Dr. Tony Holohan:

I will deal with that last part first as it may address a number of the Deputy's questions. I take the point completely. Where the Deputy describes the creation of the list, that is exactly the culture we are trying to avoid. In some parts, it might be the culture we already have, where it is seen that the response to the patient safety incident is the filling out of the form, and once the form is filled out, the duty is discharged and that is the end of the matter. Although I do not want to keep going back to the Portlaoise example, that was absolutely the case in Portlaoise. Nobody was looking at the pile but once they looked at the pile, the patterns were obvious. Clearly, it is the use of the information that is important, and its value lies only in whether it is used to create appropriate intelligence. There will need to be people who have appropriate patient safety expertise leading the implementation of that within the front line of the health services. However, that is not to say there is not a requirement in terms of reporting and the integrity and accuracy of the information. That responsibility has to reside with the clinical service, which has to take ultimate responsibility for the accurate reporting of the information. That is the kind of culture that is needed and that by reporting something, they are not dispensing with their responsibility to deal with whatever the information relates to.

With regard to the seven days, an obvious point to make is that it is a maximum, not a minimum. It is not setting the minium allowable period that has to elapse but the maximum, and it may well be, for the reasons the Deputy describes, much more appropriate that something happens within minutes or hours, depending on the nature of the incident. The seven days relates to the requirement on the provider around the notification to the State Claims Agency, not around the response capacity and certainly not around open disclosure, so the open disclosure engagement is not framed. That should be determined by the nature of the clinical circumstances.

Obviously, what we want to see happening is that, when the information becomes available and within the earliest possible time, the information is imparted properly by the appropriate clinical team, and there is appropriate training and so on to support people in doing that. As I have said before in this committee, this really only applies when something goes wrong. However, that is a much more frequent occurrence than people might imagine and, in general, the evidence is that up to 10% of hospital admissions have some form of iatrogenic or health service induced harm in respect of patients, so this is not an uncommon experience. There is really only one opportunity to put that right, which is the earliest engagement that happens between the clinical team and the patient or the family of the patient. We have to try to maintain trust and confidence. The moment that is eroded, for whatever reason, no amount of after-the-fact engagement can restore what has been lost. While I do not want to presume, I think that is the spirit in which the question was asked.