General Irish Government discussion thread [See Post 1805]

funky sausage

blanch152 wrote: »

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.

Blanch, I work in one of the largest hospitals in Ireland and are one of those front line staff you continue to harangue. Those consultants you talk of where probably looking after someone who was acutely unwell, labs are 24 hours a day but obviously after 5 emergencies take priority. I can tell you that somebody only requiring daily dressings would be discharged to their gp or to the dressing clinic in my hospital.

It is refreshing that you like to back up your points with research however as I'm sure that you aware healthcare needs and services are different in every country.

Is the benchmark of healthcare really the number of people on trolleys in A and E???

Bed management in my hospital are at work 24 hours a day, 7 days a week, in order to increase patient flow. They are more feared than any consultant or manager. However, as noted above, you can't maintain flow if someone has no where to go. There is a major lack of nursing home accommodation, community hospitals, respite beds and home-care workers.

Again, I have no issue with Leo, I feel it was a trite remark and extremely unhelpful given the problems coming his way.

blanch152

funky sausage wrote: »

Blanch, I work in one of the largest hospitals in Ireland and are one of those front line staff you continue to harangue. Those consultants you talk of where probably looking after someone who was acutely unwell, labs are 24 hours a day but obviously after 5 emergencies take priority. I can tell you that somebody only requiring daily dressings would be discharged to their gp or to the dressing clinic in my hospital.

It is refreshing that you like to back up your points with research however as I'm sure that you aware healthcare needs and services are different in every country.

Is the benchmark of healthcare really the number of people on trolleys in A and E???

Bed management in my hospital are at work 24 hours a day, 7 days a week, in order to increase patient flow. They are more feared than any consultant or manager. However, as noted above, you can't maintain flow if someone has no where to go. There is a major lack of nursing home accommodation, community hospitals, respite beds and home-care workers.

Again, I have no issue with Leo, I feel it was a trite remark and extremely unhelpful given the problems coming his way.

When you are spending more per capita on health than any other country in the EU (after adjusting for demographics), then the problems are within the system, than with the politicians or civil servants outside of it.

funky sausage

blanch152 wrote: »

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.

Staff in my place of work work 7 days in 14, so three twelve hour shifts in 1 week then four twelve hour shifts in week 2.

Ok 27 days off for my staff = 27 x 7.8 hours = 210.6 hours. So affording for the long day 210.6/11.5 = 18.3

Edward M

blanch152 wrote: »

When you are spending more per capita on health than any other country in the EU (after adjusting for demographics), then the problems are within the system, than with the politicians or civil servants outside of it.

So you would blame the front line staff?
The management and governance of the system would be my pick.

funky sausage

blanch152 wrote: »

When you are spending more per capita on health than any other country in the EU (after adjusting for demographics), then the problems are within the system, than with the politicians or civil servants outside of it.

You do realize that Simon Harris is ultimately my boss and very much part of the system??

Do you really think that the blame for years and years of mismanagement and the throwing of money at the issue lies at the feet of nurses and consultants????

James Brown

funky sausage wrote: »

You do realize that Simon Harris is ultimately my boss and very much part of the system??

Do you really think that the blame for years and years of mismanagement and the throwing of money at the issue lies at the feet of nurses and consultants????

You can't criticise the policy makers, or those who leave bad policy stand for some reason.
We've another winter crisis in the works and everyone within the industry cites capacity. Posting quotes from leo where he suggests hospitals could better manage staffing levels as some kind of a fix is a deflection, however for some reason that's being 'out to get Leo' despite quoting him and commenting on his quotes in relation to every industry professional at all levels who disagree with him.
When health minister he went on a sun holiday just as a previous trolley crisis was brewing. The man should be allowed take a holiday, but it's a bit ironic.
We have to look at the game in play. The crisis worsens this time of year and Leo has succeeded in some quarters in having the narrative turn to front line staff taking/getting too much time off. It's disgusting quite frankly. That's the issue IMO, not Leo's smoke.

blanch152

funky sausage wrote: »

You do realize that Simon Harris is ultimately my boss and very much part of the system??

Do you really think that the blame for years and years of mismanagement and the throwing of money at the issue lies at the feet of nurses and consultants????

Yeah, it is always the fault of the man at the top, who is supposed to be responsible for every engrained bad work practice at the coalface.

In the health service, it is always someone else' fault. The simple answer is that the taxpayers and the policymakers in the Department of Health are providing the HSE with more than enough money to run a world-class health service. Something is rotten in the system, and it isn't the relatively small number of HSE middle managers.

FreudianSlippers

2017 expenditure pay & pensions:
Clinical €3,409,005
Non-Clinical €1,188,166 (which seems high to me)

2017 non-pay expenditure:
Clinical €1,035,462
Primary Care and Medical Card Schemes €2,989,730 (spending a lot on this!)
Grants to Outside Agencies €4,007,433 (!!!!)

Grants to outside agencies is sucking up a lot of money - turns out trying to appease every small town with unnecessary healthcare is expensive...

Governance of grants to outside agencies In 2017 circa €4.1 billion of the HSE’s total expenditure related to grants to outside agencies. The legal framework under which the HSE provides grant funding to agencies is
set out in the Health Act 2004. These range from the large voluntary hospitals such as St. James Hospital in receipt of over €300m to small community based agencies in receipt of €500.

The HSE’s governance framework is consistent with the management and accountability arrangements for grants from exchequer funding as set out in the instruction issued by DPER in September 2014:

The requirements to submit financial reports and staffing returns and to hold monitoring meetings is dependent on the size of the Agency. During 2017 there
were weaknesses identified in the application of these processes relating to monitoring and oversight of some agencies.

The system of internal financial control operating in individual funded agencies is subject to review on a sample basis by HSE’s Internal Audit Division and, by
external audits conducted by the Office of the Comptroller and Auditor General.

Control weaknesses relating to the monitoring and oversight of agencies in receipt of exchequer funding have been identified as part of the audit of the HSE’s financial statements by the office of the Comptroller and Auditor
General in 2017 and through the work of the HSE’s Internal Audit Function.

The HSE has two types of contractual agreements with these agencies that are in the main tailored to reflect the level of funding in place.
• Service Arrangement (SA), health agencies in receipt of funding in excess of €250,000
• Grant Aid Agreement (GA), health agencies in receipt of funding less than €250,000

The Comptroller and Auditor General audited a sample of 40 health agencies funded by way of a Service Arrangement and a further 10 health agencies funded by way of a Grant Aid Agreement.

The audit found that
• Financial statements for 2016 had been submitted by three quarters of the health agencies at the time of audit. There was no evidence in some cases in
respect of review by the Health Service Executive of these financial statements.
• Monitoring meetings have not been conducted at the frequency required in accordance with the HSE guidelines in a significant number of the cases reviewed.
• There was lack of evidence that required financial performance data such as management accounts and activity data, was submitted at the required
frequency in a significant proportion of cases.
• Contractual agreement related to the provision of funding include a requirement for grantees to have appropriate risk management and governance arrangements in place and to comply with public procurement guidelines and public sector pay policy.
• Compliance statements submitted by 35 S38 agencies in relation to the financial year 2016 indicate gaps in governance arrangements such
as public sector pay policy and, in particular procurement.

https://www.hse.ie/eng/services/publications/corporate/hse-annual-report-and-financial-statements-2017-pdf.pdf

In short, HSE underpays frontline staff (retention issues), has a bloated operational/management structure and spends a lot of money on over-provision of services across the country. Any politician that even attempted to solve one of these issues would be laughed out of the place.

Podge_irl

FreudianSlippers wrote: »

In short, HSE underpays frontline staff (retention issues)

I'm not sure they underpay them so much as overwork them - though both cause retention issues and exacerbate the problem.

blanch152

FreudianSlippers wrote: »

2017 expenditure pay & pensions:
Clinical €3,409,005
Non-Clinical €1,188,166 (which seems high to me)

2017 non-pay expenditure:
Clinical €1,035,462
Primary Care and Medical Card Schemes €2,989,730 (spending a lot on this!)
Grants to Outside Agencies €4,007,433 (!!!!)

Grants to outside agencies is sucking up a lot of money - turns out trying to appease every small town with unnecessary healthcare is expensive...
https://www.hse.ie/eng/services/publications/corporate/hse-annual-report-and-financial-statements-2017-pdf.pdf

In short, HSE underpays frontline staff (retention issues), has a bloated operational/management structure and spends a lot of money on over-provision of services across the country. Any politician that even attempted to solve one of these issues would be laughed out of the place.

I agree with most of your post, but the underpayment of frontline staff does not entirely stack up.

https://paycommission.gov.ie/wp-content/uploads/pspc-report-2018-body_web.pdf

This was looked at as recently as August 2018.

"The Commission is not persuaded, based on the
evidence available, that current pay arrangements
are, in themselves, a significant impediment to
recruitment. "

What astonished me was the following:

"Nurses and midwives constitute 33% of the total
staffing of the Irish public health service"

And I was led to believe it was all just managers.

Good loser

blanch152 wrote: »

I agree with most of your post, but the underpayment of frontline staff does not entirely stack up.

https://paycommission.gov.ie/wp-content/uploads/pspc-report-2018-body_web.pdf

This was looked at as recently as August 2018.

"The Commission is not persuaded, based on the
evidence available, that current pay arrangements
are, in themselves, a significant impediment to
recruitment. "

What astonished me was the following:

"Nurses and midwives constitute 33% of the total
staffing of the Irish public health service"

And I was led to believe it was all just managers.

Interesting.


I suspect the locus of some significant problems might lie right there.


That consultant, Michael O Keefe, said more than once on radio that one could get twice as much work done in half the time in private hospitals compared to public.

Another thing we should switch to the NZ method of no fault insurance. The legals are riding the health system.

Edward M

blanch152 wrote: »

I agree with most of your post, but the underpayment of frontline staff does not entirely stack up.

https://paycommission.gov.ie/wp-content/uploads/pspc-report-2018-body_web.pdf

This was looked at as recently as August 2018.

"The Commission is not persuaded, based on the
evidence available, that current pay arrangements
are, in themselves, a significant impediment to
recruitment. "

What astonished me was the following:

"Nurses and midwives constitute 33% of the total
staffing of the Irish public health service"

And I was led to believe it was all just managers.

It's a defacto response and blame shifting exercise again right there.
N&M could make up as high a percentage of the service as you'd want to name or make it, it wouldn't matter.
When I or any other would need medical attention it's a doctor I'd be looking for firstly, then a diagnosis of my problem and a space for my treatment to be administered to me as quickly as possible.
N&M are but the lowest in the chain, the deliverers of the service not the instigators of it.
That's down to management and governance

funky sausage

blanch152 wrote: »

I agree with most of your post, but the underpayment of frontline staff does not entirely stack up.

https://paycommission.gov.ie/wp-content/uploads/pspc-report-2018-body_web.pdf

This was looked at as recently as August 2018.

"The Commission is not persuaded, based on the
evidence available, that current pay arrangements
are, in themselves, a significant impediment to
recruitment. "

What astonished me was the following:

"Nurses and midwives constitute 33% of the total
staffing of the Irish public health service"

And I was led to believe it was all just managers.

Good loser wrote: »

Interesting.


I suspect the locus of some significant problems might lie right there.


That consultant, Michael O Keefe, said more than once on radio that one could get twice as much work done in half the time in private hospitals compared to public.

Another thing we should switch to the NZ method of no fault insurance. The legals are riding the health system.

Laughable, really??? Nurses and midwives make up a large percentage of the workforce??

Private hospitals on the whole get to pick their patients and treatment paths are defined. How many patients are stuck in the Bons awaiting a nursing home placement or respite care?? How many people are rolling into private a and e's with a bit of a sore thumb or a cough??

Answer me this lads, if Tesco run out of spuds, do you get stuck into the shelf stocker's??

Good loser

funky sausage wrote: »

Laughable, really??? Nurses and midwives make up a large percentage of the workforce??

Private hospitals on the whole get to pick their patients and treatment paths are defined. How many patients are stuck in the Bons awaiting a nursing home placement or respite care?? How many people are rolling into private a and e's with a bit of a sore thumb or a cough??

Answer me this lads, if Tesco run out of spuds, do you get stuck into the shelf stocker's??

Some years ago a niece was interning or some such in Cork.


Going between the Bons and CUH. She said nurses did quite a few (relatively simple) procedures in the Bons that those in CUH flat out refused to do.

Good loser

funky sausage wrote: »

Staff in my place of work work 7 days in 14, so three twelve hour shifts in 1 week then four twelve hour shifts in week 2.

Ok 27 days off for my staff = 27 x 7.8 hours = 210.6 hours. So affording for the long day 210.6/11.5 = 18.3

Your maths is accurate (apart from 17 = 18.3)


Your message is not, it's misleading.

Those nurses only work 165 days in the year. If they're on 50k per annum they are getting €300 per day.

funky sausage

Good loser wrote: »

Some years ago a niece was interning or some such in Cork.


Going between the Bons and CUH. She said nurses did quite a few (relatively simple) procedures in the Bons that those in CUH flat out refused to do.

Really.... Inside her scope of practice....

funky sausage

Good loser wrote: »

Your maths is accurate (apart from 17 = 18.3)


Your message is not, it's misleading.

Those nurses only work 165 days in the year. If they're on 50k per annum they are getting €300 per day.

I quoted a nurse with 5 years experience, they quoted a nurse with 10 years experience.

What's your point??

I could be getting a million a day, I didn't shut down community hospital's. Money was mentioned in the retention/ recruitment of nurses not the number of trolleys in A and E

blanch152

Edward M wrote: »

It's a defacto response and blame shifting exercise again right there.
N&M could make up as high a percentage of the service as you'd want to name or make it, it wouldn't matter.
When I or any other would need medical attention it's a doctor I'd be looking for firstly, then a diagnosis of my problem and a space for my treatment to be administered to me as quickly as possible.
N&M are but the lowest in the chain, the deliverers of the service not the instigators of it.
That's down to management and governance

They are not the lowest in the chain, there are care assistants, orderlies, porters etc. who are lower in the chain.

If nurses and midwives are 33% of the health service workforce, and if taxpayers are paying for one of the most expensive health services in the world, then it is not possible that they are not part of the problem.

Edward M

blanch152 wrote: »

They are not the lowest in the chain, there are care assistants, orderlies, porters etc. who are lower in the chain.

If nurses and midwives are 33% of the health service workforce, and if taxpayers are paying for one of the most expensive health services in the world, then it is not possible that they are not part of the problem.

Of course it is.
Wastage and overspending on stuff that has virtually nothing to do with providing the service on the ground, ie beds and facilities for patients getting treatment, is the biggest problem.
The blame always stops at management and governance, to say other is complete deflection and blame shifting.
https://www.irishtimes.com/news/ireland/irish-news/new-department-of-health-hq-lay-empty-for-17-months-at-cost-of-15-8-million-1.3644953?mode=amp

nice_guy80

I see they are looking at removing flat rate expenses for lots of categories of workers

Lovely kick in the teeth to lower paid workers everywhere

Edward M

A nice little earner for the pr consultants.
Leo is pumping us full of s***e with our own money.
https://www.irishmirror.ie/news/irish-news/leo-varadkar-spin-machine-costs-13625668

Podge_irl

Fianna Fail TD Niall Collins blasted the Taoiseach and said this money should be put towards solving the housing or health crises.

He added: “It’s well known the Taoiseach is obsessed with spin and his own image but this still seems like an awful lot of money.

€1.8M over 17 months is not even close to "an awful lot of money" and the idea that it would have any effect on the housing or health budgets is farcical.

I think some oversight of how the communications unit is run is probably wise, but it just isn't that much money.

James Brown

Podge_irl wrote: »

€1.8M over 17 months is not even close to "an awful lot of money" and the idea that it would have any effect on the housing or health budgets is farcical.

I think some oversight of how the communications unit is run is probably wise, but it just isn't that much money.

Yeah, nothing to see here as per.
I mean it's not like he spent €50,000 on printer cartridges in the Dáil, over a two year period.

Edward M

Podge_irl wrote: »

€1.8M over 17 months is not even close to "an awful lot of money" and the idea that it would have any effect on the housing or health budgets is farcical.

I think some oversight of how the communications unit is run is probably wise, but it just isn't that much money.

It'd put up six houses of the standard built for the travellers in Tipperary
But joking aside, it's a huge amount just on PR.
Remember, most things Govt do is in the media anyway, imagine spending taxpayers money to have a favourable spin put on it!

blanch152

Edward M wrote: »

It'd put up six houses of the standard built for the travellers in Tipperary
But joking aside, it's a huge amount just on PR.
Remember, most things Govt do is in the media anyway, imagine spending taxpayers money to have a favourable spin put on it!

Based on your experience, what do you think is a reasonable amount of spend on such things?

How much for salaries? How much for website management costs? How much for advertising? How much for marketing research? Etc.

Edward M

blanch152 wrote: »

Based on your experience, what do you think is a reasonable amount of spend on such things?

How much for salaries? How much for website management costs? How much for advertising? How much for marketing research? Etc.

In the previous 15 months before Leo. €16200,
That's a massive jump since. Based on 2 months extra for Leo I'd say €18-20000.

blanch152

Edward M wrote: »

In the previous 15 months before Leo. €16200,
That's a massive jump since. Based on 2 months extra for Leo I'd say €18-20000.

Do you have a link to this information?

Edit: Other than a newspaper report.

Good loser

Good loser wrote: »

Your maths is accurate (apart from 17 = 18.3)


Your message is not, it's misleading.

Those nurses only work 165 days in the year. If they're on 50k per annum they are getting €300 per day.

I see the average nurse gets paid €57,000 per annum.


The average guard gets about €55,000.


If they could 'come' 'together' that would be €112,000 per annum.


They could then afford a house in Dublin!

Edward M

blanch152 wrote: »

Do you have a link to this information?

Edit: Other than a newspaper report.

I thought this conversation was about that news paper report.
Are you arguing the truth of the report?

blanch152

Edward M wrote: »

I thought this conversation was about that news paper report.
Are you arguing the truth of the report?

The newspaper report gives this quite reasonable explanation for the expenditure:

"“The expenditure referenced relates to a number of major cross-Government public information campaigns that the Department funded centrally during 2018, for example Healthy Ireland, Global Ireland, Project Ireland 2040, the Self Employed Benefits campaign, aimed at ensuring self employed people are aware of the new and existing benefits available to them.

“The majority of this expense was incurred prior to July 2018, before changes were made.

“Public information campaigns in the future will largely be funded by the relevant line Department, as opposed to being funded centrally from this Department.”

Are you arguing the truth of that? It is a factual part of the report, compared to the gibberings of Niall Collins.