Martin Ferris and his Health Card

Victor

Originally posted by MDR
The medical system from start to finish needs reform ... problem is that the unions are so resistant to it ... example, why do we need five health boards ?

We don't have 5, we have 9 Health Boards (together with independent service providers), one Health Authority, the Office for Health Management and The Health Boards Exceutive and the Department of Health. These have separate functions by area or speciality. If it was all one organisation, it would probably employ close to 100,000 people which is too big. At least with some delegation, some responsibility can be taken. Would you prefer all 100,000 to go on strike together?

Southern HB
Mid Western HB
Western HB
North Western HB
Midlands HB
South Eastern HB
North Eastern HB

and under the Eastern Regional Heath Authority, we have
East Coast Area HB
Northern Area HB
South Western Area HB
http://www.erha.ie/view_categories.php?nCatId=3&catFlag=1

bonkey

Originally posted by Victor
These have separate functions by area or speciality. If it was all one organisation, it would probably employ close to 100,000 people which is too big.

Why? Last time I checked, we didnt have 9 police forces broken down by area or specialty. Nor did we have 9 power-supply companies.

Look at larger nations, or indeed just multinational companies. 100,000 is a perfectly manageable number, as long as you have an appropriate structure in place. I do not consider 9 pretty-much-autonomous bodies to be "proper structure" incidentally.

And is that figure of 100,000 even accurate? At a rough guess, thats about 5% of our entire workforce. Surely one in 20 employed people doesnt work for the health board?

jc

gandalf

Victor I personally think that 9 Health Boards is 8 too many.

Firstly we are duplicating admin and IT over all these organisations. If we rationlise them then we can divert those funds to areas of the health service that should get them.

Also we have a centralised area for people health records so for example if I have a accident in Donegal they can gain access to my records easily something that I believe they cannot do at the moment.

I'd prefer to have Cancer treatment centres in 9 different locations than 9 different admisitration headquarters wouldn't you.

Gandalf.

mike65

Just to get this thread back on topic, Martin Ferris looks like coming under presure not to take out private health insurance, the Sinn Fein top brass are getting twitchy about thier working class cred being undermined. I posted earlier that you could'nt be a republican socialist and have VHI cover and it seems Gerry and the lads agree!

Mike.

gandalf

What they're going to use BUPA (sorry couldn't resist!).

To be honest thats a pathetic stance, if they guy is getting €70000 plus as a TD why can't he get VHI. He shouldn't get or use a Medical Card on those wages thats for sure anyway.

Gandalf.

Victor

Not wishing to go off topic, but O_o, /me is being challenged. Do you want to split the topic?

Originally posted by bonkey
Why? Last time I checked, we didnt have 9 police forces broken down by area or specialty.

There are only about 11,700 Gardaí (Jun 2002), which just happen to be broken into a number of regions and sub-regions http://www.garda.ie/angarda/orgchart.htmlAnd how many police forces are there in Switzerland?[EDIT]But we have a separate Courts Service and Prison Services and Department of Justice and see the other 17 agencies at http://www.justice.ie/802569AD005A6D62/vWeb/wpJWOD4RYJYS and not counting the Courts, Coroner and Registrar / Sherriff services provided by local authorities.[/EDIT]

Originally posted by bonkey
Nor did we have 9 power-supply companies.

Bord Gáis, ESB, Eirgrid (National Grid), Bord na Mona, Eirtricity, Energia, Viridian and all the other icckle and not so icckle ones (Aughinish Alumina, BGÉ Transmission, Bord Gáis Energy Supply, Enterprise Energy Ireland, ESB, Flogas, Innogy, Marathon, Ramco, Statoil, Viridian are all involved in the gas trade alone)? See http://www.cer.ie/ The Competition Authority are working on further expanding this and breaking up the ESB's dominance in the electricity market.

Originally posted by bonkey
Look at larger nations

You mean like Germany, where health / social services are delivered by individual communities (not cities nor States nor Federal government). Or the UK where you have IIRC individual hospitals under individual NHS trusts under the NHS under the DHSS. Now let me guess in Switzerland, it is the cantons & communities that are responsible for such services?

Originally posted by bonkey
or indeed just multinational companies.

Which have 2 or 3 subsidiaries in each country? Where directors or general managers has ultimate responsibility for that unit? and where staff are employed by a separate company to the parent and to the company holding the fixed assets? and where many staff are contracted in.

Originally posted by bonkey
And is that figure of 100,000 even accurate? At a rough guess, thats about 5% of our entire workforce. Surely one in 20 employed people doesnt work for the health board?

At December 2001 there were 93,000 public sector health employees (not including admin staff in the Dept of Health, but including the state-financed voluntary sector). It is estimated that this rose by 14,000 (not sure if this was restricted to health only, but I am under that impression) before the election. It would not include GPs, a portion of specialists or "private" hospitals. http://www.cso.ie/publications/distrib/psempearn.pdf

Victor

Originally posted by gandalf
Victor I personally think that 9 Health Boards is 8 too many.

I disagree.

Originally posted by gandalf
Firstly we are duplicating admin and IT over all these organisations. If we rationlise them then we can divert those funds to areas of the health service that should get them.

Let us say there are 500 buildings. Are you suggesting 499 receptionists in one building and none in the other 499? There are reasons to be local as well as national – would you put all the internet on one computer? Or have one phone company in charge of all the phones [damn they did that]? Would you put one politician in charge of the whole health system? Local needs can be better responded to by local organisations.

Originally posted by gandalf
Also we have a centralised area for people health records so for example if I have a accident in Donegal they can gain access to my records easily something that I believe they cannot do at the moment.

(1) How often are you outside your own HB area?

(2) How often have you been ill or had an accident outside your HB area?

Yes, it should be a long term objective, but it is not a priority.

Originally posted by gandalf
I'd prefer to have Cancer treatment centres in 9 different locations than 9 different admisitration headquarters wouldn't you.

But if one mother of all buildings in the middle of Dublin costs more (per usable square metre) than say a local office in Bray or Naas, then that central admin building is drawing funds away from your cancer care.

gandalf

Originally posted by Victor
I disagree.Let us say there are 500 buildings. Are you suggesting 499 receptionists in one building and none in the other 499? There are reasons to be local as well as national – would you put all the internet on one computer? Or have one phone company in charge of all the phones [damn they did that]? Would you put one politician in charge of the whole health system? Local needs can be better responded to by local organisations.

Lol Victor your gettin heat up by all this. Obviously I have not gone into fine details here. Receptionist would be safe they are needed in every location that deals with the public. However for example IT Dept x 9 = 9 times the staff which definately can be rationalised, canned, downsized, fired (obviously the factor they are downsized by depends on the demands of the new superboards needs). Same goes for accounts and general admin people. Just because the 9 Health Boards employ 100,000 does not mean 1 will in the same positions as before. What this will do is free up valuable resources for positions like Speech Therapists for example of which we have bugger all in the Republic.

(1) How often are you outside your own HB area?

Anytime I leave Dublin, your point ?

(2) How often have you been ill or had an accident outside your HB area?

Never thank god, but if I did I would expect our NATIONAL health service to have the ability to get my records instantly.

Yes, it should be a long term objective, but it is not a priority.But if one mother of all buildings in the middle of Dublin costs more (per usable square metre) than say a local office in Bray or Naas, then that central admin building is drawing funds away from your cancer care. [/B]

Except I didn't say I'd base it in Dublin. Actually I'd base it right in the middle of the country lets say in Tipparery for example, eventhough I live in Dublin Victor old chum I don't see the country revolving around it.

These are just some ideas I've been throwing around my head for a little while now. (Go easy on me Victor!)

Gandalf.

Victor

All I'm saying is Health Boards were being knocked without any suggestion of how to do things better.

I imagine there won't be a huge saving in the number of wages clerks if there was a centralised system. What you would have is a system where everyone would be just a number (cue discussion on civil service telephone waiting systems).

The reason the Dept of Health, the Office for Health Management, The Health Boards Executive and the Eastern Regional Heath Authority, exist is to provide core services (e.g. strategic planning, information campaigns, construction management) that need not be repeated / duplicated everywhere.

However the risk with putting everything in one place is that peripheral (from whereever the centre is) areas are forgotten.

MDR

All I just remember reading in the times that Notingham's health board in England looks after a population the same size as Ireland. One health board for 4 million people as against our 9, ultimately when it comes to health I am not a 'Tory', I don't believe that you can indefintely squeeze more productivity out of the same investment.

In Ireland however, I see a health service that is being asked to care for at best 40% of population and receives roughily between a quater and a third of our budget, and is still having trouble coping.

I haven't seen rationisation in the health service ... well ... ever ... not in my memory. People are poking the Gardai with sticks, saying 'you have never reformed since conception', me thinks a much better place to start is the Health Service. From what I understand their is huge duplication of work in the health sector.

Victor

Originally posted by MDR
All I just remember reading in the times that Notingham's health board in England looks after a population the same size as Ireland.

But what is the geographical size of the Nottingham board and how many service providers does it cover?

Originally posted by MDR
In Ireland however, I see a health service that is being asked to care for at best 40% of population and receives roughily between a quater and a third of our budget, and is still having trouble coping.

Would that be the ill forty per cent? The expenditure is 21.99% (25.39% of current, 7.70% of capital) of the budget and covers everyone in the population (even if you have to contribute something yourself through the Health Levy, VHI / BUPA or through user charges).

Originally posted by MDR
I haven't seen ration[al]isation in the health service ... well ... ever ... not in my memory.

Then why are they currently looking for 1,400 redundancies? Have you not heard of hospital closures (Barringtons, Adelaide, Meath, National Children's Hospital, Temple Street Children's), the amalgamation of A&E departments ....

Originally posted by MDR
People are poking the Gardai with sticks, saying 'you have never reformed since conception'

Makes for a change from Gardaí poking the citizenry with sticks. And rightly so, it was an organistion that stumbled from disaster to disaster because of inbreeding / nepotism and a lack of an adequate officer corp. But thats a different days (or thread's) argument.

Originally posted by MDR
me thinks a much better place to start is the Health Service. From what I understand their is huge duplication of work in the health sector.

I think you are overstating this, there might be some duplication in paperwork, however patient privacy is important.

MDR

But what is the geographical size of the Nottingham board and how many service providers does it cover?

I amn't so sure that Ireland is such a huge place that there is a geographical reason for having 9 health boards. Lets face it we are bloody tiny ! ...

Have you not heard of hospital closures (Barringtons, Adelaide, Meath, National Children's Hospital, Temple Street Children's), the amalgamation of A&E departments ....

Melodrama ? Yes, I have also heard that there is fifteen thousand more people working in the health service now than in 1999. Yes these hospitals closed, but did no open a few new ones ? Tallaght, extenstions to the Mater and Blanchardstown etc. I don't see these recent redundacies as contibuting to is reform, I think its fudamental problem is the underlying culture of the service.

And rightly so, it was an organistion that stumbled from disaster to disaster because of inbreeding / nepotism and a lack of an adequate officer corp.

Fighting Words, Inbreeding ? Didn't know my mum was a garda too As for nepotism, a better description would be GAA'ism (ie to get ahead you need to be in the GAA) or from the country or even better both. I degress even further ...

Although the Garda may have had training/support etc problems, they are not the black hole for cash the Health Service has become. I just don't see value for money in the service and haven't for a long time, and certainly haven't since I start spending time in hospitals.

I think you are overstating this, there might be some duplication in paperwork, however patient privacy is important.

Nine Health Boards, Nine Heads of these health boards, with nine large salaries, with nine large cars, with nine secertaries ...

mike65

Take this outside!

Mike.

Victor

Originally posted by MDR
Nine Health Boards, Nine Heads of these health boards, with nine large salaries, with nine large cars, with nine secertaries ...

The alternative is nine middle manager on similar salaries (it would after all be a much bigger organisaiton) filling out TPS reports instead of managing and directing.

Cork

I think that you have much duplication between health boards.
You have so many committes - Savings could be made.

I think, our population is not too big. We can't continue to justify the wastage of resources in our health system.

Victor

Has anyone specifically identifed any particular wastage here?

Down with rhetoric!

gandalf

Bloody Hell Cork can you expand ever on what your saying.

I mean you fire up the same little soundbites without ever teasing them out for once can you post with a decent breakdown of where you see the problems and what you believe the solutions are ?

Gandalf.

Cork

It is hard to be specific. I must admit that having worked in this sector:

The Freedom Of Information Act absoluely gobbles up resources.

People have to sift thru files & put older files into storage.

I feel that we maybe we have too many hospitals and too few centres of excellence.

I also feel that too much is being spend on needless courses while some nurses are not been kept up to date with medical developments.

You also have people in hospitals who cannot keep within their budgets and use any excuse to justify cost over-runs. (I know many don't have a financial background).

I am not an expert - but when you increase a health budget by 130% in 5 years - you would expect a big improvement.

I know that there is inflation but still it should have got better/

poneill

I am glad ye all went off topic so fast and left poor Martin alone.

He's on a well deserved fraternal trip to South Africa now .

Happy Christmas Martin

Cork

Why is he in South Africia?

Victor

Originally posted by Cork
The Freedom Of Information Act absoluely gobbles up resources. People have to sift thru files & put older files into storage.

FOI requests have to be paid for.

Originally posted by Cork
I feel that we maybe we have too many hospitals and too few centres of excellence.

The alternative is ... building more hospital buildings (on perhaps existing sites) - which costs money. Reducing the number of sites increases the distance travelled for ordinary care. It's a fact of life in an underpopulated country.

Originally posted by Cork
You also have people in hospitals who cannot keep within their budgets

Fair enough, A&E will only treat 50 people per night and will be closed on Monday and Tuesday.

Originally posted by Cork
use any excuse to justify cost over-runs.

This is a pandemic.

poneill

Originally posted by Cork
Why is he in South Africia?

Sigggggghhhhhhhhh

I'd love to know where you got your journalistic style tips Cork. I fear it may have been the Daily Mail so I do.

Here is the infomation you asked for on What Exactly Martin is doing on his well earned break from all this consequence and truth.

Anon