Ms Martina Harkin-Kelly:

I concur with all of my medical colleagues present. On the current level of sheer distress, our IMO colleague has mentioned that most hospitals operate daily at full capacity. He gave the figures for 2015. I can tell the committee that the figures for 2016 will be much higher. All of our members - midwives and nurses - within most acute hospitals and primary care facilities within the community complete daily a disclaimer notice highlighting the potential for risk within every single unit and department. To answer Deputy Billy Kelleher who queried whether we were highlighting the risks, nurses and midwives most certainly are.

There are two ends to the culture story. There are always two sides to every biscuit. While there is the culture of the organisation, there is still the pervasive culture of blame within it and to run for the hills when something happens. Unfortunately, those who provide care 24/7 - nurses and medics - are usually the front-line individuals who are at the end of giving the information. I stress that our colleague in the Irish Hospital Consultants Association referred to the multidisciplinary team. This team encompasses the service managers, as well those involved in decision-making processes. I agree with Deputy Billy Kelleher that there should be a duty of candour. Following the Mid Staffordshire crisis, duty of candour legislation has been introduced in the United Kingdom and it is not possible to run for the hills or be transferred laterally or centrally. We have gone down this route, but whether I am a maternity or obstetric consultant, work within the integumentary system or another system of care or a nurse on a medical or surgical floor, that is my work domain. I am not easily transferable elsewhere and away from the immediate issues at hand. I cannot disappear into the ether. I will always be there and always have to face the music.

On culture and the mindset, at the end of the day most Irish people - citizens of the country - just want answers, but the unruly bureaucracy in the system mitigates against this. I think it was mentioned, but the ability to put the structures and processes needed in place is key. Clarity and guidelines are key. My colleague, Mr. Mathews, referred to support for second and third victims - nurses, medics, medical professionals and members of the multidisciplinary team who are also victims in this scenario. We have to keep track of this also. Culturally, within Irish society, change is difficult, as is change in any cultural mindset, but particularly when involved in civil litigation or regulatory processes. It is pervasive and inbuilt into the mindset. The media perhaps have a lot to contribute with regard to what is sometimes very toxic coverage of events that are live and real for many of our members, as well as for the patients and victims and their families. That aspect also needs to be considered.

I agree that there should be a duty of candour. I would not want anyone to run for the hills. The music has to faced by everyone, but we need to be careful in the blame culture. We have to get the facts right. Good clarification is important.