Ms Anne O'Connor:

The reason we can say it is in excess of €500 million is that we have made ten-year capital projections across the HSE, although they are not specific to mental health services. The need for capital health funding has been a significant topic of discussion and within it we have captured the requirement for mental health services. That is how we derived the figure.

Before I ask Ms O'Neill to speak about recruitment and pay, I will refer to how a department works. If one takes acute units in hospitals as an example, there is a line management structure in which the nurses report to a clinical nurse manager at a particular grade who reports to an assistant director of nursing who ultimately reports to a director of nursing. The governance paper we provided at the previous meeting sets out the governance structure for mental health services. Each area has a head of service for mental health, at least one director of nursing - there are several directors of nursing in each community health organisation - and an assistant director. There is, therefore, a tight governance model.

Everyone is a professional and has his or her own professional standards. Passing the buck would not be acceptable to any of us. Everyone has his or her own personal responsibilities and ultimately we have a governance perspective on services. We hold the management teams to account - the chief officer and the heads of service - and each CHO has its own management team. There is not a variety of management teams, but there are many types of mental health team within an area. The management teams are not significant. There is generally a head of each discipline. For instance, there are a number of directors of nursing; there will be a manager for the occupational therapy service, one for the social work service and one for the psychology service and that would be it. The lack of middle layer managers in any of the allied health professional grades provides a challenge for us. There is a very flat structure for the allied health professionals. The nursing service has directors, assistant directors and different grades of clinical nurse manager, but the allied health professionals do not. One often has a single manager with a variety of basic grade and senior staff. We are trying to look at management teams.

Psychologists and psychiatrists are different staff. A Vision for Change sets out the construct and make-up of a multidisciplinary team. All teams are led by a consultant psychiatrist. It is included in A Vision for Change and we work with it. There is at least one, possibly two, consultant psychiatrist, depending on the size of the area involved. There are non-consultant hospital doctors, psychologists, occupational therapists and so on, but they are from different disciplines who train in a different way and have different qualifications. Even within the psychology service, there is a breakdown, with clinical and counselling psychologists. Part of our challenge is that A Vision for Change specifies a clinical psychology service. We believe there is a significant role for counselling psychologists in primary care and employ them in the national counselling service. We are looking at how we can employ more throughout the services we provide. Again, we are working with a policy that has set a particular direction, but it is being reviewed. We hope some of these matters will be addressed.

I ask Ms O'Neill to speak about agency staff and so on.