Dr. Niall Muldoon:

When I first joined the office, I met a number of NGOs and service providers in the area of disability. PDS teams were being discussed at the time. I remember someone describing the situation as the NGOs and service providers currently providing a Mercedes-level service and being asked to divide it up across other areas so that everyone got a Skoda-level service. I mean no disrespect to Skoda. Everyone got a different level of service, but there was no additional funding, administration, building or office supports to allow providers to do that. This is where the difficulty lies. We believed we could take everything we had, put it into a single pile and divide it equally across the country. That looked good on paper, but then came the negotiations on the division.

That there are different services in each area is an historical issue. Where was the best charity and where was the most funding coming through charities? Did St. John of God, the Daughters of Charity or the Brothers of Charity have better fundraisers? Were they better negotiators of service level agreements, SLAs? It started there and has been retained in that way. That is how it has been in CAMHS and mental health more widely. For example, if there was a psychiatric hospital in an area, that area got more funding when the hospital closed down. We tried to build on top of rocky foundations and adjust from there.

Each team can work effectively, but we must acknowledge that we will probably have to provide it more funding and services and better administrative teams and allow the professionals to do their jobs. The principle behind PDS so that CHOs have equal opportunity is right, but a greater level of resourcing needs to be considered.