An "Irish NHS" - what needs to change?

dulpit · 25-04-2021 12:17pm #1

Hey,

I saw that there was a BBC spotlight set of polls carried out last week for voters in the North and Republic. One of the questions asked was "in a United Ireland, should there be an Irish NHS?". Here are the results:

https://twitter.com/NextIrishGE/status/1385360191097614339

https://twitter.com/NextIrishGE/status/1385361279762767872

It got me thinking, what is the difference between the HSE as it exists and a true NHS? Or is the HSE that already?

I was chatting with a buddy of mine who's recently moved home from Scotland, he mentioned that dentists, GPs and medicines were covered by the NHS, whereas here you pay for most things (unless you have medical card).

I get that the HSE management is a bit all over the place, but apart from that, what sorts of services would an "Irish NHS" offer that the HSE doesn't?

Economics101 · 25-04-2021 12:30pm

The UK NHS has a lot in common with the Irish GMS as operated by the HSE. Biggest differences are coverage for GP services, Drugs costs, and dental treatment.

What is not realised is how much else the HSE and the NHS have in common: they are both basically free or heavily subsidised at the point of usage and are both almost entirely financed directly through taxation. They both seem to have a propensity to generate long delays and queues for treatment. Sometimes the HSE is worse (for hospital treatment and consultant services) and sometime the NHS is worse (apparently to get a GP appointment).

The big contrast is with many systems in continental Europe, which tend to be more insurance-based. This does not necessarily mean a State insurance scheme, but it does mean a very high degree of regulation. Often there are relatively modest co-payments to deter frivolous usage. The main result is that providers have an incentive to get people treated so they can get paid. Also the providers are not necessarily State-owned. As long as they meet all the regulatory requirements that's what matters.

People in the UK tend to think they have the world's best health service. They don't. For some reason (mainly Irish Times journalism, in my opinion) many Irish people also suffer from NHS delusion.

Kermit.de.frog · 25-04-2021 12:38pm

People not paying for stuff would strike me as a massive problem in this country as it is.

I'm not sure the answer is trying to provide more 'free' stuff that workers in the state will again pay for one way or another.

And something as proposed in the OP would be a bottomless money pit we simply can't afford because of other choices we make as a country. Like the basic concept of rates in the UK for example.

People here won't even pay for water ffs. They think clean drinking water magically arrives from the reservoir to their taps courtesy of nature.

So I would be against these initiatives because it will bankrupt us quicker and does not deal with the underlying disease in Irish society of not wanting to pay for anything.

Also agree on the UK NHS. It's far from what it's cracked up to be.

km991148 · 25-04-2021 2:04pm

UK NHS has lost its way over the last 10/15 years. Coincidentally during one of the most privatisation-heavy conservative governments.

It tricks people into thinking it's still the same as it once was because it's free at the point of entry, but more and more of the services are given by private companies. I don't necessarily think it's bad to have private firms involved, but there has to be sufficient motivation to provide good quality healthcare and not just hoover up lucrative contracts with healthcare secondary concern.

I think Irish healthcare (from my experience) is really poor. Long waiting times and having to pay for a lot. It's no better than the NHS, far worse it seems in many aspects (especially in preventative measures.. happy to treat things but not as proactive at preventing or detecting illness). The NHS seems to be declining towards the Irish type of healthcare.

This I can only see as opening the back door to American style private health. If you have the money, you will be seen quicker.

Other EU countries seem to have different models that promote overall better healthcare for the masses.

So do we need an 'Irish NHS' - yes, but based on what the NHS should be, not what it is currently evolving into.

slipperyox · 25-04-2021 2:10pm

if you look@:
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29

Ireland is clouded, as private contributions (laya, vhi etc)account for a lot too.

So, is the government going to pay this?

No

jimmycrackcorm · 25-04-2021 2:24pm

Kermit.de.frog wrote:

People here won't even pay for water ffs. They think clean drinking water magically arrives from the reservoir to their taps courtesy of nature.

I'm not surprised that so many in a poll want an NHS style system here. If you asked if pubs should give out beer for free then you'd get the same results.

jimmycrackcorm · 25-04-2021 2:27pm

km991148 wrote:

This I can only see as opening the back door to American style private health. If you have the money, you will be seen quicker.

The American system is terrible. Money might buy you access but it's poor value. Even well off middle class people can get crippled financially if they have a serious long term illness. If you have cover through your work but contract cancer as an example, where you can't continue working then tough luck.

Sadler Peak · 25-04-2021 2:31pm

Has any other country copied the British NHS model ?

Inviere · 25-04-2021 2:31pm

Economics101 wrote: »

What is not realised is how much else the HSE and the NHS have in common: they are both basically free or heavily subsidised at the point of usage and are both almost entirely financed directly through taxation. They both seem to have a propensity to generate long delays and queues for treatment. Sometimes the HSE is worse (for hospital treatment and consultant services) and sometime the NHS is worse (apparently to get a GP appointment).

That's not inherent to the model of providing care as such, more so to do with the craggy island/cute hoor approach to it. The funds generated could be put to a LOT better use than they are currently, without raising taxation levels.

suicide_circus · 25-04-2021 2:32pm

Kermit.de.frog wrote: »

People not paying for stuff would strike me as a massive problem in this country as it is.

This. In Austria for example everyone pays social (health) insurance, even people on the dole. There is no level of income that is free of income tax. There is no free public transport, everyone pays something, everyone contributes. It's no accident the have top class services and infrastructure.

Kermit.de.frog · 25-04-2021 2:37pm

suicide_circus wrote: »

This. In Austria for example everyone pays social (health) insurance, even people on the dole. There is no level of income that is free of income tax. There is no free public transport, everyone pays something, everyone contributes. It's no accident the have top class services and infrastructure.

It's funny because I do genuinely think sometimes who is paying all the taxes to keep the show on the road given the sheer numbers out of the tax brackets completely, all the loopholes, all the reliefs out there?

I fear we are heading for a serious crisis and that we have a gaping hole in our finances because the net is not as wide as it should be that won't take much to expose.

km991148 · 25-04-2021 2:38pm

jimmycrackcorm wrote: »

The American system is terrible. Money might buy you access but it's poor value. Even well off middle class people can get crippled financially if they have a serious long term illness. If you have cover through your work but contract cancer as an example, where you can't continue working then tough luck.

This is what I mean, the worst of all worlds. Pay a fortune, mediocre at best (for most).

UK is headed this way. More private providers or tax money squandered while the quality of care decreases year on year.

dulpit · 25-04-2021 3:20pm

I've definitely seen some reports that suggest that the younger cohort of voters would actually support higher taxes (or at the very least no tax reduction) if there was a tangible and clear improvement in public services.

It would need a strong political will though, most parties would look at the short term gain of reducing taxes..

EddieN75 · 25-04-2021 3:25pm

dulpit wrote: »

I've definitely seen some reports that suggest that the younger cohort of voters would actually support higher taxes (or at the very least no tax reduction) if there was a tangible and clear improvement in public services.

It would need a strong political will though, most parties would look at the short term gain of reducing taxes..

Nothing as intelligent as throwing good money after bad.

More than enough money is given to the hse. Changing the name but keeping the same people and culture won't make a difference

Hamsterchops · 25-04-2021 3:41pm

dulpit wrote: »

An "Irish NHS" - what needs to change?

What needs to change?

Well firstly we need to be part of a much bigger population of about 65 million people. The reason the NHS is better than the HSE (relatively speaking), is because of the sheer size of the NHS and the costs are spread far and wide, the NHS is moulded on a regional basis, NHS England being the largest, then you also have the NHS in Scotland, Northern Ireland & Wales.

Actually there might be an argument for the NHS being extended down here (from NI) in the event if a United Ireland. Understandably the North would not want to let it go, so maybe as a bargaining chip the NHS is extended into the ROI, obviously with us paying our share.

Now there's a nice thought.

Probably not a runner though, but it would be one way of us actually getting the NHS down here. Free GP visits for all like they have up North.

The NHS works because it's spread across such a large population.

I see sheep · 25-04-2021 3:50pm

Economics101 wrote: »

The UK NHS has a lot in common with the Irish GMS as operated by the HSE. Biggest differences are coverage for GP services, Drugs costs, and dental treatment.

What is not realised is how much else the HSE and the NHS have in common: they are both basically free or heavily subsidised at the point of usage and are both almost entirely financed directly through taxation. They both seem to have a propensity to generate long delays and queues for treatment. Sometimes the HSE is worse (for hospital treatment and consultant services) and sometime the NHS is worse (apparently to get a GP appointment).

The big contrast is with many systems in continental Europe, which tend to be more insurance-based. This does not necessarily mean a State insurance scheme, but it does mean a very high degree of regulation. Often there are relatively modest co-payments to deter frivolous usage. The main result is that providers have an incentive to get people treated so they can get paid. Also the providers are not necessarily State-owned. As long as they meet all the regulatory requirements that's what matters.

People in the UK tend to think they have the world's best health service. They don't. For some reason (mainly Irish Times journalism, in my opinion) many Irish people also suffer from NHS delusion.

The NHS is vastly superior to the Irish health service in every sense imo, having lived in both places.
The only problem is like people have said, the tories ars trying to privatise it.

dulpit · 25-04-2021 3:53pm

Hamsterchops wrote: »

What needs to change?

Well firstly we need to be part of a much bigger population of about 65 million people. The reason the NHS is better than the HSE (relatively speaking), is because of the sheer size of the NHS and the costs are spread far and wide, the NHS is moulded on a regional basis, NHS England being the largest, then you also have the NHS in Scotland, Northern Ireland & Wales.

Actually there might be an argument for the NHS being extended down here (from NI) in the event if a United Ireland. Understandably the North would not want to let it go, so maybe as a bargaining chip the NHS is extended into the ROI, obviously with us paying our share.

Now there's a nice thought.

Probably not a runner though, but it would be one way of us actually getting the NHS down here. Free GP visits for all like they have up North.

The NHS works because it's spread across such a large population.

But none of this explains (apart from the free gp) what is different between the NHS and the HSE? What do you get with the NHS that the HSE doesn't give us?

25-04-2021 4:02pm

dulpit wrote: »

I've definitely seen some reports that suggest that the younger cohort of voters would actually support higher taxes (or at the very least no tax reduction) if there was a tangible and clear improvement in public services.

It would need a strong political will though, most parties would look at the short term gain of reducing taxes..

We have a fairly high tax take already and high enough spend. Paying extra taxes shouldn’t be necessary.

25-04-2021 4:03pm

dulpit wrote: »

But none of this explains (apart from the free gp) what is different between the NHS and the HSE? What do you get with the NHS that the HSE doesn't give us?

Everything is free.

indioblack · 25-04-2021 4:09pm

km991148 wrote: »

UK NHS has lost its way over the last 10/15 years. Coincidentally during one of the most privatisation-heavy conservative governments.

It tricks people into thinking it's still the same as it once was because it's free at the point of entry, but more and more of the services are given by private companies. I don't necessarily think it's bad to have private firms involved, but there has to be sufficient motivation to provide good quality healthcare and not just hoover up lucrative contracts with healthcare secondary concern.

I think Irish healthcare (from my experience) is really poor. Long waiting times and having to pay for a lot. It's no better than the NHS, far worse it seems in many aspects (especially in preventative measures.. happy to treat things but not as proactive at preventing or detecting illness). The NHS seems to be declining towards the Irish type of healthcare.

This I can only see as opening the back door to American style private health. If you have the money, you will be seen quicker.

Other EU countries seem to have different models that promote overall better healthcare for the masses.

So do we need an 'Irish NHS' - yes, but based on what the NHS should be, not what it is currently evolving into.

I agree. I can only echo your sentiments. It's an excellent service - but not what it was. I had to make use of the NHS for some weeks this time last year - when things were bad here. The level of personal attention and care from nurses and others was impressive - considering what was happening in the country at the time. Some were retired nurses who had returned to help out. This was regular local healthcare that had to continue despite all that was happening in the country.
Your point about what the NHS may be evolving into is something I agree with.

RandomViewer · 25-04-2021 4:18pm

Kermit.de.frog wrote: »

People not paying for stuff would strike me as a massive problem in this country as it is.

I'm not sure the answer is trying to provide more 'free' stuff that workers in the state will again pay for one way or another.

And something as proposed in the OP would be a bottomless money pit we simply can't afford because of other choices we make as a country. Like the basic concept of rates in the UK for example.

People here won't even pay for water ffs. They think clean drinking water magically arrives from the reservoir to their taps courtesy of nature.

So I would be against these initiatives because it will bankrupt us quicker and does not deal with the underlying disease in Irish society of not wanting to pay for anything.

Also agree on the UK NHS. It's far from what it's cracked up to be.

Water wouldn't have been an issue if it had have been handled by ESB and added to utility bill instead FG decided to hand it to their criminal crony ,

Eric Cartman · 25-04-2021 4:22pm

I see sheep wrote: »

The NHS is vastly superior to the Irish health service in every sense imo, having lived in both places.
The only problem is like people have said, the tories ars trying to privatise it.

The NHS also has funding and queuing issues.

The only way to reform the HSE into an NHS like model is to lock out the unions and sack all the duplicate workers then take the saved money and invest it in actual services instead of management.

Graces7 · 25-04-2021 4:35pm

jimmycrackcorm wrote: »

The American system is terrible. Money might buy you access but it's poor value. Even well off middle class people can get crippled financially if they have a serious long term illness. If you have cover through your work but contract cancer as an example, where you can't continue working then tough luck.

NB Our friends in the US take out insurance for medical costs.

Eric Cartman · 25-04-2021 4:38pm

RandomViewer wrote: »

Water wouldn't have been an issue if it had have been handled by ESB and added to utility bill instead FG decided to hand it to their criminal crony ,

the objection to water charges was for the first time in a damn long time, everyone was expected to pay. Those used to living completely off the state went mad at the idea of having to pay any money for anything and got violent.

theteal · 25-04-2021 4:43pm

dulpit wrote: »

But none of this explains (apart from the free gp) what is different between the NHS and the HSE? What do you get with the NHS that the HSE doesn't give us?

I've "only" been here a decade but thanks to favourable health I'm not entirely sure how it works. From what I gather, there are 2 sides to NHS service. Like Ireland, if you're on benefits, everything is free - prescriptions and all.

Now for us working folk, some bits are free but mostly it's heavily subsidised. So your GP and hospital visits are free. When I go to collect a prescription they ask if I normally pay for them i.e. nice way of asking if you're on benefits. I do have to pay, it's like £7.50 (or thereabouts) - that's it, doesn't matter what I'm getting, that's the fee.

Dentist check ups are free. Scale and polish was £19 last time I had one. I did have root canal in the first year here. That clocked in at <£300 and that included the expensive white crown, the horrible metallic one would have been free.

I had a non-serious issue that needed a bit of surgery 2 years ago. GP visit to job done inside 3 months. No mention of money. That doesn't happen in Ireland without health insurance.

Now it's not all sunshine and lollipops. I waited 2 months for a MRI scan after destroying my knee playing football. I also hear a lot of local complaints about being unable to get through to the GP ont he phone to make an appointment. I find because it's free, they tend to go to GP for every little thing and on the flip side of that, missed appointments are a big unpunished problem.

RandomViewer · 25-04-2021 5:13pm

Eric Cartman wrote: »

the objection to water charges was for the first time in a damn long time, everyone was expected to pay. Those used to living completely off the state went mad at the idea of having to pay any money for anything and got violent.

Dobby was the reason for most of the objections, in a lot of cases people had already paid large fees for a water connection and development fees when they built the house, NCT came in without a hitch 12 years earlier, people saw blatant criminal corruption in Irish water and objected, as I said the ESB had an existing database and another levy on the bill would have gone unchallenged,

Duckworth_Luas · 25-04-2021 5:16pm

fvp4 wrote: »

Everything is free.

Nothing is free

25-04-2021 5:45pm

Only way to fix the HSE in this country is start from a blank canvas and getting rid of unlimited medical card usage.

It would be political suicide for Any minister to get the HSE to function to its potential though.

Eric Cartman · 25-04-2021 6:18pm

tommybrees wrote: »

Only way to fix the HSE in this country is start from a blank canvas and getting rid of unlimited medical card usage.

It would be political suicide for Any minister to get the HSE to function to its potential though.

anything that could realistically fix the HSE would cause strikes or riots, pissing off the unemployed or the heavily unioned public service is not something any career politician would even consider.

suicide_circus · 25-04-2021 6:45pm

I honestly think the Israeli Palestinian conflict is easier to fix than the HSE

Graces7 · 25-04-2021 6:51pm

suicide_circus wrote: »

This. In Austria for example everyone pays social (health) insurance, even people on the dole. There is no level of income that is free of income tax. There is no free public transport, everyone pays something, everyone contributes. It's no accident the have top class services and infrastructure.

Logically then they will have to raise the amounts of eg dole so that folk can pay without losing what they need to live on. eg food and heating,

Benefit levels in the UK and here take eg free health care into account. You cannot get blood out of a stone

astrofool · 25-04-2021 7:03pm

I'm a firm believer that there should be a nominal payment for everything, even €2 for a "free" GP visit would handle 90% of the missed or unnecessary visits. Everything truly free is abused and people take more than they need. If they had put the water charges at some very low level it may have worked, instead Hogan flew all sorts of kites and had lots of different allowances that no one believed or trusted the system.

Economics101 · 25-04-2021 10:33pm

A point which has been missed in the discussion so far is that the NHS costs less per head than the HSE, especially when the NHS covers over 95% of the UK population whereas over 40% of Ireland's population subscribe to private health insurance. I don't have the exact numbers to hand but overall Ireland spends a higher amount per head on total healthcare than does the UK.

The scandalous bit is that all that money seems to get such poor results (especially in terms of delayed treatment). TO make matters worse Ireland has a significantly lower % of its population aged over 65 than does the UK. And generally the oldies cost an awful lot more on average.

Mad_maxx · 25-04-2021 10:53pm

a willingness to put parochialism to one side , opposing the closure of hospitals in towns like roscommon etc , that needs to stop but due to our electoral system , its meat and drink to the likes of the healy raes

we need to get behind the " centres of excellence " strategy

Geuze · 25-04-2021 11:05pm

dulpit wrote: »

But none of this explains (apart from the free gp) what is different between the NHS and the HSE? What do you get with the NHS that the HSE doesn't give us?

Four fees in Irish healthcare:

(1) GP fee
(2) Pharma up to monthly DPS limit of 124?
(3) A&E fee = 100
(4) overnight fee in hosp = 80pn

NHS waiting time = max 18 weeks in England, from GP referral / 2 weeks for suspected cancer
[note that it seems this 18wk target isn't been met]

HSE waiting time = up to 15 / 18 months

https://www.irishtimes.com/news/health/leo-varadkar-targets-15-month-waiting-limit-for-treatment-1.2076970

Geuze · 25-04-2021 11:23pm

Economics101 wrote: »

A point which has been missed in the discussion so far is that the NHS costs less per head than the HSE, especially when the NHS covers over 95% of the UK population whereas over 40% of Ireland's population subscribe to private health insurance. I don't have the exact numbers to hand but overall Ireland spends a higher amount per head on total healthcare than does the UK.

The scandalous bit is that all that money seems to get such poor results (especially in terms of delayed treatment). TO make matters worse Ireland has a significantly lower % of its population aged over 65 than does the UK. And generally the oldies cost an awful lot more on average.

Yes, we over-spend on healthcare, relative to the age profile of our population.

dulpit · 26-04-2021 12:58am

Geuze wrote: »

Four fees in Irish healthcare:

(1) GP fee
(2) Pharma up to monthly DPS limit of 124?
(3) A&E fee = 100
(4) overnight fee in hosp = 80pn

NHS waiting time = max 18 weeks in England, from GP referral / 2 weeks for suspected cancer
[note that it seems this 18wk target isn't been met]

HSE waiting time = up to 15 / 18 months

https://www.irishtimes.com/news/health/leo-varadkar-targets-15-month-waiting-limit-for-treatment-1.2076970

So if we ignore how well (or not) the HSE is performing, the key difference of the service between HSE and NHS is that we currently pay for GPs, A&E, stays in hospitals, pharmacy, things like that.

But the actual offering of the 2 services is essentially (or theoretically, at least) the same?

dulpit · 26-04-2021 12:59am

Oh actually, is private health insurance a think in the UK?

Geuze · 26-04-2021 1:16am

dulpit wrote: »

Oh actually, is private health insurance a think in the UK?

Yes, e.g. BUPA.

I think about 10% of the pop buy it.

Geuze · 26-04-2021 1:17am

dulpit wrote: »

So if we ignore how well (or not) the HSE is performing, the key difference of the service between HSE and NHS is that we currently pay for GPs, A&E, stays in hospitals, pharmacy, things like that.

But the actual offering of the 2 services is essentially (or theoretically, at least) the same?

Another big difference is consultant contracts.

Most of ours have contracts that allow them to do private practice.

Pandiculation · 26-04-2021 1:28am

Given the shape of Irish healthcare, with lots of different providers and a significant private insurance setup, I think a continental model would make more sense in many ways.

If we went for something like a version of the French, German or Dutch systems it would give you universal healthcare with an element of a social market economy in the system for providers.

The NHS is a pretty old monolith that originated at a time when healthcare was very simple, and relatively cheap to provide and was built almost from scratch in the aftermath of a war and out of a system that was pretty old school.

I think were 70+ years late to create an NHS, but we could easily transform into a model like one of the better implementations on the continent.

There are multiple ways of doing a public health system and it doesn’t have to be the NHS, which to be quite honest has many of the issues of the HSE.

I think part of the problem the HSE has is it never made its mind up on what model It is using. It has aspects that have evolved more like the NHS and other aspects that look more like the continental systems and a layer of top up private insurance and far too much out of pocket payment.

We aren’t getting value for money nor are we getting adequate universality, yet we are paying a pretty serious amount of money into it.

There needs to be some very serious analysis of why the costs are so high.

I think an element of it could be that we are competing with some very over paid health systems for key staff. If you look at the US system, the costs are almost at an unsustainable level. It’s a balance that’s more towards private insurance but the costs per capita have grown almost exponentially since the 1990s to the point that they’re paying way more than the most expensive EU public systems, yet getting worse results.

I always get the sense here that we are both influenced by it and also we have people expecting those levels of payments, or they disappear across the Atlantic or to Australia.

The NHS has similar issues with medical staff moving abroad. The Irish system probably even more so due to issues with extremely over loaded working conditions in a lot of areas and poor career paths.

I don’t think we’re getting to the bottom of why our costs are so high though.

quokula · 26-04-2021 1:47am

Geuze wrote: »

Four fees in Irish healthcare:

(1) GP fee
(2) Pharma up to monthly DPS limit of 124?
(3) A&E fee = 100
(4) overnight fee in hosp = 80pn

NHS waiting time = max 18 weeks in England, from GP referral / 2 weeks for suspected cancer
[note that it seems this 18wk target isn't been met]

HSE waiting time = up to 15 / 18 months

https://www.irishtimes.com/news/health/leo-varadkar-targets-15-month-waiting-limit-for-treatment-1.2076970

That NHS target isn't even close to being met. I lived in the UK for ten years and I can say that my wait times varied from 6 - 18 months, never once was it less than 18 weeks. Also, you can forget about seeing a GP in under 2 weeks. It got consistently worse from year to year too as the Tories dismantled the system.

My experience with the HSE since moving home is that it's far easier to see a GP (though having to pay, obviously), and the wait time to see a consultant has been about similar. I noticed a marked difference in quality of care though - on the NHS their main priority was always to get you out the door as quickly as possible and onto the next patient, in the HSE they're actually trying to help, to the extent that I've seen much more progress in treating a chronic condition I'd been suffering in two years here than in ten years in the UK.

This is anecdotal of course and will vary by consultant but it is a pattern I saw consistently across multiple NHS trusts. I think it's a natural result of a system where they are measured according to the speed they get through their waiting list, with actual outcomes seemingly being far less important. If you have a life threatening condition it's different, but if you have a chronic condition that impacts your quality of life, the NHS just doesn't really care.

Something else I will add is that my partner is a health care professional and worked for the NHS, but earns a lot more for the same job in Ireland. Some will say that's a reason why the HSE is more inefficient and say the unions have too much power, but I personally prefer to live in a country where nurses don't routinely have to use food banks to survive, even if that does mean we get less bang for buck on healthcare expenditure.

Pandiculation · 26-04-2021 2:08am

The NHS was probably at its peak decades ago. The issue is a mixture of the Tories dismantling things and more expectations of high tech and expensive treatments in a budget that isn’t keeping up.

I find one issue in the U.K. is that the NHS tends to be seen as a national treasure, and often discussed as if there’s no public health systems anywhere else except in the U.K. The reality is it’s a mid-performer in the European public health league tables and has growing issues in some areas.

We need a far more universal system, but I’m not sure the NHS is the model to follow. It’s aims about universality are, but I think there are probably better ways of achieving that that turning the HSE into a giant, vertically integrated, monolithic organisation.

To me that would seem to be a recipe for an even more inflexible and admin heavy setup.

The continental models can achieve mixes of public and private ownership and very high levels of universality.

Kermit.de.frog · 26-04-2021 5:17am

Pandiculation wrote: »

I find one issue in the U.K. is that the NHS tends to be seen as a national treasure, and often discussed as if there’s no public health systems anywhere else except in the U.K.

It's the UK. Always been like that. It's the same uninformed misguided sense of exceptionalism as they use with their migrants whom they refer to as "ex-pats", for example.

Wanderer78 · 26-04-2021 6:40am

dulpit wrote:

I get that the HSE management is a bit all over the place, but apart from that, what sorts of services would an "Irish NHS" offer that the HSE doesn't?

A functioning health care system

26-04-2021 8:57am

Economics101 wrote: »

The UK NHS has a lot in common with the Irish GMS as operated by the HSE. Biggest differences are coverage for GP services, Drugs costs, and dental treatment.

What is not realised is how much else the HSE and the NHS have in common: they are both basically free or heavily subsidised at the point of usage and are both almost entirely financed directly through taxation. They both seem to have a propensity to generate long delays and queues for treatment. Sometimes the HSE is worse (for hospital treatment and consultant services) and sometime the NHS is worse (apparently to get a GP appointment).

The big contrast is with many systems in continental Europe, which tend to be more insurance-based. This does not necessarily mean a State insurance scheme, but it does mean a very high degree of regulation. Often there are relatively modest co-payments to deter frivolous usage. The main result is that providers have an incentive to get people treated so they can get paid. Also the providers are not necessarily State-owned. As long as they meet all the regulatory requirements that's what matters.

People in the UK tend to think they have the world's best health service. They don't. For some reason (mainly Irish Times journalism, in my opinion) many Irish people also suffer from NHS delusion.

I would disagree having worked in both the HSE and the NHS.
The NHS is far ahead in it's IT infrastructure, MDT involvement and it's public health screening.

As an example, in the NHS, I could pull up anybody's medications prescribed by their GP and also every electronic note that their GP has written on them since they introduced it 3-4 years ago (The access to this information literally is a live saver in acute med/ED.

Transfer of care between primary and secondary care is absolutely horrendous. Nobody second checks a patient's discharge in the HSE (you would be quite lucky to get one from my experience, sometimes it's just a prescription you receive.

The HSE is improving slowly but the NHS does provide a better service and better value for money (although I acknowledge it's easier to provide better value for money due to size of population.

Economics101 · 26-04-2021 10:01am

The Dazzler: you say you disagree with my post, but in fact you didn't really disagree!. You mainly raised a new point, and a very valid one: the continuing train wreck which is the HSE's lack of a proper IT system. This will become more apparent when it comes to the ongoing tracking and management of covid vaccinations

26-04-2021 10:04am

Eric Cartman wrote: »

anything that could realistically fix the HSE would cause strikes or riots, pissing off the unemployed or the heavily unioned public service is not something any career politician would even consider.

Agree 100%
It's a big mess that will probably never be fixed

Geuze · 26-04-2021 10:10am

Pandiculation wrote: »

Given the shape of Irish healthcare, with lots of different providers and a significant private insurance setup, I think a continental model would make more sense in many ways.

You may recall in 2011 (?), the FG/Lab Govt planned to introduce UHI.

UHI = universal health insurance

Plans were developed, but eventually abandoned.

I think it could be a good idea.

I am not confident about Slaintecare.

Geuze · 26-04-2021 10:17am

Deleted User wrote: »

I would disagree having worked in both the HSE and the NHS.
The NHS is far ahead in it's IT infrastructure, MDT involvement and it's public health screening.

.

+100%.

We are a centre for ICT, we have dozens of MNC here, and yet our own healthcare ICT is poor.

If I collapse 200km from home, I want the ambulance staff and local medical staff to be able to access my health history.

dulpit · 26-04-2021 10:45am

I think a lot of people are now comparing how the HSE operates versus the NHS - but my query was more to do with the idealised offerings of the 2. So if the NHS was operating perfectly and the HSE was operating perfectly, the key differences so far are:

You don't pay anything for NHS services essentially
You pay for GP, medicines, A&E, hospital stays with HSE

Are there any other key differences?

An "Irish NHS" - what needs to change?

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