Department of Health update on response to Inquiry into Hyponatraemia-related Deaths

Date published: 30 March 2018

The Department of Health can confirm that concrete steps are being taken in response to the public Inquiry report on Hyponatraemia-related deaths.


These include the establishment of a Departmental staff team to take forward work on the Inquiry’s recommendations.

Dr Paddy Woods, Deputy Chief Medical Officer, is the team’s Programme Director and is reporting directly to Permanent Secretary Richard Pengelly on its work.

Dr Woods and the staff team will be supported by a Programme Management Group.

It is planned to liaise regularly with families of the children whose deaths were the focus of the public Inquiry.

The Department will also deliver on its commitment to engage and work with a wide range of stakeholders as we co-produce new arrangements capable of meeting the expectations of the Inquiry Chairman.

The Chief Executive of the RQIA will lead an independent assurance process overseeing implementation of the recommendations. This will be based on the need to ensure that recommendations are implemented on a sustainable basis.

In line with the Inquiry recommendations, progressing work on the establishment of a legal duty of candour will be a key priority. The Department is developing options papers to inform meaningful engagement with service users and other stakeholders for a Duty of Candour both on organisations and individuals.

Detailed work has already been undertaken regarding the recommendation that an Independent Medical Examiner service be established.

Ultimately, Ministerial approval and legislation will be required to deliver a permanent solution for both a duty of candour and the establishment of an Independent Medical Examiner. Significant work will be carried out to scope these and other recommendations and to draft options for implementation. 

Many of the Inquiry recommendations can and will be taken forward without the need for legislation.

Health and Social Care Trusts have been required to set out in writing their arrangements for oversight and assurance of the Inquiry recommendations for their organisations. Those responses have been received and are now being analysed.

In relation to individuals criticised in the Inquiry report, assurances have been received from each of the Trusts in relation to medical and nursing professionals in their employment. In each case, Trusts advise that these staff have either self-referred or been referred to relevant regulatory bodies. The Department will be making no further comment on this matter until due process has been concluded.

Richard Pengelly said: “The Department will continue to focus on the report, but it is also important to consider the recommendations in a measured way. To do anything less would be a disservice to everyone involved - especially the families of the children who lost their lives. 

“We want to closely involve the families in every stage of the process and to assure them on the actions being taken and the priority attached to that work.

“I recently met with three of the families and I am keen that this constructive engagement should continue.”


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