The HSE is re-regionalising

Bring back the ould Matrons, put the fear of God in you they would.

Eric Cartman wrote: »

We really need to seperate unions and the public service for the desperate improvement of our nation

and how exactly are you going to do that given the public service workers are the unions?

end of the road wrote: »

and how exactly are you going to do that given the public service workers are the unions?

Clearly the problem is that the unions are the source of the problems in our health service. They're the ones who are boxing reform just to keep things cushy.

Eric Cartman wrote: »

end of the road wrote: »

and how exactly are you going to do that given the public service workers are the unions?

Tender for a private company to run health services in the country, lease the hospitals and facilities to them and then let them interview and hire the good workers while leaving out the bad , then have the state buy out the company to appease those who hear the words ‘private healthcare’ and foam at the mouth.

Leave the dead weight on the payroll in a now defunct HSE , do one year spending report on how much it all costs and suddenly its ‘useless whingers who do nothing all day but cost us hundreds of millions get the sack’ and theres no way the unions or the left could defend the massive useless quango anymore

you know under employment law you cant do that

Kivaro wrote: »

Is re-regionalising just a smokescreen or there is a possibility of it working?
Would love to hear from someone with experience in this sector.

It might if it is done properly and fully. There's more required than just the regionalisation piece though.
That regional piece needs to be supported by a lot centralised expertise and corporate support, such as population health profiling, resource allocation modelling, data management infrastructure and a thousand other things.

Regionalisation does push accountability and responsibility further down the line and closer to the front line which, in theory, is a good approach. A single budget per regional area along with an outcomes framework can help to ensure money is invested and decisions are taken closer to the patient, with, hopefully, some greater focus on earlier care and support interventions.

From a cultural, societal and structural perspective though we need to move away from the hospital being the centre of existence for everything.

Major fear however with the purported move is the interference that will play an even bigger role in opertion of the system.
It's already ridiculous, given the supposed legal divide between health service delivery and the political system.

At present, all the non-hospital front line work i.e public health, disabilities, elderly care etc is grouped geographically. But the hospital's are grouped to meet certain speciality targets so you end up with kilkenny in with Dublin, Waterford in with cork etc.

This means there can be minimal joined up/integrated care from hospital to community and back again because you have to go almost to ministerial level before both streams are accountable/manageable to the one person (and so things can get done). Moving hospitals back within geographical groups will mean that decision making for integrated care can happen regionally as that hospital manager and community manager in say cork will both report to the cork-kerry manager.

So yes in theory it's a better model but it was abolished the first time around due to duplication of roles.

To do it properly, all the standalone roles i.e. data collection, national policy, Garda vetting etc need to be based corporately and independently under the HSE to cut duplication of local admin.

****ing quango nonsensical merry-go-round think tank to come up with new names will probably cost €250k

mvl wrote: »

[QUOTE=Uriel
I though the GP practices are currently the centre of existence for everything.

GPs should be the centre for everything but with the vast majority being considered self employed contractors to the HSE, they are severely hampered by lack of information (as are many in the community). For instance if a GP, PHN or HHC hears that a patient has been taken away in an ambulance, there is hours of ringing around local hospitals, then wards etc trying to find the patient, convince a nurse give you a run down of condition, and then try to prepare for discharge without any official contact from the hospital. A discharge letter will often be sent home with the patient...which is too late to apply for a HCP etc.

I know my own GP doesnt have access to my blood results or hospital tests despite me being willing to sign whatever disclaimers are needed.

The amount of "failed discharges" leading to readmission as discharges haven't been planned in a logical, integrated way is ridiculous. Hospitals discharging people at the last minute on a bank holiday without letting the immunity team know as they are under staffing pressure just isn't safe until community health practitioners move to a 7 day week too.

That's not hospital staffs fault, just a reflection of the status quo.

Will this not just add a other layer of waste ? No doubt there’ll have to be a regional CEO and so on for each new “region” rather than what was to be a more centralized model

blanch152 wrote: »

https://www.oecd-ilibrary.org/docserver/health_glance-2017-56-en.pdf?expires=1563312749&id=id&accname=guest&checksum=EE64199493E52DC7CE483BDD384D21E2


7th highest number of nurses per capita in the OECD, yet we are told that nurses are not the problem.

And that is with one of the youngest populations in the OECD which means we should need less nurses and less healthcare than anyone else.


https://read.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2017/remuneration-of-nurses_health_glance-2017-58-en#page1


Meanwhile in PPP terms, we have the fourth highest remuneration of nurses in the OECD.

That is not sustainable.

If you're going beat the OECD drum at least give consideration to how the numbers for OECD are recorded and how they differ region to region (https://www.healthmanager.ie/2017/10/oecd-nurse-patient-ratios-do-not-give-the-full-picture/); one of Irelands foremost experts on the subject scratches the surface here. If you insist on beating any drum, beat the bed blocker drum, the one that's responsible for many of the failings within the current system and by far the biggest drain on our resources. This is what's making the system unsustainable.

As for part 2 of your comment about the highest remuneration, it's worth considering Ireland produces some of the most sought after graduate nurses on the planet due to the standard of the nursing education here. We have a plethora of nurse lead services in this country utilizing that education, something other countries strive so desperately to achieve. That's before we get to the topic of the reported "nurses" salaries being highly inflated due to management level positions (CNM1 through to DON *of which I think there are far too many) being included in those figures, which comes part and parcel of running these nursing lead services. This is demonstrated by foot note 1 in 8.17 of your second link (Health at a Glance 2018)

With simple surface knowledge on a topic it's incredibly easy to desktop analyse reported figures without giving due attention to, or digging deeper into what those numbers represent.

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Going back to the regional health board route isn't going to fix the festering wound of Irish healthcare. The HSE will still exist even after that happens as part of governance and oversight. I think pushing Sláintecare is the route we should be taking instead of a glorified re-branding of the health service sucking up more of the health budget and píssing it down the drain

Despite all the lovely reporting about how terrible the HSE is and the anecdotal stories of how granny spent 97 millennia waiting for a bed last week - Fact of the matter is 85% of people who responded to the National Patient Experience Survey were satisfied with the service it provided, something has to be working about it?