Would spending more money on the health service do any good?

Brendan Burgess

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Cormac Lucey has a good article in The Times today

Spare a thought for those who always pay

It makes a few points which are not often made in the Irish media
  • Ireland has the highest rate of over-qualification - reducing college fees might not be a good idea
  • Reducing class sizes would be good for the teachers but would have no effect on the children
  • Increasing the wages of those providing child care would be good for the employees but not improve the amount or quality of childcare provided.
And...

The argument that endless increases in state funding can fix big problems has been tested to destruction in the health area. According to Eurostat, the European statistics agency, Ireland spent €4,147 on health in 2014 for every man, woman and child in the state. That was 16 per cent more than the French spent, 20 per cent more than the British and 73 per cent more than the Italians. Yet public discontent with our health services seems higher than ever. Mr Varadkar is right: it is wrong to assume that spending increases always result in better services.

And, he asks who stands up for the Irish taxpayer.

Government receipts from income taxes are set to exceed 2007 levels this year by 49 per cent, or €6.6 billion. That’s about an extra €3,000 more being paid on average by each of the state’s income tax payers compared with a decade ago, but who talks about tax restoration? And who in Irish politics stands up clearly for Irish taxpayer interests?
 
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The problem with the health service is no one at the point of the expense cares about cost.

For example if I complain to VHI, they are being over billed they don't care.
If there are two ways of doing something with the same outcome, no one cares which is the most expensive.
If you can organize someone to do 4 tests on the one day, they will schedule it so you have to do 4 at different times.

Also its not the same everywhere. Some services are efficient some are not. Is this rewarded in anyway. I don't see it.
 
Hi Brendan,

The answer to the question in the thread title is clearly a no in my opinion. During the Celtic Tiger when the coffers were overflowing we still have people waiting on trolleys. The extra money just went on higher wages for existing staff. A root and branch shakedown is required and where possible the services should be privatised or at a minimum have the existing hospitals competing with each other.
 
According to Firefly:- "The extra money just went on higher wages for existing staff. A root and branch shakedown is required and where possible the services should be privatised or at a minimum have the existing hospitals competing with each other."

1. The wages for every public hospital were reduced years ago through Croke Park and Haddington Road Agreements and have not recovered since. Sorry Firefly, wherever the money went, it didn't go on wages.

2. All hospital services should be audited on an ongoing basis. But, patients still wait on hospital trolleys. Our public hospitals still have large amounts of beds primarily designated for the patients of private consultants.

3. Privatisation - Great - if you need services 8.00am - 8.00pm Monday to Friday. I know it is simplistic but the private hospitals don't want you (repeat don't want you) unless you have the spondulicks to pay up front. Furthermore, don't believe their press releases, even they have difficulty in retaining nursing and clerical staff.

4. Because of Croke Park and Haddington Road Agreements the country has a shortage of nurses. Why would a nurse return from say the UK where he/she receives a tax free yearly generous reallocation allowance and free access to nursing courses to further their careers.

5. Has anybody informed us of the "savings" in the health service of Croke Park and Haddington Road. Due to non recruitment of staff, overtime expenses etc went through the roof and agency staff employed ensured costs would even be higher. If there were guarantees that anything would lose money for the tax payer it was Croke Park and Haddington Road.

So, the private hospitals are going to save the health demands of the Irish People and will compete with each other to provide better services provided they are profitable. I better stop, I'm getting more cynical by the minute. Be careful what you wish for . . .
 
extra spending on the health service has always meant increased wages for those who work in the HSE , no reason that is going to change , politicians do well out of increasing public sector wages

a good idea would be too reduce the burden on hospitals by forcing GP,s to provide extra services , in many countries you can have an xray at your GP clinic , in ireland GP,s invest in stethescopes and a pile of magazines for the waiting room once every five years , they are far too quick to refer people on to the closest A+E
 


ireland has one of the highest nurses to patient ratios in the OECD , the problem is one of management

its not widely known but since 2008 , many areas of the public sector have been on unofficial strike , not cooperating with recommended reforms etc , the guards were on stirke unofficially for several years , dragging their feet at airport security to give one example
 
"Ireland has one of the highest nurses to patient ratios in the OECD , the problem is one of management"

Sorry GBI, at the rate the private and public hospitals are losing nurses we won't be there for too long. They won't return, you know. What management are at fault?

I have no idea what you mean by unofficial strike in the public service - can you expand?
 
That's not evidence that's anecdote.
I have plenty of "laughable" stories from the private sector too, I don't make sweeping assumptions based on it.
I see plenty of people working to the bone, doing the work of 2-3 people who have not been replaced, working within a Dickensian infrastructure - our IT system is archaic and we still have to use ledgers for many things. Even the minority that don't go above & beyond could not justly be called lazy.

But your dinner party buddies must know better than someone working in & trying to manage front line services....
 
You're right...the lack of statistics to prove that there are too many poor performers in the health system means that everything is fine.

There are great people working in the health service but in aggregate the staff are rubbish.

How you can dismiss the specific experience of senior people is beyond me.

But here's one for you:

Absenteeism due to sickness among doctors is circa 1%; among other staff, it's circa 5%!

One of my friends is looking to implement real change in his area; staff nod and say "ah yeah, we'll do that". Then two days later, he gets a letter from their union and then two days after that they go off sick.
 
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Two statistics have already been quoted to you. One about the level of nurses. One about the level of spending.
For the moment Gordon Gekko's theory is the most persuasive to me.

Please provide your alternative theory as to why despite those statistics there is the perception of a health service in chaos.
Why are we getting such an inferior health servive relative to the levels of staffing and spending vis a vis other EU countries???
 
One word, infrastructure

Take a step inside a private hospital and see the facilities there like electronic prescribing etc....and then compare that to somewhere like portlaoise hospital or even beaumont in the capital.

I have worked in other health systems in Europe, good money is being thrown after bad here because it is shoring up a creaking ship and there is not the political will to spend on the systems to support best healthcare delivery.

Staff performance is not the main problem, but easier to scapegoat with a "them & us" philosophy, as is being demonstrated here.

And healthcare staff covers more than just nurses.
 

im not saying anymore on it for fear of a penalty being imposed , surely you have heard this before in relation to AGS ? , up until they got their midnight sweetheart deal twelve months ago
 

plus our population is a good bit younger than the EU average
 

the population as a whole has share of the blame too , we think we should have state of the art hospitals , broadband similar to south korea and IT corporations in every town with a population of ten thousand , the centres of excellence proposals were very worthwhile but sure their was hay to be made by rural TD,s for threatening to leave government if an A+E were closed in the north west , i lived and worked in canterbury new zealand when i was twenty years old , one day this young buck decided to do an evil knevil on this quad bike and ended up having to be airlifted to christchurch which was an hour away , sparsely populated countries cannot expect to have hospitals within forty minutes ( or at least hospitals with sufficient service provision )
 

I've read reports from court cases where the HSE has settled for large sums of money, the performance of staff and the processes they had in place did seem lacking. So I'm not convinced in relation to staff performance.

But even if staff performance is ok, your argument would suggest that the priority should be on re-allocating the spending? We've had increased health spending for last 15 years, but it has been spent on the wrong things???
I'm not seeing a convincing argument here for increased health spending.
 
We spend more on healthcare than most countries in the OECD. We spend a larger proportion of our healthcare budget on pay than almost anyone else. The OECD ranked us last in a value for money comparison among European countries.
While there are many work practices which are archaic and there are staff who go out of their way to do as little work as possible it can't just be down to the stereotype of the lazy public sector employee. Therefore the problem is structural. If an organisation is structurally inefficient then everyone working in it is inefficient. They may be working hard but they are still inefficient. Almost every other healthcare system in the developed world is structurally better than ours; pick one and copy it. Why not? Well people don't like change. The Consultants will want more money, the nurses will want more money and the Unions will insist that nobody loses their job so even if we remove the need for 10,000 admin and managerial roles we'll still have to keep them on the pay roll. Give that we would need to hire in some new skills we'd actually end up with more people employed by the HSE, though we'd have fewer working there.
I do find it strange that when nurses or doctors go on strike because of their "professional" concerns for patients the solution is always to pay them more money.

I do agree with the point about infrastructure, and that extends to other areas such as police stations, but real improvement requires changes to the whole human infrastructure, not just the built infrastructure.

The cost of our system is that people die. To those nurses and doctors and managers and admin staff who resist change and want a pay rise to accept changes which allow the system to work better; those deaths are on you.
 
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