Healthcare a Government issue or are the HSE to blame

Jaoibh

Hi

I'm 26 I work 13 hours a day and pay my taxes and PRSI I also Pay 830 euro per year for VHI and I'm P*ssed off with the irish healthcare system.

I have family who work there and I know and hear about all the nonsense thats going on with transplant patience being left out in the hallways and only 6 nurses on the day shift and 2 nurses on the night shift in the childrens A&E department in Tallaght hospital. How people will be left crying for help with no one going to there aid.

My reason for posting is I'm tired of complaining and I want it fixed I want someone to tell me what I can do to make this problem go away.
I will give anyone who aspires to be elected into government my time to give the irish people free healthcare and drop the A&E waiting times from 8 hours to max 1 hour.

Drop me a PM or post and tell me what I need to do to make it happen!

thanks

David

leninbenjamin

too many vested interests (i.e. unions) with conflicting ideas on how it should be resolved. anytime i'm in there, with the exception of a few (typically the nurses tbh, although i'm sure there are more), the majority just take the piss, from the porter strolling around like he's nowhere to go, to the consultant not taking the time to make a proper diagnosis. the inefficiency is at all levels basically, and i guess the fear for someone like Harney is that if she attempts to rock the boat to much on an issue it'll all just collapse (although i'm not saying she isn't part of the problem herself, she clearly has to take the blame for a lot of the budgetary mess).

the best story i've heard is the moratorium on hiring unskilled staff to do stuff like filing etc. in certain labs and depts. which actually results in INCREASING costs as they have to pay the highly skilled workers overtime as the work has to get done, and not to mention it results in the waiting lists increasing too.

edit: actually as an economist completely free health care is a bad idea. free rider problem basically just results in people taking the piss. so i wouldn't be with you on that. it's efficiency we need to be looking at, rather than expanding the number of beds etc.

Jaoibh

leninbenjamin wrote: »

too many vested interests (i.e. unions) with conflicting ideas on how it should be resolved. anytime i'm in there, with the exception of a few (typically the nurses tbh, although i'm sure there are more), the majority just take the piss, from the porter strolling around like he's nowhere to go, to the consultant not taking the time to make a proper diagnosis. the inefficiency is at all levels basically, and i guess the fear for someone like Harney is that if she attempts to rock the boat to much on an issue it'll all just collapse (although i'm not saying she isn't part of the problem herself, she clearly has to take the blame for a lot of the budgetary mess).

Points very well made so are we saying Step one get rid of Mary Harney? If she wont step up to the mark to make the changes that are needed because she doesnt have the "Balls" for the job then who can do it?

What else do we as the people of the republic of ireland need to do to make the health care system work?

I wish I was educated enough in the workings of the system to make suggestions but I'm one man who wants to make a difference tell me who i have to write to? Who do I have to nag at to fix the current system or make the government make a new one! oh wait they tried that already! Are there laws in place to say we have to keep our current government even if they wont do what we want them to do?

I really dont think I'm the only person in Ireland whos completely fed up.
What can we do to make a difference?

ninty9er

I am politically affiliated and I DO give Mary Harney my full backin unlike many grassroots and backbench members of my party.

She is turning a monolith around. It's like turning Titanic. If you change direction now you only end up going dead ahead again. She doens't care what the consultants or nurses think, nor should she, they are there to serve the public NOT to serve the public in the manner that best suits themselves. The Consultant contract is already way too generous.

Consultants should be Public or Private....NOT both. I will gladly pay to see a consultant if I know that he's not overburdened with 2 waiting lists instead of 1. More liklihood of something going wrong if there are too many patients.

Offer a contract of €90k basic for a 40 hour week and cap overtime at €30K. I guarnatee there are Junior Doctors out there who will soon be consultants that would plum for them. This is similar to the John Crown idea of "I don't give a **** what happens to the new doctors as long as I'm on €400k" It happens in the retail sector constantly. Expensive staff are replaced with cheaper staff.

Med Students should be contractually bound to work in a HSE hospital for 3 years on completion of their degree.

Nursing shouldn't be a degree, it's a caring profession and should be a FÁS run scheme. Having been in hospital recently I'm more convinced of this, the ward sister was old-school. Her ward was clean, her nurses dressed the beds with the assistants, her nurses were held on equal footing.

NURSES are NOT paid badly. Their starting salary is about €2k shy of the average industrial wage.

There should be a fingerprint clocking system operated in every ward and administrative centre in the HSE (And the cicvil and public service in general). No crap about "you can't implement that unilaterally" Just clock-the -fu<k in!! Lunch is AN hour (maybe an hour and 5-7 minutes, but you won't get away with more in the private sector) not ABOUT an hour (i.e 2 hours. One person I know was told on returning to her computer after an hour and a quarter that the unions wouldn't stand for that level of dilligence[along those lines...less fancy])

The healthcare system did not discintegrate overnight. It's taken the best part of 30 years to land at the 2002 situation, it can't be fixed in 5 or even 10 years. It will take the same again to fix.

Breezer

Jaoibh wrote: »

I really dont think I'm the only person in Ireland whos completely fed up.
What can we do to make a difference?

No, of course you're not. There's a massive amount of people sharing your opinion. Recently in Dublin there was a large scale protest over the state of the health service.

Unfortunately, it's a huge problem that will take years to sort out. To be honest, I have some sympathy for Mary Harney. I agree broadly with her ideas for establishing a limited number of centres of excellence across the country and closing down some local services in order to pool resources into these centres. However, I believe there needs to be better infrastructure in place, along with a vastly improved ambulance service in rural areas, before this can work.

Harney not only has to battle unions, she also has to battle local communities who can't see beyond the fact that "we're losing our local hospital." Before the Port Laoise debacle cropped up, there was huge opposition to local hospital closures. The Port Laoise case illustrated what happens when resources are spread too thinly - there are lots of local hospitals, but they're underfunded and can't work properly. Unfortunately, there's still opposition - some of it on justified grounds, but some of it less so.

There, a Fine Gael supporter has defended Mary Harney

She's not completely blameless either though. She and her predecessor have been shown to ignore warning letters from senior hospital staff about the state of our local hospitals. Again, I agree with her in principle on the centres of excellence, but you can't put the cart before the horse.

The HSE, Harney's creation, is a mess of level upon level of bureaucracy, and needs to be cut down.

I haven't heard a huge amount from her recently regarding co-location of public and private hospitals, but to me it seemed to be pushing the 'privatise everything' agenda of the PDs to a ridiculous extent.

Should Harney be allowed to continue? I don't know is the answer. She has good points and bad points, but at the moment she's facing stalemate because she's constantly having to defend herself to absolutely everyone. A new minister might get a temporary reprieve, but ultimately the same situation would arise. Besides, I don't think there is anyone else in the government parties more capable at handling health than Harney. I'd much rather her in there than Noel Dempsey or Martin Cullen.

A good first step would be to cut down on unnecessary bureaucracy in the HSE, which is wasting valuable resources. But we have a long way to go on this issue.

ninty9er wrote:

Med Students should be contractually bound to work in a HSE hospital for 3 years on completion of their degree.

Disclaimer: I'm a med student. I'd disagree with you, but only somewhat. What we need badly in this country is a movement away from hospital treatment and towards primary care in communities. Before the elections last year, Labour had a policy to cut down on the number of junior doctors working in hospitals, moving them to primary care and leaving acute hospital care to more experienced staff. If we could provide a facility where people didn't automatically go to A & E and into a hospital bed when they got ill, it would go a long way towards freeing up beds.

I would have no objections to a 3 year contract in a HSE institution, however, just not necessarily a hospital. Many students in my class come from Malaysia, and are contractually bound to work for 10 years in the public health service there. This is in return for the government paying for their education. Ours also does this. However, if there were to be a return of fees in this country, and this contract were to be in place, I think healthcare students should be exempt.

Apologies for the less than flowing English, I'm tired.

ninty9er

Breezer wrote: »

The HSE, Harney's creation, is a mess of level upon level of bureaucracy, and needs to be cut down.

A good first step would be to cut down on unnecessary bureaucracy in the HSE, which is wasting valuable resources. But we have a long way to go on this issue.

Absolutely. And the administrators know this. My mam's friend works a 20 hour week in the HSE (she's been there since the 80s) and earns more than my dad who works a 50 hour week. They think they're worth it.

1) I disagree.
2) The public in general disagree
3) The unions know this which is why they've told staff that there will be no strikes for fear of public demonisation. Work-to-rule is the means chosen
4) We're in for a long summer

Solution) insert line: "And any other duties that may be assigned to you" in all public contracts. It already exists in most private sector contracts. It would mean any work to rule would be pointless.

Breezer wrote: »

However, if there were to be a return of fees in this country, and this contract were to be in place, I think healthcare students should be exempt.

Apologies for the less than flowing English, I'm tired.

Absolutely.

SkepticOne

Set up a system of hospital trusts and create in internal market like they do in Britain. I know some people here will be opposed to this on ideological grounds but it seems to work in Britain. Not perfectly, of course, but far better than the system here.

Make it in the interest of hospitals to attract patients with the GP acting as the main "customer" of the health service. Let the hospitals recruit staff independently and set salaries as they see fit to attract appropriate staff.

DublinWriter

I would ask those who cry for Mary Harney's head on a stick, what's the alternative? I for one wouldn't get a sound nights' sleep if the Minister for Health was the likes of Willie O'Dea, Martin Cullen or Conor Lenihan.

Although I dislike the PD's, I think Harney was always the one that tackled the thorny issues with success, such as the taxi drivers for example. She's the best of a bad lot.

If you are looking for someone to sack, then sack the electricians in Kerry General Hospital who went on strike over the issue of allowing 'non-qualified' personnel to change light-bulbs. Their work-to-rule action resulted in many operations being postponed.

During his tenure as Minister for Health, Micheál Martin sat on his ministerial backside and commissioned 37 reports by outside management consultants on the Health Service. Some estimate that the total cost for these reports, never acted on and still gathering dust on shelves in Leinster house, is in excess of €100 million.

In relation to your original question OP, the government is ultimately responsible for the delivery of public health care. Many argue that professor Drum is too ham-strung in his role as head of the HSE by his political masters to be able to affect any real change.

In theory, the HSE was a good idea executed poorly. We had 11 seperate and autonomous Health Boards managing a population the size of Birmingham. Instead of replacing the 11 boards of management (remember folks, no one gets sacked in the public sector!), the HSE basically now sits a-top the old management bodies.

The health service here is a complete basket case. Nothing but putting a nuclear bomb under it and starting again will fix the current situation.

leninbenjamin

DublinWriter wrote: »

The health service here is a complete basket case. Nothing but putting a nuclear bomb under it and starting again will fix the current situation.

couldn't agree more. while the solutions to problems may seem obvious to most (and indeed probably are) implementing them is next to impossible given;

a) the level of public ignorance/naivety on how a successful health care system should run (more beds are not a solution. keeping inefficient regional hospitals open are not a solution)
b) the unions opposition to anything that might actually make them work for their money (sweeping statement i know, but it seemingly does hold true in a lot of areas)
c) the failure of the government to 'rock the boat' for fear of losing the civil service votes (what is it, 30% of GDP (can't find a reliable figure) goes toward implementation of the civil service, the largest insitution being the HSE? that's potentially a lot of votes to lose). i think this last one is actually a very underestimated factor myself, but that's just an opinion.

personally i think at the end of the day to get the HSE working as it should we're going to have to endure a period of a lot of turbulence on behalf of the government, especially given the current economic climate. certain sectors have to be made realise that they are employees at the end of the day. the public mindset has to shift, we can't just keep looking towards the govt. as scapegoats, we need to give them room to manoeuvre and make the tough decisions. and most importantly we need to elect in the politicians with the backbone to do this.

Breezer

leninbenjamin wrote: »

a) the level of public ignorance/naivety on how a successful health care system should run (more beds are not a solution. keeping inefficient regional hospitals open are not a solution)
b) the unions opposition to anything that might actually make them work for their money (sweeping statement i know, but it seemingly does hold true in a lot of areas)
c) the failure of the government to 'rock the boat' for fear of losing the civil service votes (what is it, 30% of GDP (can't find a reliable figure) goes toward implementation of the civil service, the largest insitution being the HSE? that's potentially a lot of votes to lose). i think this last one is actually a very underestimated factor myself, but that's just an opinion.

More beds will provide a temporary reprieve, which in a field as critical as health could well be worth it. However, the beds need to be accompanied by a radical shake up of the whole structure. I agree with you on the other points.

we can't just keep looking towards the govt. as scapegoats, we need to give them room to manoeuvre and make the tough decisions. and most importantly we need to elect in the politicians with the backbone to do this.

True, and as long as the current Government remains in power I'd like to see Harney remain in Health. I don't like or agree with some of her vision, but at least she has vision. There's no one else in Government who I'd even remotely trust with the post, with the exception of Dermot Ahern who won't touch it because it would destroy his chances of ever being FF leader.

As regards cutting down on bureaucracy, Fine Gael has recently been making noises to that effect. They're being cautious though, and haven't mentioned the HSE specifically. And we need look no further than the Greens to see how easy it is to shout from the Opposition benches. But at least they're throwing the idea out there. I'd love to see Reilly in Health once he has a bit more Dáil experience. There's a man who'll not only speak his mind, but act on it. My one concern would be that if results don't follow quickly enough he could fall victim to the 'we don't like bullies' attitude of the Irish electorate.

leninbenjamin

Breezer wrote: »

More beds will provide a temporary reprieve, which in a field as critical as health could well be worth it. However, the beds need to be accompanied by a radical shake up of the whole structure. I agree with you on the other points.

personally having studied it somewhat in college (brief economics module, nothing much) i've come to the conclusion capital should be invested elsewhere. a lot of those beds are occupied because of a lack of day-patient services/scanning testing machines (proper phrasing is eluding me at this point). i'l point to scenario i've heard of in Galway. 4 people arrived in casualty on one day each requiring some kind of specialised heart? monitor of which there was only one, and it was supposed to be in place for 24hrs requiring an overnight. in this case it was the lack of the peripherals not beds that caused the backlog. it's my opinion that we've become to focused on the temporary reprieve as you call it to see the bigger picture at times.

and i agree with you about Harney remaining for the time being. there is no one better currently.

Breezer

leninbenjamin wrote: »

it's my opinion that we've become to focused on the temporary reprieve as you call it to see the bigger picture at times.

Oh I agree completely, extra beds will serve no purpose unless they form part of the bigger picture.

DadaKopf

It's not 'extra beds', it's the system and the amount of cash we decide, as taxpayers, to put into it.

It's important to think about what went before the HSE. The regional health boards. Many medical staff felt they worked quite well, but that they needed to be opened up more and reformed. Fine. They weren't accountable enough. Harney, against expert recommendations decided to set up the HSE - in effect causing a 'monolith' that wasn't entirely there to begin with. She appointed Brendan Drumm, so her fate is tied to his. But here's the rub: when something goes wrong, Harney can blame Drumm, Drumm can blame the Harney, they both can blame staff and unions, and they can blame HIQA for not enforcing standards, as if HIQA has any actual power. The blame-game goes in circles, and nothing gets done.

In the meantime, the health system is being gutted. Nurses, the backbone of any system, are finding it hard to get full-time, properly paid work. Instead, our taxes pay for their training in Irish universities but then they're left with no option but to go to Canada to practice. In the meantime, lowly-paid immigrant nurses (nothing against immigrants here) are hired on part-time contracts. This is underming overall quality of service. It's been estimated that the mess in the health system is costing 400 lives per week.

And there is simply no way that Harney's privatisation plan is going to fix anything. It'll make things worse. On one level, the rich will simply enjoy even better health than the majority of the population - health inequality. It will seriously undermine the public system. Cause a three-tiered health service. Profit-driven health is just dangerous.

I agree that all sides need to put the patient first and agree a viable strategy to move people from unneeded jobs to needed ones (retrain/reskill as needed), pay medical staff proper wages, reduce administrative burden etc. But the longer Harney stays in power (ironically, many union heads/politicos like her as a person), the more the damage will spread.

That said, our health system is still pretty good.

thebigshot

Read Agenda 21 by the United Nations. You will find a lot of answers.

Health Care is to be privatised. See the massive new Galway Clinic as an example. Public Health care is to be reduced to the bare bones.

The haves and have nots.

SkepticOne

Ultimately the buck stops with Harney. I think She and everyone else knows this. If she doesn't have the strength to take on the vested interests then she should be replaced.

El Stuntman

SkepticOne wrote: »

Ultimately the buck stops with Harney. I think She and everyone else knows this. If she doesn't have the strength to take on the vested interests then she should be replaced.

by who exactly? who among the FF ranks has demonstrated the courage and determination required?

it's easy to say 'Harney must go', not so easy to headhunt her replacement

just look at Biffo and Martin's pathetic spells in Health

sovtek

El Stuntman wrote: »

it's easy to say 'Harney must go', not so easy to headhunt her replacement

(

I think it is. Just like every system in this country that doesn't work...go to continental Europe where by and large things do work and hire they guy that runs it.

DadaKopf

SkepticOne wrote: »

Ultimately the buck stops with Harney. I think She and everyone else knows this. If she doesn't have the strength to take on the vested interests then she should be replaced.

Oh yeah, but she has a ready-made excuse.

it's easy to say 'Harney must go', not so easy to headhunt her replacement

Harney's a politician. Her job is to set policy. Her idea of what works.

If she goes, the civil servants in the Department of Health will still be there. They're the brains, Harney's just the neoliberal braun. If she went, policy would change, the people advising her and doing the work wouldn't.

El Stuntman

sovtek wrote: »

I think it is. Just like every system in this country that doesn't work...go to continental Europe where by and large things do work and hire they guy that runs it.

this would be great, unfortunately Ministers tend to be elected representatives

I'd actually be all in favour of 'de-statizing' (if that is a word, lol) the things we do badly and contracting them out to countries that do them well

integrated ticketing - anywhere else really
health provision - Sweden? France?
transport - Germany?

just hand them the money and the power and say 'get on with it'

it could never happen though

El Stuntman

DadaKopf wrote: »

Harney's a politician. Her job is to set policy. Her idea of what works.

If she goes, the civil servants in the Department of Health will still be there. They're the brains, Harney's just the neoliberal braun. If she went, policy would change, the people advising her and doing the work wouldn't.

it's government policy, not Harney's alone

do you really think she cooked up current health policy all by herself and the FF honchos at Cabinet said 'sure, grand - no problem, off ye go'?

This is a government problem and sacking Harney would only be an empty gesture to appease the media. As it is, she's the most able cabinet member.

Now come on, name one current member of government who would do a better job?

The_Minister

DadaKopf wrote: »

They weren't accountable enough. Harney, against expert recommendations decided to set up the HSE - in effect causing a 'monolith' that wasn't entirely there to begin with.

Actually, the deal was done when she entered health, by Martin.
She was handed a deal with the unions that said that noone could be fired in the amalgamation.

jmayo

I believe the only way to really reform the health system is to take on the vested interests and that includes the public service unions that have been given carte blanche since bertie arrived on the scene back in late 1980s as minister for labour.

Someone can correct me on this but looking at CSO figures it appears the numbers employed in health service has grown by 66% since 1997 ?
The public service/public sector grew by approx. 28% over that period.

They say they reformed the health boards but all they really did was add another layer of beuracracy on top to provide excuses.

HSE needs to be butchered with streamlining of administration.
We are 4 odd million yet we have all these totally inefficient admin overheads.
That means job cuts.
TDs, councillors may sound off about healthcare, HSE and various hospitals but they would also refuse to see any people fired since it would cost them votes, even if they know damm well those people are adding to the mess.
Thus health care needs to be made non political somehow.
Also HSE should be run by non healthcare person e.g. a Gerry Robinson type character.

Also we maybe a few ideas on taking out the logjam at A&E would be the following:
-local clinic based system where people do not have to access A&E for non serious primary care.
-subsidised Doctor visits so that people aren't screwed by €55 bills
-charge all weekend drunk and drug admissions a fee of about €200 (next time they may cop on)

Will any of this happen ?
I wouldn't hold my breath :rolleyes:

ninty9er

sovtek wrote: »

I think it is. Just like every system in this country that doesn't work...go to continental Europe where by and large things do work and hire they guy that runs it.

HSE Staff: Hans, how do you plan to fix the HSE?
Hans: vell, first off oll, all doktors vill haf a pay cut to €90k like in tChermany, ze nurrsses vill get no vage increese until ve haf seen a matjor imporoofment in attitude. Ze administration vill be minimised to approximately hal-f. By ze time my term is komplete I expekt zat ze HSE vill be ready four dis-establishment and transfare to ze department of Health


HSE Staff: *F&^$ That for a barrel of laughs...how long is your term
Hans: 4 years

HSE Staff: how much are they paying you
Hans: €150k

HSE Staff: **Laugh at the poverty stricken fu<ker**
Hans: Oh and zis vill be done by re-classification off all jops as ve cannot replace you in the same jop. you must re-apply if it is hyur intention to continue in a similar post to yours.
HSE Staff: **Oh SH!T he fu<king serious**

RTÉ Headlines 4 years time: HSE has cumulative budget surplus of 1bn for each of the last 3 years. The public says Hans was €600k very well spent!!

Sleepy

Does anyone else think that this could be Enda Kenny's chance to leave his legacy on Irish politics?

I know it doesn't make political sense for Fine Gael to give up the health service stick they can beat the government with so easily but if he were to announce in the Dail that Fine Gael would support the government in taking on the unions in the Health Sector there'd be no concern about votes lost (because who else can realistically form the majority party in a government in Ireland?), and there'd be nowhere for the unions to turn to. The public are never going to support a strike that either costs or has the potential to cost lives.

Who knows, if our politicians were actually more concerned with running the country than doing favours for friends or elevating their constituencies at the expense of others it could be the stepping stone to taking on the rest of the public sector unions.

I have to admit though, I'd actually be fully in favour of hiring a new CEO for the HSE and cutting it loose with a guaranteed % of the public coffers for the next five years upon which time (and only at which time) the CEO's performance could be reviewed by the cabinet. Sack Harney, don't replace her. Any politician is going to be an amateur so let's hire a pro and give them the clout they need to actually fix the thing.

El Stuntman

ninty9er, is Hans available to sort out Iarnrod Eireann at the weekends?

I like the cut of his teutonic jib

Dr Galen

hold on we saw him first!

seriously though id only there was a Hans out there I'd be a happy man. I'm fcuking sick of working in the mismanaged nonsense that is the HSE. Sick of not being able to get my work done because of bits of paper, forms, meetings and being told "no we can't do that, procedures to follow and all that, sorry nurse mystik monkey"

I'd love proper reform too, there's loads of things we nurses could be doing that we don't. Thats without really getting into being a mini-doctor. I just can't understand how the senior management of hospitals, HSE and government can still be in jobs

ninty9er

Ich bin Hans, I could do Iarnrod Éireann when I'm finished and bring AL back under state control including the repurchase of Futura as a charter.