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What is wrong with the health service, HSE

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    #32
    Tell me how
    Registered Users Posts: 21,517 ✭✭✭✭Tell me how


    One thing that I am always intrigued by when discussing circumstances in Ireland is the the number of people who work within a particular area as a portion of the population.

    In terms of healthcare professionals. The HSE has approximately 102,000 people working for it either directly or indirectly. That is about 1 in 23 of all workers in the country.
    This means that the "HSE" which we all refer to is made up by friends, partners, family members of a large portion of the country. And yet, everyone knows it doesn't work, but nobody every can identify how their area is overstaffed or they themselves are under utilised. I can understand this to some degree, why would they, turkeys voting for Christmas kind of thing.

    But it must be an incredibly difficult challenge for any Minster of Health given the behemoth that it is.


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    #33
    Geuze
    Registered Users Posts: 13,071 ✭✭✭✭Geuze


    Wanderer78 wrote: »
    Can anyone point to data to support these claims?

    Eurostat data on population and ageing

    https://ec.europa.eu/eurostat/statistics-explained/index.php/Population_structure_and_ageing

    Across the EU Member States, the highest share of young people in the total population in 2017 was observed in Ireland (21.1 %), while the lowest share was recorded in Germany (13.4 %). Regarding the share of persons aged 65 or older in the total population, Italy (22.3 %), Greece (21.5 %) and Germany (21.2 %) had the highest shares, while Ireland had the lowest share (13.5 %).



    Population_age_structure_by_major_age_groups%2C_2007_and_2017_%28%25_of_the_total_population%29.png


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    #34
    Geuze
    Registered Users Posts: 13,071 ✭✭✭✭Geuze


    Ireland median age

    Median_age_of_population%2C_2007-17_%28years%29.png


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    #35
    Geuze
    Registered Users Posts: 13,071 ✭✭✭✭Geuze


    Wanderer78 wrote: »
    Can anyone point to data to support these claims?

    Note that I teach this stuff all the time, so you can depend on my data.

    If I'm not sure, I always say so.


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    #36
    Anita Blow
    Registered Users Posts: 1,933 ✭✭✭Anita Blow


    Wanderer78 wrote: »
    Can anyone point to data to support these claims?
    Ireland has the lowest median age in the EU at just over 35.


    Healthcare expenditure as a proportion of total government spending is the highest in the EU (20% VS 15%) and is the 2nd highest in the OECD as a % of GNI (12.4% VS OECD average of 9%)


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    #37
    Anita Blow
    Registered Users Posts: 1,933 ✭✭✭Anita Blow


    Geuze beat me to it it seems!


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    #38
    Geuze
    Registered Users Posts: 13,071 ✭✭✭✭Geuze


    If anybody wishes to delve deeper, here is an analysis of the price level in Irish hosps.

    Comparing Hospitals and Health Prices and Volumes
    Across Countries: A New Approach
    Francette Koechlin, Paul Konijn, Luca Lorenzoni, Paul Schreyer

    https://link.springer.com/article/10.1007%2Fs11205-015-1196-y

    This article is probably behind a paywall.

    It finds that Irish hosp price level is 81% higher than the EU28 average.


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    #39
    Geuze
    Registered Users Posts: 13,071 ✭✭✭✭Geuze


    OECD health exp data

    http://www.oecd.org/health/health-systems/Health-Spending-Latest-Trends-Brief.pdf

    http://www.oecd.org/els/health-systems/OECD-Health-Statistics-2018-Frequently-Requested-Data.xls


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    #40
    James Brown
    Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    Tell me how wrote: »
    One thing that I am always intrigued by when discussing circumstances in Ireland is the the number of people who work within a particular area as a portion of the population.

    In terms of healthcare professionals. The HSE has approximately 102,000 people working for it either directly or indirectly. That is about 1 in 23 of all workers in the country.
    This means that the "HSE" which we all refer to is made up by friends, partners, family members of a large portion of the country. And yet, everyone knows it doesn't work, but nobody every can identify how their area is overstaffed or they themselves are under utilised. I can understand this to some degree, why would they, turkeys voting for Christmas kind of thing.

    But it must be an incredibly difficult challenge for any Minster of Health given the behemoth that it is.

    That's if you believe it's a problem that can be resolved by people simply amending obvious inefficiencies within their control. I can't see front line staff leaving things as is because they aren't bothered changing current practices. Front line staff and doctors are generally the ones seeking change.


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    #41
    Tell me how
    Registered Users Posts: 21,517 ✭✭✭✭Tell me how


    Matt Barrett wrote: »
    That's if you believe it's a problem that can be resolved by people simply amending obvious inefficiencies within their control. I can't see front line staff leaving things as is because they aren't bothered changing current practices. Front line staff and doctors are generally the ones seeking change.

    Well if we got people thinking in this way it mightn't be a bad start.
    Everyone thinks that there should be change but it should be someone else changing.
    What hope does the Minister have in such an environment? Particularly a unionised one.


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    #42
    mariaalice
    Registered Users Posts: 12,365 ✭✭✭✭mariaalice


    Matt Barrett wrote: »
    That's if you believe it's a problem that can be resolved by people simply amending obvious inefficiencies within their control. I can't see front line staff leaving things as is because they aren't bothered changing current practices. Front line staff and doctors are generally the ones seeking change.

    Its like the welfare debate, HSE covers huge areas the the average person would not consider health care as such, they also fund a large amount of NGO and charities that is why there needs to be better data about what the spending is on, blaming the staff, the unions, the administration is worse that useless.


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    #43
    James Brown
    Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    Tell me how wrote: »
    Well if we got people thinking in this way it mightn't be a bad start.
    Everyone thinks that there should be change but it should be someone else changing.
    What hope does the Minister have in such an environment? Particularly a unionised one.

    My point is maybe it's not down to an easy fix some are aware of but unwilling to address as you were suggesting.
    mariaalice wrote: »
    Its like the welfare debate, HSE covers huge areas the the average person would not consider health care as such, they also fund a large amount of NGO and charities that is why there needs to be better data about what the spending is on, blaming the staff, the unions, the administration is worse that useless.

    True.


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    #44
    Tell me how
    Registered Users Posts: 21,517 ✭✭✭✭Tell me how


    Matt Barrett wrote: »
    My point is maybe it's not down to an easy fix some are aware of but unwilling to address as you were suggesting.

    I'm not suggesting an easy fix. In fact, I'm suggesting that given the intricacies of there being so many people and so many structured influences, it is nearly impossible for a Minister for Health to effect change.


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    #45
    James Brown
    Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    Tell me how wrote: »
    I'm not suggesting an easy fix. In fact, I'm suggesting that given the intricacies of there being so many people and so many structured influences, it is nearly impossible for a Minister for Health to effect change.

    Your Turkeys voting for Christmas suggested that people who might see fixes, won't put them forward. While nobody would do themselves out of a job I think it's widely regarded that the system isn't working. Letting people go won't solve that.
    Only a Minister/Government can. I can see it being so complex it might take some study, but how long? We've had the same issues for decades and now we have a Taoiseach who was formally a health minister. If not now when do we start? If they don't know at this stage maybe it's time they hired professionals or people with an interest in health to look into not lads on their career path having to pay dues by serving as Health Minister for a stint.


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    #46
    Tell me how
    Registered Users Posts: 21,517 ✭✭✭✭Tell me how


    Matt Barrett wrote: »
    Your Turkeys voting for Christmas suggested that people who might see fixes, won't put them forward. While nobody would do themselves out of a job I think it's widely regarded that the system isn't working. Letting people go won't solve that.
    Only a Minister/Government can. I can see it being so complex it might take some study, but how long? We've had the same issues for decades and now we have a Taoiseach who was formally a health minister. If not now when do we start? If they don't know at this stage maybe it's time they hired professionals or people with an interest in health to look into not lads on their career path having to pay dues by serving as Health Minister for a stint.

    Leo Varadkar isn't the first Taoiseach who had also served as Minister for Health in recent times. Brian Cowan also held both roles.

    In fact, with the exception of Mary Coughlan who only held the office for a short period, we have had Ministers for Health who have either proven to be quite competent in the political space (Mary Harney, Micheal Martin, Leo, Brian Cowan, Harris) or medical professionals themselves (James Reilly, Leo).

    I'm not arguing the overall qualities of these individuals but none of them could be described as being completely unaware of the challenge associated with the Health service or have been expected to be completely incapable of improving it.

    So, why are we where we are? There's been enough studies done.


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    #47
    James Brown
    Closed Accounts Posts: 16,015 ✭✭✭✭James Brown


    Tell me how wrote: »
    Leo Varadkar isn't the first Taoiseach who had also served as Minister for Health in recent times. Brian Cowan also held both roles.

    In fact, with the exception of Mary Coughlan who only held the office for a short period, we have had Ministers for Health who have either proven to be quite competent in the political space (Mary Harney, Micheal Martin, Leo, Brian Cowan, Harris) or medical professionals themselves (James Reilly, Leo).

    I'm not arguing the overall qualities of these individuals but none of them could be described as being completely unaware of the challenge associated with the Health service or have been expected to be completely incapable of improving it.

    So, why are we where we are? There's been enough studies done.

    Well going by the above the question seems to be why are they pretending they don't know what to do and why aren't they doing it?
    In the case of Harney there were questions over her husbands connections to private health and we had Reilly and his allocation of Clinics. Maybe it's a case of either not wanting to get too deeply involved or only using it for their own advances?


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    #48
    Anita Blow
    Registered Users Posts: 1,933 ✭✭✭Anita Blow


    Matt Barrett wrote: »
    Well going by the above the question seems to be why are they pretending they don't know what to do and why aren't they doing it?
    In the case of Harney there were questions over her husbands connections to private health and we had Reilly and his allocation of Clinics. Maybe it's a case of either not wanting to get too deeply involved or only using it for their own advances?

    Politicians have no incentive to fix the health service. The fixes that would have the biggest impact and need to happen are too politically unpalatable:

    1) Cut administrative staff and reinvest that money in frontline staff

    2) Close rural hospitals and centralise care in larger urban hospitals

    3) Increase bed capacity, requiring substantial investment.

    The health service just isn't an issue for the general public, as evidence by the fact that both Fine Gael & Fianna Fail along with their health ministers continue to enjoy popular support. Why would either risk their chance of re-election when the general public would rather moan than do anything about the health service?


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    #49
    Tell me how
    Registered Users Posts: 21,517 ✭✭✭✭Tell me how


    Anita Blow wrote: »
    Politicians have no incentive to fix the health service. The fixes that would have the biggest impact and need to happen are too politically unpalatable:

    1) Cut administrative staff and reinvest that money in frontline staff

    2) Close rural hospitals and centralise care in larger urban hospitals

    3) Increase bed capacity, requiring substantial investment.

    The health service just isn't an issue for the general public, as evidence by the fact that both Fine Gael & Fianna Fail along with their health ministers continue to enjoy popular support. Why would either risk their chance of re-election when the general public would rather moan than do anything about the health service?

    I'm less than 45 minutes from two hospitals. Limerick Regional, or Galway Clinic. Leaving aside the fact that the Galway Clinic is private, I've yet to see how closing regional hospitals is helping.

    I think the focus should be on appropriate care in appropriate location. I was in Limerick A&E at the start of November and a lady came in from Carrigaholt with her daughter. That is a 3 hour round trip just to get even triaged.

    Is that what it has come to in this country?


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    #50
    CrabRevolution
    Registered Users Posts: 2,801 ✭✭✭CrabRevolution


    From my experience in the HSE, I don't think there's actually that much easy fat to be trimmed within the hospitals themselves.

    I know there's the popular perception out there that you can go into a Hospital and it'll staffed almost entirely by managers and administrative staff but it's not quite true. One hospital I worked in had about 300 beds and 800 staff, and there were maybe only about 15 in roles people would see as useless (even if they're not) e.g. medical records, quality assurance, statistics etc. Most departments have no full time clerical support and might have a secretary for 2 days a week. There was a 7 person senior management team, and maybe another 3-4 more directors of nursing/bed managers etc.

    If I were to guess, a lot of salaries are spent on the "business" side of the HSE, called HBS or Health Business Services. People who never see a hospital but work in large office buildings (presumably rented at generous expense by the HSE).

    My job involved dealing a lot with HBS procurement, and you'd regularly have to email 5 different people to move one step you could have done yourself in one phone call to a supplier/contractor/service provider. There's project managers, procurement specialists, tender supervisors, procurement officers etc. You've to run every action up and down the chain of supervisors and officers and get a response from each of them, who'll often just pass it to their secretary and cc you in the email.

    I'd love to skip the bullsh*t but of course the system is designed so that they control the money so if you don't jump through their hoops you get nothing. I'm told that 10+ years ago when money was flying around, procurement were only involved in large events e.g. new hospitals being kitted out, large expansions, property deals etc. but then the crash happened and they found themselves with nothing to do, so to justify their existence they began asserting that they were in charge of all aspects of buying everything in the HSE.

    All of this is supposedly in the name of efficiency and fairness for staff and suppliers etc. but I'd say they've spent €100 and wasted hundreds of man hours for every €1 they've saved. Now I know the HSE can't function without a business,accounting, administrative side, but there's no way in hell that that's the way to go about it. That's just one aspect of the HSE I've found to be a bloated mess, I'm sure there's other parallel bodies soaking up money.


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    #51
    CrabRevolution
    Registered Users Posts: 2,801 ✭✭✭CrabRevolution


    Tell me how wrote: »
    I'm less than 45 minutes from two hospitals. Limerick Regional, or Galway Clinic. Leaving aside the fact that the Galway Clinic is private, I've yet to see how closing regional hospitals is helping.

    I think the focus should be on appropriate care in appropriate location. I was in Limerick A&E at the start of November and a lady came in from Carrigaholt with her daughter. That is a 3 hour round trip just to get even triaged.

    Is that what it has come to in this country?


    That's a bit of a ridiculous point to make. If you live at the end of a sparsely populated peninsula and an enormous estuary separates you and the nearest city, it's not unreasonable to assume you'll be pretty far from any major health facilities.

    That's the trade off people make to live in these places. Nowhere on earth has the same level of services available in the depths of the countryside as they do in the cities, but that's somehow what we're expected to provide in Ireland?


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    #52
    Tell me how
    Registered Users Posts: 21,517 ✭✭✭✭Tell me how


    CrabRevolution wrote: »
    That's a bit of a ridiculous point to make. If you live at the end of a sparsely populated peninsula and an enormous estuary separates you and the nearest city, it's not unreasonable to assume you'll be pretty far from any major health facilities.

    That's the trade off people make to live in these places. Nowhere on earth has the same level of services available in the depths of the countryside as they do in the cities, but that's somehow what we're expected to provide in Ireland?

    It isn't ridiculous when only a few years ago she wouldn't have had to travel past Ennis.
    Hence the part of my post appropriate care in appropriate location.


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    #53
    kippy
    Registered Users Posts: 18,394 ✭✭✭✭kippy


    Wanderer78 wrote: »
    could this lead to ultimate collapse of our health service?

    to add another stephen kinsella piece of research, productivity has increased dramatically across most sectors over the last couple of decades, but wage inflation has remained relatively low, him believing the deunionisation of our economies being the main contributor.

    How did he come up with that piece of wisdom?
    There's been a lot of changes in society over the same time period - to put it down to one thing (that happens to suit a particular agenda) is a bit daft.
    (Maybe you are paraphrasing and there is some solid evidence to back this up)


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    #54
    Anita Blow
    Registered Users Posts: 1,933 ✭✭✭Anita Blow


    Tell me how wrote: »
    It isn't ridiculous when only a few years ago she wouldn't have had to travel past Ennis.
    Hence the part of my post appropriate care in appropriate location.

    And outcomes were likely worse. If you live in an extremely remote tip of a peninsula then a 1.5h journey to a hospital is not unreasonable.
    There's a reason the EDs were closed. We centralise care in larger hospitals because they have the necessary range of specialities to appropriately treat the proper emergencies. Local injury units can treat the vast majority of the simple complaints in smaller regional hospitals.

    For example centralisation of our stroke and heart attack care has been fundamental to our massive improvement in outcomes for both of those.


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    #55
    The Black Oil
    Moderators, Category Moderators, Entertainment Moderators, Science, Health & Environment Moderators, Regional East Moderators Posts: 18,204 CMod ✭✭✭✭The Black Oil


    There was a piece at the weekend say they're having trouble getting a replacement for DG - Tony O'Brien, not surprising. Plenty of CAMHS and psychiatry jobs vacant for ages too, from one corner of the country to another - see publicjobs.ie

    Moderator: Television, Psychology and Dublin County North.

    CMod: Entertainment



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    #56
    Anita Blow
    Registered Users Posts: 1,933 ✭✭✭Anita Blow


    HSE Director position is a poison chalice because they are entirely hamstrung by the DoH in implementing actual reforms.
    Theres 60 psychiatry consultant posts vacant currently.


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    #57
    Tell me how
    Registered Users Posts: 21,517 ✭✭✭✭Tell me how


    Anita Blow wrote: »
    And outcomes were likely worse. If you live in an extremely remote tip of a peninsula then a 1.5h journey to a hospital is not unreasonable.
    There's a reason the EDs were closed. We centralise care in larger hospitals because they have the necessary range of specialities to appropriately treat the proper emergencies. Local injury units can treat the vast majority of the simple complaints in smaller regional hospitals.

    For example centralisation of our stroke and heart attack care has been fundamental to our massive improvement in outcomes for both of those.

    I'll try once more.
    Tell me how wrote: »
    Hence the part of my post appropriate care in appropriate location.


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    #58
    Anita Blow
    Registered Users Posts: 1,933 ✭✭✭Anita Blow


    Tell me how wrote: »
    I'll try once more.

    Your example of Ennis ED, 30 mins from an ED in a model 4 hospital in a sparsely populated part of the country was an example of inappropriate care in an inappropriate location. Its remodelling as a local injury unit, with redeployment of staff to Limerick is a far better use of resources which improves outcomes for everyone in the area.
    There's no point in being 30 mins from an ED if it has none of the services to treat you in an emergency


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    #59
    Uriel.
    Registered Users Posts: 8,061 ✭✭✭Uriel.


    One of the biggest issues with reform is that people think its great until it anyway impacts on them. Try close any unneeded inefficient service and even if it based on solid evidence, you'll have locals marching and politicians capitulating. Look at any given days PQs. Practically every question is operational or based on some local issue. The Minister isn't supposed to be involved in operational issues but he is, because its politics.


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    #60
    incentsitive
    Registered Users Posts: 436 ✭✭incentsitive


    From a quick look at Google Maps Carraigaholt is 1hr 19 from Limerick, 55 minutes from Ennis.....hardly a massive difference and I'm sure in an emergency situation it is even less.


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    #61
    Del2005
    Registered Users Posts: 18,872 ✭✭✭✭Del2005


    CrabRevolution wrote: »
    From my experience in the HSE, I don't think there's actually that much easy fat to be trimmed within the hospitals themselves.

    I know there's the popular perception out there that you can go into a Hospital and it'll staffed almost entirely by managers and administrative staff but it's not quite true. One hospital I worked in had about 300 beds and 800 staff, and there were maybe only about 15 in roles people would see as useless (even if they're not) e.g. medical records, quality assurance, statistics etc. Most departments have no full time clerical support and might have a secretary for 2 days a week. There was a 7 person senior management team, and maybe another 3-4 more directors of nursing/bed managers etc.

    If I were to guess, a lot of salaries are spent on the "business" side of the HSE, called HBS or Health Business Services. People who never see a hospital but work in large office buildings (presumably rented at generous expense by the HSE).

    My job involved dealing a lot with HBS procurement, and you'd regularly have to email 5 different people to move one step you could have done yourself in one phone call to a supplier/contractor/service provider. There's project managers, procurement specialists, tender supervisors, procurement officers etc. You've to run every action up and down the chain of supervisors and officers and get a response from each of them, who'll often just pass it to their secretary and cc you in the email.

    I'd love to skip the bullsh*t but of course the system is designed so that they control the money so if you don't jump through their hoops you get nothing. I'm told that 10+ years ago when money was flying around, procurement were only involved in large events e.g. new hospitals being kitted out, large expansions, property deals etc. but then the crash happened and they found themselves with nothing to do, so to justify their existence they began asserting that they were in charge of all aspects of buying everything in the HSE.

    All of this is supposedly in the name of efficiency and fairness for staff and suppliers etc. but I'd say they've spent €100 and wasted hundreds of man hours for every €1 they've saved. Now I know the HSE can't function without a business,accounting, administrative side, but there's no way in hell that that's the way to go about it. That's just one aspect of the HSE I've found to be a bloated mess, I'm sure there's other parallel bodies soaking up money.

    This is the problem. People look at the front lines and see the chaos and think it needs more bodies, because most front line staff have sought after skills so leave, when it's the back room staff that are sucking up all the resources.

    How can multiple health boards be merged and not a single person is made redundant!


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