I was hoping things had moved on a bit since the Bristol case, and I, for one, was a great advocate for audit, significant event anlaysis etc etc, and I was, at one time, greatly enthused by the likes of people like Aiden Halligan, who told me that he had learnt an awful lot around safety, from the aviation world.
It does mostly rely on self reporting, and I'd have to agree, we've never really got to the point of a "no blame culture," some of us were hoping for. (Although, things are gradully improving.)