Health system

screamer

No absolutely not, as my extra money would just be swallowed by the hole that is the HSE rather than being reformed.
HSE needs to be reverted to health boards and tackled one at a time. Outlaw unions, it’s the only way. Cut out the unnecessary admin and ancillary staff, ask the purchasing managers to get aggressive with buying to identify savings and we need more frontline staff. It will tKe years and so I’ll keep paying for my own health insurance.

byhookorbycrook

Recently spent time in a private hospital, two beds in my room, a few 4 beds on the floor too. The place was spotless . MRI ordered at 6pm on Sunday , done at 9am on Monday . The nurse to patient ratio seemed to be good and the food was pretty good too.

Contrast that to a relation in a public hospital . Minimum 6 patients per room . Litter on the floor - stayed there until one of the visitors picked it up after 2 days . Again, not sure of the nurse to patient ratio but definitely much worse than the private hospital. The public hospital was much bigger , so economy of scale should have been in its favour , as well .

Which begs the question, that if a private hospital run as a profit-making business can make money , how on earth can a public hospital be such a mess , considering that many of the patients there were covered by VHI or similar which was billed for those patients ?

the-island-man

I was born in the late 80's and growing up I remember having all the regional health boards in existence.

Anyone else see the irony in the fact that Slaintecare seems to be veering back to that model with the "health areas"?!

Anyone here of an older vintage know what the issue with the health boards was? Why did they create the HSE?

sameoldname

byhookorbycrook wrote: »

Recently spent time in a private hospital, two beds in my room, a few 4 beds on the floor too. The place was spotless . MRI ordered at 6pm on Sunday , done at 9am on Monday . The nurse to patient ratio seemed to be good and the food was pretty good too.

Contrast that to a relation in a public hospital . Minimum 6 patients per room . Litter on the floor - stayed there until one of the visitors picked it up after 2 days . Again, not sure of the nurse to patient ratio but definitely much worse than the private hospital. The public hospital was much bigger , so economy of scale should have been in its favour , as well .

Which begs the question, that if a private hospital run as a profit-making business can make money , how on earth can a public hospital be such a mess , considering that many of the patients there were covered by VHI or similar which was billed for those patients ?

According to this article from RTE, only €650 million a year comes in from private heath insurance to public hospitals. Government spending on health this year is €18.3 billion so it's a fairly small proportion overall.
Also, people on lower incomes who don't tend to have health insurance also tend to have more health complications than those in higher income brackets. Private hospitals don't generally deal with hundreds of pissheads every weekend either, etc, etc.

Graces7

Rodin wrote: »

No discussion about health should start without addressing the health of the nation.

People need to do their bit. And they're not.

Obesity and lack or exercise are the biggest challenges facing the health service.

If you're not doing your bit to not be a burden on the system, you've no right to criticise waiting times/lists.

Ah the " blame the patient" tactic. :rolleyes::eek: Anything but face the reality.

Snow Garden

the-island-man wrote: »

I was born in the late 80's and growing up I remember having all the regional health boards in existence.

Anyone else see the irony in the fact that Slaintecare seems to be veering back to that model with the "health areas"?!

Anyone here of an older vintage know what the issue with the health boards was? Why did they create the HSE?

The reason the health boards were amalgamated into the HSE was that it would reduce costs and increase efficiency by ending duplication across the country. However there were supposed to be large scale redundancies as part of the plan. At the last minute, in order to protect votes, Harney decided there could be no redundancies. It meant there were thousands of idle people with no value add roles. The HSE subsequently made up roles for those people and created a massive unwieldy bureaucracy. It was a disaster from the start and has only gotten worse.

Paulzx

byhookorbycrook wrote: »

Which begs the question, that if a private hospital run as a profit-making business can make money , how on earth can a public hospital be such a mess , considering that many of the patients there were covered by VHI or similar which was billed for those patients ?

.............because a Private Hospital can cherry pick areas of health and medical procedures that are profitable.

..............because a Private Hospital only has patients that are paying for the priviledge of being there.


There is still no excuse for the basket case that is the HSE but it is unfair to compare it to a private hospital which has no obligation to treat and provide healthcare for every person and ailment that appears at its doors.

For example, some private hospitals that have self styled A and E's will ring 999 for an emergency public ambulance when a patient presents with a serious condition that they can't or don't want to deal with. They will of course bill the patient for the assessment but then pawn the treatment and patient off to the public system in a publicly funded 999 ambulance.

There are defintely lessons the public system can learn from private hospitals but they are 2 different animals.

JohnnyFlash

Graces7 wrote: »

Ah the " blame the patient" tactic. :rolleyes::eek: Anything but face the reality.

What reality?

Hellrazer

The health service needs to be run as a business and that goes down to individual contracts of the consultants as in my opinion they are the ones causing the majority of the hold ups in the system.

In what other business can you

1.Decide to show up for work whenever you feel like it. Clinic starts at 9.00 - consultant arrives at 9.00,f**ks off for a coffee,comes back at 10.00 and then starts to see patients. Same at 11.00 and then off for lunch for 2 hours.Disappearing halfway through a clinic for no reason. They are not being held accountable. In the last 3 months I have personally experienced this on 3 separate occasions.

2. Decide to work for your competitor ie a private hospital. Cancel your public clinic with no notice yet the patient can get an appointment the same day or the next by paying you 200 + euros. Again leaving the patients waiting. Again Ive experienced this in the last couple of months. This is an absolute disgrace.

3.Decide when you feel like working. Not bothering to show up when a clinic is supposed to be open without any reason whatsoever.

So how would I suggest fixing it?


Make sure they actually show up on time - introduce a clock in system so they are accountable.
Do away with dual contracts. They either work for the public or private but not both.
If they decide to stick with the public system then they work a 35 hour week. Starting at the start of their clinic time,taking a realistic lunch break and finishing when all the patients have been seen.

In other words make them work like any other employee.

AndrewJRenko

salonfire wrote: »

What are you talking about?

The services offered by the private hospitals like the Beacon or the Mater are excellent.

It's easy to offer excellent services if you can cherrypick the services you offer and who you offer them too.

byhookorbycrook wrote: »

Recently spent time in a private hospital, two beds in my room, a few 4 beds on the floor too. The place was spotless . MRI ordered at 6pm on Sunday , done at 9am on Monday . The nurse to patient ratio seemed to be good and the food was pretty good too.

Contrast that to a relation in a public hospital . Minimum 6 patients per room . Litter on the floor - stayed there until one of the visitors picked it up after 2 days . Again, not sure of the nurse to patient ratio but definitely much worse than the private hospital. The public hospital was much bigger , so economy of scale should have been in its favour , as well .

Which begs the question, that if a private hospital run as a profit-making business can make money , how on earth can a public hospital be such a mess , considering that many of the patients there were covered by VHI or similar which was billed for those patients ?

Why would you assume that many of the patients in a public hospital are covered by VHI? Again, it's easy to run a nice, clean service when you cherrypick the services that you provide and who you provide them to.

AndrewJRenko

Hellrazer wrote: »

The health service needs to be run as a business and that goes down to individual contracts of the consultants as in my opinion they are the ones causing the majority of the hold ups in the system.

In what other business can you

1.Decide to show up for work whenever you feel like it. Clinic starts at 9.00 - consultant arrives at 9.00,f**ks off for a coffee,comes back at 10.00 and then starts to see patients. Same at 11.00 and then off for lunch for 2 hours.Disappearing halfway through a clinic for no reason. They are not being held accountable. In the last 3 months I have personally experienced this on 3 separate occasions.

2. Decide to work for your competitor ie a private hospital. Cancel your public clinic with no notice yet the patient can get an appointment the same day or the next by paying you 200 + euros. Again leaving the patients waiting. Again Ive experienced this in the last couple of months. This is an absolute disgrace.

3.Decide when you feel like working. Not bothering to show up when a clinic is supposed to be open without any reason whatsoever.

So how would I suggest fixing it?


Make sure they actually show up on time - introduce a clock in system so they are accountable.
Do away with dual contracts. They either work for the public or private but not both.
If they decide to stick with the public system then they work a 35 hour week. Starting at the start of their clinic time,taking a realistic lunch break and finishing when all the patients have been seen.

In other words make them work like any other employee.

Where specifically are these abuses happening?

Wanderer78 wrote: »

You can be damn sure, it won't be solved on boards, nobody knows what to do here

Ah, hold on now, surely you're not suggesting that the fixing something as complex as the health service might require people who actually know something about running health services?

Sure that's no fun - can't we continue to have people with no clue post their in-depth conclusions that arise from having walked past an outside wall once in 1992?

We should do this for all professions - to hell with professional qualifications, let's get the lads on boards tell us how to win court cases, design buildings, sell products etc. The next time I'm due for surgery, I'll definitely ask the lads on boards how to do the surgery. I'm so sick of bloody experts.

mikep

No plan will work until the two big beasts are controlled, HSE and Unions.

Recently there was talk about how reforms were blocked, it seems that there was a pilot project introduced to bring in the position of "theatre assistants" which would work in tandem with nurses etc keeping things running in the operating theaters. Common in most modern health systems..

Blocked by the unions so dropped despite the fact that it would have made conditions better...


Also there is a rumour that for each new nursing post thwere has to be a "manager" appointed, backed by the union..

Big problems there..

mikep

RobAMerc wrote: »

I worked for the HSE for 3 years - what a total basket case, everyone bar non front line staff need to go and the whole organisation be rebooted
I watched as senior managers literally spent the whole day txting friends and drinking tea. Other senior managers hired multiple "aides" in order to use up budget and then left the aides watching youtube all day coz there was nothing for them to do.
I met an old acquaintance who was a senior manager in the Health Board, she told me she had never been removed when the HSE came in just replaced ! She was left in her post ( pretty much doing nothing )

What people may not understand is the HSE is simply a layer of management smeared over a bunch of fairly autonomous organisations based mainly around specialties. Each of those has in turn its own management structure, and internal organisational structures ( HR, IT etc ) and every one of those (without fail) have one purpose - keep themselves in a job by keeping the HSE out. The patient first ? My hole.

The HSE has 0 control over them and only really has the ability to gain some control when they have some leverage over them - such as a crisis.

Slainte Care is a pipe dream.( designed to line the pockets of the consultancies who helped define it ) The HSE will achieve nothing until the whole organisation is disbanded and a government with balls tackles the whole poisonous lot.

Have you ever thought of approaching a journalist with this so this could get into the public arena...

mlem123

I think a lot of these middle management types are the "lifers" that are slowly being retired out. A lot of posts in the admin side aren't being replaced when someone leaves

AndrewJRenko

mikep wrote: »

No plan will work until the two big beasts are controlled, HSE and Unions.

Recently there was talk about how reforms were blocked, it seems that there was a pilot project introduced to bring in the position of "theatre assistants" which would work in tandem with nurses etc keeping things running in the operating theaters. Common in most modern health systems..

Blocked by the unions so dropped despite the fact that it would have made conditions better...


Also there is a rumour that for each new nursing post thwere has to be a "manager" appointed, backed by the union..

Big problems there..

How exactly were the theatre assistants being blocked?
https://www.businesspost.ie/health/cork-university-hospital-hires-theatre-assistants-to-ease-staffing-shortages-68161f64

Is there any chance that we could base our discussions on something more than 'rumour'?

mikep

AndrewJRenko wrote: »

How exactly were the theatre assistants being blocked?
https://www.businesspost.ie/health/cork-university-hospital-hires-theatre-assistants-to-ease-staffing-shortages-68161f64

Is there any chance that we could base our discussions on something more than 'rumour'?

I can't access the rest of that article but this was resisted before and if you look at the link you posted it states that that their introduction has been resisted by the INMO.

Let's see if it actually happens...

1641

For the amount of money we put in we should have an excellent health service.
More money is not going to help - it needs massive reform. But whoever takes power I am very pessimistic that they will be strong enough and determined enough to take on all the vested interests involved. This includes the unions who all want who shout for better services but resist any structural changes that impact their members - and who look at proposals for change as an invitation to improve their own pay and conditions. Of course they will all shout about what others must do but not themselves.

Any real reform is going to demand change from all involved. No matter what the unions say now, just see how they will squeal and resist when their own sector is impacted. This applies to all union groupings - doctors, nurses, paramedics, care staff, administrative, etc, etc, etc, (but some are more powerful than others).

Also, watch how local communities are mobilised when rationalisation and quality improvement threatens a low grade and inefficeient local service. These are "well paid secure jobs" that they are not going to give up easily. In is sometimes revolting to see and hear protesters looking to keep a crap service by pretending to care about patients/residents when it is the jobs and money "up the road" that is the concern.

piplip87

I still think less smaller hospitals, with centres of excellence dotted around the country is the way to go.

There's too many smaller hospitals that specialise in nothing but offer nothing than a place to go until you can get transferred to Dublin.

Close smaller hospitals while buildinglarge super hospitals around the country. That specialise in everything.

Provide taxbreaks for all healthcare workers and recruit internationally.

Move chemo, infusions and other day treatments to primary care centres locally and staff these as required. My OH has to travel to Dublin every month for a two hour infusion that could be given locally. This will free up rooms in hospitals.

Smaller hospitals are great to have in a town but in reality they are just places to go until your transferred but governments won't touch them due to the backlash but resources would be better spent elsewhere.

There's too many hospitals offering the same thing 20 super hospitals outside Dublin would see large parts of the country under an hour from a hospital if strategically placed.

jmayo

ted1 wrote: »

So taking a break from the main GE thread I thought we’d start a separate health thread and see how we fix the system

I’m Currently paying about 2,500 a year so 5,000 before tax for private health insurance for myself , wife and three kids.

Don’t have day to day , so spend and additional 600 euro cash on doctors a year.

So the question is, if there was a good health system would you be willing to pay an extra 2 thousand ( per family, say700 for an individual) in taxes for a proper system as opposed to our current system ?
And if so would that fix the system ?

The worry I would have is that you pay even more into a central pot and it is wasted in the whole public health system and you are screwed when you get to hospital anyway because you are now in the public system.

The whole health system from top to bottom needs to be overhauled.

You have people with medical cards going to the doctor unnecessarily simply because it costs nothing.
Charge 10 euros a pop if unnecessary visit.

Also then you have GPs just playing it safe and sending people unnecessarily to A&E clogging up that.

Also A&Es half full with junkies and drunks wandering around, which should immediately garnish a charge for time wasting.

The HSE and indeed all public hospitals (the voluntary ones) appear to be cesspit of yokels whiling away their time until ultimately tax free lump sum and nice pension, often in unnecessary duplicated roles, consultants acting as a law onto themselves and nurses doing more management than actual front line care.
There is often quoted myth about nurses spending all their time being up to their elbows in human excrement and blood, but the truth is a lot of this is now done by nursing aids and nurses don't do that stuff anymore.
But it plays better to keep the myth going when you are chasing pay rises.

joseywhales

I am confused by this free visit situation, is that actually true?

There a missionary hospital I'm hanging out in in India for the past while they charge people in poverty, and I mean eating scraps having a share of a goat poverty, and they charge them some nominal fee like 50c or e1, which is a big deal for them but the hospital does it so that they value the time and the medication. I would have thought this was a simple concept.

Idbatterim

joseywhales wrote: »

I am confused by this free visit situation, is that actually true?

There a missionary hospital I'm hanging out in in India for the past while they charge people in poverty, and I mean eating scraps having a share of a goat poverty, and they charge them some nominal fee like 50c or e1, which is a big deal for them but the hospital does it so that they value the time and the medication. I would have thought this was a simple concept.

yes an absolute farce, E60 a gp visit if you are the working poor, free if you you are one of the "poor" that gets the money for free, rather than works for it... The "vulneable" here are sacred though, untouchable!

Yurt2

ChikiChiki wrote: »

This is a myth. I hate this defeatist attitude that is constantly trotted out.

Nothing can be solved ever so why even bother

jam_mac_jam

joseywhales wrote: »

I am confused by this free visit situation, is that actually true?

There a missionary hospital I'm hanging out in in India for the past while they charge people in poverty, and I mean eating scraps having a share of a goat poverty, and they charge them some nominal fee like 50c or e1, which is a big deal for them but the hospital does it so that they value the time and the medication. I would have thought this was a simple concept.

Yes, its true. Its free to go to the doctor as many times as you like. There is a small fee for prescriptions. When that was brought in there was much consternation. It is also free to go to A & E as many times as you like.

While there shouldn't be a situation that people can't go to the doctor, I don't think a fiver or tenner nominal charge would be too much and would prevent the situation being abused. A GP only gets a set charge for example now matter how many times you go.

There are a huge number of people with medical cards, and GP cards. I would question the wisdom of providing this to people who could afford to contribute while the system is in such a state.

jimmycrackcorm

The big problem we have with paying extra taxes for health is that the gap between those that pay and those that don't is increasing. SF are calling for people under 30k to not have to pay USC.
We don't want to pay for water.

But then, everyone can choose to pay the extra few grand to get private health insurance, so the have that so many don't just says there isn't a demand for it.

We spend billions in alcohol each year. I'm sure that money isn't all spent by high earners.

AndrewJRenko

joseywhales wrote: »

I am confused by this free visit situation, is that actually true?

There a missionary hospital I'm hanging out in in India for the past while they charge people in poverty, and I mean eating scraps having a share of a goat poverty, and they charge them some nominal fee like 50c or e1, which is a big deal for them but the hospital does it so that they value the time and the medication. I would have thought this was a simple concept.

Do you know many people who go to a doctor's surgery for the craic?

Pseudonym121

Wanderer,

It isn't correct to say that adequate mental health and psychological supports effectively don't exist. They are present and are better than many make out. You just don't hear about the 80 or 90% of people who are satisfied with care. You only hear about those who are dissatisfied and there may be many reasons for that dissatisfaction including not getting what they want --- which may not be what they need at all. I know many people who have had complaints made against them for not giving a patient a medicine they don't need because the patient went to Dr Google and now thinks they need it. With that said, there are of course some serious failures, particularly in Child and Adolescent Mental Health.

I'm a Consultant in the HSE so I have a decent level of insight into this issue and while there are myriad issues there are also some things to bear in mind:
a. We are seeing people today we simply wouldn't have given a new patient appointment to 15 years ago so access has expanded massively as resources have gone in to mental health services.

b. People's expectation of the services they'll get has also increased massively. I have patients who are genuinely upset when I won't run a special clinic for them on a day and time that suits them as opposed to the two days a week that we run review clinics.

c. The HSE reinforces failure instead of success. If you manage your team well and efficiently you don't get more resources to do more good, instead the team which has the same resources as you but isn't performing gets more resources. This is a major issue.

d. Bureaucracy has gone mad. There are endless committees and groups which meet about the smallest of issues which have no clinical relevance whatsoever. I am aware of a pointless group which meets fortnightly which spent three hours one day debating whether they were a "group" or "committee" instead of actually deciding on things which helped patients.

e. Clinicians aren't listened to. instead managers who look at budgets instead of what works for patients rule the roost. If clinicians were listened to I'm confident that common sense solutions to many issues would emerge which would be cost-neutral or even save money.

I was recently in a situation where we were losing a building in which we conducted outreach and community care and we, as a team, decided to source another building for ourselves after the HSE had failed to find a suitable building over at least a year. Within a couple of months we had found a building suited to our needs at less than 20% of the rental cost. It still took many months of bureaucratic hoop-jumping before we were able to use it to benefit patients.... and, of course, that money wasn't then used to improve care in our area but went into a central pot to be squandered by management.



How would you fix it?
a. Stop reinforcing failure.

b. Stop hiring multiple new admin staff for every new doctor or nurse being hired.

c. Devolve budgeting power down the chain of command and have it so that any money saved by a team could be used by that team to invest in local care - this way you'd incentivise people to save money and improve services instead of penalising people who save funds. Staff at the local level know whether hiring an additional radiographer or an additional nurse would be best to stop the bottlenecks in their area.

d. Stop the over-bureacratisation of the health service. A certain level is necessary, beyond that level it is simply wasteful and serves only to bolster the power of administrators who think the more admin staff they have under them the more important they are.

e. Properly fund primary care so that more chronic illnesses can be managed without acute exacerbations which require hospitalisation - this would hugely reduce bed pressure, save money ( because good chronic care is MUCH cheaper than acute crises care ) and benefit the health of the citizens of Ireland.

f. Pay restoration for doctors - there has been a massive brain drain which will continue until this is done. We are in an international market for skilled clinicians. We need to pay accordingly or we will continue to have the current situation where 500 of 2,000 consultant posts in Ireland lie empty or are filled with people who aren't properly trained. Every unfilled post adds to the waiting list while every post filed by an improperly trained person adds to avoidable mistakes in patient care and results in patients who are improperly treated and/or may die. Just monetarily the payouts for these mistakes cost more than paying the doctors properly and getting properly trained doctors who wouldn't make these mistakes. It is incredibly penny wise but pound foolish.

g. Proper funding for step down care. The term bed blockers is terrible as these are real people with real issues who are in distress but the solution to their situation is proper funding for step down care. Step down care is expensive but FAR less expensive than being an in-patient. Again penny wise but pound foolish.

h. Accelerate the implementation of specialist nursing posts and nurse prescribing - this would help tremendously in allowing nurses to manage many chronic conditions/minor exacerbations themselves without needing to involve doctors. One hour of a nurse's time is cheaper than one hour of a doctor's time so this would also save the health service money whilst improving care. It is a win win situation.

i. Massive review of management layers and a redundancy programme ( on generous terms ) for those who aren't actually improving patient care.

j. Move investigative equipment ( ECHO, CT, MRI, Ultrasound etc ) onto a 9 to 5 x 7 days per week system and reserve Saturday and Sunday for clearing the backlog of routine investigations which currently have horrendous waiting times.


The bottom line is the clinical staff are ( with some exceptions as in any organisation ) excellent and empathic but many are also burned out due to the demands of the job. Couple these clinical staff with far fewer managers and a service which focuses on patient care instead of all the current folderol, add in all of the cost neutral and cost-saving changes I've outlined above which would actually improve patient care and you COULD fix the health service without spending a single extra penny.

This idea that the health service is too complex to be solved is utter balderdash. Other countries in Europe have better health services with similar levels of investment. We could have a much better system IF there was a consensus that patient-focused solutions would be brought in and in which the paralysis brought about by endless layers of management was tackled.

Do I expect that to happen? Hell no, it is Ireland after all.

Stheno

Pseudonym121 wrote: »

Wanderer,

It isn't correct to say that adequate mental health and psychological supports effectively don't exist. They are present and are better than many make out. You just don't hear about the 80 or 90% of people who are satisfied with care. You only hear about those who are dissatisfied and there may be many reasons for that dissatisfaction including not getting what they want --- which may not be what they need at all. I know many people who have had complaints made against them for not giving a patient a medicine they don't need because the patient went to Dr Google and now thinks they need it. With that said, there are of course some serious failures, particularly in Child and Adolescent Mental Health.

I'm a Consultant in the HSE so I have a decent level of insight into this issue and while there are myriad issues there are also some things to bear in mind:
a. We are seeing people today we simply wouldn't have given a new patient appointment to 15 years ago so access has expanded massively as resources have gone in to mental health services.

b. People's expectation of the services they'll get has also increased massively. I have patients who are genuinely upset when I won't run a special clinic for them on a day and time that suits them as opposed to the two days a week that we run review clinics.

c. The HSE reinforces failure instead of success. If you manage your team well and efficiently you don't get more resources to do more good, instead the team which has the same resources as you but isn't performing gets more resources. This is a major issue.

d. Bureaucracy has gone mad. There are endless committees and groups which meet about the smallest of issues which have no clinical relevance whatsoever. I am aware of a pointless group which meets fortnightly which spent three hours one day debating whether they were a "group" or "committee" instead of actually deciding on things which helped patients.

e. Clinicians aren't listened to. instead managers who look at budgets instead of what works for patients rule the roost. If clinicians were listened to I'm confident that common sense solutions to many issues would emerge which would be cost-neutral or even save money.

I was recently in a situation where we were losing a building in which we conducted outreach and community care and we, as a team, decided to source another building for ourselves after the HSE had failed to find a suitable building over at least a year. Within a couple of months we had found a building suited to our needs at less than 20% of the rental cost. It still took many months of bureaucratic hoop-jumping before we were able to use it to benefit patients.... and, of course, that money wasn't then used to improve care in our area but went into a central pot to be squandered by management.



How would you fix it?
a. Stop reinforcing failure.

b. Stop hiring multiple new admin staff for every new doctor or nurse being hired.

c. Devolve budgeting power down the chain of command and have it so that any money saved by a team could be used by that team to invest in local care - this way you'd incentivise people to save money and improve services instead of penalising people who save funds. Staff at the local level know whether hiring an additional radiographer or an additional nurse would be best to stop the bottlenecks in their area.

d. Stop the over-bureacratisation of the health service. A certain level is necessary, beyond that level it is simply wasteful and serves only to bolster the power of administrators who think the more admin staff they have under them the more important they are.

e. Properly fund primary care so that more chronic illnesses can be managed without acute exacerbations which require hospitalisation - this would hugely reduce bed pressure, save money ( because good chronic care is MUCH cheaper than acute crises care ) and benefit the health of the citizens of Ireland.

f. Pay restoration for doctors - there has been a massive brain drain which will continue until this is done. We are in an international market for skilled clinicians. We need to pay accordingly or we will continue to have the current situation where 500 of 2,000 consultant posts in Ireland lie empty or are filled with people who aren't properly trained. Every unfilled post adds to the waiting list while every post filed by an improperly trained person adds to avoidable mistakes in patient care and results in patients who are improperly treated and/or may die. Just monetarily the payouts for these mistakes cost more than paying the doctors properly and getting properly trained doctors who wouldn't make these mistakes. It is incredibly penny wise but pound foolish.

g. Proper funding for step down care. The term bed blockers is terrible as these are real people with real issues who are in distress but the solution to their situation is proper funding for step down care. Step down care is expensive but FAR less expensive than being an in-patient. Again penny wise but pound foolish.

h. Accelerate the implementation of specialist nursing posts and nurse prescribing - this would help tremendously in allowing nurses to manage many chronic conditions/minor exacerbations themselves without needing to involve doctors. One hour of a nurse's time is cheaper than one hour of a doctor's time so this would also save the health service money whilst improving care. It is a win win situation.

i. Massive review of management layers and a redundancy programme ( on generous terms ) for those who aren't actually improving patient care.

j. Move investigative equipment ( ECHO, CT, MRI, Ultrasound etc ) onto a 9 to 5 x 7 days per week system and reserve Saturday and Sunday for clearing the backlog of routine investigations which currently have horrendous waiting times.


The bottom line is the clinical staff are ( with some exceptions as in any organisation ) excellent and empathic but many are also burned out due to the demands of the job. Couple these clinical staff with far fewer managers and a service which focuses on patient care instead of all the current folderol, add in all of the cost neutral and cost-saving changes I've outlined above which would actually improve patient care and you COULD fix the health service without spending a single extra penny.

This idea that the health service is too complex to be solved is utter balderdash. Other countries in Europe have better health services with similar levels of investment. We could have a much better system IF there was a consensus that patient-focused solutions would be brought in and in which the paralysis brought about by endless layers of management was tackled.

Do I expect that to happen? Hell no, it is Ireland after all.

Great post, well said

Pseudonym121

Ah Hellrazer, while there are obviously some bad apples in any profession let me paint you an alternative.

1. Consultant shows up at 9am. Liaises with secretary to get the list of emergency calls made overnight to the service, the number of their patients who presented to A&E and were sent home and the number who presented to A&E and were admitted.

2. While drinking a coffee triages the phonecalls and patients who were seen but not admitted and makes management plans for each of them, delegating phonecalls to other team members, the secretary, junior doctor and doing the most urgent themselves. This includes asking some of these people to come in to clinic that same day for emergency review.

3. Then phones the doctors caring for the in-patients who were admitted overnight and ensures those doctors are fully briefed in on the patients medical and other issues and any peculiarities they may have.

4. Checks email for any urgent emails which have to be replied to ASAP.

5. Begins seeing the patients in the waiting room.


Just because a Consultant isn't seeing a patient from 9am to 10am doesn't mean they aren't doing valuable clinical work. I'm very certain that just because I can't see any of you during your work hours this doesn't mean you never accomplish anything.

Consultants prioritise and in my case a patient who was sent home from A&E but is having a crisis is an emergency. On occasion if I only phone them after my clinic is finished at 2pm they may have died - this isn't hyperbole, this is the reality of the job - so I triage them first thing and ensure their care is arranged before I begin seeing the patients sitting in my waiting room - none of whom are, hopefully, in as acute distress as the person who was sent home from A&E without being admitted.

The same goes when someone jumps the queue. When you're sitting in the waiting room bitching about how long you've waited I and my consultant colleagues are triaging who is in the waiting room and while we generally see people in line with their appointment time you better believe that when the patient who presented to A&E the previous evening and who I phoned at 9:15 to come in for review ASAP arrives I'll be seeing them next. Yes that might piss you off today but if you ever have the misfortune to be that person you'll have a very different perspective.


Of course there are some bad apples but, really, when you see us go into an office and not call a patient for 30 minutes or an hour we are busy helping people just like you --- ones currently in crisis and distress.

joseywhales

AndrewJRenko wrote: »

Do you know many people who go to a doctor's surgery for the craic?

I know lots of people including myself, who have visited doctors for chest/ear/tonsil infections, that I didn't want to wait two weeks in bed to clear up with rest and fluids but I did pay full price.

I know anyone who needs to visit a doctor in Ireland can find E10 which is still charity but creates a threshold for resource waste.

Pseudonym121

As to the issue about public vs private care and 35 hour weeks.

1. Yes, public-only contracts are the way to go. They're the best value for money for the citizens of Ireland. They'll need to be well paid to keep doctors from emigrating but so long as the salary is attractive it would be healthy for medicine and the state to have mostly fully public consultants and some private consultants operating private hospitals.

2. 35 hour working week? Sign me up. I currently work a 39 hour working week plus call which is a full 7 days in a row every 3 months or so, so that's a 168 hour shift without breaks. I'd be delighted if you reduced my average weekly hours from 53 ( 39 per week plus 168 every 12 weeks ) to 35 hours a week. That'd be amazing. I find it amusing that those who know so little about medical work always overestimate the pay and luxury conditions and underestimate the hours worked, stress and difficulty of the job.

3. As for the rumour that for every new nursing post there must be a manager. No, that's simply not true in any hospital I have knowledge of. Look the reality is that the government and HSE are experts at stealth cuts. A while back they reduced the number of junior doctors on a lot of teams from 2 to 1. The workload pretty much stayed the same and the cut was sold as being a movement to a new progressive care system. The end result was that the number of patients who used to be cared for by 3 doctors now were cared for by 2. End result, poorer care. No-one ever goes on about that in public. The reality is while there are far too many managers and the unions do need to support necessary change the most extreme conspiracies about why things won't change aren't true.

The barrier to change is that no-one has had the nerve to fundamentally redesign the health service and ruthlessly focus it on patient care. Instead when the HSE was formed to gain efficiencies in management/admin basically all of the admin and management were kept on and then rapidly hired more admin and managers to help "manage" the new system. And now of course those admin are all unionised and entrenched and so another layer of problems has been created.


And lastly, the citizens are also to blame. Larger hospitals who can specialise in procedures and carry them out more frequently have better outcomes. So, if you want every county hospital to have a cardiology suite then accept that the death rate in that cardiology suite will be higher than the ones in Dublin because your local suite will do far fewer procedures. The same goes in many areas....

The ideal would be hospitals scaled back and upgraded in response to medical need and research but neither pork barrel politicians nor their constituents would support this. So we have what we have.