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What is wrong with the health service, HSE

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12357…12

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    #122
    Sam Russell
    Moderators, Science, Health & Environment Moderators Posts: 19,407 Mod ✭✭✭✭Sam Russell


    blanch152 wrote: »
    It makes a difference from the people attempting to blame the weather and the failures of the Irish soccer team on Leo and Eoghan (or are they the only things they haven't been blamed for?).

    Seriously, nobody is saying the HSE would be grand it it wasn't for the poor quality sick. That is either a misrepresentation of a failure to understand. If the reasonable proposals made on here for a small charge to be paid by everyone (yes, medical card holders, pensioners and even members of the travelling community), we would have a small element of demand management so that only people who are really sick would bother turning up.

    The restaurant comparison doesn't make sense by the way.

    Well, that sounds OK, but someone who delays treating a condition because of a charge, and they wait till it gets serious, or critical, will cost the HSE many time over the charges. This is particularly true of the older people - many of whom do not want to be a burden or nuisance.

    Older people do not generally have a single complaint but have many minor complaints that add up to a serious syndrome that needs treating if one of those complaints goes from minor to serious. There is a reason elderly are recommended to get the flu jab.

    A charge might deter some who should not be there but also deter many who should be there.


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    #123
    Podge_irl
    Moderators, Sports Moderators Posts: 25,490 Mod ✭✭✭✭Podge_irl


    Sam Russell wrote: »
    Older people do not generally have a single complaint but have many minor complaints that add up to a serious syndrome that needs treating if one of those complaints goes from minor to serious. There is a reason elderly are recommended to get the flu jab.

    Which they should be going to their GP for.


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    #124
    FreudianSlippers
    Registered Users Posts: 20,397 ✭✭✭✭FreudianSlippers


    A&E is not for "treating a condition" it's for accidents and emergencies; clue's in the name.


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    #125
    Tell me how
    Registered Users Posts: 21,520 ✭✭✭✭Tell me how


    FreudianSlippers wrote: »
    A&E is not for "treating a condition" it's for accidents and emergencies; clue's in the name.

    But, what do you suggest?

    Is it the service users (the public) who are the root of the problem?
    What do we do? 24Hr GP type cover before people go to A&E? Or a marketing drive to show the way incorrect attendance impacts the system?

    People will only stay away if they feel they have a suitable alternative.


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    #126
    Sam Russell
    Moderators, Science, Health & Environment Moderators Posts: 19,407 Mod ✭✭✭✭Sam Russell


    Podge_irl wrote: »
    Sam Russell wrote: »
    Well, that sounds OK, but someone who delays treating a condition because of a charge, and they wait till it gets serious, or critical, will cost the HSE many time over the charges. This is particularly true of the older people - many of whom do not want to be a burden or nuisance.

    Older people do not generally have a single complaint but have many minor complaints that add up to a serious syndrome that needs treating if one of those complaints goes from minor to serious. There is a reason elderly are recommended to get the flu jab.

    A charge might deter some who should not be there but also deter many who should be there.

    Which they should be going to their GP for.

    If they need admission to hospital for cardio-vascular treatment or broken bones, the GP cannot help them, and would direct them to A&E anyway.

    Many are taken to A&E by ambulance and require serious level of nursing. The average life expectancy for elderly women who suffer broken hips from a fall is something like six months. These elderly people are very fragile, or at least those that end up in A&E.


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    #127
    FreudianSlippers
    Registered Users Posts: 20,397 ✭✭✭✭FreudianSlippers


    Tell me how wrote: »
    But, what do you suggest?

    Is it the service users (the public) who are the root of the problem?
    What do we do? 24Hr GP type cover before people go to A&E? Or a marketing drive to show the way incorrect attendance impacts the system?

    People will only stay away if they feel they have a suitable alternative.

    Not sure tbh, but probably a bit of "all of the above" - I think the advent of the video-GP that some insurance companies have rolled out is a big advancement.

    I think it'll come as no surprise that I believe that the Government should be subsidising private insurance for everyone rather than an NHS-style system in Ireland; we simply don't have the population to actually/adequately pay for such a system.
    Sam Russell wrote: »
    If they need admission to hospital for cardio-vascular treatment or broken bones, the GP cannot help them, and would direct them to A&E anyway.

    Many are taken to A&E by ambulance and require serious level of nursing. The average life expectancy for elderly women who suffer broken hips from a fall is something like six months. These elderly people are very fragile, or at least those that end up in A&E.

    Both of those examples are actual accidents/emergencies and are both suffering from people rocking up to the A&E for other reasons.


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    #128
    AndrewJRenko
    Registered Users Posts: 28,468 ✭✭✭✭AndrewJRenko


    I wonder if we should open up all complex issues to management by the crowdsourced wisdom of boards.ie posters? If we're going to do 'design the health service' by boards.ie posters, let's go all the way - let's do 'brain surgery' by boards.ie posters. We'll stick a surgeon in theatre and have all the experts here tell them where and when and how deep to cut and poke around. I'm sure it's work out fine, because so many people have such deep expertise on the health service.


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    #129
    Tell me how
    Registered Users Posts: 21,520 ✭✭✭✭Tell me how


    AndrewJRenko wrote: »
    I wonder if we should open up all complex issues to management by the crowdsourced wisdom of boards.ie posters? If we're going to do 'design the health service' by boards.ie posters, let's go all the way - let's do 'brain surgery' by boards.ie posters. We'll stick a surgeon in theatre and have all the experts here tell them where and when and how deep to cut and poke around. I'm sure it's work out fine, because so many people have such deep expertise on the health service.

    How is it you have nearly 5,500 posts on boards and still don't understand the meaning of the word "discussion".


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    #130
    blanch152
    Registered Users Posts: 27,237 ✭✭✭✭blanch152


    Tell me how wrote: »
    But, what do you suggest?

    Is it the service users (the public) who are the root of the problem?
    What do we do? 24Hr GP type cover before people go to A&E? Or a marketing drive to show the way incorrect attendance impacts the system?

    People will only stay away if they feel they have a suitable alternative.

    A charge that applies to everyone is the solution I have proposed. And other than saying older people with conditions that aren't emergencies will stop using A&E (which is the aim after all!!), nobody has put up a coherent argument against it.

    The problem is not genuine emergencies, the problem is the drunk and those who are not emergency cases.


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    #131
    blanch152
    Registered Users Posts: 27,237 ✭✭✭✭blanch152


    AndrewJRenko wrote: »
    I wonder if we should open up all complex issues to management by the crowdsourced wisdom of boards.ie posters? If we're going to do 'design the health service' by boards.ie posters, let's go all the way - let's do 'brain surgery' by boards.ie posters. We'll stick a surgeon in theatre and have all the experts here tell them where and when and how deep to cut and poke around. I'm sure it's work out fine, because so many people have such deep expertise on the health service.

    The health service is the only large part of the public service that I haven't worked in, but I have worked in the education, civil service and local authority sectors, and I pretty much know an awful lot about how the public sector works well and how it doesn't. But you don't even need that experience to see how messed up the health service is at local level. Huge inefficiencies, mostly in front-line services, which include reception areas, A&E, consultants, specialist medical personnel, as well as nurses.


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    #132
    AndrewJRenko
    Registered Users Posts: 28,468 ✭✭✭✭AndrewJRenko


    Tell me how wrote: »
    How is it you have nearly 5,500 posts on boards and still don't understand the meaning of the word "discussion".

    Discussion is great, but let's not kid ourselves that it has any more value than us sitting round discussing brain surgery techniques.


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    #133
    Tell me how
    Registered Users Posts: 21,520 ✭✭✭✭Tell me how


    AndrewJRenko wrote: »

    Discussion is great, but let's not kid ourselves that it has any more value than us sitting round discussing brain surgery techniques.

    Nobody suggested any differently.

    Discussing the health service on Boards is about as valuable as discussing the traffic and commuting implications associated with the M50. But that didn't stop you playing an active part in that discussion.

    If you didn't want to join in here, you could have just stayed away.


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    #134
    FreudianSlippers
    Registered Users Posts: 20,397 ✭✭✭✭FreudianSlippers


    AndrewJRenko wrote: »

    Discussion is great, but let's not kid ourselves that it has any more value than us sitting round discussing brain surgery techniques.
    I'm not sure exactly what point you're trying to make? We shouldn't discuss the problems with the HSE because we're not medical doctors? Some of us work in law/politics/government/economics... I'm not sure I know how to "fix" the HSE, but I am certainly qualified to give my rational and economics-based opinion.

    Do you think a neurosurgeon knows how to fix the HSE because they know about brain surgery?


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    #135
    Sam Russell
    Moderators, Science, Health & Environment Moderators Posts: 19,407 Mod ✭✭✭✭Sam Russell


    AndrewJRenko wrote: »

    Discussion is great, but let's not kid ourselves that it has any more value than us sitting round discussing brain surgery techniques.

    Very few do brain surgery, but most interact at some level with the HSE.

    At one time, GPs would refer patients to an outpatient clinic in the local hospital for an appointment, but now they tend to refer patients to A&E. Why?

    A&E is certainly the sharp end of the criticisms of the H&E, and certainly a major centre of the problems patients see, but not necessarily the area that should get the most attention.

    We have a lot of highly paid managers in the HSE - what is it exactly that they do? Could we do with fewer and less well paid managers? Perhaps that is worthy of attention.

    Mental health, children's scoliosis treatment, waiting lists, provision of care packages, patients over-staying in acute hospital beds - these all deserve attention, along with many more.

    Why do we not insist Irish trained doctors must stay within the Irish health care system for a minimum time? Why do we train so many foreign doctors at the expense of Irish trainees?

    To fix the HSE, all the small, minor to major issues need tackling, instead all that happens in the subvention gets bigger year on year with no incremental improvements. No-one is in charge.


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    #136
    James Brown
    Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    How likely is it that after what amounts to decades of decline, the HSE has over paid managers, (surplus?) poorly scheduled front line staff? I'm not saying this is the case, just wondering, if true, how is it that nobody, HSE, Government, Administration, Unions etc. etc. made moves to fix these issues, or are they issues at all?
    It's been going on long enough now that the problems should be obvious to those with insider knowledge?
    If it's unions and staff, why do we throw money at the problem? If it's bad admin/management, why do we continue as is/throw money at the problem?
    There's no point in the same people making the same complaints and continuing as is.


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    #137
    Geuze
    Registered Users Posts: 13,105 ✭✭✭✭Geuze


    Matt Barrett wrote: »
    How likely is it that after what amounts to decades of decline, the HSE has over paid managers, (surplus?) poorly scheduled front line staff? I'm not saying this is the case, just wondering, if true, how is it that nobody, HSE, Government, Administration, Unions etc. etc. made moves to fix these issues, or are they issues at all?
    It's been going on long enough now that the problems should be obvious to those with insider knowledge?
    If it's unions and staff, why do we throw money at the problem? If it's bad admin/management, why do we continue as is/throw money at the problem?
    There's no point in the same people making the same complaints and continuing as is.


    When the eight regional health boards were merged into the HSE, a deal was done by Ahern with the unions.

    No job losses.

    There are 2,000 staff in HR, and the head of HR says he needs 800.

    There are 62 payroll offices in the HSE.


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    #138
    Sam Russell
    Moderators, Science, Health & Environment Moderators Posts: 19,407 Mod ✭✭✭✭Sam Russell


    Matt Barrett wrote: »
    How likely is it that after what amounts to decades of decline, the HSE has over paid managers, (surplus?) poorly scheduled front line staff? I'm not saying this is the case, just wondering, if true, how is it that nobody, HSE, Government, Administration, Unions etc. etc. made moves to fix these issues, or are they issues at all?
    It's been going on long enough now that the problems should be obvious to those with insider knowledge?
    If it's unions and staff, why do we throw money at the problem? If it's bad admin/management, why do we continue as is/throw money at the problem?
    There's no point in the same people making the same complaints and continuing as is.

    In any empire, there are empire builders who manage to increase their little bailiwick and increase their (perceived) importance by adding unnecessary procedures for others to comply with. The longer an empire exists, the more of this goes on. Of course, the more important these builders are, the more they demand in salary, office space, juniors, etc.

    Happens in every enterprise - public or private. It is countered by subsidiarity, as practised by the EU. Decisions are made at the lowest level that can competently make the decision. This has the effect of reducing the need for managers higher up the tree.


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    #139
    James Brown
    Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    Geuze wrote: »
    When the eight regional health boards were merged into the HSE, a deal was done by Ahern with the unions.

    No job losses.

    There are 2,000 staff in HR, and the head of HR says he needs 800.

    There are 62 payroll offices in the HSE.

    That might explain a surplus of staff, but not the running.
    Also we can revisit these deals. We had to eventually let the lamplighters go.
    Sam Russell wrote: »
    In any empire, there are empire builders who manage to increase their little bailiwick and increase their (perceived) importance by adding unnecessary procedures for others to comply with. The longer an empire exists, the more of this goes on. Of course, the more important these builders are, the more they demand in salary, office space, juniors, etc.

    Happens in every enterprise - public or private. It is countered by subsidiarity, as practised by the EU. Decisions are made at the lowest level that can competently make the decision. This has the effect of reducing the need for managers higher up the tree.

    But it's not a new phenomena surely? Do we just go on so? I don't know much about the inner workings but one would expect there are people who do and have ideas for fixes at the stage.


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    #140
    Sam Russell
    Moderators, Science, Health & Environment Moderators Posts: 19,407 Mod ✭✭✭✭Sam Russell


    Matt Barrett wrote: »
    That might explain a surplus of staff, but not the running.
    Also we can revisit these deals. We had to eventually let the lamplighters go.



    But it's not a new phenomena surely? Do we just go on so? I don't know much about the inner workings but one would expect there are people who do and have ideas for fixes at the stage.

    Only turkeys vote for Christmas.

    Most organisations go through rationalisation from time to time, usually when the money looks like running out. Jaguar Land Rover are currently looking to shed 5,000 jobs in the UK due to falling sales. The job losses are in management, marketing etc. - but not manufacturing.

    State funded organisations do not usually run out of money because they just ask for more and usually get it.


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    #141
    James Brown
    Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    Sam Russell wrote: »
    Only turkeys vote for Christmas.

    Most organisations go through rationalisation from time to time, usually when the money looks like running out. Jaguar Land Rover are currently looking to shed 5,000 jobs in the UK due to falling sales. The job losses are in management, marketing etc. - but not manufacturing.

    State funded organisations do not usually run out of money because they just ask for more and usually get it.

    Over payed, over staffed shouldn't mean poorly run. If anything it should mean surplus in staff.
    If we're expecting staff to quit or take a pay cut.....
    Pity we've no administrative/mangerial body beholden to the tax payer to address this.


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    #142
    Tell me how
    Registered Users Posts: 21,520 ✭✭✭✭Tell me how


    Matt Barrett wrote: »
    Over payed, over staffed shouldn't mean poorly run. If anything it should mean surplus in staff.
    If we're expecting staff to quit or take a pay cut.....
    Pity we've no administrative/mangerial body beholden to the tax payer to address this.

    One in 23 workers in the country work for the HSE. Taking their friends and family in to account, that's quite the reach to influence governmental opinion.

    Not to mention if they cut staff and the way that would be used with negative headlines to blame solely the government for impact on people's health.

    Absolute behemoth to try to control now.


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    #143
    James Brown
    Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    Tell me how wrote: »
    One in 23 workers in the country work for the HSE. Taking their friends and family in to account, that's quite the reach to influence governmental opinion.

    Not to mention if they cut staff and the way that would be used with negative headlines to blame solely the government for impact on people's health.

    Absolute behemoth to try to control now.

    I'd say after the next crash would be the next opportunity.


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    #144
    blanch152
    Registered Users Posts: 27,237 ✭✭✭✭blanch152


    Sam Russell wrote: »
    Very few do brain surgery, but most interact at some level with the HSE.

    At one time, GPs would refer patients to an outpatient clinic in the local hospital for an appointment, but now they tend to refer patients to A&E. Why?

    A&E is certainly the sharp end of the criticisms of the H&E, and certainly a major centre of the problems patients see, but not necessarily the area that should get the most attention.

    We have a lot of highly paid managers in the HSE - what is it exactly that they do? Could we do with fewer and less well paid managers? Perhaps that is worthy of attention.

    Mental health, children's scoliosis treatment, waiting lists, provision of care packages, patients over-staying in acute hospital beds - these all deserve attention, along with many more.

    Why do we not insist Irish trained doctors must stay within the Irish health care system for a minimum time? Why do we train so many foreign doctors at the expense of Irish trainees?

    To fix the HSE, all the small, minor to major issues need tackling, instead all that happens in the subvention gets bigger year on year with no incremental improvements. No-one is in charge.


    To be fair to the HSE, I would guess that there are more highly paid managers in the university sector than in the HSE.


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    #145
    Sam Russell
    Moderators, Science, Health & Environment Moderators Posts: 19,407 Mod ✭✭✭✭Sam Russell


    blanch152 wrote: »
    To be fair to the HSE, I would guess that there are more highly paid managers in the university sector than in the HSE.

    But the cost to the state in money, and mismanagement is much less.

    One problem in having too many managers is that they manage to do very little as they have to keep checking with each other and passing the parcel with no-one actually responsible.


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    #146
    AndrewJRenko
    Registered Users Posts: 28,468 ✭✭✭✭AndrewJRenko


    Tell me how wrote: »
    Nobody suggested any differently.

    Discussing the health service on Boards is about as valuable as discussing the traffic and commuting implications associated with the M50. But that didn't stop you playing an active part in that discussion.

    If you didn't want to join in here, you could have just stayed away.
    Yeah, I play an active part in those discussions, but I don't pontificate about the structure of the TII or NTA or that Metro North is the ultimate solution or Metro South is a top priority - because I recognize the limits of my own competency.
    FreudianSlippers wrote: »
    Do you think a neurosurgeon knows how to fix the HSE because they know about brain surgery?

    A neurosurgeon knows as much about fixing the HSE as I know about doing neurosurgery.
    Sam Russell wrote: »
    Very few do brain surgery, but most interact at some level with the HSE.

    This probably demonstrates the core of concern - the nonsensical idea that because you 'interact' with the HSE, you suddenly become an expert on the structure of the HSE and the best way to schedule A&E staff and the best way to procure medical supplies. Because it doesn't.

    I interact with my bank at some level, but I don't go spouting off about their management structure and their staffing levels. I interact with Virgin Media at some level but I don't become an expert on fibre connections and service management.

    So you interact with the HSE - that qualifies you to set out your customer experience, good or bad as that may be - no more and no less than that.
    Sam Russell wrote: »
    At one time, GPs would refer patients to an outpatient clinic in the local hospital for an appointment, but now they tend to refer patients to A&E. Why?
    Probably because they've closed the local hospital because they have a nasty habit of killing people, as they don't have enough critical mass of patients to keep up training and skill levels. I know feck all about medicine, but I do know that all the evidence shows that you can't have a hospital in every town and expect to have skilled, expert staff in them.
    Sam Russell wrote: »
    A&E is certainly the sharp end of the criticisms of the H&E, and certainly a major centre of the problems patients see, but not necessarily the area that should get the most attention.
    How did you work out that A&E 'gets the most attention'?
    Sam Russell wrote: »
    We have a lot of highly paid managers in the HSE - what is it exactly that they do? Could we do with fewer and less well paid managers? Perhaps that is worthy of attention.
    What exactly do they do? They manage an extremely complex service providing cradle-to-grave health and social care, largely on a free-at-point-of-delivery basis. Have you any sensible basis to claim that there are too many managers?
    Sam Russell wrote: »
    Mental health, children's scoliosis treatment, waiting lists, provision of care packages, patients over-staying in acute hospital beds - these all deserve attention, along with many more.
    Oh great ideas, betcha no-one in the HSE hasn't thought about any of these things? Would you ever do some actual research about what's going on in the HSE and understand what actual levels of attention these issues are getting.
    Sam Russell wrote: »
    Why do we not insist Irish trained doctors must stay within the Irish health care system for a minimum time? Why do we train so many foreign doctors at the expense of Irish trainees?
    How can we 'insist'? Do you want to put them in chains or what?
    Sam Russell wrote: »
    To fix the HSE, all the small, minor to major issues need tackling, instead all that happens in the subvention gets bigger year on year with no incremental improvements. No-one is in charge.
    No incremental improvements? Have you looked at the improvements in cancer survival rates? Or stroke rehab rates? Or reduced mortality in childbirth?
    Geuze wrote: »
    When the eight regional health boards were merged into the HSE, a deal was done by Ahern with the unions.

    No job losses.

    There are 2,000 staff in HR, and the head of HR says he needs 800.

    There are 62 payroll offices in the HSE.

    The Head of HR is a she. So where exactly did 'he' say anything about the need for HR staff?


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    #147
    Tell me how
    Registered Users Posts: 21,520 ✭✭✭✭Tell me how


    ^^^

    What are you doing here?
    You obviously don't want to discuss ways to improve the HSE.


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    #148
    AndrewJRenko
    Registered Users Posts: 28,468 ✭✭✭✭AndrewJRenko


    Tell me how wrote: »
    ^^^

    What are you doing here?
    You obviously don't want to discuss ways to improve the HSE.

    Here's one way to improve it - let's leave the improving to people who know what they are talking about.

    If I walk into your job and after 20 minutes, I start telling you all the things you're doing wrong, will you be taking my instructions?


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    #149
    Tell me how
    Registered Users Posts: 21,520 ✭✭✭✭Tell me how


    ^^^^[

    You are aware this is the political forum of a discussion board?
    What do you think should be discussed here?

    Who do you think should post here?
    Politicians and public sector management staff?

    Maybe the HSE shouldn't be discussed by journalists or broadcasters either.

    You don't want to contribute? Fine. Don't.


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    #150
    Geuze
    Registered Users Posts: 13,105 ✭✭✭✭Geuze


    AndrewJRenko wrote: »

    The Head of HR is a she. So where exactly did 'he' say anything about the need for HR staff?

    It was a few years ago.

    https://www.independent.ie/irish-news/hse-hires-outside-help-despite-having-full-staff-26699221.html


    2010:

    Just last week, HSE head of human resources Sean McGrath said it was widely accepted that too many staff were employed in certain areas within the HSE.

    ''There are about 2,000 people working in the HR function. I could probably get away with having 700 or 800 in that department," he said then.


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    #151
    VinLieger
    Registered Users Posts: 17,666 ✭✭✭✭VinLieger


    AndrewJRenko wrote: »
    Here's one way to improve it - let's leave the improving to people who know what they are talking about.


    Thats worked so well up until now hasnt it?


    Are you suggesting because we arent all experts in how to run the HSE we shouldnt have an opinion on it or be able to voice that opinion on a discussion forum?


    Might as well shut down boards and basically the rest of the internet in that case


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