Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

I have a number of difficulties with what we are dealing with here. Many of them stem from my experience as someone who would have supported health professionals through the system. As the system stands, it is incredibly adversarial, not just for the patients, who, of course, must be central, but also for the staff themselves.

Regulated health professionals have an arena in which issues relating to them can be investigated and in which they very often are. Many of my colleagues within the various representative bodies for health professionals and I have experience of ongoing investigations within the HSE. The Nursing and Midwifery Board of Ireland and the Medical Council investigate regulated health professionals regarding incidents where there may be a suspicion of poor professional performance, for example. There is another group of people who do not face investigation at that level but who are very often central to the incidents. They do not have their own regulatory body. Since the requirement is not mandatory, there are those involved who do not have any compunction to disclose. Whatever is done by regulated health professionals is examined in another arena but there are staff who are central to the process but who do not have any regulatory body. If the requirement is not mandatory, there is no onus on the latter staff, although they are central.

Much of this seems to hinge on the investigation taking place. There seems to be over-reliance in the HSE on investigations. As was pointed out, one could be doing well to get out of an investigation in 18 months. Some can take years. Meanwhile, other matters arise.

The documentation states it is not proposed to include a mandatory requirement concerning open disclosure but that it will be reviewed in line with experience. Making it mandatory could be reviewed in line with experience also. There are patients and also staff who have been battered by the system and the culture. The culture needs to change. I am not convinced it will necessarily be changed in a voluntary way. The reason I say this is that staff must be supported, and they must also be trained. However, without making this requirement mandatory, the training may not happen because there is always a draw on the budget. There is always something else that needs resources and somewhere else to direct the money. Unless the requirement is mandatory, the training may not happen. If not, the staff will not feel supported. I am interested in knowing how the staff will be supported through training. How can it be done? I am not convinced it will happen if the requirement is not mandatory. That is not because anyone wants to avoid responsibility but purely and simply because there is always a draw on the budget. There will always be something else. I would like to see this front and centre. Support for staff must be in place.

Consider what will occur in the context of an open disclosure. I am not referring to an admission of guilt but a statement that a bad thing happened regarding which those responsible wish to offer an explanation. The patient will be advised of the incident, albeit not by mandatory requirement at present, and the lead clinician will be the person who will sit down with him or her. Dr. Holohan said there are very many people involved so there can often be a chain of events and that, at the end of that chain or perhaps the beginning, there are staff who might not have the status of a lead clinician.

Forgive me if I have missed it, but I do not see anything that provides for information to be provided to all of the people there. Lead clinicians will sit down with patients to tell them a bad thing happened and that it should not have. They are talking about staff who have been involved in that patient's care. Do the witnesses have a view on whether we should strengthen the provisions in order to ensure that everybody involves knows what is happening?

We know the culture is not great and we have seen where it is important to find somebody to blame rather than the heart of the incident, which is not the fault of any one person - it is the adversarial nature of the system. There is a fear among staff that they are being spoken about and because the culture is one of blame rather than getting to the heart of the matter, there is a fear that in looking for someone to take the fall one is not involved in the conversation. I am sure that lead clinicians, in providing explanations, are doing their best but there is fear among staff other than lead clinicians that some blame is being apportioned. Can we do something to strengthen that and ensure that does not happen?

I refer to my earlier point with regard to investigations. A lot of this seems to hinge on the provision of investigations, which often take a very long time. I ask the witnesses to outline the timeframe they envisage from an initial explanation of what happened onwards. If there is an investigation thereafter, is it envisaged that all of the parties will be involved? I ask in the context of sharing information with people.

The lives of some patients have been destroyed because following an adverse incident they feel they have to go to battle with the system. I have also seen staff whose lives have been destroyed. They are out on sick leave because they have been traumatised by what has happened. The purpose of this is to stop that happening. I fear that unless it is mandatory, we will not get the culture change that is so desperately required.