Health policy Digital innovation in the HSE

[arbitron]

Sometimes the obvious, rather than the conspiracy theory is closer to the bone.

Working in the HSE, I agree. I don't see any evidence of conspiracy but plenty of short-term thinking and clientelism.

For example, we have too many hospitals for a country with our population and geography but it is political poison for TDs.

Private healthcare is a safety valve for the HSE/DoH that lets the pressure off just enough so that they can muddle through - e.g. NTPF outsourcing.

There is also the historical mess of amalgamating all the Health Boards, never mind the Byzantine service arrangements with various voluntary hospitals and charities.

As for the system as it is - we took something like 3,000 beds out of the Public Hospitals in 1987.
Less than half of them have, I hear, been restored.
Population in 1987 c3.5m
Population in 2023 c5m.
You can't fit a Quart into a Pint bottle (or for younger readers) 2 litres into a litre bottle

Healthcare has changed radically since 2007, never mind since 1987. Some procedures that used to require a week in hospital are now day cases, so we don't need as many beds for those. We have also moved a lot of assessments and treatments to outpatient clinics and even to the home. For example, many sleep studies which once required an overnight hospital stay in a specialist unit can now be done by the patient themselves in their own bed.

So the demand for hospital beds should (in theory) be lower now than it was in the 80s. But what has also changed is the demographics - we now have people who are living longer with more complex conditions, and the care is not available for them in the community, whether it's in their own home, nursing home, etc. That puts back-pressure on hospitals, which in turn creates a demand for beds.

Another major issue with hospital "beds" is that we are not really talking about physical beds and rooms, moreso the ward clerks, porters, nurses, physios, etc. that are required to staff them. In many hospitals they are already unable to maintain full rotas so adding more beds would be impossible.

 

[Sophrosyne]

Thanks for your post @arbitron. As mentioned previously, we seldom get specifics expressed as fact rather than hyperbole.

 

[Protocol]

Yes, we have too many hosps, okay.

I think there are 50-53?



The ED doctors say that there are too many EDs.
I think there are 29 ED?

If they are correct, then why are there queues / waiting in the 29 EDs?

 

[MugsGame]

Because demand is not distributed optimally across available capacity?

Queuing theory is a complicated counter-intuitive area.

 

[NoRegretsCoyote]

Because demand is not distributed optimally across available capacity?

Many years ago a senior public servant told me that this was as much about supply as demand.

Hospitals employ a lot of people who aren't even medical professionals: porters, maintenance, catering, admin. And a lot of local businesses are suppliers. These people all tend to have the ear of local politicians and can make a lot of noise.

Meanwhile patients tend to know where the treatment is better and are happy to drive another 30 minutes to receive it.

 

[Sophrosyne]

Might the reason for the unacceptably long queues be that when smaller EDs were closed, insufficient capacity was built into the EDs /hospitals to which patients were subsequently transferred?

To take @arbitron's point on demographics, does this come into healthcare planning?

 

[Horatio]

Yes, we have too many hosps, okay.

I think there are 50-53?



The ED doctors say that there are too many EDs.
I think there are 29 ED?

If they are correct, then why are there queues / waiting in the 29 EDs?

I suspect the processes for progressing patients through the system are lacking / absent / not complied with.

 

[becky]

So there is more to this.

 

[T McGibney]

So there is more to this.

Only if you take HSE spin as gospel.

 

[mathepac]

For example, we have too many hospitals for a country with our population and geography but it is political poison for TDs.

I disagree vehemently.

Some of these sites seem to be hospitals in name only, even in sizeable towns and cities, offering very limited medical services.

For example, I live in rural Co Kilkenny, and have a number of medical conditions and my nearest hospital is St. Luke's Kilkenny City.

For ENT consultations, I have to travel to Waterford, a 200km round trip, €60 per return visit and a day out of my life.

For oncology consultations, I have to travel to Dublin, a 290km round trip, around €80 per return visit, and another day out of my life.

For urology consultations, I have to travel to the same hospital in Dublin, a 290km round trip, another different €80 per return visit, and yet another day out of my life.

For CT scans and other imaging services, I was originally referred to Waterford by St Luke's consultants, until St. Vincent's staff informed me that imaging systems are incompatible across hospitals and images cannot be exchanged.

For CT scans and imaging services other than ENT, therefore, I now have to travel to Dublin, an additional a 290km round trip, an additional €80 rather than €60 in costs to me, and yet another day out of my life. For some reason, it is impossible to schedule CT scans, urology and/or oncology appointments on the same day, in the same hospital, in Dublin. Based on my experiences of their performance to date, for Vincents, 1 out of 3 ain't bad.

Multiple appointments for ENT services and imaging on the same day in Waterford have worked in the past.

Too many hospitals in the wrong places with limited services is my personal experience, with documented mileages and fuel, parking and toll costs, which trumps idle speculation and commentary. The failings in the health care system result in additional, direct, non-reimbursable costs to patients. No doubt Minister Ryan could comment on the additional green cost of all this "health service" imposed travel if he really had a truly green agenda.

I have more, I'll be back!

 

[becky]

Only if you take HSE spin as gospel.

I try to unhear spin.

As an admim worker in the HSE it is very tiresome that we are all lumped into one and blamed for blocking progress.

 

[Sophrosyne]

@mathepac - what a dreadful ordeal.

As you say, a hospital should mean a hospital with the full range of services.

I don't understand why you have to travel to Dublin. Surely either St Luke's or at the very least, WUH should provide you with those services.

 

[T McGibney]

I try to unhear spin.

As an admim worker in the HSE it is very tiresome that we are all lumped into one and blamed for blocking progress.

I don't think anyone is blaming you all as a group. It's beyond doubt that the organisation is full of good people doing their best, it's just so frustrating that the system within which they work is so structurally dysfunctional. Also it's easy to forget that health outcomes are improving all the time particularly in recovery rates from serious illnesses and life expectancy generally.

 

[mathepac]

Discover Ireland with the HSE @Sophrosyne !!

The referrals were issued by urology in St Luke's after I collapsed and had two emergency admissions there in Nov & Dec 2021 with serious kidney and bladder infections from the, at the time, undiagnosed cancer. I'd have assumed they had no services relevant to my conditions on-site otherwise I'd, presumably, have been offered treatment there.

I attend St. Luke's Kilkenny, a 50km round trip, and my local GP for my diabetes monitoring and treatment, including diabetic retina scans annually. That part of my treatments is working fine so far, touch wood. I was diagnosed in 2005.

Optical and dental services are in Thurles, Co Tipperary as they are closer to me than Kilkenny City, my own decision to use those services, no complaints about them.

Four counties, seven different medical service/treatment locations; there's innovation and integration for you, and the greatest communications and integration difficulties are between services in the same building - oncology, imaging, and urology in Vincent's. Not spread out over a vast campus but on different floors in the same building!

 

[bish123]

Can new technology fix a poorly functional organisation- the answer is a not likely. Technology can provide data but not wisdom. Health services in Ireland is a very complex with its own microculture that won't change with tinkering around the edges and there is no political appetite for a radical change.

 

[mathepac]

Actually, I read from the article that he is regrouping to attack the issue from a different angle.

As in from the patients' angle, which is the only angle that counts if he's to use his box of tricks to improve service levels and outcomes, reduce queues and misery?

 

[becky]

@mathepac - what a dreadful ordeal.

As you say, a hospital should mean a hospital with the full range of services.

I don't understand why you have to travel to Dublin. Surely either St Luke's or at the very least, WUH should provide you with those services.

Kilkenny is part of Ireland East Hospital Group so Waterford isn't in that group. You're meant to be treated within your own hospital group. In Clare lots want to be treated in Galway but Limerick is their group.

 

[mathepac]

Clinicians refer patients to where they believe the patient will get the appropriate treatment quickly and safely, not because a hospital's name appears in a box on a printed organization chart. The difference between an admin's view of health care and a clinician's or patient's perhaps?

In Clare lots want to be treated in Galway but Limerick is their group.

I can understand that for many reasons and also for lots of people in Clare, Galway is a shorter journey time. I wonder was that taken into account when closing services in Clare and transferring care to Limerick on the organization chart? Travel distances, time and costs for patients don't feature on the little boxes admins look at.

 

[Sophrosyne]

Kilkenny is part of Ireland East Hospital Group so Waterford isn't in that group. You're meant to be treated within your own hospital group. In Clare lots want to be treated in Galway but Limerick is their group.

Pardon my ignorance @becky!

If that is the case, why is St. Luke's in Kilkenny not a fully equipped hospital?

Another point is that there are 6 or 7 different hospital groups.

Is there some benefit in those groupings or is it just historical?

For instance, why are Dublin hospitals not all part of the same group?

 

[Groucho]

Pardon my ignorance @becky!

If that is the case, why is St. Luke's in Kilkenny not a fully equipped hospital?

Another point is that there are 6 or 7 different hospital groups.

Is there some benefit in those groupings or is it just historical?

For instance, why are Dublin hospitals not all part of the same group?

This gives you the historical context:

In 2013 James Reilly, Minister for Health announced a reorganisation of public hospitals into six hospital groups, which has been described as the most fundamental reform of the Irish acute hospital system in decades.

The decision regarding the establishment and operation of the new hospital groups was informed by two reports — ‘The Establishment of Hospital Groups as a Transition to Independent Hospital Trusts’, produced by an expert group led by Prof John Higgins, and ‘The Framework for Development – Securing the Future of Smaller Hospitals’.

The Framework for Smaller Hospitals outlined the need for smaller hospitals and larger hospitals to operate together and is therefore intrinsically linked to the formation of sustainable hospital groups.

By working in groups, hospital services will be provided by the hospitals in each group, based on the evidence based needs of their populations. Each group of hospitals will work together as single cohesive entities managed as one, to provide acute care for patients in their area, integrating with community and primary care. This aims to maximise the amount of care delivered locally, whilst ensuring complex care is safely provided in larger hospitals.

Each group will comprise between six and eleven hospitals and will include at least one major teaching hospital. Each grouping will also include a primary academic partner in order to stimulate a culture of learning and openness to change within the hospital group. Robust governance and management structures will be put in place at group level.

Originally there were six groups; in 2019 a seventh Children’s Health Ireland was added.