Dr. Gabriel Scally:

Deputy Durkan has asked an interesting set of questions. On open disclosure and how it operates, the acid test is how it operates in hard cases. These were hard cases and it operated badly. I would like to be able to say that there is really good experience elsewhere but I cannot do so. The hyponatraemia inquiry in Northern Ireland, for example, with which I had some involvement, actually uncovered a much worse situation of cover up, lies and dishonesty among clinicians. I am deeply disappointed that medical colleagues would behave in that sort of way. When it comes to hard cases, there is an element of collegiality in the medical profession that is sometimes good but at other times, unhelpful. It can be really unhelpful when it comes to telling patients and authorities the truth when things are going wrong. I am very hopeful that this can and will be changed.

On the issue of switching clinicians, I do not know if the women went ahead with doing that. I was hoping to ask them that last night but as they did not come along, I could not do so. Like Deputy Durkan, I would like to know more. I do not know if they have done so but I suspect that they may have gone ahead and switched clinicians. Sometimes it is easier to start afresh with a different clinician and to build a new relationship, especially if there is any resistance to going back, sitting down and speaking the truth to each other. That is difficult. I look forward to hearing about that. I worry about the fact that women continue to tell me that they are worried about their relationships with their clinicians because of all of this. They would love resolution to it and I would hope that they find it. I would certainly encourage any attempts that might be made in that regard. I know that some of the women would like to sit down with their clinicians and discuss what happened in the light of my report and of everything that has happened. They would very much like to say how they feel about what happened and would like their clinicians to tell them honestly about what went on. I know that some women would like that.

Deputy Durkan's question about the inaccuracy of the test being used as an excuse for complacency is interesting. I will think on that further but certainly some of the clinicians in their dealings with women dismissed things that went wrong on the basis that everyone knows that the test is not completely accurate.

I agree with the sentiment that lies behind the Deputy's question that it is not right or helpful. It is our duty to make the tests as accurate as we possibly can. I am hopeful that the shift next year to the HPV vaccine, which is a much more accurate test, will reduce that problem.

On the question about inoculation, we are not really here to discuss immunisation but part of the issue with it is that there are people who should not be immunised because of the likelihood of them reacting to a vaccine. They are then entirely dependent on the rest of the population who can have the vaccine having the vaccine. I wish there was a way to identify everyone who reacts but, sadly, that is not possible. It comes back to what I was saying at the beginning about a compensation scheme that runs in the UK for immunisation. It is a limited amount of money and there is a high level of disability involved in the judgments about that. It is an important thing to look at nonetheless. I invite Dr. Denton to continue.