What is wrong with the health service, HSE

Podge_irl wrote: »

Right, but just to focus on this one point, if the result is both profit being made for the company and better service for the "client" then is that not basically a win-win? Is there any proof that relying on private providers over public providers results in worse service?

You seem to think serving the public and making a profit are mutually exclusive and I don't agree with that line of thinking.

Fair point, but for profit doesn't care. It could well mean a good service if you can afford to pay for it. If you can't tough. The entire idea of making money off the misery of the sick goes against the whole point of a public health service. As happens elsewhere, would we have patients sent for scans and tests because it makes more money or insurance may cover it, even if they wouldn't have been called for under public? What would this mean for waiting lists, would it drive a two tier system where the poorest get the least treatment?
Would we have different doctors prescribing different brands based on cost?

Sam Russell wrote: »

...Perhaps if they were paid less the longer the waiting list, it might incentive them to reduce those waiting lists.

The big problem is why would a specialist want shorter waiting lists when he or she can offer up their private practice for those who are willing to pay for quicker service?

Sam Russell

Podge_irl wrote: »

Right, but just to focus on this one point, if the result is both profit being made for the company and better service for the "client" then is that not basically a win-win? Is there any proof that relying on private providers over public providers results in worse service?

You seem to think serving the public and making a profit are mutually exclusive and I don't agree with that line of thinking.

I am reminded of the fires in California a few years ago. A surprising thing was noticed. Some isolated houses were not affected by the fires while their neighbours were. Well, it turned out the survivors had fire protection services that came and kept their properties safe while ignoring their blazing neighbours.

Is that the kind of private health care you want?

What could be done is the pay the state funded acute hospitals on a per procedure basis so it funds what they do.

The current system for hospitals funds them whatever they do (or do not do). This system encourages waiting list because a patient on a waiting list costs nothing, while treating them does. Perhaps if they were paid less the longer the waiting list, it might incentive them to reduce those waiting lists.

Podge_irl

Matt Barrett wrote: »

What's wrong with for-profit in public service is the quality of service is only as important as the profit it makes.

Right, but just to focus on this one point, if the result is both profit being made for the company and better service for the "client" then is that not basically a win-win? Is there any proof that relying on private providers over public providers results in worse service?

You seem to think serving the public and making a profit are mutually exclusive and I don't agree with that line of thinking.

Podge_irl wrote: »

I presume their point is that doctors and nurses being paid for their work is not inherently better than private clinics who profit from the service they provide.

It is far from a perfect comparison, but there is indeed nothing inherently wrong with for-profit enterprises being involved in healthcare. Nor is there anything wrong with taking a more "business-minded" approach to aspects of public enterprises - there is in fact much good about it.

I am not a "free market will fix everything" minded person, but there is something to be said about private businesses having to earn your custom in a way a public service provider does not.

Private puts he who pays the most first. You can skip the queue if you've the money. Tax payer funded institutions should never work like that. If you want to go private, go private.
What's wrong with for-profit in public service is the quality of service is only as important as the profit it makes. Government and it's various services are not there to make money off of the public's needs or requirements, the public finances the government, by taxes, to provide these services.
Not to mention having a political representative to approach, not vote for, if they do something we don't like.
Efficiency is great. Being business minded is great. We don't need 'for profit' to be efficient.

Trying to compare individuals being paid for working within the HSE to for-profit entities is a farcical argument, as I believe was the point being approached.

Podge_irl

Matt Barrett wrote: »

What's your point? Nurses and doctors get paid for working? How dare they.

I presume their point is that doctors and nurses being paid for their work is not inherently better than private clinics who profit from the service they provide.

It is far from a perfect comparison, but there is indeed nothing inherently wrong with for-profit enterprises being involved in healthcare. Nor is there anything wrong with taking a more "business-minded" approach to aspects of public enterprises - there is in fact much good about it.

I am not a "free market will fix everything" minded person, but there is something to be said about private businesses having to earn your custom in a way a public service provider does not.

Good loser wrote: »

It's a commercial transaction - they trade their labour for money.

If there were no patients there would be no pay.

What's your point? Nurses and doctors get paid for working? How dare they.

If they say they need more money thankfully they still have the freedom to seek it and strike if needed, thanks to socialist values held dear by society, the bowsies.

Good loser wrote: »

It's a commercial transaction - they trade their labour for money.

If there were no patients there would be no pay.

Yes, but pay is different to profit.

Martina1991 wrote: »

Such daftness. Its a public service.
Healthcare workers get paid regardless of how many patients walk through the door.

It's a commercial transaction - they trade their labour for money.

If there were no patients there would be no pay.

Good loser wrote: »

What's obvious to me is that they do profit from it.

They would have no income if there were no sick or ill people.

What's more the nurses want more profit (out of their labour) than they're already getting.

Getting paid is not the same as increasing profit. It's not like as if 10% more patients come through the door and everyone working in the hospital gets paid 10% more and more than a teachers salary is dependent on class size.

I can't believe I have to explain that but it was the "What's obvious to me" part of your statement that made me think it was best to.

Martina1991

Good loser wrote:

They would have no income if there were no sick or ill people.

Such daftness. Its a public service.
Healthcare workers get paid regardless of how many patients walk through the door.

kippy wrote: »

No,
They don't.
This much should be obvious.

What's obvious to me is that they do profit from it.

They would have no income if there were no sick or ill people.

What's more the nurses want more profit (out of their labour) than they're already getting.

kippy

FreudianSlippers wrote: »

Everyone knows doctors working public only just do it for the love of it. They absolutely do not get paid a red cent... I heard once a public doctor accidentally got a paycheque and he was so angry he tore it up. :pac:

There's very little evidence to suggest that running a public service like a business is so bad - even the Eir example is silly given there is much more broadband in rural areas now due to Eir and other private enterprise than there was when it was run like a public service.

There's a lot of merit in running certain portions of the public service "like a business" (Centralisation and standardisation of Finance/IT/HR for example) - however the primary aim of any business is to make money for it's owner or shareholders.
There are many decisions made within the public service that plainly could not be made if this were the ultimate goal.

kippy

Good loser wrote: »

Do the hospital staff -doctors, nurses, porters etc not profit from the sickness/illness of their patients?

No,
They don't.
This much should be obvious.

FreudianSlippers

Everyone knows doctors working public only just do it for the love of it. They absolutely do not get paid a red cent... I heard once a public doctor accidentally got a paycheque and he was so angry he tore it up. :pac:

There's very little evidence to suggest that running a public service like a business is so bad - even the Eir example is silly given there is much more broadband in rural areas now due to Eir and other private enterprise than there was when it was run like a public service.

Good loser wrote: »

Do the hospital staff -doctors, nurses, porters etc not profit from the sickness/illness of their patients?

are you suggesting health workers are only in it for the money? Aren't we all to some extent? Should they be working for free to win favour? Doctors with a private practice do, most certainly. The longer the wait the more enticing the private clinic route, which I've been offered on more than one occasion over the years.

You're off point anyway. You shouldn't run a public service like a business. Profit comes first. Customer service only comes into it if it effects profit. If people have no option, why put profits into improving the customer experience? Look at broadband in rural areas, no money in it for Eir, so we have little to none. You cannot provide a public service like that. People before profit, if you will

Matt Barrett wrote: »

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.

Do the hospital staff -doctors, nurses, porters etc not profit from the sickness/illness of their patients?

Martina1991 wrote: »

I dont understand what you mean by technicians?

For example Operating Theatre Assistants.

[Deleted User]

blanch152 wrote: »

The structure of services won't affect the total number of nurses across the services.

It will affect the total number if someone is counting 'total number of nurses in the health service', as nurses in disability services in the UK are not in the health service, by and large. You need to be sure that you're comparing like with like.

blanch152 wrote: »

As for taxation levels etc., it would be true that nurses on salaries around €50k upwards would have higher levels of taxation. But nurses on less than €50k would be on lesser taxation levels. You are not arguing for pay increases for the nurses at the top of the scale, are you?

I'm arguing that comparing gross salaries with considering tax levels and cost of living is a meaningless comparison.

blanch152

AndrewJRenko wrote: »

Comparing gross salaries across countries is meaningless. You need to consider taxation levels, cost of property, cost of living and more to get any kind of meaningful comparison.

You need to be very careful of other international comparisons too. Other countries structure their services in different ways. In the UK, disability care services come under local authorities, not under health services, so comparisons can produce unexpected results.

Did you check the OECD comparison of hospital beds, showing how we have close to half the average OECD rates of hospital beds per capita.

We are also near the top of the list for nurses per hospital bed too.

The structure of services won't affect the total number of nurses across the services.

As for taxation levels etc., it would be true that nurses on salaries around €50k upwards would have higher levels of taxation. But nurses on less than €50k would be on lesser taxation levels. You are not arguing for pay increases for the nurses at the top of the scale, are you?

[Deleted User]

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.

Comparing gross salaries across countries is meaningless. You need to consider taxation levels, cost of property, cost of living and more to get any kind of meaningful comparison.

You need to be very careful of other international comparisons too. Other countries structure their services in different ways. In the UK, disability care services come under local authorities, not under health services, so comparisons can produce unexpected results.

Did you check the OECD comparison of hospital beds, showing how we have close to half the average OECD rates of hospital beds per capita.

marieholmfan wrote: »

Because the people let them.

People in their 90s didn't and would have regarded a trolley as luxury when they were young.

The people were conditioned. You're talking about times when getting pregnant meant you might get locked up in a home. The church had a hand in state policy. I'm not saying people couldn't have done more but you cannot punish the elderly especially when we're not faring much better. What are you doing for instance?

We're supposed to be at least striving to improve ourselves.
Are you now saying people were content with what they had, therefore they didn't try to fix things. therefore they deserve to die on trolleys?

When you see an issue that needs improving it's not unrealistic for people to speak out and expect better.

Tell me how wrote: »

1 in 23 workers in Ireland work in the HSE.
Vicky Phelan is going a long way towards influencing behaviour change in a certain element of Health Care delivery (And yes, because of her tragic story and even so she is still having difficulty doing so).
We all vote in elections to put the politicians in place to run essential services.
We actually have more power to direct focus on the HSE than we realise.
If we had protests in relation to it in the same way as we had against Water Charges maybe there would be something done.

But, the reason I am interested in a discussion is to see if anyone can suggest something which is either definitively the source of the problem or is likely to improve it. This is an anonymous online discussion forum. No one is suggesting it is the citizens council or Dail Eireann.

I'm responding to this:

marieholmfan wrote: »

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.

The problem with protesting is unless you've massive numbers chances are it won't amount to anything. Health is an ongoing issue and we've politicians and public resigned to the fact that it's too big to tackle, which I agree is unfortunate. There's also been a move from many quarters, political and media, to blacken the protester despite it being a right and a genuine belief in the issue on their behalf. Who'd be a protester in that environment?
It's not unreasonable for voters to assume incoming governments will tackle the scandal of hospital trolleys as promised.

Sam Russell

marieholmfan wrote: »

Why especially a 90 year old?

Because they could die because they are on the trolley instead of being treated in the hospital proper.

marieholmfan

Matt Barrett wrote: »

Anyone in their 80's or 90's comes from a time when people knew their place and the church ruled with an iron fist.

Because the people let them.

Matt Barrett wrote: »

We vote for people who claim to intend to tackle it.

People in their 90s didn't and would have regarded a trolley as luxury when they were young.

blanch152

Uriel. wrote: »

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

I posted the information either in this thread or the After Hours one. Others have posted it too.

marieholmfan

Sam Russell wrote: »

No-one should be left on a trolley for any extended period, especially a 90 year old.

Why especially a 90 year old?

Matt Barrett wrote: »

Anyone in their 80's or 90's comes from a time when people knew their place and the church ruled with an iron fist. The majority left school early, got any job, stuck with it, retired. The idea that even today the average person can carry much sway in regard of changing the HSE is a joke surely? We vote for people who claim to intend to tackle it, we assume they must have a plan. Sadly that's the best most of us can do.
We can however discuss it and I don't see any problem with that.

1 in 23 workers in Ireland work in the HSE.
Vicky Phelan is going a long way towards influencing behaviour change in a certain element of Health Care delivery (And yes, because of her tragic story and even so she is still having difficulty doing so).
We all vote in elections to put the politicians in place to run essential services.
We actually have more power to direct focus on the HSE than we realise.
If we had protests in relation to it in the same way as we had against Water Charges maybe there would be something done.

But, the reason I am interested in a discussion is to see if anyone can suggest something which is either definitively the source of the problem or is likely to improve it. This is an anonymous online discussion forum. No one is suggesting it is the citizens council or Dail Eireann.

Anyone in their 80's or 90's comes from a time when people knew their place and the church ruled with an iron fist. The majority left school early, got any job, stuck with it, retired. The idea that even today the average person can carry much sway in regard of changing the HSE is a joke surely? We vote for people who claim to intend to tackle it, we assume they must have a plan. Sadly that's the best most of us can do.
We can however discuss it and I don't see any problem with that.

Sam Russell

marieholmfan wrote: »

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.

That is basically disingenuous.

Assuming a working life of 40 years, then the majority of a 90 year old would be unable to work towards a solution, other than by a vote, and even that is ineffectual since a single vote will not change the health service.

No-one should be left on a trolley for any extended period, especially a 90 year old.