The HSE is re-regionalising

Eric Cartman

https://www.independent.ie/irish-news/health/redundancy-scheme-on-cards-as-fewer-health-staff-needed-38316582.html

How do we consistently allow this double and even quadruple jobbed hell hole to continue wasting money. There needs to be a serious cull in the HSE , have it completely gutted and reformed.

50 year old mary who cant use a computer - out the door
The 4 people stamping forms - out the door
Gut the rot out of it.

Stevieluvsye

I used to work in the old Eastern Health Board which it seems was far more efficient than the current set up and that is saying something

Boggles

Bring back the ould Matrons, put the fear of God in you they would.

jmayo

Eric Cartman wrote: »

https://www.independent.ie/irish-news/health/redundancy-scheme-on-cards-as-fewer-health-staff-needed-38316582.html

How do we consistently allow this double and even quadruple jobbed hell hole to continue wasting money. There needs to be a serious cull in the HSE , have it completely gutted and reformed.

50 year old mary who cant use a computer - out the door
The 4 people stamping forms - out the door
Gut the rot out of it.

It is shyteology.
All it means is more expense and spending on new signs, new letter headed paper, etc.

When Bertie created the HSE there was an opportunity to rationalise the administrative functions and cut out the duplication that existed in the health boards.
Instead it was bloated with extra layers of admin staff.
New HQ, etc.
There was no way bertie was going to take on the unions.

Also no politician can afford to take on the HSE because you will have every other politician (including in the same party) going against it because they will lose public sector votes.
And as a small country there are lots of votes in the public sector.

Of course the sacred cows of the nurses will be dragged out even though they would not be the ones facing the cuts and job losses.
in fact they should benefit from complete overall of the administrative side.

Eric Cartman

jmayo wrote: »

It is shyteology.
All it means is more expense and spending on new signs, new letter headed paper, etc.

When Bertie created the HSE there was an opportunity to rationalise the administrative functions and cut out the duplication that existed in the health boards.
Instead it was bloated with extra layers of admin staff.
New HQ, etc.
There was no way bertie was going to take on the unions.

Also no politician can afford to take on the HSE because you will have every other politician (including in the same party) going against it because they will lose public sector votes.
And as a small country there are lots of votes in the public sector.

Of course the sacred cows of the nurses will be dragged out even though they would not be the ones facing the cuts and job losses.
in fact they should benefit from complete overall of the administrative side.

I absolutely adore how the unions use nurses and junior doctors out on the front lines to protest cuts that will really only kick morbidly obese patricia who’s worked in admin for 30 years and done about 100 hours collective work in her life.

We really need to seperate unions and the public service for the desperate improvement of our nation

Floppybits

FF were cowards and wouldn't take on the unions when they created the HSE. Any company or organisation when the consolidate departments or whatever they always do the following allow affected staff to apply for positions in the new department, offer staff a move to another department or role and offer redundancy packages but to appease the unions FF caved in and said no one would lose their jobs which was nuts. This wouldn't have affected front line staff but more the admin staff.

Now we are going back to what it was before, the politicians need to grow a back bone and stand up to the unions.

Kivaro

It shows the apathy of the general public when you have very few responses to this topic on this thread ............... and I don't blame them.
Why? Because very little change will occur until the unions are challenged, middle management is cut, real accountability put in place, and performance made the major factor on whether a person keeps their job with the HSE (and pay rises etc.) versus who they know or are related to in management.

Is re-regionalising just a smokescreen or there is a possibility of it working?
Would love to hear from someone with experience in this sector.

Berserker

Floppybits wrote: »

FF were cowards and wouldn't take on the unions when they created the HSE. Any company or organisation when the consolidate departments or whatever they always do the following allow affected staff to apply for positions in the new department, offer staff a move to another department or role and offer redundancy packages but to appease the unions FF caved in and said no one would lose their jobs which was nuts. This wouldn't have affected front line staff but more the admin staff.

Now we are going back to what it was before, the politicians need to grow a back bone and stand up to the unions.

What political party will take on the unions? Would you take them on if your were a politician?

end of the road

Eric Cartman wrote: »

We really need to seperate unions and the public service for the desperate improvement of our nation

and how exactly are you going to do that given the public service workers are the unions?

Kivaro

The only way that the massive union structure is neutralised in this country is by Brussels coming in when the next recession occurs and enacting changes through austerity that the unions won't be able to do anything about.

We obviously have not learned anything from the 2008 "downturn".

jimmycrackcorm

end of the road wrote: »

and how exactly are you going to do that given the public service workers are the unions?

Clearly the problem is that the unions are the source of the problems in our health service. They're the ones who are boxing reform just to keep things cushy.

Eric Cartman

end of the road wrote: »

and how exactly are you going to do that given the public service workers are the unions?

Tender for a private company to run health services in the country, lease the hospitals and facilities to them and then let them interview and hire the good workers while leaving out the bad , then have the state buy out the company to appease those who hear the words ‘private healthcare’ and foam at the mouth.

Leave the dead weight on the payroll in a now defunct HSE , do one year spending report on how much it all costs and suddenly its ‘useless whingers who do nothing all day but cost us hundreds of millions get the sack’ and theres no way the unions or the left could defend the massive useless quango anymore

ednwireland

Eric Cartman wrote: »

end of the road wrote: »

and how exactly are you going to do that given the public service workers are the unions?

Tender for a private company to run health services in the country, lease the hospitals and facilities to them and then let them interview and hire the good workers while leaving out the bad , then have the state buy out the company to appease those who hear the words ‘private healthcare’ and foam at the mouth.

Leave the dead weight on the payroll in a now defunct HSE , do one year spending report on how much it all costs and suddenly its ‘useless whingers who do nothing all day but cost us hundreds of millions get the sack’ and theres no way the unions or the left could defend the massive useless quango anymore

you know under employment law you cant do that

end of the road

Kivaro wrote: »

The only way that the massive union structure is neutralised in this country is by Brussels coming in when the next recession occurs and enacting changes through austerity that the unions won't be able to do anything about.

We obviously have not learned anything from the 2008 "downturn".

there is no massive union structure. just various unions representing their members. there is nothing there that is possible to neutralize as people are entitled to collectively bargain.

jimmycrackcorm wrote: »

Clearly the problem is that the unions are the source of the problems in our health service. They're the ones who are boxing reform just to keep things cushy.

the unions cannot stop reform.
things like not replacing staff when they retire until a certain number is gone below is 1 perfectly fine way to remove surplus staff if there are no other departments they could be moved to.

Eric Cartman wrote: »

Tender for a private company to run health services in the country, lease the hospitals and facilities to them and then let them interview and hire the good workers while leaving out the bad , then have the state buy out the company to appease those who hear the words ‘private healthcare’ and foam at the mouth.

Leave the dead weight on the payroll in a now defunct HSE , do one year spending report on how much it all costs and suddenly its ‘useless whingers who do nothing all day but cost us hundreds of millions get the sack’ and theres no way the unions or the left could defend the massive useless quango anymore

and how much is this all going to cost? how long is it all going to take to sort out? what if the private company decide to recognise a union during the contract duration? what happens if no private company bids in the first place?
all this up-evil v simply not replacing staff when they retire, unless the numbers go below a certain threshold, which can easily be done, and which won't a problem for the unions who aren't a major issue anyway.

Uriel.

Kivaro wrote: »

Is re-regionalising just a smokescreen or there is a possibility of it working?
Would love to hear from someone with experience in this sector.

It might if it is done properly and fully. There's more required than just the regionalisation piece though.
That regional piece needs to be supported by a lot centralised expertise and corporate support, such as population health profiling, resource allocation modelling, data management infrastructure and a thousand other things.

Regionalisation does push accountability and responsibility further down the line and closer to the front line which, in theory, is a good approach. A single budget per regional area along with an outcomes framework can help to ensure money is invested and decisions are taken closer to the patient, with, hopefully, some greater focus on earlier care and support interventions.

From a cultural, societal and structural perspective though we need to move away from the hospital being the centre of existence for everything.

Major fear however with the purported move is the interference that will play an even bigger role in opertion of the system.
It's already ridiculous, given the supposed legal divide between health service delivery and the political system.

Grab All Association

Should have never happened in the first place, but reverting back to a pre 2005 structure is not going to work. In the Midwest for example, The half arsed MWHB to HSE structure rebranding is now completely irreversible. It’s true that they didn’t terminate/abolish any of these senior/managerial/legacy MWHB roles (which really wouldn’t be a bad thing if reverting back now) but a lot of these people who held on to these roles post amalgamation have since retired within the past 14 years. These roles were later abolished or centralised within the new HSE structure and they’ll struggle to hire the numbers of people with the qualifications to replace this . Whilst at the same time certain post amalgamation roles were created and they’ll find it hard as mentioned by another poster to make these people redundant.

TrixIrl

At present, all the non-hospital front line work i.e public health, disabilities, elderly care etc is grouped geographically. But the hospital's are grouped to meet certain speciality targets so you end up with kilkenny in with Dublin, Waterford in with cork etc.

This means there can be minimal joined up/integrated care from hospital to community and back again because you have to go almost to ministerial level before both streams are accountable/manageable to the one person (and so things can get done). Moving hospitals back within geographical groups will mean that decision making for integrated care can happen regionally as that hospital manager and community manager in say cork will both report to the cork-kerry manager.

So yes in theory it's a better model but it was abolished the first time around due to duplication of roles.

To do it properly, all the standalone roles i.e. data collection, national policy, Garda vetting etc need to be based corporately and independently under the HSE to cut duplication of local admin.

mvl

Uriel. wrote: »

From a cultural, societal and structural perspective though we need to move away from the hospital being the centre of existence for everything.

I though the GP practices are currently the centre of existence for everything. meaning by comparison with other EU countries, IRL has a pretty good ratio of GPs/100k residents.
But we're bad at hiring consultants.

So assume hospitals rather need hospitalists (different role than that of a subspecialist, it takes less effort/time to train) - what would it take to increase the number of consultants per 100k residents ? and would this re-regionalization help with that ?

RobbingBandit

****ing quango nonsensical merry-go-round think tank to come up with new names will probably cost €250k

blanch152

https://www.oecd-ilibrary.org/docserver/health_glance-2017-56-en.pdf?expires=1563312749&id=id&accname=guest&checksum=EE64199493E52DC7CE483BDD384D21E2


7th highest number of nurses per capita in the OECD, yet we are told that nurses are not the problem.

And that is with one of the youngest populations in the OECD which means we should need less nurses and less healthcare than anyone else.


https://read.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2017/remuneration-of-nurses_health_glance-2017-58-en#page1


Meanwhile in PPP terms, we have the fourth highest remuneration of nurses in the OECD.

That is not sustainable.

TrixIrl

mvl wrote: »

[QUOTE=Uriel
I though the GP practices are currently the centre of existence for everything.

GPs should be the centre for everything but with the vast majority being considered self employed contractors to the HSE, they are severely hampered by lack of information (as are many in the community). For instance if a GP, PHN or HHC hears that a patient has been taken away in an ambulance, there is hours of ringing around local hospitals, then wards etc trying to find the patient, convince a nurse give you a run down of condition, and then try to prepare for discharge without any official contact from the hospital. A discharge letter will often be sent home with the patient...which is too late to apply for a HCP etc.

I know my own GP doesnt have access to my blood results or hospital tests despite me being willing to sign whatever disclaimers are needed.

The amount of "failed discharges" leading to readmission as discharges haven't been planned in a logical, integrated way is ridiculous. Hospitals discharging people at the last minute on a bank holiday without letting the immunity team know as they are under staffing pressure just isn't safe until community health practitioners move to a 7 day week too.

That's not hospital staffs fault, just a reflection of the status quo.

Pissartist

Eric Cartman wrote: »

I absolutely adore how the unions use nurses and junior doctors out on the front lines to protest cuts that will really only kick morbidly obese patricia who’s worked in admin for 30 years and done about 100 hours collective work in her life.

We really need to seperate unions and the public service for the desperate improvement of our nation

Why so much hate for heavier, older ladies ?

road_high

Will this not just add a other layer of waste ? No doubt there’ll have to be a regional CEO and so on for each new “region” rather than what was to be a more centralized model

ednwireland

ednwireland wrote: »

you know under employment law you cant do that

What could be done is tender out a lot of the HSE's work to private clinics and hospitals. Reduce the size of HSE and start redundancies. That's not illegal.

HSE could then focus on the complex and the rare conditions private medical hospitals cannot manage. Staff the HSE with the specialists, pay them properly and get rid of the clipboard merchants.

Franz Von Peppercorn II

salonfire wrote: »

What could be done is tender out a lot of the HSE's work to private clinics and hospitals. Reduce the size of HSE and start redundancies. That's not illegal.

HSE could then focus on the complex and the rare conditions private medical hospitals cannot manage. Staff the HSE with the specialists, pay them properly and get rid of the clipboard merchants.

Are you allowing public patients into these private hospitals?

goose2005

Always relevant:

Miike

blanch152 wrote: »

https://www.oecd-ilibrary.org/docserver/health_glance-2017-56-en.pdf?expires=1563312749&id=id&accname=guest&checksum=EE64199493E52DC7CE483BDD384D21E2


7th highest number of nurses per capita in the OECD, yet we are told that nurses are not the problem.

And that is with one of the youngest populations in the OECD which means we should need less nurses and less healthcare than anyone else.


https://read.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2017/remuneration-of-nurses_health_glance-2017-58-en#page1


Meanwhile in PPP terms, we have the fourth highest remuneration of nurses in the OECD.

That is not sustainable.

If you're going beat the OECD drum at least give consideration to how the numbers for OECD are recorded and how they differ region to region (https://www.healthmanager.ie/2017/10/oecd-nurse-patient-ratios-do-not-give-the-full-picture/); one of Irelands foremost experts on the subject scratches the surface here. If you insist on beating any drum, beat the bed blocker drum, the one that's responsible for many of the failings within the current system and by far the biggest drain on our resources. This is what's making the system unsustainable.

As for part 2 of your comment about the highest remuneration, it's worth considering Ireland produces some of the most sought after graduate nurses on the planet due to the standard of the nursing education here. We have a plethora of nurse lead services in this country utilizing that education, something other countries strive so desperately to achieve. That's before we get to the topic of the reported "nurses" salaries being highly inflated due to management level positions (CNM1 through to DON *of which I think there are far too many) being included in those figures, which comes part and parcel of running these nursing lead services. This is demonstrated by foot note 1 in 8.17 of your second link (Health at a Glance 2018)

With simple surface knowledge on a topic it's incredibly easy to desktop analyse reported figures without giving due attention to, or digging deeper into what those numbers represent.

-

Going back to the regional health board route isn't going to fix the festering wound of Irish healthcare. The HSE will still exist even after that happens as part of governance and oversight. I think pushing Sláintecare is the route we should be taking instead of a glorified re-branding of the health service sucking up more of the health budget and píssing it down the drain

Despite all the lovely reporting about how terrible the HSE is and the anecdotal stories of how granny spent 97 millennia waiting for a bed last week - Fact of the matter is 85% of people who responded to the National Patient Experience Survey were satisfied with the service it provided, something has to be working about it?

end of the road

salonfire wrote: »

What could be done is tender out a lot of the HSE's work to private clinics and hospitals. Reduce the size of HSE and start redundancies. That's not illegal.

no but it would be absolutely pointless and a waste of all of our time and our money.
it would probably end up costing us more as we will be changing from a public service operation to profit driven operations, who will expect to make their profit come what may, as they are actually entitled to do.
and all of this instead of just not replacing staff when they retire as i suggested earlier, so we can get to the numbers that are actually needed, if we aren't actually there already given the ps recruitment bann for a few years.

salonfire wrote: »

HSE could then focus on the complex and the rare conditions private medical hospitals cannot manage. Staff the HSE with the specialists, pay them properly and get rid of the clipboard merchants.

so who is doing the admin work then if there are no clip board merchants?
you know admin work is actually needed, even if it is the case that there may be more staff currently then needed?

end of the road

end of the road wrote: »

no but it would be absolutely pointless and a waste of all of our time and our money.
it would probably end up costing us more as we will be changing from a public service operation to profit driven operations, who will expect to make their profit come what may, as they are actually entitled to do.
and all of this instead of just not replacing staff when they retire as i suggested earlier, so we can get to the numbers that are actually needed, if we aren't actually there already given the ps recruitment bann for a few years.

You're wrong as usual.

Compare the cost of public and private nursing homes for example

The private homes are much cheaper per week than the HSE run homes and are still able to make a profit.

Eric Cartman

The clipboard merchants work could mostly be done by automated computer systems if we were prepared to start sacking people for not knowing how to operate computers even after extensive training.

Franz Von Peppercorn II

salonfire wrote: »

You're wrong as usual.

Compare the cost of public and private nursing homes for example

The private homes are much cheaper per week than the HSE run homes and are still able to make a profit.

Source?

Miike

salonfire wrote: »

You're wrong as usual.

Compare the cost of public and private nursing homes for example

The private homes are much cheaper per week than the HSE run homes and are still able to make a profit.

Getting charged 17.70 for a 15g tub of Sudocrem does drive up the profit margin significantly alright.

Would you like the HSE to to give you an itemised bill every time you required hospital services? If only there was a country currently doing that... where people are priced out of basic healthcare. Oh wait there is!

Franz Von Peppercorn II

Franz Von Peppercorn II wrote: »

Are you allowing public patients into these private hospitals?

Yes, public patients in tendered private practices paid for by the taxpayer.

Private hospitals can do far more with less overheads than a public service.

This is already used in the National Treatment Purchase Fund.

Miike

Miike wrote: »

Getting charged 17.70 for a 15g tub of Sudocrem does drive up the profit margin significantly alright.

Would you like the HSE to to give you an itemised bill every time you required hospital services? If only there was a country currently doing that... where people are priced out of basic healthcare. Oh wait there is!

I did not mention an insurance system so I don't know why you're trying to compare to the US which is insurance based and is not in Government control.

Tendered practice ultimately remains in Government control to switch providers if it was failing to deliver or not value for money.

end of the road

Eric Cartman wrote: »

The clipboard merchants work could mostly be done by automated computer systems if we were prepared to start sacking people for not knowing how to operate computers even after extensive training.

whereas if we weren't prepared to sack such people who probably don't actually exist, the work couldn't be mostly done by automated computer systems?
if some or all of the work could be done by automated computer systems, then they would be in place, and as i said, we wouldn't even need to sack staff, we just don't replace them when they retire, and any younger staff could be redeployed.
but it seems to me at least that you just want to sack people for the sake of sacking people to make you feel better.

TrixIrl

*** I will never learn how to quote properly so..

Quote-

[/quote]
You're wrong as usual.

Compare the cost of public and private nursing homes for example

The private homes are much cheaper per week than the HSE run homes and are still able to make a profit. [/quote]

End quote***

Private nursing homes can choose who they take, public cannot. The vast majority of high dependency, complex cases with poor family input are in public NHs. The majority of those with cash to spend (and thus willing to sign up to expensive add-ons) are in private NHs so the standard weekly rate is not an accurate reflection.

A private nursing home group recently hired a national admissions manager as the local directors of nursing were handpicking potential residents and leaving beds empty rather than take the trickier labour intensive patients.

As well as this staff in public NHs are paid sick leave, pensions, maternity leave which the vast majority in private hospitals are not.

All this leads to a higher cost in public NHs.

Having said that, Nursing Homes Ireland are trying to renegotiate teh terms of Fair Deal which will likely involve equal rates for equal access; which is to be welcomed if only to ensure everyone has equal access to a NH of their choice and not to be cherrypicked by a NH director.

Miike

Miike wrote: »

Getting charged 17.70 for a 15g tub of Sudocrem does drive up the profit margin significantly alright.

Thanks for proving my point.

Despite this, nursing home fees are lower in private sector than the HSE.

So what are the HSE wasting money on if it costs them extra to run homes?

end of the road

salonfire wrote: »

Private hospitals can do far more with less overheads than a public service.

if that is the case, i have a feeling that it is probably because they aren't the main provider. they therefore probably won't need the overheads required to be able to treat anyone and everyone, and look after all of the information required.

Miike

salonfire wrote: »

I did not mention an insurance system so I don't know why you're trying to compare to the US which is insurance based and is not in Government control.

Tendered practice ultimately remains in Government control to switch providers if it was failing to deliver or not value for money.

I don't have the figures to hand and I'm on mobile but I will certainly post them tomorrow. The NTPF costs significantly more per case than the cost of being seen by the HSE - I assumed you meant insurance based because private tendered healthcare is quite frankly unsustainable.

salonfire wrote: »

Thanks for proving my point.

Despite this, nursing home fees are lower in private sector than the HSE.

So what are the HSE wasting money on if it costs them extra to run homes?

You can't be that daft? Why is it costing the HSE more? Oh, maybe it's because they don't charge 1000%+ for a lick of soducrem. Is this what you'd prefer to see the HSE do? Charge a +1000% markup on sundries?

end of the road

end of the road wrote: »

if that is the case, i have a feeling that it is probably because they aren't the main provider. they therefore probably won't need the overheads required to be able to treat anyone and everyone, and look after all of the information required.

Good to see you agreeing with me.

The HSE should not be required to treat everything, they are not capable in delivering in a cost-effective manner.

All the routine procedures should be tendered out and make the HSE much smaller.

Miike

Miike wrote: »

I don't have the figures to hand and I'm on mobile but I will certainly post them tomorrow. The NTPF costs significantly more per case than the cost of being seen by the HSE - I assumed you meant insurance based because private tendered healthcare is quite frankly unsustainable.




You can't be that daft? Why is it costing the HSE more? Oh, maybe it's because they don't charge 1000%+ for a lick of soducrem. Is this what you'd prefer to see the HSE do? Charge a +1000% markup on sundries?

You accuse nursing home of jacking up prices for products. Yet the cost to the consumer remains lower than the cost of the HSE facility.

I can't wait for your suggestion how the HSE justify the increased cost.

end of the road

salonfire wrote: »

Good to see you agreeing with me.

The HSE should not be required to treat everything, they are not capable in delivering in a cost-effective manner.

All the routine procedures should be tendered out and make the HSE much smaller.

that is unviable.
the hse have to be required to treat everything for the good of the health of society, and compared to your alternative i would suspect they do deliver in a cost effective manner.

Miike

Miike wrote: »

On which planet do you live? Do you think they provide a like-for-like service?

No, the private homes provide a much better service and unlike hse homes are held to a higher standard by hiqa.

end of the road

salonfire wrote: »

You accuse nursing home of jacking up prices for products. Yet the cost to the consumer remains lower than the cost of the HSE facility.

probably because the price of the products and others are added separate extras which are not included as part of the actual fees.

salonfire wrote: »

I can't wait for your suggestion how the HSE justify the increased cost.

the HSE have to take all kinds of patients.
the HSE probably do have better terms and conditions for their staff.
the HSE is probably a much larger provider over all.

Miike

Round and round we go.

salonfire wrote: »

You accuse nursing home of jacking up prices for products. Yet the cost to the consumer remains lower than the cost of the HSE facility.

I can't wait for your suggestion how the HSE justify the increased cost.

end of the road wrote: »

probably because the price of the products and others are added separate extras which are not included as part of the actual fees.
.

This.

And then this

TrixIrl wrote: »

Private nursing homes can choose who they take, public cannot. The vast majority of high dependency, complex cases with poor family input are in public NHs. The majority of those with cash to spend (and thus willing to sign up to expensive add-ons) are in private NHs so the standard weekly rate is not an accurate reflection.

A private nursing home group recently hired a national admissions manager as the local directors of nursing were handpicking potential residents and leaving beds empty rather than take the trickier labour intensive patients.

As well as this staff in public NHs are paid sick leave, pensions, maternity leave which the vast majority in private hospitals are not.

All this leads to a higher cost in public NHs.

Having said that, Nursing Homes Ireland are trying to renegotiate teh terms of Fair Deal which will likely involve equal rates for equal access; which is to be welcomed if only to ensure everyone has equal access to a NH of their choice and not to be cherrypicked by a NH director.

-

Public nursing homes are filled with complex and intensive case management because the private nursing homes won't take it on. It hurts their bottom line.

Regardless of all of that though I can agree with you in saying the HSE needs to do better in terms of cost at point of care for nursing homes but this doesn't translate to treating patients privately for "routine procedures" across the board being cheaper to the tax payer.

Franz Von Peppercorn II

salonfire wrote: »

Thanks for proving my point.

Despite this, nursing home fees are lower in private sector than the HSE.

So what are the HSE wasting money on if it costs them extra to run homes?

Source?

Eric Cartman

end of the road wrote: »

whereas if we weren't prepared to sack such people who probably don't actually exist, the work couldn't be mostly done by automated computer systems?
if some or all of the work could be done by automated computer systems, then they would be in place, and as i said, we wouldn't even need to sack staff, we just don't replace them when they retire, and any younger staff could be redeployed.
but it seems to me at least that you just want to sack people for the sake of sacking people to make you feel better.

The systems arent in place because of the unions, the same unions that prevent younger staff members taking on increased responsibility or training on such systems. Beurocracy and unions ensure the waste will continue unopposed.

Snow Garden

I worked on a contract in the HSE for about 18 months. I got to see how badly run and wasteful it is first hand. It was actually depressing. I have posted about it before. The middle management layer and unions have a lot to answer for but until there is a cull and re-org, it will never ever be fixed. In fact it is becoming worse.

The time to fix it was when the IMF came to town or after the 2011 election when FG/Labour held a massive majority. Massive missed opportunity.

The bureaucracy will continue to indirectly kill our citizens in the meantime.

end of the road

Eric Cartman wrote: »

The systems arent in place because of the unions, the same unions that prevent younger staff members taking on increased responsibility or training on such systems. Beurocracy and unions ensure the waste will continue unopposed.

the systems aren't in place because presumably there aren't ones available that can do the work required.
if the unions are preventing younger staff from taking on increased responsibility, then chances are it is because their members do not want to take on increased responsibility and have given such feedback to their unions.

blanch152

Miike wrote: »

If you're going beat the OECD drum at least give consideration to how the numbers for OECD are recorded and how they differ region to region (https://www.healthmanager.ie/2017/10/oecd-nurse-patient-ratios-do-not-give-the-full-picture/); one of Irelands foremost experts on the subject scratches the surface here. If you insist on beating any drum, beat the bed blocker drum, the one that's responsible for many of the failings within the current system and by far the biggest drain on our resources. This is what's making the system unsustainable.

As for part 2 of your comment about the highest remuneration, it's worth considering Ireland produces some of the most sought after graduate nurses on the planet due to the standard of the nursing education here. We have a plethora of nurse lead services in this country utilizing that education, something other countries strive so desperately to achieve. That's before we get to the topic of the reported "nurses" salaries being highly inflated due to management level positions (CNM1 through to DON *of which I think there are far too many) being included in those figures, which comes part and parcel of running these nursing lead services. This is demonstrated by foot note 1 in 8.17 of your second link (Health at a Glance 2018)

With simple surface knowledge on a topic it's incredibly easy to desktop analyse reported figures without giving due attention to, or digging deeper into what those numbers represent.

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Reading that analysis our ratio of nurses per bed must be through the roof and over twice the OECD average.

There are structural problems with the nursing service, including too many nurse managers as you allude to, but most of the structural problems have arisen as a result of INMO claims, some of which have been endorsed by the Labour Court which has no expertise in how hospitals should be run.

There is no doubt that nurses are part of the problem as well as part of the solution. Ditto doctors, the hospital porters are hardly responsible for the deluge of medical malpractice claims, are they?

Eric Cartman

end of the road wrote: »

the systems aren't in place because presumably there aren't ones available that can do the work required.
if the unions are preventing younger staff from taking on increased responsibility, then chances are it is because their members do not want to take on increased responsibility and have given such feedback to their unions.

So tue laziness is so endemic that they’re lobbying the union to not work hard ? And this is alright ?