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Why cant all hospitals be run like this

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    #32
    griffin100
    Registered Users Posts: 4,772 ✭✭✭griffin100


    The trade unions and their resistance to change is a real problem. Nurses work a a 3 x12hr day week, and then post pictures online of how tired they are after their long shifts and how hard they work. Yet try and move them to a standard working week and watch the pushback. It’s a lot easier to get agency work when you have four days a week off rather than the usual two most people have.
    But it’s not a simple as blaming the unions. My son was unwell over the summer and we ended up in a public hospital for a few days. When we went to A&E he was seen by a triage nurse within a few minutes and then by a number of ever increasingly senior doctors (he had an illness they couldn’t quite pin down so the doctors had to keep deferring upwards). He had an x ray and blood tests and was given a bed, all within a couple of hours. The care he got was excellent.

    I got chatting to a senior nurse and she told me Covid was great for A&E, all the usual suspects that used A&E for GP care weren’t clogging up the system as much as usual so the system was working well.

    Event though there were fewer wasters than usual in A&E there was still a few of the usual suspects who were sitting there in the waiting area with their luggage, all on a first name basis with each other and the staff, all arguing about how they should be admitted. The more noise they made the quicker they were seen and dealt with.

    TLDR: it’s complicated!!


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    #33
    Girl from Whitesnake Video
    Closed Accounts Posts: 20 ✭Girl from Whitesnake Video


    Don't believe in private healthcare. Healthcare should not be based on profit. Apparently the Cuban healthcare system is one of the best in the world!!

    Anyway in our situation now, the government should be seriously considering and if not, they should already be in the process of building temporary separate hospitals specifically for covid patients.


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    #34
    tonysopprano
    Registered Users Posts: 756 ✭✭✭tonysopprano


    Girl from Whitesnake Video wrote: »
    Don't believe in private healthcare. Healthcare should not be based on profit. Apparently the Cuban healthcare system is one of the best in the world!!

    On a not so recent holiday there and as required by local custom picked up hitchhiker, who was on her way to hospital. She had sheets, pillowcase and pillow with her as they have to bring their own.

    Healthcare is supposed to be excellent but infrastructure is lacking

    If you can do the job, do it. If you can't do the job, just teach it. If you really suck at it, just become a union executive or politician.



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    #35
    Girl from Whitesnake Video
    Closed Accounts Posts: 20 ✭Girl from Whitesnake Video


    tonysopprano wrote: »
    On a not so recent holiday there and as required by local custom picked up hitchhiker, who was on her way to hospital. She had sheets, pillowcase and pillow with her as they have to bring their own.

    Healthcare is supposed to be excellent but infrastructure is lacking

    Perhaps to do with it being a poor country and all and whose responsible for that? Yet still healthcare is 'suppose to be excellent' and whose responsible for that?


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    #36
    suicide_circus
    Registered Users Posts: 19,802 ✭✭✭✭suicide_circus


    The Irish health service is amazing....unless you've used the health services in literally any other EU country.


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    #37
    thomasm
    Registered Users Posts: 1,501 ✭✭✭thomasm


    Had a fall on holidays in Italy a few years ago. Ended up blacking out a few hours later. Was taken to hospital as a precaution and within minutes was seen by A & E consultant, had x ray and MRI as I banged my head and back and then was seen by a neurologist. All in a small hospital for a cost of €65 and this took 2.5 hours max. Also had a nurse beside me the whole time. Remarkable service.


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    #38
    Wanderer78
    Registered Users Posts: 28,814 ✭✭✭✭Wanderer78


    tails_naf wrote:
    I'm at the beacon hospital for a health check and they had me do an unscheduled chest xray. I went down to the radiology department, and was registered and had the xray completed in less than 10 minutes. The radiographers themselves took about 2 minutes end to end. Results automatically sent back to the health check. This is how you save money, that one xray room can see hundreds of people a day if needs be. No way, no messing. Why can't this be the way all hospitals work?


    Small private hospital, far simpler than far more complex, much larger public/private hospitals, incomparable really


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    #39
    whisky_galore
    Registered Users Posts: 15,790 ✭✭✭✭whisky_galore


    feelings wrote: »
    The public hospitals are outrageously inefficient and it will stay that way for the foreseeable future, unless we tackle two major issues.
    a) consultants run our public hospitals and dictate policies b) hospital staff are resistant to change, even small changes to work practices are blocked

    Most of the old hospitals are designed so that in the past, the only way out was via the mortuary.


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    #40
    Wanderer78
    Registered Users Posts: 28,814 ✭✭✭✭Wanderer78


    feelings wrote: »
    The public hospitals are outrageously inefficient and it will stay that way for the foreseeable future, unless we tackle two major issues.
    a) consultants run our public hospitals and dictate policies b) hospital staff are resistant to change, even small changes to work practices are blocked

    or maybe the 'inefficiencies' of the private sector are creating complex issues within our public/private hospitals!


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    #41
    OfflerCrocGod
    Registered Users Posts: 6,303 ✭✭✭OfflerCrocGod


    thomasm wrote: »
    Had a fall on holidays in Italy a few years ago. Ended up blacking out a few hours later. Was taken to hospital as a precaution and within minutes was seen by A & E consultant, had x ray and MRI as I banged my head and back and then was seen by a neurologist. All in a small hospital for a cost of €65 and this took 2.5 hours max. Also had a nurse beside me the whole time. Remarkable service.
    In the north I presume?


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    #42
    riclad
    Registered Users Posts: 8,184 ✭✭✭riclad


    all non urgent operations have been canceled to deal with covid,
    i think ,most people are simply staying away from public hospitals if they have a choice.
    So of course they are less crowded a than usual.


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    #43
    BrianD3
    Registered Users Posts: 8,289 ✭✭✭BrianD3


    As already stated the private hospitals get to pick and choose what work they carry out, no dealing with drunks at 3 am on a Saturday night etc.

    The HSE does some things well - if you live in an urban area and have a condition which is obviously and immediately life threatening, the ambulance service is good and you will likely get good care in whatever public hospital you are brought to.

    If it is not immediately life threatening or not thought to be so, then a very poor service is likely. On the latter point, two of my close relatives died in public hospitals in recent years, one due to complications from an incarcerated hernia, the other due to complications from an ulcer. I strongly suspect (but can't prove) that overcrowding and shambolic conditions in the acute hospitals they were admitted to contributed to these "complications" and the "poor outcomes".

    In general there are massive problems with the provision of health services in Ireland - the HSE is obviously a major part of the mess but the clusterf*ck encompasses homecare, GPs, insurers, private nursing homes, private hospitals. The trolley crisis that happens in public acute hospitals on a regular basis doesn't occur in isolation.

    Successive governments and the Dept of Health are ultimately responsible for this situation.

    A topical issue is nursing homes and Covid-19. IMO Covid-19 just highlighted fundamental and systemic problems that were present for years. Questions that need to be answered include

    Why is the State so dependent on private nursing homes?

    Is HIQA fit for purpose?

    When the Fair Deal scheme was introduced, was it to benefit citizens or part of a privatisation agenda?

    Have politicians, public hospital consultants etc. financial interests/investments in private hospltals and nursing homes?

    Why do public nursing homes, in general, charge considerably more per week than private?


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    #44
    tails_naf
    Registered Users Posts: 861 ✭✭✭tails_naf


    Wanderer78 wrote: »
    Small private hospital, far simpler than far more complex, much larger public/private hospitals, incomparable really

    Well run is well run, smaller size is hardly a factor. Mallow hospital is small and its a shambles. Went there years ago for a kidney scan and it took 2 full days to actually get the scan done. One to see the consultant for 5 mins who just said (after waiting 4 hours) why are you here, OK gp sent you, well send the appointment for the scan (that cost me one days work and 170 euro) and then back another day waiting a few hours for the scan. Small does not mean efficient. Large does not mean inefficient.

    I personally don't like the idea of private health care, but I would like to see the same efficiency that I saw in the beacon repeated in the private hospitals, if even for some reason that meant we had more smaller hospitals, though I don't think thats the issue.


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    #45
    Wanderer78
    Registered Users Posts: 28,814 ✭✭✭✭Wanderer78


    tails_naf wrote:
    I personally don't like the idea of private health care, but I would like to see the same efficiency that I saw in the beacon repeated in the private hospitals, if even for some reason that meant we had more smaller hospitals, though I don't think thats the issue.


    Larger complex organisations tend to be more complex than small complex organisations, increasing the likelihood of inefficiencies and general waste, health care is fecken complex, I'm sure there's problems within all health care systems worldwide, it's messy, I'm sure we ll still be talking about it until the last person turns out the lights


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    #46
    Dav010
    Registered Users Posts: 14,048 ✭✭✭✭Dav010


    You probably paid a lot in private health insurance over the years for that nice efficient experience, that is what private healthcare is all about, jumping the que. The consultants you saw also work in public hospitals so the treatment in theory should be the same, just quicker and in a plusher environment.


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    #47
    tails_naf
    Registered Users Posts: 861 ✭✭✭tails_naf


    Dav010 wrote: »
    You probably paid a lot in private health insurance over the years for that nice efficient experience, that is what private healthcare is all about, jumping the que. The consultants you saw also work in public hospitals so the treatment in theory should be the same, just quicker and in a plusher environment.

    The government spends over 4k per person on the public health system. My private health premium costs well less than a grand. So why does 4k get us feck all, yet only an additional quarter of that amount totally change things? I bet if the govt spent 5k per person nothing would change for the public system, so the issue is not money, its how things are run.


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    #48
    Dav010
    Registered Users Posts: 14,048 ✭✭✭✭Dav010


    tails_naf wrote: »
    The government spends over 4k per person on the public health system. My private health premium costs well less than a grand. So why does 4k get us feck all, yet only an additional quarter of that amount totally change things? I bet if the govt spent 5k per person nothing would change for the public system, so the issue is not money, its how things are run.

    Probably because a lot more people use it more often. If the Beacon converted to a public hospital tomorrow offering all the services including A&E and public outpatient services, all under the same Beacon management, your experience would be very different.


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    #49
    tails_naf
    Registered Users Posts: 861 ✭✭✭tails_naf


    Dav010 wrote: »
    Probably because a lot more people use it more often. If the Beacon converted to a public hospital tomorrow offering all the services including A&E and public outpatient services, all under the same Beacon management, your experience would be very different.

    The question is how can 1k per person get private treatment and be quickly seen, while 4k per person gets you 2 year waiting lists. It's not about the beacon, but the value obtained by monwley spent by the govt on health vs money given directly to private care. The only explanation is that one is more efficient than the other. The beacon was an example only. There are hundreds of thousands of people with private health insurance and for their 1k they are seen much faster than the hundreds of thousands without it, despite the govt spending 4k on everyone. It would be great if that 4k was just spent efficiently full stop, and no need for the private system at all...... Sure look at the maternity system with each woman keeping her medical records with her because the system can't keep track of them electronically. We're not in 1990, but our health system is.


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    #50
    Geuze
    Registered Users Posts: 13,098 ✭✭✭✭Geuze


    Short answer - a 1k typical health insurance plan only covers hosp care, with maybe limited benefits for consultants/GP visits.


    The 4k figure you quote - which is not per person - covers all publicly provided healthcare.


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    #51
    Dav010
    Registered Users Posts: 14,048 ✭✭✭✭Dav010


    tails_naf wrote: »
    The question is how can 1k per person get private treatment and be quickly seen, while 4k per person gets you 2 year waiting lists. It's not about the beacon, but the value obtained by monwley spent by the govt on health vs money given directly to private care. The only explanation is that one is more efficient than the other. The beacon was an example only. There are hundreds of thousands of people with private health insurance and for their 1k they are seen much faster than the hundreds of thousands without it, despite the govt spending 4k on everyone. It would be great if that 4k was just spent efficiently full stop, and no need for the private system at all...... Sure look at the maternity system with each woman keeping her medical records with her because the system can't keep track of them electronically. We're not in 1990, but our health system is.

    I’d agree with you, the privately run Hospital is possibly more efficiently and has smaller staff numbers. But most private hospitals are selective about the treatments they offer, their consultants pay for their consulting rooms, and they bill the private insurance companies a lot more than the €1k you pay. If all private hospitals were required to offer the full range of services a public hospital provides, particularly A&E and emergency admissions, again, your experience would be very different as acute patients would be prioritised over elective/scheduled xrays.


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    #52
    tails_naf
    Registered Users Posts: 861 ✭✭✭tails_naf


    Dav010 wrote: »
    I’d agree with you, the privately run Hospital is possibly more efficiently and has smaller staff numbers. But most private hospitals are selective about the treatments they offer, their consultants pay for their consulting rooms, and they bill the private insurance companies a lot more than the €1k you pay. If all private hospitals were required to offer the full range of services a public hospital provides, particularly A&E and emergency admissions, again, your experience would be very different as acute patients would be prioritised over elective/scheduled xrays.

    You think the private health insurance companies are making a loss so? The 1k they charge me is because on average I (and all other members) use less than that in a calendar year, so sure this year they pay out more on me, but thats how it works. The 4k per capita (actually 3.3) the govt pays out is also averaged thst way. You can get most procedures done privately, so I'm not sure what you mean about private hospitals being selective about what they offer. Do you have an example of something they don't do, on the basis of cost or otherwise?


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    #53
    Dav010
    Registered Users Posts: 14,048 ✭✭✭✭Dav010


    tails_naf wrote: »
    You think the private health insurance companies are making a loss so? The 1k they charge me is because on average I (and all other members) use less than that in a calendar year, so sure this year they pay out more on me, but thats how it works. The 4k per capita (actually 3.3) the govt pays out is also averaged thst way. You can get most procedures done privately, so I'm not sure what you mean about private hospitals being selective about what they offer. Do you have an example of something they don't do, on the basis of cost or otherwise?

    I suppose the most obvious services they don’t provide are A&E to the general public and patient admissions through A&E, which account for a huge volume of patient visits to hospitals, admissions to wards, xrays, our patient visits etc


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    #54
    tails_naf
    Registered Users Posts: 861 ✭✭✭tails_naf


    Dav010 wrote: »
    I suppose the most obvious services they don’t provide are A&E to the general public and patient admissions through A&E, which account for a huge volume of patient visits to hospitals, admissions to wards, xrays, our patient visits etc

    True, but maybe if they were give 100 euro a go, and whatever the govt currently shells out they would - from a recent report on ED expenditure:

    "With regard to ED KPIs, the data shows that performance is below target and has been worsening over the
    years. Waiting times in the ED are increasing as are the proportion of patients leaving the ED before being
    admitted or completing treatment. Trolley numbers have been growing at an average monthly rate of 1%
    over the period. These worsening performance KPIs are despite targeted initiative funding measures to
    tackle overcrowding in hospitals and reduce waiting list numbers, and the introduction of free GP care for
    over-6s and under-70s which could reasonably have been expected to reduce the need for ED visits for these
    cohorts. Furthermore, while we know from the 2018 Spend Review paper that Acute spending and staff
    resources increased by €680m (17%) over the period in question"

    Looks ripe for some efficency gains. 250m alone was spent on reducing trolley numbers, and they went up! That's a lot of private insurance premiums right there. Again I'm no fan of prvatizing / for profit health care, but would like the efficiency it seems is possible.


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    #55
    Wanderer78
    Registered Users Posts: 28,814 ✭✭✭✭Wanderer78


    tails_naf wrote:
    Looks ripe for some efficency gains. 250m alone was spent on reducing trolley numbers, and they went up! That's a lot of private insurance premiums right there. Again I'm no fan of prvatizing / for profit health care, but would like the efficiency it seems is possible.

    I do think economist mariana mazzucato has a point regarding our health care systems, we ve been working so hard on making them so efficient, when this virus came along, we didn't have the capacity to deal with it


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    #56
    adocholiday
    Registered Users Posts: 1,834 ✭✭✭adocholiday


    I have multiple family members working in various parts of the HSE. From nursing home care, to psychiatric nursing, to senior ambulance staff. Ask any of them why the HSE is a shambles and they'll tell you it's management and their stories back it up. There are people in management there that aren't fit to tie their own shoes, with massive Napoleon complexes and shocking people and process management skills. They get into these positions by virtue of their tenure, not ability.

    And that's where the unions come in. You could appoint anyone in the world to the health ministers role in Ireland it doesn't matter. Nobody can make effectual change in that role because the unions are too powerful. So these crap managers can't be touched and that goes right up the chain from the ward manager to the head of the HSE. These same crap managers are the ones who are responsible for your terrible hospital experiences.

    If we as a country want to start fixing our health service we need to start by dismantling the unions, then the minister needs to restructure the whole organisation from the bottom to the top. It is only with root and stem change that we will ever see an improvement in the Health Service.


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    #57
    Dav010
    Registered Users Posts: 14,048 ✭✭✭✭Dav010


    tails_naf wrote: »
    True, but maybe if they were give 100 euro a go, and whatever the govt currently shells out they would - from a recent report on ED expenditure:.

    Staffing a ED is extremely expensive, if you then provide for admissions, you have to have full time staff for all specialities plus their regs/SHO’s to provide adequate care on the wards. A large percentage of private Hospitals do not have full time consultants, the Consultants work in the Public Hospitals and do part time private sessions in private Hospitals, they are not employees. You put in an A&E and admissions and necessary X-ray cover, path lab, haematology, cleaning staff, catering, administration, costs of indemnity etc, Hospital running costs increase exponentially, €100 pp will not cover it.


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    #58
    angel eyes 2012
    Registered Users Posts: 900 ✭✭✭angel eyes 2012


    Dav010 wrote: »
    Staffing a ED is extremely expensive, if you then provide for admissions, you have to have full time staff for all specialities plus their regs/SHO’s to provide adequate care on the wards. A large percentage of private Hospitals do not have full time consultants, the Consultants work in the Public Hospitals and do part time private sessions in private Hospitals. You put in an A&E and admissions and necessary X-ray cover, path lab, haematology, cleaning staff, catering, administration, costs of indemnity etc, Hospital running costs increase exponentially, €100 pp will not cover it.

    There is a private A&E in Dublin but unlike public hospitals they aren't open 24/7. I attended it last year as I couldn't face the waiting room of a public hospital again. However the private A&E would not see me due to my underlying health condition and it's usually the reason why my GP carts me off to A&E too. I ended up sitting on the floor of the waiting room in public A&E for part of the night due to lack of seats. Once I was finally admitted, the only bed they had was a trolley on a sluice room due to lack of beds. Staff kept coming in collecting supplies and glancing at me awkwardly. It was actually quite funny.

    Anyway, in my experience private hospitals will not treat you if you have complex issues and generally they don't have the 'vulnerable' patients that are drunk and cause mayhem for security staff.

    Additionally there is a massive crisis about to hit the system due to increases in waiting lists.

    https://www.thejournal.ie/outpatient-waiting-lists-ireland-5176471-Aug2020/


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    #59
    Wanderer78
    Registered Users Posts: 28,814 ✭✭✭✭Wanderer78


    adocholiday wrote: »
    I have multiple family members working in various parts of the HSE. From nursing home care, to psychiatric nursing, to senior ambulance staff. Ask any of them why the HSE is a shambles and they'll tell you it's management and their stories back it up. There are people in management there that aren't fit to tie their own shoes, with massive Napoleon complexes and shocking people and process management skills. They get into these positions by virtue of their tenure, not ability.

    And that's where the unions come in. You could appoint anyone in the world to the health ministers role in Ireland it doesn't matter. Nobody can make effectual change in that role because the unions are too powerful. So these crap managers can't be touched and that goes right up the chain from the ward manager to the head of the HSE. These same crap managers are the ones who are responsible for your terrible hospital experiences.

    If we as a country want to start fixing our health service we need to start by dismantling the unions, then the minister needs to restructure the whole organisation from the bottom to the top. It is only with root and stem change that we will ever see an improvement in the Health Service.

    its interesting that from the de-unionization of our economies, particularly in the private sector, productivity has risen dramatically, yet wage inflation has remained relatively low and the precariousness of employment has worsened!


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    #60
    Dav010
    Registered Users Posts: 14,048 ✭✭✭✭Dav010


    angel eyes 2012 wrote: »
    There is a private A&E in Dublin but unlike public hospitals they aren't open 24/7. I attended it last year as I couldn't face the waiting room of a public hospital again. However the private A&E would not see me due to my underlying health condition and it's usually the reason why my GP carts me off to A&E too. I ended up sitting on the floor of the waiting room in public A&E for part of the night due to lack of seats. Once I was finally admitted, the only bed they had was a trolley on a sluice room due to lack of beds. Staff kept coming in collecting supplies and glancing at me awkwardly. It was actually quite funny.

    Anyway, in my experience private hospitals will not treat you if you have complex issues and generally they don't have the 'vulnerable' patients that are drunk and cause mayhem for security staff.

    Additionally there is a massive crisis about to hit the system due to increases in waiting lists.

    https://www.thejournal.ie/outpatient-waiting-lists-ireland-5176471-Aug2020/

    Are you talking about the A&E in the Beacon? They offer a limited service with limited hours, I don’t think they take major trauma, pregnancy, some chronic conditions or psychiatric emergencies. VHI swiftcare is more limited again.


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    #61
    blackbox
    Registered Users Posts: 4,121 ✭✭✭blackbox


    Wanderer78 wrote: »
    its interesting that from the de-unionization of our economies, particularly in the private sector, productivity has risen dramatically, yet wage inflation has remained relatively low and the precariousness of employment has worsened!

    ...and this exactly reflects the failure of Irish and UK unions.

    If the unions genuinely embraced change and improved productivity there would not be the same need for businesses to de-unionise.

    Lots of union members in Germany along with high productivity and good pay.

    In Ireland unions are focused on protecting lowest performers.


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