No country for old men (or women)

[Salvadore]

The recent RTE programme revealing the appalling level of care in a particular nursing home highlights once again the vulnerability of the old and infirm in this country.

The family concerned seems to have gone to great lengths to seek out a decent home their father and were reassured by the HIQA reports which now, sadly, seem to be unreliable at best.

Coupled with the well-documented shortcomings of the health service, it truly seems that the state is unable and/or unwilling to provide any level of dignity for people as they get older. The quicker they shuffle off and make room for others seems to be the acceptable standard.

Is it the same everywhere? Are there countries in the world where the consideration of the old and/or infirm is taken seriously?

 

[Purple]

The recent RTE programme revealing the appalling level of care in a particular nursing home highlights once again the vulnerability of the old and infirm in this country.

The family concerned seems to have gone to great lengths to seek out a decent home their father and were reassured by the HIQA reports which now, sadly, seem to be unreliable at best.

The level of auditing, both internal and external, within the HSE is a joke. A Chipper or Cafe had more meaningful supervision by the State than hospitals or nursing homes. There is little accountability and next to no sanctionability within the healthcare industry generally. Part of the problem is calling it a sector or a profession rather than an industry or a business. The State realises that restaurants are businesses and that the people who work in them and own them are just as likely as anyone else to take shortcuts, be lazy, have a bad day etc and regulate them accordingly. With the healthcare industry we still treat doctors and nurses like we used to treat priests (and we know how that ended up). They are just people to, subject to the same human frailties as anyone else.
When HIQA are doing surprise audits late at night on nursing homes and hospitals then they will be doing their job properly. Until then they won't be doing their job properly and the people who work there will be putting people's lives at risk due to their unwillingness to do their job properly.

It's very unlikely that anyone will lose their job or be meaningfully sanctioned or punished in any way. A person was in charge the night those levels of care were recorded. If they were unable to do their job due to lack of resources etc then they should have been the ones contacting HIQA and taking the recordings. They didn't and they should face criminal charges.
What will happen is that somehow the Minister for Health will be held responsible and so nothing will change.

Coupled with the well-documented shortcomings of the health service, it truly seems that the state is unable and/or unwilling to provide any level of dignity for people as they get older. The quicker they shuffle off and make room for others seems to be the acceptable standard.

This has nothing to do with how the State values older people and everything to do with the incompetence and inefficiency of the organs of the State. mental health services for young people, particularly young men with addiction issues, are just about non existent. We can't get our Speech and Language Therapists to work full time so their is a massive delay in assessments for vulnerable children. We can't get our planning officers to work efficiently enough to get planning applications processes. Where's the oversight in the OPW? Or the HSE? The The list goes on.

Is it the same everywhere?

Yes, the same thing happened in France with the same company. The State sector in France is also unable to do its job properly.

Are there countries in the world where the consideration of the old and/or infirm is taken seriously?

Is there a country where efficiency and accountability within the State sector is taken seriously?

 

[Salvadore]

This has nothing to do with how the State values older people and everything to do with the incompetence and inefficiency of the organs of the State.

But if these organs are allowed to display incompetence and inefficiency on such a scale, with apparent impunity then surely it is a reflection of the successive governments’ real interests.

 

[Purple]

But if these organs are allowed to display incompetence and inefficiency on such a scale, with apparent impunity then surely it is a reflection of the successive governments’ real interests.

No, it's a reflection of successive governments' impotence.
The permanent government of the country is the State sector and no government is anywhere near as powerful as them. The farce that was PPARS is a great example of the Government thinking they were in charge but being put back in their box by the Unions and other vested interests within the State funded Healthcare Industry. The same thing happens across the State Sector.
The biggest lie that politicians tell is that they can change things. They can only ask the Permanent Government if they would like to change things. If they agree then things are changed. If they don't then things are not changed. Change usually requires large bribes and oceans of money. If the Permanent Government change their mind they keep the money but don't change anything.

As long as we keep blaming our politicians nothing will change. It's like beating your dog and thinking it will make your neighbours dog stop pooing on your grass.

 

[mathepac]

"But we take these matters very seriously and we will take valuable learnings from them, going forward", said the Minister for [insert useless high-paid help title here]. But nothing changes. Overspend after overspend, people get mistreated, medically or otherwise, and die, they create more quangos with more jobs for the boys and girls that achieve nothing. We need revolutionary change. Who is willing to bite the bullet, take to the streets and shut the God-awful shambles down, once and for all? There, that's fightin' talk, that'll show 'em.

 

[Salvadore]

The farce that was PPARS is a great example of the Government thinking they were in charge but being put back in their box by the Unions and other vested interests within the State funded Healthcare Industry. The same thing happens across the State Sector.

You’re probably right in relation to the health sector but I think you have a misconception of the power of public sector unions. Having worked decades in the so-called permanent government, I can’t honestly point to any government initiative that died as result of union intervention. There are times when initiatives can be unrealistic and unreasonably difficult to apply, but that’s nothing to do with unions.

The biggest lie that politicians tell is that they can change things. They can only ask the Permanent Government if they would like to change things.

Thats simply not true. Ministers have the ultimate power and can insist that secretaries-general make things happen. They have advisors who act as their enforcers in this regard.

The real problem is with the quality of ministers and whether they have the competence or the interest to get things done. Many, but not all of them, are quite happy just to be there and to go with the flow.

 

[Purple]

Thats simply not true. Ministers have the ultimate power and can insist that secretaries-general make things happen. They have advisors who act as their enforcers in this regard.

Not if it involves restructuring, changes to work practices, changes to terms and conditions, increased accountability or sanctionability or reduction in employee numbers. It is the misallocation of Human Resources that is at the heart of so many of these issues.

The real problem is with the quality of ministers and whether they have the competence or the interest to get things done. Many, but not all of them, are quite happy just to be there and to go with the flow.

So we’ve never had a competent Minister for Health? I find that hard to believe.
I think that Mary Harney was competent and had an interest in getting things done and she was broken by the Unions in the healthcare sector who resisted reforms then cried their crocodile tears about people dying on trolleys etc.

 

[Peanuts20]

Coupled with the well-documented shortcomings of the health service, it truly seems that the state is unable and/or unwilling to provide any level of dignity for people as they get older. The quicker they shuffle off and make room for others seems to be the acceptable standard.

I can only speak from my own personal experience. My Mam spent the last 6 months of her life in an HSE run "old folks home", the traditional one that existed in many towns in Ireland and was treated with nothing but compassion, care and dignity in that facility and I would not hear a bad word said against it. She'd spent a few weeks beforehand in a private home where the facilities to look at were much better but Mam was often just dumped in the bed. The issue there was lack of staff and poor quality staff on little more then minimum wage and a management team that just wanted the beds filled for money.

HIOA reports are a joke. Where Mam ended up in had highlighted "issues" that were just tick the box exercise and in my experience, no one ever spoke to the patients or the families. I once saw equipment being swapped out in a rush in a ward, when I asked out of curioisity what was going on I was told HIQA were in and one of the devices had an old sellotape stain on it and that would be a mark against them.

There is a culture in the HSE and the Department of Health where it is easier to outsource then to manage things themselves. However, as any decent manager knows, you delegate/outsource the task, you don't delegate the responsibility and in my view, HIQA is not fit for purpose. Secondly, we pay carers peanuts, we don't resource home care properly and the waste is shocking.

I could write for hours on our experience, good and bad. HSE staff are normally brilliant, it's the culture that sucks.

 

[Peanuts20]

I think that Mary Harney was competent and had an interest in getting things done and she was broken by the Unions in the healthcare sector who resisted reforms then cried their crocodile tears about people dying on trolleys etc.

Completely agree, we had war with a discharge manager one day when a home care package for Mam couldn't be signed off as the manager in question was off on her honeymoon (no issue with that) but her responsibility could not be delegated upwards or downwards due to "the union" as we were told. No idea if that was true or not or just a convenient excuse and eventually, after refusing to budge an inch and in a room with by now 6 borderline useless managers, someone very senior came down and made a decision and signed it. I wonder how many other patients who are "blocking beds" are in the same boat.

I've no issue with unions standing up for staff rights, conditions and supporting their members, but not at the expense of efficiency, care and expertise.

 

[Salvadore]

Not if it involves restructuring, changes to work practices, changes to terms and conditions, increased accountability or sanctionability or reduction in employee numbers.

That’s not necessarily true either although I agree with you in relation to the accountability aspect.

So we’ve never had a competent Minister for Health? I find that hard to believe.
I think that Mary Harney was competent and had an interest in getting things done and she was broken by the Unions in the healthcare sector

That’s not what I said.

Mary Harney was indeed an excellent minister who got things done in most of the government departments to which she was assigned. That she ultimately failed to achieve meaningful change to the healthcare system shows how difficult it is to do so.

However the particular characteristics of the healthcare system shouldn’t be pointed to as proof of wholesale inefficiencies across the entirety of the public sector.

But getting back to the thread’s original question, what other countries are more successful in their provision of care to the elderly and infirm?

 

[Purple]

But getting back to the thread’s original question, what other countries are more successful in their provision of care to the elderly and infirm?

They don't have hundreds of semi-autonomous hospitals and organisations which have their own rules, own HR practices, own IT systems etc all under the umbrella of a HSE which is in fact really just a name but not really an organisation.

Imagine if every Lidl shop was different, they each bought their own stuff, stocked whatever they wanted, had different employee contracts and Terms and Conditions, different layouts and were staffed by employees and managers who couldn't be sacked, couldn't be meaningfully sanctioned and were heavily unionised but had the same branding, centrally allocated budgets and a figurehead leader who was sanctionable for things that they had no real control over and didn't have the power to actually change anything other than increasing the central budget.
Do you think Lidl as an organisation would be competitive, profitable and efficient? That's the Health Service.

 

[Purple]

However the particular characteristics of the healthcare system shouldn’t be pointed to as proof of wholesale inefficiencies across the entirety of the public sector

I agree. The Passport Office is superbly run and extremely efficient. That's because it was restructured and embraced modern Structures and the IT systems which support them.
That's what's required in the HSE. It would save billions and deliver far better services but would involve wholesale redundancies, changes to work practices and a complete restructuring. There's no way the Unions would allow that. They'd rather continue to have blood on their hands.

 

[mathepac]

Mary Harney was indeed an excellent minister who got things done in most of the government departments to which she was assigned. That she ultimately failed to achieve meaningful change to the healthcare system shows how difficult it is to do so.

To be 100% clear, Mary was an excellent minister for Mary Harney and her follow politicians.

What she did by removing responsibility for health care from the health-boards and abolishing them, was to take the pressure off elected officials (politicians) and put a public-service organisation in place, the HSE, headed by a civil/public servant, as a buffer.

That one organisation has now morphed back into at least 7 the last time I bothered to count, but that's only part of the problem. Underneath them , for example, there's CHI and the hospitals that have Lord only knows how many groupings between public and private, and so on.

As an example, I recently transferred my treatment from 2 hospitals in the Dublin area to hospitals closer to me geographically as due to travel, administrative problems, fuel, toll and parking charges, people just not being contactable, and wear and tear on me, I was losing the will to live. I now deal with 4 different hospitals (with 4 different patient ids allocated to me) and a home service provider but coordination between them is seamless (most of the time) and the other problems have been eliminated.

I fit the "profile" for the thread title and while I'm not in an elderly care facility, I empathise with some of the problems highlighted in the RTE programmes and expressed here. Three of the facilities/organisations treating me are private contractors to the HSE, two are HSE. The differences in atmosphere, attitude, cleanliness, etc, between them is stark. Guess who scores higher on the mathepac customer satisfaction scale?

 

[Salvadore]

They don't have hundreds of semi-autonomous hospitals and organisations which have their own rules, own HR practices, own IT systems etc all under the umbrella of a HSE which is in fact really just a name but not really an organisation

Yeah but which countries and health services are we talking about.

 

[mathepac]

The Passport Office is superbly run and extremely efficient.

This one too

 

[Peanuts20]

That one organisation has now morphed back into at least 7 the last time I bothered to count, but that's only part of the problem. Underneath them , for example, there's CHI and the hospitals that have Lord only knows how many groupings between public and private, and so on.

The Health Boards never really vanished in full. For example, many of their bank accounts never closed and they would still issue cheques in the old health board name,

 

[Purple]

What she did by removing responsibility for health care from the health-boards and abolishing them, was to take the pressure off elected officials (politicians) and put a public-service organisation in place, the HSE, headed by a civil/public servant, as a buffer.

That one organisation has now morphed back into at least 7 the last time I bothered to count, but that's only part of the problem. Underneath them , for example, there's CHI and the hospitals that have Lord only knows how many groupings between public and private, and so on.

Yes, when it got to the stage where restructuring, consolidation and changes in work practices were required the process stopped because neither Mary or any other elected politician in the State has the power to take on the permanent government and their unions.

 

[Purple]

Yeah but which countries and health services are we talking about.

I'm not aware of any. That said I've heard that Belgium has the best healthcare system in Europe. It is mostly privately delivered and mostly publicly funded (just like ours) but their State employees seem to be capable of doing their jobs. Maybe their unions value human life more than the selfish interests of their members.
The USA, with a grossly inefficient Healthcare System, is around 45% publicly funded. Ours is 74% publicly funded. The source of funding isn't the root cause. The integration of the national system and standardisation of processes so that best practice can be identified and implemented, as well as proper auditing and oversight, is what is critical. We don't do any of that well.