Ireland on the brink...how can health professionals help???

tallaght01

dissed doc wrote: »

Brian goes drinking with the other 8, or playing golf and has a good few sessions with the them in the tent in Galway. It's difficult to ask them to cough up 75p especially as they have been paying for all the sessions in the first place.

So, take the money from the other 2 who Brian is not too sure who or what thye are doing but they don't pass any envelopes of cash his way so feck them.

Ireland, QED.

That's my gut feeling to be honest. I know plenty of health economics in my masters, but I know very little abot macroeconomics, which may explain why.......

RobFowl wrote: »

I think what is missing (if that's the correct term) is that as I understand it due to the McCreevey and Cowan tax changes, 50% of the workforce pay no tax. Also the retired public sector earn as much as they did on retirement after about 8 years as their pensions are linked to their original final salary grading and as a result increase every year.

So at present if I need to raise 10euro from 10 workers the first five will pay none the next 3 will pay about 5.5 euro and the last 2 will pay 4.5.
Thats why the likes of the income levy appeals so much to them as it simply levies almost all but the lowest earners.

And thats before the public/private split comes into play,,,

....makes no sense to me. Not saying it's wrong. I just don't understand it. 50% of my 10 people won't pay tax. So why don't I change that? Why I don't I take nothing from the poorest guy, 75c in total from the next 3 poorest (25c each), 1.50 in total from the next poorest 3 (50c each), and 2.75 from the top 3 earners (about 90c each).

That way everyone contributes on the basis of what they can afford.

Why doesn't this happen?

My (very limited) understanding of the pension situation for public sector workers is that it's worth much less now, and they're paying a pension levy.

Does any of this make any sense to anyone?

EDIT: or if we can only take money from 5 of my people, why don't we take a euro from each one, or 1.50 from the top 2 and the remaining 3.50 divided between the other 3.

Fado Fado

maninasia wrote: »

... and pretty much ban overtime through the whole HSE (obviously some specialties or hospitals may not be possible to do). .....Institute electronic patient record and billing system under universal health scheme to boost efficiency and cut back administration costs.

Problem is, in some specialities (I'm thinking specifically of surgery) it takes a certain amount of training to become an expert in your field. I mean the kind of top-of-your-game surgeon who I'd have every confidence in letting them operate on my mum. Different studies put it at anywhere between 20,000 and 40,000 hours of training. (Not just in theatre, but the non-operative management of patients plays a huge role as well.)

Now take a figure of say 30,000 hours. If I work 80 hours a week, it will take me about seven years to acheive that goal. (Which is a reasonable figure - in the US it takes about five years of dedicated training to become a surgical consultant, while in Ireland and the UK it's at least ten.). If you limit surgical trainees to 48 hours a week, it will at least double the time it takes to achieve mastery of their chosen profession. I'll be honest - ten years is bad enough. If it took fifteen to twenty years to get to the top, I think I'd pick another career. The NHS in the UK brought in the EWTD a few years ago, and the Royal College of Surgeons have realised that it comes with major problems. This holds through anecdotally as well, with senior colleagues reporting that their counterparts in the UK simply aren't as good operatively.

Just an aside, but it's worth remembering about surgical training in an era when the EWTD is being rammed down our throats - not, I suspect, out of concern for our well being, but instead as a political and financial measure. There is no one-size fits all approach that will work for various medical specialities.

opinion guy

Fado Fado wrote: »

Now take a figure of say 30,000 hours. If I work 80 hours a week, it will take me about seven years to acheive that goal. (Which is a reasonable figure - in the US it takes about five years of dedicated training to become a surgical consultant, while in Ireland and the UK it's at least ten.). If you limit surgical trainees to 48 hours a week, it will at least double the time it takes to achieve mastery of their chosen profession. I'll be honest - ten years is bad enough. If it took fifteen to twenty years to get to the top, I think I'd pick another career.

Yeah .......OR you could stop making junior doctors spend a large portion of those 80/48 hours in the week doing non-medical work such as fetching xrays, portering patients around, phlebotomy and cannulation and giving first doses of antibiotics. 48 hours a week spent doing actually medicine is preferable to 80 hours a week doing miscellaneous sh1t.

The NHS in the UK brought in the EWTD a few years ago, and the Royal College of Surgeons have realised that it comes with major problems. This holds through anecdotally as well, with senior colleagues reporting that their counterparts in the UK simply aren't as good operatively.

I'm not interested in your anecdotes. Show me proof.

Just an aside, but it's worth remembering about surgical training in an era when the EWTD is being rammed down our throats - not, I suspect, out of concern for our well being, but instead as a political and financial measure. There is no one-size fits all approach that will work for various medical specialities.

Seriously ? You got that backwards. The EWTD is being held back for financial reasons

Traumadoc

I do not buy the surgical training argument, the thousands of hours needed do not seem to be needed elsewhere, eg Australia.

knipex

tallaght01 wrote: »

So, treat me like an 8 year old here:

If im brian cowen and I need 15 pounds to pay my bills for the year, and i decide ill get 5 pounds from wages.

There are 10 people working in my economy, and 2 of them work for me.

So i tell them i'm going to cut their wages by 2.50 each, and I won't charge the 8 other guys extra taxes. This will save me 5 quid and i can pay my bills. Result.

What I'm wondering is why he doesn't take the 10 people, and take 75 cents from each person who earns over a certain amount of money. That would earn him 7.50 if everyone paid. But only 7 of them earn over the threshold, so he takes 75c of each of them, and earns 5.25

That way 5 people pay 75c each, rather than 2 people paying 2;50 each. The 3 people who've been made unemployed or took huge pay cuts don't pay anything extra.

What am I missing here?

Haven't done economics since the LC :P

No country, organisation, person or company in the situation where spending exceeds income can ignore their cost base.

In another post you asked why two people on the same income don't pay the same tax.

In the PAYE system they do. The pension levy was a paycut disguised for various reasons as a tax. If you ignore that then all PAYE workers pay the same tax.

You also seem to think that core pay will be attacked. This is not necessarily so,. The croke park agreement protects pay rates. Even if it is revisited then it is unlikely that any pay-cuts would be implemented across the board. Its more likely they would be targeted or it would be changed to allow for compulsory redundancy..

Your entire argument is based on an assumption that currently has no basis.

lonestargirl

Traumadoc wrote: »

I do not buy the surgical training argument, the thousands of hours needed do not seem to be needed elsewhere, eg Australia.

+1, a surgical SHO being paged to the wards at 4am to start an IV is not being 'trained' in surgery.

tallaght01

knipex wrote: »

No country, organisation, person or company in the situation where spending exceeds income can ignore their cost base.

In another post you asked why two people on the same income don't pay the same tax.

In the PAYE system they do. The pension levy was a paycut disguised for various reasons as a tax. If you ignore that then all PAYE workers pay the same tax.

You also seem to think that core pay will be attacked. This is not necessarily so,. The croke park agreement protects pay rates. Even if it is revisited then it is unlikely that any pay-cuts would be implemented across the board. Its more likely they would be targeted or it would be changed to allow for compulsory redundancy..

Your entire argument is based on an assumption that currently has no basis.

See, i still don't understand.

I know everyone pays the same tax. What I'm wondering is....Lenihan is going to take money from the wages of public sector workers in the coming budget in the form of a pay cut (or am i wrong about this?) in the same way as he did in the last budget. Why, instead of taking it from 2 of my 10 people doesn't he split it between 5 or 6 of my 10 people who earn similar incomes? I'm assuming tax is the way to do it. Why is my 63 year old dad going to give a chunk of his wages away, when my 32 year old mate on the same wage in the private sector isn't, in order to make up the 5 euro. But yet they're both equally using the public services.

Is my question making any sense to anybody?

PhysiologyRocks

tallaght01 wrote: »

Is my question making any sense to anybody?

Yes, making complete sense to me, but I'm no economist either!

upforit101

The ECB is effectively running the country now.
A bail out is most probable, possibly early next year however the people bailing us out (Germans) are not too happy to do this again and again for bankrupt countries (PIGS).
And the ECB or IMF will impose massive paycuts to PS as a condition of any bailout!
The Irish Times Berlin correspondant who was on newstalk radio recently, had a good analysis of the situation that lies ahead.

Interview begins at 21:20, part one, Friday 29th Oct.
http://media.newstalk.ie/listenback/202/friday/1/popup

maninasia

RobFowl wrote: »

I think what is missing (if that's the correct term) is that as I understand it due to the McCreevey and Cowan tax changes, 50% of the workforce pay no tax. Also the retired public sector earn as much as they did on retirement after about 8 years as their pensions are linked to their original final salary grading and as a result increase every year.

So at present if I need to raise 10euro from 10 workers the first five will pay none the next 3 will pay about 5.5 euro and the last 2 will pay 4.5.
Thats why the likes of the income levy appeals so much to them as it simply levies almost all but the lowest earners.

And thats before the public/private split comes into play,,,

This is certainly a major part of the problem, it's very unusual to have such large numbers of people not paying into the tax net. Minimum wage earners do not pay tax either, Ireland's minimum wage is quite high relative to most countries.
This is independent of being a private/public, it's a structural problem as it means tax intake is simple too little.

You don't need to be an economist to understand the main problems. It's pretty obvious, overspending and undertaxation, government revenue of the last 5 years before the bust was heavily dependent on capital gains tax and VAT and it was all dependent on cheap and easy credit to keep the bubble rolling. When the credit was pulled the air that kept the bubble inflated disappeared.

There are other problems with public sector pay and pension and yet another serious one with social welfare. To put it bluntly the country has been seriously mismanaged and mistakes (due to ignorance, greed and corruption) have been made across the board, manage would not even be the right word for what has gone on! Anybody who ran a professional organisation in this way would have been fired long ago but there are many powerful interest in Ireland who don't want to lose the 'priviledges' they have and that is why you don't see strikes like in France...there is no point in protesting against a government that is keeping you on the gravy train.

karlitob

Very interesting discussion - glad it didn't descend into too much name calling/mud slinging.

I guess we all have areas where we think money could be saved. Interesting to read earlier, where the NCHD had offered money saving ideas to management and thrown in the bin.

I work as a physio in a large dublin teaching hospital.
From my point of view, NCHD is the hardest job I've ever seen. From hours, responsibility, knowledge, career progression, abuse by other members of staff - its really really really hard. There are of course some who think the sun shines out of their a&*e just because they're doctors but they are few and far between.
My thoughts on that stop at consultant level. I think the majority are fantastic but they do NOT justify their expenses and perks. Not in the least.

It is hard to justify the following:
Hospital cleaners on 30 to 35K plus overtime and allowances.
Electricians going to strike because other staff were allowed to change light bulbs or because they were no longer going to be paid a call-out fee to press a button on an alarm panel.
Nurses striking for a 35 hour week and a 10% pay increase (a staff nurse starts on €30,234 rising automatically to €43,800 plus allowances and overtime).
Porters on 35K plus that can never be found.
16% plus absenteeism in some hospitals.

- there is such a strong union presence. If I hear 'thats not my job' again - I'll go mad.


Money Saving Ideas:

i) Cut consultant salaries!!!
ii)Compulsory Redundancies - I part-time work in a HSE unit that has 4 chefs, 2 maintenance men and 1 doorman for 34 patients. Ridiculous.
iii)500million is spent on GP for medical card patients - why are we doing this. Surely its cheaper to have a building with a GP, Physio, OT, Nurse etc (I think they call it PCCC) and those HCP see all patients who attend for free. Why pay a private practicioner to see all your patients when you can employee one directly.
iv)500 million on prescriptions for medical card patients - why are we doing this. Why not employee a pharmacist directly to dispense proven generic medication rather than paying a pharmacist to dispense what his buddy, the GP, has just prescribed.
v) Cervical Cancer Vaccine - It is hoped that the vaccine will save 60 lives a year. 250 are diagnosed each year - 80 die. 100 extra staff are to be recruited by the HSE including 27 Senior Medical Officers and 88 nurses for a period 16 weeks. There are question marks over its effectiveness
– that has not been adequately tested on girls of its target age group
– that may only replace one cause of cervical cancer with another
– that cannot replace screening

They will vaccinate 30000 girls. The fact remains that 5500 women every die of Cardiovascular disease. Its Irelands no.1 killer. CVD kills more people that all cancers, all road deaths and all suicides combined.

The only risk factor for breast cancer is a family history - 700 women died of breast cancer in 2008. There were 2500 on CVD. The sad thing is that the risk factors for CVD are modifiable - unlike some cancers.
ie inactivity, smoking, drinking, high cholesterol, high blood pressure, hypercholesteraemia

There is a protected cancer screening programme. All women over a certain age are sent an invitation to come for a screening and a mammogram - yet it is heart disease that will kill them not cancer. Why can;t we get a CV assessment performed when people are coming for their screening.

Rant over.

upforit101

Nail on the head from a poster who works in the PS.
edit; except for the natural remedies/info/criminal offence for doctors bit

http://www.boards.ie/vbulletin/showpost.php?p=68633917&postcount=6

knipex

tallaght01 wrote: »

See, i still don't understand.

I know everyone pays the same tax. What I'm wondering is....Lenihan is going to take money from the wages of public sector workers in the coming budget in the form of a pay cut (or am i wrong about this?)

Where did you get that idea ? They have allready given a commitment that they wont.

tallaght01 wrote: »

in the same way as he did in the last budget. Why, instead of taking it from 2 of my 10 people doesn't he split it between 5 or 6 of my 10 people who earn similar incomes? I'm assuming tax is the way to do it. Why is my 63 year old dad going to give a chunk of his wages away, when my 32 year old mate on the same wage in the private sector isn't, in order to make up the 5 euro. But yet they're both equally using the public services.

Is my question making any sense to anybody?

Simple question. The company your mate is working for. Is it spending way more that its earning ? Is it effectively borrowing 40% of its day to day costs ?

What would happen your mate if they were ? Would your father be happy to have to put his hand in his pocket to ensure that your mates wages were untouched ? Would you ? Would you be happy to have your taxes increased to ensure that my wages were untouched and that my job was secure ?

I am not saying that I think broad sweeping paycuts are the way to go. In fact I think they are madness but because of the way the public sector works and the inflexibility of the unions the options were limited.

In a normal situation when costs have to be addressed there are multiple options you can look at, targeted redundancies, out sourcing paycuts, overtime bans, short term working etc. None of those options existed.

That is why the unions agreed to the Croke Park agreement. They finally had to accept reality.

In return for increasing flexibility regarding redeployment etc they got security on pay and the fact that there would be no compulsory redundancies.

IMHO its a start but still madness. You need to have the option of targeted paycuts and redundancies.

RobFowl

karlitob wrote: »

iii)500million is spent on GP for medical card patients - why are we doing this. Surely its cheaper to have a building with a GP, Physio, OT, Nurse etc (I think they call it PCCC) and those HCP see all patients who attend for free. Why pay a private practicioner to see all your patients when you can employee one directly.
iv)500 million on prescriptions for medical card patients - why are we doing this. Why not employee a pharmacist directly to dispense proven generic medication rather than paying a pharmacist to dispense what his buddy, the GP, has just prescribed.
.

GP's (I am one) are independent contractors and you would be surprised how little they care for providing 24/7 care for a patient.
Make them employee's and a good chunk of us would be delighted. For patients though the first change they would see is that instead of seeing their doctor on the same or next day they would instead get put on a waiting list. Also these employed GP's would work their contracted hours and clock off when their shift finishes.
With regard to employing Pharmacists directly see above.
Retort to rant over

tallaght01

knipex wrote: »

Simple question. The company your mate is working for. Is it spending way more that its earning ? Is it effectively borrowing 40% of its day to day costs ?

What would happen your mate if they were ? Would your father be happy to have to put his hand in his pocket to ensure that your mates wages were untouched ? Would you ? Would you be happy to have your taxes increased to ensure that my wages were untouched and that my job was secure ?

But my dad isn't allowed to use my mate's company for free. My mate isn't working for my dad, so why would my dad pay for the running of my mate's accounting firm? I feel dumb now what am I missing?

Traumadoc

karlitob wrote: »

Very interesting discussion - glad it didn't descend into too much name calling/mud slinging.

Your "rant" interestingly could lead to "mud slinging" - dont get me started on physios.

tallaght01

karlitob wrote: »

v) Cervical Cancer Vaccine - It is hoped that the vaccine will save 60 lives a year. 250 are diagnosed each year - 80 die. 100 extra staff are to be recruited by the HSE including 27 Senior Medical Officers and 88 nurses for a period 16 weeks. There are question marks over its effectiveness
– that has not been adequately tested on girls of its target age group
– that may only replace one cause of cervical cancer with another
– that cannot replace screening

They will vaccinate 30000 girls. The fact remains that 5500 women every die of Cardiovascular disease. Its Irelands no.1 killer. CVD kills more people that all cancers, all road deaths and all suicides combined.

The only risk factor for breast cancer is a family history - 700 women died of breast cancer in 2008. There were 2500 on CVD. The sad thing is that the risk factors for CVD are modifiable - unlike some cancers.
ie inactivity, smoking, drinking, high cholesterol, high blood pressure, hypercholesteraemia

There is a protected cancer screening programme. All women over a certain age are sent an invitation to come for a screening and a mammogram - yet it is heart disease that will kill them not cancer. Why can;t we get a CV assessment performed when people are coming for their screening.

Rant over.

Wow!

There are several risk factors for breast cancer, aside from family history...diet, age at first pregnancy, number of pregnancies, socio-economic status (probably related to number of pregnancies and age at 1st pregnancy), individual history of certain other cancers, ethnicity, timing of menopause, timing of first period.... even being tall is a risk factor. There's also some evidence that nightshift working increases the risk for breast cancer.

70 million or so HPV vaccines given worldwide, with adverse effects monitored directly by WHO and individual regulatory agencies, with no higher than expected rates of adverse effects.

Even the clinical trials had 1200 young girls enrolled in them, which is obviously dwarfed by the surveillance data that we now have.

Can't think of any vaccine that's resulted in a change of strain so quickly...especially to the extent that it couldn't be changed pretty rapidly if it happened.

Vaccination isn't intended to replace screening.

Unfortunately CVD doesn't lend itself to a national screening programme, because there isn't one single highly sensitive/specific simple test that is amenable to intervention. It would be very complex and costly, and GPs are more than capable of doing it. GPs can't do a mammogram. I doubt a national CVD screening programme is cost-effective in Ireland, though I don't have figures to hand. It's certainly not cost effective here in Oz.

opinion guy

Hmmm - if you want to criticise the HPV vaccines - really the main flaw is that it is only being given to 50% of the population - i.e. girls only. Such an approach is absurd. 50% is nothing like close enough to achieve herd immunity.

tallaght01

opinion guy wrote: »

Hmmm - if you want to criticise the HPV vaccines - really the main flaw is that it is only being given to 50% of the population - i.e. girls only. Such an approach is absurd. 50% is nothing like close enough to achieve herd immunity.

It is if you get high levels of coverage in girls.

Vorsprung

My understanding is that women ARE the herd - they're the ones dying from HPV relates cancers. The only HPV related malignant in men that I know of is....not sure! Penile cancer? I'm on my phone so Im not going to look up the penile cancer rates, but I going to go out on a limb and say the rate of deaths from HPV related malignancy in men is negligable compared to women.

And I absolutely stand to be corrected on that!

Edit - On reflection, perhaps your point was different. If so, apolgiea, I'm tired

tallaght01

Vorsprung wrote: »

My understanding is that women ARE the herd - they're the ones dying from HPV relates cancers. The only HPV related malignant in men that I know of is....not sure! Penile cancer? I'm on my phone so Im not going to look up the penile cancer rates, but I going to go out on a limb and say the rate of deaths from HPV related malignancy in men is negligable compared to women.

And I absolutely stand to be corrected on that!

Edit - On reflection, perhaps your point was different. If so, apolgiea, I'm tired

Figures for the role of herd immunity and the coverage needed for it to be effective need to be calculated for individual vaccines in individual countries. I haven't done this for HPV.

But, just thinking aloud, in countries where penile carcinoma rates are higher, where would the boys get the HPV from if all the girls are immune? (I'm ignoring the well established homosexual HPV epidemic here, which would just complicate the situation, as it doesn't affect the cervical cancer situation much..problems in this community will be anal and throat cancer caused by HPV).

Unless I've missed out on something in terms of the dynamic infection, having an immune female population should achieve good community immunity.

opinion guy

tallaght01 wrote: »

It is if you get high levels of coverage in girls.

How can it possibly be with the other 50% of the polulation free to carry it?
Men will just act as a reservoir for carriage and continually reexpose women to the virus. Vaccines fail you know. You need far higher than 50% of people vaccinated to get herd immunity and actually decrease levels of carriage to the point where incidence of resultant cervical cancers is reduced to negligible. You need something like 95% or so (it varies with each individual disease depending on the properties of the strain).

Vorsprung wrote: »

My understanding is that women ARE the herd - they're the ones dying from HPV relates cancers. The only HPV related malignant in men that I know of is....not sure! Penile cancer? I'm on my phone so Im not going to look up the penile cancer rates, but I going to go out on a limb and say the rate of deaths from HPV related malignancy in men is negligable compared to women.

And I absolutely stand to be corrected on that!

Edit - On reflection, perhaps your point was different. If so, apolgiea, I'm tired

Yeah you misundestood me. But also to point out HPV is being increasingly associated with oral/throat cancers. This is applicable to both sexes.

dissed doc

karlitob wrote: »

i) Cut consultant salaries!!!

I see this again and again, but fail to see any real logic. The cost to the state for the entire consultant workforce is ~ €260 million per year. Once tax has worked it's way through, currently at around 54% of gross in public sector employment, the net cost to the state per year for the entire 1400 consultants on €186k gross salaries is ~ €120 million per year. YOu could pay them nothing, and have no doctors at all working in the health service, and the major problem of the other 98% of the health budget is still there.

From an NCHD perspective, application numbers have been decimated for hospitals. Training scheme applications have been at 60% drops in applications with vacant training posts since summer. It's no skin off my nose, but if you want an accesible and equitable health service, it costs money.

1400 consultants at 186k each = 260 million gross
Health budget = 14 BILLION
4500 junior doctors at average 75k each = 337 million gross

The doctors are the cheapest part of the health budget. If you get rid of them (which is what is happening), you still have 13.5 BILLION in health care costs but no-one doing the actual doctoring.

A better way would be to devolve the HSE and allow local counties to raise taxes locally for their hospitals. A tax credit or income tax reduction should be introduced to allow people to pay x% to a local health insurance service to pay for whatever is the local hospital. It wouldn't suit the admin and managerial fatcats in the HSE Command & Control centres in HSE Reichskommand in Dublin.

lonestargirl

tallaght01 wrote: »

There are several risk factors for breast cancer, aside from family history...diet, age at first pregnancy, number of pregnancies, socio-economic status (probably related to number of pregnancies and age at 1st pregnancy), individual history of certain other cancers, ethnicity, timing of menopause, timing of first period.... even being tall is a risk factor. There's also some evidence that nightshift working increases the risk for breast cancer.

+++1, also the primary risk factor is age which is why there is, and should be a lower limit, for screening. Personal history is huge, increases your risk of subsequent breast cancer almost 4-fold. Paedeatric Hodgkin's patients have a 25-times greater lifetime risk of breast cancer.

tallaght01 wrote: »

It is if you get high levels of coverage in girls.

HPV causes anal cancer too - 85% are HPV positive, but the public don't like to talk about people who have anal sex.
Roughly 35% of oropharangeal and 25% of other oral cancers are HPV related - these also tend to be a younger, healthier population that your standard H+N patient (as do the EBV H+N cancers.)

On topic: do you think there would be an increase in productivity in the HSE if everyone got 2 days less annual leave? These entitlements are quite generous (I started on 29 days a year - unheard of in the private sector).

sam34

OK, this thread is not about the cervical cancer vaccine!

create another thread about that if ye want to

knipex

tallaght01 wrote: »

But my dad isn't allowed to use my mate's company for free. My mate isn't working for my dad, so why would my dad pay for the running of my mate's accounting firm?

Where did you get the idea that your mate can use public services for free ?

What does he pay his taxes for ?

Yet he also probably pays for private heath insurance because he cannot rely on the services that he already pays for through his taxes.

I never use the public libraries, alcohol addiction services, social services, the military, public water or sewerage supplies, public transport and numerous other public services. According to your logic why should I pay taxes for all these ???

tallaght01 wrote: »

I feel dumb now what am I missing?

Not dumb just biased.

I think you said earlier that your father works as a cleaner in a hospital. Why should I pay higher taxes to pay him €14 something an hour when a contact cleaner earns a little over €9 union rate ?

tallaght01

knipex wrote: »

Where did you get the idea that your mate can use public services for free ?

What does he pay his taxes for ?

Yet he also probably pays for private heath insurance because he cannot rely on the services that he already pays for through his taxes.

I never use the public libraries, alcohol addiction services, social services, the military, public water or sewerage supplies, public transport and numerous other public services. According to your logic why should I pay taxes for all these ???

I still don't get it.

My mate isn't paying enough taxes to keep the public service going. There's a shortfall in what he's paying. So to make up the gap, we either pay more, or bring the cost down.

My dad has no more entitlement to use the pubic services than my mate. They both use water, sewage, hospitals, police etc. My dad doesn't use public transport much, but he uses the roads a lot more than my mate, who goes everywhere by bus, so it all evens itself out.

Yet we're asking my dad to take the financial hit to keep those services going, and not my mate.

Nothing you've said makes me understand why that should be the case. Why is my dad about to take a big financial hit to keep the country running, compared to my mate?

RobFowl

I think it's worth taking a step back here.
We as a country have been through worse and come through it.
We've come through a period where there wast money to spend and it was wasted. The next government are already postulating proper reform and looking at the total model of health in this country rather than just tweaking the crap two (+) system we have.
We live in a great country which has achieved great things and will do so again.
Stay positive look for solutions rather than problems and constantly review your/our own practices.

tallaght01

lonestargirl wrote: »

HPV causes anal cancer too - 85% are HPV positive, but the public don't like to talk about people who have anal sex.
Roughly 35% of oropharangeal and 25% of other oral cancers are HPV related - these also tend to be a younger, healthier population that your standard H+N patient (as do the EBV H+N cancers.)

.

While I made that point above, we don't have evidence that the vaccine affects those cancers. We only know it effects CIN. So the programme is designed to hammer cervical cancers. Though I suspect there will be a knock on effect. But (again, ignoring the homosexual epidemic of HPV) if there's no female reservoir, then males won't become infected.

Nchd2010

tallaght01, I can't really follow all this hypothetical stuff about your Dad, nor do I really want to involve him in anything seeing as he's not here to defend himself, but i think, in generality, the point being made is that there are elements of the public sector that are grossly overpaid.

I know someone working for a quango who is on a 7% per annum increment. Basic, without bonuses. This is phenomenal and is unheard of in the private sector, particularly as despite signing up to Croke Park, the unions now seem to have decided that they actually only agree with the parts that protect their jobs and pay.

dissed doc

I'm all for cuts but start with admin and non- frontline staff. Unless of course you do not want to maintain services. Which of course is exactly what is happening in Ireland - the plan is to cut frontline public healthcare services (c/t opposite in UK, Germany).

maninasia

dissed doc wrote: »

I see this again and again, but fail to see any real logic. The cost to the state for the entire consultant workforce is ~ €260 million per year. Once tax has worked it's way through, currently at around 54% of gross in public sector employment, the net cost to the state per year for the entire 1400 consultants on €186k gross salaries is ~ €120 million per year. YOu could pay them nothing, and have no doctors at all working in the health service, and the major problem of the other 98% of the health budget is still there.

From an NCHD perspective, application numbers have been decimated for hospitals. Training scheme applications have been at 60% drops in applications with vacant training posts since summer. It's no skin off my nose, but if you want an accesible and equitable health service, it costs money.

1400 consultants at 186k each = 260 million gross
Health budget = 14 BILLION
4500 junior doctors at average 75k each = 337 million gross

The doctors are the cheapest part of the health budget. If you get rid of them (which is what is happening), you still have 13.5 BILLION in health care costs but no-one doing the actual doctoring.

A better way would be to devolve the HSE and allow local counties to raise taxes locally for their hospitals. A tax credit or income tax reduction should be introduced to allow people to pay x% to a local health insurance service to pay for whatever is the local hospital. It wouldn't suit the admin and managerial fatcats in the HSE Command & Control centres in HSE Reichskommand in Dublin.

I can see a couple of holes in your figures as usual, not least your tax calculation method and your avoidance of pension/benefit discussion, but I'm not going into it now. Even if the savings were neglible (which they are not) , cutting consultants salaries is sending a signal from the top down, we are all in it together, a point you don't seem to get!
It's the same with politicians, if they don't take a pay cut why should anybody else?

maninasia

Nchd2010 wrote: »

tallaght01, I can't really follow all this hypothetical stuff about your Dad, nor do I really want to involve him in anything seeing as he's not here to defend himself, but i think, in generality, the point being made is that there are elements of the public sector that are grossly overpaid.

I know someone working for a quango who is on a 7% per annum increment. Basic, without bonuses. This is phenomenal and is unheard of in the private sector, particularly as despite signing up to Croke Park, the unions now seem to have decided that they actually only agree with the parts that protect their jobs and pay.

The fact that increments are still in full swing means supposed cuts to salaries are a straw man. You'll be back to square one in a couple of years. Although I see cuts in the public sector budget as neccessary it's obvious to me, from looking at the numbers, that it will be too little too late, ECB/IMF is definitely coming in next year

maninasia

tallaght01 wrote: »

While I made that point above, we don't have evidence that the vaccine affects those cancers. We only know it effects CIN. So the programme is designed to hammer cervical cancers. Though I suspect there will be a knock on effect. But (again, ignoring the homosexual epidemic of HPV) if there's no female reservoir, then males won't become infected.

HPV is a major case of cervical cancer in women, the HPV vaccine helps to prevent a majority of these cancers, ergo use the vaccine, makes sense to me. Start with vaccinating young girls and worry about the male side when the price comes down in the future. Lots of countries with lower income than Ireland have included it in their national health schemes already. When I heard that Ireland had delayed implementation of the HPV vaccine I was shocked and it made me realise how badly run the country is and how misdirected resources are there.

maninasia

tallaght01 wrote: »

I still don't get it.

My mate isn't paying enough taxes to keep the public service going. There's a shortfall in what he's paying. So to make up the gap, we either pay more, or bring the cost down.

My dad has no more entitlement to use the pubic services than my mate. They both use water, sewage, hospitals, police etc. My dad doesn't use public transport much, but he uses the roads a lot more than my mate, who goes everywhere by bus, so it all evens itself out.

Yet we're asking my dad to take the financial hit to keep those services going, and not my mate.

Nothing you've said makes me understand why that should be the case. Why is my dad about to take a big financial hit to keep the country running, compared to my mate?

If your father worked in private industry would he get paid more, would he have a generous pension, early retirement scheme, generous holiday and flexible working time? Would he even have a job ?
Please, I"m not having a dig at your dad who sounds like a hard working guy, but you need to compare to see the true situation.

tallaght01

maninasia wrote: »

If your father worked in private industry would he get paid more, would he have a generous pension, early retirement scheme, generous holiday and flexible working time? Would he even have a job ?
Please, I"m not having a dig at your dad who sounds like a hard working guy, but you need to compare to see the true situation.

As a tradesman he certainly would have been earning significantly more money over the last decade or so. In fact, when i was 25, my dad was talking to a mate of mine who was in the same trade about some jobs that were coming up in the public sector. They got talking about pay and conditions, and my mate who was half my dad's age was earning more than him. But dad has a real pride in serving the public, so he said he was never once tempted by the private sector.

Also, my dad only ever takes about 50% of his holidays, but I'm not aware that he gets any mega entitlements. I'm pretty sure he gets a few weeks a year. he doesn't have flexible work hours. He's contracted to work 8.30-4.30 every day, but for as long as I can remember he arrives in work every single solitary day at 7am, and leaves at around 5.

There's no way in hell he could afford early retirement, and as things stand his current retirement situation is a worry for him.

This is not about my dad. His story could easily be replaced by any number of conscientious NCHDs/nurses etc. This is why i don't understand blanket pay cuts. I think everyone should just pay more, depending on what they earn. Tax the pension contributions if it's that generous (talking to my dad about how much he's going to get when he retires, it doesn't strike me as being particularly extravagant).

BUt this is my central point..."the public sector" is a heterogenous mix of people, much like "the private sector is".

I just don't get why people like my old man have to pay more towards the running of the state than others who earn the same.

tallaght01

maninasia wrote: »

HPV is a major case of cervical cancer in women, the HPV vaccine helps to prevent a majority of these cancers, ergo use the vaccine, makes sense to me. Start with vaccinating young girls and worry about the male side when the price comes down in the future. Lots of countries with lower income than Ireland have included it in their national health schemes already. When I heard that Ireland had delayed implementation of the HPV vaccine I was shocked and it made me realise how badly run the country is and how misdirected resources are there.

I'm not sure why this was quoted in response to my point. i agree with most of the points you make here

maninasia

I think you think the public sector is paying more than it's share, but you have to look at benchmarking, higher pay on average, pension entitlements and rock solid job security. It's still a good deal overall.
It's quite likely your dad would now be unemployed now or his job be in danger of disappearing if he worked in private industry. You can't compare salaries at boomtime to normal levels, and public sector workers should not get a higher salary than private sector workers simply because they have a job for life and the performance requirements are just not equivalent in general.

tallaght01

maninasia wrote: »

I think you think the public sector is paying more than it's share, but you have to look at benchmarking, higher pay on average, pension entitlements and rock solid job security. It's still a good deal overall.
It's quite likely your dad would now be unemployed now or his job be in danger of disappearing if he worked in private industry. You can't compare salaries at boomtime to normal levels, and public sector workers should not get a higher salary than private sector workers simply because they have a job for life and the performance requirements are just not equivalent in general.

I don't know all the details of the pension, but I agree the contributions should be taxed. But it's not like my ould lad is gonna be living a decadent lifestyle on his pension.

Also averages are not going to give a reasonable comparison between public and private sector wages, when you've got such vastly different earnings at both ends of the spectrum in both sectors. I'm not sure if the earnings in both sectors are normally distributed, though.

I don't know what the unemployment rate is in Ireland, but I don't think it's "likely" my dad would be unemployed if he worked in the private sector. Possible yes, but what's your definition of likely? His friends in the same business still have their jobs.

Why can't we compare boomtime salaries, when you're comparing recession salaries? i don't understand this at all. I'm still no wiser as to why public sector workers are being asked to pay more than private sector workers to run the health service. That's really the issue I have here. I just don't get this logic.

Why is the security guard in A+E/motor tax office etc going to get his pay reduced to pay for the running of the public sector, when the top lawyers in my sister's firm won't be paying extra?

Why are doctors in the public sector being asked to pay extra for the running of it, but those in the private sector won't?

I appreciate no-one (except physiologyrocks ) understands the question I'm asking, or the point I'm making, so I apologies for my lack of clarity :P

knipex

tallaght01 wrote: »

I still don't get it.

My mate isn't paying enough taxes to keep the public service going. There's a shortfall in what he's paying. So to make up the gap, we either pay more, or bring the cost down.

My dad has no more entitlement to use the pubic services than my mate. They both use water, sewage, hospitals, police etc. My dad doesn't use public transport much, but he uses the roads a lot more than my mate, who goes everywhere by bus, so it all evens itself out.

Yet we're asking my dad to take the financial hit to keep those services going, and not my mate.

You are making a HUGE assumption that all cuts in the PS will involve cuts to your fathers pay. There is no evidence of any sort to support that so why are you continuing to debate as if it were a fact and not an unsupported theory ?

Or are you arguing against cuts in the PS ?

As I have said before and I will say again with a deficit as large as the one we have, with the growth in the PS pay-bill such as we have had over the last 7 years (you do realise that the growth in the PS pay-bill from 2003 to 2010 is actually almost identical to the entire adjustment that has to be made by 2014 ?) you cannot ignore the cost element.

As I have said previously I don't think broad sweeping pay cuts is the way to address that. Targeted redundancies, targeted pay cuts, massive reform of work practices and reform of service provision is in my mind the way to go. However the PS unions will not even contemplate his course of action so the only option left open was the broad pay cuts and pension levies.

I cannot see this being repeated but if it is then I personally would lay the blame squarely on the PS unions.

tallaght01 wrote: »

As a tradesman he certainly would have been earning significantly more money over the last decade or so. In fact, when i was 25, my dad was talking to a mate of mine who was in the same trade about some jobs that were coming up in the public sector. They got talking about pay and conditions, and my mate who was half my dad's age was earning more than him. But dad has a real pride in serving the public, so he said he was never once tempted by the private sector.

As a tradesman your father was getting the exact same union rate as your mate in the private sector. He may not have been getting the same amount of overtime or travelling allowances but if you asked your father I would be willing to bet he would be much happier in his job than busting his ass on a dirty wet building site. If that was not the case then he could have and would have moved.

Out of curiosity, your mate in the same trade, how does his pay compare to your fathers now ?
Does he even have a job ?

tallaght01 wrote: »

Also, my dad only ever takes about 50% of his holidays, but I'm not aware that he gets any mega entitlements. I'm pretty sure he gets a few weeks a year. he doesn't have flexible work hours. He's contracted to work 8.30-4.30 every day, but for as long as I can remember he arrives in work every single solitary day at 7am, and leaves at around 5.

There's no way in hell he could afford early retirement, and as things stand his current retirement situation is a worry for him.

Your father does this by choice, not by force and in the private sector would be rewarded for it. However the PS does not work that way. What I would ask yourself is why not ?

But for every story like your fathers there are many like the strike in Waterford over who changes light bulbs, like St James's where they striked to protect their generous call-out payments to press a button on an alarm panel.

tallaght01 wrote: »

This is not about my dad. His story could easily be replaced by any number of conscientious NCHDs/nurses etc. This is why i don't understand blanket pay cuts. I think everyone should just pay more, depending on what they earn. Tax the pension contributions if it's that generous (talking to my dad about how much he's going to get when he retires, it doesn't strike me as being particularly extravagant)

BUt this is my central point..."the public sector" is a heterogenous mix of people, much like "the private sector is".

I just don't get why people like my old man have to pay more towards the running of the state than others who earn the same.

Now you are arguing to protect pay and terms in the PS irrespective of value for money. Screw everyone to protect the pay and conditions of a minority irrespective of the value for money they deliver.

That position is an nonsensical as the blanket paycuts.

knipex

tallaght01 wrote: »

I don't know what the unemployment rate is in Ireland, but I don't think it's "likely" my dad would be unemployed if he worked in the private sector. Possible yes, but what's your definition of likely? His friends in the same business still have their jobs.

What trade is your father in ? Because unemployment in the trades in Ireland is huge. All trades have been decimated.

tallaght01 wrote: »

Why can't we compare boomtime salaries, when you're comparing recession salaries? i don't understand this at all. I'm still no wiser as to why public sector workers are being asked to pay more than private sector workers to run the health service. That's really the issue I have here. I just don't get this logic.

As I have said before your argument is based on a false assumption about pay cuts but for a second lets just swing the tables.....

Irish unemployment has increased by over 300,000.

How many of those job losses came from the public sector ? How many compulsory redundancies occurred in the public sector ?

How many people in the private sector have taken huge pay-cuts or are working 3 day weeks ?

How many of them go to bed every night wondering if they will have a job next week ?

But to you they are not paying enough. They should also have massive tax increases just so that a minority group in Irish society can continue to be protected from the realities of the financial situation.

How much tax would you like them to pay ? Currently the effective rate is 52% how about 60% ? 70% ? putting hundreds of thousands more out of work or into poverty to ensure your dads pay remains untouched and his job remains secure.

Is that the fair you are looking for ?

tallaght01 wrote: »

Why is the security guard in A+E/motor tax office etc going to get his pay reduced to pay for the running of the public sector, when the top lawyers in my sister's firm won't be paying extra?

Firstly

I really dont know where you are getting your information from. How many solicitors have been laid off over the last 2 years ? How many are applying for jobs in Mc Donalds and quing up for jobs jobs in M&S gift wrapping ?

I don't know what firm your sister works in but its far from typical.

Secondly is your sisters firm borrowing 40% of its day to day running costs ? What would they do if it was ?

tallaght01 wrote: »

Why are doctors in the public sector being asked to pay extra for the running of it, but those in the private sector won't?

I appreciate no-one (except physiologyrocks ) understands the question I'm asking, or the point I'm making, so I apologies for my lack of clarity :P

No I understand EXACTLY your argument and its nonsensical.

Your claim that the private sector is not paying is absolute nonsense.

You pick a few mates or family as typical examples and amazingly enough in sectors which have been disproportionately hit by the down turn but manage to either maintain their jobs and pay or get pay increases. Your mates must be very very very lucky. My advice is to broaden your circle of friends and look at the reality of what is happening in the private sector.

I work in the privater sector and have seen tax increases and levies. I have not had a pay raise in 4 years and had two separate paycuts AND tax increases AND levies in the last 2 years. So have everyone else in my company and most of my friends (or at least those lucky enough to be working).

Secondly you are protesting that is very unlikely to happen.

j.mcdrmd

As I understand it:-

Salary is the major cost to the hse.

Doctors salaries make up a small portion of this.

Admin staff make up the majority.

There have been cuts across the board but doctors seem to be baring the brunt of the cuts. This is partly because on top of all the other cuts they are not being paid for all hours worked in some of the hospitals.

For example, our intern was not paid for all hours worked (without choice) for the past two months. Pay per hour worked after tax (emergency) €6 odd, before tax €9 odd.

Financial expenses cannot be met by them e.g. food, rent, transport, loan repayments.

Maybe this is partly the reason so many nchd's are leaving Ireland.

I think you have to be here to believe the rate of change that is happening in the public hospitals. If this continues there may be no public hospital system to argue about, not one with many doctors in it anyway.

The interns consultant (a great educator by the way) has personally thanked the intern for helping to ensure continuation of patient care in very difficult circumstances.

I say strike as patient care will surely suffer if this continues plus you have to be solvent. They say they can't because nobody has any respect for doctors anymore.

J. McDrmd

knipex

j.mcdrmd wrote: »

As I understand it:-

Salary is the major cost to the hse.

Approx 75% of the hospital budget is salary related. (HSE budget covers medical cards, social welfare payments, drug payment scheme etc so only a small proportion of the HSE budget goes to hospitals)

j.mcdrmd wrote: »

Doctors salaries make up a small portion of this.

No argument here

j.mcdrmd wrote: »

Admin staff make up the majority.

Actually I think its Nursing staff.

j.mcdrmd

Knipex you may well be correct.

I looked up the INMO but did not get the answer.

Incidentally I thoughy the INMO site looked great, up to date and dynamic. My memory of the IMO web site was that it seemed to be dated by comparison. So I decided to check and looked up imo.com (I know now it should be .ie)

This was the result

IN MEMORY OF

A new site coming soon
http://www.imo.com/

Seems to sum it up really.

Anyhow does anyone know the breakdown of staff of the hse?

RobFowl

j.mcdrmd wrote: »

Knipex you may well be correct.

I looked up the INMO but did not get the answer.

Incidentally I thoughy the INMO site looked great, up to date and dynamic. My memory of the IMO web site was that it seemed to be dated by comparison. So I decided to check and looked up imo.com (I know now it should be .ie)

This was the result

IN MEMORY OF

A new site coming soon
http://www.imo.com/

Seems to sum it up really.

Anyhow does anyone know the breakdown of staff of the hse?

To be fair the IMO site is at www.imo.ie

It's not the worst site either. That said the IMO financial services are excellent but IMO (yes i see the irony) the rest of the organisation lacks focus and direction.

opinion guy

So to get back on topic.

How many test are ordered needlessly ?
How do they cost ?

So called routine stuff like fbc's.
How much do fbc's, lft's, u&e's , tft's, lipids etc etc etc cost ?
Can savings be made in cutting back on tests ?

opinion guy

http://news.eircom.net/breakingnews/18866333/?view=Standard

The HSE wants 5,000 of its 28,000 administrative and clerical staff to take up voluntary redundancy or early retirement.

:eek::eek::eek::eek::eek:
28,000

Theres 28,000 admin in the HSE ?!?!?!!?
Da f*&k they do of any use ?!?!?!

So I think we can see where the wage bill comes from then. Most of these admin folks start on the same wage as a junior doctor by the way and the wage rises to consultant territory.

Vorsprung

opinion guy wrote: »

So to get back on topic.

How many test are ordered needlessly ?
How do they cost ?

So called routine stuff like fbc's.
How much do fbc's, lft's, u&e's , tft's, lipids etc etc etc cost ?
Can savings be made in cutting back on tests ?

Agree!

Coags were the one that I thought we ordered way too often. Most people don't need more than one coag during an admission.

That said, and as someone pointed out earlier, because lab staff are unlikely to be laid off if less tests are ordered, would the savings amount to much? How much of the cost of a test is down to the reagents used and how much is down to labour?

knipex

j.mcdrmd wrote: »

Knipex you may well be correct.

I looked up the INMO but did not get the answer.

I could also be wrong.

But looking at the hospital sector alone you can get a breakdown of individual hospitals.

picking some random examples of various size hospitals.

St James's

# medical/Dental: 404
# Nursing: 1,402
# Health and Social Care Professionals: 588
# Management/admin: 588
# General Support Staff: 422
# Other Patient and Client Care: 282
# Total number of WTE (whole time equivalent) staff at end Dec 2008: 3,686

Midwestern Regional Limerick

* Medical/Dental: 221
* Nursing: 727
* Health and Social Care Professionals: 242
* Management/admin: 291
* General Support Staff: 156
* Other Patient and Client Care: 226
* Total number of WTE (whole time equivalent) staff at end Dec 2008: 1,864


Our Lady of Lourdes Drogheda

* Medical/Dental: 197
* Nursing: 560
* Health and Social Care Professionals: 108
* Management/admin: 206
* General Support Staff: 202
* Other Patient and Client Care: 82
* Total number of WTE (whole time equivalent) staff at end Dec 2008: 1,354

opinion guy wrote: »

http://news.eircom.net/breakingnews/18866333/?view=Standard



:eek::eek::eek::eek::eek:
28,000

Theres 28,000 admin in the HSE ?!?!?!!?
Da f*&k they do of any use ?!?!?!

So I think we can see where the wage bill comes from then. Most of these admin folks start on the same wage as a junior doctor by the way and the wage rises to consultant territory.

28,000 isn't as bad as it sounds when you consider the HSE employ over 150,000 people so roughly 18% of staff are admin.

Low level admin people or clerical and are actually pretty low paid.

As to where they are. I would guess that a large proportion is not the majority are outside the hospitals. Look at the admin side associated with medical cards, drug payment scheme, social welfare, food inspections etc.

In the hospital side you have receptionists, secretaries, all those people who book in appointments in outpatients, x-ray, payrole, HR, etc etc......

I'm not saying they are not overstaffed in certain areas (hugely so in fact) but not all the admin people are in makey uppy jobs just designed to make health-care workers lives harder.

And one again there seems to be a perception that the HSE starts and ends with hospitals. It doesn't and only a fraction of its budget is associated with hospitals.

Dan_Solo

maninasia wrote: »

I think you think the public sector is paying more than it's share, but you have to look at benchmarking, higher pay on average, pension entitlements and rock solid job security.

I've heard this line trotted out in similar debates a million times now.
Not all of the public service are permanent you know.