HSE Bureaucracy Going Madder

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mathepac

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In order to try to help reduce last-minute rush orders, I placed a call-off with my pharmacist last week for some of the high-tech meds I take. I thought I was being considerate and cognisant of lead-times, people going on leave, annual and sick, traffic on the M50 (;)) and a bunch of other stuff. The pharmacist knew what I was at and she acknowledged that.

She contacted me on Friday last to tell me the HSE refused to accept her order for the meds until, wait for it, SATURDAY DECEMBER 20TH!! So the HSE has refused the order and the pharmacist must resubmit it on that date. Mad or what!

Any other examples of trying to be a Helpful Harry and getting smacked down by the bureaucrats? One wonders is this AI in action or Terry from Termonfecken flexing their muscles, or is that the same thing?
 
The relevant HSE Guidelines for High Tec Meds state as follows:-

"The PCERS hope to reduce all stock held to that compatible with immediate patient need and
seek the co-operation of pharmacists in ensuring that the ‘just in time’ delivery service is
maximised. See Circulars No. 019/11, 041/17, 054/017 and 016/18 for further information."

Isn't it good to see the HSE adhering to its guidelines :p
 
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I've no idea what any of that means, some kind of insider gobbledygook meant to blind me with science no doubt . All I'm trying to do is ensure that the medicines I need will be delivered and be available to me on time. Unfortunately "the system" chooses to act against me.

An order placed by the pharmacist on Saturday December 20th wont't be seen and actioned by the HSE until Monday December 22nd, at the earliest. It then runs the risk of not being delivered before Christmas which could leave me with a mere 2 or 3 day supply, if there are any delays. I was told by my consultant to ensure I had at least a 7-day buffer in my possession to protect me against supply chain foul-ups, which in my experience are frequent. In the past when I got to day 19 on the blister-pack, I'd place a call off with the local pharmacy, leaving me with 9 days on hand. It has usually worked up to now, but not always, which is why I ordered earlier than usual given the time of year.

Leaving these meds aside, when I went to order my more run-of-the-mill medications in November, the duty pharmacist told me my prescription needed to be renewed. I told him my prescription still had two months to run, for November and December. He said he couldn't see it on his system and asked me to get a six-month renewal from my GP. I did that there and then by phone from the pharmacy.

I want away to take care of some other business and returned to discover that one of the pharmacy assistants confirmed that I'd correctly stated that I had 2 months to run on my old prescription, but that the pharmacist had filled my requirements from the new prescription forwarded from my GP's office. As a consequence of the pharmacist's idiocy and obduracy, my valid extant six-monthly prescription only lasted me four months.

"The system" is there for one purpose and one purpose only:- to supply the medications needed by patients in a timely manner, in order to treat their illnesses and to protect them from undue stress and worry. It is failing because some oik apparently read about "just-in-time" delivery in a trade magazine at some stage, and another can't use the in-house system used to track prescription validity dates. The HSE knows as much about "just-in-time" delivery as it does about patient care. They're certainly more in need of guidelines about patient care than they are about "just-in-time".
 
Leo said:
Individuals shouldn't be allowed to stockpile or order more than absolutely needed if that puts supply to others at risk.
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Stockpiling :D:D:D, spare me - a few days meds in order to try to ensure "the system", which doesn't work a lot of the time, doesn't leave me short of critical medicines - that's a fair auld stretch, even for you @Leo. If "the system" worked like it should and delivered my medicines consistently "on time" rather than their ludicrous notion of "just-in-time", neither my consultant or i would countenance keeping a buffer stock. And it's not like it's stuff that could be traded on street corners or dark alleyways, if that's their fear. Expensive, yes, but of no use to anyone with a dependency on alcohol or other drugs.
 
mathepac said:
If "the system" worked like it should and delivered my medicines consistently "on time" rather than their ludicrous notion of "just-in-time", neither my consultant or i would countenance keeping a buffer stock.
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You know they are dealing with shortages in supply of many critical medicines? Your little buffer might mean someone else goes short. There are over 500 common prescription medicines where supply is just at or below demand levels. In many cases supply only meets a fraction of demand.
 
The medicines in my OP are not common, apart from which from Bernard Gloucester on down, HSE staff are paid more than enough to manage their supply chain. If they can't, then move over and employ some professionals who can.
 
Presumably "the pharmacist" mentioned in the long rigmarole that makes up post #4 is a HSE employee?

If not, then what on earth has that particular diatribe got to do with your other saga?
 
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I didn't know that pharmacists in privately-owned pharmacies were HSE employees. I did know that they get certain payments from the HSE.

If my "saga", "rigmarole" and "diatribe" about my first-hand experiences trying to deal with a non-functioning, ever-more expensive, state body are difficult to follow or understand then don't bother reading them or commenting; I certainly won't miss the non-value add commentary.
 
mathepac said:
The medicines in my OP are not common, apart from which from Bernard Gloucester on down, HSE staff are paid more than enough to manage their supply chain
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Do you think they have any power whatsoever that could solve international supply constraints? Perhaps if they agreed to pay way over the odds they'd get some more, but you'd just be on here then moaning about the prices.
 
mathepac said:
The medicines in my OP are not common, apart from which from Bernard Gloucester on down, HSE staff are paid more than enough to manage their supply chain. If they can't, then move over and employ some professionals who can.
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I don't want to drag this off topic but Bernard Gloucester is paid around €400,000. There's not many organisations employing well over 150,000 people with a budget of over €25 billion where the person in charge is only paid so little. There are plenty of Pharmacists and Doctors (including many GP's) earning more than that. The HSE has lots of problems but over paying it's managers and administrators isn't one of them. Needing so many of them, now that's a different story.

On the topic of the medication in question, once it is allocated to a person it is not available for anyone else, even f it is still in stock. It therefore it makes not to allocate it until close to the date it will be needed.
 
Purple said:
It therefore it makes not to allocate it until close to the date it will be needed.
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Who defines when it is needed? I thought I still had that freedom, or does the HSE now dictate when I can go on holiday based on their supply rules?
Purple said:
Needing so many of them, now that's a different story.
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They're almost literally falling over each other in certain circumstances.
Leo said:
Do you think they have any power whatsoever that could solve international supply constraints?
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No one at any stage has told me that any of the medicines on my prescriptions are subject to any international supply constraints or rules, just the HSE-imposed set, or do you know more about the medications I need than I do?
 
Purple said:
Or sleeping on top of each other...
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So it would appear, or fascinated by their personal mobile phones. On Friday I must attend a local hospital where I am instructed by letter to attend at check-in station A on the ground floor (often unattended if I get an early appointment), where, if there is someone in attendance, I will be instructed to proceed to check-in station B, also on the ground floor, where I will be instructed to proceed "up the stairs to the right to check-in station C on the 1st floor". Suffering obvious mobility problems I always take the lift to the left resulting in being shouted at "No, I said to take the stairs to the right". I usually ignore this.
 
High-tech meds can cost from €1,000 to €10,000 per patient per month, and total expenditure under the High Tech Medicines Scheme now exceeds €1 billion per year. At that scale, holding even 1 extra week of national stock would tie up close to €20 million in public funds. From a public finance perspective, a just-in-time supply model is the only way to have budgetary control while still giving access to these drugs at all.

The cost of some high-tech medicines is such that, for many patients, the public expenditure on these drugs alone will exceed their total lifetime tax contributions. That is not a criticism of patients but a reflection of the very real scale of modern pharma costs and the degree of collective subsidy involved. Cost control, use monitoring, and fair allocation are essential.

Many of these meds require a strict cold chain, which means big refrigerated storage capacity. Expecting community pharmacies to hold buffer stock would mean costly infrastructure upgrades and introduce additional safety risks. Also, many high-tech medicines have short shelf lives, and patients may stop treatment unexpectedly due to side effects, lack of benefit, or clinical reassessment. Unused medicines cannot be returned and some are patient-specific (for example weight-based dosing or rare indications), so stockpiling would inevitably lead to huge waste.

For many biologics and monoclonal antibodies, global supply is tight for reasons beyond national control. Once a unit is allocated to a named patient, it is effectively removed from the national pool, even if it has not yet been dispensed. Allowing early allocation for some patients would mean other (possibly sicker!) patients could go without. So the system must allocate meds as close as possible to the time of clinical need even when this feels frustrating.

This is why understandable attempts to order early are blocked. From an individual's perspective, a small buffer seems sensible and reduces anxiety, especially around Christmas/bank holidays or when there are supply problems. From a whole system perspective, if even a small minority of people did this the supply chain would become unworkable and inequitable. The rules are blunt and not well explained, and the stress created is real, but the underlying logic is about fairness and sustainability.

If the HSE abandoned just-in-time controls and allowed routine buffer stock it would inevitably (and correctly) face criticism for tying up tens of millions of euro in unused or expired medicines and for disadvantaging vulnerable patients.
 
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arbitron said:
Many of these meds require a strict cold chain, which means big refrigerated storage capacity.
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None of mine that are self-administered (tablets) or administered by nurses (injections) on home visits do. I don't know about hospital-dispensed and administered treatments as management of that supply is within the HSE and I get appointments when they are to hand in one of the local hospitals.

Long winded-post, relevance to my circumstances, medications and request relayed via the pharmacy, NIL.
 
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