Dr. Donal O'Hanlon:

With pilot projects one has to start somewhere. If one adequately funds a pilot project and can show it can be done that would be great. What can happen is that over time the degree of commitment to funding the pilot programme can be eroded. For example, in multidisciplinary teams colleagues who are on leave are not replaced and immediately a whole arm of the team no longer functions properly.

Over the ten years this has gone on, it has been a progressive demoralisation of the whole service. I say that genuinely. It has been a repeated wearing down of staff morale. According to a recent survey, this year, 44% more trainees are applying to go to Australia than applied in 2018. Over the years, I have recruited many consultants who stayed for a year or two and then went to Canada, including one about two weeks ago. These are people we have trained here. They may have spent about ten years in our system but are originally from another country. They would have integrated well and provided really good service. The reason they are going is they cannot see any political will to change things and they believe they will be treated in a more inferior way than their longer established colleagues. I do not think we are addressing that. That has knock-on effects.

Many speakers here today have spoken about multidisciplinary team working. As mentioned by Professor Sadlier, we have been doing that since the community psychiatry initiative started in the late 1980s. We have always had a multidisciplinary team. We recognise the role of medication. We also recognise the need for talk therapies, social assistance and the human contact of a very skilled psychiatric nurse. That is the way we have worked for years but we have not had the teams to deliver that. It has been kept going on a shoestring. One cannot convince people in the system that things will start to change unless there is a real political will to do so. I hope that answers some of the questions.