Mr. Ciarán Breen:

There is a good deal of interaction between the State Claims Agency and the HSE. We regularly furnish each chief executive of the hospital groups and the chief executives of the individual hospitals and HSE management with management information reports that are relative to their adverse event data and all the claims data so that they are aware of where their claims are coming from.

In addition, there are regular meetings at a very high level between the executive management team of the State Claims Agency and the executive management team of the HSE where we exchange information with it about particular things, patterns, groups or clusters that we might be seeing, or very often worries that we might have around a particular topic. I would hate for it to be characterised as nothing happening while a claim is being settled and that the HSE does not care about it. Our claims team in the State Claims Agency and the clinical risk team liaise, and there is a great deal of learning that we take from closed claims about why we had to settle at a particular level, if there are lessons to be learnt from that, and how we feed it back into the system. We constantly do that.

As you said, Chairman, we had a conversation and I will outline one of the reasons we do not break down the data on a hospital-by-hospital basis. NHS Resolution, which is our equivalent in the UK, has what it calls fact sheet 5, and it issues it publicly and regularly. It is a trust-by-trust analysis. It breaks down the information in the way we have into a group of hospitals. Its reason for not publishing it at a more granular level is in line with our reason, namely, that claims and claims analysis are not necessarily a good measure of quality because one has case mix, demographic and size of hospital. Some hospitals take on very hard cases, so therefore one would expect to see a higher rate of claims. Maternity units obviously have higher incidences of compensation rather than volumes of claim. Then there is the issue that one might raise undue concerns among the public no matter what context one puts around it. There might be a perception, wrongly, that a hospital is not one a person might go to, and there are consequences for the system if people decide they will not attend hospital A as well as for the reputation of both the hospital and the practitioners. Those are just some of the reasons. I am informed by my colleague, Colm Henry, in the HSE that it carries out real quality analysis and publishes it, which is helpful in terms of understanding what is happening in hospitals.

In the time since the inception of the State Claims Agency and all the analysis that we do, there have been very few occasions where we have had to take an issue up with a hospital chief executive about a particular practitioner.

That is not to say that we have not done that. We have, and where we have done that, a hospital addresses the issue. It might involve nothing more than the association of a practitioner with a cluster of claims. There might be different factors involved, including difficult cases such as difficult surgeries. When we come across such a cluster and where we look at the expert evidence, if there is something we need to say to a hospital chief executive, for example, that he or she might have to look at what has been happening in those cases together with the practitioner, we hand the case back to him or her and let him or her deal with it. We have done that.