The health service - most damning report yet

BrianD3

Unplanned (i.e. through A&E) care in 9 hospitals in 2018/2019 has been reviewed. The findings should be shocking, but umm, they aren't for anyone with direct experience of our death, sorry health service.

https://www.rte.ie/news/health/2022/0404/1290134-health-review/

No clear understanding of who was providing the patients' care.

"Safari rounds" ( I think that means walking around hospitals looking for patients scattered around the hospital)

Harm introduced through non specialist care.

Hospitals not operating a 24/7 care model

Problems at weekends

Not appearing to provide safe and effective care

Hospital staff didn't know who was in charge

Unsafe

etc.

The HSE didn't want the report published as they claim it is no longer relevant due to changes being made since. Absolute bull, of course it is relevant. I await the spin about how the problems in the health service are mainly due to Covid and how it was out of their control. Now everyone wear a mask and keep your distance.

As for the strategy to shift demands to the community - care in the community, from homecare to physiotherapy to public health nursing to nursing homes - shambolic.

Also, re: the 9 hospitals reviewed, IME there are even worse hospitals out there such as the Eye and Ear and Mayo General.

A few years ago, two of my close relatives died after attending A&Es in different public hospitals for conditions that while needing urgent attention, would not normally be expected to result in death in a modern health system. I suppose they were just "unlucky".

That's two in one small family, There must be thousands of others who have experienced similar, the death toll from this may well dwarf the death toll from Covid.

And yet, six figure salaries and fat pensions will still be paid. The HSE is in existence since 2005, that should have been our "NHS moment" but 17 years later, here we are. How much has been paid to a succession of Ministers, Dept of Health officials and HSE senior people in those 17 years. This serpent has many heads.

"

The HSE response is at the bottom of the linked article.

“In opting not to publish the report in 2020, the HSE told the Department of Health that the benefit of releasing the report has significantly diminished in that its principle recommendation was to accelerate the implementation of the Capacity Review of 2018 and that many measures had been put in place since.

HSE Chief Operations Officer Anne O'Connor told the Department of Health that the review had been conducted at a particular point in time, during 2019 and "prior to the impact of the learning from winter 2018/2019".

She said the findings of the review were largely predictable and reflective of work already under way, including shifting demand to the community.

Ms O'Connor said that the relevance and usefulness of the findings of the review had been considered in the context of the accelerated improvements made to deal with Covid-19.

"Therefore, the HSE has taken a decision not to proceed to finalisation and publication of a report that no longer has relevance," she told the Department of Health.”

cnocbui

I am emigrating, and the HSE and Irish health care system would be quite high on my list of reasons for doing so. I doubt ireland is capable of fixing it as facing and dealing with uncomfortable facts isn't an Irish thing.

blanch152

https://www.boards.ie/discussion/comment/118878942#Comment_118878942

Unfortunately you could be correct in that we are incapable of fixing it.

The HSE has been bedivilled by poor work practices protected by intransigent unions and stupid pay deals such as the one that created nursing management grades and promoted nurses who were actually good at nursing into a management job they weren't good at, therefore making both the nursing and management grades worse.

There are also societal issues. 75% of the people who turned up at A&E didn't need to be admitted and could have been treated in the community. Why are people turning up like that? It is madness. That isn't on the HSE, that isn't on the nurses, that isn't on local management or A&E Departments, it is on the people who turned up and the GPs who sent them.

cnocbui

https://www.boards.ie/discussion/comment/118878995#Comment_118878995

The problems are top to bottom and start with GP's and that whole system which is slow, paper based and stupidly inefficient. The whole mess starts with the education system where the medical profession have been allowed to control the whole mess and have used it to restrict the number of doctors who are educated. My local general practice is so overloaded they don't take on new patients and the turnover of Doctors seems quite high.

In other countries, it's possible for patients to directly access specialists, that isn't the case here, and it's just so inefficient, costly and time wasting.

I remember moving into my current house in 2002, and listening to the news while in the kitchen and hearing about patients on trolleys at Limerick regional. 20 years later and every year in between, it's still the norm. Other countries I can think of wouldn't tollerate that and the governments would have realized a need for greater capacity and would have provided it.

The HSE attitude to the report is typical - sweep it under the caprpet while saying no need to worry, that's all in the past, the problems have been solved, thing aren't like that now. Same sort of nonsense that's characterized how Catholic church attrocities have been dealt with by sweeping them under the carpet.

blanch152

https://www.boards.ie/discussion/comment/118879111#Comment_118879111

We spend huge amounts of taxpayer money per capita on the health service. It isn't a case of money, it isn't a case of politicians being able to fix it either, no legislation or Ministerial direction will change the poor quality of nurse management and poor practices on the ground by frontline staff, neither will it stop idiots turning up at A&E on a Friday night, just needing to sleep off drink and drugs.

cnocbui

https://www.boards.ie/discussion/comment/118879135#Comment_118879135

Absolutely. Ireland has one of the highest expenditures on healthcare in the OECD and the worst outcomes. Everyone knows that a large portion of the money is just a torrent of € going into the pockets of the HSE management layer that is hugely overpopulated and mostly unnecessary, but it's one of those generally known uncomfortable truths Ireland can't mentally deal with or openly and publicly acknowledge .

In Australia they would have been made redundant two decades ago. Here? - not a chance. The government can't get it's head around the civil sector being over financed compared to what is delivered, when compared to the norm in the EU or OECD.

Ireland doesn't do 'consequences'. I will always remember a few years ago a newspaper article about the national childrens hospital mess, where the minister for health said something like 'there needs to be an enquiry into matters, but it's important that a core element be that no individuals are to be identified, reported on or actioned.'

Hopeless - I'm off.

Ireland second-highest OECD health spending, poorest outcomes

blanch152

https://www.boards.ie/discussion/comment/118879195#Comment_118879195

With a problem that big, no Ministerial direction or legislation can solve it.

A lot of it comes from organisational behaviour, a culture of poor performance that permeates the health service right down to the frontline.

https://www.boards.ie/discussion/comment/118878995#Comment_118878995

I got into a minor Twitter spat sone time ago when I responded to a Tweet that went like this: woman who had attended GP (who didn’t seem to attempt to fix her problem or refer her to a specific outpatient centre) said “if you are uncomfortable go to A&E”. Which she did. She registered in, saw triage nurse, waited 6 hours and left in protest. Seems she got better without further attention toon. But the Tweet was protesting at the fact she was sent a bill for attending, and wasn’t seen to before she got fed up. I replied that A&E is for people who are really too unwell to be able to walk out at their convenience.

A male tweeter retorted in this fashion: “ very unfair of you to say that, I have to fit in my A&E visits between collecting children from school”. Again I countered that he should be attending his GP for stuff that can be slotted into a time frame if his convenience and that attending A&E in that fashion, taking up space and walking out because you have done where else to go, really is not appropriate and part of the problem of A&E overcrowding.

kirk.

https://www.boards.ie/discussion/comment/118878995#Comment_118878995

People are turning up at a+e because of the GP issues, delays getting appointments

Also the out-of-hours service is scaled down and it's simply handier to present at a+e out-of-hours ,here a+e is much nearer destination

Also the docs on the out-of-hours tend to refer you to a+e for minor stuff anyway as a precaution so it was simpler to bypass them anyway

There's a couple of reasons anyhow plus the hypochondriacs with medical cards

kirk.

Has Donnelly even said anything about solutions aside from hiding behind covid

I really don't recall him saying much of substance on the hse

Ubbquittious

How hard do they need to damn before something gets done about it?

Fandymo

https://www.boards.ie/discussion/comment/118878995#Comment_118878995

Where do you go in the community after 6pm or on a weekend if something happens??

blanch152

https://www.boards.ie/discussion/comment/118879416#Comment_118879416

Two excellent examples of the problems I am talking about. If someone is able to collect their kids from school, they don't need to be in A&E.

There’s a certain “illness culture”, more particularly among women (I am a woman btw, I’ll get my coat now 😂) that is of the belief that if you imagined you were sick enough to attend hospital then you must be taken very seriously. In some people’s minds it’s an “upgrade” in how others will view the importance of your suffering.

An example from some time back. Somebody I worked with was telling me about her daughter’s visit to A&E. I expressed due concern and hoped she was ok etc, and asked what was the matter. She had diarrhoea after eating something that was out of date. Now most people will stay at home beside their bathroom, take dioralyte, or Imodium from the medicine drawer or nearest pharmacy, stop eating for a bit or take light food.

There was no blood loss or extraordinary pain in her case. Just an unpleasant episode. I diplomatically enquired why she might not have taken care of it at home, the reply was that she “would surely need a drip”. Instead this extremely fit & healthy twenty something year old girl brings what could have been highly contagious Norovirus into a hospital of much sicker people who are undergoing surgeries etc and could be doing without that added misery.

Dyr

https://www.boards.ie/discussion/comment/118878942#Comment_118878942

If there's an Irish national charectaristic it's complacency, so long as the next lad is getting rode like you, it's all fine.

Dempo1

https://www.boards.ie/discussion/comment/118878915#Comment_118878915

Anne O Connor asked that this report not be released but shortly after it was it followed by an announcement she's heading off to the VHI to become Managing Director.

Paul Reid spoke of her wonderfulness generally and offerred a glowing analysis of her time in the Health sector.

Former Director of Mental Health 🙄

National Director of Community Based Health & Care 🙄

I'll leave others to decide how those assignments went.

Anne Led the Spin operation throughout the Pandemic very efficiently, one wonders who Paul Reid will have holding him up after she leaves.

https://www.irishexaminer.com/news/arid-40844015.html

Only in Ireland is Abject failure rewarded so handsomely

Dempo1

https://www.boards.ie/discussion/comment/118879563#Comment_118879563

I don't ever recall him saying anything of Substance, ever 😏

c.p.w.g.w

https://www.boards.ie/discussion/comment/118878995#Comment_118878995

Well if I need a GP appointment, I will typically be waiting 6-15 days for an appointment, they don't open weekends, close for 2.5 hours for lunch...

That's were the issue lies, also many GP's and primary care facilities use Covid19 to reduce access to services from my experience

babyducklings1

The system is so broken that people are being turned away when they try to register with a gp!

blanch152

https://www.boards.ie/discussion/comment/118879960#Comment_118879960

That only proves my point that throwing more money at the HSE and hospitals isn't the solution.

Developing community care and reducing the numbers of nurses in hospitals is a better solution.

Dempo1

https://www.boards.ie/discussion/comment/118880018#Comment_118880018

That's primarily because of the Lack of Gp"s rather than the system being broken but I do agree the system is broken.

It amazes me that after decades and multiple billions given to the Health Service, the same annual excuses given.

It's not lack of funding thats the problem it's how that funding is being managed or more likely miss managed.

The Pandemic shown a bright light on the Senior Management Team at the HSE and some of the stuff they spun was simply beggar's belief.

blanch152

https://www.boards.ie/discussion/comment/118880137#Comment_118880137

It is not just the senior management team, the culture of non-performance goes right through the organisation down to the bottom, with the first-line and middle managers probably the worst of all.

cuttingtimber22

https://www.boards.ie/discussion/comment/118879195#Comment_118879195

Does that expenditure include private health insurance?

Dempo1

https://www.boards.ie/discussion/comment/118880145#Comment_118880145

I absolutely agree with Middle management a serious problem . They seem to be incapable or more likely unable to make day to day decisions.

https://www.boards.ie/discussion/comment/118879960#Comment_118879960

Just because they are closed to appointments for 2.5 hours does not mean they are at lunch

Strumms

I’d like to see reports done regarding a&e attendances whereby we find out what percentage of people turning up, quite simply don’t need to be there…I doubt the HSE would be forthcoming with that info, there’d be war…

https://www.mater.ie/patients/emergency-department/

https://www.boards.ie/discussion/comment/118879960#Comment_118879960

All GPs will see an ill patient. If you can wait 6-15 days, you’re not ill. Doctors are still working when they’re officially closed. Ringing patients, reviewing blood and other test results.

Then at weekends there’s the out of hours service, here in Clonmel, Caredoc.

blanch152

https://www.boards.ie/discussion/comment/118880603#Comment_118880603

It is in the report, 75% of those who turned up at A&E didn't need to be there. No wonder they are under pressure.

Fasano

Every single function of this state is broken, be it Health, justice or Education. Yet somehow the heads of those functions all earn over €200,000 per year.

With regards Health, we have the head of the Department on a self appointed €292k and the head of the HSE on €411k and yet last night, over 500 people spent the night on trolleys or temporary beds because there were no beds available.

This will never be sorted out, because it is so deeply ingrained in the public sector here, short of a dictator coming in and ripping up the rule books, any politician who even tries to address this will fail miserably.

BrianD3

https://www.boards.ie/discussion/comment/118883177#Comment_118883177

It goes beyond normal public sector incompetence. Every HSE senior executive, hospital consultant, DOH official, Minister for Health, GP etc is practically guaranteed to have private health insurance for themselves and their families. And not basic plans either.

PHI won't necessarily help them in an emergency situation but it does insulate them from much of the rest of the sh1tshow that is our public health service.

Salaries will be paid unless they kill someone directly. Indirectly killing thousands of people through inaction - no consequences.

Floppybits

https://www.boards.ie/discussion/comment/118882223#Comment_118882223

What do they mean that they didn't need to be there? Did they not need to be there because what ever ailment they had could have been handled outside A&E but they people were in A&E because those services were not available at the time like after 6 in the evening or the weekends?

Would anyone who is not really seriously sick or injured go to A&E and sit there for god knows how long to seen? Speaking for myself I would need to be seriously ill/injured to even contemplate going to A&E, I could think of nothing worse than being stuck on a chair waiting hours to be seen when not being seriously ill/injured. In my case I will go to somewhere like Roc Doc and in saying that the last time I went to Roc Doc they told me that I needed to go to A&E right away as I needed to be on a drip so even if you do try to avoid A&E the facilities are not there to do that.

So for those 75% of people who are turning up to A&E, I assume they are not going there for the fun of sitting in a chair for hours on end but believe that there is something wrong and need to see someone as soon as possible.

c.p.w.g.w

https://www.boards.ie/discussion/comment/118880937#Comment_118880937

I rang a few weeks ago with gastro symptoms, was told only available appointment was a week away, explained my symptoms and told to go to A&E, went to A&E waited 8 hours and when I told the Dr dealing with me...he said, my GP should have seen me straight away and they would have been able to rule out anything serious within 5 minutes and take bloods from me to allow for further diagnostic tests...

For the record I only go to the Dr when I'm really sick o

c.p.w.g.w

I rang a few weeks ago with gastro symptoms, was told only available appointment was a week away, explained my symptoms and told to go to A&E, went to A&E waited 8 hours and when I told the Dr dealing with me...he said, my GP should have seen me straight away and they would have been able to rule out anything serious within 5 minutes and take bloods from me to allow for further diagnostic tests... everything came back clear, was just a bad dose of gastroenteritis...

For the record I only go to the Dr when I'm really sick or for routine check ups, not like I'm ringing the GP looking for appointment every other week

https://www.boards.ie/discussion/comment/118883697#Comment_118883697

Some go because there's no other option, some go for something to do. Good while ago now I was waiting ages in an emergency department with an asthma attack. 6 hours and all they offered me was an inhaler I already had. About 2 hours in a lad rocked up who had taken most of the skin off one of his shins. You wouldn't believe the giving out from certain quarters that followed when he was prioritised. Over the course of the day I noticed 3 or 4 people giving up waiting and they left. One has to wonder how sick they were to begin with. Last time I was in a "minor injuries" unit was when my doctor was closed, I rang the out of hours GP and was told to go to hospital. I was given an obvious prescription. Took me dealing with 4 people just in the hospital when a GP would have taken 30 seconds to go "Yup, go get these".

https://www.boards.ie/discussion/comment/118883842#Comment_118883842

Bit gas, reminds me of last year when I tried to get an appointment, told it'd be a week. Used the nonsense online doctor and he was English, seemed absolutely baffled that a doctor wouldn't see me and recommended I go to A+E. Again, I needed a prescription, one that I had gotten at least half a dozen times before but it just couldn't be done simply.

https://www.boards.ie/discussion/comment/118879195#Comment_118879195

Out of interest though, has anyone produced much in the way of evidence for the bureaucracy costing so much? I know dozens of people working in hospitals, nurses, some doctors, couple of consultants, an orderly lives a few doors from my parents, couple of cousins are cleaners. I can think of one person who worked in admin for the HSE and that was someone straight out of college earning basically minimum wage and was dealing with quite volatile mentally ill people and they got out ASAP.

I would have thought an issue might be having parallel systems where the it is in the interest of the higher earners to actively run down the public system to drive people further to the private system and they get more that way.

blanch152

https://www.boards.ie/discussion/comment/118883697#Comment_118883697

Read the report, it sets it all out.

If you don't believe it, read many of the posts on this thread who give other examples.

Dyr

I see the tax payer is going to keep paying Tony Hulahoop the guts of 200k a year even though he's leaving the CMO gig to work for TCD. Of course whoever replaces him as CMO will also be trousering almost 200k of Joe taxpayers money

Best little country to work a fiddle in.

Floppybits

https://www.boards.ie/discussion/comment/118884157#Comment_118884157

It's a good deal for TCD.

Multipass

The HSE is also responsible for people being in A&E who don’t need to be there. My example is a child who fell, banging her head, pre-covid. Lost consciousness and vomited. Correctly went to A&E. Was seen quickly, no complaints there. However we were told to come back in a weeks time for a check, I assumed it would be in an office somewhere, but no - we were directed to seats in the corridors of A&E, which incidentally had an outbreak of winter vomiting bug at the time. We spent about 3 hours sitting opposite patients on trolleys, with an overwhelming smell of diarrhea. There was one poor elderly man who was brought in by paramedics with a head injury, and was seen by no-one in all the time we were there, until he eventually got off the trolley and started lurching around. We waited hours there for a cursory neck examination that could have been done in another area by any intern, instead we were open to infection, and we could have brought in infection to the people waiting on trolleys. There’s no common sense, it’s the same with the clinics. Something like breast check works smoothly with an appointment system, whereas I’ve been to other clinics where everyone arrives together and waits for an unknown amount of time, without even enough chairs for everyone. 3 hours in my case, you couldn’t go to the bathroom or you’d lose your seat and have to stand.

blanch152

https://www.boards.ie/discussion/comment/118884265#Comment_118884265

To be honest, when it gets down to those types of problems at those types of levels, that isn't on the central HSE, that is the responsibiltiy of local supervisory management and middle management in the hospital who arrange such things. That is where a large part of the problem is. Hospitals are managed for the convenience of staff, and are not patient-centred.

Strumms

https://www.boards.ie/discussion/comment/118882223#Comment_118882223

True but the countrywide stats.

Anita Blow

https://www.boards.ie/discussion/comment/118883697#Comment_118883697

Anecdotal I know, but I'm a doctor who has previously worked in the ED. I can attest to the fact that at least half of cases I saw did not need to attend the department and would've been better managed in the community. In some cases it was due to difficulty accessing the GP but in other cases it wasn't clear why they didn't attend the GP first.

I've had parents bring their children in with a cough at 2AM for the sole reason that they knew the ED would be quieter then. I've had other parents lie about their children's symptoms to get investigations done and upon completion tell me "That's good I just wanted an MOT for her" and clear off and tell me to phone them with the results. In most non-urgent cases it's that they felt the ED would give them a quicker answer to minor complaints like non-serious back pain than going through their GP for referral.

Reducing ED wait times would be best achieved by increasing GP numbers, allowing greater access to diagnostics in primary care and maybe something like the 111 number in the UK that the public could use to get phone advice about where is best to attend for their medical complaint.

Floppybits

https://www.boards.ie/discussion/comment/118885574#Comment_118885574

Are those people the minority or majority? Yes they clog up A&E and they sound like the sort of people who would do that anyway for what ever warped reason. How many people were in A&E with minor stuff because there was no service for them to acess because it was outside normal hours or the weekend?

https://www.boards.ie/discussion/comment/118883946#Comment_118883946

in the UK you would not get an appointment for 3 weeks. You would be directed to ring 111. https://www.dailymail.co.uk/news/article-7855135/NHS-111-helpline-linked-20-deaths-five-years.html

it takes almost a day to get an answer at best

Anita Blow

https://www.boards.ie/discussion/comment/118885654#Comment_118885654

I wouldn't say it was a clear majority and it really depends on a given day or time of year. I think if I was to be balanced then about half of cases could be best managed in the community without needing to attend the ED. Of that half, a decent proportion of them were attending during normal work hours when there would've been access to GP, or attending out of hours with minor chronic complaints that would be best seen in an outpatient setting.

The problem is multi-factorial, its not just some people mis-using the system but it's also due to genuine people that would otherwise access GP or outpatient care if it could be delivered in a timely manner. The answer for us isn't to punish those who mis-use it (because we'll end up discouraging some cases who genuinely need to attend the ED from presenting) but to adequately equip primary and outpatient care so that people's behaviour changes and they no longer feel they need to attend an ED for these problems.

In Ireland the ED is simply seen as a gateway to specialist care for many

Dempo1

https://www.boards.ie/discussion/comment/118882223#Comment_118882223

I honestly wonder about that aspect of the report. I'm aware there is a cohort who do clog up A&E departments needlessly and it was telling how quite A&E departments were during most of the Pandemic.

I can't see people willingly go to A&E unless they absolutely had too. Does The report in relation to this matter ask why the 74% went to A & E, did they wonder was it due to lack of GP accesss, the fact that there's little option between the hours of 5pm and 9am 5 days a week and entire weekends and of course bank Holidays were GP's are not available. Out of hours GP care might be efficient in some parts of the country but certainly not all and from what I've heard it's very hit and miss.

The 74% not needing to be in A&E is figure seems a little far fetched in my humble opinion.

blanch152

https://www.boards.ie/discussion/comment/118885813#Comment_118885813

You may be right, but it backs up some of the stories on here and it also chimes with my experience.

Dempo1

https://www.boards.ie/discussion/comment/118883697#Comment_118883697

I'm with you on this, I find it hard to believe 74% of people attending A&E didn't need to be there, infact it's far fetched and I believe another attempt to spin the narrative by the HSE.

It's a simple fact that there IS no GP cover for an astonishing amount of hours in a given week. Infact GP's are only available, by my reckoning for a 3rd of the hours in any given week.

Out of hours GP services seem very hit and miss and Ironically if you live rural, it's probably quicker to go to an A&E.

I'm not being critical of Gp"s, my own excellent but when you've essentially no GP cover for 2/3 of any given week, what are people to do if there's an urgency or concern 🤔

Dempo1

https://www.boards.ie/discussion/comment/118885838#Comment_118885838

I've spoken to many A&E staff and am fully aware of the cohort who clog up the systems in A&E and I'd never be critical of GP'S or frontline staff, actually my life was saved in an A&E only last November. The vast majority attending A&E either have to be there or have no other option.

I just really believe this 74% figure is simply ludicrous.

Fasano

https://www.boards.ie/discussion/comment/118885728#Comment_118885728

It never takes long for the HSE stooge to pop up and shout “ look over there”.

Firminos

This is terrible