Dr. Niall Muldoon:

Where is the child-centredness in that approach? It is an example of clinical autonomy gone mad. This is about overall governance, and that is why the HSE needs to look at itself and ask why it is allowing this. People at the top of the HSE are paid big money to lead its mental health services but they cannot tell a psychiatrist that he or she needs to step up and treat a child. We must get involved, and we have got involved. We pushed hard and made a difference. Somebody took the child on board and he thrived within a week. It changed him completely. That should not require intervention. Someone who has taken the Hippocratic oath should be considering what is best for the patient. The first principle is to do no harm. Medical professionals must ask whether by saying "No" they are doing harm to a child. We must think about things in a different way. It seems to be that some medical professionals have rules that say they will not take on certain cases even if they have capacity and would be able to do so. At the same time, we must encourage people in certain areas to upskill so these situations will not arise again. We need to find a way to make that happen. It seems that the clinical lead remains the overall decider, which is not necessarily a good thing.