Dr. Peter Boylan:

Yes. The mastership model is crystal clear. The master is responsible for running the hospital in a corporate sense. He or she has overall responsibility. The master cannot be responsible for every single thing that happens but is, in a corporate sense, responsible for everything that happens in the hospital. That includes the financial management of the hospital. The master is not an accountant and does not have huge financial knowledge but is responsible for it. He or she has people to help, such as accountants and financial managers and so on. It is the same way with the administration, midwifery and nursing side of things. There is a director of nursing and midwifery who is responsible for that. All those people report to the master. If one is running a ship, one needs a captain. If one is running a team, one needs a captain. There has to be one person who is responsible and accountable and has the authority to do things. That person reports to the board. The master is accountable to the board, which owns the hospital in trust. The board does not have any financial interest in the hospital but owns it in trust. It is a good system and it works. The board system in the maternity hospitals works because there are people from different backgrounds - legal, financial, property and so on - who are there pro bonoto give advice on the running of the hospital. It is a system that could be introduced in some way into HSE hospitals and into the hospital groups and networks. The board is made up of people who rotate and do not stay on it forever.

Will co-location improve conditions? It probably will. It will certainly improve the conditions for the mothers, women and persons coming through the hospitals. That is very important. It is important to understand that the traditions and esprit de corps in the stand-alone maternity hospitals in many of the units around the country is very important and sometimes that gets lost in a new building. It is an important thing to consider. If the conditions improve, retention will be easier. I made reference to the importance of avoiding conflict with midwives in developing the three models of care and made reference to places outside the country. What I was referring to was the mid-Staffordshire Morecambe Bay problem where a group of midwives were working very much on their own and achieving normal birth at any cost. Unfortunately that cost worked out to be the death of babies and mothers. It is really important we make sure we continue the good tradition of midwives and doctors working together in the Irish system and that we regard obstetricians as midwives who also look after more complicated pregnancies. That is the way to approach it. We have good relations and I hope they will continue.

The new office is a tremendously positive development and will enhance care. We have already seen some of the things being developed in the area of audit and quality and safety being very helpful.

Open disclosure means that one sits down with the couple or patient who has had an adverse outcome and try to explain what has happened. One may not be able to give a full explanation because, as Dr. McKenna said, one is waiting for post mortem results. One of the difficulties is that once it goes into the legal arena, there is a tremendous division and one is not allowed to approach the couple or the patient any more. That is a big problem. In that respect, mediation is a much better way forward in dealing with medico-legal cases than the adversarial way we have at the moment which is hugely expensive, time-consuming and awful for the patients and the couple involved. It is a nightmare for them. It is hard enough looking after a child with a disability but to have to go through all of that as well on top is terrible. All maternal deaths should have an inquest. That should go without saying. It is a statutory inquiry into what happened and I do not see any reason for arguing against it.