An "Irish NHS" - what needs to change?

lazygal

mariaalice wrote: »

The state should provide the best evidence-based health care it can, but the state cant support the choices people are making because of a nonevidence base perception that private hospitals or private health care will have 'better'.

Thankfully in Ireland we have that choice.
I know people who sing the praises of midwife led care. I'm very happy that's available to them.

mariaalice

lazygal wrote: »

I wanted a consultant and a specific consultant. As I needed sections I'm even more glad it wasn't midwife led. And if you've any issues you need a consultant anyway so I'd rather have one I know and not whoever is available. I'm done with pregnancies but I'd go consultant led every time.
I found the advice on breastfeeding atrocious from all the nurses on my first.

In the UK it would have been a specially trained lactation consultant would come to your house so it's a better system.

CramCycle

Geuze wrote: »

"The Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care.1"

Surely everybody has equal access to a GP?

Some may have to pay, yes, okay.

But all people have the right to go to a GP, nobody is excluded, and there isn't a waiting list that can be jumped if you have insurance.


In France, people also have to pay to go to a GP.

How can it be then said that France has something that Ireland doesn't have?

It says equitable not equal, so there is a huge difference, not from France though so can't say how its different but here the medical card would address it somewhat but lots of people don't have one and also would avoid a GP due to cost.
As for no one being excluded, several GP practices are full in my local area so newcomers can't register with them at all, with several practices flat out refusing to take on more clients, so people are excluded but not for obvious reasons, simply a lack of space.

Geuze

CramCycle wrote: »

It says equitable not equal, so there is a huge difference, not from France though so can't say how its different but here the medical card would address it somewhat but lots of people don't have one and also would avoid a GP due to cost.

In France, a GP charges 25, and the rate is regulated by the State.

The patient pays up front.

Everybody (most people) has public insurance, which covers 70% of the cost of much healthcare.

The patient later makes a claim, and is reimbursed 17.50.

The net cost is 7.50.

Many people voluntarily choose to buy insurance to cover the other 30% of healthcare costs.

lazygal

mariaalice wrote: »

In the UK it would have been a specially trained lactation consultant would come to your house so it's a better system.

There are lactation consultants in Ireland too.

I didn't need the services of one.

I found the PHN system in one area abysmal-one nurse told me I only needed to breastfeed for 15 minutes each side. We moved when I had my third and it was like a different world. Absolutely phenomenal advice and support.

karlitob

Geuze wrote: »

"The Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care.1"

Surely everybody has equal access to a GP?

Some may have to pay, yes, okay.

But all people have the right to go to a GP, nobody is excluded, and there isn't a waiting list that can be jumped if you have insurance.


In France, people also have to pay to go to a GP.

How can it be then said that France has something that Ireland doesn't have?

Because everyone has to pay a bit on everything in France. Whereas in Ireland some people pay nothing for some services, some bits are subsidised and some bits aren’t.

It’s not universal.

karlitob

lazygal wrote: »

I had no interest in midwife led maternity care when pregnant.

Well let’s set up a service about what people may or may not want and have no recourse to international outcomes evidence or cost.
I can tel you how many patients have ‘no interest’ in being in a nursing homes or having to travel miles for chemotherapy in a centre of excellent.

And besides midwifery led care is only one part of one service for some people. It all depends.

lazygal

karlitob wrote: »

And besides midwifery led care is only one part of one service for some people. It all depends.

Lots of people choose it, and are happy with it. The choice is there for those who don't want it.

Anita Blow

mariaalice wrote: »

In the UK it would have been a specially trained lactation consultant would come to your house so it's a better system.

Lactation consultants are also common in Ireland. All major maternity units have them and a lactation outpatient service

karlitob

lazygal wrote: »

I had the master of the hospital as my consultant. She did all my c sections. A midwife would have been no good to me.

Must have been interesting to have undergone surgery with only one person in the room. The ‘master’ - wow. And was the master the only obstetrician/gynaecologist in the hospital that can perform c sections or can all trained obstetricians and gynaecologists conduct c sections.

If I was gonna have surgery I’d want to have more than one person in the room with me. an anaesthetist, a registrar and a whole wealth of theatre midwives who’ve spent years training that you deem were ‘no good for you’.

You probably think that all c sections are always appropriate. You other enlighten us how at Luke’s Kilkenny has the highest c sections in the country - nearly double the lowest.

karlitob

lazygal wrote: »

I wanted a consultant and a specific consultant. As I needed sections I'm even more glad it wasn't midwife led. And if you've any issues you need a consultant anyway so I'd rather have one I know and not whoever is available. I'm done with pregnancies but I'd go consultant led every time.
I found the advice on breastfeeding atrocious from all the nurses on my first.

You misunderstand midwifery led care and healthcare in general. You don’t who you want just cos you want them. You get who you need.

A low risk pregnancy should have a midwife led pregnancy as it’s the most cost effective with excellent outcomes - clinical and psychological. You get a consultant when you’re sick. If you’re not sick you shouldn’t get a consultant because pregnancy isn’t an illness.

If you’ve a high risk pregnancy you won’t be in a midwifery led service. It wouldn’t apply to you. Even if you wanted it - you wouldn’t get it. You wouldn’t have the choice.

And as for breastfeeding. Ireland has one of the lowest uptake rates on breastfeeding in any county in the world. That’s a cultural issue and is not the responsibility of midwives only. That’s like saying America is the fattest country in the world and it’s the fault of healthcare.

Could they be better - you’re damn right they could. Is a day or so post partum before you’re discharged sufficient to learn a brand new skill for a brand new human being. Obviously not. Their midwives - not teachers of human milestones. You’d be more accurate in saying that public health nurses should do more. Which is still not true.

Far more support is needed in the community to improve rates of breast care. But it’s an inter generational cultural issue. And an ‘ol midwife should not be moaned about by you cos you and your child - like every other first time mother ever - couldn’t figure out breast feeding straight away. Was the midwife even a mother - how would she know?

The are unreasonable and unrealistically high expectations in maternity care in Ireland that leads people to believe that it’s ****e rather than brilliant with lots of areas to improve upon.

And if you think obstetrics is **** - wait till you get older.

karlitob

lazygal wrote: »

Thankfully in Ireland we have that choice.
I know people who sing the praises of midwife led care. I'm very happy that's available to them.

No you don’t have that choice. A surgeon will not perform an operation just cos the patient wants it. It doesn’t work like that.

You reference midwifery led care. If you are a high risk patient you will not be seen in midwifery led care just cos you want it. It’s outside of the midwifes scope of practice. And clinical governance of the hospital. You can’t choose what you want.

karlitob

Geuze wrote: »

In France, a GP charges 25, and the rate is regulated by the State.

The patient pays up front.

Everybody (most people) has public insurance, which covers 70% of the cost of much healthcare.

The patient later makes a claim, and is reimbursed 17.50.

The net cost is 7.50.

Many people voluntarily choose to buy insurance to cover the other 30% of healthcare costs.

As discuss earlier - we need to rethink our funding model for health. James Reilly started it - the gps didn’t like it. He was a gp.

French citizens are taxed 20 per cent of their income toward social insurance. This social insurance fund pays 70 per cent of the cost of treatment. French citizens take out private health insurance (mutuelle) for the remaining 30 per cent for therapies, vision, and dental. So with an income of €40,000, social insurance would come to €8,000 and citizens also need private insurance to the tune of €200-€500 per annum. For comparison, in ireland PRSI is taxed at 4 per cent (if you are above exemption limits) and circa 40 per cent of the population has some form of health insurance and about 40 per cent has a medical card

Antares35

karlitob wrote: »

No you don’t have that choice. A surgeon will not perform an operation just cos the patient wants it. It doesn’t work like that.

You reference midwifery led care. If you are a high risk patient you will not be seen in midwifery led care just cos you want it. It’s outside of the midwifes scope of practice. And clinical governance of the hospital. You can’t choose what you want.

Can c-sections not be elective?

lazygal

Antares35 wrote: »

Can c-sections not be elective?

One of mine was. I decided at the first appointment to have a section. Of course people can choose how to give birth.

lazygal

karlitob wrote: »

No you don’t have that choice. A surgeon will not perform an operation just cos the patient wants it. It doesn’t work like that.

You reference midwifery led care. If you are a high risk patient you will not be seen in midwifery led care just cos you want it. It’s outside of the midwifes scope of practice. And clinical governance of the hospital. You can’t choose what you want.

I had a section because I wanted it. I had no interest in giving birth vaginally and that is of course my choice.

lazygal

karlitob wrote: »

You misunderstand midwifery led care and healthcare in general. You don’t who you want just cos you want them. You get who you need.

A low risk pregnancy should have a midwife led pregnancy as it’s the most cost effective with excellent outcomes - clinical and psychological. You get a consultant when you’re sick. If you’re not sick you shouldn’t get a consultant because pregnancy isn’t an illness.

If you’ve a high risk pregnancy you won’t be in a midwifery led service. It wouldn’t apply to you. Even if you wanted it - you wouldn’t get it. You wouldn’t have the choice.

And as for breastfeeding. Ireland has one of the lowest uptake rates on breastfeeding in any county in the world. That’s a cultural issue and is not the responsibility of midwives only. That’s like saying America is the fattest country in the world and it’s the fault of healthcare.

Could they be better - you’re damn right they could. Is a day or so post partum before you’re discharged sufficient to learn a brand new skill for a brand new human being. Obviously not. Their midwives - not teachers of human milestones. You’d be more accurate in saying that public health nurses should do more. Which is still not true.

Far more support is needed in the community to improve rates of breast care. But it’s an inter generational cultural issue. And an ‘ol midwife should not be moaned about by you cos you and your child - like every other first time mother ever - couldn’t figure out breast feeding straight away. Was the midwife even a mother - how would she know?

The are unreasonable and unrealistically high expectations in maternity care in Ireland that leads people to believe that it’s ****e rather than brilliant with lots of areas to improve upon.

And if you think obstetrics is **** - wait till you get older.

Why are you so combative?
How may times have you given birth in Ireland?

karlitob

Antares35 wrote: »

Can c-sections not be elective?

Of course they can.

karlitob

lazygal wrote: »

One of mine was. I decided at the first appointment to have a section. Of course people can choose how to give birth.

No. They can’t. You cannot operate on someone just cos you want them to. There has to be a clinical reason. That bar can be lower or higher depending on the consultant but you can’t demand it.

In the same way you can’t demand a vaginal birth of the life of the mother and child are in imminent danger and the correct course of treatment is surgical.

You don’t get to decide on your own. It’s a partnership between healthcare professional and patient.

Antares35

lazygal wrote: »

One of mine was. I decided at the first appointment to have a section. Of course people can choose how to give birth.

That's what I thought alright

lazygal

karlitob wrote: »

No. They can’t. You cannot operate on someone just cos you want them to. There has to be a clinical reason. That bar can be lower or higher depending on the consultant but you can’t demand it.

In the same way you can’t demand a vaginal birth of the life of the mother and child are in imminent danger and the correct course of treatment is surgical.

You don’t get to decide on your own. It’s a partnership between healthcare professional and patient.

Women get to decide what's best for themselves. We don't live under the eighth amendment any more.

Antares35

karlitob wrote: »

Of course they can.

Are you just contradicting yourself or have I confused the matter?

karlitob

lazygal wrote: »

Why are you so combative?
How may times have you given birth in Ireland?

How many times have you treated a patient and how many years have you spent training?

Does your cancer doctor have to have had cancer before you are happy to be treated by them?

Is a male obstetrician allowed to treat women in your world?

If I’m combative, you’re closed minded. Choice A don’t make me laugh.

Antares35

karlitob wrote: »

No you don’t have that choice. A surgeon will not perform an operation just cos the patient wants it. It doesn’t work like that.

You reference midwifery led care. If you are a high risk patient you will not be seen in midwifery led care just cos you want it. It’s outside of the midwifes scope of practice. And clinical governance of the hospital. You can’t choose what you want.

At your booking appointment you will see a consultant and they assess if you are high risk and if so, that will preclude you from opting for midwife led care. So in that sense you are right, you cannot choose to go midwife led just because you want to, if you are high risk.

However this does not mean that you HAVE to be high risk to go consultant led, if you are paying privately. My understanding that private patients can opt for consultant led, notwithstanding that their pregnancy might be low risk and they would qualify for MWL if they wished.

lazygal

karlitob wrote: »

How many times have you treated a patient and how many years have you spent training?

Does your cancer doctor have to have had cancer before you are happy to be treated by them?

Is a male obstetrician allowed to treat women in your world?

If I’m combative, you’re closed minded. Choice A don’t make me laugh.

You sound exactly like one doctor in Holles St I requested not be allowed to treat me based on how he spoke to me.

lazygal

Antares35 wrote: »

At your booking appointment you will see a consultant and they assess if you are high risk and if so, that will preclude you from opting for midwife led care. So in that sense you are right, you cannot choose to go midwife led just because you want to, if you are high risk.

However this does not mean that you HAVE to be high risk to go consultant led, if you are paying privately. My understanding that private patients can opt for consultant led, notwithstanding that their pregnancy might be low risk and they would qualify for MWL if they wished.

Public patients can choose consultant led care. But they won't get to choose which consultant and are under a team rather than one consultant. Semi private care is also an option.

karlitob

Antares35 wrote: »

Are you just contradicting yourself or have I confused the matter?

No. It’s the same point. Elective is planned. Trauma is not planned. Just because it’s elective doesn’t mean someone can demand to have it. It just means that the patient AND the healthcare professional agreed - at a planned time - to undertake a procedure or treatment.


Consider, it’s clearly silly to say that a surgeon can operate on you without your consent. Equally a surgeon can’t operate on you without her consent. And they don’t operate because you want to - only if it’s clinically indicated. It doesn’t matter what the clinical speciality is - that’s just that.

karlitob

Antares35 wrote: »

At your booking appointment you will see a consultant and they assess if you are high risk and if so, that will preclude you from opting for midwife led care. So in that sense you are right, you cannot choose to go midwife led just because you want to, if you are high risk.

However this does not mean that you HAVE to be high risk to go consultant led, if you are paying privately. My understanding that private patients can opt for consultant led, notwithstanding that their pregnancy might be low risk and they would qualify for MWL if they wished.

That’s not what I said.

Antares35

karlitob wrote: »

No. It’s the same point. Elective is planned. Trauma is not planned. Just because it’s elective doesn’t mean someone can demand to have it. It just means that the patient AND the healthcare professional agreed - at a planned time - to undertake a procedure or treatment.


Consider, it’s clearly silly to say that a surgeon can operate on you without your consent. Equally a surgeon can’t operate on you without her consent. And they don’t operate because you want to - only if it’s clinically indicated. It doesn’t matter what the clinical speciality is - that’s just that.

Elective is where the patient chooses i.e. she has a choice.

lazygal

karlitob wrote: »

That’s not what I said.

You're spitting so much venom about choice in maternity care its hard to keep track of what you said.