What is the actual problem holding back our health service?

hatrickpatrick

So we all know the public health service here is widely regarded as a disaster, particularly when it comes to overcrowding, people on trolleys, long waiting lists for medical procedures and consultations, etc etc etc.

I've been in hospital a few times over the last few years and I've actually found it ok, but maybe I've been very lucky. Was in A&E with appendicitis in Jan 2011 and had no problems. However, we all know there is in fact a serious problem here most of the time.

So what's actually causing it at a fundamental level?
Does demand outstrip supply in terms of nurses and doctors to treat people?
Is the Irish population generally less healthy and more prone to disease than other populations which don't seem to have these problems?
Is it mismanagement? Is too much health funding going into administration and not into actually providing services and paying doctors and nurses?
Are our hospitals poorly designed architecturally so that it is physically impossible for them to have enough beds for everyone who needs one?
Is there still a sort of medical cartel which deliberately restricts the number of potential university places for nursing and medicine so as to artificially prevent competition?
Are we simply not funding it enough?

The latter option seems highly unlikely as even during the boom when bucketloads of cash were being hurled at the HSE, this was one problem which never seemed to get any better, based on the way it was reported in the media anyway. So an overall health funding shortfall seems to me to be the least likely of the potential reasons our health service is (apparently) inadequate.

What would it take to fix it?
What if we dismantled the health service as it exists now and rebuilt it entirely from the bottom up? Would that help matters at all?

Basically what I'm asking is, why is our health service a mess? Is it a case of the service itself not having enough supply, or the Irish people being too demanding, IE we get sick more often than people in other countries for whatever reason?

paul71

hatrickpatrick wrote: »

Is it mismanagement? Is too much health funding going into administration and not into actually providing services and paying doctors and nurses?

Lets be blunt and honest, the exact opposite of the above is the case. Vastly overpaid Doctors leading to a cronic underfunding of administrative services resulting in Chaos.
The EU and IMF have already pointed out that this is this case. Also why are consultants allowed to run private practices from public Hospitals while being paid a salary by the state, if they want to be private practitioners they should build and pay for the running of their own Hospitals.

echo beach

hatrickpatrick wrote: »

I've been in hospital a few times over the last few years and I've actually found it ok, but maybe I've been very lucky. Was in A&E with appendicitis in Jan 2011 and had no problems. However, we all know there is in fact a serious problem here most of the time.

There is no problem dealing with appendicitis or any other accident or emergency because that is what A+E is designed to do and what it usually does very well. The problem is that most of the patients in A+E are not accidents and aren't 'medical' emergencies, they are patients suffering from chronic conditions who need hospital admission for treatment like IV fluids or IV antibiotics or oxygen. The number of patients who can get hospital in-treatment at any one time is limited by the number of beds, which is determined by the number of staff available.

These patients could be treated in a dedicated Medical Admissions Unit, referred there directly by their own GP, rather than seeing various doctors and undergoing a full series of tests before the decision is made to admit them and then the search for a bed begins.

Cavehill Red

paul71 wrote: »

Lets be blunt and honest, the exact opposite of the above is the case. Vastly overpaid Doctors leading to a cronic underfunding of administrative services resulting in Chaos.
The EU and IMF have already pointed out that this is this case. Also why are consultants allowed to run private practices from public Hospitals while being paid a salary by the state, if they want to be private practitioners they should build and pay for the running of their own Hospitals.

Yes, let's be blunt and honest. We have the HSE replicating many of the activities of the Dept of Health, but no sackings in the Dept. We have one administrative body replacing over eight health boards, but no sackings in the HSE.
Before you get into the doctor bashing (and I may join you for that leg of the discussion), let's be blunt and honest and acknowledge that the money squandered and wasted on having multiple levels of unnecessary and complicating administration is an enormous part of what's holding the Irish health service back.

Gloomtastic!

Old people. Too many old people.

Next door neighbour collapsed last weekend. Called an ambulance and he was taken to the local A&E. Went to see him the following evening and he was still in A&E, on a trolley, 24 hours later. 75% of the people in A&E were old people. All waiting to get a bed in the wards.

When I went to visit him the following evening on the wards, again 75% of patients were pensioners. The care he was receiving was excellent, he was having all these tests to find out his problem.

But did he need to be in a major hospital? Sending all old people to a second tier specialised unit would reduce bed blocking and allow emergency resources to be allocated where it's actually needed.

It's only going to get worse as the population ages.....

mathepac

The HSEs are a roaring success if you are the minister for health or a civil servant in that department. Your job is to set policy and oversee its implementation but if it all goes wrong then the HSEs are to blame and the minister cannot interfere blah blah blah.

The minister and his department have no responsibility and therefore no accountability for whatever happens in the HSEs. The HSEs (we were meant to have one replacing the Health Boards, were are now up to five HSEs and growing) are a disaster (PPARS anyone?) and have managed to suck medics, nurses and paramedics alike away from client-facing activities into admin tasks, as well as attracting more natural-born adminners. These medics and paramedics are not classified as adminners, their head-count still appears under their respective professional headings, skewing figures all over the place.

I despair of anything good ever happening in the HSEs unless they invite Charles Handy, Donald Trump, Gerry Robinson and Mr Leahy (ex-Tesco boss) in to kick in excess of 100,000 asses.

creedp

mathepac wrote: »

The HSEs are a roaring success if you are the minister for health or a civil servant in that department. Your job is to set policy and oversee its implementation but if it all goes wrong then the HSEs are to blame and the minister cannot interfere blah blah blah.

The minister and his department have no responsibility and therefore no accountability for whatever happens in the HSEs. The HSEs (we were meant to have one replacing the Health Boards, were are now up to five HSEs and growing) are a disaster (PPARS anyone?) and have managed to suck medics, nurses and paramedics alike away from client-facing activities into admin tasks, as well as attracting more natural-born adminners. These medics and paramedics are not classified as adminners, their head-count still appears under their respective professional headings, skewing figures all over the place.

So you're saying that having doctors paid a salary to treat public patients in public hospitals but also allowing them to treat private patients in the same hospitals which ensures their private patients leap frog over public patients backs at no cost to the doctors is not inefficient and unfair to the public patients? The low rates of generic prescribing by GPs even though they are trained to prescribe generically just like they are in the UK is fully the HSEs problems and not the GPs. Funny thing is UK GPs generic prescribing rate is over 80% while the Irish GPs rate is under 20%? Why?

I don't think anyone would argue that the administration of the Irish health system doesnt require reform but to argue that the clinicians are holier that thou doesn't hold water either IMO

spank_inferno

As mentioned previously, far too much control from vested interests.
The consultants are the chief perpetrators, they rule the roost.

Lack of capacity at all levels of the private sector.
Thus public hospitals have much of their resources accomodating private patients,
If public resources were just for public patients, the crowding issue would be lessened.
More private hospitals and private primary care centres would help this.

Capacity is key

gaffer91

paul71 wrote: »

Lets be blunt and honest, the exact opposite of the above is the case. Vastly overpaid Doctors leading to a cronic underfunding of administrative services resulting in Chaos.
The EU and IMF have already pointed out that this is this case. Also why are consultants allowed to run private practices from public Hospitals while being paid a salary by the state, if they want to be private practitioners they should build and pay for the running of their own Hospitals.

Have you any figures on what consultant/doctor pay is as a percentage of the health budget? Or are you just hopping on the same old doctor bashing bandwagon that the media and boards has been travelling on for the last while?

Also bear in mind that Irish medical graduates will emigrate to other English speaking countries, all of which, offer better working conditions in terms of hours, pay (with the possible exception of the UK), opportunity for post-graduate training and career advancement. It is conditions in these countries, not Poland or Spain, that we should be concious of when making healthcare reforms.

Anyway OP there are several reasons for the malaise of the healthcare system in Ireland- despite what I said earlier I actually do think existing consultant wages (and not just new entrants for once) should be cut, but not punitively.

We also employ too many nurses in Ireland (Source) but the nurses lobby is so strong that any challenge to them is practically politically impossible due to the power of the INO.
QUICK EDIT- before anyone says it, I'm aware of the new 22000 pay grade, but that is the case with all new PS entrants (i.e lower rates than existing workerss), and it still doesn't change the fact that we have too many nurses. I would also be surprised if there isn't a degree of roll back by the government at some point either.

Other issues such as an abundance of useless administrators, a duplication of services by the dept. of health and the HSE, prescribing brand name over generic drugs, (especially when they are being paid for out of public coffers) etc are also problems that need to be addressed.

BOHtox

hatrickpatrick wrote: »

So we all know the public health service

6 words in. That was quick.

I think the government should start outsourcing its healthcare to private companies. As they continue to compete with price and service, gradually reduce government interference to as low as possible.

mathepac

creedp wrote: »

.. you chose to ignore the role that clinician play in how the system is organised and operated. ...

How do you know what choices I made in framing my post?

creedp wrote: »

.. Yet you are in disbelief that I should refer to the fact you dont think clinicians have a role in the difficulties the health system finds itself it? ...

How can you possibly know what my thoughts are about clinicians. The only fact is that I haven't expressed an opinion that is critical of them

creedp wrote: »

..
I can confirm that I have yet to be diagnosed with the conditions you refer to .. what about you?

Well I'm not the one claiming the ability to read other posters' minds or intercept their choices and the knowledge and insight to be able to express these mind-reading experiences as fact.

mountai

Its not lack of investment and thats for sure. There seems to be an all prevailing attitude that our Clinicians are "Wonderful". Its a myth IMHO. They have been allowed to ride roughshod over the people of this country for far too long. There is a culture of Greed within the Health Service , where they protect what they have at all costs. Managers are duplicated , overpaid , non accountable at every level. Consultants have contracts, that pay them almost TWICE the amount that their colleagues in Germany and UK enjoy. They are also allowed to practice their PRIVATE clinics in PUBLIC hospitals , bringing their earnings to, unimaginable levels.
In this country, for every ten front line staff , there are four , yes FOUR ,support ,or back room people . In UK its ONE backroom for NINE frontline. The Health Service has developed into a MONSTER that is totally out of control , and until there is just ONE politician, with an ounce of courage, that is prepared to tackle these problems, head on

---

It will continue to devour us all.

hatrickpatrick

echo beach wrote: »

There is no problem dealing with appendicitis or any other accident or emergency because that is what A+E is designed to do and what it usually does very well. The problem is that most of the patients in A+E are not accidents and aren't 'medical' emergencies, they are patients suffering from chronic conditions who need hospital admission for treatment like IV fluids or IV antibiotics or oxygen. The number of patients who can get hospital in-treatment at any one time is limited by the number of beds, which is determined by the number of staff available.

These patients could be treated in a dedicated Medical Admissions Unit, referred there directly by their own GP, rather than seeing various doctors and undergoing a full series of tests before the decision is made to admit them and then the search for a bed begins.

Ok, so narrowing this down, is the problem that we have fewer beds than we should, or that the Irish population in general is sicker than other populations? Are Irish people more likely to need long term hospital beds than people in countries which don't have this kind of problem? Or do we simply not have enough beds per capita?

echo beach

hatrickpatrick wrote: »

Ok, so narrowing this down, is the problem that we have fewer beds than we should, or that the Irish population in general is sicker than other populations? Are Irish people more likely to need long term hospital beds than people in countries which don't have this kind of problem? Or do we simply not have enough beds per capita?

Part of the problem, and only part of it, it that we have so few alternatives to hospital care. The choice is go to hospital and be looked after by very highly trained professionals or stay at home where your family (if you have a family and they haven't emigrated) look after you with little or no backup.
There is little or nothing in between, which is in fact what many patients need. They need medical care but not 24 hour intensive medical care and that option isn't usually available when they need it.

creedp

echo beach wrote: »

Part of the problem, and only part of it, it that we have so few alternatives to hospital care. The choice is go to hospital and be looked after by very highly trained professionals or stay at home where your family (if you have a family and they haven't emigrated) look after you with little or no backup.
There is little or nothing in between, which is in fact what many patients need. They need medical care but not 24 hour intensive medical care and that option isn't usually available when they need it.

This is a key problem in Ireland .. we have no primary care services .. in Ireland a GP service and community drug schemes constitute the formal primary care services. This is why so many people end up in a A&E unecessarily which costs a fortune, is madly inefficient and causes so much hardship for so many people. Primary care has to be developed to be a 24/7 service which is the first point of contact for people who are sick. Attending hospitals should be a last resort.

Stheno

Gloomtastic! wrote: »

Old people. Too many old people.

Next door neighbour collapsed last weekend. Called an ambulance and he was taken to the local A&E. Went to see him the following evening and he was still in A&E, on a trolley, 24 hours later. 75% of the people in A&E were old people. All waiting to get a bed in the wards.

When I went to visit him the following evening on the wards, again 75% of patients were pensioners. The care he was receiving was excellent, he was having all these tests to find out his problem.

But did he need to be in a major hospital? Sending all old people to a second tier specialised unit would reduce bed blocking and allow emergency resources to be allocated where it's actually needed.

It's only going to get worse as the population ages.....

We don't have enough respite/convalescent care spaces available which would help with this.

spank_inferno wrote: »

Lack of capacity at all levels of the private sector.

On this I call bull. I suffered an injury recently and my entire care has been private, went from GP to MRI to Surgeon to physio in less than two weeks, have had nothing but the best of care, back to surgeon repeatedly and privately was able to get scans/physio etc within two days of requesting an appointment.

My physio works until 8pm Mon - Fri, both places I get MRIs open until 10pm on Saturdays.

Do you think the public system does this? If they only saw one patient in MRI working Mon - Sat 8 am - 10 pm I suspect they'd double the amount they get through.

antoobrien

It has to be a resource management issue, the amount of money that we've thrown at the HSE/health boards over the past 10+ years has been phenomenal.

There was a snippet article on one of the local newspaper websites in Galway over the weekend about the effects of budget and staff cuts in the 3 Galway region hospitals (UCHG, the Portiuncula in Ballinasloe & Roscommon). The cuts were budget reduction of 25 million (to 287m) and staffing levels cut by 105 (to 3,900).

The effects were to decrease waiting times, increase numbers treated and reduce long term waiting lists. If that isn't a clear indication of what better management of resources can achieve, then we can all just throw our hats at it.

jmayo

There is a two word answer to the OPs question...
What is the actual problem holding back our health service?

The Staff.

That includes the overpaid closed shop that is the consultants and the medical, administrative and technical staff who are members of unions who protect the inefficient, the wasteful, the duplication, the strict demarcation rules which ensures the status quo remains as is.

There was an opportunity to clear out the duplication when the health boards were amalgamated into the HSE, but instead the government buckled to union pressure and just created more layers of bureaucracy.
The whole system should have been streamlined when we had the money to pay off the incompetents and wasters kicking their feet until retirement.
Instead now we have to try and do it when there is no money.

If you look at the figures for where the job losses, sorry early retirements and natural wastage, have occurred most have happened I bet in front line actual patient interfacing staff.
Meanwhile the admin numbers remain high.

djpbarry

hatrickpatrick wrote: »

So we all know the public health service here is widely regarded as a disaster, particularly when it comes to overcrowding, people on trolleys, long waiting lists for medical procedures and consultations, etc etc etc.

I've been in hospital a few times over the last few years and I've actually found it ok, but maybe I've been very lucky.

I don't think you were lucky, I think you received the level of treatment that's to be expected from a health service that is regarded as about average by the OECD. The regard in which the Irish public holds their health service (disastrous, as you put it) has little basis in reality.

hatrickpatrick

djpbarry wrote: »

I don't think you were lucky, I think you received the level of treatment that's to be expected from a health service that is regarded as about average by the OECD. The regard in which the Irish public holds their health service (disastrous, as you put it) has little basis in reality.

I was in Beaumont for a hydrocephalus thing (skull surgery) in '07 and in Vincents in '11 for my appendix, on both occasions I honestly found it comfortable and felt well looked after. None of the trolleys scattered around the corridors horror you'd expect from watching Prime Time.
Having said that, there definitely are major issues with the health service and it's hard to deny that. The fact for example that an appointment is meaningless, is surely something that could be looked at - you have an appointment for 2 in the afternoon, you arrive at half 1 to be early, you're lucky to be seen before 3. So there are definitely problems - why not just allocate people for 3 if it's going to take that long to see them anyway? Why take up space and time having people show up wildly early for appointments which simply aren't ready yet?

mathepac

hatrickpatrick wrote: »

... Why take up space and time having people show up wildly early for appointments which simply aren't ready yet?

Because the consultants / clinics see it as more efficient use of their time to book in more people than can be seen on a given day. They know the average number of DNAs (no shows) and factor those in. The patients wait in long queues because their time and comfort are the least important to the HSEs / medics.

djpbarry

hatrickpatrick wrote: »

...there definitely are major issues with the health service and it's hard to deny that.

Not denying it for a second – there are obviously major problems, with long waiting times being a particular issue.

But, as you say, there is a tremendous amount of nonsense thrown about regarding Ireland’s “appalling” healthcare system. The constant references I hear to the magical “free” NHS really bug me too.

creedp

djpbarry wrote: »

Not denying it for a second – there are obviously major problems, with long waiting times being a particular issue.

But, as you say, there is a tremendous amount of nonsense thrown about regarding Ireland’s “appalling” healthcare system. The constant references I hear to the magical “free” NHS really bug me too.

I don't agree that health services should be free. I agree with co-payments but these must be capped at a reasonable level. For example, the idea that it is OK to continuously increase the DPS threshold which impacts most severely on ill people who have a constant requirement for presecription drugs and whose income is just above the medical card threshold is wrong IMO. Currently someone who hits the DPS threshold every month will have to pay €1,728 per year for their drugs plus GP visits and A&E visits and public hospital charges of PHI premiums pay together with any non-hospital care that a non-medical card holder cant access, e,g, physio. While all of this might be expensive for one off bouts of illness consider the serious burden it places on people who have a constant requirement to access all these services .. Ireland is no place for "ill men" (or women!!). It is in this context I think there is a place for the 'magical free NHS' discusions

Flier

A few thoughts:

More primary care - keep A&E for, well, accidents and emergencies, and serious ones at that. Most of the stuff that comes in the door can be adequately treated much more efficiently in the community.

A lot more step down care - keep acute beds for, well, acute illnesses. There are probably hundreds if not thousands of hospital beds taken up by patients who don't need to be there, but have nowhere suitable to go. When I worked in the Mater Hospital, there was an elderly patient who was a the best part of a year in the bed (post 'discharge' by the consultant). The Mater is a tertiary referral centre - among the most expensive hospital beds in the country.

More consultants. Consultants are the ones who make the final decisions on admission / discharge / investigations / treatment etc. Any decisions made by another member of the medical team are made under his authority. Some inpatients only see their consultant a couple of times a week, and much of their care is delegated to more junior doctors. More junior doctors will tend to (rightly) err on the side of caution, and so order more tests (expensive) and delay discharge (more expensive).

Out of hours work. Our hospitals are filled with expensive equipment. It is fired up sometime around 8 or 9 in the morning, and grinds to a halt shortly after 5. No wonder waiting lists are so long. Radiology, labs etc should be running 24/7, and more invasive stuff should be running probably 18 hours a day (people are not at their best during their 'core night', so I would keep non emergency surgery and the such out of those hours). Out patients should also be greatly extended - up to the tolerance of the public. I think an appointment at 7am or 9pm is perfectly acceptable.


Junior doctors aka NCHD's include every doctor in the health service up to consultant level. They are exceptional value for money. They work upto 100 hours per week (more in some cases I'm sure) and get paid for a whole lot less than that. They will do any job required of them, weather it's directly related to their 'actual' job, or something like portering bloods to the lab after hours, form filling etc. I can think of no other profession that the same could be said for. Probably in a lot of cases it is a very inefficient use of their skills and qualifications. So less of the 'doctors are over paid' rubbish.

Regarding consultants. Be careful what you wish for. The new consultant contracts, I think are getting close to the line where doctors just won't be interested in having them. The good ones that is. So the really good doctors and surgeons will stay in Australia or New Zealand, or wherever (where they are often already doing consultant grade jobs) or they will go into private practice. So those will insurance will find themselves with quick access to the best doctors, and those without.... The fact that Oz and NZ are so far away from 'home' is a lot of the reason we have many of those doctors coming back. There is a fine line between 'overpaid' and just not worth it.


That's it for now. I'm sure there'll be more if I actually sit down and think about it for a bit.

Godge

hatrickpatrick wrote: »

I was in Beaumont for a hydrocephalus thing (skull surgery) in '07 and in Vincents in '11 for my appendix, on both occasions I honestly found it comfortable and felt well looked after. None of the trolleys scattered around the corridors horror you'd expect from watching Prime Time.
Having said that, there definitely are major issues with the health service and it's hard to deny that. The fact for example that an appointment is meaningless, is surely something that could be looked at - you have an appointment for 2 in the afternoon, you arrive at half 1 to be early, you're lucky to be seen before 3. So there are definitely problems - why not just allocate people for 3 if it's going to take that long to see them anyway? Why take up space and time having people show up wildly early for appointments which simply aren't ready yet?

You have had good experiences so your anecdotes would suggest a good hospital service yet you say there definitely are major issues with the health services. Is this based on anecdotes you have not told or is it based on statistics, hard information or data?

As regards the appointments thing, the biggest issue most hospitals face in this regard is patients who don't turn up for scheduled consultations and not notifyingt he hospital, either forgetting, not caring, having gone private in the meantime, or feel better. As a result if a hospital only scheduled exactly enough people to see, they would have staff sitting around doing nothing because people don't turn up. We would have people on here complaining about going into hospitals and seeing people standing around.

djpbarry

Flier wrote: »

Junior doctors aka NCHD's include every doctor in the health service up to consultant level. They are exceptional value for money. They work upto 100 hours per week (more in some cases I'm sure) and get paid for a whole lot less than that. They will do any job required of them, weather it's directly related to their 'actual' job, or something like portering bloods to the lab after hours, form filling etc. I can think of no other profession that the same could be said for. Probably in a lot of cases it is a very inefficient use of their skills and qualifications. So less of the 'doctors are over paid' rubbish.

To be fair, that's quite a generalisation. I accept that general thrust of your argument, but let's be honest: not every doctor is doing a good job.

Flier

djpbarry wrote: »

To be fair, that's quite a generalisation. I accept that general thrust of your argument, but let's be honest: not every doctor is doing a good job.

Yes, it is a generalisation. In general, NCHD's are working way beyond their legal maximum, and don't get paid for a lot of it.
Yes, not all doctors are wonderful, the vast majority do the best they can.
Training for doctors in this country is haphazard at best.
You try going to work for 100 hours next week and see how 'good' a job you do.

djpbarry

Flier wrote: »

You try going to work for 100 hours next week and see how 'good' a job you do.

And what would that prove exactly?

Flier

Absolutely nothing. You weren't supposed to take it literally. Please don't go to work for 100 hours next week - you'll feel sh1t and make lots of mistakes.

celtictiger32

what is the actual problem holding back our health service?

james reilly

djpbarry

Flier wrote: »

Absolutely nothing. You weren't supposed to take it literally. Please don't go to work for 100 hours next week - you'll feel sh1t and make lots of mistakes.

I was obviously being flippant, because I really doubt that it is commonplace for a doctor to work 100 hours in a single week.

Flier

I don't know how commomplace it is. That it happens at all is indefensible. Speaking from personal experience, I was an NCHD in the health service. When I left (granted, a number of years ago now), I totaled up my hours. I was working on average just over 80 hours a week. My busy weeks (once every 4) I worked about 130 hours. My quiet weeks I was working just over the legal maximum (which was 65 hours at the time). That didn't include any extra 'on call' work to cover holidays or sickness. I was by no means exceptional. Granted, I was working in one of the busier surgical specialties, but many were on even more onerous call rotas than me. Things have changed very little since then I believe. The legal maximum is now 48 hours a week, thanks to an EU working time directive (which the government worked hard to get an exemption for doctors, as they realised they simply could not run the health service with such a dramatic reduction in NCHD hours). This directive is routinely ignored, the only outcome is that the HSE is reluctant to pay overtime over the 48 hours. So most doctors end up doing some work for free. One of my colleagues, in her previous job in general surgery, did a 1 in 2 'on call' for transplants, as well as her regular 1 in 5 (I think) general surgery call. Granted, transplants didn't happen that often, but she had to be in Dublin and not so much as have a glass of wine for her on call days. The 'transplant call' was unpaid.
Currently, some hospitals have moved to 24 hour 'on call' shifts in some specialties. Most hospitals have 'on call' shifts of 36 or 56 hours. None of these doctors are at their best

This is an interesting article worth a read:
http://www.medicalindependent.ie/21470/going_forward_looking_back

It's sparked a tread over in Health Sciences. I don't want to direct the ire of NCHD's over to this thread, but you can confirm my suspicions over there.

echo beach

Godge wrote: »

As regards the appointments thing, the biggest issue most hospitals face in this regard is patients who don't turn up for scheduled consultations and not notifyingt he hospital, either forgetting, not caring, having gone private in the meantime, or feel better. As a result if a hospital only scheduled exactly enough people to see, they would have staff sitting around doing nothing because people don't turn up. We would have people on here complaining about going into hospitals and seeing people standing around.

That is a problem and it won't go away completely but there could be a lot better management of appointments. Public appointments still use a system of posted out appointment cards. Sometimes the appointment is for months ahead, other times only a couple of days. They are going to patients who are ill, elderly, confused or just forgetful so it isn't surprising there is a high 'no show' rate. Once at a clinic a lady told me her name and asked me to tell if if it was called out. She was hard of hearing and had waited two hours on a previous occasion because she missed her 'shout'.
There is no system for notifying a patient that there are cancellations if they are available to take an appointment at short notice. Patients have no option to specify the day of the week or the time of day that would suit them best which might make it easier for them to keep the appointment.
There are many modern IT tools to help with scheduling but even a simple text reminder a day or two beforehand with a message to let them know if you can't attend, for whatever reason would streamline things.

Zombrex

The problem with the health service is that between those on the front line and the high ups making long term strategic decisions there is an entire over blown mess of middle management, people from the original Health boards who have to have jobs because they are public sector but who have little to do other than make busy work for themselves and gum up the system in order to ensure that they hang on to their jobs and positions of power.

I worked for an IT company for a while that did contract work for the HSE and the bureaucracy was unbelievable. The different departments weren't interested in improving things lest they themselves ended up becoming irrelevant. It is like that scene in Office Space where the guy tries to justify his position which is basically just passing messages from his secretary to the customers.

What we need is a government willing to restructure the entire middle management system in the HSE, paying people off if necessary, and forcing it into the modern world.

avalon68

celtictiger32 wrote: »

what is the actual problem holding back our health service?

james reilly

I really cant see why people always blame the health minister - reilly, and others before him have essentially had to try and introduce reform with both hands tied behind their backs. Anything they try to implement is met with union resistance. If you were given the job tomorrow - what would you do to solve the problems?

Also, comparing to the NHS isnt the best really - its far from free judging by the big wedge taken out of my salary every month tho pay for it. Coupled with being told Id have a 3 week wait to see the local GP for an ear infection this week - Im less than impressed!

Zombrex

avalon68 wrote: »

I really cant see why people always blame the health minister - reilly, and others before him have essentially had to try and introduce reform with both hands tied behind their backs. Anything they try to implement is met with union resistance. If you were given the job tomorrow - what would you do to solve the problems?

Yeah I don't like Reilly any more than the next person but it would be silly to blame it on him. The health services have been in serious trouble for decades, and again it is because people attempting to protect their jobs and careers over efficiency and quality of care.

volauvent

mountai wrote: »

Its not lack of investment and thats for sure. There seems to be an all prevailing attitude that our Clinicians are "Wonderful". Its a myth IMHO. They have been allowed to ride roughshod over the people of this country for far too long. There is a culture of Greed within the Health Service , where they protect what they have at all costs. Managers are duplicated , overpaid , non accountable at every level. Consultants have contracts, that pay them almost TWICE the amount that their colleagues in Germany and UK enjoy. They are also allowed to practice their PRIVATE clinics in PUBLIC hospitals , bringing their earnings to, unimaginable levels.
In this country, for every ten front line staff , there are four , yes FOUR ,support ,or back room people . In UK its ONE backroom for NINE frontline. The Health Service has developed into a MONSTER that is totally out of control , and until there is just ONE politician, with an ounce of courage, that is prepared to tackle these problems, head on

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It will continue to devour us all.

Good to see hospital consultants take a hit.
They are extraordinarily overpaid!
Its actually obscene how much they earn..

djpbarry

volauvent wrote: »

Good to see hospital consultants take a hit.
They are extraordinarily overpaid!
Its actually obscene how much they earn..

How much should they earn?

mountai

They should be paid the EU norm. Germany-- 120K Uk -- 100k Portugal -- 85k. Its easy --- work it out !!!.

BTW

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10% Absenteeism ???. Where else would it be allowed ??

SupaNova2

mountai wrote: »

They should be paid the EU norm. Germany-- 120K Uk -- 100k Portugal -- 85k. Its easy --- work it out !!!.

BTW

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10% Absenteeism ???. Where else would it be allowed ??

Where does the 10% figure come from?

djpbarry

mountai wrote: »

They should be paid the EU norm.

Presumably you're in favour of all salaries in Ireland being brought in line with the "EU norm", including your own? And a slashing of the minimum wage to bring it in line with our European neighbours?

Deise Vu

Try and picture a large unwieldy company where the CEO has to be elected CEO every five years and he is reporting to a board of directors which also has to be re-elected and a huge component of the board is idealogically opposed to anything that could be construed as undermining the terms and conditions of the workforce.Factor in that a large part of the managerial staff are also doing private work on company time and they are not obliged to account for how they divide their time and what they are working on.

Throw in that the board are constantly agitating for branches of the firm to opened in their parish and / or more of the annual spend is used on the branches in their neck of the woods regardless of the benefit of this spend. Finally consider that the workers have a huge input in the outcome of the Board and CEO election in terms of actual votes and the bad publicity they bring on the board when they don't get things entirely their own way.

Then you get some idea of why our Health Service should, out of respect for the english language, drop the word 'service'.

How anyone involved has a good nights sleep when they are directly involved in the pain, discomfort and even death of thousands of people is beyond me. There are over 100,000 supposedly well-educated people emplyed in the HSE. The budget is roughly €4K for every man, woman and child in the country. That is surely enough resources to provide a decent service if the will to do so was present.

djpbarry

Deise Vu wrote: »

How anyone involved has a good nights sleep when they are directly involved in the pain, discomfort and even death of thousands of people is beyond me.

Care to back up that statement with something? Or should I just dismiss it as more hyperbole?

Deise Vu wrote: »

There are over 100,000 supposedly well-educated people emplyed in the HSE. The budget is roughly €4K for every man, woman and child in the country. That is surely enough resources to provide a decent service if the will to do so was present.

Ireland's health service is better than "decent". It's good. Anyone who suggests otherwise is in serious need of a reality check.

Deise Vu

djpbarry wrote: »

Care to back up that statement with something? Or should I just dismiss it as more hyperbole?

There are people years on waiting lists for treatment of all kinds a lot of whom are in pain and discomfort and some of whom die for want of treatment such as Susie Long.

djpbarry wrote: »

Ireland's health service is better than "decent". It's good. Anyone who suggests otherwise is in serious need of a reality check.

Last year I had to bring a child to a Doctor in Italy. We were informed tourists had to go to the local A&E. My heart dropped thinking it would be like an Irish A&E: a cross between St Patricks Day in Kilburn at midnight and the Black Hole of Calcutta. Instead within 15 minutes we were in a room with a paediatrician and two nurses who performed and analysed an immediate swab test to confirm a streptococcal infection then a blood test to determine the course of treatment. The blood test was back in about an hour. My son was given an injection that day and the next and then we were handed antibiotics. It cost €58 because we didn't have our E111. Otherwise it would have been free.

One of our friends also had to go. He was being treated for reflux in ireland. Following an immediate ultrasound he was told he needed his gall bladder removed and asked did he want them to do it - while he was on holidays.

seamus

djpbarry wrote: »

Ireland's health service is better than "decent". It's good. Anyone who suggests otherwise is in serious need of a reality check.

Mate of mine managed to chop the top off his thumb in work on Monday evening. Attended A&E in Tallaght, was told there were no plastic surgeons on duty, so put the severed piece on ice overnight and attend St James's at 9am on Tuesday.
Arrived into St James's at 9am. Nope, sorry, that severed piece is only good for the bin. But sit tight and we'll clean and sew up the stump.
By 10pm last night he was still "sitting tight", being reassured that he was on the shortlist for the surgeons to look after him.

I actually don't know if he's had the surgery yet, but ignoring the absolute fiasco that is the instruction to put a severed body part on ice for 16 hours, he was left for at least 30 hours with a severed stump untreated.

That's not a "good" public health service, it's not even a "decent" one. I know anecdotes prove very little, but it's not like these kinds of stories are outliers. Practically every patient who attends public services will have a story of being left untreated in a bed or a trolley for hours, before being placed on massive waiting lists for relatively serious procedures.

There is no public health "system" in Ireland. There's a cobbled-together mess of health professionals trying to do a good job while completely tied up by bureaucracy and inefficiency.

nice_guy80

those in management positions really don't give a toss

therefore those people further down the line don't give a toss - just clock in and do what they have to do

djpbarry

Deise Vu wrote: »

There are people years on waiting lists for treatment of all kinds...

I never said otherwise, but that doesn’t make it a poor service.

Deise Vu wrote: »

Instead within 15 minutes we were in a room with a paediatrician and two nurses who performed and analysed an immediate swab test to confirm a streptococcal infection...

They were able to confirm a bacterial immediately?

djpbarry

seamus wrote: »

I know anecdotes prove very little, but it's not like these kinds of stories are outliers. Practically every patient who attends public services will have a story of being left untreated in a bed or a trolley for hours, before being placed on massive waiting lists for relatively serious procedures.

Again, I’m not suggesting otherwise – there are serious issues. No denying that. However, that doesn’t make the entire service ****.

By any objective measure (such as OECD surveys), Ireland’s health service is about average by western standards. Waiting times are definitely a problem, but the quality of treatment available is very good.

Deise Vu

nice_guy80 wrote: »

those in management positions really don't give a toss

therefore those people further down the line don't give a toss - just clock in and do what they have to do

I don't entirely agree with this. It is fairly obvious that the 'frontliners' hold the administrators in total disdain. A lot of this is probably deserved but how are you supposed to administrate when the consultants are running personal fiefdoms all over the shop, answerable to no-one, and everyone else is working according to job specs and rotas that were designed to union specs. Any remote variance from agreed procedures requires months of talks and negotiations.

This just can't work and it is up to everyone involved to admit it, tear up the rule book that is patently more important than actually delivering patient care and start again.

BlaasForRafa

djpbarry wrote: »

Presumably you're in favour of all salaries in Ireland being brought in line with the "EU norm", including your own? And a slashing of the minimum wage to bring it in line with our European neighbours?

Why should Irish consultants be paid more than those in the UK, Germany or France?

Are they qualitatively so much better than consultants in those countries? (whose health services strangely seem to work much better than ours)

Deise Vu

djpbarry wrote: »

I never said otherwise, but that doesn’t make it a poor service.
They were able to confirm a bacterial immediately?

They took a swab from his throat and stuck it into a machine they had in the room. Within a minute, I would say, they got a printout and the paediatrician said it was strep throat, which the lad is prone to but we hadn't mentioned. If they were bull****ting me the injections certainly worked the oracle.

I forgot to mention one other important point. Our first consultation (within 15 minutes of arrival as I said) was on a Saturday afternoon, the second injection was on a Sunday afternoon. The paediatrician was present both days and the bloods were done within an hour on the Saturday. My friend with the reflux / gall bladder went in in the early hours of Sunday morning. His service wasnlt nearly as good - they made him come back on Sunday morning at 8.00 AM for the ultrasound. The bastards. This was in a provincial town of no more than 20,000 population.