Health reform, here we go again

Sparks

Originally posted by irish1
But our shabby old ambulances would NOT have the same equipment as an A&E department.

And the new ambulances (I think they're called CER ambulances, but it's been a while since I read this), are only for new fleet purchases - so the old ones stay until they don't go anymore.
And the "new" CER ambulance design regulations don't apply to offroad ambulances, so you're still screwed if you need to call out Mountain Rescue (even if they don't get shut down in the next fortnight by the Coast Guard), or have your accident in a field far from the nearest road.

I'm glad they weren't just ambulance drivers then.
Interesting discussion this ( although a very serious and concerning topic )

mm

bonkey

Originally posted by Sparks
And the new ambulances (I think they're called CER ambulances, but it's been a while since I read this), are only for new fleet purchases - so the old ones stay until they don't go anymore.

I'm taking a wild guess here, but I'd say that the reason for that was to keep some control over the rollout process.

At the end of the day, with finite resources, trade-offs must be made. While we would like to overhaul the entire fleet, as well as increase its size, we simply can't afford to do that. So some form of control must be put in place.

The individual issues usually revolve around either spreading yourself thinly to increment across the board, or to concentrate on area after area.

This applies with both where the money from the budget gets allocated, and how it gets spent across the nation after allocation.

Should we vamp up the hospital response services (A&E), SoE, etc.) first, and leave ambulances till later, or do a bit of both together? Once we allocate monies to those areas, do we focus on properly fixing one region after another, or do we trickle bits to each in parallel?

Unfortunately, no matter what way you look at it, some people will not like how you do things.

I'm not convinced that the government is making all the right decisions, but I'm also pretty convinced that their plan is far from all wrong. It will take time, but it was always gonna do that.

What worries me most, is that time the problem with our health system is not solely one of underfunding.

Allocating new money to fill existing gaps is all well and good, but its time that the questions of where the previous money was wasted and what is being done to ensure that this no longer continues are answered. Maybe they have been, but being somewhat out of touch, I haven't seen anything on it.

Paying more per capita on Health Care than any other nation in Europe should give us the ability to bring our services up to their level in a respectable amount of time, but only if we can spend it as well as they have already done. Pissing good money after bad is not the way to fix the HS.

jc

Sparks

Originally posted by bonkey
I'm taking a wild guess here, but I'd say that the reason for that was to keep some control over the rollout process.
At the end of the day, with finite resources, trade-offs must be made. While we would like to overhaul the entire fleet, as well as increase its size, we simply can't afford to do that. So some form of control must be put in place.

From the irish ambulance forum, the cost of a new CEN (not CER, my bad) ambulance is ~130,000 euro. Now that's the vehicle, guess twice to three times that or more per annum in operating expences, from the experience of Berkeley county and Oklahoma City & Tulsa, who were the first examples I could find.

So the first year, say 400,000 euro, and 300,000 euro thereafter, per ambulance.
So Bertie's jet is costing us 17 new ambulances and their first year's operational budget.
(And that's at the level of operation that you need for US paramedics...)

What was that about finite resources again?

Allocating new money to fill existing gaps is all well and good, but its time that the questions of where the previous money was wasted and what is being done to ensure that this no longer continues are answered. Maybe they have been, but being somewhat out of touch, I haven't seen anything on it.

You're not the only one
And you're correct, this has to be done.
I'm just worried that they're going to do this by letting go of the rope with one hand before taking hold with the other...

Originally posted by Sparks


So the first year, say 400,000 euro, and 300,000 euro thereafter, per ambulance.
So Bertie's jet is costing us 17 new ambulances and their first year's operational budget.
(And that's at the level of operation that you need for US paramedics...)

What was that about finite resources again?

Well I'll be giving any FF politician that comes to my door a piece of my mind regarding that.
I've said it before and I'll say it again, it's a scandalous waste of money! It's not as if they have to fly to visit our colonies or anything:rolleyes:
Politicians here especially when they get into government seem to think they can't fly with the plebs!
Well now { Callous name dropping here...but what the hell }, I flew BA from London to Nice during the summer and in rows one and two of that Flight was Sarah Fergusen and her two teenage Princess daughters and their minders.
If scheduled flights are good enough for royalty , they are good enough for anyone!

Originally posted by bonkey:
but its time that the questions of where the previous money was wasted and what is being done to ensure that this no longer continues are answered. Maybe they have been, but being somewhat out of touch, I haven't seen anything on it.

As has been touched on in this thread, a lot of the problems lie in an ineffecient oversized administration and health board structure. The trouble is a lot of these people were put there via political appointments or a couple of steps removed from politics.
So theres a lot of unscratching to be done on a lot of backs before thats streamlined.

mm

bonkey

Originally posted by Man
As has been touched on in this thread, a lot of the problems lie in an ineffecient oversized administration and health board structure.

So people keep saying, and yet when asked to show the figures, they turn as mysteriously silent as the government.

In fact, the only place I can remember reading anything about how much the administrative costs are was something Victor posted here some time ago, to the effect that the admin costs were in the low single percent range.

Personally, while I think the current structure we have is a throwback to parochial Ireland, I don't believe it is where the money is being spent. Well, ok, depends how you read that...administrators spend the money, but its not being spent on administration...if you see what I mean.

But overall, I basically take the stance that if I hear anyone tell me where the problem is and how to fix it, all without the figures to back their argument...that person is trying it on.

To date, the government are falling into that category as successfully as most of the armchair experts who can tell me how to fix the current system without detailed knowledge on how its broken.

jc

Villain

It's not the cost of administrators it how the bloody fools waste the money by mismanagment as I said

"If this happened in the private sector heads would role!!"

Originally posted by bonkey
So people keep saying, and yet when asked to show the figures, they turn as mysteriously silent as the government.

I'll have to admit to starting to get tired Bonkey by the time I posted what you replied to.
The better spirit of what I meant would yes indeed include, the way the money is spent{read wasted in some cases}.
Take this for example, theres a dumb decision that cost the taxpayer €13m with no benefit to the health service.
And then there's this monumental cóck up which is even worse.

Theres over a €100 million spent with no impact on patient care at all.
What kind of Bonus does management like that deserve..?? anyone?? Anyone??

mm

gandalf

Reading back over this thread it has to be an example of what a good discussion should be. It has intelligent views from various different sides of the issues here.

My opinion is simple I think that it is against common sense to close down local A&E's in these hospitals. I am all for Centres of Excellence places that are no more than a hour and a half travel away for treatment of Cancer, Kidney Dialyses, Maternity and other disease treatments that are not immediately life threatening.

However I would have thought that having A&E stabilising units within a close distance would be quite important and I fail to see the logic in pulling back these services to larger treatment centres. I agree with others opinions here that lives will be lost by this action and it is being implemented because FF have to been seen to do something (whether it is the right thing or not).

Gandalf.

Originally posted by gandalf


However I would have thought that having A&E stabilising units within a close distance would be quite important and I fail to see the logic in pulling back these services to larger treatment centres. I agree with others opinions here that lives will be lost by this action and it is being implemented because FF have to been seen to do something (whether it is the right thing or not).

Gandalf.

I am more open to discussion on the location of these facilities.
In some cases I might argue the distance to the local A+E is too great and there may be an argument for looking into actually providing one!
There are people currently on the East Coast who are up to 60 miles from an A+E department for instance.
I've not heard of any campaigns locally mind you for one, which just goes to show what the eye don't see, the heart don't ache for!
It could also mean of course that providing one would be ineffecient or not needed which lessens the case for keeping A+E's open where their services are being unnecessarily duplicated closeby.
I completely fail to see the sense in spending equal amounts of money on two A+E departments within 20-30 miles of each other, when a state of the art facility could be located at one of those centres.
That would make sense to my mind in the light of the need to prioritise resources in a kitty that is not bottomless..
But thats all open to debate, it's at least something the cost and effeciencies of which should in my honest opinion be examined .

mm

Villain

Originally posted by Man

I completely fail to see the sense in spending equal amounts of money on two A+E departments within 20-30 miles of each other, when a state of the art facility could be located at one of those centres.

I take your valid point there Man but I don't think theres too many instances of this except in City's.

Irish Examiner have an article on this issue today:
http://www.examiner.ie/pport/web/ireland/Full_Story/did-sgL-o0528AJms.asp

star gazer

But overall, I basically take the stance that if I hear anyone tell me where the problem is and how to fix it, all without the figures to back their argument...that person is trying it on.
To date, the government are falling into that category as successfully as most of the armchair experts who can tell me how to fix the current system without detailed knowledge on how its broken.
bonkey

really good points.
One of the problems i have with these reports is that they don't apear to tell us what is wrong. None of them are saying we are losing X million here because of Y. There appears to be a kind of superficial 'ideal' set of recommendations that seemed to ignore general local issues with contrasts between a rural county(s) and city catchment for example. While i accept that hanley did two pilot areas and recomends more reports it doesn't appear to be much more than an attempt to comply with EU work directives for junior doctors. Being sceptical i'd say Hanly is a cover for cutbacks that will have to come about to slash the number of hours worked by junior doctors. McCreevy says no more money and unless the 'anecdotal blackhole' in the funding of health services is filled there isn't going to be anything to pay for improved quality care for all.