Following our recent discussion on the distinction between mandatory and voluntary disclosure, it is important to understand exactly what types of incidents trigger these conversations. Under the HSE Incident Management Framework (IMF) and the HSE Enterprise Risk Management Policy 2023, healthcare incidents are categorised by their level of impact.
By categorising these events, the HSE aims to ensure that the response and level of communication with the patient is appropriate to the harm caused.
Statutory Notifiable Incidents
At the highest level of the framework are Notifiable Incidents as defined by the Patient Safety Act 2023. These are the Notifiable 13 incidents that carry a legal mandate for disclosure. When these occur, the hospital is required to follow the formal statutory process described in Section 5 of the HSE Open Disclosure Policy 2025.
Category 1: Major and Extreme Harm
These are clinical or non-clinical incidents that result in the most severe outcomes. The policy requires full open disclosure for these events.
Extreme Harm (Impact 5): This includes the death of a patient, staff member, or visitor, or incidents leading to major permanent incapacity, such as catastrophic neurological injury.
Major Harm (Impact 4): This covers severe harm requiring significant hospital treatment, permanent disability, long-term incapacity, or significant impairment of psychological functioning.
Category 2: Moderate Harm
Category 2 incidents are significant but do not result in permanent harm. They generally require a moderate increase in treatment or care. Examples include:
Unplanned return to surgery or unplanned re-admission.
Transfer to a higher care area (e.g. ICU) due to an adverse event.
Extended hospital stays or impaired daily functioning for up to a month.
Cancellation of treatment resulting in prolonged symptoms.
Category 3: Minor or No Harm
The framework also accounts for incidents where harm is minimal or avoided entirely.
Minor Harm: Often requires only basic clinical intervention.
No Harm: Examples include medication incidents or falls where no injury occurs. The requirement here is for honest, clear, and timely communication. If there is a risk of future harm, a formal discussion under Section 5 is required.
Near Miss: These are incidents where an error was caught before it reached the patient (e.g., a wrong medication identified pre-administration). While they do not automatically require open disclosure, they are assessed on a case-by-case basis to prevent future risks.
Complex Cases: Unknown Harm
In rare cases where harm is suspected but unknown, the HSE must assess the situation individually. To ensure transparency, decisions not to disclose must be agreed upon by a Senior Accountable Officer and at least two independent Patient Representatives or Advocates.
The Objective: Honest and Compassionate Communication
Section 5 of the HSE Open Disclosure Policy is built on the principle that patients deserve a path to truth. The process is designed to be:
Open and Transparent: Providing a timely explanation of what happened.
Patient-Centred: Using a compassionate communication style that recognises the emotional impact on the family.
Accountable: Including a sincere apology and explanation where appropriate.
Crucially, the law provides protections for healthcare staff to encourage this openness, ensuring that an apology or a factual explanation is not treated as a formal admission of liability.
How Whelan Law Can Support You
Understanding whether your experience falls under Category 1 Major Harm or a Category 2 Moderate Incident is vital for securing the answers you need. At Whelan Law, we specialise in navigating the HSE Incident Management Framework to ensure that the open disclosure process is handled with the honesty and transparency you are entitled to.
If you believe a patient safety incident has occurred and want to understand your rights regarding disclosure and accountability, contact Whelan Law today. We are here to guide you through the process and ensure your voice is heard.