Mr. Bernard Gloster:

I thank Deputy Harty and certainly will attempt to capture all the questions he has asked. On key personnel, I may take that as one question with the issue of vacancies in the current 786 whole-time equivalent positions. I will start from there because that is the real profile on the ground. Of the 786 whole-time equivalent positions that we had at the end of November, we had just under seven vacancies in the medical profile, 27 in nursing, 12 in what we call allied health professionals, which would include psychology and the therapies, and 16 in what we call general supports. Dr. O'Mahoney might comment on the clinical impact of that at the end. The impact is partly mitigated in various ways. For example, out of a nursing profile of 366 there are 27 nursing vacancies. We cover an average of 16 of those vacancies with agency staff, so we spend the money arising from those vacancies on agency replacement to mitigate the risk. We also spend it on health care assistants when we cannot get nurses. That is the profile of the 786 staff and the current vacancies.

Psychology is a particular pressure for us. At the present time we have three basic grade psychology vacancies from our normal routine posts and two and a half senior psychologist vacancies. So in total we have five and half vacancies in our regular posts in mental health. We also have a number of vacancies in development posts which we have yet to fill. In terms of what we have on the ground, we have five and a half vacancies. The difficulty for us which I see on the profile is that a number of those in psychology posts will be taking maternity leave this year, which will result in very significant vacancies. The reality is that the replacement rate for clinical psychologists just does not line up with the attrition or absence rate. We have spent a considerable amount of money developing new training places on the doctoral programme in the University of Limerick and in the National University of Ireland, Galway. I manage the funding of both of those programmes for the HSE. We do everything to capture those recruits coming out, but invariably people make lifestyle choices - they travel and so on. Psychology is a pressure, there is no disputing that. Dr. O'Mahoney can talk about that in the context of other disciplines involved in the therapy.

On the acute beds, as I said there is a total of 89 beds. I have eight beds built for high observation at present which we are hoping to open. We now have the indicated and approved resource that we need to do that, which is 24 whole-time equivalents. We are having some difficulty nationally as well as locally in coming to an agreement with the relevant representative organisations as to what they would consider acceptable. That is presenting us with a challenge. The second challenge will be recruiting the numbers.

The Deputy is quite right about the bed situation in north Tipperary. Acute patients in north Tipperary now come predominantly to the acute unit in Ennis in Clare, and occasionally to Limerick. They were previously served from south Tipperary, which is a different community health care organisation, CHO, area. That is because of the old county-based mental health system when the big hospitals were in operation, a system which pre-dated even the health boards. The unit in Clonmel closed and, in accordance with A Vision for Change, it moved its direction to Kilkenny while ours moved back to the mid-west. Based on A Vision for Change, if everything was right and proper, 89 acute beds would be adequate for the population based on the measure. However, with the demographic changes we are now experiencing, A Vision for Change would have to be revised and we would need more than 89. We need more than 89. In the general sense there is a pressure on them because not every other part of A Vision for Change has been implemented. The other dependencies of A Vision for Change cause pressure. The 89 beds in the mid-west are very busy. The acute unit will be in Ennis. There is no getting away from that.

On the voluntary sector, we have a number of partner organisations under section 39 of the Health Act 2004. We do not have a heavy dependence on them as service providers, but we have a huge reliance on them as support for what we do and as support for people who have been using our services for quite some time. There are some exceptions which would be considered to be direct service providers in supporting either suicide prevention or response to suicide. The agencies we give the greatest amount of funding under section 39 of the Act are Limerick Youth Service, at just over €100,000 a year for youth mental health, and the organisation GROW. We spend just under €1 million on section 39 funding across the profile.

On dementia, the Deputy is quite right that we are very challenged in respect of the demographic profile in that regard and the separation of the different categories within that. He will be familiar with a particular unit in St. Joseph's Community Hospital in Ennis which has traditionally been managed by the elderly service as a dementia facility. We are now just in the final stages of recalibrating that to be led by a consultant psychiatrist specialising in later life. The Deputy will be familiar with him, Dr. Reynolds. He will take over the management of those beds. That will delineate their use differently and we will then be challenged in other parts of the older person sector to respond to the other types of dementia presentations.

The Deputy asked about the return of funds. I do not return funds. I tend to use them. For the last three years particularly we have had a very important rule set in the HSE, which is that divisional money comes as divisional funding and is measured in that way. My money for older persons, therefore, is measured on my spend for older persons. My money for mental health is measured on my spend for mental health. It is not the case that it can be moved around Billy to Jack. I cannot decide tomorrow to spend mental health money on something like a new primary health care centre. I do not have returned funds. I was close to a break-even position last year in respect of mental health, but all of the money I have in the mental health budget is exclusive to mental health and is all spent in that profile. That has increasingly been the position for all of us.