What would you do to sort out the HSE?

whiskeyman · 21-12-2015 03:49PM

Superhorse wrote: »

As someone who worked in the HSE and walked away from a well paying job for life with a decent future pension I have to say it can't be fixed. I went in to the job from the private sector and literally was stunned at the waste and lack of accountability from top to bottom. I just couldn't work in that environment for any longer as it is sole destroying. Also the health service is being let run into the ground as a means of "encouraging" people to sign up for private health cover and that has been the policy of the last two governments.

That's fairly depressing reading that.

If it can't be fixed, do you think it's going to spiral further into the abyss and only come out in a new shape / form?

JupiterKid · 21-12-2015 03:51PM

I would abolish the HSE - it is a bloated bureaucracy that wastes millions of euro and delivers amazingly little. Creating the HSE was one of those populist stunts of the FF/PD coalition and the legacy is waste.

There should be more funding for front-line medical services - such as A&E and acute care in hospitals. Also invest in a second tier of general clinics - between the GP and Hospital levels - to treat people who are otherwise clogging up resources in the main hospitals.

Austria! · 21-12-2015 04:10PM

Superhorse wrote: »

As someone who worked in the HSE and walked away from a well paying job for life with a decent future pension I have to say it can't be fixed. I went in to the job from the private sector and literally was stunned at the waste and lack of accountability from top to bottom. I just couldn't work in that environment for any longer as it is sole destroying. Also the health service is being let run into the ground as a means of "encouraging" people to sign up for private health cover and that has been the policy of the last two governments.

Can you give examples so we understand what you're talking about?

21-12-2015 04:11PM

When the hospitals are taken off the HSE and hospital groups are set up and run by independent hospital boards from which the government will commission services.....you will still get people giving out because when that happens the hospitals will need private industry management which means private industry salaries, a.k.a paying the CEO 500k que outraged headlines in the papers.

Neyite · 21-12-2015 04:16PM

BattleCorp wrote: »

I think time will show us that the site for the new children's hospital will be a disaster.

It will be poxy to get to. There will be no parking if you do get there. There won't be room for expansion in the future.

It will be a disaster.

A greenfield site on the edge of Dublin city in an easily accessible area is what was needed.

Terrible decision to locate it at St. James'.

I agree. A little bit outside of Dublin on a train /luas route near a motorway would have been far better. Most people I know (from outside Dublin) who had a sick child in Crumlin could only commute by car as a realistic option for outpatient /overnight stays. A train is too expensive to take from the West all that often, and often not feasible either if the child has medical /disabled equipment, plus hospital bags, plus bottle/nappy bag, plus mum/dad bringing their own clothes & toiletries for the duration of the stay. You also want to maximise your time with your child in hospital so if you have to work in Donegal or Galway on Monday, do you really want to leave your baby early on Sunday afternoon just to catch a bus or a train home because none run as late as you'd like. I'd bring a car and travel through at night at a time that suits me.

If its long term care, accommodation outside of city centre would be cheaper, and less susceptible to price hikes during peak times. It must be a nightmare for parents to secure somewhere to stay when a big event is also on in Dublin and all the prices have been hiked.

Joe prim · 21-12-2015 04:19PM

Means Of Escape wrote: »

Put the new children's hospital to be in the midlands rather than Dublin on 30 acres where the whole country can have easier access to its kind if needed

Make every citizen contribute something to their future medical needs rather than it bring free.

No way! It should be a bit further north of the Midlands, and left a bit, and on 35 acres-do you want all our sick children to DIE??????

SAMTALK · 21-12-2015 04:25PM

Jimoslimos wrote: »

Yes, remind me where the vast majority of children live in this country?

Could you also factor in the cost, not just of the hospital, but in providing adequate infrastructure (roads, railways, accommodation etc) so people can reach some sh1thole in the middle of nowhere to get medical attention or indeed work there?

So I take it then that anywhere outside Dublin is "a ****hole in the middle of nowhere"
Would you believe we have roads now:D
And our kids dont have to walk barefoot to school any more:P

Gael23 · 21-12-2015 04:28PM

Nothing can or will change while the HSE exists. There needs to be a voluntary redundancy scheme implemented. Yes that means upfront cost but medium term gain.

21-12-2015 04:39PM

Gael23 wrote: »

Nothing can or will change while the HSE exists. There needs to be a voluntary redundancy scheme implemented. Yes that means upfront cost but medium term gain.

When that happens and you have hospitals run by independant hospital boards the former managers will be re-employed by the new hospital groups after pocketing a nice redundancy from the state, because while they might be too many of them they do have specialised health care management experience....more outraged headlines 'Former hospital managers employed by new hospital groups' it is an outrage:P

listermint · 21-12-2015 04:50PM

mariaalice wrote: »

When that happens and you have hospitals run by independant hospital boards the former managers will be re-employed by the new hospital groups after pocketing a nice redundancy from the state, because while they might be too many of them they do have specialised health care management experience....more outraged headlines 'Former hospital managers employed by new hospital groups' it is an outrage:P

Move jobs then with a small relocation fee rather than redundancy.

Open and fair plans for all stakeholders to see rather than Unions behind closed doors

i.e X is where we want to be, t v and u need to be the method to get there. Show everyone what way we want to proceed and as we are always told 'patient care is why they are there'

Deise Vu · 21-12-2015 04:59PM

Surely all we need to do is appoint Nurse Doran as the main man. Bottleneck in A&E? no problem! Just give more holidays to the staff. He can complain that under-staffing will lead to patient deaths but can order out the entire nursing staff without any danger to patients. And he loves telling us the the Health Service is under-funded while at the same time using threats to extract more cash for his members whose lives apparently become unbearable round about election time every few years.

If ever a man could square a circle surely it's Nurse Doran?

Neyite · 21-12-2015 05:01PM

Anita Blow wrote: »

The hospital has to be co-located with maternity hospitals and with the large teaching hospitals. There's no point sticking it out in the midlands when the three national maternity hospitals are all in Dublin. A very sick neonate doesn't have the couple hours it would take to transfer from the Rotunda to somewhere in the middle of the country. Also needs to be attached to university hospitals to avail of the specialised services they offer and education of medical students of the three main medical schools.

A very good point. If the Rotunda was planning on staying in the City Centre that is.

Anita Blow · 21-12-2015 05:39PM

Graces7 wrote: »

Agree totally and utterly. The GPs are not pulling their weight here. They pass far too much on to A and E too easily. Also they need a drunk tank facility to top A and E getting logjammed.

Totally untrue. We have a gradually failing primary care system because not enough new GPs are coming on stream to replace the large amounts of elderly GPs now retiring. In recent years the HSE has cut allowances for GPs in rural areas (who often have to travel large distances by car to visit patients) which is why such services are struggling in those areas.

Anita Blow · 21-12-2015 05:45PM

Neyite wrote: »

A very good point. If the Rotunda was planning on staying in the City Centre that is.

My point was that the three maternity hospitals are in Dublin, not any specific part of Dublin. A critical care neonate can be transferred from maternity hospital within/along the M50 in 20-30 mins to James' Hospital. This isn't possible if the hospital is located outside of Dublin.
It's an ideological VS a practical argument. Ideologically it would be outside of the capital as a gesture to those living in other parts of the country so it doesn't seem Dublin-centric, but the reality is that the main maternity hospitals/university hospitals/medical schools are located in the capital and a functioning National Children's Hospital requires access to all three.

Ally Dick · 21-12-2015 05:49PM

Cut the number of medical cards available. Far too many scroungers and people with nothing wrong with them clogging up the doctor's surgeries. Means test the medical card for the elderly. Many of them are loaded. They won't be going to the doctor as much if they have to pay for it. Don't give medical cards to any non nationals unless they are here for 4 years. Scrap the children's hospital plans for James's. It's absolute madness. The traffic is mental as it is. Build it in Kildare or somewhere close to Dublin but not hard to get to. Break the nurses union. Too powerful. Many older clerical HSE staff are on huge money and do nothing but doss at their desk, whereas there are many people on very very low wages. Redress the balance by giving the lower staff pay increases. Put the older staff on productivity pay. You are going to have to crush the unions while you're at it to achieve this. The HSE and Doran don't give any concessions, so any time there are cuts required, patients alway suffer

JustTheOne · 21-12-2015 07:25PM

JupiterKid wrote: »

I would abolish the HSE - it is a bloated bureaucracy that wastes millions of euro and delivers amazingly little. Creating the HSE was one of those populist stunts of the FF/PD coalition and the legacy is waste.

There should be more funding for front-line medical services - such as A&E and acute care in hospitals. Also invest in a second tier of general clinics - between the GP and Hospital levels - to treat people who are otherwise clogging up resources in the main hospitals.

I hate his notion that the hse or our hospitals deliver nothing good.

There is thousands of good success stories for every one bad story in our health service.

The work done on a daily basis is exceptional and a lot of people deserve credit.

The a and e situation is a mess that needs sorting but that is one area of 100s in our health service.

blackcard · 21-12-2015 09:23PM

JustTheOne wrote: »

I hate his notion that the hse or our hospitals deliver nothing good.

There is thousands of good success stories for every one bad story in our health service.

The work done on a daily basis is exceptional and a lot of people deserve credit.

The a and e situation is a mess that needs sorting but that is one area of 100s in our health service.

I think those who are talking about the abolition of the HSE are talking nonsense, as you say there is a lot of good work being done and it would be stupid to throw out the baby with the bath water. Anecdotal talk has it that there is a lot of administrative and managerial fat in the system. how true this is I don't know but someone within the HSE should be able to identify this and get rid of it over a number of years. I think there should be cross party agreement on a course of action as we seem to be throwing loads of money at the problem at the moment without much success

Neyite · 21-12-2015 09:43PM

Anita Blow wrote: »

My point was that the three maternity hospitals are in Dublin, not any specific part of Dublin. A critical care neonate can be transferred from maternity hospital within/along the M50 in 20-30 mins to James' Hospital. This isn't possible if the hospital is located outside of Dublin.
It's an ideological VS a practical argument. Ideologically it would be outside of the capital as a gesture to those living in other parts of the country so it doesn't seem Dublin-centric, but the reality is that the main maternity hospitals/university hospitals/medical schools are located in the capital and a functioning National Children's Hospital requires access to all three.

Galway is a teaching hospital too, quite a good one too. If I'm not mistaken, there is one in Cork too?

Why is it necessary for Dublin born critical care neonates to get transferred to the children's hospital within 20 -30 mins but those born in maternity in the likes of Galway, Leitrim, Sligo and Donegal have to manage with a much longer time frame of a transfer?

4ensic15 · 21-12-2015 09:48PM

I would get in some IT to start with. I would find out where the money is going first. After that it would be time to axe 10% of the adminstrative staff.

questionmark? · 21-12-2015 09:53PM

I know it won't fix the HSE but I think slapping on a €500 Admin charge for dealing with anyone who is there because they are too drunk would help teach some people a lesson and raise some funds and hopefully in the long term free up some space on the weekends. Set it at 3 or 4 times the drink drive limit.

Cuba has a system where a doctor calls around to people's houses every year to check up on them to try and spot potential problems that in the long run can cost a lot more.

Get rid of the waste in the Admin side, screw the unions, set down a list of productivity targets set by the private sector, perform good you keep your job, perform brilliantly you get a pay rise, keep performing poorly and you lose your job.

Baggy Trousers · 21-12-2015 09:57PM

I worked on a large project with the HSE in early 2000s. It was horrendous. The waste, the bureaucracy! Sickening.

My suggestions;

Remove 50% of middle management. Reduce salaries of rest. Let them leave if it doesn't suit, no loss most of them.

Remove 50% of admin staff.

Break the stranglehold of the unions including that idiot Doran.

Hire more front line staff. Pay them well.

Sort out the web of process.

Instill a culture of accountability.

Above all takes balls - the current government did not have them.

I remember reading about a Taoiseach or Health Minister (I think it was Taoiseach Cowen) in 2000s coming to visit A&E Galway. Before he arrived to do his walk-through, HSE management instructed porters to literally hide all the trolleys in the A&E corridors in an unused ward/room. These trolleys were moved/hidden in the ward while Cowen did his walk-thru and the A&E area looked great. As soon as Cowen left, the trolleys were returned to the corridors. I cant find a link to the story now (was Galway Independent paper). This happened. I know it happened because I double checked.

Anita Blow · 21-12-2015 11:58PM

Neyite wrote: »

Galway is a teaching hospital too, quite a good one too. If I'm not mistaken, there is one in Cork too?

Both of which have their affiliated pediatric departments in CUH/UHG adjacent to their campus. Universities share a huge amount of research/clinical work with their associated hospitals. You simply cannot remove Temple St from UCD/RCSI or Crumlin from Trinity and it not have an effect on the quality of care & research at the hospital, as well as having a detrimental effect on education.

Neyite wrote: »

Why is it necessary for Dublin born critical care neonates to get transferred to the children's hospital within 20 -30 mins but those born in maternity in the likes of Galway, Leitrim, Sligo and Donegal have to manage with a much longer time frame of a transfer?

Like I said, it's not a case of "Dublin gets everything". It's a reality that:
A) By far the greatest population density is in and around Dublin

Dublin has the most direct and fastest access routes from all parts of the country
C) The hospital has to be co-located with maternity hospitals. The 3 main maternity hospitals which cater for over half of all births in the country are located in Dublin as well as most births requiring medical/specialist intervention (IE- Those most likely to require transfer to a children's hospital for input).
D) Ideally the hospital is located with university hospitals & centres of excellence to avail of specialist input where there is no pediatric equivalent.

I'm not saying I agree with the location at St. James'. I think it was an awful location. But I do agree that in or around Dublin was the only viable option.

Letree · 22-12-2015 12:20AM

Charge everyone something for going to the doctor. Free is not a good idea. Even if its only 5 or 10 euro its something.

Fran1985 · 22-12-2015 12:32AM

Unfortunately theres nothing that can be done unless unions jump on board. Right now, and indeed all through the recent recession unions took a hard stance. No redundancys. No change to work practices. No cuts to pay. The government got very little wiggle room on this. They put ban on recruitment to reduce replacing waste staff (a lot of admin and middle management staff couldnt be got rid off while good nurses and doctors left for uk and oz) and taxed the bejaysus out of the lesser paid staff with pension levys etc. Alot of this couldve been avoided if the government was allowed reduce staff numbers (catch 22 is then youve more people on the dole). The problem is the unions wont allow too much change. That is what they are there for and are working within their remit of the their members and unfortunately they hold the power. If they dont like it, they take their members to the gate.

Also, if youve ever worked in a&e you'll notice that the staff there are incredible. Problem then is theres nowhere to admit patients once treated. Go up to a ward and theres many beds taken by people with diseases contracted through needle sharing which couldve been prevented by having proper addiction treatment early on. Also elderly patients who shouldnt be there but in a home. The whole place is a mess and i wouldnt be volunteering for the health minister gig if i was in politics.

Stheno · 22-12-2015 12:38AM

Get rid of at least 4000 of the 5000 HR staff?

Ally Dick · 22-12-2015 02:36AM

I have a friend in the HSE. He is 53 and he earns 28k gross a year. His boss takes half days off for golf during the summer. She is on 60k and gives all her work to him. She is typical of the type of worker they need to get rid of.

Greentopia · 22-12-2015 03:27AM

Put a lot more resources into free or low cost public health and sporting facilities in every town in the country accessible thereby ensuring a healthier populace.

De-centralise and localise the health care system as much as possible and model it on the Tredegar Medical Society paid for by self-taxation in every community.

donegaLroad · 22-12-2015 03:37AM

Base the Irish healthcare system on the New Zealand system. We have a similar sized population.

https://en.wikipedia.org/wiki/Health_care_in_New_Zealand

*The Guardian

'healthcare access should be universal and free from financial and other barriers, that all New Zealanders should have equal access to the same standard of treatment, and that the health system should be integrated and preventive rather than curative in focus'

gctest50 · 22-12-2015 06:03AM

questionmark? wrote: »

Cuba has a system where a doctor calls around to people's houses every year to check up on them to try and spot potential problems that in the long run can cost a lot more. .

$22 dollars/month for a nurse
$60 dollars/month for a doctor

sure you could have a pair of them live-in at that rate

The government of Raul Castro adopted a wage hike for doctors working in Cuba that increases the income of the most qualified by more than 150 percent, according to information released today in the official media.

The long awaited measure sees the most highly trained specialists receiving the equivalent of US $60 a month, up from $23.

State media published a table that lists the new monthly salaries, ranging from just over $60 to the highest to $22 for a basic nurse.

Corruptedmorals · 22-12-2015 08:12AM

Anita Blow wrote: »

My point was that the three maternity hospitals are in Dublin, not any specific part of Dublin. A critical care neonate can be transferred from maternity hospital within/along the M50 in 20-30 mins to James' Hospital. This isn't possible if the hospital is located outside of Dublin.
It's an ideological VS a practical argument. Ideologically it would be outside of the capital as a gesture to those living in other parts of the country so it doesn't seem Dublin-centric, but the reality is that the main maternity hospitals/university hospitals/medical schools are located in the capital and a functioning National Children's Hospital requires access to all three.

It's also worth mentioning that Dublin-born critical neonates are from all over the country, many mothers who have major defects/problems identified prenatally on ultrasound have their care transferred to Dublin from that point on, to facilitate transfer to a children's hospital once born and stabilised. The Dublin maternity hospitals also have a greater concentration of specialists with more experience of dealing with these pregnancies and births.

What would you do to sort out the HSE?

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