Dr. Noreen O'Leary:

We agree that we should not throw this out and start from scratch again because that would cause a great deal of disruption for everybody. It is about acknowledging the very real challenges and, as the Deputy has said, finding what is working. He mentioned that we need to go back to basics. That is what we are saying as well. We need to look at the fundamentals of this and how the teams are set up, how they are working and how they deliver services.

Addressing that will help with the retention issue. As I mentioned earlier, staff are finding disability services challenging to work in - Senator Clonan gave the example of his nephew earlier - and they are choosing other options. For some people, such as young new therapists, travel may be an option. There is certainly anecdotal evidence of more established and experienced clinicians choosing to pursue other careers, to take on different roles within the public health service or to go into private practice because of that burnout we talked about earlier and the emotional impact of seeing families really upset and not being able to help them. That goes against everything you want to do as a clinician and people are struggling to continue to work in that kind of environment. If we can make children's disability services better places to work, it will help with that problem because staff will want to stay and other people will be more encouraged to come to work in them.

It does not have to be one or the other. Instead of throwing something out, we should pause and look at the fundamentals of how interventions can be delivered and how to most effectively meet the needs of children and young people. That might involve looking at what is happening internationally, taking what seems to be working and trying it here or finding out what pockets of things are working well here. There is a research approach called appreciative inquiry. People are brought together in what is very much a strengths-based approach, you look at what is working and what people are happy with and then consider how that can be replicated. We should do those things and put the findings into practice in a very timely way.

There is sometimes a feeling that we need to address everything before we can do anything. The situation is so urgent at this point that we need to start doing something but that something must have a strong rationale behind it. In talking about this, Ms Moran and I feel that we tend to be very reactive to issues in disability services. That can lead to a lot of chopping and changing and an inconsistency. We need more proactive planning and to make decisions based on good evidence from research and practice, based on what is needed. I acknowledge that things will change over time. That is okay but it should be approached in a systematic and proactive way. The Deputy mentioned his area of Tuam. Ms Moran and I-----