Time for a statutory duty of candour

Sir, – Our politicians, particularly in Fine Gael and Fianna Fáil, are being disingenuous when they wring their hands and lament the appalling situation that many women now find themselves in as they await further tests and diagnosis for cervical cancer.

For the past two years, the issue of open disclosure and a statutory duty of candour has been discussed by various committees and stakeholders in the Dáil and Seanad.

Despite many loud and clear voices calling for such a statutory duty to be enacted, the presentations made by the Department of Health insisted that such a duty should be voluntary.

Yet substantial evidence from all over the world shows that such voluntary systems are doomed to failure, despite significant resources and efforts expended on schemes in Australia, Canada and the US. It took the Mid-Staffordshire scandal and the hard-hitting Francis inquiry and report in the UK to force the British parliament to enact a statutory duty of candour in 2014 .

In July 2017, Clare Daly was the only TD to recognise how this issue was being “slid past” the Oireachtas Justice Committee stage by political manoeuvring; she tried to hold the Government to account, succeeding in an 11th-hour amendment to the proposed Civil Liability Amendment Bill, making open disclosure mandatory.

She was the only TD who took the trouble to inform herself accurately of the international research and evidence, and advocate on behalf of both patients and doctors.

While patients are of course the primary victims, it has long been recognised that medical teams are the “second victims” of medical errors and cover-ups, and often suffer devastating long-term psychological consequences. When the Civil Liability Amendment Bill came up for a final vote in November 2017, Clare Daly was stymied whilst presenting this evidence by “procedural gameplaying”. Fine Gael TDs then unanimously voted against the amendment, and Fianna Fáil TDs (many of whom had called for transparency and honesty on behalf of the HSE, and a statutory approach to be introduced) unanimously abstained. This was a shameful response to such an important issue on behalf of our elected representatives, whose duty it is to legislate in our best interests.

The HSE policy of voluntary open disclosure, while well-intentioned, is sadly ineffective, due to inadequate resources and training at all levels. Careful reading of the review of the programme by Dr J Pillinger shows that the impact of the policy is minimal. International experience reflects this outcome in other jurisdictions.

How many more scandals, tragedies and deaths do we need to witness before our legislators, the Department of Health and the State Claims Agency have the courage to do the right thing both ethically and morally and introduce a statutory duty of candour that would be in the best interests of both patients and doctors? – Yours, etc,


Dublin 1.

Sir, – In light of recent revelations, it behoves the Department of Health to provide a thorough explanation as to why it advised the Minister for Justice to abandon plans to make disclosure mandatory.

The Department of Health should also disclose whether the lobbying of any vested interest groups played a part in their decision. One wonders was the opinion of any patient groups taken on board when making this decision?

The immediate implementation of a statutory duty of candour is the only credible action now available. – Yours, etc,



Dublin 18.