Dr. Tony Holohan:

That is precisely our strategy, namely to try to give people a degree of confidence that this is a safe space. If information is disclosed, that clearly needs to be done in an appropriate manner and we will prescribe what that manner is. If people disclose information they will be entitled to protections in regard to the information being used. That will give people the confidence that they are not increasing their or other people's liability by doing what is, in effect, the right thing in terms of patient care.

The Deputy went on to make a point on a disclosure being made by a lead clinician. It is a good point and speaks to some of the surprising things that occur as a consequence of our existing system. We have come across situations where some parts of the disclosure to patients when things go wrong involved one clinician pointing the finger in the direction of other members of the clinical team. That is entirely inappropriate and unacceptable. One can guess at the motivations behind that and go into further details on specific examples. We know that happens. One may be in a situation where that the kind of culture, namely, that disclosure to a patient involves somebody pointing the finger in one direction in order to ensure the finger is not pointed back at oneself. To me, that speaks to how far we have to go on this journey to get ourselves into a situation where this is happening in the right way.

Each issue is interconnected. In some of the adversarial processes about which the Deputy spoke, the length of time it takes to get justice from the point of view of patients or professionals contributes to the sense of liability, risk and people seeking to protect themselves. It is all part of the just culture Dr. MacLellan spoke of, and she might comment on some of what I have just said.

The Deputy's point on training is good. We have drawn a different conclusion to the Deputy in regard to the role mandatory versus voluntary would play. I will not say that I think the Deputy is wrong and we are right. It is a judgment we have made. It is not perfect. Our view is that encouraging people to do the right thing and giving protection to them when they do the right thing is likely to lead to more reporting. That is the point to where we want to get. We want more disclosure, and for that disclosure to happen of the kind of quality way that it should be. Our fear is that if we simply mandated that the culture might be to tick boxes and not support patients through processes, that would have the opposite effect of what we intend