Mr. Mervyn Taylor:

In February of this year we published a discussion document, Delivering Quality Medical Care in Irish Nursing Homes. One of the things that led us to develop this work, in which we collaborated with Nursing Home Ireland and the Irish College of General Practitioners, ICGP, was our concern that it was unclear what the clinical leadership is in nursing homes, particularly in private nursing homes. Some residents are being charged €25 and others €40 a week for a GP service when the fact of the matter is that they should be entitled to this anyway because of their age. In some places there would be a very good structure while in others it would be very difficult for GPs to come in. I want to quote very briefly from this report:

The point was made that nursing home staff may not have the exposure, experience and training available in acute hospitals. It was also suggested that skills sets of nurses working in nursing homes may have gone down in recent years with a concomitant fear of making decisions in potentially crisis situations.

The difficulty here is that if a nurse needs support and there is not strong clinical support, then there is a real weakness in the system, and there has to be clinical leadership.