Dr. Tony Holohan:

Deputy Cassells has raised an important point regarding patient involvement. I do not intend, through this committee, to speak directly to patients. I will find a means of making direct contact with the patients concerned because that is what we do. We have been engaged in a number of situations like this before whereby in tragic situations we find ourselves in contact with patients who have been bereaved. An obvious example is Portlaoise hospital, where I myself led an investigation which uncovered in the baby deaths the fact that it involved not just open disclosure, but deliberate concealment and lies were told. We wrote that in the report and we have continued to engage with patients from there and from a variety of other areas. We had two of the bereaved mothers as part of the maternity strategy, which is approved by Government, we have had patient involvement in our cancer strategy, and it has overhauled completely the attitude of our cancer services. We have a patient experience survey. It is happening for the second time this month throughout our hospital system, and we are one of the few countries in the world in this regard. We have patient safety statements now which require each hospital, for maternity services first and now for hospital services generally, to publish information about safety each month in order that people can see this and to create transparency and visibility. We have built in the Department of Health a national patient safety office. The then Minister for Health, Deputy Varadkar, brought those proposals to Cabinet in late 2015 to give what we call a patient safety surveillance function. One of the things we uncovered as part of the work we have done in recent years is that different parts of our system knew difference pieces of information about safety and we did not join up that information to create a common understanding. The work we are doing seeks to do that.

However, I absolutely accept that that is not enough to respond to any of the harms and bereavements that have occurred for some of the patients about whom the Deputy has spoken. It will all be cold comfort to them. Culture change is difficult, but our experience is that working with patients in these situations - and working with them directly, as opposed to through the media - is the best means of ensuring their objective, which is to have their terrible experiences fully and directly inform the work we do.