S.TRUEMAN PhD THESIS 2016

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Administrators postulated that into the foreseeable future resources would continue to be limited. The consensus is that there is little room to manoeuvre to address the issues as they could only respond to ‘up-stream’ decisions which are made out of reach of their influence. Hence, as an example, while being acutely aware of the shortfalls in not having permanent remote staff, and an overreliance on agency and temporary staff, they were unable to change this without significant investments at a governmental and profession level: It’s very difficult to recruit into these types of positions … It’s a constant battle to work within the budget you are given. [T27, p. 2] Despite identifying issues which mirror those of the remote nurses when delivering mental healthcare they uniformly praised and acknowledged the level and quality of mental healthcare provided: My experience [mental health nurse graduated 1977] is that often they [remote nurses] … do a pretty good job, but they don’t acknowledge their own practice because they’re so concerned about the fact that they’ve never been trained. It’s a case of building capacity … with reassurance, that their practice is sound and is of a standard that meets the needs of the patient. [T19, p. 13] Technology was mentioned as a cost-efficient means of addressing issues and barriers arising from distance, staffing levels and travel. In particular, video-conferencing was identified as the anticipated technological next ‘step’ in cost efficiencies associated with delivering remote mental healthcare: There has been a number of evaluations over the years of videoconferencing and their services generally, and they were always very highly valued. [T18, p. 7]