Mr. John Connaghan:

I thank the Chairman and members for the invitation to attend the committee meeting today. I am joined today by my colleagues Dr. Colm Henry, chief clinical officer, Ms Michele Tait, programme manager of the hepatitis C programme, and Professor Aiden McCormick, clinical lead to the national hepatitis C treatment programme.

With the permission of the Chair, I will begin part of the way through the provided opening statement in order to avoid repetition. The national hepatitis C treatment programme is led by a clinical lead and a full-time programme manager. It is supported by a programme advisory group which provides oversight and strategic advice. The group is representative of key internal and external stakeholders including researchers, public health specialists, clinicians, pharmacists and service planners and aims to ensure successful implementation of the multi-annual public health plan for the treatment of hepatitis C in Ireland over the coming years.

Since 2015, the national hepatitis C treatment programme has provided treatment to some 3,600 patients, beginning with those most in critical need. The programme has commenced the extension of hepatitis C treatment away from the traditional hospital-based model where appropriate and integrating it into community-based healthcare within a number of HSE addiction treatment centres. The initial outcomes from these programmes are extremely positive, with each patient engaging fully with his or her treatment. Those who have completed their treatment have each received a sustained virological response, that is, a cure. The programme is planning a further extension of treatment availability within the community setting outside of these clinics.

The programme has established a treatment registry, which records anonymised data relating to patients provided with treatment. The registry monitors treatment uptake, activity, prescribing trends and patient outcomes. It provides a platform for clinicians to register patients they intend commencing on treatment. The Comptroller and Auditor General examination of the treatment of hepatitis C in Ireland recommended the linking of data collected through the notifications of hepatitis C under infectious diseases regulations to the national hepatitis C treatment registry. The HSE agrees that linking these data is beneficial in planning treatment. However, it presents a range of difficulties in terms of patient consent, data privacy and feasibility. Our division of public health is examining the barriers that need to be overcome in relation to linkage. The HSE is continuing to develop its existing treatment registry to ensure any patients diagnosed with hepatitis C are registered with the national treatment registry. The Comptroller and Auditor General report also makes recommendations regarding the continued planning of treatment and monitoring uptake to ensure patients continue to be identified for treatment and linked to care in order to make hepatitis C a rare disease in Ireland by 2026.

On the management of and learning from serious incidents, it is the policy of the Health Service Executive that all incidents are identified, reported and reviewed in order that learning from events can be shared. In support of this policy and based on us learning from incidents across the health service, in 2018 the HSE published its incident management framework. It sets out elements of the systems required for a responsive and proportionate approach to the prevention of incidents and the management of and learning from incidents which have occurred. It places considerable emphasis on the importance of learning and the sharing of this learning at all levels in the organisation, including nationally and at hospital and community levels. When an incident occurs, services are required to carry out a rapid risk assessment and take any immediate actions required to ensure that no other person is harmed. Following a formal review, the findings and the recommendations must then form the basis of the development of an action plan with a focus on the improvements required to reduce the risk of recurrence. The framework stresses the importance of sharing the outcome and findings of the review with other services. Cognisant of the criticism that some incidents recur, step 1 of the incident management process focuses on incident prevention. There are six steps in total in the framework.

We know that there is a strong link between the need to proactively manage risks and the occurrence of incidents. An example would be where a service puts in place a fall prevention strategy and monitors the occurrence of preventable falls against it.

The HSE recently established a project team to develop a mechanism in order that the learning from local reviews could be considered alongside information from a number of other sources, for example, closed claims and complaints related to the provision of clinical care. Since 2013, the HSE has undertaken an annual review of completed incident reports. The analysis focuses on both the quality of reports and the analysis of findings. The findings are themed to identify key areas of weakness.

The national incident management system, NIMS, hosted by the State Claims Agency enables services across the HSE and relevant funded agencies to report and manage all safety incidents. As an end to end risk management system, it facilitates the management of a safety incident though its life cycle, from initial reporting through the review process to the tracking of implementation of recommendations, while also fulfilling the legal requirement to report incidents to the State Claims Agency. A range of reports are produced by the NIMS at each level of the organisation. They allow services to monitor trends in levels of reporting, the timeliness of reporting, the severity of incidents reported, active claims and outstanding liabilities. The reports are used as part of the performance management processes and in conjunction with other measures at local patient safety and quality forums to disseminate information and set out objectives for improvement.