Ms Mary Walshe:

There are historical base budgets and additional development funding has come in since 2013. The determinants for that are related to the national service plan and the priorities within the relevant divisions. Currently, the budget is defined as in the total budget and then there is a breakdown for mental health, primary care and social care. No funding is transferred within any of those divisions. The allocated mental health budget is set at an 80:20 mix, or thereabouts, regarding pay and non-pay. Those are fixed because the staff are based in child and adolescent mental health service, CAMHS, general adult, mental health intellectual disability, MHID, and so forth.

The issue concerning developments is based on the priorities in the national service plan and the additional development funding. We have significant engagement with the national division in determining our bids. We may look for 20 new development posts. Some of those may be between CAMHS, psychiatry of old age or general adult. One is making the determinant in some ways depending on the activity and the data one has. For example, we have eight CAMHS teams and 12 networks. We have responsibility to provide service to 145,000 children under 18 years of age in my area. The ideal would be that a network should be providing services for primary care, mental health and older persons and people with disabilities within that area. We are in a little bit of a better position than my colleagues in that we are at 66% regarding A Vision for Change and ideals with regard to the make-up of the CAMHS teams. We put in a bid every year and it is determined in the negotiation with the national division as to what is funded.

Sometimes we get funding for posts which we are not able to fill. For example, it could be for an occupational therapist, OT, in MHID when we would be more successful if we had a social worker. Sometimes one has to have that level of flexibility to determine where one feels the priority could be met. We have been lucky in our area. We had a difficult past 18 months when we had significant deficits and had to use agency consultants for CAMHS. We spent over €5 million on agency staff last year. We are fortunate that many of our nursing deficits are filled by overtime, which gives a level of safety in that one has experienced staff doing overtime. While it is not ideal for their health and well-being, at least we have stability on the safety side of the service.