How to improve the HSE

Squall Leonhart · 20-07-2019 11:56PM #1

I was at the A&E department in Limerick today. The wait time to be seen was 7+ hours.

This is the 3rd time in a year I've had the misfortune. Each time I've gone to a GP and been referred onwards to the hospital.

The amount of alcohol and drug related admissions are astounding, and as there's a threat to life, top of the queue. Why is there not a way to filter these cases, I don't know, maybe a designated drug A&E! That probably is an awful idea, but it's just aggravating.

There are people there who for all the world seem chirpy and chatty and as if they view the place as a social outlet.

There are staff walking around through 3+ waiting areas calling names trying to find people, losing time with each "missing" person. Why isn't there an announcement system or a board with names on it, or a number assigned like the old tax office system, keep the medical staff looking at medical issues rather than trying to track people down.

Over a period of at least 3 hours, there were 5 hospital staff members sitting adjacent to me shooting the breeze, talking about their pints and nights out, television shows, their upcoming holidays etc. Of course staff are entitled a break, but this was 5 people for several hours just hanging out in a public area.

There must be relatively simple measures that can be introduced to help. People say cut the layers of management. But to me there would appear to be a general malaise among many staff (not all) that needs to be addressed somehow.

What would you do?

jam_mac_jam · 21-07-2019 12:04AM

I would open a large number of small clinics that can deal with breaks and do x rays similar to the vhi clinics. Have 24 doctors so people have care out of hours. A lot of people who are there may not need full hospital care.

I would improve mental health services and care for the elderly so that you don't have people being kept in for longer then needed and being in beds so others are not delayed being admitted.

ToddyDoody · 21-07-2019 02:20AM

Michael O'Leary

gctest50 · 21-07-2019 02:22AM

jam_mac_jam wrote: »

I would open a large number of small clinics that can deal with breaks and do x rays similar to the vhi clinics. .........

HSE have them :

https://www.hse.ie/eng/services/list/3/injuryunits/

Graces7 · 21-07-2019 07:23AM

In eg Canada they have "drunk tanks" so the drunks are filtered out to be treated in a different area leaving the real needs to be treated.

Last time I was in A and E was in Kerry and exactly the same as you describe except as it was midmorning no drunks.. Heard one lady say she had spent all day there the day before... young woman who came in as I was waiting for transpprt had chest pains and no immediate attention.

The staff seemed demoralised? Just not interested in patients... And in the treatment area about six medics sitting at computers . with a watiing room full to overflowing

Bantry eg has a local injury unit that works very well and quickly.

re elderly taking up beds? see end of

https://www.breakingnews.ie/ireland/kerry-university-hospital-urges-people-to-leave-the-ed-services-for-patients-who-need-them-most-938192.html

and google " bed blocking"

I was in an acute surgical ward in Kerry and 4 of the 6 beds were old folk needing a "step down" bed ie a community hospital or nursing home bed. They apparently are there but HSE not using them?

21-07-2019 08:05AM

Outsource the routine and the mundane to private clinics. If they fail to deliver or are continously unable to operate due to striking staff, strip the service from them and give it to the competition.

It will break the stranglehold unions have in the HSE.

I have experience of private health care and couldn't fault it.

_blaaz · 21-07-2019 08:09AM

salonfire wrote: »

Outsource the routine and the mundane to private clinic

I must say this was a fantastic sucess with the cervical check scheme and didnt end terribly atal with zero oversight

FF have a lot to answer for as regards this

RobAMerc · 21-07-2019 08:20AM

people seem to think the HSE is a singular entity with over arching control and power over each of it streams and specialties.
This couldnt be further from the truth.
The HSE is a series of small fifedoms each with their own governance and controls and almost invariably controlled by a group with utter disdain for the HSE who believe they know better and absolutely will not entertain seeding any control.
One thing that is ubiquitous across the organisation except for maybe the frontline staff is the total lack of care or thought for the patient. To a man, the HSE staff are looking after number 1 and secondly the organisation. The patient barely features at all in the psyche of HSE staff.

irishgeo · 21-07-2019 08:35AM

It's easy. GP surgery need to upgraded to deal with more tests etc that are currently done in the hospital. GP clinics should be a mini hospital in regards to tests anyway.

How many people in A + E actually need to be there.

Irishphotodesk · 21-07-2019 08:44AM

Simplest form of increasing productivity in the HSE, introduce a pay as you perform system, give them all a basic salary €250per week and when they complete a task within the allotted timeframe, they are given payment, if they fail to complete the task or subsequently found to have completed the task incorrectly (twice the amount given for completing the task is removed from subsequent pay)

If people are financially responsible for medical negligence cases they will be quick to ensure protocols are adhered to(this applies to all of the team involved-from admin to consultant in the persons care) also.... no person should be permitted to work over 45hours a week, absolutely no one.

21-07-2019 09:06AM

_blaaz wrote: »

I must say this was a fantastic sucess with the cervical check scheme and didnt end terribly atal with zero oversight

FF have a lot to answer for as regards this

Thanks for proving my point.

The labs that made the errors will have lost reputation and work due to their mistakes.

When HSE staff make mistakes, or simply walk off the job, do they suffer any repercussions?

_blaaz · 21-07-2019 09:26AM

salonfire wrote: »

Thanks for proving my point.

The labs that made the errors will have lost reputation and work due to their mistakes.

People literally died over not having proper oversight,to me thats too high a price to pay anyway

When HSE staff make mistakes, or simply walk off the job, do they suffer any repercussions?

Yes...pretty sure doctors can be struck off medical register

SEPT 23 1989 · 21-07-2019 09:30AM

It’s designed to fail if it worked the pigs at the trough in the private system would go hungry

most serious problems in this country health crime housing could be fixed very quickly but the people inside the tent would be out of pocket if they were solved

Never going to change

Graces7 · 21-07-2019 09:34AM

_blaaz wrote: »

People literally died over not having proper oversight,to me thats too high a price to pay anyway

Yes...pretty sure doctors can be struck off medical register

Have you tried making a formal complaint re a doctor here? head meet brick wall.

Nearly every week there are news reports of HSE being sued for deaths etc and rare to see the drs involved being struck off.

Harry Palmr · 21-07-2019 09:47AM

irishgeo wrote: »

It's easy. GP surgery need to upgraded to deal with more tests etc that are currently done in the hospital. GP clinics should be a mini hospital in regards to tests anyway.

How many people in A + E actually need to be there.

Plenty of modern GP practices are quite like this - you have up to 10 GPs who between them cover a range of specialities as well as the routine stuff, do minor
surgeries, do various tests and so on.

This is my practice at the moment https://www.thekeoghpractice.ie/

Of course if they are to do more they need to be funded appropriately and I'm sure the Dept of Health prefers to pour the 'point of contact' money largely into a single pot marked HSE rather than work out how to distribute to scores of individual practices in an accountable fashion. Which brings up the cost of
visiting - GP 50 quid, A&E - free, as long as this is the case it'll be hard to clear out the dry trippers.

Rodin · 21-07-2019 09:52AM

Too many patients go to the ED. Could discharge half of them and no harm would come to them.

Valhallapt · 21-07-2019 10:06AM

Is there not a €100 fee for an ED visit?

Squall Leonhart · 21-07-2019 10:15AM

Valhallapt wrote: »

Is there not a €100 fee for an ED visit?

If you don't have a referral letter from a GP, yes. But it's not an upfront payment, they post a bill out. I'd warrant a majority go unpaid.

Wanderer78 · 21-07-2019 10:26AM

ToddyDoody wrote:

Michael O'Leary

Haha, yea right, need an ambulance, log on to our site/app during your emergency, spend hours clicking on pointless ****e, unclicking 'added extras', paying through the nose for critical options, such as tyres on the ambulance, a bed in the vehicle, a paramedic etc etc! He's not fcuking god you know!

Squall Leonhart · 21-07-2019 10:31AM

SEPT 23 1989 wrote: »

It’s designed to fail if it worked the pigs at the trough in the private system would go hungry

most serious problems in this country health crime housing could be fixed very quickly but the people inside the tent would be out of pocket if they were solved

Never going to change

Is it really designed to fail though, or is there just unintentionally bad policies and management in place?

I'm not anti investment in hospitals, but only after some of the woeful inadequacies are addressed first. If these inefficiencies are spotted by the dogs on the street is it really so hard for policy makers to see?

Or is it as another poster said, the place is so full of different unionised factions out for themselves that it's nigh on impossible to implement a cohesive strategy? If that's the case, why can't some decisive action be taken by the government against it, sack who needs to be sacked, redeploy who needs to be moved, get the system functional and working and deal with the slew of court cases afterwards.

Graces7 · 21-07-2019 11:22AM

Rodin wrote: »

Too many patients go to the ED. Could discharge half of them and no harm would come to them.

Are you a doctor to say that?

They cannot take that risk. every year patients are wrongly discharged and die or sue

Graces7 · 21-07-2019 11:23AM

Valhallapt wrote: »

Is there not a €100 fee for an ED visit?

Not for medical card folk.

irishgeo · 21-07-2019 12:23PM

Graces7 wrote: »

Not for medical card folk.

The problem in a nutshell.

Let's just skip the GP sure he will only send us to A and E.

Should be a 100 euro for the medical card people too unless they have a gp letter.

Wanderer78 · 21-07-2019 12:30PM

irishgeo wrote: »

The problem in a nutshell.

Let's just skip the GP sure he will only send us to A and E.

Should be a 100 euro for the medical card people too unless they have a gp letter.

so people, how may not/probably dont have 100 euro, should pay, and should go to their gp first, who may or may not be on duty, or there maybe a wait for a couple hours to seen them, in an emergency situation, and this would work just fine?

Tangatagamadda Chaddabinga Bonga Bungo · 21-07-2019 12:42PM

Rodin wrote: »

Too many patients go to the ED. Could discharge half of them and no harm would come to them.

I found this to be the case with regards to old folks homes. Only about a third actually need to be there, another third should be in their own house with home help and meals on wheels. And the final third should be given the option of being put out of their misery.

It's a dark stance to have but am making it from a compassionate viewpoint. If you have alzheimer's, can't recognise your own family and wake up with a sh1t in your nappy every morning there is no point in being alive. People should be given the option to end life on their own terms, and pass away with some dignity.

Off topic I know, but am hungover and wanted to make the point, as it still ties in with healthcare in this country.

irishgeo · 21-07-2019 02:22PM

Wanderer78 wrote: »

so people, how may not/probably dont have 100 euro, should pay, and should go to their gp first, who may or may not be on duty, or there maybe a wait for a couple hours to seen them, in an emergency situation, and this would work just fine?

It's not pay at the door, it's billed later.

Wanderer78 · 21-07-2019 02:25PM

irishgeo wrote: »

It's not pay at the door, it's billed later.

true, but do you really think it would work, sending medical card holders to their gp first, possibly further delaying their emergency, emergencies tend be, well urgent?

21-07-2019 02:25PM

Wanderer78 wrote: »

so people, how may not/probably dont have 100 euro, should pay, and should go to their gp first, who may or may not be on duty, or there maybe a wait for a couple hours to seen them, in an emergency situation, and this would work just fine?

Yes people should pay, even poor people.

Just like poor people have to pay for their clothes, fuel, food, electricity, transportation, booze etc.

Wanderer78 · 21-07-2019 02:30PM

salonfire wrote: »

Yes people should pay, even poor people.

Just like poor people have to pay for their clothes, fuel, food, electricity, transportation, booze etc.

what if you actually cant afford it? i know working people that sometimes cant even afford to go to the doctor

irishgeo · 21-07-2019 02:30PM

Wanderer78 wrote: »

true, but do you really think it would work, sending medical card holders to their gp first, possibly further delaying their emergency, emergencies tend be, well urgent?

Your trying to get people out of a and E who don't need to be there. A gp visit first might clear some of these.

If it's an emergency that's fine but often it's not.

The problem is people think I'll skip the GP wait of s few hours and go straight to A + E and increase the waiting time there.

Wanderer78 · 21-07-2019 02:33PM

irishgeo wrote: »

Your trying to get people out of a and E who don't need to be there. A gp visit first might clear some of these.

If it's an emergency that's fine but often it's not.

do we have data to support this? you could be right, but....

do gps actually have the capacity to deal with this influx of people?

How to improve the HSE

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