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What is it about hospitals in Ireland?

  • 28-04-2017 9:10am
    #1
    Moderators, Science, Health & Environment Moderators Posts: 18,135 Mod ✭✭✭✭ Sam Russell


    Why do hospitals become so political?

    Tallaght took a generation to be built.

    The National Children's Hospital has taken a generation to be approved, and is destined to be the most expensive children's hospital in the world by a country mile, and still has opposers wanting it to be built on a different site, but a different site from the other site that was planned for previously. There were sites offered for free but were turned down.

    Now the National Maternity Hospital is running into trouble with former Masters resigning over the disputed ownership (not over the actual plan).

    What has to happen to sort this nonsense out?

    [By nonsense, I am referring to the constant bun fights about the politics of the matter.
    Obviously, in the case of the NMH, ownership is key, at least to the former Masters and many others. If it does not matter (according to SVUH ans NMH), then why not donate the site and ownership remains with HSE?
    Otherwise, it does matter - in which case, ownership of the site should be transferred by whatever method (CPO, gift, lease) to the HSE.
    ]


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Comments

  • Moderators, Entertainment Moderators, Science, Health & Environment Moderators Posts: 13,625 Mod ✭✭✭✭ marno21


    National Childrens Hosptial

    If I live in Killarney and have to drive there on a regular basis, getting to the M50 is tough enough without having to battle through Dublin CC traffic.

    Considering the money spent on motorways to all parts of the country in the last 10 years it makes sense to locate a national hospital close to where these all meet, e.g. the M50.

    Building it in such an urban area also creates issues around having sufficient car parking spaces for all the travelling patients.


  • Registered Users Posts: 1,918 ✭✭✭ Anita Blow


    marno21 wrote: »
    National Childrens Hosptial

    If I live in Killarney and have to drive there on a regular basis, getting to the M50 is tough enough without having to battle through Dublin CC traffic.

    Considering the money spent on motorways to all parts of the country in the last 10 years it makes sense to locate a national hospital close to where these all meet, e.g. the M50.

    Building it in such an urban area also creates issues around having sufficient car parking spaces for all the travelling patients.

    I've posted on this before but:

    A national children's hospital has to be built somewhere. It makes logical sense it's build where the majority of the population is and where it has the greatest transport links (road, rail, bus etc).

    On the point of locating it along the M50, the independent 2008 report examined location & access thoroughly and they weighed it against other competing factors. What they concluded was that quality of care superseded access for routine outpatients. IE- The hospital has to be co-located with an adult tertiary hospital, particularly for emergency situations where time is critical. The time it takes for an ambulance to make it to Connolly VS James' is minutes, but with Connolly there will be the additional time it may take for an adult surgeon to get from James' to Connolly which multiply that time by a number of factors.


  • Registered Users Posts: 3,857 ✭✭✭ realitykeeper


    Hospital staff in Ireland love to take all the beds out of service so that they will have an easy time of it.


  • Moderators, Entertainment Moderators, Politics Moderators Posts: 14,349 Mod ✭✭✭✭ johnnyskeleton


    Hospital staff in Ireland love to take all the beds out of service so that they will have an easy time of it.

    Mod note:

    Please stay on topic and read the charter re: standards of posting. This thread is about why hospitals are political hot topics in Ireland. It is not an opportunity to take cheap shots at hospital staff.


  • Registered Users Posts: 2,458 ✭✭✭ OMD


    Anita Blow wrote: »
    The hospital has to be co-located with an adult tertiary hospital, particularly for emergency situations where time is critical. The time it takes for an ambulance to make it to Connolly VS James' is minutes, but with Connolly there will be the additional time it may take for an adult surgeon to get from James' to Connolly which multiply that time by a number of factors.


    The hospital does not have to be co-located. That is the main issue. One group of "experts" recommended it should be. Far more "experts" have said it makes no difference. The reasons for co-location are poor. Many major children's hospitals worldwide are not co-located.

    Co-location means being co-located with a tertiary referral centre. Connolly is not a tertiary referral centre (for almost all conditions) meaning locating the hospital on the grounds of Connolly essentially means it is not co-located.


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  • Registered Users Posts: 3,279 ✭✭✭ NuMarvel


    Why do hospitals become so political?

    Tallaght took a generation to be built.

    The National Children's Hospital has taken a generation to be approved, and is destined to be the most expensive children's hospital in the world by a country mile, and still has opposers wanting it to be built on a different site, but a different site from the other site that was planned for previously. There were sites offered for free but were turned down.

    Now the National Maternity Hospital is running into trouble with former Masters resigning over the disputed ownership (not over the actual plan).

    What has to happen to sort this nonsense out?

    [By nonsense, I am referring to the constant bun fights about the politics of the matter.
    Obviously, in the case of the NMH, ownership is key, at least to the former Masters and many others. If it does not matter (according to SVUH ans NMH), then why not donate the site and ownership remains with HSE?
    Otherwise, it does matter - in which case, ownership of the site should be transferred by whatever method (CPO, gift, lease) to the HSE.
    ]

    I think it's in large part down to the reaction of a not completely informed public, and politicians and others jumping on that.

    Take the new NCH. I think people generally accept that it should be co-located with an adult hospital, but beyond that people's opinions on where are based on everyday issues like access and parking, and not the clinical expertise of the adult hospital. At a guess, I'd say that's because people think one large hospital is pretty much the same as the other. So politicians and others seize on that. We saw something similar with resistance to the closure of 24 hour emergency departments in smaller hospitals. Even though the clinical outcomes are better when patients go to larger hospitals for complex and emergency treatment, people still instinctually feel they are losing out if their local A&E become a minor injury unit instead.

    That said, the ownership issue with the new NMH is a bit different, and the uproar is very much (and understandably) around who are currently intended to be the owners, as opposed to the fact that the State won't own it. After all, I haven't seen anyone asking who will be the owners of the other maternity hospitals when they've moved. And the same goes for the new NCH, which will be merging of three voluntary hospitals (incuding one owned by a different order of nuns).


  • Registered Users Posts: 68,318 ✭✭✭✭ seamus


    NuMarvel wrote: »
    Take the new NCH. I think people generally accept that it should be co-located with an adult hospital, but beyond that people's opinions on where are based on everyday issues like access and parking, and not the clinical expertise of the adult hospital. At a guess, I'd say that's because people think one large hospital is pretty much the same as the other.
    I guess people are idealists and make the assumption that the standard of care and patient outcomes should be close to identical (obviously there are going to be slight variations) regardless of which hospital you go to.

    The idea that going to hospital is something of a crapshoot about whether you live or die, scares the sh1t out of people. And they make the assumption that it's all down to specific hospitals having awful staff or awful facilities. And not because of less obvious things like being 60 minutes away from an expert on complications and specialised equipment.

    Therefore if you build a new hospital, it will be great and new, with great staff and all the bells and whistles.
    So the only question really is around how easy it is to get there from the rest of the country.

    Ultimately the concept that all large hospitals should have similar outcomes is not unreasonable. In fact, it's what we should be aiming for.

    But as a country we've made the mistake of building hospital facilities absolutely everywhere with the result that budgets are stretched too thin, so compromises have to be made on what services are provided where. Or we can triple the health budget.

    This is where the politics come in. Every politician loves to whinge about poor hospital facilities in their constituency, but will fight tooth and nail to hold onto their substandard hospital rather than have to travel an extra 10 miles to a far superior one.

    This is what the Irish people want; sh1tty, underfunded hospitals all over the country, rather than a handful of really, really good ones, strategically located. So that's what we get.


  • Registered Users Posts: 20,397 ✭✭✭✭ FreudianSlippers


    OMD wrote: »
    The hospital does not have to be co-located. That is the main issue. One group of "experts" recommended it should be. Far more "experts" have said it makes no difference. The reasons for co-location are poor. Many major children's hospitals worldwide are not co-located.

    Co-location means being co-located with a tertiary referral centre. Connolly is not a tertiary referral centre (for almost all conditions) meaning locating the hospital on the grounds of Connolly essentially means it is not co-located.
    You're right... they need to be tri-located and that group of so-called experts is basically every credible medical association in the Western World.


  • Registered Users Posts: 17,641 ✭✭✭✭ Tony EH


    Anita Blow wrote: »
    I've posted on this before but:

    A national children's hospital has to be built somewhere. It makes logical sense it's build where the majority of the population is and where it has the greatest transport links (road, rail, bus etc).

    That "sense" didn't have to mean James' Hospital though, which is surrounded by traffic jammed roads at certain times of the day. Not a good recipe for getting your kid to where it needs to be if they're in a bad way.


  • Registered Users Posts: 17,641 ✭✭✭✭ Tony EH


    seamus wrote: »

    The idea that going to hospital is something of a crapshoot about whether you live or die, scares the sh1t out of people. And they make the assumption that it's all down to specific hospitals having awful staff or awful facilities. And not because of less obvious things like being 60 minutes away from an expert on complications and specialised equipment.

    It's largely unwarranted though.

    It's funny that there are people in this country that think a trip to a public hospital is an automatic death sentence. Both my parents went through the public system for years and always received the best of care. My wife's a culchie and her family's experience with hospitals is no less.

    I've never really understood this fear that some people have. Ireland may have its issues with our healthcare system, but it irks the hell out of me when people start banging on.

    Of course, there are horror stories - there are to everything. But, by and large, our system does well despite its problems. Do I think it could be better, yes I do. Is it the nightmare some people want to portray it as. Absolutely not.


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  • Registered Users Posts: 1,918 ✭✭✭ Anita Blow


    Tony EH wrote: »
    That "sense" didn't have to mean James' Hospital though, which is surrounded by traffic jammed roads at certain times of the day. Not a good recipe for getting your kid to where it needs to be if they're in a bad way.

    What other options are there? The independent group based on worldwide best practice identified that the best paediatric hospitals in the world were located alongside specialist tertiary centres and that when weighed against issues such as access for outpatients, co-location was more important.
    So realistically the only options were James', Tallaght, Mater, Vincent's or Beaumont. They're all subject to traffic problems. Maybe Tallaght less so but perhaps it was located too far from the maternity hospitals & other specialist services.


  • Registered Users Posts: 17,641 ✭✭✭✭ Tony EH


    Connolly?


  • Registered Users Posts: 7,736 ✭✭✭ Pinch Flat


    We just don't do long terms planning here, so we have a children's hospital being considered for construction nearly 35 years after it was recommended. Hospitals are planned election to election, then what was agreed previously is overturned to whatever suits the incoming regime.Hospitals are built where the political agenda suits. No necessarily the best location.

    My wife works as nurse. Some of the common observations include:

    The health system is grossly inefficient - no accountability, lots of waste, too many managers

    The health system is understaffed and underfunded.

    We have very low medical staff / consultants per head of population

    We are only now getting to grips with Primary Care - a lot of our hospitals are clogged with people who could either be seen as relatively minor cases in a PC center.

    No where for elderly to go when in hospital and treated, as we don't have an efficient nursing home systems that is affordable.

    An unhealthy population -we have high levels of obesity, heart disease, etc. An unhealthy population means hospitals are going to be busier.

    My own opinion is that the health system is kept in a mess for political gain / points scoring.


  • Registered Users Posts: 1,918 ✭✭✭ Anita Blow


    Tony EH wrote: »
    Connolly?

    Connolly is a general hospital. It isn't a specialist hospital. It has nothing comparable to the level of specialities, diagnostic facilities or treatment facilities of the 5 specialist hospitals. It's the reason it has never been a runner


  • Registered Users Posts: 21,897 ✭✭✭✭ Podge_irl


    I doubt Ireland is actually unique in this issue. Ultimately a lot of it comes down to elements of education and trust. A good job is not always done of explaining the reasoning behind decisions and there appears to be an assumption that there is always an ulterior motive.

    Seemingly no amount of explaining to someone that the clinical outcomes for them will be better if they go an hour further away in an ambulance will make them believe shutting their local A&E is a good idea. It doesn't help that they start from a position of distrust of those making the decisions.


  • Registered Users Posts: 14,311 ✭✭✭✭ jimmycrackcorm


    Anita Blow wrote:
    Connolly is a general hospital. It isn't a specialist hospital. It has nothing comparable to the level of specialities, diagnostic facilities or treatment facilities of the 5 specialist hospitals. It's the reason it has never been a runner

    Specialisms are a result of quality of the staff available at the location. Connolly could be upgraded to provide the necessary facilities and staff moved as required.

    Site limitations restrict future growth in the city hospitals. Instead we are bringing the mountain to the man.


  • Registered Users Posts: 1,918 ✭✭✭ Anita Blow


    Specialisms are a result of quality of the staff available at the location. Connolly could be upgraded to provide the necessary facilities and staff moved as required.

    Site limitations restrict future growth in the city hospitals. Instead we are bringing the mountain to the man.
    Moving a 1000 bed hospital to accommodate a 450 bed hospital is bringing a mountain to the man. It would cost hundreds of millions maybe even over a billion to move James to Connolly and would be entirely unnecessary. Connolly is 250 beds to the 1000 beds of James. It has neither the physical infrastructure to support the specialities James does and nor does it have the patient throughput required for any of the specialities James offers.


  • Moderators, Motoring & Transport Moderators Posts: 11,409 Mod ✭✭✭✭ devnull


    Connolly is a poor hospital and seems very low staffed compared to others in Dublin, friend of mine was in A&E there one night after a fall after feeling unwell, was told he was 6 in the queue when he was triaged to see a doctor, was seen after 6 hours because there was only two doctors on.

    When he saw the doctor after 6 hours he was sent for a blood test and an x-ray and had to wait 2.5 hours for the results. That shows you how badly run the hospitals are here, wait for 6 hours then before even had a discussion with doctor he's sent by doctor for x-ray and blood test without any talking about the actual problem.

    In the UK blood tests and x-rays are ordered directly by triage if it's obvious that they are needed, in Ireland you have to see the doctor first which could take many hours then wait many more hours for the result. Nurses do very little in Ireland it seems the UK ones seem to do far more which helps speed up the process in A&E.


  • Closed Accounts Posts: 3,378 ✭✭✭ CeilingFly


    marno21 wrote: »
    National Childrens Hosptial

    If I live in Killarney and have to drive there on a regular basis, getting to the M50 is tough enough without having to battle through Dublin CC traffic.

    Considering the money spent on motorways to all parts of the country in the last 10 years it makes sense to locate a national hospital close to where these all meet, e.g. the M50.

    Building it in such an urban area also creates issues around having sufficient car parking spaces for all the travelling patients.

    But if you didn't want to drive, then a location around the m50 or further would be ridiculous.

    Killarney train station to heuston, then 5 minutes luas to door of the hospital.

    Remember that it won't be the only hospital for kids. Most will be transferred by ambulance or arrive by appointment, so its not as if you would suddenly be driving from Killarney.

    But in my opinion access for visitors is extremely important. It is proven that having many visitors aids in recovery of children in hospital, thus having a hospital close to a major city maximises visits from friends and relatives.

    Whilst family will always make special trips to their children, aunts, uncles, nieces, nephews may not be so inclined if there was no other activity for a longish trip.

    On the health side, access to high level consultants within the same grounds is hugely beneficial and James' excells in that area.


  • Closed Accounts Posts: 3,378 ✭✭✭ CeilingFly


    The real blame for the politics of Irish hospitals lies with three men...

    Richard Duggan
    Joe McGrath
    Spencer Freeman.


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  • Banned (with Prison Access) Posts: 9,005 ✭✭✭ pilly


    Consultants and board members of hospitals are very political by their nature and have their own best interests at heart.

    They want to work where the best facilities and staff are with little regard for the patient.

    That being said the people crying out for a children's hospital on the M50 assume everyone drives. That's simply not the case, especially in Dublin.


  • Registered Users Posts: 17,641 ✭✭✭✭ Tony EH


    devnull wrote: »
    Connolly is a poor hospital and seems very low staffed compared to others in Dublin, friend of mine was in A&E there one night after a fall after feeling unwell, was told he was 6 in the queue when he was triaged to see a doctor, was seen after 6 hours because there was only two doctors on.

    When he saw the doctor after 6 hours he was sent for a blood test and an x-ray and had to wait 2.5 hours for the results. That shows you how badly run the hospitals are here, wait for 6 hours then before even had a discussion with doctor he's sent by doctor for x-ray and blood test without any talking about the actual problem.

    In the UK blood tests and x-rays are ordered directly by triage if it's obvious that they are needed, in Ireland you have to see the doctor first which could take many hours then wait many more hours for the result. Nurses do very little in Ireland it seems the UK ones seem to do far more which helps speed up the process in A&E.

    8.5 hours isn't much these days.

    Try over 12 in James' and being worried that you were seeing that the same staff that were on when you walked into A+E were still on when you were walking out of it.

    A lot of the issues for an overcrowded A+E comes from GP referals, when there shouldn't be any <- that came from the doctor that saw me at James' Hospital.

    And nurses do excellent work in Ireland.


  • Registered Users Posts: 9,407 ✭✭✭ antoinolachtnai


    Hospitals are political because so much is at stake. It costs about a million a day to run an acute hospital. The 5 main hospitals in Dublin alone account for over 2 percent of the total government budget.

    They are complex organisations and there is an awful lot to get right.


  • Moderators, Motoring & Transport Moderators Posts: 11,409 Mod ✭✭✭✭ devnull


    Tony EH wrote: »
    A lot of the issues for an overcrowded A+E comes from GP referals, when there shouldn't be any <- that came from the doctor that saw me at James' Hospital.

    Lot of it is caused by terrible working practices and inefficient diagnosing methods that waste peoples time and that seem to be more about box ticking than actually caring about a patient

    In the UK if someone obviously needs a blood test and/or an x-ray it will be ordered by the triage nurse so when the doctor is ready to see you he will have all the information which means you don't have to wait ages for the results to come back.

    In Ireland if you need it you have triage, have to wait for a doctor to see you for 30 seconds and sends you for tests that could have been done whilst you were waiting to see him, adding hours on to the time that you are in the department.

    In the UK now many departments have a GP there so if it's a GP type issue you go into that queue and only sent on to other queues if the GP thinks it's warranted, end result is people with GP like conditions don't clog up the A&E system.
    And nurses do excellent work in Ireland.

    I don't doubt they do, but the problem is that if they did some of the above it would vastly improve the efficiency of the system, if triage nurses could order basic tests like they can in most other European countries, you'd end up wasting far less time.


  • Closed Accounts Posts: 5,857 ✭✭✭ professore


    CeilingFly wrote: »
    But if you didn't want to drive, then a location around the m50 or further would be ridiculous.

    Killarney train station to heuston, then 5 minutes luas to door of the hospital.

    Remember that it won't be the only hospital for kids. Most will be transferred by ambulance or arrive by appointment, so its not as if you would suddenly be driving from Killarney.

    But in my opinion access for visitors is extremely important. It is proven that having many visitors aids in recovery of children in hospital, thus having a hospital close to a major city maximises visits from friends and relatives.

    Whilst family will always make special trips to their children, aunts, uncles, nieces, nephews may not be so inclined if there was no other activity for a longish trip.

    On the health side, access to high level consultants within the same grounds is hugely beneficial and James' excells in that area.

    Having had a child in Crumlin some years back for an extended period, travelling up for the day isn't the reality of a lot of parents though. A lot of their kids are very sick requiring weeks or months away from home. Is there lots of suitable affordable longer term accommodation available for the parents near the hospital? Didn't think so.

    Build it out past the Red Cow with accommodation and add another stop to the Luas. That would make it accessible for everyone, jackeens and culchies alike.


  • Closed Accounts Posts: 3,378 ✭✭✭ CeilingFly


    professore wrote: »
    Having had a child in Crumlin some years back for an extended period, travelling up for the day isn't the reality of a lot of parents though. A lot of their kids are very sick requiring weeks or months away from home. Is there lots of suitable affordable longer term accommodation available for the parents near the hospital? Didn't think so.

    Build it out past the Red Cow with accommodation and add another stop to the Luas. That would make it accessible for everyone, jackeens and culchies alike.

    There are 53 family rooms in the new hospital so you can stay with the child.

    Red cow? And if a specialist from an adult hospital is required urgently, what do you do?


  • Registered Users Posts: 1,918 ✭✭✭ Anita Blow


    professore wrote: »
    Having had a child in Crumlin some years back for an extended period, travelling up for the day isn't the reality of a lot of parents though. A lot of their kids are very sick requiring weeks or months away from home. Is there lots of suitable affordable longer term accommodation available for the parents near the hospital? Didn't think so.

    Build it out past the Red Cow with accommodation and add another stop to the Luas. That would make it accessible for everyone, jackeens and culchies alike.

    As mentioned there is an adjacent building being constructed with 50+ rooms for families of long-stay children. Additionally the private rooms in the hospital are all ensuite and have a bed for the parents


  • Registered Users Posts: 2,239 ✭✭✭ MayoSalmon


    Why do hospitals become so political?! Eh maybe because there run by the government. It is amazing that people who think we cannot afford to pay for doctors, hospitals, and medication somehow think that we can afford to pay for doctors, hospitals, medication and a government bureaucracy to administer it.


  • Moderators, Science, Health & Environment Moderators Posts: 18,135 Mod ✭✭✭✭ Sam Russell


    MayoSalmon wrote: »
    Why do hospitals become so political?! Eh maybe because there run by the government. It is amazing that people who think we cannot afford to pay for doctors, hospitals, and medication somehow think that we can afford to pay for doctors, hospitals, medication and a government bureaucracy to administer it.

    If the hospitals were all privately run, we would have to pay for doctors, hospitals, medication and a privately run bureaucracy to administer it and give a profit to the private owner.

    We might get the government run part to run better, but I doubt we could get the owners of a private hospital to take less profit.

    Why, we even have to build a €300 million maternity hospital at our expense and hand it over to a private hospital entity (for free) and then pay them to run it at our expense, and they will make a profit.

    Now explain the politics in that one.


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  • Registered Users Posts: 77,863 ✭✭✭✭ Victor


    I think a large part of it is emotional attachment. The people who demand tertiary services everywhere aren't bad, just unrealistic.
    marno21 wrote: »
    If I live in Killarney and have to drive there on a regular basis, getting to the M50 is tough enough without having to battle through Dublin CC traffic.
    Unless its an immuno-suppressed or contagious disease case, are you really going to make the child endure 8 hours in a car and a hospital appointment on the same day or are you going to get a train to a station one Luas stop from Heuston and a few stops from Connolly / Busáras?
    Building it in such an urban area also creates issues around having sufficient car parking spaces for all the travelling patients.
    James's has a huge car park in the basement.
    Tony EH wrote: »
    That "sense" didn't have to mean James' Hospital though, which is surrounded by traffic jammed roads at certain times of the day. Not a good recipe for getting your kid to where it needs to be if they're in a bad way.
    If the child is in a bad way, call an ambulance.
    Tony EH wrote: »
    Connolly?
    It seems it doesn't have the skills several of the others have.


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