Dr. Tom Ryan:

There were a lot of questions asked. I will deal with the ones about the public system first.

On open disclosure, there will be a lot of ramifications not just for clinicians but also for those involved in the administration of the health care system. From my own experience of talking to relatives of patients who have suffered an injury or died as a result of a procedure, they obviously want an apology. They want openness and candour, but they also want a promise that an event will not recur. The vast majority of relatives are more concerned to ensure it will not happen to anybody else. It is a big problem in the health care system if the hospital system is run at 95% capacity and does not have enough consultants. The open disclosure legislation will leave a clinician in a position where he or she has apologised for an adverse event but cannot give a guarantee or make a promise that it will not happen again because he or she has no direct control or influence over how the hospital is funded, resourced or organised. With open disclosure there will have to be a greater element of clinical governance within the hospital system in order that hospitals will be run more on a medical than a bureaucratic basis. That would be the natural follow on from the transparency and openness that will result from having an open disclosure policy. These may be good for the hospital system as the truth never hurt anybody. It is worth telling the truth - that one cannot run a hospital system at 95% capacity and expect nobody to suffer. There will, therefore, be a lot of knock-on effects. I do not expect the knock-on effects to be felt by doctors and nurses; the big knock-on effect will be felt by those who organise and administer the health system. That will happen down the line as a result of this legislation.

The second question was about the mediation service. Very often after an adverse event or an unexpected death that was not necessarily due to an error, the family are faced with a group of nurses and doctors whom they may not trust that much or whom they have only recently met. Their loved one has died or suffered an injury and very often they need a third party who can say: "Look, everything was done properly here. In these circumstances it is to be expected that some patients will not do well. The doctors and nurses did everything they could to try to care for your relative, but, unfortunately, things did not work out as they would have hoped." Currently that service is provided by a solicitor. The family receive a copy of the notes, go to a solicitor and ask for a medical opinion which they receive from a third party and the case immediately steps into the adversarial arena; therefore, the costs go up and the level of animosity increases. The duration of the proceedings and the time taken to arrive at a resolution of the family's concerns increase exponentially. It would be far better if there was a third party, perhaps even an external person, to counsel the family on what actually happened, that the doctors, nurses and hospital did the best for their loved one and did not actually do anything wrong. That is important if one wants to defuse the avalanche.