nav[aria-label="Primary Navigation"] { padding: 0; & ul { list-style: none; width: 100%; display: flex; flex-direction: row; justify-content: start; align-items: start; gap: 30px; padding: 0; & li { margin: 0; } & ul li { list-style: none; } } }

Child Item

What is wrong with the health service, HSE

[Deleted User]

https://www.irishtimes.com/news/health/health-services-may-be-cut-in-some-areas-under-new-plan-1.3731979.

How is this happening, the tired old answer is usually too much middle management there has to be more to it? the article is depressing reduce staff recruitment as one of the big answers no nuanced or sophisticated business orientated solutions or advocating solutions that will make issues worse, for example making people wait for the fair deal will inevitably mean people who are ready to be discharged will end up staying in hospital blocking a bed and preventing admission for someone who need it.

Find more posts tagged with

Quick Links

Comments

CrabRevolution

From my experience in the HSE, I don't think there's actually that much easy fat to be trimmed within the hospitals themselves.

I know there's the popular perception out there that you can go into a Hospital and it'll staffed almost entirely by managers and administrative staff but it's not quite true. One hospital I worked in had about 300 beds and 800 staff, and there were maybe only about 15 in roles people would see as useless (even if they're not) e.g. medical records, quality assurance, statistics etc. Most departments have no full time clerical support and might have a secretary for 2 days a week. There was a 7 person senior management team, and maybe another 3-4 more directors of nursing/bed managers etc.

If I were to guess, a lot of salaries are spent on the "business" side of the HSE, called HBS or Health Business Services. People who never see a hospital but work in large office buildings (presumably rented at generous expense by the HSE).

My job involved dealing a lot with HBS procurement, and you'd regularly have to email 5 different people to move one step you could have done yourself in one phone call to a supplier/contractor/service provider. There's project managers, procurement specialists, tender supervisors, procurement officers etc. You've to run every action up and down the chain of supervisors and officers and get a response from each of them, who'll often just pass it to their secretary and cc you in the email.

I'd love to skip the bullsh*t but of course the system is designed so that they control the money so if you don't jump through their hoops you get nothing. I'm told that 10+ years ago when money was flying around, procurement were only involved in large events e.g. new hospitals being kitted out, large expansions, property deals etc. but then the crash happened and they found themselves with nothing to do, so to justify their existence they began asserting that they were in charge of all aspects of buying everything in the HSE.

All of this is supposedly in the name of efficiency and fairness for staff and suppliers etc. but I'd say they've spent €100 and wasted hundreds of man hours for every €1 they've saved. Now I know the HSE can't function without a business,accounting, administrative side, but there's no way in hell that that's the way to go about it. That's just one aspect of the HSE I've found to be a bloated mess, I'm sure there's other parallel bodies soaking up money.

Tell me how

Anita Blow wrote: »

Politicians have no incentive to fix the health service. The fixes that would have the biggest impact and need to happen are too politically unpalatable:

1) Cut administrative staff and reinvest that money in frontline staff

2) Close rural hospitals and centralise care in larger urban hospitals

3) Increase bed capacity, requiring substantial investment.

The health service just isn't an issue for the general public, as evidence by the fact that both Fine Gael & Fianna Fail along with their health ministers continue to enjoy popular support. Why would either risk their chance of re-election when the general public would rather moan than do anything about the health service?

I'm less than 45 minutes from two hospitals. Limerick Regional, or Galway Clinic. Leaving aside the fact that the Galway Clinic is private, I've yet to see how closing regional hospitals is helping.

I think the focus should be on appropriate care in appropriate location. I was in Limerick A&E at the start of November and a lady came in from Carrigaholt with her daughter. That is a 3 hour round trip just to get even triaged.

Is that what it has come to in this country?

Anita Blow

Matt Barrett wrote: »

Well going by the above the question seems to be why are they pretending they don't know what to do and why aren't they doing it?
In the case of Harney there were questions over her husbands connections to private health and we had Reilly and his allocation of Clinics. Maybe it's a case of either not wanting to get too deeply involved or only using it for their own advances?

Politicians have no incentive to fix the health service. The fixes that would have the biggest impact and need to happen are too politically unpalatable:

1) Cut administrative staff and reinvest that money in frontline staff

2) Close rural hospitals and centralise care in larger urban hospitals

3) Increase bed capacity, requiring substantial investment.

The health service just isn't an issue for the general public, as evidence by the fact that both Fine Gael & Fianna Fail along with their health ministers continue to enjoy popular support. Why would either risk their chance of re-election when the general public would rather moan than do anything about the health service?

James Brown

Tell me how wrote: »

Leo Varadkar isn't the first Taoiseach who had also served as Minister for Health in recent times. Brian Cowan also held both roles.

In fact, with the exception of Mary Coughlan who only held the office for a short period, we have had Ministers for Health who have either proven to be quite competent in the political space (Mary Harney, Micheal Martin, Leo, Brian Cowan, Harris) or medical professionals themselves (James Reilly, Leo).

I'm not arguing the overall qualities of these individuals but none of them could be described as being completely unaware of the challenge associated with the Health service or have been expected to be completely incapable of improving it.

So, why are we where we are? There's been enough studies done.

Well going by the above the question seems to be why are they pretending they don't know what to do and why aren't they doing it?
In the case of Harney there were questions over her husbands connections to private health and we had Reilly and his allocation of Clinics. Maybe it's a case of either not wanting to get too deeply involved or only using it for their own advances?

Tell me how

Matt Barrett wrote: »

Your Turkeys voting for Christmas suggested that people who might see fixes, won't put them forward. While nobody would do themselves out of a job I think it's widely regarded that the system isn't working. Letting people go won't solve that.
Only a Minister/Government can. I can see it being so complex it might take some study, but how long? We've had the same issues for decades and now we have a Taoiseach who was formally a health minister. If not now when do we start? If they don't know at this stage maybe it's time they hired professionals or people with an interest in health to look into not lads on their career path having to pay dues by serving as Health Minister for a stint.

Leo Varadkar isn't the first Taoiseach who had also served as Minister for Health in recent times. Brian Cowan also held both roles.

In fact, with the exception of Mary Coughlan who only held the office for a short period, we have had Ministers for Health who have either proven to be quite competent in the political space (Mary Harney, Micheal Martin, Leo, Brian Cowan, Harris) or medical professionals themselves (James Reilly, Leo).

I'm not arguing the overall qualities of these individuals but none of them could be described as being completely unaware of the challenge associated with the Health service or have been expected to be completely incapable of improving it.

So, why are we where we are? There's been enough studies done.

James Brown

Tell me how wrote: »

I'm not suggesting an easy fix. In fact, I'm suggesting that given the intricacies of there being so many people and so many structured influences, it is nearly impossible for a Minister for Health to effect change.

Your Turkeys voting for Christmas suggested that people who might see fixes, won't put them forward. While nobody would do themselves out of a job I think it's widely regarded that the system isn't working. Letting people go won't solve that.
Only a Minister/Government can. I can see it being so complex it might take some study, but how long? We've had the same issues for decades and now we have a Taoiseach who was formally a health minister. If not now when do we start? If they don't know at this stage maybe it's time they hired professionals or people with an interest in health to look into not lads on their career path having to pay dues by serving as Health Minister for a stint.

Tell me how

Matt Barrett wrote: »

My point is maybe it's not down to an easy fix some are aware of but unwilling to address as you were suggesting.

I'm not suggesting an easy fix. In fact, I'm suggesting that given the intricacies of there being so many people and so many structured influences, it is nearly impossible for a Minister for Health to effect change.

James Brown

Tell me how wrote: »

Well if we got people thinking in this way it mightn't be a bad start.
Everyone thinks that there should be change but it should be someone else changing.
What hope does the Minister have in such an environment? Particularly a unionised one.

My point is maybe it's not down to an easy fix some are aware of but unwilling to address as you were suggesting.

mariaalice wrote: »

Its like the welfare debate, HSE covers huge areas the the average person would not consider health care as such, they also fund a large amount of NGO and charities that is why there needs to be better data about what the spending is on, blaming the staff, the unions, the administration is worse that useless.

True.

[Deleted User]

Matt Barrett wrote: »

That's if you believe it's a problem that can be resolved by people simply amending obvious inefficiencies within their control. I can't see front line staff leaving things as is because they aren't bothered changing current practices. Front line staff and doctors are generally the ones seeking change.

Its like the welfare debate, HSE covers huge areas the the average person would not consider health care as such, they also fund a large amount of NGO and charities that is why there needs to be better data about what the spending is on, blaming the staff, the unions, the administration is worse that useless.

Tell me how

Matt Barrett wrote: »

That's if you believe it's a problem that can be resolved by people simply amending obvious inefficiencies within their control. I can't see front line staff leaving things as is because they aren't bothered changing current practices. Front line staff and doctors are generally the ones seeking change.

Well if we got people thinking in this way it mightn't be a bad start.
Everyone thinks that there should be change but it should be someone else changing.
What hope does the Minister have in such an environment? Particularly a unionised one.

James Brown

Tell me how wrote: »

One thing that I am always intrigued by when discussing circumstances in Ireland is the the number of people who work within a particular area as a portion of the population.

In terms of healthcare professionals. The HSE has approximately 102,000 people working for it either directly or indirectly. That is about 1 in 23 of all workers in the country.
This means that the "HSE" which we all refer to is made up by friends, partners, family members of a large portion of the country. And yet, everyone knows it doesn't work, but nobody every can identify how their area is overstaffed or they themselves are under utilised. I can understand this to some degree, why would they, turkeys voting for Christmas kind of thing.

But it must be an incredibly difficult challenge for any Minster of Health given the behemoth that it is.

That's if you believe it's a problem that can be resolved by people simply amending obvious inefficiencies within their control. I can't see front line staff leaving things as is because they aren't bothered changing current practices. Front line staff and doctors are generally the ones seeking change.

Geuze

OECD health exp data

http://www.oecd.org/health/health-systems/Health-Spending-Latest-Trends-Brief.pdf

http://www.oecd.org/els/health-systems/OECD-Health-Statistics-2018-Frequently-Requested-Data.xls

Geuze

If anybody wishes to delve deeper, here is an analysis of the price level in Irish hosps.

Comparing Hospitals and Health Prices and Volumes
Across Countries: A New Approach
Francette Koechlin, Paul Konijn, Luca Lorenzoni, Paul Schreyer

https://link.springer.com/article/10.1007%2Fs11205-015-1196-y

This article is probably behind a paywall.

It finds that Irish hosp price level is 81% higher than the EU28 average.

Anita Blow

Geuze beat me to it it seems!

Anita Blow

Wanderer78 wrote: »

Can anyone point to data to support these claims?

Ireland has the lowest median age in the EU at just over 35.

Healthcare expenditure as a proportion of total government spending is the highest in the EU (20% VS 15%) and is the 2nd highest in the OECD as a % of GNI (12.4% VS OECD average of 9%)

Geuze

Wanderer78 wrote: »

Can anyone point to data to support these claims?

Note that I teach this stuff all the time, so you can depend on my data.

If I'm not sure, I always say so.

Geuze

Ireland median age

Median_age_of_population%2C_2007-17_%28years%29.png

Geuze

Wanderer78 wrote: »

Can anyone point to data to support these claims?

Eurostat data on population and ageing

https://ec.europa.eu/eurostat/statistics-explained/index.php/Population_structure_and_ageing

Across the EU Member States, the highest share of young people in the total population in 2017 was observed in Ireland (21.1 %), while the lowest share was recorded in Germany (13.4 %). Regarding the share of persons aged 65 or older in the total population, Italy (22.3 %), Greece (21.5 %) and Germany (21.2 %) had the highest shares, while Ireland had the lowest share (13.5 %).

Population_age_structure_by_major_age_groups%2C_2007_and_2017_%28%25_of_the_total_population%29.png

Population_age_structure_by_major_age_groups%2C_2007_and_2017_%28%25_of_the_total_population%29.png

Tell me how

One thing that I am always intrigued by when discussing circumstances in Ireland is the the number of people who work within a particular area as a portion of the population.

In terms of healthcare professionals. The HSE has approximately 102,000 people working for it either directly or indirectly. That is about 1 in 23 of all workers in the country.
This means that the "HSE" which we all refer to is made up by friends, partners, family members of a large portion of the country. And yet, everyone knows it doesn't work, but nobody every can identify how their area is overstaffed or they themselves are under utilised. I can understand this to some degree, why would they, turkeys voting for Christmas kind of thing.

But it must be an incredibly difficult challenge for any Minster of Health given the behemoth that it is.

Geuze

incentsitive wrote: »

I thought Ireland has an ageing population?

We do, as do all EU countries.

But we are still the youngest, or among the youngest.

Tell me how

Can I add a light hearted take on how the purpose of a Health Service can be interpreted by different players within it.

The irrefutably exceptional Yes Minister.

Wanderer78

Anita Blow wrote:

Those countries have significantly older populations than us. Ireland has the youngest population in western Europe we should not be having any such problems with our health service nor should we have higher per capita expenditure than those countries.

Geuze wrote:

We have one of the youngest pop in the EU.

Can anyone point to data to support these claims?

incentsitive

I thought Ireland has an ageing population?

Geuze

Anita Blow wrote: »

Those countries have significantly older populations than us. Ireland has the youngest population in western Europe we should not be having any such problems with our health service nor should we have higher per capita expenditure than those countries.

Indeed.

We have one of the youngest pop in the EU.

Yet our health exp pp is fifth highest across the OECD.

Anita Blow

mariaalice wrote: »

https://www.affidea.ie/prices/ how do they do it, the one in Dundrum is in an office building near a shopping center no huge infrastructure backing them up.

Certainly you could be right- I don't fully know the ins and outs of running the health service. However I don't think a small private operation is comparable to running a national health service.

- They outsource their radiology reporting so there's no on-site radiology staff, just radiographers. In fact (and I could be wrong), I think they outsource some of it abroad like the online GP services. That's not a direction I'd like to see our service moving in as I think it would compromise patient health and safety.

- Private businesses like Affidea can pick and choose where they locate. There's 10 MRI locations on their site which leaves a large proportion of the population out of their catchment, but the HSE can't pick and choose. They'd have to ensure coverage is at least as good as it is now offered by hospitals. But we can't take the MRI & CT scanners out of the hospitals, so we'd have to buy multiple more scanners than we currently have to ensure coverage in the community. The HSE doesn't have the money for this. Wexford is raising money from the community to try and get one. We'd be spending millions for no real clinical benefit.

- Because it's a small private operation they only do elective scans and there's some scans they won't do. For example my own aunt has a chronic medical condition they would not scan and advised her to attend one of the Dublin hospitals. This sort of relates to the above point, because hospitals allow for centralisation of care which then further allows for sub-specialisation. We have fantastic radiologists in our hospitals with a high degree of specialisation, but if you split them up into the community then all you will get is generalists rather than specialists.

- There's no clinical or cost benefit of moving these scans into the community. The justification for moving X-rays into the community is because they are simple to perform, very little can go wrong with them, it's usually a simple complaint which can be managed in the community (like a simple fracture) and it constitutes a large volume of the radiology workload in hospitals. CTs & MRIs however are usually for people who are much more sick or the complaint is much more severe and need to be managed in a hospital by specialised staff. These patients are managed by a team, and best practice is that the team meets regularly to coordinate their care. The radiologist is a key part of that team and it would be detrimental to their care if that radiologist was taken out of the hospital and moved into the community.

If you want to abolish waiting lists, then a cheaper and more clinically effective solution is to increase investment in the current hospital radiology departments- increase the no. of radiologists per capita and specialist radiographers we have, and invest in more MRI machines so we can operate a 24h service as opposed to the normal 9-5 we have now.

[Deleted User]

Anita Blow wrote: »

It's probably not realistic to have a complete set of diagnostic services in the community. You could have basic radiology like X-Rays and that would take a great deal of strain off the health service I imagine, but you couldn't have CTs/MRIs which are extremely expensive to buy + run and need a department behind them as well as follow-on care.

I think some of the rhetoric from politicians has sold primary care as the cure for all. It will certainly help and more routine procedures will be done in the community, but in general people who attend hospital need to be there. Our problem is bed capacity. We in general have suitably sized EDs and modern facilities but there is nowhere for patients to go if they need admitted.

https://www.affidea.ie/prices/ how do they do it, the one in Dundrum is in an office building near a shopping center no huge infrastructure backing them up.

Anita Blow

mariaalice wrote: »

I would do the exact opposite give everybody free at point of use accesses to an enhanced GP services all allied medical services and diagnostic services should be from a GP type services with the exception of something like a pet scan. procedure only hospitals with no A and E department. Enhanced step down facilities.

It's probably not realistic to have a complete set of diagnostic services in the community. You could have basic radiology like X-Rays and that would take a great deal of strain off the health service I imagine, but you couldn't have CTs/MRIs which are extremely expensive to buy + run and need a department behind them as well as follow-on care.

I think some of the rhetoric from politicians has sold primary care as the cure for all. It will certainly help and more routine procedures will be done in the community, but in general people who attend hospital need to be there. Our problem is bed capacity. We in general have suitably sized EDs and modern facilities but there is nowhere for patients to go if they need admitted.

Anita Blow

Wanderer78 wrote: »

i suspect the issues of our health services is a bit more complicated than just unions, most countries are developing similar problems

Those countries have significantly older populations than us. Ireland has the youngest population in western Europe we should not be having any such problems with our health service nor should we have higher per capita expenditure than those countries.

[Deleted User]

Matt Barrett wrote: »

I honestly have a tough time getting into the whole backward cycle of blame. The HSE is in a bad way because people are getting medical cards and they don't deserve them, staff taking vacations, (who apparently aren't) during the annual crises times, people who aren't seriously ill backing up ER. Elderly taking up beds because there's no respite to move them on to.
All of the above are quite easily solved. Have a triage system, actively turn people away who shouldn't be in ER. Revisit the allocation of Medical cards, more intermediary care for those in transition and so on.
I can't claim to know the inner workings of hospitals. All I know for certain is government won't touch it. I don't know why. I would take unions in a public service over privatisation any day.
If unions are a cause of the health crisis why isn't some journalist or other investigating and reporting on it? Right now all we have is hearsay in that regard.

They have triage people are in A and E because they have no other options, what should they do with those with mental health issues, addictions, those who are elderly but not well but not acutely ill either and so on. By giving free at the point of accesses to a GP all the huge means testing administration costs surrounding Medical cards is eliminated in one go.

stefanovich

looksee wrote: »

I am today being discharged after a week in the public healthcare system, necessitated by a bad error made in a private clinic. I have nothing but admiration for the care and attention I have received. With one single exception - a person who has whinged and complained at every possible opportunity and been a complete pita to share a ward with - I have not heard any other complaints.

This is not to say there are not problems - of course there are, 'who knew health care could be so complicated?' There are some serious problems - conditions in some nursing homes seems to be one of them - but the knee jerk mouthing off about the entire service is less than helpful.

A&E in the regional hospital in Limerick needs to be seen to be believed.

3rd world conditions.

Read this