Mr. Edward Mathews:

On the points you have addressed, it is important to have key care givers present. They include the medical and-or surgical lead person. In terms of a nursing or midwifery staff presence, whether it should be a staff nurse or midwife, a clinical midwife manager or a clinical nurse manager would depend on the circumstances involved, but it is important. There should also be somebody from administration present. I am conscious that we are talking about service users and that it is an extraordinarily vulnerable time for people. It is within the heads of the Bill that the Legislature has advised the commission and the authority that they should produce in their guidelines how a person who is receiving the disclosure should be supported. That is important also. Perhaps it might be done by the patient advocacy office or other services within the HSE. The Bill does not cover the HSE only. It covers both private and public care services.

The point we have made in our submission which is important and touches on the points the Chairman is making is that while the heads of the Bill provide wide scope for the authority and the commission to provide guidelines - there is guidance given on a number of matters - noticeably absent is anything relating to governance, review or leadership within an organisation to make an open disclosure and the training of staff in that regard. That includes staff who will have to make the disclosure and people who will have to manage it in a 24/7 cycle and facilitate meetings. If they are to be run properly, they will not be meetings at which somebody will say, "We will have that down in the nurse manager's office." It will have to be planned and properly delivered. One significant amendment that could be considered - it refers to Senator Colm Burke's point about improving matters on the ground - is making it a requirement for the authority and the commission in their standards to direct how organisations should approach governing in this way, leading to an open disclosure policy, how it would be reviewed and, importantly, how staff would be trained in that regard.

On what is said to people at the beginning, one need not say in a meeting that they cannot use what is said. The protections provided in the Bill relate to professional regulatory and civil liability proceedings. People can be invited to attend the meeting and told it is taking place in the context of making an open disclosure. They can be told what it is. At that difficult time in a person's life there is no need to mire him or her in the minutiae of legal niceties. Once the meeting has been convened and people are notified that a meeting is being held under this heading, if things fail later and when matters come to be considered by solicitors and-or the Nursing and Midwifery Board of Ireland, NMBI, the Medical Council, CORU or other regulators, they will know then about the information. It is not a matter to which I have given huge consideration but, from an empathetic point of view, I share Dr. Duddy's concern that it hardly seems to be an open discussion if one starts by saying, "Anything I say to you now cannot be said to anybody else."