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You mentioned that flow navigation is implemented in one form or another across all territorial boards. You are in a fairly unique position in that you sit across all those boards and have that perspective. How dynamic and adaptive are the territorial boards in sharing best practice? Are you able to indicate where approaches are doing well elsewhere that could be adapted across the nation as a whole and bring everyone up to a higher performance level?

I want to pick up an issue that is frequently raised by police officers, which is the amount of time that they spend dealing with cases that they do not feel qualified to address or capable of dealing with. The number of calls made to Police Scotland in which a mental health crisis or a suicide risk was cited increased by almost 10,000, from 14,540 in 2018 to 23,406 in 2022.

You mentioned the pilot of triage cars, three of which are operating in Scotland at the moment. Do you feel that there is an opportunity to look at a business case to expand that model if it is shown to be a more effective and more cost-effective solution, given the huge costs that are incurred by the police in responding to incidents involving people who have a known history of calling the police on such issues or incidents with which they are not qualified to deal when they arrive at the scene?

It seems to be clear that the dental and mental health areas are significant parts of the overall healthcare system that are under serious pressure. How sustainable is it for NHS 24 to be the first point of contact, and how effective can it be to refer on when there is not the capacity in the other services to which you are signposting? Do you feel that that approach is sustainable as part of the overall model?

My final question is about the interface between Police Scotland and NHS 24. We know that there has been an increase in the number of call-outs for the police to attend mental health-related incidents in the community. Do you refer people to the police? Are people contacting NHS 24 instead of the police? Is that a more appropriate presentation? Can you provide any analysis of that?

In the light of the reported difficulties in people accessing dentistry services and increasing numbers of NHS dentists removing themselves from NHS provision, have you noticed a structural change in access to dentistry since the pandemic? Would you consider further expansion of the urgent care pathway to help to meet the increase in the number of dental-related inquiries?

Thank you.

Sections 10 and 11 of the bill as drafted outline the requirement for the commissioner to prepare a report following any formal investigation, as well as the requirement for a person to respond to any recommendations made to them in a commissioner’s report.

Amendment 22 would give the commissioner the power to make a special report if it were to appear that recommendations made in their initial investigation report had not been, or would not be, implemented. A special report would be sent to the persons to whom the formal investigation report was sent in the first instance, and a copy would be laid before the Scottish Parliament. Further, the report could also be made public if the commissioner considered that to be appropriate.

In committee evidence, patient groups cited a need for accountability. Marie Lyon, from the Association for Children Damaged by Hormone Pregnancy Tests, said that, up to now,

“people have tended to get away with it. There has never been accountability and there have never been consequences.”—[Official Report, Health, Social Care and Sport Committee, 7 February 2023; c 22.]

Where there is a concern about patient safety, and where changes need to be made, bodies cannot be left to mark their own homework. The commissioner can be effective only if they have the ultimate option of escalating matters if recommendations are dismissed or ignored by the relevant authorities, and I believe that my proposed amendment would give the commissioner the teeth that they need in order to ensure that necessary changes are implemented. I believe that that would be a proportionate enhancement of the commissioner’s powers.

I move amendment 22.

Amendment 24, in my name, would ensure that private companies supplying medicines and medical devices are captured in the category of person who would be required to provide information under section 12 to inform investigations undertaken by the commissioner. There is a lack of clarity over whether the commissioner’s proposed powers to require organisations to provide information will apply to private companies, given that section 12 refers only to “persons” or “healthcare providers”. Amendment 24 seeks to insert a definition that ensures that, for the purposes of this section, the term “health care provider” also includes companies in the private sector that provide medicines and medical devices. I think that that is a reasonable definition.

I should also say that we will support the Government’s technical amendments to the language in section 12. We would therefore be eager for the minister to at least consider revising her position on amendment 24, as I think it entirely reasonable that we clear up the definition.

I note the minister’s comments, but a critical point of discussion at stage 1 was about the fundamental principle that reports are often simply ignored because there is no method for sanction or accountability. Amendment 22 was lodged in that spirit. Other public sector bodies—most notably, the Health and Safety Executive—have powers of compulsion to ensure that recommendations are implemented, and therefore have the capacity to sanction organisations or authorities that do not comply.

Although that might be thought to be overly onerous in this instance—perhaps it would have a chilling effect on health boards and others co-operating with the commissioner—my amendment 22 is an effort to strike a balance. It would not provide the commissioner with the sort of punitive powers that the Health and Safety Executive might have to shut premises down, for example, but it would give the commissioner the capacity to highlight areas in which the recommendations were merely ignored or simply noted by authorities and not actioned. By offering a method of naming and shaming authorities that do not comply or co-operate with the commissioner, my amendment would give the commissioner some degree of leverage to ensure that recommendations are implemented.

I note the minister’s point about the risk of defamation actions. That is a judgment that would be made on a case-by-case basis, based on legal advice. I do not think that the commissioner would knowingly prejudice or expose themselves in that way, so it is an unnecessary overreach to suggest that my amendment 22 would create such a liability. We are all subject to that liability because of the lack of parliamentary privilege in the Scottish Parliament. Improvement across the board is necessary in that respect.

Therefore, I press amendment 22, which I think is entirely reasonable.

This proposed amendment applies to the definition of “health care” in section 21 and seeks to include social care services as part of that definition in the text of the bill. We know that the social care system is facing a crisis in relation to workforce and rising costs. As a result, capacity is stretched, with social care workers stressing the difficulty, under the current circumstances, of providing the level of care that they would like to provide.

Amendment 33 would not seek to widen the commissioner’s remit to include social care as a whole. Instead, it would merely enable the commissioner to consider the interface with social care as part of their investigation only where those services “intersect with” the defined elements of healthcare in the commissioner’s remit, in relation to

“services provided ... in connection with ... illness, and ... forensic medical examinations”.

Amendment 33 is in line with the committee’s recommendations in its stage 1 report, and I encourage the minister to support it.

I move amendment 33.