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An "Irish NHS" - what needs to change?
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[Deleted User] wrote: »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.
Ordeal by throwing out banal comments without any thought process to back it up.
Ordeal by ‘accountability’ means sacking. Or at least only for ‘managers’
Ordeal by banal references to private sector.
- I have commented on that above already. The health service managers do not have the same ‘authority’ to sack their employees like penny’s does. No manager in the HSE can sack a consultant. Depending on the contract they’re on, only the ceo of the HSE can suspend a consultant. Unless there’s an obvious assault or something like that, a sacking can only happen when a separate legal entity (ie the medical council) finds against a consultant, and even then the law dictates that all other remedies must be gone though before you sack. Find me an example of that in the magic private sector.
HSE managers of hospitals do not earn more than the top docs in the hospital. Find me an example of that in the magic private sector.
I have highlighted Issues relating to the private sector above that causes some of the problems with the HSE. For example, the entire access to health services in the community is through a GP - they are 100% private sector sole traders (some are ltd companies) and the same with the pharmacists. That’s 6000-7000 SEPARATE contracts to sign with 6000-7000 SEPARATE private sector companies for the medical card scheme. The same private sector companies that you, as a tax payer, have laid €60 per shot per vaccine; that you pay €10 per sick cert, that you pay more for a locum consult than your GP, that you as a tax payer pay (mostly) for bloods and images that they order but have no recourse to the cost, that you pay for part of their indemnity and their superannuation.
So you can mouth off about mangers all you want and the magic private sector but this is the doctors set up for doctors.
As for your next part, there is no UK NHSs. There are 4 SEPARATE NHSs who all function in very different ways. It’s not clear what link you’re trying to make. One CEO of a trust in the UK was sacked for gross misconduct and fraud, and you think that some ceo in the HSE should be sacked? Do you have information that others don’t? You have a number of options available to you - protected disclosures or the guards. I’d be happy to support you as - like you - I don’t want a CEO who breaks the law and their contract. However unlike you I would want evidence first that they did something wrong, something that was in their power.
As for your comments on democratically elected governors and trusts. Firstly, there’s no evidence that there services in NHS Engl (which is what you meant) work better than ours or for other parts of the NHS which don’t have them. The reasons for our relative underperformance is not due to the absence of democratically elected governors.
We already had health boards which were controlled by democratically elected health boards and they weren’t very successful.
As for your comment on trusts, well it was part of the Fine Gael manifesto in 2011. James Reilly introduced Hospital Groups as one part of a 4 point plan. One key part of that plan was to move towards a single payer insurance model. The one that Australia had before it went to multiplayer - costs sky rocketed and now they want back to single payer. There’s your private sector for you. But back to ireland - guess who blocked it. You got it, the private sector GPs and private sector consultants who would’ve seen their take home go down significantly. Good ol private sector. And good ol GPs - without them we could’ve had universal access to healthcare in the 1950s. But we don’t - cos they’re private sector.
So while HIspital Groups have their problems, the plan was never fully implemented because of significant resistance by the people who are needed to make this happen and who managers have no authority over.
So you can mouth off about CEOs all you want but the facts don’t change. The system is perfectly designed to get the results it currently has.0 -
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.
Yes it’s expensive. There are a number of reasons for it. The main one being salaries and pensions - 1.5% of the HSE is admin and managers and 0.5% are managers. A much lower number than the NHS which also state there numbers are far too low for what they need. The mid salary costs of a staff nurse inc employer PRSI is €60k not including about 20% non pay costs (PPE etc). That’s a lot for someone with a basic 4 year professional degree.
The second main one is historical underfunding in infrastructure which makes current spend relatively more expansive. From 1980-2010, there was - in effect and when compared to the OECD - 15 years of NO financial increase in the health service. We put nothing in for 15 of those 30 years.
The third is the funding model - as you say we spend a lot on private health care and private health insurance; about 41% of population has it. About 47% has a medical card or GP card when it’s supposed to be means tested based on income not need. And we pay 4% health levy as part of our PRSi, and now our ASC - not everyone pays it.
The fourth main one is infrastructure - we’re very far behind in terms of digital, primary care (the only oecd country without universal access to primary care) and we closed hospitals in the 80s and have yet to build a new one. Yesterday will always be cheaper than today to build something.
The fifth main reason is drug costs - we spend a lot of money on drugs that have limited effectiveness because I) docs like giving it and ii) people demand it.
Point I) Did you know that proton pump inhibitors are the second largest drug cost on the medial card. Docs give so many drugs you need another drug to settle your stomach. Did you know that there’s **** all research to support the use of arthroscopies - yet orthopods do it all the time. Have you even asked a doc to consider reducing their prescribing? Ha - it’s great fun. Sure what would their buddy pharmacists do if they couldn’t charge for dispensing all the the drugs.
Point II) a lot of cancer drug modifying diseases are based on statistical modelling and do not have the real world effect that they state. Yet everyone wants pembro. Orkambi has limited improvement in lung function volumes - about 2-3% and no real world evidence that it reduces infective exacerbations, hospitalisations or death - yet the taxpayer spent €600m on it; despite the HSE body - the national pharmoexonomics centre - not recommending its purchase.
Clearly, none of these are HSE caused problems - they are government policy caused problems going back decades.0 -
[Deleted User] wrote: »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.
If you're routinely firing people, that means you are routinely awful at recruitment and management. Since when did routinely firing people become something to boast about?0 -
Ordeal by throwing out banal comments without any thought process to back it up.
Ordeal by ‘accountability’ means sacking. Or at least only for ‘managers’
Ordeal by banal references to private sector.
- I have commented on that above already. The health service managers do not have the same ‘authority’ to sack their employees like penny’s does. No manager in the HSE can sack a consultant. Depending on the contract they’re on, only the ceo of the HSE can suspend a consultant. Unless there’s an obvious assault or something like that, a sacking can only happen when a separate legal entity (ie the medical council) finds against a consultant, and even then the law dictates that all other remedies must be gone though before you sack. Find me an example of that in the magic private sector.
Well there is something to fix.HSE managers of hospitals do not earn more than the top docs in the hospital. Find me an example of that in the magic private sector.
I have highlighted Issues relating to the private sector above that causes some of the problems with the HSE. For example, the entire access to health services in the community is through a GP - they are 100% private sector sole traders (some are ltd companies) and the same with the pharmacists. That’s 6000-7000 SEPARATE contracts to sign with 6000-7000 SEPARATE private sector companies for the medical card scheme.
Something else to fix. By the way the public private sector nexus is part of the problem, no doubt about it. The NHS has full time state GPs.The same private sector companies that you, as a tax payer, have laid €60 per shot per vaccine; that you pay €10 per sick cert, that you pay more for a locum consult than your GP, that you as a tax payer pay (mostly) for bloods and images that they order but have no recourse to the cost, that you pay for part of their indemnity and their superannuation.
So you can mouth off about mangers all you want and the magic private sector but this is the doctors set up for doctors.
That needs fixing. This "private sector" in health care in reality an extension of the state. When we criticise the HSE, in reality we are criticising the whole health service model, including the private sector .As for your next part, there is no UK NHSs. There are 4 SEPARATE NHSs who all function in very different ways. It’s not clear what link you’re trying to make. One CEO of a trust in the UK was sacked for gross misconduct and fraud, and you think that some ceo in the HSE should be sacked? Do you have information that others don’t? You have a number of options available to you - protected disclosures or the guards. I’d be happy to support you as - like you - I don’t want a CEO who breaks the law and their contract. However unlike you I would want evidence first that they did something wrong, something that was in their power.
The number of NHS bodies is obviously totally irrelevant to my argument which was a simple google link on a manager being fired. The evidence that I have that the HSE doesn't sack HSE managers is that it doesn't.As for your comments on democratically elected governors and trusts. Firstly, there’s no evidence that there services in NHS Engl (which is what you meant) work better than ours or for other parts of the NHS which don’t have them. The reasons for our relative underperformance is not due to the absence of democratically elected governors.
We already had health boards which were controlled by democratically elected health boards and they weren’t very successful.
You asked about accountability, so I gave an example of accountability. Now you are trashing around with irrelevance about whether that accountability is in the English or Scottish NHS. Who cares. I shouldn't be explaining accountability to you anyway.As for your comment on trusts, well it was part of the Fine Gael manifesto in 2011. James Reilly introduced Hospital Groups as one part of a 4 point plan. One key part of that plan was to move towards a single payer insurance model. The one that Australia had before it went to multiplayer - costs sky rocketed and now they want back to single payer. There’s your private sector for you. But back to ireland - guess who blocked it. You got it, the private sector GPs and private sector consultants who would’ve seen their take home go down significantly. Good ol private sector. And good ol GPs - without them we could’ve had universal access to healthcare in the 1950s. But we don’t - cos they’re private sector.
So while HIspital Groups have their problems, the plan was never fully implemented because of significant resistance by the people who are needed to make this happen and who managers have no authority over.
So you can mouth off about CEOs all you want but the facts don’t change. The system is perfectly designed to get the results it currently has.
Great, then that is something to fix. Off you go and fix it
The fact is the service provided here is bad. This is a empirical truth.
Of the 32 countries surveyed, Ireland's healthcare comes in 31st place on the list scoring a paltry 50.38 out of 100 on the HealthCare Index, losing out on last place to a spirited effort from Ukraine (49.69).
If you spent as much time trying to fix it as you doing arguing against those facts and asking the taxpayers what we mean by "accountability" and other diversions then we might get to 28 out of 32. Baby steps.0 -
[Deleted User] wrote: »Well there is something to fix.
Something else to fix. By the way the public private sector nexus is part of the problem, no doubt about it. The NHS has full time state GPs.
That needs fixing. This "private sector" in health care in reality an extension of the state. When we criticise the HSE, in reality we are criticising the whole health service model, including the private sector .
The number of NHS bodies is obviously totally irrelevant to my argument which was a simple google link on a manager being fired. The evidence that I have that the HSE doesn't sack HSE managers is that it doesn't.
You asked about accountability, so I gave an example of accountability. Now you are trashing around with irrelevance about whether that accountability is in the English or Scottish NHS. Who cares. I shouldn't be explaining accountability to you anyway.
Great, then that is something to fix. Off you go and fix it
The fact is the service provided here is bad. This is a empirical truth.
Of the 32 countries surveyed, Ireland's healthcare comes in 31st place on the list scoring a paltry 50.38 out of 100 on the HealthCare Index, losing out on last place to a spirited effort from Ukraine (49.69).
If you spent as much time trying to fix it as you doing arguing against those facts and asking the taxpayers what we mean by "accountability" and other diversions then we might get to 28 out of 32. Baby steps.
Firstly, I’ll take my comparator evidence from reliable resources rather than some ‘independent survey’ that you just google. Have a read below and maybe you could learn something.
https://www.oecd-ilibrary.org/docserver/2393fd0a-en.pdf?expires=1620502379&id=id&accname=guest&checksum=EBACB2E34DF2D7A8218CD02A29C72D27
Secondly, I’m a tax payer too. Your voice and opinion is not above mine - it’s equal to mine. If I am to hold a fellow citizen to account I need to know what it means, what is the threshold to be held to account on, what resources are the made available, and how fair is that when compared to other employees in this state. Bandying about catchphrases on accountability when you can’t seem to define it is your problem and not mine.
Finally, and I understand your ignorance on these issues, but these are government policy issues and not management issues. See post above. It’s not for me to ‘fix’ but I’m happy with my contribution.0 -
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AndrewJRenko wrote: »If you're routinely firing people, that means you are routinely awful at recruitment and management. Since when did routinely firing people become something to boast about?
When did I say it was. Stop diverting. Clearly the question was on accountability.0 -
The yearly budget for health is now nearly €20 billion, how we haven't a health service thats world class for that money and with a population you could fit in part of London is a question that needs an answer.
Maybe Paul Reid with his 400 k salary could tell us.0 -
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.
Interesting points but only to someone outside the UK system. ( I am English and have been in Ireland for 20 years; a pensioner now)
The NHS has been an integral part of UK life for a long while now. I think the medical card system is based on it here?
What exactly do you mean by tension and conflict?
And of course you are meaning non medical card folk here? I found basically little difference here as a pensioner to accessing medical care.
And many in the UK choose to " go private" to avoid waiting lists.
But conflict? Yes we have waiting lists - but the same here for medical card folk at least.
The real tension in the UK s with eg waiting lists ie that non emergency treatments are not always immediate. But I see that here too. My neighbour waited three years for a hip replacement in sheer disabling agony
What has shocked me here is hearing folk who are on the borderline re qualifying for medical card care not being able or barely able to afford some procedure they needed.0 -
Galwayguy35 wrote: »The yearly budget for health is now nearly €20 billion, how we haven't a health service thats world class for that money and with a population you could fit in part of London is a question that needs an answer.
Maybe Paul Reid with his 400 k salary could tell us.
I’ve given some reasons in my last few posts.0 -
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Galwayguy35 wrote: »The health service in this country is a shambles for public patients, unfortunately I'm one of them who needs an operation and will probably be waiting until next year before anything happens and will still have to pay for it.
Well I disagree. It’s not a shambles.
The main issue relates to access - we have too many patients who need a service and not enough capacity. It doesn’t suit you at the moment and I am sorry to hear that. There’s a constant stress, worry and I’m sure pain. I presume ‘still have to pay for it’ is the statutory charge.
Your health service provides care to every single citizen in this state at all points of their life. It has a lot of problems. But it’s not a shambles.0 -
[Deleted User] wrote: »When did I say it was. Stop diverting. Clearly the question was on accountability.
Who do you want to be accountable for what?0 -
There are multiple factors for the shambles HSE it is - very poor bang for the buck, second highest spending per capita in OECD but overall quality of healthcare (accessibility, outcomes etc) is in the bottom of the league (EHIC). But there's certainly a lot of waste in the system, inflationary spiralling costs with no corresponding improvement of the output. The fish stinks from the head...karlitob wrote: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.
Care to respond to that and my point about the comparison with the Nordic countries?
https://www.breakingnews.ie/ireland/hse-boss-paid-e420103-in-2020-1093555.html
HSE CEO 420k pa. WTF. There are other staff on extremely high salaries. I know this is only a fraction and a drop in the sea of hse expenses but shows what's wrong. It's a symptom.
Sweden has NO HSE CEO equivalent because simply there's no need for a CEO as their healthcare is decentralised (as it should be). There are 70 regional hospitals there. The senior hospital director salary is 80-100k including bonuses, if they are long serving could be up to 120k. Swedish price level is the same/similar as in the Ireland. In Ireland, the hospital bosses have 120k minimum, plus various bonuses, commonly 200k+, and some made it to news with 300k salaries.
The fact that PUBLIC health service is called "executive" and has a CEO (and CTO etc) just like some corporation shows what's wrong with the setup. Public healthcare is not a corporation and doesn't need CEO and this wasteful central management layer on top of it. This only adds waste. Leave it to the minister of health and decentralise as in Netherlands, Austria, Nordics.0 -
Not NHS, why we can't have Dutch, Austrian, Danish, Finnish system.[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.
..
Irish government doesn't like transparency, accountability. HSE is a prime example of what's wrong with this system, it's a cultural issue. Transparency, honesty, efficiency and accountability are obviously not the cultural norm in the Ireland and Irish governance reflects that.0 -
Your health service provides care to every single citizen in this state at all points of their life. It has a lot of problems. But it’s not a shambles.
My mum was telling me about a neighbour of theirs. He had a knee replacement done a couple of months ago, he was waiting 5 years for it. The replacement hadn't gone well and he's going to need another surgery to fix it, the doctor told him that the issue was down to the delay in the initial surgery.
That's the biggest shambles of the HSE. It's not the care you get when you're in there, it's the mad delays on getting appointments.0 -
My mum was telling me about a neighbour of theirs. He had a knee replacement done a couple of months ago, he was waiting 5 years for it. The replacement hadn't gone well and he's going to need another surgery to fix it, the doctor told him that the issue was down to the delay in the initial surgery.
That's the biggest shambles of the HSE. It's not the care you get when you're in there, it's the mad delays on getting appointments.
That’s what I said.0 -
Not NHS, why we can't have Dutch, Austrian, Danish, Finnish system.
..
Irish government doesn't like transparency, accountability. HSE is a prime example of what's wrong with this system, it's a cultural issue. Transparency, honesty, efficiency and accountability are obviously not the cultural norm in the Ireland and Irish governance reflects that.
If you can give some examples to illuminate your point that would be welcomed.
As I’ve already highlighted in my above posts, if you want those type systems you have to have those type systems and the points I highlighted need to be addressed. They relate to historical and current government policy, not operational practice.
The closest system we can compare ourselves to is NHS scotland. Pound for pound we’re pretty similar. But they have twice as many beds as we do because they’re government didn’t cull beds in the 1980s like our government did.0 -
There are multiple factors for the shambles HSE it is - very poor bang for the buck, second highest spending per capita in OECD but overall quality of healthcare (accessibility, outcomes etc) is in the bottom of the league (EHIC). But there's certainly a lot of waste in the system, inflationary spiralling costs with no corresponding improvement of the output. The fish stinks from the head...
Care to respond to that and my point about the comparison with the Nordic countries?
https://www.breakingnews.ie/ireland/hse-boss-paid-e420103-in-2020-1093555.html
HSE CEO 420k pa. WTF. There are other staff on extremely high salaries. I know this is only a fraction and a drop in the sea of hse expenses but shows what's wrong. It's a symptom.
Sweden has NO HSE CEO equivalent because simply there's no need for a CEO as their healthcare is decentralised (as it should be). There are 70 regional hospitals there. The senior hospital director salary is 80-100k including bonuses, if they are long serving could be up to 120k. Swedish price level is the same/similar as in the Ireland. In Ireland, the hospital bosses have 120k minimum, plus various bonuses, commonly 200k+, and some made it to news with 300k salaries.
The fact that PUBLIC health service is called "executive" and has a CEO (and CTO etc) just like some corporation shows what's wrong with the setup. Public healthcare is not a corporation and doesn't need CEO and this wasteful central management layer on top of it. This only adds waste. Leave it to the minister of health and decentralise as in Netherlands, Austria, Nordics.
I’ve already highlighted the issues. They are government policy. If you do not want a central HSE and instead have devolved regional authorities then that is a governmental policy and a major change to legislation. I’m not against it I’m just explaining the context.
As I’ve already stated, We already had that plan in james o Reilly manifesto. But the GPS wouldn’t agree to the funding model. And it was in the middle of the recession. I’m not defending it but that’s the way it was. There was supposed to be legislation to give effect to what you suggest - but it never came. That’s not the HSE fault it’s government.
We still await the regional health authorities which is what you’re alluding to. We wait for legislation. It’s not within the HSE gift.
Finally I don’t defend his salary. Where did I say that? I don’t think any public servant should be on more than the Taoiseach, but I think the Taoiseach should be paid more.
I do however think it’s one of the hardest jobs in the public service.
I’ve already referenced the fact that employees in this country earn more than the employer. Some docs in public service earn 250,000 whereas the ceo eg james earns 120,00€. How does that work in any business?
And I agree with the E in the HSE. It’s not a good look.
I don’t agree that there’s wasteful central management. Covid has proved it. Everything required for Covid was administration - yes administration by clinical staff members but administration is what has us where we’re at. Procurement, contracts, retraining, new hires, teams call set ups, vaccination centres, oxygen, mortuaries. It’s all admin. And admin needs administrators. Abs while it’s not popular to say - we need more administrators.
There’s always references to managers but never directors of nursing. Some of whom like area directors are on 90-100k€. They are administrators. They are managers. They don’t treat patients. What’s the difference between them abs the imaginary managers in your head?0 -
Firstly, I’ll take my comparator evidence from reliable resources rather than some ‘independent survey’ that you just google. Have a read below and maybe you could learn something.
https://www.oecd-ilibrary.org/docserver/2393fd0a-en.pdf?expires=1620502379&id=id&accname=guest&checksum=EBACB2E34DF2D7A8218CD02A29C72D27
So I’m supposed to take your survey over the independent one. Ok.
https://www.numbeo.com/health-care/rankings_by_country.jsp?title=2016®ion=150Secondly, I’m a tax payer too. Your voice and opinion is not above mine - it’s equal to mine.
I said nothing about your voice being less to mine. And my taxes pay for you. Your taxes are really deductions not revenue to the state.If I am to hold a fellow citizen to account I need to know what it means, what is the threshold to be held to account on, what resources are the made available, and how fair is that when compared to other employees in this state.
I am holding the abysmal Irish health service to account. You seem to be personalising the issue.Bandying about catchphrases on accountability when you can’t seem to define it is your problem and not mine.
Not only did I give an example of accountability, I don’t actually have to explain every single normal word used in my posts. Why does it have to be defined? Because clearly you don’t want accountability.Finally, and I understand your ignorance on these issues, but these are government policy issues and not management issues. See post above. It’s not for me to ‘fix’ but I’m happy with my contribution.
Stop accusing the people who pay your wages of “ignorance”. We don’t actually have to know the ins and outs of the health service to know it doesn’t give bang for buck. No doubt there’s a political problem there but there’s also a management problem. The government are funders, and make some limited policy direction. Management decides implementation. Is this why you need accountability defined? Certainly you’ve given an example of lack of accountability here - saying the problem is “not management issues”.0 -
[Deleted User] wrote: »So I’m supposed to take your survey over the independent one. Ok.
https://www.numbeo.com/health-care/rankings_by_country.jsp?title=2016®ion=150
I said nothing about your voice being less to mine. And my taxes pay for you. Your taxes are really deductions not revenue to the state.
I am holding the abysmal Irish health service to account. You seem to be personalising the issue.
Not only did I give an example of accountability, I don’t actually have to explain every single normal word used in my posts. Why does it have to be defined? Because clearly you don’t want accountability.
Stop accusing the people who pay your wages of “ignorance”. We don’t actually have to know the ins and outs of the health service to know it doesn’t give bang for buck. No doubt there’s a political problem there but there’s also a management problem. The government are funders, and make some limited policy direction. Management decides implementation. Is this why you need accountability defined? Certainly you’ve given an example of lack of accountability here - saying the problem is “not management issues”.
First. That’s the OECD data. They are already independent. It’s already a trusted source. I’ll take your ‘independent’ assessment with a pinch of salt.
Second. ‘Blah blah blah my taxes pay for you’. Drivel. Absolute drivel. My taxes pay for you too buddy.
Third. You can’t hold a system to account. You hold people to account. You are depersonalising the issue but making banal comments. You’ve yet to explain what the definition for accountability it, who will decide it, and whether this person is help to a higher account than other people. Moaning in this thread about CEOs who aren’t sacked is a personal issue to the ceo. No more than it’s a personal issue to the doc who goes to the medical council, the nurse to the INMO or ot to Coru. There are clear standards, clear protocols and procedures, and you are ONLY assessed by your peers. Same with the teachers council. Same with the solicitors. Architects. Electricians RECI and plumbers RGI. Why do they get that right and CEOs don’t. Or the ‘managers’ that you mouth off about. I presume you mean nurse managers also.
Fourth. You don’t pay my wages. In fact, you know nothing about me. Comments like that are ignorant. And clearly if you’re not working in health or no knowledge of it - which is clear you don’t - then that’s ignorant. I don’t blame you. It’s hard and complex.
Finally, ‘limited policy direction’ by the DoH shows your ignorance not only of health but all government and wider society. DoH sets policy - all policy. HSE implements it based on money given to it. I’ve described a wide range of issues that are beyond the gift and control of the HSE.
For example - again - salaries account for approx 80-85% of HSE spend. Are you suggesting that the HSE can reduce the salaries of doctors and nurses as well as all other staff in the health service. Don’t be ignorant. That is government policy and beyond the control of the HSE.
Are you saying they the HSE can just build hospitals to increase capacity? Don’t be ignorant. The HSE submits a capital plan every year which doesn’t get funded. Old equipment. Old buildings. I’m sure you’ll mouth off about the children’s hospital but you’ll have likely never heard how the successful the HSE was in delivering that the national forensic mental health service in Portland. On time on budget and an excellent build. Imagine a newspaper saying something positive about your health service. Sure what would you have to Louth off about. Same with the 127 primary care centres and 70 on track.
https://assets.gov.ie/9510/29061fee42564c529864b5ed90fdfea5.pdf
Nope - you’ll reference the highly politicised children’s hospital being built by a separate board - not the HSE. Under the aegis of CHI a separate legal entity. And being built by your magic private sector.
I’ve never said the HSE doesn’t have management issues. They have lots of them. I never said it wasn’t inefficient A there are loads of inefficiencies.
But I am saying that these inefficiencies will not have the major effect that people seek. Those are caused by historical government policy and require major changes to government policy and legislation.
You’ve yet to respond to any specific point that I’ve mentioned in my previous posts. All you’ve said so far is
- HSE bad, though besides access I haven’t given any examples
- I want accountability and here’s a link to CEOs in nhs eng being sacked. But I’m not gonna define accountability and ‘I never said I wanted people sacked’
- I pay your wages.
Happy to engage on anything more intelligent than that. This thread is about the Irish nhs A what needs to change. Besides the banal contributions so far you haven’t really said anything.0 -
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First. That’s the OECD data. They are already independent. It’s already a trusted source. I’ll take your ‘independent’ assessment with a pinch of salt.
Second. ‘Blah blah blah my taxes pay for you’. Drivel. Absolute drivel. My taxes pay for you too buddy.
Third. You can’t hold a system to account. You hold people to account. You are depersonalising the issue but making banal comments. You’ve yet to explain what the definition for accountability it, who will decide it, and whether this person is help to a higher account than other people. Moaning in this thread about CEOs who aren’t sacked is a personal issue to the ceo. No more than it’s a personal issue to the doc who goes to the medical council, the nurse to the INMO or ot to Coru. There are clear standards, clear protocols and procedures, and you are ONLY assessed by your peers. Same with the teachers council. Same with the solicitors. Architects. Electricians RECI and plumbers RGI. Why do they get that right and CEOs don’t. Or the ‘managers’ that you mouth off about. I presume you mean nurse managers also.
Fourth. You don’t pay my wages. In fact, you know nothing about me. Comments like that are ignorant. And clearly if you’re not working in health or no knowledge of it - which is clear you don’t - then that’s ignorant. I don’t blame you. It’s hard and complex.
Finally, ‘limited policy direction’ by the DoH shows your ignorance not only of health but all government and wider society. DoH sets policy - all policy. HSE implements it based on money given to it. I’ve described a wide range of issues that are beyond the gift and control of the HSE.
For example - again - salaries account for approx 80-85% of HSE spend. Are you suggesting that the HSE can reduce the salaries of doctors and nurses as well as all other staff in the health service. Don’t be ignorant. That is government policy and beyond the control of the HSE.
Are you saying they the HSE can just build hospitals to increase capacity? Don’t be ignorant. The HSE submits a capital plan every year which doesn’t get funded. Old equipment. Old buildings. I’m sure you’ll mouth off about the children’s hospital but you’ll have likely never heard how the successful the HSE was in delivering that the national forensic mental health service in Portland. On time on budget and an excellent build. Imagine a newspaper saying something positive about your health service. Sure what would you have to Louth off about. Same with the 127 primary care centres and 70 on track.
https://assets.gov.ie/9510/29061fee42564c529864b5ed90fdfea5.pdf
Nope - you’ll reference the highly politicised children’s hospital being built by a separate board - not the HSE. Under the aegis of CHI a separate legal entity. And being built by your magic private sector.
I’ve never said the HSE doesn’t have management issues. They have lots of them. I never said it wasn’t inefficient A there are loads of inefficiencies.
But I am saying that these inefficiencies will not have the major effect that people seek. Those are caused by historical government policy and require major changes to government policy and legislation.
You’ve yet to respond to any specific point that I’ve mentioned in my previous posts. All you’ve said so far is
- HSE bad, though besides access I haven’t given any examples
- I want accountability and here’s a link to CEOs in nhs eng being sacked. But I’m not gonna define accountability and ‘I never said I wanted people sacked’
- I pay your wages.
Happy to engage on anything more intelligent than that. This thread is about the Irish nhs A what needs to change. Besides the banal contributions so far you haven’t really said anything.
Reduce salaries to everyone in the Health Service
Recruit overseas staff to replace Irish staff who can emigrate
Result - higher staff levels for the same funding resulting in better outcomes for patients
Ideally- that’s the solution. Reduce payroll costs to, say, Swedish levels as alluded to by a previous poster0 -
Reduce salaries to everyone in the Health Service
Recruit overseas staff to replace Irish staff who can emigrate
Result - higher staff levels for the same funding resulting in better outcomes for patients
Ideally- that’s the solution. Reduce payroll costs to, say, Swedish levels as alluded to by a previous poster
One slight problem with that, if you reduce salaries of health care staff the 'foreign staff won't come here why would they when they can go to any country in the world? at best you would get newly graduated staff with little experience coming here for a few months till they figured out how to get to the middle east or the US.
Modern health care is highly skilled and very complex.0 -
Reduce salaries to everyone in the Health Service
Recruit overseas staff to replace Irish staff who can emigrate
Result - higher staff levels for the same funding resulting in better outcomes for patients
Ideally- that’s the solution. Reduce payroll costs to, say, Swedish levels as alluded to by a previous poster
Ideal, until the overseas staff work out that any kind of significant quality of life is impossible here at lower salary levels, and move off somewhere else.
Not really ideal for the countries that we strip of medical staff either.0 -
mariaalice wrote: »One slight problem with that, if you reduce salaries of health care staff the 'foreign staff won't come here why would they when they can go to any country in the world? at best you would get newly graduated staff with little experience coming here for a few months till they figured out how to get to the middle east or the US.
Modern health care is highly skilled and very complex.
We have that already - it’s possible it would work but overpaying staff doesn’t work. The salaries in Ireland relative to the overall health budget are too high. And the salaries are too high relative to other workers in Ireland. And the salaries are too high relative to other countries probably US excepted.0 -
We have that already - it’s possible it would work but overpaying staff doesn’t work. The salaries in Ireland relative to the overall health budget are too high. And the salaries are too high relative to other workers in Ireland. And the salaries are too high relative to other countries probably US excepted.
https://www.independent.ie/irish-news/health/one-in-five-consultant-posts-now-vacant-as-waits-soar-39807008.html0 -
mariaalice wrote: »
I never said there were no vacancies. I’d like to see your comments on the points I made if you can0 -
Reduce salaries to everyone in the Health Service
I’ll let you tell the docs and nurses. Sure aren’t the nurses (and you can tell their nurses because of the halo they on themselves) are looking for 10 extra annual leave days.
Seriously though. It would be mass industrial action. It can’t work.
As for docs, there are issues with foreign doctors getting on training programmes. The main reason is that their standard of basic training is not comparable to Irish graduates. As for nurses, we already bring in loads - though the pandemic in India will seriously affect the states ability to bring in nurses. Again - on a serious note - Philippine nurses leave their families and their children for years, they all live together in small cheap houses and they all do it so that they can provide for their family and villages. They are really amazing people. Anyway, they won’t come if they followed your suggestion.Recruit overseas staff to replace Irish staff who can emigrate
Says who? What outcomes? Presuming you get the numbers, there are few health services that have the quality of training that we do. It’s not a numbers game, it’s a numbers and skills game.Result - higher staff levels for the same funding resulting in better outcomes for patientsIdeally- that’s the solution. Reduce payroll costs to, say, Swedish levels as alluded to by a previous poster
Is it ideal? I thought we stopped the referencing of Scandinavian countries but clearly not. Sweden has its own problems but it functions well. I had thought that Sweden’s average salary for health was much higher than ours but I’ll be guided by you on that.0 -
AndrewJRenko wrote: »Ideal, until the overseas staff work out that any kind of significant quality of life is impossible here at lower salary levels, and move off somewhere else.
Not really ideal for the countries that we strip of medical staff either.
Plenty of people would like to live in Ireland and view the quality of life as ok.
Agree it’s not a good outcome for the countries that they leave0 -
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I’ll let you tell the docs and nurses. Sure aren’t the nurses (and you can tell their nurses because of the halo they on themselves) are looking for 10 extra annual leave days.
Seriously though. It would be mass industrial action. It can’t work.
As for docs, there are issues with foreign doctors getting on training programmes. The main reason is that their standard of basic training is not comparable to Irish graduates. As for nurses, we already bring in loads - though the pandemic in India will seriously affect the states ability to bring in nurses. Again - on a serious note - Philippine nurses leave their families and their children for years, they all live together in small cheap houses and they all do it so that they can provide for their family and villages. They are really amazing people. Anyway, they won’t come if they followed your suggestion.
Says who? What outcomes? Presuming you get the numbers, there are few health services that have the quality of training that we do. It’s not a numbers game, it’s a numbers and skills game.
Is it ideal? I thought we stopped the referencing of Scandinavian countries but clearly not. Sweden has its own problems but it functions well. I had thought that Sweden’s average salary for health was much higher than ours but I’ll be guided by you on that.
I agree not every health worker is a blessing of a human being.
I agree there would be mass industrial action.
We rank badly internationally for delivery of health services. We rank highly in terms of what we spend. Somethings gotta change0
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