Dr. Philip Crowley:

I will do my very best in seeking to meet the Deputy's need for information. If there are gaps, I will certainly forward information afterwards.

We have discussed the culture on a number of occasions in the light of the deep-seated cultural problems exposed. Work we have been doing has been focused on the issue of open disclosure. When we investigate the harm caused when things go wrong - we have felt this for some time - the health care system can sometimes compound it by how it responds to families or individuals by either being secretive or not apologising. We have run more than 100 workshops with front-line staff to promote the new policy of open disclosure which was launched by the Minister. We have also conducted a patient safety culture survey, initially in the acute hospitals division, which we will seek to make available across the service. We need to take stock of what we have learned from it and how effective it is as a tool. I note the tool recommended by the Senator.

Issues around governance were raised. We have been working hard on our delivery system to develop models of governance that will ensure that the delivery system will have at the heart of decision making consideration of the impact of any decision on the quality of care for service users and patients. We have new quality patient safety committees at all levels of all organisations and are promoting the message that they analyse all available data on safety and quality of care and use them to ensure the leaderships of all organisations properly focus on the issue above all else.

We also have an audit function whereby we have a group of people who check to see if we are doing what we said we would do. We assess and evaluate the implementation of recommendations to which we have committed and all of the audit findings are to be found on our website. We have worked on the issue of leadership which is central to having an improved and more person-citizen focused culture, one entirely focused on quality of care. We have developed guidance for the entire system promoted on new forms of leadership. In many cases we want the leadership shown across the system to be standardised in order that the leadership of the health care system is engaged fully with front-line staff, patients and service users and listens and responds to them.

In terms of measuring patient experience, we have developed a new survey tool which we are promoting throughout the health care system for post-discharge surveys of patients. We have also been working with the health care system to develop patient and family groups so that we properly listen to people, perhaps in a more qualitative way, which sometimes can be richer. We are also examining options to see if we can find cost effective methods to develop more real-time feedback from patients and service users so that we respond in a very agile fashion.

We also have formed partnerships with some of the training bodies and others to try to build capacity around quality improvement. We do not believe that simply telling people to change things or promulgating guidance on something in the hurly-burly of front-line care will always get everybody to change the practice in the way that we would like it to so do. We are utilising proven methodologies of quality improvement, training people in it and training our clinical leaders and others in this methodology to try to embed within our system a commitment to not just go into work every day to do our job but to go in every day to do our job and to improve that job.

We have also worked with the Royal College of Surgeons to develop a number of national audits to ensure we examine critical areas of practice such as ICU care, trauma management and the management of hip fractures, to name but three, and others are in development, to nationally examine the issues and to explore and ensure that we know if there are variations in practice. What we seek to promote in all of this work is standardisation of practice. Variation is the enemy of quality and we seek to eradicate it. The approach is based on the adoption of practice that is not best evidence based. To carry out that programme of work we have 40 people working in the quality and patient safety division. Importantly, with an overall staff of 90,000 to 100,000 people we do not pretend that the team will work in isolation. We will not be able to assume all of those responsibilities without forming partnerships with other bodies, and most particularly working with the line divisions who all have been developing consistently a capacity for quality improvement and safety management in the period since they have been formed.

Members will see from the service plan this year and last year a very clear commitment that quality and patient safety cannot just be the responsibility of a team or a number of individuals, that we are really committing as an organisation that the entire organisation needs to focus on this because we are mindful of the challenge that has been laid down to us. We are acutely aware of the times that we fail patients and we work extremely hard to try to minimise that risk into the future.