Mr. Jim Ryan:

I will explain a little about what happens on the ground. We have a head of mental health in each of our nine CHOs. In normal circumstances, when an issue arises, it will be raised with that person. The head's reporting line is to the chief officer in each of the nine areas. There is a performance meeting each month. From there, if there are operational issues outside the norm, they will be raised with the national director and my office. There are times when the paperwork may not appear to support what happens. This is an issue that we have addressed in recent months - we are continuing to address it - to ensure that, if a risk issue is identified at a CHO level and it needs to be raised nationally, then it is done so through a system. We have improved the system in recent months.

It is also important to realise that, where an issue arises, it is escalated as appropriate. Ultimately, the solution may be at CHO level, but if there are issues that we at national level need to be involved in, that is done on a monthly basis. Issues arise each day and are managed locally, but it is rare for a situation in a CHO not to be escalated as appropriate. This is also the case where systemic issues have been identified at CHO level from which other CHOs can learn. These issues are raised in a systematic way.