Professor Cillian Twomey:

It is not true to say that nothing has been established. In my own clinical practice, for example, prior to Covid, I had assigned to me two community hospitals in the Cork city and county area which I visited on a regular basis. My colleagues in geriatric medicine in Cork continue to do the same. Admittedly, this related to HSE-funded facilities but it was an innovation that was introduced with benefit 15 or 20 years ago.

Covid-19 broadened that out considerably because it made clear that it is not good enough to have that sort of support provided to HSE facilities but it also needs to be provided to the private nursing homes. The Covid response teams did not distinguish between a public or a private residential care setting. The work that they did, which was hugely applauded, and we have an article in our report commenting on its success, did provide that necessary medical support. The person who, historically, would have had to inconveniently come from a nursing home to an outpatient clinic and wait for hours to be seen and then go back again can now be seen in that new format when the community support team visits the nursing home. We have now recommended that this model should be applicable to all residential care facilities, both public and private but there is a resources element to that. If we are asking general practitioners and geriatricians to be lead participants in it, as well as the other consultants like those in palliative care, public health and so on that are in our report, then we have to provide the resources for that to be realised. It is not impossible to do it but it absolutely must be done.

As regards the model, whether it is public or private my argument is that we should not have a huge number of large congregated settings for older people's long-term care residential needs. I am putting a strong case for a revised model, which is smaller congregated settings with a maximum of perhaps six people living in them. They can be managed much more easily, even in the context of someone being the father or mother of sons or daughters who are at work or who have gone abroad. It is about providing it in a more homely and humane way. To my mind, that will be much more a home than the institutions we have tended to generate over the past two decades.