Dr. Brendan Doody:

I agree with what my colleagues have said. I have spoken to higher skilled trainees finishing their training about the posts they would be attracted to. It is not just about money. It is about the supports and the structures around them. They want to be in supportive structure. The report on CAMHS raises the question as to whether there is need for a complete separate support structure for child and adult mental health services. Where there is a child and adolescent psychiatrist reporting to another child and adolescent psychiatrist, they would find that more supportive. The risk is about professional isolation. It is not surprising that it is not just in mental health services that consultant posts which are seen as peripheral are the ones that are least attractive. People said there are posts around which there is no certainty about who will cover for them when they are not there. It is about that level of isolation and the need for that support, which sustains them for a career of 30 to 40 years. They are thinking about how they are going to sustain this not just now, this year and next year but for all of their careers. We need to look at the structures but it is not just about money; it is about the structures and how we support the services.

It is not possible to grow services overnight. That requires sustained investment over years. It is about identifying need across a range of disciplines and training people through college for them. That is going to take time. That is the need for that multiannual investment. As mentioned earlier, we have a vision. It is about how we operationalise that vision, how we make it happen and how we address the need for the huge amount of investment required for training. When we lose a consultant, we lose the huge investment made by the State in training that person. In a sense, it is about how we create the conditions to hold on to that investment when we know that they are skills that are highly mobile and highly valued. These are the real issues. It is about we operate, about structures and all of those things. Within the structures we need to look at how we develop and innovate. Building innovation on a shaky or not so good foundation is not sustainable. We sometimes have service innovations that prove not to be sustainable. We need a sound foundation to sustain and support innovation.