What is wrong with the health service, HSE

Tell me how

VinLieger wrote: »

Are you suggesting because we arent all experts in how to run the HSE we shouldnt have an opinion on it or be able to voice that opinion on a discussion forum?

I can't understand their position in trying to shut down discussion on this.

They are an active poster in many threads with national political/strategy themes.

Sam Russell

AndrewJRenko wrote: »

Here's one way to improve it - let's leave the improving to people who know what they are talking about.

If I get bad service from an enterprise, I have a very good understanding of how they might improve their offering. Many users of the services provided by the HSE have a very good idea how the services could be improved.

One does not need to be an expert to see the major failings of the HSE. No-one should be left on a trolley for 48 hours, particularly if they are over 90 years of age as has been the case last year. Waiting lists for scoliosis operations of many years for growing children is unforgivable.

Who needs to be an expert to see such failings and call for a better system?

Tell me how

Sam Russell wrote: »

If I get bad service from an enterprise, I have a very good understanding of how they might improve their offering. Many users of the services provided by the HSE have a very good idea how the services could be improved.

One does not need to be an expert to see the major failings of the HSE. No-one should be left on a trolley for 48 hours, particularly if they are over 90 years of age as has been the case last year. Waiting lists for scoliosis operations of many years for growing children is unforgivable.

Who needs to be an expert to see such failings and call for a better system?

Not to mention that outside of education, the HSE is probably the one government body of which everyone in the country has at least some experience with it.

Tell me how

I wonder are the nurses striking for a 12% pay rise hoping that it will force the government to either pay it or to hire more nurses at the current rate to alleviate their staff number issues.

I wonder would they be happy with x number of more nurses at the current payscale or do they feel that they have to get the raise.

blanch152

AndrewJRenko wrote: »

Here's one way to improve it - let's leave the improving to people who know what they are talking about.

If I walk into your job and after 20 minutes, I start telling you all the things you're doing wrong, will you be taking my instructions?

In any online discussion there are always some posters who don't have a clue what they are talking about. We have our fair share of those, and we also have a fair share of people who are ideoligally or politically tied to certain positions and posturing.

However, from reading this thread and others, it is also clear that there are plenty of posters on here who have experience of working in the public sector, both front-line and management examples, as well as those who have worked in management in the private sector. They don't have to be experts in health care to be able to identify critical problems or to suggest credible solutions. They also have the ability to critically analyse the bleating and whinging of unions or the pathetic excuses of management, all of whom have a role in the issues of the health service.

One thing is clear - we spend an awful lot of money per capita on the health service, yet it doesn't work. It is not a problem of money, it is a problem of policy, management, working arrangements and employees. We can argue about where the balance of responsibility lies between those four, but most of the problems and nearly all of the solutions lie within the HSE. The remaining problems are problems of policy and fall between the political body and the HSE. Is the HSE strong enough in standing up to unsustainable policies (over 2 million medical cards?) put forward by politicians? Are politicians strong enough to resist the populist bleating in the media and among the opposition?

VinLieger

Tell me how wrote: »

I can't understand their position in trying to shut down discussion on this.

They are an active poster in many threads with national political/strategy themes.

Indeed, a strange attitude to have for someone who has expressed quite strong views on a variety of other topics.

AndrewJRenko

Tell me how wrote: »

I can't understand their position in trying to shut down discussion on this.

They are an active poster in many threads with national political/strategy themes.

VinLieger wrote: »

Indeed, a strange attitude to have for someone who has expressed quite strong views on a variety of other topics.

I've already addressed that issue in this earlier post.

Geuze wrote: »

It was a few years ago.

https://www.independent.ie/irish-news/hse-hires-outside-help-despite-having-full-staff-26699221.html


2010:

Just last week, HSE head of human resources Sean McGrath said it was widely accepted that too many staff were employed in certain areas within the HSE.

''There are about 2,000 people working in the HR function. I could probably get away with having 700 or 800 in that department," he said then.

Nine years ago, at a time when the organisation was dramatically cutting back numbers instead of working hard to recruit and retain staff. So how many people are in HR now? How many people do they recruit each year compared to 2010?


Is there any chance of having an educated, informed debate?

Tell me how wrote: »

Not to mention that outside of education, the HSE is probably the one government body of which everyone in the country has at least some experience with it.

Having some experience of a body does not make you an expert in running that body. Are you an expert in running banks, mobile phone companies and tv cable providers?

blanch152 wrote: »

In any online discussion there are always some posters who don't have a clue what they are talking about. We have our fair share of those, and we also have a fair share of people who are ideoligally or politically tied to certain positions and posturing.

However, from reading this thread and others, it is also clear that there are plenty of posters on here who have experience of working in the public sector, both front-line and management examples, as well as those who have worked in management in the private sector. They don't have to be experts in health care to be able to identify critical problems or to suggest credible solutions. They also have the ability to critically analyse the bleating and whinging of unions or the pathetic excuses of management, all of whom have a role in the issues of the health service.

Pots and black kettles spring to mind.

blanch152 wrote: »

One thing is clear - we spend an awful lot of money per capita on the health service, yet it doesn't work. It is not a problem of money, it is a problem of policy, management, working arrangements and employees. We can argue about where the balance of responsibility lies between those four, but most of the problems and nearly all of the solutions lie within the HSE. The remaining problems are problems of policy and fall between the political body and the HSE. Is the HSE strong enough in standing up to unsustainable policies (over 2 million medical cards?) put forward by politicians? Are politicians strong enough to resist the populist bleating in the media and among the opposition?

What particular measure did you decide to judge that 'it doesn't work'? How many babies were brought into the world without difficulty today by the HSE? How many hip operations were carried out? How many cataracts were cleared? How many people were seen in A&E? [St Vincents reported a 6% increase in A&E numbers for 2018 over 2017, btw]


You certainly ask some interesting and relevant questions, worthy of further discussion. But that's doesn't mean that anyone here is anywhere near competent to come up with reliable solutions.

Sam Russell wrote: »

If I get bad service from an enterprise, I have a very good understanding of how they might improve their offering. Many users of the services provided by the HSE have a very good idea how the services could be improved.

One does not need to be an expert to see the major failings of the HSE. No-one should be left on a trolley for 48 hours, particularly if they are over 90 years of age as has been the case last year. Waiting lists for scoliosis operations of many years for growing children is unforgivable.

Who needs to be an expert to see such failings and call for a better system?

Getting bad service (or indeed, getting good service) does not make you an expert on how to manage the most complex operation in the country. And yeah, we can all see the failings, but let's see the successes along with the failings to come to a fair assessment. And calling for a better system is fine too - but coming up with proposes that the HSE should be decentralised or decentralised or disbanded or whatever are just nonsense, like the bar stool experts shouting at the telly telling the football manager what team he should have picked.

]

James Brown

Do we, (various governments) try anything outside of hiring/having a recruitment freeze, increased funding, wage freeze etc? It seems agreed the organisation needs work I don't see how any more money or staff will help if the organisation needs changing.
Didn't this government bring in some consultants or other a while back? Any news there?
My impression is they (governments we've had) just want it to go away.

Just to note, again, Unions do an excellent job. They don't work for the tax payer, they work for their members. What Unions do or don't do as a membership entity is for our political representatives to look at. If a deal is struck that favours the Unions to the detriment of the tax payer, that's the Union being good at their job IMO. Looking to them to help the taxpayer out makes as much sense as looking at private business.

Tell me how

Matt Barrett wrote: »

Do we, (various governments) try anything outside of hiring/having a recruitment freeze, increased funding, wage freeze etc? It seems agreed the organisation needs work I don't see how any more money or staff will help if the organisation needs changing.
Didn't this government bring in some consultants or other a while back? Any news there?
My impression is they (governments we've had) just want it to go away.

Just to note, again, Unions do an excellent job. They don't work for the tax payer, they work for their members. What Unions do or don't do as a membership entity is for our political representatives to look at. If a deal is struck that favours the Unions to the detriment of the tax payer, that's the Union being good at their job IMO. Looking to them to help the taxpayer out makes as much sense as looking at private business.

Absolutely, Unions are there to protect their members.
And all of them thinks there needs to be change, they just are not willing for that change to affect their members.

It is a societal issue because not only do so many of us end up using it, but also, we or someone close to us works within the system and so we have a vested interests of sorts in not wanting them to lose their position.

Maybe the government should target a single relatively small region such as the mid west or south east or so on and try to make that self sustainable and efficient in terms of all services being available within acceptable time frames and where possible within the region. Allow them to have only the required number of administrators and managers but give them funds for front line staff and then critically and rigidly assess performance. Essentially, try to treat it like a private business as much as possible. Appoint a single person not influenced by elections to own the delivery of this project. Then, if that is proven to be successful, try to replicate it in the next region and so on.

But, could any of that realistically be done? Would union influence be the sole reason it might fail?

James Brown

Tell me how wrote: »

Absolutely, Unions are there to protect their members.
And all of them thinks there needs to be change, they just are not willing for that change to affect their members.

It is a societal issue because not only do so many of us end up using it, but also, we or someone close to us works within the system and so we have a vested interests of sorts in not wanting them to lose their position.

Maybe the government should target a single relatively small region such as the mid west or south east or so on and try to make that self sustainable and efficient in terms of all services being available within acceptable time frames and where possible within the region. Allow them to have only the required number of administrators and managers but give them funds for front line staff and then critically and rigidly assess performance. Essentially, try to treat it like a private business as much as possible. Appoint a single person not influenced by elections to own the delivery of this project. Then, if that is proven to be successful, try to replicate it in the next region and so on.

But, could any of that realistically be done? Would union influence be the sole reason it might fail?

I've read that here before. The only people I've come across who work there complain about how poorly run it is. I don't think people are going to accept a health system they feel is broken because they are concerned about people they may know working there. I don't think anyone would be expecting massive layoffs as a result of any changes.
I believe if government or whomever went public with a plan and explained how it would help fix the HS the Unions wouldn't have public support, if they fought against it. I personally don't buy the unions being that big a problem. Worst case is the system changes for the better and unionised members of staff are surplus to requirement. They are looking to secure jobs and salaries I don't think changes in the way the HSE does business will come against unions unless it involves layoffs and the like.
Fiddling around the edges and blaming unions or nurses isn't going to achieve anything.

Yes taking one small area to try might be a very good idea.

Good loser

On Saturday View last Sat. a consultant from Sligo (I think) made some good interventions.

Think he said Ireland had a very high proportion of staff nurses compared to other European countries. All are at a very high basic and there are no way near enough staff at lower grades; in other words much of the routine stuff nurses do (like taking bloods, putting in drips, taking BPs) could be done by lower paid technicians. This apparently is the situation in the HSE.

So, for instance, the number of staff nurses could be halved and half of what they currently do could be divvied up amongst technicians. Over time.

Martina1991

Good loser wrote:

So, for instance, the number of staff nurses could be halved and half of what they currently do could be divvied up amongst technicians. Over time.

I dont understand what you mean by technicians?

James Brown

Martina1991 wrote: »

I dont understand what you mean by technicians?

Also the big problem seemingly is reliance on contractors because nurses such as psychiatric are leaving the country, they are short staffed.

Martina1991

Martina1991 wrote: »

I dont understand what you mean by technicians?

There was some debate over introducing theatre assistants instead of nurses to do some jobs. This was in 2015.

https://www.irishtimes.com/news/ireland/irish-news/hse-to-look-at-introducing-hospital-theatre-assistants-1.2405731

Im not sure of the ins and outs of it but the SBP reported on Sunday that they were finally going to go ahead.

"Cork University Hospital has started to train operating theatre assistants after a battle with the INMO which opposed the move."

AndrewJRenko

Tell me how wrote: »

Matt Barrett wrote: »

Do we, (various governments) try anything outside of hiring/having a recruitment freeze, increased funding, wage freeze etc? It seems agreed the organisation needs work I don't see how any more money or staff will help if the organisation needs changing.
Didn't this government bring in some consultants or other a while back? Any news there?
My impression is they (governments we've had) just want it to go away.

Just to note, again, Unions do an excellent job. They don't work for the tax payer, they work for their members. What Unions do or don't do as a membership entity is for our political representatives to look at. If a deal is struck that favours the Unions to the detriment of the tax payer, that's the Union being good at their job IMO. Looking to them to help the taxpayer out makes as much sense as looking at private business.

Absolutely, Unions are there to protect their members.
And all of them thinks there needs to be change, they just are not willing for that change to affect their members.

It is a societal issue because not only do so many of us end up using it, but also, we or someone close to us works within the system and so we have a vested interests of sorts in not wanting them to lose their position.

Maybe the government should target a single relatively small region such as the mid west or south east or so on and try to make that self sustainable and efficient in terms of all services being available within acceptable time frames and where possible within the region. Allow them to have only the required number of administrators and managers but give them funds for front line staff and then critically and rigidly assess performance. Essentially, try to treat it like a private business as much as possible. Appoint a single person not influenced by elections to own the delivery of this project. Then, if that is proven to be successful, try to replicate it in the next region and so on.

But, could any of that realistically be done? Would union influence be the sole reason it might fail?

So when you say "treat it like a private business", can the hospitals start charging for the true costs of services provided, like a private business would? And can it pick and choose it's customers to ensure profitability, like a private business would?

James Brown

The problem with looking to private business, they let people go to increase or maintain profits, they cut or curtail services to remain in profit or a profit of their liking. All fine and dandy except the point is to serve the public not make a profit on the public suffering. Goes for more than health issues too.

blanch152

Topgear on Dave wrote: »

There was some debate over introducing theatre assistants instead of nurses to do some jobs. This was in 2015.

https://www.irishtimes.com/news/ireland/irish-news/hse-to-look-at-introducing-hospital-theatre-assistants-1.2405731

Im not sure of the ins and outs of it but the SBP reported on Sunday that they were finally going to go ahead.

"Cork University Hospital has started to train operating theatre assistants after a battle with the INMO which opposed the move."

The INMO are brilliant at protecting their patch.

Ireland is near the top of the EU list for nursing salaries.
Ireland is near the top of the EU list for nurses per capita.

We cannot sustain both of those statistics indefinitely.

Uriel.

blanch152 wrote: »

The INMO are brilliant at protecting their patch.

Ireland is near the top of the EU list for nursing salaries.
Ireland is near the top of the EU list for nurses per capita.

We cannot sustain both of those statistics indefinitely.

Do you have a link to these lists, I'd like to see the figures involved.

marieholmfan

Those over 90 years of age have had their whole lives to work to improve the public health system.
If anyone should be left on a trolley for seven hours it is a 90 year old.

Sam Russell wrote: »

If I get bad service from an enterprise, I have a very good understanding of how they might improve their offering. Many users of the services provided by the HSE have a very good idea how the services could be improved.

One does not need to be an expert to see the major failings of the HSE. No-one should be left on a trolley for 48 hours, particularly if they are over 90 years of age as has been the case last year. Waiting lists for scoliosis operations of many years for growing children is unforgivable.

Who needs to be an expert to see such failings and call for a better system?

Tell me how

marieholmfan wrote: »

Those over 90 years of age have had their whole lives to work to improve the public health system.
If anyone should be left on a trolley for seven hours it is a 90 year old.

Aside from misinterpreting people's points, how do you think the HSE can be improved?

Sam Russell

marieholmfan wrote: »

Those over 90 years of age have had their whole lives to work to improve the public health system.
If anyone should be left on a trolley for seven hours it is a 90 year old.

That is basically disingenuous.

Assuming a working life of 40 years, then the majority of a 90 year old would be unable to work towards a solution, other than by a vote, and even that is ineffectual since a single vote will not change the health service.

No-one should be left on a trolley for any extended period, especially a 90 year old.

James Brown

Anyone in their 80's or 90's comes from a time when people knew their place and the church ruled with an iron fist. The majority left school early, got any job, stuck with it, retired. The idea that even today the average person can carry much sway in regard of changing the HSE is a joke surely? We vote for people who claim to intend to tackle it, we assume they must have a plan. Sadly that's the best most of us can do.
We can however discuss it and I don't see any problem with that.

Tell me how

Matt Barrett wrote: »

Anyone in their 80's or 90's comes from a time when people knew their place and the church ruled with an iron fist. The majority left school early, got any job, stuck with it, retired. The idea that even today the average person can carry much sway in regard of changing the HSE is a joke surely? We vote for people who claim to intend to tackle it, we assume they must have a plan. Sadly that's the best most of us can do.
We can however discuss it and I don't see any problem with that.

1 in 23 workers in Ireland work in the HSE.
Vicky Phelan is going a long way towards influencing behaviour change in a certain element of Health Care delivery (And yes, because of her tragic story and even so she is still having difficulty doing so).
We all vote in elections to put the politicians in place to run essential services.
We actually have more power to direct focus on the HSE than we realise.
If we had protests in relation to it in the same way as we had against Water Charges maybe there would be something done.

But, the reason I am interested in a discussion is to see if anyone can suggest something which is either definitively the source of the problem or is likely to improve it. This is an anonymous online discussion forum. No one is suggesting it is the citizens council or Dail Eireann.

marieholmfan

Sam Russell wrote: »

No-one should be left on a trolley for any extended period, especially a 90 year old.

Why especially a 90 year old?

blanch152

Uriel. wrote: »

Do you have a link to these lists, I'd like to see the figures involved.

I posted the information either in this thread or the After Hours one. Others have posted it too.

marieholmfan

Matt Barrett wrote: »

Anyone in their 80's or 90's comes from a time when people knew their place and the church ruled with an iron fist.

Because the people let them.

Matt Barrett wrote: »

We vote for people who claim to intend to tackle it.

People in their 90s didn't and would have regarded a trolley as luxury when they were young.

Sam Russell

marieholmfan wrote: »

Why especially a 90 year old?

Because they could die because they are on the trolley instead of being treated in the hospital proper.

James Brown

Tell me how wrote: »

1 in 23 workers in Ireland work in the HSE.
Vicky Phelan is going a long way towards influencing behaviour change in a certain element of Health Care delivery (And yes, because of her tragic story and even so she is still having difficulty doing so).
We all vote in elections to put the politicians in place to run essential services.
We actually have more power to direct focus on the HSE than we realise.
If we had protests in relation to it in the same way as we had against Water Charges maybe there would be something done.

But, the reason I am interested in a discussion is to see if anyone can suggest something which is either definitively the source of the problem or is likely to improve it. This is an anonymous online discussion forum. No one is suggesting it is the citizens council or Dail Eireann.

I'm responding to this:

marieholmfan wrote: »

Those over 90 years of age have had their whole lives to work to improve the public health system.
If anyone should be left on a trolley for seven hours it is a 90 year old.

The problem with protesting is unless you've massive numbers chances are it won't amount to anything. Health is an ongoing issue and we've politicians and public resigned to the fact that it's too big to tackle, which I agree is unfortunate. There's also been a move from many quarters, political and media, to blacken the protester despite it being a right and a genuine belief in the issue on their behalf. Who'd be a protester in that environment?
It's not unreasonable for voters to assume incoming governments will tackle the scandal of hospital trolleys as promised.

James Brown

marieholmfan wrote: »

Because the people let them.



People in their 90s didn't and would have regarded a trolley as luxury when they were young.

The people were conditioned. You're talking about times when getting pregnant meant you might get locked up in a home. The church had a hand in state policy. I'm not saying people couldn't have done more but you cannot punish the elderly especially when we're not faring much better. What are you doing for instance?

We're supposed to be at least striving to improve ourselves.
Are you now saying people were content with what they had, therefore they didn't try to fix things. therefore they deserve to die on trolleys?

When you see an issue that needs improving it's not unrealistic for people to speak out and expect better.

AndrewJRenko

blanch152 wrote: »

The INMO are brilliant at protecting their patch.

Ireland is near the top of the EU list for nursing salaries.
Ireland is near the top of the EU list for nurses per capita.

We cannot sustain both of those statistics indefinitely.

Comparing gross salaries across countries is meaningless. You need to consider taxation levels, cost of property, cost of living and more to get any kind of meaningful comparison.


You need to be very careful of other international comparisons too. Other countries structure their services in different ways. In the UK, disability care services come under local authorities, not under health services, so comparisons can produce unexpected results.


Did you check the OECD comparison of hospital beds, showing how we have close to half the average OECD rates of hospital beds per capita.

blanch152

AndrewJRenko wrote: »

Comparing gross salaries across countries is meaningless. You need to consider taxation levels, cost of property, cost of living and more to get any kind of meaningful comparison.


You need to be very careful of other international comparisons too. Other countries structure their services in different ways. In the UK, disability care services come under local authorities, not under health services, so comparisons can produce unexpected results.


Did you check the OECD comparison of hospital beds, showing how we have close to half the average OECD rates of hospital beds per capita.

We are also near the top of the list for nurses per hospital bed too.

The structure of services won't affect the total number of nurses across the services.

As for taxation levels etc., it would be true that nurses on salaries around €50k upwards would have higher levels of taxation. But nurses on less than €50k would be on lesser taxation levels. You are not arguing for pay increases for the nurses at the top of the scale, are you?

AndrewJRenko

blanch152 wrote: »

The structure of services won't affect the total number of nurses across the services.

It will affect the total number if someone is counting 'total number of nurses in the health service', as nurses in disability services in the UK are not in the health service, by and large. You need to be sure that you're comparing like with like.

blanch152 wrote: »

As for taxation levels etc., it would be true that nurses on salaries around €50k upwards would have higher levels of taxation. But nurses on less than €50k would be on lesser taxation levels. You are not arguing for pay increases for the nurses at the top of the scale, are you?

I'm arguing that comparing gross salaries with considering tax levels and cost of living is a meaningless comparison.

Good loser

Martina1991 wrote: »

I dont understand what you mean by technicians?

For example Operating Theatre Assistants.

Good loser

Matt Barrett wrote: »

The problem with looking to private business, they let people go to increase or maintain profits, they cut or curtail services to remain in profit or a profit of their liking. All fine and dandy except the point is to serve the public not make a profit on the public suffering. Goes for more than health issues too.

Do the hospital staff -doctors, nurses, porters etc not profit from the sickness/illness of their patients?

James Brown

Good loser wrote: »

Do the hospital staff -doctors, nurses, porters etc not profit from the sickness/illness of their patients?

are you suggesting health workers are only in it for the money? Aren't we all to some extent? Should they be working for free to win favour? Doctors with a private practice do, most certainly. The longer the wait the more enticing the private clinic route, which I've been offered on more than one occasion over the years.

You're off point anyway. You shouldn't run a public service like a business. Profit comes first. Customer service only comes into it if it effects profit. If people have no option, why put profits into improving the customer experience? Look at broadband in rural areas, no money in it for Eir, so we have little to none. You cannot provide a public service like that. People before profit, if you will

FreudianSlippers

Everyone knows doctors working public only just do it for the love of it. They absolutely do not get paid a red cent... I heard once a public doctor accidentally got a paycheque and he was so angry he tore it up. :pac:


There's very little evidence to suggest that running a public service like a business is so bad - even the Eir example is silly given there is much more broadband in rural areas now due to Eir and other private enterprise than there was when it was run like a public service.

kippy

Good loser wrote: »

Do the hospital staff -doctors, nurses, porters etc not profit from the sickness/illness of their patients?

No,
They don't.
This much should be obvious.

kippy

FreudianSlippers wrote: »

Everyone knows doctors working public only just do it for the love of it. They absolutely do not get paid a red cent... I heard once a public doctor accidentally got a paycheque and he was so angry he tore it up. :pac:


There's very little evidence to suggest that running a public service like a business is so bad - even the Eir example is silly given there is much more broadband in rural areas now due to Eir and other private enterprise than there was when it was run like a public service.

There's a lot of merit in running certain portions of the public service "like a business" (Centralisation and standardisation of Finance/IT/HR for example) - however the primary aim of any business is to make money for it's owner or shareholders.
There are many decisions made within the public service that plainly could not be made if this were the ultimate goal.

Good loser

kippy wrote: »

No,
They don't.
This much should be obvious.

What's obvious to me is that they do profit from it.


They would have no income if there were no sick or ill people.


What's more the nurses want more profit (out of their labour) than they're already getting.

Martina1991

Good loser wrote:

They would have no income if there were no sick or ill people.

Such daftness. Its a public service.
Healthcare workers get paid regardless of how many patients walk through the door.

Tell me how

Good loser wrote: »

What's obvious to me is that they do profit from it.


They would have no income if there were no sick or ill people.


What's more the nurses want more profit (out of their labour) than they're already getting.

Getting paid is not the same as increasing profit. It's not like as if 10% more patients come through the door and everyone working in the hospital gets paid 10% more and more than a teachers salary is dependent on class size.

I can't believe I have to explain that but it was the "What's obvious to me" part of your statement that made me think it was best to.

Good loser

Martina1991 wrote: »

Such daftness. Its a public service.
Healthcare workers get paid regardless of how many patients walk through the door.

It's a commercial transaction - they trade their labour for money.


If there were no patients there would be no pay.

Tell me how

Good loser wrote: »

It's a commercial transaction - they trade their labour for money.


If there were no patients there would be no pay.

Yes, but pay is different to profit.

James Brown

Good loser wrote: »

It's a commercial transaction - they trade their labour for money.


If there were no patients there would be no pay.

What's your point? Nurses and doctors get paid for working? How dare they.

If they say they need more money thankfully they still have the freedom to seek it and strike if needed, thanks to socialist values held dear by society, the bowsies.

Podge_irl

Matt Barrett wrote: »

What's your point? Nurses and doctors get paid for working? How dare they.

I presume their point is that doctors and nurses being paid for their work is not inherently better than private clinics who profit from the service they provide.

It is far from a perfect comparison, but there is indeed nothing inherently wrong with for-profit enterprises being involved in healthcare. Nor is there anything wrong with taking a more "business-minded" approach to aspects of public enterprises - there is in fact much good about it.

I am not a "free market will fix everything" minded person, but there is something to be said about private businesses having to earn your custom in a way a public service provider does not.

James Brown

Podge_irl wrote: »

I presume their point is that doctors and nurses being paid for their work is not inherently better than private clinics who profit from the service they provide.

It is far from a perfect comparison, but there is indeed nothing inherently wrong with for-profit enterprises being involved in healthcare. Nor is there anything wrong with taking a more "business-minded" approach to aspects of public enterprises - there is in fact much good about it.

I am not a "free market will fix everything" minded person, but there is something to be said about private businesses having to earn your custom in a way a public service provider does not.

Private puts he who pays the most first. You can skip the queue if you've the money. Tax payer funded institutions should never work like that. If you want to go private, go private.
What's wrong with for-profit in public service is the quality of service is only as important as the profit it makes. Government and it's various services are not there to make money off of the public's needs or requirements, the public finances the government, by taxes, to provide these services.
Not to mention having a political representative to approach, not vote for, if they do something we don't like.
Efficiency is great. Being business minded is great. We don't need 'for profit' to be efficient.

Trying to compare individuals being paid for working within the HSE to for-profit entities is a farcical argument, as I believe was the point being approached.

Podge_irl

Matt Barrett wrote: »

What's wrong with for-profit in public service is the quality of service is only as important as the profit it makes.

Right, but just to focus on this one point, if the result is both profit being made for the company and better service for the "client" then is that not basically a win-win? Is there any proof that relying on private providers over public providers results in worse service?

You seem to think serving the public and making a profit are mutually exclusive and I don't agree with that line of thinking.

Sam Russell

Podge_irl wrote: »

Right, but just to focus on this one point, if the result is both profit being made for the company and better service for the "client" then is that not basically a win-win? Is there any proof that relying on private providers over public providers results in worse service?

You seem to think serving the public and making a profit are mutually exclusive and I don't agree with that line of thinking.

I am reminded of the fires in California a few years ago. A surprising thing was noticed. Some isolated houses were not affected by the fires while their neighbours were. Well, it turned out the survivors had fire protection services that came and kept their properties safe while ignoring their blazing neighbours.

Is that the kind of private health care you want?

What could be done is the pay the state funded acute hospitals on a per procedure basis so it funds what they do.

The current system for hospitals funds them whatever they do (or do not do). This system encourages waiting list because a patient on a waiting list costs nothing, while treating them does. Perhaps if they were paid less the longer the waiting list, it might incentive them to reduce those waiting lists.

James Brown

Podge_irl wrote: »

Right, but just to focus on this one point, if the result is both profit being made for the company and better service for the "client" then is that not basically a win-win? Is there any proof that relying on private providers over public providers results in worse service?

You seem to think serving the public and making a profit are mutually exclusive and I don't agree with that line of thinking.

Fair point, but for profit doesn't care. It could well mean a good service if you can afford to pay for it. If you can't tough. The entire idea of making money off the misery of the sick goes against the whole point of a public health service. As happens elsewhere, would we have patients sent for scans and tests because it makes more money or insurance may cover it, even if they wouldn't have been called for under public? What would this mean for waiting lists, would it drive a two tier system where the poorest get the least treatment?
Would we have different doctors prescribing different brands based on cost?

Sam Russell wrote: »

...Perhaps if they were paid less the longer the waiting list, it might incentive them to reduce those waiting lists.

The big problem is why would a specialist want shorter waiting lists when he or she can offer up their private practice for those who are willing to pay for quicker service?

Good loser

Tell me how wrote: »

Yes, but pay is different to profit.

No great difference in my opinion.
Many in the pharma business switch between the 2 modes of working - payroll or contracting. Same difference.