Ms Martina Queally:

We have particular issues in Dublin. As I said in my opening statement, exit interviews with nurses demonstrate that it is most acute among nursing staff. Exit interviews show that the cost of living in south Dublin is high, including the cost of renting and housing. That is definitely a problem, not only in terms of recruiting new candidates for our workforce but also in terms of retaining staff who want to purchase homes, start families and all that good stuff. We have had a number of initiatives as we have not been successful through national recruitment for our area. We have established a specific project under the area director of nursing. It is a special project group to look at local recruitment.

I was asked about the postgraduate and undergraduate programmes. There have been undergraduate nurses all of the time, but we never had a particular undergraduate programme in our acute units and community services with UCD. We have now established that with UCD. We will attempt to grow our workforce, which is very important. The postgraduate programme has been very successful. A lot of the general nurses who do agency work have gone on to that postgraduate programme, which has been really worthwhile. People in mental health nursing retire quite young and we are fortunate that some come back to do agency work, which has kept services safe. Some of the people doing agency work are very experienced. However, we are too reliant on them.

I am glad to say that because they are so experienced we know we have a safe service. This is a very important message for the public because mental health services can be high risk areas so providing a safe service is very important.

With regard to the contract, to be honest local recruitment has been based on temporary contracts and this has been a disadvantage. Our work with HBS under this project will allow us to recruit people to permanent posts. We hope this will improve our situation.

We are developing expertise in our advanced nurse practice and clinical nurse specialist teams, and encouraging people not only to enter our service but to develop a career with us is really our aim. Under Mr. Walsh, the area director of nursing stewardship, we are looking at advanced nurse practice programmes in CAMHS and old age psychiatry in a number of other areas, and we hope to develop these shortly. We did not get any in 2017 but we hope to be on the advanced nurse practice programme in 2018. We have a number of clinical nurse specialists. The CAMHS waiting list is high in Dún Laoghaire, and we are looking at nurse prescribing and advanced nurse practice to free up medical time so we can improve the waiting list. This is very important also.

We have a focus on service improvement in existing nursing posts and how our current staff is deployed to best effect. That is in answer to the question on A Vision for Change being value for money. It is difficult to pinpoint outcomes, but through our focus on the recovery of patients in mental health services we will be looking at, hopefully, shorter length of stay, fewer admissions, people remaining in the workforce and being in close contact and fully functioning in their own communities. This is very important in terms of our ethos and our focus on how our services are developed and run.

In terms of the breakdown of pay and non-pay, our non-pay is slightly higher than it is in the rest of the country. This is because of the number of contracted services we have. It is close enough to 70:20 but it is slightly different. It is not quite 80:20 but it is close enough.

With regard to the gaps in our teams, I gave an outline of the A Vision for Change gap. It is correct to state none of our teams is at the level of A Vision for Change. Our adult teams run at approximately 47.5%, and our child and adolescent humans at approximately 60%, of what A Vision for Change states. This is a position we want to change.