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What is wrong with the health service, HSE

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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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Dirtdrifter

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?

It's widespread imo

I've experienced it twice lately, even spending overnight with children and ultimately been tended to by a nurse and discharged.

Out-of-hours are worse for it than regular GPs

Martina1991

Many hospital services are reduced at night and on weekends.

Doctors and nurses may do day and night shifts, but other departments routinely operate at a 9am to 5pm or even 8am to 8pm Monday to Friday.

Outside of that they offer an on-call service for emergencies only, with 1 person working per department.
To have more scans/tests available 24/7 you would need more staff and ultimately more money to do it.

Sam Russell

stefanovich wrote: »

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.

If GPs are sending patients to A&E for non-urgent treatment then that is wrong. They should be sent to outpatients. It is the breakdown of the outpatients system that is at fault.

I was sent by my GP to Vincents UH for an x-ray after I damaged my foot, and he needed to know if there was a fracture. I went straight there (the X-ray dept) at about 11 am with no appointment and was seen after a 15 min wait, and was on my way within 30 mins. Brilliant service. Why is that not normal? Could this not be the normal for A&E?

Tell me how

stefanovich wrote: »

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.

Fire who?

The HSE is a mess but it is also something which has been a mess for a very long time and in which most participants hold strong bargaining positions. It has become a behemoth. But, if we for example say that we will fire everyone and start again, there are certain things to consider.

There must be a reason to fire someone or else they will challenge the decision with an unfair dismissal case.
Do we acknowledge that firing everyone would mean "no" healthcare for anyone in the public system (Que anarchy)
1 in 23 working people in the country work in the public health system. If they all have family members, friends etc, then a large portion of the country is invested in this and does not want to see things dis-improve for their friends/family member.

I'm being somewhat facetious here but it is not an easy fix. I would like to see a Minister for health target it in different ways and to have managers who could deliver local projects first which could then be pointed at to to drive national strategy.

That is why the Limerick A&E and associated downgrading of Ennis, Nenagh etc is so frustrating because it is a new system, with a newly built A&E department, and it is still a mess. If that was done right, it could provide an empirical model for other locations.

James Brown

Is there stats on the number of people turning up to A&E who don't need to be at an A&E? I can't see A&E staff at any level wearing that kind of thing for very long.

Tell me how

Matt Barrett wrote: »

Is there stats on the number of people turning up to A&E who don't need to be at an A&E? I can't see A&E staff at any level wearing that kind of thing for very long.

You can't see A&E staff tolerating people turning up who don't need to be there? or there being stats tracked to record it?

If it's the former, they can't really speak about this as it could be deemed to be a subjective view as no one can truly state how right some one is to be worried about their health. If it's the latter, I'd imagine staff would be ok but it would again be a troublesome thing to compile and publish as could lead to accusations of shifting the blame.

I was stunned, personally, on a recent trip to Limerick A&E and just how well several A&E attendees knew each other. It implies either the occurrence of a statistically low chance event happening that so many real life acquaintances ended up needing care at the same time, or that they are frequent attendees who start to recognize familiar faces. If

blanch152

Martina1991 wrote: »

Many hospital services are reduced at night and on weekends.

Doctors and nurses may do day and night shifts, but other departments routinely operate at a 9am to 5pm or even 8am to 8pm Monday to Friday.

Outside of that they offer an on-call service for emergencies only, with 1 person working per department.
To have more scans/tests available 24/7 you would need more staff and ultimately more money to do it.

If you did that, you would have significant overcapacity in hospital services. The solution would be to close smaller hospitals such as Ennis and Ballinasloe, for example. Politically, the protest parties would take advantage of this.

So, a no-win scenario politically for a government.

blanch152

Matt Barrett wrote: »

Is there stats on the number of people turning up to A&E who don't need to be at an A&E? I can't see A&E staff at any level wearing that kind of thing for very long.

What can the A&E staff do about it?

Anyway, the INMO would love that, they can more easily make the case for more money and more staff if there are hundreds of people turning up who don't need to be there.

James Brown

Tell me how wrote: »

You can't see A&E staff tolerating people turning up who don't need to be there? or there being stats tracked to record it?

If it's the former, they can't really speak about this as it could be deemed to be a subjective view as no one can truly state how right some one is to be worried about their health. If it's the latter, I'd imagine staff would be ok but it would again be a troublesome thing to compile and publish as could lead to accusations of shifting the blame.

I was stunned, personally, on a recent trip to Limerick A&E and just how well several A&E attendees knew each other. It implies either the occurrence of a statistically low chance event happening that so many real life acquaintances ended up needing care at the same time, or that they are frequent attendees who start to recognize familiar faces. If

I've no idea how you read it that way. I'm actually at a loss as to how to make it any clearer. I asked were there any stats, not show disbelief at the idea of stats.
A&E staff are spending time on hang nails and colds? I would expect it's unlikely. Maybe the people you saw are from a small suburb, in any case it's hardly evidence beyond the anecdotal. I'm not saying it is or isn't the case, just asking do we have any stats? It would be a pointless endevour to blame the problems of the HSE on the sick if it weren't the case.

Podge_irl

Matt Barrett wrote: »

I've no idea how you read it that way. I'm actually at a loss as to how to make it any clearer. I asked were there any stats, not show disbelief at the idea of stats.
A&E staff are spending time on hang nails and colds? I would expect it's unlikely. Maybe the people you saw are from a small suburb, in any case it's hardly evidence beyond the anecdotal. I'm not saying it is or isn't the case, just asking do we have any stats? It would be a pointless endevour to blame the problems of the HSE on the sick if it weren't the case.

I imagine he's confused about the comment about "I can't see A&E staff at any level wearing that kind of thing for very long." If it is indeed a problem (and much as yourself I don't know) there isn't really anything they could do about it. They need to see every patient regardless.

James Brown

Podge_irl wrote: »

I imagine he's confused about the comment about "I can't see A&E staff at any level wearing that kind of thing for very long." If it is indeed a problem (and much as yourself I don't know) there isn't really anything they could do about it. They need to see every patient regardless.

After assessing them can they not send them away? And again, without stats it's just talk isn't it?

Podge_irl

Matt Barrett wrote: »

After assessing them can they not send them away? And again, without stats it's just talk isn't it?

Pretty sure they treat them, even if a GP could have treated them.

You are correct its just talk, but not exactly something I haven't heard from doctors.

Tell me how

Matt Barrett wrote: »

After assessing them can they not send them away? And again, without stats it's just talk isn't it?

I don't know why they go to A&E if they don't need to. But, if they claim to be in pain, it is impossible for someone assessing them to say that that pain does not exist. Even if someone gets assessed with an x-ray for a sore stomach and something wasn't found, does that mean they shouldn't have been there?

You'd imagine though it would be possible to identify stats along the following parameters.

Number of visitors
Number triaged in each category
Number admitted to hospital
Number referred for specialist appointment
Number invited to attend outpatients
Number of prescriptions issued

Could reviewing such figures be an issue for anyone? The hospital? The patient? Would it help to show the efficacy of the system?

James Brown

Tell me how wrote: »

I don't know why they go to A&E if they don't need to. But, if they claim to be in pain, it is impossible for someone assessing them to say that that pain does not exist. Even if someone gets assessed with an x-ray for a sore stomach and something wasn't found, does that mean they shouldn't have been there?

You'd imagine though it would be possible to identify stats along the following parameters.

Number of visitors
Number triaged in each category
Number admitted to hospital
Number referred for specialist appointment
Number invited to attend outpatients
Number of prescriptions issued

Could reviewing such figures be an issue for anyone? The hospital? The patient? Would it help to show the efficacy of the system?

I thought the idea was put forward that people were clogging up A&E in the knowledge a local GP could address their particular issue. If we're talking people genuinely believing they are in need of emergency assistance then they should be seen.

It might show if it's a causal factor in any great measure or just stories. It's important we work on the actual areas causing problems.

Nonoperational

The issue is that A&E is no longer an accident and emergency service. It is a service for moderately unwell people to get access to the public hospital system.

People would be shocked at some of the things that come to A&E, and as much as there is a responsibility on management and staff to discharge and improve efficiency, there needs to be services in place so that A&E is not the entry point.

People who are moderately unwell at worst are being sent in acutely by GPs with no other option or calling ambulances for themselves.

Floppybits

Nonoperational wrote: »

The issue is that A&E is no longer an accident and emergency service. It is a service for moderately unwell people to get access to the public hospital system.

People would be shocked at some of the things that come to A&E, and as much as there is a responsibility on management and staff to discharge and improve efficiency, there needs to be services in place so that A&E is not the entry point.

People who are moderately unwell at worst are being sent in acutely by GPs with no other option or calling ambulances for themselves.

I don't know about you but I wouldn't got to A&E if I was moderately unwell. I remember the last time I went and I had to be dragged there.

Martina1991

Floppybits wrote:

I don't know about you but I wouldn't got to A&E if I was moderately unwell. I remember the last time I went and I had to be dragged there.

You would be surprised. I work in a hospital and though i dont have direct contact with patients, i have seen people come to A and E with their primary ailment "feeling unwell".

Tell me how

Martina1991 wrote: »

You would be surprised. I work in a hospital and though i dont have direct contact with patients, i have seen people come to A and E with their primary ailment "feeling unwell".

What do you think is their motivation for doing so?

They themselves end up being there for a long time, and I'd imagine if there isn't anything too obvious to treat, they are just told to attend their GP.

Martina1991

Quicker access to a doctor out of hours. People are impatient. If they have a medical card its free.

Over Christmas the common complaints are chest pain and abdominal pain. Now some cases would be more serious than others but it sure is a yearly coincidence at a time when people overindulge and gorge themselves.

Tell me how

Martina1991 wrote: »

Quicker access to a doctor out of hours. People are impatient. If they have a medical card its free.

Over Christmas the common complaints are chest pain and abdominal pain. Now some cases would be more serious than others but it sure is a yearly coincidence at a time when people overindulge and gorge themselves.

But are they not triaged to low priority category if their claim is 'feeling unwell'. This would mean that they will be waiting a long time.

Is an out of hours service such as Shannondoc not free on a medical card in the same way?

gctest50

Martina1991 wrote: »

Quicker access to a doctor out of hours. People are impatient. If they have a medical card its free.

Over Christmas the common complaints are chest pain and abdominal pain. Now some cases would be more serious than others but it sure is a yearly coincidence at a time when people overindulge and gorge themselves.

37% increased risk heart attack on Christmas eve though

people know this - it's a wonder they head to hospital

James Brown

The last place I'd like to be is A&E unless I legitimately thought I was very sick.
Why anyone would put themselves through that A&E experience is beyond me.
I'm still finding it difficult to blame the allegedly sick on a poorly functioning HSE.

Martina1991

Tell me how wrote:

But are they not triaged to low priority category if their claim is 'feeling unwell'. This would mean that they will be waiting a long time.

They'll still be seen to eventually. A and E isn't wedged all the time.

We always hear on the news when there are X amount on trollies. We never hear when A and E departments are quiet.

It can be a ghost town on a Friday night and trollies out the corridor on a tuesday afternoon. It just depends.

Tell me how

Martina1991 wrote: »

They'll still be seen to eventually. A and E isn't wedged all the time.

We always hear on the news when there are X amount on trollies. We never hear when A and E departments are quiet.

It can be a ghost town on a Friday night and trollies out the corridor on a tuesday afternoon. It just depends.

Of course, there will be peaks and troughs. But, if the place is a ghost town, it wouldn't be a problem that people were attending.

We are led to believe that waiting times in all A&E's throughout the country are more often than not excessively long. If this is not the case then I'd be surprised that the HSE are not countering it.

gctest50

Matt Barrett wrote: »

.............

I'm still finding it difficult to blame the allegedly sick on a poorly functioning HSE.

That's it though - will blame everyone amd everything but themselves

It's like the only whore in town compaining she's too busy on weekends and Christmas because she's the only whore in town

Tell me how

gctest50 wrote: »

That's it though - will blame everyone amd everything but themselves

It's like the only whore in town compaining she's too busy on weekends and Christmas because she's the only whore in town

James Brown

gctest50 wrote: »

That's it though - will blame everyone amd everything but themselves

It's like the only whore in town compaining she's too busy on weekends and Christmas because she's the only whore in town

It's the public running into the problems caused by a poorly run/managed HSE, not the HSE upset by the caliber of clientele.
What doesn't help, but makes for good distraction is some people coming up with any reason to blame social issues on anything but the policy makers. I mean are we to believe that a fix for the HSE can only happen when the public stop heading to A&E for little or nothing? I'm sure there's an element, but it can't be that simple. If it wasn't for the poor quality sick the HSE would be grand? I'm sure if nobody availed of the HSE there wouldn't be a problem...
It's more akin to a badly run restaurant blaming customers only having the soup and not a four course meal for the poor service and salmonella

Podge_irl

People on trolleys isn't necessarily indicative of A&E being busy, just that its not necessarily possible to admit them I imagine.

blanch152

Matt Barrett wrote: »

The last place I'd like to be is A&E unless I legitimately thought I was very sick.
Why anyone would put themselves through that A&E experience is beyond me.
I'm still finding it difficult to blame the allegedly sick on a poorly functioning HSE.

I think you missed the post where it was explained that if you have a medical card, it is completely free. That is different to out-of-hours services like Shannondoc which charge.

The solution is simple, as has been suggested so many times. A small charge, starting at €10, and ranging up to no more than €40 depending on your family circumstances/medical condition would act as a demand control measure. It would make little difference to the HSE finances because of the administration cost, but it would ensure that the taxpayer money is more than well spent.

blanch152

Matt Barrett wrote: »

It's the public running into the problems caused by a poorly run/managed HSE, not the HSE upset by the caliber of clientele.
What doesn't help, but makes for good distraction is some people coming up with any reason to blame social issues on anything but the policy makers. I mean are we to believe that a fix for the HSE can only happen when the public stop heading to A&E for little or nothing? I'm sure there's an element, but it can't be that simple. If it wasn't for the poor quality sick the HSE would be grand? I'm sure if nobody availed of the HSE there wouldn't be a problem...
It's more akin to a badly run restaurant blaming customers only having the soup and not a four course meal for the poor service and salmonella

It makes a difference from the people attempting to blame the weather and the failures of the Irish soccer team on Leo and Eoghan (or are they the only things they haven't been blamed for?).

Seriously, nobody is saying the HSE would be grand it it wasn't for the poor quality sick. That is either a misrepresentation of a failure to understand. If the reasonable proposals made on here for a small charge to be paid by everyone (yes, medical card holders, pensioners and even members of the travelling community), we would have a small element of demand management so that only people who are really sick would bother turning up.

The restaurant comparison doesn't make sense by the way.