Dr. Donal O'Hanlon:

There are a lot of positive things going on. Many improvements are taking place in the standard of care but the problem is having the manpower to deliver them. Home care is a good example. Many areas cannot recruit home care teams, even though funding is available. There is, therefore, a problem with recruitment. All our services have lost people to other countries. Staff we have trained or employed for years have left and we are employing agency staff at twice the cost to replace them. The salaries appear generous but there is an international market. The Chairman asked what contribution salaries make to the decision to leave. I can only speculate on that, although research is being conducted into that. Salary is a big component, as is the lack of resources to do our job adequately. For example, to provide a fully staffed community mental health team, at least 12 AHPs and nurses are needed and many of our teams do not have that number. It is not uncommon for people to start in the system with three or four staff. There is also a difficulty in recruitment because there has been a breach of trust in the consultants' contract and it is difficult for consultants to feel respected by the system. Dr. Browne will address the salaries.