Professor Brian Lenehan:

An important part of my role is quality of patient safety. Incident management is integral to that. For the investigation of incidents that are raised we have a robust system in place. All staff are encouraged to raise incidents, both minor and major. All staff are offered training on Q-Pulse, which is the system on which incidents are raised. I assure the Deputy that once an incident is raised, it is investigated in line with the incident management framework. It is categorised. It has a preliminary assessment done and can be closed out if it is minor, and there are learnings from that. If it requires a more substantial investigation it goes on to a systems analysis, which can be an internal or external review. I have commissioned many of them in my two years and am the commissioner of some that were commissioned by my predecessors.

This is extremely important and I am disappointed for anyone to suggest there is an ethos of bullying whereby people are discouraged from raising incidents. In my role, I encourage it to be absolutely open and transparent. If minor incidents are not raised, my office cannot know about them, investigate them or, as the Deputy said, prevent them becoming something more major. I am proud of the system we have. We have built a robust system and anything that is logged is escalated onto the national incident management system. If it is not raised in the beginning, I do not know about it. I cannot investigate it, escalate it or close it out.