The current hospital / A&E crisis

If you got rid of half of the non-healthcare workers in the HSE, it might free up more money but the staff just aren't there. There are loads of vacancies but not enough suitably qualified persons are applying.

It's so difficult to recruit enough suitably qualified front line staff that they are actively trying to get people from abroad to apply. They even offer relocation packages to those applying from the EU and non EU countries.

There are young Irish nurses and healthcare workers who cannot afford to live in Dublin and pay rent , ( just as there are young teachers and young people in every walk of life but we are talking health service here) and yet they are offering relocation packages to international nurses?

By all means we need everybody but those nurses have to live too once they get here.

But why not offer similar to young Irish nurses to entice them to stay?

Or why not give an allowance towards rent in high cost cities?

Who in their right mind would work in the health service unless you are getting paid hugely for it.

There are a load of people in the country earning huge salaries for work that is not useful to society, do not have to deal with the public, do not have to deal with daily life threatening situations, do not have housing problems ...

I would imagine there is a huge amount of waste in the HSE that could be transferred into huge employee incentives.

Even still it still probably is not worth it. Who wants to babysit violent drunk entitled people in an a and e , just one example.

Yes. Maybe it should be if it isn't.

And yes to anallowance , think it works well in other places eg London weighting for public servants.

Could be appied to all workers below a certain amount working and living in the city.

Its a perfect storm... housing and rent crisis, Covid and flu and hospital crisis , high emigration.

I think there needs to be a Dublin allowance or there will be no teachers, nurses, police ... In Dublin if housing/rent keeps increasing in cost.

But that would put up the cost of housing/rent ..

Not enough accommodation.

There in lies the rub.

Either build more accomodation in Dublin or decentralise and build there.

Maybe we need a new city ?

Hospital city in the center of Ireland.

Centred around a new Children's hospital ... no wait 🤣

3 hours drive from anywhere but max 6 hours a and e wait. And not 50 hours.

And build up. Not out.

Or just continue on as normal outbidding ourselves on properly and emigrating. 🤣🤣🤣

There's a pile of medical staff across a wide range of disciplines needed in the HSE, not just nurses.

Consultants earn from €184,842 to €252,150 from their HSE contract per year, depending on which contract they are on. They can earn more if they also do private practice. They can easily afford to live in Dublin. There are currently almost 900 unfilled consultant posts in the HSE. You can't blame Dublin prices for the lack of consultants applying for the roles. The roles just aren't attractive enough whether it is for financial reasons or working condition reasons.

I'll agree that it can be difficult for young nurses and healthcare workers to afford to live in Dublin but it's doable in most instances. How do people who work in lower paid jobs such as working in a chipper or in Spar etc. manage to live in Dublin? There are nurse and healthcare worker shortages in pretty much every area of the country, not just in Dublin. The conditions in the acute hospitals make the jobs unattractive. It's a combination of being overworked and underpaid.

The relocation package seems to apply to all grades of staff so I would assume that nurses are covered too.

Expenses such as flights, transfers, accommodation etc. must be vouched and are subject to the max. limit below.

Additional costs can also be paid.

Regarding your suggestion that this money should be used to support young Irish nurses or other healthcare workers etc., I'm not against that idea but it's practically impossible to implement. If the HSE increases the wages for Dublin nurses/healthcare workers, then they'll have to increase the wages for every other nurse/healthcare worker in the country or you'd have the possibility of widespread industrial action and the taxpayer could be stuck with an unaffordable bill. And good luck applying it only to front line workers too as other grades such as admin/management etc. will want an increase too.

I think the biggest problem facing the healthcare system is quick access to GPs. We don't have near enough GPs to cope with current demand and our population is growing rapidly. This will put further pressure on our accute hospitals and worsen the service currently provided. Currently there are about 500 GPs approaching retirement age out of a pool of approximately 2,800 GPs currently in practice. While there will be newly qualified GPs coming on stream, the number of GPs continues to reduce as more are leaving than joining.

I mentioned other healthcare workers along with other workers on lower wages, but not qualifying for benefits.

A lot of people working in the city on low wages are either living with family or on the HAP which nurses or other workers needed for jobs in the city and are not from Dublin, do not qualify for.

Dublin is the worst city but Galway and Cork are close on its heels. Other countries have brought in incentives for workers in cities and it can be done without causing ructions in the balance of fairness. Everybody can see that graduates are struggling to get housing and pay rent in Dublin particularly.

Nobody mentioned consultants struggling financially 🙄

So how do you think it can be incentivised?

I have spoken about the difficult conditions already and more staff on shifts and improved working conditions would goa long way to retaining staff.

Colm Henryon the News there discusding how as well as more beds the communitu care hubs " that are being built" will improve the situation in A&E.

But no mention of how to get staff or doctors and how to retain them!

I used the shortage of 900 consultants as an example that not all healthcare vacancies are a result of the lack of affordabe accommodation in Dublin. There are other reasons than housing expense for that cohort not wanting to work in Ireland. A large part of it I suspect is that more money can be made elsewhere and the working conditions here are more difficult than elsewhere. I'd say that's the same across the board, i.e. doctors, nurses, medical specialists etc.

I'm not being rude but an overworked nurse in Kerry or Kilkenny absolutely would give a shyte if an overworked nurse in Dublin was getting paid more than them. They'd have their hand out pretty quickly. And how can you pay Dublin nurses more without having to pay Dublin admin/management/porters/cleaners/security staff more? Don't they have the same issues with accommodation costs?

There's no easy way to fix the HSE. And fixing the HSE is only part of the problem. You'd have to solve the housing crisis too. And there's no easy way of doing that.

The way to improve recruitment is to improve working conditions and pay. Given that the HSE already is a black hole when it comes to money, I doubt the general public would be happy to pay more taxes to throw into that black hole.

Here's my solution that would probably take 20 years to implement and at a cost we can't afford.

Below is my solution but it's not realistic because we can't afford it.

Treat sick people in the community setting where possible. This should be the number one priority. Keep the acute hospitals for those who are seriously ill and need that type of care.

1. To treat people in the community setting an adequately resourced community care service is needed.
2. Train many more doctors than we currently do and incentivise doctors to become GP's. Make it financially beneficial to become a GP.
3. Set up HSE run GP practices and build the necessary buildings and provide support staff to the GPs. This could be done out of the Primary Care Centres. Most GPs are self employed and this means they have a lot of extra work to do. GPs working out of HSE buildings could remain self employed but they'd be the only employee. They wouldn't have to worry about the receptionist, the cleaner, the nurse etc. The'd work out of a HSE building and the building would supply the support staff. The GP's would only have to turn up to work and treat people. GPs would get paid for seeing x number of people per day/week/month/year. If the GP wants to work longer hours and make more money, then that should be accommodated.
4. In low population areas such as Achill Island where a GP wouldn't see enough people to earn a decent wage , the GP could be paid an agreed wage.
5. To treat sick people in the community setting, a lot of primary care centres need to be built and staffed. Adequate numbers of podiatrists, physiotherapists, S&L therapists, public health nurses etc. need to be trained and adequately remunerated.
6. Train managers to efficiently manage their staff. You'd be amazed at how many managers have little or no management training. This would increase efficiency in the service.
7. Incentivise people to train in the healthcare field by paying them a liveable wage while they are training and paying them a good wage when they qualify.
8. Offer further training for those who are ambitious and want to advance their career.

For those who need more specialised treatment than community care can provide, I'd do the following.

1. Invest in more hospitals with adequate a&e facilities that aren't built in a stupid location at a stupid cost.
2. Build feckin rectangular buildings because they are far cheaper to build than that fcukin new yoke that looks like the Eye of Sauron. Those buildings look nice but cost multiples of what a rectangle costs to build.
3. Build far more nursing homes and step-down facilities for those who don't need to be taking up a bed in an acute hospital but are too sick or unable to care for themselves at home. This would free up an awful lot of beds in the acute hospitals.

There are multiple difficulties and issues with every single thing I've suggested above. I don't have all the answers but my priority would be to try and treat as many people in the community setting and keep the acute hospitals for the more serious illnesses/incidents etc.

Yes. Always some big wig making money when the government of the day decide to sell something off. And nothing more heard about it when it comes back to bite the public in the axxxe .

The majority of people don't know or don't remember and that's what politics depend on .

We really need to change more than the health service don't we ?

I agree with everything you have said and have said much the same but not in such an organised way .

Excellent post .

Just one thing . I propose the city weighting related to rental costs in the various cities and just aimed at those sectors where staff retention is an issue . For now its graduate nurses and doctors below a certain wage .

If somebody moves to Kerry and rent is cheaper than they have to weigh that up for themselves . That is the way it is in UK for example if you move to Plymouth to work from London. And never questioned .

The conditions are what disillusions and breaks the desire to continue in the job . Better staffing and lower nurse / patient ratios are the key as well as junior doctors being able to work and learn without the pressure of working 60 to 80 hours per week much of it unsupervised.

I agree about management but many nurses have higher diplomas or masters in management and are underestimated and underutilised by those in administration. A more interdisciplinary management profile needs to be integrated in the HSE structure . It is only by listening to all voices, including patient representatives , that real effective change will happen ..and stick .

One thing that really galled me right to the end of my career was that when ICU or A&E were absolutely mental all hospital management bar some nursing admins were off on holidays for 10 days to 2 weeks. They should not be allowed to do that but should be there in the thick of it working with their staff . More so the more senior they are . It's as if they don't want to know what actually goes on at all , as long as the numbers are tidy on the page and everyone is smiling in the pictures!

And this was hidden from HIQA in UHL by hospital management .

I was thinking someone has a cardiac arrest you couldn't even get them to resuscitate them !

The purchase of painkillers....

Customer: 24 Nurofen please

Pharmacy staff: Are you addicted to painkillers?

Customer: No

Pharmacy staff: Grand, here you go.

The wait to see a GP and some people having no GP is definitely a contributing factor to where we are now. It’s about a 3-4 day wait here for our GP too, but they do their best to squeeze you in if it’s for a small baby which I appreciate. Friends of mine are being told 1-2 weeks for an appointment with their GP which is crazy.

Being seen in a timely manner in the community is vital to fix this mess long term. There needs to be enough staff for this though as just because your a GP doesn’t mean you shouldn’t have some level of work/life balance.

not block, further limit. Especially for healthcare courses…..medicine, physiotherapy, psychology ( shortage has been termed a crisis )

We need more beds more doctors…. We have the universities just not got enough graduates staying… numbers above are evidence.