Ms Breda Crehan-Roche:

As regards enhanced community care and the integrated care programme for older people, ICPOP, teams for the elderly, the best way to explain this is to give an example. Tom comes to the accident and emergency department. He has had a fall, he is seen and it is found he has fractured his hip. He goes into surgery and gets seen there. There is then a discharge programme and co-ordination where he is discharged back into the community. He is seen by the consultant geriatrician, because in Community Healthcare West, which is Galway, Mayo and Roscommon, we have four integrated care programmes for older people, each of which programmes has a consultant geriatrician. There are clinical nurse specialists, CNSs, occupational therapists, OTs, and physiotherapists, who are multidisciplinary and work closely with GPs. Tom goes back into the community but needs a little bit of transitional care. He goes into one of our ICPOP beds in one of our community nursing units and is then discharged after four weeks with a follow-up plan and with multidisciplinary teams involved.

Another situation is that of Ambrose, who has fallen but, thankfully, has not sustained a fracture. He does not need to go into hospital, so he is sent back into the community instead to be seen by a consultant geriatrician. He gets four weeks' transitional care in one of our care homes and is then discharged into the community with a follow-up, which would be multidisciplinary and would involve physiotherapists and OTs, depending on his presentation. He is seen and is looked after in the community and his family are supported with respite and home support.

That is the way it works. If somebody is in hospital, there is great integration between the hospital and the community. There are weekly discharge meetings and we look at what supports a person needs. We also have frailty at the front door. For example, last month in Galway, 133 people were seen in the accident and emergency department and we saved 236 bed days. Again, that was supported through community, step-down, transitional care beds, and being seen by consultants and by the multidisciplinary staff. That is the way it works.

There is also home support, and people get the home care packages they require, including aids and appliances and adaptations to their homes, which sometimes involves the local authorities. That is a very quick synopsis of the way it works between the hospital and the community.