How to improve the HSE

Squall Leonhart

I was at the A&E department in Limerick today. The wait time to be seen was 7+ hours.

This is the 3rd time in a year I've had the misfortune. Each time I've gone to a GP and been referred onwards to the hospital.

The amount of alcohol and drug related admissions are astounding, and as there's a threat to life, top of the queue. Why is there not a way to filter these cases, I don't know, maybe a designated drug A&E! That probably is an awful idea, but it's just aggravating.

There are people there who for all the world seem chirpy and chatty and as if they view the place as a social outlet.

There are staff walking around through 3+ waiting areas calling names trying to find people, losing time with each "missing" person. Why isn't there an announcement system or a board with names on it, or a number assigned like the old tax office system, keep the medical staff looking at medical issues rather than trying to track people down.

Over a period of at least 3 hours, there were 5 hospital staff members sitting adjacent to me shooting the breeze, talking about their pints and nights out, television shows, their upcoming holidays etc. Of course staff are entitled a break, but this was 5 people for several hours just hanging out in a public area.

There must be relatively simple measures that can be introduced to help. People say cut the layers of management. But to me there would appear to be a general malaise among many staff (not all) that needs to be addressed somehow.

What would you do?

jam_mac_jam

I would open a large number of small clinics that can deal with breaks and do x rays similar to the vhi clinics. Have 24 doctors so people have care out of hours. A lot of people who are there may not need full hospital care.

I would improve mental health services and care for the elderly so that you don't have people being kept in for longer then needed and being in beds so others are not delayed being admitted.

ToddyDoody

Michael O'Leary

gctest50

jam_mac_jam wrote: »

I would open a large number of small clinics that can deal with breaks and do x rays similar to the vhi clinics. .........

HSE have them :


https://www.hse.ie/eng/services/list/3/injuryunits/

Graces7

In eg Canada they have "drunk tanks" so the drunks are filtered out to be treated in a different area leaving the real needs to be treated.

Last time I was in A and E was in Kerry and exactly the same as you describe except as it was midmorning no drunks.. Heard one lady say she had spent all day there the day before... young woman who came in as I was waiting for transpprt had chest pains and no immediate attention.

The staff seemed demoralised? Just not interested in patients... And in the treatment area about six medics sitting at computers . with a watiing room full to overflowing

Bantry eg has a local injury unit that works very well and quickly.

re elderly taking up beds? see end of

https://www.breakingnews.ie/ireland/kerry-university-hospital-urges-people-to-leave-the-ed-services-for-patients-who-need-them-most-938192.html

and google " bed blocking"

I was in an acute surgical ward in Kerry and 4 of the 6 beds were old folk needing a "step down" bed ie a community hospital or nursing home bed. They apparently are there but HSE not using them?

Outsource the routine and the mundane to private clinics. If they fail to deliver or are continously unable to operate due to striking staff, strip the service from them and give it to the competition.

It will break the stranglehold unions have in the HSE.

I have experience of private health care and couldn't fault it.

_blaaz

salonfire wrote: »

Outsource the routine and the mundane to private clinic

I must say this was a fantastic sucess with the cervical check scheme and didnt end terribly atal with zero oversight

FF have a lot to answer for as regards this

RobAMerc

people seem to think the HSE is a singular entity with over arching control and power over each of it streams and specialties.
This couldnt be further from the truth.
The HSE is a series of small fifedoms each with their own governance and controls and almost invariably controlled by a group with utter disdain for the HSE who believe they know better and absolutely will not entertain seeding any control.
One thing that is ubiquitous across the organisation except for maybe the frontline staff is the total lack of care or thought for the patient. To a man, the HSE staff are looking after number 1 and secondly the organisation. The patient barely features at all in the psyche of HSE staff.

irishgeo

It's easy. GP surgery need to upgraded to deal with more tests etc that are currently done in the hospital. GP clinics should be a mini hospital in regards to tests anyway.

How many people in A + E actually need to be there.

Irishphotodesk

Simplest form of increasing productivity in the HSE, introduce a pay as you perform system, give them all a basic salary €250per week and when they complete a task within the allotted timeframe, they are given payment, if they fail to complete the task or subsequently found to have completed the task incorrectly (twice the amount given for completing the task is removed from subsequent pay)

If people are financially responsible for medical negligence cases they will be quick to ensure protocols are adhered to(this applies to all of the team involved-from admin to consultant in the persons care) also.... no person should be permitted to work over 45hours a week, absolutely no one.

_blaaz

_blaaz wrote: »

I must say this was a fantastic sucess with the cervical check scheme and didnt end terribly atal with zero oversight

FF have a lot to answer for as regards this

Thanks for proving my point.

The labs that made the errors will have lost reputation and work due to their mistakes.

When HSE staff make mistakes, or simply walk off the job, do they suffer any repercussions?

_blaaz

salonfire wrote: »

Thanks for proving my point.

The labs that made the errors will have lost reputation and work due to their mistakes.

People literally died over not having proper oversight,to me thats too high a price to pay anyway

When HSE staff make mistakes, or simply walk off the job, do they suffer any repercussions?

Yes...pretty sure doctors can be struck off medical register

SEPT 23 1989

It’s designed to fail if it worked the pigs at the trough in the private system would go hungry

most serious problems in this country health crime housing could be fixed very quickly but the people inside the tent would be out of pocket if they were solved

Never going to change

Graces7

_blaaz wrote: »

People literally died over not having proper oversight,to me thats too high a price to pay anyway


Yes...pretty sure doctors can be struck off medical register

Have you tried making a formal complaint re a doctor here? head meet brick wall.

Nearly every week there are news reports of HSE being sued for deaths etc and rare to see the drs involved being struck off.

Harry Palmr

irishgeo wrote: »

It's easy. GP surgery need to upgraded to deal with more tests etc that are currently done in the hospital. GP clinics should be a mini hospital in regards to tests anyway.

How many people in A + E actually need to be there.

Plenty of modern GP practices are quite like this - you have up to 10 GPs who between them cover a range of specialities as well as the routine stuff, do minor
surgeries, do various tests and so on.

This is my practice at the moment https://www.thekeoghpractice.ie/

Of course if they are to do more they need to be funded appropriately and I'm sure the Dept of Health prefers to pour the 'point of contact' money largely into a single pot marked HSE rather than work out how to distribute to scores of individual practices in an accountable fashion. Which brings up the cost of
visiting - GP 50 quid, A&E - free, as long as this is the case it'll be hard to clear out the dry trippers.

Rodin

Too many patients go to the ED. Could discharge half of them and no harm would come to them.

Valhallapt

Is there not a €100 fee for an ED visit?

Squall Leonhart

Valhallapt wrote: »

Is there not a €100 fee for an ED visit?

If you don't have a referral letter from a GP, yes. But it's not an upfront payment, they post a bill out. I'd warrant a majority go unpaid.

Wanderer78

ToddyDoody wrote:

Michael O'Leary

Haha, yea right, need an ambulance, log on to our site/app during your emergency, spend hours clicking on pointless ****e, unclicking 'added extras', paying through the nose for critical options, such as tyres on the ambulance, a bed in the vehicle, a paramedic etc etc! He's not fcuking god you know!

Squall Leonhart

SEPT 23 1989 wrote: »

It’s designed to fail if it worked the pigs at the trough in the private system would go hungry

most serious problems in this country health crime housing could be fixed very quickly but the people inside the tent would be out of pocket if they were solved

Never going to change

Is it really designed to fail though, or is there just unintentionally bad policies and management in place?

I'm not anti investment in hospitals, but only after some of the woeful inadequacies are addressed first. If these inefficiencies are spotted by the dogs on the street is it really so hard for policy makers to see?

Or is it as another poster said, the place is so full of different unionised factions out for themselves that it's nigh on impossible to implement a cohesive strategy? If that's the case, why can't some decisive action be taken by the government against it, sack who needs to be sacked, redeploy who needs to be moved, get the system functional and working and deal with the slew of court cases afterwards.

Graces7

Rodin wrote: »

Too many patients go to the ED. Could discharge half of them and no harm would come to them.

Are you a doctor to say that?

They cannot take that risk. every year patients are wrongly discharged and die or sue

Graces7

Valhallapt wrote: »

Is there not a €100 fee for an ED visit?

Not for medical card folk.

irishgeo

Graces7 wrote: »

Not for medical card folk.

The problem in a nutshell.

Let's just skip the GP sure he will only send us to A and E.

Should be a 100 euro for the medical card people too unless they have a gp letter.

Wanderer78

irishgeo wrote: »

The problem in a nutshell.

Let's just skip the GP sure he will only send us to A and E.

Should be a 100 euro for the medical card people too unless they have a gp letter.

so people, how may not/probably dont have 100 euro, should pay, and should go to their gp first, who may or may not be on duty, or there maybe a wait for a couple hours to seen them, in an emergency situation, and this would work just fine?

Tangatagamadda Chaddabinga Bonga Bungo

Rodin wrote: »

Too many patients go to the ED. Could discharge half of them and no harm would come to them.

I found this to be the case with regards to old folks homes. Only about a third actually need to be there, another third should be in their own house with home help and meals on wheels. And the final third should be given the option of being put out of their misery.

It's a dark stance to have but am making it from a compassionate viewpoint. If you have alzheimer's, can't recognise your own family and wake up with a sh1t in your nappy every morning there is no point in being alive. People should be given the option to end life on their own terms, and pass away with some dignity.

Off topic I know, but am hungover and wanted to make the point, as it still ties in with healthcare in this country.

irishgeo

Wanderer78 wrote: »

so people, how may not/probably dont have 100 euro, should pay, and should go to their gp first, who may or may not be on duty, or there maybe a wait for a couple hours to seen them, in an emergency situation, and this would work just fine?

It's not pay at the door, it's billed later.

Wanderer78

irishgeo wrote: »

It's not pay at the door, it's billed later.

true, but do you really think it would work, sending medical card holders to their gp first, possibly further delaying their emergency, emergencies tend be, well urgent?

Wanderer78

Wanderer78 wrote: »

so people, how may not/probably dont have 100 euro, should pay, and should go to their gp first, who may or may not be on duty, or there maybe a wait for a couple hours to seen them, in an emergency situation, and this would work just fine?

Yes people should pay, even poor people.

Just like poor people have to pay for their clothes, fuel, food, electricity, transportation, booze etc.

Wanderer78

salonfire wrote: »

Yes people should pay, even poor people.

Just like poor people have to pay for their clothes, fuel, food, electricity, transportation, booze etc.

what if you actually cant afford it? i know working people that sometimes cant even afford to go to the doctor

irishgeo

Wanderer78 wrote: »

true, but do you really think it would work, sending medical card holders to their gp first, possibly further delaying their emergency, emergencies tend be, well urgent?

Your trying to get people out of a and E who don't need to be there. A gp visit first might clear some of these.

If it's an emergency that's fine but often it's not.

The problem is people think I'll skip the GP wait of s few hours and go straight to A + E and increase the waiting time there.

Wanderer78

irishgeo wrote: »

Your trying to get people out of a and E who don't need to be there. A gp visit first might clear some of these.

If it's an emergency that's fine but often it's not.

do we have data to support this? you could be right, but....

do gps actually have the capacity to deal with this influx of people?

Graces7

Wanderer78 wrote: »

so people, how may not/probably dont have 100 euro, should pay, and should go to their gp first, who may or may not be on duty, or there maybe a wait for a couple hours to seen them, in an emergency situation, and this would work just fine?

Yep. If an emergency happens at night or in a rural area, and you call the GP chances are he will tell them to go to a and e.

If folk on a very low income were facing E100 they would not be able to get medical help in emergency. Trust me on this that there is no way someone eg a pensioner or unemployed or low income could find E100.

Amazing how the "solution" by non medical folk to the issues re a and e is to advocate barring folk or making a visit financially impossib,e rather than upgrade the service

Graces7

irishgeo wrote: »

Your trying to get people out of a and E who don't need to be there. A gp visit first might clear some of these.

If it's an emergency that's fine but often it's not.

The problem is people think I'll skip the GP wait of s few hours and go straight to A + E and increase the waiting time there.

what kind of urgent need are you thinking of? A broken bone? Vomiting blood? Chest pains?

Graces7

irishgeo wrote: »

The problem in a nutshell.

Let's just skip the GP sure he will only send us to A and E.

Should be a 100 euro for the medical card people too unless they have a gp letter.

I have done that. with a shattered wrist.. after a fall and in the wee small hours. Oh and once when I was bringing up blood I called the duty dr to be ordered to call an ambulance.

There are urgent situations that call for immediate action.

Squall Leonhart

Squall Leonhart wrote: »

How to improve the HSE

I brought my toddler to the local out of hours GP service last week, and to my surprise they told me it is now, since last April, open all hours outside regular GP surgery hours (and the service was renamed from EastDoc to EDoc). It used to close down at 10pm. This will be a fantastic improvement on 8-hour waits in Temple Street or Crumlin. I wonder is it motivated entirely by reducing A&E waiting lists? How is the HSE going to get this extra spend back financially?

Graces7

Deleted User wrote: »

I brought my toddler to the local out of hours GP service last week, and to my surprise they told me it is now, since last April, open all hours outside regular GP surgery hours (and the service was renamed from EastDoc to EDoc). It used to close down at 10pm. This will be a fantastic improvement on 8-hour waits in Temple Street or Crumlin. I wonder is it motivated entirely by reducing A&E waiting lists? How is the HSE going to get this extra spend back financially?

sounds as if they have radically reorganised the practice? always a dr on duty at night etc

Graces7

Graces7 wrote: »

If folk on a very low income were facing E100 they would not be able to get medical help in emergency. Trust me on this that there is no way someone eg a pensioner or unemployed or low income could find E100.

So how do they find 100 to pay their electric bill? Rent? Car insurance? Fuel? Food? Booze? Internet? Mobile credit?

angel eyes 2012

Wanderer78 wrote: »

what if you actually cant afford it? i know working people that sometimes cant even afford to go to the doctor

If you attend A&E and pay €100, you can claim it back from the HSE once you are admitted as an in-patient.

Wanderer78

angel eyes 2012 wrote:

If you attend A&E and pay €100, you can claim it back from the HSE once you are admitted as an in-patient.

Again, what if you don't have a €100?

Wanderer78

Wanderer78 wrote: »

Again, what if you don't have a €100?

Then how are you feeding yourself, clothing yourself, getting about, using a mobile phone, using the internet, etc?

end of the road

salonfire wrote: »

Outsource the routine and the mundane to private clinics. If they fail to deliver or are continously unable to operate due to striking staff, strip the service from them and give it to the competition.

It will break the stranglehold unions have in the HSE.

I have experience of private health care and couldn't fault it.

there is a massive difference between private health care existing along side a public system, and private health care replacing a public system as you propose in part. private health care being the only option definitely doesn't work. there also aren't going to be many companies equipped to tender in the first place.
also, given the unions have no stranglehold anywhere in this country and they exist in the private sector as well, your proposal makes absolutely no difference in that regard.

salonfire wrote: »

So how do they find 100 to pay their electric bill? Rent? Car insurance? Fuel? Food? Booze? Internet? Mobile credit?

very simple. they are paying those from their income. which is likely wiped out once they have all of those paid for. and some of those won't even be spending money on luxuries such as drink.

_blaaz

salonfire wrote: »

Then how are you feeding yourself, clothing yourself, getting about, using a mobile phone, using the internet, etc?

Free wifi/3 network data packages/second hand shops,lidl for food


Youd be suprised how many people couldnt come up.100 euro day before payday or have even 20 left over at end of week

The Rape of Lucretia

Close 10-12 hospitals. Increase consultant salaries to 250k and reduce their working hours. Close service in some others and concentrate specialties.

It really is that simple. Everyone in the business knows the above is the answer. But the general public, with a simplistic understanding of the problem, react incorrectly with horror to those actions. Local business and political opportunists exploit this wider ignorance for their own ends, making it political suicide for anyone in office to implement them. So the people of Ireland get the health service they deserve.

angel eyes 2012

end of the road wrote: »

there is a massive difference between private health care existing along side a public system, and private health care replacing a public system as you propose in part. private health care being the only option definitely doesn't work. there also aren't going to be many companies equipped to tender in the first place.
also, given the unions have no stranglehold anywhere in this country and they exist in the private sector as well, your proposal makes absolutely no difference in that regard.



very simple. they are paying those from their income. which is likely wiped out once they have all of those paid for. and some of those won't even be spending money on luxuries such as drink.

Try paying 134 euro per month for your medication for the rest of your life and the 60 euro doesn't look so harsh.

Calhoun

How to improve the HSE is a very big question as its a big bloated beast. If i personally was to do it i would start to look at a number of areas.

First being a value for money review, are we getting the best bang for our buck? Do we have duplicate roles in place that we could downsize on? Could we invest in IT infrastructure that would stream line admin roles?

Second being investing in our front line staff, making sure we have the right amount of numbers hired, put in place practices like we see in the UK where depending on the cost of living in your area you get a salary modifier to make sure your not on the breadline.

Third is to review how we handle intake on our front line, when i was at A+E with my daughter a while back in addition to the usual drink related there was also a few on the medical card. I got the impression as they are on it they just turned up without going to out of hours doctor. I would also maybe invest in the likes of a drunk tank so we aren't clogging up A+E with people who need to sleep it off.

Four we need to remove the whole trial by media process we have been going on for the past couple of years. It helps no one that people are actively engaging with the media to push for decisions on drugs ect

I know these alone will not help it but we have to start somewhere and not all problems with our health system are actually because of the HSE on its own.

KaneToad

ToddyDoody wrote: »

Michael O'Leary

The CEO of a budget airline?

At least you didn't mention the other "classic" - get rid of all the admin staff and hire more nurses/doctors.

Graces7

salonfire wrote: »

So how do they find 100 to pay their electric bill? Rent? Car insurance? Fuel? Food? Booze? Internet? Mobile credit?

Do you know how much pensioners actually get?

The idea of a power bill being E100! We live carefully.
No car. Food is the cheapest and simplest and don't drink. Any household and clothing needs are met from charity shops.

Internet a small local server and as I am housebound, it is my library my social contact, my shopping,

No idea what mobile credit is? I make almost no calls. email is better

E100 for A and E or E60 for a GP visit is not viable. Hence the medical card....nb only other way would be to raise the pension /disability allowances..

Sure it might cut some a and E queues. But then you are judging the medical condition of folk you have never met ? Had there been that fee I would have wrapped my shattered wrist and gritted my teeth, and I mean that.

Thankfully there is no such fee .Health care is a basic right and a necessity not a luxury. But then I was raised and lived in the UK and the NHS is for everyone. " from the cradle to the grave". It has as many problems ad as much overcrowding as we do here but no demands for high fees from those who have little .

Graces7

angel eyes 2012 wrote: »

Try paying 134 euro per month for your medication for the rest of your life and the 60 euro doesn't look so harsh.

Not sure what your point is here? If you are earning?

Graces7

Calhoun wrote: »

How to improve the HSE is a very big question as its a big bloated beast. If i personally was to do it i would start to look at a number of areas.

First being a value for money review, are we getting the best bang for our buck? Do we have duplicate roles in place that we could downsize on? Could we invest in IT infrastructure that would stream line admin roles?

Second being investing in our front line staff, making sure we have the right amount of numbers hired, put in place practices like we see in the UK where depending on the cost of living in your area you get a salary modifier to make sure your not on the breadline.

Third is to review how we handle intake on our front line, when i was at A+E with my daughter a while back in addition to the usual drink related there was also a few on the medical card. I got the impression as they are on it they just turned up without going to out of hours doctor. I would also maybe invest in the likes of a drunk tank so we aren't clogging up A+E with people who need to sleep it off.

Four we need to remove the whole trial by media process we have been going on for the past couple of years. It helps no one that people are actively engaging with the media to push for decisions on drugs ect

I know these alone will not help it but we have to start somewhere and not all problems with our health system are actually because of the HSE on its own.

Not sure what you mean? Nowhere I have lived has there been viable access to an out of hours dr? When you call them, the majority they tell you to go to a and e anyways. Makes perfect sense to go to a and e.

Calhoun

Graces7 wrote: »

Not sure what you mean? Nowhere I have lived has there been viable access to an out of hours dr? When you call them, the majority they tell you to go to a and e anyways. Makes perfect sense to go to a and e.

There is the out of service doctors, if those who are paying for the service have to filter through them then i don't see why those on the medical card should have to unless there is urgent care required. Just today i had to drive my wife 40 minutes away to the out of service Dr.

The people i was sitting near just commented that they couldn't go the Dr during the day so they turned up in A+E.

Its simple as, things are never going to change if we don't go through the proper in take processes.

gctest50

Graces7 wrote: »

Do you know how much pensioners actually get?

The idea of a power bill being E100! We live carefully.
No car. Food is the cheapest and simplest and don't drink. Any household and clothing needs are met from charity shops.

Internet a small local server and as I am housebound, it is my library my social contact, my shopping,

No idea what mobile credit is? I make almost no calls. email is better

E100 for A and E or E60 for a GP visit is not viable. ...............................

might want to check

13160 pension

420 electricity allowance

468 living alone

660 coastal island allowance

30 phone allowance

630 fuel allowance

160 tv licence

300 waste


€ 15828