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The current hospital / A&E crisis

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Comments

  • Registered Users Posts: 7,173 ✭✭✭Jinglejangle69


    But who’s fault is that?


    Cant blame a GP for covering their arses in a country where there is a payout every day for something ridiculous.

    Its all about covering ones arse.


    Ireland is finished.



  • Registered Users Posts: 171 ✭✭babyducklings1


    Definitely agree, people probably haven’t even heard of them. Also a pharmacist as the first point of contact can be good like when one of my kids got a bad cut from a fall in school , I went to the pharmacist first. They looked at the wound and gave me dressings , disinfectant etc. saved us a trip to the doctor. Maybe hse need a joined up communication strategy to let people know what other supports are out there. Might ease the burden on the over stretch.



  • Registered Users Posts: 394 ✭✭BagofWeed


    Nice try but you cannot blame this on immigration. We as a nation are incredibly useless at planning full stop. A lack of organisational skills is an Irish trait and we see it time and time again in almost every aspect of society here. We blew the boom and are well on the way to blowing the recovery too. I recognise your point though but the population has been increasing for years and our government and civil service and planning authorities have completely failed to adequately plan for it.

    I personally have only good to say about the healthcare system here and on the few occasions I turned up at A&E I was seen immediately due to my medical history. I was in a bed within 15 minutes of turning up at A&E the last time.



  • Registered Users Posts: 24,695 ✭✭✭✭Strumms


    Population is the biggest driver to demand on healthcare. As well as other critical services…..The biggest driver of population is immigration…

    yes obviously there were issues before the Ukraine situation, but that’s even more reason that ‘no limits’ was one of the most irresponsible political decisions to ever befall the state and its citizens…

    your 15 minute A&E story is not representative of the general experience, that’s for sure.



  • Moderators, Recreation & Hobbies Moderators, Social & Fun Moderators, Society & Culture Moderators Posts: 6,890 Mod ✭✭✭✭shesty


    Apologies to elderly people but they take up as much and more space in A&Es and hospital beds as kids do.

    I unfortunately had 2 stints of waiting in Beaumont A&E earlier this year (a very long story), and the majority were elderly people. One man and his wife arrived - the husband had a sore knee. She had a bag packed for an overnight stay, the works. They got quite irate when they were waiting over 4 hours (I left at that point, I was seen quicker due to suspected pnuemonia). They were a well dressed couple, most likely with private health insurance yet prior to the hospital they had not called DDOc (it was a weekend), they had not checked was there a private clinic available to them (VHI Swiftcare or similar) - no....they had come straight to the A&E, deeming it the most suitable solution. In their complaining to those around me, I heard all of this.

    That was the default situation 10-15 years ago - no nighttime doctor, go to A&E if it's serious. There are other options now, but the message doesn't seem to have got out to everyone. Then there is the fact that there is no step down care for elderly people, resulting in them blocking hospital beds for weeks (and in many cases, being in a weaker state upon release than they would have been if they had got out sooner - saw it with my own grandmother).

    I've 3 young kids - it's a disaster for GP appointments, DDoc appointments, everything.My GP is doing their best but it's soul-destroying when you ring in the morning and you're told nothing available for several days. So you wait til 6pm for DDOc, wait on the line for 45 mins for it to be answered (because it's you and every other parent in North Dublin) and if your timing is right, you might get an appointment that night. Maybe.

    What are the solutions? I don't know, but I can think of a couple of out of the box ideas that would be very unpopular. But over time, I think would pay dividends in terms of getting the system up to speed....

    Firstly pick 2-3 greenfield sites - one on the outskirts of Dublin, one towards the South near Cork or similar, and one towards the West - and build hospitals for more bed capacity. Stop asking consultants where they would like to work and just build them. Consultants are able to have rooms in private facilities all around Dublin, spending a day in each, so stop asking them where it suits them to work. Greenfield sites to allow for expansion, helicopter pads and parking facilities. We need them. Nobody can deny that.

    Secondly - controversial - consider implementing a rule that for the next 5 years, each graduating medical class must spend a minimum of (say) 3 years working in the Irish Health system, or else there is a financial penalty that must be paid. Very controversial, yes. If we don't have staff, new beds mean nothing. So the system needs to be flooded with staff in order to buy time to fix other aspects of the system.And we sink a lot of money into training medical students in this country - some payback is needed .The Health Service will just never improve otherwise.



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  • Registered Users Posts: 13,864 ✭✭✭✭Dav010


    So you would have three hospitals with no Drs, and a legal case for restriction of trade, and what financial penalty could be imposed?. There are currently 800 advertised consultant posts in Irish hospitals which cannot be filled, adding another couple of hundred in new hospitals isn’t going to improve matters.



  • Moderators, Recreation & Hobbies Moderators, Social & Fun Moderators, Society & Culture Moderators Posts: 6,890 Mod ✭✭✭✭shesty


    Yes, so address the staffing issue as mentioned.The hospitals take time to build



  • Registered Users Posts: 13,864 ✭✭✭✭Dav010


    The jobs are advertised, the positions are open, how can you fill jobs people don’t want?



  • Moderators, Recreation & Hobbies Moderators, Social & Fun Moderators, Society & Culture Moderators Posts: 6,890 Mod ✭✭✭✭shesty


    This would be my second point...

    You cannot.

    So in order to address this, how do we think outside the box?How many places in our medical courses go to non-EU students?Is there a way to incentivise (or penalise) so that graduating students spend a number of years in the Irish health system, for each graudating class over the next decade, say. Increase the staff numbers, the hours start to improve, working conditions improve, you buy time to fix the problems with facilities.I am no expert but at the other end of the scale - the consultant end - I believe there are problems with non-EU residents working as senior doctors, who cannot become consultants.There are good reasons for this, but maybe it is time to start initiating things like a time limit - if you are 10 years or more working as a senior doctor in the system, and your nationality is a barrier to becoming a consultant, maybe it's time to start saying once you are in the system of 10 years, you have a right to apply to train/aim for consultancy poitions too. I understand also that there is nothing between senior doctor/registrar and consultant - maybe that should change, another level of doctor with increased responsibility levels.

    It won't be easy and I don't pretend it will.But as it stands we cannot attract doctors to fill 800 consultant posts.The status quo is not working, and it needs to change.



  • Registered Users Posts: 15,631 ✭✭✭✭whisky_galore


    The ah shur tis grand mindset.

    Carry on whistling past the graveyard.



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  • Registered Users Posts: 13,864 ✭✭✭✭Dav010


    What does that mean?

    You stand in a third world country and you would realise how incredulously stupid it is to say we are “plunging towards” one.



  • Registered Users Posts: 4,513 ✭✭✭Xander10


    Just don't hire the shower building the children's hospital.

    We will be dead before they are finished



  • Registered Users Posts: 5,718 ✭✭✭Cordell


    Stopping graduates from leaving is not the right solution, making the jobs so attractive that they don't feel the need to leave is. I don't want to be treated by doctors and nurses who feel trapped in their jobs.



  • Registered Users Posts: 15,631 ✭✭✭✭whisky_galore


    Shur twill be grand. It'll sort itself out. No queues, no trollies, nothing to see here move along.

    Wash rinse and repeat.



  • Moderators, Recreation & Hobbies Moderators, Social & Fun Moderators, Society & Culture Moderators Posts: 6,890 Mod ✭✭✭✭shesty


    Well this is the question.Incentivise seems wrong when so much money is already being pumped in unsuccessfully mind you.We simply have not got enough staff though and you can't improve working hours and stress unless you up staff numbers, and you can't up staff numbers without some way to attract people into a broken system.It's a chicken and egg, some way has to be found to break that cycle because what we re doing isn't working.There is a new consultant's contract being negotiated and consultants are up in arms about 300k contracts that don't allow them to work private clinics (and make extra money) among other things.If those contracts are a problem, what on earth can you offer that is more attractive?? For graduates, structured hours and enough staff to cover the wards is the only other thing besides money I suspect (proper facilities would obviously help too), but how can you make that offer without enough staff as it stands and everyone leaving??

    Doctors may already feel trapped if the only way they see out is to emigrate.Maybe many would like to stay here but just can't.

    I am simply throwing out points for discussion here really.We all know the horror stories, but what are the ideas for improving the situation??As it stands I wouldn't be recommending to any of my kids to consider medicine as a career.



  • Registered Users Posts: 15,631 ✭✭✭✭whisky_galore




  • Registered Users Posts: 13,864 ✭✭✭✭Dav010


    Are coming on this thread just to type silly things and wind people up?



  • Registered Users Posts: 5,718 ✭✭✭Cordell


    I'm a simple man so here's a simple solution: look at the health systems they emigrate to and copy them. Money is not a problem, Ireland already spends a lot on healthcare and there are enough resources to spend even more.



  • Registered Users Posts: 262 ✭✭sekond


    Yes, we've had a few good saves from the local pharmacy over the years too. Minor enough stuff, rashes, earaches etc. Usually a case of "try this, and if there isn't any improvement in X days, then go to the GP". In almost all cases the pharmacist was right, and a GP visit was avoided, and when they weren't we were also able to go in to the GP and say we'd spoken to the pharmacist and tried X, Y, Z and it hadn't worked, which meant the GP was able to move onto other options.



  • Registered Users Posts: 12,993 ✭✭✭✭Geuze


    HSE staff headcount


    Dec 2019 and Nov 2022 data, three years apart, all WTE data

    Doctors - medical consultants, up from 3250 to 3861, an extra 611 or 19% more in three years

    All doctors/dentists, from interns to consultants, up from 10,857 to 12,658, an extra 1,801 or 16.6% in three years

    Nurses up from 38,205 to 43,374, up by 5,169 or 13.5% in three years



    19% more consultants in three years seems like strong growth to me?



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  • Registered Users Posts: 7,467 ✭✭✭Floppybits


    The reason why the graduates leave is that they see the state of the healthservice and the hours people have to put in just to keep the lights on and the ongoing mess in A&E, ask yourself who in their right mind would want to work in a system like that? Lets face most of us if we worked in job where the management/organisation was as poor as the HSE is and your were constantly overworked because of understaffing then I would bet you would leave that company to find somewhere better? I know I would. Fair play to all the medical staff who do stay and work in that chaotic system.



  • Registered Users Posts: 7,467 ✭✭✭Floppybits


    I agree I don't the issue is the money or incentives, well maybe at certain levels, but I think the main issue as I said above is the conditions that the medical front line staff in the HSE are expected to work in. Improvements in the conditions would go along way towards making people want to say in the services. Lets face it most people if they worked for an employer that is as badly run and mismanaged as the HSE we would be out door as fast as our two legs can carry us.

    I see the new head of the HSE is keeping their head down, I'd say he was left some mess to sort out.



  • Registered Users Posts: 4,622 ✭✭✭Deeec


    The management and planning of A & E also needs to be looked at.

    Last year I had to take my elderly mum to A & E. It was a friday about 7pm and she had a severe earache - GP closed for weekend and out of hours doc couldnt see her so I was advised to take her to A & E given the severity of the pain. Luckily for us A & E was pretty quiet. Triage seen her immediately - I asked should she not have been given a blood test there and then and was told no need. Despite being quiet very few patients were seen - eventually after a few hours she got to be examined. Doctor said she needed a blood test - had to wait then for someone to take the blood and then we were told we would have to wait for the results ( about 1/2 hr we were told). We were left in a cubicle right beside the admin/nurses station. The nurses/doctors gathered here chatting, laughing and eating cake. Very little attention was given to patients at all - it seemed they were on a Friday night buzz. After being left there for 2 hours I went and asked was the blood results not back - doctor immediately checked and said oh they are back. Examined again - then doctor had to go and consult with another doctor he so we were just left waiting again. Eventually we got out with a referral and antibiotics. That night the doctors and nurses were not working efficiently or to the best of their ability. If they had have been we could have been in half the time. Why couldnt the triage nurse have done a blood test so the results would have been there when my mum was examined? Its something that could make a difference - better triage services and somebody actually managing staff and the treatment of patients. That night I also spoke to an old man in another cubicle who asked for my help - he was left so long ignored he thought the staff forgot about him.

    I can understand why A & E is slow when there is alot of patients attending but that night it was actually quiet. Efficiency really needs to be looked at also.



  • Registered Users Posts: 8,355 ✭✭✭Cluedo Monopoly


    Who would want to be a Junior doctor in Ireland?

    Junior doctor pay issues due to payroll system - IMO (rte.ie)

    'Demoralising' issues for junior doctors caused by payroll system - IMO

    Non-consultant hospital doctors, or junior doctors, are having difficulties getting paid, due to having to join new payroll systems every time they start at a new post, according to the Irish Medical Organisation.

    Chairman of the non-consultant hospital doctors committee at the IMO Dr John Cannon said junior doctors rotate hospitals in Ireland every six to 12 months as part of their training programme.

    Speaking on RTÉ's Morning Ireland, he said that when they change hospital, even though they remain in Health Service Executive employment as their main employer, "they actually technically change employer as well at a local level.

    "So that means every time they go to a new hospital, even though they're still working for the HSE, they have to join a new payroll system as all the payroll systems in the HSE are siloed, there's no national payroll system," he added.

    Dr Cannon said that this often results in doctors going on to emergency tax, being put on the wrong pay point on the scale, missing hours that they are due in their pay, and, in some cases, not even getting paid at all.


    'Bonkers' overtime worked by junior doctors causing burnout and risks for patients (thejournal.ie)

    'Bonkers' overtime worked by junior doctors causing burnout and risks for patients

    Junior doctors in Ireland worked 2.8 million recorded overtime hours last year, according to figures from the HSE.

    EXCESSIVE OVERTIME WORKED by junior doctors is causing burnout and unsafe working conditions, doctors say.

    Junior doctors are regularly working hours far beyond what should be acceptable in Irish hospitals, doctors have told The Journal, to the detriment of patients and staff.

    What are they doing in the Hyacinth House?



  • Registered Users Posts: 1,764 ✭✭✭mumo3


    The problem with the current privatized set up, is the doctors are double jobbing with the HSE...that needs to be knocked on the head.

    I'm lucky (and I know I am) to have private insurance and I will always head there with the kids.... the most its ever cost me, was €185 for a broken bone and that was including xrays, cast and boot... but I was in and out in an hour, sure it would have cost me €100 to sit in public A&E for what 10-14 hours



  • Registered Users Posts: 8,355 ✭✭✭Cluedo Monopoly


    Health system an 'endless cycle of crisis' - IMO (rte.ie)

    Health system an 'endless cycle of crisis' - IMO

    No additional beds in northwest in three years.

    The Chief Executive the Saolta Hospital Group, which includes six hospitals in the northwest and west, has said the group has not received any additional beds in the last three years.

    Speaking on RTÉ's Morning Ireland, said if additional beds had come on stream it would improve the situation currently.

    What are they doing in the Hyacinth House?



  • Registered Users Posts: 262 ✭✭sekond


    I think this story shows one of the major problems with the health service here (and to be fair, I have experienced a similar issue overseas also) - you need a significant amount of agency and capacity to be able to navigate it. In your case, your Mum had you there to follow up on the blood tests etc - without that, how many more hours might she have been waiting.

    Me being able to investigate and find out about the local minor injuries unit (after one or two eye wateringly expensive visits to Swiftcare etc), investigate alternative options when GP was unavailable, have enough prep done why I take my kids to the GP that I can ask the right questions, know what specialists are out there, know to ask for referrals and when to press for something to be done by the GP, know who and when to follow up on things.

    I've got family with medical backgrounds, have worked briefly in the past as a receptionist in a Drs surgery and am used to dealing with complex systems. So I usually have the capacity and energy to do all that. Not everyone does. Which means they maybe end up in the wrong place and get frustrated.

    (It's also not the only part of the system that works like that - certain parts of the education system need a similar level of capacity to untangle knots and work out options).



  • Registered Users Posts: 8,355 ✭✭✭Cluedo Monopoly


    Enda Kenny promised in 2007 to end the trolley crisis. 16 years later it's worse than ever.

    He also promised to reform the Seanad.

    What are they doing in the Hyacinth House?



  • Registered Users Posts: 28,703 ✭✭✭✭Wanderer78


    ...we re clearly experiencing a catastrophic systemic collapse, and its probably never gonna be resolved, period!



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  • Registered Users Posts: 3,809 ✭✭✭joe40


    And yet medicine is still a very competitive course to get into both here and the UK. Pupils need very high LC snd HPAT scores. Nursing is also very competitive.

    I think that is a worrying aspect of these type of crisis, and all the negative commentary. Will the bright hardworking young people eventually move away from health care careers?



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