The reality of cutbacks.

woodoo

I came across this story today in the newspaper. It shocked me. I am aware that there are cutbacks but normally we hear them in general terms and find out little of the specifics.

This cancer patient has had his pain relief procedure removed from him because they are trying to save money.

http://www.irishexaminer.com/ireland/cancer-patient-refused-specialist-pain-treatment-due-to-cutbacks-189758.html

It does highlight how grossly unfair it seems to be handing over billions to pay off debts that aren't really ours at the same time cutting essential services to the likes of Thomas Keavney.

Head The Wall

We are handing millions over to pay the likes of your wages regardless of how bad or really bad you are. That is the problem

Pete_Cavan

The reality of cutbacks is that they are as a result of our budget deficit. The reality of the deficit is that it is not as a result of the bank bailout. Suggesting that the cutbacks are as a result of the bank bailout is totally incorrect.

juan.kerr

It seems as though we are cutting public services across the board but not the payroll costs. Begs the question why do we need the same levels of staff to do less.

Einhard

Public sector pay and allowances have been cut to a fairly significant degree. I think that we can debate whether there is scope for more cuts, but it's entirely untrue to state that there have been no cuts, or that they have been minimal. Not much point in discussing something when people refuse to acknowledge basic reality.

woodoo

Head The Wall wrote: »

We are handing millions over to pay the likes of your wages regardless of how bad or really bad you are. That is the problem

There is always a simmering bitterness in your posts head the wall. I wouldn't like to live your life.

This thread is about the poor man who had his pain relief cut not the public sector or the banks. People always like to jump straight to the Public Sector that is costing about 15 billion a year. Ignoring completely the 21 billion welfare bill.

May as well shut this thread down not one of the posts so far relate to the issue at hand. I'm glad you all have sympathy with his plight :rolleyes:

I am happy to have highlighted his plight anyway.

juan.kerr

Einhard wrote: »

Public sector pay and allowances have been cut to a fairly significant degree. I think that we can debate whether there is scope for more cuts, but it's entirely untrue to state that there have been no cuts, or that they have been minimal. Not much point in discussing something when people refuse to acknowledge basic reality.

I'm not convinced. Seems we are prioritising all other savings over payroll savings regardless of the long term effect. So we're seeing reduced investment in the non payroll components of infrastructure, technology, maintenance, cleaning etc.

An inevitable side effect of the Croke Park deal unfortunately, I think we're just putting off the inevitable until everyone reaches the same conclusion that we can't protect a small (but powerful / vocal) section of society to the detriment of the rest of society, particularly while the deficit shows no real sign of narrowing.

And please, no mention of protecting the bankers / developers.

Gumbo

Head The Wall wrote: »

We are handing millions over to pay the likes of your wages regardless of how bad or really bad you are. That is the problem

You are in London, and handing over nothing in the running of Ireland.

Bitter, bitter post....

femur61

Einhard wrote: »

Public sector pay and allowances have been cut to a fairly significant degree. I think that we can debate whether there is scope for more cuts, but it's entirely untrue to state that there have been no cuts, or that they have been minimal. Not much point in discussing something when people refuse to acknowledge basic reality.

May have been cut but still a huge problem with money funding the black hole in the HSE. http://www.businesspost.ie/ Its a paid fire wall but basically absenteeism still is a huge problem of the HSE. The unions have many of the PS workers brainwashed that they are unfairly paid and should be paid more. With some of the highest paid PS workers in the EU http://www.iiea.com/blogosphere/public-sector-pay-at-a-glance money has to be saved in other areas to keep the high wages. Bank bailout aside we have been pborrowing for as long I can remember, I'm in my mid 40s, long before our current crisis. Can't the PS do simple math, we are a population of 4m but yet a lot of our PS get higher wages than in the UK with their population of 60m. Where is the money coming from, the tree fairy!

woodoo

kceire wrote: »

You are in London, and handing over nothing in the running of Ireland.

Bitter, bitter post....

When he worked in Galway he was earning €10 per hour gross so i'd guess he wasn't handing over much in the way of taxes then either.

K-9

Far too much personal references and digs in this thread. Any more will result in cards, posters should know better at this stage.

Dannyboy83

More evidence of why the Croke Park Agreement is unworkable and must be scrapped.

Fine Gael state that the Unions are threatening nuclear winter if the CPA is scrapped.
Indeed, Patricia King of SIPTU recently threatened the same.

However, it should be asked - is this a viable alternative?
We are in the early stages of 'austerity', much worse is yet to come.

We have corrupted the austerity process;
in Greece, they still have that railway that consumes 5% of GDP
in Ireland, we still have the CPA and our public spending is still multiples of what it sustainably can be.

If you want to implement austerity, but don't fix your own corrupt spending... you're doing it wrong.

http://www.ronanlyons.com/2011/04/26/“slash-and-burn”-anything-but-the-need-for-realism-in-budget-2012/
it isn’t as easy to cut spending in health, education and social welfare. That’s because the bulk of all this money goes directly into someone else’s pocket as income. What these departments need is a combination of natural attrition of staff and productivity-driven growth that delivers savings each year every year for five years of the order of 5%. This is on a completely different scale to what the Croke Park Agreement has currently planned. It is estimated that its efficiency measures in education would save 0.5%, one tenth of the savings needed in a single year.

woodoo

I will post the article for people to read and perhaps remind some of what the thread is about. If that doesn't work maybe one of the Mods might change the thread title to Public Service Discussion


A man who survived cancer three times in the last decade has been told he can no longer receive specialist pain treatment at a major hospital due to HSE and Department of Health cutbacks.
Thomas Keaveney, aged 40, from Lifford in Co Donegal, revealed the situation in a letter sent to Health Minister Dr James Reilly and seen by the Irish Examiner.

The father-of-two was first diagnosed with seminoma/testicular cancer at Letterkenny General Hospital in 2001 before being referred to St Vincent’s University Hospital in Dublin for specialist care.

Just two years later he was again diagnosed with cancer, this time of the stomach glands and chest glands, and returned to St Vincent’s for chemotherapy.

Despite the high-quality care he received, in 2005 the stomach and chest cancer relapsed and were joined by a cancerous tumour in the base of Mr Keaveney’s neck, meaning he had to return to St Vincent’s for aggressive chemotherapy.

After this treatment ended on Dec 27, 2005, Mr Keaveney suffered related pains in his neck and back and began specialist pain treatment at St Vincent’s from 2006 until this week.

However, despite the delicate nature of the support — which involves inserting needles which burn off the damaged areas’ nerve endings to provide short-term pain relief — on Tuesday, he was told he could no longer receive this support.

Explaining the sudden change, a member of pain specialist consultant Dr Declan O’Keeffe’s team told Mr Keaveney this was because of HSE and Department of Health budget cut-related changes which mean hospitals cannot provide the care to patients outside their catchment area.

The only catchment area Mr Keaveney lives in is for Letterkenny General and Sligo General — neither of which have the necessary specialist services he needs.

"I was taken into an office and a doctor proceeded to ask me how I was feeling. I said I was glad to be there because I was in a lot of pain.

"At this point her facial expression changed and she began to tell me that, due to cutbacks and more so that because I was not in the catchment area, they could no longer offer me the procedures," the letter to Mr Reilly stated.

"Dr O’Keeffe confirmed the above and went on to state that he too was upset to tell his patients this; that his role was to monitor his patients and administer appropriate medical treatment, not to tell them that they could no longer receive this due to money issues," it added.

Speaking to this newspaper, Mr Keaveney said neither he nor the hospital knows where he will now receive the support needed, if it is provided.

A spokesperson for St Vincent’s said the case will be raised with the hospital’s board on Monday week in an attempt to find a solution, but stressed that the facility currently has no option other than imposing HSE and Department of Health policies.

"We have been told by the HSE that we will not be funded for treating patients from outside our catchment area, and that the HSE funding provided is to be dedicated to the care of St Vincent’s catchment area patients only, except in the case of the national designated liver transplant programme," he said.

"St Vincent’s has pursued this approach with deep regret, but it has no option."

A spokesperson for the minister declined to comment on the specific case.


Read more: http://www.irishexaminer.com/ireland/cancer-patient-refused-specialist-pain-treatment-due-to-cutbacks-189758.html#ixzz1rSU2sQn3

n97 mini

There are cutbacks to services evident to pretty much anyone who uses them. My local library doesn't open till lunchtime on any day now, which makes it pretty useless for students. My bus and train services have been cut back to the point where the bus is no longer usable for the morning commute.

woodoo wrote: »

People always like to jump straight to the Public Sector that is costing about 15 billion a year. Ignoring completely the 21 billion welfare bill.

Epic deflection.

Nijmegen

The reality of the cuts is that they are indiscriminate in their nature thanks to an unwillingness to make difficult choices. There is no prioritization for healthcare over, say, quangos because in reality none can be made. You can't abolish a quango because you can't fire the staff.

You can't de-couple these two issues: This man needs services that have to be paid for. There's draconian cuts applied to the health care budget that provides those. So they are cut.

If the government could cut other things, it could prioritise health. It can do neither. The Croke Park Agreement is Enemy Number 1 in this respect.

mikemac1

The thread is about cutbacks in the health service so I'll stay ontopic

Spending on health budget and Ministers for Finance

Charlie McCreevy 2002 6.5 billion
Brian Cowan 2008 15.5 billion
Michael Noonan 2012 13.6 billion

Just a few minutes of googling, the info is easy to find

I don't know the solution, I don't even know where the problems are.
The OP says the cutbacks are affecting people badly and that's probably the case

But where is the money going?
Is there a black hole somewhere?

I know you want cutbacks reversed OP but realy, is that going to solve anything either

It's some mess and I would not know where to start. I think I read about two thousand human resource staff in the HSE. Seems a bit mad as that function could be centralized.

A strong minister with bold plans and who could make sweeping changes might get somewhere, I'm no expert on the subject

Nijmegen

mikemac1 wrote: »

The thread is about cutbacks in the health service so I'll stay ontopic

Spending on health budget and Ministers for Finance

Charlie McCreevy 2002 6.5 billion
Brian Cowan 2008 15.5 billion
Michael Noonan 2012 13.6 billion

Just a few minutes of googling, the info is easy to find

I don't know the solution, I don't even know where the problems are.
The OP says the cutbacks are affecting people badly and that's the probably the case

But where is the money going?
Is there a black hole somewhere?

I know you want cutbacks reversed OP but realy, is that going to solve anything either

It's some mess and I would not know where to start.
A strong minister with bold plans and who could make sweeping changes might get somewhere though

Medical inflation has run well ahead of general inflation, which is something that needs tackling here and abroad.

The provision of new and upgraded services exploded costs, also. You have to remember too that our hospitals today service a much larger population than in 2002 (3.93m 2002 vs 4.59m 2011, up 16.8%) and that our older population is increasing yearly also.

I think, to be honest, that health care budgets are not bigger than they need to be in many senses. We have sick people. We treat them. We can fight around the medical inflation front and so on.

But to come back to the other point...We maybe don't need X quango. But we can't cut it to save Y hospital.

oppenheimer1

Is it not that the patient in that article will be transferred to a more local hospital to deal with his condition, rather than being refused treatment outright?

murphaph

oppenheimer1 wrote: »

Is it not that the patient in that article will be transferred to a more local hospital to deal with his condition, rather than being refused treatment outright?

The more local hospital doesn't offer this specialised treatment, so the patient is fcuked.

If people think the CPA has nothing to so with such cutbacks, they are only codding themselves.

woodoo

murphaph wrote: »

The more local hospital doesn't offer this specialised treatment, so the patient is fcuked.

If people think the CPA has nothing to so with such cutbacks, they are only codding themselves.

The CPA, high Social Welfare bill, NAMA, etc etc and the budget deficit in general of course mean that cuts need to be made. But some things should not be cut and pain management for a cancer patient is one of them.

johnnyskeleton

woodoo wrote: »

I came across this story today in the newspaper. It shocked me. I am aware that there are cutbacks but normally we hear them in general terms and find out little of the specifics.

This cancer patient has had his pain relief procedure removed from him because they are trying to save money.

http://www.irishexaminer.com/ireland/cancer-patient-refused-specialist-pain-treatment-due-to-cutbacks-189758.html

It does highlight how grossly unfair it seems to be handing over billions to pay off debts that aren't really ours at the same time cutting essential services to the likes of Thomas Keavney.

More to play devils advocate than anything else, how should we deal with the above scenario?

Leaving aside the levels of public sector pay and numbers for a moment (don't worry, I'll come back to it), we have a situation where there are cuts being made in hospitals across the country.

Generally speaking, this will result in a reduction in the services that they can offer. Obviously they have to decide what to keep and what not to keep, and presumably they have kept essential services and services to their core regional area. This means that non-essential surgeries and/or care to people outside of their area have to be cut back on.

Can this guy get some level of pain relief in his own area e.g. painkillers? Is it possible that he can get it there now (whereas previously it was only provided in Dublin)?

It seems to be a very one sided article and they don't appear to have asked the HSE or hospital to comment. It may well be that he will get another, albeit less good, service in his own area.

Apart from emotional responses (because obviously no one wants to see someone in pain not getting health services), what is wrong with what has happened here? It would be great if we had universal full health care that was world class, but I'm not sure that we can afford that. In such circumstances, I think people are going to have to accept a good standard of care instead of a world class standard of care. If they want a world class standard of care, I suppose they can pay privately for it.

Turning now to wages, on the one hand people complain at the wages paid to consultants and other medical staff, but on the other hand if they are cut more we might not get the necessary skills we require. Anecdotally, many Irish medical graduates emigrate, not because there aren't jobs here, but becuase they can get paid better in other countries. Medical care is expensive, there really is no denying that.

However, there is some concern that the percentage of the HSE's budget that goes on primary care e.g. hospitals, doctors, nurses, ambulances, attendants, medicines, little machines that go beep etc is not as high as it should be and there is a massive level of administration and/or waste.

I'm not sure how true that is, but supposing it is, how do we solve it? The HSE administration is due to it being an all Ireland administration with functions that go beyond merely providing primary care and into social work and whatnot. If we dismantle that, people will complain about a lack of social work or that people aren't being transferred from one hospital to another etc.

Also, what it would mean is that counties where there are higher taxes e.g. household charge - might have better funded hospitals than other areas.

So even when we go to look at HSE wages, much of the "waste" is actually the stuff that allowed this man to travel down to Dublin for his treatements in the first place.

So OP, no one is denying that it is unfortunate that this man doesn't get his procedure, but the question is what do we as a society do?

1. Nothing and hope for the best;
2. Tell him to accept it or get private health insurance;
3. Reduce wages in the HSE further and hope our doctors, nurses and other staff don't emigrate or get private jobs or go on strike etc;
4. Abolish the HSE management structure and thereby each hospital will be locally funded and provide for locals only and each area can decide how much tax/care they will get.
5. Ramp up funding for the HSE and damn the begrudgers who wish to balance the budget.
6. Any other ideas.

What's your solution?

Welease

woodoo wrote: »

The CPA, high Social Welfare bill, NAMA, etc etc and the budget deficit in general of course mean that cuts need to be made. But some things should not be cut and pain management for a cancer patient is one of them.

There is a finite budget available, and like it or not his (and others) pain and suffering is deemed to be more palatable for the Government, HSE and Unions than shedding some of the many thousands of unnecessary administration staff currently employed by the HSE, or speeding through reforms which would save the necessary funds.

You say "some things should not be cut".. the one and only area that has been protected from cuts was those staff covered by the CPA.. Like it or not that was the extent of concern shown to those who utilise health services in this country.

I'm sure there are numerous other opportunities for cost savings which could be undertaken to facilitate the continued servicing of critical treatments. It doesn't seem to be a priority though..

johnnyskeleton

woodoo wrote: »

The CPA, high Social Welfare bill, NAMA, etc etc and the budget deficit in general of course mean that cuts need to be made. But some things should not be cut and pain management for a cancer patient is one of them.

Well what if it is a choice of cancer treatment and post cancer treatment pain management?

Also, I can't imagine that he is simply getting no treatment for his pain now. He will probably get a good, but less expensive, system of pain relief from his local hospital e.g. strong painkillers.

woodoo

johnnyskeleton wrote: »

Can this guy get some level of pain relief in his own area e.g. painkillers? Is it possible that he can get it there now (whereas previously it was only provided in Dublin)?

He was upset at the refusal so painkillers must not be that much of a help for him.

Welease

woodoo wrote: »

He was upset at the refusal so painkillers must not be that much of a help for him.

So what would you like to see done?

johnnyskeleton

woodoo wrote: »

He was upset at the refusal so painkillers must not be that much of a help for him.

I don't think we can make that assumption. If I was given better than average treatment and then it was reduced to merely average treatment I'd be upset too, but that doesn't mean my new service is inadequate.

In any event, is that the only comment you want to make about my entire post? I made a number of points in relation to the reasonableness of not giving him this service and giving him the local service instead. Can you explain why that is wrong other than a presumption that the HSE is failing this man?

Welease has also asked you what you would do to fix the situation. I gave you a number of options, which would you choose?

The point is this - you can't just pick random hard luck stories and use them to try to make some general political point.

woodoo

johnnyskeleton wrote: »

In any event, is that the only comment you want to make about my entire post? .

There are a number of options, 1. Cut children's allowance, 2. Cut welfare (21 billion), 3. Cut allowances/T&S in Public Sector. 4 Cut Pensions, 5. 3rd rate of tax.
But whatever they do cutting services like this to people is unfair imo. People should not be left in pain.

johnnyskeleton

woodoo wrote: »

There are a number of options, 1. Cut children's allowance, 2. Cut welfare (21 billion), 3. Cut allowances/T&S in Public Sector. 4 Cut Pensions, 5. 3rd rate of tax.
But whatever they do cutting services like this to people is unfair imo. People should not be left in pain.

You'll get the exact same emotional arguments about any of the above.

1. If you cut children's allowance, won't somebody please think of the children etc.

2. If you cut welfare what about the most poor and vulernable.

3. If you cut public sector pay they're probably not going to do the work anyway, and as I have set out above in a fair bit of detail, this will not help this particular man, and could actually make matters worse for him.

4. Which pensions?

5. 3rd rate of tax? Presumably at the top end? The problem with this is that eventually you could have 90-100% tax at the top end to pay for all sorts of great medical, educational and welfare entitlements for people at the other end, becuase "People should not be left in pain" or people should not be left uneducated, or people should not get welfare entitlements.

Put another way, my foot has been a bit sore for the last few weeks. Probably sprained a muscle. In the real world, I limped along, got a bit of cream for it and considered insoles for my shoes and now its pretty much fine. However, in your world I should have been rushed to hospital, given hourly massages, physio, painkillers, the works, new shoes, someone to cover me in work (so I don't lose out on earnings), a wheelchair to rock around in and free taxis for long distance all because "People should not be left in pain". Now, my foot pain is not as serious as the pain caused by cancer, but if we are dealing with absolutes then this is the logical conclusion of what you are saying.

A little realism is required when you are debating health services. People should be given a reasonable level of pain relief if available is a more appropriate method of dealing with it.

As much sympathy as I have for someone in his situation, when dealing with the politics of it we have to be more detached.

woodoo

johnnyskeleton wrote: »

Put another way, my foot has been a bit sore for the last few weeks. Probably sprained a muscle. In the real world, I limped along, got a bit of cream for it and considered insoles for my shoes and now its pretty much fine. However, in your world I should have been rushed to hospital, given hourly massages, physio, painkillers, the works, new shoes, someone to cover me in work (so I don't lose out on earnings), a wheelchair to rock around in and free taxis for long distance all because "People should not be left in pain". Now, my foot pain is not as serious as the pain caused by cancer, but if we are dealing with absolutes then this is the logical conclusion of what you are saying.

A little realism is required when you are debating health services. People should be given a reasonable level of pain relief if available is a more appropriate method of dealing with it.

As much sympathy as I have for someone in his situation, when dealing with the politics of it we have to be more detached.

You do not have nerve damage due to chemotherapy like this man. He has been like this for years. Chronic pain is a miserable existence. I believe people like that deserve priority.

Welease

woodoo wrote: »

There are a number of options, 1. Cut children's allowance, 2. Cut welfare (21 billion), 3. Cut allowances/T&S in Public Sector. 4 Cut Pensions, 5. 3rd rate of tax.
But whatever they do cutting services like this to people is unfair imo. People should not be left in pain.

Why not do the obvious and fix where the problem lies?.. within the HSE

It is overstaffed by thousands in areas (as per the McCarthy report), it has poor budget controls in place, poor management, resource waste, issues with absence etc etc.

I'm genuinly interested to understand why you believe we should cut other areas (some of which could include the poorest in society) to continue to run a badly managed organisation. If the celtic tiger has demonstrated anything it's that continuing to throw money and resources at badly managed organisations doesn't fix them...

murphaph

Welease wrote: »

Why not do the obvious and fix where the problem lies?.. within the HSE

It is overstaffed by thousands in areas (as per the McCarthy report), it has poor budget controls in place, poor management, resource waste, issues with absence etc etc.

I'm genuinly interested to understand why you believe we should cut other areas (some of which could include the poorest in society) to continue to run a badly managed organisation. If the celtic tiger has demonstrated anything it's that continuing to throw money and resources at badly managed organisations doesn't fix them...

This.

Woodoo, do you think the overstaffing in the HSE should be addressed through redundancies to save money that could be spent on actual HSE services?

I fully agree that this man is not someone who has stubbed his toe or sprained his ankle. Chronic pain must be bloody awful and life has dealt this guy a sh!t hand by the sounds of it.

When we reach the point of having fired all the admin staff in the HSE who twiddle their thumbs all day, when we reach the point of actually making redundant council staff redundant, when we have finished the big reforms of local government (amalgamating dozens of HR, IT and payroll departments, contracting out services wherever possible etc.), when we reach the point of having reduced the perks of welfare to leave it as a pure subsistence payment for people on long term benefits (as it is most everywhere else), when we reach the point of having a stable tax base which includes property taxation, when we reach the point of having reduced the state pension to reflect what you actually paid into it, when we reach the point of current and former politicians not absolutely creaming the system for every penny and indeed stealing from the taxpayer, when we reach that point and still can't balance the books, then chronic pain treatment for a cancer patient should be up for consideration.

There is still SO MUCH fat to trim before we reach that point.

mikemac1

Time to call in Jack Welch :eek:

He has Irish roots

sarumite

While definitely pulling all the right heartstrings, it isn't really the reality of cuts. Its the reality of a poorly managed budget, where too much of the budget is spen on paying for jobs which are superfluous to the effective running ot the organisation. The government needs to start making the necessary cuts so unnecessary cuts aren't required.

johnnyskeleton

woodoo wrote: »

You do not have nerve damage due to chemotherapy like this man. He has been like this for years. Chronic pain is a miserable existence. I believe people like that deserve priority.

But that's significantly different to what you said earlier that nobody should be left in pain. Are you resiling from that absolute position?

If so, then you can take solace that he is not going to be left with nothing in his local area. He will be given pain relief treatment by way of pharmecuticals etc. That may not be top class treatment, but it is reasonable treatment and it is good enough IMO from the national health provider.

If everyone automatically gets the best treatment available, then we would not be able to afford the HSE.

antoobrien

oppenheimer1 wrote: »

Is it not that the patient in that article will be transferred to a more local hospital to deal with his condition, rather than being refused treatment outright?

murphaph wrote: »

The more local hospital doesn't offer this specialised treatment, so the patient is fcuked.

The above question is pertinent. Galway is the regional center of excellence for cancer services in the West & North West, so why isn't be being treated there?

johnnyskeleton

murphaph wrote: »

When we reach the point of having fired all the admin staff in the HSE who twiddle their thumbs all day, etc

sarumite wrote: »

While definitely pulling all the right heartstrings, it isn't really the reality of cuts. Its the reality of a poorly managed budget, where too much of the budget is spen on paying for jobs which are superfluous to the effective running ot the organisation. The government needs to start making the necessary cuts so unnecessary cuts aren't required.

But it is precicely those "superflous" jobs in admin that facilitated his admission to a hospital on the other side of the country. If the admin of the HSE were cut back and we were left with locally managed hospitals, this never would have arisen in the first place.

Welease

johnnyskeleton wrote: »

But it is precicely those "superflous" jobs in admin that facilitated his admission to a hospital on the other side of the country. If the admin of the HSE were cut back and we were left with locally managed hospitals, this never would have arisen in the first place.

The superflous Admin roles being discussed were not necessary to provide these services, and in fact (http://www.irishhealth.com/article.html?id=18146 ) the HSE HR Director Sean McGrath had previously commented "With one single organisation replacing eleven health boards, there should have been economies of scale. However, there was no redundancy programme and too many people ended up doing similar jobs. There was much duplication and added levels of admin to plough through in order to get things done."

It is those heads that the McCarthy report and everyone else understands as being superflous. A co-ordinated countrywide resource capability of the type you describe is essential, but all of these Admin heads are not necessary to provide such a service.

woodoo

johnnyskeleton wrote: »

But that's significantly different to what you said earlier that nobody should be left in pain. Are you resiling from that absolute position?

If so, then you can take solace that he is not going to be left with nothing in his local area. He will be given pain relief treatment by way of pharmecuticals etc. That may not be top class treatment, but it is reasonable treatment and it is good enough IMO from the national health provider.

If everyone automatically gets the best treatment available, then we would not be able to afford the HSE.

No my initial position was pain of the sort that this man has. I may not have made myself clear enough though. Anyone can handle pain in the short to medium term. Long term pain grinds you down.

Just on the issue of over-staffing in Local Authorities and the HSE. Yes amalgamating Councils would be good i believe and a some streamlining of departments in the HSE would be good also. But people must not assume that by doing so will save massively on jobs. Yes there will be savings but not as much as people think.

If you have 8 people working in salaries in Cork County Council and 8 People in Kerry County Council and we assume they are all busy. Simply by amalgamating all the work to Cork will not mean that you can do away with 8 jobs. The work in Cork will double. Maybe the odd middle manager may be lost. But the numbers won't be as big as hoped i believe.

Look at what happened when they centralised Medical Cards to Dublin in the belief that they could do more work with less people simply because it was all done in the same building. It has failed miserably. They are in such a mess don there its a scandal.

Efficiencies can be made but they will take time and co-operation from existing staff. That is already underway under the CPA. Thousands of staff have left and the work is being picked up by those still there. It could take 5 years. How much would really be saved by wielding the axe in a hap hazard way and in a rush?

sarumite

woodoo wrote: »

Efficiencies can be made but they will take time and co-operation from existing staff. That is already underway under the CPA. Thousands of staff have left and the work is being picked up by those still there. It could take 5 years. How much would really be saved by wielding the axe in a hap hazard way and in a rush?

The reality of the cutbacks is that they are necessary as long as we continue to run deficit and I think as long as you are advocating the government to continue with its current course and accept that certain aspects of the HSE budget is ringfenced from any further cuts, then it seems one must acknowledge that cuts in other areas of the budget will become a necessity.

Welease

sarumite wrote: »

The reality of the cutbacks is that they are necessary as long as we continue to run deficit and I think as long as you are advocating the government to continue with its current course and accept that certain aspects of the HSE budget is ringfenced from any further cuts, then it seems one must acknowledge that cuts in other areas of the budget will become a necessity.

.. and the longer those efficiencies take to achieve.. the more those other non ringfenced areas will continue to be cut.

If people are actually interested in helping Mr. Keavney and others like him, then they should be demanding that efficiencies and change in the HSE are implemented as fast as humanly possible.

johnnyskeleton

Welease wrote: »

The superflous Admin roles being discussed were not necessary to provide these services, and in fact (http://www.irishhealth.com/article.html?id=18146 ) the HSE HR Director Sean McGrath had previously commented "With one single organisation replacing eleven health boards, there should have been economies of scale. However, there was no redundancy programme and too many people ended up doing similar jobs. There was much duplication and added levels of admin to plough through in order to get things done."

It is those heads that the McCarthy report and everyone else understands as being superflous. A co-ordinated countrywide resource capability of the type you describe is essential, but all of these Admin heads are not necessary to provide such a service.

yet no one does anything about it? I mean, they are presumably doing some job, and apart from anecdotal evidence of departments where there is little to do, if there were easy cuts surely they could have been made by now.

So while I'm well aware of the cost of the public sector, increases in numbers an pay etc, if there was an easy solution surely they would have done it. If they can prove that the jobs are redundant then I don't see why they can't get rid of them.

johnnyskeleton

woodoo wrote: »

johnnyskeleton wrote: »

But that's significantly different to what you said earlier that nobody should be left in pain. Are you resiling from that absolute position?

If so, then you can take solace that he is not going to be left with nothing in his local area. He will be given pain relief treatment by way of pharmecuticals etc. That may not be top class treatment, but it is reasonable treatment and it is good enough IMO from the national health provider.

If everyone automatically gets the best treatment available, then we would not be able to afford the HSE.

No my initial position was pain of the sort that this man has. I may not have made myself clear enough though. Anyone can handle pain in the short to medium term. Long term pain grinds you down.

Ok, so it comes down to a subjective view of what should and should not be done on a case by case basis. The hospital has obviously felt that an acceptable level of pain management was available to him locally. We have to trust that the hospital is capable of deciding these issues an who are the most important patients for the limited resources available to them.

Just on the issue of over-staffing in Local Authorities and the HSE. Yes amalgamating Councils would be good i believe and a some streamlining of departments in the HSE would be good also. But people must not assume that by doing so will save massively on jobs. Yes there will be savings but not as much as people think.

If you have 8 people working in salaries in Cork County Council and 8 People in Kerry County Council and we assume they are all busy. Simply by amalgamating all the work to Cork will not mean that you can do away with 8 jobs. The work in Cork will double. Maybe the odd middle manager may be lost. But the numbers won't be as big as hoped i believe.

Look at what happened when they centralised Medical Cards to Dublin in the belief that they could do more work with less people simply because it was all done in the same building. It has failed miserably. They are in such a mess don there its a scandal.

Efficiencies can be made but they will take time and co-operation from existing staff. That is already underway under the CPA. Thousands of staff have left and the work is being picked up by those still there. It could take 5 years. How much would really be saved by wielding the axe in a hap hazard way and in a rush?

here I tend to agree with you. If it was a simple narrative of too many admin staff with nothing to do preventing hard working doctors from providing better service then it would easily be remedied. The problem is that I don't think the narative is that straightforward. What most people consider useless admin is a large structure that has a lot of administrative tasks to do. I'm sure it could be improved, streamlined etc, but the reality at present is that cuts have to be made and if it wasn't this person it might have been someone else who was denied treatment.

We can't assume that the other person is a less deserving case. That has to be decided by the hospital, more particularly by the hospital administration.

johnnyskeleton

Welease wrote: »

sarumite wrote: »

The reality of the cutbacks is that they are necessary as long as we continue to run deficit and I think as long as you are advocating the government to continue with its current course and accept that certain aspects of the HSE budget is ringfenced from any further cuts, then it seems one must acknowledge that cuts in other areas of the budget will become a necessity.

.. and the longer those efficiencies take to achieve.. the more those other non ringfenced areas will continue to be cut.

If people are actually interested in helping Mr. Keavney and others like him, then they should be demanding that efficiencies and change in the HSE are implemented as fast as humanly possible.

And if it is not possible to make such cuts, should we deprive this guy of the service he wants, or should we deprive someone else of their treatment?

Welease

johnnyskeleton wrote: »

yet no one does anything about it? I mean, they are presumably doing some job, and apart from anecdotal evidence of departments where there is little to do, if there were easy cuts surely they could have been made by now.

So while I'm well aware of the cost of the public sector, increases in numbers an pay etc, if there was an easy solution surely they would have done it. If they can prove that the jobs are redundant then I don't see why they can't get rid of them.

I'm not sure what you mean..

There are 2 primary reasons as to why it hasn't happened 1) The CPA.. no forced redundancies 2) Jobs for Life agreement when the HSE was formed (and recently tested and upheld in the Labour Courts by IMPACT members http://www.imt.ie/opinion/guests/2010/06/union-wins-on-jobs-for-life.html).

There is also the 3rd reason.. the will to do so.. If the Goverment, HSE staff or Unions had wanted to implement these resource rationalisations then the CPA would never have seen the light of day. From the HSE and Union perspective it's fairly obvious why they would not push for forced redundancies.. from the Governments side.. well it falls into the same bucket of other stuff we wonder why they don't do..

Welease

johnnyskeleton wrote: »

And if it is not possible to make such cuts, should we deprive this guy of the service he wants, or should we deprive someone else of their treatment?

I think most people are pushing that we exhaust all possible efficiencies first.. then we implement further cuts. Concern is that those who are responsible to deciding on which cuts have so far been shown to be incapable of running the HSE correctly, so many have little faith the correct cuts would be made. One would hope the cancer patient has access to services within his catchment area (Galway for example) if not, then why not..

But lets not forget many cuts have already been made, SNA's have been cut, Disability Carer payments for children are getting harder and harder to get, Services for Disabled Children are being cut left right and centre, Mental health services are seriously understaffed, 178K are waiting to see consultants apparently, elective surgeries being cancelled etc.

liammur

K-9 wrote: »

Far too much personal references and digs in this thread. Any more will result in cards, posters should know better at this stage.

+1

Noreen1

johnnyskeleton wrote: »

But that's significantly different to what you said earlier that nobody should be left in pain. Are you resiling from that absolute position?

If so, then you can take solace that he is not going to be left with nothing in his local area. He will be given pain relief treatment by way of pharmecuticals etc. That may not be top class treatment, but it is reasonable treatment and it is good enough IMO from the national health provider.

If everyone automatically gets the best treatment available, then we would not be able to afford the HSE.

You appear to think that this unfortunate gentleman had no need to go to Dublin for treatment in the first place?

The reality is that he required a treatment that was - and is - not available in his local area.

So, the question is - are people in Dublin entitled to a better service than those in Donegal?

Since the service has not been removed from those who live in the Dublin area, and the service is not available in Donegal then equality of treatment should be the issue.

So the service should be available to those who live outside the hospital catchement area (probably more cost effective, though extremely inconvenient in terms of discomfort while travelling) - or provided in Letterkenny or Sligo hospital.

Unless, of course, you believe inequality is acceptable, based on where you live?

Godge

Noreen1 wrote: »

You appear to think that this unfortunate gentleman had no need to go to Dublin for treatment in the first place?

The reality is that he required a treatment that was - and is - not available in his local area.

So, the question is - are people in Dublin entitled to a better service than those in Donegal?

Since the service has not been removed from those who live in the Dublin area, and the service is not available in Donegal then equality of treatment should be the issue.

So the service should be available to those who live outside the hospital catchement area (probably more cost effective, though extremely inconvenient in terms of discomfort while travelling) - or provided in Letterkenny or Sligo hospital.

Unless, of course, you believe inequality is acceptable, based on where you live?

To answer your question about Dublin and Donegal, the answer has to be yes, people in Dublin should get a better service than Donegal. Why? Because the cost of providing a public service to the most densely populated part of the country is much cheaper than providing a public service to the least densely populated part of the country.

Apply the logic of equal public services to another country, say Australia. Should the same level of public services be available in the outback as in the city of Melbourne. Should we have a full services hospital every 200 miles in the outback? The reasonable answer is no, those who choose to live in the outback have to pay a price in terms of accessibility and availability of public services.

The same logic applies, albeit to a lesser and more nuanced extent in Ireland. If you live outside of a major city - Dublin, Cork or Belfast - you have to expect that you will receive some degree of lesser public service. This may simply be that you have to travel to Dublin for some medical procedures, it may be that you don't have a local university, or it may be that some type of service is not accessible at all. If such rules were not applied our unsustainable public services would be even more costly.

liammur

Godge wrote: »

The same logic applies, albeit to a lesser and more nuanced extent in Ireland. If you live outside of a major city - Dublin, Cork or Belfast - you have to expect that you will receive some degree of lesser public service. This may simply be that you have to travel to Dublin for some medical procedures, it may be that you don't have a local university, or it may be that some type of service is not accessible at all. If such rules were not applied our unsustainable public services would be even more costly.

I agree with this principle, but the way we are going, people in these areas will receive no services which is not right either. Yet, they will be expected to pay for every service under the sun.

n97 mini

liammur wrote: »

people in these areas will receive no services

They will always have roads, post, electricity, phones, schools etc., which realistically is more than what some of the Australian outback receives.

Noreen1

Godge wrote: »

To answer your question about Dublin and Donegal, the answer has to be yes, people in Dublin should get a better service than Donegal. Why? Because the cost of providing a public service to the most densely populated part of the country is much cheaper than providing a public service to the least densely populated part of the country.

Nice defllection. I've already dealt with the issue of cost, by stating that it is more cost effective to provide the services in Dublin, despite the inconvenience and discomfort involved in travel.

Godge wrote: »

Apply the logic of equal public services to another country, say Australia. Should the same level of public services be available in the outback as in the city of Melbourne. Should we have a full services hospital every 200 miles in the outback? The reasonable answer is no, those who choose to live in the outback have to pay a price in terms of accessibility and availability of public services.

Already acknowledged.

Godge wrote: »

The same logic applies, albeit to a lesser and more nuanced extent in Ireland. If you live outside of a major city - Dublin, Cork or Belfast - you have to expect that you will receive some degree of lesser public service. This may simply be that you have to travel to Dublin for some medical procedures, it may be that you don't have a local university, or it may be that some type of service is not accessible at all. If such rules were not applied our unsustainable public services would be even more costly.

The poor man has not asked for services to be made available
locally.
He has stated (and his Doctor has concurred) - that he has been denied the service because he lives outside the hospitals catchment area.

So, I will ask you again. Is it acceptable to allow someone in Donegal - who is willing to travel - to suffer a level of pain, that someone in Dublin is not expected to suffer?