Dr. Tony Holohan:

I will address Senator Burke's question on open disclosure. I accept his point and his description of the scenario is not unrealistic. The key thing in the first instance is the maintenance of effective communication between the medical team and the patients. At all times, the patient should feel that whatever information is available, including the limitations of that information, has been shared with him or her. If the trust and confidence can be maintained in that way, that is the best means of ensuring patients are properly supported. Patients often find themselves in a position where they have no recourse other than to litigation to get answers to basic questions because they feel the system has closed ranks and communication has stopped and broken down. It often is not the situation that patients do not know something because the team does not know it. Unfortunately, it is often because the team has stopped communicating effectively with the patient. No relationship, in any walk of life, can be maintained in such a situation.

There are other factors that are part and parcel of the answer to the question. The time that some investigations have taken to complete has been unacceptably long. It should not take 15 months, as in the case the Senator mentioned. Unfortunately, we have examples of investigations that have taken even longer than that to complete. Work has happened, and is happening, on the setting of standards and outer limits for the period of time that should apply. We can set out some more detail for the committee on that. The nature and depth of an investigation should determine the time it takes. Whatever information is known at a point in time should be shared with a patient. That includes doctors telling patients they are not sure but they have a particular concern or worry and they are sharing it with the patient. That constitutes the right kind of disclosure environment as opposed to one where doctors tell patients they cannot tell them anything until they know the outcome of something that will be months away.

On the question on the breakdown of costs, we will get the Senator the information. I would like to clarify that he asked for the figures year-on-year and for the difference between the amount paid in compensation and the amount spent on legal fees.