Dr. Kathleen MacLellan:

The points on training and preparation of staff are really well made.

The reality is that any type of open disclosure is not easy. It is not easy, obviously, for the patient and family, but it is also not easy for staff. We have a responsibility and duty to support our staff.

The State Claims Agency in partnership with the HSE has been in the process of rolling out a training programme which has been evaluated. The evaluation of the open disclosure pilot was published earlier this year. We understand that 2,813 staff across the HSE have been trained on open disclosure, with around 8,000 briefed on open disclosure. People across the system have been trained as "train the trainers". Based on our discussions with the HSE we believe that is very helpful; it is a start. The open disclosure pilot makes it very clear that there are a number of key success factors in being able to change the culture on open disclosure. Those factors are continuing education, continuing support for staff, clear leadership and buy-in and support across the whole system, involving not just the health professionals, but also the management.

We agree that staff should be provided with training. That training should be ongoing and there should be debriefing for staff. That will form part of the discussions on our priorities for the service plan for patient safety. We have a clear view on patient safety for the health system. It needs to start to be taken very seriously. We cannot just keep talking about it. It is very important and requires capacity and capability but also expertise and real buy-in and support. The Deputy's point that it will not happen without training is absolutely correct and the international experience indicates it is critical for us to provide the training and support for staff.

I refer to something we discussed earlier which might be of interest to the committee, relating to the standards for patient safety instances, and the concerns about the length of time and types of reviews. Those standards, which we commissioned through HIQA and the Mental Health Commission, are up for public consultation on HIQA's website. The committee may be interested in the content of that and the direction in which it is heading. In the absence of standards coming from the regulators we have difficulty with the variability in how those investigations and reviews happen across the system.