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Dr Hughes said that “Multiple paths already exist” in the healthcare system. Earlier, you cited the police as an example. Dr Hughes also said:

“It is partly about understanding the powers that others have, but it is also for others to understand the powers that exist in the system and to work collaboratively”—[Official Report, Health, Social Care and Sport Committee, 21 February 2023; c 36.]

to achieve the common goal.

Bearing in mind that the reporting line is to Parliament rather than to ministers, is there provision in the bill for there to be an assessment period after a certain time to see how the PSC works with other organisations and, if necessary, to define further through secondary legislation those interactions and interfaces? Is that something that the committee could consider in its report?

I want to pick up on the point about resourcing. Budget and head count are one thing, but understanding the competences that you need in the team is critical. There is a huge risk of data inundation and having to make sense of large volumes of information. Have you given much thought to how you can build a process that is resilient enough to draw meaningful conclusions from what is being fed into your office and how you process that? We have a major concern about how that can be managed by what is, initially, such a small team.

That is helpful. It is a help to know about the line to the select committee, which is something that we can reflect on.

I am thinking about the need for a combination of powers and the capacity to gather meaningful insights. Let us take, for example, the transvaginal mesh scandal, where the patient voice was ignored and not heard by the data collecting mechanisms in the Scottish national system, which meant that patients found themselves at a loss to express their concerns beyond petitioning Parliament—it was only then that an inquiry was pursued. Do you see the need to advise change in the way in which data is collected and managed? If you were hearing qualitative insights from patients, but you did not have the quantitative information to verify whether there was a wider national issue, would you be able to recommend that such information would have to start being collected at a certain point in the patient journey in order for us to understand over time whether there was a wider concern? Would you consider such a mechanism necessary?

The Department of Health and Social Care in England has put forward the argument that being appointed by Government would give the commissioner a powerful role in the system and that

“A commissioner which is entirely removed from the policy department can be more easily overlooked by government.”

Do you agree? Do you think that that is a potential risk?

Thank you, both, for attending. What you have said so far is interesting. You said earlier that you would publish best practice, for example, against which health authorities could benchmark and perhaps implement recommendations. Do you feel that there should be some sort of mechanism for escalation, if there is something so egregious, or some area of injustice, that you feel needs to be urgently addressed, which cannot merely be left to collegiate discussion or recommendation?

It would not necessarily be you issuing an enforcement order, as the Health and Safety Executive does, for example. Perhaps, in your case, it might be a recommendation to the minister that they should use a statutory instrument to implement changes, or, in the case of the proposed commissioner, it might be a recommendation to Parliament to do that. While bearing in mind that there is a need to foster openness and inclusivity to avoid people shutting down and feeling as though they will be attacked if they dare to raise issues openly, do you feel that a potential mechanism for escalation is important? Do you feel that there is a balance to be struck in terms of escalation?

As a former member of the Citizen Participation and Public Petitions Committee, I recall sitting in the session on 8 June 2022 with Gordon Baird and others in which we took evidence on four petitions covering rural healthcare. It quickly developed into a much more effective and quality discussion. It did not just home in on the idea of an agency but took in the broader issue of the agency of patients to advocate for themselves and for clinicians to advocate on their behalf. In particular, it focused on the power imbalance between health boards and other stakeholders in the system.

In that respect, the petition remains relevant, so there is scope for the committee to consider how we take those legitimate and sincere concerns forward. Although it is inevitable that inequalities will exist by virtue of geography in any healthcare system, because you cannot have a fully functioning neurosurgical department in a town of 100 people, we nonetheless need to look at ways in which we can mitigate those issues effectively.

Where changes to service provision are occurring, are we effectively ensuring that ambulance provision, travel allowances and protocols are in place to reduce the risks of, for example, going into labour in a way that means that someone is dangerously far from a maternity department? We should be cognisant of all those issues, which I do not think are necessarily being fed back into the healthcare decision-making system through health boards. Perhaps that is where this committee would have a locus in helping to further the petitioners’ concerns. That would be my suggestion.

Thank you.

My view is that we are not bound to the petitioners’ specific ask, and an inquiry would give us a useful basis on which to roll the issues forward. We can still retreat from that. In my view, it is not a binary thing, in that we have to agree whether there should be an agency or not. We can certainly take on board—

It is proposed that the patient safety commissioner for Scotland will be a parliamentary commissioner—in other words, they will be appointed by the Scottish Parliament, not by the Scottish Government. Is it preferable that the proposed line of accountability is to Parliament rather than to Government or the national health service as an institution?

I will bring in the front-line representatives on that, starting with Mr McClelland.