Dr. Donal O'Hanlon:

To start off, there are no subsidies for working in the mental health service as opposed to other branches of the HSE, to my knowledge. There are pretty standard working conditions. In respect of what makes a post attractive, I am in an odd position in that I spent 13 years in North America. Coming back, my working life changed because I was spending less time seeing patients directly and a lot of time looking for resources for patients.

One spends time looking for a bed for someone, trying to squeeze him or her into a clinic or trying to arrange someone on the team to plug a gap for an unfilled post in order that someone gets a home visit, etc. That is a difference. In general, when someone is recruited into our health service, many of the simple things to support him or her, such as a desk, a computer, an office in which to see patients or access to enough office suites to be able to work productively, may not be in place. It has been a long-standing problem in the system that these things are often not in place.

Salary is certainly a factor, but there is also the difficulty in understanding the management structures and the ethos. In other jurisdictions there were very clear governance structures that were very centred on patient care. There was very heavy medical influence on these as there were other professionals influencing them, but there was a clear voice.

I will try to deal with part of the question of recruitment. Overall, the HSE generally cannot recruit for a local competition. It needs special permission to do so. Therefore, often it will recruit from a national panel. For many other disciplines, if we wanted a nurse with particular expertise, we may not be able to organise a competition in one region to do so. We would have to pull off a national panel, which means someone may get a job in Dublin but may wish to work in Donegal. Therefore, that person may be there for six months and then a job may come up in his or her desired location and he or she moves. This is very understandable, but then one must start the whole process again. In general, my experience has been that it takes about six to 12 months to recruit someone. That seems to apply to all grades, and the stages-----