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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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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 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.

Good loser

Martina1991 wrote: »

I dont understand what you mean by technicians?

For example Operating Theatre Assistants.

Good loser

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?

James Brown

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

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.

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.

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.

Good loser

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.

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.

Tell me how

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.

Good loser

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.

Tell me how

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.

James Brown

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.

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.

James Brown

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 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.

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.

James Brown

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?

Good loser

Tell me how wrote: »

Yes, but pay is different to profit.

No great difference in my opinion.
Many in the pharma business switch between the 2 modes of working - payroll or contracting. Same difference.

Good loser

Matt Barrett wrote: »

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.

Socialist values cost society dearly alright.

Too often get their ends through blackmail,threat and intimidation.

Watch the next few months' headlines. Although for once (so far) RTE don't seem to be cheering them on.

VonZan

Matt Barrett wrote: »

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.

Striking only exists as an option for a tiny fraction of society. The majority of strikes are called by public sector workers in vital services who use it as a method to hold the taxpayer to ransom due to the pressure on the government by loss of service. Thankfully isn't the word I'd use.

[Deleted User]

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.

Many health services are fundamentally unprofitable. Mental health services, addiction services, treating chronic illnesses etc. You can make great money with a nice simple, predictable orthopaedic or cardiac procedure, so private medical providers cherrypick the services they provide.

Tell me how

Good loser wrote: »

No great difference in my opinion.
Many in the pharma business switch between the 2 modes of working - payroll or contracting. Same difference.

The concept of Profit versus pay and contract versus payroll are not related.

kippy

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.

How are you defining "profit"?

road_high

There’s a whole load of clinics, hospitals, management all doing the same thing- goes back to when we had Health Boards and services were almost duplicated on a county basis (I think even the county councils ran them)- so there’s still not enough efficiency of scale and centralization of things like HR and the like. Must add msssivle to the costs

[Deleted User]

road_high wrote: »

There’s a whole load of clinics, hospitals, management all doing the same thing- goes back to when we had Health Boards and services were almost duplicated on a county basis (I think even the county councils ran them)- so there’s still not enough efficiency of scale and centralization of things like HR and the like. Must add msssivle to the costs

And yet, when the HSE do try to rationalise services, we have every sh1t stirring TD and local councillors manning the barricades to protest against 'losing our' whatever.

Good loser

kippy wrote: »

How are you defining "profit"?

Remuneration.

kippy

Good loser wrote: »

Remuneration.

Ah, well if you are using the wrong definition, no one can help you.

They are indeed getting remunerated for doing a job.

James Brown

Good loser wrote: »

No great difference in my opinion.
Many in the pharma business switch between the 2 modes of working - payroll or contracting. Same difference.

You're confusing choices private individuals make with choices the people's government might make with the people's money.

Good loser wrote: »

Socialist values cost society dearly alright.

Too often get their ends through blackmail,threat and intimidation.

Watch the next few months' headlines. Although for once (so far) RTE don't seem to be cheering them on.

Society is built upon socialist values. We all pay tax to government to manage our state.
Despite the best efforts in some areas the government should be working for you and I despite any scaremongering and spin from selfish concerns, inappropriate behaviour or looking after our own.