An "Irish NHS" - what needs to change?

salonfire

https://www.boards.ie/discussion/comment/117659161#Comment_117659161

Levels of pay for nursing staff are not terrible and are much better than average.

For those nurses who do work in high cost of living areas, you'll have to take it up with their union as to why they don't allow a Dublin allowance similar to a London allowance. They have the ear of the Minister every couple of years, why do you think they have not suggested this allowance?

AndrewJRenko

https://www.boards.ie/discussion/comment/117687622#Comment_117687622

Why do you assume that they haven't mentioned the allowance?

salonfire

https://www.boards.ie/discussion/comment/117690991#Comment_117690991

Because union requests are usually made public and there has been no mention of it.

Probably because it is unacceptable to those outside Dublin leaving their Dublin colleagues in relative poverty compared to the cost of living.

So much for worker solidarity eh?

Whereas those, non union, private sector companies will pay relative to the cost of living.

mariaalice

https://www.boards.ie/discussion/comment/117691298#Comment_117691298

Are you still on the nurses are paid too much as the cause of all ills in the health services? and are you the poster who said they have no porters in private hospitals? I hate to disillusion you but staff in private hospitals are very well paid and looked after. The issues in the Irish health system have very little to do with nurses' pay but some seem to be obsessed with them.

salonfire

https://www.boards.ie/discussion/comment/117696202#Comment_117696202

Where did I say nurses pay is the cause of HSE problems?

If you read carefully, I was countering the myth that nurses have terrible pay. How can it be terrible when it's above average? I'm sorry, but it's just basic arithmetic. Not my fault if other people are unable to understand basic arithmetic.

mariaalice

https://www.boards.ie/discussion/comment/117696424#Comment_117696424

But what has that to do with issues in the HSE? the nursing unions are just that a union they are going to advocate for their member who are age between 22 and 65 work all over Ireland in the very diverse workplaces from hospitals to the community they are both male and female they are not some homogenised group.

mariaalice

Plus you do reference nurses a lot and often in an unpleasant way.

jcon1913

A recent artlice by Sean Barret an economist from Trinity College maintains we already spend too much on health relative to other countries

https://headtopics.com/ie/ireland-s-health-system-isn-t-as-underfunded-understaffed-or-underresourced-as-we-think-21794992

Any thoughts?

mariaalice

So basically reduce the number of hospital beds and the number of nurses, pay the nurses less, compel all medical graudates to work in the irish health care system to bring up the number of doctors per head of population, problem solved its as easy as that should work, no employment or contractual issue with that at all!

jcon1913

https://www.boards.ie/discussion/comment/117914756#Comment_117914756

I'm ot saying that these are the only problems or suggesting solutions - but simply spending more is not going to solve anything.

In fact the report says that the level of hospital beds in Ireland is low compared to other countries in the OECD, but you wouldn't let that fact get in the way of a negative comment...

here are a few quotes:

Health at a Glance, does not support the claims of underfunding, understaffing and underresourcing, We should think again.On health spending, the department annual publication,Health In Ireland(2019 edition), shows the country has the third-highest share of GDP/GNI

spent on health in the OECD, at 12.0pc exceeded only by 12.2pc in Switzerland and 16.9pc in the USA. Health In Ireland also shows medical and dental staff in the public health service increased by 32.6pc between 2010 and 2019 and that total public expenditure on health here increased by 28.8pc between 2010 and 2019. Given that Ireland has a far lower proportion of its population over 65 than the other OECD countries, we have to ask why we have such a high healthcare cost.

Later...

Health at a Glance(2019 edition) indicates that, compared with the OECD average of 3.5 practising physicians per 1,000 population, Ireland is 13pc short at 3.1. Notable countries with a lower complement of doctors than Ireland are three with which we have close medical connections – the United Kingdom with 2.8 doctors per 1,000 population, Canada with 2.7 and the United States with 2.6.

The 13pc increase in the supply of physicians in Ireland required to attain the OECD average is already available here. Ireland graduated in 2017 by a large margin the highest number of medical graduates in the OECD, at 24.9 per 100,000 population.This is 90pc higher than the OECD average of 13.1 and 16pc higher than in Denmark, the second-ranked country of 36 reporting to the OECD. Ireland, at 24.9 per 100,000, exceeds by more than double the medical graduates per 100,000 population in Germany (12), Switzerland (11.2) and France (9.5) and by more than treble the figure for the United States (7.8) and Canada (7.7).

The number of practising nurses per 1,000 population in Ireland is 12.2. This is 39pc higher than the OECD average of 8.8. The Irish figure is 56pc higher than in the UK at 7.8 and 4pc higher than in the US at 11.7.

The Irish ratio of nurses to doctors, at 4.5, is the second-highest in the OECD after Japan at 4.7. Ireland has 67pc more nurses per doctor than the OECD average of 2.7. The Irish ratio of nurses to doctors is more than eight times the ratio in Spain and Italy, which have 1.5 nurses per doctor.

The average remuneration of hospital nurses in Ireland in 2017 was €64,200. This was the fifth-highest in the OECD and 31pc above the OECD average of $49,000. Irish remuneration was greater than Germany’s by 20pc, the UK’s by 26pc and France’s by 51pc.

The Irish number of hospital beds per 1,000 people is low at 3.0 compared with the OECD average of 4.7. On the other hand, Ireland has 7pc more beds per head than the US, 15pc more than Denmark, 20pc more than the UK and Canada and 36pc more than Sweden.

The cost of residential care as a percentage of median income in 17 OECD countries reporting this number is 206. In Ireland it is 391 – 90pc higher. The Irish problem is the high cost of provision of care rather than the proportion of over-65s in the population. Most of the debate about the Irish health services seems to take place regardless of facts about budgets, resources, manning levels and remuneration.

mariaalice

I read the report, it's not a negative comment, it's a lot of facts but no analysis of how to change things, you can not force medical graduates to work in irish health care system as a way of improving the ratio of doctors, nor could the HSE lower nursing ratios and salaries to some OECD 'avarage'.

mariaalice

Pesky things like wage agreements, employment law, contracts and the freedom to work anywhere one chooses, would get in the way of some of the suggestion.

mariaalice

https://www.boards.ie/discussion/comment/117913168#Comment_117913168

I am also wondering how you lower the cost of the provision of care in Ireland.

jcon1913

https://www.boards.ie/discussion/comment/117914756#Comment_117914756

''So basically reduce the number of hospital beds'' - no thats not what the report said, it said that we have a lower than average number of hospital beds.

in a later comment you say:

''I read the report, it's not a negative comment''

ok thats fine.

Yes it is short on analysis - but it is long on facts. Would you care to comment on them?

There are structural inefficiencies in the health service in this country - they are the facts.

Clearly when there is that amount of overstaffing there is a major problem, and no, the answer is not to force people who are on comfortable salaries out of a job, but maybe we should cut back on the number of medical graduates we produce. There must be a thousand other improvements that could make a difference to delivery of health services in this country.

mariaalice

Is it overstaffing or inefficient use of staff though, do you really believe there are nurses and doctors sitting around twiddling their thumbs because they have nothing to do due to all the overstaffing?

We have a lower than average OECD doctor to populations ratio so why would we reduce the level of medical graduates we produce?.

What about health care administration, medical scientists, occupational therapists, physiotherapists, and all allied medical professionals do we have we too many of them as well?

The cost of housing, transport, utilities, construction, etc is very high in Ireland it is not just a health care issue.

Geuze

Yes, we do overspend, relative to the age profile of our population.

Why or how do we overspend?

(1) We have very high pay rates

A GP in France charges 25, for example.

Another example, the vaccines, our GP gets 25+25+10 = 60 euro. A British GP giving out vaccines gets GBP 12.58 + 12.58

Consultants here charge way more than abroad, it is approx 50 euro in France.

(2) we overspend on drugs, this is due to high prices and low usage of generics

We don't negotiate hard on prices, for fear of risking pharma FDI

(3) we have too many hosps, approx 50-54

(4) massive duplication

Geuze

https://www.boards.ie/discussion/comment/117917342#Comment_117917342

Yes, there are staff sitting around.

My friend's wife works as a nurse in Sligo (I won't mention the unit), and yes, he confirms that they often don't match the size of the daily list to the staff.

We all know about the consultant who says he gets four times as much work done per session in a private hosp compared to an HSE hosp.

mariaalice

https://www.boards.ie/discussion/comment/117917766#Comment_117917766

I am amazed, an anecdote from my friend's wife is your evidence?

mariaalice

https://www.boards.ie/discussion/comment/117917758#Comment_117917758

But what is your answer though, also the solution must be workable.

Do you have any theory as to why in major urban areas there is a shortage of nurses? and a shortage of doctors all over, and why we have so many Indian, Pakistani and Filipino medical staff.

mariaalice

Of course, there are issues the same with the provision of a lot of public services in Ireland, but the reporter quoted is stating the obvious as if it is a revelation, we live in a high wage, a high-cost economy which impacts the costs of the delivery of services, who knew😉.

Sectoral interests such as professional bodies, unions, the left( anti-privatisation ) the right ( pro-privatisation ) all have a vested interest in presenting the information in a certain way, anyone with half a brain should be able to understand that.

Everybody seems to be able to identify the issues as they see them but never the solutions.

jcon1913

https://www.boards.ie/discussion/comment/117918190#Comment_117918190

But your own views are anecdotal - what evidence do you have that Irish hospitals are run efficiently in the face of evidence as presented to you?

jcon1913

https://www.boards.ie/discussion/comment/117918209#Comment_117918209

Why to we have so many doctors from overseas? Because the individuals view jobs in Ireland as well-paid relative to their own country - I cant think of any other reason.

mariaalice

https://www.boards.ie/discussion/comment/117920203#Comment_117920203

Not because we need them then?

mariaalice

https://www.boards.ie/discussion/comment/117920194#Comment_117920194

If you read my post non are anecdotal Irish hospitals are not run efficiently I never said they were, I have used both the public and private system and they are as disorganised as each other, however, you do get a private room and a menu to choose from in the private hospital.

There are large issues with the HSE.

Grab All Association

Some dangerous “doctors” with dubious credentials employed by the HSE.

I know people on GMS who were appointed a fake doctor when their GP of over 30 years retired. Nothing but complaints from every patient I know of his.

Nothing against foreigners, but they need to be graduates of the Irish or U.K. medical schools (RCSI etc) and not hired over the phone as has happened in the past.

Podge_irl

https://www.boards.ie/discussion/comment/117917758#Comment_117917758

Ireland does negotiate on drug prices, and failure to do so at times has nothing to do with Pharma FDI. The Orkambi incident demonstrates quite well the difficulty with negotiating on drug prices. The HSE was offered a deal paying significantly more than the NHS and they refused - there was then an (understandable) onslaught of pressure to fund the drug. The pressure was wildly misdirected at the HSE instead of at the producers of the drug who were price gouging Ireland. Eventually the HSE held firm and got a better deal on the drug, but not without a large swathe of the population thinking they were heartless bastards.

We do probably have too many hospitals however. There has been progress made on this with the centres of excellence but the resulting shutdown of many regional hospitals has not exactly been easy politically. We are our own worst enemies at times with issues such as this.

mariaalice

https://www.boards.ie/discussion/comment/117920490#Comment_117920490

In other works, a lot if not most of the issues are caused by pressure on the government and politicians by various sectoral interests which make change difficult.

Podge_irl

https://www.boards.ie/discussion/comment/117920700#Comment_117920700

Absolutely, though one of those sectoral interests is unfortunately the electorate who are not always great at looking at the bigger picture. Not helped, of course, by plenty of people who know better piling on anyway. Closing certain regional hospitals was undeniably the correct thing to do and anyone who spent even a brief period looking into it would know that, but it didn't stop politicians and interest groups campaigning vociferously against it.

I would be pleasantly surprised if someone could "make" the NHS in this day and age.

Mad_maxx

https://www.boards.ie/discussion/comment/116994415#Comment_116994415

No party here prioritises tax cuts over increased public spending

Mad_maxx

https://www.boards.ie/discussion/comment/116994842#Comment_116994842

That means loosing votes as sacked surplus to requirements workers have votes and so do their relatives

We also need to close down a bunch of regional hospitals but again a vote loosing strategy

The public don't really want reform of the health service , we are a deeply immature electorate, parochial to the point of being ungovernable