What is wrong with the health service, HSE

Tell me how

VinLieger wrote: »

Are you suggesting because we arent all experts in how to run the HSE we shouldnt have an opinion on it or be able to voice that opinion on a discussion forum?

I can't understand their position in trying to shut down discussion on this.

They are an active poster in many threads with national political/strategy themes.

Sam Russell

AndrewJRenko wrote: »

Here's one way to improve it - let's leave the improving to people who know what they are talking about.

If I get bad service from an enterprise, I have a very good understanding of how they might improve their offering. Many users of the services provided by the HSE have a very good idea how the services could be improved.

One does not need to be an expert to see the major failings of the HSE. No-one should be left on a trolley for 48 hours, particularly if they are over 90 years of age as has been the case last year. Waiting lists for scoliosis operations of many years for growing children is unforgivable.

Who needs to be an expert to see such failings and call for a better system?

Tell me how

Sam Russell wrote: »

If I get bad service from an enterprise, I have a very good understanding of how they might improve their offering. Many users of the services provided by the HSE have a very good idea how the services could be improved.

One does not need to be an expert to see the major failings of the HSE. No-one should be left on a trolley for 48 hours, particularly if they are over 90 years of age as has been the case last year. Waiting lists for scoliosis operations of many years for growing children is unforgivable.

Who needs to be an expert to see such failings and call for a better system?

Not to mention that outside of education, the HSE is probably the one government body of which everyone in the country has at least some experience with it.

Tell me how

I wonder are the nurses striking for a 12% pay rise hoping that it will force the government to either pay it or to hire more nurses at the current rate to alleviate their staff number issues.

I wonder would they be happy with x number of more nurses at the current payscale or do they feel that they have to get the raise.

blanch152

AndrewJRenko wrote: »

Here's one way to improve it - let's leave the improving to people who know what they are talking about.

If I walk into your job and after 20 minutes, I start telling you all the things you're doing wrong, will you be taking my instructions?

In any online discussion there are always some posters who don't have a clue what they are talking about. We have our fair share of those, and we also have a fair share of people who are ideoligally or politically tied to certain positions and posturing.

However, from reading this thread and others, it is also clear that there are plenty of posters on here who have experience of working in the public sector, both front-line and management examples, as well as those who have worked in management in the private sector. They don't have to be experts in health care to be able to identify critical problems or to suggest credible solutions. They also have the ability to critically analyse the bleating and whinging of unions or the pathetic excuses of management, all of whom have a role in the issues of the health service.

One thing is clear - we spend an awful lot of money per capita on the health service, yet it doesn't work. It is not a problem of money, it is a problem of policy, management, working arrangements and employees. We can argue about where the balance of responsibility lies between those four, but most of the problems and nearly all of the solutions lie within the HSE. The remaining problems are problems of policy and fall between the political body and the HSE. Is the HSE strong enough in standing up to unsustainable policies (over 2 million medical cards?) put forward by politicians? Are politicians strong enough to resist the populist bleating in the media and among the opposition?

VinLieger

Tell me how wrote: »

I can't understand their position in trying to shut down discussion on this.

They are an active poster in many threads with national political/strategy themes.

Indeed, a strange attitude to have for someone who has expressed quite strong views on a variety of other topics.

AndrewJRenko

Tell me how wrote: »

I can't understand their position in trying to shut down discussion on this.

They are an active poster in many threads with national political/strategy themes.

VinLieger wrote: »

Indeed, a strange attitude to have for someone who has expressed quite strong views on a variety of other topics.

I've already addressed that issue in this earlier post.

Geuze wrote: »

It was a few years ago.

https://www.independent.ie/irish-news/hse-hires-outside-help-despite-having-full-staff-26699221.html


2010:

Just last week, HSE head of human resources Sean McGrath said it was widely accepted that too many staff were employed in certain areas within the HSE.

''There are about 2,000 people working in the HR function. I could probably get away with having 700 or 800 in that department," he said then.

Nine years ago, at a time when the organisation was dramatically cutting back numbers instead of working hard to recruit and retain staff. So how many people are in HR now? How many people do they recruit each year compared to 2010?


Is there any chance of having an educated, informed debate?

Tell me how wrote: »

Not to mention that outside of education, the HSE is probably the one government body of which everyone in the country has at least some experience with it.

Having some experience of a body does not make you an expert in running that body. Are you an expert in running banks, mobile phone companies and tv cable providers?

blanch152 wrote: »

In any online discussion there are always some posters who don't have a clue what they are talking about. We have our fair share of those, and we also have a fair share of people who are ideoligally or politically tied to certain positions and posturing.

However, from reading this thread and others, it is also clear that there are plenty of posters on here who have experience of working in the public sector, both front-line and management examples, as well as those who have worked in management in the private sector. They don't have to be experts in health care to be able to identify critical problems or to suggest credible solutions. They also have the ability to critically analyse the bleating and whinging of unions or the pathetic excuses of management, all of whom have a role in the issues of the health service.

Pots and black kettles spring to mind.

blanch152 wrote: »

One thing is clear - we spend an awful lot of money per capita on the health service, yet it doesn't work. It is not a problem of money, it is a problem of policy, management, working arrangements and employees. We can argue about where the balance of responsibility lies between those four, but most of the problems and nearly all of the solutions lie within the HSE. The remaining problems are problems of policy and fall between the political body and the HSE. Is the HSE strong enough in standing up to unsustainable policies (over 2 million medical cards?) put forward by politicians? Are politicians strong enough to resist the populist bleating in the media and among the opposition?

What particular measure did you decide to judge that 'it doesn't work'? How many babies were brought into the world without difficulty today by the HSE? How many hip operations were carried out? How many cataracts were cleared? How many people were seen in A&E? [St Vincents reported a 6% increase in A&E numbers for 2018 over 2017, btw]


You certainly ask some interesting and relevant questions, worthy of further discussion. But that's doesn't mean that anyone here is anywhere near competent to come up with reliable solutions.

Sam Russell wrote: »

If I get bad service from an enterprise, I have a very good understanding of how they might improve their offering. Many users of the services provided by the HSE have a very good idea how the services could be improved.

One does not need to be an expert to see the major failings of the HSE. No-one should be left on a trolley for 48 hours, particularly if they are over 90 years of age as has been the case last year. Waiting lists for scoliosis operations of many years for growing children is unforgivable.

Who needs to be an expert to see such failings and call for a better system?

Getting bad service (or indeed, getting good service) does not make you an expert on how to manage the most complex operation in the country. And yeah, we can all see the failings, but let's see the successes along with the failings to come to a fair assessment. And calling for a better system is fine too - but coming up with proposes that the HSE should be decentralised or decentralised or disbanded or whatever are just nonsense, like the bar stool experts shouting at the telly telling the football manager what team he should have picked.

]

James Brown

Do we, (various governments) try anything outside of hiring/having a recruitment freeze, increased funding, wage freeze etc? It seems agreed the organisation needs work I don't see how any more money or staff will help if the organisation needs changing.
Didn't this government bring in some consultants or other a while back? Any news there?
My impression is they (governments we've had) just want it to go away.

Just to note, again, Unions do an excellent job. They don't work for the tax payer, they work for their members. What Unions do or don't do as a membership entity is for our political representatives to look at. If a deal is struck that favours the Unions to the detriment of the tax payer, that's the Union being good at their job IMO. Looking to them to help the taxpayer out makes as much sense as looking at private business.

Tell me how

Matt Barrett wrote: »

Do we, (various governments) try anything outside of hiring/having a recruitment freeze, increased funding, wage freeze etc? It seems agreed the organisation needs work I don't see how any more money or staff will help if the organisation needs changing.
Didn't this government bring in some consultants or other a while back? Any news there?
My impression is they (governments we've had) just want it to go away.

Just to note, again, Unions do an excellent job. They don't work for the tax payer, they work for their members. What Unions do or don't do as a membership entity is for our political representatives to look at. If a deal is struck that favours the Unions to the detriment of the tax payer, that's the Union being good at their job IMO. Looking to them to help the taxpayer out makes as much sense as looking at private business.

Absolutely, Unions are there to protect their members.
And all of them thinks there needs to be change, they just are not willing for that change to affect their members.

It is a societal issue because not only do so many of us end up using it, but also, we or someone close to us works within the system and so we have a vested interests of sorts in not wanting them to lose their position.

Maybe the government should target a single relatively small region such as the mid west or south east or so on and try to make that self sustainable and efficient in terms of all services being available within acceptable time frames and where possible within the region. Allow them to have only the required number of administrators and managers but give them funds for front line staff and then critically and rigidly assess performance. Essentially, try to treat it like a private business as much as possible. Appoint a single person not influenced by elections to own the delivery of this project. Then, if that is proven to be successful, try to replicate it in the next region and so on.

But, could any of that realistically be done? Would union influence be the sole reason it might fail?

James Brown

Tell me how wrote: »

Absolutely, Unions are there to protect their members.
And all of them thinks there needs to be change, they just are not willing for that change to affect their members.

It is a societal issue because not only do so many of us end up using it, but also, we or someone close to us works within the system and so we have a vested interests of sorts in not wanting them to lose their position.

Maybe the government should target a single relatively small region such as the mid west or south east or so on and try to make that self sustainable and efficient in terms of all services being available within acceptable time frames and where possible within the region. Allow them to have only the required number of administrators and managers but give them funds for front line staff and then critically and rigidly assess performance. Essentially, try to treat it like a private business as much as possible. Appoint a single person not influenced by elections to own the delivery of this project. Then, if that is proven to be successful, try to replicate it in the next region and so on.

But, could any of that realistically be done? Would union influence be the sole reason it might fail?

I've read that here before. The only people I've come across who work there complain about how poorly run it is. I don't think people are going to accept a health system they feel is broken because they are concerned about people they may know working there. I don't think anyone would be expecting massive layoffs as a result of any changes.
I believe if government or whomever went public with a plan and explained how it would help fix the HS the Unions wouldn't have public support, if they fought against it. I personally don't buy the unions being that big a problem. Worst case is the system changes for the better and unionised members of staff are surplus to requirement. They are looking to secure jobs and salaries I don't think changes in the way the HSE does business will come against unions unless it involves layoffs and the like.
Fiddling around the edges and blaming unions or nurses isn't going to achieve anything.

Yes taking one small area to try might be a very good idea.

Good loser

On Saturday View last Sat. a consultant from Sligo (I think) made some good interventions.

Think he said Ireland had a very high proportion of staff nurses compared to other European countries. All are at a very high basic and there are no way near enough staff at lower grades; in other words much of the routine stuff nurses do (like taking bloods, putting in drips, taking BPs) could be done by lower paid technicians. This apparently is the situation in the HSE.

So, for instance, the number of staff nurses could be halved and half of what they currently do could be divvied up amongst technicians. Over time.

Martina1991

Good loser wrote:

So, for instance, the number of staff nurses could be halved and half of what they currently do could be divvied up amongst technicians. Over time.

I dont understand what you mean by technicians?

James Brown

Martina1991 wrote: »

I dont understand what you mean by technicians?

Also the big problem seemingly is reliance on contractors because nurses such as psychiatric are leaving the country, they are short staffed.

Topgear on Dave

Martina1991 wrote: »

I dont understand what you mean by technicians?

There was some debate over introducing theatre assistants instead of nurses to do some jobs. This was in 2015.

https://www.irishtimes.com/news/ireland/irish-news/hse-to-look-at-introducing-hospital-theatre-assistants-1.2405731

Im not sure of the ins and outs of it but the SBP reported on Sunday that they were finally going to go ahead.

"Cork University Hospital has started to train operating theatre assistants after a battle with the INMO which opposed the move."

AndrewJRenko

Tell me how wrote: »

Matt Barrett wrote: »

Do we, (various governments) try anything outside of hiring/having a recruitment freeze, increased funding, wage freeze etc? It seems agreed the organisation needs work I don't see how any more money or staff will help if the organisation needs changing.
Didn't this government bring in some consultants or other a while back? Any news there?
My impression is they (governments we've had) just want it to go away.

Just to note, again, Unions do an excellent job. They don't work for the tax payer, they work for their members. What Unions do or don't do as a membership entity is for our political representatives to look at. If a deal is struck that favours the Unions to the detriment of the tax payer, that's the Union being good at their job IMO. Looking to them to help the taxpayer out makes as much sense as looking at private business.

Absolutely, Unions are there to protect their members.
And all of them thinks there needs to be change, they just are not willing for that change to affect their members.

It is a societal issue because not only do so many of us end up using it, but also, we or someone close to us works within the system and so we have a vested interests of sorts in not wanting them to lose their position.

Maybe the government should target a single relatively small region such as the mid west or south east or so on and try to make that self sustainable and efficient in terms of all services being available within acceptable time frames and where possible within the region. Allow them to have only the required number of administrators and managers but give them funds for front line staff and then critically and rigidly assess performance. Essentially, try to treat it like a private business as much as possible. Appoint a single person not influenced by elections to own the delivery of this project. Then, if that is proven to be successful, try to replicate it in the next region and so on.

But, could any of that realistically be done? Would union influence be the sole reason it might fail?

So when you say "treat it like a private business", can the hospitals start charging for the true costs of services provided, like a private business would? And can it pick and choose it's customers to ensure profitability, like a private business would?

James Brown

The problem with looking to private business, they let people go to increase or maintain profits, they cut or curtail services to remain in profit or a profit of their liking. All fine and dandy except the point is to serve the public not make a profit on the public suffering. Goes for more than health issues too.

blanch152

Topgear on Dave wrote: »

There was some debate over introducing theatre assistants instead of nurses to do some jobs. This was in 2015.

https://www.irishtimes.com/news/ireland/irish-news/hse-to-look-at-introducing-hospital-theatre-assistants-1.2405731

Im not sure of the ins and outs of it but the SBP reported on Sunday that they were finally going to go ahead.

"Cork University Hospital has started to train operating theatre assistants after a battle with the INMO which opposed the move."

The INMO are brilliant at protecting their patch.

Ireland is near the top of the EU list for nursing salaries.
Ireland is near the top of the EU list for nurses per capita.

We cannot sustain both of those statistics indefinitely.

Uriel.

blanch152 wrote: »

The INMO are brilliant at protecting their patch.

Ireland is near the top of the EU list for nursing salaries.
Ireland is near the top of the EU list for nurses per capita.

We cannot sustain both of those statistics indefinitely.

Do you have a link to these lists, I'd like to see the figures involved.

marieholmfan

Those over 90 years of age have had their whole lives to work to improve the public health system.
If anyone should be left on a trolley for seven hours it is a 90 year old.

Sam Russell wrote: »

If I get bad service from an enterprise, I have a very good understanding of how they might improve their offering. Many users of the services provided by the HSE have a very good idea how the services could be improved.

One does not need to be an expert to see the major failings of the HSE. No-one should be left on a trolley for 48 hours, particularly if they are over 90 years of age as has been the case last year. Waiting lists for scoliosis operations of many years for growing children is unforgivable.

Who needs to be an expert to see such failings and call for a better system?

Tell me how

marieholmfan wrote: »

Those over 90 years of age have had their whole lives to work to improve the public health system.
If anyone should be left on a trolley for seven hours it is a 90 year old.

Aside from misinterpreting people's points, how do you think the HSE can be improved?

Sam Russell

marieholmfan wrote: »

Those over 90 years of age have had their whole lives to work to improve the public health system.
If anyone should be left on a trolley for seven hours it is a 90 year old.

That is basically disingenuous.

Assuming a working life of 40 years, then the majority of a 90 year old would be unable to work towards a solution, other than by a vote, and even that is ineffectual since a single vote will not change the health service.

No-one should be left on a trolley for any extended period, especially a 90 year old.

James Brown

Anyone in their 80's or 90's comes from a time when people knew their place and the church ruled with an iron fist. The majority left school early, got any job, stuck with it, retired. The idea that even today the average person can carry much sway in regard of changing the HSE is a joke surely? We vote for people who claim to intend to tackle it, we assume they must have a plan. Sadly that's the best most of us can do.
We can however discuss it and I don't see any problem with that.

Tell me how

Matt Barrett wrote: »

Anyone in their 80's or 90's comes from a time when people knew their place and the church ruled with an iron fist. The majority left school early, got any job, stuck with it, retired. The idea that even today the average person can carry much sway in regard of changing the HSE is a joke surely? We vote for people who claim to intend to tackle it, we assume they must have a plan. Sadly that's the best most of us can do.
We can however discuss it and I don't see any problem with that.

1 in 23 workers in Ireland work in the HSE.
Vicky Phelan is going a long way towards influencing behaviour change in a certain element of Health Care delivery (And yes, because of her tragic story and even so she is still having difficulty doing so).
We all vote in elections to put the politicians in place to run essential services.
We actually have more power to direct focus on the HSE than we realise.
If we had protests in relation to it in the same way as we had against Water Charges maybe there would be something done.

But, the reason I am interested in a discussion is to see if anyone can suggest something which is either definitively the source of the problem or is likely to improve it. This is an anonymous online discussion forum. No one is suggesting it is the citizens council or Dail Eireann.

marieholmfan

Sam Russell wrote: »

No-one should be left on a trolley for any extended period, especially a 90 year old.

Why especially a 90 year old?

blanch152

Uriel. wrote: »

Do you have a link to these lists, I'd like to see the figures involved.

I posted the information either in this thread or the After Hours one. Others have posted it too.

marieholmfan

Matt Barrett wrote: »

Anyone in their 80's or 90's comes from a time when people knew their place and the church ruled with an iron fist.

Because the people let them.

Matt Barrett wrote: »

We vote for people who claim to intend to tackle it.

People in their 90s didn't and would have regarded a trolley as luxury when they were young.

Sam Russell

marieholmfan wrote: »

Why especially a 90 year old?

Because they could die because they are on the trolley instead of being treated in the hospital proper.

James Brown

Tell me how wrote: »

1 in 23 workers in Ireland work in the HSE.
Vicky Phelan is going a long way towards influencing behaviour change in a certain element of Health Care delivery (And yes, because of her tragic story and even so she is still having difficulty doing so).
We all vote in elections to put the politicians in place to run essential services.
We actually have more power to direct focus on the HSE than we realise.
If we had protests in relation to it in the same way as we had against Water Charges maybe there would be something done.

But, the reason I am interested in a discussion is to see if anyone can suggest something which is either definitively the source of the problem or is likely to improve it. This is an anonymous online discussion forum. No one is suggesting it is the citizens council or Dail Eireann.

I'm responding to this:

marieholmfan wrote: »

Those over 90 years of age have had their whole lives to work to improve the public health system.
If anyone should be left on a trolley for seven hours it is a 90 year old.

The problem with protesting is unless you've massive numbers chances are it won't amount to anything. Health is an ongoing issue and we've politicians and public resigned to the fact that it's too big to tackle, which I agree is unfortunate. There's also been a move from many quarters, political and media, to blacken the protester despite it being a right and a genuine belief in the issue on their behalf. Who'd be a protester in that environment?
It's not unreasonable for voters to assume incoming governments will tackle the scandal of hospital trolleys as promised.

James Brown

marieholmfan wrote: »

Because the people let them.



People in their 90s didn't and would have regarded a trolley as luxury when they were young.

The people were conditioned. You're talking about times when getting pregnant meant you might get locked up in a home. The church had a hand in state policy. I'm not saying people couldn't have done more but you cannot punish the elderly especially when we're not faring much better. What are you doing for instance?

We're supposed to be at least striving to improve ourselves.
Are you now saying people were content with what they had, therefore they didn't try to fix things. therefore they deserve to die on trolleys?

When you see an issue that needs improving it's not unrealistic for people to speak out and expect better.

AndrewJRenko

blanch152 wrote: »

The INMO are brilliant at protecting their patch.

Ireland is near the top of the EU list for nursing salaries.
Ireland is near the top of the EU list for nurses per capita.

We cannot sustain both of those statistics indefinitely.

Comparing gross salaries across countries is meaningless. You need to consider taxation levels, cost of property, cost of living and more to get any kind of meaningful comparison.


You need to be very careful of other international comparisons too. Other countries structure their services in different ways. In the UK, disability care services come under local authorities, not under health services, so comparisons can produce unexpected results.


Did you check the OECD comparison of hospital beds, showing how we have close to half the average OECD rates of hospital beds per capita.