In context: Patient Safety Commissioner for Scotland Bill

The Scottish Parliament has given unanimous backing to a Patient Safety Commissioner for Scotland Bill in a move designed to improve healthcare and prevent scandals.

What’s the bill about?

The bill was introduced by First Minister Humza Yousaf in his former role as health secretary with the explicit aim of creating a commissioner to oversee patient safety in Scotland’s hospitals.

It came after NHS Scotland became embroiled in a series of health-related scandals, including how the case of Tayside brain surgeon Sam Eljamel, who harmed dozens of patients but was allowed to continue operating until he was suspended in late 2013, was handled.

The role of the commissioner will be to “advocate for systemic improvement in the safety of health care, including forensic medical examinations, in Scotland and promote the importance of the views of patients and other members of the public in relation to the safety of health care”.

The commissioner will be responsible for conducting formal investigations into possible safety issues and “gathering, analysing and reporting on information from patients and members of the public about safety concerns”. In order to ensure the investigations are fully informed, the commissioner will have the authority to require people to provide information.

No MSPs voted against the bill – is everyone in Holyrood happy with it?

No. Scottish Labour had tabled a series of amendments to the bill, which they dubbed Milly’s Law, that would have imposed additional duties on the commissioner.

Named for Milly Main, a 10-year-old girl who died in 2017 after contracting an infection at the Queen Elizabeth University Hospital in Glasgow, the amendments included requiring the commissioner to advocate for those affected by major incidents in relation to the safety of health care and placing a duty on the commissioner to provide information for whistleblowers on how to disclose information relating to such incidents.

The Scottish Government had already rejected the amendments at an earlier reading of the bill, but Labour tabled them again. They were voted down by the SNP and the Greens. Labour health spokeswoman Jackie Baillie called the move a “a betrayal of the very people that this bill was supposed to give voice to”.

“Amendments Scottish Labour brought forward presented an opportunity to reset the balance between patients, whistleblowers, families and powerful public bodies,” she said. “These amendments could have ensured that bereaved families were very much at the heart of the response to disasters and public scandals within the bill.”

What have other parties had to say about it?

SNP public health minister Jenni Minto said the party had voted down Milly’s Law because it felt it would “tie the commissioner’s hands”.

“I’ve considered very carefully how best to achieve this and my view remains that it is more effective to allow the commissioner to be guided by patients on the issues they look into and the actions they take,” she said.

“I do not wish to inadvertently tie the commissioner’s hands in respect of the sort of circumstances they can look into and I worry this group of amendments, by adding very specific steps for the commissioner to take in relation to a certain group of incidents, would unintentionally undermine the commissioner’s vital ability to set their own agenda and to look into the issues of most concern to patients.”

Scottish Conservative public health spokeswoman Tess White welcomed the bill, noting that a commissioner is required due to the Scottish Government’s handling of the NHS. “At a time when the NHS is in crisis under this SNP-Green government and capacity is at breaking point, an independent patient safety advocate is particularly welcome,” she said.

Hasn’t there been some grumbling about the number of commissioners in Scotland?

Yes. SNP MSP Kenny Gibson, who is convener of the Holyrood finance committee, said the creation of the patient safety commissioner would add to the £16.6m already spent on seven existing commissioners. They variously cover ethical standards in public life, biometrics, children and young people, and human rights. There is also an information commissioner, a public services ombudsman and the Standards Commission for Scotland.

In addition to patient safety, proposals are being considered to introduce commissioners covering victims, older people, wellbeing and sustainable development. That plan is to double the total number from seven to 14. Gibson said the government “will have to grasp the nettle” and assess whether commissioners give value.

SNP colleague Fergus Ewing went further, suggesting that government commissioners are like the last tsars of Russia and should be purged. In a meeting of the parliament’s Citizen Participation and Public Petitions Committee Ewing, who is challenging a one-week suspension from the party for rebelling on a number of votes, asked whether “we get value for money from our tsars”. “Are they really relevant to our citizens?,” he asked.

Tory MSP Jackson Carlaw said doubling the number of commissioners would “create by stealth a new level of government in Scotland”.