What is wrong with the health service, HSE

Matt Barrett wrote: »

That might explain a surplus of staff, but not the running.
Also we can revisit these deals. We had to eventually let the lamplighters go.

But it's not a new phenomena surely? Do we just go on so? I don't know much about the inner workings but one would expect there are people who do and have ideas for fixes at the stage.

Only turkeys vote for Christmas.

Most organisations go through rationalisation from time to time, usually when the money looks like running out. Jaguar Land Rover are currently looking to shed 5,000 jobs in the UK due to falling sales. The job losses are in management, marketing etc. - but not manufacturing.

State funded organisations do not usually run out of money because they just ask for more and usually get it.

Geuze wrote: »

When the eight regional health boards were merged into the HSE, a deal was done by Ahern with the unions.

No job losses.

There are 2,000 staff in HR, and the head of HR says he needs 800.

There are 62 payroll offices in the HSE.

That might explain a surplus of staff, but not the running.
Also we can revisit these deals. We had to eventually let the lamplighters go.

Sam Russell wrote: »

In any empire, there are empire builders who manage to increase their little bailiwick and increase their (perceived) importance by adding unnecessary procedures for others to comply with. The longer an empire exists, the more of this goes on. Of course, the more important these builders are, the more they demand in salary, office space, juniors, etc.

Happens in every enterprise - public or private. It is countered by subsidiarity, as practised by the EU. Decisions are made at the lowest level that can competently make the decision. This has the effect of reducing the need for managers higher up the tree.

But it's not a new phenomena surely? Do we just go on so? I don't know much about the inner workings but one would expect there are people who do and have ideas for fixes at the stage.

Matt Barrett wrote: »

How likely is it that after what amounts to decades of decline, the HSE has over paid managers, (surplus?) poorly scheduled front line staff? I'm not saying this is the case, just wondering, if true, how is it that nobody, HSE, Government, Administration, Unions etc. etc. made moves to fix these issues, or are they issues at all?
It's been going on long enough now that the problems should be obvious to those with insider knowledge?
If it's unions and staff, why do we throw money at the problem? If it's bad admin/management, why do we continue as is/throw money at the problem?
There's no point in the same people making the same complaints and continuing as is.

In any empire, there are empire builders who manage to increase their little bailiwick and increase their (perceived) importance by adding unnecessary procedures for others to comply with. The longer an empire exists, the more of this goes on. Of course, the more important these builders are, the more they demand in salary, office space, juniors, etc.

Happens in every enterprise - public or private. It is countered by subsidiarity, as practised by the EU. Decisions are made at the lowest level that can competently make the decision. This has the effect of reducing the need for managers higher up the tree.

Geuze

Matt Barrett wrote: »

How likely is it that after what amounts to decades of decline, the HSE has over paid managers, (surplus?) poorly scheduled front line staff? I'm not saying this is the case, just wondering, if true, how is it that nobody, HSE, Government, Administration, Unions etc. etc. made moves to fix these issues, or are they issues at all?
It's been going on long enough now that the problems should be obvious to those with insider knowledge?
If it's unions and staff, why do we throw money at the problem? If it's bad admin/management, why do we continue as is/throw money at the problem?
There's no point in the same people making the same complaints and continuing as is.

When the eight regional health boards were merged into the HSE, a deal was done by Ahern with the unions.

No job losses.

There are 2,000 staff in HR, and the head of HR says he needs 800.

There are 62 payroll offices in the HSE.

How likely is it that after what amounts to decades of decline, the HSE has over paid managers, (surplus?) poorly scheduled front line staff? I'm not saying this is the case, just wondering, if true, how is it that nobody, HSE, Government, Administration, Unions etc. etc. made moves to fix these issues, or are they issues at all?
It's been going on long enough now that the problems should be obvious to those with insider knowledge?
If it's unions and staff, why do we throw money at the problem? If it's bad admin/management, why do we continue as is/throw money at the problem?
There's no point in the same people making the same complaints and continuing as is.

AndrewJRenko wrote: »

Discussion is great, but let's not kid ourselves that it has any more value than us sitting round discussing brain surgery techniques.

Very few do brain surgery, but most interact at some level with the HSE.

At one time, GPs would refer patients to an outpatient clinic in the local hospital for an appointment, but now they tend to refer patients to A&E. Why?

A&E is certainly the sharp end of the criticisms of the H&E, and certainly a major centre of the problems patients see, but not necessarily the area that should get the most attention.

We have a lot of highly paid managers in the HSE - what is it exactly that they do? Could we do with fewer and less well paid managers? Perhaps that is worthy of attention.

Mental health, children's scoliosis treatment, waiting lists, provision of care packages, patients over-staying in acute hospital beds - these all deserve attention, along with many more.

Why do we not insist Irish trained doctors must stay within the Irish health care system for a minimum time? Why do we train so many foreign doctors at the expense of Irish trainees?

To fix the HSE, all the small, minor to major issues need tackling, instead all that happens in the subvention gets bigger year on year with no incremental improvements. No-one is in charge.

FreudianSlippers

AndrewJRenko wrote: »

Discussion is great, but let's not kid ourselves that it has any more value than us sitting round discussing brain surgery techniques.

I'm not sure exactly what point you're trying to make? We shouldn't discuss the problems with the HSE because we're not medical doctors? Some of us work in law/politics/government/economics... I'm not sure I know how to "fix" the HSE, but I am certainly qualified to give my rational and economics-based opinion.

Do you think a neurosurgeon knows how to fix the HSE because they know about brain surgery?

AndrewJRenko wrote: »

Discussion is great, but let's not kid ourselves that it has any more value than us sitting round discussing brain surgery techniques.

Nobody suggested any differently.

Discussing the health service on Boards is about as valuable as discussing the traffic and commuting implications associated with the M50. But that didn't stop you playing an active part in that discussion.

If you didn't want to join in here, you could have just stayed away.

[Deleted User]

Tell me how wrote: »

How is it you have nearly 5,500 posts on boards and still don't understand the meaning of the word "discussion".

Discussion is great, but let's not kid ourselves that it has any more value than us sitting round discussing brain surgery techniques.

AndrewJRenko wrote: »

I wonder if we should open up all complex issues to management by the crowdsourced wisdom of boards.ie posters? If we're going to do 'design the health service' by boards.ie posters, let's go all the way - let's do 'brain surgery' by boards.ie posters. We'll stick a surgeon in theatre and have all the experts here tell them where and when and how deep to cut and poke around. I'm sure it's work out fine, because so many people have such deep expertise on the health service.

The health service is the only large part of the public service that I haven't worked in, but I have worked in the education, civil service and local authority sectors, and I pretty much know an awful lot about how the public sector works well and how it doesn't. But you don't even need that experience to see how messed up the health service is at local level. Huge inefficiencies, mostly in front-line services, which include reception areas, A&E, consultants, specialist medical personnel, as well as nurses.

Tell me how wrote: »

But, what do you suggest?

Is it the service users (the public) who are the root of the problem?
What do we do? 24Hr GP type cover before people go to A&E? Or a marketing drive to show the way incorrect attendance impacts the system?

People will only stay away if they feel they have a suitable alternative.

A charge that applies to everyone is the solution I have proposed. And other than saying older people with conditions that aren't emergencies will stop using A&E (which is the aim after all!!), nobody has put up a coherent argument against it.

The problem is not genuine emergencies, the problem is the drunk and those who are not emergency cases.

AndrewJRenko wrote: »

I wonder if we should open up all complex issues to management by the crowdsourced wisdom of boards.ie posters? If we're going to do 'design the health service' by boards.ie posters, let's go all the way - let's do 'brain surgery' by boards.ie posters. We'll stick a surgeon in theatre and have all the experts here tell them where and when and how deep to cut and poke around. I'm sure it's work out fine, because so many people have such deep expertise on the health service.

How is it you have nearly 5,500 posts on boards and still don't understand the meaning of the word "discussion".

[Deleted User]

I wonder if we should open up all complex issues to management by the crowdsourced wisdom of boards.ie posters? If we're going to do 'design the health service' by boards.ie posters, let's go all the way - let's do 'brain surgery' by boards.ie posters. We'll stick a surgeon in theatre and have all the experts here tell them where and when and how deep to cut and poke around. I'm sure it's work out fine, because so many people have such deep expertise on the health service.

FreudianSlippers

Tell me how wrote: »

But, what do you suggest?

Is it the service users (the public) who are the root of the problem?
What do we do? 24Hr GP type cover before people go to A&E? Or a marketing drive to show the way incorrect attendance impacts the system?

People will only stay away if they feel they have a suitable alternative.

Not sure tbh, but probably a bit of "all of the above" - I think the advent of the video-GP that some insurance companies have rolled out is a big advancement.

I think it'll come as no surprise that I believe that the Government should be subsidising private insurance for everyone rather than an NHS-style system in Ireland; we simply don't have the population to actually/adequately pay for such a system.

Sam Russell wrote: »

If they need admission to hospital for cardio-vascular treatment or broken bones, the GP cannot help them, and would direct them to A&E anyway.

Many are taken to A&E by ambulance and require serious level of nursing. The average life expectancy for elderly women who suffer broken hips from a fall is something like six months. These elderly people are very fragile, or at least those that end up in A&E.

Both of those examples are actual accidents/emergencies and are both suffering from people rocking up to the A&E for other reasons.

Podge_irl wrote: »

Sam Russell wrote: »

Well, that sounds OK, but someone who delays treating a condition because of a charge, and they wait till it gets serious, or critical, will cost the HSE many time over the charges. This is particularly true of the older people - many of whom do not want to be a burden or nuisance.

Older people do not generally have a single complaint but have many minor complaints that add up to a serious syndrome that needs treating if one of those complaints goes from minor to serious. There is a reason elderly are recommended to get the flu jab.

A charge might deter some who should not be there but also deter many who should be there.

Which they should be going to their GP for.

If they need admission to hospital for cardio-vascular treatment or broken bones, the GP cannot help them, and would direct them to A&E anyway.

Many are taken to A&E by ambulance and require serious level of nursing. The average life expectancy for elderly women who suffer broken hips from a fall is something like six months. These elderly people are very fragile, or at least those that end up in A&E.

FreudianSlippers wrote: »

A&E is not for "treating a condition" it's for accidents and emergencies; clue's in the name.

But, what do you suggest?

Is it the service users (the public) who are the root of the problem?
What do we do? 24Hr GP type cover before people go to A&E? Or a marketing drive to show the way incorrect attendance impacts the system?

People will only stay away if they feel they have a suitable alternative.

FreudianSlippers

A&E is not for "treating a condition" it's for accidents and emergencies; clue's in the name.

Podge_irl

Sam Russell wrote: »

Older people do not generally have a single complaint but have many minor complaints that add up to a serious syndrome that needs treating if one of those complaints goes from minor to serious. There is a reason elderly are recommended to get the flu jab.

Which they should be going to their GP for.

blanch152 wrote: »

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.

Well, that sounds OK, but someone who delays treating a condition because of a charge, and they wait till it gets serious, or critical, will cost the HSE many time over the charges. This is particularly true of the older people - many of whom do not want to be a burden or nuisance.

Older people do not generally have a single complaint but have many minor complaints that add up to a serious syndrome that needs treating if one of those complaints goes from minor to serious. There is a reason elderly are recommended to get the flu jab.

A charge might deter some who should not be there but also deter many who should be there.

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.

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.

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.

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

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

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

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.

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.

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.

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