Publication - Consultation paper

Patient Safety Commissioner role for Scotland: consultation

Published: 5 Mar 2021

This paper seeks views on what the Patient Safety Commissioner role should look like; who it should report to; and how the role should interact with existing legislation and policies, as well as with the various organisations involved in providing and improving health and care services in Scotland.

Patient Safety Commissioner role for Scotland: consultation
Chapter 4: Functions of the Patient Safety Commissioner

Chapter 4: Functions of the Patient Safety Commissioner

What has come across clearly, both from 'First Do No Harm' and the Patient Reference Group, is that patients need to be treated with dignity and respect, they need to be listened to, and their voices need to be stronger so that they can influence changes to the healthcare system.  However, what is less clear is how we can achieve this.  

Table 1 describes some of the policies, processes, organisations and areas of legislation that aim to support patients to be heard, and yet discussions with the Patient Reference Group have made it clear that there are gaps in this framework.  It is vital that the Patient Safety Commissioner role adds benefit for patients, rather than duplicating what already exists.

Table 1: Supporting patients' voices in the healthcare system in Scotland
Name or title Description
Patient Rights (Scotland) Act 2011 (see [2] below) The act aims to improve your experience of using health services and to support you to become more involved in your health and healthcare.

It gives you the right to know that the healthcare you receive will consider your needs and what would most benefit your health and wellbeing. It also encourages you to take part in decisions about your health and wellbeing, and gives you the information and support you need to do so.  It sets out that NHS bodies should encourage patients to give feedback or comments, or raise concerns or complaints, on healthcare.
Charter of Patient Rights and Responsibilities Under the Patient Rights (Scotland) Act 2011, Scottish Ministers have published a Charter of Patient Rights and Responsibilities, which summarises the duties of relevant NHS bodies and the behaviour expected from people using services.

The charter states that everyone's needs, preferences, culture, beliefs, values and level of understanding will be taken into account and respected when they use NHS services. You have the right to ask those providing your care whether the care they suggest is right for you and if they can suggest any alternatives.

The charter also states that you have the right to be given all the information you need about your medicines, any possible side effects, and other options which may be available, in a way you can understand.

Also, it states that you have the right to be involved in decisions about your care and treatment, and be able to take an active part in discussions and decisions about your health and treatment.
NHS complaints process As set out in the Patient Rights (Scotland) Act 2011, you have a right to give feedback on, or to make a complaint about, the care you have received from the NHS, and your NHS Board should encourage you to do so.

You should make your complaint to the person or organisation that you are complaining about (for example, if it is a complaint about a GP, make your complaint to the surgery).  If you do not want to make a direct complaint, or your complaint has not been sorted out, you should contact your local Health Board or Special Health Board.
Scottish Public Services Ombudsman (SPSO) The SPSO is the final stage for complaints about most devolved public services, including the NHS.

If you are unhappy with the Health Board's final decision about your complaint (see above), you can ask the SPSO to review it. The SPSO can look at  what your complaint is about and the decisions medical professionals made. They can make recommendations on how individuals' complaints can be resolved and on how systems can be improved.

The SPSO is also the complaints standards authority.  They have a duty to monitor, share best practice on complaints handling, and set up complaints procedures for organisations, including the NHS, and they must follow these procedures by law.  In this role, the SPSO provides support and training for those handling complaints.

The SPSO's services are free and independent, and their powers and duties come mainly from the Scottish Public Services Ombudsman Act 2002. The SPSO is a Scottish Parliamentary Supported Body, with the same level of independence as the commissioners mentioned in chapter 3. 
Patient Advice and Support Service (PASS) For help and advice with complaints, you can contact your local PASS. PASS was set up by the Patient Rights (Scotland) Act 2011 to provide advice and support services to patients and other members of the public in relation to the health service.   PASS
  • promotes an awareness and understanding of patients' rights and responsibilities (and in particular, promotes awareness of the Charter of Patient Rights and Responsibilities); 
  • advises and supports people who want to give feedback or comments or raise concerns or complaints about healthcare;
  • provides information and advice on matters it considers people using the health service would be interested in; and
  • makes people aware of and, if appropriate, directs them to:
    • other sources of advice and support; and
    • those who can represent them (for example, advocates).
Care Opinion The Care Opinion website allows you to share your experience of health or care services online, and is another way of providing feedback on services provided by the NHS.

Care Opinion is a non-profit community-interest company.  They read the stories they receive and, where appropriate, publish them on their website.  They also try to email relevant staff in the services a copy of the story (if these services are signed up to Care Opinion).  Often staff will reply to the stories on the website.
Regulatory bodies You can complain to the relevant healthcare professional bodies (see [3] below) (for instance, the General Medical Council, General Pharmaceutical Council and Nursing and Midwifery Council) if you have serious concerns about a health or care worker's fitness to practise.

These bodies hold the lists of healthcare professionals who are licensed to practise in the UK.
Organisational Duty of Candour Procedure The organisational Duty of Candour legislation (see [4] below) sets out the procedure that organisations providing health services, care services and social work services in Scotland must follow by law when there has been an unintended or unexpected incident that results in death or harm (or further treatment is needed to prevent injury that would result in death or harm).

The purpose of the legislation is to make sure that organisations tell those affected that an unintended or unexpected incident has happened, apologise, involve them in meetings about the incident, review what happened so they can find areas that could be improved, and learn from the incident (taking account of the views of relevant people).
Medicines and Healthcare products Regulatory Agency (MHRA) Yellow Card Scheme Through the Yellow Card Scheme, patients and members of the public can report a suspected problem with a medicine or medical device to the MHRA.

The MHRA regulate medicines, medical devices and blood components for transfusion in the UK.

As you can see from table 1, many people and organisations are already trying to support patients' voices in the healthcare system in Scotland.  The Patient Reference Group has discussed the need for better communication between the various parts of the healthcare system, both in Scotland and more widely across the UK (including regulatory bodies), as well as with other bodies with an interest in providing safe healthcare (for example, charities and the voluntary sector, such as Patients Associations).  The Patient Reference Group suggested that the Patient Safety Commissioner may have a role in looking at this. 

Further discussions on the role of a Patient Safety Commissioner have focused on how this will be carried out ─ for instance, whether the commissioner would deal with patients and members of the public case by case, or work with existing bodies and healthcare services to see which issues they need to look at.

We also need to consider how the Patient Safety Commissioner role will add to, rather than duplicate, what is already in place, and how they would make sure that they are truly representing the views of patients.

The Patient Reference Group has also discussed the importance of the professional background of the person appointed as Patient Safety Commissioner.  Some members felt they should have a legal background, others a clinical background, and some suggested it shouldn't matter, as long as the person had a good knowledge and understanding of the issues they were dealing with and was approachable and genuinely interested in improving the safety of the health service.  The group did think it was important that the person appointed must have the power to influence real change (which we discuss further in chapter 5).

As we noted in chapter 2, it is unlikely that the Patient Safety Commissioner would be working alone. Instead, they would be part of a larger body or would have a support network, made up of people from a range of professional backgrounds.

Question 6: How much do you know about existing policies and organisations already in place (listed in table 1 on page 11) to support patients' voices to be heard within the healthcare system? 

Very aware (I have heard of all of them)

Quite aware (I have heard of most of them)

Not very aware (I have heard of a few of them)

Not aware at all (I have not heard of any of them)

Please give reasons for your response in the box below. Please be as specific as you can, and include any resources or references to evidence on this topic that we should consider.

Question 7: In your view, despite the existing ways patients can make their voices heard (listed in table 1 on page 11), why do you think people still feel that this is not happening?

Please give your response in the box below. Please be as specific as you can, and include any resources or references to evidence on this topic that we should consider.

Question 8: In your view, what should the main functions of the Patient Safety Commissioner be? 

Please give your response in the box below. Please be as specific as you can, and include any resources or references to evidence on this topic that we should consider.

Question 9: What skills and expertise do you think the Patient Safety Commissioner needs to carry out their role?

Please give your response in the box below. Please be as specific as you can, and include any resources or references to evidence on this topic that we should consider.

Question 10: What support do you think the Patient Safety Commissioner would need?

Please give your response in the box below. Please be as specific as you can, and include any resources or references to evidence on this topic that we should consider.


Contact

Email: ConsultationPSC@gov.scot