Dr. Kathleen MacLellan:

I wish to address one or two points. We have worked closely with HIQA through our working group to look at the types of resources and requirements that will be required for HIQA to do this. It is important to note that this year we secured through the Estimates an increase of €3.5 million for HIQA to build on its functions over this year. That is a significant increase to allow it to start preparing and to take on new functions.

Our intention in this Bill is for the licensed entity to be as close to the hospital as possible. Hospitals are not established homogeneously across the public and private sectors. We will work with the Attorney General's office and drafters to pin all of it down through the general scheme. Internationally, it is felt that the closer a licensed entity is to the coalface of the delivery of a health service the better the processes.

Deputy Durkan mentioned clinical incidents and asked about the tracking of incidents across private and public hospitals. We support that. All hospitals are obligated to record all incidents, regardless of the level, on the national incident management system. This builds capacity and resources in the public hospital system but we do not have access to incident management across the private sector. However, as we move forward with the legislation we expect that the private sector will participate in the support systems by making the information available. As Dr. Holohan said, we are looking at an analysis of incidents across the system because while they are tragic, requiring some issues be managed for individual patients and families, they provide significant learning for the system. The international patient safety science field is about learning from patient safety incidents as quickly as possible, rather than over a year or two years, and acting as quickly as possible. This is something we need to focus on in our healthcare system.

As the chief medical officer said, we have introduced a number of national clinical guidelines on foot of major patient safety events. In addition to the early warning system, sepsis management has reduced mortality rates across all inpatients and the clinical handover is another clear patient safety measure. The patient safety licence system gives us a real opportunity to ensure these measures are fully integrated across the whole system so that the public can be reassured. Every month, patient safety statements will be published for everybody - the public, hospital staff and clinical governance within hospitals - to read.

We fully accept that we need to develop these systems much further within the private sector. We have engaged very strongly with the private sector on the national clinical effectiveness committee and the sector has agreed, in principle, to implement the national clinical guidelines. One of the current audits is of radiology and we have discussed how it can be implemented with both the private and public sector. The first clinical audit was the trauma audit and that has contributed to the development of trauma strategy.