Why is Ireland's healthcare system in shambles?

mr_fegelien

I remember last year being sent a letter by the HSE that my appointment for a nose operation which I had requested for when I was a minor (16yrs old in 2014) was due in a month. I cancelled it.

These stories aren't uncommon. I have private health insurance but even then things like visiting a GP are expensive €60+ only for them to tell you that everything is fine when it's not. This doesn't happen in any other European country.

Don't get me wrong, Ireland has great facilities. I was scheduled on a private insurance for an MRI scan 3 years ago that only cost €200. But for public patients, the waiting list is horrendous.

And our government wants to build the most expensive children's hospital in the world here. What gives?

FintanMcluskey

The unions and the work strategies they indoctrinate.

Nothing else

StevenToast

Good old mr fegelien...the king of boards.ie....

Too many chiefs, not enough Indians.

Money being siphoned by private insurance.

da_miser

mr_fegelien wrote: »

I remember last year being sent a letter by the HSE that my appointment for a nose operation which I had requested for when I was a minor (16yrs old in 2014) was due in a month. I cancelled it.

These stories aren't uncommon. I have private health insurance but even then things like visiting a GP are expensive €60+ only for them to tell you that everything is fine when it's not. This doesn't happen in any other European country.

Don't get me wrong, Ireland has great facilities. I was scheduled on a private insurance for an MRI scan 3 years ago that only cost €200. But for public patients, the waiting list is horrendous.

And our government wants to build the most expensive children's hospital in the world here. What gives?

You where put on the long finger because nothing was really wrong with you, a requested nose job because of vanity, bottom of the waiting list, and rightly so.
If you need it the medical procedures will be fast tracked, if you want a nose job pay for it yourself, tax payer is put to the rack for vanity in this country.

JohnnyFlash

It's not.

Ireland is having the same issues as the rest of the mature social democracies we are part of. People are living longer because they had better lives under social democracy - better access to medicine, treatment, and follow-up care. We now have loads of lovely healthy people in their 70's, 80's, and 90's. Bully for them to be honest.

But the figures aren't really stacking up. Someone has to keep paying for our health system, and they aren't.

Society - complex.

c.p.w.g.w

Because the unions are too strong...if we could get rid of the majority of admin staff we could hire more nurses, Dr's & open more beds

SEPT 23 1989

Like the legal system

Follow the money

If there was money to be made in fixing the problem it would be easily done

Too many snouts in the trough making money off broken systems

JohnnyFlash

c.p.w.g.w wrote: »

Because the unions are too strong...if we could get rid of the majority of admin staff we could hire more nurses, Dr's & open more beds

Ya, because replacing all admin and management layers in a health service would be a great idea.

c.p.w.g.w

JohnnyFlash wrote: »

Ya, because replacing all admin and management layers in a health service would be a great idea.

Not all of it...there is plenty of staff who aren't needed, my mates mother's works in one hospital and there are 3 of them working the same desk...they literally spent most of their days watching Netflix...well pre Covid19 that is

Heighway61

The suits need to be fed first.

JohnnyFlash

https://en.wikipedia.org/wiki/List_of_countries_by_Human_Development_Index

ronivek

c.p.w.g.w wrote: »

Not all of it...there is plenty of staff who aren't needed, my mates mother's works in one hospital and there are 3 of them working the same desk...they literally spent most of their days watching Netflix...well pre Covid19 that is

I’m sure that really happened and isn’t a complete fabrication by either you, your friend, his mother, or some combination of the three.

screamer

Run by the pen pushers for the pen pushers.
Unionised to the hilt, too much red tape and successive politicians lacking the b@lls to fix the root causes for years now. Too many people wanting it all for free, and over reliance on fleecing private patients to prop up their public hospital bills. Mostly, too many snouts not enough trough.

c.p.w.g.w

ronivek wrote: »

I’m sure that really happened and isn’t a complete fabrication by either you, your friend, his mother, or some combination of the three.

Not the only person i'm hearing it from...Certain their was a report doing the rounds from a few years ago and showed a certain percentage of admin staff could be reduced as they aren't needed, if work practices are streamlined...

I know in one particular county council that most of the jobs will not exist once lads retire...new positions will be created to amalgamate positions together...Streamlining of positions...FIL is currently training his replacement, we the person who will be taking over his tasks on top of additional tasks from another role that will no longer exist

FintanMcluskey

FintanMcluskey wrote: »

The unions and the work strategies they indoctrinate.

Nothing else

Supporting evidence?

I would suggest its the complete over use of the system for minor issues.

redzerdrog

HSE from top to bottom has the be one of the most disjointed operations ever

AllForIt

Because all state health care systems are socialist minded, and socialism doesn't work.

Hibernicis

Very poor management combined with endless political interference.

JohnnyFlash

redzerdrog wrote: »

HSE from top to bottom has the be one of the most disjointed operations ever

It's not though.

It's a highly effective health care delivery system. Far better than the health boards that preceded it. We have world class outcomes in cancer care. We are world leaders in the treatment of most soft tissue related cancers.

I'm not sure people really get how good we have it compared to almost every other country in the world.

AllForIt

Hibernicis wrote: »

Very poor management combined with endless political interference.

Because it's not run as a business. Just full of managers with aimless objectives without any financial responsibilities.

You stick the financial concern in there and everything changes.

Social health care does not work. It's idealist fantasy.

There is no point in complaining about the management when the management don't have a financial objective.

completedit

One problem I think, well no, just one feature of the health system that I think we as a society need to move on from is the lionizing of nurses. They do good and valuable work and more power to them but there needs to be more perspective when they start pulling our heart strings about worker conditions. Yes, nurses will go to Australia or Dubai or Canada and make more but we can't compare our wages to some random countries nurses happen to decide to go to for a lifestyle change. How do we compare respect to our European neighbors should be the yardstick.

The point about the nurses is just an observation. The main point is we need to be realistic and drop this 'only in Ireland' mindset. As an above poster said, we have it good and I think people should realize this more often than not. It's my belief that we had a generation who live in glocamora land. While the rest of Europe was being bombed into oblivion, we were living in Dev's sheltered Ireland and as a result, we're a bit mollycoddled. We had tough times but not to the depths that they experienced on the continent.

completedit

completedit wrote: »

One problem I think, well no, just one feature of the health system that I think we as a society need to move on from is the lionizing of nurses. They do good and valuable work and more power to them but there needs to be more perspective when they start pulling our heart strings about worker conditions. Yes, nurses will go to Australia or Dubai or Canada and make more but we can't compare our wages to some random countries nurses happen to decide to go to for a lifestyle change. How do we compare respect to our European neighbors should be the yardstick..

Starts off by suggesting we need to stop having unrealistic views of people doing a job most wouldnt touch.

Then follows by saying we shouldnt compare to nations salaries that are close to ours in most respects

Then finishes by suggesting the correct view is to compare to other european countries with salaries and costs of living that are half what ours are and would result in private salaries being decimated if done across the entire board.

You couldnt afford an average Irish mortgage on a Spanish or Bulgarian salary

Dempo1

It is a shambles, I had first hand experience of a general hospital right in the middle of the main lockdown, Broken limb to be precise. Whilst the care generally was excellent apart from an incident that led to a formal complaint, I was sent home after a temporary fix up to await an operation at a private hospital 150km away and 3 days wait, again great experience there.

Here's the bit I don't get, the general hospital had 3 patients, me being one, it was empty, I get the covid restrictions but this was being dealt with in designated wards. On the follow up, 4 weeks later, life appeared to be getting back to normal but still empty and certain services, xrays etc not available beyond absolute emergencies, essentially my recovery time went from 6 weeks to over 12 weeks. I got a real sense they didn't want me there, get them in, get them out.

As an aside, I have a condition that requires clinic appointments every 3 months, again now stopped with a quite bizzare telephone consultation replacing physical appointments . Again, clinic is seperate to but located at a general hospital and protocols could easily be put in place. I sympathise with people who have more serious conditions than I, such as cancer etc. It is just beyond belief the HSE essentially emptied their hospitals and have now created an enormous back log of people awaiting tests and indeed ongoing care. History shows us this will take years to resolve, it's just madness and alarming.

PhilOssophy

c.p.w.g.w wrote: »

Not the only person i'm hearing it from...Certain their was a report doing the rounds from a few years ago and showed a certain percentage of admin staff could be reduced as they aren't needed, if work practices are streamlined...

I know in one particular county council that most of the jobs will not exist once lads retire...new positions will be created to amalgamate positions together...Streamlining of positions...FIL is currently training his replacement, we the person who will be taking over his tasks on top of additional tasks from another role that will no longer exist

They won't exist......not so sure. The unions will insist that these people be replaced. This is a problem across our public sector, the unions won't want to lose a paying member so lets charge the tax payer for somebody who is not needed.

JPCN1

Hibernicis wrote: »

Very poor management combined with endless political interference.

Dept of Health.
HSE.
Unions.
Politicians.

If it ever is to be fixed the Party that does it will be wiped out in the next election.

The National Children's Hospital has to be one of the most depressing episodes in many a year.

Gorteen

Management incompetence
Political interference
Overly complex systems and layers of administration
Union dogma, "the answer's no....what's the question"
Striving for excellence when safe and sufficient is more realistic
Too many strategy documents with limited implementation

mr_fegelien

JPCN1 wrote: »

Dept of Health.
HSE.
Unions.
Politicians.

If it ever is to be fixed the Party that does it will be wiped out in the next election.

The National Children's Hospital has to be one of the most depressing episodes in many a year.

Can someone explain to me what is exactly wrong with HSE management? How does it compare to how other state health bodies are run in other countries?

Eric Cartman

Breaking the unions and sacking most middle management and admin staff is the only way to fix it

crossman47

Gorteen wrote: »

Management incompetence
Political interference
Overly complex systems and layers of administration
Union dogma, "the answer's no....what's the question"
Striving for excellence when safe and sufficient is more realistic
Too many strategy documents with limited implementation

You forgot one of the biggest of all - our own attitudes. I include those who head straight for A&E for minor issues and those who want a hospital in close proximity. Our cancer treatment is top class because a Canadian (Prof. Keane) insisted on centres of excellence and, in fairness, he got political backing from Mary Harney.

noodler

c.p.w.g.w wrote: »

Because the unions are too strong...if we could get rid of the majority of admin staff we could hire more nurses, Dr's & open more beds

We keep pumping up numbers across the board actually and the same problems persist

lalababa

2.4 million workers, average earnings 37k. That's 88million. Social welfare bill is around 20 million but don't know the breakdown is how much are hand outs. Irish examiner says '20 million in payments' and 1.3 million in receipt on behalf of 2 million people.
Let's say 20 million.
Add all up and it's 108 million.
Healthcare spend per capita in nearing 3k. And 20 billion in total. This apparently includes VHI spend ie both public and private, and both types of retirement homes (??)
If Ireland went universal (fully public)
I'd say costs would rise 'coz we all know public will cost more than private. Let's say 25 billion. That would be a 23% cost to earnings. Ie everyone with ANY income would pay 23% towards healthcare. I personally wouldn't mind as long as perhaps the new system and services were privately managed in an efficient manner perhaps bringing down that % to under 20.
Any thoughts on these figures... they're probably naively simple and just plain wrong..:)

piplip87

When they brought in the HSE they merged all the health boards except that would obviously lead to job losses. Yet with unions you had many people essentially doing the same job. This led to major waste of public money.

Also there are too many small hospitals doing feck all, they are essentially just hotels for sick people waiting to be transferred to larger hospitals. Any attempt to close these is met with fierce local opposition as they provide jobs and comfort.

The main problem is lack of GP's. I know in my area you can wait for up to two days for a GP appointment. Some people may not even bother heading for a GP and go straight to A&E which in turn clogs up the department.

I think we need massive investment primary care and primary care centres. More GP's and cut the cost of GP visits

As for waiting lists Micheal Martin brought in the National Treatment Purchase Fund when minister for health and this has a proven track record of reducing wait times and getting people the care they need. The left don't like it because it gives money to private hospitals but infairness if you need a procedure done you don't care where the money is going. This should be funded along with more funding for public services and public hospitals.

PhilOssophy

PhilOssophy wrote: »

They won't exist......not so sure. The unions will insist that these people be replaced. This is a problem across our public sector, the unions won't want to lose a paying member so lets charge the tax payer for somebody who is not needed.

Again, largest union in the country is for private sector. Majority of unionised staff are private sector. Last 3 industrial actions have been in the private sector including the last outright strike.

lalababa

lalababa wrote: »

2.4 million workers, average earnings 37k. That's 88million. Social welfare bill is around 20 million but don't know the breakdown is how much are hand outs. Irish examiner says '20 million in payments' and 1.3 million in receipt on behalf of 2 million people.
Let's say 20 million.
Add all up and it's 108 million.
Healthcare spend per capita in nearing 3k. And 20 billion in total. This apparently includes VHI spend ie both public and private, and both types of retirement homes (??)
If Ireland went universal (fully public)
I'd say costs would rise 'coz we all know public will cost more than private. Let's say 25 billion. That would be a 23% cost to earnings. Ie everyone with ANY income would pay 23% towards healthcare. I personally wouldn't mind as long as perhaps the new system and services were privately managed in an efficient manner perhaps bringing down that % to under 20.
Any thoughts on these figures... they're probably naively simple and just plain wrong..:)

Yep, electricity and phones went down when privatised.

Health for profit instead of actually costing less than the cost of providing the service would certainly mean a reduction in costs.

The only time a private company reduces it's charges is as a result of competition. When there's a monopoly, they gauge.

storker

My OH got a temporary bump from Staff Nurse to CNM2 while she took over a section while the incumbent was on transfer somewhere else. While she was there she made several improvements and provided more services to a greater number of patients. Then she had to step away when the person who "owned" the role came back saw from a distance her improvements being neglected. She was bumped back down to staff nurse and put in a section where she has seen some scope for improvement but has no authority to effect any, and has experienced resistance any time she has made suggestions. She was one of the few in her section to volunteer to nurse COVID-19 patients.

I think this says a lot about what's wrong with the HSE.

Edgware

[Deleted User] wrote: »

Too many chiefs, not enough Indians.

Money being siphoned by private insurance.

But a lot of the doctors are Indian.

Mad_maxx

Requires a sea change in attitude from the public too ,we have far too many small and unfit for purpose regional hospitals that swallow massive amount of resources

God help any politician who suggests closing them however

FHFM50

da_miser wrote: »

You where put on the long finger because nothing was really wrong with you, a requested nose job because of vanity, bottom of the waiting list, and rightly so.
If you need it the medical procedures will be fast tracked, if you want a nose job pay for it yourself, tax payer is put to the rack for vanity in this country.

The HSE would never pay for a nose job. It was probably a sinus surgery that wasn't urgent.

PhilOssophy

Mad_maxx wrote: »

Requires a sea change in attitude from the public too ,we have far too many small and unfit for purpose regional hospitals that swallow massive amount of resources

God help any politician who suggests closing them however

That is nonsense, why not have people getting routine surgeries locally if they can? It is fine to say close the regional hospitals, but then you have a crazy situation where people are dying in ambulances because they can't be got to a hospital on time.

Mad_maxx

PhilOssophy wrote: »

That is nonsense, why not have people getting routine surgeries locally if they can? It is fine to say close the regional hospitals, but then you have a crazy situation where people are dying in ambulances because they can't be got to a hospital on time.

It's anything but nonsense,it's a waste of resources having under used services in sparsely populated area's

Geuze

ronivek wrote: »

I’m sure that really happened and isn’t a complete fabrication by either you, your friend, his mother, or some combination of the three.

It is well known that when the 8 Health Boards merged into the HSE in 2005, not a single job was lost.

Bertie Ahern did a deal with the unions

So there is massive duplication and waste.

All well known.

Two groups run the HSE - the doctors and the unions.

A HSE manager is not a manager like a Tesco, Aldi or Vodafone manager.

Geuze

Mad_maxx wrote: »

Requires a sea change in attitude from the public too ,we have far too many small and unfit for purpose regional hospitals that swallow massive amount of resources

God help any politician who suggests closing them however

Yes, 50-53 hospitals does seem too many.

Water John

Don't think you can say, it's a shambles. Lots of beauracratic problems and poor management. But get seriously ill and you'll get a world class service for free.

mr_fegelien

Water John wrote: »

Don't think you can say, it's a shambles. Lots of beauracratic problems and poor management. But get seriously ill and you'll get a world class service for free.

What's so poor about the management?

Can anything genuinely be done to fix it? I don't think those in charge are just lazy. There has to be a reason.

YellowBucket

Geuze wrote: »

Yes, 50-53 hospitals does seem too many.

We’ve far too many hospitals in general.

I mean it’s insane that the only hospital that meets class 1 trauma centre requirements is CUH in Cork because it can cope with neurosurgery, cardiothoracic, major spinal and orthopaedic stuff etc etc all on one site.

Even in Dublin none of the hospitals can do that because there’s a mini empire around each of them and they three medical schools and a bunch of religious orders that can’t see eye to eye on anything. That’s how we ended up with the tug of war and budgetary management fiasco over the children’s hospital.

You probably realistically need to limit serious complex medicine to centres in cities with serious medical school and hospital back up : Dublin, Cork, Limerick & Galway (sorry Waterford.) and in Dublin they need to be amalgamated and reorganised into maybe 3 focal hospitals.

Beyond that anything else should be really just for minor stuff, or dealing with plans that are worked out from one of those centres. Like it should be feasible to deliver say chemotherapy in any hospital and have it coordinated out of Dublin, Cork etc

We also need to pull money into primary care and stop with the nonsense of GPs referring people to A&E.

The big issue in Ireland actually stems from how the health care system evolved. We never really had a healrhcare system, rather it was a hospital system and that was driven by the fact that the majority of funding historically came from the Irish Hospital Sweep Stakes. There was no money for primary care or any of the non hospital aspects and that’s how the system then evolved entirely lob sided.

The mix of NHS like Beveridge model of direct provision and optional, but hugely widespread insurance makes no sense either.

We should have morphed the state owned VHI into a universal health insurance system like those in much of continental Europe. Instead we’ve become sort of lost between the two models.

Have a read of Prof. Mary E. Daly’s paper on it.

http://historyhub.ie/the-curse-of-the-irish-hospitals-sweepstake

The fact that we haven’t managed to get our heads around resolving this mess is an absolute indictment of Irish politics, public policy and public discourse though.
We have no excuse whatsoever for getting this so badly wrong. We have had decades as a very rich country and we also have underperformed, even relative to countries with far fewer financial resources.

nthclare

mr_fegelien wrote: »

What's so poor about the management?

Can anything genuinely be done to fix it? I don't think those in charge are just lazy. There has to be a reason.

Just so much red tape and another problem is procurement.
I could order something on Amazon and it would arrive at my house in a day or two.
Procurement in the public sector is like a relay that lasts a week but could be done and dusted in two click's.

First you have to go through a catalogue from the company the public sector is a buyer from, say you want to order PPE like a box of gloves.
Well it could take a week to order the box of gloves because you have to go to your supervisor then they the manager, they say they'll think about it.
Then to accounts to get money, then to procurement, then there's a back log in procurement, then eventually procurement gets back to the accounts,manager, supervisor and you to say that they'll get the gloves,then the same process again, eventually you'll get to the gloves but the wrong size... and the procedure start's all over again...
Absolute bolloxing around...

They'll all-in it together, there's huge paper work and meetings lot's of meetings about nothing.

The majority of them sit at a meeting hoping they'ed be swallowed up by the ground.
Listening to someone who loves getting well paid for basically doing nothing.

PhilOssophy

Mad_maxx wrote: »

It's anything but nonsense,it's a waste of resources having under used services in sparsely populated area's

Depends where you are ending the cull though, are you proposing that every small hospital be closed and we end up with 5-6 super hospitals in Dublin, Limerick, Cork and Galway? I think that would be crazy.

Shefwedfan

c.p.w.g.w wrote: »

Not all of it...there is plenty of staff who aren't needed, my mates mother's works in one hospital and there are 3 of them working the same desk...they literally spent most of their days watching Netflix...well pre Covid19 that is

My mates mother :-)

Ever think she is watching Netflix because she is lazy? Nothing to do with HSE and she just won’t do her job?

Even watching Netflix is breaking all the HSE network regulations and the network is locked down so she can’t do that. So unles watching on her phone that’s not true

I have found before,might not be the case here, that you will find the person has loads of work but will sit on ass and someone else will just get on with it and do it, otherwise it never gets done. This happens everywhere, good people covering for lazy people

Mad_maxx

PhilOssophy wrote: »

Depends where you are ending the cull though, are you proposing that every small hospital be closed and we end up with 5-6 super hospitals in Dublin, Limerick, Cork and Galway? I think that would be crazy.

Why?

Money can be diverted to more local advanced primary care clinic's for routine stuff, GP clinic's have an extremely limited service in Ireland

You could also invest in a better air ambulance service for those living in more rural areas for speedy transfer to hospital, i lived in Canterbury new Zealand years ago, hospital was 120 km away, air ambulance was method of transfer for emergencies

Former Former

PhilOssophy wrote: »

Depends where you are ending the cull though, are you proposing that every small hospital be closed and we end up with 5-6 super hospitals in Dublin, Limerick, Cork and Galway? I think that would be crazy.

That's pretty much exactly what you should do.

You don't need to close them all but they should be downgraded substantially, so that they would be basically primary care centres and if you need something more specialised you go to a bigger town.

You'd obviously need more than 5 or 6 but the current model is not right.