Health service culture must change following damning report
It would be difficult to imagine a more damning assessment of senior doctors and managers than that handed down by Mr Justice John O'Hara following his inquiry into hyponatraemia-related deaths.
His report published yesterday - at the end of a protracted and difficult public inquiry into the deaths of five children - marked a dark and shameful day for the health service in Northern Ireland.
The judge's conclusions were absolutely devastating. He found that four of the five deaths could have been avoided and the medical care received fell far below acceptable standards.
As if that was not bad enough, the grieving parents were 'deliberately misled' by consultants and health trust chiefs.
Furthermore, there was a failure to inform both the parents and the coroner about the major shortcomings in the care of these children.
Mr Justice O'Hara criticised what he termed a 'cover up' by some consultants, accusing some doctors of behaving 'evasively, dishonestly and ineptly'.
It is clear from his findings that medical professionals and senior managers were protecting their own reputations and interests.
This report was a vindication of the parents who should not have had to fight long and hard get at the truth of what happened to their children.
These youngsters were entrusted into the care of our health service. Their families trusted the professionals looking after them.
There is an expectation that if something goes catastrophically wrong, then health professionals should be candid about mistakes and ensure that lessons are learned.
It should not have taken a public inquiry for the truth to be told about these deaths. We have to wonder if there had been no media attention in the first place and no inquiry, would the families have ever found out what happened?
It is clear the culture in the health service has to change. There needs to be a culture of openness and transparency, a requirement that errors are admitted and bereaved relatives given the full facts.
As Mr Justice O'Hara said, it is time to put the public interest first.