Why is Ireland's healthcare system in shambles?

lalababa

2.4 million workers, average earnings 37k. That's 88million. Social welfare bill is around 20 million but don't know the breakdown is how much are hand outs. Irish examiner says '20 million in payments' and 1.3 million in receipt on behalf of 2 million people.
Let's say 20 million.
Add all up and it's 108 million.
Healthcare spend per capita in nearing 3k. And 20 billion in total. This apparently includes VHI spend ie both public and private, and both types of retirement homes (??)
If Ireland went universal (fully public)
I'd say costs would rise 'coz we all know public will cost more than private. Let's say 25 billion. That would be a 23% cost to earnings. Ie everyone with ANY income would pay 23% towards healthcare. I personally wouldn't mind as long as perhaps the new system and services were privately managed in an efficient manner perhaps bringing down that % to under 20.
Any thoughts on these figures... they're probably naively simple and just plain wrong..:)

piplip87

When they brought in the HSE they merged all the health boards except that would obviously lead to job losses. Yet with unions you had many people essentially doing the same job. This led to major waste of public money.

Also there are too many small hospitals doing feck all, they are essentially just hotels for sick people waiting to be transferred to larger hospitals. Any attempt to close these is met with fierce local opposition as they provide jobs and comfort.

The main problem is lack of GP's. I know in my area you can wait for up to two days for a GP appointment. Some people may not even bother heading for a GP and go straight to A&E which in turn clogs up the department.

I think we need massive investment primary care and primary care centres. More GP's and cut the cost of GP visits

As for waiting lists Micheal Martin brought in the National Treatment Purchase Fund when minister for health and this has a proven track record of reducing wait times and getting people the care they need. The left don't like it because it gives money to private hospitals but infairness if you need a procedure done you don't care where the money is going. This should be funded along with more funding for public services and public hospitals.

PhilOssophy

PhilOssophy wrote: »

They won't exist......not so sure. The unions will insist that these people be replaced. This is a problem across our public sector, the unions won't want to lose a paying member so lets charge the tax payer for somebody who is not needed.

Again, largest union in the country is for private sector. Majority of unionised staff are private sector. Last 3 industrial actions have been in the private sector including the last outright strike.

lalababa

lalababa wrote: »

2.4 million workers, average earnings 37k. That's 88million. Social welfare bill is around 20 million but don't know the breakdown is how much are hand outs. Irish examiner says '20 million in payments' and 1.3 million in receipt on behalf of 2 million people.
Let's say 20 million.
Add all up and it's 108 million.
Healthcare spend per capita in nearing 3k. And 20 billion in total. This apparently includes VHI spend ie both public and private, and both types of retirement homes (??)
If Ireland went universal (fully public)
I'd say costs would rise 'coz we all know public will cost more than private. Let's say 25 billion. That would be a 23% cost to earnings. Ie everyone with ANY income would pay 23% towards healthcare. I personally wouldn't mind as long as perhaps the new system and services were privately managed in an efficient manner perhaps bringing down that % to under 20.
Any thoughts on these figures... they're probably naively simple and just plain wrong..:)

Yep, electricity and phones went down when privatised.

Health for profit instead of actually costing less than the cost of providing the service would certainly mean a reduction in costs.

The only time a private company reduces it's charges is as a result of competition. When there's a monopoly, they gauge.

storker

My OH got a temporary bump from Staff Nurse to CNM2 while she took over a section while the incumbent was on transfer somewhere else. While she was there she made several improvements and provided more services to a greater number of patients. Then she had to step away when the person who "owned" the role came back saw from a distance her improvements being neglected. She was bumped back down to staff nurse and put in a section where she has seen some scope for improvement but has no authority to effect any, and has experienced resistance any time she has made suggestions. She was one of the few in her section to volunteer to nurse COVID-19 patients.

I think this says a lot about what's wrong with the HSE.

Edgware

[Deleted User] wrote: »

Too many chiefs, not enough Indians.

Money being siphoned by private insurance.

But a lot of the doctors are Indian.

Mad_maxx

Requires a sea change in attitude from the public too ,we have far too many small and unfit for purpose regional hospitals that swallow massive amount of resources

God help any politician who suggests closing them however

FHFM50

da_miser wrote: »

You where put on the long finger because nothing was really wrong with you, a requested nose job because of vanity, bottom of the waiting list, and rightly so.
If you need it the medical procedures will be fast tracked, if you want a nose job pay for it yourself, tax payer is put to the rack for vanity in this country.

The HSE would never pay for a nose job. It was probably a sinus surgery that wasn't urgent.

PhilOssophy

Mad_maxx wrote: »

Requires a sea change in attitude from the public too ,we have far too many small and unfit for purpose regional hospitals that swallow massive amount of resources

God help any politician who suggests closing them however

That is nonsense, why not have people getting routine surgeries locally if they can? It is fine to say close the regional hospitals, but then you have a crazy situation where people are dying in ambulances because they can't be got to a hospital on time.

Mad_maxx

PhilOssophy wrote: »

That is nonsense, why not have people getting routine surgeries locally if they can? It is fine to say close the regional hospitals, but then you have a crazy situation where people are dying in ambulances because they can't be got to a hospital on time.

It's anything but nonsense,it's a waste of resources having under used services in sparsely populated area's

Geuze

ronivek wrote: »

I’m sure that really happened and isn’t a complete fabrication by either you, your friend, his mother, or some combination of the three.

It is well known that when the 8 Health Boards merged into the HSE in 2005, not a single job was lost.

Bertie Ahern did a deal with the unions

So there is massive duplication and waste.

All well known.

Two groups run the HSE - the doctors and the unions.

A HSE manager is not a manager like a Tesco, Aldi or Vodafone manager.

Geuze

Mad_maxx wrote: »

Requires a sea change in attitude from the public too ,we have far too many small and unfit for purpose regional hospitals that swallow massive amount of resources

God help any politician who suggests closing them however

Yes, 50-53 hospitals does seem too many.

Water John

Don't think you can say, it's a shambles. Lots of beauracratic problems and poor management. But get seriously ill and you'll get a world class service for free.

mr_fegelien

Water John wrote: »

Don't think you can say, it's a shambles. Lots of beauracratic problems and poor management. But get seriously ill and you'll get a world class service for free.

What's so poor about the management?

Can anything genuinely be done to fix it? I don't think those in charge are just lazy. There has to be a reason.

YellowBucket

Geuze wrote: »

Yes, 50-53 hospitals does seem too many.

We’ve far too many hospitals in general.

I mean it’s insane that the only hospital that meets class 1 trauma centre requirements is CUH in Cork because it can cope with neurosurgery, cardiothoracic, major spinal and orthopaedic stuff etc etc all on one site.

Even in Dublin none of the hospitals can do that because there’s a mini empire around each of them and they three medical schools and a bunch of religious orders that can’t see eye to eye on anything. That’s how we ended up with the tug of war and budgetary management fiasco over the children’s hospital.

You probably realistically need to limit serious complex medicine to centres in cities with serious medical school and hospital back up : Dublin, Cork, Limerick & Galway (sorry Waterford.) and in Dublin they need to be amalgamated and reorganised into maybe 3 focal hospitals.

Beyond that anything else should be really just for minor stuff, or dealing with plans that are worked out from one of those centres. Like it should be feasible to deliver say chemotherapy in any hospital and have it coordinated out of Dublin, Cork etc

We also need to pull money into primary care and stop with the nonsense of GPs referring people to A&E.

The big issue in Ireland actually stems from how the health care system evolved. We never really had a healrhcare system, rather it was a hospital system and that was driven by the fact that the majority of funding historically came from the Irish Hospital Sweep Stakes. There was no money for primary care or any of the non hospital aspects and that’s how the system then evolved entirely lob sided.

The mix of NHS like Beveridge model of direct provision and optional, but hugely widespread insurance makes no sense either.

We should have morphed the state owned VHI into a universal health insurance system like those in much of continental Europe. Instead we’ve become sort of lost between the two models.

Have a read of Prof. Mary E. Daly’s paper on it.

http://historyhub.ie/the-curse-of-the-irish-hospitals-sweepstake

The fact that we haven’t managed to get our heads around resolving this mess is an absolute indictment of Irish politics, public policy and public discourse though.
We have no excuse whatsoever for getting this so badly wrong. We have had decades as a very rich country and we also have underperformed, even relative to countries with far fewer financial resources.

nthclare

mr_fegelien wrote: »

What's so poor about the management?

Can anything genuinely be done to fix it? I don't think those in charge are just lazy. There has to be a reason.

Just so much red tape and another problem is procurement.
I could order something on Amazon and it would arrive at my house in a day or two.
Procurement in the public sector is like a relay that lasts a week but could be done and dusted in two click's.

First you have to go through a catalogue from the company the public sector is a buyer from, say you want to order PPE like a box of gloves.
Well it could take a week to order the box of gloves because you have to go to your supervisor then they the manager, they say they'll think about it.
Then to accounts to get money, then to procurement, then there's a back log in procurement, then eventually procurement gets back to the accounts,manager, supervisor and you to say that they'll get the gloves,then the same process again, eventually you'll get to the gloves but the wrong size... and the procedure start's all over again...
Absolute bolloxing around...

They'll all-in it together, there's huge paper work and meetings lot's of meetings about nothing.

The majority of them sit at a meeting hoping they'ed be swallowed up by the ground.
Listening to someone who loves getting well paid for basically doing nothing.

PhilOssophy

Mad_maxx wrote: »

It's anything but nonsense,it's a waste of resources having under used services in sparsely populated area's

Depends where you are ending the cull though, are you proposing that every small hospital be closed and we end up with 5-6 super hospitals in Dublin, Limerick, Cork and Galway? I think that would be crazy.

Shefwedfan

c.p.w.g.w wrote: »

Not all of it...there is plenty of staff who aren't needed, my mates mother's works in one hospital and there are 3 of them working the same desk...they literally spent most of their days watching Netflix...well pre Covid19 that is

My mates mother :-)

Ever think she is watching Netflix because she is lazy? Nothing to do with HSE and she just won’t do her job?

Even watching Netflix is breaking all the HSE network regulations and the network is locked down so she can’t do that. So unles watching on her phone that’s not true

I have found before,might not be the case here, that you will find the person has loads of work but will sit on ass and someone else will just get on with it and do it, otherwise it never gets done. This happens everywhere, good people covering for lazy people

Mad_maxx

PhilOssophy wrote: »

Depends where you are ending the cull though, are you proposing that every small hospital be closed and we end up with 5-6 super hospitals in Dublin, Limerick, Cork and Galway? I think that would be crazy.

Why?

Money can be diverted to more local advanced primary care clinic's for routine stuff, GP clinic's have an extremely limited service in Ireland

You could also invest in a better air ambulance service for those living in more rural areas for speedy transfer to hospital, i lived in Canterbury new Zealand years ago, hospital was 120 km away, air ambulance was method of transfer for emergencies

Former Former

PhilOssophy wrote: »

Depends where you are ending the cull though, are you proposing that every small hospital be closed and we end up with 5-6 super hospitals in Dublin, Limerick, Cork and Galway? I think that would be crazy.

That's pretty much exactly what you should do.

You don't need to close them all but they should be downgraded substantially, so that they would be basically primary care centres and if you need something more specialised you go to a bigger town.

You'd obviously need more than 5 or 6 but the current model is not right.

Shefwedfan

PhilOssophy wrote: »

Depends where you are ending the cull though, are you proposing that every small hospital be closed and we end up with 5-6 super hospitals in Dublin, Limerick, Cork and Galway? I think that would be crazy.

Apart from A&E hospitals dotted around ireland is a waste. Ireland is tiny. In most situations you will be an hour drive from a main city.

Even the cost of electricity heating etc is too high for all these hospitals, plus support staff playing Netflix seemingly

McGiver

FintanMcluskey wrote: »

The unions and the work strategies they indoctrinate.

Nothing else

Not true. Unions don't help with labour costs and flexibility but that's absolutely not the primary reason for this shambles.

The reason is complicated, duplicated, inefficient, corrupted, nepotistic, obscure management as well as "corporate" structure.

Staff discipline is also an issue.

HSE IT systems are shocking and cannot be unified to move to a proper digitisation solution to increase efficiency, basically I've been told by a person who did thesis on this and knows HSE internally that the systems are build in a way that they cannot talk to each other and can't be linked. Hence a lot has to be done on paper which is laughable.

Money is leaking in huge amounts due to inefficiencies, nepotism, corruption and private providers are syphoning it as well.

Scratch it and build it from the ground again, properly.

Where I come from GPs are free, you can walk in and be seen rather quickly (minutes to few hours max) or book online, booking of appointments to various specialist consultants are typically done online, and typical waiting time for an appointment in the public sector is few weeks max, we use e-prescriptions (via text on phone) no silly papers, A&E waiting time is few hours max, there are no trolleys in general, I've never seen or heard anyone being put on a trolley for more than few minutes when they need to move the person but never would they leave anyone anywhere on it, for every appointment or procedure (GP, consultant or hospital) you always receive a short report with records of the appointment and the results, equipment wise the same or slightly better, parking in front of hospitals is free etc.

So coming from this and then seeing the reality in Ireland, allegedly one of the highest GDP per capita in Europe, is quite shocking. One of the most laughable carryon is the letters they sent here for appointments and other communication from the HSE, it's like from middle ages, why do they waste paper, can't they send an email, text or call?

breezy1985

mr_fegelien wrote: »

What's so poor about the management?

Can anything genuinely be done to fix it? I don't think those in charge are just lazy. There has to be a reason.

I don't know enough to know if this is happening in the HSE but you hear of cases where:

Staff consists of 4 managers and 80 workers in 4 sites so 1 manager in 1 site with 20 workers.
1 site will be cut and 40 workers so now 3 sites with about 13 workers each but still 4 managers

McGiver

JohnnyFlash wrote: »

It's not.

Ireland is having the same issues as the rest of the mature social democracies we are part of. People are living longer because they had better lives under social democracy - better access to medicine, treatment, and follow-up care. We now have loads of lovely healthy people in their 70's, 80's, and 90's. Bully for them to be honest.

But the figures aren't really stacking up. Someone has to keep paying for our health system, and they aren't.

Society - complex.

Every health care system in Europe has some issues, that is correct. But what matters is the degree of the impact and this is what matters.

The situation in Ireland is much worse. Scandinavian, German, Belgian, Portuguese, French, Czech, Austrian, Dutch health care systems are objectively much better at what matters.

You should read EHCI report and see what they think about Ireland. There are multiple criteria involved, Ireland does fine in most, not so fine in few but is the worst in Europe in accessibility. But even if waiting times were fixed it would be still average at best.

1.3.22 Ireland
22nd place, 669 points.
Ireland has been dropping in the Index for one main reason: In 2018, Ireland is alone in last position for Accessibility, with patient organisations steadily giving very pessimistic feedback in the HCP survey.
Unfortunately, this was confirmed by the Irish HSE and MoH after the release of the EHCI 2015 report, when they said in a memo that the programme initiated to reduce healthcare waiting times in Ireland aims at a target of no more than 18 months’ (!) wait for a specialist appointment. Even if and when that target is reached, it will still be the worst waiting time situation in Europe.

https://healthpowerhouse.com/media/EHCI-2018/EHCI-2018-report.pdf

Igotadose

Poor quality of health care. Routine operations in the US which take place overnight in your average hospital, will cause you to spend days in an Irish hospital. Why? Want to free more trolleys? Shorten unnecessary hospital stays. The data, in an over-administered organization like the HSE, should readily be available around stays per operation and a good hard look by doctors (not administrators) done to budget for hospital bed time. I

Hospitals not run by doctors, but by administrators. Kind of says it all, the goal won't be to provide health care, it'll be goodies for administrators. Ireland has one of the highest percentages of 'administrators' in health care in Europe, and some of the worst health outcomes.

Primitive practices. Mental health care is borderline barbaric here, with "Minnesota methods" still being used here for addiction services, or voodoo like AA, where the rest of the world has moved on. Mental health workers outside Ireland are required to be degreed, in the US at least a Masters. Here you buy a cert with a two week course and off you go, hang out that shingle. Laughable. The dentists still do extractions. Try finding one that'll do that in the US. Might as well tie strings to doors and slam them shut to extract teeth.

The Church. The RCC shouldn't be involved in *any* aspect of health care. No owning hospitals. No priests/nuns on hospital boards unless they're medically qualified. No ownership of hospitals by the RCC. It is not a pro-health-care organization at all, and anything based on sky fairy worship isn't going to be scientific.

McGiver

Shefwedfan wrote: »

Apart from A&E hospitals dotted around ireland is a waste. Ireland is tiny. In most situations you will be an hour drive from a main city.

Even the cost of electricity heating etc is too high for all these hospitals, plus support staff playing Netflix seemingly

Don't agree. Accessibility and reach and range of services are both important for quality health care. Ireland is the worst in accessibility in Europe and reducing already mediocre reach of services is not a good idea IMHO.

LuasSimon

There are too many staff who expect to get get 60k plus but have no great skills and have become bone lazy over the years due to the lack of any accountability in HSE .

McGiver

Mad_maxx wrote: »

Why?

Money can be diverted to more local advanced primary care clinic's for routine stuff, GP clinic's have an extremely limited service in Ireland

You could also invest in a better air ambulance service for those living in more rural areas for speedy transfer to hospital, i lived in Canterbury new Zealand years ago, hospital was 120 km away, air ambulance was method of transfer for emergencies

This is the correct approach.

And yeah I've been in a situation where we needed air transport and it was not provided because the helicopter was out. I believe there's only 1 or 2 in the base in Athlone. Which is a huge issue.

McGiver

Igotadose wrote: »

Poor quality of health care. Routine operations in the US which take place overnight in your average hospital, will cause you to spend days in an Irish hospital. Why? Want to free more trolleys? Shorten unnecessary hospital stays. The data, in an over-administered organization like the HSE, should readily be available around stays per operation and a good hard look by doctors (not administrators) done to budget for hospital bed time. I

Hospitals not run by doctors, but by administrators. Kind of says it all, the goal won't be to provide health care, it'll be goodies for administrators. Ireland has one of the highest percentages of 'administrators' in health care in Europe, and some of the worst health outcomes.

Primitive practices. Mental health care is borderline barbaric here, with "Minnesota methods" still being used here for addiction services, or voodoo like AA, where the rest of the world has moved on. Mental health workers outside Ireland are required to be degreed, in the US at least a Masters. Here you buy a cert with a two week course and off you go, hang out that shingle. Laughable. The dentists still do extractions. Try finding one that'll do that in the US. Might as well tie strings to doors and slam them shut to extract teeth.

The Church. The RCC shouldn't be involved in *any* aspect of health care. No owning hospitals. No priests/nuns on hospital boards unless they're medically qualified. No ownership of hospitals by the RCC. It is not a pro-health-care organization at all, and anything based on sky fairy worship isn't going to be scientific.

Agree on all of that. Bar the outcomes, they're not that bad after all when objectively assessed, but the issue is that it costs huge money to get there (one of the highest in OECD per capita, pathetic bang for the buck ratio) and some people won't get the outcomes because of abysmal accessibility.

Absolutely regarding the Church - we're not in the middle ages. Nuns can go praying and doing charity, perhaps run care homes, but out of the hospitals immediately, the church has no mandate or qualification or even moral right to touch them, especially public ones. That the separation of the church and the state is not complete in Ireland in 2020 is shocking. The same goes for the schools btw...

Igotadose

McGiver wrote: »

Agree on all of that. Bar the outcomes, they're not that bad after all when objectively assessed, but the issue is that it costs huge money to get there (one of the highest in OECD per capita, pathetic bang for the buck ratio) and some people won't get the outcomes because of abysmal accessibility.

Absolutely regarding the Church - we're not in the middle ages. Nuns can go praying and doing charity, perhaps run care homes, but out of the hospitals immediately, the church has no mandate or qualification or even moral right to touch them, especially public ones. That the separation of the church and the state is not complete in Ireland in 2020 is shocking. The same goes for the schools btw...

And if you remember, the 'administrator-driven' HSE was responsible for setting up contract tracing early on during Covid. They fumbled for *weeks* setting up a center, including at one point claiming they had problems with their e-mail server. Laughable. We're talking a force at the time of maybe 100 people communicating via e-mail with each other and contacts. A week? Your average secondary-school student could do such in a day in Ireland. It'd be cloud based with redundant automated backup and secure in a day if you assigned a University student in the same day. But the HSE? A week, and it didn't work. Eventually they sort of muddled through, but of course there are no reports on just how well our contract tracing facility is doing, at least, none from the HSE. All that transparency. Yes, I know the app was successful, but overall how are we doing? With so many administrators, we should know.

With regard to the tracing center in Limerick, I think the nim in charge said something about "Lessons learned" to the media when confronted on it. Standard HSE dodge - we'll fix it the next time (see: Cervical Check for one of many scandals where they're almost on the edge of getting it right today.)

And, naturally, the lad in charge of the HSE has an MBA. Not a doctor. I think the only reason Ireland's stayed afloat during the Covid crisis is the doctors are more empowered now than normally (cf: Nphet). Imagine if they weren't...