Roisin Shortall on Marian Finucane

Royal Legend

GCU Flexible Demeanour wrote: »

But how could either of them have thought there were resources to fund new primary care entitlements, at a cost of hundreds of millions, when it was clear that it would be next to impossible to even protect existing entitlements? It just strikes me as incredible.

Then again, I've no idea why anyone would have subscribed to such an unfeasible programme for government. I don't know why an incoming government would commit to actions they were plainly unable to deliver.You could be right.

Has anyone any idea how Wexford General Hospital got to be the priority for capital funding? Seemingly its extension is actually being built, as distinct from these primary care centres that are just proposals at this stage.

That is quite amazing, Waterford Regional just opened a new A&E ???? Why is there a need for a second A&E in Wexford, considering that in the majority of areas they are closing secondary units? Well done Mr Howlin on securing this for your area, if thats not stroke politics I dont know what is.
P.S. I am not commenting that Wexford should not have an A&E, just stating that people should consider why simialr units are being closed in Navan and other areas

Sponge Bob

GCU Flexible Demeanour wrote: »

One solution, which might help, is if the HSE just employed GPs on salaries, the way that some hospital consultants are now employed. Then there wouldn't be this whole merry dance with GPs - who have the status of self-employed contractors - as the doctor would just be on your staff.

That was what we did until the 1960s under the 'dispensery district' system. Then we privatised it.

Laminations

Qualitymark wrote: »

Could you back each of these statements up, by any hopeful chance?

Just on the last point - Here's the letter Reilly sent to Shortall in July explaining why he had to amend her list. It also dispels her claim that she was left in the dark.

sparkling sea

Laminations wrote: »

Just on the last point - Here's the letter Reilly sent to Shortall in July explaining why he had to amend her list. It also dispels her claim that she was left in the dark.

This letter doesn't clarify or bring finality to anything, I can't believe they even try to bullsh*t each other, things just get worse and worse:mad: The letter doesn't address exactly how 15 extra centres were decided on. It gives no description of the methodology used in deciding on the number of extra clinics or the selection criteria for these clinics.

Not one person has yet addressed how 2 clinics in Mr Reilly's constituency were selected - the criteria seems to be they were in Mr Reilly's constituency. Ms Shortall should have been aware that "stroke politics" should always to factored in to decision making in Irish politics - Labour and FG claimed they wanted change, they won the election and are now the defacto FF party buy choice not by necessesity.

Its a pity she resigned but then again, if she hadn't resigned we would be left thinking that "they are all the same" - I hope a few more will follow her example in the Labour party; we need someone in government to hold FG to account and not just roll over so they can hold on to power.

test4444

sparkling sea wrote: »

Not one person has yet addressed how 2 clinics in Mr Reilly's constituency were selected - the criteria seems to be they were in Mr Reilly's constituency.

Reilly has alluded to the reason but he really can't come out and say it. The reason is simple; under Shorthall's PPP scheme NO GP has signed up to enter one of the centres and NO GP would. (because of the socialist nature of the ppp). Reilly picked centres which had a high likely hood of success. Success being built, having GPs signed up and run in a manner which provides real Healthcare (ie. not run by the HSE). By picking on this basis he felt he would actually be able to deliver the require 20 centres. If he added by any other priority the likely hood would be that less then 20 centres would be built and running.

eire4

n97 mini wrote: »

Anything would be better than what we have.

I disagree. The Americans have a for profit health care industry. Tens of millions cannot afford insurance and even of those who do the insurance companies often do everything they can to restrict paying out on claims. Obama's health care reforms improve a few areas here and there such as insurance companies refusing to give coverage to those with a pre existing condition but at the end of the day the American health system is most definitely not what Ireland needs as it will leave massive numbers without any coverage and costs will be driven up massively when health becomes all about profits and not about care which is what exists in America.

Qualitymark

Terribly interesting programme on BBC4 TV now ( October 1, 2012 9:52 p.m. ) about the birth of Britain's National Health.

Royal Legend

sparkling sea wrote: »

This letter doesn't clarify or bring finality to anything, I can't believe they even try to bullsh*t each other, things just get worse and worse:mad: The letter doesn't address exactly how 15 extra centres were decided on. It gives no description of the methodology used in deciding on the number of extra clinics or the selection criteria for these clinics.

Not one person has yet addressed how 2 clinics in Mr Reilly's constituency were selected - the criteria seems to be they were in Mr Reilly's constituency. Ms Shortall should have been aware that "stroke politics" should always to factored in to decision making in Irish politics - Labour and FG claimed they wanted change, they won the election and are now the defacto FF party buy choice not by necessesity.

Its a pity she resigned but then again, if she hadn't resigned we would be left thinking that "they are all the same" - I hope a few more will follow her example in the Labour party; we need someone in government to hold FG to account and not just roll over so they can hold on to power.

Not really, she should have either voted with the vote of no confidence in Reilly or came out straight and took Reilly head on in regards to the issues whe had, but, no she took the wasy option and walked away.
She is a waste of space

GCU Flexible Demeanour

test4444 wrote: »

Reilly has alluded to the reason but he really can't come out and say it. The reason is simple; under Shorthall's PPP scheme NO GP has signed up to enter one of the centres and NO GP would. (because of the socialist nature of the ppp). Reilly picked centres which had a high likely hood of success.

Well, he does need to come out with it.

Because, effectively, what you are saying is that locations cannot be picked on the basis of a priority based on an assessment of the health needs of the local population to be served. The crucial factor is simply whether a GP will sign up, regardless of any health policy objective; it's actually quite a stark statement.

test4444

GCU Flexible Demeanour wrote: »

Because, effectively, what you are saying is that locations cannot be picked on the basis of a priority based on an assessment of the health needs of the local population to be served. The crucial factor is simply whether a GP will sign up, regardless of any health policy objective; it's actually quite a stark statement.

What is Primary Care and what is a Primary Care cente for? These two questions have been ignored. A Primary Care centre is a location where patients can receive normal GP primary care Plus none-acute proceedures which have been traditionally done in Hospitals but can be done at a lower cost by the private sector in these centres which have a higher medical standard then a normal GP's surgery. These centres can save money and relieve the strain on Hospitals.

So ideally they are in high population areas. There is a priority to place them near acute hospitals so that they can free up resources in the hospitals. Also consultants can use the facilites to do out patient proceedures.

Shorthall didn't prioritise by Health needs as financial deprevation does not translate to health needs not being met. Due to medical cards the average number of GP visits in a deprived area far exceeds the number of visits per patient per year in a middle class area (even taking into account more economic based health problems).

It is not stark to priorities being able to use a building as a primary care centre before building a physical structure. If you can't fill it with GPs it would be just another empty waste of our money.

Would it come as a shock that labour TDs are from deprived areas or that Sinn Fein are gaining votes from Labour in deprived areas?

syklops

eire4 wrote: »

I disagree. The Americans have a for profit health care industry. Tens of millions cannot afford insurance and even of those who do the insurance companies often do everything they can to restrict paying out on claims. Obama's health care reforms improve a few areas here and there such as insurance companies refusing to give coverage to those with a pre existing condition but at the end of the day the American health system is most definitely not what Ireland needs as it will leave massive numbers without any coverage and costs will be driven up massively when health becomes all about profits and not about care which is what exists in America.

Have you experienced our health service?????

creedp

syklops wrote: »

Have you experienced our health service?????

I think the issue is that two wrongs don't make a right ... both systems are sub-standard but switching to an American styled system which cost in the region of 17% of GDP in the US (Irish system is in the regions of 9% of GDP), the most expensive healthcare system in the work by a country mile, and thereby ensuring that a significant proportion of the population have no health insurance is not something that should be considered.

creedp

test4444 wrote: »

What is Primary Care and what is a Primary Care cente for? These two questions have been ignored. A Primary Care centre is a location where patients can receive normal GP primary care Plus none-acute proceedures which have been traditionally done in Hospitals but can be done at a lower cost by the private sector in these centres which have a higher medical standard then a normal GP's surgery. These centres can save money and relieve the strain on Hospitals.

So ideally they are in high population areas. There is a priority to place them near acute hospitals so that they can free up resources in the hospitals. Also consultants can use the facilites to do out patient proceedures.

Shorthall didn't prioritise by Health needs as financial deprevation does not translate to health needs not being met. Due to medical cards the average number of GP visits in a deprived area far exceeds the number of visits per patient per year in a middle class area (even taking into account more economic based health problems).

It is not stark to priorities being able to use a building as a primary care centre before building a physical structure. If you can't fill it with GPs it would be just another empty waste of our money.

Would it come as a shock that labour TDs are from deprived areas or that Sinn Fein are gaining votes from Labour in deprived areas?

Why do you think that Primary Care Centres can only be efficiently operated by the private sector .. is this the norm elsewhere or is is the case that in Ireland this would be the only game in town? I would have thought that Primary Care is much broader that GP services and incorporates all the other medical professionals such as physios, occupational therapists, chiropodists, etc, etc,. Is is this aspect of Primary Care Centres that is most important in my view as it stops GPs unnecessarily referring people into hospitals for services that can be provided much more efficiently for the system and more importantly for the patients in the community. The problem at the present in Ireland is that GPs are private contractors who refer far to many patients into the public hospital system for minor ailments/diagnostics/examinations which could much more efficiently be provided in a Primary Care Centre staffed by a broad range of professionals (public or private) who have access to modern diagnositc equipment.

Of course when you say that consultants should be able to use the primary care facilities for diagnostics you probably mean private consultants also .. who would pay for this by the way? Currently I understand private consultants can use public hospital diagnostics for their private patients at no cost to patient or Consultant .. would you expect the same arrangements to apply in the Primary Care Centres. That would be handy as it would allow private patients of consultants in public hospitals to avoid the nasty queues for diagnostics in public hospitals and instead access efficient privately delivered diagnostics in primary care centres .. everyones a winner, or are they?

I can never understand if private healthcare is so good why haven't private GPs/other professionals got together and invested in private primary care facilities and therefore provide an alternative private service to their patients that is of a high quality and cost effective at the same time. If it was such a good proposition then they should have no problem persuading insurance companies to provide relevant private cover for such services and everybody would be happy. In this scenario the private sector would indeed deliver on the promise of removing pressure form the embattled, old fashioned, inefficient public sector. But of couses it doesn't happen and will only happen if the State steps in.

sparkling sea

test4444 wrote: »

Reilly has alluded to the reason but he really can't come out and say it. The reason is simple; under Shorthall's PPP scheme NO GP has signed up to enter one of the centres and NO GP would. (because of the socialist nature of the ppp). Reilly picked centres which had a high likely hood of success. Success being built, having GPs signed up and run in a manner which provides real Healthcare (ie. not run by the HSE). By picking on this basis he felt he would actually be able to deliver the require 20 centres. If he added by any other priority the likely hood would be that less then 20 centres would be built and running.

Your reasoning seems to suggest that success rather than need is the definitive factor. Mr Reilly being efficient for efficiency sake, rather than being effictive when effectiness is what is actually needed now.

Again, the only evidence of criteria needed appears to be that the centres where located in James Reilly's constituency, and to add oil to the fire, the Sunday papers stated that some politicans are known to have privately stated this.

Although, it was particularly telling that only one Minister, Leo Varadkar actually had the good sense to concede that Mr Reilly's decision, could be seen as stroke politics. Everyone one else followed the FF line of doing business, stick to the party line, ignore reality - it is exactly like when Bertie was in charge, no actual opinions or reality allowed, not in this country under his leadership.

If Mr Reilly cannot explain the parameters or methodology or evidenced based reasoning, that was used in his decision making process, then he is wrong person to hold the position of Minister for Health. Futhermore if his criteria cannot be scientifically measured, he is using the wrong criteria, simple as.

"Reilly has alluded" might be a good enough explaintion for you but it isn't for me. I don't want any politicans alluding anything.
I demand transparency in decision making because I have lost trust in all politicans, as most people in this country have; Ministers like James Reilly and Phil Hogan will leave people feeling like they may as well vote FF back in "the next time", so many people have said this to me this weekend - better the devil you know and at least they admit their devils and don't pretend their do gooders, I never expected FG and Labour to be as unscrupulous and comtemptous with regard to transparency as they now appear to be.

I would never have believed that people would start perceiving FG as equally corrupt as FF. FG seem to have forgotten who they are and what they stand for as do Labour. The saying that power corrupts seems to stand up here.

We as a nation sat back while politicans "alluded" to all sorts of things; I would have assumed everyone would have learned the lesson by now and insisted on transparency but unbelievably, (in political speak) it seems some are slower to learn than others.

test4444

creedp wrote: »

The problem at the present in Ireland is that GPs are private contractors who refer far to many patients into the public hospital system for minor ailments/diagnostics/examinations which could much more efficiently be provided in a Primary Care Centre staffed by a broad range of professionals.

You are quite right but the problem is not the GP or Primary Care Centre, the problem is the HSE and their budgets. Health costs money and items like Coagulation management, 24 hr BP, 24 hr ecg, ultra sound,stess test, etc. etc. are charged for at a Primary Care Centre. Private patients pay. Who pays for the public patient? It cost about 20 times less to provide these proceedures in the centre vs the hospital, but the HSE, at the moment, won't fund these for public patients. Rielly's money follows the patient is supposed to fix this. It can't work until the HSE is totally reorganised and the current boses are replaced. Oh, that's what is happening.

The other problem is that you need a minimum number of centes located near hospitals to move the out patient services enmass else you still have to pay saleries and facilities for the few remaining patients going to the hospital instead of primary care centres.

Qualitymark

@test4444 In France, every neighbourhood has a lab where you go to get those tests. You go to your GP, separately. If you have, say, an eye problem, you go to your local eye specialist (without a note from the GP or any such nonsense). It all works. Nobody's paid huge amounts. It's grown-up.

creedp

test4444 wrote: »

You are quite right but the problem is not the GP or Primary Care Centre, the problem is the HSE and their budgets. Health costs money and items like Coagulation management, 24 hr BP, 24 hr ecg, ultra sound,stess test, etc. etc. are charged for at a Primary Care Centre. Private patients pay. Who pays for the public patient? It cost about 20 times less to provide these proceedures in the centre vs the hospital, but the HSE, at the moment, won't fund these for public patients. Rielly's money follows the patient is supposed to fix this. It can't work until the HSE is totally reorganised and the current boses are replaced. Oh, that's what is happening.

The other problem is that you need a minimum number of centes located near hospitals to move the out patient services enmass else you still have to pay saleries and facilities for the few remaining patients going to the hospital instead of primary care centres.

The real problem here is the eligibility system where only medical card/GP visit card holders are entitled to public GP services. If we had a system where everyone has entitlememnt to core public health services, including GP and other core primary care services we wouldn't have the problems we have now. A non medical/GP visit card holder cannot access public GP services in this country and as a consequence the HSE won't fund/provide public primary care services to these patients. So instead we continue with the current dinosaur approach of sending these patients into hospital for a blood test.

Absolutely ridiculous. But then we hear its impossible to provide GP services to everyone in this economic climate ... it would be a hell of a lot more accurate to say we can't afford not to provide public GP services to everyone - the issue of whether they should be free to everyone is a seperate question.

Qualitymark

creedp wrote: »

The real problem here is the eligibility system where only medical card/GP visit card holders are entitled to public GP services. If we had a system where everyone has entitlememnt to core public health se

The BBC4 programme last night on the British National Health Service's history showed the same thing: doctors were adamantly opposed to the idea when it was being planned, thinking they'd lose their profitable private businesses. Nye Bevan said he'd "filled their mouths with gold" to persuade them to come in.