What is wrong with the health service, HSE

James Brown · 06-02-2019 3:29pm

The Nurses and Midwives Union has a job to do. It's not looking after the tax payer or trying to fix a health system I believe nobody at top level wants to fix or touch in any meaningful way.
Why should a Midwife or Nurse continue to work in conditions they believe are understaffed and underpaid, for the greater good? Come off it.
We've a government who use divisive tactics in every crisis and are content to leave things broken.

[Deleted User] · 06-02-2019 3:29pm

Tell me how wrote: »

The point in bold would be extremely detrimental to the country if we suggested every union, group and body think in this way.

Many of 'us the public' work in the HSE. 1 in every 23 workers in the country are directly or indirectly employed by it.
Every layer within the system seems to be focused on saying there needs to be change elsewhere but not in their section and given the numbers (direct workers, ancillary workers and the families of these) involved as a percentage of the population I fear that the minister who tries to radically overhaul it would disappear overnight.

We have had the following Ministers for health in the last twenty years.

3 GP's
2 Taoisigh
1 Tanaiste

Why do you think we have not managed to improve the system having gone from the health boards, to the HSE, and now, in some places, small suggestions that we go back towards health boards again.

So the nurse union should not campaign for nurses because of the government saying it will hurt them with other unions?

FFS, that is the comments which have allowed the government ride right over them for the past 20 years

Tell me how · 06-02-2019 3:33pm

Deleted User wrote: »

So the nurse union should not campaign for nurses because of the government saying it will hurt them with other unions?

FFS, that is the comments which have allowed the government ride right over them for the past 20 years

It's a very me, me, me approach and one which is not suitable when given that they are one body within the public sector.

I am not at all suggesting that unions do not advocate primarily for their members but that they do not be completely blinkered to the fact that they are operating in a shared space.

What do you think of the claims of GP's needing €200B and nurses needing €300B? Do you think both should get the full amount?

[Deleted User] · 06-02-2019 3:35pm

Tell me how wrote: »

It's a very me, me, me approach and one which is not suitable when given that they are one body within the public sector.

I am not at all suggesting that unions do not advocate primarily for their members but that they do not be completely blinkered to the fact that they are not operating in a shared space.

What do you think of the claims of GP's needing €200B and nurses needing €300B? Do you think both should get the full amount?

GPs can become state employees if they wish

Tell me how · 06-02-2019 3:40pm

Deleted User wrote: »

GPs can become state employees if they wish

Come on now, you are dodging the question.

James Brown · 06-02-2019 3:53pm

Tell me how wrote: »

Come on now, you are dodging the question.

As a tax payer I'd rather they all worked for free. However what they say they need may be genuine or not, but needs to be negotiated. The idea that they shouldn't be asking at all for the greater good is farcical.

[Deleted User] · 06-02-2019 3:53pm

Tell me how wrote: »

Come on now, you are dodging the question.

No I am not. They are private businesses and can be treated as so.

Public pay system has no say in how they allocate their local budgets.

Tell me how · 06-02-2019 3:56pm

Deleted User wrote: »

No I am not. They are private businesses and can be treated as so.

Public pay system has no say in how they allocate their local budgets.

So, you have no opinion on GP's claims that they need €200M/annum to overcome chronic staff shortage in the area but you think the nurses should get their €300M/annum without question.

And both these payments would have to come from the public purse.
How do you think this will end if every group makes their demands in isolation?

[Deleted User] · 06-02-2019 4:07pm

Tell me how wrote: »

So, you have no opinion on GP's claims that they need €200M/annum to overcome chronic staff shortage in the area but you think the nurses should get their €300M/annum without question.

And both these payments would have to come from the public purse.
How do you think this will end if every group makes their demands in isolation?

And this is pure deflection from the merits of the current industrial action.

Exactly what the government does so well, there is always a reason to not engage with the nurses

Tell me how · 06-02-2019 4:12pm

Deleted User wrote: »

And this is pure deflection from the merits of the current industrial action.

Exactly what the government does so well, there is always a reason to not engage with the nurses

No. I promise Iam not trying to deflect. I genuinely would like to see nurses on the ward earn more, but I think bowing to their 12% demands at this point, in this way, would be wrong.

But, the reality is that those GP's were protesting today. That is a current action.

If we only handle things that are at the industrial action stage, what will the impact of this approach be?

Tell me how · 06-02-2019 4:12pm

Matt Barrett wrote: »

As a tax payer I'd rather they all worked for free. However what they say they need may be genuine or not, but needs to be negotiated. The idea that they shouldn't be asking at all for the greater good is farcical.

Thank you for your consistency in missing the point.

Squatter · 06-02-2019 4:28pm

Deleted User wrote: »

And this is pure deflection from the merits of the current industrial action.

Exactly what the government does so well, there is always a reason to not engage with the nurses

Governments should NEVER engage with ANY trade union, period. Their role is provide the structures through which Union claims can be processed and to honour any agreements that result.

Our national IR legacy problem is that the Drumcondra knacker made a name for himself as the "hands on" Minister for Labour who threw taxpayers' funds at any PS industrial dispute and deluded the Unions into believing that they had a right to demand negotiations with government Ministers.

We saw it quite recently with the PS transport unions - can't remember whether it was Luas, Dublin Bus or Bus Eireann (or maybe all three) - where to his credit Shane Ross (who, generally speaking I despise) had the intelligence to refuse to get involved, despite the NBRU's pleading.

James Brown · 06-02-2019 6:08pm

Tell me how wrote: »

Thank you for your consistency in missing the point.

Well with elaborations like the comment above I cannot fail but to continue to do so.

Geuze · 06-02-2019 6:08pm

The GP fee in France rose from 23 to 25 in 2017, after being 23 since 2011.

Consultants in France charge 50, after referral from a GP.

https://www.frenchentree.com/living-in-france/healthcare/doctors-fees-to-rise-in-2017/

https://blog.parisunraveled.com/how-much-does-it-cost-to-go-to-the-doctor-in-france/

Irish GPs claim they are starved of resources, yet they charge 50+.

L1011 · 06-02-2019 7:09pm

The GP in France gets that fee from absolutely everyone, or an insurer in their stead

Irish GPs get annual fees for GMS patients that can be as little as 44 a YEAR for a patient that is liable to turn up almost twice as often as a private one. Some practices are 80% GMS due to demographics and dodgy cards issued en masse on behalf of local TDs in the past.

Private only surgeries in Ireland often charge less, 30 isn't uncommon; but only cities and big towns have the population to support these

[Deleted User] · 06-02-2019 8:22pm

L1011 wrote: »

The GP in France gets that fee from absolutely everyone, or an insurer in their stead

Irish GPs get annual fees for GMS patients that can be as little as 44 a YEAR for a patient that is liable to turn up almost twice as often as a private one. Some practices are 80% GMS due to demographics and dodgy cards issued en masse on behalf of local TDs in the past.

Private only surgeries in Ireland often charge less, 30 isn't uncommon; but only cities and big towns have the population to support these

And all this has what, exactly, to do with the merits of the nurses greviences?

See, muddy the water, deflect from the issue being discussed and lump everyone in together.

Tell me how · 06-02-2019 9:00pm

Deleted User wrote: »

And all this has what, exactly, to do with the merits of the nurses greviences?

See, muddy the water, deflect from the issue being discussed and lump everyone in together.

You keep using that phrase, 'muddy the water'. It seems that you only want to talk about the nurses issue and it is clear that that is the one which concerns you and your feelings on it.

We have problems in so many areas in the health service; nurse numbers and moral, GP numbers and moral, waiting lists for all public procedures, access to mental health care, A&E experiences, childrens hospital project fiasco (which could well bring down the government)

Focusing on just one issue is not the appropriate way to try to deliver a capable system and I do think that things should be tackled in some sort of order but all the while keeping the other areas in mind.

There is a specific thread to discuss the nurses strike and the merits on their claim already in action on the site.

L1011 · 06-02-2019 9:28pm

Deleted User wrote: »

And all this has what, exactly, to do with the merits of the nurses greviences?

See, muddy the water, deflect from the issue being discussed and lump everyone in together.

I was replying to someone else bringing up GP fees - challenge them on this, not me!

Additionally, the topic of this thread isn't solely the nurses issues, but general health service issues.

Good loser · 07-02-2019 2:57am

Deleted User wrote: »

Then target the inefficiencies in the HSE and pay the nurses the same as we pay other BSc. (Hons) graduates into the service.

If you have a staff shortage you have to pay more to attract/retain. If you don't then service WILL drop as you will have the same amount of work now to be done with less people.
Overworked people make mistakes, take longer to perform, take more sick days.

Far too long we (as a country) have cried crocodile tears for the nurses, saying they deserve more, yet knowing we can get away without paying them as (up to know) they care too much about their roles, in patient care, to really threaten the status quo.

Even now every picket line has a roster of nurses to immediately go into the hospital if anything serious happens. Right now the government KNOW that nurses will break their own picket if they are truly needed in the hospital and are comfortable sitting back as the sh1t can not immediately hit the fan.
And if there is something this government loves doing, it is kicking the can down the road.
They don't give a tuppence worth about delayed procedures.

There is no comparison between the qualifications of general nurses and physios etc. The points required for nursing are trivial while physios points are comparable to those for medicine. For example Physios need to have honours physics in the LC. The College courses are much more demanding.

Plus the responsibilities afterwards are vastly different. Nurses spend much of their time writing files and ticking boxes.

Also it appears over Europe the annual turnover in nurses is 15% per annum v. 5% in Ireland.

Nesta99 · 07-02-2019 8:04am

Deleted User wrote: »

Then target the inefficiencies in the HSE and pay the nurses the same as we pay other BSc. (Hons) graduates into the service.

If you have a staff shortage you have to pay more to attract/retain. If you don't then service WILL drop as you will have the same amount of work now to be done with less people.
Overworked people make mistakes, take longer to perform, take more sick days.

Far too long we (as a country) have cried crocodile tears for the nurses, saying they deserve more, yet knowing we can get away without paying them as (up to know) they care too much about their roles, in patient care, to really threaten the status quo.

Even now every picket line has a roster of nurses to immediately go into the hospital if anything serious happens. Right now the government KNOW that nurses will break their own picket if they are truly needed in the hospital and are comfortable sitting back as the sh1t can not immediately hit the fan.
And if there is something this government loves doing, it is kicking the can down the road.
They don't give a tuppence worth about delayed procedures.

You do know how many more nurses there are than paramedical staff? Its not possible to pay all BSc qualified staff the same especially as all BSc qualifications are not the same. Take the example of a profusionist and general nursing graduates, there is no comparison with the level of expertise required yet both may be conferred with a BSc.

Additionally the levels of nurse staffing are much higher now than they were in the past when the health service was more functional. There is a much changed attitude toward work ethic now compared to previous eras of the service. There was no time to get all the chat in at the nurses station unless it was delivering a report. I have heard it time and again where nurses will now say things like 'What about our time to sit down and get all the craic'. No frontline health professionals have the right to be tardy and compromise patient care regardless of how overworked and underpaid they feel they are.This attitude is of course not across the board but it is all too common nontheless. If people constantly talk up how poor their working conditions are some are going to start completely believing it and behave accordingly. Comparison with working conditions, pay etc needs direct comparison with other similar systems - not comparison with jobs in Dubai or Austrailia but with the UK and other European services. Relative to the size of the country and per head of population things are not far off the mark here and exceed the expenditure on the health service than many other European countries.

A couple of my own experiences having moved from other public health services: A nurse on night duty locking herself in an office having pulled two chairs together, taken a pillow and blanket from the linen room in PACU and slept for most of the night ignoring the bleep and did this regularly. She left it to others to pick up the slack but at 5amm just before the medics started doing rounds she was up and all busy. Another one, with different staff, three nurses to cover a ward and on a weekend shift one of the three would leave to do shopping when on the clock. When that nurse returned another would head out for their shopping. These staff called in their union when they were asked to rotate to different areas of the hospital on the grounds of change in work practices. Their reasoning was that of entitlement due to being over worked and under payed. Other areas there was constant talk along the lines of 'someone is out to get us and are leaking info to the media' the logic of when there is nothing going wrong there is nothing to leak was lost on them! A nurse escort on an ambulance transfer clocking off before a handover was done as it was the end of the shift caused friction, another asked to be dropped home on the way back from a transfer. There needs to be a change in thinking, recruitment/acceptance on to a nurse training programme. Dont get me wrong there are very dedicated nursing staff but they are let down by some of their less umm motivated colleagues. But nobody goes in to these professions with their eyes closed expecting to get rich on a HSE nursing salary.

There are some pretty minor changes in policy that would lead to improvement overal imo eg compulsory staff rotation, not just around one hospital but across regional centres - apart from preventing deskilling in general it break a cycle of perpetuating poor practice as it isnt always known that something is poor practice and training is passed from mentor to student, the student become a mentor themselves in due course and the cycle goes on, if that makes sense?

A ward sister needs to accompany the medics on their rounds and take notes, book diagnostics and follow up on them. The amount of time wasted as some odered disgnostic hasnt been carried out is ridiculous and leads to patient overstay.Its generally left to junior doctors to do this and patients just fall through the cracks so a single focal point is needed. This could be done with a well trained medical secretary.

Introduce a 24hr GP service in each ED, if someone is triaged as non emergency then they are directed to the GP and even with a medical card they pay for that service maybe even on top of the ED surcharge. This would free up space significantly as people will be discouraged from basically using the ED as a GP service, thinking they will be seen quicker etc. I know one person who called an ambulance after puking and the reason was mainly in case they threw up in their car and it would smell after, they would think twice about doing it if it was going to cost them. In this regard not everything shouldnt be entirely free even if the financial resources were there, there should be some discretion allowed on billing those who abuse the system, how to implement this i'm not that sure but at least a Proper public awareness camgaign on this issue from school age should be rolled out to encourage a more civiclly responsible attitude.
Patients often fear that they have been overlooked or files lost when waiting in an ED or clinics and this means a lot of time, mainly nurses' time is taken up dealing with enquiries looking for reassurance that the patient hasnt been forgotten. A visual display with a patients name or number that is a rough guide to their progression in a queue has been used successfully in other services thus reducing the time spent running to check if files are in the pile.

I was shocked to find out that one of the larger regional hospitals doesnt have a dedicated staff training department, so whenever a new policy or clinical guideline etc is introduced, over a protracted period nurses are taken off front line duties to train the rest of the staff and this is on everything from manual/patient handling, safeguarding to a new sepsis protocol say. This has implications on a whole lot of levels that impact on staffing and patient care.

Constant, uniform 7 day a week 24hr rosters would be a big help, there is no reason that physio for example cant be done after a particular time if it helps clear a bed. The tendancy for patients not to be discarged over a weekend even if they are well enough to go home beause a consultant isnt around loses so much capacity (a crude guestimate based on 1 bed unnecessarily in use on a weekend in 10 hospitals is nearly 3 years so how much could be knocked off waiting lists across the whole service due to bed shortages or people on trolleys in an ED).

There are lots of reasonably easy things that could be done and not at great cost or disruption that would improve things. Including the reprimanding lackidaisical surgeon who strolls in an hour after their clinic or list was due to start!! Nobody is above doing their job as they are supposed to do!!

Iandempsey · 07-02-2019 6:03pm

what's going on with primary care here for basic stuff?

it's 2 weeks to get an appointment at the GP for a blood pressure check,and the 'out of hours service' has been centralized meaning it's moved far away

i'll be heading over to a+e just to get this done

James Brown · 07-02-2019 6:43pm

Whether the Nurses and Midwives get their rise or not, the quality of service in the HSE will not be effected as far as I can see. It makes for good distraction.

Nesta99 · 07-02-2019 6:54pm

Iandempsey wrote: »

what's going on with primary care here for basic stuff?

it's 2 weeks to get an appointment at the GP for a blood pressure check,and the 'out of hours service' has been centralized meaning it's moved far away

i'll be heading over to a+e just to get this done

Most pharmacies offer blood pressure checks often for free if it is just a routine check. You should be able to see your GP quicker than in 2 weeks but a pharmacy is better than waiting in an ED for hours if not an emergency. But then I did get a referral from my GP for an ECG in the local cardiac clinic last June and the appointment arrived in the post for june 2019......:mad:

L1011 · 07-02-2019 7:12pm

Iandempsey wrote: »

what's going on with primary care here for basic stuff?

it's 2 weeks to get an appointment at the GP for a blood pressure check,and the 'out of hours service' has been centralized meaning it's moved far away

i'll be heading over to a+e just to get this done

A&E shouldn't even entertain you with that. It's not an emergency

Tell me how · 07-02-2019 7:17pm

L1011 wrote: »

A&E shouldn't even entertain you with that. It's not an emergency

Yeah but all the ads relating to diseases suggest immediate action once concerned. If someone, for example is feeling consistently weak and light headed and can't get an appointment with a GP, then A&E is the only option.

Still, I can't understand why it would take two weeks before getting a nurse in a GP office to do this.

GSRNBP · 07-02-2019 8:19pm

Iandempsey wrote: »

what's going on with primary care here for basic stuff?

it's 2 weeks to get an appointment at the GP for a blood pressure check,and the 'out of hours service' has been centralized meaning it's moved far away

I go to an extremely busy GP (which is a new building which amalgamated a few practices around my area. I rang yesterday morning for the ol' 35-year-old human NCT and I am in tomorrow.

I take it you live in the country?

i'll be heading over to a+e just to get this done

THIS is why our A&Es are ****ed! :eek:

GSRNBP · 07-02-2019 8:22pm

Tell me how wrote: »

Yeah but all the ads relating to diseases suggest immediate action once concerned. If someone, for example is feeling consistently weak and light headed and can't get an appointment with a GP, then A&E is the only option.

Still, I can't understand why it would take two weeks before getting a nurse in a GP office to do this.

As another poster said, if they need to get BP checked, go to literally any chemist. If they feel they're having a cardiac event then go to A&E. Some people are also hypochondriacs (not making an assumption about the poster in question, but just saying!)

Iandempsey · 07-02-2019 8:34pm

Nesta99 wrote: »

Most pharmacies offer blood pressure checks often for free if it is just a routine check. You should be able to see your GP quicker than in 2 weeks but a pharmacy is better than waiting in an ED for hours if not an emergency. But then I did get a referral from my GP for an ECG in the local cardiac clinic last June and the appointment arrived in the post for june 2019......:mad:

i already know it's high, i'll prob need medication

a lot of people head straight to a+e for anything here( out the country), at least you'll wait and be seen that day

Nesta99 · 08-02-2019 3:57pm

Iandempsey wrote: »

i already know it's high, i'll prob need medication

a lot of people head straight to a+e for anything here( out the country), at least you'll wait and be seen that day

See what I mean people, and the vicious cycle of directing resources to all the EDs to cope with crowding rather than the possibility of expanding GP services. and by that it could be by employing practice nurses (for BP checks) or paramedics who can offer occupational therapy type services in the home as preventatives to accidents/lifestyle issues etc.

I go back to what I said earlier though to manage people who feel that they must go to an ED for what ar GP issues -

Introduce a 24hr GP service in each ED, if someone is triaged as non emergency then they are directed to the GP and even with a medical card they pay for that service maybe even on top of the ED surcharge. This would free up space significantly as people will be discouraged from basically using the ED as a GP service, thinking they will be seen quicker etc.

Martina1991 · 08-02-2019 4:13pm

Nesta99 wrote:

Introduce a 24hr GP service in each ED, if someone is triaged as non emergency then they are directed to the GP and even with a medical card they pay for that service maybe even on top of the ED surcharge. This would free up space significantly as people will be discouraged from basically using the ED as a GP service, thinking they will be seen quicker etc.

There already is an out of hours GP system all over the country. Westdoc, Caredoc, Shannondoc etc. People will still go to A and E if the out of hours GP is busy or too far away.

What is wrong with the health service, HSE

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