutiny of the bill, and I'd like to record her thanks to the committee clerks, the Scottish Parliament Information Centre researchers and everyone else who has supported the committee's work on the bill so far. I'd also like to take a moment to reflect on the evidence provided by those who engaged with the committee before commenting on the committee's recommendations. I thank all of those who assisted the committee with its scrutiny, those who responded to our calls for evidence, and those who gave evidence in person or online. I would particularly like to thank Charlie Bethan, Marie Lyon, Fraser Morton and Bill Wright, who spoke to the committee about their personal experiences of serious patient safety issues. They told us that their voices were repeatedly ignored by a system that was meant to provide care and support for them and their families, and by those who were meant to regulate that system. They told us that their fights were not over, their issues still not resolved, some still not resolved after more than 70 years, and they told us about investigations that are still needed and support that is still required. In some cases there has been no resolution, grief has been compounded by the way that they have been treated, and families have had no closure. We are grateful for their testimony to the committee. We know how difficult it must be to keep recounting their experiences, and I want to commend their passionate campaigns on behalf of others in similar situations who do not have that opportunity or voice. Their experiences emphasise the vital role a patient safety commissioner can play. A patient safety commissioner cannot change what they have been through, but it could make a real difference to how cases like theirs are managed in the future, providing a voice for those patients and their families and championing their causes. Looking forward, the commissioner could use those powers to try to make sure that no one else has the same experiences. Crucially, it could ensure that lessons are learned and other such incidents are prevented from happening in the future, as well as identifying patient safety issues that require investigation, but that the system is not yet aware of. Our report concentrates on areas where the committee thinks that the bill, as it is currently drafted, might need to be clarified to make sure that it can achieve those outcomes. The committee supports widening the remit of the role beyond medicines and medical devices to include patient safety more broadly. Will the committee recognise the complex systems that are related to patient safety, governance and regulation already in place in Scotland? We believe that the voice of patients is missing from those systems. The commissioner can fill that gap, amplifying the voices of patients and advocating for systemic improvements that draw on patient experiences. The committee welcomes the independence of the role as set out in the bill and endorses proposals that the commissioner should have the freedom to define and establish the principles that will underpin their work and the remit and scope of that work. We believe that patients should be given an opportunity to provide input into the process of establishing the office of commissioner and informing its strategic direction. That will ensure that patients' concerns are addressed and that their voice is heard as the commissioner embarks on their important work. During its scrutiny, the committee heard a range of views about the scope of the commissioner's role. Some argued that that was too right and others argued that it did not go far enough. Issues were raised about how safety concerns in social work would be dealt with, especially given that, as one witness noticed, people do not experience primary care, secondary care, social care or nursing care. They experience care. Some also suggested that the commissioner should additionally have a role in taking on individual cases. On the whole, the committee believes that the bill strikes the right balance by defining a remit that is broad but manageable. However, we would like the Scottish Government to confirm that the commissioner would be in power to investigate to make recommendations and to act as the voice of patients with respect to issues that intersect with or transcend health and social care. While not wanting to interfere with the commissioner's independence, the committee calls for a commitment that the principles underpinning the work of the patient's safety commissioner will include an explicit commitment to listen to and support underrepresented voices. The committee particularly believes that this is important, given the specific patient safety issues that gave rise to the Cumberlage review and the circumstances of those affected by them, notably women. The committee considers that it is vital that the commissioner has the necessary capabilities to compel evidence from all organisations involved in providing health care, including private companies that supply medicines and medical devices. It should also have the power to follow up on the implementation of its recommendations. It is of paramount importance that there is public confidence in the role of the commissioner, given the patient experiences highlighted by the Cumberlage review, with many feelings that they were not listened to and frustrated by the length of time taken for their problems to be acknowledged. Work will need to be done to raise public awareness of this new role but equally to manage expectations. Crucially, the role will need to be sufficiently resourced to fulfil its functions. The committee recommends robust monitoring and evaluation to ensure patients' voices are effectively amplified through the work of the patient safety commissioner and that there is on-going public confidence in the role and in the wider system for reviewing and addressing patient safety issues. In conclusion, the committee is content to support the general principles of the bill and considers that it is a crucial addition to the patient safety landscape in Scotland that should help to ensure that patients' voices are consistently heard and acted upon. I am grateful to the minister for having provided such a quick response to the committee's stage 1 report. I set out in that response. We look forward to seeing further improvements to the bill at stage 2, reflecting your key recommendations. I am pleased to open this stage 1 debate on patient safety commissioner for Scotland Bill on behalf of the Scottish Conservatives. I pay tribute to the Health, Social Care and Sport Committee clerks, our present and former conveners and especially to the witnesses' campaigners and experts who contributed their insights and lived experience. As a starting point, we must recognise why a patient safety commissioner for Scotland is needed. In the report of the UK-wide independent medicines and medical devices safety review, Baroness Cumberledge pointed to the avoidable harm that patients, mostly women, have experienced as a result of the hormone pregnancy test primidos using sodium valparate in pregnancy and pelvic mesh implants. In the report, Baroness Cumberledge described the truly heart-wrenching stories of acute suffering, families fractured, children harmed and much else. Adverse effect of hormone pregnancy tests, including congenital anomalies and tragically miscarriage, stillbirth and baby deaths. If taken by mothers during pregnancy, sodium valparate can cause physical and neurodevelopmental effects in children. Many MSPs in the chamber this afternoon have been contacted by mesh-injured women about the life-changing and distressing symptoms the surgery has caused. Alarmingly, Baroness Cumberledge found that the patient voice was dismissed, that patients blamed themselves for the harm to their children caused by medicines they took in good faith and that they struggled to navigate a complex healthcare landscape in order to advocate for themselves. It was against this background that Baroness Cumberledge's report called for a public spokesperson with the necessary authority in standing to talk about and report on to influencing casual where necessary without fear or favour on matters related to patient safety, which brings us to the bill we're debating today. Presiding Officer, this bill is consensual. It has cross-party support. The Scottish Conservatives are pleased to support the general principles of the legislation at stage 1. However, support does not mean absence of scrutiny. The role of the patient safety commissioner must be an effective champion for patients, so it is vital to get the approach and the role's powers right. As the Royal College of Nursing emphasises, the views of staff on patient safety must be heard and the commissioner must have the power to follow up on the implementation of recommendations. In her evidence, Baroness Cumberledge said that she was satisfied with the bill and agreed with all of it, and that it is extremely well put together. She described the patient safety commissioner as the golden thread running through a complex patient safety in clinical governance landscape and helping to tie it all together. The patient safety landscape is indeed saturated. Alongside regional health boards, we have the Scottish Public Services Ombudsman, Healthcare Improvement Scotland, the Scottish Patient Safety programme, the NHS incident reporting and investigation centre, a patient advice and support service provided by Citizens Advice Scotland, professional regulatory bodies such as the General Medical Council and legislation including the patient rights Scotland Act 2011, and that list isn't exhaustive. The patient safety commissioner can help to unify these organisations and create more coherence in a cluttered landscape, but there is also a risk of duplication. What works well on paper doesn't always work in practice, and there will need to be relationship building on both sides to effectively support and advocate for patients. I know when the former health secretary first announced the patient safety commissioner for Scotland, she indicated that the role would focus on improvements to patient safety around the use of medicines and medical devices. The Scottish Government's approach has since changed considerably, however, with the bill widening the remit of the patient safety commissioner to patient safety more generally. A wider remit has implications for resourcing, something the committee did explore in some depth after the finance and public administration committee raised a red flag, and they said it was an expensive extension to our public sector, which is a cause for concern. In his evidence to the committee, Dr Gary Duncan, chief of staff to the patient safety commissioner for England, who has a much narrower remit, emphasised that we would need expanded resources if we wanted to take on further work, and that suggests that more resources will need to be available sooner rather than later for the role in Scotland. In her evidence, the then Minister for Public Health, Women's Health and Sport responded to resourcing concerns by pointing to the collaborative role that the commissioner has expected to adopt by working with existing patient safety bodies, organisations and regulators. This way of working, the minister indicated, will reduce the burden of work on the PSC. However, there still is insufficient clarity around this dynamic on the face of the bill, something that does need to be addressed at stage 2. It is important to get the resourcing right because there are already high expectations around what this role will achieve for patients whose voices have too often been ignored. However, it is also important because public funds are being used, and there should be transparency and accountability around that process from the outset. To this end, even after the bill completes its parliamentary passage, the Health, Social Care and Sport Committee should be involved. It should be involved in oversight and monitoring of the patient safety commissioners' performance. Notwithstanding those comments, Presiding Officer, it is clear that there is significant support for this bill. My colleagues and I look forward to strengthening it at stage 2. Thank you very much, Ms White. I now call Paul Sweeney for around seven minutes, Mr Sweeney. Thank you, Deputy Presiding Officer. Labour will support the bill at stage 1 today, as we are supportive of the general principles, albeit that we have some reservations on the detail contained in the proposed bill, and we will look to engage with the Government on amendments before stage 2. As has already been outlined, the bill seeks to establish the Office of Patient Safety Commissioner for Scotland, as described in section 1, and that patient safety commissioner will have two primary functions to advocate for systemic improvement in the safety of healthcare and to promote the importance of the views of patients and other members of the public in relation to the safety of healthcare. Both of those provisions are warmly welcome, and as a deputy convener of the Health, Social Care and Sport Committee, I echo the comments of the convener, the member for Lleugland, to the excellent stage 1 committee report that was published at the end of April. I would also like to take a moment, Deputy Presiding Officer, to thank the clerks and officials for their work on that report. It is a great summary, and I recommend that all members take some time to digest it. The bill is supported by a wide array of stakeholders, including the likes of Valparate Scotland, Hemophilia Scotland and the Association for Children Damaged by Hormone Pregnancy Tests, all of whom gave evidence to the committee, and for that I am incredibly grateful. The establishment of a patient safety commissioner for Scotland is something that is long overdue. At present, the voice of patients and NHS service users is all too often forgotten, and it frequently leads to situations where we do not learn from systemic mistakes and failures that have been made in the past and run the risk of repeating them. That is an issue that the committee highlighted in our report, and I think that it is safe to say that there was a large body of concern among stakeholders that the proposed commissioner will not have the remit to investigate individual complaints, as well as the fact that there will be no locus for the commissioner on matters pertaining to systemic issues in social care. Given the inherently intertwined nature of health in the national health service and social care, which the Government seems to recognise and agree with given the proposed bill for the national care service, I think that it would be helpful for some thought to be given on how we perhaps expand, whether immediately or in the future, the role of the commissioner to include social care. That is something that was raised by my colleague Mr O'Kane, the member for West Scotland and the committee. I know that the minister disagrees with the idea of extending the remit to include social care, but we know just how complex the policy and regulatory landscape currently is, and I would hate for us to be back here again in just a few years doing something similar for social care when we could deal with it in the here and now in this bill process. As the Scottish Public Service's ombudsman has said in their evidence to the lead committee, given the potentially seismic changes in the health and social care landscape in Scotland, it is evident to the SPSO that a legacy of separation between health and social care, which is embedded in this bill, which focuses solely on health care, may be coming outpaced by other developments. We and the Labour Party do also have some concerns around the resourcing of the commissioner's office. Currently, we are looking at a budget of around £644,000 per annum, while I think that I appreciate that it is a significant sum of money. We are talking about a role that is tasked with investigating extremely complex, deep-rooted issues, and I do worry that the role risks becoming a PR exercise rather than a substantive mechanism for delivering justice and positive outcomes for patients. I would also just like to clarify that this is not a concern held solely by Labour. The Royal College of GPs in Scotland's patient forum has raised this and has emphasised the disappointment that they would feel should future budgetary decisions caused the commissioner's office to fold, suggesting instead that funding levels should be confirmed by parliamentary procedure. I would like to see the Government give further consideration to whether such a budget is adequate and would welcome further engagement and dialogue on that particular point as we progress through the legislative process. However, on a positive note, we do agree with the Government that a patient champion is required, although we may have slightly different views on exactly what that looks like in practice. We are also grateful to the Government for its commitment in the committee and that the commissioner should be able to hear from staff as well in relation to patient safety concerns as flagged by the Royal College of Nursing Scotland. On a more general point, because I am conscious of the time, I want to assure the Government that Labour will work with it to ensure that we end up in a place where we are all in agreement and can wave this bill through unanimously. There are plenty of policy areas where we have disagreement, but I genuinely do not think that that has to be one of them. 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 have been adversely affected by do not come to pass ever again. I commit myself to working constructively with the Government. I know that I speak for my Labour colleagues when I say that they also want to work positively with the Government, and we have heard from a wide variety of stakeholders that they want to do that too. On that note, I will conclude and look forward to the bill's progression through its subsequent stages. I can advise the chamber that we have a little bit of time in hand, so if anybody wants to make an intervention, you can take it safe in the knowledge, you will get your time back. With that, I call Alex Cole-Hamilton around six minutes. Before I start, I express my apologies to the chamber for having to leave the debate early this afternoon for an unavoidable reason. I rise to offer my support and the support of the Scottish Liberal Democrats, the general principles of this bill, and thank the committee for its work to this point. The NHS, which we often rehearse, is one of the finest and best-loved national treasures that the isles have ever produced. It emerged as a liberal brainchild delivered by the Labour Party as a universal system designed to give remedy to patients in need and to support the hard-working staff that administer it. This system is now in crisis, and we have said that many times in the chamber, but it bears repeating that patients and staff alike are being failed routinely by this Government. The NHS's most basic principle is that people can access healthcare at their time of need. For too many Scottish people, this principle is no longer being fulfilled. Figures from last month reveal that cancer waiting times are the worst on record for the fifth quarter in a row. Meanwhile, one in 10 people had to wait longer than eight hours to be seen in our accident and emergency departments. Our healthcare staff go above and beyond the call of duty every single day, but instability and lack of resort are having a deleterious effect on patient safety. The past decade has been mired with healthcare scandal, and we have heard much of that in the exchanges in this chamber. There are tens of thousands of women who have been inflicted with an excruciating and debilitating life-changing pain because of mesh implants gone wrong. There are multiple deaths, including that of two children linked to sanitation problems at the flagship Queen Elizabeth university hospital. There are only two of the multiple scandals that Scottish healthcare has faced in recent times. It is clear that structural change is required, including safeguards that ensure patient safety. There is an urgent need for a powerful, independent figure—a canary in the mind, if you like—that champions the rights of patients and secures, improvements and treatments. The establishment of a patient safety commissioner in Scotland could aid the course of such a change. Although the Scottish Liberal Democrats have been calling for this creation of this position for over three years, there are several concerning elements regarding the road to its delivery. Scotland was the first nation to start talking about a patient safety commissioner in the whole of these islands. However, in dithering and delay, that has become characteristic of this SNP green government. We are still only in the early stages of its inception. Meanwhile, England has not only had a patient safety commissioner appointed, but it has been in post for over eight months now. That delay is causing real harm. That was evidenced by an excellent article written by Marion Scott of The Sunday Post. She spoke to Victoria from Ayrshire, a woman who is three-year-old, tragically died at the Queen Elizabeth university hospital. Victoria said, "...one of the promises I held on to was that the government would be appointing a commissioner to do everything possible to prevent future health scandals. But here we are. Nobody has been appointed and I feel betrayed all over again." I am sure that there are many people across Scotland, like Victoria, who feel similarly let down. Furthermore, the patient safety commissioner is a post that is designed to listen to the invaluable insights that patients have of our NHS and thus a platform for their voices. It is somewhat confusing, therefore, as others have said, that such a commissioner is expected to amplify the concerns of those patients if they are not given the ability to directly listen to them on an individual basis. It is worth noting those concerns from stakeholders that, as it currently proposes, patient safety commissioner would not be able to listen to individual complaints. Elaine Holmes, the founder of Scottish mesh survivors, expressed that this barrier to patient access, in her words, flies in the face of everything a patient safety commissioner should be. It is vital that a lived experience is at the heart of the patient safety commissioner's job and their mission, and patients having clear access to the position is fundamental. I should remind the chamber that there is precedent for this. We empowered Scotland's commissioner for children and young people to listen directly to individual voices and take up individual cases through investigative powers. We must also remember the key role that our NHS staff play in ensuring that patient welfare. With their expertise and their experience, our staff are often best placed to identify when there are problems within patient care. Despite that, in their latest report, the RCN noted that members do not always feel listened to when they raise concerns regarding the wellbeing of their patients. Would he also acknowledge that the work of the patient safety commissioner should not only be seen as a stick but also seen as a learning opportunity for staff and for wider health boards to change policy and go forward in a positive manner? I absolutely agree with the intervention of Gillian Mackay. Of course, there should be investigative powers, but there should also be an opportunity for them to disseminate best practice and to help to bring best practice to the fore and to celebrate success in our health service. Staff too should have the ability to properly voice those concerns. I look forward to further clarifications from the minister about how those avenues will be put in place. Staff safety and patient safety are inexorably linked. Right now, NHS staff are having to endure mammoth workloads to the detriment of their own wellbeing. In advocating and pushing for patient safety, we must not forget the importance, too, of staff safety. As I indicated at the beginning of my speech, the NHS is an integral and life-saving institution. Its value to our country cannot be understated and it is incumbent upon us as policy makers to fight tooth and nail to preserve it. In order to do so, we must introduce real structural change. That starts with the commissioner. The introduction of that office could play a significant part in the reform that we need to see. However, only if it is introduced properly, that means that everyone and anyone can, with concerns or experience a patient's safety, have access to it. I am very happy to speak in this stage 1 debate on the patient safety commissioner for Scotland bill. Thank you to those who have engaged with the committee and gave evidence that it is very much appreciated. I think that a patient safety commissioner is much needed and I will now go on to outline why. Once considered the gold standard and billed as a simple procedure, hundreds of thousands of people have had transvaginal mesh fitted. Although many are symptom free, for thousands, the negative side effects have been profoundly life-altering. Yet, despite the widespread negative impacts, Elaine Holmes and all of McElroy, founders of Scottish mesh survivors, were both told that they were unique, that the extreme and constant pain that they were living with had not been seen in anyone else. They believed that until they met each other. However, their symptoms were not unique. As we have heard, the patient safety commissioner was recommended by the independent medicines and medical devices safety review. Speaking of that review, Baroness Cumberlidge said, We have never encountered anything like this, the intensity of suffering, the fact that it lasted for 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 thousands, tens of thousands. Despite the variety of issues covered, the review found several common themes. Those patients were not listened to. When the healthcare system would not support them, they, like Elaine and all of, turned to each other. Despite raising their concerns again and again, the problems that they faced were not acknowledged, sometimes for years. For those years, many patients lived in pain and uncertainty, and we cannot let this happen again. Transvaginal mesh, sodium, valparate and pregnancy and primodos all have something in common. Their adverse effects impact women, a group that has historically been and continue to be dismissed and patronised in medical settings. That is an experience that I know and I can relate to, and I am sure many others in the chamber can too. It is of the utmost importance that those barriers are acknowledged and are at the heart of that legislation. We clearly have some way to go. Recently, the Young Women's Movement found that young women in Scotland are not taken seriously in healthcare settings. They are often dismissed and their experiences are minimised. They are often left with no further offer of support or follow-up. Age, gender, living in rural areas, being part of an ethnic minority, being disabled, being trans and body type and weight compounded those issues. That is why, as a committee, we have recommended that the commissioner be given powers to undertake follow-ups to ensure that patients have been listened to and safety issues have been addressed. In addition, the committee has called for the principles underpinning the work of the patient safety commissioner to include an explicit commitment to listening to and supported underrepresented voices. Several witnesses described an existing cluttered landscape in terms of patient safety, not only cluttered but siloed, allowing patient safety issues to be missed to slip through the cracks. With that bill, we have an opportunity to connect those silos with the role of the PSE acting as a golden thread, as Tess White has already alluded to. The commissioner will offer clear responsibility for patient safety and will be in a position to join the dots and identify systemic problems. As a committee, we are dedicated to ensuring that those patients are listened to, the commissioner would be required to establish an advisory group, 50 per cent of which would be drawn from patients and their representatives. It is vital that those barriers to participate on such an advisory group are minimised as far as possible, and we have recommended that all representatives on the advisory group be entitled to reimbursement, regardless of employment status. That is especially important given the links between long-term sickness and unemployment. Travel expense calculations should also take into account the potentially higher costs that those travelling from rural or less well connected areas may face. The English PSE is already in post and making a difference, and we can learn from her appointment. I am pleased that the Scottish Government has agreed with the vast majority of our recommendations. Above all, the patient safety commissioner must be a voice for patients, and people must finally be listened to and have back-up when things go wrong. We have an opportunity here, one that experts have said could fundamentally alter the landscape of patient safety for the better. Let's get on with making this happen. I am pleased to have the opportunity to speak in this debate on patient safety commissioner for Scotland Bill. I would also like to add my thanks to the Health, Social Care and Sports Committee, and especially to the witnesses, campaigners and experts who have contributed to this report. As my colleague Tess White has said, we recognise the need for a patient safety commissioner for Scotland. Listening to some of the speeches that have already been said, they really resonate with what I want to say today in the experience of a constituent. I want to take my time here to illustrate the need by highlighting a rather harrowing case that I was involved with earlier on in my political career, which ended up dragging on for several years. As yet, I am still to reach a resolution. I was contacted by a couple who was mentioned earlier on by Claire Hoche, Fraser Morton and her partner, June, who tragically lost their son, Lucas, in childbirth. The official report stated that he was still born. However, the couple struggled to accept this as this was rushed through in any questions that they had were shut down and went nowhere. They were sure that he had been alive right up until the point of birth, and they requested a serious adverse event review. This was denied, as in the insistence that Lucas was still born, and therefore an SAER was not needed. The time they approached me, they had already established an anomaly in baby deaths at Crosshouse hospital, statistics showing that there was an unusually high level of that kind of loss at the hospital over a number of years. I attended various meetings with them when they met with hospital officials and board members, as well as Health Improvement Scotland and even the Cabinet Secretary. It was obvious from those earlier meetings that they were being fobbed off with apparent hope that they would eventually give it up. However, what they did not realise was the persistence of Fraser and June, and they went about reading many case reviews across the UK, eventually building up a knowledge that would be very difficult to argue against. They joined with other families with similar concerns, who incidentally have been labelled as troublemakers by some who were under scrutiny. There was even an attempt to blame some staff for the tragedy, even everything bar accepting the need to review and to learn. Eventually, Health Improvement Scotland agreed to instigate an investigation, and, at the same time, a BBC investigative journalist began her own scrutiny. The upshot of investigations was that there were serious flaws highlighted, not least of all, that the neonatal unit at Crosshouse was 24 staff short, and that staff at Crosshouse were under far too much pressure as a result. I would say here that Fraser and June are directly responsible for the neonatal unit in Crosshouse being fully staffed. I would also point out that they continue to support other couples around the UK in similar circumstances, even raising money for cuddlecots to help parents to deal with their grief. The reason to tell this story is that, if we were able to wind the clock back and put a patient safety commissioner in place prior to this all-transbanding, perhaps the loss and other losses might have been avoided. Not least because statistics indicating a problem like increased baby death would hopefully be noticed, investigated and corrected way before it got to this stage. Having identified a problem, the safety commissioner would be able to monitor that hospital to ensure continued improvement. That is a point that I heard Evelyn Tweed making. What of this case highlighted to me that there seems to be no accountability, no place for patients to go where there is no self-interest in the outcome. What is highlighted to me is nearly always the system that is at fault and not the healthcare professionals who incidentally do seem to carry the can far too often. Serious adverse event reviews are measured and health boards do not want them against their record, and they vary widely from health board to health board. That should not be the criteria for investigating a serious adverse event review, because we often talk about what must be learned and changes that must be made to prevent similar things from happening again, as Gillian Martin's intervention to Alex Cole-Hamilton highlighted. How can lessons be learned if the issues that cause the incident are not properly investigated and discussed without prejudice and without blame? That, to me, is why, along with many of my colleagues in Scottish Conservatives, we will be supporting this bill. A patient safety commissioner should be able to have an overview and an oversight of health boards, be able to spot potential warning signs and make impartial investigations and recommendations. For me, the remit of the position has to be very clearly defined by looking at cases such as the one that I have highlighted, where we can ask the question, what would a commissioner have to be able to do to improve this situation? Real life, that is where the difference must be felt. My only concern is that the remit of the commissioner becomes too wide and the real impact it could make diluted. I appreciate, in summing up, if the minister could assure the chamber what considerations are being given to make the remit of the commissioner as tight as is needed to make them as effective as they can possibly be. After all, it is about supporting our NHS and making a patient's journey as safe as it can possibly be, Deputy Presiding Officer. As a member of the health committee, I am pleased to speak in this debate on stage 1 of the patient safety commissioner bill. I remind members that I am a registered nurse with a current NMC registration as well. As colleagues have said, the bill was introduced in response to the recommendation of the Cumberlage review. It is in direct response to patient-led campaigns on the hormonal pregnancy test, premedos, sodiumvapary in pregnancy and transvaginal surgical mesh. Each of those products was associated with significant patient harms and injury. One of the main findings of the Cumberlage review was that patients were not listened to. We took direct evidence at committee from Charlie Bethune, and I subsequently met Mr Bethune, as he is a constituent of mine. He and his wife, Leslie, have championed the cause of children impacted by the anti-epilepsy medication sodiumvapary due to the impact that it had on their or that it has on their adopted daughter, and many others affected where the numbers across the UK are estimated to be 20,000. Again, as colleagues described, a patient safety commissioner should be created to listen to and amplify the voice for patients to drive systemic improvements in care with a focus on medicines and medical devices. The patient safety commissioner, or the PSC, will be an independent champion for everyone receiving healthcare, working alongside the healthcare providers such as Nez and Healthcare Improvement Scotland. The Scottish Government places high importance on the patient voice and the patient experience. During the stage 1 scrutiny at committee, many of the questions that were related to the remit of the Scottish PSC, as the remit proposed here in Scotland is wider than the commissioner in England, and 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 recommended 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 that every investigation is fully informed. I believe that the remit of the PSC is directly relevant to constituency work that I have been raising in Dumfries and Galloway in my south Scotland region. The specific areas that I think that this could play a part of are focus on cancer treatment and cancer pathways and travel reimbursement. Dumfries and Galloway is geographically in the south-west of Scotland, but it is aligned with the east of Scotland cancer network. Nowhere in D&G are services closer to Edinburgh than Glasgow. In many cases, particularly in Evestronard and Mignonshire, this means a 260-mile round trip for treatment. Constituents have been campaigning regarding the unnecessary travel for over 20 years now. I know from engagement with constituents that this trip can often exacerbate already poor health, cosmoric anxiety and unnecessary stress. Perhaps a patient safety commissioner will help to amplify the voices of my constituents to address that. Additionally, in patients in D&G, there are means tested for reimbursement for journeys for medical appointments, which are over 30 miles, despite the fact that people live similarly in other rural parts of Scotland or not. Other travel reimbursement schemes exist in the Highlands and Islands, for instance. I know that those issues are not overly safety-related, but considering specific issues in the evidence-percentage that care and compassion should also be considered is worth noting today. I would seek assurances from the minister that a future commissioner will consider issues that I have just highlighted to pursue real change. I welcome the minister's response to the committee report that was issued this morning. In particular, I welcome that the minister has agreed with our committee's recommendation that the wording in section 164C should be amended to specify that members of the proposed advisory group who represent patients must actively demonstrate a commitment to representing the voice of patients rather than simply appearing to the patient safety commissioner to be representative of patients. That is really important as a recommendation, as it ensures that those who are receiving care are being represented by someone who has an acute understanding of the impact of their circumstances and who is committed to improving processes moving forward. Therefore, I welcome that appointments to the advisory group will be subject to oversight by the Scottish Parliament corporate body, who will function as an external check on their appropriateness. It is clear that the legislation will make sure that the voices of people using health services are heard and that their concerns are acted on with the creation of a champion that is independent of the NHS or government, who will focus on the safety of people receiving healthcare in Scotland. It is vitally important that patients have a voice and a place to turn to if they have safety concerns, and that bill will help to ensure that that happens. I look forward to continuing scrutiny of the bill as we move forward to stage 2. I also hear in Brian Whittle's experience of Fraser and Chris House that it gives us a powerful statement of the necessary need for a patient safety commissioner. I welcome Brian Whittle's comments today. In closing, I welcome the words of the minister that the PSC will work collaboratively with healthcare bodies. I thank all those, including the many, who demonstrated great courage and helped us to get to this place today. I too support the general principles of the bill. I apologise to fellow members, as I will not be able to remain in the chamber for the entirety of the debate, and I have been granted permission to leave before its conclusion. I would like to thank my colleagues on the health, social care and sport committee for their work on the bill. I was not on the committee at this time, but I know how hard they worked. I would also like to thank the committee clerks for their guidance. As mentioned by my colleague Paul Sweeney, Labour will be supporting the bill at stage 1. We agree with the general principles and, as such, support the establishment of a patient safety commissioner, ensuring that patients have a champion and a voice to protect their interests. For too long, patient safety has not been prioritised by the Government. We have heard in this chamber of the tragedy experienced by families who, for too long, were made to suffer in silence. Members have given us some very clear examples of that. If the minister truly wishes to see the establishment of a commissioner lead to real and meaningful change, she must listen to committee recommendations to ensure lived experiences are heard and considered at every stage of the appointment process. Moreover, the Scottish Government must agree to Labour's calls for the commissioner when appointed to be well resourced, my colleague mentioned that, with funding and having the power to stand up for patients' rights and advocate for the safe treatment and care that they should be receiving. We want the bill to be successful, but we also want it to be meaningful. The appointment of a commissioner is the first step. There is a long way to go afterwards to deliver for patients across the country. In her response to the committee's recommendations addressing calls to define patient safety, the minister noted that she believed, and I quote, the meaning of safety is well understood by patients and the public. That may well be true, but we do not know if it is well understood by the Scottish Government. Despite passing safe staffing legislation years ago, health and social care staff are still waiting for the implementation of legislation to improve conditions. We know from the trade union such as unison that, among many of the issues that are faced are staffing levels that are dangerous to staff and patients. If it had taken the Government four years to confirm when it will implement legislation with particular focus on improving staff and patient safety, how can people have the confidence that it will be any different in that case? Patient safety cannot be improved without significant improvements to staff safety that go hand in hand. On that point, the minister may wish to consider whether the bill should provide clarity around the commissioner's role in taking forward the concerns of staff that seek to raise patient safety issues. Therefore, we need commitments that the legislation will be meaningful and will positively impact patients. Scottish Labour will continue to call on existing challenges in staffing safety to be met to ensure that the bill does not fail to achieve the aims that it has set out. Furthermore, as has been mentioned, we know that the commissioner's initial remit will not include social care and the committee has supported that position. However, I note from the minister's letter to the committee that she acknowledges that this requires flexibility. Although I would stress the importance of considering the committee's recommendation regarding giving the commissioner the ability to have a role in issues that intersect and transcend health and social care, it is quite an important point that the committee raised. The new patient safety commissioner will have their work cut out for them if they are to address issues linked to patient safety with the gravity that they deserve, but concerns around funding levels are real and must not be ignored. I hope that the minister will work constructively at future stages, which I am sure she will, to ensure that the bill can be as strong as possible. I believe that we are here and across the chamber. That is where we want to be. However, we cannot suggest for a moment that a patient safety commissioner alone will see significant improvements to patient safety. As we have seen in recent times, confidence has eroded due to scandals linked to patient safety, often as we have heard linked to women's health and mesh and more recently the provision of endometriosis care. Although the bill is welcome, the SNP has overseen long-term decline in the running of public services, and while clinicians and staff go above and beyond for patients, confidence is not where we want it to be and people are demanding real and tangible change. In concluding, the bill has our support at stage 1. The bill is well-intentioned and similar to safe staffing legislation, if implemented effectively and with purpose supported by the financial resources and freedom of the commissioner to stand up for patients' rights and advocate for safe treatment and care, then it can be successful. It is important now that we reserve, reverse the trend that has been around and work towards delivering positive patient experiences and improving patient safety when we are moving forward. I thank the chamber for the debate. I now call Stephanie Callaghan to be followed by Gillian Mackay around six minutes. I am pleased as well to speak in this debate as a member of the Health, Social Care and Sport Committee, and I too want to thank all those who generously gave their time to provide evidence to the committee and thanks also to the committee clerks and to my colleagues for their hardworking commitment. I also special thanks to Brian Whittle for speaking in his constituency experience with such passion and compassion. The health and wellbeing of Scotland's people lies at the heart of the Scottish Government's responsibilities and the patient safety commissioner for Scotland Bill is an important step. One that ensures, one that helps to ensure that good quality, accessible and patient-centric healthcare services are available to all of us. The independent medicines and medical devices safety review, known as the Cumberlidge review, draws attention to significant challenges around health-related quality and safety and highlights major disparities in how different groups of patients and service users experience healthcare services and in balance that must be addressed. We have heard a patient commissioner would act as an advocate for patients directly representing their interests in healthcare and drawing on their feedback and experiences to enhance safety and quality of care. The bill's primary purpose is to give patients a voice, especially those patients who are least likely to be heard in our healthcare system. Despite the Scottish Government's good progress in patient safety in recent years, some patients have been let down and the consequences of not listening have been extensive and damaging. For example, we've heard today about vaginal mesh and it's still an issue many years on. The Cumberlidge review and committee evidence highlights that women still experience a lack of understanding around their symptoms. I'm sure that we can agree that it's wrong and harmful that women experiencing excruciatingly chronic pain are not taken seriously. Too many women are told that these are just women's issues and I thank Carol—I can't remember your surname—I thank Carol for bringing up endometriosis today also. This is a clear impediment to securing a correct diagnosis and the right support for people. Irene Oldfather from health and social care at Alliance Scotland spoke for many women when she said that she felt that they were not being listened to as an understatement. They were banging their heads against brick walls. I welcome the recent response from the minister to committee by recognising our call for the patient safety commissioner's work to include an explicit commitment to listening and supporting underrepresented voices and for agreeing with the need to follow up and work with other organisations to ensure that recommendations really do bring positive change. Patient trust must be strengthened and our intervention is critical and that's exactly what a patient safety commissioner will do. Further to this, the bill recognises the key role data analytics will play in effectively supporting the patient safety commissioner to amplify the voices of patients. For example, we've heard today also about sodium valproate and how it can be an essential medicine for those with epilepsy or bipolar disorder but we're not aware of the imposed physical and neurodevelopmental risks to babies if prescribed during pregnancy and the trauma and guilt that were so well described by Tess White. Substantial evidence reaffirming those risks has emerged since the early 2000s yet Valproate Scotland has noted that there is still no exact figure on how many people in Scotland have been impacted, only an estimation which is around 2000 and prevalence really must be understood or those affected suffer in silence and go unsupported but thanks to fierce campaigning by Valproate Scotland that specific data is now being collected however we should not be reliant on campaigners to bring these issues to the forefront. We must be proactive not reactive in data collection to identify trains early and minimise harms and it's good to the minister's reassurance that the commissioner will have access to the data analytics that are required to implement robust, evidence-based systematic improvements. We simply cannot afford to allow another surgical vaginal mesh or sodium valproate event to unfolds. Today we have heard much about patient experiences that highlight the need for this bill and about the importance of creating a patient safety commissioner role independent of government to champion patients' rights. We've heard the patient safety commissioner needs authority to investigate and report on patient safety matters and also the power to make recommendations to healthcare providers, professional regulatory bodies and the Scottish Government. In closing, this bill should matter to every Scottish citizen because any one of us might unexpectedly face a situation that goes beyond an individual complaint and appreciate a patient commissioner on our side. I stand by the bill's aims and I hope and trust that members will support the general principles today. I too welcome the introduction of this bill and would like to thank all those who gave evidence to the health and social care committee, the committee clerks and those organisations who provided briefings for today's debate. This is one of those rare occasions where we don't disagree on the issue and can have a genuine discussion on how we get the best out of this bill for patients. The committee heard a wide range of views from those who gave evidence. We heard varying opinions on how the commissioner should respond to individual cases. When I asked her in committee Baroness Cumberlidge stated that the commissioner needs to be able to take an overall system-wide view so that they can identify trends and that there are other organisations that can support individuals. However, we also heard from Hemophilia Scotland that people don't always know where to go when they have complaints and that a culture of defensiveness in the NHS may prevent their complaints from being addressed. They made the powerful point that the infected blood inquiry has resulted in the issuing of apologies that some people have been waiting 20 years for and that there is value in the commissioner being the first point of contact rather than the last. There was, however, largely consensus among those who gave evidence about the commissioner not taking on and solving individual cases, but certainly listening to individual concerns and identifying where they form a pattern. The role of the commissioner in relation to individual cases must be clearly defined as the bill progresses through parliament so that it can be clearly communicated to the public. As the committee reports states, given the on-going issues around patients feeling that they are not listening to and the length of time taken for their problems to be acknowledged, raising public awareness and managing expectations in relation to the role of the patient's safety commissioner will be essential and the Government must plan for that accordingly. Alongside excellent communication about the role and responsibilities of the commissioner, there must be an early focus on the building of relationships. It was stressed to the committee that patients will need to see the commissioner as someone who is on their side when they may have struggled to be heard for some time. The commissioner must take a person-centred approach to complaints that recognise the individual behind the complaint. Those with lived and living experience of patient safety issues should also have a meaningful role in the recruitment process. That will be essential in establishing patient trust and confidence in the commissioner. Consulting with people with lived experience and other stakeholders should be an on-going process and not a one-off event. The report also calls for the commissioner to consult stakeholders on the principles that will underpin the role and that they should include an explicit commitment to listening to and supporting underrepresented voices. The commissioner must be keenly aware that not all complaints are treated equally and that existing inequalities will impact the experiences of patients when things go wrong. The themes that were examined in the Cumberlage review specifically affected women and found a culture of science around women's pain and discomfort, which is often dismissed or ignored by the very system that is meant to keep patients healthy and well. The commissioner must take an intersectional approach. In a 2022 report by MBRRACE UK, it was revealed that in the UK black women are 3.7 times more likely to die than white women due to complications from pregnancy. Asian women were 1.8 times more likely to die than white women, while for mixed ethnicity women it was 1.3 times. The GMC has suggested that the commissioner should adopt an explicit focus on addressing and mitigating healthcare inequalities, where those have the potential to impact on patient safety—a call that I fully support. Turning to the relationship between NHS staff and the commissioner, I appreciate the comments from the then Minister for Public Health, Women's Health and Sport during her evidence session. She was clear that there should be communication between the two and that that could be clarified in the bill. The Royal College of Nursing has welcomed this commitment and has highlighted that, although policies and procedures are in place for staff to raise concerns, they do not always feel that those concerns are heard. Given the pressure that staff are under at the moment, it will be essential to build positive relationships from the beginning, so that staff are not reluctant to raise issues due to fears about punishment. Both staff and the commissioner will share a commitment to patient safety, so we need to create an environment where they can work towards that common goal. The commissioner will need to work cooperatively and not just be seen as wielding a big stick. As the committee report notes, the complex governance structures that are currently in place with responsibility for the safety of patient care shared among several organisations not only creates the risk of overlap and duplication of effort but can make things confusing for patients and lead to them having to retell their stories over and over to different agencies. That is one example of how raising complaints can be traumatic for patients. More detail is clearly needed on how the commissioner will work with other agencies and to ensure that there is no meaningful duplication or overlap. I look forward to that clarification being added. Although the establishment of a commissioner will hopefully help to alleviate some of the aforementioned trauma experienced by patients who are raising complaints, the need for emotional and practical support is still clear. As we have seen from the effective blood inquiry, seeking resolution for complaints can be an extremely lengthy, drawn-out process that can reinforce trauma for patients. It needs to be made clear what support is available to patients and how they can access it while their complaints are being investigated. The appointment of a patient safety commissioner is a vital step towards the improvement of patient safety and will provide reassurance to people that, where things go wrong, their voices will be listened to and lessons will be learned. Therefore, the Scottish Greens will be supporting the bill at stage 1. David Torrance To be followed by Colin Smith Thank you, Presiding Officer. It is well established that health is a fundamental human right that should be treated as such. While our healthcare system has faced unprecedented challenges in recent years, my view is that it is essential, going forward, to use this time as an opportunity to learn and do better for safety of patients and for the foundation of our healthcare system. We are faced with unique circumstances in this period of post-pandemic rebuilding to implement the necessary changes needed to put patient safety at the heart of our healthcare. I therefore very much welcome the patient safety commissioner for Scotland Bill, which intends to establish a patient safety commissioner to ensure that patient's voices are heard, amplified and carefully considered. The bill proposes that the patient safety commissioner would have two key functions to advocate systemic improvements in the safety of healthcare and to promote the importance of the views of patients and other members of the public in relation to safety of healthcare. As a member of Health and Social Care and Sport Committee, I have had the privilege of taking verbal and written evidence from a range of stakeholders and experts across the sector whose views have been invaluable in informing the committee. In addition, we have heard from a range of patients and patients representatives, many of whom have strongly supported the establishment of a patient safety commissioner for Scotland and told us about the differences such a role could have made in their cases. I am incredibly pleased that the committee has unanimously backed the bill, and its patient safety commissioner for Scotland Bill was introduced in response to recommendations for the UK Government's commissioned CYMBOLAGE review. The committee was in fact pleased to welcome Barnas CYMBOLAGE to our first evidence session on the bill earlier this year. The review was established to examine how the health system responds to reports from patients that have patient safety concerns related to medicines and medical devices. Our committee has heard on numerous occasions that a patient safety commissioner for Scotland Bill goes further on that than the corresponding legislation in England. As the bill is currently drafted, the patient safety commissioner for Scotland do not only have the power to make public knowledge if an organisation fails to cooperate, but goes further on that the commissioner would have the power to compel the organisation to act. It is reassuring to hear that the patient safety commissioner for England has already made remarkable progress, and if the bill is passed, I would forward to see even better results in Scotland. I want to personally thank the individuals and members of the public who have volunteered their time to speak to the committee. At the evidence session, many of them spoke of their personal experiences. I know that all of us present at the committee means we are incredibly moved by their stories. Patients need to feel safe in their hands of our medical professions and I cannot fathom that an imaginable pain and mental distress that patients across the country and their families have faced. The harm that has been caused to them and their families is often avoidable, and I appreciate and recognise that many continue to fight for answers. Safety lies at the heart of delivering our health service, and it will be essential for the commissioner to install trust and confidence in our communities and be clear and strong with voice for patients. The reason we are here today to debate this bill is thanks to the tireless work of campaigners and individuals who have been massively affected by the issue. They are absolutely certain and future generations will be benefited from a safer healthcare thanks to their incredible efforts. Presiding Officer, we cannot talk about healthcare without discussing the universal and entrenched in qualities patient patients. During the committee's evidence sessions, we heard at time and at time again how marginalised groups are bearing the brunt of patient safety issues and how the establishment of a patient safety commissioner could ensure that the marginalised patient voices are heard and that concerns are picked up on and acted upon. Patient safety is incredibly gendered. Experts told the committee that women and children were overwhelmed by the groups that have been affected by medicines and medical devices that have been thought to jeopardise patient safety. Women across Scotland have been let down by ingrained prejudice within the medical system, and their search has shown that the healthcare system seems to be poor at listening to women and taking them seriously. Their concerns about their health and wellbeing and the outcomes of the procedures that they have had. Based on the evidence that we have heard, it is clear that there is a requirement for a system to act in a more coherent way for the public interest, and the establishment of a patient safety commissioner has effective mechanisms in doing so. In response to a consultation, the Health and Social Care Alliance Scotland sell a number of considerations, many of which are very much welcome, including the importance of a fully transparent appointment process for the commissioner, and that the role and remit can clearly explain to general public through accessible and inclusive messaging. With this in mind, and as the bill progresses in later stages, I believe that the clear focus should be on the given on points. First, the remit and scope of the patient safety commissioner needs to be clarified to ensure a clear definition of roles across medical systems. The medical system is a complex in the landscape, and the essential role of the commissioner is clearly defined so that there is no overlapping current government systems, and so that patients know who they can contact or support. Second, the commissioner needs to be independent of the Government and the NHS to have the resources to carry out and store properly. This will help to restore public confidence in our healthcare system and encourage patients to come forward to report any cases of medical wrongdoing. Third, the person-centered approach is critical and necessary. Patient voices, particularly those from marginalised or underrepresented groups, need to be at the heart of the work that this group is going forward. Diversity of voices is paramount to patient safety, and those who have lived experiences should play a meaningful role in the process of establishing a patient safety commissioner for Scotland. Throughout this post-process, I am confident that the Scottish Government will continue to work with relevant organisations to ensure an outcome that is robust and comprehensive. In conclusion, Presiding Officer, and once again, I would like to thank those who gave evidence to the committee and the run-up to us to be there. I look forward to building progress in the upcoming stages. Thank you, Presiding Officer. I add my thanks to the Health, Social Care and Sports Committee, members and clads for the work that they have done on their stage 1 report and to all those who took the time to give evidence to the committee to shape that report. It is clear from reading the evidence to the committee that there is widespread support for the establishment of a patient safety commissioner, which is crucially independent of the Government providing that strong voice for patients championing their interests. Patient safety should be a non-negotiable aspect of our health and social care service. However, as we have heard in the debate already, too often patients in Scotland do feel that they have been failed. From the chemotherapy dosing scandal for breast cancer patients in Tayside and the pelvic mesh surgery scandal to the infected blood scandal and the tragic death of Millie Mayne at Glasgow's Queen Elizabeth University hospital due to contaminated water, it is clear that Scotland does need an independent body with the power and resources to shed light on those mistakes and crucially to ensure lessons are learned for the future. Too often patients feel that they are not being heard, too often they feel that they do not have the information to make the right decision about their care, too often they do not trust the answers that they are given and too often they do not believe that the system prioritises their health in that of their families. Take the example from Parkinson's UK, who highlighted in their evidence to the committee the time critical nature of the administration of Parkinson's medicines. If people with Parkinson's do not get their medication on time, even a delay of 30 minutes can seriously impact on their health. Through their get-on time campaign, Parkinson's UK and the wider Parkinson's community have been raising significant concerns about missing late medicines in hospital since 2006, almost two decades ago. Yet Parkinson's UK estimates that there are still around 100,000 incidents a year in Scotland in which Parkinson's medication is administered more than half an hour late in breach of clinical guidelines or has missed altogether on occasions, often with tragic consequences. As we heard in the debate with Sodium Valprate Damage, the Parkinson's community also feel that calls from patients too often fall on deaf ears at a systematic level. In evidence to the committee, some have argued that there are already established organisations Healthcare Improvement Scotland, the Scottish Public Services Ombudsman, the Health and Safety Executive and Initiatives, such as the NHS Scotland patient safety programme, and they have expressed concerns about overlapping responsibilities. Of course, as a committee highlights, we do need to avoid duplication, but it is also clear that the scandals that we have heard were not properly addressed by the current organisations and the current systems that we have in place. That is devastating for patients, but it is also devastating for clinicians and other staff, the overwhelming majority of whom go above and beyond every single day. Concerns were also raised by the Finance and Public Administration Committee about the increasing number of commissioners and the resource challenges that this brings to the Scottish Parliamentary Corporate Body. That is not an argument against new commissioners. It is an argument that the Health, Social Care and Sports Committee rightly makes to properly resource the Parliament's corporate body to support the work of the patient safety commissioner and any others that may be proposed and to properly resource the commissioners themselves. There are strong arguments for the role that commissioners can play in independently scrutinising Government and providing voices to people with lived experiences, not least in health. There is another petition before this Parliament from Dr Gordon Baird, a retired GP in my region, urging the Government to establish independent advocacy in health, specifically in this case for rural areas to ensure that health service provision there is fair and reasonable. Dr Baird has cited the successful model of Australia's rural healthcare commissioner. He took up the cause after his former music teacher, a woman in her 80s, with terminal cancer had to spend nearly nine hours travelling back from Edinburgh to her home and sand head each time following pallative therapy. For no other reason than the historical convenience of consultants that led to Dumfries and Galloway being part of the east of Scotland cancer network rather than the west of Scotland network. It means patients from the region primarily having to travel to Edinburgh. I will take an intervention on that one. I thank colleagues for giving way. It is just a really quick one. Would you agree that Dr Gordon Baird has been working on this for 20 years? That and many other issues in our rural communities, concerns that have been brought by patients about the lack of services in an area, have just not been tackled. In this case, what it means is that patients from the region having to travel to Edinburgh for that specialist cancer care, not Glasgow, which is far closer for those residents in the west. The health board has promised, as Emma Harper highlighted, action to realign to the west of Scotland since 2006, but there has been no progress from them or government to deliver that. Since 2018, we have also seen the maternity unit at Galloway hospitals when we are closed. We were told temporarily because of a shortage of bedwives. It means mums to be in Wigtonshire having to travel up to 90 miles to Dumfries to give birth. One of my constituents, Claire Fleming, lives in Glenloos, 50 miles from Strunrath. Her first pregnancy was with Abby, who was sadly still born. Despite the tragic end to that pregnancy, Claire had to drive herself to the hospital in Dumfries to deliver Abby. That is 60 miles away. Since then, she has had three children, Molly, Andrew and James, which is wonderful, but along with husband Richard, she has had to clock up over 7,500 miles between her home in Dumfries for maternity appointments, because, even before the maternity unit in Strunrath closed services had been scaled back. Claire suffered from hyperemesis during pregnancy, which means that she had to stop on that journey to Dumfries every 15 minutes to be sick. She told me that she was aware of women in Wigtonshire who decided not to get pregnant because they were so scared of having to make that journey in a rush if they went into labour for fear. They would have to give birth on a lay-by at the side of the road. Claire herself has chosen to be sterilised because she says that she could not face that journey again. Presiding Officer, that has not put in patient safety first. I have no doubt that, had we had a rural health commissioner shining a light on those scandals independently holding Government to account, we would have seen progress before to end those scandals before now. I have no doubt that a patient safety commissioner, who is properly resourced with the proper powers and, crucially, is backed by safe staffing levels in her hospitals, could play an important role in standing up for patients' rights and advocating for the safe treatment and care that we should all be receiving. My apologies, Presiding Officer. I got kicked out and I had to log myself back in again. Signals are not a member across this chamber who does not put themselves forward to stand for election without believing that they can work to improve and protect the lives and wellbeing of the constituencies that they represent. The health and safety of each and every one of us, that every one of the people of your constituency, your city and across Scotland is above all at the heart of all the work that we do as an MSP. The NHS is, as we often reflect, one of the finest institutes in the world. The care and dedication of the staff and practitioners is second to none, and I am always and always at the levels of diligence shown when carrying out such complex and challenging care. However, it would be remiss of me not to admit that one of the more difficult parts of our job as members is dealing with complaints and concerns when it comes to the NHS. In my experience, our office has usually found the greater Glasgow and Clyde board to be extremely helpful when it comes to difficult issues. However, there have been and will be times when perhaps issues fall out with their remit and are left with patients frustrated and issues unresolved. I have recently been in discussion with constituents or survivors and members of groups supporting patients who were treated with transvaginal mesh, and it was completely flabbergasted and horrified by the shocking stories of discomfort, pain and wider impact that it had in their life. This Parliament has listened to many debates on this particular subject, and we, as members, have learned so much from the various testimonies referred to us by the brave women who have campaigned so hard for patients to have correctional treatment where possible and for steps to be taken to support those involved. Therefore, I was delighted to see in the launch of the Cambridge review that this was one of the cases highlighted for the need for the introduction of the patient safety commissioner. Signals of healthcare and innovation have worked hand in hand forever. However, as we move into another changing world of AI and tech-led healthcare, human beings must always be at the centre of all our care provision. I was recently speaking to a tight one diabetic patient who within a few years has gone from monitoring their sugar levels with a manual prick of their finger and using difficult mathematical calculations and insulin pens to deliver insulin to a monitor that can be scanned with a smartphone and insulin delivered through a micro pump that is attached to the patient's body. That not only ensures that the patient has more accurate and cohesive regulation of insulin in the body, but it could mean a massive improvement to the life of the patient and a reduction of other difficult side effects that come with poor diabetic management. However, something that was very interesting to hear was that the technology, transformative, is not without flaws. For example, if the Bluetooth signal from the smartphone to the pump fails, insulin will cease to be delivered, resulting in a spike in blood glucose levels. That is a very specific example of even when medical technology is transformative, it does not go without its difficulties. The safety officer would be a perfect place for somebody who wishes to raise an issue that could have effects for other people beside themselves, but does not want to seem as if they are complaining about a particularly good service. So, hopefully, the patient safety commissioner would be able to take that forward and see if there is something that could get done about it. I think that that is a very good step in this bill. One of the key areas that I am really pleased about is that it is designed to improve communications with patients and members of the public. I saw that, during the Cumberland report, the evidence that recommended that a patient's lived experience should no longer be considered as anecdotal and should not be downgraded as it presently is when it is weighted against scientific and evidence-based medicine. The Scottish Government has recognised public calls for the patients to have a new voice and continued engagement with the people of Scotland has confirmed that it should be a priority to fulfil the recommendations of the Cumberland's review, and this bill very clearly seeks to do so. When it comes to public safety and health, the best outcome for patients will only be achieved if there is a strong partnership working. The NHS procurement run by the NSS is a prime example of that, where clinicians and management work together to ensure that the needs of the organisation and, ultimately, the service users are met in the most efficient, safe and cost-effective way. Therefore, it is great that, while the commissioner will be independent, they will work closely with professionals such as clinicians, lawyers and advocates, to ensure that a whole around the service is delivered to the people of Scotland. I am confident that patient complaints are dealt with to the best of each individual health board's ability, but organisations such as Health Improvement Scotland and others are doing all they can to ensure the safety of the people using healthcare facilities, both public and private, across Scotland. However, the Scottish Government is right to take on the committee report to follow the guidance of the Cumberland's review and the evidence that will ensure that the voices of service users are not lost among the many others. While the commissioner will not be advocating in individual cases of patients, it is good that there will be advocacy for safety and health across Scotland and that the voices of patients and service users are central to this. Patients will benefit greatly from streamlined advocacy and guidance when it comes to their safety and care within the healthcare system. The overwhelming public support during the consultation period for this bill is proof that this is absolutely the right implementation to make. If I am delighted to support the patient safety commissioner for Scotland at stage 1. Thank you very much, Presiding Officer. I am pleased to have the opportunity to close this debate on behalf of Scottish Labour. Can I begin by welcoming Jenny Mintle to her place as a minister on the first occasion? I have been across from her in this chamber and quite possibly in this context at the last, because I am speaking today as the former deputy convener of the Health, Social Care and Sport Committee. Not the minister, of course. I am referring to my own move in terms of shadow roles. However, I am pleased to be speaking looking back at my time in the Health, Social Care and Sport Committee and following on from a number of colleagues in that committee in speaking about this bill today. Because in the committee we scrutinise these proposals very carefully and thoughtfully. It was clear from all the evidence sessions that there is a consensus that the patient safety commissioner can play an important role in improving public confidence in the healthcare system and serving as a powerful advocate indeed for patients. I think that as has been articulated by my colleague today and was notably Paul Sweeney in his opening, Scottish Labour does support the establishment of the patient safety commissioner to champion the rights of patients and to defend their interests. However, as we have said, we want to see this bill be as robust as possible and go as far as it possibly can to ensure that those interests are being defended, as I say, robustly. It is a positive step, of course, that the Government is implementing a key recommendation of the Cumballage review because in recent years, as we have heard across the chamber, we have witnessed too many scandals, often with fatal consequences affecting too many families. Indeed, the stark reality is that we cannot afford the cost, both the economic cost but, critically, the human cost of unsafe care. Globally, it is estimated that unsafe care in health settings significantly contributes to over 3 million deaths per year and that is clearly a very sobering and significant number. Here in Scotland, the financial cost of unsafe care is estimated to be around £2 billion. So I think in disrespect the importance of legislation is self-evident. The crucial aspect, as I have said in my opening, is that this legislation is well crafted and indeed well implemented. I think that, as we have heard today, there are often pieces of well-intentioned legislation which have failed to have an impact on improving patient safety or indeed patient care. We heard from my colleague Carol Mocken in her contribution about the passing of the Health and Care Staffing Act 2019, which was held as a landmark piece of legislation to improve patient safety, as well as the safety of the workforce by ensuring that safe staffing levels on wards. However, four years hence, since that legislation was supported across the chamber, we have had a failure, I think, to properly implement that legislation and indeed to meet those standards. So I think that everyone is keen once more to raise that issue and to see progress in that space. Reflecting on today's debate, Presiding Officer, Alex Cole-Hamilton and Colin Smyth raised, I thought, quite rightly the scandals that have impacted patients across the country, most notably at the Queen Elizabeth University hospital. I think that those very harrowing stories are part of the reason that we need to ensure that this bill goes as far as possible. Scottish Labour has advocated for many years for better and more robust systems to be in place in order to ensure that the voices of patients who have been victims of poor care are at the heart of any enquiries into tragedies, most notably the story, of course, of Millie Mayne and the advocacy, I think, for a Millie's law in order to put families at the heart of those enquiries. I think that we need to see the patient commissioner taking a very strong role in that. Evelyn Tweed, I thought, spoke powerfully about the importance of the barriers that are experienced, particularly by women in healthcare and acknowledged that those have to be broken down. I am sure that we would all agree that we want to see the breaking down of those barriers and I think that that is why the recommendations of the committee that Evelyn Tweed referenced about following up with patients, giving them a holistic support and indeed representing the under-represented in this space is so vitally important. And both Brian Whittle and Emma Harper I think brought to the chamber's attention the personal cost of the experiences that people have had across Scotland, experiencing unthinkable pain, both physical and mental, and having to live with that pain for many years in order to progress towards an outcome. So I thought that those contributions were particularly important in helping us to really focus on what we want this patient safety commissioner to do. I think that at the heart of this we have to see transparency, accountability and crucially safety. They are the values that I think we would all want to see underpin the proposal. And I think as the bill moves to stage 2, it's critical that the Government works with members from across the chamber to iron out some of those issues that were raised by the committee at stage 1. And I do welcome the minister in her opening saying that the Government is in listening mode. I think that's really important. The issues that stood out for me from the committee's point of view have already I think been covered, but I think exploring how healthcare staff can freely without fear of repercussion raise patient safety concerns with the commissioner. And once again, I appreciate the minister saying that she will work with officials to see what we can do in terms of that. For me also providing greater clarity on the powers of the commissioner to compel private companies who provide devices and medicines to submit evidence during investigations, you know, making sure that the commissioner has teeth to push those companies to do that. Paul Sweeney mentioned, I think, investigations into individual cases. I do think that that is important in merits looking at. And I think clarifying the remit of the commissioner in relation to social care as Paul Sweeney also mentioned and how that would interact with the proposals for a national care service is very important because we know that there are significant issues in terms of safety and social care that came to light, of course, during the pandemic and through the period since, which do need to be addressed and I think that there is opportunity to do that in this. I will draw to a close, Presiding Officer, but I want to join others in thanking the committee, indeed my former colleagues in the committee for all of their work, the clerks, those who gave evidence. And as I stated earlier in my remarks, Scottish Labour will support the bill because there is, evidently, a consensus on the need for a patient safety commissioner recognised by all parties in this Parliament. But indeed, as the bill now moves forward to subsequent stages, it's critical that the Government get it right and deliver because patients have already waited too long and they do need a champion. Thank you. Thank you. And I know Cole on Sandesh Gohan. Thank you. I want to start my remarks by stating for the record that the vast, vast majority of health interactions are safe. And I thank all NHS and social care staff for their hard work. The Scottish Conservatives support the principles of the bill to introduce a patient safety commissioner for Scotland who will promote the concerns of patients and advocate for systemic improvements in healthcare. The Scottish Conservatives want to see an NHS which is modern, efficient and local and takes a fresh approach to try and fix the issues within healthcare. And it's interesting to consider the background to this bill and test why it reminded us that back in 2018 Baroness Cumberlidge led a review into the harmful side effects of medicines and medical devices in England. The review made nine recommendations including the appointment of a patient safety commissioner in England. In September 2020, the then health secretary Jane Freeman announced the Scottish Government's intention to produce a patient safety commissioner for Scotland and I quote, not everyone gets the outcome they are looking for and not everyone feels that they are being properly listened to. But from the evidence that we took, the patient safety commissioner will not be taking on individual cases. In February 2021, the English patient safety commissioner was introduced into law by an amendment to the medicines and medical devices bill. We've also heard from numerous members that the proposed Scottish PCS is different to the English one. The proposed Scottish patient safety commissioner would be nominated and sponsored by and therefore accountable to this Parliament whereas the English PCS is sponsored by the Department of Health and Social Care. Furthermore, whilst the English PSC only covers medication and medical safety devices, the Scottish equivalent will cover all aspects of patient safety. Patient safety is paramount and we need to be very careful in how we frame the duties and responsibilities of Scotland's patient safety commissioner. While the PSC is accountable to Parliament, Parliament should not be micromanaging the commissioner and from the evidence that we heard, the PSC will indeed be independent. We should also be mindful that we're dealing with the public's money around £650,000 per year which TESWITE was correct to raise. The spend must be justified. We need to demonstrate value for money. There are also concerns of a possible duplication of efforts and how the PSC will sit within existing organisations. There is already complex regulatory scrutiny and oversight landscape for the NHS in Scotland and the creation of another scrutiny body comes with risks of overlap especially where functions and remit is not clearly articulated within the context of the wider landscape. Minister Minto explained that the PCS will look at trends through the healthcare system and it is this golden thread that is vital to safety as it stops the same issues continuing to harm patients. Being a member of the health committee it is vital we discover the interaction between the commissioner and other commissioners and key stakeholders. Again, as Minister Minto stated, this is because the commissioner will not be undertaking investigations but rather try to use expertise from outside. And I agree with Minister Minto that we need to foster a safe, open and learning culture within healthcare. And as our convener of the health committee has stated we are all grateful to the patients who gave such powerful evidence which Brian Whittle so eloquently repeated their painful experiences. They are using them to help create a system that prevents other patients and families going through the same pain. The commissioner requires public engagement and public confidence that they are there to protect patients and will actually listen to them. Tess White told us that patients felt dismissed and that Baroness Cumberledge sought this post and was very clear in her evidence to the committee that she agreed with this bill. Alex Cole-Hamilton and Brian Whittle spoke of how slow we have been in creating this post. Though through evidence we have heard that listening to individuals to find the golden thread would be great for individual cases but those cases will be signposted to the appropriate other place. I agree with the Royal College of Nurses and Mr Cole-Hamilton that staff safety is paramount to patient safety. How can a nurse deliver excellent care when we ask them to fill reams of paperwork which is duplicated? How can they be asked to cope with too many patients and constantly be under severe pressure? Carol Mock and you were right to speak of the safe staffing legislation because there is nothing more demoralising than constantly having rotor gaps that you need to cover. Paul Sweeney you make excellent points about the social care aspect but at the moment it seems that the role of the commissioner is very large and getting on top of that before expansion is definitely required. Mr Sweeney also questions the cost which the Scottish Conservatives are also concerned about but the overall cost of commissioners has been flagged by the Public Administrations Committee and we must be mindful of achieving a balance and not diluting the post as Brian Whittle said. Evelyn Tweed told us that women seem to be constantly dismissed and are not taken seriously in healthcare settings. 50% of the population are not getting the help they need. We must do better and I hope the commissioner is a step in the right direction but we need to see the Scottish Government doing more for women and as Ginny Mackay has said ethnic minorities suffer disproportionately as well. Brian Whittle was spot on that most incidents are systemic issues. It's described as the Swiss cheese model because the holes line up allowing the incident to occur and the commissioner must find these potential holes and close them. The Scottish Conservatives want this bill to succeed so we'll support it at this stage. Going forward we are keen to see more detail on the relationship between the commissioner and Parliament. What is the appropriate scrutiny criteria? We believe that the commissioner should set the work agenda for each year along with the criteria that they feel that they should be judged against and present this to the Health, Social Care and Sport Committee along with the previous year's work for scrutiny. We then want to see the health committee hold a debate each year on the work of the commissioner. We have a great opportunity here to establish a force for good, accountable to Parliament and delivers value from money. Let us move ahead but let's also carefully consider the detail and I declare my interest as a practising NHS doctor. Thank you. And I now call on the minister to wind up. Thank you. Thank you, Presiding Officer. I am very grateful to all members for their extremely thoughtful contributions to what has been a very constructive and helpful debate. It is welcome that the chamber recognises that there is more to do to ensure that patients are listened to when they have concerns about safety of healthcare and agrees that the creation of an independent patient safety commissioner is an important step that will promote the patient voice and make healthcare in Scotland safer for us all. I will of course carefully consider all the points raised today before stage 2. The range of suggestions that have been put forward to ensure that the patient safety commissioner is as effective as possible is very welcome and is a doubtless testament to the commitment of the members of this Parliament to the safety of their constituents and all who need to access the healthcare system in Scotland irrespective of whether that healthcare is provided by the NHS or through another route. Clearly some issues debated today will need to be considered further but I am pleased that there appears to be a general support for the general principles of the bill across the chamber. So if I may I would like to turn to some of the contributions that have been made. Paul Cain thank you for your kind words and I really reflect on what you said about the thoughtful consideration of the committee under the convenership of Gillian Martin. The evidence sessions that I watched were very very powerful especially those of the people that had been impacted by previous circumstances. The bill well crafted so I thank my bill team for that. Sandesh Gulhane I echo your words about the thanks to the healthcare staff that do work in our NHS and also noting that Jean Freeman first introduced this idea to the Parliament as a result of Baroness Cumberledge. There are various other points that you raised that I think I'll touch on if I have time. Claire Hohie thank you you too raised the evidence and the social care and also the unrepresented voices specifically around women as did Tess White. And you also emphasised and it was a word that I've used a lot is collaboration the importance of that. Paul Sweeney you talked about individual cases and the healthcare around that and offered to have further dialogue with me which I would very much appreciate. Alex Cole-Hamilton I think it's important just to emphasise that the establishment of our commissioner is standalone primary legislation not as Sandesh Gulhane mentioned an add-on to another bill so we've given ours our commissioner statutory powers we have also taken much time to listen to individuals and that's something that patients wanted. Evelyn Tweed yes of course test point thank you minister for taking an intervention the RCN have raised a really important point about safe staffing being integral to patient safety so in your new role do you see that as a key principle and will you be looking into it at stage 2 thank you minister thank you test white for that intervention we've certainly taken I've taken the decision to review staffing and the contribution that they can make to the commissioner but it will be the commissioner that will make the decisions as to what they they view as their priorities but certainly take a note of that so I was talking about Evelyn Tweed she referenced the young women's movement and I attended at their launch of the research that they had done on women's experiences and would like to reflect and I agree with the points that Evelyn Tweed raised Brian Whittle thank you very much for bringing to the chamber Fraser and June Morton's experience I was particularly moved by his evidence and also his selfless actions and the whole thing that you pointed on that we need to review and learn and move on positively and use their terrible experience traumatic experience Brian Whittle very grateful minister to take an intervention I wonder if he would agree with me that one of the things we have to do in bringing the commissioner forward here is to ensure that staff feel empowered enough and safe enough to give evidence in these cases where they don't feel there's going to be representation or blame Minister I thank Mr Whittle for that intervention and just reaffirm as I said to his colleague Tess White that that's something that I have responded to in my letter that I think it is important that we review that side of it as the staff indications as well Emma Harper also talked about the importance of listening and amplifying patients voices and along with Colin Smith talked about travel from rural communities which I recognise representing Argyll and Bute I would say that I'm happy to look at this but again it's something that the patient safety commissioner will make decisions as to whether he or she reviews Carol Mocken talked about lived experience and the power to stand up for patients rights and also as a first step Stephanie Callaghan patient trust must be strengthened and to me that is the one of the core points of this bill and we are proactive not reactive Julian Mackay talked about building relationships and a person-centred approach David Torrance also talked about trust and confidence in our communities and James Dornan again highlighted Barnas Cumberledge lived experience is not anecdotal and again I believe that that is central to what we're doing how much time have I got sorry there was a scheduled eight minutes minister but do please continue we have some time okay that's fine so I'd like to touch on some of some of the points that have been raised so I I do feel strongly that the safety commissioner's focus must be on the safety of healthcare and I'm pleased that the committee agrees with this the commissioner's remit covers the safety of healthcare irrespective of where it is delivered and I believe this means that there will have to be requisite scope to examine issues at the intersection of health and social care as the committee has looked at with regard to underrepresented voices which a number of members raised this will be whoever whoever is appointed as the patient safety commissioner to determine this and but I agree that a firm commitment underrepresented voices must sit at the heart of the role Tess White again you talked about women and I'm very proud to be the women's health minister and this is a key priority of the Scottish Government and the women's health plan sets out actions designed to achieve long-term success so I would hope that if it is appropriate then there would be collaboration between and overlap between between the two areas and I agree as well that we have to get the resourcing rights which has been raised it needs to be transparent and accountable and sorry we also discussed a bit about individual cases and I've already offered to Paul to have a conversation with him separately and I would just underline the fact that it is an independent process that we will have to hold the patient safety commissioner correct through Parliament and whether also through the committee as well Carol Mockin talked about the definition of patient safety and there are a number of definitions with regards to patient safety and I think whether it's the World Health Organization or NHS England's and I would suggest perhaps that that is something again that the commissioner may wish to look at so this bill will establish an independent public advocate for patients in Scotland on the safety of healthcare accountable to this Parliament and thereby the people of Scotland the patient voice will be at the heart of the patient safety commissioner role the commissioner will be informed at all times by the views of patients when deciding what they focus on and which issues they wish to investigate and crucially they will be accessible to patients to hear their stories directly people sharing their views and experiences will be key to making the role work and improving the safety of healthcare for us all this will be a significant step forward for patient safety in Scotland and will build on the extensive suite of rights that already enable patients to give feedback I believe that this bill is an important and positive step in making a Scotland's healthcare system more responsive to the needs of patients and the wider public Let us work together to make this step and show the people of Scotland that we are committed to ensuring that their healthcare system is as safe as possible as Stephanie Callaghan said it matters to every single one of us I call on Parliament to support the general principles of the bill Thank you That concludes the debate on patient safety commissioner for Scotland Bill at stage 1 it is now time to move on to the next item of business which is consideration of motion 6897 on a financial resolution for the patient safety commissioner for Scotland Bill and I invite Michael Matheson to move the motion Thank you cabinet secretary the question on this motion will be put at decision time The next item of business is consideration of business motion 8894 in the name of George Adam on behalf of parliamentary bureau setting out a business programme and I call on George Adam to move the motion Thank you, Presiding Officer I'm moved Thank you minister No member has asked to speak on the motion and the question is that motion 8894 be agreed Are we all agreed? The motion is therefore agreed Excuse me I am minded I am minded to accept a motion without notice under rule 11.2.4 of standing orders that decision time be brought forward to now and I invite the minister for parliamentary business to move the motion Extremely happy to do so Presiding Officer Thank you and the question is that decision time be brought forward to now Are we all agreed? We are and there are two questions to be put The first is that motion 8869 in the name of Jenny Minto on patient safety commissioner for Scotland Bill be agreed Are we all agreed? The motion is therefore agreed and the final question is the motion 6897 in the name of John Swinney on a financial resolution for the patient safety commissioner for Scotland Bill be agreed Are we all agreed? The motion is therefore agreed and that concludes decision time and we will now move on to members business in the name of Fiona Hyslop