Dr. Joanne McCarthy:

Redeployment happened. In fact, there was an earlier question about the challenge of reopening services that we did not get a chance to discuss. When the onset happened initially there was a redeployment of staff from day services to residential services. I presume they were backfilling the 24-7 care that was required in residential services. There is a problem now because people in those residential services will not be resuming full day services. Those day service staff are still supporting the residential services so how does one release those redeployed people back into supporting the reopening of day services? There is an issue there because the same staff cannot be double jobbing. They cannot be bilocated.

There is also an ongoing issue that must be understood. We are moving away, and rightly so, from the concept of day services whereby one goes into a building, one stays there from 9 a.m. to 5 p.m. and then one is picked up and brought home. It is much more person centred. People have individual work plans. Some of them might be working two days a week in the local coffee shop or they might be going to an education and training board and doing some type of further education course. Day services are very different now from the traditional sense, and should increasingly become more different. However, none of those places is open now. People who would normally be using mainstream community-based services, which is the right answer, are now looking to come back into - it is almost a regression - old models of service. This is at a time when we must abide by NPHET guidelines regarding the number who can be in at a single time. How fit for purpose are these buildings which we are trying to empty and which now are filling back up again? It is a complex issue both for the services that are trying to reopen and the families and individuals who are really stretched and need an answer fast.

I know from our representatives and the representatives of other colleagues that these live debates are happening. They are taking place at micro or CHO level where each service provider is engaging, and should be in deep engagement, with its CHO to figure out how it will reopen the service and what level of service can be reopened. At national level there are efforts to try to give an overarching framework to support that delivery. They are live issues, but we are dealing with very specific challenges within the system.

Finally, and it is awful and vulgar, there is a cost implication. It is going to cost more to deliver the very same level of service, not to mind to expand or respond to the day services and the new additional services that will have to be introduced over the next year. We are told that the services have to deliver within budget.

There is additional pandemic-related support for PPE and services; there is not for the fact that it will cost more to deliver even the same level of service. I think there is a realisation that, as crude as the return to the concept of cost is, we have to take it seriously if we are really serious about resolving this issue.