Patient Safety Commissioner: consultation analysis

Analysis of responses to our consultation on creating a Patient Safety Commissioner role for Scotland, which ran from 5 March to 28 May 2021. The consultation sought the views of the public and other interested parties of what the role should be.

Chapter 5: Responses on functions of the Patient Safety Commissioner

There were 5 questions in the consultation document which related to the functions and set-up of the PSC in Scotland.

Question 6: How much do you know about existing policies and organisations already in place to support patients' voices to be heard within the healthcare system?

This was a closed question which offered specific response options. A list had been provided within the consultation document setting out some of the policies, processes and pieces of legislation that are already in place. The narrative highlighted the fact that it will be important that the PSC does not duplicate what already exists. The list of policies etc is reproduced at Annex C for reference.

The table below sets out the levels of awareness of these and the responses to question 7 below expands on the challenges associated with these existing policies and processes.

Answer Organisations Individuals Total
Not aware at all (I have not heard of any of them) 2 3 5
Not very aware (I have heard of a few of them) 3 14 17
Quite aware (I have heard of most of them) 10 22 32
Very aware (I have heard of all of them) 12 10 22
Not answered 19 1 20
Total 46 50 96

Question 7: In your view, despite the existing ways patients can make their voices heard, why do think people still feel that this is not happening?

55 respondents answered this question (8 organisations and 47 individuals). This was an open question inviting free text responses.

Some of the issues raised were around accessibility or otherwise of the existing systems; the complexity and/or time consuming nature of many of the processes (including issues around difficulties for people with certain conditions which make these processes more inaccessible, or tiring; difficulties for those wrestling with health issues or grief; general difficulties around literacy and health literacy; language barriers; digital exclusion; and finding the processes daunting).

"A lot of them rely on patients taking ownership and being proactive in feeding into a system. A Patient Safety Commissioner's role should be to act on patients' behalf".

There was also limited awareness or promotion of the options for feeding back and a concern that you might be complaining about the person handling the complaint.

Some respondents felt that they had been dismissed or not believed when they had tried to raise issues. Others expressed lack of trust or confidence in current systems and processes (including concerns that many of these processes are not independent, so not on the side of the patient, or a feeling that there is no point as past complaints have made no impact; concern about professionals closing ranks, lying or covering things up).

Other issues highlighted by respondents were that agencies are not joined up, so patients often have to give the same feedback/complaints to numerous people/agencies. Trends in complaints and feedback are not picked up so systemic issues are not considered - only individual instances of patient concern.

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

51 respondents answered this question (6 organisations and 45 individuals). This was an open question inviting free text responses.

Those individuals who responded were clear that the PSC should provide a clear route for patients to express concerns and should listen to and act upon the patients' voice as well as ensuring learning and change happens as an outcome of patients raising concerns. There was also an emphasis on the PSC acting quickly as some of the existing processes are seen as taking a long time.

Investigating or intervening in the care and treatment of patients (including holding organisations to account, scrutiny, reporting and monitoring) was also seen as important.

As well as the above, the responses from organisations were generally of the view that the PSC should be proactive as well as reactive and should investigate patterns and trends of concern. Some responses from NHS bodies suggested that the PSC should work with Boards to improve patient safety and to provide a national platform for learning.

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

78 respondents answered this question (32 organisations and 46 individuals). This was an open question inviting free text responses.

There was not a great deal of difference between the responses from individuals and those from organisations, nor amongst organisations between NHS bodies and others. Some of the skills highlighted were compassion, caring, empathy, lived experience, political acumen; knowledge of the NHS, self-confidence, ability to lead and work with others, advocacy expertise.

One respondent was concerned about the suggestion that the PSC could come from a legal background but others were supportive of a legal or clinical background.

There were also some responses from individuals who were of the view that the PSC should not come from a clinical background.

A number of responses highlighted the fact that no one individual could meet all the requirements and so it would be necessary for the PSC to be supported by a wider network of experts. This was dealt with further in the following question.

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

70 respondents answered this question (28 organisations and 42 individuals). This was an open question inviting free text responses.

As would be expected there was an extensive list given by respondents of the support the PSC would need. From the responses it was clear that some people envisaged the PSC as being an individual and others envisaged the PSC as being an organisation, either centralised or dispersed across Scotland with representation in different Boards or localities.

Either way, respondents were clear on the need for an office system to support the role as well as different kinds of expertise. The list included analytical, communications, IT, professional, clinical, legal, safety, ethics, equalities and human rights experts. Alongside these the PSC will need support and input from other organisations and individuals, particularly patients, as well as sufficient financial resources to ensure that they are able to carry out their role.

Some respondents also mentioned the need for Parliamentary and political support and backing, which will need to be balanced with the fact that they will be independent.



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