Professor Cillian Twomey:

On whether we were concerned about people who are very ill being able to get to an acute hospital, I will mention one of the positives that emerged regarding the Covid response teams that we are now recommending, in recommendation 7.1, be permanently institutionalised as community support teams. This was reported to us by participants, including community nurses, geriatricians, infectious control staff, public health officials and so on. Heretofore the amount of support nursing homes got was decided somewhat haphazardly, perhaps more so in the private sector than in the public sector. These committees, however, were able to give support, including clinical support where necessary. This sometimes allowed the medical issue that had arisen to be dealt with satisfactorily in the nursing home. Equally, these teams were able to say that people needed to be transferred to an acute hospital because of the issue they had and to organise that transfer.

From now on, such community support teams need to be made permanent. This will lead to much better clinical decision-making about which patients or residents should be transferred and when. Sometimes nursing homes are worried about the publicity that might accrue to them if people who are close to the end of their lives and are dying die or if more than one or two such people die in a week. A support team would be able to say that a person is dying and that the humane thing to do is to support him or her where he or she is and where he or she has been looked after so well for so long, if that is the appropriate answer. A structure such as the community support teams which would support that kind of decision-making would make for a much more enhanced level and standard of care, while also providing reassurance to families, residents and staff in residential care settings.