IHRD-37

Family Involvement in SAI Investigations

Hyponatraemia Inquiry · Report of the Inquiry into Hyponatraemia-related Deaths · Issued 31 January 2018 · Addressed to: HSC Trusts

Government responseDepartment of Health NI: Accepted (Mar 2021)

DeliveryDepartment of Health NI states no delivery position (Jun 2026)

Recommendation, verbatim from the inquiry

●Inquiry recommendation

Trusts should seek to maximise the involvement of families in SAI investigations and in particular: (i) Trusts should publish a statement of patient and family rights in relation to all SAI processes including complaints. (ii) Families should be given the opportunity to become involved in setting the terms of reference for an investigation. (iii) Families should, if they so wish, engage with the investigation and receive feedback on progress. (iv) A fully funded Patient Advocacy Service should be established, independent of individual Trusts, to assist families in the process. It should be allowed funded access to independent expert advice in complex cases. (v) Families in cases of SAI related child death should be entitled to see relevant documentation, including all records, written communication between healthcare professionals and expert reports. (vi) All written Trust communication to parents or family after a SAI related child death should be signed or co-signed by the chief executive. (vii) Families should be afforded the opportunity to respond to the findings of an investigation report and all such responses should be answered in writing. (viii) Family GPs should, with family consent, receive copies of feedback provided. (ix) Families should be formally advised of the lessons learned and the changes effected. (x) Trusts should seek, and where appropriate act upon, feedback from families about adverse clinical incident handling and investigation.

Hyponatraemia Inquiry, Report of the Inquiry into Hyponatraemia-related Deaths · 31 Jan 2018 Source PDF →

Published evidence summary

AI-generated evidence summary

The Inquiry asked trusts to maximise family involvement in Serious Adverse Incident (SAI) investigations. In June 2026, Minister of Health Mike Nesbitt stated that recommendations relating to SAIs are under active consideration as part of an ongoing departmental programme to redesign the existing procedure (Mike Nesbitt, Jun 2026). The Minister explained that further detail on the extent to which each recommendation will be addressed through the programme will be available once final strategic proposals are agreed (Mike Nesbitt, Jun 2026).

Sources

Mike Nesbitt, Jun 2026

AI-generated summary of the record on this page, checked by a second model and automatic checks, 2 Oct 2026.

About this summary
This recommendation applies across many organisations. The record above reflects central policy activity; adoption in individual organisations may vary.

Report-level response context

The Minister of Health accepted all 96 recommendations together, in one sentence of a written statement to the Northern Ireland Assembly on 25 March 2021. That sentence is not a response to any one recommendation alone, and the Department of Health published no response to each recommendation. The Department's statements of 31 January, 2 February and 30 March 2018 contain no acceptance of the recommendations.

Government response

●Department of Health NI · Accepted · 25 Mar 2021

Words of: Mr Swann, Minister of Health, written ministerial statement to the Northern Ireland Assembly, 25 March 2021

My Department accepts the recommendations of the O'Hara Report in their entirety.

Extract from: Department of Health - Inquiry into Hyponatraemia Related Deaths (IHRD) Implementation Programme Update

Delivery

●Department of Health NI states no delivery position · 20 Jun 2026

The remaining 21 IHRD recommendations which relate to SAIs are under active consideration as part of the Department’s ongoing programme to redesign the extant SAI Procedure. These recommendations are set out in Table 2 below. Further detail on the extent to which each of these remaining IHRD recommendations will be addressed through the SAI Redesign Programme will be available once I have considered and agreed the final strategic proposals.

From: AQW 45206/22-27 (Northern Ireland Assembly written question: IHRD recommendations that reference Serious Adverse Incidents), Mike Nesbitt, Minister of Health (Northern Ireland)

Site note: The Minister's written answer gives this passage once, for the 21 recommendations (counting the parts of recommendation 37 separately) it lists in its Table 2, and this recommendation is one of them. It gives no position on any one of them. Table 2 lists parts (i), (ii), (iii) and (v) to (x) of recommendation 37; it does not list part (iv).

How this page is built

The recommendation and the government responses are verbatim from primary documents. Delivery statements and other bodies' findings are shown in their own words, each with its source. The summary is written by this site and labelled as such. The Index does not paraphrase sources or characterise intent; it records what has been published.