Health reform, here we go again

star gazer

Does anybody get tired of report after report after report into the health services? We hear the minister spending huge amounts of money but what have we gotten in return for our taxes? It's like a broken record, 'crisis' in the health service, minister announces new report. The EU directive on Junior doctors will probably force some changes to happen, but who will stand up for the people when the negotiations get started. i'm sorry to go OTT on this rant but it frustrates me to think €9billion is spent but we don't get much more than the £3billion of a few years ago. People are suffering and we get reports.

Cork

Reform will come thru reports.

Ad hoc & little planning is the root of problems in health.

OK - with every system - you need to plan. You need to plan on how effectively to organise the system, how to staff the system & how to deliver a good level of service.

You need to plan on how to use resources effectively. Maybe, they have been too many reports. Or perhaps reports should have been commissioned at the same time.

But I can see, that by staggering reports - You are giving those involved in the system a period of consultation.

That they are not snowed under by many reports. Change within a system needs to be accepted by those involved working within it.

But it is only when the changes are umplemented - that these reports can be judged a success or failure.

(This posting is influenced by doing Business in College - It probably contains soundbytes - but it is trying to show the importance of planning for change).

gandalf

Cork you are really starting to annoy me now !!!!

Its getting close to me quoting "Now was that 5 bullets or 6, in all this excitment I can't rightly remember. Well punk are you feeling lucky!!!"

If I see one more soundbite without a full and proper explanition I will take action !!!!

Gandalf.

star gazer

Ad hoc & little planning is the root of problems in health.
Cork

I know i was in a strange way looking for hope but this goes a little beyond optimism

You need to plan on how to use resources effectively.
Cork

This is a damning attack on what Micheal Martin and Brian Cowen did with all the extra money they had to spend, thank you Cork.

But it is only when the changes are umplemented - that these reports can be judged a success or failure.
Cork

After what time frame? Apparently we have had 148 reports from the dept of health in five years, admitedly most wouldn't be relevent to this discussion, but all we get is report after report. The Minister for Health has been given billions extra and the time that most of his predecessors didn't have to actually get to grips with the department of health brief. Is it so unfair to expect action now! Why should we have to put up with a second rate service where patients see a different registrar every time they go for repeat appointments, where people wait on trolleys or on lists longer than an arm?

To be brutally honest

I heard people from West Clare on morning Ireland this morning complaining about the down grading of Ennis hospital.
I also heard on the same show, similar complaints about Wexford general hospital.
I thought to my self therein lies the problem.
They are complaining about, the prospect of having to drive an extra pathetically small 20 miles to get to the upgraded and better facility.

In my locality on the East coast the nearest hospital is more than an hours drive away and for some villages up to an hour and a half.
By the logic of the people complaining, I should have a fully staffed hospital located down here:rolleyes:
I don't think so Tim!

People should realise,( in my honest opinion) that resources are limited and politicians regardless of what party they come from who are willing to take the risk of the wrath of misguided locals in order to carry out necessary reform deserve some slack, otherwise the reform will never start.


mm

Villain

Man,

Downgrading Hosiptals involves closing A&E departments, now god forbid you were to have a serious accident and were critically injured you would be taken by ambulance to the nearest A&E clinic for treatment, and in this case EVERY minute counts!!

So closing A&E clinics will result in deaths!

I agree changes have to be made and some services have to be more centralised but I don't think A&E clinics should be closed.

Originally posted by irish1
Man,

Downgrading Hosiptals involves closing A&E departments, now god forbid you were to have a serious accident and were critically injured you would be taken by ambulance to the nearest A&E clinic for treatment, and in this case EVERY minute counts!!

So closing A&E clinics will result in deaths!

Thats exactly the logic that has us in this mess.
consider the scenario whereby modern ambulances have equipment to stabilise accident victims suffecient to bring them another 20 miles or so.
Tell me why then I shouldn't have a hospital within a half hour of me??
Lets build one eh:rolleyes:

Villain

Originally posted by Man
Thats exactly the logic that has us in this mess.
consider the scenario whereby modern ambulances have equipment to stabilise accident victims suffecient to bring them another 20 miles or so.
Tell me why then I shouldn't have a hospital within a half hour of me??
Lets build one eh:rolleyes:

I haven't heard any mention of these ambulance that can offer the same treatment as an A&E clinic.

I'm looking to build anymore hospitals I'm simply saying closing A&E clinics will result in lives been lost.

And don't bother rolling your eyes.

Originally posted by irish1
I'm simply saying closing A&E clinics will result in lives been lost.

Well thats debatable, to be honest, I'm over an hour from the nearest hospital.
Why should someone thirty miles or less from two different hospitals have scarce resources pumped into two sites?? when a better in patient service could be provided at just the one central site.

mm

Villain

Originally posted by Man
Well thats debatable, to be honest, I'm over an hour from the nearest hospital.
Why should someone thirty miles or less from two different hospitals have scarce resources pumped into two sites?? when a better in patient service could be provided at just the one central site.

mm

Because closing the A&E clinics will force some people to have to travel further, people may LIVE a 30 miles from the nearest hosiptal but they may be involved in a car accident another 20 miles further away.

There was talk of Kilkenny hospital's A&E clinic been close so people from Carlow would have to go to Waterford or Tallaght!!

And "better pateint service" can only be delivered if the person arrives alive at the hospital!

Originally posted by irish1

And "better pateint service" can only be delivered if the person arrives alive at the hospital!

whats debateable about that notion is, the fact that more people may die whilst waiting for a hospital appointment at present, than die because of being in an abulance for an extra 20 miles or so.
A good percentage of those that die en route to the hospital may have been so critical that they would have died anyway.


Incidently this might be a time to point out that the :rolleyes: is a Sarcasm smiley or at least thats the interpretation i would always have on it, and my build another hospital near me was a comment of sarcasm not derision or insult towards you, If it was taken that way I apoligise
My point is really that, in a country as small as this one,investing money thinly in too many hospitals is half the problem.
I live beside a town with ten or twelve thousand people in it and a rural environs of way over 20,000 and a busy dual carriageway on the N11 which has seen plenty of RTA's.
The town has an ambulance station.
It doesn't need a hospital,if it had one maybe or rather definitely I'd be hearing cries for scarce resources to be pumped into that too...
There is absolutely no doubt in my mind that the health service needs a radical shake up and if an improvement in the effeciency of the resources spent on it means a better overall service resulting from the closure of a few A+E departments amongst other things then so be it imho.

mm

Sparks

They are complaining about, the prospect of having to drive an extra pathetically small 20 miles to get to the upgraded and better facility.

As I once pointed out to Cork, the reality of downgrading hospitals isn't pretty. Take one twelve-year-old boy, and give him a seemingly minor accident - until he sits up and notices that his leg is bent the wrong way and where he used to have a patella, he's now got two lumps under his skin heading for his hip and his ankle. Now put this kid, in severe pain and shock, in the car and drive eight point 4 miles to locklinstown hospital's A&E department. Find out that the knee is dislocated and broken and so is the patella - and you have to take him to St.Vincents because they're the "center of excellence" for fixing this injury. Now put him in an ambulance and watch him for the remaining 12 miles or so on bumpy roads, with him coming out from under the anesthetic because of the pain more than once along the way.

THEN you can talk about the "pathetically small 20 miles".

And that's a real case by the way, it was my kid brother.

Or you could take my neighbour, who collapsed on the beach with a heart attack in greystones and had to travel the 20 miles to dublin. The only reason he survived was because he knew he was in a high-risk category and kept exceptionally fit and made sure that his local GP knew and had regular checkups, and that his wife and elder kids knew what to do if that happened - and he still wouldn't have survived, if he'd been walking without his wife at the time, or if there hadn't been passers-by to help carry him to the car. The 20 miles meant a great deal to his chances.

And before you say "advanced ambulances", you should know that there are no paramedics in Ireland. Ambulance drivers that try even basic procedures, like inserting a chest drain or performing a traechotomy, will be summarily fired last time I checked, and are then personally liable if someone sues. (Hint - that's why they're called ambulance drivers).

Hell, we don't even have an air ambulance in this country, let alone paramedics. That alone has led to several people being made paraplegics due to post-accident trauma caused by being transferred on Irish roads in normal ambulances.

Memnoch

Originally posted by Man
Well thats debatable, to be honest, I'm over an hour from the nearest hospital.
Why should someone thirty miles or less from two different hospitals have scarce resources pumped into two sites?? when a better in patient service could be provided at just the one central site.

mm

I'm really sorry to have to say this but your post only displays a complete ignorance of medicine and medical emergencies.

As part of my course I did a 6 week attachment in Medicine and Surgery at Monaghan hospital last year. Near the end of the 6 weeks a pregnant woman went into premature labour and had complications. She was driven to Monaghan General Hospital but because there was no Obs & Gynae Unit they were unable to help her and had to transport her as fast as possible via ambulance to another hospital. Her baby died on route. A simple Oxytocin drip to induce would probably have been enough to save the baby's life. (i'm not sure that it is oxytocin could have been another drip). But it was a simple drip and a simple proceedure that would easily have saved the babies life.

The fact is that it is impossible for ambulances to carry equipment for every medical emergency. Also many types of emergencies such as a severe MI attack CANNOT be stabilised by the paramedics. The need the A & E ward asap.

The extra 20 minutes that it takes to get a patient suffering from a DVT related pulmonary embolus or an MI or a CVA to the NEXT nearest hospital is enough to doom such patients to their death.

Add this to the fact that AS IT IS in rural counties in Ireland medical fascilities are already sparse, you want to reduce them further?????

edit - its easy for you to talk lightly about these kind of situations. Do you have any family members or close friends that were killed or debilitated because of this? No? Then think of those who have lost loved ones that could have been saved, but for this

Villain

I take your points, but I think theres a lot of ways to change the system that will improve the service, without closing A&E depts.

And:rolleyes: is called "rolleyes" so thats what is means.

Originally posted by Memnoch

As part of my course I did a 6 week attachment in Medicine and Surgery at Monaghan hospital last year. Near the end of the 6 weeks a pregnant woman went into premature labour and had complications. She was driven to Monaghan General Hospital but because there was no Obs & Gynae Unit they were unable to help her and had to transport her as fast as possible via ambulance to another hospital. Her baby died on route. A simple Oxytocin drip to induce would probably have been enough to save the baby's life. (i'm not sure that it is oxytocin could have been another drip). But it was a simple drip and a simple proceedure that would easily have saved the babies life.

The fact is that it is impossible for ambulances to carry equipment for every medical emergency. Also many types of emergencies such as a severe MI attack CANNOT be stabilised by the paramedics. The need the A & E ward asap.

I remember that case, it made headline news and was discussed in this forum.
By your analysis, that Baby would have died , if the exact same pregnancy and labour occured local to me.
So should we all move to Monaghan then or build another hosiptal here??
It's very easy too, you know to get emotive about very rare situations like that one, but that doesn't justify a bottomless moneypit for an existing ineffecient situation without reform.

Sparks

Originally posted by Man
It's very easy too, you know to get emotive about very rare situations like that one, but that doesn't justify a bottomless moneypit for an existing ineffecient situation without reform.

And it's damn easy to say "look, we need to do this, so sorry for the cost in lives, but you'll thank me at the end of the day".

It's idiotic moves like downgrading hospitals to save money that makes me thing that the Minister for Health ought to have to take the Hippocratic Oath on accepting his post.

Memnoch

Originally posted by Man
I remember that case, it made headline news and was discussed in this forum.
By your analysis, that Baby would have died , if the exact same pregnancy and labour occured local to me.
So should we all move to Monaghan then or build another hosiptal here??
It's very easy too, you know to get emotive about very rare situations like that one, but that doesn't justify a bottomless moneypit for an existing ineffecient situation without reform.

the question is where is the inefficiency arising from? You take the govt's word that closing hosps down will help, it won't. The inefficiency is in the administration, and the amount of money they eat for themselves and throw away.

This is not a "rare" case. Yes this case was ideal for sensationalisation but problems like this occur all the time. Most of the times it doesn't mean death, so it doesn't get reported. But ppl are debilitated and incapacitated often.

Again its so easy to talk this crap about getting to emotive.

had this happened to your wife or your sister, you would be singing a different tune i bet.

Originally posted by Sparks
As I once pointed out to Cork, the reality of downgrading hospitals isn't pretty. Take one twelve-year-old boy, and give him a seemingly minor accident - until he sits up and notices that his leg is bent the wrong way and where he used to have a patella, he's now got two lumps under his skin heading for his hip and his ankle. Now put this kid, in severe pain and shock, in the car and drive eight point 4 miles to locklinstown hospital's A&E department. Find out that the knee is dislocated and broken and so is the patella - and you have to take him to St.Vincents because they're the "center of excellence" for fixing this injury. Now put him in an ambulance and watch him for the remaining 12 miles or so on bumpy roads, with him coming out from under the anesthetic because of the pain more than once along the way.

THEN you can talk about the "pathetically small 20 miles".

And that's a real case by the way, it was my kid brother.

Or you could take my neighbour, who collapsed on the beach with a heart attack in greystones and had to travel the 20 miles to dublin. The only reason he survived was because he knew he was in a high-risk category and kept exceptionally fit and made sure that his local GP knew and had regular checkups, and that his wife and elder kids knew what to do if that happened - and he still wouldn't have survived, if he'd been walking without his wife at the time, or if there hadn't been passers-by to help carry him to the car. The 20 miles meant a great deal to his chances.

I see your point Sparks, loughlinstown is also the nearest hospital to me and maybe 15,000 other people, and it's over an hour away, your poor brother would have been in even more pain
The road is bumpy now, but soon it will be mostly dual carriageway.
I sympathise with your Brother and neighbours situation, But it's not an argument for having hospitals every 20 miles or so, that would be an impossible stretch on resources for such a small country.

mm

Villain

Man,

You arguing that closing A&E departments will be good for the medical system, but I think most people can see that these facilities are essential.

There is plenty of other areas that can be changed.

If the Government close an A&E clinic and a patient dies enroute to the next A&E clinic and there is evidence that had the patient been treated quicker they would have survived I would call that MANSLAUGHTER!!

Originally posted by Memnoch

had this happened to your wife or your sister, you would be singing a different tune i bet.

Thats more emotion there, so I'll give you some too , as you have asked.I have had plenty of examples of bad encounters recently with the medical system inside our badly run hospitals.
My own Father for instance, who was incapacitated at the time fell off his bed in hospital { pm me if you wish for the details of the Dublin hospital involved } in the middle of the night.
His wounds weren't even dressed when I called to see him at noon the next day and his face was caked in dry blood.,( he was a pensioner and died a month later )
I of course called the registrar on that occasion who seemed more afraid of a law suit than genuinely interested in my Father.
There are many cases of woe, which have led me to the opinion that simply pouring money into too many hospitals is part of the problem.
And you are very right regarding administration, from what I have heard from Doctors and nurses.
mm

Sparks

Originally posted by Man
I sympathise with your Brother and neighbours situation, But it's not an argument for having hospitals every 20 miles or so, that would be an impossible stretch on resources for such a small country.

No-one is saying that we need a Johns Hopkins every 20 miles - what we are saying is that an A&E department that can stabilise a patient for a rapid transfer, preferably by air ambulance and with paramedics is a necessary system. Closing down A&E departments is not the way to establish such a system.

There was a large amount of talk two years ago about establishing a better system of primary health care in this country (that is, your local GP, but with much more equipment and far better facilities, as well as additional staff in a central health center in every town). That idea would have seen the ability to take a patient from a trauma and get him medical care within a few minutes, which would give him or her far better chances of survival. Has that been dropped? I sure haven't heard anything of it since the election! And how will closing down A&E departments before the "health centres" are up and running to carry the load manage to save lives?

The problem here isn't change - everyone from patients to doctors to voters to politicians agrees that change is needed badly (and have done for years in most cases) - the problem here is the manner in which that change is carried out. Noone with any care for those that are in the system wants to see change carried out in a way that risks lives further.

bandraoi

Alot of you are missing the non-economic point that a doctor needs a certain level of expertise in order to successfully treat an injury.

To keep up a level of expertise they have to see a certain number of patients a year with similiar injuries or problems.

If services are distributed among a wide range of small hospitals then you're going to end up with less skilled doctors.

Even if the small hospitals are there they often can't deal effectively with the emergencies coming to them so they do more harm than good by delaying a patients arrival at a facility which can treat them

Gillie

I'm afraid it seems to be a case of "Wait and see what happens"
I work in the HB and was recently at a meeting about this reform. Our Sernior management had nothing! No Timeframe, No Definite Planning, No Clue. A lot of us came away from that meeting worried about our future employment although we were assured that we would be safe! (I understand and accept that Life & Death issues arrising from a closure of an A&E department far outrank my employment status/problems so theres no need to call be selfish).

We were told that it was Senior Management that would be re-shuffled but quite frankly that didn't go far to relieve the worries.

In my humble opinion I feel that the current gov need to be seen to doing something and whether it works or not they will be ok. If the expected timeframe for these changes is not met while their in government then they can blame the next government.

Why can't they stagger these changes and take care of the important things first i.e. A&E issues, Lack of beds, Doctors, Nurses etc. rather than going hell for leather with radical reform.

As far as overspending/incorrect use of funds go I have seen some examples of that. Usually in the form of a new service being introduced and not considering what it will cost is the long term. One poor example would be here in the HB where they have smoking Ceasation Office that employs to very capable people who are probably on a nice wage. This service is relatively new but why can't an existing broader service (Health Promotion) take care of the Non Smoking community. I release this is a fairly meagre example of Incorrect Spending but it's just something that has bothered me.

Villain

I could be wrong here but I thought the number of doctors needed for A&E was very small usually just one on call. They just stabilise the patient.

Originally posted by Sparks
No-one is saying that we need a Johns Hopkins every 20 miles - what we are saying is that an A&E department that can stabilise a patient for a rapid transfer, preferably by air ambulance and with paramedics is a necessary system. Closing down A&E departments is not the way to establish such a system.

I see what you are saying, all that I am saying is really, that the pot as it exists would be better spent possibly if some hospitals were upgraded at the xpense of others being down graded.
Thats not carte blanche to downgrade all small hospitals , it's just a case of being realistic as to what we can afford and how best to treat patients and where with those resources.
Spending more money more effectively on one hospital 20 miles away from another fits that bill within reason.

mm

Sparks

Originally posted by bandraoi
Alot of you are missing the non-economic point that a doctor needs a certain level of expertise in order to successfully treat an injury.
To keep up a level of expertise they have to see a certain number of patients a year with similiar injuries or problems.
If services are distributed among a wide range of small hospitals then you're going to end up with less skilled doctors.

Yes, because we're totally unable to rotate doctors from hospital to hospital.

Even if the small hospitals are there they often can't deal effectively with the emergencies coming to them so they do more harm than good by delaying a patients arrival at a facility which can treat them

Yes, because it's so unlikely that a doctor would know how to put in a chest drain, or open a trachea, or stop major bleeding, or use an automated defibrillator, or administer a painkiller, or apply a neck brace and backboard, or stabilise a fracture, or ...
Well, you get my point. Second year med students (or even well-trained first aid people) could do those tasks. All of which would increase a patient's chances for survival, some of which would be necessary for survival.
Ambulance drivers are banned from doing any of them. And we don't have paramedics. So closing down A&E departments, even if they're not Johns Hopkins standard, is a bad idea until some other system is in place and operating to take the load.

Sparks

Originally posted by Man
Spending more money more effectively on one hospital 20 miles away from another fits that bill within reason.

Investing in hospital A while just sustaining hospital B would be within the bounds of reason.
Shutting down the A&E ward of hospital B and then investing in hospital A, would be depraved indifference to human life.

See why we're concerned? Besides, why would you shut down A&E wards? Why not wards whose patients aren't under the same level of criticality, like ortho wards?

Originally posted by Sparks

Yes, because it's so unlikely that a doctor would know how to put in a chest drain, or open a trachea, or stop major bleeding, or use an automated defibrillator, or administer a painkiller, or apply a neck brace and backboard, or stabilise a fracture, or ...

At this point I can tell you that In november 2001, I was involved in a car accident less that a mile from home.
An ambulance was called from the base station in the town beside me.
I was strapped to a spinal board and had a neck brace put on me by the two uniformed people in the ambulance.
Are you telling me that these people weren't qualified?? and are banned from doing this??
One of the guys also took my blood pressure several times on the way up to loughlinstown...
Sparks, either these guys were breaking the law or you might be wrong regarding paramedics being available on ambulances.
By the way thank god, I only had cuts and bruises from that accident.

mm

bandraoi

Originally posted by Sparks
Second year med students (or even well-trained first aid people) could do those tasks.

I believe the introduction of paramedics and properly trained ambulance personnel is one of the measures cited in the report as being vital to its implementation.

Villain

Originally posted by bandraoi
I believe the introduction of paramedics and properly trained ambulance personnel is one of the measures cited in the report as being vital to its implementation.

But our shabby old ambulances would NOT have the same equipment as an A&E department.


The main problem with the health IMHO is at management level, money after money has being invested and we'r not getting the results. If this happened in the private sector heads would role!!


edited

Sparks

Are you telling me that these people weren't qualified?? and are banned from doing this?? Sparks, either these guys were breaking the law or you might be wrong regarding paramedics being available on ambulances.

No, they're not paramedics - they're called Emergency Medical Technicians, and we do have a few of them (though not as many as we need). And no, they're not "as good as" paramedics. By which (and I want to stress this), I mean that they are not allowed perform as many procedures, not that they are less competent - they save a lot of lives.
But no, they cannot perform even minor life-saving surgery like putting in a chest drain, or carrying out a traechotomy. They can (and I was wrong about this one) use an AED (that's the automatic defibrillator), though they have to take yet another course (only a day's worth, but annoying when taken on top of the 30 odd weeks of training to become an EMT). They can stabilise you with neck braces and backboards, and they can administer oxygen and do CPR - but they can't give you medication (unless that's been changed too, though I see no evidence of it on the NATS site) or insert a drip to give you fluids, or pretty much anything that would come under the heading of "invasive procedures".
(And ambulance drivers are even more limited)

By the way thank god, I only had cuts and bruises from that accident.

Glad to hear it!