University Hospital Limerick- what can be done?

I’m not long back from a short trip to Poland, hotel happened to be next to a private clinic so out of curiosity I investigated its services to compare to ours. One notable differance is that consultants there hold rooms 24/7. It is possible to get a very quick appointment to see a specialist, as they hold clinic even at 2am Saturday night. None of the 9-5 Mon-Fri we have here. I have heard tell that the public system is decent too. There’s a great work ethic in Poland, they don’t down tools because of the hour and leave you high and dry. Getting an appointment at the private clinic you click on dates and times, like booking a hairdresser appointment, prescribe your condition and previous attendance with doctors. Only rules are you bring ID when attending, and don’t bring your dog into the clinic.

Igotadose

https://www.boards.ie/discussion/comment/121953497#Comment_121953497

9-5 with breaks for lunch, lots of official holidays, nothing on the weekend… HSE controls who watches the HSE, so nothing will change.

mykrodot

https://www.boards.ie/discussion/comment/121953257#Comment_121953257

the funny thing was that she went to "doc on call" or whatever it's called in Limerick. She did this even though she has a GP but she knew she wouldn't get an appointment with her GP at 3pm in the afternoon! Thankfully the Doc on Call saw the 4 year old immediately and gave her steroids and antibiotics. Crazy system that you can't see your GP if you have a sick child, so you pay to see an emergency doctor in the middle of the afternoon (not the middle of the night)…… then live in fear of your child getting sicker as then you will need to go to UHL!

mykrodot

https://www.boards.ie/discussion/comment/121952275#Comment_121952275

thanks for that info, I will pass it on!

History Queen

It'll be interesting to see if there is any outcome from this or a miraculous one day improvement in the stateof the hospital. Why visits like this or by HIQA aren't unannounced I don't understand. I'm a teacher and we have both prescheduled inspections and unannounced "drive bys". There doesn't seem to be an equivalent in health.

https://www.breakingnews.ie/ireland/minister-for-health-and-hse-boss-to-make-crisis-visit-to-university-hospital-limerick-1608723.html

Igotadose

https://www.boards.ie/discussion/comment/121967434#Comment_121967434

Because of regulatory capture. HSE is responsible for policing itself, and making itself look good, too. They're not neutral.

In other countries the two functions are independent. Not Ireland.

What I found amusing the other day was looking up HSE rankings. A few years ago (2018?) it was something like 80th. Now, much higher. So, the question I had, that I couldn't find an answer to, was what changed, and why Ireland had to have an 80th ranked health system for so long, presumably from the start of the HSE.

If it just took a couple years for such a rapid improvement, what prevented it from happening earlier? In my opinion, there was no will to do this because those that do the policing report to the same management as those that do the, hmmm, indiscretions.

History Queen

I'm unconvinced by this... what is a virtual ward? How will it work? I suspect, (hopefully wrongly) that it will be a way of keeping elderly people at home with little care. Anyone have any insight?

https://www.independent.ie/irish-news/health/virtual-wards-more-beds-and-six-day-roster-for-senior-doctors-outlined-as-new-plan-to-tackle-severe-uhl-overcrowding/a635738831.html

Igotadose

https://www.boards.ie/discussion/comment/121974971#Comment_121974971

Doesn't matter. HSE will just prevaricate about the impacts - they audit themselves. No chance at the truth.

FWIW, my plumber spent 4 days on a trolley with painful diverticulitis. 4 days. Youngish man. On a trolley. But, oh, US health care - where in my 50+ years living in the US I never knew anyone stuck on a trolley for days - is so bad and the HSE is just great. Yet, everyone I know here, has a trolley/inept surgical outcome story.

2 days is typical treatment for diverticulitis in the US. It almost never requires a hospital stay. Everything in Ireland seems to require a hospital stay.

Igotadose

Why is it a six-day roster? You just lay around on Sunday in pain?

karlitob

https://www.boards.ie/discussion/comment/121974971#Comment_121974971

There are many models of virtual ward. This is the one planned from end of last year.

https://www.gov.ie/en/press-release/211c0-minister-for-health-announces-acute-virtual-ward-programme-in-limerick-university-hospital-and-st-vincents-university-hospital/

History Queen

https://www.boards.ie/discussion/comment/121976932#Comment_121976932

Thanks for the information.

Beta Ray Bill

The problem in nearly every A&E and hospital is one of management and staffing levels

1: We need more medical staff. Problem here is there are kids coming out of Secondary school with 600 points in their LC and aren't getting medicine, because "there aren't enough places". There haven't been enough places in medicine for about 20 years now. Colleges need to get staff or face consequences. (I don't know what those consequences should be)

2: Medical Staff should not be managing medical staff. In a medical sense yes, It's good to have a senior person that can be consulted with on Medical issues. Their performance, effectiveness and rostering should not be managed by Medical staff (Someone with basic medical knowledge maybe, not a doctor, nurse or consultant though).

3: If you are employed by the HSE and you're "patient facing", you should have to do one shift in A&E per month, regardless of whether you're a Porter or a Consultant. You have to do one per month.

4: Nurses and Docs working for free during college has to stop. Apprentices get paid, they should too.

5: Non performing Docs, Nurse and Consultants need to be gotten rid of. Any person who works in medicine knows what I'm talking about.

6: Mega 16 hour shifts should not be permitted. I would not like to be treated by a Doc in A&E at the end of their 4th day on a 16 hour shift. Minimum shifts must also be AT LEAST 8 hours. Consultants doing 3 or 4 hours a day and then finishing early and out to play Golf in the afternoon is unacceptable for someone earning so much.

7: Public/Private split. If you work in private practise you cannot work in public practise and vice versa. There also needs to be controls on fitness to practise. A large number of people in A&E are people that have undergone a procedure in a private hospital and something has gone wrong so they send them to A&E (AS MENTAL AS THAT SOUNDS!). For example if private consultant John is performing procedures and 1 out of every 10 of those people ends up in A&E the private Consultant John needs to be stopped doing those procedures.

It's going to take years to fix, but a proper plan needs to be put in place now

BlueSkyDreams

https://www.boards.ie/discussion/comment/121977727#Comment_121977727

The majority of doctors that qualify in ireland, leave.

So whether they do medicine or not doesnt make much difference, as newly qualified doctors are, in the majority, exiting the country anyway.

Beta Ray Bill

https://www.boards.ie/discussion/comment/121977731#Comment_121977731

They're leaving cause the conditions and pay relative to other places is appalling.
My Cousin worked in UHL (In the A&E) the place is a joke, she's gone too.

Her 16 hour A&E shift consisted of her and one (maybe two) other doctors.

A real plan needs to be put together that brings in everyone. Management, Medical Staff, Government and Colleges

Another thing is that it shouldn't take an additional 4 years (I think) to become a GP once you've completed your Degree in Medicine. More GP's would alleviate the pressure on A&E

BlueSkyDreams

https://www.boards.ie/discussion/comment/121977734#Comment_121977734

But the GPs are leaving once they qualify and we are only functioning because we are able to bring in doctors from abroad.

Agree there needs to be a wholesale plan to change though.

skimpydoo

Nothing can be done until the current shower in government are gone.

History Queen

https://www.boards.ie/discussion/comment/121982258#Comment_121982258

I don't think a change in government will make a difference and its likely that many of the current government will be in power again after an election anyway

Igotadose

https://www.boards.ie/discussion/comment/121982258#Comment_121982258

HSE's the problem. Not fit for purpose.

karlitob

https://www.boards.ie/discussion/comment/121983021#Comment_121983021

I’d be interested to know by you understand is the ‘HSE’.

Francie Barrett

https://www.irishexaminer.com/news/arid-41369017.html

Harrowing but unfortunately common experience in an Irish hospital.

Beta Ray Bill

https://www.boards.ie/discussion/comment/121983021#Comment_121983021

Agree.

Also the wage structure, like why should a Nurse working in Donegal get paid the same as a Nurse in Dublin? (given their job and grade is the same). Cost of living in Dublin is WAY higher than Donegal.

I get they do have "allowances" but the problem is if they ever move job, taking the allowance away is near impossible or forgotten about by HR/Payroll.

Flat rate, plus and OT/Weekend rate both based on Job and location is what's required.

Maybe they should split the HSE up into regional health boards. Problem here is there would be a lot of Management bloat.

markodaly

I am not so sure we have one of the best health service in the world according to a poster here.

Geuze

It's great at spending money, that's for sure.

A GP in France charges 26.50, compare that to here.

We paid the GP twice what we the UK paid to administer the COVID vaccine!!

karlitob

https://www.boards.ie/discussion/comment/121996818#Comment_121996818

France have a very different model of health funding than Ireland does.

Some information for you from OECD to make a comparison.

You’ll see that France spends more per capita on health than Ireland, more per GDP, has fewer practicing doctors than Ireland, fewer practising nurses than Ireland and nearly twice!! the number of hospital beds Ireland has.

https://www.oecd.org/france/health-at-a-glance-France-EN.pdf

https://www.oecd.org/ireland/health-at-a-glance-Ireland-EN.pdf

Geuze

France spends 4,542 per person, we spend more at 5,689 pp.

The main reason we spend more, yet get less quantity output, is because our prices are too high.

A consultant in France charges 50-60, compared to maybe 175-225 here.

No wonder the quantity of output per euro spent is lower here!!

Geuze

As the price level is so high here, inflated by medical fees, our exp pp in PPS is less than the French.

We spend more than them in euros, but get less output, as the prices are so high.

karlitob

https://www.boards.ie/discussion/comment/121998182#Comment_121998182

The OECD data still stands by itself but as I’m sure you are aware there are a lot of nuances to the metadata used in many different metrics within similar domains. Both can be correct at once.

I agree in general re costs and price level re fees - as I’ve mentioned before the private GPs and private pharmacists and private consultants are not HSE / public. I took your comment of ‘great at spending money’ as criticism of inept management by ‘the HSE’ rather than what I infer is private sector prices as well as the general cost of doing business in Ireland.

karlitob

In general, my point on my last comment is we don’t have enough beds to address the issues that have been highlighted in this thread.

Spend and model of healthcare financing and pricing in Ireland is a different thread!!

karlitob

https://www.boards.ie/discussion/comment/121996818#Comment_121996818

And not only that but the state paid for vaccinators to do the work, the state paid for an IT system to track those vaccinated and the private GPs refused to enter data but happy to take €60 regardless of whether the vax was given by them or a practice nurse that the state also contributes to.

BobMc

I've often thought could the trainee Drs and Nurses be approached differently, College fees here are significantly less than say the US, what does it cost a student in fees here? over the course of becoming a Dr. ? the US perhaps 250-400k $, so comparatively its cheap here, maybe all trainees should be offered as part of college a 2 yr entry level deal at an agreed Salary dont screw them over and make them work in the Irish system or pay the fees, now of course you could say what about the other trades but its a suggestion but just a thought.