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Those were really important points about anticipating problems. Service design is done in the context of resource constraints. There is a finite resource that cannot neatly match increasing demand. Inevitably, decisions that are made will have safety implications. A recent example is that the Glasgow health and social care partnership has advised that, under the current settlement for local government, it will not be able to meet its statutory requirement for service delivery in Glasgow. There is clearly a patient safety consideration there.

Is there scope for the commissioner to have a role in assessing decisions within different public bodies about the potential impact on patient safety, and perhaps making a recommendation to Parliament on what the commissioner thinks is the optimum balance or solution in that context? It is not necessarily a patient referring an issue that they are reacting to; rather, it is anticipating the allocation of constrained resources in a difficult environment, such as the one that we are looking at now, in the budgets, and considering the impact of such decisions. The impact, for example, on discharges from mental health estates into more appropriate settings, is that patients might have to stay in hospital as opposed to being discharged.

My main question is about the accountability of the commissioner. Mr Wright made a powerful point earlier about the role of the Executive in denying recourse or appropriate investigation. The bill proposes that the commissioner be independent of the Scottish Government—the Executive branch—and of the national health service and instead be accountable to this Parliament, as a democratic body. Do you agree with that proposal and, if so, why? Considering your comments, Mr Wright, I will direct that question to you in the first instance.

How can the bill be strengthened in terms of holding bodies accountable in terms of the commissioner’s recommendations? Are there specific measures that you would like to be introduced, such as the ability for the commissioner to levy fines on health boards? Are there any powers that we could implement? What could the Parliament do to hold public bodies to account in addition to backing up the commissioner’s recommendations?

I thank the witnesses for their comments so far. I will pick up what Dr Chopra and Mr Watson have said about the issues around inclusivity. The commissioner’s remit is vast and they will have quite a narrow resource. There is a tendency for the sharpest elbows and well-resourced campaigns to get the attention. How do we ensure that there are protocols and mechanisms in place to ensure that the process remains inclusive? For example, last week, we heard about some medical devices impacting disproportionately on women, who are often ignored and dismissed by the medical profession. How do we ensure that those things are adequately addressed by the commissioner?

Has the Government undertaken any analysis of the extent to which profit is extracted from the care system? Obviously, it is important to undertake expenditure to ensure that care is provided, but there might well be instances in which profits are being generated as a result. Does the Government maintain oversight of the profit that is being generated to ensure that it is not excessive?

Thank you for your comments so far. It is clear to me from reading the background to your report and the report itself that there are gendered aspects to complaints, in particular, and that harmful side effects seem disproportionately to affect women. How can specialised gendered consideration of complaints be not overlooked, given the otherwise vast remit that the commissioner will no doubt be undertaking and the volume of complaints that will be received?

Thank you for your comments so far about the budget and resource constraints.

During consultation on the bill, there have been suggestions that those constraints would leave the proposed patient safety commissioner unable in practice to dedicate resources to any kind of investigatory work, except in exceptional circumstances. Do you share that concern, given the current budget of around £644,000 per annum? Is there a danger that having a commissioner could end up becoming a public relations exercise, rather than a substantive mechanism for delivering justice, or good outcomes, for patients?

Is there an opportunity to build collaboration with adjacent organisations, perhaps by working more deeply with Parliament committees to extend the resource and practice that is available? Do you see that as an opportunity, rather than having the commissioner sitting in a separate silo within bureaucracy?

Thank you for your comments so far. I am curious about the information from the Scottish Public Services Ombudsman that shows that about 64 per cent of the complaints and inquiries that it received related to clinical treatment and diagnosis and that approximately 60 per cent of those complaints were upheld.

I note that the patient safety commissioner is not responsible for dealing with those individual cases, but does Baroness Cumberlege believe that there is an argument that the PSC should focus heavily on specific areas of healthcare and patient safety such as clinical treatment?

The 278 compensation payments that NHS Scotland made in the past year represented £60 million of expenditure. Surely, if we can get to the root cause of why so many complaints are being made regarding clinical treatment and diagnosis, we will be in a better position in the longer term not just to improve the patient journey, but to achieve great cost avoidance as well.

Minister, given that this is an annual manual exercise, have you given any consideration to whether a formula could be introduced that would make it more of an automatic stabiliser and would mean an immediate increase?

Sorry, convener. Thank you for the welcome to the committee. I have two relevant interests to declare: I am a member of the GMB and Unite the union.