An "Irish NHS" - what needs to change?

Traumadoc

karlitob wrote: »

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.


.

Rubbish.

karlitob

jcon1913 wrote: »

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.

No matter what the salary - it’ll always be the largest part of any budget. It’s approx 80-85% I think. If you halved salaries, there would be a commensurate reduction in funding.

Average full time wage in ireland in 2019 was €49k. In 2017 the health service paid 110k staff €6.7bn which is about €63k on average. This is just a quick search but considering the speciality and high standards on training I wouldn’t have thought they health staff and paid too much - except social workers. They’re paid way too much in my view for what they do.

jcon1913

mariaalice wrote: »

My point is that even at the salaries they have now there are many vaccines, so reducing salaries would result in even more vaccines.

Not necessarily - the vacancies are not being filled for more complex reasons than low salaries.

You failed to contradict my points that salaries in the health services are too high relative to other workers in Ireland and internationally.

We need to train more docs via the graduate courses and recruit overseas docs that would help

karlitob

Traumadoc wrote: »

Rubbish.

Happy to be educated.

Are you saying we have no problem with foreign educated doctors in peripheral hospitals like letterkenny, naas etc. Why can’t foreign trained docs get on training schemes. If there are so many vacant consultant posts why aren’t they being filled by foreign trained doctors?

Genuinely asking your view.

jcon1913

karlitob wrote: »

No matter what the salary - it’ll always be the largest part of any budget. It’s approx 80-85% I think. If you halved salaries, there would be a commensurate reduction in funding.

Average full time wage in ireland in 2019 was €49k. In 2017 the health service paid 110k staff €6.7bn which is about €63k on average. This is just a quick search but considering the speciality and high standards on training I wouldn’t have thought they health staff and paid too much - except social workers. They’re paid way too much in my view for what they do.

Now compare what Irish health staff are paid relative to other workers in Ireland and internationally if you want

Traumadoc

jcon1913 wrote: »

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

They reduced the salaries and people left , unfortunately efforts to recruit from abroad failed miserably and now hundreds of consultant positions are unfilled , hospitals cannot recruit nurses , unless they come from the phillipines or India.

CramCycle

I always thought the HSE and NHS were broadly similar but talking to people who have moved here or returned from the UK, it simply isn't. It is great compared to some places but that isn't good enough. It is better than the US but the cost of a GP or A&E visit is prohibitive to those with a minor but genuine need that you run the risk of missing many things.

Personally, I would love a costing done of if we stopped charging A&E entry fee and GP fees, removed the administration staff who deal with the bills in the HSE and redeployed them to other sections of the civil service, and there are a lot, what would the true cost be. Taking into account that the sooner people are treated or seen too, the less they are likely to cost the state in the long run. the only administrative staff should be appointment booking, rotas and procurement. I would happily pay more tax for a better run and no cost prohibitive entry requirement. The fact that we hear on a regular basis a selling point for private health insurance is that some customers wouldn't be here if they hadn't had VHI take care of them super quick. That is not a positive, that is a horrifying negative.

karlitob

jcon1913 wrote: »

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 change

We’re not as bad across the board as everyone makes out. I’m sure you mean access but we are actually brilliant at providing services considering the low number of beds and low number of doctors. Have a look at some of the oecd stats.
We’re also fairly good at cancer services.
And all in all fairly good at our health outcomes.

Clearly lots of problems and lots of areas to improve upon. But not as bad as is often made out.

karlitob

Traumadoc wrote: »

They reduced the salaries and people left , unfortunately efforts to recruit from abroad failed miserably and now hundreds of consultant positions are unfilled , hospitals cannot recruit nurses , unless they come from the phillipines or India.

The HSE has recruited 1000s of nurses over the past number of years. 1500 since Dec 2019.

There is a mismatch between college training places and requirements. All newly qualified nurses are given guaranteed contracts. All newly qualified snurses have accelerated access to the enhanced nurse contact where the midpoint salary is €64k.

The Irish health system has the most nurse per capita than any other oecd country and the highest ratio of nurses to docs.

We need more docs, we need nurses in certain areas such a theatre and critical care, and we need more healthcare professionals that aren’t just nurses - pharmacists, physios, ots, speechies. We need extended scope of practice and more advanced roles for those professions and all other 30 HSCPs. There’s more to healthcare than docs and nurses. Why do nurses have 2% of their workforce in advanced practice roles and the rest of us plebs making do. The tyranny of the majority.

Traumadoc

karlitob wrote: »

Happy to be educated.

Are you saying we have no problem with foreign educated doctors in peripheral hospitals like letterkenny, naas etc. Why can’t foreign trained docs get on training schemes. If there are so many vacant consultant posts why aren’t they being filled by foreign trained doctors?

Genuinely asking your view.

Not really , we have a problem recruiting consultants for a start , for example in Letterkenny you might have 3 orthopaedic consultants , its pretty tough doing a 1 in 3 call with poor support , much more attractive jobs elsewhere doing a 1 in 10 call in say a large Dublin hospital
When specialist training positions are decided , the 10 Dublin consultants will win out and the specialist registration positions will go to Dublin hospitals.

The doctors wanting to get onto specialist training soon learn that to get on to a scheme , you are better working in a Dublin hospital . hence working in a peripheral hospital is seen as a dead end job.

Irish doctors seldom if ever want to work as junior doctors in Letterkenny, there are easier , and better jobs for career progression.

The difficulty in recruiting also suits an agenda to close these hospitals in a Chomsky manner , - eg no one Irish will apply for consultant position to work in Port Laoise hospital as it is the next to close .

As for the reason non- nationals cannot get on training jobs is because they are full of Irish who leave once trained.

Traumadoc

karlitob wrote: »

No matter what the salary - it’ll always be the largest part of any budget. It’s approx 80-85% I think. If you halved salaries, there would be a commensurate reduction in funding.

Average full time wage in ireland in 2019 was €49k. In 2017 the health service paid 110k staff €6.7bn which is about €63k on average. This is just a quick search but considering the speciality and high standards on training I wouldn’t have thought they health staff and paid too much - except social workers. They’re paid way too much in my view for what they do.

Does that include employers PRSI and pension costs

And you said that pay accounts for 80-85% of HSE spend , so therefore the annual budget for the HSE is less than 10 billion?

karlitob

Traumadoc wrote: »

Does that include employers PRSI and pension costs

And you said that pay accounts for 80-85% of HSE spend , so therefore the annual budget for the HSE is less than 10 billion?

Didn’t think I’d be quizzed but fair enough - I was wrong. €6bn pay and pensions and €11bn in non pay costs. I was miles off.

https://www.hse.ie/eng/services/publications/corporate/hse-annual-report-and-financial-statements-2019.pdf

Traumadoc

karlitob wrote: »

Didn’t think I’d be quizzed but fair enough - I was wrong. €6bn pay and pensions and €11bn in non pay costs. I was miles off.

https://www.hse.ie/eng/services/publications/corporate/hse-annual-report-and-financial-statements-2019.pdf

Yep the pay and pensions cost of the HSE accounting for 80% of costs is a lie told often enough to get the mob mad that they believe it to be the truth and demand pay cuts.

karlitob

Traumadoc wrote: »

Yep the pay and pensions cost of the HSE accounting for 80% of costs is a lie told often enough to get the mob mad that they believe it to be the truth and demand pay cuts.

I presume you’re not intimating i lied - I was wrong. If I lied I wouldn’t have put in correct pay costs - in both posts. Nor have I advocated for pay cuts - except for social workers. I’m fairly strong on that point.

Traumadoc

karlitob wrote: »

I presume you’re not intimating i lied - I was wrong. If I lied I wouldn’t have put in correct pay costs - in both posts. Nor have I advocated for pay cuts - except for social workers. I’m fairly strong on that point.

No a lie would be deliberate , but it is a common belief - why did you state that- was it your belief ad if so why?

PhoneMain

karlitob wrote: »

Happy to be educated.

Are you saying we have no problem with foreign educated doctors in peripheral hospitals like letterkenny, naas etc. Why can’t foreign trained docs get on training schemes. If there are so many vacant consultant posts why aren’t they being filled by foreign trained doctors?

Genuinely asking your view.

Personally I think it's because they know Irish people (unless you're from the locality) dont want to move to the likes of Portlaoise, Ballinasloe, Tullamore, Clonmel, Ennis, Letterkenny etc. Keeping the situation as is means that foreign doctors make up a large percentage of staff in these places with the occasional training scheme doctor sent there for a year or so.

karlitob

Traumadoc wrote: »

Not really , we have a problem recruiting consultants for a start , for example in Letterkenny you might have 3 orthopaedic consultants , its pretty tough doing a 1 in 3 call with poor support , much more attractive jobs elsewhere doing a 1 in 10 call in say a large Dublin hospital
When specialist training positions are decided , the 10 Dublin consultants will win out and the specialist registration positions will go to Dublin hospitals.

The doctors wanting to get onto specialist training soon learn that to get on to a scheme , you are better working in a Dublin hospital . hence working in a peripheral hospital is seen as a dead end job.

Irish doctors seldom if ever want to work as junior doctors in Letterkenny, there are easier , and better jobs for career progression.

The difficulty in recruiting also suits an agenda to close these hospitals in a Chomsky manner , - eg no one Irish will apply for consultant position to work in Port Laoise hospital as it is the next to close .

As for the reason non- nationals cannot get on training jobs is because they are full of Irish who leave once trained.

Thanks for that.

Why do docs not want to be consultants in letterkenny (as opposed to junior docs as you mention above)

karlitob

PhoneMain wrote: »

Personally I think it's because they know Irish people (unless you're from the locality) dont want to move to the likes of Portlaoise, Ballinasloe, Tullamore, Clonmel, Ennis, Letterkenny etc. Keeping the situation as is means that foreign doctors make up a large percentage of staff in these places with the occasional training scheme doctor sent there for a year or so.

Well I would think there’s some element to it. I haven’t seen a breakdown on geography of vacant consultant posts but I doubt it’s in Dublin, Limerick, cork, Galway or even Waterford. Which makes me thing that the reason are not all salary related.
I’m a healthcare progressional also - couldn’t pay me enough to work in letterkenny. All the actions in the big hospital. But there might be a salary that people would move there for. But then you have different salary levels (as there already is).

PhoneMain

karlitob wrote: »

Well I would think there’s some element to it. I haven’t seen a breakdown on geography of vacant consultant posts but I doubt it’s in Dublin, Limerick, cork, Galway or even Waterford. Which makes me thing that the reason are not all salary related.
I’m a healthcare progressional also - couldn’t pay me enough to work in letterkenny. All the actions in the big hospital. But there might be a salary that people would move there for. But then you have different salary levels (as there already is).

Healthcare professional as well. I think there's definitely a geography element to it as well, if you're from Galway, Cork, Dublin then there's a reasonable chance you'll have gone to college there, you might intern there, your friends & family will be there so why would you want to base your life in somewhere like the midlands where you dont have many facilities or connoections of things like the sea never mind working in a smaller hospital that might not work as well (I'm being policially correct here, I could describe these hospitals in other ways!) with less resources.

Traumadoc

karlitob wrote: »

Thanks for that.

Why do docs not want to be consultants in letterkenny (as opposed to junior docs as you mention above)

Mostly it is the onerous call usually one in 3, you get the same pay as someone on a one in 10 call in Dublin.

Dublin/Galway/Limerick/Cork would have higher levels of private patients - plus access to private hospitals, one of which is co- located with the public hospital.

Traumadoc

karlitob wrote: »

Well I would think there’s some element to it. I haven’t seen a breakdown on geography of vacant consultant posts but I doubt it’s in Dublin, Limerick, cork, Galway or even Waterford. Which makes me thing that the reason are not all salary related.
I’m a healthcare progressional also - couldn’t pay me enough to work in letterkenny. All the actions in the big hospital. But there might be a salary that people would move there for. But then you have different salary levels (as there already is).

You earn far less in the country hospitals., also the country loading for consultants not working in the East of the country was removed in 2008. But that said there are difficulties recruiting in Dublin/Cork as well- but there wont be any closures of Dublin/Cork hospitals because they cannot recruit - the same cannot be said for country hospitals.

karlitob

PhoneMain wrote: »

Healthcare professional as well. I think there's definitely a geography element to it as well, if you're from Galway, Cork, Dublin then there's a reasonable chance you'll have gone to college there, you might intern there, your friends & family will be there so why would you want to base your life in somewhere like the midlands where you dont have many facilities or connoections of things like the sea never mind working in a smaller hospital that might not work as well (I'm being policially correct here, I could describe these hospitals in other ways!) with less resources.

And of course therein lies the problem. ‘We’ are only good at our jobs because we’re in big hospitals with lots of support, lots of dedicated professionals and lots of interesting patients. We stand on the shoulders of giants who made the hospital what it is and we just add to it.
Staff in those other hospitals don’t have that luxury. No ‘big’ consultant jobs. No nice things said about them. Comments from the likes of me looking down their nose at them. It’s no wonder they don’t function so well. And yet they are of critical importance to the health service. Model 3s and model 2s are so important. Imagine what they’d be like if we could transfer our best healthcare professionals from all disciplines in the big hospitals (inc managers) down there.

karlitob

Traumadoc wrote: »

You earn far less in the country hospitals., also the country loading for consultants not working in the East of the country was removed in 2008.

Can you explain that? How would consultants on comparable contracts (a, b or c) earn less in a hospital in the country rather than city?

karlitob

Traumadoc wrote: »

Mostly it is the onerous call usually one in 3, you get the same pay as someone on a one in 10 call in Dublin.

Dublin/Galway/Limerick/Cork would have higher levels of private patients - plus access to private hospitals, one of which is co- located with the public hospital.

But there’s onerous calls in Dublin. The children’s hospitals - some surgical services.
Max fax in sjh if I remember correctly.

And there’s not been b or c contracts in a while in thought. Public only contract in SVUH is the same as LUH, is it not?


By the way - why aren’t you working??!!!!

PhoneMain

karlitob wrote: »

By the way - why aren’t you working??!!!!

Go easy on him, I'm supposed to be studying

conorhal

When it comes to solutions, I have a few suggestions.

1) Train enough doctors.
At minimum we need to double the number of doctors we train, why are we not doing this?
Fund the places in colleges and put the infrastructure in place to produce enough doctors to meet our needs. we piss billions up the wall when mere millions are not being spent to address a root cause of the issue.

2)Retaining graduates from medical school.
I think most people would agree that graduates in medicine are a resource that the state has invested a significant amount of time and money training but year after year nothing is done to retain such vital resources in the state.
We should be offering those good enough to get into medicine zero fees, free accomodation and a per-diem to students that constitute a critical resource that we require.
However, these benefits should only be offered on the basis that those in reciept of them are obliged to work within the Irish hospital system for 10 years. If that doesn't suit them and they want to hop on the first plane to the UK or the US instead then then would be required to pay back the cost of their education in full or chose to pay it in full from the outset.

3) Wages in medicine need to go down and so do the hours worked.
You can make a hell of a lot of money as a doctor, if you're prepared to burn out fast.
Some kind of balance needs to be created where we pay less but provide medical professionals better conditions in compensation for that. No doctor should have to work more then a 40hr week and shift work should accomodate a life.
That means more doctors working fewer hours on less pay. I personally know a couple of doctors that have left high paying jobs to have a work life balance.

jcon1913

conorhal wrote: »

When it comes to solutions, I have a few suggestions.

1) Train enough doctors.
At minimum we need to double the number of doctors we train, why are we not doing this?
Fund the places in colleges and put the infrastructure in place to produce enough doctors to meet our needs. we piss billions up the wall when mere millions are not being spent to address a root cause of the issue.

2)Retaining graduates from medical school.
I think most people would agree that graduates in medicine are a resource that the state has invested a significant amount of time and money training but year after year nothing is done to retain such vital resources in the state.
We should be offering those good enough to get into medicine zero fees, free accomodation and a per-diem to students that constitute a critical resource that we require.
However, these benefits should only be offered on the basis that those in reciept of them are obliged to work within the Irish hospital system for 10 years. If that doesn't suit them and they want to hop on the first plane to the UK or the US instead then then would be required to pay back the cost of their education in full or chose to pay it in full from the outset.

3) Wages in medicine need to go down and so do the hours worked.
You can make a hell of a lot of money as a doctor, if you're prepared to burn out fast.
Some kind of balance needs to be created where we pay less but provide medical professionals better conditions in compensation for that. No doctor should have to work more then a 40hr week and shift work should accomodate a life.
That means more doctors working fewer hours on less pay. I personally know a couple of doctors that have left high paying jobs to have a work life balance.

Some good points there.

Very difficult to get students to pay after they leave college.

Maybe get rid of the undergraduate courses and make medicine a graduate school thing. Higher fees and more mature students.

The students going in to medicine at age 22/23/24 would be graduates from science etc and would be more committed to a career in medicine.

IMHO from meeting both med students who went the undergraduate course and others who went the post-graduate route the latter seem happier with their choice- as in they had more time to think about it.

Sweeping generalisations so feel to disagree

Anita Blow

conorhal wrote: »

2)Retaining graduates from medical school.
I think most people would agree that graduates in medicine are a resource that the state has invested a significant amount of time and money training but year after year nothing is done to retain such vital resources in the state.
We should be offering those good enough to get into medicine zero fees, free accomodation and a per-diem to students that constitute a critical resource that we require.
However, these benefits should only be offered on the basis that those in reciept of them are obliged to work within the Irish hospital system for 10 years. If that doesn't suit them and they want to hop on the first plane to the UK or the US instead then then would be required to pay back the cost of their education in full or chose to pay it in full from the outset.

This in practice would be damaging to the health service. Ireland is small and critically dependent on trainees going abroad on fellowships during HST or post-CCST to larger centres to gain further experience/sub-specialisation and then return to Ireland to bring those skills back.
The reality of this is that trainees entirely self fund this fellowship and take a massive pay cut in doing so (in most countries a fellowship would be about 50% of a registrar salary) so they save for many years (or take out a loan) for this experience abroad.

While a good deal (probably most I'd say) do come back at some point, many stay abroad for a multitude of reasons relating to the HSE. Working conditions for doctors are absolutely shocking and this remains so as a consultant. Another big factor is that the jobs just aren't where people want to work- we have far too many small regional hospitals that do bog standard medicine/surgery and it's difficult for someone that's gone on fellowship in Harvard or Melbourne or London to come back and work in a small rural centre with none of the complexity they've spent years specialising in.

ILoveYourVibes

conorhal wrote: »

2)Retaining graduates from medical school.

I think Irish nurses in the UK are like the highest non uk nationals represented ...or a close second.

Traumadoc

karlitob wrote: »

But there’s onerous calls in Dublin. The children’s hospitals - some surgical services.
Max fax in sjh if I remember correctly.

And there’s not been b or c contracts in a while in thought. Public only contract in SVUH is the same as LUH, is it not?


By the way - why aren’t you working??!!!!

Sorry just got home an hour ago. Onerous call in Dublin is only in specialities in which there are no positions outside of Dublin eg Max fax or paediatric neurosurgery.

As for b or c contracts , most contracts offered now are B contracts some C contracts but a lot of positions are changed quickly after appointment form B to C.

The only A contracts ( public only) are in Emergency medicine or psychiatry.

If you want to go through them: look at the information booklets

https://publicjobs.ie/en/job-search?category=3&searchphrase=


But you can see most advertised consultant positions are B.