Dear Subscribers and Stakeholders.
We hope that you are all keeping well.
Welcome to this our first Irish Patients’ Association Briefing Note, it’s a little long, being our first one!
Call for independent inquiry into deaths of nursing home residents.
So many lives have been lost, and many who mourn such loss, do so in solitude, with heavy hearts. Many have unanswered questions.
One grouping of people who died, were elderly residents in residential settings. We believe that there is a need for an independent inquiry to establish why such mortality occurred.
Read our submission to the Expert Committee on Nursing Homes established by Minister Harris on the recommendation of National Public Health Emergency Team (NPHET). [See attached Files]
We need a government.
As I write, so long after the General Election, like so many others, we anxiously await the outcome of the deliberations of the various political party members.
Will they support the current program for government and form a political ‘Celtic Troika’?  
Or will they not?
Political leadership is urgently needed to steer us through this tempest; of a global pandemic, environmental and economic systems, and a stressed public health care system, the likes of which are beyond living memory.
A Challenging time for Patients
While a lot of public recognition, which is rightly deserved, has been given to front line workers everywhere, the past 3 months has   also been a hugely challenging time, especially for; Patients, their families, and those close to them.
While small in number, the most assertive people contacting us to protest, about the organisation of our health care system, were private patients in their mid-20’s to early 30’s who experienced long delays for COVID19 tests and results.
There was further concern by other groups of patients who experienced difficulties in accessing their consultant’s, when they became albeit temporarily ‘one’ with the public health care system.
As these private patients begin to return to their domain of timely access to care, they can now  emphasise and understand, that  the wait experienced by public patients “is not a happy or indeed a safe one” they will be very cautious in accepting a single point of access to  a public health care system if this does not improve. Having experienced in some small part the lot of the public patient, public patients may now have the support of private patients for urgent reform. ‘We are all in this together', not just combating COVID19 but also combating Health Inequalities,
Echoing  Patients' Voices  
The  most heart-breaking experiences are those we heard of, regarding elderly loved ones in their 80’s 90’s. Alone in hospitals or discharged to their homes  with little or no support.
One account yet to be investigated   “ I could see my mother (89) standing in a corridor and I asked the nurse to look after her and get a chair for her, she was rude and dismissive and told me “to leave and if I wasn't happy I could take my mother with me. ” 
another writes of an elderly parent, the patient is “quite deaf and doesn’t have a mobile phone so we have no way of communicating with him. We have phoned the ward but are being provided with very little information”
and another tells us about an elderly parent “ Discharge day was yesterday the doctor phoned me putting me under pressure 8 mins trying to get me to discharge him from their care. I refused to agree on the grounds that his limbs were extremely swollen. He can hardly walk, he is so weak… ” 
yet another writes “ So you know doctor that the patient you are discharging could have COVID19 now?  later that day, elderly Dad brought to the door of the hospital by a nurse and his overnight bag was handed to his son – then she ran away, literally ran away, no isolation advice and no chat about the risks of COVID19 ”   read more about this experience  https://www.irishpatients.ie/post/border-tales-of-covid19by-anonymous
At time of writing this Brief, another family share their experience of a 90-year-old parent, terminally ill, allegedly being denied a visit by a family member, despite meeting HSE visiting criteria,
Lack of Engagement
Our experience of engagement with the HSE and  others during the first phase of covid19  has  at best been muted, the HSE did not contact us to  ask  what we were hearing from patients family’s in various health care settings – if there was such a commitment to patient advocacy in the past why was there such a lack of engagement at  a time of national emergency?
While the IPA is non-political, we do acknowledge engagement by Fianna Fail and Sinn  Fein,  Health Spokespeople and advisors during the past 3 months.
“Change and reform in our healthcare systems must not be preceded by preventable funerals and injury to patients”
Non-Covid19 care
The  day after COVID19 will be the same, if not worse than the day before COVID19 for Public Patients on waiting lists or those attending emergency departments, COVID19 had no part in contributing to that legacy.
At end of May 2020  
Patients Waiting for their First Consultant Led Appointment.
Total Numbered                                        575,863      with 12mths +    207,970
Patients   Waiting Inpatient Surgeries        86,946       with 12mths +      13,500
Read https://www.irishpatients.ie/post/the-day-before-irelands-first-covi-19s-case-0001
The European Alliance to Personalised Medicine (EAPM) earlier this week highlighted a new cohort of patients.“ While the wave of COVID-19 patients is heading downwards in many major cities, another surge is ongoing and looks set to have a considerable impact going forward. It turns out that a substantial number of [Covid19] survivors are suffering serious medical problems post-treatment. Obviously, that will further stretch the resources of hospitals, rehabilitation centres and other medical providers as, over the coming weeks and months, we’ll be learning a lot about the quality of survival, from the thick end of it. ”
BED’s
At the COVID19 multi stakeholder meeting held by the Department of Health 6th March we referred to the huge overcrowding in our Eds this winter vs 2018/19 winter.
At that time there were 200 beds scheduled to be taken out of system at the End March, the response by the DOH, was that the 200 beds will be kept on stream till end of June and beyond if needed
Yesterday June 23rd, we were informed that  3 hospitals, St Vincent's in Dublin, Cavan and Mullingar had no vacant general beds or critical care beds free.
We would say there definitely needed.
Emergency Committee needed for Non COvid19 care
We need a National Public Health Emergency Team (NPHET) type committee to deal with the massive unmet need of noncovid19 patients which in itself is now a public health emergency.
This must be one of the first actions of the New Government when it is formed, and the patient's voice must be at that table.


Finally, we welcome your feedback or suggestions.
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It is only by working in a mutually respectful partnership among all stakeholders, will present and future patients, finally, be at the centre of all decision making.

 Slainte

Stephen McMahon  PSCA (OTC)


Director


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"Change and Reform in our healthcare systems should not be preceded by preventable funerals and injury to patients"


www.irishpatients.ie

Irish Patients' Association
Dublin
00353876594183

Eibhlín Mulroe is the CEO of Cancer Trials Ireland, a not for profit organisation with a mission to bring Irish patients’ early access to the latest cancer treatments through research and to establish Ireland as a recognised centre of high quality translational and clinical research. She is formerly CEO of the Irish Platform for Patient Organisations, Science, and Industry. Eibhlín has a BSocSc Hons from Queens University Belfast and is an MBA graduate from the Smurfit Business School, University College Dublin. International Clinical Trials Day: Highlighting Irish research on Cancer and COVID-19 At a time when scientific research has never been more critical, Cancer Trials Ireland recently shared leadership of the Irish celebration of International Clinical Trials Day by highlighting studies investigating the impact of COVID-19 on people with cancer, and also by highlighting people who had taken part in clinical trials. Cancer treatment and screening may have been hit by COVID-19 in recent months, but people in Ireland can be absolutely certain that the cancer research sector is as committed and proactive as ever, in spite of the crisis. I want to recognise and applaud our funders – including the Health Research Board, the Irish Cancer Society – for their unwavering commitment to cancer research during the pandemic. It is a strong indicator of just how important clinical and cancer trials are for patients in Ireland. For people with cancer in Ireland, access to trials can be the best treatment option when the standard treatments are not working. It is important that we are able to offer these options at all times despite any societal turbulence. It is critical that we are able to create an infrastructure for clinical trials that can withstand a public health emergency or any other situation that puts up additional barriers to patient participation in trials. ‘Interventional’ (i.e. new treatment) clinical trials in Ireland. More widely, over a third (37%) of the clinical trials investigating a medicine/treatment/intervention are cancer clinical trials. Overall, there are 209 clinical trials open to recruiting new patients in Ireland, of which 78 of which are cancer clinical trials.1 People interested in learning more about cancer clinical trials should talk to their doctor, and visit the Cancer Trials Ireland website. “I would not be alive today if it wasn’t for cancer clinical trials”. One patient who has benefitted from taking part in a cancer clinical trial is Seamus Cotter, who works in the aviation sector in Shannon, and now sits on the Cancer Trials Ireland Patient Consultation Committee. Seamus was diagnosed with Stage IV lung cancer in May 2016. He was eligible for a cancer clinical trial, and by April 2017 his scan showed up clear – as has every scan since then. In his own words: “I would not be alive today if it wasn’t for cancer clinical trials”. Cancer Trials Ireland & COVID-19 We are currently engaged in the following ways with respect to COVID-19: · Studying the effects of COVID-19 on patients with cancer in Ireland in real time (COVID-IYON) · Studying the effects of COVID-19 on people with lung cancer, as part of an international collaboration with Italy (TERAVOLT) · Assisting the National Cancer Control Programme (NCCP) in applying for ethical approval for two COVID/Patient Registry studies Further details on the COVID-IYON study Cancer Trials Ireland is currently supporting on an observational study across 12 cancer care and malignant haematology care centres in Ireland to better understand the effect that COVID-19 is having on cancer patients who have contracted the virus. The study is led by Professor Linda Coate, University Hospital Limerick and Dr. Colm MacEochagain, SpR, University Hospital Limerick. Studies like this one are critical in the developing the healthcare system’s understanding of how best to support the community of people with cancer. References: 1 https://www.clinicaltrials.gov/

Media Release Thursday 28th May 2020 14:00 Hrs The Irish Patients Association is calling for a full independent investigation into the reported deaths outlined in todays HSE report at residential care settings. Of the 1,615 Deaths recorded nationally on Tuesday 26th May 2020 from COVID19. Today, a HSE report states that 1,030 deaths of these occurred at 167 residential settings which includes community hospitals, long stay units, residential institutions and nursing homes. At the recent Special Committee on Covid-19 Response debate - Tuesday, 26 May 2020, Pheilim Quinn, the CEO of HIQA stated that “from the onset of this public health emergency, HIQA has endeavoured to make an effective contribution to the national response through our interactions with the Department of Health, the HSE, providers, residents and relatives”. Mary Dunnion, the Chief Inspector of Social Services also gave evidence before the Special Committee. The Chief Inspector is accountable directly to the Oireachtas for the performance of her statutory duties of registering and inspecting nursing homes under Part 8 of the Health Act 2007. Mary Dunnion’ s consistent position has been that, as the independent regulator of nursing homes, the Chief Inspector performs her statutory functions of registering and inspecting nursing homes independently of HIQA, the HIQA Board and others. The Office of the Chief inspector registers and inspects 584 nursing homes accommodating approximately 30,000 residents. The Chief Inspector, as part of her registration and inspection functions under the Health Act, conducts interviews to establish the fitness of all persons who are registered by the Chief Inspector to be the Persons-in-Charge of all private and voluntary nursing homes. The Chief Inspector, on an ongoing basis, conducts inspections of nursing homes to assess the compliance by the persons-in-charge with ministerial regulations and HIQA Standards, including the Care & Welfare Regulations amended recently by Simon Harris, the Minister of Health on 2 October 2017. The Persons-in-Charge of nursing homes are, as a rule, registered nurses and are statutory responsible for clinical supervision and care and welfare of residents within the nursing homes. The assessment of the fitness of Persons-in-Charge and ongoing compliance assessment is the statutory responsibility of Mary Dunnion, the Chief Inspector. In this context, at the recent Oireachtas committee, the Chief Inspector said, “we identified premises that would be challenged in the context of managing Covid-19 outbreaks. Our findings would have been communicated to the Department of Health and the HSE. We are talking about February and March.” Phelim Quinn, the CEO of HIQA has a seat on NPHET. Mary Dunnion, the Chief Inspector, has had no seat on NPHET, despite the unfolding tragedy in the Irish nursing home sector. We are just emerging from the country’s first phase of COVID-19, a second phase may occur, the severity will depend on us all looking out for each other and being open to learning from the mistakes of the past and being accountable for the welfare of the elderly, vulnerable, frail and sick people in the State-regulated nursing homes up and down the county. . The Irish Patients Association is calling for a full independent investigation into the reported deaths outlined in todays HSE report at residential care settings. Further, the Irish Patients Association calls on the Government to establish a full investigation of the independence and effectiveness of the State’s regulation of private and voluntary nursing, with a particular focus on the role of the Chief Inspector to date in the State’s response to the national tragedy that has unfolded in nursing homes under her regulatory remit. It is understood that the Irish nursing home regulator profiled certain nursing homes as high risk and provided a list in March 2020 to the Department of Health. It is important that all patients, residents and families understand the reasons why that list was prepared, why it was handed to the Department of Health by the independent regulator and why there was no communication with the residents or their families regarding that list at the relevant time. It will also be necessary to establish whether or not all operators whose names appear on that list were informed by the independent regulator. It will be important to establish how many of the nursing home names appearing in today’s Irish Times, also appear on the list relayed by the regulator through HIQA to the Department of Health as list of high -risk nursing homes. Finally, it will also be necessary to establish when did Phelim Quinn, HIQA’s CEO become aware of the list, when was HIQA’s Board made aware of the list, when was the HSE Board made aware of the list and when was NPHET made aware of the list

Margaret is a National and International Patient Advocate, advocating for safer heath care, she is former Global Lead for World Health Organisation’s Patient for Patient safety, member Patients for Patient Safety Network Ireland. When visiting a doctor, patients expect a listening ear, an accurate diagnosis and timely treatment. Margaret Murphy encountered the opposite – a flawed health system that lacked the capacity to respond to her 21-year-old son’s deteriorating health. “Every point of contact within the Irish medical system failed Kevin,” explains Margaret. “Simple measures were not taken and he needlessly lost his life.” “Patient advocacy is a responsibility that has been thrust upon us by our experiences,” says Margaret. “We know we can’t change the past, but we can use the past to inform the present and influence a better future.”i COVID 19 – Unexpected and Welcome Consequences Published 11th May 2020 Now in the third decade of my patient safety advocacy journey it is strange to find myself considering that Covid19 is in fact contributing to the advancement of the founding principles and core values of the global advocacy movement, established in 2004 as the WHO Patients for Patient Safety Programme. Our call from the outset has been for care that is delivered with head, with heart, with hand – that is employing intellect, compassion and skill. That call also asked for greater transparency and disclosure together with meaningful engagement and involvement in healthcare at all levels as a right for patients, families and civil society – the intention being that we would become co-producers and co-creators of safe care. Despite the best of intentions, it has been a hard slog and uphill struggle. ‘We have all been cut down to size’ But in recent times, it seems to me that the intent and aspiration is coming to fruition, now that we are assailed by a common enemy, an enemy that presses on regardless irrespective of race, creed, position or title. It is clear that we all - each and every one of us – have been cut down to size We are all equal in our vulnerability. Perhaps it is the combination of that powerful vulnerability and equality of fragility that is fuelling the significant leadership magnificent response from all in our society. ‘we now be trustworthy and deserving of being true partners in this call to action’ We can see how this is playing out. Our healthcare and political leaders have been open and honest (some would say brutally honest) with us, explaining the rationale for the escalation of the various measures to improve our chances of coming safely through this onslaught by an invisible adversary. We deserve no less and we want no less. Those leaders keep emphasising that we are ‘in this together’ as they enlist and urge, indeed entreat, each of us to rally to the call – to do our bit in tandem with the Trojan efforts of those on the frontline who turn up every day to continue to provide healthcare at no little cost to themselves and their families. If this is not co-creation and true engagement, I don’t know what is. This is what we asked for. This is what we demanded in what were more ‘normal’ times and sometimes less receptive times. Just as we entrust ourselves and our loved ones to healthcare it is important that we now be trustworthy and deserving of being true partners in this call to action, that we observe the guidance and comply with recommendations. The level of leadership and directness of communication has been admirable. It comes from co-ordinated sources: (a) from all our political leaders who have demonstrated a level of gravitas and statesmanship that is both reassuring and commendable. (b) from our healthcare leaders who are grappling with the complexities of our situation at so many levels and who, it is very clear, are not sparing themselves in planning a way forward and out of this dilemma. For us the rallying call is one which has proven to serve us well in previous ages: UNITED WE STAND, DIVIDED WE FALL. NI NEART GO CUR LE CEILE. This is the time for us to HOLD…. HOLD…. HOLD to be gladiators in solidarity against the current threat…… Embracing that new identity of being a homebird is counter intuitive for many of us 70+ elders as is cocooning and focusing on ourselves as spectators. Positivity and finding that ray of hope is crucial and which puts me in mind of the words of the poet Arthur Clough and devoted assistant to Florence Nightingale: Say not the struggle nought availeth, The labour and the wounds are vain, The enemy faints not, nor faileth, And as things have been, they remain. If hopes were dupes, fears may be liars; It may be, in yon smoke concealed, Your comrades chase e'en now the fliers, And, but for you, possess the field. For while the tired waves, vainly breaking Seem here no painful inch to gain, Far back through creeks and inlets making, Comes silent, flooding in, the main. And not by eastern windows only, When daylight comes, comes in the light, In front the sun climbs slow, how slowly, But westward, look, the land is bright. As we all work together in cooperation and consideration may brightness and sun soon be restored to our land and to our lives. We home birds look forward to release from our gilded cages when like golden eagles we will soar to new heights while in grateful thanks for the gift of new insights, for family and for the volunteers who have minded us so beautifully. Rath De orainn go leir. Margaret Murphy Contact Details with Editor

Working from home didn’t seem too tough at the start of this pandemic. My partner and I are lucky to have jobs where we can still earn a crust from the comfort of our house. The worst part of the lockdown was not travelling up to our border county home to see the folks. We missed them in their cocoons. A few weeks ago, the worst happened, one of our parents had a stroke and very quickly rushed to Hospital. The last place we wanted to send a loved one during a pandemic, but a stroke is a stroke. The neighbours, the local GP, ambulance driver acted so swiftly that the treatment was administered just in time and the main man was ready to fight another day. Information was hard to get and getting into see the patient was an absolute “no no” or at least that’s what I thought. When my other half returned from dropping clothes into his Dad, he said the nurse was really nice, she let me in to see Dad for a minute. My heart sank. Who else did the nice nurse let in, she was being kind but COVID19 ain’t so kind and less so with no Personal Protective Equipment (PPE). “Trying to get to talk to the treating consultant was not easy” The worrying started. Once the stroke was treated all we wanted to do was get Dad home. Ringing the ward and trying to get to talk to the treating consultant was not easy. When we did get to talk to a Health Care Worker HCW we were told there was a queue for the final scan needed before he could be discharged. This narrative went on for 4 days – eventually after a heated discussion with one HCW we got some answers. Asking about whether there was equality for all patients and if stroke patients were being deprioritised - we were told there were actually no staff available to do the scan due to them being in isolation – fair enough. Why didn’t we hear that from the get go. I just can understand why they can’t just be straight ? patients and families can handle the truth, it’s a pandemic, it’s no one’s fault but we have to be honest. “What we can’t handle is not having information” What we can’t handle is not having all the information. No one, including that HCW wanted our Dad in the hospital one minute longer because of the risk of COVID19. We worried about the risk of not having that final scan but after a good “chat” we all agreed it was time to go home. “So you know doctor that the patient you are discharging could have COVID19 now? Do you know that he cares for and lives with someone in her late 70s?” “Eh no? “ “So, are we isolating him at home?” “Well there’s no symptoms so we can’t test?” “Literally ran away” Fast forward to later that day, elderly Dad brought to the door of the hospital by a nurse and his overnight bag was handed to his son – then she ran away, literally ran away, No isolation advice and no chat about the risks of COVID19. Is it her fault? Is it the Doctors fault? No, they are doing their very best and operating to the processes and procedures in place. They are putting themselves at risk and that is admirable. “Who writes the procedures?” My question is, who writes the procedures? Why wasn’t there a policy of testing patients who have been exposed to HCWs with COVID19? I am sure if the policy existed the HCWs would have executed the test and relevant advice on isolation. My elderly Dad was in the care of his son for a week after leaving the hospital, did he isolate – no. Why? “The kids might have insisted on it but sure the doctor didn’t say it was necessary.” he could be heard thinking! “Right so Da, will you get a test then just to be safe?” “Alright son” “Mammy collapses” 3 days later the test is positive, 3 days later again, Mammy collapses and spends 2 weeks in hospital with COVID19. The adult “kids” have symptoms – son tests positive. “Media blaming the nordies” Stories abound about the high numbers of COVID19 on the border and media blaming the nordies. I am no expert, but it doesn’t take a genius to work out that if we are discharging patients into the community without isolating them or testing them then your local hospital has a large part to play in the high numbers contacting the virus. “What about the old people with no annoying relatives to stand up for them?” I hope this story helps others. We need better guidelines for hospitals when discharging all patients. We also need to think about the loneliness of patients in hospital tonight. They can’t see their families; their families can’t see them and most importantly no one can have a face to face with the treating team. We had an awful experience with one HCW but to be very fair to the hospital after raising the issue they apologised. Information has been so much more forthcoming since then – but what about the old people with no annoying relatives to stand up for them? Our Taoiseach asked us to cherish the elderly – processes in the HSE need to reflect that sentiment.

The Irish Patients Association calls on the Minister for Health and all political Parties to urgently address the building surge of patients in need of care that is not Covid19 related. It needs a similar group such as NPHET  – Too many lives are at risk, Too many Patients suffering, too many anxious if they will get timely access to safe care. Since mid-April we have quantified and highlighted the ever-increasing fall in attendances and admissions at our emergency departments vs the same period last year. One doesn’t have to be a medical expert to read that this massive build-up of unmet need is a cause of serious patient and public health concern. The HSE signed a major contract to buy in capacity from the private sector. A massive cost of €115 million per month for 3 months. We understand that this equates to almost 9 years of NTPF funding, specifically for private hospitals use for public patients. Our Private sector sources advise, if the Private system was given €100 million, in a year our waiting lists would be almost zero. While the deal was signed off on March 30th 2020, initially it was a contingency capacity  for covid19 surge which thankfully hasn’t happened.  On May 1st the HSE announced that it was planning to maximise this resource in the interests of non-Covid 19 Patients. eg elective and outpatient waiting lists etc. . While we welcome this development, we have concerns about its oversight. With only 8 weeks left in the €316 million deal. A huge opportunity to flatten the curve for non covid19 public demand presents itself. At the same time to integrate care for private patients also in need of care. Among our main concerns; there is no clear published guideline as to how clinical priorities are being set for the most urgent elective care or outpatient appointments, while left to local hospitals to link into the private sector how does we ensure consistency in their use of the private sector? Over sight of the delivery from this historic investment, must have meaningful multi-stakeholder involvement.  We understand that the HSE has a committee overseeing this utilisation of  the private capacity however  it is ‘bizarre’ that no private hospital representatives are in this group, nor consultant representatives, nor patient interests. We must work together as ‘equal’ stakeholders,  to deliver needed care; that for many, in so many ways , can't wait !

Going into the COVID19 Pandemic, our Health Care system was ‘fragile’ even to meet expected demand in 2020. On the day before the Republic of Ireland’s first case of COVID-19 was declared, on February 28th 2020 it was the 104th day of the IPA’s monitoring of the 2019/2020 winter period vs the previous year. The source data we analysed from the Irish Nurse Midwives Organisations’ Trolly Watch. So, on Feb 27th we had 73 days with more than 500 patients on trolleys and wards vs 28 in the previous winter . Serious and sustained overcrowding had the knock impact on patient safety. It was, and still is an undeclared national emergency that has now been massively overshadowed by COVID-19. This winter’s surge was planned for in the HSE budget, and demand was not much dissimilar to the previous winter. The HSE tried to control this surge with various escalation protocols to meet the demand; such as cancellation of elective surgeries, improving home care packages and the addition of 200 extra beds up to Match 2020. Ireland has a very unfair two-tier health care system nowhere is this more evident than the huge waiting lists that have existed for many years despite so many political promises to the public in the mist of so many vested interests. On the day before our first COVID19 case was recorded, our public waiting lists as per National Treatment Purchase Fund (NTPF) for February 2020 were. Inpatient Elective waiting lists eg Hip Replacements Total 0-3 Mths 3-6 Mths 6-9 Mths 9-12 Mths 12-15 Mths 15-18 Mths 18+Mths 66,705 27,709 16,119 7,901 5,301 2,934 1,959 4,782 Outpatient Appointment awaiting first Consultant led Appointment Total 0-3 Mths 3-6 Mths 6-9 Mths. 9-12 Mths 12-15 Mths 15-18 Mths 18+Mths 558,554 158,173 100,174 70,468 56,537 36,944 30,358 105,900 International comment noted, that even if we met the Governments target time of treatment within 15 months we would still be the worst in Europe. In addition to those waiting for access to treatment there are also many people with disabilities who often may need care from family, partners or health system. The 2016 Census tells us that there were 311,580 Males with a disability and 331,551 Women. Other vulnerable groups such as Asthma, Diabetes add a further 470,000 and 250,000 respectfully. In addition to this patient groups there are some 250,000 suffering from Depression not including other mental health illnesses. To deal with this significant demand, red flags were raised about falling numbers of family doctors, consultants and nursing shortages. This was the demand, and will continue to be during our handling of the COVID19 pandemic. OPINION Patient’s and Health care service users, need a new Government to be formed. One that is built on transparency, solidarity and where the ask is ‘what can you do for your country’. Ethically we need to decide, that vested interests in all their guises can no longer command a disproportionate influence on consumption and use of resources, which will ultimately impact on fellow citizens.
In Healthcare delivery, The fragile domain of Trust must be protected, built on Performance and Accountability not PR and spin.

CV19-0320-2 Queries for Community Care and Acute Care Continuity of Business as Usual in the Community While most attention has been placed on Acute services, ICU beds, clearing beds, extension of cancellations of outpatient appointment’s, and elective surgeries. The World Health Organisation have stated that now we need more nursing home services in the community and at home testing kits. We need to enhance service provision extend role of pharmacy and community IV in the community to treat patients in their home or residence. It was established Monday 9th March that the National Emergency Plan for Managing Epidemic’s has not been updated since 2007 and is currently being updated. The following are concerns that have been raised with us by members of the public and experienced professionals. What enhanced supports have we put in place to stop all patients being transferred to Hospital. This refers to the most vulnerable eg Residents in Nursing Homes, and those requiring care at home. What enhanced supports are being put in place to keep patients away from congregation? example: in nursing homes and pharmacies’ in the community. Have we developed a home testing kit for patients? Have we a plan to collect same? How are pharmacies being used to protect patients in the community? Will we develop a triage app that will allow pharmacies to triage and dispense medication service and testing? This is urgent as the GPs will be under enormous workload in the coming week Elderly patients are still being transferred to hospital for treatment they should be getting in Nursing Homes such as IVs and minor falls. What steps are being put in place to avoid transfers for our most vulnerable? Reports are coming in that families are very worried about what will happen to their loved ones if they get sick. Principle: Patients come first and should not be used as a pawn by any party in dealing with this historic challenge to our society. Flexibility among and within professions will be needed to share the burden among the frontline in acute and community settings. Some models of the impact of Coronavirus as high as 60% of population with 5% being critical and up to 3% total mortality, Our Acute system cannot cope with this demand in addition to normal demand, this is why treatment in the community is a HIGH PRIORITY now. We have unconfirmed reports that St James Hospital has an emergency pop-up tent hospital that they have not been able to erect due to the space being occupied reserved for the children’s hospital development. Is this true? if so, where will this tent be erected ? and with it, the same services as previously planned for?