The HSE is re-regionalising

Miike · 17-07-2019 12:29am

salonfire wrote: »

You're wrong as usual.

Compare the cost of public and private nursing homes for example

The private homes are much cheaper per week than the HSE run homes and are still able to make a profit.

Getting charged 17.70 for a 15g tub of Sudocrem does drive up the profit margin significantly alright.

Would you like the HSE to to give you an itemised bill every time you required hospital services? If only there was a country currently doing that... where people are priced out of basic healthcare. Oh wait there is!

salonfire · 17-07-2019 12:30am

Franz Von Peppercorn II wrote: »

Are you allowing public patients into these private hospitals?

Yes, public patients in tendered private practices paid for by the taxpayer.

Private hospitals can do far more with less overheads than a public service.

This is already used in the National Treatment Purchase Fund.

salonfire · 17-07-2019 12:35am

Miike wrote: »

Getting charged 17.70 for a 15g tub of Sudocrem does drive up the profit margin significantly alright.

Would you like the HSE to to give you an itemised bill every time you required hospital services? If only there was a country currently doing that... where people are priced out of basic healthcare. Oh wait there is!

I did not mention an insurance system so I don't know why you're trying to compare to the US which is insurance based and is not in Government control.

Tendered practice ultimately remains in Government control to switch providers if it was failing to deliver or not value for money.

end of the road · 17-07-2019 12:40am

Eric Cartman wrote: »

The clipboard merchants work could mostly be done by automated computer systems if we were prepared to start sacking people for not knowing how to operate computers even after extensive training.

whereas if we weren't prepared to sack such people who probably don't actually exist, the work couldn't be mostly done by automated computer systems?
if some or all of the work could be done by automated computer systems, then they would be in place, and as i said, we wouldn't even need to sack staff, we just don't replace them when they retire, and any younger staff could be redeployed.
but it seems to me at least that you just want to sack people for the sake of sacking people to make you feel better.

TrixIrl · 17-07-2019 12:43am

*** I will never learn how to quote properly so..

Quote-

[/quote]
You're wrong as usual.

Compare the cost of public and private nursing homes for example

The private homes are much cheaper per week than the HSE run homes and are still able to make a profit. [/quote]

End quote***

Private nursing homes can choose who they take, public cannot. The vast majority of high dependency, complex cases with poor family input are in public NHs. The majority of those with cash to spend (and thus willing to sign up to expensive add-ons) are in private NHs so the standard weekly rate is not an accurate reflection.

A private nursing home group recently hired a national admissions manager as the local directors of nursing were handpicking potential residents and leaving beds empty rather than take the trickier labour intensive patients.

As well as this staff in public NHs are paid sick leave, pensions, maternity leave which the vast majority in private hospitals are not.

All this leads to a higher cost in public NHs.

Having said that, Nursing Homes Ireland are trying to renegotiate teh terms of Fair Deal which will likely involve equal rates for equal access; which is to be welcomed if only to ensure everyone has equal access to a NH of their choice and not to be cherrypicked by a NH director.

salonfire · 17-07-2019 12:43am

Miike wrote: »

Getting charged 17.70 for a 15g tub of Sudocrem does drive up the profit margin significantly alright.

Thanks for proving my point.

Despite this, nursing home fees are lower in private sector than the HSE.

So what are the HSE wasting money on if it costs them extra to run homes?

end of the road · 17-07-2019 12:48am

salonfire wrote: »

Private hospitals can do far more with less overheads than a public service.

if that is the case, i have a feeling that it is probably because they aren't the main provider. they therefore probably won't need the overheads required to be able to treat anyone and everyone, and look after all of the information required.

Miike · 17-07-2019 12:57am

salonfire wrote: »

I did not mention an insurance system so I don't know why you're trying to compare to the US which is insurance based and is not in Government control.

Tendered practice ultimately remains in Government control to switch providers if it was failing to deliver or not value for money.

I don't have the figures to hand and I'm on mobile but I will certainly post them tomorrow. The NTPF costs significantly more per case than the cost of being seen by the HSE - I assumed you meant insurance based because private tendered healthcare is quite frankly unsustainable.

salonfire wrote: »

Thanks for proving my point.

Despite this, nursing home fees are lower in private sector than the HSE.

So what are the HSE wasting money on if it costs them extra to run homes?

You can't be that daft? Why is it costing the HSE more? Oh, maybe it's because they don't charge 1000%+ for a lick of soducrem. Is this what you'd prefer to see the HSE do? Charge a +1000% markup on sundries?

salonfire · 17-07-2019 12:58am

end of the road wrote: »

if that is the case, i have a feeling that it is probably because they aren't the main provider. they therefore probably won't need the overheads required to be able to treat anyone and everyone, and look after all of the information required.

Good to see you agreeing with me.

The HSE should not be required to treat everything, they are not capable in delivering in a cost-effective manner.

All the routine procedures should be tendered out and make the HSE much smaller.

salonfire · 17-07-2019 1:03am

Miike wrote: »

I don't have the figures to hand and I'm on mobile but I will certainly post them tomorrow. The NTPF costs significantly more per case than the cost of being seen by the HSE - I assumed you meant insurance based because private tendered healthcare is quite frankly unsustainable.

You can't be that daft? Why is it costing the HSE more? Oh, maybe it's because they don't charge 1000%+ for a lick of soducrem. Is this what you'd prefer to see the HSE do? Charge a +1000% markup on sundries?

You accuse nursing home of jacking up prices for products. Yet the cost to the consumer remains lower than the cost of the HSE facility.

I can't wait for your suggestion how the HSE justify the increased cost.

end of the road · 17-07-2019 1:04am

salonfire wrote: »

Good to see you agreeing with me.

The HSE should not be required to treat everything, they are not capable in delivering in a cost-effective manner.

All the routine procedures should be tendered out and make the HSE much smaller.

that is unviable.
the hse have to be required to treat everything for the good of the health of society, and compared to your alternative i would suspect they do deliver in a cost effective manner.

salonfire · 17-07-2019 1:09am

Miike wrote: »

On which planet do you live? Do you think they provide a like-for-like service?

No, the private homes provide a much better service and unlike hse homes are held to a higher standard by hiqa.

end of the road · 17-07-2019 1:11am

salonfire wrote: »

You accuse nursing home of jacking up prices for products. Yet the cost to the consumer remains lower than the cost of the HSE facility.

probably because the price of the products and others are added separate extras which are not included as part of the actual fees.

salonfire wrote: »

I can't wait for your suggestion how the HSE justify the increased cost.

the HSE have to take all kinds of patients.
the HSE probably do have better terms and conditions for their staff.
the HSE is probably a much larger provider over all.

Miike · 17-07-2019 1:19am

Round and round we go.

salonfire wrote: »

You accuse nursing home of jacking up prices for products. Yet the cost to the consumer remains lower than the cost of the HSE facility.

I can't wait for your suggestion how the HSE justify the increased cost.

end of the road wrote: »

probably because the price of the products and others are added separate extras which are not included as part of the actual fees.
.

This.

And then this

TrixIrl wrote: »

Private nursing homes can choose who they take, public cannot. The vast majority of high dependency, complex cases with poor family input are in public NHs. The majority of those with cash to spend (and thus willing to sign up to expensive add-ons) are in private NHs so the standard weekly rate is not an accurate reflection.

A private nursing home group recently hired a national admissions manager as the local directors of nursing were handpicking potential residents and leaving beds empty rather than take the trickier labour intensive patients.

As well as this staff in public NHs are paid sick leave, pensions, maternity leave which the vast majority in private hospitals are not.

All this leads to a higher cost in public NHs.

Having said that, Nursing Homes Ireland are trying to renegotiate teh terms of Fair Deal which will likely involve equal rates for equal access; which is to be welcomed if only to ensure everyone has equal access to a NH of their choice and not to be cherrypicked by a NH director.

-

Public nursing homes are filled with complex and intensive case management because the private nursing homes won't take it on. It hurts their bottom line.

Regardless of all of that though I can agree with you in saying the HSE needs to do better in terms of cost at point of care for nursing homes but this doesn't translate to treating patients privately for "routine procedures" across the board being cheaper to the tax payer.

Franz Von Peppercorn II · 17-07-2019 9:04am

salonfire wrote: »

Thanks for proving my point.

Despite this, nursing home fees are lower in private sector than the HSE.

So what are the HSE wasting money on if it costs them extra to run homes?

Source?

Eric Cartman · 17-07-2019 9:42am

end of the road wrote: »

whereas if we weren't prepared to sack such people who probably don't actually exist, the work couldn't be mostly done by automated computer systems?
if some or all of the work could be done by automated computer systems, then they would be in place, and as i said, we wouldn't even need to sack staff, we just don't replace them when they retire, and any younger staff could be redeployed.
but it seems to me at least that you just want to sack people for the sake of sacking people to make you feel better.

The systems arent in place because of the unions, the same unions that prevent younger staff members taking on increased responsibility or training on such systems. Beurocracy and unions ensure the waste will continue unopposed.

Snow Garden · 17-07-2019 9:59am

I worked on a contract in the HSE for about 18 months. I got to see how badly run and wasteful it is first hand. It was actually depressing. I have posted about it before. The middle management layer and unions have a lot to answer for but until there is a cull and re-org, it will never ever be fixed. In fact it is becoming worse.

The time to fix it was when the IMF came to town or after the 2011 election when FG/Labour held a massive majority. Massive missed opportunity.

The bureaucracy will continue to indirectly kill our citizens in the meantime.

end of the road · 17-07-2019 10:12am

Eric Cartman wrote: »

The systems arent in place because of the unions, the same unions that prevent younger staff members taking on increased responsibility or training on such systems. Beurocracy and unions ensure the waste will continue unopposed.

the systems aren't in place because presumably there aren't ones available that can do the work required.
if the unions are preventing younger staff from taking on increased responsibility, then chances are it is because their members do not want to take on increased responsibility and have given such feedback to their unions.

blanch152 · 17-07-2019 10:17am

Miike wrote: »

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.

-

Reading that analysis our ratio of nurses per bed must be through the roof and over twice the OECD average.

There are structural problems with the nursing service, including too many nurse managers as you allude to, but most of the structural problems have arisen as a result of INMO claims, some of which have been endorsed by the Labour Court which has no expertise in how hospitals should be run.

There is no doubt that nurses are part of the problem as well as part of the solution. Ditto doctors, the hospital porters are hardly responsible for the deluge of medical malpractice claims, are they?

Eric Cartman · 17-07-2019 12:06pm

end of the road wrote: »

the systems aren't in place because presumably there aren't ones available that can do the work required.
if the unions are preventing younger staff from taking on increased responsibility, then chances are it is because their members do not want to take on increased responsibility and have given such feedback to their unions.

So tue laziness is so endemic that they’re lobbying the union to not work hard ? And this is alright ?

angeleyes · 17-07-2019 12:11pm

Kivaro wrote: »

The only way that the massive union structure is neutralised in this country is by Brussels coming in when the next recession occurs and enacting changes through austerity that the unions won't be able to do anything about.

We obviously have not learned anything from the 2008 "downturn".

The next recession might be sooner than we think especially if the UK leaves the E.U. without a deal in October.

end of the road · 17-07-2019 12:25pm

Eric Cartman wrote: »

So tue laziness is so endemic that they’re lobbying the union to not work hard ? And this is alright ?

no, lobbying the union not to have to take on extra work that may have nothing to do with the job they are paid to do. nothing to do with lazyness but to do with being busy with what they have to do already.
if there are any genuine lazy staff then there are disciplinary procedures available to deal with that issue and it is up to management to use them. if they choose not to do so then that is their own fault.

Snow Garden · 17-07-2019 12:39pm

end of the road wrote: »

no, lobbying the union not to have to take on extra work that may have nothing to do with the job they are paid to do. nothing to do with lazyness but to do with being busy with what they have to do already.
if there are any genuine lazy staff then there are disciplinary procedures available to deal with that issue and it is up to management to use them. if they choose not to do so then that is their own fault.

In my experience the lazy staff were simply sidelined. Managers were very very reluctant to start disciplinary proceedings. I think they felt it was not worth the hassle especially when blinkered union reps got involved.

end of the road · 17-07-2019 3:24pm

Snow Garden wrote: »

In my experience the lazy staff were simply sidelined. Managers were very very reluctant to start disciplinary proceedings. I think they felt it was not worth the hassle especially when blinkered union reps got involved.

or perhapse it's more likely that there wasn't enough evidence required to engage in the procedure, so the management rightly decided not to try until they had such evidence. that sounds more likely to be the case IMO then your possibility.
if there is evidence and the procedure is followed correctly, there is nothing the non-blinkered union reps can do because it will be a slam dunk, and unions and union reps cannot prevent staff from being disciplined or sacked if said staff breach the terms of their employment.

Snow Garden · 17-07-2019 3:42pm

end of the road wrote: »

or perhapse it's more likely that there wasn't enough evidence required to engage in the procedure, so the management rightly decided not to try until they had such evidence. that sounds more likely to be the case IMO then your possibility.
if there is evidence and the procedure is followed correctly, there is nothing the non-blinkered union reps can do because it will be a slam dunk, and unions and union reps cannot prevent staff from being disciplined or sacked if said staff breach the terms of their employment.

Who the hell are you? Some kind of HSE apologist? Have you ever worked there?

I saw dossing and ineptness on a grand scale and nothing was done. Wasn't enough evidence...:D

It always seemed to me that 20% of the folks were doing 80% of the work. I am not sure how the 20% stayed motivated considering the working environment.

Faye McAleer · 17-07-2019 3:51pm

Why not create a free healthcare system like the NHS?

I'm 17. I live in Carrickmore and would like reunification more than anything as would my friends. If the south already has a good healthcare system that is free at the point of use it could easily join up with the system we have here once we are united.

Would it not be a good idea for this to happen?

Franz Von Peppercorn II · 17-07-2019 3:54pm

end of the road wrote: »

or perhapse it's more likely that there wasn't enough evidence required to engage in the procedure, so the management rightly decided not to try until they had such evidence. that sounds more likely to be the case IMO then your possibility..

No it doesn’t. You admit there are probably lazy staff and yet who has been fired?

Franz Von Peppercorn II · 17-07-2019 3:55pm

Faye McAleer wrote: »

Why not create a free healthcare system like the NHS?

I'm 17. I live in Carrickmore and would like reunification more than anything as would my friends. If the south already has a good healthcare system that is free at the point of use it could easily join up with the system we have here once we are united.

Would it not be a good idea for this to happen?

It would be nice but we have to fix the system we have first.

Faye McAleer · 17-07-2019 4:04pm

I play for Carrickmore GAA and I go to the Dean Maguirc College where I will do my A-Levels next year.

Would it not be good for young people like me who are starting out in life to have a good life within one Ireland, including a good health system?

Look at New Zealand's healthcare system.

Last Stop · 17-07-2019 6:52pm

So what do we make of the plan to disband the HSE and replace it with six regional healthcare areas?

To me it’s the wrong approach as you will now have 6 people doing the exact same job in each area. I’m talking about general admin / pensions / payroll etc. If I understand this correctly, there will be no overseeing authority (besides the Department) so in theory there will be big discrepancies between each area.

If there is one thing that baffles me in Ireland it is our ability to complicate everything to a point where it doesn’t even begin to make sense. The ideal situation would ironically be a combination of the current HSE and six regional area. This would mean you would have an overseeing authority to ensure standards are the same, manage basic tasks that don’t change from area to area and have one authority who can be held to account. That is they way any private firm is run.

The biggest problem in the HSE was that when the 11 regional boards were combined, not a single person lost their job. That to me is lunacy.

While I know I’m ranting and raving, it’s incredibly frustrating as there are so many simple things that whoever the overseeing organisation is could do to improve the heath service. The

The HSE is re-regionalising

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