The HSE

Floppybits

I felt I had to start a thread to get peoples feelings on the performance of the HSE. My own feelings are that this organization is responsible for a lot of the problems in the health care system. They seem to sometimes act without thinking and this causes major problems, the most recent being the miss D case in the courts. I don’t think that they act in the best interest of the patient and I think this can be seen with the state the AandE departments are in.

In other areas they don’t act all and we have seen this in the two appalling tragedies in the Wexford. I mean after the first tragedy you would have thought that the HSE would have moved heaven and earth to get some sort of out of hours counselling service set up to maybe help avoid tragedies like this happening again but no they did nothing after the first one and then left the second up to a priest and garda to try and help. Have they done anything since to improve this?

Another thing that I don’t like about the HSE is the amount of money they waste be it on spin doctors or marketing people, the money wasted on PPARS. If that money was redirected into different areas of the health service, possibly cleaning and maintenance or hiring more nurses or doctors, not managers, then maybe things would be a bit better. Also the arrogance of the HSE, maybe this is just me but I find that they are so arrogant that they feel that they don’t have to answer to anyone, now maybe that stems from the arrogance that is shown by the current government.

Yesterday was the first time I have seen anyone criticise the HSE and that was a judge and have we heard any sort of statement from the HSE, nope nothing not a dickie bird.

Could it be that the job of managing the health service is just to big for the HSE and maybe another way of handling the health service needs to be looked at?

Anyway that is my view on the HSE. I would gladly love to hear other people’s views on this organisation.

FlutterinBantam

The HSE consists of EVERYBODY involved in public health care in Ireland.

perhaps a realisation of that little fact would be a start??

tallaght01

Is the health service executive not an executive panel responsible for the running of the healthcare system?
That was my impression, but I work in the UK, so may well be misinformed.

Mitch Connor

FlutterinBantam wrote:

The HSE consists of EVERYBODY involved in public health care in Ireland.

perhaps a realisation of that little fact would be a start??

in mostly the same was as the government consists of everyone in ireland, in that we all have a say.

Floppybits

Ok, I will re-phrase my question, Are you happy with the performance of the HSE?

Are you happy with the fact there is no out of hours support for people who might be contemplating Suicide?

Are you happy that a poor girl was dragged through the courts for no other reason than someone want to cover their Butt?

Are you happy having to wait days in A+E?

I will tell you Im not. You all say the HSE represents the people of Ireland, I dont think they do, If they did then the questions above wouldnt need to be answered.

sam34

Floppybits wrote:

Are you happy with the fact there is no out of hours support for people who might be contemplating Suicide?
.

there is. every area in this country has a designated psychiatric unit which provides 24/7 cover for assessment and treatment & management of suicidal people, depressed people, distressed people, psychotic people,neurotic people................
these services are provided by a junior doctor and a consulatant on call 24/7

just because social workers are not available, it doesnt mean nobody is available.

Wishbone Ash

sam34 wrote:

there is. every area in this country has a designated psychiatric unit which provides 24/7 cover for assessment and treatment & management of suicidal people, depressed people, distressed people, psychotic people,neurotic people...............

If there are no available beds, the person is sometimes turned away!

ronbyrne2005

Do you think the government and the HSE want things the way they are? Obviously not. Now Im no fan of government but they have increased the amount spent on system from 4 to 14 billion in last ten years, we now spend 3500euro per year for every man woman and child in the country. This is more than in other better health systems like France,UK and Canada. It is actually quite hard to start up a new management structure to run such a massive organisation. /theres the legacy of the old health board systems, too much admin in places, too many managers, inefficient work practises, communication problems, factions fighting for power etc etc. They should really have brought in an international expert or someone who has managed health systems before rather than Prof Drumm who is a doctor not a manger/CEO . So basically the government has thrown cash at the problem without implementing efficent, effective management and work practises. Bertie and co are afraid to take on unions (mainly admin unions) and force changes that are needed. If theres capital requirements then borrow whats required and build all the facilities needed and also make a single tier quality system like NHS.

FlutterinBantam

Good man Ron... thats it in a few paragraphs.

I agree with everything you say except that Prof. Drumm was as qualified and well thought of as anyone else in that field,to solve the problem.

gandalf

Yeah ronbyrne you have highlighted the problem. The Government have thrown good money after bad with NO responsibility at all for it. The HSE was formed from all the Health Boards but no one lost their jobs.

Surely when organisations merge then functions like IT, Admin, Middle Management, Upper Management are duplicated therefore logically I would expect redundancies?

Instead these people were guaranteed Jobs for life?

How many beds do 15,000 Admins jobs buy?

I'm a labour supporter but the time has come for Public jobs to be open to the same conditions as those of us that work in the Private sector.

Hotblack Desiato

gandalf wrote:

I'm a labour supporter but the time has come for Public jobs to be open to the same conditions as those of us that work in the Private sector.

The Department of Finance always refuses to make a redundancy offer - that's the only thing stopping any public servant surplus to requirements from losing their job. Contrary to public opinion there is no right to a "job for life".

sam34

Wishbone Ash wrote:

If there are no available beds, the person is sometimes turned away!

yes, this can happen sometimes. but not always. and anyway the person may not even need admission. not everybody who thinks of suicide or threatens it is going to do it. the psychiatrist has to make a clinical judgement in every case. but that doesnt take away from th fact that the service for assessment and treatment is always there. treatment doesnt have to equal admission.

thebitterpill

I disagree sam.

Availability and accessability are two different things. Without a service being easily accessable it's availibility is irrelevent. This is especially true for mental health services. If a mentally ill patient has to jump through twenty hoops to get seen, they won't get seen. The way psychiatry is set up in this country is that there are many hoops. People get shuttled around between hospitals, doctors and units. They ring around and get told to ring someone else continuously.

The fact that there are no support services available outside of 9-5 mon-friday is a significant impediment to those seeking help. Do you really expect someone who is depressed and suicidal to first ring a GP, be told to ring a 2nd and maybe a 3rd GP, till one agrees to see them. See the GP, be referred to a unit only to arrive there and be told they are in the wrong catchment area and then have to go to a second unit? Because often that's what patients are put through.

The same applies to relatives of mentally ill patients trying to get help for them. It's hard enough getting someone to go see one person, much less dragging them around like a yo-yo till you get to someone willing to help. Families need support services to help them access the availible mental health services. Psychiatrists on call are hardly going to be able to leave there post to go to someone's house at 3am on Saturday morning. Esp if they are the only psychiatrist in that hospital that night.

sam34

thebitterpill wrote:

I disagree sam.

Availability and accessability are two different things. Without a service being easily accessable it's availibility is irrelevent. This is especially true for mental health services. If a mentally ill patient has to jump through twenty hoops to get seen, they won't get seen. The way psychiatry is set up in this country is that there are many hoops. People get shuttled around between hospitals, doctors and units. They ring around and get told to ring someone else continuously.

The fact that there are no support services available outside of 9-5 mon-friday is a significant impediment to those seeking help. Do you really expect someone who is depressed and suicidal to first ring a GP, be told to ring a 2nd and maybe a 3rd GP, till one agrees to see them. See the GP, be referred to a unit only to arrive there and be told they are in the wrong catchment area and then have to go to a second unit? Because often that's what patients are put through.

The same applies to relatives of mentally ill patients trying to get help for them. It's hard enough getting someone to go see one person, much less dragging them around like a yo-yo till you get to someone willing to help. Families need support services to help them access the availible mental health services. Psychiatrists on call are hardly going to be able to leave there post to go to someone's house at 3am on Saturday morning. Esp if they are the only psychiatrist in that hospital that night.

things are not quite as grim as you'd have us believe, i think. yes, psych services in this country operate on a catchment area basis. all "established" patients know this, and know where they should attend. new patients should by and large be referred by a gp, and the gps know the system, or can find out with a quick call. and if for whatever reason the gp doesnt know and cant find out, if they send the patient to their nearest a&e the patient will have to have a psych assessment before being sent home or elsewhere. ( i know this doesnt help the a&e problems but thats another issue)

i dont know whyy you say there are no "support services" available outside 9 to 5 mon to fri- there are services available, as i have already outlined.

with regards families accessing help--- not sure if you are familiar with the new mental health act, i suspect you're not. if someone is posing a danger to themselves or others due to a mental illness, then they can be certified to their local unit. if they are at home and refusng to go to hospital, then the family can ask the unit for an "assisted admission", whereby staff from the unit go to the patients home and bring them in.
And no, the psychiatrist on call doesnt go to peoples houses while on duty. firstly, their primary duty is to the ward and they cant be disappearing off for a few hours with nobody available to cover the ward. and anyway, do cardiologists go to the home of patients with chest pain? no. do neurologists call to the homes of their MS patients who are relapsing? no. this is impractical and unnecessary.

finally, could you explain exactly what you mean by "support services" - apparantly you dont consider 24 hr medical cover to be a support service. also you think that families should have supportservices to help them access the mental health services. Eh?? could you clarify who this would be?

thebitterpill

sam, if only it was so easy. The reality is what you are saying sounds fine in theory and on paper but in practise it doesn't work like that. Having worked in psychiatry and being in contact with people who need to access the mental health services paints a very different picture.

sam34 wrote:

things are not quite as grim as you'd have us believe, i think. yes, psych services in this country operate on a catchment area basis. all "established" patients know this, and know where they should attend.

Established patients might know which hospital they should go to. But that doesn't make it any easier for someone who is suicidal and depressed to actually get in a car and drive for forty minutes on a motorway to get to the service while their mental state is deteriorating. Nor is it a very good idea. Established patients do commit suicide, I submit, that is a failing of a service. They might want to go to the nearest A&E, but they will know from experience that unless the hospital has a psych department they will simply be told to go to another unit anyway. But we can blame the patient if you prefer. Often established patients will ring a psych unit and say they are unwell and be told to go to their GP first.

new patients should by and large be referred by a gp, and the gps know the system, or can find out with a quick call. and if for whatever reason the gp doesnt know and cant find out, if they send the patient to their nearest a&e the patient will have to have a psych assessment before being sent home or elsewhere. ( i know this doesnt help the a&e problems but thats another issue)

Again great in theory. The reality that is repeated by patients time and time again is there is no one number to call to get help, though one might think that a call to the GP on call service should do the trick. Most people dont want to admit they might have a mental illness. Though they might speak to a social worker who can help them get the help they need. But that avenue is not availible outside hours. GP's don't always have all the catchment area information. Patients get referred to psych units only to be told they are in the wrong place.

i dont know whyy you say there are no "support services" available outside 9 to 5 mon to fri- there are services available, as i have already outlined.

A single psychiatrist on call in a hospital for 200-300k population is not a 'service.' And certainly not a community based service.

with regards families accessing help--- not sure if you are familiar with the new mental health act, i suspect you're not.

I would ask you to not make presumptions about what I know and don't know. I've actually worked in psychiatry in Ireland, and was there for the transition into the new mental health act. I suspect from your posts that you lack this practical experience.

if someone is posing a danger to themselves or others due to a mental illness, then they can be certified to their local unit. if they are at home and refusng to go to hospital, then the family can ask the unit for an "assisted admission", whereby staff from the unit go to the patients home and bring them in.

It's not so cut and dry. For someone with no past history of mental illness it's actually very difficult to 'commit' them against their will. They are lots of grey areas, and it can be a difficult clinical decision for a psychiatrist, much less a GP.
The units are horribly short staffed. It's not as easy as you think to just drive over and cart someone to a psych unit. The bueracracy involved is immense. I had to fight tooth and nail on call to get a patient escorted to a medical hospital from a psych unit for treatment of wounds because we didn't have the basic facilities at our unit and were not 'covered,' to treat them. The staff wanted the patients family to take the responsiblity because they couldn't spare anyone.

And no, the psychiatrist on call doesnt go to peoples houses while on duty. firstly, their primary duty is to the ward and they cant be disappearing off for a few hours with nobody available to cover the ward. and anyway, do cardiologists go to the home of patients with chest pain? no. do neurologists call to the homes of their MS patients who are relapsing? no. this is impractical and unnecessary.

that is the difference between psychiatry and general medicine, which I suspect you are unaware of. Psychiatry is and needs to be a COMMUNITY BASED service, where as general medicine is by necessity an institution based service.

finally, could you explain exactly what you mean by "support services" - apparantly you dont consider 24 hr medical cover to be a support service. also you think that families should have supportservices to help them access the mental health services. Eh?? could you clarify who this would be?

social workers, community psychaitric nurses, community rapid response intervention teams.

sam34

thebitterpill wrote:

sam, if only it was so easy. The reality is what you are saying sounds fine in theory and on paper but in practise it doesn't work like that. Having worked in psychiatry and being in contact with people who need to access the mental health services paints a very different picture.



Established patients might know which hospital they should go to. But that doesn't make it any easier for someone who is suicidal and depressed to actually get in a car and drive for forty minutes on a motorway to get to the service while their mental state is deteriorating. Nor is it a very good idea. Established patients do commit suicide, I submit, that is a failing of a service. They might want to go to the nearest A&E, but they will know from experience that unless the hospital has a psych department they will simply be told to go to another unit anyway. But we can blame the patient if you prefer. Often established patients will ring a psych unit and say they are unwell and be told to go to their GP first.



Again great in theory. The reality that is repeated by patients time and time again is there is no one number to call to get help, though one might think that a call to the GP on call service should do the trick. Most people dont want to admit they might have a mental illness. Though they might speak to a social worker who can help them get the help they need. But that avenue is not availible outside hours. GP's don't always have all the catchment area information. Patients get referred to psych units only to be told they are in the wrong place.



A single psychiatrist on call in a hospital for 200-300k population is not a 'service.' And certainly not a community based service.



I would ask you to not make presumptions about what I know and don't know. I've actually worked in psychiatry in Ireland, and was there for the transition into the new mental health act. I suspect from your posts that you lack this practical experience.



It's not so cut and dry. For someone with no past history of mental illness it's actually very difficult to 'commit' them against their will. They are lots of grey areas, and it can be a difficult clinical decision for a psychiatrist, much less a GP.
The units are horribly short staffed. It's not as easy as you think to just drive over and cart someone to a psych unit. The bueracracy involved is immense. I had to fight tooth and nail on call to get a patient escorted to a medical hospital from a psych unit for treatment of wounds because we didn't have the basic facilities at our unit and were not 'covered,' to treat them. The staff wanted the patients family to take the responsiblity because they couldn't spare anyone.



that is the difference between psychiatry and general medicine, which I suspect you are unaware of. Psychiatry is and needs to be a COMMUNITY BASED service, where as general medicine is by necessity an institution based service.


social workers, community psychaitric nurses, community rapid response intervention teams.

firstly, you asked me not to make presumptions about what you do and do not know, yet you then go on to make two presumptions about me- one, that i "lack the experience" of working in psychiatry in ireland and through the transition to the new MHA. this is wrong, i have many years of experience in psych in ireland, am a fully qualified psychiatrist and have worked using both the old and new MHAs. Secondly you assume that i dont know the difference between psychaitry and general medicine- believe me im all too aware of the difference. so there we have two (incorrect) presumptions made by you. maybe you should practice what you preach and not make assumptions.

secondly, its never "easy" for someone whose mental state is deteriorating to "drive 40 mins on a motorway" to a hospital. what about family? friends? taxi? CPN? ambulance?
you "admit" that established patients do commit suicide, which you think is a "failing of the service". its not always a service failure. suicide can be considered and is considered by many to be an end state of depression and other severe and enduring mental illnesses. its not always preventible, and will never always be preventible.

and if established patients ring a psych unit and are told go to a gp first - well, the reality is that not everyone will need referral to hospital, often things can be sorted out in primary care. same as if someone rang a cardiology ward, they'd be told attend a gp first.

if gps dont have the catchment area info immediately to hand, they can find it out very easily.its not rocket science.

why does someone need a social worker "to help them get the help they need"?if they can pick up the phone and ring a SW than thay can pick up the phone and ring a doctor. save them waiting for a SW to ring back.

i dont know where you have worked that has a catchment area of 200 to 300k. no place i have worked in or heard of has that size catchment area. and one psychiatrist on call is providing a service. patients will be assessed and managed. patients wont be turned away because the doctor is tired or busy. and the psych services are not claiming that they are community based. that is what the govt and MHC foresee but the reality is that we are a long way from a nationwide community based service, and all psychiatrists are very keenly aware of that.

its actually quite straight forward to commit someone to hospital. i dont see how you can say its a difficult decision for a gp - they dont make the decision to admit, when they sign the form all they are signing a recommendation for assessment by a consultant psychiatrist. its then up to the psychiatrist whether to proceed with detention. and the principle is the same hether the patient has a history or not.
getting someone transferred to a gen hosp from a psych unit is totally different to an assisted admission. the bureaucracy in an assisted admission is far from "immense". quite straight forward actually.

with regards to your penultimate post, psychiatry IS not (yet) community based.

the psychiatric services are not perfect, im not trying to pretend they are. im well aware they're not. but im fed up of having to defend them to people who make sweeping statements.

thebitterpill

sam34 wrote:

firstly, you asked me not to make presumptions about what you do and do not know, yet you then go on to make two presumptions about me- one, that i "lack the experience" of working in psychiatry in ireland and through the transition to the new MHA. this is wrong, i have many years of experience in psych in ireland, am a fully qualified psychiatrist and have worked using both the old and new MHAs. Secondly you assume that i dont know the difference between psychaitry and general medicine- believe me im all too aware of the difference. so there we have two (incorrect) presumptions made by you. maybe you should practice what you preach and not make assumptions.

I think you missed the point I was trying to make. Which is that it is easy to make assumptions, and I used a couple of my own to illustrate that point. I used your wording 'i suspect,' speficially to make that point.

secondly, its never "easy" for someone whose mental state is deteriorating to "drive 40 mins on a motorway" to a hospital. what about family? friends? taxi? CPN? ambulance?

Not if they are alone. CPN's aren't availible 24/7. Again we are talking about someone who is depressed.

you "admit" that established patients do commit suicide, which you think is a "failing of the service". its not always a service failure. suicide can be considered and is considered by many to be an end state of depression and other severe and enduring mental illnesses. its not always preventible, and will never always be preventible.

Certainly. As two examples, I believe the deaths of the DUNNE family are a failure of the service. As was the case when a mother was turned away and drowned herself and her two children a couple of years ago. It may not be always preventable however the reality is that the service is not up to scratch and not easy to access. And even if we accept that not every suicide is preventable it's obvious to see that more would be prevented if the service was PROPERLY resourced and RUN.

and if established patients ring a psych unit and are told go to a gp first - well, the reality is that not everyone will need referral to hospital, often things can be sorted out in primary care. same as if someone rang a cardiology ward, they'd be told attend a gp first.

my point is and was that patients get carted around. Ring the hospital, go see the GP, GP says go to A&E, A&E say go to psych unit.

if gps dont have the catchment area info immediately to hand, they can find it out very easily.its not rocket science.

The GP at night is usually the doc on call, they usually just ring whichever psych unit is closest, which to me makes more sense than shuttling patients around based on catchment area.

why does someone need a social worker "to help them get the help they need"?if they can pick up the phone and ring a SW than thay can pick up the phone and ring a doctor. save them waiting for a SW to ring back.

Because the reality is that patients get the short end of the stick and get shafted and shuttled between services, doctors and units. A social worker understands the system and can put pressure on medical personal to do the right thing.

i dont know where you have worked that has a catchment area of 200 to 300k. no place i have worked in or heard of has that size catchment area. and one psychiatrist on call is providing a service. patients will be assessed and managed. patients wont be turned away because the doctor is tired or busy. and the psych services are not claiming that they are community based. that is what the govt and MHC foresee but the reality is that we are a long way from a nationwide community based service, and all psychiatrists are very keenly aware of that.

I'll give you a couple of examples. Drogedha has a population of 70-80k people and is part of a larger catchment area with several other towns all attached to a single institution for psychiatric services. Dublin has a population of what? 3-4 million people? How many psychiatrists are on call in hospitals in dublin at night? I'm not saying who is claiming what. Psychiatry in Ireland should be community based and we are far short of that. I'm glad that's something we can both agree on, that we are a long way from providing a community based service, which is considered best practise by the government and the mental health comission as well as the UK.

its actually quite straight forward to commit someone to hospital. i dont see how you can say its a difficult decision for a gp - they dont make the decision to admit, when they sign the form all they are signing a recommendation for assessment by a consultant psychiatrist. its then up to the psychiatrist whether to proceed with detention. and the principle is the same hether the patient has a history or not.
getting someone transferred to a gen hosp from a psych unit is totally different to an assisted admission. the bureaucracy in an assisted admission is far from "immense". quite straight forward actually.

I don't know if you are a consultant, but that statement is true for consultants only. Once you actually manage to get someone down to the unit, all the consultant has to do is waltz in the next morning make an assessment and sign a form. But this is an onerous task at night when there are no support services and a skeleton crew.

with regards to your penultimate post, psychiatry IS not (yet) community based.

My point exactly. It falls far short of providing a community based service in this country. But psychiatry is a community based profession.

the psychiatric services are not perfect, im not trying to pretend they are. im well aware they're not. but im fed up of having to defend them to people who make sweeping statements.

Not perfect? That's a gross understatement. Psychiatry in Ireland is grossly under resourced, and poorly run. In fact, wasn't there a report from the mental health commision a few months ago about just how ABYSMAL the services are? Or what about the Prime Time program on RTE a few months back highlighting the plight of young men stuck in Long stay wards in psychiatric hospitals.

I'm going to leave you with the last word on this debate in your next post cause otherwise there would be no end.

Just a quick question. Are you a consultant?

sam34

just to answer a few of your points:
no, cpn's arent available 24/7. taxis are. as are ambulances. and just because people are depressed it doesnt mean they dont have family and friends.

the dunne and grace family tragedies arent failures of the psych services because the services werent at all involved in either of the cases. psychiatrists cant be responsible for people theyve never assessed or treated.

if the on call doc rings the nearest psych unit and that isnt the correct one then the staff in taht unit will be able to redirect them to the appropriate unit. not rocket science.

the catchment area system aims to reduce "shuttling" between units and patients falling between two stools. everyone who is relevant knows who is looking after the patient and where they should go.

cant see your point re the gp and certifying. all the gp has to do is see the patient and sign the form if theyve any concerns this patient is a danger. the gp does not have to get the person to hospital, thats up to the staff of teh unit if an assisted admission is required. the gp is not making any major decisions, all theyre doing is looking for a consultant opinion. the consultant (many of whom come in whenever the patient does btw and doesnt wait to the next day to "waltz in") is the one signing the order to detain the patient and therefore taking all the responsibility.

the prime time programme was pretty sensationalist and onesided. i can say this as i knew a lot of the patients on it.

ive no idea what you are specialising in or if youre training to be a gp.however im prepared to bet that your speciality doesnt offer a perfect service either. but making sweeping generalised critical statements doesnt help.

and no, im not a consultant, im an SR.

btw, nice way of getting out of having to reply to any of my above points!;)

ronbyrne2005

Have visited people in public and private pyschiatric hospitals and public ones are kips. Shocking lack of general and specific psychotherapy in public service too.

sam34

ronbyrne2005 wrote:

Have visited people in public and private pyschiatric hospitals and public ones are kips. Shocking lack of general and specific psychotherapy in public service too.

lets all jump on the anti-psychiatry bandwagon, shall we?

:rolleyes: