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"Such is the current media climate that the first three questions a chief executive officer will be asked when something goes wrong is 'Who knew what?', 'When did they know?' and 'What did they do about it?'"

(Sir Liam Donaldson speaking at the annual scientific gathering of the Faculty of Public Health Medicine held in Southport on 25th June 2002.)

"Sometimes it is tempting to avert your gaze from a problem - particularly if it involves confronting deep seated issues within the organisation. To look away is almost always a mistake. The courageous route is to face up to it and resolve it despite the difficulties."

(Sir Liam Donaldson speaking on 'Clinical risk management' at the annual gathering on clinical pathology accreditation held at the Commonwealth Institute in London, 19th March 2002.)

"In the past three years there has been an unprecedented level of public concern about incidents within the NHS in which there have been serious failures in standards of care. Although rare in proportion to the large volume of good health care delivered week in week out, such failures have threatened to undermine public confidence in the NHS as a whole."

(Sir Liam Donaldson writing in Journal of Epidemiology and Community Health 2001; 55:371-372.)

 "Society has always been concerned about those areas over which it has no real control. The health service has largely been free over the years of that control because of the extraordinary degree of trust vested in it. What reassurance can we give our public - the stakeholders in the NHS that the trust is being honoured and that this will get better?"

(Sir Liam Donaldson speaking on the subject 'Whistleblowing and clinical governance' at the BMA/BMJ Conference - Whistleblowing: Changing the way we work held at BMA House, Friday 10 December 1999.)

 "Beyond simply being able to deal with complaints sympathetically or respond to the results of patient or user surveys, the Medical Director must genuinely be able to put herself/himself into the shoes of patients and see services through their eyes. This external focus is vital and it is so often missing when organisations fail."

(Sir Liam Donaldson speaking on the subject 'Tomorrow's medical director' at the Ninth Annual Conference of British Association of Medical Managers (BAMM): Clinical Governance in Action, Sheffield, 2-4 June 1999.)

 "Ultimately the focus of attention in dealing with poor clinical performance must be on prevention and early detection as much as having mechanisms to deal with the consequences."

(Sir Liam Donaldson speaking at a conference on the development of surgical competence on clinical performance and priorities in the NHS, organised by The Smith & Nephew Foundation and The Royal College of Surgeons of England, at The Queen Elizabeth II Conference Centre, Westminster, Tuesday 2 November 1999.)

 "Despite the enthusiasm and commitment to quality improvement by health services and health professionals over the past decade, public confidence is still very susceptible to media coverage of problems in the delivery of health services. Thus, reports of inquiries into lapses in standards of care in particular hospitals often recount a catalogue of failures in management and clinical leadership as well as errant individual behaviour. Worse still is the enormously negative public impact of recurrences of similar failures, giving an impression that health services are unable to correct problems reliably and conveying a sense of history repeating itself."

(Sir Liam Donaldson writing in the Journal of Epidemiology and Community Health 1998; 52: 73-4.)

 "The existence of a whistleblowing charter is reassuring to the public at one level but when the whistle does blow - perhaps late in the day - it will always be seen with a 'surely it didn't have to come to this' view."

(Sir Liam Donaldson speaking on the subject 'Whistleblowing and clinical governance' at the BMA/BMJ Conference - Whistleblowing: Changing the way we work held at BMA House, Friday 10 December 1999.)

 "It is particularly important that difficult decisions are not ducked regularly. Someone who averts the gaze or opts for a quiet life gradually loses the respect of her or his peers. So too does someone who undermines senior colleagues, plays games, manipulates or who is not corporate or loyal to the organisation."

(Sir Liam Donaldson speaking on the subject 'Tomorrow's medical director' at the Ninth Annual Conference of British Association of Medical Managers (BAMM): Clinical Governance in Action, Sheffield, 2-4 June 1999.)

 "In any health care system, a small proportion of the medical workforce will pose problems arising from their practice or conduct. This will raise complex issues which are difficult to deal with. It is important that these are faced up to and ways are found to manage the problem effectively."

(Sir Liam Donaldson writing in Problem Doctors: a conspiracy of silence. Lens P, Wal G van der (Eds). Amsterdam: 10S Press, 1997.)

 "In dealing with disciplinary problems among doctors - here are some guiding principles:

(Sir Liam Donaldson writing in the British Medical Journal 1994; 308:1277-82.)

"In the small relatively closed society which comprises a hospital workforce, there are few issues which arouse greater consternation, tension or anxiety than the doctor whose competence, conduct or performance is causing concern. Such problems pose conflicts and dilemmas which strike at the heart of the caring ethos. How to balance the safety of patients against support for a colleague. How to sustain teamwork and morale when one member of such a team is mistrusted by the others. How to share a concern when to do so might be seen as disloyal or vindictive to another member of staff. All these issues, and more, confront those who would seek to develop effective mechanisms for dealing with doctors with problems in a hospital workforce."

(Sir Liam Donaldson writing in Problem Doctors: a conspiracy of silence. Lens P, Wal G van der (Eds). Amsterdam: 10S Press, 1997.)

 "People do not necessarily expect a happy ending to a controversial situation ..but they do expect a return to stability."

(Sir Liam Donaldson writing in the British Medical Journal 1995; 310:104-7.)

 "The most difficult and time-consuming cases to resolve were those in which a doctor's attitude and behaviour was disruptive or highly unreasonable. So serious did this become in some of the cases I describe that clinical departments were almost brought to a standstill. The resulting poor communication, the absence of teamwork, the atmosphere of hostility, and the poor morale could not, in my view, have been other than detrimental to patient care."

(Sir Liam Donaldson writing in the British Medical Journal 1994; 308:1277-82.)

 "A solution must be found which introduces greater flexibility, less confrontation, and more openness, as well as striking an appropriate balance between professional self regulatory and employer based mechanisms for dealing with problem doctors."

(Sir Liam Donaldson writing in the British Medical Journal 1994; 308:1277-82.)