Dr. John O'Mahoney:

As my colleague said, we have a 24-hour emergency service. The service is operated from 9 a.m. to 5 p.m. in each area and after 5 p.m. it is located, as are most emergencies in the mid-west, in University Hospital Limerick, where a consultant, a NCHD and crisis nurses are available.

With regard to 16 to 18 year olds, only one of all our CAMHS teams is not in a position to manage all the 16 to 18 year olds. It is in Nenagh. All the rest of our teams manage the 16 to 18 year olds. As Deputy Carey pointed out, we now have two CAMHS teams in Clare, which is within decimal points of the A Vision for Change requirement. They account for 117,000 people. We were lucky enough to be able to attract a consultant psychiatrist and, as a result, we have now attracted other allied health professionals. The difficulty we have with recruitment is a difficulty that exists both nationally and internationally. We are competing with other countries to recruit people. I spent 19 years of my professional life working abroad and I have been back here for 12 years. In fact, I ended up in my current position because I felt that I might be able to put whatever experience I had gained abroad to use in helping us to adapt to providing a service for a small nation with limited resources.

Notwithstanding Senator Feighan's comments about the public purse, there is no getting away from the fact that 6.6% of general health funding is less than half of the funding in all northern European countries and a third to a quarter of that of most of those countries. As a result, we have difficulty filling our teams. When I meet colleagues of mine who are working abroad and ask if they will come back they ask, "Will I have a full team?". I tell them we are getting there, but they are the difficulties in recruitment and retention. One of two colleagues I worked with in Limerick has been doing one of my former jobs in Canada for the past six years, probably better than I did it by all accounts. These are the recruitment issues we face. It is about morale and ensuring we have these teams. While A Vision for Change is the benchmark, in some ways it may have been a little aspirational. Nonetheless, if one compares the amount of funding and the number of staff we employ with their equivalents in the rest of northern Europe we are far behind. That creates difficulties and there is no way around that.