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We will provide progress updates as those events take place. After each event, we will provide an update on what we think we have learned. I guess that, in co-design, there is a process of agreeing what everybody has learned, so we will absolutely be providing some detail on that as we go.

I understand the concern about the lack of scrutiny of secondary powers, and I am mindful that the process that is laid out is a minimum standard. I am comfortable with making sure that we engage on the secondary powers as well and that there is a process of assuring that everybody understands what is required.

I get your analogy about buying a car, but it is not quite the same. We are designing and building the car; we are not going out to a showroom and buying one. That is kind of the point.

There has to be a process of checking in with stakeholders at regular points throughout the process to make sure that everybody is comfortable with the direction of travel. With the pause, we have demonstrated that we are willing to do that. In fact, we are keen to do it, because we want the change to work. We see the change as absolutely vital for Scotland. The only way in which we will manage to deliver it is by working closely with all the stakeholders and partners to deliver it together.

The Scottish Government is committed to ensuring that there is appropriate staffing in the national health service and care services to enable the provision of safe and high-quality services and the best outcomes for the people who use them. In 2019, the Parliament passed the Health and Care (Staffing) (Scotland) Bill to provide a statutory basis for the provision of appropriate staffing in both the NHS and care services. That enables a rigorous, evidence-based approach to decision making relating to staffing requirements and supports an open and honest culture that engages staff in those processes. Among other things, the 2019 act inserts new provisions relating to staffing into the National Health Service (Scotland) Act 1978 and the Public Services Reform (Scotland) Act 2010.

Implementation of the 2019 act was paused to redeploy personnel and resources to the Covid-19 pandemic response. A new implementation team was convened last year, and the Cabinet Secretary for Health and Social Care announced in June 2022 that all the act’s provisions would come into force by April 2024.

The 2019 act was reviewed as part of the implementation work, and six technical errors were identified. During the bill’s passage through Parliament, numerous amendments were made at stages 2 and 3. On some occasions, to ensure that amendments were properly reflected throughout the bill, cross-references to other provisions in the bill required to be inserted or amended. That was completed in the majority of cases, but in six instances those updates were not made, and the act contains errors. They now require correction to ensure that amendments that Parliament made to the bill are properly integrated. That will ensure that the act can be given full effect and the Scottish Parliament’s intention delivered. The draft regulations that are before the committee make ancillary provision under section 14 of the 2019 act in order to achieve that.

The first amendment will ensure that the obligation on health boards and the Common Services Agency for the Scottish health service—commonly known as NHS National Services Scotland—to raise awareness among staff about procedures for notifying any risks that they identify relating to staffing levels under new section 12IC of the 1978 act will extend to all relevant aspects of that notification procedure.

The second amendment will ensure that the obligation on health boards and NHS National Services Scotland to raise awareness among staff about the procedures that are put in place for the escalation of risks under new section 12ID of the 1978 act will extend to all relevant aspects of those escalation procedures.

The third amendment will ensure that each health board and NHS National Services Scotland must, under new section 12IL of the 1978 act, provide employees with information about how it has identified and taken all reasonable steps to mitigate risks as part of the common staffing method.

The fourth amendment will ensure that the Scottish Ambulance Service board will, under new section 12IM of the 1978 act, be under a duty to report to the Scottish ministers annually on how it has carried out its duties under new sections 12IE, 12IF, 12IH and 12II of the 1978 act. Those are the duties to have arrangements to address severe and recurrent risks, to seek clinical advice on staffing and to ensure that adequate time is given to clinical leaders, and duties relating to the training of staff.

The fifth amendment will ensure that the Scottish Ambulance Service board will have regard to guidance that is issued by the Scottish ministers, under new section 12IN of the 1978 act, about the carrying out of its duties under new sections 12IE, 12IF, 12IH and 12II of the 1978 act.

The two amendments that relate to the Scottish Ambulance Service board will largely bring it into line with other health boards and special health boards that deliver direct patient care in terms of its obligations relating to staffing.

The final amendment relates to the review and redevelopment of existing staffing methods by Social Care and Social Work Improvement Scotland—better known as the Care Inspectorate—under new section 82C of the Public Services Reform (Scotland) Act 2010. The amendment will ensure that the Care Inspectorate may, in a revised staffing method, require persons who provide care services to put and keep in place appropriate risk management procedures, in the same way that it could when developing a new staffing method under section 82A.

Stakeholders including representatives from health boards, relevant special health boards, NHS National Services Scotland, local authorities, integration authorities, Healthcare Improvement Scotland, the Care Inspectorate, professional bodies, trade unions and professional regulatory bodies have all been invited to participate in working groups to prepare the statutory guidance to accompany the 2019 act. As part of that process, the proposed changes that are detailed in the draft regulations were circulated for comment, and no objections were raised.

I fully support the draft regulations as the means of correcting technical errors in the 2019 act. They will ensure that the act can be given full effect and that the Scottish Parliament’s intentions can be delivered. I am happy to answer any questions that members have.

We are certainly working to that timescale. It is worth understanding that the working groups on implementation have been working according to the will of Parliament, so it expects the technical amendments to be made.

In response to Emma Harper’s point, I note that some of the amendments are intended to empower staff to ensure that they know the process for identifying risks and who they should report them to. They are simply technical amendments that will ensure that cross-referencing within the act is accurate and that it contains the will and intention of Parliament.

Motion moved,

That the Health, Social Care and Sport Committee recommends that the Health and Care (Staffing) (Scotland) Act 2019 Amendment Regulations 2023 [draft] be approved.—[Maree Todd]

Motion agreed to.

I am open to proposals on that issue, and as the role beds in, it might be an area that evolves, if it becomes a challenge for the patient safety commissioner to ensure that organisations take account of what the commissioner is saying, report accurately and take achievable actions. Therefore, I am open to the idea that more might be required. As introduced, the bill allows for dialogue on the best way forward. There is potential for collegiate working, which is generally the best way to enable such openness and learning. However, I understand that there is concern.

I genuinely believe that a patient safety commissioner would add something to the landscape. There are lots of people and organisations that are able to take action—including punitive action—and to hold organisations to account, but I think that the patient safety commissioner offers something different. The big tragedies when patients’ voices were not listened to, their stories were not heard and action was not taken soon enough are an example of the kind of systemic issues that I am absolutely certain that the patient safety commissioner will be able to pick up on.

I am open to that. The Patient Safety Commissioner for England is right: we should start small and be agile with the role. It is a brand-new role and we need to think carefully about how it evolves.

I think that we have gone for about the same size of budget in Scotland as the UK Government did for the role in England, and there will be similar numbers working in the team, yet there are 10 times as many people living in England. That reflects our slightly broader remit.

I am certain that we are adequately resourcing the role as it starts out. As we have all said, the role is likely to evolve and we might need to look at that in the future. However, I am certain that we are starting out in the right place.

That is certainly possible. I am somebody who loves data. Data does not lie, so if you can get your analysis correct, it will tell you a lot about what is going on.

I am not closed to the idea that there may need to be a role for somebody with data analysis expertise. However, in my view, we already have the best data analysts in Scotland in Healthcare Improvement Scotland, and we need to take care not to replicate roles. We need to understand how the organisations that might already be looking into issues are able to gather and analyse data and come up with understanding and insights into how situations evolve. I am not sure that we need another organisation with that capacity checking the numbers from those organisations.

As I said, however, I am not totally closed to the idea. The role will evolve as time goes on, and there is hardly a role in any part of Government—or in public life, because this role will be independent from Government—that would not benefit from a bit of data analysis.

However, the mesh scandal has changed the way that medical devices are monitored and information is gathered about them, so there are much tighter and better systems in place. On medication, the yellow card system will pick up signals, but there was not the same level of robustness in picking up on issues related to medical devices.

I am the minister for women’s health, and there a reason why that post exists. Women face health inequalities because of our inequality in power, status and wealth. Many of the issues that we are talking about are because women are not listened to when we come forward with concerns. We absolutely need to recognise that that is the case and make sure that the system is picking up on that. A great deal of work has been put in to improve the post-surveillance of devices once they have been implanted.

You touched on something in your line of questioning that troubles me about how the system currently listens to people raising concerns, who we find easy to ignore and dismiss and who we pay attention to. The patient safety commissioner role will undoubtedly be key to making that more equitable.

When we asked that question, the answer that came loud and clear from people who had been affected by safety issues was that they wanted the role to be independent, and that a different organisation that was either part of the NHS or part of Government would not cut it. What would cut it is someone who is there primarily for them and is accountable to the people of Scotland. I can absolutely understand that. I can see the pros and cons of all sides, but I agree about the importance of independence from the Government and from the NHS itself. As ���˿���, we will all have mailboxes full of people saying, “They’re marking their own homework,” and who do not have trust in the system.

It is important that people who come to the patient safety commissioner can trust and have confidence in the process. That independence from both the Government and the NHS will help that.

We think so. We think that the budget is appropriate for the commissioner’s proposed remit. The commissioner will be an advocate for patient safety and the patient voice, and that role will be underpinned by formal information-gathering powers. We are not intending them to be a new regulator or to have a primarily investigative role. We would say that, largely, other organisations will do the investigations and the patient safety commissioner will work collaboratively with them. We developed the costs that are set out in the financial memorandum on that basis.

As Parliament scrutinises the commissioner’s work, it will take decisions on whether the remit of the role and its accompanying funding need to change.

It is absolutely fundamental. The idea is that Parliament will scrutinise the reports that the commissioner produces. Such reports will, of course, be of interest to the Government and there will be action points for us to take note of, but the intention is that Parliament will scrutinise the information that the commissioner produces. That is much the same in relation to the children’s commissioner; when I worked as the Minister for Children and Young People, the children’s commissioner was very clear about his role: he was appointed by Parliament and he was accountable to Parliament. The patient safety commissioner will be independent from the Government—that is what patients are asking for.