The reality of cutbacks.

mikemac1

Time to call in Jack Welch :eek:

He has Irish roots

sarumite

While definitely pulling all the right heartstrings, it isn't really the reality of cuts. Its the reality of a poorly managed budget, where too much of the budget is spen on paying for jobs which are superfluous to the effective running ot the organisation. The government needs to start making the necessary cuts so unnecessary cuts aren't required.

johnnyskeleton

woodoo wrote: »

You do not have nerve damage due to chemotherapy like this man. He has been like this for years. Chronic pain is a miserable existence. I believe people like that deserve priority.

But that's significantly different to what you said earlier that nobody should be left in pain. Are you resiling from that absolute position?

If so, then you can take solace that he is not going to be left with nothing in his local area. He will be given pain relief treatment by way of pharmecuticals etc. That may not be top class treatment, but it is reasonable treatment and it is good enough IMO from the national health provider.

If everyone automatically gets the best treatment available, then we would not be able to afford the HSE.

antoobrien

oppenheimer1 wrote: »

Is it not that the patient in that article will be transferred to a more local hospital to deal with his condition, rather than being refused treatment outright?

murphaph wrote: »

The more local hospital doesn't offer this specialised treatment, so the patient is fcuked.

The above question is pertinent. Galway is the regional center of excellence for cancer services in the West & North West, so why isn't be being treated there?

johnnyskeleton

murphaph wrote: »

When we reach the point of having fired all the admin staff in the HSE who twiddle their thumbs all day, etc

sarumite wrote: »

While definitely pulling all the right heartstrings, it isn't really the reality of cuts. Its the reality of a poorly managed budget, where too much of the budget is spen on paying for jobs which are superfluous to the effective running ot the organisation. The government needs to start making the necessary cuts so unnecessary cuts aren't required.

But it is precicely those "superflous" jobs in admin that facilitated his admission to a hospital on the other side of the country. If the admin of the HSE were cut back and we were left with locally managed hospitals, this never would have arisen in the first place.

Welease

johnnyskeleton wrote: »

But it is precicely those "superflous" jobs in admin that facilitated his admission to a hospital on the other side of the country. If the admin of the HSE were cut back and we were left with locally managed hospitals, this never would have arisen in the first place.

The superflous Admin roles being discussed were not necessary to provide these services, and in fact (http://www.irishhealth.com/article.html?id=18146 ) the HSE HR Director Sean McGrath had previously commented "With one single organisation replacing eleven health boards, there should have been economies of scale. However, there was no redundancy programme and too many people ended up doing similar jobs. There was much duplication and added levels of admin to plough through in order to get things done."

It is those heads that the McCarthy report and everyone else understands as being superflous. A co-ordinated countrywide resource capability of the type you describe is essential, but all of these Admin heads are not necessary to provide such a service.

woodoo

johnnyskeleton wrote: »

But that's significantly different to what you said earlier that nobody should be left in pain. Are you resiling from that absolute position?

If so, then you can take solace that he is not going to be left with nothing in his local area. He will be given pain relief treatment by way of pharmecuticals etc. That may not be top class treatment, but it is reasonable treatment and it is good enough IMO from the national health provider.

If everyone automatically gets the best treatment available, then we would not be able to afford the HSE.

No my initial position was pain of the sort that this man has. I may not have made myself clear enough though. Anyone can handle pain in the short to medium term. Long term pain grinds you down.

Just on the issue of over-staffing in Local Authorities and the HSE. Yes amalgamating Councils would be good i believe and a some streamlining of departments in the HSE would be good also. But people must not assume that by doing so will save massively on jobs. Yes there will be savings but not as much as people think.

If you have 8 people working in salaries in Cork County Council and 8 People in Kerry County Council and we assume they are all busy. Simply by amalgamating all the work to Cork will not mean that you can do away with 8 jobs. The work in Cork will double. Maybe the odd middle manager may be lost. But the numbers won't be as big as hoped i believe.

Look at what happened when they centralised Medical Cards to Dublin in the belief that they could do more work with less people simply because it was all done in the same building. It has failed miserably. They are in such a mess don there its a scandal.

Efficiencies can be made but they will take time and co-operation from existing staff. That is already underway under the CPA. Thousands of staff have left and the work is being picked up by those still there. It could take 5 years. How much would really be saved by wielding the axe in a hap hazard way and in a rush?

sarumite

woodoo wrote: »

Efficiencies can be made but they will take time and co-operation from existing staff. That is already underway under the CPA. Thousands of staff have left and the work is being picked up by those still there. It could take 5 years. How much would really be saved by wielding the axe in a hap hazard way and in a rush?

The reality of the cutbacks is that they are necessary as long as we continue to run deficit and I think as long as you are advocating the government to continue with its current course and accept that certain aspects of the HSE budget is ringfenced from any further cuts, then it seems one must acknowledge that cuts in other areas of the budget will become a necessity.

Welease

sarumite wrote: »

The reality of the cutbacks is that they are necessary as long as we continue to run deficit and I think as long as you are advocating the government to continue with its current course and accept that certain aspects of the HSE budget is ringfenced from any further cuts, then it seems one must acknowledge that cuts in other areas of the budget will become a necessity.

.. and the longer those efficiencies take to achieve.. the more those other non ringfenced areas will continue to be cut.

If people are actually interested in helping Mr. Keavney and others like him, then they should be demanding that efficiencies and change in the HSE are implemented as fast as humanly possible.

johnnyskeleton

Welease wrote: »

The superflous Admin roles being discussed were not necessary to provide these services, and in fact (http://www.irishhealth.com/article.html?id=18146 ) the HSE HR Director Sean McGrath had previously commented "With one single organisation replacing eleven health boards, there should have been economies of scale. However, there was no redundancy programme and too many people ended up doing similar jobs. There was much duplication and added levels of admin to plough through in order to get things done."

It is those heads that the McCarthy report and everyone else understands as being superflous. A co-ordinated countrywide resource capability of the type you describe is essential, but all of these Admin heads are not necessary to provide such a service.

yet no one does anything about it? I mean, they are presumably doing some job, and apart from anecdotal evidence of departments where there is little to do, if there were easy cuts surely they could have been made by now.

So while I'm well aware of the cost of the public sector, increases in numbers an pay etc, if there was an easy solution surely they would have done it. If they can prove that the jobs are redundant then I don't see why they can't get rid of them.

johnnyskeleton

woodoo wrote: »

johnnyskeleton wrote: »

But that's significantly different to what you said earlier that nobody should be left in pain. Are you resiling from that absolute position?

If so, then you can take solace that he is not going to be left with nothing in his local area. He will be given pain relief treatment by way of pharmecuticals etc. That may not be top class treatment, but it is reasonable treatment and it is good enough IMO from the national health provider.

If everyone automatically gets the best treatment available, then we would not be able to afford the HSE.

No my initial position was pain of the sort that this man has. I may not have made myself clear enough though. Anyone can handle pain in the short to medium term. Long term pain grinds you down.

Ok, so it comes down to a subjective view of what should and should not be done on a case by case basis. The hospital has obviously felt that an acceptable level of pain management was available to him locally. We have to trust that the hospital is capable of deciding these issues an who are the most important patients for the limited resources available to them.

Just on the issue of over-staffing in Local Authorities and the HSE. Yes amalgamating Councils would be good i believe and a some streamlining of departments in the HSE would be good also. But people must not assume that by doing so will save massively on jobs. Yes there will be savings but not as much as people think.

If you have 8 people working in salaries in Cork County Council and 8 People in Kerry County Council and we assume they are all busy. Simply by amalgamating all the work to Cork will not mean that you can do away with 8 jobs. The work in Cork will double. Maybe the odd middle manager may be lost. But the numbers won't be as big as hoped i believe.

Look at what happened when they centralised Medical Cards to Dublin in the belief that they could do more work with less people simply because it was all done in the same building. It has failed miserably. They are in such a mess don there its a scandal.

Efficiencies can be made but they will take time and co-operation from existing staff. That is already underway under the CPA. Thousands of staff have left and the work is being picked up by those still there. It could take 5 years. How much would really be saved by wielding the axe in a hap hazard way and in a rush?

here I tend to agree with you. If it was a simple narrative of too many admin staff with nothing to do preventing hard working doctors from providing better service then it would easily be remedied. The problem is that I don't think the narative is that straightforward. What most people consider useless admin is a large structure that has a lot of administrative tasks to do. I'm sure it could be improved, streamlined etc, but the reality at present is that cuts have to be made and if it wasn't this person it might have been someone else who was denied treatment.

We can't assume that the other person is a less deserving case. That has to be decided by the hospital, more particularly by the hospital administration.

johnnyskeleton

Welease wrote: »

sarumite wrote: »

The reality of the cutbacks is that they are necessary as long as we continue to run deficit and I think as long as you are advocating the government to continue with its current course and accept that certain aspects of the HSE budget is ringfenced from any further cuts, then it seems one must acknowledge that cuts in other areas of the budget will become a necessity.

.. and the longer those efficiencies take to achieve.. the more those other non ringfenced areas will continue to be cut.

If people are actually interested in helping Mr. Keavney and others like him, then they should be demanding that efficiencies and change in the HSE are implemented as fast as humanly possible.

And if it is not possible to make such cuts, should we deprive this guy of the service he wants, or should we deprive someone else of their treatment?

Welease

johnnyskeleton wrote: »

yet no one does anything about it? I mean, they are presumably doing some job, and apart from anecdotal evidence of departments where there is little to do, if there were easy cuts surely they could have been made by now.

So while I'm well aware of the cost of the public sector, increases in numbers an pay etc, if there was an easy solution surely they would have done it. If they can prove that the jobs are redundant then I don't see why they can't get rid of them.

I'm not sure what you mean..

There are 2 primary reasons as to why it hasn't happened 1) The CPA.. no forced redundancies 2) Jobs for Life agreement when the HSE was formed (and recently tested and upheld in the Labour Courts by IMPACT members http://www.imt.ie/opinion/guests/2010/06/union-wins-on-jobs-for-life.html).

There is also the 3rd reason.. the will to do so.. If the Goverment, HSE staff or Unions had wanted to implement these resource rationalisations then the CPA would never have seen the light of day. From the HSE and Union perspective it's fairly obvious why they would not push for forced redundancies.. from the Governments side.. well it falls into the same bucket of other stuff we wonder why they don't do..

Welease

johnnyskeleton wrote: »

And if it is not possible to make such cuts, should we deprive this guy of the service he wants, or should we deprive someone else of their treatment?

I think most people are pushing that we exhaust all possible efficiencies first.. then we implement further cuts. Concern is that those who are responsible to deciding on which cuts have so far been shown to be incapable of running the HSE correctly, so many have little faith the correct cuts would be made. One would hope the cancer patient has access to services within his catchment area (Galway for example) if not, then why not..

But lets not forget many cuts have already been made, SNA's have been cut, Disability Carer payments for children are getting harder and harder to get, Services for Disabled Children are being cut left right and centre, Mental health services are seriously understaffed, 178K are waiting to see consultants apparently, elective surgeries being cancelled etc.

liammur

K-9 wrote: »

Far too much personal references and digs in this thread. Any more will result in cards, posters should know better at this stage.

+1

Noreen1

johnnyskeleton wrote: »

But that's significantly different to what you said earlier that nobody should be left in pain. Are you resiling from that absolute position?

If so, then you can take solace that he is not going to be left with nothing in his local area. He will be given pain relief treatment by way of pharmecuticals etc. That may not be top class treatment, but it is reasonable treatment and it is good enough IMO from the national health provider.

If everyone automatically gets the best treatment available, then we would not be able to afford the HSE.

You appear to think that this unfortunate gentleman had no need to go to Dublin for treatment in the first place?

The reality is that he required a treatment that was - and is - not available in his local area.

So, the question is - are people in Dublin entitled to a better service than those in Donegal?

Since the service has not been removed from those who live in the Dublin area, and the service is not available in Donegal then equality of treatment should be the issue.

So the service should be available to those who live outside the hospital catchement area (probably more cost effective, though extremely inconvenient in terms of discomfort while travelling) - or provided in Letterkenny or Sligo hospital.

Unless, of course, you believe inequality is acceptable, based on where you live?

Godge

Noreen1 wrote: »

You appear to think that this unfortunate gentleman had no need to go to Dublin for treatment in the first place?

The reality is that he required a treatment that was - and is - not available in his local area.

So, the question is - are people in Dublin entitled to a better service than those in Donegal?

Since the service has not been removed from those who live in the Dublin area, and the service is not available in Donegal then equality of treatment should be the issue.

So the service should be available to those who live outside the hospital catchement area (probably more cost effective, though extremely inconvenient in terms of discomfort while travelling) - or provided in Letterkenny or Sligo hospital.

Unless, of course, you believe inequality is acceptable, based on where you live?

To answer your question about Dublin and Donegal, the answer has to be yes, people in Dublin should get a better service than Donegal. Why? Because the cost of providing a public service to the most densely populated part of the country is much cheaper than providing a public service to the least densely populated part of the country.

Apply the logic of equal public services to another country, say Australia. Should the same level of public services be available in the outback as in the city of Melbourne. Should we have a full services hospital every 200 miles in the outback? The reasonable answer is no, those who choose to live in the outback have to pay a price in terms of accessibility and availability of public services.

The same logic applies, albeit to a lesser and more nuanced extent in Ireland. If you live outside of a major city - Dublin, Cork or Belfast - you have to expect that you will receive some degree of lesser public service. This may simply be that you have to travel to Dublin for some medical procedures, it may be that you don't have a local university, or it may be that some type of service is not accessible at all. If such rules were not applied our unsustainable public services would be even more costly.

liammur

Godge wrote: »

The same logic applies, albeit to a lesser and more nuanced extent in Ireland. If you live outside of a major city - Dublin, Cork or Belfast - you have to expect that you will receive some degree of lesser public service. This may simply be that you have to travel to Dublin for some medical procedures, it may be that you don't have a local university, or it may be that some type of service is not accessible at all. If such rules were not applied our unsustainable public services would be even more costly.

I agree with this principle, but the way we are going, people in these areas will receive no services which is not right either. Yet, they will be expected to pay for every service under the sun.

n97 mini

liammur wrote: »

people in these areas will receive no services

They will always have roads, post, electricity, phones, schools etc., which realistically is more than what some of the Australian outback receives.

Noreen1

Godge wrote: »

To answer your question about Dublin and Donegal, the answer has to be yes, people in Dublin should get a better service than Donegal. Why? Because the cost of providing a public service to the most densely populated part of the country is much cheaper than providing a public service to the least densely populated part of the country.

Nice defllection. I've already dealt with the issue of cost, by stating that it is more cost effective to provide the services in Dublin, despite the inconvenience and discomfort involved in travel.

Godge wrote: »

Apply the logic of equal public services to another country, say Australia. Should the same level of public services be available in the outback as in the city of Melbourne. Should we have a full services hospital every 200 miles in the outback? The reasonable answer is no, those who choose to live in the outback have to pay a price in terms of accessibility and availability of public services.

Already acknowledged.

Godge wrote: »

The same logic applies, albeit to a lesser and more nuanced extent in Ireland. If you live outside of a major city - Dublin, Cork or Belfast - you have to expect that you will receive some degree of lesser public service. This may simply be that you have to travel to Dublin for some medical procedures, it may be that you don't have a local university, or it may be that some type of service is not accessible at all. If such rules were not applied our unsustainable public services would be even more costly.

The poor man has not asked for services to be made available
locally.
He has stated (and his Doctor has concurred) - that he has been denied the service because he lives outside the hospitals catchment area.

So, I will ask you again. Is it acceptable to allow someone in Donegal - who is willing to travel - to suffer a level of pain, that someone in Dublin is not expected to suffer?

murphaph

Godge wrote: »

To answer your question about Dublin and Donegal, the answer has to be yes, people in Dublin should get a better service than Donegal. Why? Because the cost of providing a public service to the most densely populated part of the country is much cheaper than providing a public service to the least densely populated part of the country.

Apply the logic of equal public services to another country, say Australia. Should the same level of public services be available in the outback as in the city of Melbourne. Should we have a full services hospital every 200 miles in the outback? The reasonable answer is no, those who choose to live in the outback have to pay a price in terms of accessibility and availability of public services.

The same logic applies, albeit to a lesser and more nuanced extent in Ireland. If you live outside of a major city - Dublin, Cork or Belfast - you have to expect that you will receive some degree of lesser public service. This may simply be that you have to travel to Dublin for some medical procedures, it may be that you don't have a local university, or it may be that some type of service is not accessible at all. If such rules were not applied our unsustainable public services would be even more costly.

This is all completely correct, however the man is being denied the better treatment available in Dublin, even though he appears willing to travel for it. He is not complaining that it is not provided in Donegal, rather that because he lives there, he is no longer eligible to receive this form of treatment.

The HSE, rather than reduce its internal expenditures be making redundant admin staff redundant and/or amalgamating admin departments and then making the excess redundant, has chosen to save money by eliminating this man's treatment based on his address.

I am fully in favour of centres of excellence and so on and a smaller role for regional and local hospitals, closing nonsensical ones completely, but I can see that in this case it's different. The patient is not having his service relocated. He's having it removed to save money, primarily because the HSE never made the tough decisions to make that organisation more streamlined, as was expected with the merger of the health boards.

Head The Wall

liammur wrote: »

+1

Agreed and it shows up their intelligence to post something about me being bitter and another one about me paying very little tax. I moved to a country where I am paying three times as much tax as I was in Ireland and I have no problem in doing so as I can see that there are decent services in return.

If they can't see the connection between Irish paying very little tax and the crap services received well that says it all

Tipp Man

Head The Wall wrote: »

Agreed and it shows up their intelligence to post something about me being bitter and another one about me paying very little tax. I moved to a country where I am paying three times as much tax as I was in Ireland and I have no problem in doing so as I can see that there are decent services in return.

If they can't see the connection between Irish paying very little tax and the crap services received well that says it all

WTF??

What you mean is that the majority of Irish are paying very little tax and some are paying a huge amount of tax??? My GF paid 52% on her bonus only last month

what you will see in UK is low to medium income people pay a lot more tax than here where they pay damn all

In this country we have too few people paying too much of the income tax

Head The Wall

I think you will find that around 4 - 5% of people in Ireland pay around 60% of the income tax. Provide some figures to back up your claim

antoobrien

Tipp Man wrote: »

what you will see in UK is low to medium income people pay a lot more tax than here where they pay damn all

In this country we have too few people paying too much of the income tax

Head The Wall wrote: »

I think you will find that around 4 - 5% of people in Ireland pay around 60% of the income tax. Provide some figures to back up your claim

I think you should go back and read the post again HTW, Tipp Man is more or less agreeing with you.

Edit: the 2010 income tax statistics are available on the revenue webnsite

Tipp Man

Head The Wall wrote: »

I think you will find that around 4 - 5% of people in Ireland pay around 60% of the income tax. Provide some figures to back up your claim

ah thats what i am saying

woodoo

Godge wrote: »

To answer your question about Dublin and Donegal, the answer has to be yes, people in Dublin should get a better service than Donegal. Why? Because the cost of providing a public service to the most densely populated part of the country is much cheaper than providing a public service to the least densely populated part of the country.

Apply the logic of equal public services to another country, say Australia. Should the same level of public services be available in the outback as in the city of Melbourne. Should we have a full services hospital every 200 miles in the outback? The reasonable answer is no, those who choose to live in the outback have to pay a price in terms of accessibility and availability of public services.

The same logic applies, albeit to a lesser and more nuanced extent in Ireland. If you live outside of a major city - Dublin, Cork or Belfast - you have to expect that you will receive some degree of lesser public service. This may simply be that you have to travel to Dublin for some medical procedures, it may be that you don't have a local university, or it may be that some type of service is not accessible at all. If such rules were not applied our unsustainable public services would be even more costly.

This doesn't deal with the fact that he is not allowed to receive the service in Dublin either. That is unfair. All out taxes go to central government.

woodoo

Head The Wall wrote: »

Agreed and it shows up their intelligence to post something about me being bitter and another one about me paying very little tax. I moved to a country where I am paying three times as much tax as I was in Ireland and I have no problem in doing so as I can see that there are decent services in return.

If they can't see the connection between Irish paying very little tax and the crap services received well that says it all

3 times a pittance = very damn little.

You have no business commenting on Ireland anymore you don't live here or pay any taxes.

sarumite

woodoo wrote: »

3 times a pittance = very damn little.

You have no business commenting on Ireland anymore you don't live here or pay any taxes.

S/He is Irish. S/he probably has family and friends in this country and may look to come back someday. Not everyone is lucky enough to have found stable employment in Ireland and many have been forced to emigrate. To have someone lucky enough to not have to go through such an unfortunate experience telling someone else what business they have or have not is more than just a little bit obnoxious imo.

murphaph

woodoo wrote: »

3 times a pittance = very damn little.

You have no business commenting on Ireland anymore you don't live here or pay any taxes.

Would you prefer that all unemployed just sit on their holes in Ireland crippling the system even further? If anything economic emigrants should have more of a say in how their country is run. It's bad enough they get no vote-you want to deny them even the right to express themselves on a bloody Internet forum!