Tom Clonan (Independent) | Oireachtas source

I thank everybody for coming in. It is one of the habits of these Houses to sit late.

We had a very interesting and engaging set of witnesses last week, particularly Dr. Hillery, the chair of the Mental Health Commission, and Professor Lucey, who is the Inspector of Mental Health Services. They said that, in their opinion, CAMHS was in failure and was failing children and adolescents in Ireland. They both emphasised that was not a criticism of the people who work in CAMHS, but it probably flows from the point made repeatedly about the difficulties in recruiting and retaining staff. Last year we heard evidence from Paul Reid, then CEO of the HSE, that, similarly, the progressing disability services programme and CDNTs were in failure, and I know the roadmap intends to address that. In Mr. O'Regan's evidence he said repeatedly that it is about capacity and trying to recruit the staff. There are 700 people not recruited to those teams, and that seems to be echoed across the board. We are short 700 primary school teachers, I think. We have problems within An Garda Síochána and elsewhere, in other parts of the public service. My view on that is that it is probably an echo of austerity measures that were implemented during the financial emergency. To repeat what Dr. Hillery and Professor Lucey said, it is not a criticism of anybody here or anybody who works on these teams. They are starting from a position of intellectual honesty in that they say they have a serious problem. I really appreciate Mr. Walsh's comments because they align with my family's lived experience. Because of these constraints, through no individual's fault or negligence, the needs of the majority of families are not being met.

I have a couple of specific questions about that. I will address the first to Mr. Kelly. I congratulate him on his appointment and thank him for coming to Ireland. What we need is for people to come to work in our system. I note that he worked in the Pennines with the NHS and in Australia. I do not know what brought him back but we are delighted to have him. In his experience internationally, are we completely out of step with the situation as it applies in, let us say, Australia or the UK? I am sure they have their challenges there, but are we in a significantly more challenging position?

These two questions are interlinked, so I invite anybody to answer them. Given that we are at this moment of crisis, is there anything we, as the Legislature, can do to assist? Professor Jim Lucey said last week that he would like to have more regulatory powers and to have those powers expanded. Specifically, is this an opportunity to redesign CAMHS completely? Do the witnesses think the model of CAMHS we are operating at the moment is effective or efficient, or could it be better? Is this an opportunity to redesign how CAMHS works?

There was also a brief discussion last week about the appointment to consultant posts of doctors who do not have higher specialist training. In that regard, Dr. Hillery was very specific. He said there are adolescent and child psychiatrists who have really impressive qualifications, who have gone abroad and who have really upskilled themselves in areas such as autism and areas of special interest. He said we have to try to find a way to attract them to work in our system because they tend to gravitate elsewhere. He asked how we might facilitate that. The witnesses on that day also said this was not a phenomenon that was as common in other specialties or other disciplines. Does the HSE have a view as to why it would appoint people who do not have higher specialist training into these critical posts? In the Kerry CAMHS scandal, for want of a better word, my understanding is that some of the inappropriate prescribing was down to somebody who was not adequately supervised and who did not have that higher specialist training.

We also heard evidence on the day Paul Reid addressed the challenges for the progressing disability services programme and CDNTs. We had a very senior witness who said it was his view that psychiatrists should not be the leaders of the multidisciplinary teams. I thought that was an extraordinary assertion to make. In the CAMHS teams, do the witnesses have a view as to who should lead the multidisciplinary teams in that area? My view is that it should be the psychiatrists. It is my understanding that in other areas of medicine it would be considered unusual if some other member of the team were to step up and say, "I will manage this."

Mr. Kelly might have a view on my last question. What is it about our system that we have hundreds and hundreds of wonderful occupational therapists, OTs, physios, speech and language therapists, psychiatrists and oncologists heading to Canada, Australia and New Zealand? Last Christmas, I think a photograph was taken on Bondi Beach of something like 230 medics. If only we could repatriate them.

It is probably an echo of the austerity measures. In redesigning the roadmap or the way forward for the CDNTs, the witnesses are working very hard to add value and impact following the CAMHS crisis but is there something we could do to try to attract people back? I know the purse strings are held by the Departments of Health and Children, Equality, Disability, Integration and Youth and, therefore, it is not straightforward. Mr. Bernard Gloster has been very vocal since his appointment about the need for funding.