The Medical Council queried the College of Psychiatrists of Ireland about why it purportedly did not raise major concerns regarding HSE child and adolescent mental health services (CAMHS) during an accreditation process.
The Council’s accreditation of the College’s training programmes, including child and adolescent psychiatry, concluded with ‘no major findings’. The report was approved by the Council’s education and training committee (ETC) and Minister for Health Stephen Donnelly in late 2022. The inspection occurred in May 2021.
The Council’s correspondence came on foot of publication of the interim report on CAMHS by the Inspector of Mental Health Services in January 2023. The Inspector found serious deficits, reflecting many of the longstanding concerns expressed by organisations including the College.
In March 2023, a meeting of the Council ETC noted that the Inspector’s interim report included “very serious findings”. It heard that the College had issued a statement in response stating that “continued lack of investment in this specialist area will have a negative impact on patients and on psychiatric training”, according to the minutes obtained under Freedom of Information law [the College’s statement did not specifically mention training, but poor resourcing and major staffing deficits, including of consultant psychiatrists, in CAMHS].
“[Council Director of Education and Training Ms Una O’Rourke] stated that she has written to the College to hear its views and to enquire as to why these issues were not raised by the College as a major concern at the time of the Medical Council accreditation.”
At a meeting in May 2023, the ETC agreed that “consideration should be given to how the Council could be made aware of other pending issues/media reports during accreditations to avoid such situations in the future”.
The Council undertakes cyclical formal accreditations of postgraduate training programmes and training bodies under its statutory duty to quality assure training. It uses a set of accreditation standards that cover areas including the curriculum, assessment, and outcomes.
Dr Aoibhinn Lynch, the Dean of Education at the College, told the Medical Independent that it raised several points with the Council when contacted on this matter.
In regard to the accreditation process, Dr Lynch said she was requested by the Council to present an overview of the four psychiatry training programmes. She said her presentation included references to the challenges for psychiatry training, such as lack of protected training time for trainers, insufficient State funding of training, and recruitment and retention issues.
Dr Lynch noted that the accreditation agenda and subject matter are set by the Council. She said the College had responded to all requests for documents and information. It also provided documents that were not specifically requested, including a national workforce report for psychiatry. This report by HSE National Doctors Training and Planning (NDTP) referenced “severe” recruitment and retention issues.
Dr Lynch said it was also pointed out that the inspection took place in advance of the publication of the Maskey review and the interim and final reports by the Inspector of Mental Health Services.
A final point was that accreditation inspections only related to training posts and not non-training posts. Dr Lynch said some of the deficits highlighted in the various reports on CAMHS were in locations that did not have training posts in child and adolescent psychiatry.
The College advocated that increasing support for formal training was part of the solution to such deficits, according to Dr Lynch. She said it wanted all NCHD posts in psychiatry to be training posts with limited exceptions.
She added that the College was not the employer of trainees and sought to use its influence in regard to workplace issues
A Medical Council spokesperson commented: “While the Medical Council assessors found the four programmes to be of a consistently high standard, they made a number of recommendations for improvements. Approval is conditional upon the College addressing a number of areas, including advocating for protected time for training, developing a disability policy to support trainees in all four specialties, and developing a policy on evaluation of assessment methods.”
The Council spokesperson said one of its recommendations was that the College completed its own accreditation assessments of training infrastructure, which had been disrupted in the pandemic.
According to the spokesperson, its assessor teams must use the Council’s accreditation standards to assess a programme’s suitability for accreditation.
“An assessor may use the knowledge they have regarding a specialty to question the postgraduate body, provided it falls within the remit of the standards against which the programmes are being assessed.”
During the accreditation, it was noted that the College has received a reduced level of funding per capita trainee compared to other training bodies, despite an increase in trainee numbers to the four programmes.
“The accreditation interview with College representatives reinforced the significant shortfalls in funding. It was outlined that the College is faced with generating income through the utilisation of other activities. The College explained they are advocating for an increased level of funding through engaging with the HSE and the NDTP.”
The Council said it supported and encouraged the continuation of engagements aimed at obtaining additional funding to manage “increasing demands in the speciality”.
“As such, the Council has set a recommendation for the College to address,” they commented.
The Council spokesperson concluded that it recognised the “commitment and hard work of staff within psychiatry whom, with additional supports, could achieve great progress. Addressing issues in psychiatry services will not only improve patient safety, but also positively impact on the quality and sustainability of training in Ireland.”