Mr. Bernard Gloster:

That is a valid point. I made the point to the committee last week than when making change in any organisation, particularly in a large public sector body like the HSE, one can change the structure all one likes but it will be a useless exercise if one does not focus on the culture that underpins it. There is also the clinical practice. The clinical practice is moving in leaps and bounds. The structure is the regional health authorities, RHA, to bring about a more regionalised, local and timely decision making process. The culture is quite significant. Sometimes we talk about clinicians resisting progress. Generally I find in the majority of cases that people might not be happy about making changes to the way we do things because they genuinely have concerns about whether the change is a good thing for the people on the receiving end. The Senator has hit the nail on the head because this does not relate to just mental health services. It is right across the social care system, much more than the acute hospital or primary care system. It is across the entire social care system in services for people with disabilities, services for children with complex needs and services for people with enduring mental illness and associated issues.

The reality is that the Irish public service comes from a place of a paternalistic history and background because that is all we knew. It is not that we were bad people; that is what we knew. Changing that involves a mind shift but I do believe a substantial amount is happening in different ways because we now have a young and much more highly educated workforce across all of our disciplines. They have been exposed to a different way of thinking and will carry us on that tide. Approaches such as the recovery model in mental health have gained a lot of traction. There is a lot of evidence of improvement. To be fair to clinicians, and doctors in particular, they will be always concerned about how to protect and mind the people who present to them in great distress. They do not know what to do but to contain and care. It is a culture issue. There is no point in calling it anything else.