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



## Brendan Burgess (29 Sep 2017)

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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## AlbacoreA (29 Sep 2017)

You have to register to read that article. 

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.


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## Firefly (30 Sep 2017)

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.


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## Leper (1 Oct 2017)

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 . . .


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## galway_blow_in (1 Oct 2017)

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


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## galway_blow_in (1 Oct 2017)

Leper said:


> 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.
> 
> ...




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


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## Leper (1 Oct 2017)

"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?


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## Gordon Gekko (1 Oct 2017)

Let's call a spade a spade...staff are overpaid and too many of them are lazy and overly-unionised.


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## Miakk (1 Oct 2017)

Evidence, Gordon Gekko?


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## Gordon Gekko (1 Oct 2017)

Miakk said:


> Evidence, Gordon Gekko?



Dinner with three senior people last week. Some of the stuff that goes on is laughable.


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## Miakk (2 Oct 2017)

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....


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## Gordon Gekko (2 Oct 2017)

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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## odyssey06 (2 Oct 2017)

Miakk said:


> 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....



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???


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## Miakk (2 Oct 2017)

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.


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## galway_blow_in (2 Oct 2017)

Leper said:


> "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?



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


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## galway_blow_in (2 Oct 2017)

odyssey06 said:


> 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???



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


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## galway_blow_in (2 Oct 2017)

Miakk said:


> 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.
> 
> ...



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 )


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## odyssey06 (2 Oct 2017)

Miakk said:


> 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.



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.


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## Purple (2 Oct 2017)

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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## Gordon Gekko (2 Oct 2017)

Have you considered the fact that private hospitals don't tolerate poor performers or bizarre work practices?


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## Early Riser (2 Oct 2017)

Gordon Gekko said:


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



So "three senior people" told you some anecdotes at dinner and you now have "evidence" to make a sweeping generalization about the whole health Service ? Can I ask when was the last time "three senior people" told you some anecdotes about how they themselves weren't up to, or weren't really motivated enough to, do their own jobs properly ? I guess never. 

It is very easy to tell anecdotes to disparage others to both elevate one's own importance and to indulge and flatter the prejudice of others. It usually says more about the competence, confidence and motivation of the teller. 

If these were "three senior people" - competent senior people - I would have been much more impressed if they had outlined an analysis of the organizational , structural and managerial issues underlying health service dysfunction and proposals to address same. If they weren't senior enough for this, perhaps they might have outlined real tangible change they were able to achieve in their own area of responsibility (rather than pub bore anecdotes).

But perhaps, Gordon's anecdote does illustrate one real problem in the health service (or any dysfunctional organization) - one group casting stones at another, particularly when they are insecure about how they are performing in their own roles.


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## Gordon Gekko (2 Oct 2017)

You're right...the ludicrous levels of absenteeism mean nothing.


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## Purple (2 Oct 2017)

It is strange that absenteeism for nurses is a multiple of that of doctors considering that they are working in the same environment and doctors work much longer hours.


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## Firefly (2 Oct 2017)

Leper said:


> 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.




Hi Leper,

There's no arguing that wages were cut via Croke Park. The point I am making is that in the years upto the Celtic Tiger, say from 2000 to 2006 we had progressive benchmarking exercises where wages in the public sector passed out those in the private sector. During this time I do not believe the standard of healthcare improved improved. And that's the point, putting more money into health essentially just means higher wages. 

Firefly.


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## Early Riser (2 Oct 2017)

Gordon Gekko said:


> You're right...the ludicrous levels of absenteeism mean nothing




Everything means something.



Purple said:


> It is strange that absenteeism for nurses is a multiple of that of doctors considering that they are working in the same environment and doctors work much longer hours.



So, perhaps, it means that nurses are inherently more lazy than doctors ? Or more lazy than private sector workers, generally ? 

I am sure once "three senior people" have worked out which it is, they will implement a cunning plan to sort things out. I have every confidence in this sophisticated level of organizational thinking and change management. I bet they have Harvard MBAs.


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## Firefly (2 Oct 2017)

Early Riser said:


> I am sure once "three senior people" have worked out which it is, they will implement a cunning plan to sort things out. I have every confidence in this sophisticated level of organizational thinking and change management. I bet they have Harvard MBAs.



Interesting point. It's a point that's been made often in the past that the level of academic education in the public sector is a valid reason for why they should be paid so much. It's refreshing to see others see this for the scam that it is!!


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## Leper (2 Oct 2017)

Gordon Gekko said:


> Have you considered the fact that private hospitals don't tolerate poor performers or bizarre work practices?



Yes they do. In fact the largest payouts of compensation to mistreated patients have been from private hospitals and their consultants.


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## Leper (2 Oct 2017)

Gordon Gekko said:


> You're right...the ludicrous levels of absenteeism mean nothing.



What ludicrous levels of absenteeism?


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## Leper (2 Oct 2017)

Gordon Gekko said:


> Let's call a spade a spade...staff are overpaid and too many of them are lazy and overly-unionised.



Probably the most ill thought out and downright offensive comment on this thread todate. Proof please (or at least source). Are you also saying that hospital staff should not be members of trade unions?


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## Gordon Gekko (2 Oct 2017)

Absenteeism is 5 times higher


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## Early Riser (2 Oct 2017)

Leper said:


> Probably the most ill thought out and downright offensive comment on this thread todate. Proof please (or at least source). Are you also saying that hospital staff should not be members of trade unions?



Leper, I am surprised at your accusation. You should know by now that Gordon is a paragon of rational explanation, based upon considered analysis of all the complexities of any situation and all the available empirical evidence. Let's spell out this explanation:

1 There are major problems with the Health Service.

2 There is a simple explanation for this.

3 Staff are overpaid, lazy and over-unionised.

4 They are so overpaid that they have to take sick leave to spend their money.

5 So, "absenteeism is 5 times higher".

6 Nurses are particularly lazy. Doctors are not.

7 I know all this because I had dinner with "three senior people".

8 These three senior people are not part of the problem because they had dinner with me.

9 They told me stories that conformed with my pre-conceptions about the Health Service.

10 Therefore, these stories are an accurate analysis of the underlying problem with the Health Service.

11 These three senior people can't effect any change because staff are overpaid, lazy and over-unionised.

12 Repeat from number 4 down ad nauseam.


I am surprised at your difficulty grasping this. But, no fear - Gordon will explain it more fully (and simply) in his up-coming Ladybird Book ("A Spade is a Spade").


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## galway_blow_in (2 Oct 2017)

the only thing ive learned from reading this thread is that sarcastic posts are popular


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## Firefly (2 Oct 2017)

Early Riser said:


> I am surprised at your difficulty grasping this. But, no fear - Gordon will explain it more fully (and simply) in his up-coming Ladybird Book ("A Spade is a Spade").



Plenty of pictures in it anyway so you'll be grand


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## becky (2 Oct 2017)

I am convinced that the reason for low rate for doctors is under reporting. Consultants and junior doctors work all over the hospitals unlike nurses who have a ward/clinic base.

In relation to whether more money is needed, i'm a no.

I'd like to see less adverts for posts like these
https://hse.ie/eng/staff/Jobs/Job_Search/Management_Admin_ICT/?pageNumber=2

Read page 1 also.


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## Leper (3 Oct 2017)

Consultants and junior doctors work all over the hospitals (The consultants deal with their private patients not just some public patients in our public hospitals and these are not confined to one room).Consequently, the NCHD's ("junior" doctors) would change rooms accordingly. [Incidentally, the words "junior doctors" only exist when they are interviewed on national television news. In the hospitals they are known as Registrars, Senior House Officers etc. Ask anybody who gave birth who will inform you it's the relevant Registrar who attends most births.

Most nurses would not be confined to one ward or one clinic. Many consultants leave hospitals pretty early to staff their private clinics elsewhere.


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## cremeegg (3 Oct 2017)

Miakk said:


> That's not evidence that's anecdote.
> I have plenty of "laughable" stories from the private sector too.



Sure, but that is the private sector, if they operate inefficiently they go broke. Thats their problem not the taxpayers. (With of course the shameful exception of the banks)




Miakk said:


> 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



And are these people to be admired. Its easy to admire the nurse who cares for the sick person, but if they are propping up a sick system they are at fault for its continuation as much as those who actively block referm




Miakk said:


> our IT system is archaic and we still have to use ledgers for many things.



Well pumping €200m into PPARS didn't do any good. Introducing an electronic patient records system would be a major achievement for the health service, but I think that they system, management staff and unions are simply not capable of doing it.

By contrast Revenue moved every taxpayer in the country onto ROS with very little proble


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## Daithi7 (3 Oct 2017)

To answer the original question: No.

The Irish health service offers the worst value in the world.  (source OECD) We pay in the highest decile of costs per person,  with the lowest decile in outcomes and this is with a relatively young population who should be easier to cater for. It's a disgrace. 

The simple fact is that the public sector is grossly overpaid,  over pensioned and over protected.  They are also woefully inefficient. 

Thank Bertie for benchmarking!! '


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## cremeegg (3 Oct 2017)

Daithi7 said:


> The Irish health service offers the worst value in the world.  (source OECD)



Have you a link for that


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## Purple (3 Oct 2017)

cremeegg said:


> Have you a link for that


Link


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## odyssey06 (3 Oct 2017)

Purple said:


> Link



From the linked article:
"The share of  generic drugs in the market is low in Ireland in both in volume (*29% compared with an OECD average of 48%*) and in value (16% compared with an OECD average of 24%)."

Clearly the HSE already has too much budget.


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## Early Riser (3 Oct 2017)

Daithi7 said:


> The Irish health service offers the worst value in the world. (source OECD)



I think the OECD report was ever so slightly more subtle than your summary might suggest. Cormac Lucey is quoted in the OP. I believe he is considered one of the more "fiscally reliable" right of centre economists ? Here is a link to his analysis and musings on some of the data:

https://brianmlucey.wordpress.com/2016/04/05/health-care-spending-ireland-v-oecd/ .

I understand that cross-national health expenditure comparisons are very tricky, as what is included in Health Budgets varies considerably. Care in the community, disability supports and aging supports may or may not be included in health budgets. Here is a link to the Central Statistics Office presentation of an analysis in this area: http://www.cso.ie/en/media/csoie/ne...in_Health_The_Evidence_A_User_Perspective.pdf

I refer especially to the conclusions in the final slide and this one particularly : _Deriving lessons (or worse, policy) “at a glance”from international comparisons is potentially misleading. _However, I expect it will be fully ignored_.
_
Links to summaries from OECD reports:

https://www.oecd.org/ireland/Health-at-a-Glance-2015-Key-Findings-IRELAND.pdf

http://www.oecd.org/ireland/Health-Policy-in-Ireland-February-2016.pdf



Daithi7 said:


> The simple fact is that the public sector is grossly overpaid, over pensioned and over protected.



Another simple fact is that we have a manpower crisis at professional level in the Health Service. I refer to doctors, nurses and mental health professionals. There have been ongoing difficulties in trying to bring mental health community care teams up to strength. I believe some are barely functioning. We are producing graduates. There would seem to be some contradiction, then, between these two "simple facts". Partly this might be because we we may appear well paid relative to other EU countries but our competition for manpower is from other English speaking countries - who offer better terms and conditions (free market forces?).



odyssey06 said:


> "The share of  generic drugs in the market is low in Ireland in both in volume (*29% compared with an OECD average of 48%*) and in value (16% compared with an OECD average of 24%)."
> 
> Clearly the HSE already has too much budget.



I am not sure how clear this conclusion is. Do you really reckon that the HSE is willingly or negligently paying excessively when they could do otherwise. I think the only thing clear is that there is an issue and it needs to be answered. Could it be in any way related to the fact that we have a high concentration of Pharma companies in Ireland who provide well paid jobs and who might, therefore, have a certain leverage at Government level? I don't know the answer. But in trying to reach one I would refer again to to the underlined quote from the CSO above.

Just to note in general - I do not know the answer to the question about increased health spending (I don't think I would find it so difficult, though, if I was an aging parent with an adult child who was desperately waiting for disability or mental health services). I recognise that we pay a lot for our health services and I do think that they are poorly configured and need drastic (but difficult) reform. I don't think that some of the cheap points about staff being lazy, overpaid, etc provide an insight in what is needed or how reform might take place.

And I think that resistance to reform might come as much from outside the health sector as within. What politician will support reform when it comes to some perceived loss in their own constituency? - Because we the voters will reward him/her accordingly at the next election. Notice who is involved with some of the "save our services" type groups - members of the local business community, primarily concerned with loss of "well-paid" jobs located locally and, thus, "spending power".

Or perhaps the nub of the problem is lazy nurses.





_
_


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## cremeegg (3 Oct 2017)

Early Riser said:


> Or perhaps the nub of the problem is lazy nurses.



Or nurses working in a poorly organised system, becoming demoralised by that system.

Nurses cannot get pay rises because of the differentials operated across the health sector. If the nurses got 10% the porters, cleaners, office boys etc would all have to get 10%. The market economy doesn't operate in healthland.


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## Purple (3 Oct 2017)

Early Riser said:


> Another simple fact is that we have a manpower crisis at professional level in the Health Service.


 Is that due to a shortage of manpower or the inefficient allocation and use of manpower? If it is the latter then the solution is not more manpower.



Early Riser said:


> There have been ongoing difficulties in trying to bring mental health community care teams up to strength. I believe some are barely functioning.


 See above. The involvement of a very fractured private sector and massive duplication of service as well as an almost complete lack of oversight is also an issue here. I speak from personal experience. 



Early Riser said:


> We are producing graduates. There would seem to be some contradiction, then, between these two "simple facts". Partly this might be because we we may appear well paid relative to other EU countries but our competition for manpower is from other English speaking countries - who offer better terms and conditions (free market forces?).


 About a third of Trinity medical graduates are overseas students. I'd say the figure for the RCSI is higher. Those guys were never going to stay here. 



Early Riser said:


> Could it be in any way related to the fact that we have a high concentration of Pharma companies in Ireland who provide well paid jobs and who might, therefore, have a certain leverage at Government level?


 Yes. 



Early Riser said:


> And I think that resistance to reform might come as much from outside the health sector as within. What politician will support reform when it comes to some perceived loss in their own constituency? - Because we the voters will reward him/her accordingly at the next election. Notice who is involved with some of the "save our services" type groups - members of the local business community, primarily concerned with loss of "well-paid" jobs located locally and, thus, "spending power".


 I agree completely. That is a major part of the problem.



Early Riser said:


> Or perhaps the nub of the problem is lazy nurses.


 No, but lets not pretend that they are not part of the problem. We need to get away from the emotional presumption that front line = good, clerical/managerial = bad.


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## Purple (3 Oct 2017)

Early Riser said:


> I understand that cross-national health expenditure comparisons are very tricky, as what is included in Health Budgets varies considerably. Care in the community, disability supports and aging supports may or may not be included in health budgets. Here is a link to the Central Statistics Office presentation of an analysis in this area: http://www.cso.ie/en/media/csoie/ne...in_Health_The_Evidence_A_User_Perspective.pdf


I notice that one of the charts shows expenditure for Ireland in both GDP and GNI. GNI is a much more meaningful figure for us to use when expressing expenditure as a percentage as out GDP figure is bloated due to multinationals. When you see a expenditure expressed as a percentage of GDP you need to multiply it by about 1.2 to get the real figure (GNI).


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## odyssey06 (3 Oct 2017)

Early Riser said:


> I am not sure how clear this conclusion is. Do you really reckon that the HSE is willingly or negligently paying excessively when they could do otherwise.



Yes. I reckon this is the case. And not just on generic medicines. I don't see evidence from the HSE of the kind of concern for costs that a private company has.


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## Early Riser (3 Oct 2017)

Purple said:


> No, but lets not pretend that they are not part of the problem. We need to get away from the emotional presumption that front line = good, clerical/managerial = bad.



I actually completely agree with this, so clearly I phrased myself badly. No one should be beyond scrutiny. For "nurses" feel free to substitute clerical, admin or whatever. My point is that it is lazy and counter-productive to reduce the issues to a simplistic blame-game (whether from within or without the health service).



Purple said:


> Is that due to a shortage of manpower or the inefficient allocation and use of manpower? If it is the latter then the solution is not more manpower.



Or perhaps, a bit of both? They are not mutually exclusive. Also manpower mix and make-up. Nurses are highly trained and consequently relatively expensive to employ. Could some of their current tasks be undertaken by less extensively trained personnel ? And the nurses expertise more appropriately applied where it is most beneficial and necessary?

My broader point though, is that despite ongoing recruitment campaigns, there are widespread vacancies that remain unfilled in the Health Service. That would seem to give the lie to the other claim that staff are overpaid. Many see the pay and conditions elsewhere as more attractive.



Purple said:


> About a third of Trinity medical graduates are overseas students. I'd say the figure for the RCSI is higher. Those guys were never going to stay here.



Fair point. How many Irish graduates, doctors-in-training or trained doctors are leaving though? I don't know the answer to this. Perhaps, the reports are wrong?




cremeegg said:


> Nurses cannot get pay rises because of the differentials operated across the health sector. If the nurses got 10% the porters, cleaners, office boys etc would all have to get 10%. The market economy doesn't operate in healthland.




I am not going to comment on the relative merits and value of porters, cleaners and "office boys" (because I do not know) but I agree that the pay linkages are a big problem in the public sector.


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## Purple (3 Oct 2017)

Early Riser said:


> My broader point though, is that despite ongoing recruitment campaigns, there are widespread vacancies that remain unfilled in the Health Service. That would seem to give the lie to the other claim that staff are overpaid. Many see the pay and conditions elsewhere as more attractive.


 Okay, but we have to work with what we can afford and we can't even afford what we currently have so, in light of your previous point, employ lower paid people to do some of the work currently done by nurses. How'd little Liam like that one?


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## Purple (3 Oct 2017)

Early Riser said:


> Perhaps, the reports are wrong?


Sensational headlines are the stock and trade of the Irish media. Just think of the reports on radio or current affairs programs on TV. It is the same format every time. Take a story about a school; background noise from the yard/ classroom then a teacher/parent frames the issue in an emotive "Will someone please think of the children!" context, then the reporter discusses the issue without any reference to the root cause, then the parent again, then the yard/children background noise. There is no attempt at a contextual cost benefit analysis or any good reason why the issue is still an issue. The solution is always more money.


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## Early Riser (3 Oct 2017)

odyssey06 said:


> Yes. I reckon this is the case. And not just on generic medicines. I don't see evidence from the HSE of the kind of concern for costs that a private company has.



Perhaps you have some more knowledge of this than is reported in the media? There seems to be pretty intensive negotiations re drug pricing:

https://www.imt.ie/news/unilateral-drug-price-cuts-threatened-26-05-2016/

But it is never going to be like a bus company, because we the public will not accept the threat of loss of access. Of course, the companies won't just cut it off but there could be "supply chain issues" (Not to mention the threat of re-location).

Look also at the issue of the new designer drugs that have been forced through in recent years,  whatever the outcome of the appraisal by the National Centre for Pharmacoeconomics. And the companies know they have the HSE/Government over a barrel :

http://www.independent.ie/sport/col...tter-pill-for-us-all-to-swallow-35284322.html

(I have no opinion on this specific drug - it is just one example of several).


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## Early Riser (3 Oct 2017)

Purple said:


> Sensational headlines are the stock and trade of the Irish media. Just think of the reports on radio or current affairs programs on TV. It is the same format every time. Take a story about a school; background noise from the yard/ classroom then a teacher/parent frames the issue in an emotive "Will someone please think of the children!" context, then the reporter discusses the issue without any reference to the root cause, then the parent again, then the yard/children background noise. There is no attempt at a contextual cost benefit analysis or any good reason why the issue is still an issue. The solution is always more money.



That is interesting but I am not sure if specifically relevant. Do you have any figures on on the numbers of Irish doctors/doctors-in-training leaving?


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## Early Riser (3 Oct 2017)

Purple said:


> Okay, but we have to work with what we can afford and we can't even afford what we currently have so, in light of your previous point, employ lower paid people to do some of the work currently done by nurses. How'd little Liam like that one?




I don't know what you are saying or asking here.


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## Purple (3 Oct 2017)

Early Riser said:


> I don't know what you are saying or asking here.


You said that other countries may have lower skilled people doing work that nurses do here. Maybe we should do the same? If we do what will little Liam Doran have to say about it?


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## Early Riser (3 Oct 2017)

Purple said:


> You said that other countries may have lower skilled people doing work that nurses do here. Maybe we should do the same? If we do what will little Liam Doran have to say about it?



 Ah, Sorry, I didn't get the Liam reference. He probably won't be happy about it - Don't know and don't care.

Just to clarify: doing *some* of the work or *some *of the types of work that nurses are doing. There will still be plenty of demand for their skills.


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## odyssey06 (3 Oct 2017)

Early Riser said:


> But it is never going to be like a bus company, because we the public will not accept the threat of loss of access. Of course, the companies won't just cut it off but there could be "supply chain issues" (Not to mention the threat of re-location).



I would settle for them being as cost conscious as health providers in other EU states.
Relocation is not the HSE's concern. Getting the best deal on medicines is.

And to return to the main topic... I have seen differing opinions on why we are getting such poor return for health spending. Nothing solid to suggest the solution is increasing the budget.


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## Early Riser (3 Oct 2017)

odyssey06 said:


> I would settle for them being as cost conscious as health providers in other EU states.



So your suggestion is that medicines are relatively expensive in Ireland because the HSE couldn't be bothered enough to do something about it - a variation of the laziness explanation? I don't know enough about it to argue, but I suspect that it may be more complex - and that it is your simple explanation that is "lazy".

Here are a few reports that seem to suggest that there might be a bit more complexity about the issue:

[broken link removed]

https://www.esri.ie/pubs/RS32.pdf



odyssey06 said:


> Relocation is not the HSE's concern. Getting the best deal on medicines is.



You are not being a bit naive to suggest that the HSE can act in a political vacuum on this issue? Or faux naive?


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## odyssey06 (3 Oct 2017)

Early Riser said:


> So your suggestion is that medicines are relatively expensive in Ireland because the HSE couldn't be bothered enough to do something about it - a variation of the laziness explanation? I don't know enough about it to argue, but I suspect that it may be more complex - and that it is your simple explanation that is "lazy".



Where did I use the word lazy???
A lot of semi-state bodies, including the HSE, find it easier to get more money from the government than to try tackling their costs.

Sometimes explanations are simple. Sometimes they are complex. Sometimes simple explanations are right, sometimes they are wrong. Complexity is no indicator of "rightness".

You linked a 194 page report.  I don't have time to wade through it all. If you have read it in full please point out the sections that justify Ireland paying over the odds for medicines, with page number reference.
I read the summary conclusion...
It dismisses concerns about re-location as a possible reason for why Ireland is paying over the odds for medicines (Ref pages 117-118).
So I'm not sure where you are going with that.

The state has been increasing its use of generics, but whatever it is doing, it is not doing it quickly enough - or else why are we still paying so much more than other EU member states?
If the earlier information is now out dated and in fact Ireland is paying average prices for medicines, please provide the latest information.

I'm sure everything always looks "more complex" to the HSE too. Yet other health services in the EU have found a way to pay less than we do for medicines and they don't work in a political vacuum either do they??? The HSE have not. It's entirely legitimate to criticise them for this.


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