What is wrong with the health service, HSE

James Brown · 08-02-2019 4:16pm

Nesta99 wrote: »

[/B]

See what I mean people, and the vicious cycle of directing resources to all the EDs to cope with crowding rather than the possibility of expanding GP services. and by that it could be by employing practice nurses (for BP checks) or paramedics who can offer occupational therapy type services in the home as preventatives to accidents/lifestyle issues etc.

I go back to what I said earlier though to manage people who feel that they must go to an ED for what ar GP issues -

Introduce a 24hr GP service in each ED, if someone is triaged as non emergency then they are directed to the GP and even with a medical card they pay for that service maybe even on top of the ED surcharge. This would free up space significantly as people will be discouraged from basically using the ED as a GP service, thinking they will be seen quicker etc.

You couldn't. It's basically looking to expand the Emergency Department and would likely mean more randomers crowding the place. Everyone walking in is a potential emergency.
Send them home if it's not an emergency is the only way.

dartboardio · 08-02-2019 4:26pm

It’s all very contradictory, I work in the medical card unit which I’m ashamed to say is just a little call centre, it saddens me first of all when you have a family with two children on €400 a week and they cannot get a medical card. How the hell could they afford it if a child got sick? The visit alone is €50 minimum.

It’s also really unfair that take a man on a CE scheme, automatically entitled, his wife may have several medical issues and may not get a medical card because the combined income is classed as ‘too high’

I’ve seen terminally ill people wait six months for a medical card because the guys who process it are holding it up trying to ‘clarify’ why there was a €20 reduction in a social welfare payment a year ago.....

But yet if you’re on Jobseeker’s Allowance and put in your application you’ll have your card within two weeks.

The majority of people I talk to about the application for example are lovely, and don’t take anything for granted. Although more often than not we will get people shouting down the phone that they are entitled to their medical card even if they have an income of €1000 per week and minor medical issues.

I suppose the point is this country makes me sick, a tax rate of 40% with nothing to show for it, and most people stay sick rather than visiting a doctor because it’s simply too expensive.

It’s ridiculous that if you’re aged 16-25 and earning over €164 per week you will not get a medical card, €220 for a gp visit card. If that doesn’t motivate people to sit at home I dunno what does!

James Brown · 08-02-2019 6:37pm

dartboardio wrote: »

It’s all very contradictory, I work in the medical card unit which I’m ashamed to say is just a little call centre, it saddens me first of all when you have a family with two children on €400 a week and they cannot get a medical card. How the hell could they afford it if a child got sick? The visit alone is €50 minimum.

It’s also really unfair that take a man on a CE scheme, automatically entitled, his wife may have several medical issues and may not get a medical card because the combined income is classed as ‘too high’

I’ve seen terminally ill people wait six months for a medical card because the guys who process it are holding it up trying to ‘clarify’ why there was a €20 reduction in a social welfare payment a year ago.....

But yet if you’re on Jobseeker’s Allowance and put in your application you’ll have your card within two weeks.

The majority of people I talk to about the application for example are lovely, and don’t take anything for granted. Although more often than not we will get people shouting down the phone that they are entitled to their medical card even if they have an income of €1000 per week and minor medical issues.

I suppose the point is this country makes me sick, a tax rate of 40% with nothing to show for it, and most people stay sick rather than visiting a doctor because it’s simply too expensive.

It’s ridiculous that if you’re aged 16-25 and earning over €164 per week you will not get a medical card, €220 for a gp visit card. If that doesn’t motivate people to sit at home I dunno what does!

I know of similar in a housing context. A young man literally homeless, where he slept was known, getting bumped down the housing list because some wan goes in with her Ma, "She's pregnant, she needs a flat". These Independent/Sun newspaper worthy case studies cause issues for many.
I've a relative who needed a hip operation. It took so long he had to get the other done as well as he'd been compensating, overusing etc. He was actually told that.

Nesta99 · 09-02-2019 8:19pm

Martina1991 wrote: »

There already is an out of hours GP system all over the country. Westdoc, Caredoc, Shannondoc etc. People will still go to A and E if the out of hours GP is busy or too far away.

All of which generally just refer on to an ED especially in paediatrics. An in house GP is the only way to go. Martin it takes no more than an office space. These people will turn up and will have to be admitted to the ED at minimum to be discharged home. This alternative system ensures that the ED is reserved for emergencies only and non emergencies get sent home. Of course all patients in an ED are emergencies, it is why there is a triage system, indeed all people are potential emergencies only dont know it. An ED GP system works, I have seen it work, it has reduced congestion by approximately 25% where implemented in other health services. I am not stating thing based on opinion but on experience!!

L1011 · 09-02-2019 8:46pm

Staff the out of hours system with full time GPs and ensure access to at least a summary of their primary care EHR record, rather than locums or daytime GPs doing rota with no clue of patients histories. That will reduce the number of A&E referalls from those services

Martina1991 · 09-02-2019 9:01pm

Nesta99 wrote:

These people will turn up and will have to be admitted to the ED at minimum to be discharged home. This alternative system ensures that the ED is reserved for emergencies only and non emergencies get sent home. Of course all patients in an ED are emergencies, it is why there is a triage system, indeed all people are potential emergencies only dont know it.

I just can't understand why someone would drive/ get an ambulance to A&E , which may be far from where they live, just to see a GP and go home again, when they could have seen their local out of hours GP that should be in their area.

Nesta99 · 10-02-2019 12:14pm

There are a very significant amount of people who use the ED system as a GP system. They are usually self referrals and not via ambulance and the ambulance crews wouldnt take them to an ED and advise to see their GP. A GP service in the ED is to cope and discharge appropriately non emergencies rather then the current system where they are amitted to the ED until they are discharged to by the ED doctors. It isnt a 24 GP service for the purpose of providing that service but as straight forward and safe method to lesson abusers of the ED. As for underminding the mindset, I was on an ambulance crew that was called to check out and individual with chest pain - took him the 5-10 minutes to the hospital where he proceeded to get up and go, he didnt have chest pain he had an appointment in the hospital and wanted a lift. Wouldnt walk and didnt want to pay for a taxi.

Schnitzler Hiyori Geta · 11-02-2019 11:17am

dartboardio wrote: »

It’s all very contradictory, I work in the medical card unit which I’m ashamed to say is just a little call centre, it saddens me first of all when you have a family with two children on €400 a week and they cannot get a medical card. How the hell could they afford it if a child got sick? The visit alone is €50 minimum.

If you only earn €400 a week, you should not be having two children. It's irresponsible at best.

Flyingsnowball · 11-02-2019 11:19am

Schnitzler Hiyori Geta wrote: »

If you only earn €400 a week, you should not be having two children. It's irresponsible at best.

Oh my, should we neuter all factory and shop workers in the country?

Schnitzler Hiyori Geta · 11-02-2019 11:21am

Flyingsnowball wrote: »

Oh my, should we neuter all factory and shop workers in the country?

Did I say that? It's irresponsible to have a bunch of kids you can't afford.

Flyingsnowball · 11-02-2019 11:29am

Schnitzler Hiyori Geta wrote: »

Did I say that? It's irresponsible to have a bunch of kids you can't afford.

People were born to reproduce. If the state that we all sign up to take part in cannot give a working man or woman a wage that lets him or her reproduce society would fall apart fairly sharpish.

You see law and order is a luxury that can be gained with a good societal structure. It’s not a thing you are owed just because you have more money than the poor people. It’s a very delicate thing is law and order.

Schnitzler Hiyori Geta · 11-02-2019 11:33am

Flyingsnowball wrote: »

People were born to reproduce. If the state that we all sign up to take part in cannot give a working man or woman a wage that lets him or her reproduce society would fall apart fairly sharpish.

You see law and order is a luxury that can be gained with a good societal structure. It’s not a thing you are owed just because you have more money than the poor people. It’s a very delicate thing is law and order.

€400 a week is one person working minimum wage. Aside from the absolutely nonsense "people were born to reproduce" statement, if you're seriously suggesting that "society would fall apart fairly sharpish" because two people pulling in one minimum wage income between them don't have a rake of children I think you have a dim view on society.

I'm not sure at all what the "law and order" statement remotely means.

blanch152 · 11-02-2019 12:02pm

dartboardio wrote: »

It’s all very contradictory, I work in the medical card unit which I’m ashamed to say is just a little call centre, it saddens me first of all when you have a family with two children on €400 a week and they cannot get a medical card. How the hell could they afford it if a child got sick? The visit alone is €50 minimum.

It’s also really unfair that take a man on a CE scheme, automatically entitled, his wife may have several medical issues and may not get a medical card because the combined income is classed as ‘too high’

I’ve seen terminally ill people wait six months for a medical card because the guys who process it are holding it up trying to ‘clarify’ why there was a €20 reduction in a social welfare payment a year ago.....

But yet if you’re on Jobseeker’s Allowance and put in your application you’ll have your card within two weeks.

The majority of people I talk to about the application for example are lovely, and don’t take anything for granted. Although more often than not we will get people shouting down the phone that they are entitled to their medical card even if they have an income of €1000 per week and minor medical issues.

I suppose the point is this country makes me sick, a tax rate of 40% with nothing to show for it, and most people stay sick rather than visiting a doctor because it’s simply too expensive.

It’s ridiculous that if you’re aged 16-25 and earning over €164 per week you will not get a medical card, €220 for a gp visit card. If that doesn’t motivate people to sit at home I dunno what does!

50% of the population have a medical card of one kind or another.

If there are deserving cases that are losing out, and I am not doubting you on that, then it is clear that there are very many undeserving cases getting a medical card.

blanch152 · 11-02-2019 12:03pm

Flyingsnowball wrote: »

People were born to reproduce. If the state that we all sign up to take part in cannot give a working man or woman a wage that lets him or her reproduce society would fall apart fairly sharpish.

You see law and order is a luxury that can be gained with a good societal structure. It’s not a thing you are owed just because you have more money than the poor people. It’s a very delicate thing is law and order.

Why should the state give someone a wage?

Schnitzler Hiyori Geta · 11-02-2019 12:05pm

blanch152 wrote: »

Why should the state give someone a wage?

I'm not against the idea in theory, but I'd support UBI over the current dysfunctional welfare-benefit system. It's that system which is partially the answer to the OP question.

James Brown · 11-02-2019 3:04pm

Cap childrens allowance. You shouldn't be able to make a tax payer funded career out of having children. Have as many as you like, the state will only support so much. As regards health, if people are here, they need be looked after in a civil society, and yes people take advantage but many don't. The children's hospital over run is a good example of what's wrong with the HSE. Throw money, no accountability, move along. Why they're stopping at nurses is the mystery. Maybe the issue is too transparent to throw money at unlike the mystery children's hospital cabal.

Good loser · 12-02-2019 1:04am

blanch152 wrote: »

50% of the population have a medical card of one kind or another.

If there are deserving cases that are losing out, and I am not doubting you on that, then it is clear that there are very many undeserving cases getting a medical card.

Might have heard years ago (Blaney time) that 80% in Donegal had medical cards.
Can anybody confirm?

Nesta99 · 12-02-2019 5:24am

The figures always baffle me with approx 1.5million people with medical cards and 500k with GP cards. Thats a good chunk of the population that are living on a pretty meagre monthly even considering the aging population and over 70s MC entitlement. (http://www.citizensinformation.ie/en/health/medical_cards_and_gp_visit_cards/medical_card_means_test_under_70s.html)

It is very common to have patients who are outside the threshold of means testing for medical cards but have chronic conditions like asthma/diabetes etc who neglect their condidtions as a result of struggling with the cost of their monthly meds (€180 pm cap these days??). That subsequently costs the HSE significantly more for the acute care of a flae up in the condidtion than it would cost to allow the patient manage their condition. (A bugbear of mine is/was when a GP service charge for bloods to be drawn even for MC patients!! although its probably preferable than the UK system where GPs dont take bloods at all and patients have to be referred to go to the phlebotomy department of their closest hospital and queue up).
It's a bit off topic but there is massive waste in the system of repeat prescriptions being dispensed without review by a GP or pharmacist and months, maybe years of unused prescription drugs build up, going out of date in the back of someones cupboard. It's often the elderly that this happens with but its not necessarily their fault - they just get their 3 monthly prescription filled and dispensed without asking questions. The amount of times people arrive in with a relatives bag of prescription drugs that are unnecessary, from being superceded by a newer better and not necessarily more expensive drug, drugs for a past ailment that no longer requires treatment etc. It has to run to a waste of millions per annum.

L1011 · 12-02-2019 8:39am

DPS cap is 122 I think, having dropped a few times from its peak. Never reached 180

What is wrong with the health service, HSE

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