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Politics>What is wrong with the health service, HSE
mariaalice 10:03 17-12-2018 (2 Thanks)
https://www.irishtimes.com/news/heal...plan-1.3731979.

How is this happening, the tired old answer is usually too much middle management there has to be more to it? the article is depressing reduce staff recruitment as one of the big answers no nuanced or sophisticated business orientated solutions or advocating solutions that will make issues worse, for example making people wait for the fair deal will inevitably mean people who are ready to be discharged will end up staying in hospital blocking a bed and preventing admission for someone who need it.
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Wanderer78 10:05 17-12-2018 (1 Thanks)
Not a particularly surprising story, the decline of our critical sectors continues
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Eric Cartman 10:34 17-12-2018 (65 Thanks)
The problem is that you had the 4 regional health boards, The HSE was formed and because of unions instead of sacking 2 or 3 of the 4 people doing the same job, they all stayed, so you just had all the same people from the same boards under one roof , As time has gone on , backed up by unions , even as staff have retired these positions have been retained, and worse still, computerising and automating of services has led to more staff being needed because some older staff just refuse to upskill, so you need younger staff to be the link between them and a computer. Then theres the procurement infighting where buying expensive equipment for one hospital causes a budget issue and a political fight because a hospital in another region wants the same machine at the same time. Then we decided to give Really good specialised doctors the ability to write themselves a blank cheque as a consultant , then we allow political peer pressure to chose putting hospitals on land thats slow to access because of traffic and really expensive to buy just so they can score points with locals.

Then we hand out medical cards to too many people who kick up but because of an inadequate out of hours / close GP service, some people are determined to bring themselves and their kids to A&E for a cough, Then because we have a massively overpriced nursing home strategy and an ineffective strategy to tackle drug abuse , we have junkies and the elderly bed blocking to spend as much time in hospital as they can to offset the cost of the accomodation they do need. Couple that with a mantra of working frontline staff to the bone and never coming in underbudget on anything and you have a timebomb waiting to happen where the standard of public care gets further and further away from private care standards , eventually creating a complete two tier medical system where you can either afford it or may aswell not have gone to hospital at all.
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penno 10:44 17-12-2018 (2 Thanks)
Not to mention all the 'outside on the steps of the courthouse' pay outs. Nobody accountable, i dread to think what the annual cost is.
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touts 11:06 17-12-2018 (15 Thanks)
No doubt they will have to hire a few hundred more accountants to run the project to reduce services.

I think it was Stephen Kinsella who did a study a couple of years ago that found 42% of staff in HSE are admin staff. In NHS that is 20%. In private healthcare it is 10%.

The health service is run by administrators and accountants as a cash cow for administrators and accountants. They keep the system as bloated and inefficient as possible so that it takes an army of administrators just to keep it from toppling over.
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Wanderer78 11:14 17-12-2018
Originally Posted by touts:
No doubt they will have to hire a few hundred more accountants to run the project to reduce services.

I think it was Stephen Kinsella who did a study a couple of years ago that found 42% of staff in HSE are admin staff. In NHS that is 20%. In private healthcare it is 10%.

The health service is run by administrators and accountants as a cash cow for administrators and accountants. They keep the system as bloated and inefficient as possible so that it takes an army of administrators just to keep it from toppling over.
i think joe stiglitz has argued in the past, the more privatized a health care system becomes, the more bloated it becomes with admin and accountants, so whos right?
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mariaalice 11:20 17-12-2018 (5 Thanks)
Originally Posted by touts:
No doubt they will have to hire a few hundred more accountants to run the project to reduce services.

I think it was Stephen Kinsella who did a study a couple of years ago that found 42% of staff in HSE are admin staff. In NHS that is 20%. In private healthcare it is 10%.

The health service is run by administrators and accountants as a cash cow for administrators and accountants. They keep the system as bloated and inefficient as possible so that it takes an army of administrators just to keep it from toppling over.
There are supervisors working in medical areas being classed as administration also staff in wider allied health care are classed as administrators so its not a good comparison but does highlight the lack of proper data about what is going on.
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Anita Blow 11:30 17-12-2018 (27 Thanks)
Originally Posted by Eric Cartman:
The problem is that you had the 4 regional health boards, The HSE was formed and because of unions instead of sacking 2 or 3 of the 4 people doing the same job, they all stayed, so you just had all the same people from the same boards under one roof , As time has gone on , backed up by unions , even as staff have retired these positions have been retained, and worse still, computerising and automating of services has led to more staff being needed because some older staff just refuse to upskill, so you need younger staff to be the link between them and a computer. Then theres the procurement infighting where buying expensive equipment for one hospital causes a budget issue and a political fight because a hospital in another region wants the same machine at the same time. Then we decided to give Really good specialised doctors the ability to write themselves a blank cheque as a consultant , then we allow political peer pressure to chose putting hospitals on land thats slow to access because of traffic and really expensive to buy just so they can score points with locals.

Then we hand out medical cards to too many people who kick up but because of an inadequate out of hours / close GP service, some people are determined to bring themselves and their kids to A&E for a cough, Then because we have a massively overpriced nursing home strategy and an ineffective strategy to tackle drug abuse , we have junkies and the elderly bed blocking to spend as much time in hospital as they can to offset the cost of the accomodation they do need. Couple that with a mantra of working frontline staff to the bone and never coming in underbudget on anything and you have a timebomb waiting to happen where the standard of public care gets further and further away from private care standards , eventually creating a complete two tier medical system where you can either afford it or may aswell not have gone to hospital at all.
For the most part I agree but disagree with a couple points.

1) Consultants haven't really been given a blank cheque. In fact consultants since 2012 are on 30% less pay than their pre-2012 counterparts which has led to us haemorrhaging consultants. As someone who works in the health service I cannot stress how absolutely dire the situation is with consultant recruitment and retention. For example, the Mater lost 3 orthopaedic surgeons to private practice all at once at the beginning of last year. That is literally thousands of OPD patients who had their appointments and surgeries postponed indefinitely as the remaining consultants had closed their lists due to being overcapacity. To my knowledge the mater has been able to recruit only a single consultant to replace them. The general public cannot appreciate how dire a situation it is that we are near bottom of almost every OECD league table for no. of specialists per capita, and we still have had 500 consultant vacancies (the most there has ever been in the health service) for the past 1.5y. We literally can't even recruit to maintain our bottom-of-the-table position.

2) The location of the children's hospital was probably the one non-parochial, evidence-based decision that was made in this health service. Would encourage you to read the report outlining the justification for the hospital and why the locations were chosen. Was devised by experts from UK/Aus etc. Ease of access was considered and given some weighting, but quality of care and range of services available with co-location superseded it which was only right.

3) In general from my experience in a busy paediatric ED, the majority of presentations were justifiable. Very few cases of coughs or simple stuff presenting to ED, especially since under-6s GP care came in. For the most part the patient isn't to blame for the state of our ED waiting times, it's bed capacity
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FreudianSlippers 11:30 17-12-2018 (12 Thanks)
Scrap the HSE, sack all the employees, bust the unions and then start all over.
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Wanderer78 11:34 17-12-2018
Originally Posted by FreudianSlippers:
Scrap the HSE, sack all the employees, bust the unions and then start all over.
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.
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mariaalice 11:37 17-12-2018 (1 Thanks)
I would split all social care spending i.e care for disabilities, mental health, and non medical care for the elderly such as home support and nursing homes, from medical care, so we could a least see where the money is going.
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Berserker 12:30 17-12-2018 (3 Thanks)
Originally Posted by Wanderer78:
could this lead to ultimate collapse of our health service?
Yes, in a word. The unions have too much of a hold on the health service. They'd collapse the service in no time. Massive reform of the structure of the service is needed, first and foremost. One single national body is more than enough, given the size of the country. Reduce the number of hospitals. We have far too many hospitals in the country and this idea of having a having every service possible on your doorstep needs to be quashed. If person 'A' chooses to live in the backend of Mayo, they need to accept that they are going to have to travel to a city to get specialist care.
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Wanderer78 12:33 17-12-2018 (2 Thanks)
Originally Posted by Berserker:
Yes, in a word. The unions have too much of a hold on the health service. They'd collapse the service in no time. Massive reform of the structure of the service is needed, first and foremost. One single national body is more than enough, given the size of the country. Reduce the number of hospitals. We have far too many hospitals in the country and this idea of having a having every service possible on your doorstep needs to be quashed. If person 'A' chooses to live in the backend of Mayo, they need to accept that they are going to have to travel to a city to get specialist care.
i suspect the issues of our health services is a bit more complicated than just unions, most countries are developing similar problems
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Berserker 12:35 17-12-2018 (2 Thanks)
Originally Posted by Wanderer78:
i suspect the issues of our health services is a bit more complicated than just unions, most countries are developing similar problems
They are. My post is a start and the unions and structure of the service are a big part of the problem.
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Geuze 12:37 17-12-2018 (8 Thanks)
Excessive spending overall

Excessive exp on pharma

Too many hosps

Too many EDs

2,000 staff in HR, the head of HR said he needs 800

62 payroll offices

8 health boards merged into HSE, Bertie Ahern did a deal with unions, no jobs lost

Consultants face incentives to focus on private work
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