Dr. Jennifer Creese:

I thank the Deputy for the question. When we surveyed hospital doctors, a quarter of them said they would not speak up if they had issues at work. Probably about half of those respondents spoke about fear. The kinds of things they said they were worried about included, and particularly for junior doctors, repercussions emanating from the consultants who were going to be giving them references, grading and pushing them through their higher specialist training, HST, and then progressing them through their careers. Much of this aspect, then, probably has to do with the culture of medicine as a profession, and the specific culture of medicine in Ireland, in what is a relatively small community. In some respects, therefore, it does not really matter for these doctors whether they do have anecdotal evidence or a direct example of someone having spoken out and having been punished for doing so. It is more so that a kind of fear is built in throughout the culture about what would happen because that is the way the hierarchy works.

There are always stories about someone having heard something said about someone else's experience, but those stories perpetuate themselves and are very much bred into the culture. This is challenging to address at a policy level. What can be done is to have a framework reference system in place that can act as a kind of a safety net behind that so that-----