Ms Anne O'Connor:

Mr. Mulvany will answer some of the questions relating to finance and I will answer others.

Deputy Browne asked about accountability and performance. It is important to state that we know where money has been spent. We have access to a whole raft of reports that are produced every month. It is just not broken down by specialties in the way the Deputy is requesting. The HSE has a system of financial accounting that is quite extensive. Any local manager, CHO manager or the division can look into these accounts and see exactly where money has gone. It is inaccurate to say we cannot see where money has been spent; it is just not categorised by specialty in mental health in the way the Deputy is seeking.

Regarding accountability around reporting, we have monthly performance meetings with every chief officer in the country. Finance forms part of those discussions. It is important to balance that with the equally important discussion on quality and safety of services. Ultimately money is related to service delivery and we need to ensure that services are also safe, etc. There is accountability within the CHO dealing with monthly performance. I am also held to account every month in terms of the balanced scorecard in the HSE service plan looking at the metrics that include finance and HR metrics. There is a clear line of accountability right through the system in terms of governance and as Mr. Mulvany mentioned, we are also accountable on an external basis and appear before this and other Oireachtas committees.

On external placement, the cost in 2016 was €40 million. It goes to external placements which are funded from the mental health budget and relate to people who have a specific need that is not met within our own services. Some of the costs could be nursing homes or they could be in very specialist facilities for people. Out of area placements were mentioned previously. They are not all out of area placements, they are just placements that are provided by another provider. That cost has grown by about €10 million in the last three years. It is a growing cost and something that we seek to address through a service improvement initiative, looking at how we can provide better services to people with complex mental health difficulties.

The retraction of funds for Roscommon is a topic that has been well covered previously. The money that came out of the Roscommon budget was never spent on mental health. It was money that had been coded to mental health that was going elsewhere in the system. With the establishment of the mental health division we were able to see that and examine how to use it for mental health. CHO2, where Roscommon sits, is still one of the more highly funded areas in mental health. Kildare is the most poorly resourced part of the country, and it has suffered as a result of not having a psychiatric institution. There is no great legacy value in that area in terms of resources.

We mentioned that our budget was 80% plus pay. There is very little in our core budget that we are able to move around unless we stop employing staff in certain areas. That would mean ceasing to provide services in certain areas.

Our flexibility in recent years comes from our development funding. That allows us to develop initiatives in areas. We seek to look at the areas which are most in need of services. Page 6 of the document on funding which we supplied to members has a list of the types of investments that have been provided in each of those years around our development funding. We have developed new teams across all specialties, opened new acute units in Cork, Drogheda and other places.