Mr. Stephen Mulvany:

I will try to address some of the funding questions. There is absolutely an audit of mental health spending. We have an internal audit, so mental health is just as likely as any other service area to be subject to an internal audit that would yield a report with recommendations, actions and follow-up. Separately, we are held accountable through external audit by the Comptroller and Auditor General, and again mental health is as likely as any other spending area to be subject to external audit by the Comptroller and Auditor General. There is audit and accountability around mental health funding. Our annual financial statements cover the total cost of mental health spending and those statements are audited, with the report coming through the Committee of Public Accounts to this House. It is part of the accountability line. We are also accountable to the Department of Health and we publish a financial and activity report every quarter that includes mental health detail, although I accept it is not at the level sought by Deputies.

To answer the question of whether we know where the money goes, we do. Perhaps I was not articulate enough in demonstrating that we do not yet have a system that allows us to run a routine report and gather separately all the child and adolescent mental health services, CAMHS, or all age costs. On a monthly basis we produce data that allows us to see outputs. A Deputy asked that question but I will let colleagues speak about outcomes, as we are a little bit away from reporting outcomes. We can see outputs in terms of activity that is going through community-based teams. We can see the number of people being admitted to CAMHS units. We can see what the money is doing, measured by limited enough ICT data that we have around activity. We have measures of activity for all our community teams across the different specialties.

We have periodically examined how many clinical staff we have in each clinical team across the various community health care organisations, CHOs. There is a head of finance in each of the CHOs and it supports the management team, including the head of mental health services and the executive clinical director for mental health. There is greater visibility at a local level and we can, as required, gather specific data on most of the different ways people might want to examine the mental health spend. We have not yet got the capacity where that is all sitting in a single system with a single reporting tool in order that we can run routine reports readily. That is the subject of many discussions in different committees in this House and I am thankful it is being addressed. There is investment going into financial systems in the HSE. The HSE is 12 years in existence and still does not have a single integrated financial or human resources system. It certainly does not have a single integrated mental health system or electronic health record, EHR, for mental health.

We set out each year our requirement for both capital and revenue. Deputy Harty asked a question at the start that I did not get a chance to answer but I will do it now. In the A Vision for Change plan, one of the strongest elements was that it sets out a requirement that is population-based. Regardless of whether people want to update the specifics inside, it sets out a resourcing requirement for both staff and units in terms of physical capacity. I disagree with one comment that was made in that part of the provision of mental health services goes on in buildings that must be up to standard and safe. We must house the staff that we are trying to recruit.