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Are there some things that just shouldn't be cut?

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  • Closed Accounts Posts: 1,615 ✭✭✭NewDubliner


    This post has been deleted.
    True, each fatal accident has an economic cost of about 1m euro.

    As for the driving testing, based on my experience in Dublin every day, I'd say the drivers themselves could do with a bit of reforming. The waiting lists would be shorter if people learned to drive before doing the test. But, as usual, it's easier to blame the system.


  • Registered Users Posts: 7,373 ✭✭✭Dr Galen


    unfortunately over the last few years reducing class sizes has been seen as the panacea to all our educational woes. As you rightly point out it would take drastic reductions in order to make a real difference, not the ones and twos that have been talked about recently.

    we should probably take class sizes etc as a different issue to school building works etc as one is purely educational in nature and one is more of a construction type thing. If the money was there and could be protected in some way, then now's the time with construction costs at the lowest to go about a capital school building/renovation project. Would help keep jobs in the shorter term, keeping people off the dole and with some money in their pockets, which ideally they'll spend in shops etc etc etc


  • Registered Users Posts: 7,373 ✭✭✭Dr Galen


    True, each fatal accident has an economic cost of about 1m euro.

    As for the driving testing, based on my experience in Dublin every day, I'd say the drivers themselves could do with a bit of reforming. The waiting lists would be shorter if people learned to drive before doing the test. But, as usual, it's easier to blame the system.

    while i'd agree that the standard of driving can be terrible, don't forget a lot of these drivers HAVE a full licence and seem to lose the run of themselves after a few years. I too spend a lot of time on the road, and some of the things you see are truly shocking. I have no idea how road deaths are actually so low in this country.

    the system does have a lot to answer for, and tbh I cant see why the whole of the driver testing system can't be shipped out to a private company. once SGS got involved the waiting lists plummeted, speaking from experience of the system (the wife) it was professional, well run, efficient and not a soft touch at all. Maybe others have different views on it though


  • Closed Accounts Posts: 39,022 ✭✭✭✭Permabear


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  • Closed Accounts Posts: 39,022 ✭✭✭✭Permabear


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  • Closed Accounts Posts: 4,271 ✭✭✭irish_bob


    This post has been deleted.


    most of the increases spending on education went towards making our teachers the highest paid in the eu


  • Registered Users Posts: 3,032 ✭✭✭ParkRunner


    We have a noticeboard in work (civil service) and I have seen more notices saying such and such a person is retiring in the last month than I have seen in the last 3 years combined. There's an exodus going on from what I can see at the top end of the civil service. It won't save much immediately but it is something, especially with no promotions or recruitment occuring.


  • Registered Users Posts: 504 ✭✭✭Svalbard


    nesf wrote: »
    I don't think it makes sense to ring fence entire Departments and say there should be no cuts in Education or Health. Individual parts of these Departments are essential but there is always areas within these Departments that can be cut down and situations like this should be.

    There is never enough money to go around. People just need to accept this.
    There is a stupid amount of waste in the HSE. Waste in HSE is no better than waste in the Dept of Agriculture. We can't afford to give a crap about class sizes.

    Are there some things that shouldn't be cut? Yes. But there are far fewer of these things than people want to believe.

    There is a stupid amount of waste in the HSE. But isn't it just hilarious where the cuts are being made?

    - No more nurses/OTs/Physios/Speech & Language therapists/Junior doctors/Consultants to be hired.

    - Possible lay-offs of above (esp. nurses)

    - Massive cuts in hours and training allowances to junior doctors (effectively fewer doctors on call, doctors no longer being trained in Ireland)

    - The closure of beds/wards around the country

    - Closing A&E departments

    - Possibly closing entire hospitals

    - HSE backing out of plan to help carers

    - Backing out of previous commitments to provide cervical cancer vaccine

    - Taking medical cards from the elderly



    And what's not being cut........

    - Massive salaries of management grades, of which there are far too many

    - "Vital" departments such as "Team Building" - a friend who works in the HSE had to spend an entire day at a course about Team Building. The HSE has a team of people going around the country doing these talks. They even buy lunch for those who attend since this dept is so flush with money!

    - pro-HSE spin-doctoring seen in the media.

    - Sean Mc Grath, ex-CEO of National Irish Bank, now employed by the HSE to reduce the pay bill. If he manages to reduce the pay of front-line clinical staff, he gets a nice 25% bonus for himself on top of his E250,000 salary.

    - HSE spending over E29,000 on 'art-work' for one primary care clinic in Naas!!

    - 70,000 plus admin staff. Compared with 11,000 nurses and 4,500 junior doctors - you know, the ones actually looking after patients!!



    So yeah, cuts need to be made. But where is the question.


  • Closed Accounts Posts: 16,165 ✭✭✭✭brianthebard


    unfortunately over the last few years reducing class sizes has been seen as the panacea to all our educational woes. As you rightly point out it would take drastic reductions in order to make a real difference, not the ones and twos that have been talked about recently.

    we should probably take class sizes etc as a different issue to school building works etc as one is purely educational in nature and one is more of a construction type thing. If the money was there and could be protected in some way, then now's the time with construction costs at the lowest to go about a capital school building/renovation project. Would help keep jobs in the shorter term, keeping people off the dole and with some money in their pockets, which ideally they'll spend in shops etc etc etc

    Ok the one act of reducing class size is not going to create a race of super geniuses. But lets look at it the other way; what harm is it going to do to reduce class size?


  • Registered Users Posts: 8,452 ✭✭✭Time Magazine


    Ok the one act of reducing class size is not going to create a race of super geniuses. But lets look at it the other way; what harm is it going to do to reduce class size?
    The money it would cost could provide better cancer screening services.


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  • Registered Users Posts: 14,339 ✭✭✭✭jimmycrackcorm


    We didn't have 6000 special needs assistants when I was growing up and there was no outcry then - did someone put something in the water for this generation of kids?

    As a parent myself, I think that education cutbacks (like large class sizes) could be largely mitigated if parents spent more time helping their kids and less time watching Eastenders. After all home school kids don't turn out stupid!


  • Closed Accounts Posts: 10,012 ✭✭✭✭thebman


    We didn't have 6000 special needs assistants when I was growing up and there was no outcry then - did someone put something in the water for this generation of kids?

    As a parent myself, I think that education cutbacks (like large class sizes) could be largely mitigated if parents spent more time helping their kids and less time watching Eastenders. After all home school kids don't turn out stupid!

    No we learned how to teach kids with special needs since then and learned that they can function properly in society if given one to one care where as if you cut this and just dump them in with 30 other kids they can't learn and become dependent on state aid for the rest of their lives so in the long run, it is cheaper to educate them properly now.

    And the 6,000 isn't enough but it is better than nothing so we can't afford to cut special needs classes. We should increase the size of regular classes before cutting special needs and hitting the most vulnerable people in our education system.

    I don't think the parents have the skillset required to teach kids with special needs. I'd assume there is a special method to teaching them and that it requires a lot of time which is why it requires 1-1 teaching and why a parent might not have the time to teach them when they get home at 7 in the evening stressed and tired because they are trying to keep their job.


  • Closed Accounts Posts: 217 ✭✭Alcatel


    Like I say, there's always something that some group will say cannot be cut. That's just plain tough, is the message that politicians seeking re-election can't pass on in quite those straight words. We're broke. If you, god forbid, have a family where one child needs special home schooling, and one of the parents is out of work, and everyone needs to be fed, you'll make cuts. You'll cut the food that you eat. You'll cut back on some of the special stuff for the kid and keep the bare essentials. You'll cut becuase the bank won't give you an endless loan to fund everything through the bad times. This is the same, on a macro level.


  • Closed Accounts Posts: 34 joe freethinker


    nesf wrote: »
    I don't think it makes sense to ring fence entire Departments and say there should be no cuts in Education or Health. Individual parts of these Departments are essential but there is always areas within these Departments that can be cut down and situations like this should be.

    There is never enough money to go around. People just need to accept this.
    I agree but special needs shouldn't suffer


  • Closed Accounts Posts: 217 ✭✭Alcatel


    I agree but special needs shouldn't suffer
    As I say, that's what everyone says about Group X or Y. "I think Education shouldn't be cut." "I think hospitals shouldn't be touched." Etc. All fair viewpoints. But no money for it...


  • Closed Accounts Posts: 10,012 ✭✭✭✭thebman


    Alcatel wrote: »
    Like I say, there's always something that some group will say cannot be cut. That's just plain tough, is the message that politicians seeking re-election can't pass on in quite those straight words. We're broke. If you, god forbid, have a family where one child needs special home schooling, and one of the parents is out of work, and everyone needs to be fed, you'll make cuts. You'll cut the food that you eat. You'll cut back on some of the special stuff for the kid and keep the bare essentials. You'll cut becuase the bank won't give you an endless loan to fund everything through the bad times. This is the same, on a macro level.

    Yes but you can cut other areas of education without cutting special needs or at least minimise the damage done. You can cut teachers wages and not invest in other programs for schools that would have minimal benefit before you start looking at cutting this area.

    Again I'll say it, studies show it ends up costing the state more if they don't provide children with special needs their education requirements.

    I don't see how it makes sense to leave them living off the state when they could get jobs and work if provided with the right kind of education.


  • Closed Accounts Posts: 406 ✭✭Disease Ridden


    I dont think class sizes increasing by 2 or 3 children will have any noticeable effect on exam performance, literacy skills etc and, even if it does, tough. Out of all the sacrifices that have to be made, surely increasing class sizes is one of the least painful?

    I see that people often bring up things like the storing of the E-Voting machines, the number of junior ministers, misiters' bloated pay and expenses and lots of other things that, if sorted out, wont have much of an effect on governement revenues. I'm of the opinion that the government should start off by attacking these things, not for the puny revenues that it would generate, but to smply shut everybody up about them and to give them no reason to give out about having to make sacrifices themselves.

    Also, take 13 quid off the unemployed (myself included!). This should only generate in the region of 300,000,000 in a year when unemployment is about 450,000 which, although not a massive amount, will keep the middle earners quiet while they have to make sacrifices. It also further increases the gap between the lowest paid workers and the unemployed and so slightly lessens the incentive for the lowest paid workers to add to the government paybill. Also, were in virtual deflation at the minute so I dont see why the unemployed cant take a cut.

    The key is to comply with peoples' demands to make cuts to things that, while they might not generate much revenue, will shut them up. That way the government will face a softened up crowd when they have to wield the axe!


  • Closed Accounts Posts: 10,012 ✭✭✭✭thebman


    I dont think class sizes increasing by 2 or 3 children will have any noticeable effect on exam performance, literacy skills etc and, even if it does, tough. Out of all the sacrifices that have to be made, surely increasing class sizes is one of the least painful?

    I see that people often bring up things like the storing of the E-Voting machines, the number of junior ministers, misiters' bloated pay and expenses and lots of other things that, if sorted out, wont have much of an effect on governement revenues. I'm of the opinion that the government should start off by attacking these things, not for the puny revenues that it would generate, but to smply shut everybody up about them and to give them no reason to give out about having to make sacrifices themselves.

    True but special needs is different to the rest of the class. It is one to one teaching that has to occur.

    You can increase the average class size to 32 or so if you want (god knows mine was like that when I grew up) and students can still perform but you can't get rid of special needs IMO or at least you need to minimize any damage that occurs in that area. The parents simply cannot home school those children or in many cases afford the private education they would otherwise require if the public school system wasn't willing to provide for them.

    Also, take 13 quid off the unemployed (myself included!). This should only generate in the region of 300,000,000 in a year when unemployment is about 450,000 which, although not a massive amount, will keep the middle earners quiet while they have to make sacrifices. It also further bridges the gap between the lowest paid workers and the unemployed and so slightly lessens the incentive for the lowest paid workers to add to the government paybill.

    I would say more in the range of 100 euro off every single (as in not married) unemployed person with no children or other responsibilities and have a look at people living with parents allowance. I think there are a lot of savings that can be made in these areas as people are saying they are getting by fine on these payments. While I don't want to hurt them, I do want them to think about their purchases and shop in Lidl or the cheapest store to them instead of Tesco or Dunnes or other upper market stores.

    I would also say move more of the money to rent supplement from dole money as rent supplement is too low and people are paying rent out of dole instead. Seems a bit ridiculous. You'd probably have to look at mortgage relief benefits (I don't know anything about that side of things as I don't have a mortgage, don't know if it is a benefit).

    Child benefit to be cut off for every employed person that falls in the lower tax net (which might be everyone in a couple of weeks).


  • Closed Accounts Posts: 39,022 ✭✭✭✭Permabear


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  • Moderators, Motoring & Transport Moderators, Technology & Internet Moderators Posts: 22,776 Mod ✭✭✭✭bk


    This post has been deleted.

    Agreed and if you think about it, in order to cut class sizes in half, you would have to more then double the education budget. Yet as you say we've had a 74% increase in education spending between 1995 and 2004, which could have gone a long way to giving us class sizes of close to 15, instead class sizes only decreased by 2!!!

    So where did all the extra spending go?

    I can't prove it, but I assume it just went into increased teachers salaries, with no major increase in actual numbers of teachers.


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  • Closed Accounts Posts: 217 ✭✭Alcatel


    The reality is that the situation is so bad that we may end up needing to both increase regular class sizes, cut teacher pay and cut special needs funding. That's how bad it is. This isn't a 2bn cuts operation, we earn 30bn a year and spend 20bn on social welfare before we lift a finger to education or health. That's where we are.

    As for the fat in the public sector, I agree it needs to be targeted - indeed, just as many businesses are we should see this as an opportunity to cut aggressively (though I have little hope of it happening, the public sector unions have too much of a hold on the nuts of the government); but in the end that will not give us the billions upon billions of savings we need right now, today.

    This is the difference between saying "I'll drive my car less, thus cutting my fuel bill in the long run" and "I need to sell my car". We're in the latter.


  • Closed Accounts Posts: 10,012 ✭✭✭✭thebman


    Alcatel wrote: »
    The reality is that the situation is so bad that we may end up needing to both increase regular class sizes, cut teacher pay and cut special needs funding. That's how bad it is. This isn't a 2bn cuts operation, we earn 30bn a year and spend 20bn on social welfare before we lift a finger to education or health. That's where we are.

    As for the fat in the public sector, I agree it needs to be targeted - indeed, just as many businesses are we should see this as an opportunity to cut aggressively (though I have little hope of it happening, the public sector unions have too much of a hold on the nuts of the government); but in the end that will not give us the billions upon billions of savings we need right now, today.

    This is the difference between saying "I'll drive my car less, thus cutting my fuel bill in the long run" and "I need to sell my car". We're in the latter.

    I'm aware of how bad the situation is but the only place your going to get the level of cuts we need is cutting wages and welfare and large costly infrastructure projects. Then services will have to be cut but we should keep whatever services we can. Cutting special needs costs us more in the long run so should be left alone if possible.

    This is different to cutting health where someone might die if you cut services. Someone will inevitably die as a result of health cuts but dying won't cost the state more money for the next 60-70 years. We'll probably still be paying for special needs cuts in some cases when we are in the next recession after this one assuming it is cut. I'm sure some special needs services can be cut but some of them should not be touched because from a financial point of view, it won't save money overall and it will ruin kids lives.

    That is a very stupid and negative thing to do IMO. It is just reckless cost cutting without looking at the effects of the cost cutting. It will cost more so what is the point? Cut elsewhere, there are plenty of other places you can cut services from even within education. Just because there is a deficit does not justify such illogical attitudes to mindless cost cutting. If its going to cost more to cut a service in the long run, how can you justify cutting it over a service where this isn't the case?

    Mindless cost cutting is a bad thing. Like in my last office, where finance decided to force us to use recycled cartridges for our printer because they were cheaper but they leaked every other time and we spent half the day cleaning them and calling in some body to service the printer as it damages other parts so we told them it doesn't work and they insisted we keep using the cartridges because they were cheaper. Eventually had to get managers involved to correct the moronic attitude to cost cutting.


  • Closed Accounts Posts: 217 ✭✭Alcatel


    thebman wrote: »
    I'm aware of how bad the situation is but the only place your going to get the level of cuts we need is cutting wages and welfare and large costly infrastructure projects. Then services will have to be cut but we should keep whatever services we can. Cutting special needs costs us more in the long run so should be left alone if possible.

    This is different to cutting health where someone might die if you cut services. Someone will inevitably die as a result of health cuts but dying won't cost the state more money for the next 60-70 years. We'll probably still be paying for special needs cuts in some cases when we are in the next recession after this one assuming it is cut. I'm sure some special needs services can be cut but some of them should not be touched because from a financial point of view, it won't save money overall and it will ruin kids lives.

    That is a very stupid and negative thing to do IMO. It is just reckless cost cutting without looking at the effects of the cost cutting. It will cost more so what is the point? Cut elsewhere, there are plenty of other places you can cut services from even within education. Just because there is a deficit does not justify such illogical attitudes to mindless cost cutting. If its going to cost more to cut a service in the long run, how can you justify cutting it over a service where this isn't the case?

    Mindless cost cutting is a bad thing. Like in my last office, where finance decided to force us to use recycled cartridges for our printer because they were cheaper but they leaked every other time and we spent half the day cleaning them and calling in some body to service the printer as it damages other parts so we told them it doesn't work and they insisted we keep using the cartridges because they were cheaper. Eventually had to get managers involved to correct the moronic attitude to cost cutting.
    Cutting services is an upfront saving. Salary, office costs, building costs, whatever you want to point to, when the service is gone it's gone and you don't pay for it from tomorrow onwards.

    Also, how much does it cost us long run versus how much do we save now? The need to save now may well be far more pressing than the need to reduce long term, more managable damage. That's the same as any business calcalation: I shut down a part of my business that accounted for 15% of revenue and was striving, slowly but surely, towards profitability. I lost 15% of revenue like that, but I cut the costs of that program and therefore made a net gain here and now; though in the long run naturally I don't have the customers for that particular program to buy into the other parts of my business. But I needed the cost saving now, and I'll worry about that bit tomorrow.


  • Closed Accounts Posts: 10,012 ✭✭✭✭thebman


    Alcatel wrote: »
    Cutting services is an upfront saving. Salary, office costs, building costs, whatever you want to point to, when the service is gone it's gone and you don't pay for it from tomorrow onwards.

    Also, how much does it cost us long run versus how much do we save now? The need to save now may well be far more pressing than the need to reduce long term, more managable damage. That's the same as any business calcalation: I shut down a part of my business that accounted for 15% of revenue and was striving, slowly but surely, towards profitability. I lost 15% of revenue like that, but I cut the costs of that program and therefore made a net gain here and now; though in the long run naturally I don't have the customers for that particular program to buy into the other parts of my business. But I needed the cost saving now, and I'll worry about that bit tomorrow.

    I see the point, I just think it is illogical to have a variable like tomorrow undefined.

    Usually there are proper good savings that can be made that the people cutting costs don't know about since they don't know really know anything about the area they are cutting costs in. The people that do know are left out of the loop and bad decisions are made.

    As for special needs people, paying them disabilities and having them live off the state for 60-70 years and probably more will cost the state significantly more than their education now I think but I don't have figures for that. Its just common sense though IMO.


  • Closed Accounts Posts: 217 ✭✭Alcatel


    thebman wrote: »
    I see the point, I just think it is illogical to have a variable like tomorrow undefined.

    Usually there are proper good savings that can be made that the people cutting costs don't know about since they don't know really know anything about the area they are cutting costs in. The people that do know are left out of the loop and bad decisions are made.

    As for special needs people, paying them disabilities and having them live off the state for 60-70 years and probably more will cost the state significantly more than their education now I think but I don't have figures for that. Its just common sense though IMO.
    Problem is the debt is today. You could tell me that my 15% of the business will, tomorrow, provide me with 100% year on year growth of my entire business in 2 years (or even 2 weeks) time; but if I can't afford it that's just tough.

    Cutting government is a pain, it's just such a huge, unmanaged mess. That being said, Ireland has a total revenue that's less than some highly successful multinationals... It would be good if governments the world over could be managed more like business (business that's got it's aims towards serving the public best, naturally... but it has been proven that business leadership is good for the charitable sector, ala Bill Gates, Warren Buffet etc, so why not government?)

    Then we could make streamlining and cuts a relatively easy thing to do. And you could pull up the figures with the click of a finger and predict what this and that will affect. As it is we've a giant mess with un-firable civil servants, inefficient systems so bad we can't even tell how bad it is, poor service delivery... And making these cuts will be a giant brushstroke operation in which, I agree, the disadvantaged will be hit hard.

    But, at the end of the day, when you gotta cut, you gotta cut. It hurt me to cut that 15% segment of my business, knowing the potential. But there's tomorrow's potential and today's bills.


  • Registered Users Posts: 4,929 ✭✭✭Raiser


    Cut all Departments and every bloated avenue of despotic public spending - prune them viciously and without mercy.....

    Perhaps when people routinely die in our Health system in sufficient numbers to register on the radar of peoples consciousness and not be easily disregarded by crafty spin then people will not tolerate the absurd teetering tiers of needless management, fat-cat bonuses and preposterous w@nkers who have made a career out of feathering their retirement nests - all under the snout of Mary Harney.

    Perhaps we need to have 45 kids per class freezing every day in a rat-infested, mould-stained, creaking prefab before people cry "enough" and begin to refuse to accept what we all know is a shameful current debacle presided over by the the devious redneck Batt O'Keefe.

    Maybe we needed to show the Banks that because they failed to follow the basic logic and axioms of financial procedure - and instead conducted themselves like drunk, gormless 17 year olds while giving every Gobdaw with a sweaty palm in view all of our money until the whole lot imploded - THERE IS A FCUKING CONSEQUENCE. Seriously - how hard is it to replace Cretins like these? Can you not just find replacement Bankers pawing through skips??? Why are we continuing to reward Ireland dumbest criminals?

    Cut especially from any department presided over by a small man in a big suit who spends his days rubber stamping ridiculously inflated requests for and fictitious accounts of runaway overtime. Junior Ministers [read jobs for dumb, unemployable Nephews] and the 100's of Government "consultants" can fcuk off too - remember the one that hadn't mastered basic arithmetic on behalf of O'Keefe who was too lazy to reach into his desk drawer for a fcuking calculator???? There's an example of money well spent.

    Let it all go to absolute shíte - then maybe people will pull their heads out of there arsés and stand up for themselves. A good start would be the countless numbers of people who could whistle-blow on corruption at every fcuking level in the Civil service but are too fcuking cowardly to do so on one hand and 'cause they envy their corrupt Bosses office chair and flash car on the other.....

    FFS.


  • Registered Users Posts: 245 ✭✭otwb


    Svalbard wrote: »
    There is a stupid amount of waste in the HSE. [

    And what's not being cut........


    - 70,000 plus admin staff. Compared with 11,000 nurses and 4,500 junior doctors - you know, the ones actually looking after patients!!


    So yeah, cuts need to be made. But where is the question.

    Agree with most of your points, but who do you think organises patients appointments and moves them around the hospital/finds medical records/organises waiting rooms/ensures that there is equipment and facilities available for clinics and theatre etc.

    Admin staff are vital to the efficient operation of a hospital, lets not forget that. Should concentrate savings on those HSE (as distinct from hospital based staff) management levels who were not needed post amalgimation of the health boards. Pare services from the top down and not the bottom up.


  • Registered Users Posts: 7,373 ✭✭✭Dr Galen


    otwb wrote: »
    Agree with most of your points, but who do you think organises patients appointments and moves them around the hospital/finds medical records/organises waiting rooms/ensures that there is equipment and facilities available for clinics and theatre etc.

    Admin staff are vital to the efficient operation of a hospital, lets not forget that. Should concentrate savings on those HSE (as distinct from hospital based staff) management levels who were not needed post amalgimation of the health boards. Pare services from the top down and not the bottom up.

    nail on head.

    Posts like the one you quoted show a lack of understanding of how the HSE and hospitals work, which in fairness posters can't be blamed for, as I don't think anyone really knows, certainly not Harney anyway.

    There's plenty of room for cuts, reorganisations and efficiencies in the HSE but they will take time and more importantly good planning to see through and unfortunately time is not what we've got a lot of


  • Registered Users Posts: 8,841 ✭✭✭SeanW


    otwb wrote: »
    Agree with most of your points, but who do you think organises patients appointments and moves them around the hospital/finds medical records/organises waiting rooms/ensures that there is equipment and facilities available for clinics and theatre etc.

    Admin staff are vital to the efficient operation of a hospital, lets not forget that. Should concentrate savings on those HSE (as distinct from hospital based staff) management levels who were not needed post amalgimation of the health boards. Pare services from the top down and not the bottom up.
    Perhaps, but why does a health service with such a small amount of doctors and nurses require such an obscene ration of clerical and managerial staff? How many admin staff and middle managers does it take to buy medical equipment or organise a a waiting room?


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  • Closed Accounts Posts: 1,615 ✭✭✭NewDubliner


    SeanW wrote: »
    Perhaps, but why does a health service with such a small amount of doctors and nurses require such an obscene ration of clerical and managerial staff? How many admin staff and middle managers does it take to buy medical equipment or organise a a waiting room?
    Ireland's population is too spread out meaning that we have to have lots of hospitals and clinics all over the place. If our population were more concentrated in urban areas, we'd achieve economies of scale based on larger hospitals and resource pooling.


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