Idbatterim wrote: » yes an absolute farce, E60 a gp visit if you are the working poor, free if you you are one of the "poor" that gets the money for free, rather than works for it... The "vulneable" here are sacred though, untouchable!
Geuze wrote: » The data on GP visits has been published over and over again. People with med cards visit more. Obviously if something is free, people will use it more.Plus there may be a selection bias - people with GMS medical cards tend to be poorer or older, so they will be going to GP more.
Deleted User wrote: » I agree with Rodin to an extent. Like all areas of our lives, we must exercise some level of personal responsibility. If you’re unemployed, 20 something living with parents, what do you do? (A) Get a job. Save for a deposit and get a mortgage then start a family. Or (B) Go on the dole. Then on the housing list. Then have one or more babies. Likewise, if you’re diabetic due to lack of exercise and being obese, what do you do? Haunt the doctor and hospital on a weekly basis, while not changing your lifestyle? Or work with the health professionals and get fitter, lose weight and spend less time with doctor and hospital. Now, that won’t work for every diabetic, but it just might help. Likewise if someone spends every weekend drinking themselves silly, sometimes ending up in hospital or unable to go to work Monday morning, the solution is in their own hands.
Graces7 wrote: » Ah the " blame the patient" tactic. :rolleyes::eek: Anything but face the reality.
Mantis Toboggan wrote: » 1 million medical cards despite near full employment. That's what I can't understand. Thank you FG.
AndrewJRenko wrote: » Source please? Is this the one dodgy study of six offices that didn't actually count all visits?
Pseudonym121 wrote: » 1641: It wasn’t my intention to paint a picture of resistance to change only among admin. I was simply identifying where I felt the greatest problems and resistance to change lie. Obviously other levels, including clinical grades, are resistant to change also. What is the view of medical unions and doctors ( since unions are made up of doctors ) to public only contracts... Well, firstly given how contracts work the new public only contracts that have been mooted would only be compulsory for new entrants. The new entrant consultants ( Senior/Specialist Registrars due to become Consultants over the next 2 to 3 years ) that I’ve spoken to are all perfectly fine with public only contracts, or they have already decided to emigrate. The vast majority are fine with them though so long as the baseline level of pay is competitive with international pay rates ( competitive means Consultants would still earn far less than they could in Canada, Australia or America but the difference wouldn’t be so large that it would be a no-brainer to emigrate —- currently a new entrant Consultant could go to Australia or Canada and immediately earn double ( take home ) what they earn in Ireland and rising from there. If the difference is about 50% or less then they’ll stay, if it is more increasing numbers will emigrate.). The relatively new Consultants and older Consultants who’ve already made their money from their private work would be happy to change to the new Contract. Yes there would be a cohort who have bought the big house, big car etc who financially need to keep pulling in big money and they would refuse to move to the new contract and in typically Irish fashion they would continue on their old contract until such time as they retire. At present Ireland has 1500 qualified Consultants in post. There are more in post but they haven’t done the requisite training and shouldn’t be allowed to be in post on safety grounds. Slaintecare envisions about 3,000 Consultants which would be a more fitting number for a country the size of Ireland. Let’s assume that 2/3rd of the current crop would take the new contract ( reasonable if it comes with a reasonable pay rise (a say 20%) to partially compensate them for the 20% private work they used to be entitled to ) and all the new entrants are only offered public only contracts you would find yourself five years down the road having more than 2,500 public only Consultants and less than 500 on the old contracts - this number ever-dwindling as they retired. So, you’d have 80%+ on public only contracts pretty soon if the government was competent ( big if ). Within about 15 years the number of Consultants on old contracts would be negligible due to retirements. Nursing numbers: There is a massive problem with nursing retention and morale caused by them being undervalued and their abilities being under-utilised. In broad terms if nurses are ambitious and want to be promoted/get pay rises they need to go into the management track and we lose them to actual work on the wards/with patients. What we need is more nurse specialist posts where good nurses can keep getting up skilled and promoted whilst taking workload for basic chronic illness management off doctors’ plates ( better for patients and cheaper for the health service ) whilst still maintaining clinical work. Also if you generally make the job more attractive ( nurse specialist pathway, more respect, better support for training, hiring more nurses aids to do the scut work nurses currently do etc ) then more will stay which would help solve the staffing crisis. Oftentimes when your family are in hospital the number of nurses on the wards are below the number required to provide adequate care. The numbers are then made up by agency staff who don’t know where anything is, more student nurses etc. This again results in poorer care. So the problem with nursing is that there are too few nurses choosing to work in the HSE and those who do stay and have ambition don’t have the appropriate career pathway to continue providing patient care whilst being promoted and paid appropriately. The nurses I work with are great, experienced, capable and go above and beyond for patients. They are also, all, exasperated with how they are treated, the lack of appropriate promotion pathways which keep them in contact with patients and many are looking to leave/wouldn’t advise their children to enter nursing. A simply yardstick I have for a job is whether or not people would advise their children to enter it. Most nurses I know wouldn’t advise their children to go into nursing in Ireland. Does it have to be this way? Absolutely not, these same nurses have usually done a year in Australia or Canada or know someone who has emigrated and so they know it doesn’t have to be this way - this adds to the frustration. My apologies if this is wordy but I’m trying to be thorough and and give your questions the thought they deserve — whilst avoiding doing research for an article ;-)
AndrewJRenko wrote: » It's easy to offer excellent services if you can cherrypick the services you offer and who you offer them too.
Graces7 wrote: » Really? Hmmmm….You "know" more than we do.And this is not about " charity"! What a misunderstanding of our health care system you have. And infections are best caught and treated early especially with old folk and disabled folk whose health is vulnerable. PS I grew up and lived with the NHS of course. A much better system and even there you can choose to be treated privately.
wobbie10 wrote: » I work in GP office and the figures cant be argued. The average visits per annum for private patients is approx 2 , visits per Medical card patients is approx 4.5, Doctor visit cards for under 6 kids is over 6 visits per year !! Free GP visits = 1 week wait to see GP. 2 tier system will be created
AndrewJRenko wrote: » So that's a no, then, you don't know many people who visit their GP for the craic. Source please? Is this the one dodgy study of six offices that didn't actually count all visits?
joseywhales wrote: » I know lots of people including myself, who have visited doctors for chest/ear/tonsil infections, that I didn't want to wait two weeks in bed to clear up with rest and fluids but I did pay full price. I know anyone who needs to visit a doctor in Ireland can find E10 which is still charity but creates a threshold for resource waste.
Graces7 wrote: » You beat me to it! This is one of those myths that go round. I cannot remember ( and I have a medical card) the last time I saw a doctor. let alone with no good reason. Most of us have far better things to do than that. Or is there some massive attraction going on at the surgery? And how would anyone know why a person was in the waiting room? REALLY! All illnesses also need catching as they develop; not to have to put it off because of money needed. The folk I feel bad for are the borderline folk. But how would charging us help that situation? Oh re the drunks. In some countries these are streamed off to a separate "drunk tank" .
joseywhales wrote: » I know lots of people including myself, who have visited doctors for chest/ear/tonsil infections, that I didn't want to wait two weeks in bed to clear up with rest and fluids but I did pay full price.I know anyone who needs to visit a doctor in Ireland can find E10 which is still charity but creates a threshold for resource waste.
Pseudonym121 wrote: » Wanderer, It isn't correct to say that adequate mental health and psychological supports effectively don't exist. They are present and are better than many make out. You just don't hear about the 80 or 90% of people who are satisfied with care. You only hear about those who are dissatisfied and there may be many reasons for that dissatisfaction including not getting what they want --- which may not be what they need at all. I know many people who have had complaints made against them for not giving a patient a medicine they don't need because the patient went to Dr Google and now thinks they need it. With that said, there are of course some serious failures, particularly in Child and Adolescent Mental Health. I'm a Consultant in the HSE so I have a decent level of insight into this issue and while there are myriad issues there are also some things to bear in mind: a. We are seeing people today we simply wouldn't have given a new patient appointment to 15 years ago so access has expanded massively as resources have gone in to mental health services. b. People's expectation of the services they'll get has also increased massively. I have patients who are genuinely upset when I won't run a special clinic for them on a day and time that suits them as opposed to the two days a week that we run review clinics. c. The HSE reinforces failure instead of success. If you manage your team well and efficiently you don't get more resources to do more good, instead the team which has the same resources as you but isn't performing gets more resources. This is a major issue. d. Bureaucracy has gone mad. There are endless committees and groups which meet about the smallest of issues which have no clinical relevance whatsoever. I am aware of a pointless group which meets fortnightly which spent three hours one day debating whether they were a "group" or "committee" instead of actually deciding on things which helped patients. e. Clinicians aren't listened to. instead managers who look at budgets instead of what works for patients rule the roost. If clinicians were listened to I'm confident that common sense solutions to many issues would emerge which would be cost-neutral or even save money. I was recently in a situation where we were losing a building in which we conducted outreach and community care and we, as a team, decided to source another building for ourselves after the HSE had failed to find a suitable building over at least a year. Within a couple of months we had found a building suited to our needs at less than 20% of the rental cost. It still took many months of bureaucratic hoop-jumping before we were able to use it to benefit patients.... and, of course, that money wasn't then used to improve care in our area but went into a central pot to be squandered by management. How would you fix it? a. Stop reinforcing failure. b. Stop hiring multiple new admin staff for every new doctor or nurse being hired. c. Devolve budgeting power down the chain of command and have it so that any money saved by a team could be used by that team to invest in local care - this way you'd incentivise people to save money and improve services instead of penalising people who save funds. Staff at the local level know whether hiring an additional radiographer or an additional nurse would be best to stop the bottlenecks in their area. d. Stop the over-bureacratisation of the health service. A certain level is necessary, beyond that level it is simply wasteful and serves only to bolster the power of administrators who think the more admin staff they have under them the more important they are. e. Properly fund primary care so that more chronic illnesses can be managed without acute exacerbations which require hospitalisation - this would hugely reduce bed pressure, save money ( because good chronic care is MUCH cheaper than acute crises care ) and benefit the health of the citizens of Ireland. f. Pay restoration for doctors - there has been a massive brain drain which will continue until this is done. We are in an international market for skilled clinicians. We need to pay accordingly or we will continue to have the current situation where 500 of 2,000 consultant posts in Ireland lie empty or are filled with people who aren't properly trained. Every unfilled post adds to the waiting list while every post filed by an improperly trained person adds to avoidable mistakes in patient care and results in patients who are improperly treated and/or may die. Just monetarily the payouts for these mistakes cost more than paying the doctors properly and getting properly trained doctors who wouldn't make these mistakes. It is incredibly penny wise but pound foolish. g. Proper funding for step down care. The term bed blockers is terrible as these are real people with real issues who are in distress but the solution to their situation is proper funding for step down care. Step down care is expensive but FAR less expensive than being an in-patient. Again penny wise but pound foolish. h. Accelerate the implementation of specialist nursing posts and nurse prescribing - this would help tremendously in allowing nurses to manage many chronic conditions/minor exacerbations themselves without needing to involve doctors. One hour of a nurse's time is cheaper than one hour of a doctor's time so this would also save the health service money whilst improving care. It is a win win situation. i. Massive review of management layers and a redundancy programme ( on generous terms ) for those who aren't actually improving patient care. j. Move investigative equipment ( ECHO, CT, MRI, Ultrasound etc ) onto a 9 to 5 x 7 days per week system and reserve Saturday and Sunday for clearing the backlog of routine investigations which currently have horrendous waiting times. The bottom line is the clinical staff are ( with some exceptions as in any organisation ) excellent and empathic but many are also burned out due to the demands of the job. Couple these clinical staff with far fewer managers and a service which focuses on patient care instead of all the current folderol, add in all of the cost neutral and cost-saving changes I've outlined above which would actually improve patient care and you COULD fix the health service without spending a single extra penny. This idea that the health service is too complex to be solved is utter balderdash. Other countries in Europe have better health services with similar levels of investment. We could have a much better system IF there was a consensus that patient-focused solutions would be brought in and in which the paralysis brought about by endless layers of management was tackled. Do I expect that to happen? Hell no, it is Ireland after all.
AndrewJRenko wrote: » Do you know many people who go to a doctor's surgery for the craic?
Pseudonym121 wrote: » 1. Yes, public-only contracts are the way to go. They're the best value for money for the citizens of Ireland. They'll need to be well paid to keep doctors from emigrating but so long as the salary is attractive it would be healthy for medicine and the state to have mostly fully public consultants and some private consultants operating private hospitals. ........ ........... The barrier to change is that no-one has had the nerve to fundamentally redesign the health service and ruthlessly focused it on patient care. Instead when the HSE was formed to gain efficiencies in management/admin basically all of the admin and management were kept on and then rapidly hired more admin and managers to help "manage" the new system. And now of course those admin are all unionised and entrenched and so another layer of problems has been created............ And lastly, the citizens are also to blame. Larger hospitals who can specialise in procedures and carry them out more frequently have better outcomes. So, if you want every county hospital to have a cardiology suite then accept that the death rate in that cardiology suite will be higher than the ones in Dublin because your local suite will do far fewer procedures. The same goes in many areas.... The ideal would be hospitals scaled back and upgraded in response to medical need and research but neither pork barrel politicians nor their constituents would support this. So we have what we have.
ChikiChiki wrote: » Ard you saying the HSE does not have standardised HR and IT systems/processes?
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