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I was in Elgin during the summer, which was the first place where I had come across the daily mile. People at the health centre there spoke about the importance of exercise, which is just as important as what we eat. Staff at the health centre explained how they are supporting families, and not only with the daily mile. People aged from eight months to 80 are attending the health centre to get support with fitness, whether through the daily mile or something more physical such as swimming or weight training. That is really important.

I heard from people who live with long Covid that there needs to be more public awareness of the conditions that they live with. I heard from one gentleman in his early 70s who had been fit and used to go out walking a lot. It now takes him more than half an hour to walk half a mile.

There is a need for better knowledge on the part of the wider public about the impacts of long Covid. I was pleased that I had officials with me on that visit and will have them with me in my meetings next week and the following week. That means that they have heard about that need, and I am speaking to them about how we can improve awareness of long Covid in the population.

That is a really important question that was highlighted to me yesterday when I heard from a mother whose son had been described as “fat” and “obese,” which had given him a dreadful lack of confidence.

You are absolutely right that language is incredibly important, as is how we work with local authorities, schools and other public bodies to ensure that the message is spread across our services. One example is the good food nation plan, which talks about ensuring that children have the opportunity to eat good healthy food. I saw that in operation last week at a primary school in Edinburgh, where they were talking about breakfast and healthy foods, such as Weetabix and fresh fruit. There is a whole conversation to be had around language, which is important in education centres as well as across the general public. We are very cognisant of that.

I lodged amendment 2 in response to the committee’s recommendation to remove section 4 of the bill as drafted on the basis that it is already provided for in the Equality Act 2010.

I move amendment 2.

I do not support amendment 22, which would allow the commissioner to make a special report on any recommendations from a previous report that they felt had not been, or would not be, implemented. The bill expressly gives the commissioner power to publish information on the implementation, or not, of their recommendations. The amendment is therefore superfluous.

I am also concerned that requiring the commissioner to lay before Parliament a report about actions that they felt would not be implemented could leave them open to defamation actions, as it anticipates or speculates about wrongdoing by others.

I urge members not to vote for amendment 22.

I am keen to ensure that patients who are underrepresented are sought out for greater involvement. I have listened carefully to what Paul Sweeney has said about amendment 16 and about the importance of focusing the commissioner on hearing from those who, too often, are not heard from. I agree with that. I cannot support his amendment, however, because the way that it is expressed might not quite capture what is intended. Being “under-represented in health care” is not necessarily the same as being underlistened to. It is very much part of the problem that some groups are overrepresented in the amount of healthcare that they need and those are precisely the groups with the softest voices. I invite Paul Sweeney not to press amendment 16 and to work with us to bring this important issue back at stage 3.

Amendments 3 to 5 in my name will impose the same consultation requirement on the commissioner in relation to the principles as apply to the strategic plan, including in particular a requirement to consult those whom the commissioner considers appropriate, to ensure that the principles in the strategic plan reflect patients’ concerns. The amendments give effect to a recommendation in the committee’s stage 1 report. The Government agrees with the committee that it is important for stakeholders’ voices to be taken account of when formulating the principles as well as the strategic plan.

Amendment 19, in the name of Tess White, shares some common ground with my amendment 5, as Sandesh Gulhane noted, in that it would require the commissioner to consult on the statement of principles. It also adds an explicit requirement for them to consult with the relevant parliamentary committee. I cannot support amendment 19 because, if amendment 5 is agreed to—as, I hope, it will be—the bill would end up with a duplicate consultation duty. I ask Sandesh Gulhane, on behalf of Tess White, not to move amendment 19, and ask Tess White, if she is willing, to work with us to bring an amendment back at stage 3.

I am also unable to support Tess White’s amendment 17. Although I agree that, as part of investigating and monitoring potential patient safety issues, the commissioner will wish to hear from staff, they are already empowered to do so. Placing a requirement on the commissioner by way of a principle that they will seek the views of staff risks cutting across their focus on patients’ voices.

Amendment 18, in the name of Tess White, would add a number of things that the statement of principles must include. A few of the items that are listed could be described as principles, but some would more appropriately sit within the strategic plan that is required by section 5 and, indeed, already do. An example is how the issues to be investigated will be identified. The commissioner’s purview is already defined in section 2(1). Amendment 18 refers to the setting of a

“threshold for opening an investigation”.

The varied nature of concerns that the commissioner may investigate means that trying to define a threshold that would be appropriate in all cases will be difficult. The Government’s view is that the commissioner should be trusted to exercise independent judgment about when to instigate an investigation within the framework of the commissioner’s strategic plan and principles. The Parliament can then hold the commissioner to account for those decisions. Therefore, I ask members not to support amendment 18.

For a similar reason, I cannot support amendment 21 in the name of Tess White. Producing a work programme, much of the content of which is already covered in the strategic plan, would use up the commissioner’s resources. The additional requirement to set out the work that the commissioner intends to undertake in the next year would not leave adequate space for them to react to new and emerging issues of patient safety. For those reasons, I ask members not to support amendment 21.

I request that Paul Sweeney, and Sandesh Gulhane on behalf of Tess White, do not press amendment 16 or move amendment 19, and that members do not agree to amendments 17, 18 and 21.

In moving my amendments, I want to ensure that the commissioner can access the data that is needed to do their job. Where I oppose amendments, that is so that we can try to protect the spirit of openness and frankness and not threaten the improvements that we all strive for.

Amendment 6 agreed to.

Amendments 7, 8 and 9 moved—[Jenni Minto]—and agreed to.

Amendment 24 moved—[Paul Sweeney].

I do not support amendment 11. The commissioner will need sufficient time in post to understand the patient safety landscape, gather sufficient information, carry out any investigations that they feel are necessary and see their recommendations lead to change. Eight years is the standard period of office for all Scottish parliamentary commissioners. A commitment has been made to the Presiding Officer that the patient safety commissioner will be as consistent as possible with existing procedures to reduce the burden on the Scottish Parliament. I therefore ask Sandesh Gulhane not to press amendment 11.

I thank Jackie Baillie for her powerful words. None of us should ever forget in these discussions that the bill is about ensuring that people and their families can benefit from safer care in the future. That is at the forefront of my mind every day and I know that the same will be true for everyone around the table. I know how much of an advocate Jackie Baillie has been for patients and I thank her again for that.

We all want the patient safety commissioner to amplify the voice of patients and drive improvements in safety, and it is important that they have the freedom to do that however they see fit. I would absolutely expect that the commissioner would wish to hear from bereaved families as well as affected patients when they wished to raise an issue relating to patient safety, including in the sorts of circumstances that Jackie Baillie has mentioned.

It is critical that we do not inadvertently tie the commissioner’s hands in that respect. Everything that we are doing with the bill is intended to ensure that the commissioner has the freedom, scope and authority to set their own agenda without fear or favour, to speak up for patients and to drive improvements. Writing very specific steps for the commissioner into the bill would risk getting in the way of their doing that kind of work and working to prevent major patient safety issues from developing in the first place.

The key functions of the commissioner’s role are set out in section 2(1) of the bill. In particular, they are:

“(a) to advocate for systemic improvement in the safety of health care, and

(b) to promote the importance of the views of patients and other members of the public in relation to the safety of health care.”

I am concerned that the amendments in this group would limit the commissioner’s ability to do that. They risk clouding the public’s understanding of the commissioner’s role and would represent a significant departure from the extent of their current remit and from what was agreed at stage 1. Indeed, the committee agreed at stage 1 that it was appropriate for the commissioner not to become involved in resolving individual cases, as avenues for that already exist. It is critical to let the commissioner be guided by patients and families, not by politicians, on what action they need to take.

Following a major incident, the commissioner would have an important role in gathering information from people who were affected and investigating whether a systemic issue had led to it. There is nothing to prevent the commissioner from doing that through the powers and functions that exist in the bill. I therefore urge members not to agree to the amendments.

I am very sorry to hear that some patients have reported complications after having received a hernia mesh implant. I am grateful to Katy Clark for all her efforts in this area and to the patients who have raised concerns, including those who have petitioned the Parliament. Officials and ministers, including the former First Minister, have heard directly from patients, and we have listened carefully and taken their concerns very seriously.

In the chamber a couple of weeks ago, Katy Clark asked me for a meeting. I believe that my officials have been in touch about their meeting her. Once that has happened, we can review the situation.

As a result of what patients have told us, the Government commissioned the Scottish Health Technologies Group to produce two reports on use of hernia mesh. The reports, which are based on current published evidence, support the continued use of mesh in abdominal wall and groin hernia repairs. The reports stress the importance of shared decision making and informed consent, and they emphasise the importance of choice and the availability of alternative treatments for people who want them. We have discussed the findings with professional bodies, including the relevant royal colleges and the British Hernia Society. We will continue to work with them on this important issue.

The chief medical officer has asked medical directors to consider the development of local clinical groups and broader clinical networks for the management of complex cases. Furthermore, there is work on-going with regard to establishing registries to encourage better data collection, which will provide important surveillance and outcome information in the future.

It is therefore clear that the Government is listening and acting on the concerns that have been expressed. However, it is important that the action that we take is proportionate. There seemed to be broad consensus on that point when the Parliament debated the issue in January. The Government is thus of the opinion that further review is not warranted.

I am unable to support amendment 23, but I am happy to discuss the issue further, perhaps in the lead-up to stage 3. By legislating for a particular strand of work, the amendment risks undermining the independence of the commissioner. The commissioner should be able to decide their own priorities based on the concerns that patients raise with them. It is important that the commissioner is forward facing and uses their time to gather information and horizon scan for potential patient safety issues.

I urge members not to vote for amendment 23.