Jim Daly (Cork South West, Fine Gael) | Oireachtas source

I thank all Senators for the time, energy and commitment they continue to give to this area and for their contributions. I will dispense with my prepared script and try to answer some of the questions they have asked as best I can and address some of the points they have raised.

Senator Swanick asked a question about the CAMHS staff in Wexford and Waterford and whether they can still do their jobs. He said Deputy Browne has mentioned this. The reality, as the Senator knows, is that there is a CAMHS team in each of the areas. It is not just one consultant psychiatrist; there are teams of varying numbers, ideally 13, although not all of them can achieve that. There are occupational therapists, OTs, speech and language therapists, psychologists etc., on the teams. This is what we are talking about when we look to other areas. We wish to get consultant psychiatrists from other areas to provide the necessary clinical governance for these teams to continue. How do we do this? A very obvious way is telepsychiatry, whereby a consultant psychiatrist can clinically govern the team's work peer to peer on screen in order that the team continues its work.

Senator Grace O'Sullivan asked me a question about weekend clinics. They are being offered to young people on Saturdays and Sundays. Some consultant psychiatrists very generously work weekends from other areas to provide cover here. They can also provide clinical governance cover from Monday to Friday. Of course this is not ideal and we do not want to be in this space.

There is the issue of three people having resigned at the same time. One, Dr. Moore, has spoken about the conditions in which he worked, which is his right and entitlement. I have no difficulty with that whatsoever. I have only been in this job for a year but I have met Dr. Moore several times. As Senator Freeman said, I was in Wexford, where he worked, 12 months ago, and he asked me about the building and the facilities. As I understand it, the new facilities in Wexford will be open in six weeks' time to allow the team to move in, in order that they do not have to continue in the present situation. I do not say this defensively; I say it as a matter of fact. Dr. Moore has raised other issues. He talked about it taking an hour to fill out the paperwork involved in admitting a young person to a CAMHS unit. Of course it takes an hour to fill out that paperwork. That is the least time it should take. One is admitting a child to an inpatient unit. Should Dr. Moore be doing all that? I would take issue with that. A consultant psychiatrist should be doing exactly what a consultant psychiatrist should be doing. There should be step-down models of administering a consultant psychiatrist's work to ensure he or she is not overburdened with paperwork. This is the space we need to be in. These are the conversations we need to have.

We need to look at how we do what we do to change our direction. We can beat up the HSE about the lack of consultant psychiatrists all day long, but whether one considers the NHS or the position in Australia, New Zealand, Canada or the United States, there is a worldwide shortage of consultant psychiatrists. There are just not enough of them, and this will not be fixed overnight. Therefore, we need to look at new ways of administering what consultant psychiatrists do. We need to look at what they do in New York, for example. I saw recently that they have physicians' assistants who open up the body on the operating table, the surgeon comes in and does the procedure and the physician's assistant does the closing up. Here the surgeon opens up the body, does the procedure and closes up the body. There are better ways of using consultants' time.

The online space offers enormous potential. I have seen telepsychiatry in operation in other countries. If one considers an example in which a child presents with psychosis overnight in an emergency department, ED, he or she would be far better off if there were an online consultant psychiatrist available to carry out the assessment. In fact, many children are much more comfortable dealing with screens now because of the lifestyle we have evolved into and it has been proven that children on the autism spectrum react to screens better than to real life. What this says about the way we are raising children is another debate. Were this facility available in emergency departments, there would be 24-hour cover, as opposed to patients having to wait for seven hours in an accident and emergency department for a consultant psychiatrist to come on duty at 9 a.m. the next morning, which is far from perfect. It is about how we do what we do.

Three consultant psychiatrists have resigned at the same time. One had an issue with conditions; the other two had very different reasons for leaving. One, as I understand, is moving on to do a fellowship, which is their entitlement and their right, and intends to return to work in the area but wants to improve their learning, which is any consultant's right. In fact, we should be encouraging that. The third consultant was delivered through a locum agency and has now informed that agency that they are no longer available to work for it. I do not know why. It is not my business why people do this. It is very unfortunate that the three resignations have come at the same time. This has been presented by many in language to the effect that this is "a crisis" and that everything has "collapsed". Our challenge now is to recruit consultant psychiatrists into the Waterford-Wexford area. If some of us wish to keep shouting and roaring about it as "a crisis", "calamity", "chaos", all these words-----