The current hospital / A&E crisis

Goldengirl

https://www.boards.ie/discussion/comment/120067927#Comment_120067927

The blood test I understand, as Triage can only order bloods in certain situations , others have to be determined by the doctor.

The laughing and chatting was unfortunate as you were beside where they were having tea . Not all staff would be having break at the same time , but you were left with that perception because you were waiting and anxious to go. That was not good I agree .

We waited 6 hours for a blood test result to come back for a member of my family in an A&E recently ( 8 hours in the waiting area total even though he was in a lot of pain) . In the end I asked them to give them to me ( ex nurse specialist but in another area ) or we were leaving AMA . We got the results within a half hour from a doctor.. He was admitted after that.

I was spitting feathers but loathe to say anything as I felt it was not my place ...turned out the doctor had everything organized and ready . Just had to wait another 12 hours for a bed on a trolley, by which time he had all his tests done and sorted and was being discharged a few hours later!

The big issue was the wait on the labs and lack of bed in hindsight.

BattleCorp

https://www.boards.ie/discussion/comment/120063068#Comment_120063068

If you got rid of half of the non-healthcare workers in the HSE, it might free up more money but the staff just aren't there. There are loads of vacancies but not enough suitably qualified persons are applying.

It's so difficult to recruit enough suitably qualified front line staff that they are actively trying to get people from abroad to apply. They even offer relocation packages to those applying from the EU and non EU countries.

Geuze

https://www.boards.ie/discussion/comment/120069124#Comment_120069124

This is WTE data, so it takes account of new hires and leavers.

Population growth is 3.6% over three years.

2019 = 4.921m

2022 = 5.1m

Goldengirl

https://www.boards.ie/discussion/comment/120070007#Comment_120070007

There are young Irish nurses and healthcare workers who cannot afford to live in Dublin and pay rent , ( just as there are young teachers and young people in every walk of life but we are talking health service here) and yet they are offering relocation packages to international nurses?

By all means we need everybody but those nurses have to live too once they get here.

But why not offer similar to young Irish nurses to entice them to stay?

Or why not give an allowance towards rent in high cost cities?

Goldengirl

Fair enough @Geuze

Maths was never my strong point so will take your word for it.!

I would be sceptical though because it is from the HSE.

SuperBowserWorld

Who in their right mind would work in the health service unless you are getting paid hugely for it.

There are a load of people in the country earning huge salaries for work that is not useful to society, do not have to deal with the public, do not have to deal with daily life threatening situations, do not have housing problems ...

I would imagine there is a huge amount of waste in the HSE that could be transferred into huge employee incentives.

Even still it still probably is not worth it. Who wants to babysit violent drunk entitled people in an a and e , just one example.

recode the site

https://www.boards.ie/discussion/comment/120070067#Comment_120070067

Trouble is everyone would be looking for the “Dublin allowance…”, unions would fight for it all around. Maybe indeed it’s what’s needed.

Maybe the relocation package is to entice Irish trained nurses back to? 🤔

Goldengirl

https://www.boards.ie/discussion/comment/120070191#Comment_120070191

Yes. Maybe it should be if it isn't.

And yes to anallowance , think it works well in other places eg London weighting for public servants.

Could be appied to all workers below a certain amount working and living in the city.

Its a perfect storm... housing and rent crisis, Covid and flu and hospital crisis , high emigration.

recode the site

There is a big elephant in the room re GPs that nobody is willing to mention. It’s a fact these times that the majority of newer GPs are female, and a high proportion of those have family carer responsibilities and this work part time. In the case of my own GP practice, there is the original man working full time, a newer man working full time and two part-time female GPs who most patients I know try and avoid as they are evidently quite disinterested in their doctoring. Any time my late mother or myself saw them the response would almost invariably be “I’m not your usual GP do not in best position to help you”. Now I’m sure there are many wonderful dedicated female GPs but I’ve yet to personally meet one. I’m female btw.

SuperBowserWorld

I think there needs to be a Dublin allowance or there will be no teachers, nurses, police ... In Dublin if housing/rent keeps increasing in cost.

But that would put up the cost of housing/rent ..

Not enough accommodation.

There in lies the rub.

Either build more accomodation in Dublin or decentralise and build there.

Maybe we need a new city ?

Hospital city in the center of Ireland.

Centred around a new Children's hospital ... no wait 🤣

3 hours drive from anywhere but max 6 hours a and e wait. And not 50 hours.

And build up. Not out.

Or just continue on as normal outbidding ourselves on properly and emigrating. 🤣🤣🤣

Wishbone Ash

Bear in mind that, in addition to young people leaving the HSE, an average of 40 older staff per day retire from the HSE creating over 250 vacancies per week in addition to the other vacancies.

Dav010

https://www.boards.ie/discussion/comment/120070253#Comment_120070253

700 of the current 3600 GPs here plan to retire within the next 5 yrs, 20% of all GP practices are single Doctor only, another 20% have two Doctors. In all probability, a significant number of rural Clinics will cease to exist in the coming years.0

https://www.boards.ie/discussion/comment/120070246#Comment_120070246

Though the problem may be most acute in Dublin, staffing issues exist in every hospital nationwide, where the cost of living is lower than the capital.

SuperBowserWorld

https://www.boards.ie/discussion/comment/120070281#Comment_120070281

Yes, there is no incentive to join like what I said in my previous post. Seems like the health service has been hollowed out and it's just buildings, car parks and management.

The fundamentals of our society are broken. The long term stuff. The people we need are not rewarded or incentivised, accomodation has become the only investment opportunity in town (again), people getting pets cause they can't afford children. 🤣

It's crazy.

We kind of forget, then stories like a 90 year old being on a trolly for 50+ hours and a huge budget surplus with stupid smiles on the ministers of finance ( 2 of them for some reason ) and you would just laugh out loud at the absolute **** show this country is.

edit probably oversimplified, but these problems are never solved here.

BattleCorp

https://www.boards.ie/discussion/comment/120070067#Comment_120070067

There's a pile of medical staff across a wide range of disciplines needed in the HSE, not just nurses.

Consultants earn from €184,842 to €252,150 from their HSE contract per year, depending on which contract they are on. They can earn more if they also do private practice. They can easily afford to live in Dublin. There are currently almost 900 unfilled consultant posts in the HSE. You can't blame Dublin prices for the lack of consultants applying for the roles. The roles just aren't attractive enough whether it is for financial reasons or working condition reasons.

I'll agree that it can be difficult for young nurses and healthcare workers to afford to live in Dublin but it's doable in most instances. How do people who work in lower paid jobs such as working in a chipper or in Spar etc. manage to live in Dublin? There are nurse and healthcare worker shortages in pretty much every area of the country, not just in Dublin. The conditions in the acute hospitals make the jobs unattractive. It's a combination of being overworked and underpaid.

The relocation package seems to apply to all grades of staff so I would assume that nurses are covered too.

Expenses such as flights, transfers, accommodation etc. must be vouched and are subject to the max. limit below.

Additional costs can also be paid.

Regarding your suggestion that this money should be used to support young Irish nurses or other healthcare workers etc., I'm not against that idea but it's practically impossible to implement. If the HSE increases the wages for Dublin nurses/healthcare workers, then they'll have to increase the wages for every other nurse/healthcare worker in the country or you'd have the possibility of widespread industrial action and the taxpayer could be stuck with an unaffordable bill. And good luck applying it only to front line workers too as other grades such as admin/management etc. will want an increase too.

I think the biggest problem facing the healthcare system is quick access to GPs. We don't have near enough GPs to cope with current demand and our population is growing rapidly. This will put further pressure on our accute hospitals and worsen the service currently provided. Currently there are about 500 GPs approaching retirement age out of a pool of approximately 2,800 GPs currently in practice. While there will be newly qualified GPs coming on stream, the number of GPs continues to reduce as more are leaving than joining.

Goldengirl

https://www.boards.ie/discussion/comment/120070246#Comment_120070246

Back to dedicated nurses accomodation or public servant apartments as in London city centre😁

Goldengirl

https://www.boards.ie/discussion/comment/120070374#Comment_120070374

I mentioned other healthcare workers along with other workers on lower wages, but not qualifying for benefits.

A lot of people working in the city on low wages are either living with family or on the HAP which nurses or other workers needed for jobs in the city and are not from Dublin, do not qualify for.

Dublin is the worst city but Galway and Cork are close on its heels. Other countries have brought in incentives for workers in cities and it can be done without causing ructions in the balance of fairness. Everybody can see that graduates are struggling to get housing and pay rent in Dublin particularly.

Nobody mentioned consultants struggling financially 🙄

So how do you think it can be incentivised?

I have spoken about the difficult conditions already and more staff on shifts and improved working conditions would goa long way to retaining staff.

Colm Henryon the News there discusding how as well as more beds the communitu care hubs " that are being built" will improve the situation in A&E.

But no mention of how to get staff or doctors and how to retain them!

recode the site

https://www.boards.ie/discussion/comment/120069565#Comment_120069565

None. But I still am of the opinion that GPs do not work anything as hard as they used to decades ago when they would actually do house visits, Saturday mornings and sometimes up to 7pm. I don’t see GPs sweating their butts off saving, doing cpr, saving lives in corridors; half the time it’s a 4 minute phone call & a few clicks on the keyboard. try and convince me that someone half-heartedly working half-time, office type hours, clicking a mouse, is over-working themselves. A huge number of GPs are part-timers. I personally very fond of my own GP, he’s a lovely guy and personally dedicated, but his colleagues are far from that.

top floor

https://www.boards.ie/discussion/comment/120070246#Comment_120070246

But the worst overcrowding is in Limerick, followed by Cork, Galway etc?

recode the site

https://www.boards.ie/discussion/comment/120070531#Comment_120070531

The Mespil Flats in Dublin 4 was a de facto public servants rental residence back in the day before Irish Life, the landlord, sold at cost to big wigs

BattleCorp

https://www.boards.ie/discussion/comment/120070595#Comment_120070595

I used the shortage of 900 consultants as an example that not all healthcare vacancies are a result of the lack of affordabe accommodation in Dublin. There are other reasons than housing expense for that cohort not wanting to work in Ireland. A large part of it I suspect is that more money can be made elsewhere and the working conditions here are more difficult than elsewhere. I'd say that's the same across the board, i.e. doctors, nurses, medical specialists etc.

I'm not being rude but an overworked nurse in Kerry or Kilkenny absolutely would give a shyte if an overworked nurse in Dublin was getting paid more than them. They'd have their hand out pretty quickly. And how can you pay Dublin nurses more without having to pay Dublin admin/management/porters/cleaners/security staff more? Don't they have the same issues with accommodation costs?

There's no easy way to fix the HSE. And fixing the HSE is only part of the problem. You'd have to solve the housing crisis too. And there's no easy way of doing that.

The way to improve recruitment is to improve working conditions and pay. Given that the HSE already is a black hole when it comes to money, I doubt the general public would be happy to pay more taxes to throw into that black hole.

Here's my solution that would probably take 20 years to implement and at a cost we can't afford.

Below is my solution but it's not realistic because we can't afford it.

Treat sick people in the community setting where possible. This should be the number one priority. Keep the acute hospitals for those who are seriously ill and need that type of care.

1. To treat people in the community setting an adequately resourced community care service is needed.
2. Train many more doctors than we currently do and incentivise doctors to become GP's. Make it financially beneficial to become a GP.
3. Set up HSE run GP practices and build the necessary buildings and provide support staff to the GPs. This could be done out of the Primary Care Centres. Most GPs are self employed and this means they have a lot of extra work to do. GPs working out of HSE buildings could remain self employed but they'd be the only employee. They wouldn't have to worry about the receptionist, the cleaner, the nurse etc. The'd work out of a HSE building and the building would supply the support staff. The GP's would only have to turn up to work and treat people. GPs would get paid for seeing x number of people per day/week/month/year. If the GP wants to work longer hours and make more money, then that should be accommodated.
4. In low population areas such as Achill Island where a GP wouldn't see enough people to earn a decent wage , the GP could be paid an agreed wage.
5. To treat sick people in the community setting, a lot of primary care centres need to be built and staffed. Adequate numbers of podiatrists, physiotherapists, S&L therapists, public health nurses etc. need to be trained and adequately remunerated.
6. Train managers to efficiently manage their staff. You'd be amazed at how many managers have little or no management training. This would increase efficiency in the service.
7. Incentivise people to train in the healthcare field by paying them a liveable wage while they are training and paying them a good wage when they qualify.
8. Offer further training for those who are ambitious and want to advance their career.

For those who need more specialised treatment than community care can provide, I'd do the following.

1. Invest in more hospitals with adequate a&e facilities that aren't built in a stupid location at a stupid cost.
2. Build feckin rectangular buildings because they are far cheaper to build than that fcukin new yoke that looks like the Eye of Sauron. Those buildings look nice but cost multiples of what a rectangle costs to build.
3. Build far more nursing homes and step-down facilities for those who don't need to be taking up a bed in an acute hospital but are too sick or unable to care for themselves at home. This would free up an awful lot of beds in the acute hospitals.

There are multiple difficulties and issues with every single thing I've suggested above. I don't have all the answers but my priority would be to try and treat as many people in the community setting and keep the acute hospitals for the more serious illnesses/incidents etc.

Goldengirl

https://www.boards.ie/discussion/comment/120070623#Comment_120070623

All areas of the service are in crisis.

The worst overcrowding is usually Limerick for the obvious reason that all feeder / stepdown hospitals around it have been down graded and closed in the last twenty years .

But it could be Beaumont tomorrow or the Mater .

This problem is not a new situation ...and is not all mismanagement .

It is chickens coming home to roost.

Too many successive budgets / governments minimising the problems of overcrowding and reducing beds necessary for stepdown community care . All of us can name a local hospital nearby that have been closed recently . Where do those patients go ?

Concentrating all services in major hospitals while downgrading others was always going to lead to problems of lack of housing for healthcare workers, long commute and wait times for patients . Great consultants and experienced teams but that is no good if you can't access the care or staff the service .

All talk about community care over the last few years when we all have experience of aging GPs and younger GPs who are not going to work extra hours needed and they can't get locums. They have also so many now on free GP service that there are no appointments left for anyone else .

Who makes these decisions ?

Successive health ministers come along with great ideas and are advised by HSE management on big bucks telling them that.. yes no problem, we'll build your co-location public / private hospital ( Mary Harney ) or we'll start your community hubs next year ( James Reilly ) , free GP care for under 7s ( Simon Harris) now its under 12s promised (Stepgen Donnelly ) .

All good plans and its good that the smiling finance ministers can say the money is there , but do they take into account how this is going to be built , staffed , and serviced ?

Or what should be done with the current catastrophic service in the meantime . It lies neglected because they are all concentrating on the big pretty plan.

And how many of these plans never come to fruition ? As you can see from the few above anything with a major capital build outlay will not go ahead or will be so delayed for various political reasons so that eventually they are either shelved or useless by the time it is finally done.

Or like the Children's Hospital , 40 years later and multiples of the price .

No joined up thinking or planning for what is actually needed ...

An aging population with increasing health needs ,eg more beds doctors, nurses , social care , home help, community physio and additional rehabilitation, step down convalescent services .

It's a bloody disgrace . And the politicians get away with it because the demographic electing them appear to be happy with private healthcare as the answer .

Goldengirl

https://www.boards.ie/discussion/comment/120070698#Comment_120070698

Yes. Always some big wig making money when the government of the day decide to sell something off. And nothing more heard about it when it comes back to bite the public in the axxxe .

The majority of people don't know or don't remember and that's what politics depend on .

We really need to change more than the health service don't we ?

Cluedo Monopoly

The footage of the overcrowding on the 9 news is distressing. I have been there with family members and it's traumatising.

Beatty69

https://www.boards.ie/discussion/comment/120067269#Comment_120067269

Don't believe this for a second.

FGR

It's controversial but I do think a huge part of the issue of trying to get a GP appointment (or even to be accepted by a GP Surgery at all!) is because the state didn't put the systems and resources in place before allowing free GP care for all children.

Even if it was a token €10 for a child I have no doubt many parents would only bring their children in if something was serious whereas I've noticed in recent years that so much as a sniffle results in a doctor's visit.

Goldengirl

https://www.boards.ie/discussion/comment/120070776#Comment_120070776

I agree with everything you have said and have said much the same but not in such an organised way .

Excellent post .

Just one thing . I propose the city weighting related to rental costs in the various cities and just aimed at those sectors where staff retention is an issue . For now its graduate nurses and doctors below a certain wage .

If somebody moves to Kerry and rent is cheaper than they have to weigh that up for themselves . That is the way it is in UK for example if you move to Plymouth to work from London. And never questioned .

The conditions are what disillusions and breaks the desire to continue in the job . Better staffing and lower nurse / patient ratios are the key as well as junior doctors being able to work and learn without the pressure of working 60 to 80 hours per week much of it unsupervised.

I agree about management but many nurses have higher diplomas or masters in management and are underestimated and underutilised by those in administration. A more interdisciplinary management profile needs to be integrated in the HSE structure . It is only by listening to all voices, including patient representatives , that real effective change will happen ..and stick .

One thing that really galled me right to the end of my career was that when ICU or A&E were absolutely mental all hospital management bar some nursing admins were off on holidays for 10 days to 2 weeks. They should not be allowed to do that but should be there in the thick of it working with their staff . More so the more senior they are . It's as if they don't want to know what actually goes on at all , as long as the numbers are tidy on the page and everyone is smiling in the pictures!

TheRiverman

The footage shown on Six One and 9 o'clock News tonight is appalling, with every Health and Safety rule and guideline in the book broken.

Goldengirl

https://www.boards.ie/discussion/comment/120071150#Comment_120071150

And this was hidden from HIQA in UHL by hospital management .

I was thinking someone has a cardiac arrest you couldn't even get them to resuscitate them !

The HorsesMouth

This is typical of the beurocracy in Ireland.

We have a wonderful GP who is in their late 60s. She wants to take a step back but wants to continue working for a few years so she has sent her medical card patient to another GP practice while she'd keep working on with her private patients.

She now cannot afford to keep her private patients as she has to pay extortionate rates to keep private and not medical cards (it's cheaper to retire), despite the fact she has already sorted out her medical card holders with another lovely GP.

So now she's retiring fully even though she doesn't want to and we are all left trying to get on the long list of some other GP in the town as no other practice will take us all on at the moment! A joke.

recode the site

https://www.boards.ie/discussion/comment/120071284#Comment_120071284

If someone had a cardiac arrest it probably would go unnoticed in that melee. At least another space would be vacant.