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General Irish Government discussion thread [See Post 1805]
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Maybe Leo's next campaign poster can read "I'll end the scandal of patients on trolleys hospital staff taking their due holidays even when it's not really the problem".0
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Matt Barrett wrote: »A number of factors, the weather/flu season for one.
Even if hospitals closed on December 25th, it wouldn't explain away the worsening crisis over the preceding months and there after. Leo chose a soft target to distract from himself and his government.
You have to look at the context and timing.
Right, but the context isn't about the generally worsening crisis. The question and answer were very specifically about the "winter crisis" which is a localised worsening of an admittedly already poor situation.
I think it is unfair to characterise it as an explanation or attempted solution to the general healthcare problems.0 -
corner back 2 wrote: »I agree with efficiency but you can't just state frontline staff should be more efficient without explaining how. Once again patient flow can't happen if there is nowhere to put patients or nowhere to discharge patients to. Explain how frontline staff can solve this. I gave you my explanation of how the whole health service could be more efficient.
Fair enough, but it is the relatively poor efficiency that is contributing to the problem of having nowhere to put patients.
The problem of patients where you have nowhere to discharge them to is also another long-running issue that definitely needs a solution. I do not know what that is though. Better homecare funding would help.0 -
Fair enough, but it is the relatively poor efficiency that is contributing to the problem of having nowhere to put patients.
The problem of patients where you have nowhere to discharge them to is also another long-running issue that definitely needs a solution. I do not know what that is though. Better homecare funding would help.
More beds would do no harm. All the hospital workers at every level seem to be putting that forward as a suggestion.Right, but the context isn't about the generally worsening crisis. The question and answer were very specifically about the "winter crisis" which is a localised worsening of an admittedly already poor situation.
I think it is unfair to characterise it as an explanation or attempted solution to the general healthcare problems.
In as much as it's unfair to characterise it as an explanation or attempted solution to the "winter crisis" as Leo did.0 -
Michael Healy-Rae has found a way around long waiting times for his constituents.
Smart man.
https://www.thejournal.ie/healy-rae-buses-patients-to-belfast-for-hip-and-knee-replacements-4317747-Nov2018/0 -
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Michael Healy-Rae has found a way around long waiting times for his constituents.
Smart man.
https://www.thejournal.ie/healy-rae-buses-patients-to-belfast-for-hip-and-knee-replacements-4317747-Nov2018/
I thought it was going to include reading tea leafs and not crossing through a fairy fort.0 -
He is not saying they are! He is saying there should be a period where no discretionary leave at all is given. It is not uncommon in any industry. This would create artificially high staffing levels for a brief period.
Other industries get to shut down at specified periods or have off peak times. Hospitals do not. We are not argos.
More front line staff is not the answer here. The agreed staffing levels are adequate.
You make a great point about homecare packages, which just are not available and take a age to setup. We are dealing with a lot of elderly patients who can't just be pushed out the door when well with no support.0 -
funky sausage wrote: »Other industries get to shut down at specified periods or have off peak times. Hospitals do not. We are not argos.
More front line staff is not the answer here. The agreed staffing levels are adequate.
I would slightly disagree with that assertion. There are plenty of industries were there are simply times of the year where no one really gets to take holidays - first few days of a month are pretty much no-gos for a lot of people who need to do reporting in my work. In retail industry you can't really take holidays during festive seasons. This is not offset by a time when the industry "shuts down" - it just means holidays can only be planned in a 48-50 week window instead of 52.
In terms of having "off-peak times" yeah, I am willing to acknowledge the logic falls down here due to the general problems with the health system. I'm generally looking at it as a baseline of "as bad as it is now" and trying to avoid it getting worse for a period. Long term huge changes are needed.
Again though, I'm not sure the main point was aimed at "frontline" staff (depending on how you define that term). It was aimed more at the ancillary functions that enable frontline staff to work more efficiently. Getting a patient an MRI/X-ray/whatever one day earlier means potentially freeing up the bed one day earlier.
Unfortunately none of the solutions are quick and ultimately I don't think we are implementing them very well anyway. A focus on why we are comparatively so slow at turning around patients is important though - it is not a question of blame but finding out why.
Actually, I find it instructive to look at past winter plans:
https://www.hse.ie/eng/services/news/media/pressrel/winterinitiative1617.html
These are a list of things that should be done all-year round. More home-care packages, more transitional care beds, community intervention teams? That is exactly what should be done constantly.
The previous "winter" plans would have worked better as a framework for long-term improvements but I imagine there were budgeting issues that stopped them being sensibly rolled out long-term. It is basically an attempt to fix underlying problems when things are really **** and then forgetting about them afterwards.
Trying to increase staffing levels during a period of heavy usage is a plan to combat a short-term emergency. It should not be an either/or between the two approaches. We've clearly recognised some of the problems, they need to be looked at consistently not just when it is REALLY bad. But on top of that, it is not unreasonably to suggest that maybe we need to look at bumping up staff levels artificially for a couple week period if that will help.0 -
I would slightly disagree with that assertion. There are plenty of industries were there are simply times of the year where no one really gets to take holidays - first few days of a month are pretty much no-gos for a lot of people who need to do reporting in my work. In retail industry you can't really take holidays during festive seasons. This is not offset by a time when the industry "shuts down" - it just means holidays can only be planned in a 48-50 week window instead of 52.
In terms of having "off-peak times" yeah, I am willing to acknowledge the logic falls down here due to the general problems with the health system. I'm generally looking at it as a baseline of "as bad as it is now" and trying to avoid it getting worse for a period. Long term huge changes are needed.
Again though, I'm not sure the main point was aimed at "frontline" staff (depending on how you define that term). It was aimed more at the ancillary functions that enable frontline staff to work more efficiently. Getting a patient an MRI/X-ray/whatever one day earlier means potentially freeing up the bed one day earlier.
Unfortunately none of the solutions are quick and ultimately I don't think we are implementing them very well anyway. A focus on why we are comparatively so slow at turning around patients is important though - it is not a question of blame but finding out why.
Actually, I find it instructive to look at past winter plans:
https://www.hse.ie/eng/services/news/media/pressrel/winterinitiative1617.html
These are a list of things that should be done all-year round. More home-care packages, more transitional care beds, community intervention teams? That is exactly what should be done constantly.
The previous "winter" plans would have worked better as a framework for long-term improvements but I imagine there were budgeting issues that stopped them being sensibly rolled out long-term. It is basically an attempt to fix underlying problems when things are really **** and then forgetting about them afterwards.
Trying to increase staffing levels during a period of heavy usage is a plan to combat a short-term emergency. It should not be an either/or between the two approaches. We've clearly recognised some of the problems, they need to be looked at consistently not just when it is REALLY bad. But on top of that, it is not unreasonably to suggest that maybe we need to look at bumping up staff levels artificially for a couple week period if that will help.
I can tell you are a reasonable person and I have actually found a lot of common ground with you during the debate of this issue. My only question is why you won't accept the word of people on the ground that the crisis/peak goes on for 3 or 4 months rather than the 12 days that Leo suggests?0 -
The festive season is not really any different to any other period during the winter time. If you look at Christmas day and Stephens as just another weekend. All other services are back in between. Leo knows Christmas is an emotive time for a lot of staff and his statement has caused a lot of consternation for all staff. From my own experience the new year is never a problem.
We are not currently a full on 7 day a week service because it isn't funded that way. All services are available but limited.
I suppose from my point of view, my wards need five nurse's to run efficiently, having six will not increase efficiency.
It's really not good enough to point fingers at hospital staff/management because it is Christmas. As of today there are 125 people on trolleys in my hospital, it's November, my ward will be short 1 nurse for the next few days as there are four vacant posts and there are no agency nurses available.0 -
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Everybody but Leo saying staff taking time off isn't the problem with the winter period. Industry professionals have been quoted in the media and on this thread saying as much. They all cite lack of capacity as the key issue. This is not news.
When faced with the oncoming period were the crisis becomes worse he's pointing at staff who are owed time off from working above their requirements for taking time off. He may well roll out 'sure it's worse elsewhere'.0 -
corner back 2 wrote: »I can tell you are a reasonable person and I have actually found a lot of common ground with you during the debate of this issue. My only question is why you won't accept the word of people on the ground that the crisis/peak goes on for 3 or 4 months rather than the 12 days that Leo suggests?
People on the ground are not always actually the best judges of the larger picture. A "12 day problem" can easily have impacts that extend for a much longer period of time. You ask a driver what causes a traffic jam and he really won't have a clue. I don't think their views should be treated as unimpeachable truth. I trust them when it comes to healthcare decisions, but running a hospital is a different skillset.
I am prone to heading down rabbit holes and getting further entrenched in a point than I really mean to but my original issue was with this quote:Is Leo seriously so ill-informed that he thinks more staff available in hospitals will create less need for trolleys? Wasn't he Minister for Health at one time? It's having to leave patients on trolleys that's the bigger problem over the holiday period. How can more staff prepare beds that aren't there? It's like he's not been following the scandal of hospital trolleys at all. Did he not even read Enda's spiel?
Varadkar may be doing very many things, he may be disingenuous and deflecting, but fundamentally the concept that more staff, particularly in ancillary units, may result in less need to trolleys is perfectly fine. There is no need to portray him as an idiot. You can simply disagree with him.0 -
People on the ground are not always actually the best judges of the larger picture. A "12 day problem" can easily have impacts that extend for a much longer period of time. You ask a driver what causes a traffic jam and he really won't have a clue. I don't think their views should be treated as unimpeachable truth. I trust them when it comes to healthcare decisions, but running a hospital is a different skillset.
I am prone to heading down rabbit holes and getting further entrenched in a point than I really mean to but my original issue was with this quote:
Varadkar may be doing very many things, he may be disingenuous and deflecting, but fundamentally the concept that more staff, particularly in ancillary units, may result in less need to trolleys is perfectly fine. There is no need to portray him as an idiot. You can simply disagree with him.
And Leo has a better more expert opinion than, well, all the medical staff and experts?
Generally speaking more staff is better than less, but not the issue with the worsening winter period and not the issue when staff are over worked and not gone missing on their holidays as Leo suggests is the problem we should be looking to.
He's no idiot, but his spin game needs work.0 -
People on the ground are not always actually the best judges of the larger picture. A "12 day problem" can easily have impacts that extend for a much longer period of time. You ask a driver what causes a traffic jam and he really won't have a clue. I don't think their views should be treated as unimpeachable truth. I trust them when it comes to healthcare decisions, but running a hospital is a different skillset.
Again you haven't answered the question. I didn't ask you about the cause of the problem. I asked why you still refuse to acknowledge that the problem is more than 12 days and has in fact started already.0 -
Here's a blast from the very recent past...
Health Minister Leo on hollers in Florida during a hospital trolley crisis.Mr Varadkar said that he is “sick to death” with the serious overcrowding in hospital wards and that he feels a “responsibility” to patients who have been forced to linger on trolleys.
“I am sick to death of this problem, quite frankly… and I feel a responsibility to them (patients) and their families”.
But Mr Varadkar was forced to defend his decision to go on a sun holiday to Florida – where some of his family are based - just days before the crisis broke out.
https://www.independent.ie/irish-news/health/leo-varadkar-claims-he-foresaw-ae-crisis-after-returning-from-sun-holiday-30890436.html0 -
corner back 2 wrote: »
Again you haven't answered the question. I didn't ask you about the cause of the problem. I asked why you still refuse to acknowledge that the problem is more than 12 days and has in fact started already.
The problem is 365 days a year. It doesn't mean the problem doesn't get even worse over a certain period.
I am also definitely over-arguing this beyond where I feel. The HSE is a mess - I do think a large amount of this is inefficiency in the sense of not having exits for patients and not having sufficient support and frankly just poor organisation.
My problem with this is more political to be honest. I would like the HSE reorganised and stremlined, I would like more funding for ancillary services, I would like more homecare and more therapists. I would like actual solutions - but the very same politicians giving **** to Varadkar for attempting to shift resources around are the same people who would complain about job losses in the HSE, or raised taxes etc. I just find it tiresome.0 -
The problem is 365 days a year. It doesn't mean the problem doesn't get even worse over a certain period.
I am also definitely over-arguing this beyond where I feel. The HSE is a mess - I do think a large amount of this is inefficiency in the sense of not having exits for patients and not having sufficient support and frankly just poor organisation.
My problem with this is more political to be honest. I would like the HSE reorganised and stremlined, I would like more funding for ancillary services, I would like more homecare and more therapists. I would like actual solutions - but the very same politicians giving **** to Varadkar for attempting to shift resources around are the same people who would complain about job losses in the HSE, or raised taxes etc. I just find it tiresome.
Not just the very same politicians, but also the very same posters who see everything through a prism. If Leo criticised senior management in the HSE, they would only be doing their jobs, if he suggested consultants work less private hours, he would be told they should be paid more.
This thread is awful, with certain posters not willing to discuss issues, just willing to distort and spin and blame everything on Leo. It is more than tiresome.
The Taoiseach did not limit his comments to twelve days as some have suggested. He said peak resources to match peak demand. That was interpreted by media, opposition politicians and opportunistic posters as meaning he was shutting Christmas down.0 -
Not just the very same politicians, but also the very same posters who see everything through a prism. If Leo criticised senior management in the HSE, they would only be doing their jobs, if he suggested consultants work less private hours, he would be told they should be paid more.
This thread is awful, with certain posters not willing to discuss issues, just willing to distort and spin and blame everything on Leo. It is more than tiresome.
The Taoiseach did not limit his comments to twelve days as some have suggested. He said peak resources to match peak demand. That was interpreted by media, opposition politicians and opportunistic posters as meaning he was shutting Christmas down.
Hi Blanch, please define peak demand. We both know he was talking about Christmas. I have no problem with Leo.0 -
funky sausage wrote: »I'm involved in the rostering of front line nurses in a busy hospital.
It's disappointing that Leo does not know that all single days annual leave requests cannot be given unless they are cost neutral. The staff where I work get one weeks annual leave every six weeks, if they have the annual leave to take, this is inbuilt into the roster, and ensures staff get fair access to their entitled annual leave.
There are no nurses getting extended leave at any time during the year, unless they swap their weeks with their colleagues.
Does that mean they get 7 weeks annual leave per year?
Public holidays would add another 6/8 days. That's huge.0 -
Not just the very same politicians, but also the very same posters who see everything through a prism. If Leo criticised senior management in the HSE, they would only be doing their jobs, if he suggested consultants work less private hours, he would be told they should be paid more.
This thread is awful, with certain posters not willing to discuss issues, just willing to distort and spin and blame everything on Leo. It is more than tiresome.
The Taoiseach did not limit his comments to twelve days as some have suggested. He said peak resources to match peak demand. That was interpreted by media, opposition politicians and opportunistic posters as meaning he was shutting Christmas down.
Tiresome, wearisome and puerile?0 -
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Good loser wrote: »Does that mean they get 7 weeks annual leave per year?
Public holidays would add another 6/8 days. That's huge.
That is disgraceful.....if true.0 -
It's not true - I think.Kermit.de.frog wrote: »That is disgraceful.....if true.
What funky sausage says is that the staff "get one weeks annual leave every six weeks, if they have the annual leave to take". This tells us nothing about the total amount of annual leave they get in a year; just about the rate at which they can take it.
So you could have, say, an entitlement to 4 weeks annual leave per year. You have the right to take it at the rate of 1 week every six weeks, if you want to, until you have exhausted it (which will happen, obviously, 24 weeks into the year) at which point you have no more leave left for the rest of the year.0 -
Not just the very same politicians, but also the very same posters who see everything through a prism. If Leo criticised senior management in the HSE, they would only be doing their jobs, if he suggested consultants work less private hours, he would be told they should be paid more.
This thread is awful, with certain posters not willing to discuss issues, just willing to distort and spin and blame everything on Leo. It is more than tiresome.
The Taoiseach did not limit his comments to twelve days as some have suggested. He said peak resources to match peak demand. That was interpreted by media, opposition politicians and opportunistic posters as meaning he was shutting Christmas down.
Everyone is able to read back through the thread and they will be well able to see what was said. Your effort to summarise is another spin on what people actually said. Yes the Taoiseach was specifically talking about a 12 day period. You can't just change the facts to suit yourself. People on here were asked for suggestions how to solve the problem and they gave them. You can't change that fact either. The posters you have called out here are not opportunistic as you have said. They are the front line workers who Leo was talking about and they are here because they care. The distortion and spin is on one side here. I have never posted on this forum before. I am not overtly political but I do care. The first person I contacted when I read Leo's comments was my local FG TD on twitter who was gracious enough to reply. So go question someone else's motives.0 -
corner back 2 wrote: »Everyone is able to read back through the thread and they will be well able to see what was said. Your effort to summarise is another spin on what people actually said. Yes the Taoiseach was specifically talking about a 12 day period. You can't just change the facts to suit yourself. People on here were asked for suggestions how to solve the problem and they gave them. You can't change that fact either. The posters you have called out here are not opportunistic as you have said. They are the front line workers who Leo was talking about and they are here because they care. The distortion and spin is on one side here. I have never posted on this forum before. I am not overtly political but I do care. The first person I contacted when I read Leo's comments was my local FG TD on twitter who was gracious enough to reply. So go question someone else's motives.
I'd say very few question front line staffs commitment.
My own experiences of the last year would leave me with nothing but praise for their work. In very difficult overcrowded and over worked circumstances they were nothing but professional, courteous and helpful to the point of doing all they could as fast as they could.
That said I wasn't happy with the length of time my two experiences with the hospital service took, but in no way do I blame that on the frontline staff available.
Beds and space is the problem mostly, local hospital and A&E closures have put a lot more pressure on the resources of the ones left open.
I think more should have been done to upgrade and create more space in the hospitals that were dedicated to providling the service after these closures, but this didn't happen.0 -
I'd say very few question front line staffs commitment.
My own experiences of the last year would leave me with nothing but praise for their work. In very difficult overcrowded and over worked circumstances they were nothing but professional, courteous and helpful to the point of doing all they could as fast as they could.
That said I wasn't happy with the length of time my two experiences with the hospital service took, but in no way do I blame that on the frontline staff available.
Beds and space is the problem mostly, local hospital and A&E closures have put a lot more pressure on the resources of the ones left open.
I think more should have been done to upgrade and create more space in the hospitals that were dedicated to providling the service after these closures, but this didn't happen.
Those technical staff who were unavailable to do your tests are frontline staff. The consultants who were unavailable to discharge you from your bed are frontline staff.
The reports and statistics I linked to before are clear. The average length of stay in Irish hospitals is well above average. Reducing that to the average by having frontline staff available to test and discharge patients where relevant, especially during the peak demand months of December and January should be a priority before we provide more beds.
Poor utilisation of existing resources does not justify extra resources. We have the best funded health system in the EU but one of the worst health services. It doesn't add up that frontline staff have no role to play in squaring that circle.0 -
Those technical staff who were unavailable to do your tests are frontline staff. The consultants who were unavailable to discharge you from your bed are frontline staff.
The reports and statistics I linked to before are clear. The average length of stay in Irish hospitals is well above average. Reducing that to the average by having frontline staff available to test and discharge patients where relevant, especially during the peak demand months of December and January should be a priority before we provide more beds.
Poor utilisation of existing resources does not justify extra resources. We have the best funded health system in the EU but one of the worst health services. It doesn't add up that frontline staff have no role to play in squaring that circle.
As I said earlier, no one works 365 days a year or can be expected to.
There obviously aren't enough staff to cover this type of situation, which now consists of almost all year long over crowding and seemingly endless waiting lists.
I don't blame the front line staff for that situation, blame for that must be in management or governance of the service.0 -
As I said earlier, no one works 365 days a year or can be expected to.
There obviously aren't enough staff to cover this type of situation, which now consists of almost all year long over crowding and seemingly endless waiting lists.
I don't blame the front line staff for that situation, blame for that must be in management or governance of the service.
Our staffing levels per patient and per capita are relatively high by international standards. What are the staff doing?0 -
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Good loser wrote: »Does that mean they get 7 weeks annual leave per year?
Public holidays would add another 6/8 days. That's huge.Kermit.de.frog wrote: »That is disgraceful.....if true.Peregrinus wrote: »It's not true - I think.
What funky sausage says is that the staff "get one weeks annual leave every six weeks, if they have the annual leave to take".
Thanks Peregrinus, average of around 17 days a year, if working long days.0 -
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funky sausage wrote: »Thanks Peregrinus, average of around 17 days a year, if working long days.
If working long days? Does that mean you only work four days a week and get a three-day weekend every week? or 9 in 14, with alternating two and three-day weekends?
The actual annual leave for a full-time five-day over seven working nurse is 36 if you have more than ten years service. For that, you work public holidays if rostered (so a net 27).
https://www.inmo.ie/_ino/Documents/Annual_Leave(June_2011).pdf
A bit more than the 17 cited.0
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