Mr. Dean Sullivan:

There are a lot of points in there. A couple of points related to the restructuring. One point was about the potential benefit of focusing on a longer term strategy with a loss of focus on day-to-day issues. I do not think the centre should be other than by exception focusing on day-to-day issues. I think that that rightly should be sitting out with the community health organisations and with the acute hospital groups and only by exception when they have not resolved them should they be escalated. A point was made earlier about the respite discussion, for example. In a situation where there is adequate respite capacity that clearly is a discussion that should be happening at local level between the local delivery teams within the CHO and the relevant families, parents, patients and so on. It is not a thing that we should be trying to run ahead of those responsible. That is why I focused on the HSE's central role.

In terms of the focus on mental health, I will come back to what I described earlier. Before the creation of my role within the organisation and then in turn the role of Mr. Healy working with me and then Ms O'Connor working with Mr. John Connaghan, there was not that overview of the wider picture in terms of health and social care funding and within that funding the specific priorities for a whole range of services. The focus there needs to be in mental health and in other areas on upstream investment to avoid the need to access CAMHS at all, as Ms O’Connor said. We were just looking up and down the individual silos. I genuinely believe there will be huge benefit in terms of how we plan and prioritise health and social care services as a result of this split. If I did not believe that I would not be here in this role. Having said that, if we turn this into just the creation of three new silos from the five or six that we had before that would be just daft, so we have to continue to work together. We recognise that the primacy for strategy and planning work within mental health and more generally will sit with me, Mr. Healy, and others. The primacy for ensuring that what we identify within plans is delivered will sit with Ms O'Connor and colleagues, but clearly we are not developing those plans and strategies in isolation from them. We will work in an integrated way. We have been and we are now. That is why we are here today in the way that we are. We will continue to do that. We still have the clinical lead that was mentioned earlier in response to a previous question. We all feed across to each other. He is giving mental health input into both my side of the house and to Mr. John Connaghan's side of the house on the operational side of things. I genuinely believe huge benefits can be secured from this structure.

That is provided we approach it in the right way and do not create a new set of silos to replace the old ones we have. There is nothing in the time I have had the privilege of in working with Ms O'Connor, Mr. Healy, Mr. Ryan and others that gives me any sense that would be the case. I come back to the point I made earlier that it is all about patients and clients at the end of the day. We need to do the very best we can within the resources we have. Sometimes we wander into spaces where we assume there is a failing within the system but the resourcing of the system is so far away from what it needs to be. We mentioned the 10% figure earlier and 10% of €15 billion is €1.5 billion. That assumes €15 billion is the right figure. In a world where resourcing for specialist mental health is hundreds of millions of euro away from what is needed if we were to get to the 10% figure, it is not surprising we have some of our difficulties. We need to address those difficulties not just by investing at the end point of the problem in CAMHS and so on, and it involves all the upstream services we mentioned.

I am not here today to lobby for extra resources for health at all but I ask for a degree of realism around where we find ourselves today in the journey in which we are on and the priority we will continue to give to mental health services.