Professor Matthew Sadlier:

The Deputy made some very valid points. On the matter of agency staff, it can be a question of different pay rates. I would love to be able not to say that. It is not necessarily true that we can always fill posts with agency staff either. They can often be short term or temporary. I know of a post in an area where there was something like 14 different consultants in a two-year period. The fact a post is listed as being covered by agency staff does not necessarily mean they are they same agency staff there last week or in two weeks' time.

My only gripes, as it were, are around two things. First is about when we get reports like A Vision for Change, Sharing the Vision, Sláintecare, but looking at those on mental health in particular. They need to be accompanied by an operational report. We get reports that are ideologically driven. They outline how a utopian mental health service would work. For instance, they might say we will have mental health team and a primary care centre all over the country without anybody having established whether people will work in a mental health centre or a primary care centre across the country. How much will this cost? Have we engaged on the operational side of how to deliver this? Sometimes we set out health policies with a utopian ideology of where we want to get to without necessarily understanding if that will happen in the real world. Consultant psychiatrists work as per the Sláintecare concept of a consultant. It is about 20 years since a consultant psychiatrist was appointed when he or she has had access to private practice. I am not sure of the date but every consultant in psychiatry since then, and it is well over 90-odd per cent, do not have access to private practice.

They work in a community base yet this is a speciality where, give or take, one third of posts are vacant. The process in psychiatry is supposed to be this ideological one that we are supposed to be getting to but it is the one where we have the biggest problem.

My final point is one I get tired of trying to bang home. I am not against the delivery of care in the community or against basing care in the community, but delivering and basing care in the community is more expensive and less inefficient and requires a redundancy. Where a mental health team is comprised of one consultant, one junior doctor, one psychologist, one social worker and one occupational therapist and it is based in a primary care centre in a rural area and the consultant wakes up some morning with a sore throat - in the current world environment we are told not to attend work if we have a sore throat - the outpatient clinic for that morning is cancelled. If one member of the team gets sick or has to take leave, that area does not get another staff member. We are dispersing our teams into small teams rather than having a more departmental or larger hub model of the type operated in Australia, where there are four or five consultants or a larger team assigned to one area, such that you have that redundancy. They are the questions that were not built into this. There is no mental health services report issued to set out how the structure would work. I have never seen in an appendix how we cover annual leave. Every staff member gets four, five or six weeks' annual leave, depending on their contract. How do we cover that? They are the type of operational issues that are not being considered.