Official Report: Minutes of Evidence

The Chairperson (Mr McGuigan): I welcome Dr Patricia Donnelly, chair of the inquiries implementation programme management board; Mr Brian O'Hagan, health and social care (HSC) leadership centre and personal and public involvement (PPI) adviser; Mr Robbie Davis, director of healthcare inquiries oversight directorate; Mr Kieran McAteer, director of quality, safety and improvement; Mr Vincent Ramirez, who works on the infected blood inquiry (IBI) in the healthcare inquiries oversight directorate; and Michael O'Neill, head of independent medical examiner (IME) service policy branch. Thank you all very much. You can give us a quick overview, and then we will ask questions.

Mr Robbie Davis (Department of Health): I will make a start. Good afternoon, and thank you for giving us the opportunity to speak with you today. I am director of the healthcare inquiries oversight directorate in the Department. My colleague Kieran McAteer, director of quality, safety and improvement, is also in attendance. We are supported by Vincent and Michael, who will cover aspects of the infected blood inquiry and duty of candour respectively. Also joining us today are two independent members of our programme management board, Dr Patricia Donnelly and Brian O'Hagan. My colleagues and I will take this opportunity to provide you with an update on the work of the Department's inquiries implementation programme management board. We will also do our best to answer any questions that you have relating to the implementation of public inquiry recommendations under the coordination of my directorate.

I would like to start by recognising the individual patients and families who are at the heart of each of the public inquiries that we are discussing. Behind each inquiry, there are a great many individuals, patients and their loved ones, who have come to grave harm as a result of failures in our healthcare system. Those individuals and their families remain at the forefront of our mind.

Our key objectives in overseeing the implementation of these inquiry recommendations are to enhance patient safety and to restore public confidence in our healthcare system. A written briefing was provided in advance of this update session, and, hopefully, that has provided you with sufficient background material. In order to avoid repeating the content of that paper, if you are in agreement, Chair, I will take the opportunity to highlight a few key points.

The Chairperson (Mr McGuigan): Go ahead.

Mr Davis: In my most recent verbal update to the Committee, I provided an overview of the governance arrangements of the inquiries implementation programme management board, including the co-design and assurance arrangements. You may recall that I highlighted our intention to provide a consistent departmental approach to the alignment, engagement and assurance requirements relating to the implementation of inquiry recommendations. The programme board and governance approach have been designed to accommodate all relevant healthcare inquiry reports with a Northern Ireland dimension. That includes NI-specific and UK-led inquiries and reports such as the infected blood inquiry and the Cumberlege and Hughes reports. On the publication of their respective reports, it is intended that the recommendations arising from the urology services inquiry (USI) and the Muckamore Abbey Hospital inquiry will also fall under those governance arrangements.

You will likely already be aware of the fact that a thematic approach has been adopted to ensure that the commonality across inquiry recommendations can be readily identified and to provide a cohesive approach to the delivery of the intended outcomes. As further inquiry reports are published, their recommendations will be considered in the context of the extant themes and work streams in order to make the most of our opportunities to build upon systems learning. In order to be most effective, it is essential that inquiry recommendations are considered in the round and not in isolation. From the outset of the process, it has been our intention to ensure that those individuals who are adversely affected by the failings in patient care have the opportunity to shape the practical implementation of the reforms that public inquiries identify.

I take this opportunity to draw your attention to appendix 1 in your briefing pack, which provides the report on the involvement of the independent neurology liaison group in the independent neurology inquiry (INI) implementation programme. I am greatly encouraged by the finding that the collaborative approach was not symbolic and, indeed, that it transformed the work from a compliance exercise into a reform process that was anchored in real-world impact and ethical accountability. That was made possible thanks only to the trust that was placed in the Department by former patients of Michael Watt and by family members of former patients, who embarked on that journey in good faith and, consequently, made a transformational impact.

The independent neurology liaison group was established to enhance the Department's co-production model, placing the lived experience of patients, families and carers at the heart of scrutiny and decision-making. The group's work aligned with the work of the assurance subgroup to further enhance feedback from the service users, carers and families on the assurance process and implementation programme. The group consisted of 14 members, comprising patients and family members of patients. The group's work has been completed, with assurance frameworks now in place for each of the 76 neurology inquiry recommendations.

Members of the group recommend that the approach of seeking and embracing the lived experience of service users and their families prior to the implementation phase of future inquiry recommendations be adopted as standard practice. I am confident that the co-design approach that was taken with the group provides a blueprint for how we can ensure that patient and family voices are represented in the implementation of future inquiry recommendations. I am very grateful that Brian O'Hagan, co-chair of the group, is present today to take any questions that you may have on that approach. On behalf of the Department, I extend my sincere thanks to Mr Tom Ward, who also co-chaired the group and who is not present today.

I will move on to a few key points about the neurology implementation programme. You will be well aware of the fact that the neurology inquiry report was published some three years ago. The 76 recommendations therein identified a series of requirements to improve patient safety requiring action from not only the Department but the GMC, healthcare organisations and the independent sector.

I advise you that the current position regarding the neurology implementation programme is that 57 out of the 76 neurology recommendations have been verified as having been implemented. That followed a review by the independent neurology liaison group, scrutiny by the assurance subgroup and approval by the programme board. Eight neurology recommendations are ongoing, with implementation imminent, and are now classified as ongoing and about to be implemented. The remaining 11 neurology recommendations have agreed assurance frameworks and action plans in place. However, those require some further action to be taken before the recommendations can be verified as having been fully implemented. They will be subject to further assurance processes to finalise. I note that one recommendation, recommendation 68, will be deferred until such times as the UK Government have set out the Department of Health and Social Care (DHSC) time frame for the reform of GMC legislation.

I will now briefly touch on the urology services inquiry. The written paper that was provided to you on 10 June included an updated position on the USI, which, as you will know, was established in September 2021 and is chaired by Christine Smith KC. Members will be aware that the inquiry is wholly independent and not accountable to the Department of Health. As such, it is not possible for the Department to provide a timescale for completion of the inquiry. However, as previously noted, we understand that the inquiry team is in the process of writing its report. The Department will, of course, consider the report, its findings and its recommendations when published in due course.

Finally, before I pass over to Kieran, I would like to touch on the infected blood inquiry. You will be aware of the fact that the infected blood inquiry was announced in July 2017 and established as a UK-wide independent public statutory inquiry, with Sir Brian Langstaff KC as the chair. The inquiry published its first interim report in July 2022 and its second interim report in April 2023, which set the framework for compensation. Committee members were last updated on that work in May 2024 as part of a briefing on the Victims and Prisoners Bill, which, following enactment, the UK Government have used as the vehicle to develop the infected blood compensation scheme and establish the Infected Blood Compensation Authority (IBCA) The inquiry report was published on 20 May 2024. It includes 12 recommendations and 58 sub-recommendations that cut across a wide range of policy areas, including quality, safety and improvement, workforce and the culture and working practices of the wider Executive, Civil Service and health and social care system.

Recommendation 1 concerns the establishment of a UK-wide infected blood compensation scheme. The Department's population health directorate has been overseeing the transition from the Northern Ireland infected blood support scheme to the UK-wide Infected Blood Compensation Authority, which will take over legal responsibility for infected blood support scheme payments.

The healthcare inquiries oversight directorate, which I lead, will be responsible for coordinating the Department's response to the non-compensation elements of the infected blood inquiry. As that was a UK-wide inquiry, the Cabinet Office has led the comprehensive response to Sir Brian's recommendations, and departmental officials participate in four-nation working groups to ensure that a joined-up approach is taken insofar as possible. As such, some of the recommendations are being taken forward on a UK-wide basis. That is the case for recommendation 2, which will see a UK memorial committee being set up to provide a steer on what memorials should be provided and where, including in Northern Ireland.

Recommendation 3, which aims at ensuring that the learnings from the inquiry are fully embedded in clinical practice and training, is also being taken forward on a UK-wide basis, with the General Medical Council leading on its implementation. There are, however, regional considerations in that work. In contrast, recommendation 4, which concerns the introduction in Northern Ireland of a duty of candour in healthcare, is being taken forward by quality, safety and improvement directorate colleagues. My colleague Kieran will explore that with you in more detail shortly. Members will be aware, however, that recommendation 5, which seeks to expand such a duty to civil servants and Ministers, was referred to the Executive in December 2024, and the Department of Finance is now leading on its implementation.

Other recommendations will also mostly be implemented regionally under the leadership of departmental officials or health and social care partners. An IBI regional group that is made up of representatives from HSC trusts, the Northern Ireland Transfusion Committee, the Northern Ireland Blood Transfusion Service and relevant policy and professional leads will advise the Department on the best approach to implementation. The IBI regional group members provide progress updates on their respective work areas. Those updates have been conveyed to inform the UK Government's response to the IBI statements, which were published in December 2024 and May 2025. The regional group will be central to the assurance process, particularly in identifying the areas of current practice that already meet the requirements of some recommendations and, crucially, where gaps exist that need to be addressed. That will be considered at the next meeting of the inquiry's implementation programme management board. Stakeholder outreach and involvement are key to that work. An infected blood stakeholder group consisting of representatives from infected and affected communities and families in Northern Ireland was set up in 2023 and has been meeting regularly since then to impart its views and perspectives.

Finally, members will also be aware that the inquiry held additional oral hearings on 7 and 8 May 2025 that focused on the timelines and adequacy of the UK Government's approach to compensation. An additional report was published on 9 July formulating 26 recommendations on compensation that are aimed at providing faster and fairer compensation to victims. Those are being taken forward by population health directorate colleagues.

I would now like to pass over to my colleague Kieran, who will provide his opening remarks.

Mr Kieran McAteer (Department of Health): Thank you for the opportunity to provide an update on the implementation of recommendations from the inquiry into hyponatraemia-related deaths and provide only a brief overview of the background, as I know that members are aware of that, and then an overview of ongoing work.

In January 2018, Sir John O'Hara published his inquiry report, which examined the death of five children in hospitals in Northern Ireland. The report made 96 recommendations, comprising 120 separate actions. Chair, I know that, today, we will focus on the implementation of the recommendations, but I think that it is important to acknowledge and remember the origins of the work, which was to address the failings that led to the tragic death of those young children who, along with their families, were so badly let down.

The Department established an implementation programme to address the 120 actions. That work was paused in March 2020 due to the pandemic and was recommenced in 2021. The current position is that 70 of the 120 actions have been implemented. Of the remaining 50, 15 relate to duty of candour and being open; four relate to Regulation and Quality Improvement Authority (RQIA) functions that relate to duty of candour and the serious adverse incident (SAI) process; 21 relate to the serious adverse incident process, which we spoke about last week, Chair; one relates to the establishment of an independent medical examiner; seven relate to workforce actions; and two relate to issues around criminal negligence and litigation.

I will start with an update on the duty of candour. Members may have had an opportunity to read today's statement from the Health Minister on the duty of candour proposals on, first, plans for an organisational duty of candour for Northern Ireland healthcare bodies and, secondly, the Public Office (Accountability) Bill, which was introduced in Westminster last Tuesday. Subject to agreement, that Bill will place a statutory duty of candour on all public authorities and officials, including those working in healthcare, to perform their functions in the public interest with candour, frankness and transparency. I will provide some details on each piece of legislation.

The first piece of legislation is the organisational duty of candour for Northern Ireland, which will be a stand-alone piece of legislation for Northern Ireland only. In high-level terms, an organisational duty will place a legal obligation on health and social care organisations to act with transparency and honesty when there has been an unintended or unexpected incident that results or could result in death or harm. Those organisations will also have to ensure that patients and families are informed promptly, compassionately and accurately. The legislation will bring Northern Ireland into line with the other UK nations, where similar duties already exist, and it will deliver on the commitments that were given in response to the infected blood inquiry, which Robbie discussed. The Minister wants the Department to bring forward the legislation as soon as possible, and he has targeted this mandate for that. Officials will develop the policy detail of the Bill over the coming period, taking into account the legislation in the other UK nations and the lessons learnt there.

The second piece of legislation that was set out in the Minister's statement today is the Public Office (Accountability) Bill, which was introduced in Westminster. The Bill is proposed to be UK-wide legislation that covers all public authorities and officials. It has some exemptions for Parliaments and courts. It is intended to ensure that public authorities and officials perform their functions at all times in the public interest and with candour and openness. It is an element of the UK Government's and the Northern Ireland Executive's response to the recommendations of the infected blood inquiry and the Hillsborough and other inquiries.

The Bill that has been introduced will deliver a number of different elements on candour and openness, including that public bodies and officials will have a new duty of candour and assistance at statutory and non-statutory inquiries, coroners' inquests and other investigations. The details of the types of other investigations that might attract the duty have not been described in the Bill; instead, it provides a broad regulation-making power that may be used following appropriate consideration and consultation to define in secondary legislation the types of other investigations that might attract the duty of candour. Public servants will also be placed under new duties of candour relating to their day-to-day work. The professional duties of candour will be set out in mandatory codes of ethics at an organisational level and will be tailored to different sectors.

The Bill also seeks to create a new offence of misleading the public. That offence is aimed at addressing some of the most serious wrongdoing in public services and is targeted squarely at those who aim to mislead the public or cover up the truth. It will not include, for example, accidental mistakes or inaccuracies. Engagement with Whitehall officials and coordination with the Northern Ireland Departments' considerations of the emerging Bill has been led by colleagues in the Department of Finance. The final detail of the Bill has been shared with officials in Northern Ireland in the past few days, and it now requires more detailed consideration and analysis. All Northern Ireland Civil Service (NICS) Departments must engage with their respective stakeholders to assess and understand the full implications of the Bill. It is the same for us in Health and Social Care, and we will, of course, further engage with the Committee subject to the your agreement, Chair. The engagement will inform further advice to the Health Minister in due course.

As I mentioned, it is proposed that the Public Office (Accountability) Bill will be UK-wide. The Assembly's consent will be required in due course for the Bill to extend to Northern Ireland. Given the cross-cutting nature of the Bill, agreement from the Northern Ireland Executive will be required for a legislative consent motion (LCM) to be brought before the Assembly for debate.

The broad policy intent for the Health Minister and the Department of Health is to achieve alignment with the other UK nations on an organisational and individual duty of candour. The Minister acknowledged in his statement today that aligning Northern Ireland with the rest of the UK on a duty of candour brings several strategic, operational and cultural benefits for the Health and Social Care system here and promotes consistency and fairness of approach across the UK.

I will briefly comment on some of the other work. I appreciate that a lot of the detail is in members' packs. We updated the Committee last week on the SAI redesign. Some 21 actions from the inquiry into hyponatraemia-related deaths (IHRD) relate to the SAI redesign. Members will also be aware of the regional Being Open framework. That aims to ensure that individuals in our Health and Social Care system are fully empowered to exercise candour and openness and that HSC organisations have in place the necessary support and systems to enable and nurture a truly open culture. A public consultation on the framework ran for 15 weeks and ended at the end of March 2025. It included nine online engagement sessions with service users in line with co-production principles, and 270 responses have been received. The Department has reviewed the responses and assessed the feedback and recurring themes, and, subject to the Minister's agreement, a consultation analysis report will be published in October 2025.

A writing group has been established to consider the responses to the consultation and to make the necessary changes to the framework, and, again subject to the Minister's agreement to the final document, it is anticipated that the framework will be published in October 2025. That will be followed by an implementation period in which the Department will work with trusts and others to embed the use of the framework. The Being Open framework will complement and support implementation of the proposed legislation on the duty of candour, which I just outlined, and will help to further embed a compassionate, open and just learning culture in Northern Ireland HSC.

Four IHRD recommendations are related to RQIA. They are dependent on the implementation of the statutory duty and the new SAI process. Work will be taken forward under those two work strands. One IHRD recommendation is related to the establishment of an independent medical service or independent medical examiner service. An IME is concerned primarily with three functions: first, ensuring that deaths are appropriately and completely reported to the coroner when required; secondly, reviewing the quality and accuracy of medical certificates of cause of death; and thirdly, identifying any safety and/or governance issues related to deaths and death certification at an early stage. Work to conduct prototypes for a statutory IME service for Northern Ireland has been ongoing since 2020, and that has been a significant undertaking by the Department working with trusts.

Further detail is in the pack, but I will say briefly that the latest prototype started in April 2025 and will identify the implications for reviewing deaths certified in hospital out of hours and at weekends. A final prototype that focuses on reviewing deaths in the community will commence in the new year. Once the full implications of those prototypes have been assessed, proposals for a statutory system can be developed in partnership with the Department of Finance, which is responsible for death registration; the Department of Justice, which is responsible for the Coroners Service; and the Department for Communities, which is responsible for burial and cremation policy. That is a significant undertaking and cross-departmental work that will require the development of new primary legislation and full public consultation, and we will be dependent on resource in the Department.

Hopefully, the breadth and depth of the work that we have set out demonstrates that the implementation of the recommendations remains a clear priority for the Department. Substantive work is under way across a number of policy and legislative areas. Over the next number of months, we will see significant milestones achieved. While the work is clearly challenging and complex — we discussed some of that when talking about the SAI last week — it is also necessary and, with sustained implementation and focus, can help to deliver significant improvements in culture that support openness, learning and balanced accountability across our Health and Social Care system, ultimately leading to improvement in the delivery of care.

We will do our best to answer questions.

The Chairperson (Mr McGuigan): Thank you very much. There was an awful lot of detail in that. It is obviously important detail. In our healthcare systems and public services, we absolutely need a culture, from the organisational and individual point of view, that is all about protecting and saving people and treating them in the way that they should be treated and as we would expect. Obviously, given the number of inquiries that we have talked about here, that has not been the case in the past.

Kieran, I suspect that, with a lot of this, the headline-stealer will be the duty of candour. We have just had a statement from the Minister about that that I am trying to understand. The Minister is saying that he plans to bring forward duty of candour legislation in this mandate from an organisational point of view and that he will engage with Departments across the water on the Public Office (Accountability) Bill, which will deal, essentially, with the duty of candour from an individual point of view. Is my understanding correct?

Mr McAteer: Yes, Chair, that is correct.

The Chairperson (Mr McGuigan): OK. Will the Public Office (Accountability) Bill include workers from the health and social care sector?

Mr McAteer: That is correct.

The Chairperson (Mr McGuigan): OK, that was pretty straightforward. That will obviously be vital and, given what we have discussed today, complicated. The Minister is committing to that legislation before the end of the mandate, but we do not have a lot of time left. Can you indicate when we are likely to see that and when the Committee and the Assembly can start working on it? An awful lot of Members will want to engage on that legislation, and the Committee will want to take it seriously to ensure that it is not rushed and that the outcome is in the best interests of the people whom we serve.

Mr McAteer: With regard to the two separate pieces of legislation, we do not have a definitive project time frame for the Bill on the organisational duty of candour. The Minister has asked that we bring it forward in this mandate, and we will prioritise accordingly. We have the organisational duties in the other nations, so we are not starting from a blank sheet of paper. We can learn from what is already there. We can learn from what has worked well and what can be improved. Reviews have been undertaken recently in England on the implementation of the duty there, and I think that colleagues in Scotland are about to commence theirs. You are absolutely right, Chair, that it is a challenging time frame. It will be introduced in the 2026-27 mandate year, I suspect, but, certainly, the development phase will commence now. As I said, we are not starting from a blank sheet of paper, so we can, hopefully, do that with a fair wind.

We received the full detail of the Public Office (Accountability) Bill in the past few days. The Executive indicated in March this year their agreement in principle for Northern Ireland to be included in the scope of the Bill, but that was contingent on an assessment of all the details and any risks associated with them. That period of engagement with all sectors across all Northern Ireland Civil Service Departments starts now. We in the Department of Health expect to be in a position to come back to update the Committee further, with your permission, some time in October, if that works. As I said, that will be subject to further engagement sectorally, updating the Minister and a decision from the Executive, and it will then be brought to the Assembly to discuss in a legislative consent motion.

Michael, is there any further sense of the time frame as the Bill progresses through Westminster? I may have heard one year. Apologies, Chair, a lot of detail has been coming at us in the past few days.

Mr Michael O'Neill (Department of Health): Yes, I think that the working assumption is a year for the passage of the UK-wide Bill. Where the organisational duty is concerned, another advantage that we have, in addition to the fact that we have organisational duties in the other three nations, is that, across the UK, people are working on the area at the moment because of the infected blood work. Sometimes, when you are playing catch-up in a policy area, it can be hard to engage with other nations, so that should be an advantage in expediting some of this work.

The Chairperson (Mr McGuigan): The duty of candour Bill will go through the legislative process here. Which Department will lead on the Public Office (Accountability) Bill?

Mr McAteer: The Department of Finance has led to date on engagement with Whitehall. There is a cross-departmental working group, and all Departments are represented on that. To date, each of the Departments has a sectoral interest, for want of a better term. We have a focus, for example, on the duty of candour provisions and on making sure that we fully understand them and can break them down. With regard to the full breadth of the Bill, there are other areas that are being more closely scrutinised by colleagues in Justice or in Finance. DOF is leading on the coordination of the inputs, but, now that each Department has seen the full content of the Bill, they will take the work forward in their respective sectors by gathering views and assessing implications sectorally.

The Chairperson (Mr McGuigan): Departments and politicians here can feed into the process. At the end of it, will the Bill come from Westminster, with us being asked to agree or disagree to an LCM without any ability to amend or to have specific legislation attached to it here?

Mr McAteer: You are right to say that the legislative consent motion will be the key vehicle for agreeing it or otherwise. I do not know about the opportunity for politicians here to influence the Bill as it works its way through the Westminster parliamentary process; we can look into that further. The Bill has enabling and regulation-making powers in certain areas that will be brought forward in respective jurisdictions. I do not know the full scope of that or have all the detail; as I said, it came through just in the past few days.

The overall Bill will be a Westminster process and will be subject to a legislative consent motion with which there will be the associated Executive and Assembly debate and agreement. If any regulations were brought forward as a result of the primary legislation, I understand, they would be local or, at least, a number of them would be local.

Do you have anything to add to that, Michael?

Mr O'Neill: The enabling powers provide powers for Northern Ireland Ministers to make regulations to extend the provisions. Statutory inquiries are codified in the Bill. Non-statutory inquiries and the other investigations are where the enabling powers could come in. That is where the local control of those investigations can happen.

The Chairperson (Mr McGuigan): Thank you. Robbie, I want to quickly go back to you and maybe also to Brian about the programme management board. You said that co-design is important, and I agree. Was there any change as a result of the feedback that you received from engagement with stakeholders?

Mr Davis: Yes. Significant changes have been made to the Department's implementation of recommendations on the basis of the input of the members of the group. On that point, it is best that I hand over to Brian and Patricia.

Mr Brian O'Hagan (Department of Health): I am delighted to talk about this, Chair. Initially, liaison groups started as part of the hyponatraemia engagement piece. The families would not engage in that for a multitude of reasons; they were traumatised. The Department decided that it did not want to go ahead without there being some public involvement, so it recruited people from the health and social care world who were interested, such as service users and carers, to be a public voice. They decided that they would work better in that process if they could coalesce as one group and speak across all the programmes. They called themselves a "liaison group", and I was nominated to chair that group throughout that time.

When it came to developing a process to involve people in the implementation of the neurology inquiry, the Department asked me to give it a hand in looking at how it might do that. That was simply a process whereby we asked those affected and their families and no one else — it was exclusive to them — whether they wanted to be involved in the first place. We put a call out through the Patient and Client Council (PCC), the Public Health Agency (PHA) and other agencies through which we knew people would get the message. Initially, 23 people contacted us to say that they wanted to be involved. I met each of them, talked through what people wanted from the process and explained what we could give them from the process. That was a big thing. It was not about changing the wording of an inquiry that had already been recognised but about how to implement each of those things and use their lived experience to identify the knowledge that they could add. The group started off from that process. Fourteen people signed up to it, and the process began.

Patricia Donnelly led the assurance work. That was a separate group that looked at the assurance framework, what would be needed to implement that and where it would work in the system. Early in the process, Patricia recognised that, if she were to take the least complex of those frameworks and work with the group on them, it would build the group's capacity to understand how the health system worked as they went through it. That was because, even though those people were experts in their own conditions and treatments and in how the inquiry affected them, nobody came to the board with full knowledge of how a health service works. An example of that is knowledge about responsible officers. I was asked, "What impact do they have?" and, "How do they work within a system?". As the members of the group were going through the work, they asked me to find a piece of knowledge about something or to tell them how a particular thing worked. That is how we progressed. The Department was incredibly hands-off beyond providing us with the secretariat.

The group nominated one of its members as a co-chair, and we were incredibly fortunate that it nominated a guy called Tom Ward. Tom co-chaired the entire process with me, and the success of it is largely down to his leadership. Tom and I took the views of the group after it had gone through the recommendations, comparing them with the original frameworks and with what, it thought, could happen, and brought them to Patricia's assurance framework group, which was a group of independent people, where Tom and I would argue our group's case for change. That is a long-winded way of telling you how the process worked.

You wanted to know about the exact changes. First, the group changed language. It changed "should" and "may" to "must", making the language proactive and leaving no ambiguity about what people were being asked to do in the system. The second element was to do with understanding the context of patient safety. It came about simply because the group asked, "When we talk about patient safety in this context, what are we talking about?". Patient safety permeated the report and recommendations, but there was no distinct definition of it. There were about five definitions, including one NHS definition, others that were used in Northern Ireland for different things and a World Health Organization definition. After scrutinising the available definitions, the group made the argument that the World Health Organization definition was most robust and would carry most weight. It argued the point at Patricia's group, and the inquiries implementation programme management board then endorsed that as the definition of patient safety to be used in Northern Ireland going forward. That has implications far beyond the INI work. In the Being Human patient safety framework that the RQIA launched yesterday, it is the accepted definition. The group's definition permeates the SAI work that the Committee talked about last week and the Being Open framework

Another significant change that the group brought about was a pivot in the whole inquiry as the recommendations were being written. They were functional and system-oriented before the group realised that they needed to be reoriented towards what the inquiry was all about: protecting the patient. Patient safety should have been the key aspect of it.

Having got a good, robust definition of patient safety into the system, the group looked at a key recommendation on a new quality and safety committee for trusts that would have the same standing as the audit committee and so be incredibly powerful. The group recognised that adding the word "patient" to it would entirely change what the committee would do and how the public would see it. A "patient safety and quality committee" suddenly became a focus for the entire system in realising that we were talking not just about the quality of a system — the functions of or regulations in it — but about protecting people; that was at the core of it.

Those are just the simplest things — if you had your sleeping bags, I could bore you all night about every change — but, if you are really interested, the group asked me at the halfway mark to create a benchmark to show what they had changed, and I wrote a report on that. We concluded the process by writing another report on what the group agreed with that they had changed.

It is important to say that none of that work was done by one group on its own. It was the co-production with Robbie's team and Patricia's assurance group that was the key mechanism for change. That is where the change came together and where the real co-production piece and its uniqueness came from. As a result, the group was shortlisted for a Picker Experience Network (PEN) award for co-production that will be presented on 2 October. The group has had wide reach and impact.

The Chairperson (Mr McGuigan): Brian, that was an informative answer. I am glad to hear that the work is bearing fruit. In all of this, it is important that we learn from the experience of those most impacted.

Although I am chairing the session and have allowed it to run an hour behind time, I will ask the panel, please, to be a wee bit more succinct in your answers.

Mr McGrath: Thank you for the presentation. It was so detailed that, if you asked us 20 questions, I am not sure that we would remember all the facts and figures that it contained.

I have a really quick question. Given the breadth of issues that we have had over the years, where are we in the benchmarking against other jurisdictions and areas? Living here, it feels as though we have had more inquiries, problems and issues — big issues — than other areas. The neurology inquiry was, I think, one of the biggest across the UK. We have a host of issues. Is it the same in other jurisdictions? Do they face a similar number of inquiries in their health services? If we are, unfortunately, ahead of the rest, why do we face so many issues?

Mr Davis: That is a good question. Northern Ireland has had specific circumstances that have led to inquiries being called. The neurology recall was one of the largest in history and certainly the largest in Northern Ireland. Similarly, the urology inquiry was based on the practice of a single consultant. In Northern Ireland, over the past number of years, there have been more inquiries than you would expect. I do not anticipate that being a continuing pattern; indeed, the purpose of the programme board, as I tried to set out, is to draw together the common themes across the inquiries. I imagine that, when future reports are published, they will give us, as a Department, an opportunity to mark our homework and see how well we have learned from the neurology and hyponatraemia inquiries and how successfully we have given effect to their recommendations. We should be reading through improvements, seeing fewer instances of issues and driving down the opportunities for those failures in patient care.

Mr McGrath: You are not the people who created the problems or difficulties; you are the ones who are looking at the inquiries, so that is no reflection on you. I think of cases that have been presented to us on other themes by people who say, "We want a public inquiry" because they have difficulties: for example, the Ladies with Letters. It just feels as though we have an awful lot of problems in our health service that result in inquiries. From the outside looking in, that could make you a bit scared. It is really good to hear that we are scoping out the common themes so that we can apply the lessons to the system and the public can have full confidence.

There is one point that we did not get from you: how do we compare when we are benchmarked against other places? We could have more inquiries because we grant more of them, or we could have more inquiries because we have more issues. You mentioned that there may be specific circumstances that lead to inquiries. What are the circumstances that lead us to have the problems that cause inquiries, and can we fix them?

Dr Patricia Donnelly (Department of Health): There are probably two issues. One is openness: people call for inquiries when they do not trust the response that they have had from organisations. The pivot that we are making in the system is about openness and the expectations that the public and patients should have right from the start of their care and about services acknowledging where the risks are, being more realistic about them and being more open about information when things start to go wrong or there is the potential for harm. Health and social care are not without risks, but, if we pretend that they are, it is a real shock to people when they find that a drug does not work or a surgery does not have the outcome that they expected. The time has come — and beyond — for openness. I hope that, as openness improves and the culture improves, the call for inquiries will reduce.

The Committee will be aware of the Northern Ireland Public Services Ombudsman's (NIPSO) launch of the complaint-handling standards in June. That was about building trust at a very early stage, acknowledging at a very early stage that there was harm or hurt and being open about that. That stops people feeling further harm and hurt. Sometimes people say — Committee members have heard this, as I have — that an apology is not enough, that it had to be dragged out of people, happened too far down the line and did not feel meaningful. We must amend that by building trust from the start, answering all the questions that are asked and following through so that there is an outcome. The fact that the system is now in the implementation phase of that revised guidance will start to improve areas where there are complaints, improve the handling of serious adverse incidents, where things have already gone wrong, and then change that culture completely. People need to be less passive in receiving their care so that they expect more.

There is something about the scale of Northern Ireland. Think about some of the inquiries that have been held here that are yet to report. Those inquiries have been about people who are lone working. Northern Ireland cannot afford to have a whole team of consultants from a speciality or sub-speciality. The risks often lie in sub-specialities. Recommendations 15 and 42 in the neurology inquiry are about how to address the issues with lone working. You need to know when it is happening. You need to mitigate it, control it in every way, monitor it and offer support to the individual who is lone working. If we want to deliver in those highly specialised services in Northern Ireland, we cannot afford — financially or in resource terms — to have more than just an individual working in those highly specialised areas. We need to know that. In other parts of the UK and in Ireland, there are bigger teams; they have the opportunity to offer that because of their population size. We have a vulnerability there, but we would rather have that service than not have it, and that is part of a risk that we have to recognise and try to monitor.

Mr McGrath: That is useful. An element of lone working is that there is no peer observation. There is a certain logic to what you said. The openness is crucial. That point made me chuckle inside, because I remember, when my mother was going through an operation two years ago, a doctor standing there, and it was as if they were reading off a list: "10% may have a complication; 20% may have this; 30% may have something else; and 20% don't make it". I was like, "OK, let's hope we're in the first 80% and not that 20% at the end". That was a great way of detailing exactly what the expectations were for that operation so that, if — God forbid — something were to go wrong, we could say, "Well, we were told at the beginning that those risks were there". That means that you do not become resentful afterwards. That openness in delivering care is important.

Dr P Donnelly: It is also about what the alternatives are. There may be other options. It is about moving away from that paternalistic attitude of the doctor knowing best and it being a case of, "I'm going to tell you what you're going to do". People need to understand the options, and I think that there is more openness around that.

Mr McGrath: Thank you.

Miss McAllister: Thank you very much for coming along today. I was looking at the table that you provided to the Committee in March. That was helpful in giving us an insight into what stage some of the recommendations were at. A lot of my questions will be to do with those, if you do not mind.

I have one question that might be quick to answer. I could not find whether recommendation 30 of the hyponatraemia inquiry, which is about confidential online reporting, has been implemented. When you were last here, in October or November, that had not, I think, been completely implemented. The recommendation is:

When NIPSO was before the Committee, there was discussion of the Scottish model of a whistle-blower guardian. That was a few weeks after you were at the Committee. NIPSO spoke to the importance of that confidential reporting. Where are we on either of those?

Dr P Donnelly: I do not know whether anyone else is going to answer that.

Miss McAllister: The recommendation may be in the neurology inquiry report rather than the hyponatraemia inquiry report.

Dr P Donnelly: No, it is hyponatraemia.

Mr McAteer: It is hyponatraemia. The recommendation is:

I do not have an update on that. I do not know whether any substantive work has been done on that since we were last here. I would need to check some of the detail. We have that marked as "Implemented" rather than "Not implemented". I would need to look at some of the papers. That may predate my time in this role. I do not know whether Brian or Patricia recall. If not, we can certainly come back to you on that.

Dr P Donnelly: I think that there were issues about the speaking-up champions, so that there were opportunities for individuals. Trusts have gone ahead with some of that. The big issue is always about making sure that things are done systematically and there is consistency right across. There has been quite a focus on that. We heard a presentation just yesterday from the Western Trust that I must highly commend. The trust was encouraging whistle-blowing and was seeing a general rise in that. Also, it was tracking an increase in the number of people not holding on to their anonymity. They were prepared to step forward and be named. That is when it really becomes meaningful, because a complaint can be investigated more fully as you are able to track right through and get more information from the individual. There are initiatives.

I would make the point that I have made many times about the hyponatraemia recommendations. Sometimes, when it came to implementation, they were not implemented exactly as written, but they were implemented absolutely as intended. It was a matter of looking at the intention of the recommendation and making sure that the systems were in place. Further work is going on in that space but quite a bit of work is already under way in trusts.

Miss McAllister: I may submit a written question about the review of that to give more time rather than just asking you now.

Mr McAteer: There is a raising concerns policy and whistle-blowing arrangements in place. The Department refreshed its raising concerns policy, I think, only last year. It is active and is monitored by trusts' internal governance. As Patricia said, whether it stipulates the exact wording of recommendation 30 I am not sure.

Mr O'Hagan: The Being Open framework that is coming will build a cultural change around that. That is what has always been the difficult aspect.

Miss McAllister: My next question is about the Being Open framework. Many of the actions from the neurology and hyponatraemia inquiries have not been implemented because of the duty of candour issue or waiting for that Being Open framework. The consultation on the framework closed in March, so where are we with it? With regard to the actual change to the SAIs, your feedback, Brian, fed into the significant changes. The Committee is keen to see the change that that framework will bring, but we do not have information in front of us.

Mr McAteer: As you say, the consultation on the Being Open framework closed in March. We hope to set up a consultation analysis board and updated framework next month, followed by a period of implementation and support with trusts.

The Being Open framework, as you indicated, will be key to the cultural journey around openness. It has been roundly welcomed in the consultation responses. There is broad approval for the intent of the framework and what it is designed to achieve. There is also broad approval for how the document is structured, setting out routine openness with a focus on learning and openness when things go wrong. That latter tier — when things go wrong — relates, as you rightly say, to the SAI process, and the SAI process is big on and clear on a compassionate, open and just learning culture, systems-based learning, blame-free space and psychological safety so that staff can come forward and engage in learning for the purposes of understanding what went wrong, engaging with the family and helping them to understand what went wrong and, importantly, embedding learning. The Being Open framework will focus on those things.

With regard to changes in the SAI process relating to feedback from service users, patients and families, there is a long history to a lot of that work, building on the IHRD work stream and the rich patient and family data that came through the RQIA report. As I set out last week, we have established our own processes as part of the SAI redesign work. We have recruited service users through an open recruitment competition. We have an engagement platform. I think that 30 people applied for that, and three are on our programme structures. The remainder we have engaged with a few times. We have also engaged with the PCC platform, and all that involvement work is set in the context of a wider programme of engagement and involvement across our service with trusts, boards and other stakeholders.

As for how that has translated into the framework itself, the framework and the standards have a core focus on engagement with families, patients and service users in a compassionate and open way, early in the process, in line with their wishes. There is a substantive —.

Miss McAllister: When will that be up and running?

Mr McAteer: We hope to publish the SAI framework in November, and that will commence a transitionary phase. We set out some of the detail last week.

Miss McAllister: On the Hillsborough law, has the Department or the Minister given any feedback on whether they will support the Executive's signing up to an LCM for Northern Ireland? That is passing through Parliament, and it is mostly based on an individual duty of candour. Will the previous research that states that an organisational duty of candour does not work feed into that? A lot of research has said that it does not work. The Hillsborough law, as it is known — I cannot remember the proper name — focuses on a statutory duty. We must be clear that it is not about accidental mistakes; it is about deliberate cover-ups and misleading. How will that inform the Department in deciding whether to go ahead with an organisational duty of candour?

Mr McAteer: There are a couple of things in that. The process to date has been that, in March, the Executive agreed in principle to the LCM. We are now at the stage where the detail of the Bill has come through, and there will now be a period of discussion and engagement. It will be subject to Executive approval and Assembly discussion. We will go through all that.

Miss McAllister: So the Department has not decided yet. Has the Minister decided yet on his view?

Mr McAteer: No, because we received the detail of the Bill only in the past few days. In March, the Minister was content to agree in principle to going along with the Bill, but Minister O'Dowd, in his response on behalf of the Executive at the time, was very clear that a full legislative consent motion would be contingent on an assessment of all the detail etc and engagement at this stage.

We will take forward stand-alone legislation on an organisational duty of candour. As you rightly say, in England, they have undertaken a review of the application of the law. I do not think that they are minded to fundamentally change the legislation at this stage. Those are only interim findings, but there are some lessons to be learned on the application and understanding of the duty, the spirit of how it is applied in practice and the need for compassionate engagement with the families. I understand that colleagues in Scotland are reviewing their duty as well. There is rich learning for us on how we can improve the Bill as we go forward.

Michael, I do not know whether there is anything you want to add to that.

Mr O'Neill: On the point about alignment, the proposal is that the Hillsborough law — the Public Office (Accountability) Bill — will come in across the UK. England, Scotland and Wales already have an organisational duty of candour. On alignment, the combination of those laws will work. That is why the Minister is keen for Northern Ireland to be aligned on both organisational and individual duties.

Miss McAllister: The Bill was laid the other day. I have read briefings from legal professionals on it, and there is not a great deal of commentary on the absence of the organisational duty of candour here. If it is not working in England and Scotland, and if the final report that comes out of the review states that it is so fundamentally flawed that it is still not holding individuals to account, given that we are time-pressured, will the Department take cognisance of that and not move forward with the Bill here?

Mr McAteer: The infected blood inquiry recommended that Northern Ireland bring in an organisational duty of candour, because it is out of sync with the other nations, and the Department has responded to say that it will do that. The Minister has stated publicly that he is not content that Northern Ireland is out of sync with the other nations in that regard. I am not over all the detail. The interim findings from the review in England are not that it is fundamentally flawed, as you indicated there, but that there is absolutely learning about the application. As I say, colleagues in Scotland and Wales are about to engage on that.

As Michael said, the Hillsborough law focuses on public officials and public authorities. As you said, it attracts a criminal sanction as well. We will bring in the organisational duty in line with the infected blood inquiry and we will learn the lessons from the other nations. That is what the Minister has asked for. Indeed, the feedback from the Being Open duty of candour consultation has indicated strong support for an organisational duty of candour.

Miss McAllister: Did it indicate strong support for an individual duty as well?

Mr McAteer: It indicated around 70% support for an individual duty of candour. If I am right, Michael — I apologise, because we have not analysed all the figures — I think that there was also support from Health and Social Care for that. Reservations were expressed, however, and members will have heard from the BMA and other colleagues about the application of an individual duty of candour. All that having been said, the Minister's ambition and that of the Department is to have alignment on the organisational and individual duty of candour, which will be achieved through the Public Office (Accountability) Bill, across the public sector and in healthcare so that they will not go any further or have a less stringent regime.

Miss McAllister: Thank you. That has been very helpful.

Mr D Donnelly: There is a lot of information there, and our questions have covered a lot of areas. It is important to highlight that the inquiry reports and recommendations exist only because of the dedication of campaign groups over many years, on behalf of patients and families who have suffered harm and lost loved ones. We have them to thank for making the health service safer for everyone.

We went through quite a few different themes there. I want to go back to the duty of candour. Is it fair to say that a lack of openness and transparency was a common theme through all the inquiries and that the need for a duty of candour was possibly the most common recommendation?

Mr McAteer: That is a fair comment. Patricia and Brian may wish to come in on that. It is absolutely a theme in IHRD and in the infected blood inquiry, and it may well come up in other inquiries that are still to report. The breadth of work that the Department and the HSC are undertaking in that space, including the SAI framework, NIPSO, the Being Open framework, the Patient Safety and Quality Committee and the implementation of a whole host of other recommendations, alongside the duty of candour legislation, underscores the significance of the issue. It is fair to say that it has come through as a theme in other inquiries.

Mr O'Hagan: Candour is a major issue. A lot of the recommendations focus on things that were already in the system but that people did not do. As processes went through, they omitted to mention that they did not do those things. That is a theme that is not just common in a Northern Ireland context: it is a theme right across the UK. It is people stopping information flows about wrongdoing and patient safety incidents that causes the vast majority of inquiries. There was a question earlier about whether we have more inquiries here than in the other parts of the UK. We probably do, because we are a bit more cautious about getting to the truth and, as Patricia mentioned, because there is mistrust of systems. However, the implementation rate of what comes out of our inquiries here is a lot higher than it is in the rest of the UK. There are things still lying around from the Francis report that have not been implemented. It is not necessarily about how many inquiries you have, but about what you do with the information, how you implement it and how you do that change.

The candour piece has always been difficult. I sat on the duty of candour work stream for IHRD initially, and I was very pro about having them both in place. We put our recommendations to the Minister at that time in the culmination of that work. There is a difficulty around an individual duty of candour. It is recognised that it would set us apart from the rest of Europe, not just the rest of the UK. There is some value in bringing forward the Hillsborough work. All public officials should be accountable in that way, individually and organisationally. Interestingly, when we talked to the INI group about this — Peter McBride talked about the Being Open policy and cultural change — it recognised very much that the organisational duty would have had the most impact for it at that time in holding officials to account for the cover-up and their failure to identify what Michael Watt had done wrong and to admit to the system what he had done wrong in good time to stop any more harm happening. That is the balance of public opinion. It swings both ways. There is accountability for the individual and the organisation, but, as was said earlier, it must be remembered that Justice O'Hara was talking about repeated occurrences. He was not talking about people misspeaking at a time; he was talking about people actively and deliberately going out of their way to attempt to cover something up in a public inquiry or public statements etc. That is the focus. It would also have been the focus of the individual one. He was talking about those individuals in those inquiries. I think that some of that would be covered by an organisational duty anyway.

The Chairperson (Mr McGuigan): I am conscious that we do not want to get into a discussion about the legislation. We will have that conversation as we go through the process. I do not want to stop any of the discussion, but I am conscious that we are running late.

Dr P Donnelly: I will make one final comment. As you have understood it, the duty of candour happens when something pretty catastrophic has gone wrong, but the biggest thing that needs to change is the cultural piece around being open, so that people feel that they can speak up and be curious about what is happening around them. The biggest protection that we have is our staff. The staff can notice when there is a risk and speak up about it before it causes harm. We do not want to have a punitive system that looks only for blame; we want one that looks for learning. We will not have issues with candour if we already have an openness culture.

Mr McAteer: Very briefly, Brian made a good point about the implementation of the recommendations. We are undertaking a lot of activity to implement the recommendations here. I think that a review was undertaken last year in England because, in the English context, they recognised that they had so many inquiries, so many recommendations outstanding and so much overlap. They really wanted to cut through that and understand why that was the case.

I know that we are concentrating on inquiries, and rightly so, but it would be remiss of me not to say that there are thousands of interactions each day across our health service, the vast majority of which deliver good outcomes and good care. Members have acknowledged that on many occasions. The context is inquiries, but that is a legitimate point.

Mr D Donnelly: It is certainly good to hear that the implementation of recommendations is higher here in Northern Ireland. That is certainly something positive that we can take away. However, you can also see why there might be a lack of trust in the system when things go wrong, given that we have had all these scandals and the need for these inquiries. Given what the Chair has said, I have a question about the new offence of misleading the public. I do not know whether you will be able to tell us much today about that, other than that it is coming.

Mr McAteer: Yes, there is provision in the Bill for that. Subject to the necessary agreements, it will apply across all the public authorities and officials that are caught within scope. Michael, do you have anything pertinent to add?

Mr O'Neill: We saw that provision only very recently. It is really meant to focus on misleading the public at a very general level — a very widespread misleading of the public — as opposed to misleading a member of the public on a specific issue. It is the Grenfell and Hillsborough type of issues. If you do not mind, we will focus on the detail of that particular issue in a number of weeks, once we have had the opportunity to consider the detail of the Bill.

Mr D Donnelly: I have one last question about the Being Open framework. When does that go live? When are we likely to see that?

Mr McAteer: We are finalising the analysis of the feedback and updating the framework. We hope to publish in November. There will then be a period of implementation and support with trusts on how they embed and make best use of the framework. We are targeting November.

Mrs Dodds: Just building on Danny's line of questioning, I am interested in the interaction between the Being Open framework and the Bill on an organisational duty of candour and how that will work. There is a lot of talk about the Being Open framework, but the Committee has spent hours talking about the Belfast Health and Social Care Trust and all the issues there. We have had numerous reports, and people in the trust who are responsible for the Being Open framework are working on it, but we do not see a lot of being open, if you understand what I mean. I am interested in the interaction between that framework and the Bill, which would address an organisational duty of candour.

On Monday, I asked the Health Minister about the review of the handover of the maternity hospital that was to be carried out. He said something that was very interesting, which was that — I am paraphrasing his words — the review was not carried out because a member of staff did not cooperate. Again, we are talking about being open, but will some element of the Bill compel staff to cooperate? I genuinely did not quite understand what the Minister was saying. I intend to ask more questions, believe it or not, in the spirit of being open. It seems to me that you cannot simply discontinue a review because somebody did not cooperate. Is that a thing?

Mr McAteer: I will try to answer that, and others might want to join in.

Mrs Dodds: Thank you, Kieran. If you can bring any light to that issue, it would be brilliant.

Mr McAteer: I am not sure that I know the detail of the specific query about the handover of maternity services. The Bill as currently constructed will not deal with that, if we are talking about the Public Office (Accountability) Bill. It will have a duty of candour and a duty of assistance in statutory or non-statutory inquiries or coroner's inquests. There is a provision to set out and define other investigations where the duty might apply.

Mrs Dodds: May I be really rude and interrupt? The Bill is about not a general duty of candour but a duty of candour in specific situations; have I picked that up right?

Mr McAteer: That is correct. As written, the Bill is about a duty of candour in statutory inquiries, which are those higher-end inquires in line with the Inquiries Act 2000; in non-statutory inquiries that a Minister might call; and in coroner's inquests. Again, they are the sort of higher-end, for want of a better term, inquiries and inquests. There is provision in the Bill for respective Ministers to set out other investigations in which they want the duty to apply. There has been no real discussion around what that might mean across the public sector or the healthcare space. There is an enabling power to set them out in secondary legislation, but that will require a depth of consideration, consultation and ministerial discussion with local stakeholders. There is the ability —.

Mrs Dodds: So, sorry, the Bill as constructed is only going to apply at a very high level within a legal process that is already set up. Is that right?

Mr McAteer: Yes, under those provisions as I described them. There are other separate provisions. The Bill also requires —.

Mrs Dodds: I will give you an example, and you can tell me whether the Bill will apply. In the Southern Health and Social Care Trust, 17,500 women had their smear test results recalled. We know that the trust did not correctly monitor the performance of screeners from 2008 until at least 2018. We know that two women have died and that a number of other women have been the subject of SAI reviews because they have now been diagnosed with cervical cancer. How would the Bill treat that?

Mr O'Hagan: I am happy to touch on that one, Kieran.

Mr McAteer: Sure.

Mrs Dodds: It is just so that we can understand the Bill's parameters.

Mr O'Neill: That it is not a statutory inquiry or a ministerial-led inquiry —.

Mrs Dodds: It will not affect it.

Mr O'Neill: It will not. However, Northern Ireland Ministers across the board will have a power under the new law to extend the provisions to the likes of that, if that is what is desired. It is not in the Bill, but it provides a power that we do not currently have, so it gets us to the stage where we could then make secondary regulations, if a Minister in the future wanted to extend the power in those circumstances after consultation with stakeholders etc.

Mr McAteer: I will add two things. First, the organisational duty of candour will require organisations to be candid when there is a notifiable incident. We will define all of the detail of that, but, in the other nations, an incident that has an unintended or unexpected outcome and has led to serious harm or death constitutes a notifiable incident, and there is a statutory to report that to the family and offer an apology. So that type of scenario will be captured —.

Mrs Dodds: That will be captured under the local organisational duty of candour Bill.

Mr McAteer: That is my understanding of it.

Mrs Dodds: What about making individuals comply with the investigation in that scenario?

Mr O'Hagan: That is a live discussion that we have had around neurology and the Being Open work. What you are talking about is at the nub of it. During the INI and IHRD stuff, it was identified that organisations waited for professional regulators to deal with something, as opposed to dealing with it themselves. You have hit exactly what the problem is. The contractual obligations should have been enough to remove someone if they did not cooperate. The whole of the HSC has a value to which all employees subscribe to when they sign up, and that is honesty and openness. It is one of its four core values. Through that alone, an organisation could hold somebody to account and dismiss them on account of the fact that they were not being honest and open.

Mrs Dodds: To be honest, I do not understand what the Minister was referring to, so I am not really that focused on it at all. What struck me was whether we are in a situation in Northern Ireland now where people are not obliged to comply with an investigation. Will the Being Open framework or the organisational duty of candour or the latest from Westminster actually help us to resolve those situations? That is really what I was trying to find out.

Dr P Donnelly: I should say that there are a number of IHRD recommendations that are there to support both openness and duty of candour. That is where organisations will have it explicitly in employment contracts that the individuals have to be candid, and it also covers whether they do not omit information. There is another provision around identifying and cooperating on serious adverse incidents. That is how you start to be able to deal with that at an organisational level and hold the individuals to account. I cannot speak for the current situation that you are describing.

Mrs Dodds: No, I do not really understand it either.

Dr P Donnelly: Very certainly, those things only work when the Bill is enacted, and then the regulator has a part to play. The trusts themselves have a part to play with what they include in an employment contract.

Mr McAteer: I know that we are throwing out a lot of different provisions and standards, but the Westminster Bill has other provisions that are relevant here as well. Under that Bill, public servants will also be placed under new duties of candour in relation to their day-to-day work through codes of ethics:

That is not regulated professionals but a professional duty of candour for staff. It continues:

That is a second tier to that. The third tier is that employing authorities:

There is a number of building provisions there. The organisational duty will capture it, and professional standards already capture it. I do not quite understand, as you said, the context of the other one. There is what Patricia has outlined, and then there are other provisions in the Westminster Bill for professional duties of candour around day-to-day activities and that employers must put a code of ethics in play and must set out the sanctions for non-compliance with that. They are new statutory provisions through the Westminster Bill.

Mrs Dodds: There will be the top level, but there are tiers of levels in the Bill. Will you come back to brief us on the Bill as you get more in-depth information? That would be really important. It is an area that we all want to see. I am sure that everybody on this Committee has talked to and been emotionally connected to people who feel harm. It is really important that we get the information that helps us decipher what the Bill is doing and how it is progressing. The next Westminster election is in 2029, so the legislation has plenty of time to pass, has it not? Anyway, thank you very much.

The Chairperson (Mr McGuigan): Thank you very much. That was a very thorough assessment of very important issues. You will certainly be back, hopefully very soon, Kieran, in relation to the duty of candour and all this other stuff as well.