The current hospital / A&E crisis

Anita Blow

I've worked in emergency departments and feel very lucky to be able to do bloods or imaging to reassure myself about a clinical decision or guide my management, or to be able to pick up a phone and speak to a specialist team for advice. Even if ED is backed out the door I don't begrudge a decision made by a GP to refer- they're making the best decision based on the information available to them at the time.

I know most would be glad to access community investigations to save referring, but to do this we need infrastructure and we also need far more GPs. Taking bloods from a kid for example would require an additional nurse to help and can take up to 20-25 min which means less people that can be seen in that day.

redlough

https://www.boards.ie/discussion/comment/120089473#Comment_120089473

https://www.boards.ie/discussion/comment/120089754#Comment_120089754

You have zero experience of the job so you have no idea if it is stressful or not.

The one person speaking from actual experience would seem to disagree with you as well.

https://www.boards.ie/discussion/comment/120090533#Comment_120090533

Plenty of people end up with missed or delayed diagnoses that don’t seem to unduly concern GPs. My late mother used to say “as long as you tell the doctor what you think is wrong, they are ok”. She was extremely astute, had to use devious means to obtain the Vitamin B12 & thyroid tests to get the diagnoses she suspected. She ended up adding to the blood requests, which yielded the diagnoses. But one funny typo she made was FSH which caused a great giggle when going back to get the results! She was 84 at the time 😂 From then on I gave her quarterly IM cyanocobalamin.

https://www.boards.ie/discussion/comment/120091077#Comment_120091077

Some GPs are great, some not so. They very much differ in the amount of interest they appear to take in their job. Same with nurses, care assistants, etc. People differ in their approach to work. Many people are square pegs in round holes career-wise. Because mammy & daddy would afford to send daughter/son to medicine & they got the points doesn’t automatically make them suitable material for the role. My own GP is lovely and caring, always feel the better for seeing him, but avoid two of the others in the practice at all costs for very good reason.

yaknowski

In a large Dublin A&E yest where not a wink of sleep was had due to some prisoner wailing for food. 4 Gardai there all night, minding 2 clowns.

Then a well-heeled, well-spoken lady also screaming harassment at one of the workers for not letting her visit her ma in A&E. Garda could have easily told her to jog on but didn't.

Seems to be a lot of internal politicking going on earwigging on convos. Surgeon who accepted me was explaining to a Junior lad about how to play the game as the CT team didn't want to take me on. So he had to convince them in a roundabout way by leaving vagueness that might prompt them to cover their own asses.

Seems like it's fucked from every which way.

Podge_irl

https://www.boards.ie/discussion/comment/120091749#Comment_120091749

Of course there is internal politicking. Has anyone here working in any company that doesn't have internal disagreements and shitfights?

Martina1991

https://www.boards.ie/discussion/comment/120090889#Comment_120090889

I'm a Medical Scientist myself working in a hospital laboratory and the vast majority of our work comes from GP practices.

All of our GP workload is done and processed on the day the sample is taken. On our busiest days (Tuesdays and Wednesdays) some work may be left over, but all GP samples are processed and reported within 24 hours of the sample arriving to the laboratory. A lot of people who have samples (blood, urine, swabs, faeces etc) taken at GP practices are probably told to call or come back in a week or more for the results, but in reality they are done long before that.

We often have to phone GPs to notify them of very abnormal results that need immediate attention. If it is after 5pm, we call the out of hours GP service with all patient details and they contact the patient and tell them to come to ED.

I am just giving my experience from our hospital. Some of the bigger hospitals in Dublin, Cork, Galway may have longer turnaround times, but many of the smaller hospitals would be the same.

Dav010

https://www.boards.ie/discussion/comment/120092175#Comment_120092175

Undersubscribed as in qualified Drs did not wish to apply to specialise as GPs. The unfilled places, which is not as assumption, you can look it up, are not dependent on leaving cert points as entry to a GP scheme occurs after graduation, not after secondary school. There are currently just under 1000 Drs in the GP training scheme at the moment, 285 were taken in this year, again, these figures are available to view if you look them up. There are currently 25% more inhabitants in Ireland since 2002, the highest population since The Famine, I doubt anyone envisaged such growth 20 yrs ago.

In relation to points, this has always been mentioned as an issue with intake into health care courses, the points are so high that Universities are getting book smart students rather than students suitable to be Drs, it was one of the reasons why the HPAT was introduced. It is not ideal that LC results alone decide whether a student gains entry, but for now it is possibly the best indicator of whether a 19yr old will be able to complete the 6 yrs of extensive learning that it takes to graduate as a Dr. Entry requirements/points apply to most undergraduate courses, it is understandable why the requirement for a course like medicine would be among the highest given it’s popularity with top students. It is also worth baring in mind that there is now a graduate entry option into medicine in UL, so LC points is now not the only means by which people who wish to become Drs can gain entry to medicine.

When you say gaining financially, who are you referring to? The ICGP, who are responsible for training GPs are trying to increase the numbers on their schemes to meet demand, working GPs are buckling under the pressure, most have closed their lists to new patients because they are at their limit, there are Practices advertising GP jobs who have not received any applications, many can’t retire or sell their Practices because there is no one to take their place. The IMO are warning the government that GP levels are dangerously low and that Drs are emigrating rather than staying to work as GPs. I’m struggling to see who you think is gaining financially from this situation.

The Government chose to expand the med card scheme and GP care for children and are ploughing vast amounts of money into the Health system, if they wanted to save money they would cut back med cards and have patients pay for GP visits, not expand it. I don’t see how limiting GPs helps the State financially, and certainly problems with healthcare are going to be a major issue at the next election so it is in TDs best financial interest to try and improve access, not hinder it if they want to try and keep their jobs.

Atlantic Dawn

47 patients perfectly well on wards over 6 months to be released from a hospital bed (€878 per night x 182.5 = €160k per patient), it's a good job money pissed up against the wall is standard practice in the HSE, €7.5 million up the Swan E.

https://www.independent.ie/irish-news/medically-well-patients-remain-on-wards-longer-than-six-months-over-lack-of-suitable-step-down-care-42277331.html

Anita Blow

GP training spots are at their current number due to a number of reasons- the primary one being government funding. It’s the department of health that that decides how many training placements in each of the schemes it will fund and this will be mapped to long-term workforce planning (will there be a GP job at the end of the scheme to fill). That is the primary limitation.

Other factors to consider is training infrastructure- you need to find teams to place these new training spots on and appropriate training sites. It’s generally up to the HSE and training bodies to make sure there’s adequate trainee supervision and a balance of trainees and skill mix in a team.

The problem with GP training as with most training in Ireland is that there’s no long-term workforce planning so the HSE/DoH either doesn’t know or is will fully ignorant to the staffing needs of the health service going forward and how it will achieve that

Goldengirl

https://www.boards.ie/discussion/comment/120092802#Comment_120092802

Those patients are not " well enough " to go home though ..that is the point. They need step down care . In hospitals that have been systematically closed or cutback over the years .

They certainly don't need all the funding that it costs to keep a patient in a busy general hospital , but funding is still necessary for appropriate care elsewhere in the community.

That report also states 6000, not in hospital , are waiting for homecare . A system that has been decimated over years and years of cutbacks and ignored by politicians who refuse to move Slaintecare forward.

Where are these people? Are they home with their families struggling to manage and ending up readmitted due to lack of appropriate care in the community ?

Are they unnecessarily taking up a nursing home bed ? So many would be happier and managed just as well at home if adequate home care packages were available.

Slaintecare addresses better community care and chronic disease management ..in the community . Thus relieving pressure on hospitals and allowing them to do what they should be doing .

Anita Blow

That article is referencing medical school places, not training scheme posts. Since 2003 three new graduate programs have commenced in addition to the existing undergraduate programs and consequently today 50% of medical graduates are graduate-entry so numbers have increased dramatically.

We train plenty of doctors to medical school level, the limiting factor is intern posts and subsequent training posts. No point in increasing medical school posts if we have no training schemes to put them into. At present for example there’s a 6:1 competition ratio for surgery which means that there isn’t a training spot for 80% of applicants to the scheme.

Again the limiting factor here is primarily government funding

Anita Blow

That’s not the training infrastructure im talking about. Each training post needs to be attached to a medical team, consultant supervisor and in the case of GP needs a GP trainer for the final two years of the scheme. Lack of investment in physical infrastructure (hospitals) and staff (trainers and medical teams) mean that this is still lacking. We need more medical teams and more consultants to be able to facilitate an increase in training numbers for any speciality.

Cluedo Monopoly

Its actually pathetic to listen to the FFG ministers this week trotting out the same old excuses over and over. They must have a laminated sheet with what they are allowed say. They wont answer any direct questions. All the experts are saying that hospitals are running at a very high capacity throughout the year and cannot handle any surge whatsoever without resorting to trolleys. The solution is simple and all the experts agree - more beds, more staff. These ministers are embarrassing themselves with their guff. They were warned about this in July and did SFA. It will happen again next winter, guaranteed.

Jarhead_Tendler

https://www.boards.ie/discussion/comment/120081445#Comment_120081445

Now we also have HIQA who are led by former HSE managers who also couldn't manage the system correctly in their own time at the gig

joseywhales

Holy moley, my mother wouldn't give me a paracetamol if I was responsive, I might see a GP if I couldn't eat for an entire day, I never made it to a hospital, I think nothing less than a coma would have sufficed. And my aunt was a GP, it was free like, just didn't want to bother her too often. Now she was great, she was confident to diagnose and treat, no passing people on

BrianD3

I am in regular contact with homecare agency workers and they've said that there seem to be more people getting homecare packages recently. Sounds like a good thing to alleviate hospital overcrowding? Not if the homecare agencies are going to "squeeze in" even more "care" without taking on more staff. Which is what appears to be happening,

Result is an already poor service (as per my other thread in this forum) is in danger of becoming worse with even more problems with missed and truncated care visits. The latter is probably resulting in widespread time card fraud by the agencies and their workers as they are paid PUBLIC MONEY for work not carried out. Little or no oversight by the inept HSE. Possibly adopting a see no evil approach.

Meanwhile, the current media attention comes off the same HSE and government as trolley numbers in hospitals come down. Problem transferred elsewhere where there is less attention, job done.

AndrewJRenko

https://www.boards.ie/discussion/comment/120090560#Comment_120090560

It would certainly slash population numbers significantly.

AndrewJRenko

https://www.boards.ie/discussion/comment/120107700#Comment_120107700

Looks like one of the seven is ex HSE

https://www.hiqa.ie/about-us/management-team

Should they be recruiting people that have no health service experience?

kirk.

Extra beds are like building more roads , they will just fill up again in no time

Outside of hospital is where they need to target the money

breezy1985

https://www.boards.ie/discussion/comment/120092699#Comment_120092699

Where I work in community healthcare we say 2-3 days but that's to give time for the physical results to return and the consultants to get some time to review.

UHL lab seem to actually have them done within 24hrs because the very rare occasion something serious came up we got a phone call in that time.

kirk.

Free GP care ?

How is this even being discussed, it's just a blind alley in the current state of the health system

Goldengirl

https://www.boards.ie/discussion/comment/120121506#Comment_120121506

Its all just smoke and mirrors...

Goldengirl

https://www.boards.ie/discussion/comment/120121596#Comment_120121596

Was talking about the free gp care for all! Just a lollipop to distract people from the disaster.

We are now being distracted from the joke that is the Winter Emergency plan, to a 3 year plan down the road!

Don't look here, look over there 👀

kirk.

Would clog up GPs and A+E even more

Hard pushed GPs will be referring even more onwards

kirk.

https://www.boards.ie/discussion/comment/120121629#Comment_120121629

That's what we need if they're competent

Put them in the out of hours service that's been scaled back for starters

And get them to actually treat something more minor than a headache or a scratch with sending people to a+e . Provide government indemnity or whatevers needed so they're not afraid to treat people

kowloon

https://www.boards.ie/discussion/comment/120064221#Comment_120064221

Reminds me of these posters in the hospital:

kirk.

https://www.boards.ie/discussion/comment/120121895#Comment_120121895

Back in the day people believed what advertiser's said

Graces7

https://www.boards.ie/discussion/comment/120073021#Comment_120073021

I lived and live very remote and am prone to resp. infections ( nearly 80) One of my excellent GPs let me hold a course of antibiotics at home to avoid escalation while waiting to be seen. There is no reason IF the patient treats this with respect. And it avoided using A and E a couple of times.

I was always told that the reluctance re giving antibiotics is that if used too often when really badly needed they will be ineffective. But if they are available at a pharmacy that can be monitored?

Graces7

https://www.boards.ie/discussion/comment/120080021#Comment_120080021

Not sure what happens these days but in the UK in the past it was fasttrack to the nearest mental hospital... Now most of the big ones are closed though...