James Browne (Wexford, Fianna Fail)
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I want to address the lack of psychologists in our health service. Often when I or other Deputies highlight service gaps in mental health services provision or the fact that CAMHS staffing levels are barely more than half that recommended in A Vision for Change, the response by the Government is to cite difficulties in recruitment as a key cause of the difficulties.

However, some of these difficulties could well be self-inflicted. I am speaking in particular to the recruitment of psychologists by the HSE. There has been an issue with this for a number of years especially related to whether they were clinical or counselling psychologists. In 2009 the HSE established a working group of psychology managers to review recruitment procedures for psychologists. Criteria were developed that clearly favoured clinical psychologists for employment in the HSE. Counselling psychologists were deemed eligible to work with only one care group despite already working in the areas from which they were suddenly deemed ineligible.

As a consequence of this, counselling psychologists were excluded entirely from child and adolescent mental health, CAMH, services between 2009 and June 2016. A review process was conducted resulting in some progress being made with regard to the opening up in principle of HSE posts to psychologists other than clinical psychologists. Ultimately it made some helpful and some unhelpful recommendations. The major concern is the stipulation that psychologists who have completed training programmes that do not map neatly to specific criteria around placements were deemed as ineligible for particular care areas in 2016 and 2017 recruitment campaigns and could potentially never be able to work in the HSE after October 2019.

The effect of the recommendations in the period since the issuing of the report has been that trainee psychologists other than trainee clinical psychologists do not know whether they will be eligible to work in the HSE after they graduate. They may be faced with an effective lifetime ban on working in the HSE if the October 2019 stipulation stands.

After the issuing of the review report in June 2016, the HSE convened an implementation group to look at the issue emerging from the report but it seems its terms of reference were extremely narrow. The report of that group was, as I understand it, issued in June 2017 but remained with the national director and was not released until 22 November 2017 despite repeated requests from multiple interested stakeholders. Trinity College Dublin has sought and is still seeking a response from the HSE about the problems that are being caused for the current doctorate in counselling psychology programme. IMPACT and the Psychological Society of Ireland have made attempts to engage with the HSE but the executive has still not responded.

The exclusionary recruitment practices used by the HSE for psychologists do not exist in other countries, including the United Kingdom. Its practices are also in direct contravention of the recruitment policy of the Psychological Society of Ireland. As long as the HSE continues to make inadequate use of high-quality psychologists because of its demonstrated preference for clinical psychologists only, will we not continue to face what the HSE terms recruitment challenges?

Finian McGrath (Dublin Bay North, Independent)
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I thank the Deputy for raising this very important matter. The Minister, Deputy Harris, sends his apologies. I have a particular interest in the area of psychology and I keep a close eye on it in my role as Minister of State with responsibility for disabilities.

I thank the Acting Chairman for allowing me the opportunity to set out the current criteria and practices for recruiting HSE psychologists. Over the years, there have been ongoing issues with the eligibility criteria for recruitment to HSE psychologist positions. In particular, a change to the eligibility criteria in 2009 made it more difficult for counselling and educational psychologists to obtain employment in the HSE. This change led to the development of eight care groups. Clinical psychologists were eligible for employment in all eight care groups. Counselling and educational psychologists were eligible for employment in one of these care groups.

In order to address these issues, a review commenced in 2015 to examine the eligibility criteria and to make recommendations. The purpose for the review was to ensure the availability of a good supply of candidates with the appropriate skills and experience to meet the needs of service users. The 2016 report of the review group made a number of recommendations, which were accepted. It recommended revised eligibility for entry into competitions for psychology posts, both at basic and senior level. The review group also recommended that the number of care group areas be reduced from eight care groups to four.

It also recommended changes in eligibility. These changes mean that counselling psychologists are now eligible to apply for psychologist positions in all four care group areas. Educational psychologists are eligible for two. The HSE advises that the new care group criteria have been implemented since 1 March 2016 and applied to basic grade and senior psychology competitions held throughout 2016 and 2017. In addition, the review group also looked at the qualification requirements. It has recommended a broadening of these requirements. Instead of named psychology qualifications only, eligibility will be made up of a combination of qualifications and placement or supervised work experience.

An implementation group, chaired by an independent chairperson, has been established to map out the practical steps necessary to implement the revised eligibility requirements. On conclusion of its work, I am advised that the implementation group submitted its report and recommendations to the HSE leadership team for consideration. After its consideration, the HSE accepted all the recommendations in full. I understand that the implementation date has been deferred, for operational reasons, until October 2019. This means that the current criteria for placements remain in effect until then.

I understand that four of the other recommendations made by the implementation group can be implemented without delay. One of these is the formation of a group composed of recruitment managers and principal psychology managers. This group will consider any new definitions to be used in advance of recruitment competitions. It will also deal with unforeseen or difficult decisions that may arise during competitions. This will ensure that fairness and consistency can be protected.

Another important recommendation approved by the leadership team is the creation of a national psychology placement office. In order to prepare for this, a project team will be established to advance this recommendation.

I am confident that the implementation of the recommendations as outlined will significantly improve the role of the psychology services in supporting vulnerable service users and their families.

James Browne (Wexford, Fianna Fail)
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The Minister of State mentioned the placement criteria several times. The concern is that the HSE may be trying to compel a large number of existing employees to complete very extensive in-service training in order to maintain eligibility for their own jobs for promotion or transfer. This would severely affect service capacity and the opportunity for service development, as well as the career opportunities available to those employees. It is likely that this will not apply to clinical psychologist employees but only to counselling and educational psychologists. There is no clear rationale for the requirement other than an attempt to implement criteria which have already been shown to lead to multiple problems.

IMPACT has notified the HSE of this numerous times but it has failed to account for it. There are no such requirements, for example, for counselling psychologists employed in the NHS in the UK. The bottom line is that although the recent report is positive in tone, the threat of placements not being recognised and thus graduates being ineligible still stands as the new definitions of appropriate placement are potentially as ambiguous as in the past and could be used to exclude some graduates on an ad hocbasis, as has occurred in the past. As written, they seem to exclude HSE adult primary care services. We still urgently need somebody in the HSE with authority to pre-approve a placement as eligible and help to secure such a placement. There are enough senior psychologists in the system to cater for it.

Although there are enough high-quality psychologists who are appropriately qualified, as would be recognised in the UK, HSE placement requirements, in particular undefined and ad hocrequirements, are excluding those highly qualified psychologists. This is the concern that has been raised by Trinity College, the Psychological Society of Ireland and IMPACT. The issue needs to be addressed as a matter of urgency.

We are constantly being told we have a severe shortage of psychologists, but the bodies that know their stuff maintain that the psychologists are there but the HSE is blocking them for ad hocreasons.

Finian McGrath (Dublin Bay North, Independent)
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I again thank the Deputy for raising this very important matter. I will bring his comments and views back to the Minister, Deputy Harris.

As of October 2017, there are 954 psychologists employed in the HSE, of whom 925 are clinical psychologists. That is the up-to-date situation. We must not create unnecessary delays in attracting the right health-care professionals to the right positions.

It is clear that there is a vital role for all psychologists, clinical, counselling and educational, in our health service. That is the reason we must all do what we can to employ those individuals to ensure that our health service is as good as it can be.

I am confident that the new framework, as recommended by the review and which is fully under way, will be more than fit for purpose. I am pleased that the Health Service Executive, HSE, is putting in place the necessary supports to enable that. For example, the national psychology placement office will ensure that psychology students of all disciplines have equal access to the placements they need to pursue their chosen careers.

This will go a long way towards protecting our most vulnerable patients by ensuring that services are in place where they are needed the most. On the other issues, I will relay the Deputy's views to the Minister, Deputy Harris.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I thank the Minister of State. I also thank Deputy Browne for his co-operation. The final Topical Issue is in the name of Deputy Tóibín.