Sir, – Perhaps Robert Watt, the former secretary general at the Department of Health, was being ironic when he spoke about the problems of blame culture (“‘Gotcha’ blame culture must end if key projects to be delivered faster, says Robert Watt”, July 24th). He said: “If we’re going to do things quickly and take risks, we have to have an acceptance that some things will go wrong. But we have to have a culture which learns from that as opposed to a culture which is about blame and pointing the finger.” Watt has reason to know about the exorbitant cost of a blame culture. During his five years heading up the Department of Health, the State Claims Agency (reporting to the Minister for Finance) paid out €1.8 billion mostly in healthcare claims. This sum comes from the overall health budget, controlled by the Department of Health. It is a culture that costs patients dearly.The money paid by the State Claims Agency over that five-year period was enough to fund the current national Speech and Language Therapy workforce for the next 15 years. Or to build a hospice in every county in Ireland. Undoubtedly, people who are harmed when things ”go wrong” – to borrow Watt’s phrase – ought to have their costs covered. The system should provide psychological safety and interrogate why things didn’t go well, learning ways to improve. However, in the health service that he recently departed, there is little freedom from finger-pointing. Hence, the escalating cost of claims.As we do not have a no-fault scheme in healthcare, we are confident that the finger will be pointed vigorously. This has ramped up defensive clinical practice, where extra tests and assessments are ordered to build protection against future blame. Defensive practice adds to the cost of any project, including healthcare.Like the planners, architects and engineers that Watt refers to, healthcare professionals frequently act quickly. The situation is often changing as we make decisions. But experience has shown that we will be blamed at every stage by experts (often from another jurisdiction) who will coolly pick over the details long after the events occurred.It is heartening that senior officials exiting the Department of Health have such a keen awareness of the blame culture. This proposed new approach to delivering public services is welcome.Meanwhile, in the health system there remains an outstanding liability of €5.4 billion to settle cases where blame has been established in the care of patients. The high cost of adversarial finger-pointing must be taken from the budget that the State will allocate to care for its people.Watt is correct, albeit a little late, to call for less blame and more learning in how we do things. – Yours, etc,DR SUZANNE CROWE,Ranelagh, Dublin 6.