Interview on Morning Ireland

[Summer]

Did anyone hear the interview on Morning Ireland this morning with the relative of a man who had died in the Mater after being 4 days on a trolley. It was a heart breaking story. I find it very hard to reconcile the fact that we have 100 public representatives going on a junket to Gibralter and people are being treated like animals in our hospitals. This government is a joke.

 

[mcullen]

Health system

Ultimate responsibility for this mess rests with the Minister for Health. Micheal Martin came out of that department smelling of roses - the truth however is completely different, as everyone can see. The UK fixed a similar problem in less than 2 years - who will argue that we will not be in the same mess in five years time?

Until politicians are held accountable (I mean really accountable, such as "get your This post will be deleted if not edited to remove bad language back here and fix the mess you left or else you're out the door, pal") we will always have issuees like this. As a people, we do a poor job of constructively criticising the ills in our society

M

 

[ajapale]

Re: Health system

The UK fixed a similar problem in less than 2 years

This is simply not true. They simply tricked about with the waiting time metrics to give an impression of improvement.

This disfunctional behaviour was clearly illustrated just last weekend where a critically ill 17yo could not get an ambulance despite 4 ambulances being parked up at casualty with minor cases on board. The A&E department were refusing to take cases from the ambulance because it would affect their waiting time measurements.

www.timesonline.co.uk/art...81,00.html

The consultant was told that although three ambulances were standing outside the University Hospital of North Staffordshire in Stoke-on-Trent, they could not leave until their their patients had been accepted into the accident and emergency department.

We must not go down the UK route of putting in inappropriate measures which drive disfunctional behaviour.

The english are very fond of these measures but they invariably back fire on them. See crime figures, educational league tables and NHS measures.

ajapale

 

[Summer]

Health Issues

Our Government is responsible. How, when or why the mess was created is of no importance. Our elderly are dying on trolleys like animals. What is being done about any of this? Roll on the next general election for some change.

 

[mcullen]

UK data

You see, that is exactly the point I am making about Irish people being totally useless when it comes to constructive criticism of major issues.

The point of this thread is the ongoing problems in Irish hospitals. The reply focused on one point I made, namely the UK hospital situation (which I disagree with, by the way). It completely ignored the main issue....

M

 

[purple]

Re: UK data

Why does the spot light never fall on the people who manage and run the hospitals? It's like blaming the directors of a company for it's failures without looking at the managers.
It is too easy to blame the minister who happens to get the poison challis of health for all it's woes.
Why do we call it a health service when we expect it to be run like a customer focused business? and I think it has to be run like a business or it will continue to lurch along in the state it's in. If we called it the health industry and regulated and ran it as a health industry it would be a start because the doctors and nurses who work in it are not doing it for nothing, despite their moralistic bleating on the radio they make sure they are looked after first on the money front then and only then do they wring their hands and cry "what about the children and old people!?!"
We didn't hear about overcrowding in A&E when the INO were looking for massive pay rises. They didn't say "no, don't pay benchmarking. Put the money into providing more beds for old people".
Not one opposition spokesperson had said that the problem with the health service is that the people who run it are a bunch of clowns who should all be fired and a management company should be hired to replace them.
I have no respect for the likes of Lize McManus etc who use this as a political opportunity to damage the government and not a failing of every government for the last 20 years who didn't have the balls to sort it out.

Irish people being totally useless when it comes to constructive criticism of major issues.

I agree 100%

 

[John]

Look at the employees

With consultants making > €0.5m per annum, and heavily unionised nurses and doctors creaming the system, no wonder much of our massively increased health system spend has been squandered.

It is well past time that some one like Mary Harney was needed in there. Mary'll sort these lot out.

 

[rainyday]

Re: UK data

Hi Purp - I just love your agreement on the absence of constructive criticism. It really puts your knee-jerk, broad generalisations of "a bunch of clowns who should all be fired and a management company should be hired to replace them" and "I think it has to be run like a business" in context. It's not a business. Businesses are run to make money for their shareholders. A public health service is run to provide a public health service. Why would we want to add a shareholders margin on top of the existing costs we pay out.

Health service managers are not 'a bunch of clowns'. Like all management groups, there are few great ones, a load of average ones, and a few terrible ones. From personal experience, they are generally good hard-working people who do their best to provide a good service within the restrictions of the system. Lets not forget that it is the successive ministers of Health who have built, supported and failed to reform the structures of the system. They have built and supported the existing management structures and management appointments. That's why they should take responsibility first & foremost for the current system.

Which great shining example of private industry management would you like to replace the existing health service management? Perhaps those great guys from AIB who cream off their customers? Or those great guys from O2 or Vodafone or NTL who get blasted on these pages for their terrible customer service from time to time? Or maybe we should follow the UK example and put in place the foundation trusts to give the hospitals more power over their own budgets (and wait to see how long it takes before we have to send in the accountants with the rescue plan.

Facile assumptions that the great god of capitalism will solve the many problems of our health service at a stroke are not helpful. It hasn't worked anywhere else. The manpower just does not exist in the private service.

I don't claim to have the answers either. There may well be a role for the private service in some areas (e.g. nursing home beds to free up hospital space) but let's get some reality into the debate.

 

[ajapale]

Re: UK data

Hi Mcullen,

The reply focused on one point I made, namely the UK hospital situation (which I disagree with, by the way). It completely ignored the main issue....

Sorry, I thought the main issue was A&E waiting times and patients waiting on trolleys to be seen.

I think that your point about the UK is worth persuing. A If the UK sorted out their A&E waiting times in 2 years. I would be very interested in learning how they did it and B If the UK has failed to sort out their A&E waiting times. I would be very interested to find out what mistakes they made.

I believe the latter is the case, and illustrated the point with a tragic example.

Inappropriate metrics rarely occur in capitalist free enteprise as shareholder value is the only true metric and the accountants are its high priests. As rainyday has pointed out you cant use shareholder value as a metric for public service...so what do you use.? My point is that you have to really consider very carefully what metrics you use. Badly chosen measures lead to enourmous disfunction and waste.

ajapale

 

[rainyday]

Re: UK data

Inappropriate metrics rarely occur in capitalist free enteprise as shareholder value is the only true metric and the accountants are its high priests.

I disagree. I've seen many, many cases of inappropriate metrics in place in capitalist free enterprises. As soon as any metric system is put in place, the players start finding ways to 'play' the system. One recent example was a 4 hour response time to service calls - once calls went beyond the 4 hours, they were treated as a 'lost cause' by the operators who would then concentrate on other calls coming close to the 4 hour limit instead of handling the oldest calls first.

 

[ajapale]

Re: UK data

Yes rainyday, of course you are correct,many inappropriate, badly thought out and wrongheaded metrics do exist in capitalist free enterpise systems as well. Its just that shareholder value is an easier concept to get your head around and ways of measuring it have been trired and tested over the years.

ajapale

 

[LookAtMe]

.

wrongheaded metrics do exist in capitalist free enterpise systems as well

Only when they've been tainted with socialist ideals. Such as when the profit margin is far removed from middle managers.

A start-up certainly wouldn't survive under such conditions.

 

[purple]

Hi Rainyday,

A public health service is run to provide a public health service. Why would we want to add a shareholders margin on top of the existing costs we pay out.

My point is that all we hear about is the lack of value for money, the ratio of clerical workers to "front line" staff etc. These are relevant only if you expect a return on investment, like in a business. I never suggested that the health service should be sold off, you are seeing that one through your pink tinted glasses, so shareholder margin doesn't come into it.
Consultants run their operations like a business but since the system is set up as a service they can cream off a huge income. A few ideas from the business world about how you stop your employees stiffing you might go a long way to stopping that.

Lets not forget that it is the successive ministers of Health who have built, supported and failed to reform the structures of the system.

I agree, but would you not agree that the resistance to change from the very people who should be pushing for it is a major factor here.

From personal experience, they are generally good hard-working people who do their best to provide a good service

so that means they are well meaning clowns, but clowns none the less.

Which great shining example of private industry management would you like to replace the existing health service management?

Aer Lingus are now being run a lot like a private sector business but are still a public company. That's a good example.

Facile assumptions that the great god of capitalism will solve the many problems of our health service at a stroke are not helpful

Get down off your high horse there cowboy.

 

[rainyday]

Hi Purp - I'm not going to play your game and pull selective quotes from your post & answer them. You were the one suggesting that 'all the clowns' should be fired and replaced - so please tell us realistically how this could happen;

- How much would the redundancies and/or unfair dismissals costs?
- How much industrial relations disruption/strikes would you expect and how would you manage the impact of these?
- Where are you going to find several thousand private sector managers? How much will these cost (over & above the costs of the existing managers)? How are going to get around their lack of industry experience?

 

[ajapale]

Re: .

Hi Look@Me,

A start-up certainly wouldn't survive under such conditions.

It would be interesting to look at Viavas the health insurance startup. I would be willing to wager that they have some non finanancial (customer service) metrics in place. I know VHI and BUPA have. And further I would guess that some of these are inappropriate and disfunctional in nature.

ajapale

 

[daltonr]

Re: .

Good Management is Good Management.
Bad Management is Bad Management.

If you tell Good managers that their goal is not shareholder
value, but rather improving the Patients experience if hospital,
then good managers will achieve that.

So it's isn't fair to reject out of hand the idea of running the health service more like a business. I would find managers who have shown themselves to be excellent at producing results in very large companies, by taking hard decisions and allocating resources effectively.

It may be that in the past they allocated resources to achieve maximum profits. But the goal could be changed, the skills to effect change, take decisions, and allocate resources are what is needed, and these skills are more evident in succesful businesses than in public companies.

We also can't absolve the government of blame in this. The government spent money building things, but didn't allocate the funding to run them, hense state of the art facilities lay empty.

Now you don't have to be a genius to figure out that that
if you're not going to use something, it's a waste to build it, and the money spend building it should have been given to existing hospitals to keep beds open.

The problem with the health service long term is about structures and management. It's also about better preventative measures, the smoking ban, better diet, exercise etc.

But the immediate problem is about money. Yes, they've poured in billions extra, No, I have no idea where it's gone. But the current fiasco is completely solvable with correct spending. And correct spending is the ONLY thing that will fix it.

We have patients using hospital beds who should be in Nursing homes. Nursing homes are cheaper than hospital beds. So why not move the people???.

Because if you move them you free up hospital beds that will be filled by sick people. So you're still paying for the hospital bed, but now you're also paying for the bed in the nursing home.

This isn't some intractable problem. It's not rocket science. It's a deliberate thought out allocation of resources.

None of the parties are willing to tell the truth. That in all probability we need to raise taxes.

My worry is that given past experience we'll probably get the tax rises, but the service won't improve in line with it. And that's where the excellent managers come it.

-Rd

 

[Blue Blaa]

Hospitals

Privatise the health service

 

[jasper]

Health service

Hey Blue Blaa what about buying Spike Island ..you could run it as a private enterprise ..

 

[rainyday]

Re: Health service

Privatise the health service

How?

 

[purple]

Hi Purp - I'm not going to play your game and pull selective quotes from your post & answer them.

rainyday, I find your replies interesting and enjoy replying to them but I have to say you have a hard neck accusing me of that when you are a master of it yourself!
As for your constructive points, I do not suggest that every manager should be sacked, I suggest that there is a very ineffective senior management and changing the wallpaper will not be enough.
I agree with daltonr;

Because if you move them you free up hospital beds that will be filled by sick people. So you're still paying for the hospital bed, but now you're also paying for the bed in the nursing home.

You also have an extra cost here because while the "bed blocker" is in hospital they don't require expensive tests and medicines so they help keep costs per bed down.