Dr. Tony Holohan:

I will address the issue on measurement first, which is a good question on how we will ultimately know. Disclosure is something that happens in the privacy of a consulting room or clinic, and there is not a window into this. We are in the process of building intelligence capacity through the so-called patient experience survey. Mr. Keating referenced this in passing earlier. I am not saying it will provide the entire answer to the question. It is a survey of hospitals in the first instance and it is more limited than we want it to be ultimately. We want to extend it to maternity hospitals and other healthcare settings. It gets into a substantial amount of detail with patients as to a wide range of their experiences. The second report will be published in the coming weeks. The first report, published in autumn last year, showed, for example, that the quality of information given to people at the point of discharge and the understanding with which people left hospitals or healthcare institutions was very poor. I imagine the issues that reflect on disclosures and the quality of those disclosures might be something we can include and we will be able to make inferences through it. We also have HIQA. It will be empowered to inspect, have standards relating to open disclosure and will be in a position to report on this. It is a good question and one we need to keep in mind because what we are trying to do is improve the quality of the disclosure engagements that take place.

In the context of the Scally report and transparency, we cannot say yet - because of the process of implementation planning we are going through - that all of the legislative requirements we may need to respond to all of his recommendations are contained in this. We are open to the possibility that as we do this work over the coming weeks, and we will be back to the Government with the Minister bringing his proposed implementation plan in December, that there may well be identified some additional requirement for us to add to this list of measures and to the provisions in the Bill. I am not saying "Yea" or "Nay", I am just not ruling it out. Our minds are open to that possibility. What I am saying is I cannot not sit here and state this is sufficient and we need to do nothing more with it.

With regard to equivalence with the duty of candour, our provisions will go beyond the duty of candour in the sense they will apply not only to organisations and the duty on an organisation to make arrangements for disclosure to happen in the same way that is provided for in law in the UK but also to individual practitioners, and there will be penalties in respect of them. We will go further than the UK. Ms Adams will answer the question on the definition of clinical audit.