A new survey has placed Ireland 25th out of 26 European countries examined for the qu

ArthurDent · 26-06-2006 08:25PM #1

Linky from RTE news
http://www.rte.ie/news/2006/0626/health1.html

25th out of 26th for quality of health service - holy cr@p and all Mary Hearny can say is well some of the stats used are out of date:eek: - oh that's all right then that'll move us from 25 to what 24th or 23rd in the list.

Any particular reason no-one is screaming for her resignation?

Heinrich · 26-06-2006 08:30PM

ArthurDent wrote:

Linky from RTE news
http://www.rte.ie/news/2006/0626/health1.html

25th out of 26th for quality of health service - holy cr@p and all Mary Hearny can say is well some of the stats used are out of date:eek: - oh that's all right then that'll move us from 25 to what 24th or 23rd in the list.

Any particular reason no-one is screaming for her resignation?

Because any criticism of our inept government falls on deaf ears.

Agent Smith · 26-06-2006 08:32PM

so....

who we beat?

Sleipnir · 26-06-2006 08:43PM

Basically, every person on this island knows that we have the health service of a 2nd world country. Even though we all know this, the politicians can't admit it to us. "Waiting times are down at an all time low" even though you still may have to lie in a trolley for 24 hrs. How does that work? Simply, there's only so much PR can do but they can't just give up on that!

I cracked my thumb a few months ago and I mean I'm pretty certain that there was a break in the bone (a lump formed on the bone soon thereafter) In any other country in Europe you would go to a hospital, be seen quickly in a clean, safe environment. Then you would go home and would have follow-up care when it was required. If surgery was required? "No problem, we'll do it while you're here."
However, I had to weigh up the cons of being stuck in an uncomfortable chair in a dirty waiting room for 24 hrs wondering was the drunk/junkie going to lose it. Or longer as I would have needed an x-ray.

I chose to put up with my broken thumb as it certainly wouldn't be any more painful then our health system could be.
That's what we are reduced to doing.

constitutionus · 26-06-2006 08:47PM

agent smith wrote:

so....

who we beat?

lithuania, which means all the other new accession countries beat us :rolleyes: some feat for the richest country in europe

"medical outcomes are bleak", what the hell does that mean! sounds like even if you do get treated your buggered anyway, methinks im off to france if i break anything

sceptre · 26-06-2006 09:41PM

Sleipnir wrote:

"Waiting times are down at an all time low" even though you still may have to lie in a trolley for 24 hrs. How does that work?

You change the categorisation of being on a trolley and don't tell people.

It's easy. Here's a possible incomplete plan for having a better health service:

Cut waiting lists? Easy. Just delay the process by which doctors refer patients for treatment so people aren't put on the waiting list[1].
Redesignate trolleys as mobile beds. You're lucky to have them.
Erect temporary prefabricated buildings where initial consultations can be made. Remember to issue press release counting the amount of additional square footage added to hospitals in the past year. Include tent space in the figure.
Waiting lists will effectively control themselves if they're made long enough, make them precisely the right length for people with life-threatening conditions and the number of new entrants on the list will be the same as the number of deaths, hence problem solved.
Regularly publish details of the extra money being spent without divulging how much of that money is split into facilities, actual health care workers and administration. Make figures available as an answer to any question akin to "just what's being done?" Never split current and capital expenditure. Remember that leasing under 12 months can legitimately be inserted into current expenditure without bothering to find a crooked accountant.
When stuck for a "complete reforming reorganisation", split any large units into smaller units and combine any smaller units into a larger one. Any such organisation will take so long that you may well be out of government by the time the process you announced in your manifesto is finished. Plays well with the plebs and is a favourite technique for "getting red of red tape and bureaucracy" even if you're not stuck in the Dept of Health. Ignore any commentators who point out that it works less well than the old structure and actually costs more, they're damned dirty traitors.
Press releases, press releases, press releases. Very important - people should know something's being done.

Yeah, I know I'm being cynical but there's a reasonable to possibly more than reasonable element of truth to quite a bit of the above list even though I didn't initially type it with any reference to the current administration.

[1]Oddly enough, this one is effectively being done. Certain non-surgical services which require a referral letter now require a referral letter to be sent by the referring consultant to the relevant central command for the service which must then be forwarded on to the relevant consultant. Where this gets especially silly is where you've a doctor downstairs in hospital X posting a letter to hospital Y so a letter can be sent to doctor Z who works upstairs in hospital X. I've had conversations with a number of hospital consultants who have, without prompting, pointed out how silly this process can be.

ArthurDent · 26-06-2006 09:45PM

Does anyone know where a link can be found to actual survey? I'd love to know what all the catgories we were scored on are, particularly in the light of a worse than average infant mortality rate quoted

Never mind - just found it -

http://www.healthpowerhouse.com/media/EHCI2006.pdf

ronbyrne2005 · 26-06-2006 10:25PM

This is just the public health service i assume? If the private sector is included i wouldnt think its that bad but at the end of the day we are spending more per capita than most of the top countries yet the service is still crap and it has to be down to the lack of reform and civil service attitudes of many in the public health system.

lostexpectation · 27-06-2006 07:42AM

ronbyrne2005 wrote:

This is just the public health service i assume? If the private sector is included i wouldnt think its that bad but at the end of the day we are spending more per capita than most of the top countries yet the service is still crap and it has to be down to the lack of reform and civil service attitudes of many in the public health system.

wasn't there report the other day saying the complete opposite that we're not spending that much at all!

Gurgle · 27-06-2006 07:47AM

ArthurDent wrote:

Any particular reason no-one is screaming for her resignation?

Because shes only been in the job a few months and modernising / streamlining our health service (with embedded unions) is going to be like changing the orbit of the moon.

tbh, the only way it can be done fast is with a battle-axe and introducing capital punishment for union bosses.

mountainyman · 27-06-2006 08:15AM

Mary Harney sought and was accepted for the job of Minister for Health and Children in September 2004.

21-22 Months; quite a broad definition of a few.

MM

utopian · 27-06-2006 08:30AM

Gurgle wrote:

Because shes only been in the job a few months and modernising / streamlining our health service (with embedded unions) is going to be like changing the orbit of the moon.

tbh, the only way it can be done fast is with a battle-axe and introducing capital punishment for union bosses.

That's right - it's the fault of the unions. That's why France came first.

Do "union bosses" include Finbarr Fitzpatrick?

bonkey · 27-06-2006 09:19AM

Sleipnir wrote:

In any other country in Europe you would go to a hospital, be seen quickly in a clean, safe environment. Then you would go home and would have follow-up care when it was required.

Not entirely true.

Here, I could just as easily go to my GP

Many of them here have their own X-Ray capability.

If surgery was needed, then sure...a trip to the hospital would be needed. Most likely, they'd ask me when I'd like to schedule the surgery for.

And Switzerland only came 5th!

The following should be noted however:

www.rte.ie wrote:

The report found that France has the most consumer-friendly healthcare system around Europe, followed closely by the Netherlands, Germany, Sweden, Switzerland and Luxembourg.

The report isn't necessarily stating what is the best health-care, but rather the most consumer-friendly.

My guess is because "best" is somewhat vague.

I'd also be interested in seeing trends rather than annual positions...even if those trends were nothing more than last year's rankings and totals.

I'm personally of the opinion that Swiss health-care standards are slowly, slowly sliding downwards, while in Ireland they're slowly, slowly improving. Whats interesting is that the Swiss seem even more concerned with fixing their slide than the Irish are in playing "catch-up".

jc

Zombrex · 27-06-2006 09:49AM

bonkey wrote:

The report isn't necessarily stating what is the best health-care, but rather the most consumer-friendly.

Yeah thats important to remember, it is value for money. As in how much money we spend on healthcare compared to what we actually get out of it. So basically we are spending a lot on health care and getting very poor performance out of all this money. Time for heads to roll I think.

bonkey · 27-06-2006 10:11AM

Wicknight wrote:

Yeah thats important to remember, it is value for money.

Is it? Consumer-friendly means just that - its something the consumer finds easy to deal with, and which provides what they're looking for.

Whether or not what they are looking for is necessary, actually contributes to better health, or is a cost-effective way of achieving the same net health-centric result.....that doesn't seem to be looked at at all.

As a f'r instance...lets go back to my comment about many GPs over here having their own X-Ray machines. Thats certainly consumer-friendly, but is it cost-effective? Perhaps so, but I doubt it.

As in how much money we spend on healthcare compared to what we actually get out of it.

This, at the end of the day, is the fundamental problem with the Irish system. Regardless of how friendly the service is to the consumer, what the service is costing is totally unjustifiable.

Time for heads to roll I think.

Its long overdue. Thats another problem. Like Dublin traffic for so many years, its a problem no-one wants to really tackle, because its politically a lose-lose proposition.

jc

Zombrex · 27-06-2006 10:47AM

bonkey wrote:

Is it? Consumer-friendly means just that - its something the consumer finds easy to deal with, and which provides what they're looking for.

Well thats where the "value" bit comes in. Value for money doesn't necessarily mean "cheap"

Anyway, I think we both agree, that was just my reading of the report from the news. What ever way it is read it is still pretty damning for Ireland and the government.

PHB · 27-06-2006 10:50AM

Harney took on the job because she knew if she actually fixed the thing, it would give the PD's a huge huge huge huge election push. She is however failing, and it's really backfiring on her and the PD's, as FF will get less tared with it, just a little bit.
It's probably why she is facing a leadership challenge kinda.

clg · 27-06-2006 11:19AM

I think one of the biggest issues with the health service is at the weekends....

I was listening to the radio there a while ago and they were going on about some report that mary harney had got some consultants to do. It turns out that there was a list of actions/recommendations on the report... However, it also came to pass that none of the report applied to the weekends.. all the statistics and all that were taken from during the week...

Now - i had someone close to me who spent time in a certain hospital in dublin for about a month there recently. During their stay a bank holiday happened to fall. Now, i would seriously have imagined if anything they would need more staff for a bank holiday weekend, but it looked like they didnt admit any patients to a certain ward, and ended up closing the ward for the bank holiday weekend, presumably so a load of doctors can take the bank holiday weekend off. Now i know - fair enough - people are entitled to weekends off, but according to the report i was listening about on the radio, this never came up.... This type of thing could certainly be a high contributor to people getting stuck on trolleys etc, for a time before, during, and after that weekend, and having no beds in the hospital. The thing about this is - how is the government, or Mary Harney, actually able to resolve situations like this, if the reports that they are getting dont have this type of stuff in it.

I have also heard that consultants only work office hours, ie 9 to 5, and only during the week, not at the weekends (maybe theres a skeleton consultant staff, or oncall or something) but as far as i can see, hospitals are waaay busier at the weekends than during the week.

So i have to wonder, why havent the government tried to sort out this consultants only working during the week thing, and if they have, why havent we heard about it....

J.R.HARTLEY · 27-06-2006 11:26AM

clg wrote:

.

I have also heard that consultants only work office hours, ie 9 to 5, and only during the week, not at the weekends (maybe theres a skeleton consultant staff, or oncall or something) but as far as i can see, hospitals are waaay busier at the weekends than during the week.

well you heard wrong, i've been attending 2 oncologist colsultants over the last 2 years and they are in at 7am in the morning s and have often come around to my room at 7 and 8 pm to say goodnight.

clg · 27-06-2006 11:35AM

J.R.HARTLEY wrote:

well you heard wrong, i've been attending 2 oncologist colsultants over the last 2 years and they are in at 7am in the morning s and have often come around to my room at 7 and 8 pm to say goodnight.

Fair enough. Just saying what i heard. Maybe it was just the contract arrangements that i heard (only have to work office hours, 9-5) and that the consultants are putting in overtime etc. I am not questioning the commitment of consultants or doctors, who i know are busy people, i still have to question the situation of the bank holiday weekend. And of that i do have first hand experience. There were no consultants available to talk to or to look at the person i knew in hospital for this weekend, and there most certainly was a ward closed just for this weekend.

Heinrich · 27-06-2006 12:27PM

bonkey wrote:

Not entirely true.

Here, I could just as easily go to my GP
Many of them here have their own X-Ray capability.

If surgery was needed, then sure...a trip to the hospital would be needed. Most likely, they'd ask me when I'd like to schedule the surgery for.

And Switzerland only came 5th!

I don't know what the situation is on the other side of the roesti graben but in Geneva there are medical centers, called Permanances, which are open 24/7. The are well equipped with x-ray facilities, blood testing labs and facilities for broken limbs etc. If there is an emergency which they can't handle it's off to l'Hopital Cantonal direct.

Just this morning I went for a blood test to a clinic in Beaumont and should receive the results in a week to 10 days. A blood test ordered by the doctor in the Permanance in Geneva is carried out on the spot and the doctor has the results the following day!

I think there must be a war on hypochondria in Ireland and the population is discouraged from becoming ill.

constitutionus · 27-06-2006 12:42PM

Wicknight wrote:

Yeah thats important to remember, it is value for money. As in how much money we spend on healthcare compared to what we actually get out of it. So basically we are spending a lot on health care and getting very poor performance out of all this money. Time for heads to roll I think.

unfortunetly harney signed a contract to ensure this'll never happens. meaning despite the abolishment of the 11 health boards to institute the HSE we still have all 11 health boards members on full pay doing bugger all. the eleven heads of the old boards alone account for over a million euro a year , and thats not including benchmarking and pensions that they'll get going into the future. if this was the private sector they'd be out on their asses but not in the good ol boy network of the public sector. think about this next time someone mentions the need for water rates cause we've no money . worse theyre doing the whole thing over again with decentralisation! this government is a joke :rolleyes:

esperanza · 27-06-2006 01:18PM

Wicknight wrote:

Yeah thats important to remember, it is value for money. As in how much money we spend on healthcare compared to what we actually get out of it. So basically we are spending a lot on health care and getting very poor performance out of all this money. Time for heads to roll I think.

1) Although, money is generally spent very badly in Ireland on healthcare (I think we all agree on that one), we also make very low social security contibutions compared to some more "Socialist" (Bismarck) heathcare systems namely France, Germany, Switzerland. In France for example, 21% of your salary goes towards social security, a significant proportion which includes healthcare; in Germany it is the same. (I've worked in both countries, and must say that the service is second to none, so there is real value for money).

2) If Irish people want more from the system, they will also have to pay higher social security contributions (first politicians need to smarten up their act in current efficient spending though).
So, do you think the Irish would pay more to the State (the people elect the politicians, after all and they should be obliged to deliver on their promises, right?).

We have traditionnally followed the Beveridge model and I don't think you can change to a Bismarck model of healthcare overnight, although perhaps a combination of both, as is used in Sweden and other Nordic countries may prove a good middleground.

Interesting PP presentation on topic here:

www.hiva.be/docs/en/45/157/

3) In Ireland, we sorely lack certain healthcare professionals, such as cardiologists, which only serves to aggravate the problems of waiting lists. This problem is not an easy one to solve.

I did forget to add that the generous state healthcare systems are becoming less and less economically sustainable. Recent examples of necessary reforms to alleviate healthcare debt in France (GP referral to most specialists), Germany (one-off 15 euro charge per trimester for doctor's visit). Perhaps others can provide further examples.

Glenbhoy · 27-06-2006 02:14PM

You are correct re our taxation rates Esperanza, but am I wrong in thinking that Swiss rates of direct taxation are also quite low.
Re the health system itself the problems are multiple. The biggest problems are:
Not enough doctors - perhaps if we had places for more than 300 students a yearr, that would help.
Too many admin staff eating up too many resources (this is anecdotal from my time in the health service).
Unions - no explanation necessary.
Wages for admin staff and most medical staff are far too high, this problem manifests itself in many ways - it's not just the ongoing wage/pension cost, it also stops new capital investment, because, in order to invest in a new hospital ward/beds etc, you have to ensure that money will be available to staff that investment, it's a similar situation with new equipment, authorisation will only received from the department when it can be proven that staffing will be available (from the budget already allocated).
Short termism - this problem manifests itself in every organisation, particularly in the public sector - basically give someone a budget and they will spend it, the rationale being that if they don't, they'll have less next year. I have witnessed some ridculous wastage due to this.
There are many other problems, and my own solution would be to start the whole system from scratch, because, such is the nature within the HS, that change is nigh impossible. (so speaks a frustrated contractor in the HS in a previous life).

Carb · 27-06-2006 03:07PM

esperanza wrote:

1) Although, money is generally spent very badly in Ireland on healthcare (I think we all agree on that one), we also make very low social security contibutions compared to some more "Socialist" (Bismarck) heathcare systems namely France, Germany, Switzerland. In France for example, 21% of your salary goes towards social security, a significant proportion which includes healthcare; in Germany it is the same. (I've worked in both countries, and must say that the service is second to none, so there is real value for money).

2) If Irish people want more from the system, they will also have to pay higher social security contributions (first politicians need to smarten up their act in current efficient spending though).
So, do you think the Irish would pay more to the State (the people elect the politicians, after all and they should be obliged to deliver on their promises, right?).

I originally posted this in a reply to the election thread, but its probably more relevant here:

Well apart form the 4% employees PRSI, the 2% health levy, the employers PRSI in the region of 10-12%, roughly 50% of the population feel obliged to have health insurance. And yet you will still have further medical expenses after that.

People talk about the 10/11 billion per year that goes into health. I'd love to know how much they take in for charging people in hospitals or for other services, or for renting out beds to private patients.

esperanza · 27-06-2006 04:15PM

Glenbhoy wrote:

You are correct re our taxation rates Esperanza, but am I wrong in thinking that Swiss rates of direct taxation are also quite low.
Re the health system itself the problems are multiple. The biggest problems are:
Not enough doctors - perhaps if we had places for more than 300 students a year, that would help.

Certainly, but they also need lecturers or trainee doctors to train them. We are a small country with near to full employment, so it could be difficult to find the staff.

Found interesting wikipedia article here:
http://en.wikipedia.org/wiki/Publicly-funded_health_care

ronbyrne2005 · 27-06-2006 05:26PM

esperanza wrote:

Certainly, but they also need lecturers or trainee doctors to train them. We are a small country with near to full employment, so it could be difficult to find the staff.

Found interesting wikipedia article here:
http://en.wikipedia.org/wiki/Publicly-funded_health_care

Just stop training the hundreds of foreign students and pay the colleges to train irish students to service the irish health system.approximately half of the doctors trained in ireland arent irish and most will /do eventually move back to their country/another country, there is capacity to train more irish doctor if the governement will spend the cash.plus im sure theres room in many medical colleges for extra students,whats the difference between lecturing 50 and a 100 unless its labs/practicals,if necessary we can import short term medical lecturers etc but the current cap on irish students in medical schools is a joke.

esperanza · 27-06-2006 05:33PM

Ireland has also fared badly in another recent international report!!

http://www.sbpost.ie/post/pages/p/story.aspx-qqqt=NEWS-qqqs=news-qqqid=15280-qqqx=1.asp

esperanza · 27-06-2006 05:38PM

ronbyrne2005 wrote:

Just stop training the hundreds of foreign students and pay the colleges to train irish students to service the irish health system.approximately half of the doctors trained in ireland arent irish and most will /do eventually move back to their country/another country, there is capacity to train more irish doctor if the governement will spend the cash.plus im sure theres room in many medical colleges for extra students,whats the difference between lecturing 50 and a 100 unless its labs/practicals,if necessary we can import short term medical lecturers etc but the current cap on irish students in medical schools is a joke.

Well, foreign students are entitled to move back to their home country or anywhere else to practice if they wish, you cannot really prevent that.

The government cannot come up with cash just like that, we have to make our contribution, and with one of the lowest taxation rates in Europe, you get what you pay for, don't you?

(Of course, there's much wastage too, but there should be more accountability, as is the case in Nordic countries, I thought our gvt have a stance on this, no?)

Glenbhoy · 27-06-2006 07:35PM

esperanza wrote:

(Of course, there's much wastage too, but there should be more accountability, as is the case in Nordic countries, I thought our gvt have a stance on this, no?)

This government don't have a stance on anything unless the Indo has it plastered all over the front page first!!
Re the doctors training situation, afaik, we train approx 700 p.a, 300 irish and the remainder are students from overseas, who pay large fees which subsidise the rest of them. Say the fees (for non-EU students) are somewhere around 20K p.a (don't know why i think this), so say that's approx 6m p.a, in the grand scheme of things that's not a lot of revenue to forgo in order to double the output of doctors (the majority of whom, we would hope would remain here).

esperanza · 27-06-2006 07:57PM

Glenbhoy wrote:

This government don't have a stance on anything unless the Indo has it plastered all over the front page first!!
Re the doctors training situation, afaik, we train approx 700 p.a, 300 irish and the remainder are students from overseas, who pay large fees which subsidise the rest of them. Say the fees (for non-EU students) are somewhere around 20K p.a (don't know why i think this), so say that's approx 6m p.a, in the grand scheme of things that's not a lot of revenue to forgo in order to double the output of doctors (the majority of whom, we would hope would remain here).

Well, why not introduce a limit on the number of foreign students allowed access to these medical courses?

I can see what's behind it though, why get more Irish students (many of whom will probably get grants) on courses, when you can get foreign students to fork out ridiculous sums (which benefits the govt.)?

It's all about greed, isn't it? Changing mentalities is the hardest of all, you can change the system alright but that is not enough.

What about voting in the Greens? They seem the fairest of the lot with regard to health issues.

A new survey has placed Ireland 25th out of 26 European countries examined for the qu

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