Jim Daly (Cork South West, Fine Gael) | Oireachtas source

That was a lengthy and substantial contribution and, therefore, I must respond. I could not disagree more with the Deputy.

It is a fact that there is a worldwide shortage of consultant psychiatrists. We are short 60 of them in Ireland. I cannot make two out of any one consultant, no matter how hard I try. I can try breeding them or cloning them but I cannot make two out of one. All the Government policy, pay and everything else will not make two out of one when there is a worldwide shortage experienced by the United States, Australia and elsewhere. In those places and the rest of the modern world, they have caught up with technology to use it effectively. There are now so many consultant specialties. Time was when there was just a consultant psychiatrist, but now there are consultant psychiatrists for adults and for children, as well as consultant psychiatrists with a specialty in anxiety or in eating disorders for children and for adults, but there are not enough of them because people are presenting in their droves.

Technology is merely a platform. If there is a consultant on that screen, and if that consultant is fully trained, qualified and accredited and so on, the level of service to the child is not being diluted. As a parent, if I went to Cork University Hospital at 2 a.m. tomorrow and was told there was no consultant psychiatrist available until 9 a.m., but if there was a remote consultant psychiatrist who was immediately available, qualified, could speak to the child, assess, diagnose, prescribe and admit if necessary, which would I prefer? Would I prefer my child to be in a state of psychosis in accident and emergency services, with the craziness of it from 2 a.m. until 9 a.m.? I would happily accept the screen psychiatrist.

It has been proven that children with autism are more comfortable using a screen, although I am not suggesting that a screen is superior to face to face. Rather, in a situation where there is a vacuum of 60 consultant psychiatrists in Ireland, I have two options. I can continue to do what I always did but, as the Chairman noted, if we always do what we always did, we will always get what we always got. I can answer parliamentary question after parliamentary question to say we have recruitment and retention challenges. On the other hand, as Minister of State, I can accept my responsibility, step up to the plate and consider a new and alternative way of operating. It does not make sense to have a consultant psychiatrist sitting for 24 hours a day in the accident and emergency department if there are only two presentations for him or her in that period. We have to be real about what we do. This is not to replace human beings.

There is a vacancy in Wexford, where a consultant psychiatrist left his post in a high-profile manner. A consultant from Galway visits Wexford every weekend to deliver clinics for children and adolescents, for which she travels a seven-hour journey in total. I could remove those seven hours in the morning by providing a screen and she would not have to leave Galway because she could assess her patients there with a team which is not remote. When one presents at accident and emergency services, there are doctors, registered general nurses and a whole team of medics. The consultant psychiatrist will be part of that team but will not be physically present, and the input will be via a screen to make more available this precious resource that is not as widely accessible as we would like.

It is the same with the consultant in Galway who requires a full child and adolescent mental health services team. As the Deputy will know, it is a multi-disciplinary team with eight or nine professionals, but they are led by a consultant psychiatrist. When a consultant psychiatrist leaves, we do not want that team to be paralysed. A consultant psychiatrist from another area will be able to use technology, discuss the cases and the caseload, and give advice to the psychologist, the occupational therapist and so on.