Health system

Stheno

ChikiChiki wrote: »

Ard you saying the HSE does not have standardised HR and IT systems/processes?

Not across the board no.

I worked as a contract trainer there. The infighting between different regional reps from the same department was embarrassing to observe

1641

Pseudonym121 wrote: »

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.
........
...........

The barrier to change is that no-one has had the nerve to fundamentally redesign the health service and ruthlessly focused 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.

Some very good points. But I am not convinced that the resistance to change is only at management/admin level. No doubt it is there at this level but it is there in clinical grades also.

Every group fingers the problem as somewhere else. What is the view of the medical unions towards excluding private medicine from public hospitals- and public-only contracts?
Re: nursing levels? Does not our volume of nursing staff rate quite well in international comparisons relative to our population size? Is it an issue of numbers - or are there other issues?


Agree that citizenry are also to blame. There will be uproar when local rationalisation is mooted.


Agree it could all be fixed, but not without breaking a lot of eggs. Apart from public uproar over local issues there would also undoubtedly be industrial relations disputes along the way, with consequent disruption to service. How will Mr and Ms Public react to this? How will the political opposition react (whoever this may be - although it is a given that PBP will be apoplectic)?


As there will undoubtedly be pain along the way before a new service emerges, and as it is a several year process, the government that takes it on wholeheartedly will probably guarantee their anniliation at the following election. So it really is back to Joe and Josephine Public again.

Graces7

AndrewJRenko wrote: »

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

You beat me to it! This is one of those myths that go round. I cannot remember ( and I have a medical card) the last time I saw a doctor. let alone with no good reason. Most of us have far better things to do than that. Or is there some massive attraction going on at the surgery?

And how would anyone know why a person was in the waiting room? REALLY!

All illnesses also need catching as they develop; not to have to put it off because of money needed. The folk I feel bad for are the borderline folk.

But how would charging us help that situation?

Oh re the drunks. In some countries these are streamed off to a separate "drunk tank" .

Snow Garden

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. You should email it to Harris or the next Health minister.

Graces7

joseywhales wrote: »

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.

Really? Hmmmm….You "know" more than we do.

And this is not about " charity"! What a misunderstanding of our health care system you have.

And infections are best caught and treated early especially with old folk and disabled folk whose health is vulnerable.

PS I grew up and lived with the NHS of course. A much better system and even there you can choose to be treated privately.

1641

Graces7 wrote: »

You beat me to it! This is one of those myths that go round. I cannot remember ( and I have a medical card) the last time I saw a doctor. let alone with no good reason. Most of us have far better things to do than that. Or is there some massive attraction going on at the surgery?

And how would anyone know why a person was in the waiting room? REALLY!

All illnesses also need catching as they develop; not to have to put it off because of money needed. The folk I feel bad for are the borderline folk.

But how would charging us help that situation?

Oh re the drunks. In some countries these are streamed off to a separate "drunk tank" .

I assume that the majority of people who have a medical card do not visit the GP unnecesssarily - or excessively. But it would be naive to think that some do not. Any "free" commodity will generate waste. We have relatively cheap food in supermarkets - and high levels of food waste as it is. If food was "free" the wastage would be far higher.


Some visit the GP out of lonliness - sad but also wasteful. Some are the worried well. Some have psychosomatic illnesses - in need of help but not unnecessary tests and checks - and not well served by GP visits.
I accept that a fee may put off some people from attending when they really should attend. So the charge versus not charge is not an easy one. It is a matter of finding a balance - and making best use of a precious but expensive commodity (someone has to pay for it).
You reference the NHS in another post. How long is the average wait to get an appointment with a GP there these days? Around 15 days was the last I read.

wobbie10

I work in GP office and the figures cant be argued. The average visits per annum for private patients is approx 2 , visits per Medical card patients is approx 4.5, Doctor visit cards for under 6 kids is over 6 visits per year !!
Free GP visits = 1 week wait to see GP.
2 tier system will be created

AndrewJRenko

joseywhales wrote: »

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.

So that's a no, then, you don't know many people who visit their GP for the craic.

wobbie10 wrote: »

I work in GP office and the figures cant be argued. The average visits per annum for private patients is approx 2 , visits per Medical card patients is approx 4.5, Doctor visit cards for under 6 kids is over 6 visits per year !!
Free GP visits = 1 week wait to see GP.
2 tier system will be created

Source please? Is this the one dodgy study of six offices that didn't actually count all visits?

jam_mac_jam

If something is free you are going to use it more often. That's why they put the charge on prescription medicine.

You don't want anyone to not vist a doctor because of the expanse but a small charge may deter unnecessary visits. Nobody is going to the doctor for the craic and most vists are going to be needed.

I would think it's more in need for a and e. People should go to their doctor in some cases first. It's a small issue in the grand scheme of things.

jam_mac_jam

AndrewJRenko wrote: »

So that's a no, then, you don't know many people who visit their GP for the craic.





Source please? Is this the one dodgy study of six offices that didn't actually count all visits?

How is the person going to provide a source for something they have observed in their work.

thomasdylan

AndrewJRenko wrote: »

So that's a no, then, you don't know many people who visit their GP for the craic.





Source please? Is this the one dodgy study of six offices that didn't actually count all visits?

https://www.ncbi.nlm.nih.gov/m/pubmed/24834590/

Mantis Toboggan

wobbie10 wrote: »

I work in GP office and the figures cant be argued. The average visits per annum for private patients is approx 2 , visits per Medical card patients is approx 4.5, Doctor visit cards for under 6 kids is over 6 visits per year !!
Free GP visits = 1 week wait to see GP.
2 tier system will be created

1 million medical cards despite near full employment. That's what I can't understand. Thank you FG.

Pseudonym121

1641:

It wasn’t my intention to paint a picture of resistance to change only among admin. I was simply identifying where I felt the greatest problems and resistance to change lie. Obviously other levels, including clinical grades, are resistant to change also.

What is the view of medical unions and doctors ( since unions are made up of doctors ) to public only contracts...

Well, firstly given how contracts work the new public only contracts that have been mooted would only be compulsory for new entrants. The new entrant consultants ( Senior/Specialist Registrars due to become Consultants over the next 2 to 3 years ) that I’ve spoken to are all perfectly fine with public only contracts, or they have already decided to emigrate. The vast majority are fine with them though so long as the baseline level of pay is competitive with international pay rates ( competitive means Consultants would still earn far less than they could in Canada, Australia or America but the difference wouldn’t be so large that it would be a no-brainer to emigrate —- currently a new entrant Consultant could go to Australia or Canada and immediately earn double ( take home ) what they earn in Ireland and rising from there. If the difference is about 50% or less then they’ll stay, if it is more increasing numbers will emigrate.).

The relatively new Consultants and older Consultants who’ve already made their money from their private work would be happy to change to the new Contract. Yes there would be a cohort who have bought the big house, big car etc who financially need to keep pulling in big money and they would refuse to move to the new contract and in typically Irish fashion they would continue on their old contract until such time as they retire.

At present Ireland has 1500 qualified Consultants in post. There are more in post but they haven’t done the requisite training and shouldn’t be allowed to be in post on safety grounds. Slaintecare envisions about 3,000 Consultants which would be a more fitting number for a country the size of Ireland. Let’s assume that 2/3rd of the current crop would take the new contract ( reasonable if it comes with a reasonable pay rise (a say 20%) to partially compensate them for the 20% private work they used to be entitled to ) and all the new entrants are only offered public only contracts you would find yourself five years down the road having more than 2,500 public only Consultants and less than 500 on the old contracts - this number ever-dwindling as they retired. So, you’d have 80%+ on public only contracts pretty soon if the government was competent ( big if ). Within about 15 years the number of Consultants on old contracts would be negligible due to retirements.

Nursing numbers: There is a massive problem with nursing retention and morale caused by them being undervalued and their abilities being under-utilised. In broad terms if nurses are ambitious and want to be promoted/get pay rises they need to go into the management track and we lose them to actual work on the wards/with patients. What we need is more nurse specialist posts where good nurses can keep getting up skilled and promoted whilst taking workload for basic chronic illness management off doctors’ plates ( better for patients and cheaper for the health service ) whilst still maintaining clinical work.

Also if you generally make the job more attractive ( nurse specialist pathway, more respect, better support for training, hiring more nurses aids to do the scut work nurses currently do etc ) then more will stay which would help solve the staffing crisis. Oftentimes when your family are in hospital the number of nurses on the wards are below the number required to provide adequate care. The numbers are then made up by agency staff who don’t know where anything is, more student nurses etc. This again results in poorer care.

So the problem with nursing is that there are too few nurses choosing to work in the HSE and those who do stay and have ambition don’t have the appropriate career pathway to continue providing patient care whilst being promoted and paid appropriately.

The nurses I work with are great, experienced, capable and go above and beyond for patients. They are also, all, exasperated with how they are treated, the lack of appropriate promotion pathways which keep them in contact with patients and many are looking to leave/wouldn’t advise their children to enter nursing.

A simply yardstick I have for a job is whether or not people would advise their children to enter it. Most nurses I know wouldn’t advise their children to go into nursing in Ireland.

Does it have to be this way? Absolutely not, these same nurses have usually done a year in Australia or Canada or know someone who has emigrated and so they know it doesn’t have to be this way - this adds to the frustration.

My apologies if this is wordy but I’m trying to be thorough and and give your questions the thought they deserve — whilst avoiding doing research for an article ;-)

Pseudonym121

Snowgarden:

As re: emailing this to the new Minister of Health. LOL! I think it would be far better to email it to someone who actually cared about the citizens of the state instead ;-). Harris has been utterly useless in a way which exceeded even our ( Consultants and nurses ) lowest expectations.


Re: NHS.
I think that in the past the NHS was clearly better than the HSE. I think that over the past 15 years or so that gap has narrowed significantly and the NHS is now surpassed by the HSE in many areas.

For example the NHS talks about targets and seems to meet or nearly meet targets the HSE doesn’t meet - 4 hours to be seen in A&E or operations within x months but much of this is just window dressing put in to meet government targets instead of actually deliver care. I’ll explain how they do it below...

A) 4 hour target to be seen in A&E by a doctor. That’s really easy they just make it that the doctor pops in, sees you for 30 seconds and then orders bloods, bloods which are done in Ireland by a 30 second conversation between the nurse seeing you and the junior doctor. Hey presto, the doctor saw you, now wait another 4 to 6 hours while they firefight all the other crises and finally come back to you. End result the target of seeing you in 4 hours was met but you only had a meaningful interaction with a doctor ( defined as one which actually achieves a diagnosis and treatment plan ) after 8 hours or more. Looks good on paper though.

B)Surgery. What happens is that they simply book you in for surgery before the x months of the target time is up knowing full well that you won’t get surgery that day. They then cancel the surgeries due to unforeseen emergencies ( which they totally foresaw ) and send you home. The target time resets and they have another x months before they need to play the game again. I had a friend in the UK who was brought into a day ward on three occasions ( a day ward wasn’t appropriate for him because he would have had to stay for rehab post-op ) before finally being booked in to a proper ward on the 4th occasion - when he actually got the operation. Each time he was booked into the day ward they all got bloods and then were all ( about a dozen patients at a time) told their ops were cancelled and they should go home before the actual booked in day patients came in at 10am.

So, a lot of meeting of targets is just a shell game.


Mantis:
Why medical cards for 1 million people with full employment.

Well, there are a number of illnesses which get you a full medical card without means testing - cancer is one of them, schizophrenia and a whole host of psychiatric illnesses are other. I’m very happy to work in a country and pay my taxes to a system which does that and means that people with serious mental health problems continue to get free medicine and care even if they recover sufficiently to the point that they can get a job and the dignity and self-respect which comes with that. So a lot of medical cards are actually simply because a lot of people have them due to being very seriously unwell and that’s great.

And then there’s the usual Irish humbugs of:
A) Auction politics - you’ll never lose votes as a TD or councillor by listening to Mary’s sob story and fighting for her to get a medical card. Remember the motivation of TDs and Councillors is rarely what’s best for the country and mostly about what will get them re-elected. Handing out medical cards is a vote winner.

People lie and fake it and/or they just settle on benefits once they have them and choose not to return to work. I have many patients who are very happy being in benefits and actively resist engaging with therapies which could improve their lives for fear of losing the medical card and/or their disability allowance. They either refuse the therapy or don’t show up or make formal complaints if you refuse to fill in forms to say they’re as disabled as they claim to be.

There is no real system or support for clinicians who stand up to this so a lot of GPs just go along with it or pass the buck to specialists ( hospital Consultants ) who are in a better position to say no.


And now I must go back to the research -*boo* * hiss*.

joseywhales

Graces7 wrote: »

Really? Hmmmm….You "know" more than we do.

And this is not about " charity"! What a misunderstanding of our health care system you have.

And infections are best caught and treated early especially with old folk and disabled folk whose health is vulnerable.

PS I grew up and lived with the NHS of course. A much better system and even there you can choose to be treated privately.

What would you call providing care to those who cannot afford it?
It's the definition of charity.

So there are people in Ireland, who do not have access to E10 to save their lives?

salonfire

AndrewJRenko wrote: »

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

Thanks for agreeing with my point.

Take away as much as possible from the HSE to what private hospitals will accept.

What remains of the HSE might resemble a functioning entity.

The benefits are better health care for patients and the deadwood staff of the HSE can be dumped out and costs massively reduced

mikep

Hi Pseudonym121
In post #57 you mention the hiring of multiple admin per doctor/nurse recruited, is this a union or HSE requirement/demand??

What do all these admin staff do??

For a few years now I've been wondering if a retrain or redundancy plan was rolled out, would it work??

Thanks for your informative posts..

1641

Pseudonym121 wrote: »

1641:

It wasn’t my intention to paint a picture of resistance to change only among admin. I was simply identifying where I felt the greatest problems and resistance to change lie. Obviously other levels, including clinical grades, are resistant to change also.

What is the view of medical unions and doctors ( since unions are made up of doctors ) to public only contracts...

Well, firstly given how contracts work the new public only contracts that have been mooted would only be compulsory for new entrants. The new entrant consultants ( Senior/Specialist Registrars due to become Consultants over the next 2 to 3 years ) that I’ve spoken to are all perfectly fine with public only contracts, or they have already decided to emigrate. The vast majority are fine with them though so long as the baseline level of pay is competitive with international pay rates ( competitive means Consultants would still earn far less than they could in Canada, Australia or America but the difference wouldn’t be so large that it would be a no-brainer to emigrate —- currently a new entrant Consultant could go to Australia or Canada and immediately earn double ( take home ) what they earn in Ireland and rising from there. If the difference is about 50% or less then they’ll stay, if it is more increasing numbers will emigrate.).

The relatively new Consultants and older Consultants who’ve already made their money from their private work would be happy to change to the new Contract. Yes there would be a cohort who have bought the big house, big car etc who financially need to keep pulling in big money and they would refuse to move to the new contract and in typically Irish fashion they would continue on their old contract until such time as they retire.

At present Ireland has 1500 qualified Consultants in post. There are more in post but they haven’t done the requisite training and shouldn’t be allowed to be in post on safety grounds. Slaintecare envisions about 3,000 Consultants which would be a more fitting number for a country the size of Ireland. Let’s assume that 2/3rd of the current crop would take the new contract ( reasonable if it comes with a reasonable pay rise (a say 20%) to partially compensate them for the 20% private work they used to be entitled to ) and all the new entrants are only offered public only contracts you would find yourself five years down the road having more than 2,500 public only Consultants and less than 500 on the old contracts - this number ever-dwindling as they retired. So, you’d have 80%+ on public only contracts pretty soon if the government was competent ( big if ). Within about 15 years the number of Consultants on old contracts would be negligible due to retirements.

Nursing numbers: There is a massive problem with nursing retention and morale caused by them being undervalued and their abilities being under-utilised. In broad terms if nurses are ambitious and want to be promoted/get pay rises they need to go into the management track and we lose them to actual work on the wards/with patients. What we need is more nurse specialist posts where good nurses can keep getting up skilled and promoted whilst taking workload for basic chronic illness management off doctors’ plates ( better for patients and cheaper for the health service ) whilst still maintaining clinical work.

Also if you generally make the job more attractive ( nurse specialist pathway, more respect, better support for training, hiring more nurses aids to do the scut work nurses currently do etc ) then more will stay which would help solve the staffing crisis. Oftentimes when your family are in hospital the number of nurses on the wards are below the number required to provide adequate care. The numbers are then made up by agency staff who don’t know where anything is, more student nurses etc. This again results in poorer care.

So the problem with nursing is that there are too few nurses choosing to work in the HSE and those who do stay and have ambition don’t have the appropriate career pathway to continue providing patient care whilst being promoted and paid appropriately.

The nurses I work with are great, experienced, capable and go above and beyond for patients. They are also, all, exasperated with how they are treated, the lack of appropriate promotion pathways which keep them in contact with patients and many are looking to leave/wouldn’t advise their children to enter nursing.

A simply yardstick I have for a job is whether or not people would advise their children to enter it. Most nurses I know wouldn’t advise their children to go into nursing in Ireland.

Does it have to be this way? Absolutely not, these same nurses have usually done a year in Australia or Canada or know someone who has emigrated and so they know it doesn’t have to be this way - this adds to the frustration.

My apologies if this is wordy but I’m trying to be thorough and and give your questions the thought they deserve — whilst avoiding doing research for an article ;-)

Thanks for taking the time to reply - and for the good points.


Just to note - I have never questioned the dedication and professionalism of clinicians in the HSE, be they medical, nursing or paramedical. Well, most of them. There are a minority in all these categories who are a bad advert for their profession - and are probably a source of frustration to their professional colleagues as well. One problem in the HSE is that it is very difficult to remove obstrucive and obstreperous staff (and lazy staff) - the system is too cumbersome and the unions will stand by every one - short of murder, possibly. Admittedly it is a wider public sector problem but it is very impactful in a healthcare system.


I have had loads of interactions with the HSE over the years and generally I observed loads of hardworking and dedicated people - but in a crazy system where the "hard work" often does not translate into good service outcomes. But I have also come across some awful "services" where people do little more than go through the motions.


To say that staff are dedicated, professional and caring is very different to saying that they will go along with radical system reform. Regularly even relatively mild and local reform in the HSE has been either bedevilled or at least delayed by recalcitrant union demands. Systems wide transformation will present nightmares in this regard. And it will take years. And public sympathy will be enlisted (for the "resistance").

I agree with you about the rather rosy tinted comparisons that some people make between the HSE and the NHS. In many ways I would rather be treated within the HSE and the NHS (once I had been admitted). And some of the "services" the NHS provides are simply appalling if not disgraceful - take people with lifelong disabilities, for example, autism.

In a seperate point you refer to people preferring to "stay disabled" (my terminology), playing the system and forcing doctors to provide prescriptions, etc. I accept that it must be hard to resist. But you also refer to politicians giving in to local and short demands rather than looking towards the longer term national interest in a reformed service. Unfortunately that is how our system works - it is the ones who "do things" locally, and who protect "local services", who get reelected. The local politician is arguably under at least as much pressure to "deliver" with a another election always pending, as the doctor is.

It is back to the public again. We want a reformed health service. But I doubt we have the stomach for the process and turmoil of reform and we will want the politician who delivers locally rather than the one who stays focussed on the "national interest".

Geuze

AndrewJRenko wrote: »

Source please? Is this the one dodgy study of six offices that didn't actually count all visits?

The data on GP visits has been published over and over again.

People with med cards visit more.

Obviously if something is free, people will use it more.

Plus there may be a selection bias - people with GMS medical cards tend to be poorer or older, so they will be going to GP more.

Geuze

Mantis Toboggan wrote: »

1 million medical cards despite near full employment. That's what I can't understand. Thank you FG.

Bear in mind that although unemployment is low, joblessness is very high.

We lead Europe in joblessness.

Many of the jobless people will qualify for GMS med cards.

Graces7

Graces7 wrote: »

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

I agree with Rodin to an extent. Like all areas of our lives, we must exercise some level of personal responsibility.
If you’re unemployed, 20 something living with parents, what do you do?
(A) Get a job. Save for a deposit and get a mortgage then start a family.
Or (B) Go on the dole. Then on the housing list. Then have one or more babies.
Likewise, if you’re diabetic due to lack of exercise and being obese, what do you do? Haunt the doctor and hospital on a weekly basis, while not changing your lifestyle? Or work with the health professionals and get fitter, lose weight and spend less time with doctor and hospital. Now, that won’t work for every diabetic, but it just might help.
Likewise if someone spends every weekend drinking themselves silly, sometimes ending up in hospital or unable to go to work Monday morning, the solution is in their own hands.

Graces7

Deleted User wrote: »

I agree with Rodin to an extent. Like all areas of our lives, we must exercise some level of personal responsibility.
If you’re unemployed, 20 something living with parents, what do you do?
(A) Get a job. Save for a deposit and get a mortgage then start a family.
Or (B) Go on the dole. Then on the housing list. Then have one or more babies.
Likewise, if you’re diabetic due to lack of exercise and being obese, what do you do? Haunt the doctor and hospital on a weekly basis, while not changing your lifestyle? Or work with the health professionals and get fitter, lose weight and spend less time with doctor and hospital. Now, that won’t work for every diabetic, but it just might help.
Likewise if someone spends every weekend drinking themselves silly, sometimes ending up in hospital or unable to go to work Monday morning, the solution is in their own hands.

Old saying.. If ifs and ans were pots and pans, beggars would ride horses..

You are so.... cynical! such a view of your fellow citizens! And yes, blame the patient rather than blame the dire state of the health service , I write as one blameless in every item yet unable to access any real primary care that is applicable. And like the neighbour here, hardworking, not overweight etc who had to wait three years in agony for an "urgent" hip replacement as he could not afford to pay up front and go north.

Bolded is utter hyperbole!

Sort the system please. Get the waiting lists down, improve services and only then expect over stressed folk to care.

Graces7

Geuze wrote: »

The data on GP visits has been published over and over again.

People with med cards visit more.

Obviously if something is free, people will use it more.

Plus there may be a selection bias - people with GMS medical cards tend to be poorer or older, so they will be going to GP more.

Of course. Or unemployed due to illness or disability.

Idbatterim

Idbatterim wrote: »

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!

Not all medical card holders are “poor”. The over 70’s for example.

However, I do feel that every medical card holder should be charged a minimum of €5 per doctor visit.

Yurt2

Aren't people given medical cards if they have chronic illnesses also? It would stand to reason those type of people would need to access treatment more frequently...

Graces7

Graces7 wrote: »

Old saying.. If ifs and ans were pots and pans, beggars would ride horses..

You are so.... cynical! such a view of your fellow citizens! And yes, blame the patient rather than blame the dire state of the health service , I write as one blameless in every item yet unable to access any real primary care that is applicable. And like the neighbour here, hardworking, not overweight etc who had to wait three years in agony for an "urgent" hip replacement as he could not afford to pay up front and go north.

Bolded is utter hyperbole!

Sort the system please. Get the waiting lists down, improve services and only then expect over stressed folk to care.

My dear old grandad used say that there were 11 commandments. Number 11 saying “Poor man, help thyself”.

beauf

Mantis Toboggan wrote: »

1 million medical cards despite near full employment. That's what I can't understand. Thank you FG.

Often sick and people with needs need to work to make ends meet.

Someone in our family had a medical cards with a serious illness. It's was withdrawn. Spent a couple of years trying to get it back. Only reinstated weeks before they died.

I know a few people who need it but had it withdrawn.

It's actually hard to get some things without it as they often don't have systems in place to handle people without medical cards.

shesty

wobbie10 wrote: »

I work in GP office and the figures cant be argued. The average visits per annum for private patients is approx 2 , visits per Medical card patients is approx 4.5, Doctor visit cards for under 6 kids is over 6 visits per year !!
Free GP visits = 1 week wait to see GP.
2 tier system will be created

There are 2 ways to read statistics there...as a parent of 3 kids Under 6, I do bring my kids to the doctor when sick.I don't bring them in for every sniffle because we both work and arranging doctor visits in my overbooked GP surgery is quite frankly, massive hassle.So they have to be definitely in need of a doctor visit before I bring them in.My 5 year old had maybe 2 doctor visits in 2019.My 3 year old had ...4/5, all clustered around the winter months, and my 1 year old, similar...possibly 5/6.

Smaller kids catch everything.Every bloody germ that passes them by, they welcome it in!!So of course there are more under 6s visit.A better measure might be how many of those visits result in a prescription (and even that is fairly subjective), a split of how many visits a child comes in for per year of their age under 6, or a look at the spread of visits of a representative group of children across a year-are you seeing some more often than others, do they have things like asthma or other complaints, and then you might be able to single out which, or if, kids are being brought in too often.

Be wary of quoting broad statistics like that.

beauf

Yurt! wrote: »

Aren't people given medical cards if they have chronic illnesses also? It would stand to reason those type of people would need to access treatment more frequently...

Given. ... You have to apply, often and in great detail. Signed and endorsed by doctors, social workers, accountants. It's a bit like the quest for the holy grail only harder and less successful.

Graces7

Deleted User wrote: »

Not all medical card holders are “poor”. The over 70’s for example.

However, I do feel that every medical card holder should be charged a minimum of €5 per doctor visit.

Have you any stats on that please? I am nearly 80 and would class as poor.

Why charge? It will cause problems, believe me, to those of us on very limited income due to age or other situations. The entire point of the medical card is that accessing care is free to those in need.
Your idea goes against the whole meaning iof the medical card.

The NHS gets it right. All the way. Free access to health care from cradle to grave. It is a total necessity not a commodity. Paid for by taxes; no quibbles and no discrimination.