Mr. Tony O'Brien:

It does but in the nature of a disciplinary process, I must be just a little more careful. I believe the issue of open disclosure would be better placed in a legal construct. I personally am in favour of a legal duty of candour. That would be in everybody's interests. The open disclosure policy we have pursued does not currently have a legal framework underpinning it and it is mandated within the organisation. It is being used very extensively but it was not in place at the time.

There is the issue of the implementation of previous reports. There is acknowledgement that the recommendations of the Ennis and Mallow reports have been implemented. Clearly, they were not fully implemented in Portlaoise as to do so would have conflicted with a policy position of the Government. The nature of the reconfiguration of the remainder of the small hospitals, as per the small hospitals framework, has occurred. It would not be appropriate to suggest that there has not been implementation of those previous reports. With regard to the O'Malley report, I played a key role in the implementation of the national cancer strategy, which had the effect of implementing many of the recommendations in the report. Dr. O'Reilly has played a continuing role in that regard. There has been very significant implementation - completed and ongoing - with respect to the HIQA inquiry that I asked for with regard to the death of the late Savita Halappanavar. There has been significant implementation that is ongoing with regard to the recommendations of the chief medical officer. There are some generalised comments about failure to implement but when one considers the detail of those recommendations, there is very substantial implementation. There was a combined oversight group with the small hospitals framework that included HSE, Department of Health and HIQA representation.

With regard to the implementation of further recommendations, the model that occurred with respect to the small hospitals framework - the so-called Ennis and Mallow framework - is good. One of the recommendations of HIQA is that the Minister would put in place an oversight mechanism to monitor implementation. That mirrors what happened on that occasion. The Minister has committed to doing that and it is appropriate. Where HIQA has indicated it is for the HSE to implement recommendations, it is because the HSE needs to implement them. The HSE is the only body that could implement them, it will do so and it will be supported in doing so by the oversight mechanism the Minister has referred to.

The State Claims Agency issue is a reference to a section of the report. It is a reference to a review in Portlaoise referring to meetings that took place approximately eight years ago between State Claims Agency representatives and managers from what was then called the midlands hospital group. The first meeting, which took place in November 2007, discussed the potential order of maternity services at Portlaoise hospital. That meeting considered the need to conduct the proposed audit in view of the fact that the hospital had identified and accepted the problems that were of concern to the State Claims Agency, had an action plan in place to address them and was conducting a related incident investigation. A further meeting was arranged in December 2007, at which it was agreed that in light of the information provided by the hospital and the HSE after the November meeting, a review of the maternity service in Portlaoise was not required at that point in time. That is a position that has been discussed and it is an agreed position, as it were, in terms of what happened at the time between the HSE and the State Claims Agency.

The truth is the HSE has an extremely good working relationship with the State Claims Agency.

Personnel across the health service have multiple interactions with the agency at various levels and on an almost daily basis. This relationship is a critical component of risk and incident management across the health service. Since the time referred to in the HIQA report, the State Claims Agency has also augmented its own approach and makes earlier and more direct contact at senior levels both within hospitals and-or with HSE management where this is required. This process is fully supported by the HSE and involves formal interactions at a national level between the two agencies.