University Hospital Limerick- what can be done?

Igotadose

https://www.boards.ie/discussion/comment/121998249#Comment_121998249

Why couldn't Ireland do this without bringing in contractors? Shortage of competence despite all the money spent on medical care? In fact, I believe Ireland made the best decision here as I'd have expected if this was run by the HSE to be a complete goat rodeo with unqualified people, random behaviour from it's IT systems and lots of foulups.

Best thing Ireland did was find good contractors for this work.

markodaly

https://www.boards.ie/discussion/comment/121998222#Comment_121998222

The OECD data still stands by itself 

Not really as measuring spending by per capita GDP is highly flawed given the nature of the Irish economy. Our GDP as a measure doesn't correlate correctly. Anyone interested in stats should know that.

https://www.politico.eu/article/ireland-gdp-growth-multinationals-misleading/

markodaly

https://www.boards.ie/discussion/comment/121999970#Comment_121999970

I remember seeing the ex-head of HSE IT on The Tonight Show lifting the lid on the incompetence of the organisation.

In his world, there are factions and people in there deliberately stopping modernisation and IT projects.

They were somewhat successful during Covid to rapidly deliver certain systems because in his words these people were busy with other things, given the pandemic. But post-pandemic, back to normal. He had to step down as he could do his job.

We all know the Irish health system is somewhat dysfunctional and not really delivering the level of care it should provide given the money we spend on it. I work in a large multinational and my colleagues come from all over the world. The one thing they all remark on, without any prompt from me, is how bad the health system is, compared to their countries.

These are all youngish people, who are bright, well-educated, capable and normally healthy.

I have lived abroad for a while as well, and have experience with health care in other countries as well as here.

While our health system is not 3rd world, like Somalia or Malawi (I've seen 3rd world health care!), it is certainly not on par with my own experience of health care in modern Western countries.

Now, I am sure the HSE can produce report after report saying that they are doing a great job, but it reeks of inertia.

cnocbui

https://www.boards.ie/discussion/comment/121998231#Comment_121998231

'Not enough beds', exactly what the main issues is with LRH, yet when I said a new,modern far larger hospital needs to be built from scratch, you said that was a terrible idea.

It's the only reasonable solution that would solve the insanity of peolple on trolleys as an entrenched normal for at least the last 20 years straight.

bikermartin

https://www.boards.ie/discussion/2058337785/university-hospital-limerick-what-can-be-done

Efforts should be made to increase the capacity and efficiency of healthcare services, including streamlining processes, reducing administrative burdens, and optimizing workflows to improve patient flow and reduce waiting times.

Igotadose

https://www.boards.ie/discussion/comment/122000942#Comment_122000942

I'd suggest they prioritize preventing patients from falling out of trolleys, dying, and laying on the floor for 1.5 hours before someone notices. Just sayin', that seems higher priority than efficiency and capacity improvements, which it seems like the HSE has been attempting for some time.

Igotadose

https://www.boards.ie/discussion/comment/122000814#Comment_122000814

Has the HSE implemented its suggestions to prevent the hack that crashed it 2 years ago, or is that still under investigation? Seems like at least 1 of the offices to be created by the end of 2022 is yet to be filled: https://www.medicalindependent.ie/in-the-news/new-search-for-hse-chief-technology-officer-following-withdrawal-of-candidate/

Although, there is nearly a billion euro budget for the recommendations:

https://www.hse.ie/eng/about/personalpq/pq/2023-pq-responses/may-2023/pq-23294-23-robert-troy.pdf

But, I'm sure the HSE have it all well under control.

Podge_irl

https://www.boards.ie/discussion/comment/122000855#Comment_122000855

Because it doesn't address the underlying causes of why the hospital is so oversubscribed. It's the equivalent of adding a lane to the motorway - it never solves the problem.

cnocbui

https://www.boards.ie/discussion/comment/122001677#Comment_122001677

Well rounding up 75% of the population in it's catchment area and euthanasing/shooting them all isn't likely to be a policy that will gain much traction.

Alternatively, if you've a magic wand that will stop people getting sick and needing the services of UHL, I suggest you start waving it.

What was that genius suggestion I saw recently - oh yes, stick 4 GP's just inside the door to triage. Good thing there's so many GP's about with nothing better to do. I just made an appointment to see mine and it will be in over a month's time. There are many GP practices in and around Limerick refusing to take on more patients because they haven't the capacity, yet some boof-head thinks finding 4 to triage at UHL is an 'idea'.

Podge_irl

https://www.boards.ie/discussion/comment/122002145#Comment_122002145

The solution, which karlitob discussed, is about the infrastructure in the region around the hospital. However, this is often politically difficult.

You need social care to free up beds, you need regional hospitals doing routine surgeries (not however ED which is what people most often want), you need out of hours GP care. Replacing UHL with a newer, fancier, larger building won't solve any of the main problems.

cnocbui

https://www.boards.ie/discussion/comment/122002274#Comment_122002274

Simple question, if you have sufficient beds for the number of people requiring hospitalisation, would there still be patients on trolleys for the next 2 decades straight, like the last 2 decades? Stating the problem isn't an insufficiency in available beds is not credible.

Out of hours GP care? Did you fall off a trolley? I have already pointed out there are not enough GP's in the community as is.

Routine surgeries at regional hopitals? Wow, that's something to take in, I need to sit down. I was on a fu​cking 18 month waiting list for a simple proceedure at Nenagh RH, and that's with slipping in because of a cancellation. A snowballs chance in hell…

The medical profession in this country are incredibly successful at moat digging to prevent any increase in medical student numbers. When my son graduated from HS, there was a girl who wanted to study medicine. She was incredibly happy and getting pats on the back when we were collecting the results as she had something like 540 points and seemed a shoe in to do medicine. Except it wasn't to be, as she 'supposedly' failed the hpat, but neither I nor my son believe that for a millisecond. There is no independent oversight of the HPAT, nor transparency, nor is there any appeal process that I am aware of.

And she wasn't the only one. I believe there were two others who wanted to do medicine, got the requisite leaving cert numbers and then were excluded by likely manipulation of their HPAT scores.

It seems to be a weird thing with medicine. Doctors in South Korea have been marching in their thousands in protest at government plans to increase the enrolment numbers for medicine, and this is despite SK having an already low Dr to population ratio by international standards.

https://www.reuters.com/world/asia-pacific/why-are-south-korean-trainee-doctors-strike-over-medical-school-quotas-2024-02-21/

Podge_irl

https://www.boards.ie/discussion/comment/122002412#Comment_122002412

Simple question, if you have sufficient beds for the number of people requiring hospitalisation, would there still be patients on trolleys for the next 2 decades straight, like the last 2 decades? Stating the problem isn't an insufficiency in available beds is not credible.

More acute hospital beds in a Model 4 hospital would be one of the least cost efficient or effective ways of combating the trolley issue.

Your conspiracy theories about Hpat are entertaining, but utterly baseless on the most basic level. Course numbers are set in advance and if multiple people achieve the required standard they simply raise the standard or move to random allocation if needs be. This is how the entire CAO system operates.

karlitob

https://www.boards.ie/discussion/comment/122000855#Comment_122000855

I had to go back and check what you said / I said.

You said “There is only one sane answer and that is to replace UHL instead of trying to constantly patch it with sticking plasters, and build a new, large modern hospital.”

I told you that was a mental and stupid suggestion (it’s what I meant even if I didn’t say it). And I stand by that.

What kind of person thinks that the way to improve the situation in UHL is to knock it and replace it with another hospital. I’m sure everyone who reads your post will form their own opinion of you and your insights on how to improve our healthcare services.

karlitob

https://www.boards.ie/discussion/comment/122002412#Comment_122002412

hahaha I see you’re back to your ‘I read this about one thing in one place in a non comparable health system and now I’ll apply it to a system I know nothing about’.

I gotta say - you’ve really kept me entertained on this thread. Keep em coming.

Anita Blow

The bottleneck in producing doctors is not medical school- we produce plenty of Irish/EU doctors from college. The bottleneck is postgraduate training. There's no point in increasing medical school places if there isn't a commensurate rise in training scheme spots. At present we have competition ratios for postgraduate training of 2-8 (or more) for every one training spot. So there's no shortage of people applying from medical school/intern year, they're just not getting training spots. That is solely down to DoH who decide on the number of postgraduate training spots. The colleges have been advocating for years to increase this.

Unfortunately postgrad training in Ireland is a mess and there isn't a quick fix. These training numbers need to be mapped to supervising consultants (of which there's a shortage) and suitable hospitals with training opportunities (we have too many small hospitals of no training value) and ideally if there was any workforce planning would be mapped to consultant posts on completion of training. There are some schemes that may have 10-15 trainees per year and 1 or no consultant posts for them on completion of training, leaving the overwhelming majority having to move abroad for a job.

karlitob

https://www.boards.ie/discussion/comment/122009522#Comment_122009522

Thanks for that Anita. Very interesting - all of which makes sense.

Can I challenge you and ask - is it all DoH? Surely some of the restrictions, a least historically have been from the colleges themselves?

Also - with your post in mind, what’s your view on why so many consultant posts are unfilled? Wrong type of role in the wrong place? Pay?

Thanks again for your post.

Anita Blow

I think historically there was likely an element of protectionism from consultants- I believe in the past they may have held a veto over contract types offered to new entrants to limit private practice (and thus competition for themselves). The work/training environment is very different now though due to the shortage in consultant/NCHD numbers and new contract. I don’t think the colleges themselves have ever colluded and certainly now are keen to expand numbers and have lobbied annually for additional training spots.
I think to be fair to the DoH there has been a significant increase in training numbers ever since COVID.

To be honest I have no clue why they’re unfilled. It’s an extremely competitive environment and the vast majority of trainees complete their training scheme with zero prospect of a consultant post. The expectation is to go abroad and wait it out there until a post comes up at home. I would say many of those unfilled posts are in the smaller hospitals where people do not want to work. There’s very little vacancies in the bigger hospitals.
Smaller hospitals need to be shut and centralised into larger services to attract highly qualified consultants back to jobs that will actually be rewarding. As it stands, nobody who is being forced abroad after training to places like Sydney, Melbourne, Toronto, States etc is going to ever come back to do a general surgical job in Clonmel

karlitob

https://www.boards.ie/discussion/comment/122013415#Comment_122013415

Thanks for that. Good to have that background.

Met an former colleague recently who said they were working in a general hospital midlands and straight away said ‘lifestyle choice’ but in a ‘life got in the way of working in a big tertiary hospital and I’m a bit sad about it’ kind of way.

I’m not sure what can be done. The smaller general hospitals are the workhorses of the (acute) health service IMO. Most (says he sweepingly) healthcare is chronic disease management. Older / ageing people collecting healthcare conditions needed multidisciplinary management and needed safe and effective interfaces of care.

Another colleague came back from the states with this hyper specialised skill set in respiratory. The banality of IECOPD seems to pale in comparison. It always makes me think that we might be overspecialising in some areas making day to day healthcare a bit boring. Interesting in your view on that sweeping generalisation.

Am I correct in saying that there are two consultant levels in NHS England. If I understood it correctly - it was in effect making the SpR a consultant 1, and then the long term ageing professor of this, and director of research that consultant a consultant 2. But that had obvious issues of two tier consultants.

No easy answers!!

Anita Blow

I think absolutely every speciality has its bread and butter that constitutes the majority of the work- COPD in resp, Diabetes in endo, IHD in cardiology. That’ll be the same in every hospital but you do kind of need the rare and complicated stuff to motivate you and keep the job interesting. That’ll be more true for other specialities and is particularly important for maintaining skill mix. For example in emergency medicine, small EDs like Navan (and Roscommon before it closed) suffered from their size because the catchment was just too small to have any complexity. As a result ED doctors weren’t getting exposure to complex presentations and procedures like chest drains or intubations which compromised patient safety if somebody did present requiring those but there’s no staff present trained to deal with it. This is why those units cannot be accredited for training. That’s replicated across most specialities where many of the small hospitals simply don’t have the caseload or complexity to be accredited. My own experience in a small peripheral mirrors that- the unit was just far too small and quiet and for me it was a waste of 6 months of my training.

I don’t think there’s formally 2 consultant levels in in the UK. They have a similar structure to us. Definitely in the States there’s a tiered consultant level but that’s because their training is much shorter so their early career consultants would be equivalent to our registrars in training

Igotadose

https://www.boards.ie/discussion/comment/122014739#Comment_122014739

In order to qualify as a specialist in the US which I believe is the equivalent of consultant here, isn't it a minimum of 11 years of education training? 4 years of undergraduate specializing in medicine, 4 years medical school, pass the boards, then residency (3 years, as much as 7 in some specialities). Then the doctor may have a subspecialty training of 3 years.

Are you certain it's 'much shorter' than in Ireland? How long is the equivalent in Ireland? In the UK, don't they go from university right into 'junior doctors' even before completing medical school? A quick google of 'neurosurgeon training requirements in ireland v. US' shows Ireland 8 years, US 12

Anita Blow

Postgraduate training is much shorter in the states. After medical school they go directly into a residency training programme which is about 3 years for GP, 5 years for medicine and 5-7 years for surgery.

In Ireland upon graduation you will do 1 general intern year, 2 years basic training for medicine/surgery and then 5 years higher specialist training for medicine and 5-7 years for surgery. This is then generally followed by a 1-2 year fellowship before being eligible for a consultant post. UK is the same but they do 2 years as an intern.
So in general we do about 3 years more training than in the States

karlitob

https://www.boards.ie/discussion/comment/122017317#Comment_122017317

Do we not have an 5-6 year undergrad but they have a 4 and 4 undergrad and medical school?

Podge_irl

https://www.boards.ie/discussion/comment/122017413#Comment_122017413

The undergrad it just a generic undergraduate degree though. In theory it can be in anything. It's frankly a bizarre setup.

Igotadose

https://www.boards.ie/discussion/comment/122017429#Comment_122017429

Yes, but you won't get into med school without passing the MCAT and having a good grounding in the basic science - chem and physics, and mathematics. Pre-med degrees have been around forever.

Podge_irl

https://www.boards.ie/discussion/comment/122017522#Comment_122017522

Sure, just saying that I wouldn't call it 8 years of an undergrad vs 5 for Ireland.

Igotadose

https://www.boards.ie/discussion/comment/122017547#Comment_122017547

Hard to make an apples:apples comparison without any idea of the curricula requirements. In the US, it's the AMA that sets them.

Who sets them in Ireland?

Anita Blow

They do a pre-med undergrad but I’m speaking about postgraduate training. Nobody really considers medical school/pre-med as the start point in practice.

European directive sets the clinical hours requirement for medical school in Europe and then Irish Medical Council sets basic curriculum requirements

Igotadose

More on uhl

https://www.breakingnews.ie/ireland/doctor-who-treated-aoife-johnston-tells-inquest-uhl-is-not-a-safe-environment-for-patients-1616761.html

cnocbui

https://www.boards.ie/discussion/comment/122054517#Comment_122054517

Interesting, the prevelance of sepsis mortality in this country is shocking. 3,000 deaths PA. In Australia there are 5,000 deaths for a population 5 times Ireland's.

Igotadose

https://www.boards.ie/discussion/comment/122054856#Comment_122054856

I'm sure there are dozens of administrators working overtime on this, there're probably lots of data dumps reports just on the subject and it's a key action item for their 50 year plan or whatever they call it. There'll be lessons learned and action plans and with just a few more billion euros, problem solved /sarcasm