Dr. Brendan Doody:

Again, we need to look at what other countries have done because it is important we learn. Other countries have experienced difficulties regarding service, service planning and development. In our workforce planning, we need to look at what the current workforce is because sometimes we might think we have created more posts but over the next five years, there may be an increased number of retirements given the age profile. It might be a case of "We have created all these additional posts so why hasn't that resulted in an increased number of consultants on the ground?"

If we do not invest sustainably, there will be periods when certain specialties suddenly expand and many consultants are recruited at the same time. That is fine until it comes to retirement when a large number of retirements happen together. A service must be grown and invested in sustainably. We cannot just put a lot of money into it and expect changes to happen overnight. Health services - not just mental health services - are delivered by people and technology. Investment in people is taking a long time. We want to invest, but we need to do that on a multi-annual basis.

We must then ensure that we attract graduates. This is about providing undergraduates with exposure to psychiatry. In our service, we are fortunate to have two psychiatry intern posts. Interestingly, they are very sought after. This is a question of how to provide early training opportunities. Psychiatry has often been at a disadvantage in this respect, with doctors making their career choices early. As such, it is important that they have an opportunity to be exposed to working in mental health services before they complete their training and their pre-registration year.

We have spoken about an operational plan. A workforce plan is required, by which I mean a plan that sets out what we want the service to look like. We must then determine how to put in place the structures to make that happen and train people. It is five-year, ten-year and 15-year planning as opposed to believing that we can invest a great deal of money in the short term and expect change. We are just chasing people, which has been an issue previously. An interesting point was made about increasing the number of posts. All that means is staff moving from one part of the country to another. Additional staff are not being recruited. Instead, vacancies are being created somewhere else. Staff drift from areas where there is a high cost base. Although there are advantages in some respects, there is a disadvantage to services being in cities where there are high accommodation costs.

Many elements feed into this situation. As a result, we need a co-ordinated operational plan and workforce plan if we want there to be change. It will not happen unless we address these aspects simultaneously.