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An "Irish NHS" - what needs to change?
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PhoneMain wrote:The general public also have to change their attitude to hospitals as well. Theres loads of small, inefficient hospitals around the country that cant be shut down as the public wont tolerate their local town not having 1 and having to travel an extra 10 mins to get to a hospital (dont mention emergencies cos often you will have ambulances blue lighting past these hospitals in the case of heart attacks, strokes etc). We have far too many hospitals for our population and this just leads to cost duplication and inefficiencies.
Completely incorrect. Ireland beds per capita figure is very poor given the money invested and the outcomes (trolleys!). And you would want to reduce it further. It's already anaemic.
Focusing on large industrial grade hospitals is totally outdated 1970s stuff. Primary care should be decentralised, and so should the secondary one. The best European systems operate so (the Nordics, Netherlands, Austria, Germany).
Also, in terms of beds per capita and ICUs per capita, Ireland is trailing behind most EU and OECD countries. Add the second highest healthcare spending per capita in OECD and it's clear that the Irish system delivers very poor value for the huge money invested.
Beds per 1000 population
Germany - 8.00 beds
Czechia - 6.63 beds
Belgium - 5.76 beds
Finland - 3.32 beds
Ireland - 2.96 beds
ICUs per 100k population
Germany - 38.7
Czechia - 11.6
Belgium - 15.9
Finland - 6.1
Ireland - 6.5
What is worse is that Finland, Denmark and Netherlands have very similar stats, but spend less and have better outcomes and their healthcare systems are EU and world top (see EHCI reports).
https://en.m.wikipedia.org/wiki/List_of_countries_by_hospital_beds
https://www.numbeo.com/health-care/rankings_by_country.jsp
https://healthpowerhouse.com/media/EHCI-2018/EHCI-2018-report.pdf0 -
So does the air and water just magically appear in your tyre or is there costs involved in setting it up?
Similarly, who should pay the GPs salary, the nurses salary, the receptionists salary? What value do you place on a GPs role and years of training? Believe me, if GPs are in it for the money, they'd make a lot more money a lot easier in other careers
becoming a GP is difficult and a long road but you have got to be joking telling people that they are underpaid- really? Trainee GPs earn more than €80,000 in their 3rd and 4th years which puts them in the top ten percent of earners in Ireland. Can we take it that the average GP has taxable income of twice that putting the average GP close to the top 1% of earners. The greed of the medical profession is something to behold in this country.
I think we need to accept that Irish born doctors can work in the USA for far better money than here and that we will have a majority of foreign born doctors treating Irish patients and happy to do so for what the typical Irish doctor considers Mickey Mouse money0 -
Today's Six One news, the private nursing home sector is complaining about the cost of providing care and how much the taxpayer/resident pays for it under the Fair Deal scheme. Regional variations. Talk of rural nursing homes having to close due to not having economies of scale. Talk of higher costs going forward due to more stringent infection control measures post Covid (infection control measures that should surely have been in place all along?)
Sounds like another Irish healthcare clusterf*ck and postcode lottery in the making. The state is very dependent on private sector, for profit entities to provide this critical service - the majority of nursing homes in the country are private. The public ones tend to charge considerably more to the taxpayer/resident under the Fair Deal. As with acute hospitals and GPs we have a mess of public and private. Who suffers and who pays? The taxpayer and those who need the service?0 -
Completely incorrect. Ireland beds per capita figure is very poor given the money invested and the outcomes (trolleys!). And you would want to reduce it further. It's already anaemic.
Focusing on large industrial grade hospitals is totally outdated 1970s stuff. Primary care should be decentralised, and so should the secondary one. The best European systems operate so (the Nordics, Netherlands, Austria, Germany).
Also, in terms of beds per capita and ICUs per capita, Ireland is trailing behind most EU and OECD countries. Add the second highest healthcare spending per capita in OECD and it's clear that the Irish system delivers very poor value for the huge money invested.
Beds per 1000 population
Germany - 8.00 beds
Czechia - 6.63 beds
Belgium - 5.76 beds
Finland - 3.32 beds
Ireland - 2.96 beds
ICUs per 100k population
Germany - 38.7
Czechia - 11.6
Belgium - 15.9
Finland - 6.1
Ireland - 6.5
What is worse is that Finland, Denmark and Netherlands have very similar stats, but spend less and have better outcomes and their healthcare systems are EU and world top (see EHCI reports).
https://en.m.wikipedia.org/wiki/List_of_countries_by_hospital_beds
https://www.numbeo.com/health-care/rankings_by_country.jsp
https://healthpowerhouse.com/media/EHCI-2018/EHCI-2018-report.pdf
While I know the Irish health system has serious issues and I'm not trying to defend the HSE here, Numbeo gets quoted as if it's some kind of scientific survey.
"This section is based on surveys from visitors of this website. Questions for these surveys are similar to many similar scientific and government surveys."
https://www.numbeo.com/health-care/indices_explained.jsp
It's about as scientific as a boards.ie poll.
The methodologies of the other surveys are far more robust.0 -
I think we need to accept that Irish born doctors can work in the USA for far better money than here and that we will have a majority of foreign born doctors treating Irish patients and happy to do so for what the typical Irish doctor considers Mickey Mouse money
The problem with that is we're training them for anything but mickey mouse money.-1 -
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Why not? Works fine in Austria and Czechia. Not huge countries by any measure. Or Finland, same size, also peripheral market.
UHI/NHI is absolutely essential for any sort of Continental style health care reform.
I'm not an expert, but we had an FG led government with a manifesto commitment to UHI from 2011, they had a good go at it, and they gave up.Absolutely.
I wouldn't mind a token GP charge either. Serves as a regulator and soft deterrent from overuse.
Up to 20 euro, no problem
Is it really a good idea to deter people from going to the doctor? €20 is a significant problem for some people.Pandiculation wrote: »The problem with that is we're training them for anything but mickey mouse money.
Not to worry, we make up for it by harvesting doctors and nurses trained at considerable expense in India, Philippines and other developing countries into our health service, regardless of whether their home countries can afford it or not.0 -
Agreed - if it was up to me I'd phase out undergraduate medical school, everyone going to be a doctor should go to graduate school like in the USA.Pandiculation wrote: »The problem with that is we're training them for anything but mickey mouse money.
You can go to graduate school here but it costs about €12,500 a year ( still cheap by USA standards ) for four years. But at least it is closer to making a contribution to the real cost of a medical education.
Ironically the people that contribute the most towards the income of an college are the ones studying Arts Humanities and Business, because its relatively cheap for lecture to huge classes, and the students pay the same fees €3,000 per year and there is a capitation grant for every student from the Higher Education Authority.0 -
Pandiculation wrote: »While I know the Irish health system has serious issues and I'm not trying to defend the HSE here, Numbeo gets quoted as if it's some kind of scientific survey.
"This section is based on surveys from visitors of this website. Questions for these surveys are similar to many similar scientific and government surveys."
https://www.numbeo.com/health-care/indices_explained.jsp
It's about as scientific as a boards.ie poll.
The methodologies of the other surveys are far more robust.
Numbeo is not the core of my post. Actually, I just threw it there for comparison. And I don't agree, Numbeo isn't that bad as poll on boards. This particular one I linked closely tracks EHIC.
You may need to focus on the hard stats and EHIC for example.0 -
becoming a GP is difficult and a long road but you have got to be joking telling people that they are underpaid- really? Trainee GPs earn more than €80,000 in their 3rd and 4th years which puts them in the top ten percent of earners in Ireland. Can we take it that the average GP has taxable income of twice that putting the average GP close to the top 1% of earners. The greed of the medical profession is something to behold in this country.
I can't understand how GP say they are underpaid.
They charge double what a French GP charges, 50 vs 25.
They get double what a UK GP gets for a vaccination.
I welcome any explanation from any GP.
I suspect the answer is that the private patients subsidise the fees earned from the GMS?0 -
Numbeo is not the core of my post. Actually, I just threw it there for comparison. And I don't agree, Numbeo isn't that bad as poll on boards. This particular one I linked closely tracks EHIC.
You may need to focus on the hard stats and EHIC for example.
The one that shocked me and I can’t find a link to post was a statistical analysis of the number of various common elective procedures being carried out in various EU countries. Ireland volumes were remarkably low for procedures like cataract surgery, hip replacement etc. So it’s fairly clear that where we’ve long waiting lists there are very definitely major underlying capacity issues.
We were ranking well in areas like cardiac surgery ans so on, but anything elective seemed to be very definitely showing signs of huge waiting lists.0 -
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Focusing on large industrial grade hospitals is totally outdated 1970s stuff. Primary care should be decentralised, and so should the secondary one. The best European systems operate so (the Nordics, Netherlands, Austria, Germany).
You're mixing local hospitals with primary care. The pertinent example is how people want local hospitals to have cancer services when the best practice is to have a small number of specialized hospitals dealing in this.0 -
jimmycrackcorm wrote: »You're mixing local hospitals with primary care. The pertinent example is how people want local hospitals to have cancer services when the best practice is to have a small number of specialized hospitals dealing in this.
You can also very successfully have aspects of treatment in primary care type settings. For example, a lot of cancer patients are travelling huge distances for what are basic infusions and blood samples and so on. A lot of that can be setup by big specialised cancer care hospitals in one of the cities and then delivered closer to home.
I know for example a relative of mine in Dublin was going to the Mater for her monthly infusions, but because of COVID-19 safety concerns, that was moved to a community clinic in the suburbs and it has absolutely changed her life. She's in and out in no time and it's much less stress and hassle.
If you'd well equipped primary care centres in every community, rural and urban, a lot more could be delivered locally.
What we don't need is a load of half-arsed small hospitals all doing the same thing.
There's also a major role in that for things like dealing with bumps, bruises, minor breaks, all of those kinds of issues in more of a primary care / local injuries unit context. There's absolutely no need for these kinds of things to be getting brought to major acute hospitals, yet that's what keeps happening here.
Some of the stuff I've seen here would just shock you to the core. For example, I had a cardiac screening, which was done in a public hospital and it was reasonable enough to do it there for echocardiogram and all of that, but I had to go back to basically collect a monitor, and they checked me in as an day case!?! It made absolutely no sense whatsoever. It was a 10 min trip to pick up a simple monitor that a GP or a nurse could have hooked up.
We also need to urgently deal with the lack of availability of elective surgeries like cataracts, hip replacements etc. That probably means adding a lot of additional capacity in non-acute hospitals, but specialist centres. The demand for those kinds of procedures is only going to go up as the population of people who will need them rises as the 1970s / 80s Irish baby boomers begin to head into later middle age and then old age. We're not planning ahead properly at all.
We're also falling way behind on queues for things like specialist ENT services, which are a huge issue if you're ending up getting access to something like Cochlear implant surgery far too late in development. it's beyond ridiculous that that's currently only available in Beaumont and not in a neuroscience centre like CUH for example. The queues for that are enormous too.
If you look at something like the endless issues in the Midwest that's causing UHL to clog up, it seems like they reorganised the system without adding capacity and also perhaps ignored growing demand in Limerick City due to just population growth. That really needs to be dealt with. There are huge inconsistencies in services available in the cities outside of Dublin and that's also placing stupid amounts of pressure on the acute hospitals in Dublin as a result, not to mention placing pressure on patients.
It's like we're planning for the past sometimes when you look at the mismatch between facilities and population centres.
This isn't an argument about reopening scattered rural hospitals, but rather making sure that the facilities that are there reflect population trends and not how things were in 1977.
Everything about it just strikes me as pathetically bad planning and various vested interests setting agendas, including an element of empire building. If you look at how that NCH project was bounced around from site to site, it was like nobody had oversight of it and a bunch of people just all had notions about where it should be.
To me that was the canary in the mine. It shows exactly what's wrong with the system i.e. there's both weak management and 'too many cooks' who think they know everything pushing policy in the middle.
We also need to get past this scenario where a minister comes in and is left dealing with a system that will resist reform, and play politics, and then chews them up and spits them out. Absolutely nobody seems to have been able to knock it into shape.
The SlainteCare approach makes some sense, but I think we really need to move more towards a situation where the health system is put on the operating table and dealt with as a crisis situation that needs to be put right. Every one of the parties knows there's a massive problem and the only way it'll be resolved is by some kind of consensus building on a way forward, and an assurance that a policy to create a new system will keep ploughing on.
There are legacy issues, but you're looking at an Ireland that's been very wealthy now for several decades. No more excuses!0 -
Pandiculation wrote: »You can also very successfully have aspects of treatment in primary care type settings. For example, a lot of cancer patients are travelling huge distances for what are basic infusions and blood samples and so on. A lot of that can be setup by big specialised cancer care hospitals in one of the cities and then delivered closer to home.
I know for example a relative of mine in Dublin was going to the Mater for her monthly infusions, but because of COVID-19 safety concerns, that was moved to a community clinic in the suburbs and it has absolutely changed her life. She's in and out in no time and it's much less stress and hassle.
If you'd well equipped primary care centres in every community, rural and urban, a lot more could be delivered locally.
What we don't need is a load of half-arsed small hospitals all doing the same thing.
There's also a major role in that for things like dealing with bumps, bruises, minor breaks, all of those kinds of issues in more of a primary care / local injuries unit context. There's absolutely no need for these kinds of things to be getting brought to major acute hospitals, yet that's what keeps happening here.
Absolutely agree with everything you say, but the Irish attitude is that unless there is a local hospital then it simply won't do. We certainly could do with a special drunk tank for weekend nights to de-clog A&E in non-covid times. Nurses should also be empowered to attain additional skills to provide a range of treatments instead of requiring a doctor in every case. I once brought my kid to A&E to get stitches but had to wait until a doctor was available to do them. This is something that nurses should be qualified for.0 -
I know the chances of it happening are unlikely but would a compulsory medical for everyone once a year pick up a lot of issues early on , so early intervention would lead to better outcomes0
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RandomViewer wrote: »I know the chances of it happening are unlikely but would a compulsory medical for everyone once a year pick up a lot of issues early on , so early intervention would lead to better outcomes
Vaccine passports cause objections, and I presume compulsory covid vaccinations would bring even greater objections. Now can you imagine the outrage if one were to try (universal) compulsory annual medicals?
While there is a case for compulsion in the case of contagious diseases, a general requirement for medical tests would be a huge infringement on personal liberties. The frightening thing is that it is not beyond the mindset of many of our authoritarian medics.0 -
Economics101 wrote: »Vaccine passports cause objections, and I presume compulsory covid vaccinations would bring even greater objections. Now can you imagine the outrage if one were to try (universal) compulsory annual medicals?
While there is a case for compulsion in the case of contagious diseases, a general requirement for medical tests would be a huge infringement on personal liberties. The frightening thing is that it is not beyond the mindset of many of our authoritarian medics.
I highly disagree with your last point!! Consent is one of the core tenets of medical treatment. Compulsary vaccinations will never be a thing either.
Couple of things however.
1) Certain contagious diseases are notifed to public health, patients arent given a chance to disagree with it. Available here
https://www.hpsc.ie/notifiablediseases/listofnotifiablediseases/
2) There's no evidence of the benefit of general screening in asymptomatic individuals. There's certain criteria that have to be met for screening to be used, hence why we only screen for certain cancers (Breast, bowel, colon) and not for others (prostate, lung etc).
3) The HSE is doing great work in putting resources into primary care. GPs now can refer medical card patients for scans through private providers to help clear waiting lists. Chronic Disease Management programme is also being rolled out that gives structured twice yearly consultations with specific tests e.g. bloods, ecg, urinalysis to patients with certain chronic diseases e.g. Diabetes
4) Ultimately the best thing that people can do to help the health service is maintain a good lifestyle. Have a healthy weight, exercise, dont smoke, minimal alcohol etc0 -
I highly disagree with your last point!! Consent is one of the core tenets of medical treatment. Compulsary vaccinations will never be a thing either.
I only hope you are right. One of the problems I see with medical provision by the State (a la NHS) is the danger of an attitude: "if we the State/Taxpayer pay for your medical care we have the right to mandate/dictate how you behave"
Of course you are right in saying that consent is crucial. The danger as I see it is more from civil servants/administrators rather than frontline medics. A doctor in the NHS is paid by the State, but his/her responsibility is to the patient: there is an inevitable element of tension, and maybe conflict, there.0 -
I highly disagree with your last point!! Consent is one of the core tenets of medical treatment. Compulsary vaccinations will never be a thing either.
Couple of things however.
1) Certain contagious diseases are notifed to public health, patients arent given a chance to disagree with it. Available here
https://www.hpsc.ie/notifiablediseases/listofnotifiablediseases/
2) There's no evidence of the benefit of general screening in asymptomatic individuals. There's certain criteria that have to be met for screening to be used, hence why we only screen for certain cancers (Breast, bowel, colon) and not for others (prostate, lung etc).
3) The HSE is doing great work in putting resources into primary care. GPs now can refer medical card patients for scans through private providers to help clear waiting lists. Chronic Disease Management programme is also being rolled out that gives structured twice yearly consultations with specific tests e.g. bloods, ecg, urinalysis to patients with certain chronic diseases e.g. Diabetes
4) Ultimately the best thing that people can do to help the health service is maintain a good lifestyle. Have a healthy weight, exercise, dont smoke, minimal alcohol etc
When you see smokers standing outside the hospital with the drip stand beside them it just shouts re##$#0 -
RandomViewer wrote: »When you see smokers standing outside the hospital with the drip stand beside them it just shouts re##$#
Or the person who doesnt trust whats in vaccines but smokes 40 per day.0 -
Anyone see the Tommie Gorman cancer programme on RTE last night, it covered the setting up of a centre of excellence for neuroendocrine tumours in St. Vincent's. A Dr. O'Toole was deemed to be the best person to lead the centre but he was already employed in St James's. This caused a significant issue and the separation between the hospitals was described as "The Berlin Wall". A considerable amount of work was needed at high levels in the Dept of Heath to get the centre setup as a result.
Got there in the end but Gorman had been going to Sweden for treatment for yeas because he couldn't get it here.
How many of the following apply to the health service in Ireland and cause problems such as this
Siloed thinking
Little Kingdom Mentality
Legacy/Systemic/Structural issues
Computer Says No.0 -
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And corruption, nepotism.Anyone see the Tommie Gorman cancer programme on RTE last night, it covered the setting up of a centre of excellence for neuroendocrine tumours in St. Vincent's. A Dr. O'Toole was deemed to be the best person to lead the centre but he was already employed in St James's. This caused a significant issue and the separation between the hospitals was described as "The Berlin Wall". A considerable amount of work was needed at high levels in the Dept of Heath to get the centre setup as a result.
Got there in the end but Gorman had been going to Sweden for treatment for yeas because he couldn't get it here.
How many of the following apply to the health service in Ireland and cause problems such as this
Siloed thinking
Little Kingdom Mentality
Legacy/Systemic/Structural issues
Computer Says No.
And too many bosses.
And associated exteremely high wages & bonuses for HSE bosses (of whom there are too many as well.
HSE bosses and also politicians in Ireland are way overpaid comapared to GNI & average/mean salary if you compare them with Swedish, Nowegian, French or German counterparts. It's shocking actually.0 -
Pandiculation wrote: »You can also very successfully have aspects of treatment in primary care type settings. For example, a lot of cancer patients are travelling huge distances for what are basic infusions and blood samples and so on. A lot of that can be setup by big specialised cancer care hospitals in one of the cities and then delivered closer to home.
I know for example a relative of mine in Dublin was going to the Mater for her monthly infusions, but because of COVID-19 safety concerns, that was moved to a community clinic in the suburbs and it has absolutely changed her life. She's in and out in no time and it's much less stress and hassle.
If you'd well equipped primary care centres in every community, rural and urban, a lot more could be delivered locally.
What we don't need is a load of half-arsed small hospitals all doing the same thing.
There's also a major role in that for things like dealing with bumps, bruises, minor breaks, all of those kinds of issues in more of a primary care / local injuries unit context. There's absolutely no need for these kinds of things to be getting brought to major acute hospitals, yet that's what keeps happening here.
Some of the stuff I've seen here would just shock you to the core. For example, I had a cardiac screening, which was done in a public hospital and it was reasonable enough to do it there for echocardiogram and all of that, but I had to go back to basically collect a monitor, and they checked me in as an day case!?! It made absolutely no sense whatsoever. It was a 10 min trip to pick up a simple monitor that a GP or a nurse could have hooked up.
We also need to urgently deal with the lack of availability of elective surgeries like cataracts, hip replacements etc. That probably means adding a lot of additional capacity in non-acute hospitals, but specialist centres. The demand for those kinds of procedures is only going to go up as the population of people who will need them rises as the 1970s / 80s Irish baby boomers begin to head into later middle age and then old age. We're not planning ahead properly at all.
We're also falling way behind on queues for things like specialist ENT services, which are a huge issue if you're ending up getting access to something like Cochlear implant surgery far too late in development. it's beyond ridiculous that that's currently only available in Beaumont and not in a neuroscience centre like CUH for example. The queues for that are enormous too.
If you look at something like the endless issues in the Midwest that's causing UHL to clog up, it seems like they reorganised the system without adding capacity and also perhaps ignored growing demand in Limerick City due to just population growth. That really needs to be dealt with. There are huge inconsistencies in services available in the cities outside of Dublin and that's also placing stupid amounts of pressure on the acute hospitals in Dublin as a result, not to mention placing pressure on patients.
It's like we're planning for the past sometimes when you look at the mismatch between facilities and population centres.
This isn't an argument about reopening scattered rural hospitals, but rather making sure that the facilities that are there reflect population trends and not how things were in 1977.
Everything about it just strikes me as pathetically bad planning and various vested interests setting agendas, including an element of empire building. If you look at how that NCH project was bounced around from site to site, it was like nobody had oversight of it and a bunch of people just all had notions about where it should be.
To me that was the canary in the mine. It shows exactly what's wrong with the system i.e. there's both weak management and 'too many cooks' who think they know everything pushing policy in the middle.
We also need to get past this scenario where a minister comes in and is left dealing with a system that will resist reform, and play politics, and then chews them up and spits them out. Absolutely nobody seems to have been able to knock it into shape.
The SlainteCare approach makes some sense, but I think we really need to move more towards a situation where the health system is put on the operating table and dealt with as a crisis situation that needs to be put right. Every one of the parties knows there's a massive problem and the only way it'll be resolved is by some kind of consensus building on a way forward, and an assurance that a policy to create a new system will keep ploughing on.
There are legacy issues, but you're looking at an Ireland that's been very wealthy now for several decades. No more excuses!
There’s a lot to digest there. And I’ve only read it once but a few things strike me as I read them.
Essentially you’re looking for lots more capacity in many different domains - both clinical and structural. With the best will in the world, the at takes lots of time and lots of money. While services could be more efficient it’s just not gonna give the capacity to supply what you want above.
Weak management. I would agree with you there but I often wonder is healthcare where the managers aren’t in charge and have very little authority over their employees - doctors and nurses in the main. And where the two (three) keystones of the primary care service are private companies - GPs, pharmacists and dentists.
What currently happens is a big melee of push/pull factors between MULTIPLE stakeholders, including the DoH and the public. Everyone wants something different. Everyone. So the current approach is one of influence and negotiation. Trying to find a medium where most people are happy. Even today in the Irish times - nuerosurgery in beaumont are not happy that the Mater is the trauma centre. You’ll hear about the burns unit in sjh next. The neurosurgeons say how special and how important they are - they’ll use the patient as leverage (we care and the fecking HSE doesn’t type of thing) - and something will happen for everyone to get along. they say that no neurosurgeon doctor was on the independent panel. But there were plenty of experts on the panel in this area internationally. But it wouldn’t matter if there were neurosurgeons on the panel - they wouldn’t be happy. So not all docs are on the same page.
As for GPS and pharmacists - there’s about 3000-3500 of both - with a contract (if they provide GMS services) for each of them. That’s 6000-7000 individual contracts. They don’t speak with the same voice, they are all separate companies. The medical card scheme is broken - very broken. A report from RCSI - more doctors - recommended getting rid of it because it is built on the basis of income and not need. But nearly half the population have One (so not the poorest) and it’s used as a political football - people with terminal disease, cervical check fall out. Do these people ‘deserve it’ - well that depends. If it’s means tested, as it should be, then it depends on the test. If it’s on need, then sure - but what about the rest of us who don’t have the voice that the multimillion euro Irish cancer society pr wing have behind them.
My point here is - either there is significant change to way we do things, or we keep going along the way we’re going along and tinkering at the edges.
Managers manage. An obvious thing to say - they don’t decide on policy. They get experts in to advise on policy and then they put together the policy and implement it (HSE operations) or the policy is given to them (DoH) to implement. Either way, consensus and support are needed to implement - not authoritarianism.
Your suggestions above are fine and all but where is the leadership to do it; and the key ingredient that all leaders NEED - followers.
I don’t have the answers - I’m just putting my two cents in. All I know is that OUR health service is not broken; it doesn’t need fixing. It needs all stakeholders involved to focus on what’s best for the health of our society. And that includes citizens - they can’t be focussed on singular groups, it has to be everybody.
I read a piece by a Cystic fibrosis group who wanted to be prioritised for the vaccine. It’s very frustrating to listen to them. Lots of medical experts - including patient groups - contribute to that vaccine sequencing list. EVERYONE has to be included. What this group don’t say is who they don’t should be bumped down the list so they can climb the ladder. Someone has to make that decision - it’s not an easy decision; and it’s thankless but still it’s a decision that has to be made for the ALL citizens.
Anyway - that’s my two cents.0 -
And corruption, nepotism.
And too many bosses.
And associated exteremely high wages & bonuses for HSE bosses (of whom there are too many as well.
HSE bosses and also politicians in Ireland are way overpaid comapared to GNI & average/mean salary if you compare them with Swedish, Nowegian, French or German counterparts. It's shocking actually.
No. Two separate companies with their own boards - section 38 of the health act - with consultants who do not want to ceed power and autonomy - that are under an SLA with the HSE. If they don’t want to do it, there’s very little that the HSE can do about it.
But seeing as you’re so interested, I’m sure you’ll be canvassing your TD to change the 1970 Health Act to remove all section 38 hospitals so as to be under one umbrella organisation to remove the ‘Berlin wall’ as you say.
You’ll also be putting in a Protected Disclousre to the HSE or the guards about the corruption and nepotism that’s rife. The HSE operates recruitment under a license from an independent government function - you pay for it in your taxes. I can get you the number if you want to report known instances of nepotism. I’m sure they’ll want to hear from you.0 -
There’s a lot to digest there. And I’ve only read it once but a few things strike me as I read them.
Essentially you’re looking for lots more capacity in many different domains - both clinical and structural. With the best will in the world, the at takes lots of time and lots of money. While services could be more efficient it’s just not gonna give the capacity to supply what you want above.
Weak management. I would agree with you there but I often wonder is healthcare where the managers aren’t in charge and have very little authority over their employees - doctors and nurses in the main. And where the two (three) keystones of the primary care service are private companies - GPs, pharmacists and dentists.
What currently happens is a big melee of push/pull factors between MULTIPLE stakeholders, including the DoH and the public. Everyone wants something different. Everyone. So the current approach is one of influence and negotiation. Trying to find a medium where most people are happy. Even today in the Irish times - nuerosurgery in beaumont are not happy that the Mater is the trauma centre. You’ll hear about the burns unit in sjh next. The neurosurgeons say how special and how important they are - they’ll use the patient as leverage (we care and the fecking HSE doesn’t type of thing) - and something will happen for everyone to get along. they say that no neurosurgeon doctor was on the independent panel. But there were plenty of experts on the panel in this area internationally. But it wouldn’t matter if there were neurosurgeons on the panel - they wouldn’t be happy. So not all docs are on the same page.
As for GPS and pharmacists - there’s about 3000-3500 of both - with a contract (if they provide GMS services) for each of them. That’s 6000-7000 individual contracts. They don’t speak with the same voice, they are all separate companies. The medical card scheme is broken - very broken. A report from RCSI - more doctors - recommended getting rid of it because it is built on the basis of income and not need. But nearly half the population have One (so not the poorest) and it’s used as a political football - people with terminal disease, cervical check fall out. Do these people ‘deserve it’ - well that depends. If it’s means tested, as it should be, then it depends on the test. If it’s on need, then sure - but what about the rest of us who don’t have the voice that the multimillion euro Irish cancer society pr wing have behind them.
My point here is - either there is significant change to way we do things, or we keep going along the way we’re going along and tinkering at the edges.
Managers manage. An obvious thing to say - they don’t decide on policy. They get experts in to advise on policy and then they put together the policy and implement it (HSE operations) or the policy is given to them (DoH) to implement. Either way, consensus and support are needed to implement - not authoritarianism.
Your suggestions above are fine and all but where is the leadership to do it; and the key ingredient that all leaders NEED - followers.
I don’t have the answers - I’m just putting my two cents in. All I know is that OUR health service is not broken; it doesn’t need fixing. It needs all stakeholders involved to focus on what’s best for the health of our society. And that includes citizens - they can’t be focussed on singular groups, it has to be everybody.
I read a piece by a Cystic fibrosis group who wanted to be prioritised for the vaccine. It’s very frustrating to listen to them. Lots of medical experts - including patient groups - contribute to that vaccine sequencing list. EVERYONE has to be included. What this group don’t say is who they don’t should be bumped down the list so they can climb the ladder. Someone has to make that decision - it’s not an easy decision; and it’s thankless but still it’s a decision that has to be made for the ALL citizens.
Anyway - that’s my two cents.
A prescient Letter from the Irish times that supposed my point above. Everyone got an opinion - but those who need to follow the plan, don’t because they think they know best. Try and manage that!!!
Sir, – I write in response to the expression of dismay by a number of neurosurgeons at Beaumont Hospital (Letters, May 4th) in relation to the recent decision to designate Dublin’s Mater hospital rather than their own hospital as Dublin’s major trauma centre.
International studies have consistently shown that concentrating the care of severely injured patients in dedicated major trauma centres is associated with improved access to care, reduced length of stay and demonstrably better outcomes for patients. As your letter writers note, at present no single Dublin hospital has all the acute specialties required in a major trauma centre. Instead, several key trauma specialties are spread across Dublin in different hospitals. As a result, during 2014-2019, 31 per cent of adult trauma patients were transferred at least once to another hospital as the receiving hospital could not provide the totality of care required. The designation of the Mater hospital as a major trauma centre followed a rigorous process. It included a public consultation on the designation process during which all stakeholders had the opportunity to contribute; each Dublin hospital group made submissions to an independent assessment panel; the panel visited all potential Dublin hospitals and met with clinical leaders and hospital managers; the panel requested subject experts to be available to them and consulted with a leading neurosurgeon specialising in neurotrauma at a major trauma centre in another jurisdiction as part of its deliberations. It was at the end of this very comprehensive process that it advised the HSE on the hospitals to be designated as the major trauma centre and Dublin trauma units.
The recommendation of the panel was approved by the board of the HSE and was accepted by Government. The advice of the panel took into account the totality of what was required to develop a major trauma centre in Dublin so that it could support the trauma system for Ireland. It is estimated that the trauma system will reduce the likelihood of death from trauma by 20 per cent.
The assertion that the HSE intends to establish a “mini-neurosurgical centre” at the Mater Hospital is not correct. The plan is for the National Office of Trauma Services to collaborate with the National Neurosurgical Centre (at Beaumont and Temple Street) to develop a system that best serves patients requiring trauma and other neurosurgical care.
Many models for the delivery of trauma neurosurgery in trauma centres exist around the world, and lessons from these, but most importantly from the incumbents who currently deliver the service, will inform the model that best suits Dublin. Meetings have taken place and will continue between the HSE and interested representatives of the National Neurosurgical Centre, and it is disappointing that the efforts to collaborate on the part of the HSE Trauma Office have not previously been referenced.
The trauma system decided upon will deliver better outcomes for patients. Delivering high-quality care requires a highly functioning team working together collaboratively in the interests of patients. The HSE’s Trauma Office will always strive to foster a spirit of co-operation in the knowledge that this is what will save lives and prevent disability. – Yours, etc,
KEITH SYNNOTT,
Consultant Orthopaedic
and Spine Surgeon,
National Spinal
Injuries Unit,
National Clinical Lead
for Trauma Services,
HSE National Office
for Trauma Services,
Dublin0 -
And corruption, nepotism.
And too many bosses.
And associated exteremely high wages & bonuses for HSE bosses (of whom there are too many as well.
HSE bosses and also politicians in Ireland are way overpaid comapared to GNI & average/mean salary if you compare them with Swedish, Nowegian, French or German counterparts. It's shocking actually.
Please give details of the corruption and nepotism that you're aware of.
What bonuses do HSE bosses get?0 -
AndrewJRenko wrote: »Please give details of the corruption and nepotism that you're aware of.
What bonuses do HSE bosses get?
Your automatic defense of the public service, as a public servant, is why we can’t have an NHS. It needs accountability.0 -
Economics101 wrote: »Vaccine passports cause objections, and I presume compulsory covid vaccinations would bring even greater objections. Now can you imagine the outrage if one were to try (universal) compulsory annual medicals?
While there is a case for compulsion in the case of contagious diseases, a general requirement for medical tests would be a huge infringement on personal liberties. The frightening thing is that it is not beyond the mindset of many of our authoritarian medics.
You specifically referred to 'authoritarian medics' in your first post and then switched to 'civil servants/administrators' when challenged. Where are you getting this from? Where have any 'civil servants/administrators' or 'authoritarian medics' called for compulsory annual medicals or other compulsory treatments?Economics101 wrote: »I only hope you are right. One of the problems I see with medical provision by the State (a la NHS) is the danger of an attitude: "if we the State/Taxpayer pay for your medical care we have the right to mandate/dictate how you behave"
Of course you are right in saying that consent is crucial. The danger as I see it is more from civil servants/administrators rather than frontline medics. A doctor in the NHS is paid by the State, but his/her responsibility is to the patient: there is an inevitable element of tension, and maybe conflict, there.
That's not a fair reflection on the NCH project. They chose the Mater site originally, then An Bord Pleanala rejected it. No-one can really be blamed for not knowing how ABP would react in advance. You only have to look at the series of High Court rulings about ABP proceedings to see how unpredictable they are.Pandiculation wrote: »Everything about it just strikes me as pathetically bad planning and various vested interests setting agendas, including an element of empire building. If you look at how that NCH project was bounced around from site to site, it was like nobody had oversight of it and a bunch of people just all had notions about where it should be.
After it was ruled out, an expert group revisited it the options and chose the St James site. Of course, every bar stool expert had their own views on M50 sites and Blanch sites, but the expert group made an expert decision.0 -
[Deleted User] wrote: »Your automatic defense of the public service, as a public servant, is why we can’t have an NHS. It needs accountability.
What do you define as accountability? What is it and who is it who must be accountable? Who will hold that person to account? Will this standard of accountability to apply to every person in the work force in ireland? What is different about accountability in the NHS when compared to ireland? And how is that difference better?0 -
What do you define as accountability? What is it and who is it who must be accountable? Who will hold that person to account? Will this standard of accountability to apply to every person in the work force in ireland? What is different about accountability in the NHS when compared to ireland? And how is that difference better?
Ordeal by lots of questions.
I’ll take two.
Will this standard of accountability to apply to every person in the work force in ireland?
People are routinely fired in private sector jobs.
What is different about accountability in the NHS when compared to ireland
The U.K. divides its hospitals into trusts, those trusts have democratically elected governors, and people can be fired.
https://www.nationalhealthexecutive.com/Health-Care-News/newcastle-trust-ceo-sacked-for-gross-misconduct-
Why is it up to me to solve your problems anyway? Clearly the HSE is inefficient, in a country with a younger population, and a back up private insurance model, than the U.K.0 -
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4000 per person a year to run the HSE
We're one of the top spenders for public health care in the EU which is mind blowing when you consider that we also spend a fortune on private healthcare
Whats wrong with the HSE? Screams the public sector, nothing from their perspective I suppose. Joe taxpayer will wonder why he pays a fortune for a dysfunctional system on top of the private healthcare he needs because he's stupid enough to work.
Not to worry though, Slaintecare will offer more of the same with a new name. Happy days.0
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