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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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marieholmfan

Those over 90 years of age have had their whole lives to work to improve the public health system.
If anyone should be left on a trolley for seven hours it is a 90 year old.

Sam Russell wrote: »

If I get bad service from an enterprise, I have a very good understanding of how they might improve their offering. Many users of the services provided by the HSE have a very good idea how the services could be improved.

One does not need to be an expert to see the major failings of the HSE. No-one should be left on a trolley for 48 hours, particularly if they are over 90 years of age as has been the case last year. Waiting lists for scoliosis operations of many years for growing children is unforgivable.

Who needs to be an expert to see such failings and call for a better system?

Uriel.

blanch152 wrote: »

The INMO are brilliant at protecting their patch.

Ireland is near the top of the EU list for nursing salaries.
Ireland is near the top of the EU list for nurses per capita.

We cannot sustain both of those statistics indefinitely.

Do you have a link to these lists, I'd like to see the figures involved.

blanch152

Topgear on Dave wrote: »

There was some debate over introducing theatre assistants instead of nurses to do some jobs. This was in 2015.

https://www.irishtimes.com/news/ireland/irish-news/hse-to-look-at-introducing-hospital-theatre-assistants-1.2405731

Im not sure of the ins and outs of it but the SBP reported on Sunday that they were finally going to go ahead.

"Cork University Hospital has started to train operating theatre assistants after a battle with the INMO which opposed the move."

The INMO are brilliant at protecting their patch.

Ireland is near the top of the EU list for nursing salaries.
Ireland is near the top of the EU list for nurses per capita.

We cannot sustain both of those statistics indefinitely.

James Brown

The problem with looking to private business, they let people go to increase or maintain profits, they cut or curtail services to remain in profit or a profit of their liking. All fine and dandy except the point is to serve the public not make a profit on the public suffering. Goes for more than health issues too.

[Deleted User]

Tell me how wrote: »

Matt Barrett wrote: »

Do we, (various governments) try anything outside of hiring/having a recruitment freeze, increased funding, wage freeze etc? It seems agreed the organisation needs work I don't see how any more money or staff will help if the organisation needs changing.
Didn't this government bring in some consultants or other a while back? Any news there?
My impression is they (governments we've had) just want it to go away.

Just to note, again, Unions do an excellent job. They don't work for the tax payer, they work for their members. What Unions do or don't do as a membership entity is for our political representatives to look at. If a deal is struck that favours the Unions to the detriment of the tax payer, that's the Union being good at their job IMO. Looking to them to help the taxpayer out makes as much sense as looking at private business.

Absolutely, Unions are there to protect their members.
And all of them thinks there needs to be change, they just are not willing for that change to affect their members.

It is a societal issue because not only do so many of us end up using it, but also, we or someone close to us works within the system and so we have a vested interests of sorts in not wanting them to lose their position.

Maybe the government should target a single relatively small region such as the mid west or south east or so on and try to make that self sustainable and efficient in terms of all services being available within acceptable time frames and where possible within the region. Allow them to have only the required number of administrators and managers but give them funds for front line staff and then critically and rigidly assess performance. Essentially, try to treat it like a private business as much as possible. Appoint a single person not influenced by elections to own the delivery of this project. Then, if that is proven to be successful, try to replicate it in the next region and so on.

But, could any of that realistically be done? Would union influence be the sole reason it might fail?

So when you say "treat it like a private business", can the hospitals start charging for the true costs of services provided, like a private business would? And can it pick and choose it's customers to ensure profitability, like a private business would?

[Deleted User]

Martina1991 wrote: »

I dont understand what you mean by technicians?

There was some debate over introducing theatre assistants instead of nurses to do some jobs. This was in 2015.

https://www.irishtimes.com/news/ireland/irish-news/hse-to-look-at-introducing-hospital-theatre-assistants-1.2405731

Im not sure of the ins and outs of it but the SBP reported on Sunday that they were finally going to go ahead.

"Cork University Hospital has started to train operating theatre assistants after a battle with the INMO which opposed the move."

James Brown

Martina1991 wrote: »

I dont understand what you mean by technicians?

Also the big problem seemingly is reliance on contractors because nurses such as psychiatric are leaving the country, they are short staffed.

Martina1991

Good loser wrote:

So, for instance, the number of staff nurses could be halved and half of what they currently do could be divvied up amongst technicians. Over time.

I dont understand what you mean by technicians?

Good loser

On Saturday View last Sat. a consultant from Sligo (I think) made some good interventions.

Think he said Ireland had a very high proportion of staff nurses compared to other European countries. All are at a very high basic and there are no way near enough staff at lower grades; in other words much of the routine stuff nurses do (like taking bloods, putting in drips, taking BPs) could be done by lower paid technicians. This apparently is the situation in the HSE.

So, for instance, the number of staff nurses could be halved and half of what they currently do could be divvied up amongst technicians. Over time.

James Brown

Tell me how wrote: »

Absolutely, Unions are there to protect their members.
And all of them thinks there needs to be change, they just are not willing for that change to affect their members.

It is a societal issue because not only do so many of us end up using it, but also, we or someone close to us works within the system and so we have a vested interests of sorts in not wanting them to lose their position.

Maybe the government should target a single relatively small region such as the mid west or south east or so on and try to make that self sustainable and efficient in terms of all services being available within acceptable time frames and where possible within the region. Allow them to have only the required number of administrators and managers but give them funds for front line staff and then critically and rigidly assess performance. Essentially, try to treat it like a private business as much as possible. Appoint a single person not influenced by elections to own the delivery of this project. Then, if that is proven to be successful, try to replicate it in the next region and so on.

But, could any of that realistically be done? Would union influence be the sole reason it might fail?

I've read that here before. The only people I've come across who work there complain about how poorly run it is. I don't think people are going to accept a health system they feel is broken because they are concerned about people they may know working there. I don't think anyone would be expecting massive layoffs as a result of any changes.
I believe if government or whomever went public with a plan and explained how it would help fix the HS the Unions wouldn't have public support, if they fought against it. I personally don't buy the unions being that big a problem. Worst case is the system changes for the better and unionised members of staff are surplus to requirement. They are looking to secure jobs and salaries I don't think changes in the way the HSE does business will come against unions unless it involves layoffs and the like.
Fiddling around the edges and blaming unions or nurses isn't going to achieve anything.

Yes taking one small area to try might be a very good idea.

Tell me how

Matt Barrett wrote: »

Do we, (various governments) try anything outside of hiring/having a recruitment freeze, increased funding, wage freeze etc? It seems agreed the organisation needs work I don't see how any more money or staff will help if the organisation needs changing.
Didn't this government bring in some consultants or other a while back? Any news there?
My impression is they (governments we've had) just want it to go away.

Just to note, again, Unions do an excellent job. They don't work for the tax payer, they work for their members. What Unions do or don't do as a membership entity is for our political representatives to look at. If a deal is struck that favours the Unions to the detriment of the tax payer, that's the Union being good at their job IMO. Looking to them to help the taxpayer out makes as much sense as looking at private business.

Absolutely, Unions are there to protect their members.
And all of them thinks there needs to be change, they just are not willing for that change to affect their members.

It is a societal issue because not only do so many of us end up using it, but also, we or someone close to us works within the system and so we have a vested interests of sorts in not wanting them to lose their position.

Maybe the government should target a single relatively small region such as the mid west or south east or so on and try to make that self sustainable and efficient in terms of all services being available within acceptable time frames and where possible within the region. Allow them to have only the required number of administrators and managers but give them funds for front line staff and then critically and rigidly assess performance. Essentially, try to treat it like a private business as much as possible. Appoint a single person not influenced by elections to own the delivery of this project. Then, if that is proven to be successful, try to replicate it in the next region and so on.

But, could any of that realistically be done? Would union influence be the sole reason it might fail?

James Brown

Do we, (various governments) try anything outside of hiring/having a recruitment freeze, increased funding, wage freeze etc? It seems agreed the organisation needs work I don't see how any more money or staff will help if the organisation needs changing.
Didn't this government bring in some consultants or other a while back? Any news there?
My impression is they (governments we've had) just want it to go away.

Just to note, again, Unions do an excellent job. They don't work for the tax payer, they work for their members. What Unions do or don't do as a membership entity is for our political representatives to look at. If a deal is struck that favours the Unions to the detriment of the tax payer, that's the Union being good at their job IMO. Looking to them to help the taxpayer out makes as much sense as looking at private business.

[Deleted User]

Tell me how wrote: »

I can't understand their position in trying to shut down discussion on this.

They are an active poster in many threads with national political/strategy themes.

VinLieger wrote: »

Indeed, a strange attitude to have for someone who has expressed quite strong views on a variety of other topics.

I've already addressed that issue in this earlier post.

Geuze wrote: »

It was a few years ago.

https://www.independent.ie/irish-news/hse-hires-outside-help-despite-having-full-staff-26699221.html

2010:

Just last week, HSE head of human resources Sean McGrath said it was widely accepted that too many staff were employed in certain areas within the HSE.

''There are about 2,000 people working in the HR function. I could probably get away with having 700 or 800 in that department," he said then.

Nine years ago, at a time when the organisation was dramatically cutting back numbers instead of working hard to recruit and retain staff. So how many people are in HR now? How many people do they recruit each year compared to 2010?

Is there any chance of having an educated, informed debate?

Tell me how wrote: »

Not to mention that outside of education, the HSE is probably the one government body of which everyone in the country has at least some experience with it.

Having some experience of a body does not make you an expert in running that body. Are you an expert in running banks, mobile phone companies and tv cable providers?

blanch152 wrote: »

In any online discussion there are always some posters who don't have a clue what they are talking about. We have our fair share of those, and we also have a fair share of people who are ideoligally or politically tied to certain positions and posturing.

However, from reading this thread and others, it is also clear that there are plenty of posters on here who have experience of working in the public sector, both front-line and management examples, as well as those who have worked in management in the private sector. They don't have to be experts in health care to be able to identify critical problems or to suggest credible solutions. They also have the ability to critically analyse the bleating and whinging of unions or the pathetic excuses of management, all of whom have a role in the issues of the health service.

Pots and black kettles spring to mind.

blanch152 wrote: »

One thing is clear - we spend an awful lot of money per capita on the health service, yet it doesn't work. It is not a problem of money, it is a problem of policy, management, working arrangements and employees. We can argue about where the balance of responsibility lies between those four, but most of the problems and nearly all of the solutions lie within the HSE. The remaining problems are problems of policy and fall between the political body and the HSE. Is the HSE strong enough in standing up to unsustainable policies (over 2 million medical cards?) put forward by politicians? Are politicians strong enough to resist the populist bleating in the media and among the opposition?

What particular measure did you decide to judge that 'it doesn't work'? How many babies were brought into the world without difficulty today by the HSE? How many hip operations were carried out? How many cataracts were cleared? How many people were seen in A&E? [St Vincents reported a 6% increase in A&E numbers for 2018 over 2017, btw]

You certainly ask some interesting and relevant questions, worthy of further discussion. But that's doesn't mean that anyone here is anywhere near competent to come up with reliable solutions.

Sam Russell wrote: »

If I get bad service from an enterprise, I have a very good understanding of how they might improve their offering. Many users of the services provided by the HSE have a very good idea how the services could be improved.

One does not need to be an expert to see the major failings of the HSE. No-one should be left on a trolley for 48 hours, particularly if they are over 90 years of age as has been the case last year. Waiting lists for scoliosis operations of many years for growing children is unforgivable.

Who needs to be an expert to see such failings and call for a better system?

Getting bad service (or indeed, getting good service) does not make you an expert on how to manage the most complex operation in the country. And yeah, we can all see the failings, but let's see the successes along with the failings to come to a fair assessment. And calling for a better system is fine too - but coming up with proposes that the HSE should be decentralised or decentralised or disbanded or whatever are just nonsense, like the bar stool experts shouting at the telly telling the football manager what team he should have picked.

]

VinLieger

Tell me how wrote: »

I can't understand their position in trying to shut down discussion on this.

They are an active poster in many threads with national political/strategy themes.

Indeed, a strange attitude to have for someone who has expressed quite strong views on a variety of other topics.

blanch152

AndrewJRenko wrote: »

Here's one way to improve it - let's leave the improving to people who know what they are talking about.

If I walk into your job and after 20 minutes, I start telling you all the things you're doing wrong, will you be taking my instructions?

In any online discussion there are always some posters who don't have a clue what they are talking about. We have our fair share of those, and we also have a fair share of people who are ideoligally or politically tied to certain positions and posturing.

However, from reading this thread and others, it is also clear that there are plenty of posters on here who have experience of working in the public sector, both front-line and management examples, as well as those who have worked in management in the private sector. They don't have to be experts in health care to be able to identify critical problems or to suggest credible solutions. They also have the ability to critically analyse the bleating and whinging of unions or the pathetic excuses of management, all of whom have a role in the issues of the health service.

One thing is clear - we spend an awful lot of money per capita on the health service, yet it doesn't work. It is not a problem of money, it is a problem of policy, management, working arrangements and employees. We can argue about where the balance of responsibility lies between those four, but most of the problems and nearly all of the solutions lie within the HSE. The remaining problems are problems of policy and fall between the political body and the HSE. Is the HSE strong enough in standing up to unsustainable policies (over 2 million medical cards?) put forward by politicians? Are politicians strong enough to resist the populist bleating in the media and among the opposition?

Tell me how

I wonder are the nurses striking for a 12% pay rise hoping that it will force the government to either pay it or to hire more nurses at the current rate to alleviate their staff number issues.

I wonder would they be happy with x number of more nurses at the current payscale or do they feel that they have to get the raise.

Tell me how

Sam Russell wrote: »

If I get bad service from an enterprise, I have a very good understanding of how they might improve their offering. Many users of the services provided by the HSE have a very good idea how the services could be improved.

One does not need to be an expert to see the major failings of the HSE. No-one should be left on a trolley for 48 hours, particularly if they are over 90 years of age as has been the case last year. Waiting lists for scoliosis operations of many years for growing children is unforgivable.

Who needs to be an expert to see such failings and call for a better system?

Not to mention that outside of education, the HSE is probably the one government body of which everyone in the country has at least some experience with it.

Sam Russell

AndrewJRenko wrote: »

Here's one way to improve it - let's leave the improving to people who know what they are talking about.

If I get bad service from an enterprise, I have a very good understanding of how they might improve their offering. Many users of the services provided by the HSE have a very good idea how the services could be improved.

One does not need to be an expert to see the major failings of the HSE. No-one should be left on a trolley for 48 hours, particularly if they are over 90 years of age as has been the case last year. Waiting lists for scoliosis operations of many years for growing children is unforgivable.

Who needs to be an expert to see such failings and call for a better system?

Tell me how

VinLieger wrote: »

Are you suggesting because we arent all experts in how to run the HSE we shouldnt have an opinion on it or be able to voice that opinion on a discussion forum?

I can't understand their position in trying to shut down discussion on this.

They are an active poster in many threads with national political/strategy themes.

VinLieger

AndrewJRenko wrote: »

Here's one way to improve it - let's leave the improving to people who know what they are talking about.

Thats worked so well up until now hasnt it?

Are you suggesting because we arent all experts in how to run the HSE we shouldnt have an opinion on it or be able to voice that opinion on a discussion forum?

Might as well shut down boards and basically the rest of the internet in that case

Geuze

AndrewJRenko wrote: »

The Head of HR is a she. So where exactly did 'he' say anything about the need for HR staff?

It was a few years ago.

https://www.independent.ie/irish-news/hse-hires-outside-help-despite-having-full-staff-26699221.html

2010:

Just last week, HSE head of human resources Sean McGrath said it was widely accepted that too many staff were employed in certain areas within the HSE.

''There are about 2,000 people working in the HR function. I could probably get away with having 700 or 800 in that department," he said then.

Tell me how

^^^^[

You are aware this is the political forum of a discussion board?
What do you think should be discussed here?

Who do you think should post here?
Politicians and public sector management staff?

Maybe the HSE shouldn't be discussed by journalists or broadcasters either.

You don't want to contribute? Fine. Don't.

[Deleted User]

Tell me how wrote: »

^^^

What are you doing here?
You obviously don't want to discuss ways to improve the HSE.

Here's one way to improve it - let's leave the improving to people who know what they are talking about.

If I walk into your job and after 20 minutes, I start telling you all the things you're doing wrong, will you be taking my instructions?

Tell me how

^^^

What are you doing here?
You obviously don't want to discuss ways to improve the HSE.

[Deleted User]

Tell me how wrote: »

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.

Yeah, I play an active part in those discussions, but I don't pontificate about the structure of the TII or NTA or that Metro North is the ultimate solution or Metro South is a top priority - because I recognize the limits of my own competency.

FreudianSlippers wrote: »

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

A neurosurgeon knows as much about fixing the HSE as I know about doing neurosurgery.

Sam Russell wrote: »

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

This probably demonstrates the core of concern - the nonsensical idea that because you 'interact' with the HSE, you suddenly become an expert on the structure of the HSE and the best way to schedule A&E staff and the best way to procure medical supplies. Because it doesn't.

I interact with my bank at some level, but I don't go spouting off about their management structure and their staffing levels. I interact with Virgin Media at some level but I don't become an expert on fibre connections and service management.

So you interact with the HSE - that qualifies you to set out your customer experience, good or bad as that may be - no more and no less than that.

Sam Russell wrote: »

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?

Probably because they've closed the local hospital because they have a nasty habit of killing people, as they don't have enough critical mass of patients to keep up training and skill levels. I know feck all about medicine, but I do know that all the evidence shows that you can't have a hospital in every town and expect to have skilled, expert staff in them.

Sam Russell wrote: »

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.

How did you work out that A&E 'gets the most attention'?

Sam Russell wrote: »

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.

What exactly do they do? They manage an extremely complex service providing cradle-to-grave health and social care, largely on a free-at-point-of-delivery basis. Have you any sensible basis to claim that there are too many managers?

Sam Russell wrote: »

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.

Oh great ideas, betcha no-one in the HSE hasn't thought about any of these things? Would you ever do some actual research about what's going on in the HSE and understand what actual levels of attention these issues are getting.

Sam Russell wrote: »

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?

How can we 'insist'? Do you want to put them in chains or what?

Sam Russell wrote: »

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.

No incremental improvements? Have you looked at the improvements in cancer survival rates? Or stroke rehab rates? Or reduced mortality in childbirth?

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.

The Head of HR is a she. So where exactly did 'he' say anything about the need for HR staff?

Sam Russell

blanch152 wrote: »

To be fair to the HSE, I would guess that there are more highly paid managers in the university sector than in the HSE.

But the cost to the state in money, and mismanagement is much less.

One problem in having too many managers is that they manage to do very little as they have to keep checking with each other and passing the parcel with no-one actually responsible.

blanch152

Sam Russell wrote: »

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.

To be fair to the HSE, I would guess that there are more highly paid managers in the university sector than in the HSE.

James Brown

Tell me how wrote: »

One in 23 workers in the country work for the HSE. Taking their friends and family in to account, that's quite the reach to influence governmental opinion.

Not to mention if they cut staff and the way that would be used with negative headlines to blame solely the government for impact on people's health.

Absolute behemoth to try to control now.

I'd say after the next crash would be the next opportunity.

Tell me how

Matt Barrett wrote: »

Over payed, over staffed shouldn't mean poorly run. If anything it should mean surplus in staff.
If we're expecting staff to quit or take a pay cut.....
Pity we've no administrative/mangerial body beholden to the tax payer to address this.

One in 23 workers in the country work for the HSE. Taking their friends and family in to account, that's quite the reach to influence governmental opinion.

Not to mention if they cut staff and the way that would be used with negative headlines to blame solely the government for impact on people's health.

Absolute behemoth to try to control now.

James Brown

Sam Russell wrote: »

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.

Over payed, over staffed shouldn't mean poorly run. If anything it should mean surplus in staff.
If we're expecting staff to quit or take a pay cut.....
Pity we've no administrative/mangerial body beholden to the tax payer to address this.