Mr. David Walsh:

I thank the Deputy for raising those issues. Regarding agency staff, the total spend last year on agency staff was €8 million and, of that, €6.3 million related to general adult services and the rest was across child and adolescent and psychiatry later in life services and that is split between nursing and medical staff. Agency nursing staff costs are very high and growing. It reflects the problem we have in recruiting and retaining staff within the service. For example, we have got 184 service development posts since 2012 and we have filled 143 of them but we have only 34 more staff because we are leaking more staff out the backdoor. That is a real issue.

That leads into the Deputy's issue around consistency. If a child or an adult comes back for their next appointment and they do not recognise anyone who is there, that is a problem. In terms of the medical staffing, that has begun to stabilise even though the problem has not been completely addressed but with the nursing and allied health professionals the high rate of turnover remains a problem.

On the question of CHO 7 giving back money, we generally do not. In 2016, we overspent by in or around €3 million and, in 2017, having got much more support from the mental health division, we came very close to breaking even, but the difference was in or around €100,000 or €150,000. That reflects the fact that we have more than 14% of the population but we only have 10% of the budget. That is an immediate stressor within the system.

With respect to the psychiatry of later life services, the service in Kildare only started in the past few years and it is building. The Deputy will note that from A Vision for Change figures. They are very low in terms of the psychiatry of later life services. In terms of the figures across Tallaght hospital and St. James's Hospital sectors, the professionals within them provide a very good service but they are still very much below the bar in terms of A Vision for Change targets. With respect to Monasterevin, I will broaden it out beyond Monasterevin and point out that we need to make better use of all our health care facilities beyond having merely a 9 a.m. to 5 p.m. service. I expect to have a firm design around Monasterevin that I would be happy to share with the Deputy over the next month or so.