Mr. Ger Reaney:

Beyond medical agency staff, the other area in which we use agency staff to a significant degree is nursing. In most cases, that is for temporary positions so they may be covering vacancies for maternity or sick leave or they may be placed where we need additional staff for a short period due to particular needs of people in residential centres, for example. Most of the positions that we are filling are not permanent positions. We currently have 12 vacancies in our nursing area but we could have up to 40 positions filled through agency. The rest would be temporary short-term positions. There could be a vacancy in east Cork this week and next month it may be in west Cork. It is difficult to fill those vacancies with regular staff, although we continue to explore ways in which we can reduce our agency staffing because of the premium cost that we have to pay on that.

The Deputy mentioned the idea of putting in place teams that are fully staffed. I mentioned that one of the initiatives in 2018 will be an eating disorder team. Since we wrote our submission to the committee, we received confirmation that we will be a pilot for an early intervention team for adults. Both of those teams will be fully put in place. That provides an opportunity to test the Deputy's thesis. These are coming on the back of clinical programmes. To some extent, it also addresses how proactive we are or otherwise in addressing deficits. For various reasons, including the fact that we have consultants working as part of the clinical programmes nationally, our area has been quite proactive in working with our national team and seeking to be a pilot site or initial developing site for both of these areas. Both will be put in place, subject to recruitment, as full teams.

A question on the power of decision-making was also put to my colleagues earlier. We start each year with the service we have. While we have the capacity to move funding from adults to children or from residential to community in theory, that is based on the extent to which we can reduce the need and the service in one area to build it up in another. It is not always that easy to take away a service that is needed in one area in order to fill a need - which may be greater - in another. Where we do have decision-making authority entirely is in respect of new funding. That decision-making is done in co-operation with our national teams. Approval for 90% of the posts relating to development funding in recent years was based on local decisions. Usually, a national framework is put in place in order that we might prioritise the CAMHS service this year or specialist services for older people another year, but we will prioritise where those staff go. I assure the committee that the decision-making, in as far as it can be in an overall national framework, rests with myself and Ms Gleeson and her management team.

I understand that the youth health service lead will be advertised early this year, hopefully in the first quarter. If we can get more details on that, we will provide them to the Deputy.

On workforce planning, I would like to get the contact details for the Deputy's friend in Australia before I leave this meeting. We would be very happy to talk to that person about a position. We are coming out of the period when there was a recruitment moratorium. It is only about three years since that was in place. Some of the overhang from that remains in the minds of certain staff. We are working hard to create an atmosphere where people feel valued. We have development programmes in all our staffing areas, including nursing. Staff have the opportunity to study for postgraduate qualifications and specialise in areas in which they are interested. We try to line that up with the service need. That is good workforce planning but we have some way to go. We have increased the number of nurse training places at Institute of Technology Tralee. All of those who wanted to work in Kerry have been offered jobs there. Similarly, those trained at UCC have been offered jobs in Cork. We have a level of forward planning. It is not perfect but it is something that we develop further year by year.