Irish Health System

ressem

And in Ireland we count social spending as part of the health budget

I saw this IMO speech transcript
http://www.imo.ie/view_categories.php?cat_id=596&doc_id=4143&sCat=596
that among other criticisms, states that rent allowance, childrens shoes, youth services etc are included in the health budget, accounting for 2.4 billion of the headline spending in '04. Perhaps that's what your lecturer was talking about?



Re:MRSA
BBC radio reported on policy in Denmark, which involved isolating incoming patients that came from high risk institutions, nursing homes etc, until they are cleared for MRSA. The consequence in Scandanavia was a 90%+ drop in MRSA infections down to 1% of intensive care patients. Compared to 20% in France, and ? in Ireland. Seems sensible. Chances of seeing it in Ireland?

http://news.independent.co.uk/uk/health_medical/article2083868.ece

Re:rundown
I'm not old enough to remember the '80s health system, so can anyone link/elaborate on in what ways was it run down so much, in such an way that can't be reversed in 10 years? Only I would have thought that only increasing doctor and nurse training numbers had that sort of lag.

And again, according to the IMO link, GP numbers have been static for 10 years.

gandalf

Looks like Mary and the HSE are impliementing Fantasy Health Care figures with regard to the much lauded Cancer care initiative. No real surprise there then.

Harney defends cancer care strategy timescale

19 January 2007 19:10

The Minister for Health, Mary Harney, has denied claims that the Government's Cancer Care Strategy cannot be delivered by 2011 as planned.

Her comments follow the leaking of an internal Health Service Executive document which said the timeframe was 'not achievable'.

Ms Harney said the leaked document had been surpassed by recent developments, and that neither she nor the HSE accepted its contention that the plan could only be fully delivered by 2013 or 2014.

The leaked document also complained that the HSE had not been consulted before the strategy was announced, and pointed out that there was no experience in Ireland with Public Private Partnerships for the provision of health facilities.

John McCormack of the Irish Cancer Society says the plan must be implemented as soon as possible.

http://www.rte.ie/news/2007/0119/cancer.html

This is the kind of story the papers should be highlighting not manufactured ones about who is going to shack up with who after the next election.

tallaght01

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.

MRSA is a hushed up scurge responsible for misery and deaths wholesale in our hospitals because hygene is not being enforced.
You go to hospital to be cured/treated not killed.

It's eradication should be a health care imperative-it's far from being a tiny problem.

tallaght01

Tristrame wrote:

MRSA is a hushed up scurge responsible for misery and deaths wholesale in our hospitals because hygene is not being enforced.
You go to hospital to be cured/treated not killed.

It's eradication should be a health care imperative-it's far from being a tiny problem.

I didn't say it was a tiny problem. I said it won't make much difference to the state of the health service if it was eradicated. If you believe otherwise, then that's fine. I wouldn't bother having that argument with you. LIke I said, the hospials were a mess before MRSA reared it's head. And "hushed up?". What's the evidence for that? I don't work in Ireland anymore, so would appreciate a link to your proof.

People get really stressed about MRSA, when in reality the big drains on hospital resources are smoking, boozing, drugs and unhealthy lifestyles. People are very quick to blame hospitals for their ill health, but are much slower to take responsibilty for their own health. Just go into your local respiratory unit, and see how much MRSA is a problem compared to smoking rlated illnes....go into your local gastroenterology unit and see how big a problem MRSA is when compared to alcohol abuse and viral hepatitis....I could go on by talking about cardiology units etc.

Not saying MRSA isn't a a problem (In fact not sure where tristrame thnks I was making that point at all) but that we need to put it into perspective. Just coz it's in the newspapers, doesn't mean it's the biggest health priority.


Kind regards

Rebeller

tallaght01 wrote:

People get really stressed about MRSA, when in reality the big drains on hospital resources are smoking, boozing, drugs and unhealthy lifestyles. People are very quick to blame hospitals for their ill health, but are much slower to take responsibilty for their own health.

:eek: :eek: :eek:

Yes, I agree the cause of the problems in our healthcare system are those selfish people who insist on getting sick all the time! And what about those inconsiderate b**tards who insist on sending their children to school causing classroom overcrowding!!!

Come on! Puleesssse!. I am assuming from your last post

tallaght01 wrote:

All of the consultants in my neonatal intensive care unit...

that you work in the healthcare business (nurse, doctor etc.)

If I'm correct in that assumption then what you have stated above is indicative of the arrogance and uncaring attitude endemic in the medical profession in this country.

For someone who has decided to become a member of a profession which plays such a vital role in society to express such a view is extremely worrying.

It is perhaps further evidence of what really lies behind the problems of our health system disaster?

is_that_so

I had a conversation with a HSE employee about the whole Health system recently and I was reminded of the BBC show screened last week. Hopefully it will be repeated. This link and this one echo many of the comments posted here. Interestingly Gerry Robinson comes to the same conclusion that it's a "can do" attitude from all stakeholders that will help make it happen.

tallaght01

Rebeller wrote:

:eek: :eek: :eek:

Yes, I agree the cause of the problems in our healthcare system are those selfish people who insist on getting sick all the time! And what about those inconsiderate b**tards who insist on sending their children to school causing classroom overcrowding!!!

Come on! Puleesssse!. I am assuming from your last post



that you work in the healthcare business (nurse, doctor etc.)

If I'm correct in that assumption then what you have stated above is indicative of the arrogance and uncaring attitude endemic in the medical profession in this country.

For someone who has decided to become a member of a profession which plays such a vital role in society to express such a view is extremely worrying.

It is perhaps further evidence of what really lies behind the problems of our health system disaster?

I probably shouldn't reply to this tosh, but I will anyway. The point I was making is that there's a huge media fenzy about MRSA. There's much less of a frenzy about the other causes of ill health. Smoking related illness, diet related illness, alcohol related illness/accidents and drug related illness/accidents cause many many many more times the amount of death and illness than MRSA does. These deaths occur more commonly the more poor you are, as you have a higher likelihood of being a smoker/heavy dinker/drug abuser/having a poor diet. My research interests are in public health...ie how to help these people. As oposed to not giving a damn about them, as rebeller seems to be implying.

Do other posters think that asking the public to take responsibility for their health is controversial? If the general consensus is yes, then I'll happily take it back.

As for the snide comments about the use of "my" when describing the unit where I work...people talk about "my" school, "my" office, "my" family, my "flight", "my" village all the time, without the presumption of ownership. Again, if people point out that it's not the cause, I'll officially retract the "My". I can replace it with "The people of Glasgow's" if we would prefer.

Uncaring, arrogant and unsympathetic. Ah, that old chestnut about health professionals "in this country", when I specifically said I work overseas.

Just for the record...and I appreciate I shouldn't get sucked into this....I'm a doctor in an intensive care unit for premature babies. I work in Glasgow. I've worked in Glasgow for several years because they have possibly the most deprived population in Europe. They have pretty much the poorest health in Europe, or the developed world in fact. I got into medicine to help the most vulnerable people.

Aswell as doing childrens medicine in Africa for free, I have done adult acute medicine in the east end of glasgow. I was rostered to finish at 5 most days. I would never ever get a lunch break. I would never ever finish before 8pm. Thats 3 hours free overtime per day,aswell as working through lunch. I came in for a few hours every sunday, without pay. I did this because I care deeply about my patients. I regularly also did oncall for 13 hours a time. 9am until 9pm. I would never ever leave before midnight. I would never ever get a lunchbreak. many, probably most, of my patients had illnesses that were, to a degree, self inflicted. I still stayed by their bed while they were dying. I don't judge. I just state the facts. These are the people I want to help.

Eventually you burn out. I now do childrens medicine. The hours are essentially the same. I get paid less per hour than most people in the hospital if you include all the overtime I do for free. I still work about 15-20 hours per week overtime for free. I have just worked 10 nightshifts in a row. 3 were unpaid. I deal with the sickest babies in the country. I deal with the most distraught parents in the country. I have been ill twice in the last month, mostly because I'm run down and exhausted. This is pretty normal for me and many of my colleagues. I don't take time off work, because we don't have enough staff. I don't go home and talk about work. I don't look for praise.

But it really annyoys me when people perpetuate this myth of us swanning around like some stereotyped doctor from a carry on movie, spending our days on the golf course, and treating our patients like faceless numbers.

To anybody who has read the entirity of this tripe, I apologise. Sometimes you just have to let rip.

Kind regards.

aidan_walsh

The point I was making is that there's a huge media fenzy about MRSA. There's much less of a frenzy about the other causes of ill health. Smoking related illness, diet related illness, alcohol related illness/accidents and drug related illness/accidents cause many many many more times the amount of death and illness than MRSA does. These deaths occur more commonly the more poor you are, as you have a higher likelihood of being a smoker/heavy dinker/drug abuser/having a poor diet. My research interests are in public health...ie how to help these people. As oposed to not giving a damn about them, as rebeller seems to be implying.

I have yet to hear of a hospital ward being closed because someone has smoking-related cancer or binge-related blood alcohol poisoning.

Do other posters think that asking the public to take responsibility for their health is controversial?

No. But that's their prerogative and the health service is there to look after them irrespective of their personal life choices. They don't need to get sicker in hospital just because they are there at all.

tallaght01

aidan_walsh wrote:

I have yet to hear of a hospital ward being closed because someone has smoking-related cancer or binge-related blood alcohol poisoning.


No. But that's their prerogative and the health service is there to look after them irrespective of their personal life choices. They don't need to get sicker in hospital just because they are there at all.

Amazing. You have never heard of wards being closed because of alcohol or smoking related illness??? Try pretty much every ward at some point during the year. They all get full and have to close. It's why people wait on trolleys trying to get into these wards. Also, ward closures, are a tiny drain on our health service compared to MRSA in the grand scheme of things. I've said before, just coz it's in the papers, doesn't mean it's the biggest health issue.

And the health service does look after those with self inflicted illness. Of course we do. These are the people I work like a dog for. What's your point exactly?

Dr Galen

tallaght01 its quite alright mate. I can certainly back you up on a lot of what you say in your post. I'm friends with many Junior Doc's (interns) and to be honest their life sucks. Again they are due to finish at 5.30 each day but they're never out before at least 7, and they're generally always on before me and i start at 7.15am.

What really gets me though is the oncall shifts. The interns come in and work a full day, then are on call for the night, with maybe 2 hours sleep and then work the rest of the following day. A lot of the time they'll get maybe a few quick breaks for food during the day but certainly not a "lunch hour". How this can be tolerated I dunno.

Previous posters have been making points about MRSA. And your right, its very worrying and is certainly a big issue in our health service. There are many reasons and causes for the rise of it, and yes, hygiene standards are in there, but to make generalised statements about health professionals never washing hands is wrong mate. I agree work needs to be done for sure, but the vast majority of healthcare workers are meticulous about hand washing, not only because of MRSA, but dude, imagine the kind of stuff we get on our hands........of course we're always washing them. Oher people have linked to stats about MRSA rates etc so I'm not going to again, and the suggestion was made about isolation for suspected high risk patients, whcih is a great idea...in theory, not enuogh isolation rooms, and pretty much all hospitals screnn patients that are transferred in from nursing homes/other hospitals as soon as they arrive.

sorry now cos i've gone a bit OT, we're not discussing MRSA but the Health System in general.

is_that_so

The health system here has a problem with MRSA it probably should not have. We are the worst in Europe for it and a lot of that is down to dubious hygiene, both personal and institutional. MRSA is preventable or can be minimised. Agreed it is not a drain but it is one simple thing we can't even get right.

aidan_walsh

You have never heard of wards being closed because of alcohol or smoking related illness??? Try pretty much every ward at some point during the year. They all get full and have to close. It's why people wait on trolleys trying to get into these wards.

Perhaps I didn't put enough emphasis on the word someone.

Also, ward closures, are a tiny drain on our health service compared to MRSA in the grand scheme of things. I've said before, just coz it's in the papers, doesn't mean it's the biggest health issue.

Agreed, the media has a habit of blowing things out of proportion.

And the health service does look after those with self inflicted illness. Of course we do. These are the people I work like a dog for. What's your point exactly?

The problem is that MRSA is something that the health service has to tackle, not the general public. And so far there has been a massive failing in that respect, which is letting both the public and the service down. There have been studies which show that health staff weren't taking even the simplest hygiene precautions, washing their hands. How can anyone say that thats a failing of anyone but the systems?

tallaght01

aidan_walsh wrote:

Perhaps I didn't put enough emphasis on the word someone.



The problem is that MRSA is something that the health service has to tackle, not the general public. And so far there has been a massive failing in that respect, which is letting both the public and the service down. There have been studies which show that health staff weren't taking even the simplest hygiene precautions, washing their hands. How can anyone say that thats a failing of anyone but the systems?

"someone" or "1000000" people is irrlevant. For eg, HIV is much bigger health issue in the world than MRSA, but a ward has never been shut because "someone" has HIV. I still don't understand ur point.

in terms of your second point, I'm not sure about your studies, and their sample size and their P-value, confidence intervals etc. But, and I'm sure the nurse who posted above will back me up on this, its an exceptional rarity for medical and nursing staff not to wash hands many many many times during the course of a shift.
I work with an amazing team of nurses, and their hygiene is immaculate. But occasionally we get an MRSA outbreak. The poor nurses i work with have terrible dry skin on their hands from washing them so often with the rubbish soap that the hospital supplies. As I type, i've a huge area of dry skin on my hand from crazy amounts of handwasing. Doctors and nurses are not the only people who touch patients, ya know

Kind regards

Dr Galen

The problem is that MRSA is something that the health service has to tackle, not the general public.

unfortunately thats not strictly true. the service definitely needs to do more i agree on both an institutional level and a personal one, but visitors and patients also need to do this too. we have signs up everywhere asking families to use the alcohol gel and explaining why its needed and do they do it....:D well ok sometimes. maybe if the HSE engaged in a proper campaign of education for the general public this would help, and would also help cut down on the spread of other hospital acquired infections ie winter vomiting bug, C Dif, etc etc. So what I'm saying is that, everyone has a bit to do in this,

There have been studies which show that health staff weren't taking even the simplest hygiene precautions, washing their hands. How can anyone say that thats a failing of anyone but the systems?

Not questioning your words here, but do you have any sources or links that I can have a look at, interested to see the results etc. I'd also likew to ask you have you been witness to the general widespread non washing of hands that you seem to be implying here. Like I've already said mate, from what I see everyday hand washing is habitual now. Sure, its drummed into us from the first day of starting college and the same for the other professions.

But your points on how handwashing can seriously cut down on the spread of such infections is very true and i also agree that more work needs to be done, but its not enough to just say this, can I ask, have you any solutions or ideas?

Anyways, the OP didn't start a thread about MRSA so maybe we'll leave it there.

tallaght01

Your right, nurse baz. It's not an MRSA thread. It's time to knock it on the head :P

However, MRSA is a political issue. I'm sure you'd agree that it takes up a disproportionate amount of media time than what it deserves. It therefore becomes an issue that the politicians care about.

I would argue that they care more about MRSA now than they do about smoking, drinking etc. Do you agree?

aidan_walsh

unfortunately thats not strictly true. the service definitely needs to do more i agree on both an institutional level and a personal one, but visitors and patients also need to do this too. we have signs up everywhere asking families to use the alcohol gel and explaining why its needed and do they do it.... well ok sometimes. maybe if the HSE engaged in a proper campaign of education for the general public this would help, and would also help cut down on the spread of other hospital acquired infections ie winter vomiting bug, C Dif, etc etc. So what I'm saying is that, everyone has a bit to do in this,

Fair point.

Not questioning your words here, but do you have any sources or links that I can have a look at, interested to see the results etc.

Only the National Hygiene Audit 2005 and 2006. The situation has been improving, but there are still problem hospitals.

I'd also likew to ask you have you been witness to the general widespread non washing of hands that you seem to be implying here.

Personally, no. Thankfully I don't have much cause to be in hospitals on a regular basis, so much of what I understand comes from third party sources.

Like I've already said mate, from what I see everyday hand washing is habitual now. Sure, its drummed into us from the first day of starting college and the same for the other professions.

But why was it let lapse? Not a question aimed at anyone here, as I know nobody can answer it, just a general comment.

its not enough to just say this, can I ask, have you any solutions or ideas?

You're right, more education, more stringent hygiene policies for the visiting public as well as working professionals. But we also need to see enforcement of those policies, and that I don't know.

faceman

Im quite shocked at some of the posts in this thread. Are we that naive to believe that doctors and nurses are the cause of MRSA and other issues in health care in ireland? aidan_walsh, just what is your point?

There are international regulations in place to govern how many hours pilots can fly a plane and how much time they get off after rosters. Why isnt there something similar for our medical professionals? (There is something in the uk from what i understand, but its not enforced)

The minister for health is at the top of the foodchain. And this country has never had a decent minister for health for as long as im alive. If we need changes, its him we need to lobby. Doctors are overworked, fact. But doctors and nurses didnt cause MRSA. Crowded hospitals, poor facilities, fatigued staff. Get on to the people who decide the budget and manage the funds/resources.

Dr Galen

maybe we can have an MRSA discussion at another time, but I feel that'l only be fuelling the media hyped fire over it. Believe me, there are much bigger things out there that Mr Average Public needs to be worried about other than MRSA.

As for the Health System, why don't we close it all down and start again....

well because in fifty years time our grandkids will be having the same argument imo. The system is rife with issues, all have been mentioned before but i see very few solutions.

It'd be great if I could encourage people to use their vote and get things chancged but I honestly don't really believe it will make the differnece that some people think it would. At the end of the day whether its Bertie, Enda, Pat or Jabba the Hut in charge, we'll still have bloated management structures, inflexible contracts, and a system that really doesn't allow for change in a short space of time

Dr Galen

god my typing has gone to sh1te

faceman

nurse_baz wrote:

It'd be great if I could encourage people to use their vote and get things chancged but I honestly don't really believe it will make the differnece that some people think it would. At the end of the day whether its Bertie, Enda, Pat or Jabba the Hut in charge, we'll still have bloated management structures, inflexible contracts, and a system that really doesn't allow for change in a short space of time

exactly. there is no one in government with the qualifications, guts and ability to see things through, to bring reform into the health system. The government needs to bring fresh eyes and brains here.

To be fair tho nurse_baz, i dont know if any of the other parties would make much difference either?

tallaght01

Thanks for the kind words, faceman. Its good to know that some people realise that most docs and nurses try their best and are in the job for the right reasons.

For those who aren't interested enough to read botht he national hygiene audits that were linked above, they show that the hands of hospital staff are generally very clean. I'm not sure what the poster is using them to get at.

Kind regards.

is_that_so

faceman wrote:

Im quite shocked at some of the posts in this thread. Are we that naive to believe that doctors and nurses are the cause of MRSA and other issues in health care in ireland? aidan_walsh, just what is your point?

There are international regulations in place to govern how many hours pilots can fly a plane and how much time they get off after rosters. Why isnt there something similar for our medical professionals? (There is something in the uk from what i understand, but its not enforced)

The minister for health is at the top of the foodchain. And this country has never had a decent minister for health for as long as im alive. If we need changes, its him we need to lobby. Doctors are overworked, fact. But doctors and nurses didnt cause MRSA. Crowded hospitals, poor facilities, fatigued staff. Get on to the people who decide the budget and manage the funds/resources.

Not all of it is resources and I agree with you that some doctors and nurses at the coalface do their best. Much of the rest of it is politics and resistance to change. Alas there are others along with administrators and parts of the HSE whose position is questionable. There is a lot of politics at work on all sides.

As regards a good minister Harney is the closest we have come to a good minister in some time. However until such time as all vested interests are faced down and made aware that they are all stakeholders in fixing it, Health will remain a ministerial graveyard. That is something that our politicians can do.

faceman

is_that_so wrote:

Not all of it is resources and I agree with you that some doctors and nurses at the coalface do their best. Much of the rest of it is politics and resistance to change. Alas there are others along with administrators and parts of the HSE whose position is questionable. There is a lot of politics at work on all sides.

As regards a good minister Harney is the closest we have come to a good minister in some time. However until such time as all vested interests are faced down and made aware that they are all stakeholders in fixing it, Health will remain a ministerial graveyard. That is something that our politicians can do.

Harney was the best of a bad bunch, which still isnt good enough when its comes to something like healthcare.

We need to be clear in our understanding though, the issues need to be addressed from the top down. Leave the sensationalist stories of blaming doctors and nurses to the tabloids and the late late show! Maybe we should introduce a mandate that states only doctors/nurses who develop eczema from handwashing are permitted to handle patients? (kidding)

gandalf

In the last 2 years I have had a closer sight of the Health Service than I really wanted due to family illness and death. MRSA was a factor in my fathers death btw.

The one thing that is obvious is that the doctors and nurses in the system are doing their best, I could not fault any of them, some were a bit unfriendly but thats understandable given the pressure they are under. Whats obvious is there are not enough front line staff and the hospital is top heavy with administration who seem to be preoccupied with finding out if you have VHI or not (and getting the patient to sign up for private care even though they are in a public hospital).

The one thing we hear is we are spending more money on the health service than ever before, even more than some of the leading countries for health care. Given the government do things like this http://www.rte.ie/news/2005/0104/health.html its little wonder. I thought the idea of setting up the HSE was to streamline the admin side of things, can't very well do that and give people jobs for life.

is_that_so

I asked someone from the HSE how long it will take to "fix" and they reckoned 10 years assuming that everyone can be brought on board. If this is indeed the case then it might be better for them to manage our expectations. At the very least we should get some indications where they are and where they are going to. Like that Bank of Ireland ad a few years back - 100 steps to better banking.
The HSE is almost like an oil tanker - it takes a long time for it to stop and turn round.

oscarBravo

nurse_baz wrote:

the service definitely needs to do more i agree on both an institutional level and a personal one, but visitors and patients also need to do this too.

Agreed. I'm regularly shocked, when visiting people in hospital, at the sheer number of members of the public who leave the toilets without washing their hands - including some who've just emerged from a cubicle, eww.

Dr Galen

if anyone is interested Primetime tonight is all about A&E 1 year on.