Health Service Inefficiency

[Leper]

And yet they won't reform contracts, payroll or work practices that cost the State hundreds of millions. Have you need to Naas Hospital A&E? Go in and spend a few hours sitting there. It would be hilarious if it wasn't so serious. The chaotic and incompetent way the Nurses run the place has to be seem to be believed.

Junior doctors did those kind of hours, mainly Interns. SHO's also worked crazy hours (many still do). Neither Interns or SHO's are operating on anyone. Registrars do simple procedures, if approved to do so by the Consultant they work under. Let's not make stuff up. They are certainly writing prescriptions and monitoring patients when way too tired to do so but that's because Consultants won't do their job and when those NCHD's become Consultants they don't do their job either.

I wouldn't clean out septic tanks for a living but some people so. Horses for courses.

That's an oxymoron.
How come we have one of the best funded healthcare systems in the world but some of the worst metrics for outcomes in the OECD?
Is it all the fault of every single Minister for Health for the last 40 years? Oh, is it the HSE? If so that begs the question, 'Who are the HSE?'. Of course the HSE are the 120,000 people who work in it, including every single doctor and nurse. Sorry guys, but you gotta' take responsibility for the mess you perpetuate. Heroes? Don't make me laugh.

There is so much wrong with Purple's post above it's difficult to know where to start:-

1. I would say that nearly every grade in the Public/Civil Service has been reformed and had work practices changed. Civil servants have consciences you know! But, the glaring exception (and one probably referred to is the Consultants Common Contract) which every political representative known to man has failed to understand. Nurses, Attendants, Physiotherapists, Clerical grades etc have all rowed in with continuous change. Right! I'll concede that the Medical Consultants are a law unto themselves but don't equate all others with them. The Payroll debacle was championed by one of our best know accountancy firms in the private sector and they got it spectacularly wrong. Please don't blame the rank-and-file foot soldiers for such a disaster.

2. Next error of the Purpled One:- Please note nurses don't run hospitals. It's the Consultants - Duh! (Next television interview you hear a consultant giving describing his/her job is that "We" (the consultants) run hospitals). The one area I sympathise with consultants is the litigation situation in Ireland and of course other professionals (solicitors etc) "ambulance chasing" ensure this will not get any better and will continue to cost the state millions.

3. Junior Doctors (a misnomer) with proper title NCHD (Non Consultant Hospital Doctor). I bet it's years since you heard an NCHD referring to the grade as Junior Doctor. But, for the sake of this discussion let's call them Junior Doctors. Believe me, when you see their total yearly payroll details you'll never refer to them again as Junior Doctors. Yes, I agree they work atrocious long hours and also I agree many of them could not work properly with much lack of sleep etc.

4. Now for Leo's point that Ireland has more nurses per capita than anybody else. Spectacularly Wrong. Nurses work a 39 hour week before overtime etc. Many, many nurses work much less hours and it suits management in the HSE to say "we" employ more nurses than any other country. But, when the Wholetime Equivalent kicks in i.e. those who work 39 hours weekly and those who work a fraction of that the nursing staffing figures show nothing like what is being claimed.

 

[arbitron]

I didn't either. No one here said staff seeking pay rises was the issue, the issue is the horrendous waste and inefficiency that is currently in the system.

You said "How do you feel paying them even more to do even less could be a good thing?"

Why is it you think that Eurostat would use a different criteria for Ireland than the rest of the EU???

Why would the DoH/HSE claim to have a higher rate than is reality when that would just make them look even more incompetent? When we rank down the list in terms of beds by population.

We actually had this discussion before and I explained in detail: https://www.askaboutmoney.com/threa...yments-to-state-employees.224893/post-1738847

TL;DR = it's complex.

 

[arbitron]

Please note nurses don't run hospitals. It's the Consultants - Duh! (Next television interview you hear a consultant giving describing his/her job is that "We" (the consultants) run hospitals).

Consultants have a lot of power but nowhere near as much as people think. Nurses literally do run hospitals in many cases - just off the top of my head the CEOs of St. James's Hospital, Children's Health Ireland, University Hospital Limerick are all nurses.

 

[RetirementPlan]

Where are you getting that from?

The question I raised here was to challenge the claim that trade unions are 'solely responsible' for preventing efficient service delivery.

I and others have asked for any specific examples to support this claim, and the only answer seems to be the 'curse on all yer houses' response that tries to blame everyone.

Trade unions aren't responsible for running the health service. If anyone has any specific examples of where trade unions have been the main blocking factor to health service reform, I'd be interested in hearing them, preferably ones in recent history, like 10-20 years.

 

[Purple]

I and others have asked for any specific examples to support this claim, and the only answer seems to be the 'curse on all yer houses' response that tries to blame everyone.

Here's one from their own Trade Paper.
I do know that every time they go on strike, no matter that the issue, the solution is a pay rise.

 

[Purple]

There is so much wrong with Purple's post above it's difficult to know where to start:-

1. I would say that nearly every grade in the Public/Civil Service has been reformed and had work practices changed. Civil servants have consciences you know! But, the glaring exception (and one probably referred to is the Consultants Common Contract) which every political representative known to man has failed to understand. Nurses, Attendants, Physiotherapists, Clerical grades etc have all rowed in with continuous change. Right! I'll concede that the Medical Consultants are a law unto themselves but don't equate all others with them. The Payroll debacle was championed by one of our best know accountancy firms in the private sector and they got it spectacularly wrong. Please don't blame the rank-and-file foot soldiers for such a disaster.

2. Next error of the Purpled One:- Please note nurses don't run hospitals. It's the Consultants - Duh! (Next television interview you hear a consultant giving describing his/her job is that "We" (the consultants) run hospitals). The one area I sympathise with consultants is the litigation situation in Ireland and of course other professionals (solicitors etc) "ambulance chasing" ensure this will not get any better and will continue to cost the state millions.

3. Junior Doctors (a misnomer) with proper title NCHD (Non Consultant Hospital Doctor). I bet it's years since you heard an NCHD referring to the grade as Junior Doctor. But, for the sake of this discussion let's call them Junior Doctors. Believe me, when you see their total yearly payroll details you'll never refer to them again as Junior Doctors. Yes, I agree they work atrocious long hours and also I agree many of them could not work properly with much lack of sleep etc.

4. Now for Leo's point that Ireland has more nurses per capita than anybody else. Spectacularly Wrong. Nurses work a 39 hour week before overtime etc. Many, many nurses work much less hours and it suits management in the HSE to say "we" employ more nurses than any other country. But, when the Wholetime Equivalent kicks in i.e. those who work 39 hours weekly and those who work a fraction of that the nursing staffing figures show nothing like what is being claimed.

Just too much waffle and hyperbole there but specifically on "The Payroll debacle was championed by one of our best know accountancy firms in the private sector and they got it spectacularly wrong. Please don't blame the rank-and-file foot soldiers for such a disaster." I have to call Bull on that one. PPARS was an attempt to put a payroll system in place after decades of trying to standardise Nursing contracts. The INMO refused to standardise them, they were instead happy to waste tens of million that could and should have gone to help the sick and vulnerable. Their leaders have blood on their hands.

 

[RetirementPlan]

Here's one from their own Trade Paper.
I do know that every time they go on strike, no matter that the issue, the solution is a pay rise.

Looks like that's a UK commercial publication/website - but regardless, this was about a pay deal that would "result in 6,000 posts being lost from the public health service over the next three years, and a probable reduction of over 3,500 acute hospital beds" - and you're beating up on the union for not standing back and allowing the already weakened service to be even further weakened?

I don't recall the detail, but did they actually agree a deal with both unions a few months later?

 

[RetirementPlan]

Just too much waffle and hyperbole there but specifically on "The Payroll debacle was championed by one of our best know accountancy firms in the private sector and they got it spectacularly wrong. Please don't blame the rank-and-file foot soldiers for such a disaster." I have to call Bull on that one. PPARS was an attempt to put a payroll system in place after decades of trying to standardise Nursing contracts. The INMO refused to standardise them, they were instead happy to waste tens of million that could and should have gone to help the sick and vulnerable. Their leaders have blood on their hands.

Are you sure that the INO was the barrier to PPARS?
From: https://www.inmo.ie/Article/PrintArticle/4529

The decision to have a new standard payroll system is solely an employer’s choice and trade union agreement on the matter was not sought. However, employers have sought union co-operation with the implementation.

In principle, the INO along with all unions, have consented to such co-operation on the basis of a nationally agreed framework and an acceptance by employers that the level of consultation and negotiation at local level must be high.

BTW, since the cream of the private sector (IBM and Deloitte) utterly failed to deliver their commitments with PPARS, HSE went ahead quietly and centralised the payroll using SAP. No nursing unions were harmed or blamed during that implementation.

 

[Thirsty]

And all of this relates to the OP in what way?

 

[Leo]

The question I raised here was to challenge the claim that trade unions are 'solely responsible' for preventing efficient service delivery.

Nothing in my post suggested they were solely responsible, and for the record I don't believe they are. While they play a significant role, staff across a range of grades are all implicated.

 

[Leper]

Just too much waffle and hyperbole there but specifically on "The Payroll debacle was championed by one of our best know accountancy firms in the private sector and they got it spectacularly wrong. Please don't blame the rank-and-file foot soldiers for such a disaster." I have to call Bull on that one. PPARS was an attempt to put a payroll system in place after decades of trying to standardise Nursing contracts. The INMO refusYoed to standardise them, they were instead happy to waste tens of million that could and should have gone to help the sick and vulnerable. Their leaders have blood on their hands.

You say the INMO (nurses union) is the cause of PPARS failing. Say that above a whisper in any Irish hospital (or even in any HSE clerical block) and you'd be laughed out of the building in an instant. I was involved in PPARS at a fairly low level and knew from its inception the wrong "roadmap" was laid out and couldn't possibly work even if all the unions championed its cause. And for the record I pointed out at several meetings where PPARS would fail and was ignored (I'm being kind just saying "ignored").

 

[ATC110]

Are you holding the Trade Unions responsible for the running of the health services?

Ruining rather than running

 

[cremeegg]

BTW, since the cream of the private sector (IBM and Deloitte) utterly failed to deliver their commitments with PPARS, HSE went ahead quietly and centralised the payroll using SAP. No nursing unions were harmed or blamed during that implementation.

Have you any more info on what eventually happened.

Some if not all public sector payroll is still breathtakingly incompetent.

After decades in the private sector I joined the Public Sector a few years ago.

In September I received a substantial pay rise for new responsibilities, the centralised payroll still hasn't managed to pay me the increased amount. They hope to have it resolved in early Dec !

 

[Leper]

Have you any more info on what eventually happened.

Some if not all public sector payroll is still breathtakingly incompetent.

After decades in the private sector I joined the Public Sector a few years ago.

In September I received a substantial pay rise for new responsibilities, the centralised payroll still hasn't managed to pay me the increased amount. They hope to have it resolved in early Dec !

1. I have much information on what really happened during the PPARS project. Even from a low level I could easily forecast its eventual spectacular failure. (Blowing my own trumpet) nobody listened to me when I pointed out glaring faults at an early stage. In fact, I was "ticked" by management along with reps of the private responsible company. Consequently, I remained silent and PPARS died seven/ten days before its widescale launch. I won't deliberate on my cocky calls to management after advising them to listen to those who know something. None of them apologised to me later (as expected). Age is catching up with me and my memory is not the sharpest, but I think the PPARS project cost €240,000,000.00. If it's €140,000,000.00 forgive my senior moment. To answer Cremeegg's question I could sum up the whole project that went wrong on Day 1 and went more wrong exponentially from Day 2.

2. "Some if not all public sector payroll is still breathtakingly incompetent." - This is true of both the Public and Private Sectors. Ask anybody with problems with Revenue and Social Welfare.

3. Welcome to the Public Sector, I'm sure it will be all the richer for your presence and experience. (not sarcasm)

4. In September you received a pay rise for new responsibilities and haven't yet been paid. All pay rises must be "sanctioned" after agreement and likely this didn't happen during September (and perhaps October). During September payroll for October would largely have been prepared and you were never going to receive your pay rise by November. I would bet you won't get it in December either, It's likely you'll get your pay award early in 2022 and perhaps later the arrears due.

For the record:- Centralised Payroll is only a tool of the organisation. The people there can only pay as per instructions from elsewhere.

 

[Purple]

Are you sure that the INO was the barrier to PPARS?
From: https://www.inmo.ie/Article/PrintArticle/4529


BTW, since the cream of the private sector (IBM and Deloitte) utterly failed to deliver their commitments with PPARS, HSE went ahead quietly and centralised the payroll using SAP. No nursing unions were harmed or blamed during that implementation.

For PPARS to work contracts needed to be standardised. That didn't happen. It was never going to be allowed to happen.

With the greatest respect to other posters I'm not going to reply to "I know what happened but I can't say" posts.

What we can say for sure is that we have one of the best funded healthcare systems in the world.
We spend way above average on wages as a proportion of total spend.
We train more doctors per head of population than any other country in the world.
We have a very high ratio of nurses to overall population.
We have a young population.

We have a grossly inefficient healthcare system.
The public are badly served by it.
The people who run it are doctors and nurses and other scientists and administrators who have moved up through the ranks.
Assuming that they are not all incompetent what are the blocks which prevent reform and improvement in efficiencies?
The doctors and nurses and scientists and managers in the HSE I have spoken to over the years have all laid the blame for resisting reforms at the feet of the Unions. All of them, without exception. They have also blamed promotion systems, pay and workload, how some people are over worked and others do next to nothing. How doctors stymy changes because it doesn't suit their personal needs or their ego, but every one of them say that Unions are there like a boulder in the middle of the road blocking anything they can block and taking every opportunity to turn everything into a pay claim.

Now, can we get back on topic?

 

[RetirementPlan]

Ruining rather than running

Yet again, it would be great if you could give some specific examples

 

[Leo]

We actually had this discussion before and I explained in detail: https://www.askaboutmoney.com/threa...yments-to-state-employees.224893/post-1738847

TL;DR = it's complex.

What you didn't explain was why Eurostat, the professionals charged with producing such stats, would use a different reporting model for the rest of Europe? After all, failing to account for such anomalies would be a rookie error for a statistician.

 

[time to plan]

It'd be easier to give examples of where it hasn't happened.

There is absolutely no need for unions in the public sector - Larkin could never have envisaged the statutory protections and benefits they enjoy.

Staff working where they've historically worked and want to continue working rather than where they're needed.
Health services such as MRIs only being available 9-5pm creating a huge waiting list and years to get a scan.
Staff refusing to undertake additional training during the working day unless they get a pay increase for "upskilling.
Avaricious unions holding the general public to ransom by withdrawing essential services when they decide to go on strike, ostensibly for "health and safety", but in reality always for even more money for their cosseted already overpaid members.
The PS unions exists for the sole benefit of the people working in it discommoding the hapless public they purport to serve in the process.

They are subversive organisations, should be dissolved, their assets seized and their leaders exiled.

I remember a set of European nations went down this route in the 1930s.

 

[Purple]

I remember a set of European nations went down this route in the 1930s.

I think there is aa need for Unions in the Public Sector. I just don't think the power balance is right. It's not that Unions can change things but they stymie reform and delay change. In any organisation with 120,000 employees there will be scope for rationalisation. There is massive duplication of process all over the State Sector and within the HSE in particular. The problem is that because Public Sector employees in effect can't be made redundant it is not possible for those in charge to manage their most valuable resource, their people, to give the greatest benefit to those who consume their services.
I know two nurses who left here to work in London because of the frustrations of working in our grossly inefficient health service.

I know a woman who moved back to Ireland from England having worked in their health service. She assesses houses for grant supports for special needs children, hoists, lifts, wet-rooms etc. In England she used a Tablet, taking photo's and filling in the details on-line. She then emailed it to her boss for approval and the work was done. She was audited each year and knew she would be sacked and criminal charges brought if she was fiddling the system.
Back here she takes photos on her phone, emails them to herself, prints them out and types up a form which then goes through 2 committees before the grant is approved. She said the overhead costs are more than three times as high here than in the UK and it takes up to a year longer to have the grant approved. She asked if the system could be changed and was told to shut up and do her job. That's the sort of waste that needs to be addressed but it would involve reducing numbers, laying people off.

 

[RetirementPlan]

For PPARS to work contracts needed to be standardised. That didn't happen. It was never going to be allowed to happen.

With the greatest respect to other posters I'm not going to reply to "I know what happened but I can't say" posts.

What we can say for sure is that we have one of the best funded healthcare systems in the world.
We spend way above average on wages as a proportion of total spend.
We train more doctors per head of population than any other country in the world.
We have a very high ratio of nurses to overall population.
We have a young population.

We have a grossly inefficient healthcare system.
The public are badly served by it.
The people who run it are doctors and nurses and other scientists and administrators who have moved up through the ranks.
Assuming that they are not all incompetent what are the blocks which prevent reform and improvement in efficiencies?
The doctors and nurses and scientists and managers in the HSE I have spoken to over the years have all laid the blame for resisting reforms at the feet of the Unions. All of them, without exception. They have also blamed promotion systems, pay and workload, how some people are over worked and others do next to nothing. How doctors stymy changes because it doesn't suit their personal needs or their ego, but every one of them say that Unions are there like a boulder in the middle of the road blocking anything they can block and taking every opportunity to turn everything into a pay claim.

Now, can we get back on topic?

From the C&AG review of PPARS, the major issues seem to be around project governance rather than the standardisation issue, which was at least partially addressed. If standardisation was a prerequisite, this should have been painfully obvious up front to all stakeholders. It shouldn't have come as a surprise several years into the project.

Pretty much every country in the world has complaints about their healthcare service. The UK spent £37 billion on a track and trace system that did pretty much nothing to halt Covid spread.

Maybe this stuff is just hard, very hard, imaginably hard given the size and history of the organisations, the incessant consumer demands, the ever changing landscape, the technology developments and associated cost. It's easy to blame unions, but if they were the huge barrier being claimed here, it should be fairly easy to produce examples of the kinds of scenarios where unions have been the barrier to progress.