Dr. Stephanie O'Keeffe:

The other thing, which I was going to mention to the Chairman when he started off with those questions, is that I am not sure. I am not a lawyer. In some respects, you can see that even though it was a minority, some consultants did choose to follow through with the letter.

Retrospectively, because I was not aware of it at the time, it is clear from the communication with the consultant, Dr. Kevin Hickey, that he understood what was required by the CervicalCheck programme. My understanding is that it was not a fear of litigation because they were not at fault. It was really about the communication to the patient about something that had failed, that should have worked previously and how that information could be communicated.

While I agree with the Chair that medical ethics and legal issues are involved in many cases of open disclosure, in this instance it was not the consultants' fault. The treating clinicians were not responsible for what had happened. However, it was deemed that they were the appropriate people to tell. I accept the Chair's questions because of what has happened but I did not think that there was anything going wrong. Perhaps I should have but I did not.