Mr. Donan Kelly:

It is important to acknowledge the good clinicians that are working in CAMHS at the moment, particularly as they are working in quite strenuous circumstances given the demand that is out there, as the commission's report highlights. There is lots of good work going on, although there are issues with demand and with siloed working.

On the first question regarding how we fare in comparison to other jurisdictions in the provision of services, demand is an issue in both the NHS and in Australia vis-à-vistheir services. We have an opportunity here in the context of our CAMHS improvement programme and the child and youth service programme. Sharing the Vision is quite a clear document in terms of the development of mental health services and a lot of the 31 recommendations in the Mental Health Commission's report read across to things that we will be doing through that programme of work.

In terms of where we are on the governance issues and some of the things the commission has highlighted, our office will have a renewed focus on the standardisation of the operational guidelines in CAMHS. We have done a baseline audit and it is looking like an improving picture. The other piece is the demand that is coming through and the actual resource that is there to deliver the service. On top of that, it is about integrating the various levels of pathways, particularly around early intervention. Many of the models elsewhere that we would be hoping to implement in this country bring together all of the providers from the primary care level, education, our colleagues in Tusla, our colleagues in organisations like Jigsaw, Pieta House and other voluntary, community and social enterprises, VCSEs, to provide a much more robust pathway whereby people get access from a very early stage.

My involvement in both Australia and the UK has been in setting up those single points of access for services so that there is a one-stop shop. That is something we are looking to replicate in the work we are doing with disability services at the moment and that we will bring in down the line, hopefully. That is a brief outline of the situation. We are starting at a low baseline. There are things we need to do internally in terms of improvements to the governance structures and that work is underway at the moment. It is also about keeping a strategic focus on the longer term, about building up a more needs-centred and person-centred approach to care rather than a stratified system which tries to box people into one team or another. Young people and their families invariably fall between services because of that siloed way of working. We need to have a more joined-up service.

That in itself will bring efficiencies, which was the subject of the Senator's second question. At the moment, a lot of referrals that come through from primary care will go not only to CAMHS teams, but to CDNTs and primary care psychology services simply because people know there are long waiting lists. Again, more integration will help with some of that efficiency.

I will skip to the last question and let my colleague, Dr. Burke, answer the question on non-consultant hospital doctors. The Senator is correct that there is a big flow but it is not a problem that is particular to the healthcare system in this country. It is the same in the UK, with people going out to Australia to work. We see them on Bondi beach but the HSE is working on its recruitment and retention policies. If we can make services better for people to work in, which is part of the issue at the moment, we will naturally start to attract people back.