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Our commissioner will have a slightly broader role. It is a new role and the commissioner will learn in the job. However, the point of the role is to listen to patients, hear what they are saying and ensure that the healthcare system is able to pick up and act on safety concerns that have been raised by patients because we know that that has not happened in the past or has not happened fast enough.

It should be perfectly possible for staff to raise concerns and for the patient safety commissioner to listen to those concerns. I expect the patient safety commissioner to be an ear in the system and listening to staff would be an important part of that.

We need to make clear that staff can raise their concerns. We are at stage 1 of the legislation and I am open to ideas about how we can make sure that that is clear. Essentially, however, the commissioner should be a listening ear. It would seem odd to me if they were not listening to staff.

We need to be careful that we do not duplicate existing powers. Regulators can take action against individual professionals, there are the police and there is the potential to take action in various ways, so we need to ensure that we are not duplicating effort. The fundamental role of the patient safety commissioner is to ensure that the voices of patients are heard and that that open learning culture is fostered so that the system learns and prevents further harm, rather than these things going on for far too long and harm continuing while those issues unfold.

Yes. There are people with that type of expertise who do a lot of independent consultancy work, so an individual role may not be needed. It may simply be that expertise is needed in one situation, and there might be capacity to think about using individuals with specific expertise as the role develops.

The commissioner’s role came from the Cumberlege report. It was not the Government that came up with it, and it was not the Parliament that suggested it, as has happened with many other commissioners. There were really solid reasons to bring forward the commissioner’s role.

There probably is a need to look at the commissioners as a whole strategically. There is always room to look at where the whole Government’s focus is and what resources are going where—that often happens around budget time—as opposed to the individual commissioner whom we are discussing.

It seems reasonable to me. We do not want the patient safety commissioner to be picking up noise from the system and dismissing it as something anecdotal rather than an evidence-based concern. Sometimes having the data is the only way of dispelling concerns about whether what you are picking up is genuine or just some incorrect signal.

There will have to be a robust capacity for data analysis, but I am not going to write the job descriptions for the various job roles in the team now. I should say, though, that there is a lot of data analysis expertise already in the system, and that will have to complement the work that is being done, but I get what was said last week about being able to crunch the data and develop fresh insights.

I hope so. There are pockets of brilliant practice all over Scotland in many areas. One of our challenges is making sure that that practice is the same all over Scotland and making sure that the same quality and safety focus happens everywhere. That would be a good outcome, but I do not see it as being a primary one, because, remember, this role is absolutely focused on the voice of the patient. Where the commissioner finds good practice, that might be one way of improving the situation if they found a safety concern in one part of the country.

That actually illustrates just why it is a valuable thing to develop the role of a patient safety commissioner. It is a complex landscape with lots of people working in the area. I have personal experience of working with the Scottish patient safety programme when I was a clinician. That has a very different role to the ombudsman, but patients do not necessarily understand that complex landscape.

The role of the commissioner will be to help patients to navigate that complex landscape and make sure that their story is heard by the right people who can act on it. There have been enough incidents where that has not happened to need to recognise that. Patient safety is of vital importance: first do no harm.

Patient safety is absolutely crucial, so it is understandable that there are quite so many systems designed to ensure that care is delivered in a safe way, and to investigate when things go wrong. That is perfectly reasonable, but patients find it quite bewildering and disempowering. That is the bit that we want to make sure is not the case going forward. I and all of you on the committee will have heard stories directly from patients who have been harmed by the system and we want to make sure that that does not happen again.

We want to learn the lessons each time. Therefore, the role of the patient safety commissioner is very much unlike that of the GMC and other professional regulators, who will sometimes take action. The focus of the patient safety commissioner will be different. That role will be very much about establishing what happened and trying to help the system to learn from that, rather than punishing or taking action against individuals within the system.

The main focus of the patient safety commissioner will need to be patient safety. I think that what you are describing is perhaps systems lacking patient-centredness. I am very passionate that our NHS should be person centred. Sometimes, however, we find that people are having to travel long distances, past other services that they could use. That does not make sense to them, but it does not necessarily introduce a safety risk. Our patient safety commissioner will have to be very focused on safety. It is fundamental to the role.

There are perhaps other ways that we can ensure that there is patient-centredness in the system. All the work that happened on realistic medicine, which is essentially about getting high-quality person-centred care in the right place at the right time, with the patient being a sharer of decision making in their care, is absolutely what we are striving to deliver in our NHS.

That is certainly something that the committee can consider. It is a really complex landscape, which is almost impossible for patients to understand—it is quite hard even for health professionals and those who work in the system to understand it. There is an issue around making all the slightly different organisations that have a keen interest in safety work together to get the best possible outcome. We are always open to the idea of going back to look at whether we have achieved our aim and whether legislation is working as intended and delivering the best possible results. There is always the opportunity to look again at that.