General Irish Government discussion thread [See Post 1805]

Podge_irl · 08-11-2018 1:51pm

corner back 2 wrote: »

The other fact is that there is no extra leave available over Christmas for nurses and doctors than any other time of the year.

So? He never said there was.

Podge_irl · 08-11-2018 1:54pm

corner back 2 wrote: »

What is your assumption of his motives? I am sure he would never try to deflect from the problems at hand by blaming front-line staff. Amazingly I found myself agreeing with Michael Martin on Newstalk this morning!! Leo must be really doing something wrong if that is the case!!!

I think he has spotted a particular scenario that is contributing to the problem and wanted to highlight it. I think he has done a poor enough job of it, and he should not have said it in such a manner that let people think he thought it was the entire problem (as it obviously is not). I am trying to focus on what he actually said rather than ascribing motives though.

Essentially though, I'm not doubting his sincerity and you are and there is probably not much that will change that.

corner back 2 · 08-11-2018 2:06pm

Podge_irl wrote: »

I think he has spotted a particular scenario that is contributing to the problem and wanted to highlight it. I think he has done a poor enough job of it, and he should not have said it in such a manner that let people think he thought it was the entire problem (as it obviously is not). I am trying to focus on what he actually said rather than ascribing motives though.

Essentially though, I'm not doubting his sincerity and you are and there is probably not much that will change that.

Yes because he has failed to present any solutions in the long or short term only soundbites. Smoke screen, deflection politics of blaming the straw man while producing no concrete proposals. Do I belive anyone will do better? I'm not sure but I did have great hopes for Leo but it seems as with many before the further you move up the ladder the more detached you become from the reality on the ground.

corner back 2 · 08-11-2018 2:08pm

blanch152 wrote: »

The point is that it isn't any other time of the year. December/January is peak demand. There should be less leave available over that period than any other time of the year.

Nothing more and nothing less than that, which is a fair statement.

The point is peak times for hospitals are all year round now. But that doesn't matter for the purpose of the soundbite.

Podge_irl · 08-11-2018 2:14pm

corner back 2 wrote: »

Yes because he has failed to present any solutions in the long or short term only soundbites. Smoke screen, deflection politics of blaming the straw man while producing no concrete proposals. Do I belive anyone will do better? I'm not sure but I did have great hopes for Leo but it seems as with many before the further you move up the ladder the more detached you become from the reality on the ground.

He has just presented one aspect that can help contribute to a solution - i.e. looking at administration and rostering.

No one else here has managed to suggest anything that I've noticed?

corner back 2 wrote: »

The point is peak times for hospitals are all year round now. But that doesn't matter for the purpose of the soundbite.

Again, this is not true. Hospitals are under pressure year round, but "peak time" has an actual meaning and it is not year round.

corner back 2 · 08-11-2018 2:29pm

Again, this is not true. Hospitals are under pressure year round, but "peak time" has an actual meaning and it is not year round.[/quote]

Irish hospitals are running between 97% and 103% occupancy all year round.(IMO figures) So 100% is not a peak fair enough.
So yesterday wasn't a peak with 600 on trolleys? Tell that to the patients and staff involved. I'm living in the real world here.

corner back 2 · 08-11-2018 2:36pm

Podge_irl wrote: »

He has just presented one aspect that can help contribute to a solution - i.e. looking at administration and rostering.

No he didnt he specifically blamed the "holidays" of front line staff over a 12 day period when asked about what his solutions were for the trolley crisis. Apparently I'm not allowed to interpret what he said but you are.

James Brown · 08-11-2018 2:53pm

Good loser wrote: »

You can backchannel every problem to either Leo (or Eoghan).

Fit the facts to suit the charge.

Over and over and over again.

Tedious in the extreme.

[A nephew works in a London hospital. On Jan 2 this year 29 nurses had phoned in sick by lunchtime. Theresa May's fault no doubt!]

So quoting Leo and criticising what he said doesn't fit into your conspiracy rant I'm afraid.

James Brown · 08-11-2018 2:54pm

Podge_irl wrote: »

Bed shortages and staff shortages are related - they are not separate problems.

Agreed and all the staff in the world won't magic up all the beds required. Leo is distracting.

James Brown · 08-11-2018 2:57pm

Podge_irl wrote: »

The Dáil being in session and the government and TDs working are completely separate things, but I'm sure you know that.

You're arguing against your own logic. If we need government intervention/policy to solve worsening crises how much progress would be made with every one of them off on holidays?

Podge_irl wrote: »

Do people not understand that having a bed to put someone in is directly related to staffing across the entire hospital, including diagnostic units?

Anyway, I'll take it you don't have a better suggestion then.

It plays a part for sure. It's Leo's only comment from his bag of tricks however, which by all accounts is false and misleading.
Not to forget staff are owed hours from working extra hours and using over time. This shows while more staff helps, his highlighting lack of staff is not in agreement with the people on the ground or the Fine Gael party and pratically everyone in the country. He's playing at smoke and mirrors to divert as per. He's found wanting and looking into another shameful season of hospital trolley scandals, which are an issue year round.

blanch152 · 08-11-2018 3:26pm

corner back 2 wrote: »

Again, this is not true. Hospitals are under pressure year round, but "peak time" has an actual meaning and it is not year round.

Irish hospitals are running between 97% and 103% occupancy all year round.(IMO figures) So 100% is not a peak fair enough.
So yesterday wasn't a peak with 600 on trolleys? Tell that to the patients and staff involved. I'm living in the real world here.

Matt Barrett wrote: »

So quoting Leo and criticising what he said doesn't fit into your conspiracy rant I'm afraid.

We can have meaningless exchanges of soundbites defending frontline staff, or we can look at some hard facts. Here is an interesting article:

http://www.publicpolicy.ie/average-length-of-stay-in-irish-hospitals/

"After carrying out the age demographic adjustment Ireland has the tenth highest ALOS out of 34 OECD countries and the third highest in the EU (after Finland and the Slovak Republic)."

Bingo, there is your problem identified by Leo up in lights. Why ALOS matters is explained here:

"Reducing the time spent in hospital reduces the cost per patient and allows more patients to be treated in a given period. Moreover, a shorter stay in hospital allows treatment to be shifted from expensive inpatient care to less expensive outpatient care. "

And the solution:

"Improvements along this metric are likely to yield considerable benefits in terms of lower average cost per patient and a significant increase in the availability of hospital bed-days."

Now, annual leave at peak times is one factor, but there may well be others. As this report shows, and as Leo clearly alludes to, while Irish hospitals may be running between 97% and 103% occupancy all year round, they are certainly not running at 97% efficiency at any time. Improving this efficiency before asking for more money is a key requirement. It is not something within the gift of politicians, it not something that can be done by civil servants in Hawkins House, it is not even something that senior HSE management can deliver on, it is a requirement on frontline staff and their managers to up their game, and to treat people as efficiently and effectively as other EU and OECD states do.

If Irish hospitals are operating even at average EU efficiency, and there are still not enough beds, then we can truly say that there is a shortage of beds. At current levels of efficiency, it is a handy but ultimately false excuse.

Podge_irl · 08-11-2018 3:55pm

blanch152 wrote: »

Improving this efficiency before asking for more money is a key requirement. It is not something within the gift of politicians, it not something that can be done by civil servants in Hawkins House, it is not even something that senior HSE management can deliver on, it is a requirement on frontline staff and their managers to up their game, and to treat people as efficiently and effectively as other EU and OECD states do.

I don't really agree with that. Structural inefficiencies are not within the abilities of front-line staff to do much of anything about. Senior HSE management is exactly who need to look at that.

Matt Barrett wrote: »

You're arguing against your own logic. If we need government intervention/policy to solve worsening crises how much progress would be made with every one of them off on holidays?

Dáil recess =/= the government being on holidays

Matt Barrett wrote: »

Not to forget staff are owed hours from working extra hours and using over time. This shows while more staff helps, his highlighting lack of staff is not in agreement with the people on the ground or the Fine Gael party and pratically everyone in the country.

There aren't enough staff (or to be pedantic about it, there is a staffing problem anyway, be that distribution, efficiency or total numbers). That can not be fixed overnight and something obviously needs to be done about it. Can't be fixed before this winter though.

Podge_irl · 08-11-2018 3:59pm

Matt Barrett wrote: »

Agreed and all the staff in the world won't magic up all the beds required. Leo is distracting.

And all the beds in the world won't alleviate an underlying structural problem.

The problem is not just the number of beds. That is the symptom.

corner back 2 · 08-11-2018 4:03pm

blanch152 wrote: »

We can have meaningless exchanges of soundbites defending frontline staff, or we can look at some hard facts. Here is an interesting article:

http://www.publicpolicy.ie/average-length-of-stay-in-irish-hospitals/

"After carrying out the age demographic adjustment Ireland has the tenth highest ALOS out of 34 OECD countries and the third highest in the EU (after Finland and the Slovak Republic)."

Bingo, there is your problem identified by Leo up in lights. Why ALOS matters is explained here:

"Reducing the time spent in hospital reduces the cost per patient and allows more patients to be treated in a given period. Moreover, a shorter stay in hospital allows treatment to be shifted from expensive inpatient care to less expensive outpatient care. "

And the solution:

"Improvements along this metric are likely to yield considerable benefits in terms of lower average cost per patient and a significant increase in the availability of hospital bed-days."

Now, annual leave at peak times is one factor, but there may well be others. As this report shows, and as Leo clearly alludes to, while Irish hospitals may be running between 97% and 103% occupancy all year round, they are certainly not running at 97% efficiency at any time. Improving this efficiency before asking for more money is a key requirement. It is not something within the gift of politicians, it not something that can be done by civil servants in Hawkins House, it is not even something that senior HSE management can deliver on, it is a requirement on frontline staff and their managers to up their game, and to treat people as efficiently and effectively as other EU and OECD states do.

If Irish hospitals are operating even at average EU efficiency, and there are still not enough beds, then we can truly say that there is a shortage of beds. At current levels of efficiency, it is a handy but ultimately false excuse.

At least you bothered to research your answer but explain how frontline staff can up there efficiency if there is nowhere to put the patients. Will we put bunk beds in the hospital? Will we reduce the nurse to patient ratio? Will we reduce anaesthetic cover? Will we do elective surgery 24 hours a day? Which service will we cancel at the expense of another service?
Please explain with your obvious expertise of how a hospital operates of how frontline staff become more efficient? Maybe more hours for less money and no holidays? Maybe leave the patients alone at night because they will be asleep anyway and we can have more staff during the day?

Podge_irl · 08-11-2018 4:13pm

corner back 2 wrote: »

At least you bothered to research your answer but explain how frontline staff can up there efficiency if there is nowhere to put the patients. Will we put bunk beds in the hospital? Will we reduce the nurse to patient ratio? Will we reduce anaesthetic cover? Will we do elective surgery 24 hours a day? Which service will we cancel at the expense of another service?

Will we try and have diagnostic and lab services open longer or more frequently so we can process patients and discharge them quicker?

James Brown · 08-11-2018 4:13pm

Podge_irl wrote: »

And all the beds in the world won't alleviate an underlying structural problem.

The problem is not just the number of beds. That is the symptom.

You keep saying that and I'll keep agreeing with you.

Leo is using staffing as a diversion. It plays a part, but not so much in this instance as the current staff are actually owed time off for working above and beyond their regular hours. So to suggest them not being around or not taking holidays might help the situation is diversion on Leo's part and disingenuous.

Speaking on RTÉ's Today with Sean O'Rourke, she said INMO members work 365 days a year and many have built up a considerable amount of hours that they are owed.

She said one department in one hospital has 1,000 hours owed.

Ms Ní Sheaghdha said annual leave is curtailed over periods like Christmas and hospital rosters are "totally dependent on agency (staff) and overtime".

I'll quote Dr. O'Connor the medical Director of Cork University Hospital;

Dr O'Connor said it was "bordering on disingenuous and insulting" to HSE staff to suggest that significant numbers take extended leave over this period.
https://www.rte.ie/news/2018/1108/1009469-winter-staffing/

There a problem with the health system. This is common knowledge. There is also a shortage of beds. This is common knowledge.

James Brown · 08-11-2018 4:23pm

Podge_irl wrote: »

...

Again, this is not true. Hospitals are under pressure year round, but "peak time" has an actual meaning and it is not year round.

To be fair, when you break records when already at crisis level, 'peak' simply means worse crisis. Peak suggests there's an acceptable lowering when 'off-peak'. We are always past crisis level. We are in danger or normalising or setting the bar low by suggesting such IMO. It's more honest to say the crisis worsens at this time of year.

Podge_irl · 08-11-2018 4:23pm

Matt Barrett wrote: »

You keep saying that and I'll keep agreeing with you.

Leo is using staffing as a diversion. It plays a part, but not so much in this instance as the current staff are actually owed time off for working above and beyond their regular hours. So to suggest them not being around or not taking holidays might help the situation is diversion on Leo's part and disingenuous.

They are owed time because of poor work practices forced upon them and general staff shortages. I am not disagreeing with this. 'Staffing over winter is not an issue because staff are owed hours' is not a position that makes any logical sense though. No one is suggesting they are shirking their responsibilities or taking extended holidays.

Varadkar actually stated two things:

a) there are a large number of 'non-working' days over the Christmas period. This is true
b) perhaps for a period of a couple weeks the rostering should be managed so no staff leave is taken during the busiest period.

That is not suggesting they take extra holidays at this time of year, simply that perhaps the normal amount of staff leave should actually be reduced.

If this is all nonsense, then what is the problem and what is the solution?

Podge_irl · 08-11-2018 4:25pm

Matt Barrett wrote: »

To be fair, when you break records when already at crisis level, 'peak' simply means worse crisis. Peak suggests there's an acceptable lowering when 'off-peak'. We are always past crisis level. We are in danger or normalising or setting the bar low by suggesting such IMO. It's more honest to say the crisis worsens at this time of year.

Absolutely, I have no issue with that. But the debate began around the plan for the "even worse crisis" that comes in winter every year.

James Brown · 08-11-2018 4:29pm

Podge_irl wrote: »

They are owed time because of poor work practices forced upon them and general staff shortages. I am not disagreeing with this. 'Staffing over winter is not an issue because staff are owed hours' is not a position that makes any logical sense though. No one is suggesting they are shirking their responsibilities or taking extended holidays.

Varadkar actually stated two things:

a) there are a large number of 'non-working' days over the Christmas period. This is true
b) perhaps for a period of a couple weeks the rostering should be managed so no staff leave is taken during the busiest period.

That is not suggesting they take extra holidays at this time of year, simply that perhaps the normal amount of staff leave should actually be reduced.

If this is all nonsense, then what is the problem and what is the solution?

Nobody said it's nonsense. It would plays a part, none or very little in this instance by the accounts of the people on the ground. I can only keep agreeing it plays a part so many times. You keep bringing it back to that.

Varadkar is putting staff holidays front and center in a discussion about the health crisis and it worsening over this period. That's diversion and the issue.

Podge_irl · 08-11-2018 4:30pm

Matt Barrett wrote: »

Nobody said it's nonsense. I can only keep agreeing it plays a part so many times. You keep bringing it back to that.
Varadkar is putting staff holidays front and center in a discussion about the health crisis and it worsening over this period. That's diversion and the issue.

It worsens over this period cause more people get sick. He is saying during a period of peak usage of the hospitals we should perhaps also have peak staffing.

If you want, you can view that as blaming doctors and nurses for taking holidays. I view it as criticizing administration.

Edit: I don't even think it was particularly directed at "frontline" staff, but the ancillary services.

James Brown · 08-11-2018 4:35pm

Podge_irl wrote: »

It worsens over this period cause more people get sick. He is saying during a period of peak usage of the hospitals we should perhaps also have peak staffing.

If you want, you can view that as blaming doctors and nurses for taking holidays. I view it as criticizing administration.

Edit: I don't even think it was particularly directed at "frontline" staff, but the ancillary services.

That's polishing a t**d.
Edit: It's pointing at staff and saying them taking holidays is the problem, or only one he felt important enough to mention.
It's a national crisis worsening year on year. His party was elected in 2011 on a promise to end the scandal of people on trolleys due to lack of beds and despite all accounts to the contrary he is putting staffing levels as his number one comment in regard to the crisis worsening at this time of year. That is diversion and disingenuous IMO.

corner back 2 · 08-11-2018 4:36pm

Podge_irl wrote: »

Will we try and have diagnostic and lab services open longer or more frequently so we can process patients and discharge them quicker?

Believe it or not the majority are open 24/7 providing cover everyday of the year. Yes they can not run "full whack" as Leo says all the time. And if you move staff to cover one period another period will suffer.

Everyone is talking about solutions involving front line staff. How about we reduce the levels of middle management and duplication in the HSE and the department of Health. Then we divert the money saved to primary care, step down care and home help to keep people out of hospitals and then everyone can be more efficient! Not rocket science efficiency in everyone's gift when the right conditions exist.

Podge_irl · 08-11-2018 4:41pm

Matt Barrett wrote: »

And he's polishing a t**d.
It's a national crisis worsening year on year. His party was elected in 2011 on a promise to end the scandal of people on trolleys due to lack of beds and despite all accounts to the contrary he is putting staffing levels as his number one comment in regard to the crisis worsening at this time of year. That is diversion and disingenuous IMO.

Yes, they have failed spectacularly to solve the underlying crisis. However, bearing in mind we are talking in relative terms here, why does the crisis worsen at this time of year then? The same underlying criteria are still there.

I am, perhaps, guilty of looking at the comment too naively, but it is difficult to fault the underlying logic of it.

corner back 2 wrote: »

Everyone is talking about solutions involving front line staff. How about we reduce the levels of middle management and duplication in the HSE and the department of Health. Then we divert the money saved to primary care, step down care and home help to keep people out of hospitals and then everyone can be more efficient! Not rocket science efficiency in everyone's gift when the right conditions exist.

I have no problem with that - seems a perfectly sensible solution. Though I'm pretty sure many have tried and failed to negotiate that particular morass.

James Brown · 08-11-2018 5:09pm

Podge_irl wrote: »

Yes, they have failed spectacularly to solve the underlying crisis. However, bearing in mind we are talking in relative terms here, why does the crisis worsen at this time of year then? The same underlying criteria are still there.

A number of factors, the weather/flu season for one.
Even if hospitals closed on December 25th, it wouldn't explain away the worsening crisis over the preceding months and there after. Leo chose a soft target to distract from himself and his government.

Podge_irl wrote: »

I am, perhaps, guilty of looking at the comment too naively, but it is difficult to fault the underlying logic of it.

You have to look at the context and timing.

blanch152 · 08-11-2018 5:27pm

corner back 2 wrote: »

At least you bothered to research your answer but explain how frontline staff can up there efficiency if there is nowhere to put the patients. Will we put bunk beds in the hospital? Will we reduce the nurse to patient ratio? Will we reduce anaesthetic cover? Will we do elective surgery 24 hours a day? Which service will we cancel at the expense of another service?
Please explain with your obvious expertise of how a hospital operates of how frontline staff become more efficient? Maybe more hours for less money and no holidays? Maybe leave the patients alone at night because they will be asleep anyway and we can have more staff during the day?

Every other country in the EU bar Finland manages to do it, so don't understand why we can't.

The 2018 Capacity Review of the Health Services identified enhancing patient flow as a key objective. A large number of measures were included in it, hospitals could start there.

blanch152 · 08-11-2018 5:30pm

Matt Barrett wrote: »

Nobody said it's nonsense. It would plays a part, none or very little in this instance by the accounts of the people on the ground. I can only keep agreeing it plays a part so many times. You keep bringing it back to that.

Varadkar is putting staff holidays front and center in a discussion about the health crisis and it worsening over this period. That's diversion and the issue.

Eh, you did. Do you not remember this:

Matt Barrett wrote: »

No it's not. It's that we have an ongoing hospital bed shortage, exacerbated by the winter period. We know this, every year. Now Varadkar is suggesting staff not taking holidays would help solve this and staff organisations saying they are actually due hours and working over time. So Leo is taking nonsense even if his concept holds merit. He is trying to divert blame. There is absolutely no plan and 7 or 8 years in after Enda said he'd tackle the problem, and Leo having a stint as Minister of health, here's Leo diverting. Maybe if they tackled the crises they wouldn't need so much spin and nonsense.

corner back 2 · 08-11-2018 5:35pm

blanch152 wrote: »

Every other country in the EU bar Finland manages to do it, so don't understand why we can't.

The 2018 Capacity Review of the Health Services identified enhancing patient flow as a key objective. A large number of measures were included in it, hospitals could start there.

I agree with efficiency but you can't just state frontline staff should be more efficient without explaining how. Once again patient flow can't happen if there is nowhere to put patients or nowhere to discharge patients to. Explain how frontline staff can solve this. I gave you my explanation of how the whole health service could be more efficient.

funky sausage · 08-11-2018 5:52pm

I'm involved in the rostering of front line nurses in a busy hospital.

It's disappointing that Leo does not know that all single days annual leave requests cannot be given unless they are cost neutral. The staff where I work get one weeks annual leave every six weeks, if they have the annual leave to take, this is inbuilt into the roster, and ensures staff get fair access to their entitled annual leave.

There are no nurses getting extended leave at any time during the year, unless they swap their weeks with their colleagues.

Podge_irl · 08-11-2018 5:58pm

funky sausage wrote: »

There are no nurses getting extended leave at any time during the year, unless they swap their weeks with their colleagues.

He is not saying they are! He is saying there should be a period where no discretionary leave at all is given. It is not uncommon in any industry. This would create artificially high staffing levels for a brief period.

General Irish Government discussion thread [See Post 1805]

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