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What is wrong with the health service, HSE

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  • 17-12-2018 11:03am
    #1
    Registered Users Posts: 12,493 ✭✭✭✭


    https://www.irishtimes.com/news/health/health-services-may-be-cut-in-some-areas-under-new-plan-1.3731979.

    How is this happening, the tired old answer is usually too much middle management there has to be more to it? the article is depressing reduce staff recruitment as one of the big answers no nuanced or sophisticated business orientated solutions or advocating solutions that will make issues worse, for example making people wait for the fair deal will inevitably mean people who are ready to be discharged will end up staying in hospital blocking a bed and preventing admission for someone who need it.


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Comments

  • Registered Users Posts: 29,414 ✭✭✭✭Wanderer78


    Not a particularly surprising story, the decline of our critical sectors continues


  • Registered Users Posts: 26,280 ✭✭✭✭Eric Cartman


    The problem is that you had the 4 regional health boards, The HSE was formed and because of unions instead of sacking 2 or 3 of the 4 people doing the same job, they all stayed, so you just had all the same people from the same boards under one roof , As time has gone on , backed up by unions , even as staff have retired these positions have been retained, and worse still, computerising and automating of services has led to more staff being needed because some older staff just refuse to upskill, so you need younger staff to be the link between them and a computer. Then theres the procurement infighting where buying expensive equipment for one hospital causes a budget issue and a political fight because a hospital in another region wants the same machine at the same time. Then we decided to give Really good specialised doctors the ability to write themselves a blank cheque as a consultant , then we allow political peer pressure to chose putting hospitals on land thats slow to access because of traffic and really expensive to buy just so they can score points with locals.

    Then we hand out medical cards to too many people who kick up but because of an inadequate out of hours / close GP service, some people are determined to bring themselves and their kids to A&E for a cough, Then because we have a massively overpriced nursing home strategy and an ineffective strategy to tackle drug abuse , we have junkies and the elderly bed blocking to spend as much time in hospital as they can to offset the cost of the accomodation they do need. Couple that with a mantra of working frontline staff to the bone and never coming in underbudget on anything and you have a timebomb waiting to happen where the standard of public care gets further and further away from private care standards , eventually creating a complete two tier medical system where you can either afford it or may aswell not have gone to hospital at all.


  • Registered Users Posts: 51 ✭✭penno


    Not to mention all the 'outside on the steps of the courthouse' pay outs. Nobody accountable, i dread to think what the annual cost is.


  • Registered Users Posts: 6,498 ✭✭✭touts


    No doubt they will have to hire a few hundred more accountants to run the project to reduce services.

    I think it was Stephen Kinsella who did a study a couple of years ago that found 42% of staff in HSE are admin staff. In NHS that is 20%. In private healthcare it is 10%.

    The health service is run by administrators and accountants as a cash cow for administrators and accountants. They keep the system as bloated and inefficient as possible so that it takes an army of administrators just to keep it from toppling over.


  • Registered Users Posts: 29,414 ✭✭✭✭Wanderer78


    touts wrote: »
    No doubt they will have to hire a few hundred more accountants to run the project to reduce services.

    I think it was Stephen Kinsella who did a study a couple of years ago that found 42% of staff in HSE are admin staff. In NHS that is 20%. In private healthcare it is 10%.

    The health service is run by administrators and accountants as a cash cow for administrators and accountants. They keep the system as bloated and inefficient as possible so that it takes an army of administrators just to keep it from toppling over.

    i think joe stiglitz has argued in the past, the more privatized a health care system becomes, the more bloated it becomes with admin and accountants, so whos right?


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  • Registered Users Posts: 12,493 ✭✭✭✭mariaalice


    touts wrote: »
    No doubt they will have to hire a few hundred more accountants to run the project to reduce services.

    I think it was Stephen Kinsella who did a study a couple of years ago that found 42% of staff in HSE are admin staff. In NHS that is 20%. In private healthcare it is 10%.

    The health service is run by administrators and accountants as a cash cow for administrators and accountants. They keep the system as bloated and inefficient as possible so that it takes an army of administrators just to keep it from toppling over.

    There are supervisors working in medical areas being classed as administration also staff in wider allied health care are classed as administrators so its not a good comparison but does highlight the lack of proper data about what is going on.


  • Registered Users Posts: 1,933 ✭✭✭Anita Blow


    The problem is that you had the 4 regional health boards, The HSE was formed and because of unions instead of sacking 2 or 3 of the 4 people doing the same job, they all stayed, so you just had all the same people from the same boards under one roof , As time has gone on , backed up by unions , even as staff have retired these positions have been retained, and worse still, computerising and automating of services has led to more staff being needed because some older staff just refuse to upskill, so you need younger staff to be the link between them and a computer. Then theres the procurement infighting where buying expensive equipment for one hospital causes a budget issue and a political fight because a hospital in another region wants the same machine at the same time. Then we decided to give Really good specialised doctors the ability to write themselves a blank cheque as a consultant , then we allow political peer pressure to chose putting hospitals on land thats slow to access because of traffic and really expensive to buy just so they can score points with locals.

    Then we hand out medical cards to too many people who kick up but because of an inadequate out of hours / close GP service, some people are determined to bring themselves and their kids to A&E for a cough, Then because we have a massively overpriced nursing home strategy and an ineffective strategy to tackle drug abuse , we have junkies and the elderly bed blocking to spend as much time in hospital as they can to offset the cost of the accomodation they do need. Couple that with a mantra of working frontline staff to the bone and never coming in underbudget on anything and you have a timebomb waiting to happen where the standard of public care gets further and further away from private care standards , eventually creating a complete two tier medical system where you can either afford it or may aswell not have gone to hospital at all.

    For the most part I agree but disagree with a couple points.

    1) Consultants haven't really been given a blank cheque. In fact consultants since 2012 are on 30% less pay than their pre-2012 counterparts which has led to us haemorrhaging consultants. As someone who works in the health service I cannot stress how absolutely dire the situation is with consultant recruitment and retention. For example, the Mater lost 3 orthopaedic surgeons to private practice all at once at the beginning of last year. That is literally thousands of OPD patients who had their appointments and surgeries postponed indefinitely as the remaining consultants had closed their lists due to being overcapacity. To my knowledge the mater has been able to recruit only a single consultant to replace them. The general public cannot appreciate how dire a situation it is that we are near bottom of almost every OECD league table for no. of specialists per capita, and we still have had 500 consultant vacancies (the most there has ever been in the health service) for the past 1.5y. We literally can't even recruit to maintain our bottom-of-the-table position.

    2) The location of the children's hospital was probably the one non-parochial, evidence-based decision that was made in this health service. Would encourage you to read the report outlining the justification for the hospital and why the locations were chosen. Was devised by experts from UK/Aus etc. Ease of access was considered and given some weighting, but quality of care and range of services available with co-location superseded it which was only right.

    3) In general from my experience in a busy paediatric ED, the majority of presentations were justifiable. Very few cases of coughs or simple stuff presenting to ED, especially since under-6s GP care came in. For the most part the patient isn't to blame for the state of our ED waiting times, it's bed capacity


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


    Scrap the HSE, sack all the employees, bust the unions and then start all over.


  • Registered Users Posts: 29,414 ✭✭✭✭Wanderer78


    Scrap the HSE, sack all the employees, bust the unions and then start all over.

    could this lead to ultimate collapse of our health service?

    to add another stephen kinsella piece of research, productivity has increased dramatically across most sectors over the last couple of decades, but wage inflation has remained relatively low, him believing the deunionisation of our economies being the main contributor.


  • Registered Users Posts: 12,493 ✭✭✭✭mariaalice


    I would split all social care spending i.e care for disabilities, mental health, and non medical care for the elderly such as home support and nursing homes, from medical care, so we could a least see where the money is going.


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  • Closed Accounts Posts: 9,046 ✭✭✭Berserker


    Wanderer78 wrote: »
    could this lead to ultimate collapse of our health service?

    Yes, in a word. The unions have too much of a hold on the health service. They'd collapse the service in no time. Massive reform of the structure of the service is needed, first and foremost. One single national body is more than enough, given the size of the country. Reduce the number of hospitals. We have far too many hospitals in the country and this idea of having a having every service possible on your doorstep needs to be quashed. If person 'A' chooses to live in the backend of Mayo, they need to accept that they are going to have to travel to a city to get specialist care.


  • Registered Users Posts: 29,414 ✭✭✭✭Wanderer78


    Berserker wrote: »
    Yes, in a word. The unions have too much of a hold on the health service. They'd collapse the service in no time. Massive reform of the structure of the service is needed, first and foremost. One single national body is more than enough, given the size of the country. Reduce the number of hospitals. We have far too many hospitals in the country and this idea of having a having every service possible on your doorstep needs to be quashed. If person 'A' chooses to live in the backend of Mayo, they need to accept that they are going to have to travel to a city to get specialist care.

    i suspect the issues of our health services is a bit more complicated than just unions, most countries are developing similar problems


  • Closed Accounts Posts: 9,046 ✭✭✭Berserker


    Wanderer78 wrote: »
    i suspect the issues of our health services is a bit more complicated than just unions, most countries are developing similar problems

    They are. My post is a start and the unions and structure of the service are a big part of the problem.


  • Registered Users Posts: 13,392 ✭✭✭✭Geuze


    Excessive spending overall

    Excessive exp on pharma

    Too many hosps

    Too many EDs

    2,000 staff in HR, the head of HR said he needs 800

    62 payroll offices

    8 health boards merged into HSE, Bertie Ahern did a deal with unions, no jobs lost

    Consultants face incentives to focus on private work


  • Registered Users Posts: 29,414 ✭✭✭✭Wanderer78


    Berserker wrote: »
    They are. My post is a start and the unions and structure of the service are a big part of the problem.

    i will agree that unions can and do have a negative effect in running elements of our economies, but i also do think economists such as kinsella also have a point about productivity and unions.


  • Registered Users Posts: 28,461 ✭✭✭✭looksee


    I am today being discharged after a week in the public healthcare system, necessitated by a bad error made in a private clinic. I have nothing but admiration for the care and attention I have received. With one single exception - a person who has whinged and complained at every possible opportunity and been a complete pita to share a ward with - I have not heard any other complaints.

    This is not to say there are not problems - of course there are, 'who knew health care could be so complicated?' There are some serious problems - conditions in some nursing homes seems to be one of them - but the knee jerk mouthing off about the entire service is less than helpful.


  • Closed Accounts Posts: 809 ✭✭✭Blaizes


    Review medical cards.Give ALL children in Ireland two or three visits to GP per year as currently this is not the case if they don't qualify for a medical card or GP visit card. Very wrong it is.


  • Registered Users Posts: 12,493 ✭✭✭✭mariaalice


    Blaizes wrote: »
    Review medical cards.Give ALL children in Ireland two or three visits to GP per year as currently this is not the case if they don't qualify for a medical card or GP visit card. Very wrong it is.

    I would do the exact opposite give everybody free at point of use accesses to an enhanced GP services all allied medical services and diagnostic services should be from a GP type services with the exception of something like a pet scan. procedure only hospitals with no A and E department. Enhanced step down facilities.


  • Closed Accounts Posts: 16,013 ✭✭✭✭James Brown


    I honestly have a tough time getting into the whole backward cycle of blame. The HSE is in a bad way because people are getting medical cards and they don't deserve them, staff taking vacations, (who apparently aren't) during the annual crises times, people who aren't seriously ill backing up ER. Elderly taking up beds because there's no respite to move them on to.
    All of the above are quite easily solved. Have a triage system, actively turn people away who shouldn't be in ER. Revisit the allocation of Medical cards, more intermediary care for those in transition and so on.
    I can't claim to know the inner workings of hospitals. All I know for certain is government won't touch it. I don't know why. I would take unions in a public service over privatisation any day.
    If unions are a cause of the health crisis why isn't some journalist or other investigating and reporting on it? Right now all we have is hearsay in that regard.


  • Registered Users Posts: 5,490 ✭✭✭stefanovich


    looksee wrote: »
    I am today being discharged after a week in the public healthcare system, necessitated by a bad error made in a private clinic. I have nothing but admiration for the care and attention I have received. With one single exception - a person who has whinged and complained at every possible opportunity and been a complete pita to share a ward with - I have not heard any other complaints.

    This is not to say there are not problems - of course there are, 'who knew health care could be so complicated?' There are some serious problems - conditions in some nursing homes seems to be one of them - but the knee jerk mouthing off about the entire service is less than helpful.

    A&E in the regional hospital in Limerick needs to be seen to be believed.

    3rd world conditions.

    Read this


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  • Registered Users Posts: 12,493 ✭✭✭✭mariaalice


    I honestly have a tough time getting into the whole backward cycle of blame. The HSE is in a bad way because people are getting medical cards and they don't deserve them, staff taking vacations, (who apparently aren't) during the annual crises times, people who aren't seriously ill backing up ER. Elderly taking up beds because there's no respite to move them on to.
    All of the above are quite easily solved. Have a triage system, actively turn people away who shouldn't be in ER. Revisit the allocation of Medical cards, more intermediary care for those in transition and so on.
    I can't claim to know the inner workings of hospitals. All I know for certain is government won't touch it. I don't know why. I would take unions in a public service over privatisation any day.
    If unions are a cause of the health crisis why isn't some journalist or other investigating and reporting on it? Right now all we have is hearsay in that regard.

    They have triage people are in A and E because they have no other options, what should they do with those with mental health issues, addictions, those who are elderly but not well but not acutely ill either and so on. By giving free at the point of accesses to a GP all the huge means testing administration costs surrounding Medical cards is eliminated in one go.


  • Registered Users Posts: 1,933 ✭✭✭Anita Blow


    Wanderer78 wrote: »
    i suspect the issues of our health services is a bit more complicated than just unions, most countries are developing similar problems

    Those countries have significantly older populations than us. Ireland has the youngest population in western Europe we should not be having any such problems with our health service nor should we have higher per capita expenditure than those countries.


  • Registered Users Posts: 1,933 ✭✭✭Anita Blow


    mariaalice wrote: »
    I would do the exact opposite give everybody free at point of use accesses to an enhanced GP services all allied medical services and diagnostic services should be from a GP type services with the exception of something like a pet scan. procedure only hospitals with no A and E department. Enhanced step down facilities.

    It's probably not realistic to have a complete set of diagnostic services in the community. You could have basic radiology like X-Rays and that would take a great deal of strain off the health service I imagine, but you couldn't have CTs/MRIs which are extremely expensive to buy + run and need a department behind them as well as follow-on care.

    I think some of the rhetoric from politicians has sold primary care as the cure for all. It will certainly help and more routine procedures will be done in the community, but in general people who attend hospital need to be there. Our problem is bed capacity. We in general have suitably sized EDs and modern facilities but there is nowhere for patients to go if they need admitted.


  • Registered Users Posts: 12,493 ✭✭✭✭mariaalice


    Anita Blow wrote: »
    It's probably not realistic to have a complete set of diagnostic services in the community. You could have basic radiology like X-Rays and that would take a great deal of strain off the health service I imagine, but you couldn't have CTs/MRIs which are extremely expensive to buy + run and need a department behind them as well as follow-on care.

    I think some of the rhetoric from politicians has sold primary care as the cure for all. It will certainly help and more routine procedures will be done in the community, but in general people who attend hospital need to be there. Our problem is bed capacity. We in general have suitably sized EDs and modern facilities but there is nowhere for patients to go if they need admitted.

    https://www.affidea.ie/prices/ how do they do it, the one in Dundrum is in an office building near a shopping center no huge infrastructure backing them up.


  • Registered Users Posts: 1,933 ✭✭✭Anita Blow


    mariaalice wrote: »
    https://www.affidea.ie/prices/ how do they do it, the one in Dundrum is in an office building near a shopping center no huge infrastructure backing them up.

    Certainly you could be right- I don't fully know the ins and outs of running the health service. However I don't think a small private operation is comparable to running a national health service.

    - They outsource their radiology reporting so there's no on-site radiology staff, just radiographers. In fact (and I could be wrong), I think they outsource some of it abroad like the online GP services. That's not a direction I'd like to see our service moving in as I think it would compromise patient health and safety.

    - Private businesses like Affidea can pick and choose where they locate. There's 10 MRI locations on their site which leaves a large proportion of the population out of their catchment, but the HSE can't pick and choose. They'd have to ensure coverage is at least as good as it is now offered by hospitals. But we can't take the MRI & CT scanners out of the hospitals, so we'd have to buy multiple more scanners than we currently have to ensure coverage in the community. The HSE doesn't have the money for this. Wexford is raising money from the community to try and get one. We'd be spending millions for no real clinical benefit.

    - Because it's a small private operation they only do elective scans and there's some scans they won't do. For example my own aunt has a chronic medical condition they would not scan and advised her to attend one of the Dublin hospitals. This sort of relates to the above point, because hospitals allow for centralisation of care which then further allows for sub-specialisation. We have fantastic radiologists in our hospitals with a high degree of specialisation, but if you split them up into the community then all you will get is generalists rather than specialists.

    - There's no clinical or cost benefit of moving these scans into the community. The justification for moving X-rays into the community is because they are simple to perform, very little can go wrong with them, it's usually a simple complaint which can be managed in the community (like a simple fracture) and it constitutes a large volume of the radiology workload in hospitals. CTs & MRIs however are usually for people who are much more sick or the complaint is much more severe and need to be managed in a hospital by specialised staff. These patients are managed by a team, and best practice is that the team meets regularly to coordinate their care. The radiologist is a key part of that team and it would be detrimental to their care if that radiologist was taken out of the hospital and moved into the community.

    If you want to abolish waiting lists, then a cheaper and more clinically effective solution is to increase investment in the current hospital radiology departments- increase the no. of radiologists per capita and specialist radiographers we have, and invest in more MRI machines so we can operate a 24h service as opposed to the normal 9-5 we have now.


  • Registered Users Posts: 13,392 ✭✭✭✭Geuze


    Anita Blow wrote: »
    Those countries have significantly older populations than us. Ireland has the youngest population in western Europe we should not be having any such problems with our health service nor should we have higher per capita expenditure than those countries.

    Indeed.

    We have one of the youngest pop in the EU.

    Yet our health exp pp is fifth highest across the OECD.


  • Registered Users Posts: 436 ✭✭incentsitive


    I thought Ireland has an ageing population?


  • Registered Users Posts: 29,414 ✭✭✭✭Wanderer78


    Anita Blow wrote:
    Those countries have significantly older populations than us. Ireland has the youngest population in western Europe we should not be having any such problems with our health service nor should we have higher per capita expenditure than those countries.

    Geuze wrote:
    We have one of the youngest pop in the EU.


    Can anyone point to data to support these claims?


  • Registered Users Posts: 21,627 ✭✭✭✭Tell me how


    Can I add a light hearted take on how the purpose of a Health Service can be interpreted by different players within it.

    The irrefutably exceptional Yes Minister.



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  • Registered Users Posts: 13,392 ✭✭✭✭Geuze


    I thought Ireland has an ageing population?

    We do, as do all EU countries.

    But we are still the youngest, or among the youngest.


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