Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

-----if that is okay, to address these issues because I cannot do so in two minutes. With regard to the look-back, the advice to Government and the Government position is being led by many years of domestic and international expertise, which indicates that programmatic audits are learning audits. We know they are now used all over the HSE in all manner of clinical areas every day.

They are used by clinicians to get better at identifying patient safety issues, detecting cancers and so forth. They happen every day. At an informal meeting of the health committee today, there was a briefing at which Dr. Colm Henry, the HSE's chief clinical officer, made the point that anonymised audits were used as standard practice in health systems around the world. The Madden report in 2008 stated powerfully that our public health service had to have these learning or programmatic audits and that we always had to be improving what we were doing. It recommended anonymising audits. We have covered some of the reasons for that.

I accept that there is no perfect answer to this situation and that reasonable points have been made across the floor. The advice at the time was to anonymise the audits. Importantly, the expert reference group that was set up following Dr. Scally's report strongly recommended anonymisation of the audits. The view of the UK's National Institute of Clinical Excellence, NICE, which is held in high regard internationally in this respect, is that audits should be anonymised. I asked officials to examine other countries around the world that were considered to be good at this. What I have heard back from country after country and institute after institute is that these audits should be anonymised.

Probably of most importance is the fact that the WHO will publish a view on this matter early in the new year. Ireland and many other countries are involved in its work. We will wait to see what the WHO says, but the indication I have from my Department is that the WHO will also be suggesting that the audits be anonymised because they are learning audits. We have discussed several reasons for doing this, one of which is that clinicians need access to all of the data. They use aggregated data. Dr. Henry stated that people used a great deal of different information. It may be information that no one sought consent for or information that we do not need today but clinicians decide in five years' time is useful. It means that the people running the audits and our doctors have access to the widest possible amount of information so that they can provide the best quality service for patients.

There are other reasons. Deputy Shortall asked whether we had a sense of whether patients who were given the choice in the UK actually wanted a review of their slides. I believe the officials stated that approximately 40% to 50% of women said "Yes". Critically, the other 60% or 50% did not. If we conduct audits on an ongoing basis - they should be done across the system every day - and we do not anonymise them, the patient must be told if discordance and errors are found. However, approximately half of those patients might never have wanted to know that information. This is something that we must balance. There is no perfect answer, but the answer is to put it entirely in the power of the patient.

Everyone has supported the patient review process that is in place. There has been a reasonable request that we amend the Bill to make that mandatory. We do not normally legislate at that level of operating procedure, but we are all aware that there is a unique context to this.

Various Deputies referenced the culture. It is changing. Deputy McDonald asked whether I have faith in a culture of open disclosure. I believe that many important changes have been, and are being, made. In terms of open disclosure and culture, for example, we have this Bill. It will not answer everything, but it plays an important part. Once the Bill is in place in January, the HSE will publish a new national framework. Ms Noeline Blackwell is chairing and leading that work. The HSE's open disclosure policy will be updated in line with the framework and the framework will be cognisant of this Bill. There is a national open disclosure office now when there was none previously. There is also mandatory open disclosure training within the HSE now. I am happy that more than 90% of clinicians have undergone this training, but that figure needs to be 100%. The professional bodies-----

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