Ms Dorothea Dowling:

I will deal first with the question on policy issues from a board perspective. We have made numerous submissions to our parent Department and, in turn, the Department of Justice and Equality on taking from the courts some of the cases that would be appropriate to our non-adversarial documents-only medically focused system. Thus, they could be assessed quickly and at a low cost. This has nothing to do with how the State Claims Agency handles claims. That agency's role is to investigate the liability and talk to the various individuals who might be involved. The difficulty is the way in which legislation was formed in that if the agency considers its client needs to answer a case, it must take the litigation route. We are suggesting there be an option for claimants who happen to have a fall, slip or trip that is being dealt with by the State Claims Agency. We believe they should have the same redress option as any other claimant, that is, to use the non-adversarial PIAB system. I wonder whether it is even constitutional for somebody to be required to go through a litigation system. If one were to fall in a supermarket, one could go through the non-adversarial system.

The board secretary was very much part of our team at the time we were organising all of this, that is, before there was a board. When the legislation was being drafted, an unfortunate coincidence was that the enterprise-wide liability system for the medical sector was being negotiated. There was a slight exception clause inserted into the legislation that stated the medical negligence aspect would not be catered for at the time because it was under discussion. However, it was always intended that we would be covered. The idea of the enterprise-wide liability system in respect of medical negligence cases and the idea of the new system that the Judiciary is calling for mean that it should not matter to the injured party whether the doctor, nurse or hospital is involved where there is a case to be dealt with. There is no point in 60% of the State's money being spent on sorting out who takes what percentage when, in fact, the person injured may have to fall on State services in the meantime. I refer to periodic payments, in accordance with the Medical Insurance Advisory Bureau's recommendations, rather than one lump sum, and to circumstances in which one's care costs would be dealt with annually on the basis of care as the needs arises. The other side of the current system is such that someone who receives €6 million or €10 million may not know how to manage it for the entirety of their lives. Perhaps their life expectancy is not as great as originally anticipated. Such circumstances should be compared with those of somebody else who may be in deficit over a similar period.

It is not a case of our setting ourselves up in competition with the State Claims Agency. We have very different roles. What we are saying is that, rather than having all cases dealt with by the State Claims Agency enter the old litigation system, claimants should have an option of using the non-adversarial system operated by the PIAB. It seems that if there are slips, trips and falls in a hospital, they are all within the ambit of medical negligence procedures.

In regard to the issue of redress, we have not been consulted on many relevant matters to the extent that we might have liked, but Ms Byron has been in discussions on some of them. She will elaborate on the issue.