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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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Geuze

AndrewJRenko wrote: »

It shows that a privatised system leaves many people exposed without health care.

I would only accept total private provision of healthcare as long as 100% of population are covered.

Let hosps be run by various providers - for-profit, State, church, anybody, and let's see plenty of competition.

But every patient can access every hosp.

[Deleted User]

Geuze wrote: »

I would only accept total private provision of healthcare as long as 100% of population are covered.

Let hosps be run by various providers - for-profit, State, church, anybody, and let's see plenty of competition.

But every patient can access every hosp.

Something like the Universal Health Insurance proposal that we ruled out a few years back, when we realised that the Irish market was too small for competition to be effective?

Geuze

Yes.

There are three insurers at the moment.

If we moved to UHI, surely more insurers would enter the market?

L1011

Geuze wrote: »

Yes.

There are three insurers at the moment.

If we moved to UHI, surely more insurers would enter the market?

Not guaranteed at all - there would have to be increased margin to cause that and generally completion is expected to reduce margin not increase it

James Brown

Not to mention the possibility of price fixing. Competition isn't a guarantee of value or quality based on the market, (see car insurance, car sales etc.).

Geuze

Geuze wrote: »

Yes.

There are three insurers at the moment.

If we moved to UHI, surely more insurers would enter the market?

What about moving to non-profit insurance?

Like in DE and CH.

I'm not sure if the FR insurers are non-profit.

Sam Russell

Geuze wrote: »

What about moving to non-profit insurance?

Like in DE and CH.

I'm not sure if the FR insurers are non-profit.

VHI are non-profit.

Why not extend the medical card to become an insurance scheme where holders are charged based on their means.

It is like most Government free schemes where either you get everything for free or get nothing free. (I am thinking of Free Travel pass, First time house grant, legal aid, etc.)

James Brown

How are any of these ideas going to fix the problems of staffing, beds, admin, unions, lackluster governing? I can see some politicians taking an interest if it's opened up to the private market all right.

GSRNBP

Matt Barrett wrote: »

How are any of these ideas going to fix the problems of staffing, beds, admin, unions, lackluster governing? I can see some politicians taking an interest if it's opened up to the private market all right.

Open to correction on this from the previous posters, but I don't get the impression that's what they're talking about. I believe what they propose is State-owned, privately run hospitals with a UHI aspect which is either free or subsidised heavily depending on your income.

James Brown

GSRNBP wrote: »

Open to correction on this from the previous posters, but I don't get the impression that's what they're talking about. I believe what they propose is State-owned, privately run hospitals with a UHI aspect which is either free or subsidised heavily depending on your income.

I'm wondering what the fixes will be? I'm wondering how changing the scheme will solve the issues as listed. Also privately run means tenders and sweet deals.

Good loser

Austrailia and Switzerland seem to have effective health systems.

Both private/public mix, I think.

In the last UK election heard nurses on QT complaining that they had only got a 1% salary increase in the previous 10 years.
Also I believe UK nurses salaries are 20% lower than Irish salaries. Of course public sector salaries in Ireland are 40% higher than private sector salaries while in UK they are equal.

ressem

It doesn't seem to be the case throughout Australia. There's an article stating today that in Australia the Patient:Nurse ratio is 4:1 during the day, compared to 7:1 in Ireland.
But Australian papers say that in parts of Australia (New South Wales rural and regional hospitals) the ratio can be up to 11:1 Patients: Nurses.

https://www.smh.com.au/politics/nsw/premier-unmoved-on-calls-for-mandated-minimum-nurse-to-patient-ratios-20180918-p504h8.html

Australia doesn't have huge health spending relative to us, is the root difference that patients spend less time in hospital?
https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/indicators-of-australias-health/waiting-time-for-emergency-department-care
90% of non-urgent patients seen within 2 hours (scheduled appointments I guess)?edit- no. presented at emergency.
75% of semi-urgent within 60 minutes.
65% of urgent within 30 minutes.
75% of emergency within 10 minutes.

James Brown

We've spoke about throwing money at it not solving anything. However it seems they'll continue to throw money at certain things. I say they, we're waiting on the latest investigation to find out who or what was responsible for the massive children's hospital over spend, coming up on 1bn, (currently predicted to be 1.7bn from original 985m)? I read about all the appointments people will miss because of striking over under staffing concerns in areas but mainly pay. Maybe the same people could throw 1bn. at the nurses as it seems that money is no object depending on who's doing the throwing or the asking.

Gunmonkey

Matt Barrett wrote: »

We've spoke about throwing money at it not solving anything. However it seems they'll continue to throw money at certain things. I say they, we're waiting on the latest investigation to find out who or what was responsible for the massive children's hospital over spend, coming up on 1bn, (currently predicted to be 1.7bn from original 985m)? I read about all the appointments people will miss because of striking over under staffing concerns in areas but mainly pay. Maybe the same people could throw 1bn. at the nurses as it seems that money is no object depending on who's doing the throwing or the asking.

Over what period of time would this 1Bn be thrown at the nurses? Would this be comparable to the term use of the new hospital, which could be in use from anywhere of 30 to 60 to 100 years? If you take it as only being used for 50 years, thats €20m a year.....which is a drop compared to the roughly €300m a year the nurses payrise will cost, right?

So we get 3 years of nurses pay increase and then...its dropped back down again? Or are you advocating an extra 1Bn of spending every 3 years in perpetuity but then turn and whinge about the same over-run on a long long long overdue capital investment that will be a once in a generation (maybe even two or three generation) project?

I dont like the cost over-run either, but 1Bn over 50 years is a lot more sustainable and better invested than the 16Bn to nurses over the same period, with no guarantees that wage increase would equate to a comparable improvement in service.

James Brown

Gunmonkey wrote: »

Over what period of time would this 1Bn be thrown at the nurses? Would this be comparable to the term use of the new hospital, which could be in use from anywhere of 30 to 60 to 100 years? If you take it as only being used for 50 years, thats €20m a year.....which is a drop compared to the roughly €300m a year the nurses payrise will cost, right?

So we get 3 years of nurses pay increase and then...its dropped back down again? Or are you advocating an extra 1Bn of spending every 3 years in perpetuity but then turn and whinge about the same over-run on a long long long overdue capital investment that will be a once in a generation (maybe even two or three generation) project?

I dont like the cost over-run either, but 1Bn over 50 years is a lot more sustainable and better invested than the 16Bn to nurses over the same period, with no guarantees that wage increase would equate to a comparable improvement in service.

The point is there's money can be got if the will or gross negligent mismanagement is there. Theres this much money spent, whether wasted or not, on what and by who, we don't know, but for Nurses and midwives we seem to know ever detail right down to all the patients being put out.
I don't expect service to improve in the slightest with any pay rise. Why would it?

[Deleted User]

Matt Barrett wrote: »

I don't expect service to improve in the slightest with any pay rise. Why would it?

Id say the government don't either and that's why they're holding the line.

naughto

Who will break first I don’t see the nurses backing down so the government will have to do something.
Thursday is a wipe out now aswell, if it gets to tues Wednesday thurs next week it will be carnage

CrabRevolution

Matt Barrett wrote: »

The point is there's money can be got if the will or gross negligent mismanagement is there. Theres this much money spent, whether wasted or not, on what and by who, we don't know, but for Nurses and midwives we seem to know ever detail right down to all the patients being put out.
I don't expect service to improve in the slightest with any pay rise. Why would it?

That money wasn't pulled from the back of the sofa, it will come from scrapping other health projects and hospital builds.

James Brown

Topgear on Dave wrote: »

Id say the government don't either and that's why they're holding the line.

Has it been suggested by any party that a pay raise would improve services?

CrabRevolution wrote: »

That money wasn't pulled from the back of the sofa, it will come from scrapping other health projects and hospital builds.

I know. Doesn't seem to have been as much a concern as Midwives and Nurses salaries though. Maybe they should give them what they ask and then after the fact discuss how terrible it was and how it shouldn't have happened, but it's done now?

Varadkar is handling it badly. He should be making arguments on behalf of public spending concerns not trying to tell tales about patients being put out, as it's a bit much to take considering the government record in that regard.

pirlo80

2 INMO nurses discuss the issues in depth here https://www.youtube.com/watch?v=Q6v-c83ySsA

Tell me how

pirlo80 wrote: »

2 INMO nurses discuss the issues in depth here https://www.youtube.com/watch?v=Q6v-c83ySsA

FFS.

I clicked in to this at 5 min 30 seconds to hear Paddy say to them that "when the country was collapsing it was you guys who were taking the hits".

I think nurses are incredibly influential in the care of an individual while in hospital but I think there is a lot of very selective assessment of the situation going on.

markodaly

Comparing the €2 Billion for the new Children's hospital (which is a lot) to a pay rise for nurses is not comparing like for like.

One is a one-off capital spend, the other is a recurring expense which feeds into the total bill for the next few years and decades.

The costing of the NCH is a joke alright, symptomatic of the HSE and the PS in general. These are the same issues at play in many dysfunctional government departments which leads to poor working conditions for nurses.
Yet, many fail to draw the comparison.

Maybe nurses do deserve a pay rise but it's not going to fix the chronic issues of managing the health system.

[Deleted User]

markodaly wrote: »

Comparing the €2 Billion for the new Children's hospital (which is a lot) to a pay rise for nurses is not comparing like for like.

One is a one-off capital spend, the other is a recurring expense which feeds into the total bill for the next few years and decades.

The costing of the NCH is a joke alright, symptomatic of the HSE and the PS in general. These are the same issues at play in many dysfunctional government departments which leads to poor working conditions for nurses.
Yet, many fail to draw the comparison.

Maybe nurses do deserve a pay rise but it's not going to fix the chronic issues of managing the health system.

Then target the inefficiencies in the HSE and pay the nurses the same as we pay other BSc. (Hons) graduates into the service.

If you have a staff shortage you have to pay more to attract/retain. If you don't then service WILL drop as you will have the same amount of work now to be done with less people.
Overworked people make mistakes, take longer to perform, take more sick days.

Far too long we (as a country) have cried crocodile tears for the nurses, saying they deserve more, yet knowing we can get away without paying them as (up to know) they care too much about their roles, in patient care, to really threaten the status quo.

Even now every picket line has a roster of nurses to immediately go into the hospital if anything serious happens. Right now the government KNOW that nurses will break their own picket if they are truly needed in the hospital and are comfortable sitting back as the sh1t can not immediately hit the fan.
And if there is something this government loves doing, it is kicking the can down the road.
They don't give a tuppence worth about delayed procedures.

markodaly

But you have not answered the basic question. How does a pay rise on its own improve working conditions and thus lead to better health outcomes? Logic dictates that you can hire more nurses for the same pot.

You say its hard to keep and recruit nurses, but that is the same the world over. A nurse will never be out of a job and will always have an Australia or a Canada to go to.

[Deleted User]

markodaly wrote: »

But you have not answered the basic question. How does a pay rise on its own improve working conditions and thus lead to better health outcomes? Logic dictates that you can hire more nurses for the same pot.

You say its hard to keep and recruit nurses, but that is the same the world over. A nurse will never be out of a job and will always have an Australia or a Canada to go to.

It improves conditions as you retain staff. Positions are currently advertised and unfilled and there are hundreds of needed positions not even on the books do to the fact that it would only hurt the HSE numbers further, showing even more open positions.

How do people not understand simple supply and demand?

Better pay means less nurses leaving and more applicants to the profession. Less staff leaving and more entrants means better nurse:patient ratio. We will always have people leave for other countries and have other countries but it is the HSEs job to make staying in the country attractive to remain in.

Better ratio means nurses are not completely overworked.
Nurses not overworked means better nurses.

Just like EVERY other field. Hiding behind a pay agreement is not going to fix that. There is a specified staffing level required for safe and adequate care and, just like in other professions, the scarcity of resources dictates pay levels.

There is a shortage in Ireland for IT security staff, salaries are skyrocketing because of this. It will hit an equilibrium and salaries will stabilise. How is this different?

Do I think that public sector should get paid as much as private? No because of job security and pension etc but you can not ignore market forces draining your staff and hurting the remaining.

markodaly

Deleted User wrote: »

It improves conditions as you retain staff.

Sorry but that is way too simplistic.
How do France, Germany and Holland provide good health services? I don't think they pay nurses more than we do.

Better pay means less nurses leaving and more applicants to the profession. Less staff leaving and more entrants means better nurse:patient ratio.
Better ratio means nurses are not completely overworked.
Nurses not overworked means better nurses.

An overly simplistic take on it, not even accounting for the fact that better-paid nurses = less money to hire nurses.

Just like EVERY other field. Hiding behind a pay agreement is not going to fix that. There is a specified staffing level required for safe and adequate care and, just like in other professions, the scarcity of resources dictates pay levels.

There is a shortage in Ireland for IT security staff, salaries are skyrocketing because of this. It will hit an equilibrium and salaries will stabilise. How is this different?

Is the shortage only in Ireland? I think you will find that there is a shortage of good IT staff all over the world, same with nursing.

To me, the question has not been answered, it's just too simplistic.
We heard the same argument with the Gardai, yet is anyone under the illusion we have the best police force in the world, despite being one of the best paid?

Tell me how

Deleted User wrote: »

It improves conditions as you retain staff. Positions are currently advertised and unfilled and there are hundreds of needed positions not even on the books do to the fact that it would only hurt the HSE numbers further, showing even more open positions.

How do people not understand simple supply and demand?

Better pay means less nurses leaving and more applicants to the profession. Less staff leaving and more entrants means better nurse:patient ratio. We will always have people leave for other countries and have other countries but it is the HSEs job to make staying in the country attractive to remain in.

Better ratio means nurses are not completely overworked.
Nurses not overworked means better nurses.

Just like EVERY other field. Hiding behind a pay agreement is not going to fix that. There is a specified staffing level required for safe and adequate care and, just like in other professions, the scarcity of resources dictates pay levels.

There is a shortage in Ireland for IT security staff, salaries are skyrocketing because of this. It will hit an equilibrium and salaries will stabilise. How is this different?

Do I think that public sector should get paid as much as private? No because of job security and pension etc but you can not ignore market forces draining your staff and hurting the remaining.

I don't disagree with you entirely but I am also sceptical that increasing numbers will automatically improve conditions in the long run.

I fear that it would likely mean more nurses working in an inefficient system than we have now which will hide the problems, but not fix them.

We can't look at this as a simple supply and demand issue either because of the numbers involved and also because to do so would ignore the work of the Pay commission investigation which found that pay was not the paramount issue at play for nurses.

There is also the reality that if nurses are successful, paramedics, firemen, teachers, prison officers, etc are likely to also bring claims for pay rises. each grouping will be able to cite unfavourable working conditions, unsociable hours, the difference they make to the individuals they work with and so on. The whole idea of a nationally agreed pay deal is to not have this scenario ongoing.
Just this morning there was a demonstration of GP's outside Leinster House complaining on the issues they have there. Their representative reckons that they need €200M per year to adequately provide GP care throughout the country.

Nurses want €300M/Year
GP's want €200/Year

I don't think we can find the half a Billion it would take to satisfy these requests not just one year but for every year going forward. Which should be paid if it is to be just one group? The Healthcare budget is already at €17B. More than double it was approaching the height of the celtic tiger era.

[Deleted User]

Tell me how wrote: »

I don't disagree with you entirely but I am also sceptical that increasing numbers will automatically improve conditions in the long run.

I fear that it would likely mean more nurses working in an inefficient system than we have now which will hide the problems, but not fix them.

We can't look at this as a simple supply and demand issue either because of the numbers involved and also because to do so would ignore the work of the Pay commission investigation which found that pay was not the paramount issue at play for nurses.

There is also the reality that if nurses are successful, paramedics, firemen, teachers, prison officers, etc are likely to also bring claims for pay rises. each grouping will be able to cite unfavourable working conditions, unsociable hours, the difference they make to the individuals they work with and so on. The whole idea of a nationally agreed pay deal is to not have this scenario ongoing.
Just this morning there was a demonstration of GP's outside Leinster House complaining on the issues they have there. Their representative reckons that they need €200M per year to adequately provide GP care throughout the country.

Nurses want €300M/Year
GP's want €200/Year

I don't think we can find the half a Billion it would take to satisfy these requests not just one year but for every year going forward. The Healthcare budget is already at €17B. More than double it was approaching the height of the celtic tiger era.

Yes the HSE is broken. Yes it is inefficient, sorting out the nurses will not fix it.

BUT
Nurses are understaffed. We have more "Nurses" on the books because we count former nurses, doing non nurse roles, as nurses. Other countries only count the nurses in actual nurse positions.
It will improve nurse conditions of burnout and exhaustion, it will not fix other areas in the HSE.

Nurses should not be caring about what other unions do/want. They need to look after themselves (for once)

What we, as a public, should be screaming about is the complete lack of political will to target the HSE backroom and run it properly. That is where our health service falls down and is a money pit. It is NOT the fault of nurses nor in their remit to remedy.
What is in their remit is having best practice patient:Nurse ratios and, you know, having time to take a toilet break once in a while

James Brown

We currently have Nurses working in an inefficient system. These Nurses are seeking more staff and better pay. The fact that the system is inefficient is a causal factor in the Nurses seeking more staff, better pay I'd imagine.

If I were a Nurse or Midwife I'd be concerned about the plight of Nurses and Midwives.

All I'm hearing is the system is inefficient and giving Nurses what they claim they need may not help tackle those endemic system inefficiencies. Followed by 'if we give the Nurses a rise, sure everyone will want one'. Valid concerns but not valid points against the Nurses demands.

Again, where was all this concern and scrutiny in regards to the spend on the Children's Hospital? Or does that money come from a different place?
And to those looking to Private business, look at Harris. He's playing the 'nobody told me nuthin' but when I find out who it was what done the thing, I'll be sooo mad'. This is the problem and we'd have it with any organisation be it public or private. Case in point, the Hospital build was private contracting, paid by the tax payer, overseen by, I assume somebody whos remit was looking after the public interest.
The idea that turning things over to private business will bring an end to inefficiency and throwing money is a joke.

Tell me how

Deleted User wrote: »

Yes the HSE is broken. Yes it is inefficient, sorting out the nurses will not fix it.

BUT
Nurses are understaffed. We have more "Nurses" on the books because we count former nurses, doing non nurse roles, as nurses. Other countries only count the nurses in actual nurse positions.
It will improve nurse conditions of burnout and exhaustion, it will not fix other areas in the HSE.

Nurses should not be caring about what other unions do/want. They need to look after themselves (for once)

What we, as a public, should be screaming about is the complete lack of political will to target the HSE backroom and run it properly. That is where our health service falls down and is a money pit. It is NOT the fault of nurses nor in their remit to remedy.
What is in their remit is having best practice patient:Nurse ratios and, you know, having time to take a toilet break once in a while

The point in bold would be extremely detrimental to the country if we suggested every union, group and body think in this way.

Many of 'us the public' work in the HSE. 1 in every 23 workers in the country are directly or indirectly employed by it.
Every layer within the system seems to be focused on saying there needs to be change elsewhere but not in their section and given the numbers (direct workers, ancillary workers and the families of these) involved as a percentage of the population I fear that the minister who tries to radically overhaul it would disappear overnight.

We have had the following Ministers for health in the last twenty years.

3 GP's
2 Taoisigh
1 Tanaiste

Why do you think we have not managed to improve the system having gone from the health boards, to the HSE, and now, in some places, small suggestions that we go back towards health boards again.