What exactly is the problem in the HSE?

v638sg7k1a92bx

I've posted this here as opposed to AH or politics to avoid the thread descending into nonsense and also because it would be interesting to hear the opinions of people who work or are closer to the what goes on in the HSE and our hospitals.

From my own personal experience over the past week, a family member who has dementia was admitted to A&E in Tallaght and spend a day and a half on a trolley before being admitted to a ward even though we have private medical insurance. Even after getting onto the ward, it was extremely difficult to get to speak to a doctor. As it transpired, there was only two doctors working that night and one was in A&E! Is it not just a case of simply hiring more staff if they are needed? just for arguments sake we overstate and the salary and say every doctor who work in a hospital earns €200,000. If we hired and extra 100 doctors that's €20m which is a drop in the ocean for the overall HSE budget and would make a huge impact in front line services. Am I missing something or is there another reason why only two doctors would be working that evening?

Is my example over simplified or are is there something else I'm missing? What do other posters think?

sweetie

management.

Spook_ie

Tickers - we too have private health insurance, however, when it comes to A&E everyone is treated the same. The real benefit of private insurance is when treatment/surgery is elective. Our daughter visited a public A&E last year and was put into plaster, but after this was taken off it was determined that she still had a problem with a ligament and needed an MRI & surgery, the Consultant told us to get the MRI done privately (2 days later) and we were rung to say she needed surgery and this was done a week later.

munchkin_utd

I'll illustrate it by saying how it is done abroad, and then Ireland, and you can figure the difference

Abroad in say Germany you pay medical insurance (for me and the wife something like 15,000euro a year) and THEY pay the bills. The hospitals dont get a government subsidy for operations or running costs. It'd be similar in America where hospitals are never government ran so rely solely on income from insurance to cover their costs.
Every treatment the hospital provides is paid for by insurance. If they do extra operations they get more money. If they do more tests, they get more money. If they have such a demand for operations that they need to build a new operating theatre, then the extra staff and extra running costs are covered by extra income got by doing extra operations.
And if they have a low number of operations/ treatments or are otherwise not paying their way, they will go bust and close.

so basically, the services automatically tailor themselves in scale to the demand.

In Ireland, each hospital is given a bucket of money by the HSE each year to live off.
I like to think of it as sending a heap of cash in the back door of the hospital from the government whereas in Germany/ USA you come in the front door as a patient with a heap of funds virtually attached to you (via your medical insurance).
A german/ US paitent is an asset whereas in Ireland a paitent is an extra cost to somehow be treated from the resources that are already paid for.
They have a go to see how many operations and tests they can do and how many beds, doctors, nurses they can employ from the bucket of cash they were given but theres little room for expansion when needed.
If more people come to a hospital for disgnosis/ treatment then theres no extra cash (aside from the likes of VHI paitents) to cover the extra demand because of budgets being fixed by the HSE at the beginning of the year - so you get waiting lists.

Theres plenty of waste in medical systems abroad, and possibly more than in Ireland.
Still, to have a system that can have you go in with a pain in your hip and have scans and the hip replaced within 10 days (which happened a work colleagues mother recently), I'd live with a little wastage and the extra cost of what it is abroad!

Mucco

munchkin_utd wrote: »

in Germany/ USA you come in the front door as a patient with a heap of funds virtually attached to you (via your medical insurance).

Be careful what you wish for. The 'fee for service' model often leads to excessive care. More tests = more profit for the hospital. The patient often thinks that more tests = better care, so they are happier. However, whether the tests are needed or not is far from clear. What is clear is that the US spends >18% of GDP on healthcare compared to about 12% in western Europe. The health outcomes in the US are no better than Europe (often worse).
See this article by Atul Gawande:
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

We can spend 20% of our income on healthcare if we want, but what are you willing to sacrifice in order to do so?

Agnieszka_88

munchkin_utd wrote: »

Abroad in say Germany you pay medical insurance (for me and the wife something like 15,000euro a year) and THEY pay the bills. The hospitals dont get a government subsidy for operations or running costs. It'd be similar in America where hospitals are never government ran so rely solely on income from insurance to cover their costs.

There are reasons for why the German health care system is so successful.
1: it's compulsory, everybody must be insured, no exceptions.
2: the high number of available Krankenkassen ("sickness funds") - to stay on the market, they need to compete with each other, so some of them offer lots of different benefits: treatment options, second opinions, max. double rooms in a hospital, preventive programmes, immunisations etc, for which the hospitals/doctors then of course get paid more.
3: really high premiums, especially for high-earning singles without kids ("social solidarity" they call it)- I pay almost as much as you do for yourself & your wife.
4: the German government doesn't provide health care or finance it directly, it only regulates insurance companies - and I think we will all agree that where there is politics, there is mismanagement and waste, no matter in which country. in here, the hospitals are businesses that have to earn their keep, free market principles apply, so if you won't try to employ good doctors/nurses and manage your hospital efficiently, you will go bust. It's kind of worth noticing that the people who run hospitals over here are usually very sharp, very experienced and expensive managers and no one complains about it as long as they manage to keep up the situation where the hospital can afford them.

SpaceTime

The biggest problem that I've found with the HSE's services is all about management and administration as well as just how the system is structured.

There are endless legacy services that are offered through all sorts of unaccountable 'trust' type organisations that seem to be in receipt of nearly 100% state funding.

The whole thing's long over due being taken apart and rebuilt from scratch. Too many festering legacy issues.
Changing the funding model will not change the duplication, triplication and separation of services in cities and sloppy administration and management.

An elderly relative of mine was undergoing cancer treatment in a major Dublin hospital and she was called in on several occasions for absolutely no reason. When she'd turn up they'd either lost the file or just kept her sitting in a waiting room for 4 hours (when she was having serious serious issues with walking, sitting, using toilets etc). Then when she'd get to meet the doctor, the consultation would turnout to be completely pointless.

They were also bringing her in to take blood samples and keeping her for hours and other really basic things that shouldn't have been done in a hospital setting at all or could even have been done by a district nurse.

We also found that there was basically zero communication between departments and when she'd arrive they'd have no idea why she was there or what the background to her case was.
It was even worse when she was transferred around the city to other units.

Basically, she had to start keeping copies of letters and build up her own file which she kept with her.
There didn't seem to be any kind of single liaison or point of contact or anything really. It was just like she was thrown into this big messy system and had to fend for herself.

I just always get the impression the Irish Health "System" is full of well meaning individuals all running around in chaos like headless chickens.

dissed doc

Jordyn Faint Pecan wrote: »

.....Even after getting onto the ward, it was extremely difficult to get to speak to a doctor. As it transpired, there was only two doctors working that night and one was in A&E! Is it not just a case of simply hiring more staff if they are needed?

That boat has long sailed. There is a worldwide shortage of doctors and government policy for the last decade has been to create many incentives for those doctors to leave the country.

You can't hire what is not available.

just for arguments sake we overstate and the salary and say every doctor who work in a hospital earns €200,000. If we hired and extra 100 doctors that's €20m which is a drop in the ocean for the overall HSE budget and would make a huge impact in front line services. Am I missing something or is there another reason why only two doctors would be working that evening?

(you are overstating drastically!!!) but even at that, doctors account in total of around 5% of the HSE's total budget (all consultants, all NCHD doctors). Needless to say, trying to reduce that 5% to 4.5% while ignoring the other 95% of costs won't make any difference. In a sense you are correct, despite the media-political industry attempting to focus the public on doctors' salaries.

The end driver of the healthcare delivery is the doctor who makes the yes/no clinical decisions. Endless money will not solve a problem which is now that no doctors both Irish or foreign want to stay working in Ireland is significant numbers to provide a reasonable health service.

This is why if even every doctor was forced to work for free, the cost overrun would not disappear, because the problem is the doctors.

Xeyn

The HSE's policies seem to be reactively driven rather than proactive. Anyone in the system could have foreseen the countless problems that are facing us today years ago.
As dissed doc states, the frontline staff have had enough. Doctors have left in droves and continue to do so.
Nurses are being treated quote badly as well and it remains to be seen what happens there. The HSE management failed to realise what a mobile workforce they employ. Doctors and nurses can find work in almost any country in the world should their mind be bent towards it.
The recent strike by the NCHDs sought to reduce potential harm to patients by cutting back dangerous work practices - in humane & illegal hours which consequently would actually reduce the pay of those on strike (less overtime) yet the spin doctors still tried to make it out as if it was in part a money issue.
They are making concerted efforts to try an rectify the situation now but it's too little too late for a lot of the staff.
I just completed yet another 36 hour shift in a major Dublin hospital.

If you look back at data over decades you can see a consistent trend with regards to A&E attendances and admissions to hospital as they increase year by year. Did the HSE make plans for this? Only once the situation came to a head (trolleys, deaths etc). Reactive.

The hospital management system in Ireland needs an overhaul.

treecreeper

we do have a problem, anyone ever get two letters on the same day telling you you had an appointment, duplicated? also sometimes, one letter for an appointment and another cancelling it, and another giving you another date? what about giving you an OT forty miles from where you live, can you imagine if that OT stayed in her own area how many clients she would be able to attend to when she has to drive eighty miles there and back to see one, take a paid for lunch and get back to office at closing time, the list is endless, management is in utter chaos. we have no health care in ireland, the wealthy may, the poor do not ever for a long time now.

SpaceTime

SpaceTime wrote: »

The biggest problem that I've found with the HSE's services is all about management and administration as well as just how the system is structured.

There are endless legacy services that are offered through all sorts of unaccountable 'trust' type organisations that seem to be in receipt of nearly 100% state funding.

The whole thing's long over due being taken apart and rebuilt from scratch. Too many festering legacy issues.
Changing the funding model will not change the duplication, triplication and separation of services in cities and sloppy administration and management.

An elderly relative of mine was undergoing cancer treatment in a major Dublin hospital and she was called in on several occasions for absolutely no reason. When she'd turn up they'd either lost the file or just kept her sitting in a waiting room for 4 hours (when she was having serious serious issues with walking, sitting, using toilets etc). Then when she'd get to meet the doctor, the consultation would turnout to be completely pointless.

They were also bringing her in to take blood samples and keeping her for hours and other really basic things that shouldn't have been done in a hospital setting at all or could even have been done by a district nurse.

We also found that there was basically zero communication between departments and when she'd arrive they'd have no idea why she was there or what the background to her case was.
It was even worse when she was transferred around the city to other units.

Basically, she had to start keeping copies of letters and build up her own file which she kept with her.
There didn't seem to be any kind of single liaison or point of contact or anything really. It was just like she was thrown into this big messy system and had to fend for herself.

I just always get the impression the Irish Health "System" is full of well meaning individuals all running around in chaos like headless chickens.

Elderly relative of mine had the exact same experience. Endless appointments for literally no purpose. It's like bureaucracy gone mad but also total lack of accountability, lack of auditing or analysis of why they do things or the outcomes of their administrative processes.
The entire system is totally incompetent!

It's like nobody ever tests how this works from a patient perspective and patients are seen as some kind of annoying thing to be ordered around and talked down to.

You also get the sense in some hospitals and services that you're being given something out of charity even though it's 100% state funded.

Xeyn

SpaceTime wrote: »

Elderly relative of mine had the exact same experience. Endless appointments for literally no purpose. It's like bureaucracy gone mad but also total lack of accountability, lack of auditing or analysis of why they do things or the outcomes of their administrative processes.
The entire system is totally incompetent!

It's like nobody ever tests how this works from a patient perspective and patients are seen as some kind of annoying thing to be ordered around and talked down to.

You also get the sense in some hospitals and services that you're being given something out of charity even though it's 100% state funded.

Actually patient audits are performed by doctors all the time. I did one myself. Unfortunately we as doctors, rarely get listened to by the administrative processes of the HSE. With the number of unnecessary admin staff in the health services you would think they would be the one to audit patient satisfaction etc

I don't quite get your last statement though about charity and state funding?

SpaceTime

I mean when you go to certain 100% state funded services you get the same 'vibe' as you world expect if you were asking for charity from a 'free' hospital. It varies from place to place, but some of the organisations my gran had to deal with had a very bad attitude.

In the French system that's definitely not the sense you get

Phill Ewinn

Xeyn wrote: »

Actually patient audits are performed by doctors all the time. I did one myself. Unfortunately we as doctors, rarely get liistened to by the administrative processes of the HSE. With the number of unnecessary admin staff in the health services you would think they would be the one to audit patient satisfaction etc

I don't quite get your last statement though about charity and state funding?

Can I ask why it is that doctors and nurses and their unions and associations don't push or lobby for changes to the administrative process??

Everyone understands the inefficiency of the administrative processes.

SpaceTime

They brought my gran in 6 times and lost her file. She'd a collapsed hip and a missing femour and terminal cancer.

She was also highly susceptible to infection.

Yet over and over they called her in for the most pointless reasons and made her wait in public waiting rooms with serious infection risks

She'd also go from dept to dept and for some reason they'd have no information when she arrived!

The staff seem to have trained under Computa Says No woman from Little Britain.

My impression was that they simply do not care about patients. The medical staff are run off their feet and generally fine. The admin system (if you can call it that) is just ridiculous though.

Xeyn

Phill Ewinn wrote: »

Can I ask why it is that doctors and nurses and their unions and associations don't push or lobby for changes to the administrative process??

Everyone understands the inefficiency of the administrative processes.

How exactly do you want them to go about that especially if they simply won't listen? It's 'them that make the rules' and believe me, many of my bosses have tried and they all say essentially the same thing- it's like banging your head against the wall.
But doctors are voting now. With their feet. (Admittedly for a variety of reasons though)

Xeyn

SpaceTime wrote: »

They brought my gran in 6 times and lost her file. She'd a collapsed hip and a missing femour and terminal cancer.

She was also highly susceptible to infection.

Yet over and over they called her in for the most pointless reasons and made her wait in public waiting rooms with serious infection risks

She'd also go from dept to dept and for some reason they'd have no information when she arrived!

The staff seem to have trained under Computa Says No woman from Little Britain.

My impression was that they simply do not care about patients. The medical staff are run off their feet and generally fine. The admin system (if you can call it that) is just ridiculous though.

I hope complaints were made. Bad PR is the only fire that warms their behinds apparently.

Phill Ewinn

Xeyn wrote: »

But doctors are voting now. With their feet.

Thats solving nothing.

Xeyn wrote: »

How exactly do you want them to go about that especially if they simply won't listen?

I don't know.

Xeyn

Phill Ewinn wrote: »

Thats solving nothing.

As stated the health service has always been reactive instead of proactive. This is a consequence not an intentional move- however it will force their hand.
I've been told by my last two consultant bosses that I would be a fool to stick it out here.
There are many politically motivated doctors who I have faith in will change things for the better once a platform is created for them. Unfortunately that platform is looking increasingly like it's taking the form of the rubble that will be left from our health system.

treecreeper

i am told there are thousands of complaints against the hse but the hse dont care nor listen.
the doctors say too that they are not listened to by the hse.
everyone says the hse is chaotic and appointments going nowhere.
doctors leaving due to chaos.
isnt it time to disband for good the hse as its the CHAOS, it seems nothing else.
what about a system where by get out by force eg legal actions, court cases, complaints to europe, human rights, amnesty and trade unions, ah forget the last they seemingly have bought in to an agreement not to enter into complaints of any kind within the health care system. we need to take a few test cases of incompentency and also danger to life.

SpaceTime

It's not a 'system' either. It's largely a state funded bunch of 'voluntary' organisations.

I'm not surprised that there's no accountability and chaos. That's how the 'system' is built!

It's more like something that just happened rather than a system that was planned

treecreeper

doctors, nurses, ot's, physios, psychologists etc are not part of any voluntary organisation, they are medics working in OUR health service, which isnt voluntary, its a paid job by the Department of health who give the HSE full rein to reign and do the job of running health in ireland, so who is the HSE 's boss?
the Department of Health who can if they want, pull the plug at anytime, when it comes to managers of the health care system.
if the department of health sacked the who shebang of managers then maybe we could start building again.
they know the hse is not fit for purpose but what do they do, go and give the next experiement and organisors of that experiement men who ran the hse to run the new experiment, thats what i call a department of health incompency which again means we need ride of reilly, pitty i cannot rid the typos as easily.

treecreeper

you wont find the department of health admitting they have anything to do with the HSE, both mary harney and this lot have actually told me that they have nothing to do with health, thats the job of the hse, seriously that was said to me.

treecreeper

we have a very complex health system, the private care and insurance shore up the public health system.
the system now is so chaotic many refuse to work in the overloaded chaos of all departments and the doctors feel its almost beyond repair due to taking so much out of the budget it is unworkable.
they have just enlisted ten more managers at the top level.
we have too many managers, too many foot soldiers and what happens then no one knows what they are doing.
files are all paper files so there is more trouble in the filing system, stuff gets lost and there is no cross communication.
communication is about the worst.
i am seriously ill and to me i have few services at all.
you try to get physio for neurodegeneration and there is none, been to a few departments and all are empty where they should be full of people needing controlled exercise regimes and deep massage. it doesnt happen anymore.
OT's have restrictive budgets and slam a patient to bits when they require such items as powered wheelchairs.
even some OT's refuse to take part payment for such an item claiming such things as 'who will own it then?\ they have an inability to sort that type of problem swiftly, this case of the powered wheelchair has gone to the legal advisers!
but the patient has been told they will not engage in a public/private funding for such a powered wheelchair, they have already spent three and a half years trying to figure all this out.
its chaos, thats the only word.
the patient is left depressed, unserved, disgruntled and blamed.
a new group has been formed on Facebook called 'Victims of the HSE unite' its there to see if the victims can unite and do something as a group.
many living with serious illness, disease and disability in the community cannot be monitered as in an institution setting which is beginning to happen thank god, but those in a house in the middle of community get neglected and so this is the group that is targeted for victims of the hSE unite.
if you feel harmed, abused or hurt by the HSe do call into that public facebook page.
all abuse, harm will be reported as obligatory to the guards.
but its a solidarity group in the making.
policy of what to do is in its infancy but that will be worked out with the group etc.
but at the onset confidentiality will be uppermost in this group and abuse will be reported to the authorities if it is named.

SpaceTime

The problem is that it's basically run for a load of in-fighting vested interests all wanting to build throw own power structure.

There's no point in blaming the current or recent Ministers for Health. They need to be given full public support to reform the system. Any attempts at serious reform are met with extreme resistance and even political behaviour by those with an interest in preserving the various status quos.

Honestly, I'm not sure how you'd fix it.

Harney, as much as I didn't really agree with her policies, tried to set up the HSE to rebuild from scratch only to discover that the old system wouldn't go away no matter what she did. So, she ended up in her attempts to 'tame the beast' creating two beasts that were even less tameable.

Michael Martin skirted the issue entirely and rolled out the smoking ban and left largely unscathed.

The fact that the HSE survived, almost totally unreformed, through the Trokia's period in power here shows just how serious an issue we have.

Nobody seems to have the political firepower to reform it and there are huge areas of the system that refuse to see the big picture, refuse to see it from an end user's perspective and do not really seem to want to change anything ever.

There's an argument that perhaps we should just abolish everything and start from scratch, but then everyone would probably sue everyone else for 1000 years costing the state trillions.

So, I don't know how you can fix it really.

I've no doubts that the HSE and Dept of Health will destroy Leo Varadkar too. He seems well intentioned, as does Kathleen Lynch, yet look what they're left dealing with... Hidden scandals like the care home thing etc etc etc.

Annabella1

Every secretary /administrator is permanent and untouchable.
They get promoted based on years worked and pay increases continue thanks to increment structure.
There is no incentive to be any good

virtual_kick in the face

^^^

Step 1: Fire all the needless office/Admin people.

j.mcdrmd

Pretence.

The HSE pretend to deliver health care.

They don't.

drzhivago

treecreeper wrote: »

doctors, nurses, ot's, physios, psychologists etc are not part of any voluntary organisation,

Slightly off point here but there are all of the above working volunatrily (i.e. free) for some of the charitable organisations which provide much needed services

On top of that there are others employed who work for Voluntary Hospitals( tricky concept- these are not state or HSE owned facilities though in many cases they now receive bulk of funding from HSE, initially these were for example charitable institutions set up by nuns/religious orders who had "visiting" consultant staff who treated poor for free and had admission rights for their private patients- bulk of budget in those days came from the orders or the private patients while the reverse is the case now But these places remain independent or as the title given to them as a group "voluntary hospitals" so the phrase above could apply to either grouping of medics

treecreeper wrote: »

they are medics working in OUR health service, which isnt voluntary, its a paid job by the Department of health who give the HSE full rein to reign and do the job of running health in ireland,

again not entirely true 25% of hospital based healthcare is provided by Independent or Private hospitals as they are generally known and these have no input or funding from DOH or HSE

In General practice/Primary care where 90% of total health contacts take place the Doh/HSe only part fund provision of medical care for 40% of the population i.e. medical card system so again not run either by DoH or HSE

treecreeper wrote: »

so who is the HSE 's boss?
the Department of Health who can if they want, pull the plug at anytime, when it comes to managers of the health care system.

Ah sorry to be a pedant again but we had 11 health boards pre single HSE-- there were a lot of promotions in the run up to closure of health boards and no one laid off - Take for example a finance manager - Old system 11 finance managers (and the rest) - new system 1 HSE finance manager + 11 others (and deputies and assistants) who really did not have a job but could not be laid off without significant cash outlays

treecreeper wrote: »

if the department of health sacked the who shebang of managers then maybe we could start building again.
they know the hse is not fit for purpose but what do they do, go and give the next experiement and organisors of that experiement men who ran the hse to run the new experiment, thats what i call a department of health incompency which again means we need ride of reilly, pitty i cannot rid the typos as easily.

his_dudeness

In defence to the HSE, and it pains me to defend it, not all of its problems are of its own doing.

The Irish people, while wanting a better health service, also want this better health service to be at every street corner in ever county providing every service possible. How many protests have there been around the closure or downgrading of departments despite medical and financial arguments to support them? And how many times have parish pump politics taking hold and prevented them, thus perpetuating a lesser quality service.

As an example, HiQA recently published a report that maternity services in Portlaoise should be closed and patients moved to another "bigger" centre. This is the same department that has been in the news on three different occasions in the last year with scandals. And yet, minister Varadkar has said it won't close. Needless to say, the people of Laois don't want it to close. This is part of the HSE problem, not being allowed make the necessary big decisions.

Oddly, I think the downgrading of Roscommon and reconfiguration Of Ennis and Nenagh, and in particular the perseverance of same in the face of public opposition, albeit driven mostly by a costing argument, is some of the bravest decisions the HSE has taken.

echo beach

his_dudeness wrote: »

As an example, HiQA recently published a report that maternity services in Portlaoise should be closed and patients moved to another "bigger" centre. This is the same department that has been in the news on three different occasions in the last year with scandals. And yet, minister Varadkar has said it won't close. Needless to say, the people of Laois don't want it to close. This is part of the HSE problem, not being allowed make the necessary big decisions.

It isn't a 'big' decision to close a unit that has problems and move those patients to a 'bigger' centre that isn't given any extra resources to deal with them. All that does is move the problem from one place to another. HIQA has also been damning of A+E in Tallaght hospital, despite its size.
A 'big' decision would involve 'solving' the problem, either in the location that has the problem or elsewhere, and the HSE does not have either the resources or the management ability to do that. Political interference is part of the problem but if the HSE did its job properly politicians and public would trust it to make the correct decisions. At the moment we can't trust it.

maninasia

The 'system' as such should largely be broken down into individual units (hospitals) or hospital groups, which operate in a public or private capacity under their own management structure. They should then compete for patients and get funded on a service per patient model. A universal insurance system can help to cover insurance premium gaps for poorer folks.

Yes there are some problems that can go with such a model, but improved service due to competition and private investment would be a vast improvement on the current situation. The playing field will be a lot more transparent and hospitals will succeed or fail according to their overall performance, in the main.

Also I would suggest the culture of the blame game and the idea of 'management' and 'consultants' and 'foot soldiers' would need to be broken down and changed to one where people see themselves as part of a bigger entity (hospital/dept) working towards a common goal.

Also it's very clear that the current system is a shambles IT wise, get a chipped card for each patient, and stick the records on a central database, it's not that hard in this day and age.

treecreeper

i have always felt that the groups, units of care should be broken down. i suggest 'small injuries' clinics, alcoholic and drug addicts and problem solving clinics, (places to rest overnight after a binge and see someone next day but not in the main A'E services, these should be attached to the psychiatric hospitals or other) the step down facilities have been needed for over a decade and ignored.
the community care and primary care with 'visions' have all been known for decades and nothing done about it.
when you lop off transport to hospitals from various smaller towns and villages no wonder there is an outcry against shutting smaller hospitals.
the hse cannot have it everyway.
if we do not sort the problem its not going to go away!
the system is now 'unattractive' for any professional to work in, and dangerous.
we have a dangerous health service provision yet top medical colleges and research units at the universities, the result being educate and emigrate. madness.
we have a high elderly population but its known they fare better and want to be in the community
what happens now is all the public health nurses time is taken up with the baby clinics, i see it. and the elderly who need care are not getting it, they should be equal in health.
the children and babies now will be getting free gp services, this will not have impact to the pubic health centre where the mothers and babies go for all sorts of things, -everything, you would think irish mothers have not been having babies for centuries.
its a waste of resources.
and money
the community element is going, when everyone feels the state should care for just about everyone.
the elderly are being shoved away as soon as they can be got rid of into mass dying homes where they await their time in passing.
the window of use has decreased from babyhood to about fifty after that we begin again at the babyhood stage and the rest prepare for the massive institutions where we ditch the mothers and fathers.
community care should be just that.
its the one big issues with the hospitals and not being dealt with.
its too expensive to keep people in these institutions, small community places should be funded at far less expense and far better emotionally and physically not to mention morally.
IT is a madness, with one co ordinator of services doing the payroll for all her workers BY HAND for three weeks out of every month.
what country works like this ?
all have an electronic pay slip and all patients an electronic data information number.
all patients should have a duplicate of the doctors letters, test results etc.
we in Ireland have to apply for these, through our gp who have to request them and then to get any other information you either have to beg for it or get it under FOI>
can you blame the doctors for not knowing up to speed data when the patient cannot bring a folder with him/her and behave like adults, not some kind of demigod looking after eggits.
we are people who are ruled by medics and we all should be in this together, including including the elderly in the framework, not as expendible but part of community.
end of rant!

Vorsprung

I find ED overcrowding particularly sickening. Lots of reasons for it, and it is a hospital problem rather than an ED problem in many cases.

Lots of ED consultants being interviewed in the media, and I wonder if things would be a little better if some of those ED consultants actually spent time on their respective shop floors instead of on the radio/TV. An inconvenient fact that is being ignored.

One of many, many reasons.

treecreeper

anyone understand 'human rights law' and how one goes about taking a case against the HSE under this, because all else has failed in a case very close to my heart, they say after failing to get justice for health care there is a way to europe, well where do i find any links to how to process this please.

echo beach

Vorsprung wrote: »

Lots of ED consultants being interviewed in the media, and I wonder if things would be a little better if some of those ED consultants actually spent time on their respective shop floors instead of on the radio/TV. An inconvenient fact that is being ignored.

One of many, many reasons.

The people waiting in A+E will already have been seen and it has been decided they need to be admitted and probably need further tests.
A radio or TV interview only takes 10 or 15 mins and by drawing attention to the problem may well do more good than standing around looking at a sea of people, most of whom are medical cases and not the people an ED consultant is best placed to help.

As you say there are many reasons for the problem but the HSE seem convinced that the main factor is delayed discharge. The general manger of Letterkenny hospital says this isn't an issue for them with only 2 or 3 patients awaiting step down beds when there were up to 37 patients waiting for admission. Something doesn't add up.
I see a lack of provision in primary care, especially in the evenings, at weekends and over the holidays when patients are left to out of hours services staffed by doctors who don't know the patients, their history or their backgrounds. Sending patients to hospital becomes the default option because there aren't the resources to provide the regular home visits needed to safely treat these patients in their own home.
A 'flying squad' of GPs and nurses who would visit the patients at home 2-3 times a day and who had direct access to out-patient facilities for tests and x-rays might relieve some of the pressure without using up acute beds.

Vorsprung

echo beach wrote: »

A radio or TV interview only takes 10 or 15 mins and by drawing attention to the problem may well do more good than standing around looking at a sea of people, most of whom are medical cases and not the people an ED consultant is best placed to help.

Firstly, I suppose I'm referring to certain consultants who are on the radio a lot of the time.

Secondly, lots of studies to show that ED consultant presence on the floor reduces inappropriate admissions and discharges. I don't know that those papers specifically deal with medical patients.

echo beach wrote: »

As you say there are many reasons for the problem but the HSE seem convinced that the main factor is delayed discharge. The general manger of Letterkenny hospital says this isn't an issue for them with only 2 or 3 patients awaiting step down beds when there were up to 37 patients waiting for admission. Something doesn't add up.

Different in different places. I hear it's a particular problem in Beamount. How someone in the HSE decides that it's better value to spend around a thousand euro a night on an acute hospital bed instead of 1000 euro a week on a nursing home bed is beyond me.

echo beach wrote: »

I see a lack of provision in primary care, especially in the evenings, at weekends and over the holidays when patients are left to out of hours services staffed by doctors who don't know the patients, their history or their backgrounds. Sending patients to hospital becomes the default option because there aren't the resources to provide the regular home visits needed to safely treat these patients in their own home.

Agree 100%. Timely access to diagnostics and adequate funding to manage chronic disease instead of increasingly infrequent tertiary reviews constitute some of the issues that need to be addressed. No doubt there's an up front cost but I can't but imagine that the savings in the long run would outweigh that initial cost.

Same could be applied to hospital inpatient teams, I remember having to refer from ED to an inpatient to get a CTPA, wastage is incredible!

Apologies for bringing it down to money but it's the only language the HSE speak.

treecreeper

those who have severe illness and disease who are already living in the community in their own homes do not get to see any medical staff day in day out and i know two individuals, yearning to stay in their own homes, who are not that elderly being 63 never ever have a visit from a nurse even. the problem seems to be understaffing and a demographic of other needs within primary care clogging up the works.
if the nurses have a catchment area of young families and a centre that is permanently taken up with baby issues, then the elderly, very sick etc do not get the services they need.
the money goes where the need is, and its children first.
this is alarming. there is simply no balance at all.
one nurse covering for the chronically ill for instance and that alone would mean that she can concentrate on that group.
its about how one manages particular areas.
there is also community committment which is fast eroding. an article about a pensioner cycling two hours to get her pension in a rural area says it all - where are her neighbours?
there isnt enough senior or consultant A'E doctors on the floor of the department, leading to unsafe decision making.

echo beach

Vorsprung wrote: »

How someone in the HSE decides that it's better value to spend around a thousand euro a night on an acute hospital bed instead of 1000 euro a week on a nursing home bed is beyond me.

What you are leaving out of the sums is the fact that as soon as a person moves to a nursing home the acute hospital bed gets filled with another patient so the only way it saves the HSE money is if they close that bed. Otherwise they will have to pay for two beds instead of one.
All the figures are averages. The average cost of the acute hospital bed may be 1000 euro but the patient awaiting discharge costs a good bit less than that because they aren't getting active treatment. Replace them with a seriously ill patient and the cost will be greater, as will the stress on already stretched staff. The reality is that it suits management and staff to have a certain percentage of beds taken up with those who aren't very sick, either awaiting discharge or waiting for tests or waiting for a consultant's opinion. I've had occasion over the years to visit a variety of wards in various hospitals and notice that about a third of patients (nearly always 2 on a 6 bed ward) tend to fit into those categories.

bleg

The problem is that the HSE faces a so called "wicked problem."

http://en.wikipedia.org/wiki/Wicked_problem

A wicked problem is a problem that is difficult or impossible to solve because of incomplete, contradictory, and changing requirements that are often difficult to recognize. The use of term "wicked" here has come to denote resistance to resolution, rather than evil.[1] Moreover, because of complex interdependencies, the effort to solve one aspect of a wicked problem may reveal or create other problems.

treecreeper

wicked or evil....who suffers...and thats why whether wicked or evil someone should try and divide it all up and sort the bloody mess.
people are dying cos of the mess.
people are facing some sinister forces within management which means care for them is being denied.
and far worse, whole generations, usually the elderly are dumped at the mercy of people who are either wicked or evil

echo beach

bleg wrote: »

The problem is that the HSE faces a so called "wicked problem."

http://en.wikipedia.org/wiki/Wicked_problem

In some respects it is a 'wicked' problem but I'm not sure it fully fits the description. Nobody seems to have much difficulty recognising the requirements, and they don't change that much except to increase in volume at certain times.

czipownik

Why don't we decentralize the public health service in Ireland? Just dismantle the HSE and build contract/tender based system like in Poland for example. This way, poor performers like the maternity in Portlaoise are simply rooted out, i.e. no contract renewal at beginning of next year.

Polish system is opened to both public and private entities (health centers, hospitals, practices). Every procedure all the way from organ transplant down to GP consultation has its unit price on the list generated by the ministry of health. Publicly insured patient have their user and login into internet website where they can follow all procedures performed/attended.

I think the problem here in Ireland is that the HSE is a black whole or well without the bottom. Plenty of beaurocrats, administration, complex reporting structures, no trasparency in the event of medical misconduct/mistakes.

Having contract system in place, allows to track what pricing level can be achieved for each procedure = competition.

adamshare01

Management and administration

SpaceTime

There are a few big problems:

1) Administration where instead of recruiting people to positions based on merit, they're being advanced to management based on their length of service. This isn't really a viable way of recruiting good management.

They also don't seem to understand the difference between "management" and "administration". They're two related but totally different skill sets.

Confusing the two creates a problem for both patients and medical staff.

2) The two tier system (and I think this is a big thing).

Ireland has a public/private hybrid health system. So we take most of the patients who are likely to demand high levels of customer service out of the public system and leave it full of people who are more likely to be passive about how they're treated.

In the NHS or other public systems, everyone from the local solicitor, the journalist, the GP, the local MP to the unemployed former construction worker are all sharing the same system. If something goes wrong, you will absolutely hear about it.

So, we've basically created in Ireland a system of "working class" vs "middle class" healthcare and rigidly stuck with it come hell or high water despite our claims to be more 'classless' than the UK.

To make it even worse, it's not even a fully private system. Instead we have a barrier fee to keep the two streams separate in the same hospitals.

3) A culture that has come from the concept of free charitable hospitals where patients were 'the poor'.

Unfortunately, I think there is a culture that pervades the whole public system here (especially aspects of the voluntary hospitals which are almost totally state funded) that patients are some kind of charity cases instead of customers of a public service. I don't get that sense in the NHS system but I do get it in some Irish hospitals.

People are being expected to accept whatever they get and be lucky to get it because they haven't 'paid' (other than heavily through their income tax and paying 23% VAT on everything for their entire lives).

Like it or not, that attitude definitely exists.

I was really, extremely annoyed with how my own grandmother was treated by non-medical staff in a major hospital in Dublin. She had terminal cancer and literally had no bones in one of her leg (replaced by steel bars).

The medical staff were really nice, but the administration staff kept calling her in for non-existent appointments and making her wait for hours and hours on hard chairs for absolutely no reason when the woman literally could hardly get herself out her own hall door with assistance.

I remember on one particular day we spent 7 hours in a waiting room for absolutely no reason. They discovered they'd lost the files and had a bit of a mix up. "oops!"

There was also no thought put into thinking about how they could possibly do things without calling her in.
A lot of the consultations were pointless and could have been conducted by phone. A lot of the blood samples could have been collected by a community nurse or a GP.

They also couldn't seem to manage simple things like doing several simple things on one day. Instead they'd call her in maybe on a Monday, then a Tuesday and a Friday for appointments that seemed to be about chats about nothing or to collect a simple blood test.

Every one of these appointments meant that a very sick, very old lady was sitting on a hard chair for hours and that family members had to take time off work or try to work from laptops in waiting rooms.

Another relative of mine is using the same hospital, and is quite ill with a form of cancer and it's similar. They seem to run clinics where they just call about 100 people in at the same time and them expect them to wait all day for a simple consultation.
It's like they just couldn't be bothered making proper appointments and expect 'the plebs' to just file in and wait.

While the facility is modern (thanks to state money) the attitude is still as dismissive as ever.

On the other side of it, I was over in St Luke's in Beaumont (Radiotherapy facility) which is basically a single facility for both public and private patients and it was like the difference between night and day.

They couldn't have been nicer or more efficient if they tried.

The admin team were fantastically helpful, genuinely had an interest in what they were doing and how the patients were doing and even made a big effort to actually come over and greet people by their first name and have a proper chat when they arrived.

It just shows what is possible!

I am 100% convinced that all of the problems in certain hospitals are coming from a management and institutional culture that needs to be tackled very aggressively.

4) Culture of non-transparency

This has to be tackled and tackled very aggressively too.
It's completely unacceptable in a system that makes life/death decisions that there is a culture of trying to suppress reports and gag staff.

Did we learn absolutely nothing from the institutional abuse scandals of the past?

Big vested interests and bureaucracies will protect themselves.

Sorry this is a bit of a long rant but the HSE REALLY annoys me!

SpaceTime

I'd just add one of the things that shocked me the most was how they had no single point of contact for patients in that major Dublin hospital.

My grandmother who sadly passed away a couple of years ago and my other relative who is currently battling an incurable type of cancer have had this experience.

They arrive in and basically it seems that nobody is looking after them. Each aspect of their case is being dealt with in a very remote, technical way by very good medical staff, but nobody seems to be visibly coordinating anything.

For example, she was sent for radiotherapy at another hospital without much explanation. She had no idea why she was having radiotherapy or what it was achieving!

She thought it was curing the cancer, when it was actually palliative and nobody had told her that very clearly until the radiation oncologist directly treating her was a bit surprised she didn't realise this.

The other hospital St Lukes were very good, but when she was passed back to her own team, the feedback just stopped. She got a very sore throat and nobody seemed to know why. She'd no idea if it was a side effect because nobody had explained what part of her body had been irradiated!

She keeps all her own files as the hospital doesn't seem to coordinate anything. So she arrives with a big wad of paperwork and appointment slips.

This is an old lady who isn't particularly good any of this stuff, tends to be quite worried about dealing with 'authority' and just goes along with all this stuff.

She's having to book her own blood tests, has no idea what they're for etc. Spends her time freaking out in case she doesn't get a blood test in time before some particular treatment that requires the measurement of some blood chemistry beforehand.

I don't know why a sick, old lady is dealing with that stuff herself...

The information is there, but you have to dig for it.

Again, I'm not faulting the medical team here as she's actually getting really top notch technical treatment, but the problem is the lack of an interface layer between them and the patient. They really badly need this.
The hospital's administration people are effectively just queue managers. That's all the seem to do.

The system is extremely broken in certain hospitals and I honestly don't think it's a lack of financial resources. Throwing money at the problem won't solve basic structural and management issues like this.

I'm not saying there aren't resource issues, but this to me seems like an entirely organisational issue. It's not being tackled. They need to actually get patients to act as secret shoppers and discover how the system REALLY works and how to fix it.

treecreeper

being ill as i am and a public patient i recently returned from the uk NHS system for rare diseases treatment and assessment - comparisons -
group thinking in nhs has the neurologist and physiotherapist grovelling on the floor assessing movements, measuring, marking and mapping.
ireland - interview in a bare room producing nothing.
NHS - consultant can hold your hand when speaking of vital important information on living with a rare disease
HSE - consultant plays 'what do you want me to do?' as if he doesnt know himself.
NHS - consultant pushes you back to ward chatting all the way
HSE - consultant fecks you out after a brief interview porter called waiting forever.
NHS - consultant will advocate
HSE - NOne do this
there is absolutely no team work for patients in the HSE, they dont understand it, in the NHS you can have teams all over the place and interlinking. it seems so natural there to do this, they do not treat their patients like sh....

dissed doc

treecreeper wrote: »

being ill as i am and a public patient i recently returned from the uk NHS system for rare diseases treatment and assessment - comparisons -
group thinking in nhs has the neurologist and physiotherapist grovelling on the floor assessing movements, measuring, marking and mapping.
ireland - interview in a bare room producing nothing.
NHS - consultant can hold your hand when speaking of vital important information on living with a rare disease
HSE - consultant plays 'what do you want me to do?' as if he doesnt know himself.
NHS - consultant pushes you back to ward chatting all the way
HSE - consultant fecks you out after a brief interview porter called waiting forever.
NHS - consultant will advocate
HSE - NOne do this
there is absolutely no team work for patients in the HSE, they dont understand it, in the NHS you can have teams all over the place and interlinking. it seems so natural there to do this, they do not treat their patients like sh....

The NHS was to be and still is for the moment a component of the British identity since it's founding, so rightly or wrongly it inspires and consumes the goodwill of the employees, who are beginning to desert it.

The HSE is an administrative system for executive managers, it can by it's nature never inspire loyality, and even more so, because it openly attacks it's own employees.

The public decide along with the media, how public bodies treat public employees. If you don't like what you are seeing, it is because it reflects how those people have been treated over the past decade. Consultants have been bullied for a decade in all media and by the HSE. What do you expect? Hand holding and compassion? Human nature doesn't work like that.

It is what it is, and the way the people are is the way people are. If you or anybody want that caring compassionate interaction, you should know, it comes from the top down. Demoralised and bullied staff do not have to make excuses for reacting in a human way to their treatment at the hands of the media, politicians and public over the past decade.

treecreeper

i am unsure what you are trying to say here.
what if, you as a sick person became sick and then treated in the above way. which came first the chicken or the egg.
i do agree that the organisation is demoralised and bullying is rife both within and from outside.
therefore to cure such an ill is to kill it off!
many want to see change.
many in the hse are really good and caring.
but if the whole thing is in chaos from top to bottom and inside out, where can it go from here?
it is getting worse not better.
i am not using any excuse for poor services, bullying from top to bottom and inside means that everyone has a right to bully another no matter?
when you become sick for the first time in your life the shock of bad treatment is awful.
period.
when you become sick for hte first time in your life and meet some expertise in all aspects of care the shock too is evident inside i feel different.
the rest is awful.

_Tombstone_

How have consultants being bullied in the media?

treecreeper

media is selective.
anyone trying to get a point across is chosen, selectively by media.
therefore between politicians and media you have a basic autocracy.
no one will allow you have your say unless they say so.

whether media bullies consultants by allowing the public say what it wants to say might be a way of saying this.
but to speak of bullying, i have never seen or heard of bullying of consultants in the media.
they argue over their pay scale, which isnt the same as bullying.

we have a culture here in ireland, as one person said the NHS is part of their identity.
but the culture here in ireland is not good towards patients.
consultants do strutt.
they rule.
they are to be believed whether right or wrong and pretty selective who and how they treat people.
me saying that is not bullying them.
the day they hold a patients hand in care or wheel them back to the wards by showing that extra step of empathy is the day i see our culture of arrogance weakening towards what should be equal share and care in sickness.