Dr. Tony Holohan:

On the Senator's first question, the provisions of the Civil Liability Act will give the same protections in respect of the information as will apply for their admissibility to the Medical Council. The information gathered and recorded in that way is protected from those types of processes, and those types of assurances can be given to our practitioners in that regard.

Regarding the question about the death in a hospital, I realise it was not specifically about maternity but arising from some of the work that has been done on our response to what happened at Holles Street and the death of Malak Thawley there would be an automatic requirement for an external investigation to be conducted in every situation where there is a maternal death in a maternity hospital. That has not been the standard heretofore but it will be a practice for the future. As regards the process that will apply in respect of deaths in hospitals, I will make a number of comments although I do not wish to give a long-winded response. Work has been under way to try to develop standards for patient safety incidents that give us a much clearer sense of the type of response that is necessary in response to the type of incident, to ensure we get a proper proportional response and that people are not left for long periods of time as the Senator described. When people are looking for information following the death of a loved one in extreme situations we must see expeditious inquiry and expeditious responses. That is part of the intention of having a more appropriate set of standards that operates in the same way across the health system. The reality is that, heretofore, in some parts of the system the response is better than in other parts of it and there must be a much more standard approach to that. Part of that ultimately will be the backstop the licensing legislation will give us to be able to ensure proper enforcement of those arrangements within the health care system.

I am not sidestepping the Senator's point about inquests because I understand what he stated regarding variable practices, and no criticism of coroners is intended, in the speed at which coronial investigations take place depending on the part of the country in which one lives. They generate important information from a patient safety point of view. From our perspective, to have a means of being able to see in a more agile way the outcome of coronial processes and the intelligence that comes from the investigation of those deaths would be one of the things we would like to happen. The coronial process is under the Department of Justice and Equality. We have worked and will continue to work with that Department to ensure that as it examines policy and legislation in that area our perspectives are provided on what we would like to see happening there.

With regard to accountability, there are two dimensions to this. I will make a distinction between organisational accountability and professional accountability. The Senator's point about the need to have a system of professional accountability for managers is well made. We have a system of professional accountability for the great majority of the health care professions. Within their individual professional line there is a means of setting standards, expectations, fitness to practice arrangements, in some cases competence assurance and so forth. That is the system of professional accountability. It should complement, but is distinct from, what must then also exist within an organisation which is that individuals are held to account within that organisation for their performance whatever their background, be they managers or professionals.

It may well be the case in the context of a practitioner or person who has a system of professional accountability that there are questions of performance that do not give rise to questions of competence - and are therefore questions for their regulators - but might still fall short of an appropriate standard of performance. That should apply across the board. Much work has been done within the HSE around the development of the so-called accountability framework, which the committee has probably heard about from the HSE. However, the point in ensuring that the HSE's system of accountability is more responsive and reflective of the totality of staff in the HSE is one that I would accept. The HSE has a disciplinary code and set of requirements in relation to that which it must operate itself in response to an incident if it seeks to take disciplinary action. That is a different set of arrangements to what the Senator is describing which is a set of professional standards and a professional accountability line for people in management positions, which does exist in other jurisdictions.