Dr. Brendan Doody:

As clinical director of services for over 13 years, I can speak about what is happening on the ground. On the one hand, one looks at the positives. We have invested in a new purpose-built community service based in Cherry Orchard. In that building we officially launched last month our specialist community eating disorder service. It was the first such team and a second is to start in Cork as part of the clinical programme for eating disorders. We have established a specific ADHD pathway team within our service. In the west Wicklow-Kildare area we cover the service has four teams, where once there was one and we hope to develop a fifth. We had an inpatient unit in 2006 with six operational beds.

In 2015, we opened our brand new bespoke inpatient unit, which has won architectural design awards. Visitors from abroad have been very impressed by it. What means more to me is the feedback from young people and families. The Deputy has visited the unit, and seen that it is all single en suite bedrooms. We have a sports hall and a gym, attached school and parent accommodation. All of these are important.

They are the positives. The frustrations, however, are that our teams are not at the full complement. Some teams have the complement of disciplines but not the numbers. Other teams are not at the full multidisciplinary complement. Some of this is due to lack of funding for new posts, some to staff going on maternity leave or leaving to take up posts elsewhere, and to delays in refilling an approved post when somebody leaves. There can be a significant gap. It is frustrating that we cannot provide the right level of service. There are much pride in the progress that has been made and frustration that we cannot deliver the service. Families are very appreciative of the service but it is important for that response to be timely.

On the inpatient side, we strive for maximum capacity in our unit. The way it has been designed has facilitated our capacity. Since we opened, we have averaged 80% to 90% occupancy but there have been times when we have not reached that level. That may have been for case mix reasons. At one point we had to close half of the unit because of staff shortages and we are running with significant vacancies within the inpatient setting. We require additional funding to fund new posts to build the teams up to the recommended level. The other frustration is that we are running vacancies where the issue is not funding but difficulty recruiting particular specialties.

We are involved in the planning of the inpatient unit in the new children's hospital, which will be under our governance. It will have an eight-bed specialist eating disorder unit and a 12-bed unit. That is another 20 beds. Ten beds will come on-stream in a low secure adolescent unit which is part of the redevelopment of the national forensic services. We are compromised because we do not have access to a low secure facility for those who have a high level of acuity and need that kind of environment for their care. If we have to manage such young people in open hour units, that will affect our ability to leverage services for others. The frustration on the ground is that, although there has been progress, it has not been at the level or speed we would like. Some of that is a funding issue, some not. Some time ago we were apologising to families for the facility; now we are proud of showing them the unit and the physical environment. The environment, however, is only one part. We need the staff to deliver the service. We need all those levels. Staff also feel the frustration at not being able to provide the level of service that we would wish to.