Mr. Stephen Mulvany:

There are two parts to this. The first, which the Deputy raised and is the most important, is trying to make sure we are managing the risk and reducing it for patients and service users. We are very significantly focused on that. The State Claims Agency, in fairness, has given us great assistance in that. We seek to focus on making sure that we log and report incidents and that we investigate them, seek to learn the lessons and respond. Specifically, in the case of a subset of the incidents that are driving a disproportionately large amount of the annual payment that the State Claims Agency makes and we reimburse - the catastrophic birth cases - we have established under the chief clinical officer a separate central team which works with maternity units when they have these tragic cases to see what can be done differently and what lessons can be learned. That is despite the fact that the incidence of those catastrophic cases, which are individual personal tragedies for the families involved, is in line with international norms for developed western economies. We still would like to reduce it and reduce it further.

The second part is that the State Claims Agency, under its own legislation, is the indemnifier for the State. As well as providing risk management support to us, which is excellent, it also has to seek to progress the claims. We discussed that with Deputy Catherine Murphy. It does not itself control the legal process in which it operates. I understand that there are efforts to streamline elements of that legal process. The evidence to us is that the increasing level of costs appearing in our accounts for reimbursing the State Claims Agency and the increasing noted contingent liability around future costs of claims are not being driven predominantly by the volume of claims increasing or the severity of claims. They are being driven by the legal process and increases in the cost of processing, completing and paying out claims. It is not the piece that we predominately can influence but the piece that relates to the legal process.