What would you do to sort out the HSE?

Anita Blow

It wasnt me123 wrote: »

This is the nonsense of the present system - it should be the medical staff making the medical decisions, not a patient holding the medical staff to ransom. It should be carefully explained to them, as they have all their faculties, that this is part of their medical care, they need 24 hour minding and the hospital needs the bed - now get dressed and get moving.

Tough though when its your own family members but the reality of the elderly taking up hospital beds when nursing home / respite care is what they need, is frightening.

Build the nursing homes and we will fill them. That should be the HSE's new slogan

A patient who is compos mentis cannot be forced into any medical treatment so that would never happen.

It wasnt me123

Anita Blow wrote: »

A patient who is compos mentis cannot be forced into any medical treatment so that would never happen.

Don't force them, give them the choice.

Nursing home with step down care which is what you need or out the door but we need the hospital bed - its not a hotel - you can't take up/use expensive resources because you decide to have a hissy fit - hospital managers need to earn their crust - these are the options, pick one, get dressed and hop it

gctest50

ken wrote: »

The only problem with that is this. I personally know someone that cannot care for themselves at home. They refuse to go in to a nursing home and cannot be forced into one as long as they have their full faculties.

So they stay lying in a hospital bed till they are well enough to go home(probably never gonna happen).

They agree to go to a home(they have said if they are forced they'll ring a taxi home immediately)

That would be one of the best improvements if it could be fixed

Some people mistake hospitals for cruise ships

They quickly learn that if they start the "cannot care for themselves at home" carry on and "have their full faculties" they get a free go on the HSE boat

Ally Dick

machiavellianme wrote: »

This might actually work if the GPs did anything anymore. Instead they act more like GPS and give you lots of directions to others who might be able to figure out what is wrong with you. The general practitioners are becoming mere middle men with no accountability or responsibility.

I completely agree. My GP knows that I have VHI, and loves referring me to his buddies. I've spent nearly a year going to specialists for my various minor ailments.

JuliusCaesar

Cork Lass wrote: »

Anyone who presents to A&E with a problem that could have been treated by a GPshould be charged at least double the standard fee. That would keep a lot of time wasters at home.

Fee for attending A&E at present: €100.00

Fee for attending GP at present: €50


Did you not know that?

Ally Dick

Clandestine wrote: »

-2 grand flat charge for drink/drug related admissions.

A bit harsh, after I am punched in the face outside a pub while walking home from my prayer group

Anita Blow

It wasnt me123 wrote: »

Don't force them, give them the choice.

Nursing home with step down care which is what you need or out the door but we need the hospital bed - its not a hotel - you can't take up/use expensive resources because you decide to have a hissy fit - hospital managers need to earn their crust - these are the options, pick one, get dressed and hop it

Which is what happens currently. I've worked on many wards and in several step-down facilities where in some cases the ward was almost 100% elderly patients awaiting discharge. The idea that we have large amounts of elderly patients refusing to go home is untrue. I can only think of one such case in my experience in three years working in Dublin.

What happens at the moment if a person is unable to live independently at home after an admission to hospital:

1) Discharged to long-term care
2) Discharged to convalescence for short-term rehab to regain independence
3) Remains in the hospital while a homecare package is set-up before they return home
None of these are anything to do on the patient's end. They are all to do with availability of LTC/Convalescence spots or waiting for funding to be approved.

A doctor's primary concern is the wellbeing of the patient. It would be irresponsible (& unethical with repercussions from the medical council) to discharge a patient that is not fit to return home.

spurious

Create promotional posts for nurses that do not result in them stopping nursing. Too many qualified nurses pushing paper.

Widen the recruitment pool. Recruit many more Healthcare assistants to do the lower level tasks that qualified already stretched nurses are wasted on. Create an entry mechanism (similar to the old cadet system) where it is possible to enter nursing through being a Healthcare Assistant first, without necessarily the high level of points required for direct entry. If this creates a lower level within nursing, so be it. You do not need four years training to take a temperature or blood pressure. Free up the higher qualified nurses to do other things.

Retain the staff we have. Give newly qualified nurses the option of signing up for a five or ten year contract at a higher pay rate than present new recruits get (which is less than cleaners get). Count service in Ireland as more than service abroad for promotional posts. Encourage people to stay.

Have a pre-triage triage in A&E. Show the 'I need a tablet for the pain in me head' types the door or a large bill (not covered by the medical card). Have a seperate room for the drunk and drugged who will be seen if someone has the time.

gctest50

spurious wrote: »

..... If this creates a lower level within nursing, so be it. You do not need four years training to take a temperature or blood pressure..........

surely the point of having actual nurses doing that is they may spot "other things" ?

It wasnt me123

[QUOTE=Anita Blow;98174446]Which is what happens currently. I've worked on many wards and in several step-down facilities where in some cases the ward was almost 100% elderly patients awaiting discharge. ......

3) Remains in the hospital while a homecare package is set-up before they return home
None of these are anything to do on the patient's end. They are all to do with availability of LTC/Convalescence spots or waiting for funding to be approved.

A doctor's primary concern is the wellbeing of the patient. It would be irresponsible (& unethical with repercussions from the medical council) to discharge a patient that is not fit to return home.[/QUOTE]


But it isn't what currently happens all the time because there isn't always respite/nursing home beds available - my point was to build more, part pay for them with their old age pension/means test it - and put the elderly in them. And let them wait there while they put the homecare package together/funding/etc. Sometimes that takes weeks and they are taking up hospital beds.

Obviously I wasn't advocating tossing old age pensioners out on the street from a hospital without adequate care, but they can't dictate where they go for medical treatment - if the doctor says you don't need a hospital but cant go home yet until we do any of the above, then you go to Convalescence care - it should be up to the medical staff, not some auld wan saying I don't want that and taking up valuable resources and medical expertise because they don't fancy the local nursing home - if a consultant says go, they will go because the elderly think consultants are gods.

TomBtheGoat

Let the experts who know about service delivery, like nurses & doctors, run the show. And cull the backroom suits & glorified pen pushers who are actually calling the shots.

gctest50

TomBtheGoat wrote: »

Let the experts who know about service delivery, like nurses & doctors, run the show. And cull the backroom suits & glorified pen pushers who are actually calling the shots.

I doubt the "backroom suits & glorified pen pushers" are killing and maiming patients to the tune of €85 million compensation


http://www.thejournal.ie/state-claims-agency-payouts-hse-1370954-Mar2014/

Responding to a parliamentary question, the Minister for Health outlined that more than €197 has been paid out in the past three years for claims against the HSE.

power101

We need to change from an expensive reactive policy to prevention and early diagnosis. A few ideas :

1) One free visit for whole population per year to a GP which includes blood tests etc. Same as the one free dental visit that everyone is allowed.

2) Increase smoking age over three years from 18 to 21. Studies have shown that there is a huge reduction in young people taking up smoking when it is not as easy for them to purchase cigarettes.

3) Tax on sugary foods to reduce obesity and diabetes. Using the tax from this to subsidise sports and exercise in Ireland and to offset alcohol advertising.

Ken.

To get rid of smoking we need to follow Tasmania's lead. They are trying to bring in a law that basically means that anyone born after 2000 will never ever be allowed to buy cigarettes. With penalties for anyone providing cigarettes to the 'tobacco-free generation'.
http://www.sbs.com.au/news/article/2014/11/20/tasmanian-tobacco-bill-ban-smoking-youth

gctest50

power101 wrote: »

...
3) Tax on sugary foods to reduce obesity and diabetes. Using the tax from this to subsidise sports and exercise in Ireland and to offset alcohol advertising.

too simplistic though

The studies, which were conducted between 1990 and 2011, included 2,625 people who were recently diagnosed with diabetes, about 12% of whom were at normal weight.


The lean patients looked metabolically similar to those who were obese, with the exception of their weight, the researchers found.
But they were twice as likely to die at any point than their heavier counterparts

cython

Hammer89 wrote: »

I don't concern myself with these matters, but if several elected officials have tried and failed, then the answer probably doesn't lie with someone on Boards.ie.

If elected officials were appointed to preside over areas where they had some expertise this might be valid. In reality our current and previous ministers for health have been an aberration in being doctors, and even at that running a GP's practice or working as a frontline doctor is a far cry from running an entire health service, and the same goes for any ministerial portfolio.

In reality the responsibility lies with the (largely long-term) senior civil servants in each department more than the elected figureheads that change every few years, and thus have limited time to accomplish anything anyway.

LordSutch

blackcard wrote: »

What would you do to sort out the HSE?

Strip down and streamline the bloated behemoth that is the HSE.

How?

Copy & Paste a scaled down version of the NHS (as it was in the 1980s) before privatisation crept in. Then tailor it to our needs and modernise it for the 21st century - Bingo!

Ken.

I'd vote for that guy^^^^^

power101

gctest50 wrote: »

too simplistic though

The studies, which were conducted between 1990 and 2011, included 2,625 people who were recently diagnosed with diabetes, about 12% of whom were at normal weight.


The lean patients looked metabolically similar to those who were obese, with the exception of their weight, the researchers found.
But they were twice as likely to die at any point than their heavier counterparts

Ok... What about the 88% who were not at normal weight who are more likely to die and have worse health than the normal population... You're talking of a small subset and giving that as the reason we shouldn't try to reduce risk for almost 9/10 of the people diagnosed with diabetes!?

power101

ken wrote: »

To get rid of smoking we need to follow Tasmania's lead. They are trying to bring in a law that basically means that anyone born after 2000 will never ever be allowed to buy cigarettes. With penalties for anyone providing cigarettes to the 'tobacco-free generation'.
http://www.sbs.com.au/news/article/2014/11/20/tasmanian-tobacco-bill-ban-smoking-youth

Yes I'm very aware of this and would happily support this in the years to come if its proved it would have a bigger impact than increasing age to 21. I would just be worried about banning things outright as it just has never worked when you look back at Alcohol / Drugs etc...

blackcard

It is probably easy to give out about the HSE and probably about any health service in the world. People give out about the NHS and the American health service. Is there a model that a country of Ireland's size should follow?

gctest50

power101 wrote: »

Ok... What about the 88% who were not at normal weight who are more likely to die and..........

been told often enough try not to eat too much / eat healthier and small bit of exercise

hospitals get mistaken for cruise ships,

hse gets mistaken for their mammies

Joe prim

Ally Dick wrote: »

I have a friend in the HSE. He is 53 and he earns 28k gross a year. His boss takes half days off for golf during the summer. She is on 60k and gives all her work to him. She is typical of the type of worker they need to get rid of.

No, your friend should be got rid of as well, he is aiding and abetting fraud, and I do not think his work is necessary, as it is his 60k bosse's work he is doing, and she can go off playing golf, so she isn't needed either, sack them both, I say.
My cousin lives next door to a girl whose brother-in-law's uncle works in the HSE and he says etc. Etc etc.........
'

Azalea

Can't know until I'm in the situation, with information on budgets and other resources.

Very easy to "know" what to do when not in the situation. Sums up the entire Journal.ie comments sections.

It would appear to make sense to reduce admin personnel through natural wastage, and to privatise *some* aspects of admin. This appears to be happening already though.

suicide_circus

The parochial parish pump insistence of locals that Ballylowpopulationdensity should have a cancer centre of excellence dosnt help

Wompa1

c_man wrote: »

Ha! Well good for you. You'd be the first I've ever heard of doing so, during the crash all the main proponents of the Nordic model I knew from college fuked off to Oz, Canada and the UK. I just knew one guy who got a job in Finland. Threw it in after six months saying they were the most boring, alcoholic nation and he'd go daft.

I have one friend that has been living in Norway for almost 10 years and another that's been living in Sweden for 6. They both love it over there. From speaking with them, it sounds like Norway is the best of the countries to live in over there. But as my friend told me, it's not a free ride by any means.

The only Nordic country I have been to is Norway. It was pretty spectacular.

brokensoul84

I would get all people who work in psychiatric services to sit down and learn to listen to their patients and try and understand mental health issues from a patients view point not just from what a text book says.

GFT

Legalise cannabis oil. Quick application for anyone having to wait hours on a trolly.