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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.

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[Deleted User]

There was a big redundancy schema in I think 2010, There is a huge infrastructure backing up the HSE, engineers, QS, electricians, plumbers, maintenance, gardeners, health and safety, catering and so on none of which do front line work but system has to have them because health care is carried out in buildings.

Tell me how

Anita Blow wrote: »

Your example of Ennis ED, 30 mins from an ED in a model 4 hospital in a sparsely populated part of the country was an example of inappropriate care in an inappropriate location. Its remodelling as a local injury unit, with redeployment of staff to Limerick is a far better use of resources which improves outcomes for everyone in the area.
There's no point in being 30 mins from an ED if it has none of the services to treat you in an emergency

My point is that is that the care is not available within the local injury unity in order to best meet the needs of the populace.

It is only open until 20:00 but realistically (it seems but don't quote me on that) that few go there between 18:00 and 20:00 as they are afraid or they expect that they will be told that they must attend Limerick because of the time of day it is. I'm not sure how true that is but I can say that I was told by an ambulance driver that there was no point them trying to bring me to Ennis as it was after 17:00 and they wouldn't accept the ambulance there.

I have no problem with the centralisation of specialised care but the downgrading and primarily the reduction in hours of care in hospitals such as Ennis and Nenagh and others is detrimental to the patient in less serious instances and to the overall system in flooding hospitals which cannot handle the volumes. This has the knock on effect of putting more sick people in the same location for longer periods, increasing the risk of picking up or transmitting an infection or virus.

Of course the HSE, Government are going to advocate for even more centralisation of services. Why wouldn't they. If any business were told that the customers would come to them then it is understandable that they would try to maintain as few locations as possible.

But, and this is my point. It. is. not. working. One of the links in an earlier post was from someone who spent several hours in A&E in limerick in a relatively non-serious condition before then being sent by ambulance to a bed in Ennis.

I, as many others am genuinely fearful at the thought of my elderly parents having to approach an A&E for care as it currently stands.

incentsitive wrote: »

From a quick look at Google Maps Carraigaholt is 1hr 19 from Limerick, 55 minutes from Ennis.....hardly a massive difference and I'm sure in an emergency situation it is even less.

I mentioned Carraigaholt because that was the example I witnessed where someone was attending an A&E when realistically a local injury unit would have been suitable. But, it was not available given that it was heading in to the late evening. The impact of the re-structuring has resulted in some people now having less services than they had previously. I know you have to think of the greater good, but, are we seeing the improvements? And if not, why not?

Personally, I would like to see local injury units available 24/7. I would like to see the ability for people to be triaged in these units and to be entered in to the A&E pipeline in the main hospital before they attend the hospital. Approximate waiting times for triage categories are on display (certainly within Limerick A&E) so why not use a combination of this awareness and mobile phones to inform the patient when they will be seen in A&E before having to attend and go to the back of the queue.

touts

There's a serious party political broadcast on behalf of the HSE on Saturday with Cormac O'Hara at the moment. Opened with a surgeon using the fact that he is working on Christmas Eve as evidence of how hard he works. He then explains that he only does operations on Mondays and this year Christmas Eve is a Monday so he decided to work.

A surgeon working for the HSE who only does operations one day a week......

I suppose that means he had the guts of three weeks off last year when Christmas Day and New Year's Day were Mondays.

But apparently he has a robot (I kid you not) that can visit patients for him the other days.

touts

And then they had an administrator come on and explain how Tallaght is lucky to have good local representatives including minister Zapone to help them get the money they need from the state.

How the hell can it be acceptable that having a local minister is a determining factor in how much money a hospital gets.

Uriel.

touts wrote: »

And then they had an administrator come on and explain how Tallaght is lucky to have good local representatives including minister Zapone to help them get the money they need from the state.

How the hell can it be acceptable that having a local minister is a determining factor in how much money a hospital gets.

That's the way it is and always has been

[Deleted User]

Local voters demand their local TDs bring home the bacon.
Or they'll change them for someone who will do it.

Uriel.

Topgear on Dave wrote: »

Local voters demand their local TDs bring home the bacon.
Or they'll change them for someone who will do it.

And that's the problem with electing national representatives on the basis of local constituencies.

FreudianSlippers

touts wrote: »

There's a serious party political broadcast on behalf of the HSE on Saturday with Cormac O'Hara at the moment. Opened with a surgeon using the fact that he is working on Christmas Eve as evidence of how hard he works. He then explains that he only does operations on Mondays and this year Christmas Eve is a Monday so he decided to work.

A surgeon working for the HSE who only does operations one day a week......

I suppose that means he had the guts of three weeks off last year when Christmas Day and New Year's Day were Mondays.

But apparently he has a robot (I kid you not) that can visit patients for him the other days.

This reads as anti-intellectualism if I'm being frank. You have no idea of why this person does surgeries on Monday and you clearly have no idea of the weekly in-and-out job of a surgeon; the importance of clinic, rounds, etc.

oscarBravo

touts wrote: »

He then explains that he only does operations on Mondays...

I've been under the care of a consultant ophthalmologist for seven or eight years now. I've seen him between two and six times a year in that period, and only two of those visits were for surgery.

I know he only does operations one or two days a week, but I'm under no illusions that he spends the rest of his time golfing.

CrabRevolution

touts wrote: »

There's a serious party political broadcast on behalf of the HSE on Saturday with Cormac O'Hara at the moment. Opened with a surgeon using the fact that he is working on Christmas Eve as evidence of how hard he works. He then explains that he only does operations on Mondays and this year Christmas Eve is a Monday so he decided to work.

A surgeon working for the HSE who only does operations one day a week......

I suppose that means he had the guts of three weeks off last year when Christmas Day and New Year's Day were Mondays.

But apparently he has a robot (I kid you not) that can visit patients for him the other days.

I think this does nothing but show how little you know of how the system works. It's not like he's sitting around scratching himself the other 6 days a week. He'll be doing rounds, consultancy, teaching etc. A different surgeon is probably using the operating theatre each the other days of the week, so its not like it's lying empty waiting for him to return.

On top of that, it's not just a case of the surgeon showing up for a few hours and getting a few hours of surgery done by himself. For surgery you need a team of nurses, attendants, anaesthetists etc. You also need bed spaces to prepare patients, beds for patients to recover, disinfection services etc. A surgeon could be willing to operate 7 days a week but it's worth nothing if they don't provide the supporting services.

nice_guy80

HSE - too many snouts in the trough

Good loser

CrabRevolution wrote: »

I think this does nothing but show how little you know of how the system works. It's not like he's sitting around scratching himself the other 6 days a week. He'll be doing rounds, consultancy, teaching etc. A different surgeon is probably using the operating theatre each the other days of the week, so its not like it's lying empty waiting for him to return.

On top of that, it's not just a case of the surgeon showing up for a few hours and getting a few hours of surgery done by himself. For surgery you need a team of nurses, attendants, anaesthetists etc. You also need bed spaces to prepare patients, beds for patients to recover, disinfection services etc. A surgeon could be willing to operate 7 days a week but it's worth nothing if they don't provide the supporting services.

You speculate - but we don't know do we?
What I find astonishing is all the radio/TV programs about the HSE that go nowhere; generally because of the abysmal quality of the presenters.

How many times have there been hour long programs where 15/20 mins are devoted to sorting out what is wrong with the HSE? Laughable!
Each segment of the HSE should be subjected to forensic scrutiny. That recent examination of nurses' pay was thorough and fact based.
(Should have been done on the guards last year).

Good loser

CrabRevolution wrote: »

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.

Impressive post.

You have identified one problem there for sure.

sliabh 1956

I was in the Regional in Limerick on Saturday to see someone who had been admitted on thursday night she was still in the corridoor of the A&E amongst 30 or more other patients the scene was was more like that of a military field hospital than a modern hospital which it is, she was in the new section that has been opened recently. What struck me most was the good humored nature of the staff as the attended the patients trying to squeeze past visitors and trolleys . They were curteous and helful at all times which to me was something wondreful.
How they can work under these conditions is simply amazing. I felt that visitors were making the situation that bit more diffucult though I saw people helping their loved ones with their needs as well. This was in just one section of the Hospital. From what I saw this new section is not able to cope with the numbers even though it is a new addition to the existing hospital. The lady got a bed in a ward that evening . She is now back in Ennis Hospital in a room all to herself. It makes you wonder why Ennis was downsized in the first place seeing as Limerick is unable to cope with patients it recieves. There was one other positive thing about Limerick Regional there was plenty of parking available. But all the staff in Limerick were a credit to their profession.

ednwireland

i wonder if anyone knows where the 17 billion plus euro is been spent.

i would suspect that there are black holes out there that are hoovering up money (empty offices been rented springs to mind)

but until you figure where the money is going i doubt you have a hope of reforming the health service.

nc6000

ednwireland wrote: »

i wonder if anyone knows where the 17 billion plus euro is been spent.

How does the amount we spend on health compare to other countries?

I saw that in the last UK budget their increase in NHS funding was more than our entire health budget.

Granted the UK is much larger and comparing the NHS to the HSE isn't exactly an equal comparison but is the budget big enough to start with?

An earlier post here mentions the new A&E in Limerick and how it's overcrowded with up to 30 people on trolleys. Does this not simply mean that the new facility wasn't fit for purpose from the outset and should have been bigger?

prawnsambo

nc6000 wrote: »

How does the amount we spend on health compare to other countries?

I saw that in the last UK budget their increase in NHS funding was more than our entire health budget.

Granted the UK is much larger and comparing the NHS to the HSE isn't exactly an equal comparison but is the budget big enough to start with?

An earlier post here mentions the new A&E in Limerick and how it's overcrowded with up to 30 people on trolleys. Does this not simply mean that the new facility wasn't fit for purpose from the outset and should have been bigger?

Over crowding in hospitals isn't always about space. There could be empty wards that can't open because there isn't enough staff to actually run them.

sliabh 1956

My Mother in Law was discharged to day from Ennis such a contrast from Limerick a spacious room all to herself constant attention and excellent food all this as a public patient from the over crowding and general mayhem to the calm and serenity of Ennis. How can such a contrast exist from a HSE which has a central planning body .

mav79

I don't know how widespread this is, but from my personal experience in the last year. Local GP's and out of hours doctors e.g. Westdoc, or Shannon doc seem to be passing the responsibility on to A&E.

Three times in the last few months I've needed to bring family to the doctors only to be told to go straight to A&E where we've had 12 hour waits holding up staff and occupying beds only to see a doctor for 15 minutes and being sent home.
This is with no extra tests being done e.g. x-rays or scans.
Are GP's afraid to diagnose patients causing overcrowding in the hospitals?

prawnsambo

mav79 wrote: »

I don't know how widespread this is, but from my personal experience in the last year. Local GP's and out of hours doctors e.g. Westdoc, or Shannon doc seem to be passing the responsibility on to A&E.

Three times in the last few months I've needed to bring family to the doctors only to be told to go straight to A&E where we've had 12 hour waits holding up staff and occupying beds only to see a doctor for 15 minutes and being sent home.
This is with no extra tests being done e.g. x-rays or scans.
Are GP's afraid to diagnose patients causing overcrowding in the hospitals?

Those locum services are notorious for it. And not just west of the Shannon either. They don't have the patient history or experience of a long standing local GP and don't want the responsibility. Or at least that's how it seems to me. I've heard numerous instances of this happening with those kinds of services

Good loser

prawnsambo wrote: »

Those locum services are notorious for it. And not just west of the Shannon either. They don't have the patient history or experience of a long standing local GP and don't want the responsibility. Or at least that's how it seems to me. I've heard numerous instances of this happening with those kinds of services

I would believe that.

If/as that's the case what's the use of all the talk of pushing people away from A & E's to GP's?

I believe too some GP's get pissed off with HSE and get payback by 'passing the parcel'.

I wonder if all routine surgeries were out sourced to private hospitals would it ease the load on HSE hospitals? With competitive tendering for contracts?

Sam Russell

Good loser wrote: »

I would believe that.

If/as that's the case what's the use of all the talk of pushing people away from A & E's to GP's?

I believe too some GP's get pissed off with HSE and get payback by 'passing the parcel'.

I wonder if all routine surgeries were out sourced to private hospitals would it ease the load on HSE hospitals? With competitive tendering for contracts?

A lot of problems start in the A&E departments.

1. Well, I would invest in an out of hours GP service alongside A&E, with triage sending appropriate cases to them. The GPs could be local GPs on a rota (and funded by the HSE). Appropriate fees paid to the GP. It might be a place for trainee GPs to get experience.

2. I would introduce a stream for patients who are elderly - say over 70. This would be to reduce the scandals we read about of '92 year old left on trolley for 36 hours' or similar. Most elderly patients do not have one ailment but many, and need specialist treatment. This could be carried out in a different part of the hospital - or even a separate clinic.

3. I would treat trivial cases either with quick fixes, or give them the bums rush. Too many patients, considered to be trivial are left wait for ever in the hope they will just go away. They give the system a bad name.

4. I would transfer patients, where possible, to out patient care if appropriate, rather than having them hang around waiting and clogging up A&E. I was kept in A&E for three days because they wanted to give me a tests that was not available after 4 pm, and then I had to wait for the consultant to release me, but they would not let me go away and come back at the appropriate time.

5. Pay public hospitals on a per procedure basis, and not a block grant, and not allow any private work within the public hospital.

6. Separate the public acute hospitals from the current system and run them directly from the HSE under a directorate, publicly answerable.

7. Cut the top administrative positions in the HSE that are sucking the money from the system.

Tell me how

Sam Russell wrote: »

A lot of problems start in the A&E departments.

1. Well, I would invest in an out of hours GP service alongside A&E, with triage sending appropriate cases to them. The GPs could be local GPs on a rota (and funded by the HSE). Appropriate fees paid to the GP. It might be a place for trainee GPs to get experience.

Are you suggesting people go to A&E first and then they decide to send them to a GP? I would think the GP (or local injury unit) completes the triage assessment and then send patients to A&E as necessary. Needs to be 24/7.

2. I would introduce a stream for patients who are elderly - say over 70. This would be to reduce the scandals we read about of '92 year old left on trolley for 36 hours' or similar. Most elderly patients do not have one ailment but many, and need specialist treatment. This could be carried out in a different part of the hospital - or even a separate clinic.

Agree with the intent of this but can also see it being problematic as in “why is a 71 year old with a light cold being prioritised over a 68 year old with pneumonia.”

3. I would treat trivial cases either with quick fixes, or give them the bums rush. Too many patients, considered to be trivial are left wait for ever in the hope they will just go away. They give the system a bad name.

Hopefully if point 1 worked correctly, this would no longer be a major problem.

4. I would transfer patients, where possible, to out patient care if appropriate, rather than having them hang around waiting and clogging up A&E. I was kept in A&E for three days because they wanted to give me a tests that was not available after 4 pm, and then I had to wait for the consultant to release me, but they would not let me go away and come back at the appropriate time.

Agree. Allow patients to return for tests if possible.

5. Pay public hospitals on a per procedure basis, and not a block grant, and not allow any private work within the public hospital.

Could be problematic if they end up starting to push for a procedure route to increase budget when it is not definitively the best option. (I’m saying “if” as have to believe most Dr’s adhere to keeping the patient in mind for best care”)

6. Separate the public acute hospitals from the current system and run them directly from the HSE under a directorate, publicly answerable.

Would be concerned that this would end up with divested interests and focus which would lead to issues in operation.

7. Cut the top administrative positions in the HSE that are sucking the money from the system.

Way easier said than done I’d imagine. Everyone thinks there should be cuts/changes… but not in their section/role.

Sam Russell

Tell me how wrote: »

Are you suggesting people go to A&E first and then they decide to send them to a GP? I would think the GP (or local injury unit) completes the triage assessment and then send patients to A&E as necessary. Needs to be 24/7.

What I am seeing is that some people go to A&E with complaints that a GP would be better dealing with first. The A&E dept that had a GP service attached would direct the patient to that service as it would be more appropriate for that patient.

If I have a sick child, or a sick adult, going to the GP, particularly out of hours, is not really an option for some, so they go to A&E. But if I go to A&E, I do not see a doctor for many hours, and all I may need is confirmation that the condition is not urgent, and I can go home content. The A&E dept has a lot of routine to go through before a doctor even looks at the patient, all of which is not needed in many cases.

If 10% of patients were cleared by GP level intervention, it would ease congestion hugely.

Tell me how

Sam Russell wrote: »

What I am seeing is that some people go to A&E with complaints that a GP would be better dealing with first. The A&E dept that had a GP service attached would direct the patient to that service as it would be more appropriate for that patient.

If I have a sick child, or a sick adult, going to the GP, particularly out of hours, is not really an option for some, so they go to A&E. But if I go to A&E, I do not see a doctor for many hours, and all I may need is confirmation that the condition is not urgent, and I can go home content. The A&E dept has a lot of routine to go through before a doctor even looks at the patient, all of which is not needed in many cases.

If 10% of patients were cleared by GP level intervention, it would ease congestion hugely.

I do agree. But I don't think A&E directing the people to GP would help ease congestion. My reason for suggesting local injury units triage service users (at all times of the day) is that it keeps them away from the A&E until they need to be seen. If there is an 8- 10 hour waiting time for their category triage for example, the patient wouldn't attend the A&E for 7-9 hours.
It does mean reopening local injury units for longer periods than they are currently open but I feel the benefits on the operation of the A&E would justify this.

Sam Russell

Tell me how wrote: »

I do agree. But I don't think A&E directing the people to GP would help ease congestion. My reason for suggesting local injury units triage service users (at all times of the day) is that it keeps them away from the A&E until they need to be seen. If there is an 8- 10 hour waiting time for their category triage for example, the patient wouldn't attend the A&E for 7-9 hours.
It does mean reopening local injury units for longer periods than they are currently open but I feel the benefits on the operation of the A&E would justify this.

I think you miss my point. The GP is part of A&E. just down the corridor. The patient opts for the GP, pays the appropriate fee, and has a definite wait time. Alternatively, and indeterminate time for triage and a long wait in A&E.

Tell me how

Sam Russell wrote: »

I think you miss my point. The GP is part of A&E. just down the corridor. The patient opts for the GP, pays the appropriate fee, and has a definite wait time. Alternatively, and indeterminate time for triage and a long wait in A&E.

But they are still in the A&E waiting area until seen by the GP. You still have the same numbers walking in the A&E doors.

I think this DR would get backed up as the other DR's in A&E currently are doing.

Sam Russell

Tell me how wrote: »

But they are still in the A&E waiting area until seen by the GP. You still have the same numbers walking in the A&E doors.
I think this DR would get backed up as the other DR's in A&E currently are doing.

That is a question of organisation. They do not have to be in the same waiting area, and I would think they should not be. Also, it could be posted as a separate service, and so people would choose which service they needed.

Look, there are no real statistics in any of this.

How many people attend A&E unnecessarily? (Using attending doctors as the judge).

How many patients could be discharged earlier than currently to outpatients?

And many more measures. You cannot solve this type of situation without proper statistical measurements, and without trialling new systems.

Good loser

Sam Russell wrote: »

That is a question of organisation. They do not have to be in the same waiting area, and I would think they should not be. Also, it could be posted as a separate service, and so people would choose which service they needed.

Look, there are no real statistics in any of this.

How many people attend A&E unnecessarily? (Using attending doctors as the judge).

How many patients could be discharged earlier than currently to outpatients?

And many more measures. You cannot solve this type of situation without proper statistical measurements, and without trialling new systems.

We're mostly speculating in the dark aren't we?

Have heard it said that 90% of those in A&E's need to be there; still the removal of the extra 10% would make a very,very significant difference.

I imagine part of the problem is the fact that A&E's are in all the large cities so a large % of the pop. are within easy reach of them. The truculant, the bullies, addicts etc are too convenienced.

Once they get inside the door of the A&E they are a problem (from the numbers angle).
I believe New York has sorted things a lot with 'tough love'. Must have the stick with the carrot.
Just a thought: Are the legal profession a lot to blame for the HSE problems?

A relation was in A&E in Sydney for last while; now leaving, he hated it.
Will hear more re comparisons with us when he comes home.

An acquaintance was in A/E recently. Very busy, trollies etc. When daughter wanted her mouth seen to and wanted to do it herself the nurse stopped her. At the same time saying we're understaffed, overworked and underpaid!! Completely inappropriate comment in those circs.

stefanovich

From my experience GPs redirect to A&E as it is the fastest way to get you a bed. John's will give letter and redirect you to A&E in the regional where you can sit on a chair for 12 hours even though they know what is wrong, what you need and where you need to go. A large portion of patients that are taking up beds are waiting for MRI scans, that seems to be a massive bottleneck.

The whole system (if you can even call it that) is an utter disgrace.

Solution?

Start firing.