Dr. Amanda Burke:

The Senator asked if is there anything this committee can do to help. CAMHS has been chronically underfunded and we have a lot of catching up to do. We need a commitment to multi-annual funding so that we do not have to go back every year and pitch our strategy. Our workforce plans depend on a number of years. We have to resource the universities to produce enough graduates and then we have to get those graduates into training programmes. We need to be able to plan and to know we have the resources available to do that going forward.

The Senator also asked if this is an opportunity to redesign the system and the answer is yes, absolutely. Sharing the Vision is a document of its time. It was great in that it laid out how we plan services but multidisciplinary teams working in isolation cannot provide everything. We have to provide evidence-based care and the evidence base is for practitioners who have fidelity to the models, particularly in psychological therapies, that they are doing them a lot and that there are proper supervision structures. However, we cannot do that in every multidisciplinary team. As well as resourcing our teams, we also need to work on a clinical directorate model that shares resources across teams for those more specialist types of therapies. This also provides collegiality, peer supervision and lends itself to clinical audit. The Senator referenced Kerry and it was an example of an isolated team without enough staff to provide adequate supervision to practitioners. A clinical directorate model across a regional health area, RHA, is a much safer practice, analogous to what happens in hospitals.

We have moved forward on this. This year we have five pilot sites for the CAMHS hubs and those hubs are providing a real alternative to inpatient care for young people. They are also being staffed with very experienced practitioners who can be shared across a region and who can provide a level of support. Those kinds of things matter in the context of attracting graduates back. Terms and conditions are not just about financial rewards. On foot of the new consultant contract we have certainly seen a difference in terms of more candidates applying for posts. That is starting to work, which is really positive but it is not just abut that; it is also about collegiality, having good colleagues to work with and being able to have one's own area of expertise as well. In CAMHS we have not done that. We have not allowed practitioners who have a special interest in an area to set up a clinic in a region that can be a tertiary referral centre. We are resourcing CAMHS, particularly through the CAMHS hubs, with quite sophisticated telepsychiatry, which means we can spread the service across the country. There are lots of practical things we can do to improve terms and conditions for people and to attract them back but we need this committee's help.