Irish Health System

Keeks

With the up coming election, My attention is strangely drawn to how our health system works. Or rather the fact that I dont know how it works?

How does it work? What is its structure? How much of its huge budget is taken up with unncessary bureucary?

Since the establishmnet of the HSE i haven't really followed what has happned? I remember that politicans us to sit onthe old health boards and get vasts sums for it. Is this still the case?

NeverSayDie

This site should help, I think it's more from a user/consumer point of view, but it seems to detail the organisations involved:
http://www.citizensinformation.ie/categories/health/how-health-is-organised

CivilServant

So who is to blame for about the BUPA debacle? I'd rather vote against the party who made that happen or am I simplifying things too much?

Plissken1

The HSE are a nightmare. Apart from the fact that they only seem to employ rude people, between the lot of them, they couldnt even run a bath. Lots of large salaries and fancy job titles, no common sense.

spank_inferno

An answer to the poster would be that no one is entirely sure how the Health service is run. It is far from the worst service in the world, but because of its vast scale no manager/minister has been able to do much to improve it.

1 point is that there is no definitive figure for how many people even work in the health service, there are just approximations. This means that no one can be sure how many managers there should be in the organisation.
There are either too few or far too many

From what I can gague its run similar to a "corporate model"
But whatever model its run on, its run far too much for the benefit of the employees rather than the consumer.
Expenditure is kept very tight so this impacts on those who need services(thinking especialy of those with disabilities).
But there is little of this dicipline when it comes to the wage bill.

Wages in the health service must surely take up most of the budget.
This should be controlled before services to the citizens of ireland are restricted at all

Heinrich

Not looking for someone to blame for the mess that is the Health Service I think we can attribute accountability to the lady whom the electorate voted into parliament and the gentleman who, as head of parliament, appointed the lady to the position.

If the top men in corporate fail as the HS has done their heads would roll. Our answer is to grant huge "bonusses" to Drum and Co.

Government ministers do it themselves as far as increases go.

Let's see what the electorate say in June and if they put the current inept leaders back in then we should at leasr be accorded the courtesy of silence...

CivilServant

CivilServant wrote:

So who is to blame for about the BUPA debacle?

BUPA?

GusherING

The Irish Health Care system is a hybrid, it is half universal health care and half corporate. This is the single biggest problem in my opinion, we are a bit of both but not one or the other.

All patients in Ireland are entitled to free health care service, yet our facilities in every sector of the health system are insufficient to meet demand, due largely to chronic under-investment over a sustained period of time (ie. when the country was poor). Huge investment is required now, but even when we are pumping billions in now, the gap will need more spending and to be sustained over time in the future.

Under Charlie Haughey in the late 1970's, Consultant doctors were given contracts where they work 33 hours in a public hospital and are paid by the state and get a pension. What they do during those 33 hours is up to them, there is no monitoring whatsoever of how their time is spent. Whether that time is spent on public patients without insurance or private patients with VHI or Bupa cover is up to the doctor himself. On top of the 33 hours they are paid by the state, consultants are free to do as many private patients as they like, so their income is boosted considerably higher (and their public pay ain't half bad, c.100,000e a year!). Needless to say, reform of this one sided system is near impossible, the doctors always kick up a fuss. Why would they give up the sweetest deal in the country?

Now beacuse of the aforementioned facility deficit, the doctors have a choice of patients, either the public ones, who their state contract is paying them to look after with no supervision as to whether they do or not, or the private patient who will earn them a 'bonus' payment from the insurance company. Nobody is checking to see how many public patients are dealt with, its not in the contract you see. The incentive exists for the private patient to be chosen everytime.

So what we have here is the creation of a two-tier system, where those who have private insurance get helped first, beacuse the doctors have most to gain from them. If you are a public patient, you're kept at the back of the queue for months and years in cases because you are not regarded as an incentive to the doctors. Personally, I think this discrimination is outrageous, I think those who are most sick or urgent should get precedent rather than how your treatment is being paid for.

Ask anybody who buys insurance why they do it. They'll say 'to skip the queues' 90% of the time. Remember, health insurance is very expensive and not everybody can afford it, especially the poorest in our society. Lets work this out now: I am poor so I can't afford private insurance and to be seen quickly I need private insurance otherwise I will be on a waiting list for months. What type of people are waiting the longest? Not the rich and healthy, but the poor and sickest. What sort of country are we when we allow this to rest on our conscience?

If I had to say who is responsible, I'd say everyone who voted in an election in the last 30 years for governments which allowed this mess to occur. Thats pretty much every party and thus, every citizen.

Keeks

Correct me if I am wrong but did Micheál Martin try to do a complete overhaul of the Irish health system when he was Minister for health and get shafted in the process?

spank_inferno

I think he did, And Mary Harney similarly so.

But a combination of lack of political will and the weight of all the vested interests in the health service skupper most attempts at reform.

I feel sorry for Harney, she wanted this poisoned chalice and I doubt there was a queue of FF guys eager for the brief. I wonder if she regrets the decision now?

1 issue I thought she was bang on about was the construction of private hospitals, but the media gave a bad perception of the idea.

Imagine this: At the moment hundreds of hospital beds paid for by the tax payer are occupied in "private wings" for patients on vhi/bupa etc.
Thats a huge potential supply of capacity for the overstretched public patient sector, available on the same site.
The idea was to encourage private enterprise to construct private hospitals.
then if the private patients move away from public hospitals this would free up space for public patients

net result: More hospital space for those who need it most
cost: Not much but for the tax breaks given to companies to build these hospitals.

Unfortunately the media considered this privatisation of the health service.
The reality was it was the nationalisation of private bed capacity in public hospitals.

No left/right ideoligy Bulls**t.... just an example of 1 reform plan.

probably will never happen mind... elections a comin

Heinrich

The health service do not "run" it simply staggers from one crisis to the next. The following editorial from the Irish Independent highlights some gruesome facts.

For instance the lady who died of cancer and her family being told she could now come in for treatment.

They spend a fortune on staffing with the disastrous results as we are now being made aware of. They then issue a statement that they will be engaging consultants to see where they are going wrong. The figures they stated were inaccurate as they later announced. Nobody seems to know what is going on.

Nobody is accountable as Mrs Harney can blame the HSE and they can blame her. Or perhaps the patients should not be falling ill. When voting time comes along I am persuaded that even the most incompetent could "manage" the debacles as easily as the curent *management*

Misery and the health service

LIKE the traumatised victim of a car crash condemned to watch the event over and over again in slow motion, we seem destined to continually address some freshly highlighted failing of our costly health service.

A pattern repeats itself. Public attention is drawn to individual misfortune, as in the Leas Cross case, or a patient's long hours spent on trolleys, or a death caused by MRSA.

Then we are reminded of the huge sums being spent on health and the inability to deliver value.

A case in point is the absence of a free nationwide cervical screening programme, despite 200 new cases detected each year and 70 deaths each year. The attendant delay in delivering test results is a scandal.

As always, the figures translate into individual misery. Today we report the case of a woman who had to wait ten months for the result of her cervical smear test and is now fearfully awaiting the results of a second test.

In other countries a result is available within two or three weeks.

Recently a woman told how, eight weeks after her sister had died of cancer, her family received a phone call from a doctor asking when she would be able to attend for treatment. She was speaking at the launch of a research consortium called Cervica which is to study prevalence rates, public attitudes and conduct a cost/benefit analysis of screening methods.

People are weary of groundwork and surveys. Some 175 reports on the health services have been published since 1997. The public need the health service to start delivering.

The benefits of massive spending trickle far too slowly onto the hospital wards. This year, about €14bn of taxpayers' money will be spent, most of it on salaries.

Three years ago, the Brennan Report turned a critical eye on accountability in the health service. It would be interesting to know how many of the report's 136 recommendations, many of them unpalatable to a government intent on cosseting the public service, have been implemented.

In the meantime, we would like to know why it is so difficult to introduce an effective cervical cancer screening programme, as other European countries have done.

On second thoughts, we don't want to know why. We just want to see it up and running.

Keeks

Henrich where is that quote taken from?

Captain Trips

GusherING wrote:

Under Charlie Haughey in the late 1970's, Consultant doctors were given contracts where they work 33 hours in a public hospital and are paid by the state and get a pension. What they do during those 33 hours is up to them, there is no monitoring whatsoever of how their time is spent. Whether that time is spent on public patients without insurance or private patients with VHI or Bupa cover is up to the doctor himself. On top of the 33 hours they are paid by the state, consultants are free to do as many private patients as they like, so their income is boosted considerably higher (and their public pay ain't half bad, c.100,000e a year!). Needless to say, reform of this one sided system is near impossible, the doctors always kick up a fuss. Why would they give up the sweetest deal in the country?.

I think that's a bit unfair - the doctors ARE obligated to treat public patients that are under their care - and they don't pick and choose when they arrive at A/E, which is the only way to access medical care as the system has been managed - and not managed by doctors but by managers. This is the same problem the NHS in the UK has, too much adminstrative managerial culture, and too little listening to doctors and nurses. Currently managers can get over £100,000 over their in a truly "corporate" structure, and the result as we see is not pretty if you;ve been following at all.

So, any public patient that arrives in a hospital, you or me, we will be under the care of a consultant that has no choice in treatment; so, if someone brings a relative in that needs a social residential placement but can't get it, they arrive at A/E, they get admitted and the result is another bed gone.

We have the 5th highest number of hospital beds per capita in the WORLD. Yes, look at NationMaster to check.

However, again we see today that the HSE were going to blow €100,000,000 on consultancy fees (that's to the likes of Morgan Stanley, etc.,not hospital consultants - the words are similar and useful for the Indo's political leanings) - that is the wasteful corporate strutcure of running it "like a business" - because that's where the major expenses are.

To the poster asking how come he doesn't know how it works or it's functions, I suggest perhaps reading the HSE website, which has it's structure and departments detailed in full with contact numbers. One search in google and I found http://www.hse.ie/en/AboutUs/FiletoUpload,3998,en.pdf.

We can see that in the 2005 financial report, available here http://www.hse.ie/en/Publications/HSEPublications/AnnualReportFinancialStatements2005/FiletoUpload,3194,en.pdf a few interesting things:

Overall budget was over 11 billion. Pay for clinical staff accounted for 2.5 billion - that is ALL of the nurses, doctors, OTs, everyone who actually has a clinical job interacting with patients. Over half that again went on NON-clinical pay. The vast majority of the health budget - over 78% - is nothing to do with salaries for clinical staff at all.

According to this [/url]http://archives.tcm.ie/businesspost/2006/11/26/story19165.asp[/url], €2 billion of the €2.5 for pay goes to nursing staff.

I'd rather my doctor or nurse (or prison officer or garda) got paid well, as opposed to a lacky TD or some MBA goon from Goldman Sachs, or a golfing buddy who gets a construction deal on a hospital or HSE building, or a buddy who gets the contract for €50 million for voting machines, etc., etc. etc., .

FlutterinBantam

[QUOTE=Captain Trips

I'd rather my doctor or nurse (or prison officer or garda) got paid well, as opposed to a lacky TD or some MBA goon from Goldman Sachs, or a golfing buddy who gets a construction deal on a hospital or HSE building, or a buddy who gets the contract for €50 million for voting machines, etc., etc. etc., .[/QUOTE]


Last I heard all those people are extremely well paid.

You see, the problem is that a lot of the front line staff and professionals see their job as 9-5 Mon -Fri.
So lets face reality, use the facilities to the maximum and tell the punters who want a nice steady nine to five number to try the civil service.

Victor

Heinrich wrote:

If the top men in corporate fail as the HS has done their heads would roll. Our answer is to grant huge "bonusses" to Drum and Co.

How many corporate types, in companies with 100,000 employees, would have a similar base salary?

Heinrich

Victor wrote:

How many corporate types, in companies with 100,000 employees, would have a similar base salary?

Never mind the base salaries, what we are discussing is the gross incomptence and the positions the incompetents hold!

Hobbes

spank_inferno wrote:

An answer to the poster would be that no one is entirely sure how the Health service is run. It is far from the worst service in the world

We should be comparing ourselves to the best in the world, not the worst.

dajaffa

What puzzles me is where has all the money been going over the last few years. As far as I can see there's billions being pumped into hospital admin rather than on employing more doctors, nurses, physios etc or increasing the number of beds.

As far as I'm concerned the number one problem with the Health Service is the lack of spaces in state-run nursing homes. A lack of these, (generally private ones are of a lower standard, partially due to the fact that they are just there to make a profit imo) leads to many elderly people ending up staying in hospitals far longer than is needed cause if they go home the community care isn't up to scratch and there's often not a hope of a bed in a nursing home in the short to medium term. 66% of patients in Irish hospitals are over the age of 65. The shortage of long-stay beds results in beds intended for rehab patients being clogged up by patients waiting for a long stay bed.

Furthermore a leaf we really ought to take out of Australia's book is to hire a much larger number of nurses aids (there they have 1 for every 2 patients) which would result in the retention of more Irish trained nurses staying in Ireland to work. Many of those who have been hired over the last few years who were trained in other countries simply aren't as well trained as those that trained in Ireland.

Another point is that we don't even offer enough posts for interns in the Irish healthcare system and many graduates leave to work in other countries because they actually cannot get a job in Ireland without waiting around for a year or 6 months so they leave. Anyone who watched "Junior Doctors" on RTE should be in no doubt that there is a clear shortage of interns resulting in those who get jobs working huge amount of overtime which costs more than it would to hire more initially, + result in a better service.

My personal pet hate is that there are practically no jobs for basic grade physios + many end up having to work as temps in offices because of the huge lack of jobs. On the ground there is a shortage, but the funding isn't there for more. Long-term if funding were in place it would actually save money as many patients would be able to leave hospitals after a shorter period of time as they would receive proper rehab more frequently...

*is stopping ranting before fuse-blowing ensues*

is_that_so

One of the problems that the Health service had is that it was "destroyed" (an ex health professional who worked there in the 80s said this to me) in the 1980s.

In the days of belt-tightening health suffered very badly. Much of the cash that went in the late 90s was just catching up. The health service is a monolith and IMO many parts of it are still strongly resistant to change. The idea of bringing Professor Drumm in to run it was that his no-nonsense approach would shake things up.

Matched up against that are all the vested interests to ensure that things don't change or change in a way that suits them. Health as a ministry is almost a political kiss of death. No-one gets out alive. All the jumping up and down and ranting that we do will not get things to improve until everyone who has a stake in it has a desire to improve it for the benefit of all and not for powerful lobby groups.

Rebeller

Our health service is in the state it's in not only because of serious lack of investment during Champagne Charlie's belt tightening years of the 80s but more particularly as a result of successive governments' failure to tackle deep rooted vested interests and incompetence within the system.

Health Service staff themselves have to accept some responsibility for the failings of the system instead of blaming "lack of resources" for every failing.

For example, lack of hygiene (i.e. doctors and nurses failing to wash their hands after going to the toilet or between patients) has been identified as one of the primary causes of the high rate of MRSA infection in our hospitals.

The doctors and nurse blame lack of resources for this, which is just ridiculous.

You do not need increased investment to get people to follow basic hygiene practices such as washing your hands after taking a piss etc etc. People working in the restaurant business accept that hand washing is a standard requirement of the job. It's a bit scary to think that our supposedly highly educated medical professionals were never taught by their mammies and daddies to wipe wash their hands after wiping their arses (excuse the vulgarity).

The above stems from the never ending failing of all aspects of Irish society since the foundation of the state........the inability to take responsibility for one's actions.

Guess what, if someone dies through neglect in a nursing home or the incompetence of a surgeon, or a nurses forgetting to wash her hands after visiting the bathroom, then someone is always responsible. The "system" cannot be blame for everything as of it was an independent self existing entity separate from those who work within it.

If you're willing to accept big salaries like Professor Drum and Minister Harney then the buck stops with you for any failures.

If I work in a shop and consistently fail to account for takings at the end of each night I will most likely eventually be fired.

If you are elected to office to serve the interests of your nation and repeatedly fail to accomplish anything then you need to step aside.

If you accept a job as head of the HSE and fail to accomplish any of the tasks you were hired to do then you need to take responsibility and resign or lose your job.

Lack of accountabilty and failure to take responsibility for one's actions is at the root of Ireland's health service fiasco.

dajaffa

Rebeller wrote:

Health Service staff themselves have to accept some responsibility for the failings of the system instead of blaming "lack of resources" for every failing.

For example, lack of hygiene (i.e. doctors and nurses failing to wash their hands after going to the toilet or between patients) has been identified as one of the primary causes of the high rate of MRSA infection in our hospitals.

Though that is true, lack of resources is a problem too for that example. Most wards in Crumlin for example have too few toilets that have to be shared by the patients and this is a major issue with regard to the spread of infection.

nesf

Rebeller wrote:

If you're willing to accept big salaries like Professor Drum and Minister Harney then the buck stops with you for any failures.

How does that work? If I go into a shop that's part of a big chain and trip over some oil that's been spilt on the ground by a store assistant, is the general manager of the chain responsible because they earn a large salary or is it the person who spilt the oil and neglected to clean it up responsible?

How can your pay dictate your level of responsibility? Really, I fail to see how someone else being paid more absolves other's of responsibility.


The vested interests in the health service are usually ignored in the rush to blame the HSE or Mary Harney for the problems within the health service. For a much talked about topic, most people seem to have no clue about how the system works. Par for the course in this country though.

InFront

I think it's obvious that he means if someone is going to take on the job with all of its responsibilities and benefits, then you need to take the blame when your policies go wrong. And not say... blame nurses. Not that Minister Harney would ever do such a thing.

ronbyrne2005

we spend much more per capita on health system than the worlds best systems so the staff in our system or the deployment of resources(by admin etc) must be less effecient than worlds best. Why cant we just copy best practise of say france and canada? The medical staff in our system are among best paid in world when pensions etc are taken into account but they always want more. There should be enough resources in the system to provide world class service but its not happening although i think a&e issue clouds the wider issue and we may have been coming from a low resource base. The fact that the minister is ideologically in favour of privatisation is also a difficulty. Maybe everyone should be given free medical insurance and privatise the whole system or nationalise the whole system and run it in an international best practise benchmarked way(like french system) but the current system seems not to be working, get international consultants/experts to review and propose the best way and just do it and feck the unions etc.

nesf

InFront wrote:

I think it's obvious that he means if someone is going to take on the job with all of its responsibilities and benefits, then you need to take the blame when your policies go wrong. And not say... blame nurses. Not that Minister Harney would ever do such a thing.

No, he simply equated salary with responsibility. Also, for me anyway, the responsibility argument falls into the 'ought implies can' problem. Someone's level of responsibility is roughly tied to their ability to effect or prevent what occured. Mary Harney, for instance, has a lot more control over national policy than the actions of individual nurses yet some people seem to hold her equally responsible for both. I find that childish and more than a little silly tbh.

Vorsprung

ronbyrne2005 wrote:

we spend much more per capita on health system

OECD wrote:

Total health spending accounted for 7.1% of GDP in Ireland in 2004, some way below the latest available average of 8.9% across OECD countries. The United States is, by far, the country that spends the most on health as a share of its economy, with 15.3% of its GDP allocated to health in 2004. Switzerland and Germany followed with, respectively, 11.6% and 10.9% of their GDP spent on health. Several EU countries - France, Belgium, Greece and Portugal – also devoted 10% or more of GDP to health in 2004.

Linky

And in Ireland we count social spending as part of the health budget, so in real terms we spend about 80% of the budget on front line services. Don't have a source for that, my Public Health lecturer said it on Friday

I agree with Rebeller when he says that its up to staff to contribute to hygiene. But as dajaffa said it is down to resources too. People with MRSA in beds beside people with CF in Vincents don't exactly inspire confidence. 2 toilets per ward in Vincents also, and one shower.

Rebeller

InFront wrote:

I think it's obvious that he means if someone is going to take on the job with all of its responsibilities and benefits, then you need to take the blame when your policies go wrong. And not say... blame nurses. Not that Minister Harney would ever do such a thing.

Yes, this is exactly what I meant.

nesf wrote:

No, he simply equated salary with responsibility. Also, for me anyway, the responsibility argument falls into the 'ought implies can' problem. Someone's level of responsibility is roughly tied to their ability to effect or prevent what occured. Mary Harney, for instance, has a lot more control over national policy than the actions of individual nurses yet some people seem to hold her equally responsible for both. I find that childish and more than a little silly tbh

If a situation of increases in violent crime, reduction in detection and conviction rates and longstanding evidence of police corruption and incompetence prevails unchecked under the watch of a serving Garda Commissioner and Minister for Justice then it is they who are ultimately responsible and should either resign or be removed from office.

While neither party may have been directly involved in the above actions both are responsible for identifying such issues and dealing with them. Just as bus drivers are paid to drive the buses, Ministers are paid to run the state on our behalf as our public representatives.

Joe soap does not have any control over who is appointed to senior management, decision-making positions within the health service, department of justice etc. Joe soap pays his taxes (unless he is a member of the super rich club of course) and elects (supposedly) competent political representatives to set up, operate and manage the day to day services expected in any wealthy, developed, western European constitutional democracy. Joe soap neither cares or wants to know how the various services work. Joe soap wants to get to work in a reasonable amount of time by car or on public transport; Joe Soap wants to be able to turn on the tap to get water to quench his thirst; Joe Soap wants to be able to avail of world-class health care if he falls ill. Joe Soap does not want to know how the roads are built, what makes the buses run, where tap water comes from or how the health service bureaucracy works. Joe Soap pays his public representatives and senior public managers such as Mary Hearney, Bertie Ahern and Professor Drum to worry about such things.

In exchange for competently, effectively and accountably spending our tax euros and providing us with easily accessible, efficient, well run public services we pay these public representatives and public sector managers 6 figure salaries, we provide our competent resourceful ministers with luxury jets and chauffeur driven mercedes so they can avoid the inconveniences and irritations of day to day life (traffic jams etc) and devote their available time to solving the nation's problems and effectively spending our tax euros.

If the MD of a large multinational corporation fails to address ever-falling production levels and drops in sales he will ultimately be held accountable even though he or she might not have been directly responsible for either of these problems.

It comes down to this: if you want the power and the pay the buck stops with you when the sh*t hits the fan!

nesf

Rebeller wrote:

If a situation of increases in violent crime, reduction in detection and conviction rates and longstanding evidence of police corruption and incompetence prevails unchecked under the watch of a serving Garda Commissioner and Minister for Justice then it is they who are ultimately responsible and should either resign or be removed from office.

While neither party may have been directly involved in the above actions both are responsible for identifying such issues and dealing with them. Just as bus drivers are paid to drive the buses, Ministers are paid to run the state on our behalf as our public representatives.

Joe soap does not have any control over who is appointed to senior management, decision-making positions within the health service, department of justice etc. Joe soap pays his taxes (unless he is a member of the super rich club of course) and elects (supposedly) competent political representatives to set up, operate and manage the day to day services expected in any wealthy, developed, western European constitutional democracy. Joe soap neither cares or wants to know how the various services work. Joe soap wants to get to work in a reasonable amount of time by car or on public transport; Joe Soap wants to be able to turn on the tap to get water to quench his thirst; Joe Soap wants to be able to avail of world-class health care if he falls ill. Joe Soap does not want to know how the roads are built, what makes the buses run, where tap water comes from or how the health service bureaucracy works. Joe Soap pays his public representatives and senior public managers such as Mary Hearney, Bertie Ahern and Professor Drum to worry about such things.

In exchange for competently, effectively and accountably spending our tax euros and providing us with easily accessible, efficient, well run public services we pay these public representatives and public sector managers 6 figure salaries, we provide our competent resourceful ministers with luxury jets and chauffeur driven mercedes so they can avoid the inconveniences and irritations of day to day life (traffic jams etc) and devote their available time to solving the nation's problems and effectively spending our tax euros.

If the MD of a large multinational corporation fails to address ever-falling production levels and drops in sales he will ultimately be held accountable even though he or she might not have been directly responsible for either of these problems.

It comes down to this: if you want the power and the pay the buck stops with you when the sh*t hits the fan!

See, I took issue with your equating of earnings with responsibility not necessarily the idea of politicians taking responsibility for their 'area'. Though, personally, I don't blame Martin Cullen for the poor signing on the road outside. I blame the City Council. Ditto with crime and the local gardai. Overall policy regarding transport or justice I hold politicians responsible for, but I'm not naive enough to believe that they can have much impact on the rank and file operation of things in this country. There is far too much inertia in the institutions, and taking on public servants usually results in essential services being hit by strikes which no one wants to see.

The biggest issue is the combination of the state, Joe Soap and the media. Joe soap gets up in arms over something that the media has told them and the state, usually, reacts to them and changes tack. Generally, this is a bad thing regardless of all the romantic imagery associated with the common man. Too many of them 'believe what they read' if you know what I mean.

tallaght01

GusherING makes a point about consultants being able to see who they like, whether they be private or public patients during their "33hours" per week. As a doctor, I certainly wasn't aware that this is the case. I'm not saying that it's not possibly hiden somewhere deep in the recesses of the consultant contract, but does the poster have any evidence for this? I'll move back to Ireland if it's true lol. All of the consultants in my neonatal intensive care unit work about 60 hours per week. This was the same when I was in Ireland. When I did A+E in Ireland, there was only one consultant for the whole (extremely busy) unit. By the time they hired another one, he'd been the only consultant there for 6months (ie he was on call 24hours a day, 7days a week for 6months!)

Then FlutterinBantam says that "a lot of the front line staff see their job as 9-5 Mon -Fri. So lets face reality, use the facilities to the maximum and tell the punters who want a nice steady nine to five number to try the civil service". Again, not entirely convinced that's true. I, and most of my colleagues, work many hours beyond what we're rostered for each day, for no remuneration, and that's been the case everywhere I've worked. Most docs don't get a lunch break. I certainly don't even bring sandwiches to work anymore because I know I won't get to eat them. We all, virtually without exception, work nights and weekends. Docs are probably the most extreme example of poor working hours, but other healthcare professions get similarly shafted.

Then rebeller makes some nonsensical point linking in MRSA with the current health crisis. MRSA is a problem, with many more factors involved than handwashing. It's also the case that the health service was a shambles long before MRSA was common. MRSA is a problem, but it's eradication would only lead to a tiny change in the healthcare mess.

I realise this post isn't strong on solutions, but I just wanted to put the case of the healthcare professionals into the mix, seeing as some people were making some pretty outlandish comments.

Kind regards

Rebeller

tallaght01 wrote:

Then rebeller makes some nonsensical point linking in MRSA with the current health crisis. MRSA is a problem, with many more factors involved than handwashing. It's also the case that the health service was a shambles long before MRSA was common. MRSA is a problem, but it's eradication would only lead to a tiny change in the healthcare mess.

My point is that the MRSA problem is but a symptom of the prevailing lack of accountability and unwillingness to take responsibly that is a feature of all public institutions/services in this state, none more so than the health service.

I do not believe that the service is entirely staffed by uncaring, irresponsible "employees" looking for a cushy 9-5 number. There are many who go well above and beyond the call of duty so to speak but who are frustrated in their efforts by a culture of inertia and foot dragging.

However, those who work in the front line of any system have a vital role to play (and should take on a part of the responsibility) in bringing about effective reform of said system.

The role played by doctors, nurses and other medical professionals is vastly different from the role played by the average joe soap working in his local pub or grocery store. For that reason there are much greater demands on medical professionals. The nature of the job requires working hours that will be longer and perhaps more antisocial (people don't always choose when to get sick after all) than those worked by your average public servant or private sector office employee. For this good compensation is offered.

Vast root and branch reform of the entire structure of the system needs to be carried out. This will take great courage and determination and a willingness to commit political suicide. I won't hold my breath on that one if the current shower are voted in again this year!

Lack of resources in itself is not the problem. It is the failure to account for how that money is spent and whether or not true value for money is obtained for all our tax euros that is at issue.

Free universal public health care is the only way forward. This can only be achieved through increased taxation (it is far more equitable for all to contribute according to their means [PAYE] rather than all pay the same price regardless of financial circumstances on the open private insurance health market)

It is no longer acceptable that medical practitioners are responsible for regulating their own profession (the same applies to the legal and auctioneering professions etc). An independent non political regulatory medical authority needs to be set up to govern all aspects of medical training, qualification and practice. Why not introduce greater democracy into the system by allowing for the direct election of the head of the HSE for example?

Health Managers should be given greater autonomy in how allocated budgets are spent. However, this needs to be tied in with far greater accountability.

Perhaps they could be obliged to report to the HSE on a monthly basis with explanations of how resources are being allocated, the number of procedures being carried out where appropriate and what steps are being taken to reduce waiting lists etc etc.

Repeated failure to achieve stated goals would result in dismissal.

The problems of our health service will only be solved by getting tough.

I accept that it might make the job less pleasant (in the short term anyway) for many of those working on the coal face but benefits will be seen in the long term.

My comments and opinions are expressed as an infrequent (thankfully) user of the system.

ronbyrne2005

bigjimthefirst wrote:

Linky

And in Ireland we count social spending as part of the health budget, so in real terms we spend about 80% of the budget on front line services. Don't have a source for that, my Public Health lecturer said it on Friday

I agree with Rebeller when he says that its up to staff to contribute to hygiene. But as dajaffa said it is down to resources too. People with MRSA in beds beside people with CF in Vincents don't exactly inspire confidence. 2 toilets per ward in Vincents also, and one shower.

Using GDP figures are inaccurate(our gdp levels are distorted by high levels of multinational activity here). Dividing amount spent by population is more accurate while accounting for age differences(older countries have more older people who get sicker more often etc)