# Up to €1 Billion in extra payments to State Employees



## Purple (23 Sep 2021)

Pandemic bonus across public sector could exceed €1 billion, Minister warns​
Are we really going to hand out up to a billion Euro to people who didn't lose their job during the pandemic for, well, actually doing their job during the pandemic?
Admittedly for some it was probably the first time in their career they actually did their job properly but that's no reason to throw money at them.


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## blanketyblank (23 Sep 2021)

Personally   I think its nuts!    And who decides where it will end?  The bill will probably end up even bigger.    Crazy stuff


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## mathepac (23 Sep 2021)

Bear in mind as well that a lot of them continued getting paid while the services they were supposed to provide vanished.  Passports anyone, Revenue help anyone?


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## odyssey06 (23 Sep 2021)

I think a bonus should be part of the public sector pay generally based on GNP \ revenues \ surplus.

Instead of committing us to pay increases that need to be paid even if tax revenues tank.

Country has a good year, nice bonus.
Country has a bad year, no bonus, but you still have a job.

So I'd rather see a big once off bonus now, than instead give what looks like a small pay increase now but in the long run will cost far more.


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## Purple (23 Sep 2021)

odyssey06 said:


> I think a bonus should be part of the public sector pay generally based on GNP \ revenues \ surplus.
> 
> Instead of committing us to pay increases that need to be paid even if tax revenues tank.
> 
> ...


Maybe GNI* but no way GNP. 
There'd also have to be a surplus in tax revenue. Personally I'd like to see it linked to delivery of service targets within budget. They'd also have to get rid of the fixed pay increases they get for just shining the This post will be deleted if not edited to remove bad language of their trousers for another year.


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## Peanuts20 (23 Sep 2021)

Personally I think the starting point should be the families of those on the front line who lost their lives. 2 non-medical staff for example, (kitchen porter and cleaner) in one hospital that I am aware of. 

secondly should be staff who have long covid and are unable to return to work.


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## WolfeTone (23 Sep 2021)

Purple said:


> Are we really going to hand out up to a billion Euro to people who didn't lose their job during the pandemic



That compares to the multi-billions that was handed out, rightly in my opinion, to people who did lose their jobs.


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## Allpartied (23 Sep 2021)

There are a couple of things that could be done which would really help staff morale, particularly in the front line areas, such as acute hospitals. 

Maybe provide night staff with some proper food/refreshments in the hospitals, subsidised or even free.   

A well equipped gymnasium for staff, something like that. 

In the long run, I think the " lockdown" provided quite a few people with a welcome sabbatical.   A nice, relatively, stress free period of downtime. 
Maybe all front line emergency responding public servants could be offered a three month paid  sabbatical , for every 20 years worked.   It would be a huge help to people who work in extremely stressful environments.   I think it's hard for people to understand that working in Emergency Departments, or ICU, or Maternity Units, presents the staff with highly charged, sometimes battle zone type experiences, day after day.  The staff train themselves to quash their natural responses, but, eventually it takes its toll.  

Maybe a little thinking outside the box would be a better gesture, than a cheque for a couple of hundred quid, across the board.


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## Pinoy adventure (23 Sep 2021)

WolfeTone said:


> That compares to the multi-billions that was handed out, rightly in my opinion, to people who did lose their jobs.



Isn’t there going too be an €1800++ once off payment made too those who lost the job because of COVID ?


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## Gordon Gekko (23 Sep 2021)

Whoever first came up with this idea of a bonus for public sector workers, frontline, healthcare, or otherwise, should be taken out and shot. And then shot again just to be sure.

Absolute claptrap…nonsense of the highest order.


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## kinnjohn (23 Sep 2021)

Gordon Gekko said:


> Whoever first came up with this idea of a bonus for public sector workers, frontline, healthcare, or otherwise, should be taken out and shot. And then shot again just to be sure.
> 
> Absolute claptrap…nonsense of the highest order.


Should we keep a few spare for there deluded  cheerleaders, it would be pointless shooting them don't you know we vote for who they are, We never Question what they are going to do when they get Elected,


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## WolfeTone (23 Sep 2021)

Gordon Gekko said:


> Whoever first came up with this idea of a bonus for public sector workers, frontline, healthcare, or otherwise, should be taken out and shot. And then shot again just to be sure.
> 
> Absolute claptrap…nonsense of the highest order.



I'm not so sure. Apparently in the hospitality sector there is a labour shortage in no small part to PUP being more than what employers were willing to pay. 
I don't recall much complaining about unemployed restaurant staff getting €350 for doing nothing while they could have been used to deep clean the streets of Covid like they did in China. 
But professional healthcare workers, working in the frontline over the whole duration look for something extra? - how soon we forget those that kept us healthy and treated our sick. 

Personally, I think we all deserve a bonus. Money is free, is being printed at will, time to spread the love once more and party.


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## Gordon Gekko (23 Sep 2021)

They did their job.

Lots of people lost their jobs and faced penury.

And we want to reward people with fulltime, secure, and pensionable jobs.

Important jobs, yes, but they were just doing their job.

Preposterous.


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## kinnjohn (23 Sep 2021)

WolfeTone said:


> I'm not so sure. Apparently in the hospitality sector there is a labour shortage in no small part to PUP being more than what employers were willing to pay.


If they paid the same wages as Hospitality staff get in Germany Austria there would be no shortage of staff,


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## WolfeTone (23 Sep 2021)

Gordon Gekko said:


> Lots of people lost their jobs and faced penury.



They lost their jobs, but did they face penury? Incomes were protected, nobody went hungry, homelessness was reduced, asset prices increased.



kinnjohn said:


> If they paid the same wages as Hospitality staff get in Germany Austria there would be no shortage of staff,



Exactly the point. The State is paying better to those who lost their job and are not working, than what employers are prepared to pay. Anyway you look at it, unemployed hospitality workers are a protected sector. 
But people who were working, doing their job, are to be resented for wanting something extra? 
That "we are all in this together" mentality has evaporated quickly.


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## kinnjohn (23 Sep 2021)

Gordon Gekko said:


> They did their job.
> 
> Lots of people lost their jobs and faced penury.
> 
> ...


Have you an opinion on who will see cutbacks and stealth taxes, why are we not blaming Mary Lou,

I might as well ask you what political party will benefit long-term from present Government policies,


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## kinnjohn (23 Sep 2021)

WolfeTone said:


> That compares to the multi-billions that was handed out, rightly in my opinion, to people who did lose their jobs.


For the most part, they were getting paid a small amount when you factor in the social security there Employers and employees pay to the Government through payroll, along with Income tax each week,


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## WolfeTone (23 Sep 2021)

kinnjohn said:


> For the most part, they were getting paid a small amount when you factor in the social security there Employers and employees pay to the Government through payroll, along with Income tax each week,



They were getting paid MORE than they would have got if the pandemic hadn't happened and they were still at work. 
Don't get me wrong, give the nature of crisis I think the government did the right thing. 
They protected social cohesion. The cost of that we can start to consider as economic activity returns to a new normal. 
But we all cheered the healthcare workers, transport workers, food producers, suppliers and toilet roll manufacturers. 
There is going to be significant changes in income levels and with it tax adjustments over the coming years. Now is a good time to put those frontline workers at the front of the queue. 
Public sector workers have trade unions to support their position. Who have retail grocer and meat plant workers got?


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## arbitron (23 Sep 2021)

I work in a hospital and I haven't heard any staff talking about a bonus. Certainly a lot of people are overdue a break but not many crying out for extra leave. The demand seems to be mainly coming from unions whose job it is to make themselves seen to be doing something for members. And I say that as a long-time union rep.

We can have an endless debate about whether healthcare workers are superheroes or just doing their well-paid, secure jobs, but most of us would rather see Slaintecare implemented rather than get a one-off token payment. As Allpartied said above, meaningful measures to boost morale would go a long way.

Laboratory staff have been treated like rubbish for years. Nurses have been highlighting understaffing and unsafe conditions as long as I can remember. Lots of burnout manifesting now that started long ago. Part of my job involves recruitment and retention of doctors and let me tell you it is a constant nightmare which pay rises will not solve.

WolfeTone is right, the government needs to address rights and conditions for the likes of meat factory workers and people in precarious work who have no-one in their corner.


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## Gordon Gekko (23 Sep 2021)

If they’re overdue a break, take a holiday


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## Purple (24 Sep 2021)

The best thing that could happen to help those working in the healthcare sector is to restructure the whole sector so that it functions properly. That would alleviate more stress and frustration and free up more resources than any tokenistic payment or extra holidays. People in that sector are generally well paid and have long holidays. What they need is the alleviation of the day to day frustrations caused by working in a badly structured and grossly wasteful health service.


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## WolfeTone (24 Sep 2021)

arbitron said:


> Nurses have been highlighting understaffing





Gordon Gekko said:


> If they’re overdue a break, take a holiday



That's part of the problem. If staff are on leave, in an environment where there is under staffing, it adds to the pressure of those remaining on duty. And in the circumstances of a pandemic, may be inclined to delay taking their leave leading to incidents of burnout and fatigue over the long term.


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## odyssey06 (24 Sep 2021)

There's talk of an extra bank holiday to "pay back frontline staff" ... how on earth does that do that? There still needs to be frontline cover on bank holidays. I don't get it.

If they said it was to boost hospitality now that places are back open I'd get it, but not this.


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## Leo (24 Sep 2021)

Gordon Gekko said:


> If they’re overdue a break, take a holiday


Ah but this is the HSE, in some roles if you're not on the holiday rota 2 years in advance not a hope of getting it!


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## Leo (24 Sep 2021)

arbitron said:


> Nurses have been highlighting understaffing and unsafe conditions as long as I can remember.


All the time while we have one of the highest number of nurses per capita in the EU!


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## arbitron (24 Sep 2021)

Leo said:


> All the time while we have one of the highest number of nurses per capita in the EU!


That figure needs context as to whether they are full time or part time, public or private, clinical/research/managerial, hospital/GP/nursing home, etc. When you look at reports on this (OECD, etc.) they qualify those stats by saying that high numbers per capita can still mean staff shortages depending on demand and the scope of work performed. So if we have fewer doctors and healthcare assistants per capita then more of the work is done by nurses.


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## odyssey06 (24 Sep 2021)

arbitron said:


> That figure needs context as to whether they are full time or part time, public or private, clinical/research/managerial, hospital/GP/nursing home, etc. When you look at reports on this (OECD, etc.) they qualify those stats by saying that high numbers per capita can still mean staff shortages depending on demand and the scope of work performed. So if we have fewer doctors and healthcare assistants per capita then more of the work is done by nurses.


It would also need context of the demographics for Ireland versus other EU countries rather than just a raw 'per capita'.


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## Leo (24 Sep 2021)

arbitron said:


> That figure needs context as to whether they are full time or part time, public or private, clinical/research/managerial, hospital/GP/nursing home, etc.


Wouldn't it be the staff shortage numbers that need more context? If we have more than most, but still have shortages, then it's likely those we do have aren't deployed in the right areas?


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## Leo (24 Sep 2021)

odyssey06 said:


> It would also need context of the demographics for Ireland versus other EU countries rather than just a raw 'per capita'.


True, we have one of the youngest populations. 20% of our population is over 60 when the European average is 26%.


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## arbitron (24 Sep 2021)

Leo said:


> Wouldn't it be the staff shortage numbers that need more context? If we have more than most, but still have shortages, then it's likely those we do have aren't deployed in the right areas?


The picture is very complex.

Some countries (e.g. Austria) only report the number of nurses working in hospitals, so their figures look much lower than ours. Meanwhile we include nurses who may be lecturing or working in a lab which artificially inflates our numbers. It is easy to look at a headline figure but the data behind the numbers are nuanced and you quickly realise it is tabloid stuff.

Nursing jobs are not all interchangeable. There can be complete skills mismatches, e.g. having lots of nurses trained in paediatric emergency medicine doesn't help if we are trying to staff adult ICUs. It can take years to retrain in a specialist area.

We also need to consider the ratios of nurses to other staff too. We have lower doctor numbers compared to OECD average, which can add to the nursing workload.

The infrastructure and resources matter too. Other countries may have fewer nurses because they have modern electronic records which allow the staff to work more efficiently. There really is a lot more to it than measuring the whole time equivalents.


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## Purple (24 Sep 2021)

arbitron said:


> The infrastructure and resources matter too. Other countries may have fewer nurses because they have modern electronic records which allow the staff to work more efficiently. There really is a lot more to it than measuring the whole time equivalents.


That's a really important point and creates massive duplication of processes within the HSE.
A relative of mine was admitted to St. James's Hospital through one department and then again through a different department about 6 weeks later. He had two different patient numbers, two different sets of records and they had no idea that the other set existed. If that level of duplication exists within one hospital I can only imagine what it's like nationally. 
That's the sort of thing that needs to be fixes, along with standardisation of contracts etc. There is literally billions to be saved and thousands of people who could be redeployed to useful roles.


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## Leo (24 Sep 2021)

arbitron said:


> Some countries (e.g. Austria) only report the number of nurses working in hospitals, so their figures look much lower than ours.


Eurostat account for all that...


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## Leo (24 Sep 2021)

Purple said:


> A relative of mine was admitted to St. James's Hospital through one department and then again through a different department about 6 weeks later. He had two different patient numbers, two different sets of records and they had no idea that the other set existed. If that level of duplication exists within one hospital I can only imagine what it's like nationally.


Same in the hospital my wife works in, administration blame GDPR!


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## Purple (24 Sep 2021)

Leo said:


> Same in the hospital my wife works in, administration blame GDPR!


How many different nursing grades and contracts are there in her hospital? How many variations of contracts are there in total?

There must be thousands of different contracts with different leave arrangements and T's & C's in across the HSE. Isn't that the reason PPARS failed? How many people work in payroll in the HSE and how much does that cost?
There's more than enough money spent on health, we just choose to waste so much of it that there's not enough where it's needed.


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## Leo (24 Sep 2021)

Purple said:


> How many different nursing grades and contracts are there in her hospital? How many variations of contracts are there in total?


Somewhere approaching infinity....it's one of the larger hospitals that subsumed other smaller hospitals over the decades, all the variations of contracts and T&Cs from the legacy hospitals remain. Things like leave and rosters are still managed via whiteboards and complex spreadsheets because the IT system can't cope with all the variations.


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## PMU (24 Sep 2021)

Leo said:


> All the time while we have one of the highest number of nurses per capita in the EU!


Correct.  The second highest, per 100,000 inhabitants, after Germany. https://ec.europa.eu/eurostat/stati...statistics_-_nursing_and_caring_professionals


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## Purple (24 Sep 2021)

Leo said:


> Somewhere approaching infinity....it's one of the larger hospitals that subsumed other smaller hospitals over the decades, all the variations of contracts and T&Cs from the legacy hospitals remain. Things like leave and rosters are still managed via whiteboards and complex spreadsheets because the IT system can't cope with all the variations.


And the cost (waste) probably run into the millions.


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## Purple (24 Sep 2021)

arbitron said:


> Some countries (e.g. Austria) only report the number of nurses working in hospitals, so their figures look much lower than ours. Meanwhile we include nurses who may be lecturing or working in a lab which artificially inflates our numbers. It is easy to look at a headline figure but the data behind the numbers are nuanced and you quickly realise it is tabloid stuff.


Yea, but the INMO calls them all front line staff and wants a bribe for them all for working through the pandemic. Judging by the calls to RTE this morning most of them don't want it and would rather see the money spent fixing things.


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## gianni (24 Sep 2021)

This term 'frontline' is nonsense. What is a frontline worker? You may aswell try to reward all the 'good' workers...


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## Shirazman (24 Sep 2021)

Leo said:


> Same in the hospital my wife works in, *administration blame GDPR*!



Shout it from the rooftops!    GDPR (inflicted on us by our witless MEPs) has been an absolute disaster that appears to benefit only criminals and faudsters.


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## Purple (24 Sep 2021)

gianni said:


> This term 'frontline' is nonsense. What is a frontline worker? You may aswell try to reward all the 'good' workers...


The people who were most exposed were the ones working on checkouts in supermarkets. They are on much lower pay and their employers made a fortune during the lockdown. I'm sure many doctors and nurses and care assistants and Porters worked very hard through that period but numbers in A&E were very low, elective surgeries were cancelled and I'm sure there were plenty of other areas where they were their workload dropped during that time.


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## Purple (24 Sep 2021)

Shirazman said:


> Shout it from the rooftops!    GDPR (inflicted on us by our witless MEPs) has been an absolute disaster that appears to benefit only criminals and faudsters.


I'm a big fan of the GDPR but it needs to be understood properly and not used as a smokescreen for incompetence and bad practice to hide behind.


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## Shirazman (24 Sep 2021)

Purple said:


> I'm a big fan of the GDPR but it needs to be understood properly and not used as a smokescreen for incompetence and bad practice to hide behind.



I agree with you up to a point (as a former boss of mine used to say whenever he vehemently disagreed with someone over something.)


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## Firefly (30 Sep 2021)

gianni said:


> This term 'frontline' is nonsense. What is a frontline worker?


For the HSE, IMO, it is those who had to wear PPE..


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## Leo (30 Sep 2021)

The 'frontline' term was widely used in the health service prior to covid to refer to staff in patient contact roles.

Of course as soon as a reward is mooted for frontline workers, representative bodies for other public services are looking to jump on the gravy train. Why not the whole essential services list?


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## gianni (30 Sep 2021)

Firefly said:


> For the HSE, IMO, it is those who had to wear PPE..


What grade of PPE? 

I'm deliberately being pedantic as I think this idea of singling out a specific group of workers is a minefield. I can't believe that any politician thought it was a good idea to open that can of worms. It can only be a bad news story. Those that don't  'qualify' will feel very aggrieved and a proportion of those that do 'qualify' will also be miffed at the size/nature of the reward. Lose, lose.


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## kinnjohn (30 Sep 2021)

gianni said:


> What grade of PPE?
> 
> I'm deliberately being pedantic as I think this idea of singling out a specific group of workers is a minefield. I can't believe that any politician thought it was a good idea to open that can of worms. It can only be a bad news story. Those that don't  'qualify' will feel very aggrieved and a proportion of those that do 'qualify' will also be miffed at the size/nature of the reward. Lose, lose.


Reading some posts on hear you would think the Left and SF are the only ones to have found the Money tree,

the most dangerous people to leave in charge of the so-called money tree are in government at present, they can't wait to spend every cent they can borrow at the moment,


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## WolfeTone (1 Oct 2021)

gianni said:


> This term 'frontline' is nonsense. What is a frontline worker?



I would suggest it is those workers who keep working that is critical to maintain social cohesion. Healthcare workers, law enforcement, food producers and providers, transport workers as examples.


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## Purple (1 Oct 2021)

WolfeTone said:


> I would suggest it is those workers who keep working that is critical to maintain social cohesion. Healthcare workers, law enforcement, food producers and providers, transport workers as examples.


Refuse collection, water and sewage treatment, power generation, packaging for food, logistics administration, IT for all of the above, maintenance and repair for all of the above, mechanics, petrol station employees, homeless services, needle exchanges, drug dealers... the list goes on and on.

If it's just social cohesion then don't forget the Pub and Bookies, at least near where I work. 

If all the water and sewage workers and all the bin men stopped working for a month it would kill more people than if all the doctors and nurses stopped working for a month.


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## Purple (1 Oct 2021)

kinnjohn said:


> Reading some posts on hear you would think the Left and SF are the only ones to have found the Money tree,
> 
> the most dangerous people to leave in charge of the so-called money tree are in government at present, they can't wait to spend every cent they can borrow at the moment,


Be careful what you wish for.


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## Purple (1 Oct 2021)

'Front Line' only applies State employees. The other Front Line people don't count.
In that context;

Can we not just give them all a round of applause or something?

What if we all promised not to roll our eyes when they tell us (for the umpteenth time) how hard they worked, how brilliant they all are, how they are the best in the world and how underpaid they are?

What if we had a national "Sure aren't you great" day for them?


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## kinnjohn (1 Oct 2021)

Purple said:


> Be careful what you wish for.


I hope they don't
but it is heading in that direction, I am hoping we can turn the bus before the present crowd crashes it, not looking likely judging by posters reaction to the urge to spend every cent they can possibly borrow on our behalf,


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## odyssey06 (1 Oct 2021)

Did no political advisors warn the government that however many people you give this bonus to, there will be twice as many who feel they should have gotten it... so you're burning political capital as well as money?


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## Leo (1 Oct 2021)

Purple said:


> Can we not just give them all a round of applause or something?


Some of them have already gotten a lovely medal and a form letter from the president! Now I want a medal too.... and some holidays, and cash to spend on those holidays.....I mean we were all in it together!


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## time to plan (1 Oct 2021)

Purple said:


> That's a really important point and creates massive duplication of processes within the HSE.
> A relative of mine was admitted to St. James's Hospital through one department and then again through a different department about 6 weeks later. He had two different patient numbers, two different sets of records and they had no idea that the other set existed. If that level of duplication exists within one hospital I can only imagine what it's like nationally.
> That's the sort of thing that needs to be fixes, along with standardisation of contracts etc. There is literally billions to be saved and thousands of people who could be redeployed to useful roles.


St James's isn't a HSE hospital, and it does have one of the more advanced electronic health records in the Irish public system, but it is still being rolled out, so you will still find fragmented records there across different department.. 

But generally the Irish publicly funded health system is 20 years behind other health systems in terms of electronic health records - paper records are still predominant. It's a necessary investment to make, and will cost well over a billion over 10 to 15 years. Unfortunately there aren't literally billions to be saved - the evidence is quite poor for economic benefits as a return on investment (no matter what the software vendors tell you), but it is part of the necessary infrastructure for a modern health system, that will leader to safer higher quality and more efficient care (but these efficiencies will typically be found in clinical staff having more time to care, rather than rooting around for scraps of patient information, rather than in cash savings).


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## RetirementPlan (1 Oct 2021)

Shirazman said:


> Shout it from the rooftops!    GDPR (inflicted on us by our witless MEPs) has been an absolute disaster that appears to benefit only criminals and faudsters.


How has GDPR benefited criminals and fraudsters?


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## Leo (1 Oct 2021)

RetirementPlan said:


> How has GDPR benefited criminals and fraudsters?


Let's see how Graham O'Dwyer's appeal goes...


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## MrEarl (2 Oct 2021)

The Government could reduce this cost a bit, by not giving cash and instead giving vouchers for things like holidays, supermarkets or department stores, which they could buy in bulk and at a discount.

Anything that's done needs to be very clearly given on once off basis, and preferably only given to those earning below a certain income threshold -I see no reason to give it to high earners, no more than pay them overtime etc. !


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## Purple (4 Oct 2021)

time to plan said:


> St James's isn't a HSE hospital,


So the biggest acute hospital in Ireland isn't controlled or run by the HSE and instead operates its own systems and processes. Is that really the case?
If so it's both amazing and appalling.


time to plan said:


> it does have one of the more advanced electronic health records in the Irish public system, but it is still being rolled out, so you will still find fragmented records there across different department..


Wow, that's amazing and appalling too.


time to plan said:


> But generally the Irish publicly funded health system is 20 years behind other health systems in terms of electronic health records


And in terms of organisational structure and general byzantine layers at every turns, which is probably the reason for the electronic health records being delayed and so expensive . And that's the reason for the waste.


time to plan said:


> - paper records are still predominant. It's a necessary investment to make, and will cost well over a billion over 10 to 15 years.


Without restructuring of other areas, yes it will.


time to plan said:


> Unfortunately there aren't literally billions to be saved - the evidence is quite poor for economic benefits as a return on investment (no matter what the software vendors tell you), but it is part of the necessary infrastructure for a modern health system, that will leader to safer higher quality and more efficient care (but these efficiencies will typically be found in clinical staff having more time to care, rather than rooting around for scraps of patient information, rather than in cash savings).


There are billions to be saved, but not with putting electronic reporting systems on top of the existing structures. Anyone in a management position in the health service who doesn't see that is incompetent and is part of the problem.


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## time to plan (4 Oct 2021)

Worth


Purple said:


> So the biggest acute hospital in Ireland isn't controlled or run by the HSE and instead operates its own systems and processes. Is that really the case?
> If so it's both amazing and appalling.
> 
> Wow, that's amazing and appalling too.
> ...


Worth reading up on Section 38 organisations to understand how the large Dublin hospitals and Dublin maternity hospitals and some others are publicly funded but not part of HSE. I don’t know anyone who thinks that bringing them under HSE management would improve them!

Reading your post, if you don’t mind me saying you have a certain amateur naivety about healthcare organisation. Electronic health records are fundamentally different from ‘electronic reporting systems’. Also, it’s unclear whether the problem with the HSE and broader public system is principally structural. There’s a strong argument to be made that it is cultural. 

The cost I was putting forward for electronic health records is not an inflated cost due to Irish structures, but pretty well benchmarked internationally. The main reason, I suggest that no progress has been made here is the DPER reluctance to fund, probably as a fallout of the PPARS debacle.


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## SGWidow (4 Oct 2021)

time to plan said:


> St James's isn't a HSE hospital, and it does have one of the more advanced electronic health records in the Irish public system, but it is still being rolled out, so you will still find fragmented records there across different department.



Just a very quick question - are records in one hospital accessible in another hospital? If someone has a procedure in hospital A and then attends hospital B, will hospital B be aware of the patient's history in hospital A?


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## Purple (4 Oct 2021)

SGWidow said:


> Just a very quick question - are records in one hospital accessible in another hospital? If someone has a procedure in hospital A and then attends hospital B, will hospital B be aware of the patient's history in hospital A?


In the case of my son he had two different sets of records in the same hospital. The second time he was admitted they were unaware of the first admission. That said I was in Naas hospital a few months back and that's like an episode of Fr. Ted.


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## Purple (4 Oct 2021)

time to plan said:


> Worth
> 
> Worth reading up on Section 38 organisations to understand how the large Dublin hospitals and Dublin maternity hospitals and some others are publicly funded but not part of HSE. I don’t know anyone who thinks that bringing them under HSE management would improve them!


The notion that it is a good idea for each hospital to have different systems for recording patient information is mind boggling. 
The duplication of process and resource has to run into the tens of millions.


time to plan said:


> Reading your post, if you don’t mind me saying you have a certain amateur naivety about healthcare organisation.


Yes, I am probably grossly underestimating how wasteful and inefficient they are in this country.


time to plan said:


> Electronic health records are fundamentally different from ‘electronic reporting systems’.


I'm well aware of the difference. 


time to plan said:


> Also, it’s unclear whether the problem with the HSE and broader public system is principally structural. There’s a strong argument to be made that it is cultural.


In my experience as a QA engineer, manager and LEAN practitioner one feeds into the other.


time to plan said:


> The cost I was putting forward for electronic health records is not an inflated cost due to Irish structures, but pretty well benchmarked internationally. The main reason, I suggest that no progress has been made here is the DPER reluctance to fund, probably as a fallout of the PPARS debacle.


We have one of the best funded healthcare systems in the world. There is absolutely no shortage of resources. The people who work in the Publicly funded healthcare sector choose to waste them, with the resultant suffering and deaths. If it was me I'd be uncomfortable with having that blood on my hands but then again I'm a bit naive.


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## time to plan (4 Oct 2021)

SGWidow said:


> Just a very quick question - are records in one hospital accessible in another hospital? If someone has a procedure in hospital A and then attends hospital B, will hospital B be aware of the patient's history in hospital A?


Typically no, with the exception of radiology reports and images. It’s a real problem for continuity of care.


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## time to plan (4 Oct 2021)

Purple said:


> The notion that it is a good idea for each hospital to have different systems for recording patient information is mind boggling.
> The duplication of process and resource has to run into the tens of millions.
> 
> Yes, I am probably grossly underestimating how wasteful and inefficient they are in this country.
> ...


Indeed you are. But no offence intended. LEAN has applications in healthcare. Bolton hospitals was a good example last time I looked. But it is rather more complex overall than that.


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## noproblem (4 Oct 2021)

When someone said that St James's wasn't a HSE hospital I was very surprised. Is it a fact, or someone just saying that it isn't?


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## arbitron (4 Oct 2021)

noproblem said:


> When someone said that St James's wasn't a HSE hospital I was very surprised. Is it a fact, or someone just saying that it isn't?


SJH is a voluntary hospital like the Mater, St Vincent's, Rotunda, etc. They are usually "owned" by trusts/charities/religious orders and the HSE pays them to provide services. They retain a lot of control over their operations, e.g. they may have their own IT dept. It is effectively outsourcing. Similar to the way most schools run. Here's a list of the voluntaries: https://foi.gov.ie/voluntary-hospitals/

Hospitals like Connolly, Cavan, Sligo, Tullamore, etc. are statutory hospitals, i.e. owned and run by the HSE. They tend to be more centralised in their operations, e.g. IT is run centrally/regionally.

This difference is the reason that HSE hospitals were worse hit by the cyber attack than many voluntaries.


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## Purple (5 Oct 2021)

time to plan said:


> Indeed you are.


Indeed, that's how it can look when obvious problems are pointed out to the institutionalised. 


time to plan said:


> But no offence intended.


None taken. This is an internet discussion forum where strangers talk. If people get offended here they need to take a hard look at themselves. 


time to plan said:


> LEAN has applications in healthcare.


It certainly does, as do management practices and structures from the latter part of the 20th century (let's not be too ambitious). 


time to plan said:


> But it is rather more complex overall than that.


The excuse used the world over by the inept and intransigent to justify their ineptitude and intransigence.
Nearly all organisational problems are really a collection of small simple problems. The 'more complex' problems are nearly always just a larger collection of small problems. 
The problems does indeed start with culture and the culture of victimhood amongst healthcare employees is both tiresome and unjustified. The reason their job is hard, in the minority of cases when their job is actually hard, is their own fault. They are the HSE. It's up to them collectively to fix things.


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## PebbleBeach2020 (5 Oct 2021)

this thread has gone totally off topic hasnt it?


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## Leo (5 Oct 2021)

time to plan said:


> I don’t know anyone who thinks that bringing them under HSE management would improve them!


My wife works in one of the 'voluntary' hospitals. The stories of waste I hear would make your blood boil! I can't imagine the HSE could do much worse!


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## RetirementPlan (5 Oct 2021)

Leo said:


> Let's see how Graham O'Dwyer's appeal goes...


The legal concerns about the broad data collection and retention of telecom data arising in that case pre-date GDPR, and were red flags under existing Data Protection legislation.

I was hoping that the poster who claimed that GDPR helped criminals and fraudsters might explain the basis for that claim.


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## Purple (5 Oct 2021)

Okay, back on topic. When State employees have chosen to waste a billion less by accepting reforms that should have happened 30 years ago I'd be happy to give them a cut of it.


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## RetirementPlan (5 Oct 2021)

SGWidow said:


> Just a very quick question - are records in one hospital accessible in another hospital? If someone has a procedure in hospital A and then attends hospital B, will hospital B be aware of the patient's history in hospital A?


It depends. The HSE have been rolling out very substantial eHealth initiatives over the past five years or so - see https://www.ehealthireland.ie/ for more details - but given the size, breadth of functions and organisational complexity of the health sector, we're still a long way of integrated systems for all functions for all hospitals. They also did some excellent work over the past 18 months, such as the Covid tracker, the vaccine booking portal and the Covid certificates.


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## SGWidow (5 Oct 2021)

Does this mean when a hospital joins this system it records a procedure for patients prospectively - i.e. the hospital doesn't digitise its archives but simply records all new procedures from a given date?


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## Purple (5 Oct 2021)

RetirementPlan said:


> They also did some excellent work over the past 18 months, such as the Covid tracker, the vaccine booking portal and the Covid certificates.


Yes, when they can start from scratch and don't have to build on the foundation of  40 years of ineptitude they can do excellent things. 

The problem is that they are hidebound by history.


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## PMU (5 Oct 2021)

time to plan said:


> St James's isn't a HSE hospital, and it does have one of the more advanced electronic health records in the Irish public system, but it is still being rolled out, so you will still find fragmented records there across different department..
> 
> But generally the Irish publicly funded health system is 20 years behind other health systems in terms of electronic health records - paper records are still predominant. It's a necessary investment to make, and will cost well over a billion over 10 to 15 years.


 
I wouldn't hold your breath. 20 years ago the UK launched the National Programme for Information Technology's NHS Care Records Service to provide a national standards-based interoperable electronic health records system. Unfortunatley, it wasn't a success and incurred significant losses, with the programme being terminated in 2011. Now, if the UK can't deliver an EHRS, I really don't see it happening here.


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## RetirementPlan (5 Oct 2021)

SGWidow said:


> Does this mean when a hospital joins this system it records a procedure for patients prospectively - i.e. the hospital doesn't digitise its archives but simply records all new procedures from a given date?


Don't think there is any single yes/no answer to this. It depends on the function being digitised and the hospital and probably a whole lot of other factors too. There may be cases where it makes sense to digitise recent records, or cases where it is better just to start from day one and work ahead from there. It's hard to see the merit in going back and digitising EVERY patient record of EVERY issue, given the work that would be involved and the likely age of the archives.


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## Purple (5 Oct 2021)

PMU said:


> I wouldn't hold your breath. 20 years ago the UK launched the National Programme for Information Technology's NHS Care Records Service to provide a national standards-based interoperable electronic health records system. Unfortunatley, it wasn't a success and incurred significant losses, with the programme being terminated in 2011. Now, if the UK can't deliver an EHRS, I really don't see it happening here.


IT systems have the annoying requirement that they need to be based in logic. In order for any system like this, or PPARS or anything else to work the underlying system needs to be reformed and standardised. The scope for saving, and the resultant freeing up of resources to improve services and working conditions, is colossal. Unfortunately the vested interests within the industry have too much power to frustrate change.

In order to merge IT systems HR systems and functions should be integrated first.
In order to integrate data entry a standard procedure for entering that data has to be introduced first.

Given the movement of Amazon, Apple, Google and Microsoft into the healthcare space I expect them to have offerings for healthcare systems in the medium term. I'm surprised that GE, Siemens or even smaller players like Draeger haven't developed an offering yet, given their relative dominance in the diagnostics and patient monitoring sector.

The last time I was in an A&E I did wonder why they couldn't give each patient a silicones bracelet with an RFID tag imbedded in it rather than a printed bracelet with a bar code. The RFID tag could hold their current records and track their location within the hospital. It's 30 year old technology and it's dirt cheap.


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## arbitron (5 Oct 2021)

This is probably worth splitting off into a different thread entirely.


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## time to plan (5 Oct 2021)

PMU said:


> I wouldn't hold your breath. 20 years ago the UK launched the National Programme for Information Technology's NHS Care Records Service to provide a national standards-based interoperable electronic health records system. Unfortunatley, it wasn't a success and incurred significant losses, with the programme being terminated in 2011. Now, if the UK can't deliver an EHRS, I really don't see it happening here.


I lived through it (minor point - it was England not the UK). NPfIT is a great example of how not to do it - centralised command and control, run by ex management consultants, thinking that healthcare isn’t much different from an airline, manufacturing or the London Confestion Charge. Instead healthcare is a high variation sector so the challenges to digitise are significant. 

NHS acute and community trusts have subsequently (to NPfIT) done a pretty good job of implementing Electronic Patient Record systems and integrating them. Ultimately, the investment has to be made in Ireland. It can’t continue forever as the only advanced economy largely reliant on paper records.


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## time to plan (5 Oct 2021)

Leo said:


> My wife works in one of the 'voluntary' hospitals. The stories of waste I hear would make your blood boil! I can't imagine the HSE could do much worse!


You have no idea.


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## time to plan (5 Oct 2021)

SGWidow said:


> Does this mean when a hospital joins this system it records a procedure for patients prospectively - i.e. the hospital doesn't digitise its archives but simply records all new procedures from a given date?


They are different approaches taken. Galway University Hospitals is scanning and indexing historic paper records but it’s an expensive business to do on top of implementing Electronic Health Record solutions. However, there is no need to scan the entire archive as most patients with records will never be seen again. A scan on demand system means that you just scan the records of patients scheduled to be admitted or with an appointment. There is the. The challenge of dealing with ED attendances. But it’s still very expensive. 

It is more common to start with a relatively clean slate, taking a view as to what electronic data can / should be migrated - appointments, attendances, diagnostic results and reports etc. It leads to a mixed process where existing patients have their paper records pulled for a time and if they are long term patients, a summary can be created on the new electronic system. - e.g allergies, active and historic diagnoses, historic procedures. 

Eventually the need for historic paper records diminishes. 

It’s painful but probably the only economically viable approach to getting off paper.


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## time to plan (5 Oct 2021)

IT systems have the annoying requirement that they need to be based in logic. In order for any system like this, or PPARS or anything else to work the underlying system needs to be reformed and standardised. The scope for saving, and the resultant freeing up of resources to improve services and working conditions, is colossal. Unfortunately the vested interests within the industry have too much power to frustrate change.


Purple said:


> In order to merge IT systems HR systems and functions should be integrated first.
> In order to integrate data entry a standard procedure for entering that data has to be introduced first.
> 
> Given the movement of Amazon, Apple, Google and Microsoft into the healthcare space I expect them to have offerings for healthcare systems in the medium term. I'm surprised that GE, Siemens or even smaller players like Draeger haven't developed an offering yet, given their relative dominance in the diagnostics and patient monitoring sector.
> ...


Cerner bought Siemens Healthcare.

RFID is interesting. You wouldn’t use it to hold patient records but their identity from which records can be accessed but you still need electronic records.

There is a startup in Limerick called Pinpoint Medical who do something similar with WiFi (triangulation? I don’t really remember)

Where RFID is used in healthcare is in tracking the location of paper notes, which can be a real problem.


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## time to plan (5 Oct 2021)

Purple said:


> Indeed, that's how it can look when obvious problems are pointed out to the institutionalised.
> 
> None taken. This is an internet discussion forum where strangers talk. If people get offended here they need to take a hard look at themselves.
> 
> ...


You are still naive. The complexity of healthcare stems to a large extent from it being a low volume high variation sector. There’s always a stream of consultant types trying to apply fixes from manufacturing, airlines etc. They always screw it up in my experience. 

Having said that, the Irish health system is a particularly poor specimen.


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## time to plan (5 Oct 2021)

arbitron said:


> SJH is a voluntary hospital like the Mater, St Vincent's, Rotunda, etc. They are usually "owned" by trusts/charities/religious orders and the HSE pays them to provide services. They retain a lot of control over their operations, e.g. they may have their own IT dept. It is effectively outsourcing. Similar to the way most schools run. Here's a list of the voluntaries: https://foi.gov.ie/voluntary-hospitals/
> 
> Hospitals like Connolly, Cavan, Sligo, Tullamore, etc. are statutory hospitals, i.e. owned and run by the HSE. They tend to be more centralised in their operations, e.g. IT is run centrally/regionally.
> 
> This difference is the reason that HSE hospitals were worse hit by the cyber attack than many voluntaries.


That is almost correct. While they are very commonly called voluntaries, I believe St James’s and Beaumont are statutory, but not HSE, and that their Boards are appointed by the Minister of Health. Section 38 agencies is the correct term but that is a bit picky. 

I think they are funded by the Department of Health rather than the HSE but I could well have that wrong.


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## time to plan (5 Oct 2021)

I may have taken this thread off track enough. Will leave it now.


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## time to plan (5 Oct 2021)

I tell a lie. One last thing, to illustrate the cultural problems. And I’m not union bashing - as it happens I am pro unions, but this was really shocking and I can’t imagine it happening in a similarly unionised health system (e.g NHS) where the fundamental culture is one of public service. 









						HSE accuses union of undermining Covid-19 strategies
					

The HSE has accused the Fórsa trade union of undermining strategies to tackle the Covid-19 virus and potentially putting patients at risk by refusing to cooperate with certain technology in a row over staffing.




					www.rte.ie


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## Purple (6 Oct 2021)

time to plan said:


> Cerner bought Siemens Healthcare.


You better tell Siemens Healthcare that. They think they are now called Siemens Healthineers and employ 66,000 people with manufacturing plants in Ireland, the USA, Germany, the UK and many other countries.



time to plan said:


> RFID is interesting. You wouldn’t use it to hold patient records but their identity from which records can be accessed but you still need electronic records.


Yes, just like a bar code. The ability to track the patient location is the bonus, along with the contactless nature of an RFID tag.


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## Purple (6 Oct 2021)

time to plan said:


> You are still naive. The complexity of healthcare stems to a large extent from it being a low volume high variation sector. There’s always a stream of consultant types trying to apply fixes from manufacturing, airlines etc. They always screw it up in my experience.
> 
> Having said that, the Irish health system is a particularly poor specimen.


The level of variation at the structural side is far greater than necessary due to the structural and personal incompetence of the organisation and those running it.


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## Purple (6 Oct 2021)

time to plan said:


> I tell a lie. One last thing, to illustrate the cultural problems. And I’m not union bashing - as it happens I am pro unions, but this was really shocking and I can’t imagine it happening in a similarly unionised health system (e.g NHS) where the fundamental culture is one of public service.
> 
> 
> 
> ...


Yes, one of the many vested interests at play.


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## Leo (6 Oct 2021)

time to plan said:


> You have no idea.


Examples?


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## Purple (6 Oct 2021)

@Leo noted the stories of waste within one hospital to which @time to plan replied "You have no idea.".
@time to plan mentioned earlier that;


time to plan said:


> There’s always a stream of consultant types trying to apply fixes from manufacturing, airlines etc. They always screw it up in my experience.


Is it too much to ask that one of the best funded healthcare systems in the world, employing well over 100,000 people, or more than one in twenty people who works in this country, could manage to make some fist of fixing things themselves? If the people who work in the HSE (the people who actually are the HSE) spent 10% of the energy they currently spend whinging and moaning on actually making things better it would probably go a long way to improving things.


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## RetirementPlan (6 Oct 2021)

time to plan said:


> You are still naive. The complexity of healthcare stems to a large extent from it being a low volume high variation sector. There’s always a stream of consultant types trying to apply fixes from manufacturing, airlines etc. They always screw it up in my experience.
> 
> Having said that, the Irish health system is a particularly poor specimen.





time to plan said:


> I tell a lie. One last thing, to illustrate the cultural problems. And I’m not union bashing - as it happens I am pro unions, but this was really shocking and I can’t imagine it happening in a similarly unionised health system (e.g NHS) where the fundamental culture is one of public service.
> 
> 
> 
> ...


In fairness, the issue being raised by the union in this case is the over-reliance on the external consultants, the ones who always screw it up, as you noted yourself.


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## PMU (6 Oct 2021)

RetirementPlan said:


> In fairness, the issue being raised by the union in this case is the over-reliance on the external consultants, the ones who always screw it up, as you noted yourself.


The RTE report https://www.rte.ie/news/2020/0518/1139188-hse-union-row/ makes it clear that "The dispute centres on union concerns about the HSE's use of agency personnel and contractors in the HSE,.....to deliver ICT services, rather than using direct staff employees already on recruitment panels".  So it's not about external consultants, (i.e. those who provide intellectual and other services not normally available in-house), but hiring contractors (i.e. those who implement systems) when in-house promotion panels already exist.  Any trade union worth its salt would defend its members interests in this case.


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## becky (8 Oct 2021)

time to plan said:


> That is almost correct. While they are very commonly called voluntaries, I believe St James’s and Beaumont are statutory, but not HSE, and that their Boards are appointed by the Minister of Health. Section 38 agencies is the correct term but that is a bit picky.
> 
> I think they are funded by the Department of Health rather than the HSE but I could well have that wrong.


All the voluntary hospitals (the vols as they are known) get their funding (and they don't like it one bit) from HSE but retain their own boards.


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## Purple (8 Oct 2021)

becky said:


> All the voluntary hospitals (the vols as they are known) get their funding (and they don't like it one bit) from HSE but retain their own boards.


He who pays the piper calls the tune. The problem seems to be the ability of the musician to read music.


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## Shirazman (13 Oct 2021)

RetirementPlan said:


> I was hoping that the poster who claimed that GDPR helped criminals and fraudsters might explain the basis for that claim.



Sorry old boy, I've been away in the Algarve for the past few days so completely missed your plaintive cry for assistance.  (Incidentally, I appreciate your strict observance of the GDPR protocols in not quoting my moniker in the above response; very correct and appropriate of you! )  

I find it difficult to believe that someone would genuinely be unaware of the role of GDPR in preventing criminal investigations and in facilitating the carrying out of fraudulent actions.   But then perhaps you were trying to wind me up?    But if you genuinely want to see how GDPR can assist fraudsters then I refer you to the Flynn/Clarke case in Cork Circuit Court earlier this year.


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## RetirementPlan (13 Oct 2021)

Shirazman said:


> Flynn/Clarke case in Cork


I'm vaguely aware of the case. From what I can see, the entire fraud and the vast majority of the investigation predates GDPR. The Garda raided them in June 2018, having been investigating since 2016. GDPR came into law in May 2018.
https://www.irishexaminer.com/news/courtandcrime/arid-40231541.html


> Police entered the Altus apartment, with a warrant, on June 26, 2018, and


So what specifically is the GDPR issue here?


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