Dr. Peter McKenna:

I was going to mention the open disclosure issue. The question between the clinicians and the programme is important. I was involved through hearing about it from clinicians. They were of the opinion that they were asked to give information that had been known to the programme for some time. They had not been involved in the collation of the material and at the outset, when it was probably inevitable that this was going to happen, they had not been involved in the construction of the audit or the dissemination of the outcome. That would explain their reluctance to give the information.

The principle of open disclosure, from a clinical point of view, is well established. If, for example, in the course of a hysterectomy I was to damage somebody's bladder, the onus would be on me to explain that I was sorry that I had done it and why it had happened. I would explain that it happened in so many instances, that it was unusual and again that I was very sorry. What would happen in that hypothetical example would be current and the error I would be disclosing was mine. The question of an audit is quite different. The information would be retrospective and I would be disclosing somebody else's error. That was not something with which the clinicians were immediately comfortable. It is a departure from what most people consider to be their normal day to day activity.