More cuts in health spending

ART6

http://www.irishtimes.com/newspaper/frontpage/2012/0707/1224319603326.html

In years gone by I had no reason to avail of the HSE, but now my wife is in hospital, and she is seriously ill. She is unable to stand or walk, and she cannot feed herself. Accordingly my son and I have been taking it in turns to go to her a mealtimes and take on the task of feeding her. This is difficult for my son as he runs his own business and is under some pressure.

In the week gone by I met with the senior doctor who is in charge of her ward (and two others). That was something of a revelation. He knew that my son and I had been attending to feed my wife, and he said that without that she might not always be fed. Her ward is staffed by three nurses and two students (who, he said, are not being paid). The nurses would try to feed her, but if they received a call for, for example, someone who urgently needed the toilet, then they would have to leave her. In that case it was probable that the catering staff would simply take away any uneaten food. At one point my wife became severely dehydrated because she couldn't handle the glass of water that was left on her bed table. This resulted in her being fitted with a saline drip because the nurses simply didn't have time to give her drinks.

I want to get my wife home, and I asked if the hospital had yet prepared the care plan that would allow it to happen. The doctor sighed "We can prepare all the care plans you like, but there is no funding. Until then she will stay in here and be threatened with all of the hospital-induced infections there are."

He then told me that he had worked in the hospital for twenty five years, but was leaving this year. He said he was moving to the UK to work in the health service there. He was doing that because he was trying to run three wards with one junior doctor and one intern, and what he was expected to do was impossible.

I recall posts some time ago from Biggins and the battle he had with the HSE to obtain treatment for his seriously ill child. It seems that nothing has changed. It seems, to me anyway, that whatever happens we must satisfy the financial demands of bond holders and to hell with the people.

This has got to stop, but I don't have a clue how to stop it other than kicking Dr. Reilly out of office for incompetence and, hopefully, taking Enda and the rest of his pigs snouts with him. I intend to send this missive to every damned TD I can find, with the secure knowledge that it will make no difference at all because it will not affect salaries, expenses, and pensions for another few years.:mad:

Welease

I think it's somewhat shortsighted to throw out complaints about bond holders elsewhere when "we" ourselves choose to offer jobs for life within the HSE, have unnecessary multiples of admin staff, waste money left right and centre, allow the consultants to keep beds full unnecessarily over the weekends, and run one of the most inefficient organisations I have ever had the misery to deal with.... The bulk of the problems within the HSE could and should be sorted out by the HSE, Unions and staff members.

My current experience (brain tumor) has been similar to your wife's.. so I do sympathise, but I believe the blame for issues within the HSE lies fairly and squarely within Ireland and more specifically the HSE members itself.

tayto lover

I hear your pain OP and my family is in a similar situation with my sister who had a severe stroke and is paralysed on her left side. She will be going into a Nursing Home soon though where she can be looked after properly. Have you tried to get your wife into a Nursing Home ?

Chucky the tree

ART6 wrote: »

I recall posts some time ago from Biggins and the battle he had with the HSE to obtain treatment for his seriously ill child. It seems that nothing has changed. It seems, to me anyway, that whatever happens we must satisfy the financial demands of bond holders and to hell with the people.

This has got to stop, but I don't have a clue how to stop it other than kicking Dr. Reilly out of office for incompetence and, hopefully, taking Enda and the rest of his pigs snouts with him. I intend to send this missive to every damned TD I can find, with the secure knowledge that it will make no difference at all because it will not affect salaries, expenses, and pensions for another few years.:mad:

No offence but you don't have much of a clue tbh. Our poor health service has nothing to do with the bond holders or any other type of BS. It is because we are running a massive deficit, which isn't the fault of the bondholders.

sarumite

ART6 wrote: »

This has got to stop, but I don't have a clue how to stop it other than kicking Dr. Reilly out of office for incompetence and, hopefully, taking Enda and the rest of his pigs snouts with him. I intend to send this missive to every damned TD I can find, with the secure knowledge that it will make no difference at all because it will not affect salaries, expenses, and pensions for another few years.:mad:

Sadly Dr. Reilly is actually not the problem and kicking him out of the office won't change anything whatsoever. The doctor you mentioned who will move to the UK soon will find himself out of the fire and into the frying pan. We believe healthcare is a natural right, we just haven't found a way to adequately fund it. That isn't a problem specific to Ireland. Recenlty Italy also announced a round of cuts in healthcare spending, the UK has used the NHS as a pawn in every political election and the French are saddled with taxes (56% of GDP not including the latest round of tax rises) partly to pay for their health care.

n97 mini

I have the utmost of sympathy for your plight OP, but as others have said this is a problem created by the HSE, not the bondholders or anyone else.

As someone who has been dealing with the health service in this country for longer than I care to remember I can safely say it was better when there was less money being spent, and matrons were in charge, etc.

Charlie McCreevy got at least one thing right in his tenure as Minister for Finance when he said in an interview on RTE Radio 1 that he had doubled the expenditure on health, had seen no improvement, so it was clear that money was not the solution.

mikemac1

Just to follow up on that, a few months back some googling got me this

Minister for Finance and what was allocated to health in the budget

Charlie McCreevy 2002 6.5 billion
Brian Cowan 2008 15.5 billion
Michael Noonan 2012 13.6 billion


It's being cut back now OP, you are correct

Seems to be a black-hole tbh, that money is being pumped in but is the service far better then ten years ago?
I don't know

bluesea

ART6 wrote: »

http://www.irishtimes.com/newspaper/frontpage/2012/0707/1224319603326.html

In years gone by I had no reason to avail of the HSE, but now my wife is in hospital, and she is seriously ill. She is unable to stand or walk, and she cannot feed herself. Accordingly my son and I have been taking it in turns to go to her a mealtimes and take on the task of feeding her. This is difficult for my son as he runs his own business and is under some pressure.

In the week gone by I met with the senior doctor who is in charge of her ward (and two others). That was something of a revelation. He knew that my son and I had been attending to feed my wife, and he said that without that she might not always be fed. Her ward is staffed by three nurses and two students (who, he said, are not being paid). The nurses would try to feed her, but if they received a call for, for example, someone who urgently needed the toilet, then they would have to leave her. In that case it was probable that the catering staff would simply take away any uneaten food. At one point my wife became severely dehydrated because she couldn't handle the glass of water that was left on her bed table. This resulted in her being fitted with a saline drip because the nurses simply didn't have time to give her drinks.

I want to get my wife home, and I asked if the hospital had yet prepared the care plan that would allow it to happen. The doctor sighed "We can prepare all the care plans you like, but there is no funding. Until then she will stay in here and be threatened with all of the hospital-induced infections there are."

He then told me that he had worked in the hospital for twenty five years, but was leaving this year. He said he was moving to the UK to work in the health service there. He was doing that because he was trying to run three wards with one junior doctor and one intern, and what he was expected to do was impossible.

I recall posts some time ago from Biggins and the battle he had with the HSE to obtain treatment for his seriously ill child. It seems that nothing has changed. It seems, to me anyway, that whatever happens we must satisfy the financial demands of bond holders and to hell with the people.

This has got to stop, but I don't have a clue how to stop it other than kicking Dr. Reilly out of office for incompetence and, hopefully, taking Enda and the rest of his pigs snouts with him. I intend to send this missive to every damned TD I can find, with the secure knowledge that it will make no difference at all because it will not affect salaries, expenses, and pensions for another few years.:mad:

Send this post to every Td in Dail Eireann and to the National Press and you will find your wife will have her care plan in no time and be send safely home to your care..

I am so sorry for you and the trauma you are faced with. If you didn't go in to feed your wife she would eventually die from malnutrition. This is a very serious problem in the UK
http://www.independent.co.uk/news/uk/politics/tories-fear-50000-hospital-patients-dying-from-malnutrition-1910747.html

Nody

ART6 wrote: »

[URL]I recall posts some time ago from Biggins and the battle he had with the HSE to obtain treatment for his seriously ill child. It seems that nothing has changed. It seems, to me anyway, that whatever happens we must satisfy the financial demands of bond holders and to hell with the people.

This has got to stop, but I don't have a clue how to stop it other than kicking Dr. Reilly out of office for incompetence and, hopefully, taking Enda and the rest of his pigs snouts with him. I intend to send this missive to every damned TD I can find, with the secure knowledge that it will make no difference at all because it will not affect salaries, expenses, and pensions for another few years.:mad:[/url]

This has nothing to do with bond holders and all to do with incompetence in the HSE.

Back in 2006 (i.e. before the crash) I had a friend diagnosed with lung cancer after he had collapsed twice. Standard treatment is chemo and radiation which means you can't walk or do anything physical and are very weak. He was told he had to commute to the hospital (40km ride single way) every day for two weeks to get his chemo treatment because they could not find a room for him at the hospital.

This has NOTHING to do with bond holders and ALL to do with incompetence in the HSE in mismanaging money through excessive and utterly useless bureaucracy were HSE directors build their own kingdoms and no one can get fired for any reason.

golden lane

bluesea wrote: »

Send this post to every Td in Dail Eireann and to the National Press and you will find your wife will have her care plan in no time and be send safely home to your care..

I am so sorry for you and the trauma you are faced with. If you didn't go in to feed your wife she would eventually die from malnutrition. This is a very serious problem in the UK
http://www.independent.co.uk/news/uk/politics/tories-fear-50000-hospital-patients-dying-from-malnutrition-1910747.html[/QUOTE]

yes, they are dying every day in the uk........hahaha..

headline makers.....for profit......

golden lane

bluesea wrote: »

golden lane wrote: »

I think you are a very ignorant person for making such an ill founded comment. This is a very relevant thread for everyone who may have a sick person in hospital.

it is a forum.......you can think what you like......my reply was to your ignorant post.......not a reflection on any patients in the uk....or elsewhere........stop making headlines.....leave that to the newspapers......they are great at selling papers..............

tell me your experiences in an nhs hospital.......and i will tell you mine....

murphaph

ART6 wrote: »

It seems that nothing has changed. It seems, to me anyway, that whatever happens we must satisfy the financial demands of bond holders and to hell with the people.

I am genuinely saddened by your troubles OP but I really fell your anger is mis-directed. I feel you should be directing your anger towards the shambles of an organisation that is the HSE itself. It should be directed towards the consultants who earn double what they'd earn in Germany (where healthcare is MUCH better), towards the army of admin staff who just make up the numbers and who were never made redundant when the health boards were amalgamated (we were told the HSE would bring huge savings remember), but above all towards a succession of spineless IRISH governments elected by IRISH people who have never once been able to tackle the mess that is Irish healthcare. It is not the fault of a few bond holders. It's our fault.

Tragedy

The HSE and our hospitals are far too complex to be able to simply come out and say "Unions" or "Mary Harney" or "Overpaid" or whatever you may. Having worked in one, it really opened my eyes as to just how incredibly expensive it is to run a modern hospital - whether it's wages, staff numbers, materials and medicine cost etc.

I don't know of any example of a modern health service being slowly, incrementally improved/streamlined/cost-reduced and I personally don't believe it is possible. To create a new health system without the baggage of the previous requires a revolution, not an evolution.

A useless bit of trivia: A child's chart from the 90's would consist of maybe 20 pages. A comparable chart from today would be 120 pages. That's 100 extra pages of information that someone needs to input, analyse and annotate.

ART6

murphaph wrote: »

I am genuinely saddened by your troubles OP but I really fell your anger is mis-directed. I feel you should be directing your anger towards the shambles of an organisation that is the HSE itself. It should be directed towards the consultants who earn double what they'd earn in Germany (where healthcare is MUCH better), towards the army of admin staff who just make up the numbers and who were never made redundant when the health boards were amalgamated (we were told the HSE would bring huge savings remember), but above all towards a succession of spineless IRISH governments elected by IRISH people who have never once been able to tackle the mess that is Irish healthcare. It is not the fault of a few bond holders. It's our fault.

Thank you. Your concern (and others who have posted similar comments here) is much appreciated, buy I am just one of God knows how many others that are affected by the system and its failures. I also accept the points made about the apparent management shambles that is the HSE, although it does have its good points and there are a lot of people within it who are doing their level best in difficult circumstances.

However, we were told by the last government how one Mary Harney was going to fix the health service for once and for all, managing in the process to reduce to a near-shambles of bureaucracy. Meanwhile her cabinet colleagues enshrined the Croke Park agreement in stone and hid from the unions under the table, while also taking what has amounted to €65 billions or so out of the public to pay off secure and non-secure bondholders and adding it to the sovereign debt burden. This is a debt that must be repaid upon the instructions of the EU. This in addition to the fact that due to the recession the government's income is in deficit in any case.

So, the HSE, along with all other public services, is facing savage cuts in funding when expenditure is rising. Dr. Reilly, who was going to revolutionise the service, has so far done so by reducing the services it offers to patients while increasing the cost to those patients. He has continued with the early retirement scheme that has led to the loss of many experienced front line staff (retire early or lose part of your pension!), and has then, predictably, had to re-hire them along with expensive agency staff to keep hospitals running. This is clearly a brilliant strategy that means that where we were once paying a senior nurse a salary we are now paying her both a salary and a pension, and are hiring agency nurses who were unable to find work in the HSE as employees and so are now hired by it at (I would guess) anything up to double what their salary cost would have been.

So while I agree with the others who have posted here about the management shambles of the HSE, I would suggest that the shambles starts at the top where the buck should stop but doesn't appear to. Dr. Reilly, like his colleagues and those who went before them, seems rather more exercised by his expenses, salary, small army of advisers, and pension entitlements than actually doing the job the taxpayer pays him so richly for.

astrofool

ART6 wrote: »

Thank you. Your concern (and others who have posted similar comments here) is much appreciated, buy I am just one of God knows how many others that are affected by the system and its failures. I also accept the points made about the apparent management shambles that is the HSE, although it does have its good points and there are a lot of people within it who are doing their level best in difficult circumstances.

However, we were told by the last government how one Mary Harney was going to fix the health service for once and for all, managing in the process to reduce to a near-shambles of bureaucracy. Meanwhile her cabinet colleagues enshrined the Croke Park agreement in stone and hid from the unions under the table, while also taking what has amounted to €65 billions or so out of the public to pay off secure and non-secure bondholders and adding it to the sovereign debt burden. This is a debt that must be repaid upon the instructions of the EU. This in addition to the fact that due to the recession the government's income is in deficit in any case.

So, the HSE, along with all other public services, is facing savage cuts in funding when expenditure is rising. Dr. Reilly, who was going to revolutionise the service, has so far done so by reducing the services it offers to patients while increasing the cost to those patients. He has continued with the early retirement scheme that has led to the loss of many experienced front line staff (retire early or lose part of your pension!), and has then, predictably, had to re-hire them along with expensive agency staff to keep hospitals running. This is clearly a brilliant strategy that means that where we were once paying a senior nurse a salary we are now paying her both a salary and a pension, and are hiring agency nurses who were unable to find work in the HSE as employees and so are now hired by it at (I would guess) anything up to double what their salary cost would have been.

So while I agree with the others who have posted here about the management shambles of the HSE, I would suggest that the shambles starts at the top where the buck should stop but doesn't appear to. Dr. Reilly, like his colleagues and those who went before them, seems rather more exercised by his expenses, salary, small army of advisers, and pension entitlements than actually doing the job the taxpayer pays him so richly for.

Unfortunately it's the top level civil servants that call the shots, minister after minister has failed to change the health service in any meaningful way, the only way to change anything has been to shovel masses of money at it in the hope that some of it may end up helping patients.

Reilly wants a root and branch change of the system, but this will take a long time, and in the mean time, there is no money, instead of getting rid of the protected do-nothings, the un-protected frontline is hit instead.

Sorry about your wife's condition, and hope she pulls through.

ART6

astrofool wrote: »

Unfortunately it's the top level civil servants that call the shots, minister after minister has failed to change the health service in any meaningful way, the only way to change anything has been to shovel masses of money at it in the hope that some of it may end up helping patients.

Reilly wants a root and branch change of the system, but this will take a long time, and in the mean time, there is no money, instead of getting rid of the protected do-nothings, the un-protected frontline is hit instead.

Sorry about your wife's condition, and hope she pulls through.

If what you say is true, that it is the top civil servants that call the shots (and I don't doubt it for a minute), then that leads to the obvious question of what we are paying Dr. Reilly for? Is not the role of a minister to instruct civil servants and require them to act according to those instructions? Is that not what high level managers and directors are supposed to do, and to rapidly get rid of those who will not obey? Oh! I forget. Jobs for life and all that. The Irish version of the untouchables.

For the last thirty five years I have served as a director, including managing director, of several substantial engineering companies both in the UK and Ireland. Our shareholders (properly) held my colleagues and I accountable for the performance of the companies, and if in any of them there was an issue with the administration department refusing or obstructing management decisions, I was expected to deal with it firmly, otherwise the shareholders would simply vote me off the board at the next AGM. I would always listen to views expressed by all staff, and would always take them into account, but once a Board decision had been reached, it would be applied.

However, what we seem to have in the health service is a minister who is incapable of exercising his authority, budget over runs that (according to RTE 1 today) is likely to reach €500 millions by the end of this year, the closure of A&E units and beds that was, under Dr. Reilly's supervision, never going to happen. Waiting times that were going to be drastically cut have increased. Recruitment embargos have resulted in retired nurses on pensions being re-hired. Front line staff being contracted from agencies. Savings that were supposed to occur from the early retirement scheme (which from the view of a private sector director was utterly ludicrous) have not happened, but the review body has added into the equation all sorts of unrelated savings in an attempt to show that the minister, who, I suspect doesn't know his left foot from his right, is very firmly on top of the job while filling in his unvouchered expenses form.

Who was it that coined the phrase "You couldn't make it up?"

ressem

Best wishes for your wife's good recovery.

ART6 wrote: »

If what you say is true, that it is the top civil servants that call the shots, then that leads to the obvious question of what we are paying Dr. Reilly for? Is not the role of a minister to instruct civil servants and require them to act according to those instructions? Is that not what high level managers and directors are supposed to do, and to rapidly get rid of those who will not obey?
...

The minister isn't the HSE CEO, he's the shareholder representative.
The minister appoints a secretary general from the civil service who stays for 7 years, and the HSE Interim CEO+ board http://www.hse.ie/eng/about/Who/Management_Team/.

http://www.hmi.ie/2012/02/recruitment-secretary-general-of-department-of-health/ wrote:

The role of the Secretary General is to provide:
effective management and leadership of the Department of Health, both in its own direct work and in its leadership role for the overall health sector;
As “Accounting Officer”, the Secretary General has specific obligations and responsibilities in relation to accountability to the Oireachtas for the work and expenditure of the Department.
...
She/he will be required to set strategic direction and vision for the work of the Department having regard to the external environment, including understanding the broader public policy and political context.

In this case the Sec Gen Michael Scanlan who retired this April at the age of 56 and replaced with Dr Ambrose McLoughlin, Dentist and former CEO of the Pharmaceutical Society of Ireland (pharmacy qualifications and complaints http://www.thepsi.ie).

With regard to Mr Scanlan "whose work as Secretary General was exemplary" according to O'Reilly, do we actually know anything abut the quality of his work, any more than we knew about Kevin Cardiff in his Finance role.
In the case of the board and CEO there are minutes at least.

And they are slooooowly changing the structure at the top, from CEO + board to 7 directorships with their own budget. Legislation allowing for this was passed in December. What's going to prevent this becoming another lot of energy spent rearranging chair placement?

http://www.dohc.ie/press/releases/2012/20120316b.html wrote:

The new appointments are temporary in nature as the Government moves to introduce new legislation to establish a new Directorates structure in the HSE. The Directorate structure – putting in place a Director General and 6 other Directors, overseeing seven specific lines of service - will also see the abolition of the HSE Board.

I don't know how much truth there is to the sindo's €40 hospital meals, but stuff like the nurses rostered week into 12 hour shifts that is so inflexible in terms of having nurses around for peak times just looks like management inaction that they are only changing now to 6 hour rosters.
http://implementationbody.gov.ie/wp-content/uploads/2012/04/2012-Health-Sector.pdf
I can't see anything else in the implementation plan that holds any hope for those in your family's situation. The best hope would be a public drive to train and staff volunteers.
There are trustworthy people that have the time and will to help but at the moment are cold shouldered due to regulation, protectionism and a lack of knowledge and organisation about how they can help without causing hurt or conflict.

ART6

ressem wrote: »

Best wishes for your wife's good recovery.
The minister isn't the HSE CEO, he's the shareholder representative.
The minister appoints a secretary general from the civil service who stays for 7 years, and the HSE Interim CEO+ board http://www.hse.ie/eng/about/Who/Management_Team/.

ressem, thanks for your best wishes. I appreciate it, and it helps.

Clearly you know much more about the HSE that I do, but your explanations leave me with a concern: Is the HSE not a public service? Is the government and its ministers not responsible for public services? Or is the HSE just another of the countless quangos that have long permitted incompetent ministers to avoid responsibility for anything other than their salaries and pensions?

I find myself trying to avoid appearing to be trolling in issues like this, but I am becoming bitterly angry. I see student nurses in my wife's ward dashing about like lunatics for fourteen hours a day shifts, ward sisters who's feet never seem to touch ground. Junior doctors who are trying with limited experience to administer to the sick in two or three wards and never having the time to really get to the bottom of what is actually wrong with any individual patient. My wife is a private patient, and her care is paid for by my health insurance. What in the name of God would be happening to her if she was a public patient?

I don't care whatever the structure of the HSE is that permits Dr. Reilly to avoid responsibility for anything. If that is the structure then it is deeply wrong. I hold him responsible. He is where the buck should stop, but in the long practise of Irish government, it will of course not!

Chucky the tree

Do you really expect the minister for health, no matter who he is, to turn around the health service in a year?

ART6

Chucky the tree wrote: »

Do you really expect the minister for health, no matter who he is, to turn around the health service in a year?

No. But I do expect to see some evidence of a plan to do so, with his taking full control in doing so without all of the empty promises and excuses that the HSE is not actually his responsibility. Simple question: Is the HSE a public service? If it is, then is a minister not responsible for its management? If he is not, then what actually is the HSE? Is it a private sector operation intent upon profits or is it some nebulous entity that exists in the ether between the private and public sectors without any accountability for anything it does although it appears to demand public money for its very existence?

The HSE is funded by taxpayer's money, and that, in my view, makes the minister accountable for its management. Dr. Reilly is simply not performing. No surprise there then!

christmas2012

all i can say is healthcare jobs are being lost left right and centre there is no hope for them now coming out of college expecting to land a job in that area..

ART6

christmas2012 wrote: »

all i can say is healthcare jobs are being lost left right and centre there is no hope for them now coming out of college expecting to land a job in that area..

Sure. And all of the public cost of training them has benefited Abu Dhabi and new Zealand or wherever. Meanwhile our own sick and injured are being sacrificed upon the alter of the banking bail out. I know that I keep harping on that, as do so many other people in this country, but we are in this mess not only because of the incompetent management of the HSE and other public services, but also because of incompetent government. With some desperation I wonder when this will ever stop. It sure as hell won't stop with Enda Kenny and his crew.

I believe that there is a solution: First appoint a minster for health who is single minded, determined, and capable of leadership. Then, reverse the HSE into the ministry of health and make that minister solely responsible for its reorganisation. Stop all of this nonsense of early retirements and re-hiring. Offer consultants realistic salaries commensurate with their qualifications and experience, and say goodbye to any who don't wish to accept the offer. If you don't want the job then go elsewhere! Take a long cold look at what all of the various tiers of management actually do to provide patient care, and be rid of those functions that do not assist that. A company that makes widgets concentrates its activities on making widgets. So, similarly, should the HSE.

n97 mini

ART6 wrote: »

Meanwhile our own sick and injured are being sacrificed upon the alter of the banking bail out.

The HSE was severely dysfunctional before any bailout. If there had never been any bailout I doubt very much if the service would be any better now. There might be more (mostly unneeded) staff, but that's it.

Chucky the tree

ART6 wrote: »

No. But I do expect to see some evidence of a plan to do so, with his taking full control in doing so without all of the empty promises and excuses that the HSE is not actually his responsibility. Simple question: Is the HSE a public service? If it is, then is a minister not responsible for its management? If he is not, then what actually is the HSE? Is it a private sector operation intent upon profits or is it some nebulous entity that exists in the ether between the private and public sectors without any accountability for anything it does although it appears to demand public money for its very existence?

The HSE is funded by taxpayer's money, and that, in my view, makes the minister accountable for its management. Dr. Reilly is simply not performing. No surprise there then!

It is a public service, that's the problem. He cant hire and fire who he wants, the person he hires cant fire who they want etc. His basically doing a job with both hands tied behind his back.

ART6 wrote: »

Sure. And all of the public cost of training them has benefited Abu Dhabi and new Zealand or wherever. Meanwhile our own sick and injured are being sacrificed upon the alter of the banking bail out. I know that I keep harping on that, as do so many other people in this country, but we are in this mess not only because of the incompetent management of the HSE and other public services, but also because of incompetent government. With some desperation I wonder when this will ever stop. It sure as hell won't stop with Enda Kenny and his crew.

I believe that there is a solution: First appoint a minster for health who is single minded, determined, and capable of leadership. Then, reverse the HSE into the ministry of health and make that minister solely responsible for its reorganisation. Stop all of this nonsense of early retirements and re-hiring. Offer consultants realistic salaries commensurate with their qualifications and experience, and say goodbye to any who don't wish to accept the offer. If you don't want the job then go elsewhere! Take a long cold look at what all of the various tiers of management actually do to provide patient care, and be rid of those functions that do not assist that. A company that makes widgets concentrates its activities on making widgets. So, similarly, should the HSE.

Why do you keep coming out with this garbage when it's been pointed out to you it is not the case?

Dannyboy83

http://www.independent.ie/national-news/hse-sharpening-its-scalpel-as-hospital-meal-costs-hit-40-3161611.html
New figures comparing the cost of producing a meal across 32 hospitals showed that an orthopaedic hospital spent €40.60 on every meal it doled out to patients.

This is insanity.
I spend about that much on a week's worth of food.

It's little wonder they burning through money at such a rate.

murphaph

Dannyboy83 wrote: »

This is insanity.
I spend about that much on a week's worth of food.

It's little wonder they burning through money at such a rate.

Wow. We all knew the HSE and indeed most public services were innefficient but €40 for a plate of slop food is outrageous.

There are clearly lots of extra staff floating around many of these hospital kitchens that can't/won't be made redundant.

Why not?

Nody

murphaph wrote: »

Wow. We all knew the HSE and indeed most public services were innefficient but €40 for a plate of slop food is outrageous.

There are clearly lots of extra staff floating around many of these hospital kitchens that can't/won't be made redundant.

Why not?

I read the article earlier but decided not to post it and for a very simple reason. This is an example from another public body but will give you an idea of why it is most likely BS numbers in the report (numbers made up but this is a real world example).

A new copy machine is bought in to replace an old and not very well functioning and the new one is cheaper on the ink etc.

Book value (i.e. the value listed as the value of the machine):
Old machine: 1k (written down value over several years)
New machine: 100k (as it's brand new and no value has been written off yet).

The machines are expected to print 10k copies a month (before someone points it out yes, the numbers don't make sense but this is not proper accounting, this is only an example of the principle).

Cost per copy:
Old machine: 1k/10k = 0.1 per copy
New machine: 100k/10k = 10 per copy

Any department using the new machine is charged 10 per copy, using the old machine they are charged 0.1 per copy by the accounting department. Which machine do you think all the department were using constantly (even though the cost to the department was higher)?

Coming back to the article; what I think in this case is not that the food cost (i.e. the ingredients) is that much different but rather that the overhead costs (new kitchen machines, rental cost of kitchen were one department pays another for the space they use, how much of "general" costs are assigned to the kitchen etc.) vary greatly between hospitals; esp. depending on the state of renovation and write off values.

Dannyboy83

Nody wrote: »

Coming back to the article; what I think in this case is not that the food cost (i.e. the ingredients) is that much different but rather that the overhead costs (new kitchen machines, rental cost of kitchen were one department pays another for the space they use, how much of "general" costs are assigned to the kitchen etc.) vary greatly between hospitals; esp. depending on the state of renovation and write off values.

Thanks for taking the time to explain, and I sincerely hope you are correct.
The alternative would make anyone who pays tax feel quite sick I'm sure.

My sister used to work in the HSE and there is probably a good chance you are correct with the above example, as she said during the Pharmacy strike in 2009 - utterly obscene amounts of money were wasted on purchasing new books, equipment and so on intended for a temporary facility.
There was a hiring embargo which meant that contractors were also higher at something like thrice the going rate for an employee - but technically they weren't allowed to work! So they were paid to drink coffee and read the paper.

I suppose that could then be factored into the end cost to make the actual pharmacies on strike appear much cheaper...I cannot remember the specifics, but she had always said the HSE was a farcical organisation where no work was ever done and endless meetings and coffee breaks were held, but even that was too much for her, she left not long after.

http://www.irishtimes.com/newspaper/ireland/2009/1212/1224260596843.html
Pharmacy strike cost HSE €3.85m for contingency sites
THE HEALTH Service Executive incurred costs of almost €4 million while providing temporary drug-dispensing services during the 12-day pharmacists’ dispute earlier this year.

Official figures obtained by The Irish Timesshow the HSE was forced to spend some €3.85 million, an average of €320,000 a day, providing cover at nine contingency pharmacies it operated in the west and southwest of the country from August 1st-12th.

ressem

There is plenty of paperwork as Tragedy pointed out earlier, but apparently there is no initial to confirm that a patient unable to fend for themselves has eaten. So does the management of the hospital know that the problem exists when it doesn't appear on 'key performance index' quality statistics?

Would it be worth contacting the quality management of the hospital to point out to point out that your wife is not being fed to ensure that they can't profess ignorance?

Or is there an organisation of hospice volunteers associated with the hospital from whom you could ask for help?

ART6

Chucky the tree wrote: »

Why do you keep coming out with this garbage when it's been pointed out to you it is not the case?

I may choose to disagree with you upon occasions. When I do I would attempt to explain why I disagree. I then reserve the right to stick to my opinion if I believe it to be correct, but I do not then start to accuse you of posting "garbage" because you have a different viewpoint.

The fact remains that as a result of the recession and the high levels of unemployment etc., government revenues are well below expenditure. Add to that the payments on the multi-billion loans from the EU/IMF and the payments to unsecured bond holders, all lumbered onto sovereign debt, and Ireland is technically insolvent. To meet the debt repayments and the current account deficit, clearly draconian cost cutting and tax increases are inescapable.

That must surely affect the HSE and every other essential public service?

ressem wrote: »

There is plenty of paperwork as Tragedy pointed out earlier, but apparently there is no initial to confirm that a patient unable to fend for themselves has eaten. So does the management of the hospital know that the problem exists when it doesn't appear on 'key performance index' quality statistics?

Would it be worth contacting the quality management of the hospital to point out to point out that your wife is not being fed to ensure that they can't profess ignorance?

Or is there an organisation of hospice volunteers associated with the hospital from whom you could ask for help?

Many thanks for your suggestion. At the moment I do the lunch duty to feed her, and my son (who is self-employed) does the dinner duty. We do that because we can see only too well that the hospital staff simply cannot cope. They don't have enough people in the front line. Nurses go about like blue arsed flies for fourteen hours a day and can't be everywhere. I have no confidence that any "Quality control systems" so beloved of PS management would have the slightest effect. I believe it to be simply management bull****.

I know nothing about the mechanisms of the HSE (although I am prepared to believe that is is just as shambolic as the rest of our public services). All I know is what was told to me by the ward doctor, as I explained in an earlier post in this thread. What I do know, and I would not question the extraordinary work of the front line staff who have always been caring and concerned while under pressure, is that I must get her home ASAP before her condition worsens.

The problem is that I need certain support services at home to be able to care for her, since she cannot stand or feed herself. For some reason that completely escapes me I can only avail of those services if I have a medical card. I cannot simply pay for them. So I have applied for such card (a month ago).

This, to me, is the madness that has inflicted our public services. We won't let you pay for something you need and can afford, but equally we won't let you have it unless you are on welfare.

Who is responsible for that? It appears that it cannot be a cabinet minister who has devolved all authority to a quango. It cannot be the quango political appointees since it is up to the individual hospital managements to manage their budgets but can incur vast over-runs without penalty. So where does the accountability stop? With the guy who sweeps the yard?:mad:

K-9

ART6 wrote: »

I may choose to disagree with you upon occasions. When I do I would attempt to explain why I disagree. I then reserve the right to stick to my opinion if I believe it to be correct, but I do not then start to accuse you of posting "garbage" because you have a different viewpoint.

The fact remains that as a result of the recession and the high levels of unemployment etc., government revenues are well below expenditure. Add to that the payments on the multi-billion loans from the EU/IMF and the payments to unsecured bond holders, all lumbered onto sovereign debt, and Ireland is technically insolvent. To meet the debt repayments and the current account deficit, clearly draconian cost cutting and tax increases are inescapable.

That must surely affect the HSE and every other essential public service?

I think the point that is being made is that these payments aren't the reason for cuts and definitely not the bailout, after all, if we didn't have a bailout we'd have to probably half the health budget.

I can understand where you are coming from. My mother benefited from intensive respite care a couple of years ago after a stroke, excellent care. Budget cuts came in and this was one of the areas targeted, the wards were closed. That puts extra pressure on families as patients are being released far too early, plus hospitals have to keep patients longer rather than transfer them to respite. I sometimes think cuts are targeted at balance sheets and budgets, not think through the costs incurred in stopping services.

BostonB

While I can emphasis with staff being overworked. Its common across many sectors.

But from first hand experience, I can say many of the issues I have seen is down to the empathy of "some" staff to patients. Many people seem to treat working in health as a career rather than a vocation and thus you get some people who have no empathy or aptitude for looking after people. This a marked difference to 20 yrs ago in my personal opinion. Many seem to be more interested in doing the paperwork than helping the person 5 feet from them. Also seems to be a lot of jobworths, particularly in administration. Administration across the sector seems to be very poor. I've had to battle people for 3 months to get a simple fax sent correctly or answer a phone. I'm still trying to sort out a billing issue from 2 yrs ago, and they can't answer simple billing issues.

Without fail all of the above leads to things costing more for no reason. Seems an attitude problem as a sweeping generalisation with the sector. That said you do meet some really exceptional people working in health at all levels. I'm not tarring them with the same brush.

Finally I think there should be a basic English standard for all staff working in the sector. I have experienced some excellent non native english speakers, with English better than mine. But I've also met people who I couldn't communicate with, their English simply wasn't good enough, and that shouldn't happen.

Welease

K-9 wrote: »

I think the point that is being made is that these payments aren't the reason for cuts and definitely not the bailout, after all, if we didn't have a bailout we'd have to probably half the health budget.

I can understand where you are coming from. My mother benefited from intensive respite care a couple of years ago after a stroke, excellent care. Budget cuts came in and this was one of the areas targeted, the wards were closed. That puts extra pressure on families as patients are being released far too early, plus hospitals have to keep patients longer rather than transfer them to respite. I sometimes think cuts are targeted at balance sheets and budgets, not think through the costs incurred in stopping services.

So are additions.. sadly..

I am currently suffering from a brain tumor and have spent the bulk of the last 3 weeks in hospital with no treatment or medication being taken.. I was kept in because i am a private patient and the VHI can be charged €935 + €75 per day for me taking up a bed. I was allowed out each and every day to roam about (going shopping, cinema, visit parents etc.) but had to return at 8:30 each night to ensure my bed was billed to me and kept optional for me. My breakfast/lunch/dinner was delivered to my empty bed each and every day because it will be delivered each and every day irrespective of my approved absence. When my head was finally drilled and a brain biopsy taken, I was released in 36 hours...
My stay over the 2-3 weeks in hospital was completely unnecessary, and stopped someone who needed immediate treatment being admitted because I helped ensure consultants got paid maximum amounts.

BostonB

I've certainly experienced a day treatment turn into a two night stay for no good reason other than poor administration. TBH the insurance company were very disinterested in chasing up inflated costs too.

ressem

That must surely affect the HSE and every other essential public service?

Please remember though that all though the bubble while expenditure doubled, the ridiculous workload on nurses and junior doctors was endemic.

Since before Minister Rory "Dr. Death" O'Hanlon management of the health services has been a mess. Out of control cost increases, then slash and burn cuts at the front line. The 'Angola' department.

The wages cost is about 5 billion out of the 13 billion.

The 36 million spent on external legal costs annually would almost cover the difference between pay and pension of the 1300 nurses retiring on WTE.

I have no confidence that any "Quality control systems" so beloved of PS management would have the slightest effect. I believe it to be simply management bull****.

And yet it forms the bulk of information on which higher managers base their decisions.

As Welease says, the public resources are misused to allow consultants and hospital to claim their fee from the private insurance company. As I saw a few weeks back, a private patient that needed a unit of blood drawn was stuck in a trolley waiting a consultant even though it's a regular, scheduled, common procedure which a GP or trained nurse could carry out in 30 minutes. Spending everyone's valuable time all to extract 570 quid (500 for the trolley wait) from the VHI.

In contrast in the Galway Clinic I saw how they lined up 4 patients with a similar elective procedure, placed them in the same ward, operated on all of them with a 3 hour gap, physio procedures each day one after another, out the same time 5 days later. Assembly line efficient.

creedp

BostonB wrote: »

I've certainly experienced a day treatment turn into a two night stay for no good reason other than poor administration. TBH the insurance company were very disinterested in chasing up inflated costs too.

I think this is part of the problem .. why don't private insurance companies who it seems are operating in a competitive environment attempt to drive down costs? Its all to easy to pass on these costs to their customers it seems. Maybe the new entrant to the market will spark some kind of a pressure on this front.

Chucky the tree

ART6 wrote: »

I may choose to disagree with you upon occasions. When I do I would attempt to explain why I disagree. I then reserve the right to stick to my opinion if I believe it to be correct, but I do not then start to accuse you of posting "garbage" because you have a different viewpoint.

The fact remains that as a result of the recession and the high levels of unemployment etc., government revenues are well below expenditure. Add to that the payments on the multi-billion loans from the EU/IMF and the payments to unsecured bond holders, all lumbered onto sovereign debt, and Ireland is technically insolvent. To meet the debt repayments and the current account deficit, clearly draconian cost cutting and tax increases are inescapable.

The fact remains that without the bailout we'd be spending far less on our health service. It's a bit much to be having a whinge about the bailout, then having a whinge about spending cuts. If you think we could have avoided the bailout and spending cuts then your viewpoint is wrong.

BostonB

The Health service was dysfunctional and bloated years before the bailout. It was hidden under the mountain of money/debt thrown at it.

Tragedy

ressem wrote: »

The 36 million spent on external legal costs annually would almost cover the difference between pay and pension of the 1300 nurses retiring on WTE.

36,000,000 / 1,300 = €28k (roughly)
Staff Nurse wage scale is €30,234 - €43,800. As far as I know, employer's PRSI is 10.75% of salary which brings the wage scale to €33,484 - €48,508.

That's ignoring the cost of provisioning for their pensions, and the cost of providing ancillary staff to service the nurses (admin, health care assistants, canteen etc).


That's the problem with people trying to analyse the failures of the health system, people rarely look at the big picture.

ressem

Tragedy wrote: »

36,000,000 / 1,300 = €28k (roughly)
Staff Nurse wage scale is €30,234 - €43,800. As far as I know, employer's PRSI is 10.75% of salary which brings the wage scale to €33,484 - €48,508.

That's ignoring the cost of provisioning for their pensions, and the cost of providing ancillary staff to service the nurses (admin, health care assistants, canteen etc).

That's the problem with people trying to analyse the failures of the health system, people rarely look at the big picture.

In my defense, I did say (Pay - Pension) * 1300. Provision for pensions vs paying out pension. Ancillary staff are there already (as I didn't mention new hiring) and as retirements were opt-in and widely dispersed, saving here are questionable and as yet unknown.

This is a discussion board and none of the posters are management in the HSE so we speculate on the information and end results that we see.

And that is an acknowledgement that there are large failings in the organisation by all stakeholders.
Informed discussion would require the report on implementation of universal health insurance, demonstration by the management that they are aware of the issues that ART6 and others encounter and what steps and progress are intended to patch the problem.
If they want to counter the continuous stream of demoralising news they need to show some sign that faults will be remedied.

Tragedy

ressem wrote: »

In my defense, I did say (Pay - Pension) * 1300. Provision for pensions vs paying out pension. Ancillary staff are there already (as I didn't mention new hiring) and as retirements were opt-in and widely dispersed, saving here are questionable and as yet unknown.

This is a discussion board and none of the posters are management in the HSE so we speculate on the information and end results that we see.

And that is an acknowledgement that there are large failings in the organisation by all stakeholders.
Informed discussion would require the report on implementation of universal health insurance, demonstration by the management that they are aware of the issues that ART6 and others encounter and what steps and progress are intended to patch the problem.
If they want to counter the continuous stream of demoralising news they need to show some sign that faults will be remedied.

In your defense, you said the €36m would almost cover 1,300 nurses retiring. In reality, €36m would cover 650 if lucky.

Delancey

OP , you have my sympathies - it must be very stressful for you and your family.

I have worked in the HSE so feel reasonably qualified to speak on the subject. The first and most crucial thing to learn about the HSE is the most important people there are not the patients , the most important people are the staff and I include the much-loved nurses as well as the much-maligned Consultants in that . From the most senior consultant down to the lowest cleaner the HSE is structured and operates to their benefit with the patient coming a distant second.
Understand this and you are well on the way to learning why the HSE is the disaster it is.

Staff rosters , hiring and promotion processes , department operating hours , etc and so on and so forth are all geared towards the benefit of staff so its small wonder that fully 1/3 of the HSE pay bill is spent on ' premium ' payments for unsocial hours working.

The Croke Park Agreement is a disaster for patients as staff pay cannot be reduced so the only way to cope with reduced budgets is to attack patient services.

In my time there I was stunned at the incompetence and lack of education of senior management - my former manager is now in a very senior position and would be on a salary around 100,000 - he doesn't even having a Leaving Certificate.

On my first day I was told about my ' entitledment ' to 5 uncertified sick days in a year and how my colleagues ' expected ' me to utilise that fully so as to generate overtime opportunities for them - that is the standard of regard for the patient.

Between unions , lousy management and interference from gombee politicians our Health Service stands as a monument to a scandalous failure of this country.

bear_hunter

Delancey wrote: »

OP , you have my sympathies - it must be very stressful for you and your family.

I have worked in the HSE so feel reasonably qualified to speak on the subject. The first and most crucial thing to learn about the HSE is the most important people there are not the patients , the most important people are the staff and I include the much-loved nurses as well as the much-maligned Consultants in that . From the most senior consultant down to the lowest cleaner the HSE is structured and operates to their benefit with the patient coming a distant second.
Understand this and you are well on the way to learning why the HSE is the disaster it is.

Staff rosters , hiring and promotion processes , department operating hours , etc and so on and so forth are all geared towards the benefit of staff so its small wonder that fully 1/3 of the HSE pay bill is spent on ' premium ' payments for unsocial hours working.

The Croke Park Agreement is a disaster for patients as staff pay cannot be reduced so the only way to cope with reduced budgets is to attack patient services.

In my time there I was stunned at the incompetence and lack of education of senior management - my former manager is now in a very senior position and would be on a salary around 100,000 - he doesn't even having a Leaving Certificate.

On my first day I was told about my ' entitledment ' to 5 uncertified sick days in a year and how my colleagues ' expected ' me to utilise that fully so as to generate overtime opportunities for them - that is the standard of regard for the patient.

Between unions , lousy management and interference from gombee politicians our Health Service stands as a monument to a scandalous failure of this country.

all sectors of the state exist first and foremost to serve those who work within them

Dannyboy83

Delancey wrote: »

I have worked in the HSE so feel reasonably qualified to speak on the subject. The first and most crucial thing to learn about the HSE is the most important people there are not the patients , the most important people are the staff and I include the much-loved nurses as well as the much-maligned Consultants in that . From the most senior consultant down to the lowest cleaner the HSE is structured and operates to their benefit with the patient coming a distant second.
Understand this and you are well on the way to learning why the HSE is the disaster it is.

Staff rosters , hiring and promotion processes , department operating hours , etc and so on and so forth are all geared towards the benefit of staff so its small wonder that fully 1/3 of the HSE pay bill is spent on ' premium ' payments for unsocial hours working.

The Croke Park Agreement is a disaster for patients as staff pay cannot be reduced so the only way to cope with reduced budgets is to attack patient services.

In my time there I was stunned at the incompetence and lack of education of senior management - my former manager is now in a very senior position and would be on a salary around 100,000 - he doesn't even having a Leaving Certificate.

On my first day I was told about my ' entitledment ' to 5 uncertified sick days in a year and how my colleagues ' expected ' me to utilise that fully so as to generate overtime opportunities for them - that is the standard of regard for the patient.

Between unions , lousy management and interference from gombee politicians our Health Service stands as a monument to a scandalous failure of this country.

Key parts of HSE cuts plan rejected

Looks like you were right on the money!

Tragedy

Considering I'm waiting 20months for a "non-urgent" appointment with an Ophthalmic surgeon, I can understand why the argument that outpatient appointments and minor operations should be sacrificed to save overtime payments is being deemed unacceptable.

creedp

Tragedy wrote: »

Considering I'm waiting 20months for a "non-urgent" appointment with an Ophthalmic surgeon, I can understand why the argument that outpatient appointments and minor operations should be sacrificed to save overtime payments is being deemed unacceptable.

One of the key problems with the Irish 'public' health system is that if you paid privately to see the 'public' consultant you would probably see him within a couple of weeks. Its like a lot of organisational problems, if reform is needed it must start at the top. The idea that a consultant paid around €250k a year by the taxpayer to work in a public hospital to treat public patients can choose to ignore (sorry delay seeing them) public patients in favour of fast tracking private patients (irrespective of their clinical need for the care) is simply unacceptable in an equitable healthcare system. You show your mpney and you get looked after. Yes its fine in a private healthcare system but not in a public one. This is where we must start in any reform of the 'public' health system.

murphaph

creedp wrote: »

One of the key problems with the Irish 'public' health system is that if you paid privately to see the 'public' consultant you would probably see him within a couple of weeks. Its like a lot of organisational problems, if reform is needed it must start at the top. The idea that a consultant paid around €250k a year by the taxpayer to work in a public hospital to treat public patients can choose to ignore (sorry delay seeing them) public patients in favour of fast tracking private patients (irrespective of their clinical need for the care) is simply unacceptable in an equitable healthcare system. You show your mpney and you get looked after. Yes its fine in a private healthcare system but not in a public one. This is where we must start in any reform of the 'public' health system.

Totally agree. Public hospitals should not have private consultants. If they want to practice privately, let them set up their own businesses/hospitals, get their own insurance and take their own business risks.

The whole healthcare industry in Ireland is there more for the benefit of vested interests than patients.

Tragedy

creedp wrote: »

One of the key problems with the Irish 'public' health system is that if you paid privately to see the 'public' consultant you would probably see him within a couple of weeks. Its like a lot of organisational problems, if reform is needed it must start at the top. The idea that a consultant paid around €250k a year by the taxpayer to work in a public hospital to treat public patients can choose to ignore (sorry delay seeing them) public patients in favour of fast tracking private patients (irrespective of their clinical need for the care) is simply unacceptable in an equitable healthcare system. You show your mpney and you get looked after. Yes its fine in a private healthcare system but not in a public one. This is where we must start in any reform of the 'public' health system.

Girlfriend was waiting 12 months to see a sinus specialist in the Eye & Ear hospital, privately.

Permabear

This post has been deleted.

creedp

Tragedy wrote: »

Girlfriend was waiting 12 months to see a sinus specialist in the Eye & Ear hospital, privately.

That's very unusual in my experience. If I was you I would advise her to seek a different private consultant in future. Saw one myself a few years back and I was 6 weeks waiting.

Rasheed

I am a nurse working in the HSE at the moment and i sincerely sympathise with anyone waiting for appointments or procedures.

The core of the HSE, in my opionin is excellent. This is my experience as both a patient in a mojor acute hospital for 3 months, as a child of a person who has been recently very ill and as an employee.

Where it lets itself down is the management. The hierarchial system that is present, managers to staff ratio 3:1, or so it seems, is ridiculous. This seems to have come from people getting promotions during the health boards to HSE transfer.

As someone else has mentioned, the administration staff numbers are out of control. But these are all permanent so will be there until the pension. To pay these, a front line staff member will be sacrificed. Documentation has got out of control but the amount of administration wandering round a hospital is crazy.

I think someone radical like Micheal O Leary is needed to completly overhaul the whole system!

Having said all that, with my illness, EVERYTHING I needed was supplied and i wanted/waited for nothing so I think it does work in some cases.