Mr. Bernard Gloster:

I thank Deputy Neville for his questions. In respect of backfill recruitment, and I will provide the Deputy with a specific list of the actual posts subsequent to the meeting, in terms of the global figure of 786, we are running a recurring deficit in terms of filling jobs of 50 to 60 posts. The breakdown is right across the spectrum, with probably the largest number of unfilled posts being in nursing.

On the child and adolescent mental health service, CAMHS, teams, CAMHS east, CAMHS west, CAMHS central, the reason that one sees in the appendices a population of 47,000 between those three teams and a combined actual staffing of just under 25 personnel is the origin of the service. The service started with one consultant in 90 O'Connell Street in the city centre and then it grew to two and so on. While there has been expansion, they consolidate and share their focus. They started out originally as the city team and many of the expanded teams have moved to a new base at Punches Cross in Limerick. There is a lot of cross-sharing of the resource. CAMHS west tends to refer to Newcastle West and that direction and CAMHS east is towards Kilmallock and Doon.

On utilising the money in our budget, traditionally money for development posts is given when the post has been filled. In other words, the post would be filled and then the money would be drawn down. In more recent times, however, the money has been front-loaded and has been given upfront, as our national colleagues told the committee. Some of the money would be used on mitigating risk for vacancies. For example, in 2017, we spent approximately €4 million on agencies for mental health in the mid west. The most significant element of expenditure was on doctors, followed by nursing. We would use money to mitigate risk. We would use money by agreement with the national division. We might decide to target a particular initiative, but as a once-off cost, so that when we come to fill the post, we would still have the money to fill it and we would not end up with a recurring cost. The once-off cost could be on anything from supporting additional training and development to doing a targeted waiting list initiative. If an additional psychologist or consultant was identified as being available through an agency and we had some spare capacity in the run rate of our funding, I might say to Dr. O'Mahoney that if we could attract that person for three months through the agency, perhaps we could take them in to shave off what we are worried about on the waiting list. That is an example of a service improvement. Equally, we can do something on IT. Our IT system is a very old system. It has served us very well but we will have to make modifications to it. I think IT has a patient administration system.

My colleague Dr. O'Mahoney may wish to add to what I have said on the CAHMS teams.