# James Reilly & Brendan Howlin



## Calico (20 Sep 2012)

Given that the first-time outpatient waiting list has now doubled in a year, and will have more than doubled by the time all the figures are in, will James Reilly be allowed to completely obliterate what's left of our broken health service or will Enda Kenny do as he said he would a year ago and get rid of non-performing ministers? And in the wake of the public sector allowances farce, the same question for Brendan Howlin? I mean, it would funny if it weren't so serious!

http://www.rte.ie/news/2012/0920/hospital-outpatient-waiting.html


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## Purple (21 Sep 2012)

The real question is will James Reilly be allowed to make the heath system work or will the unions and other vested interest groups continue to make sure it is run for the benefit of the people who work in it rather than the nations sick and infirm. 
There is more than enough money being spent on health, it's just being spent on the wrong things and in the wrong places. For example, how is it that the Jack & Jill foundation can deliver the same services as the HSE for one third the cost?


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## Chris (21 Sep 2012)

Purple said:


> The real question is will James Reilly be allowed to make the heath system work or will the unions and other vested interest groups continue to make sure it is run for the benefit of the people who work in it rather than the nations sick and infirm.
> There is more than enough money being spent on health, it's just being spent on the wrong things and in the wrong places. For example, how is it that the Jack & Jill foundation can deliver the same services as the HSE for one third the cost?



Because they actually don't have an "endless" source of revenue. Very much like a private enterprise they are dependent on donations, they have to make every penny stretch or they essentially go out of business. If they make money stretch further they help more people and  donors are more willing to help out organizations where they can see that their money is put to good use.
The HSE and its sub-organisations do not have that incentive. If you don't spend your budget this year it will be cut next year, it is the exact reverse, no incentive to make funds stretch as far as possible. And then as you already mentioned you have union protected jobs and wages making it difficult/impossible to reduce numbers and costs.


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## Purple (21 Sep 2012)

And that's why a universal health insurance system is better; everyone who comes in the door is a private patient and a source of revenue.


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## Chris (21 Sep 2012)

Purple said:


> And that's why a universal health insurance system is better; everyone who comes in the door is a private patient and a source of revenue.



As long as the insurance is private and open to competition. The UK is often put up as a poster boy for universal health care, but it is pretty much entirely run by the state through the tax system, and they have the same cost problems and very long waiting lists.


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## mathepac (24 Sep 2012)

It is unfair to compare the "single-level" UK health system to our shambolic approach to caring for sick and infirm citizens. In the UK everything from GP consultations to nurse-practitioner house calls is free, not so here. They have their problems as high-lighted by Gerry Robinson et al. but please compare like with like.


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## Purple (24 Sep 2012)

mathepac said:


> It is unfair to compare the "single-level" UK health system to our shambolic approach to caring for sick and infirm citizens. In the UK everything from GP consultations to nurse-practitioner house calls is free, not so here. They have their problems as high-lighted by Gerry Robinson et al. but please compare like with like.



An insurance based system would provide a single-level system; everyone is a private patient. 
The UK system does not provide free GP consultations or nurse-practitioner house calls. They are simply not paid for by the end user at the time they receive the service. They are paid for though; doctors and nurses in the UK get paid, I know it’s considerably less than their counterparts here but they still get something.
The delivery, clinical and admin structures in the UK, as well as the levels of accountability that their doctors and nurses are subjected to, are decades ahead of ours.


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## cork (24 Sep 2012)

I really have no confidence in either James Reilly & Brendan Howlin.

What criteria James Reilly use to add these health centres in his area?

As taxpapyers - are we not entitled to know this?

As for Howlin?  Wexford did pretty well from the stimulus package.

Both  James Reilly & Brendan Howlin seem to be hostages to public sector unions.

I am beginning to believe we need national government.


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## Purple (24 Sep 2012)

cork said:


> I am beginning to believe we need national government.



We had one, it was called Social(ist) Partnership. Basically everyone at the table got what they wanted. It didn't matter that it was unaffordable. 
Those at the table genuinely thought that they were representing everyone; the employers bodies thought they were representing all employers even though they largely just represented bodies in the protected sector and the unions thought that they were representing all "workers" even though they  largely just represented employees in the protected sector. Nothing was costed before it was promised and structural weaknesses in our economy (and society) were exacerbated.

The net result was much like the last few pages of Orwell's Animal Farm.
I’m not a fan of national governments (of social partnerships) because I am a fan of democracy.


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## cork (25 Sep 2012)

There is a report that identified 500 million savings that could be achieved in local government.

This report is gathering dust.

They say the "low hanging fruit" is gone.

I believe that no serious attempt has been made to reform anything.


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## Chris (25 Sep 2012)

mathepac said:


> It is unfair to compare the "single-level" UK health system to our shambolic approach to caring for sick and infirm citizens. In the UK everything from GP consultations to nurse-practitioner house calls is free, not so here. They have their problems as high-lighted by Gerry Robinson et al. but please compare like with like.



The NHS is not free, it is paid for through payroll deductions, and it doesn't come cheap.



cork said:


> There is a report that identified 500 million savings that could be achieved in local government.
> 
> This report is gathering dust.
> 
> ...



I fully agree and the evidence is in the annual government spending reports. Ireland is still spending vastly more than it did immediately before the crisis.


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## Complainer (25 Sep 2012)

Chris said:


> As long as the insurance is private and open to competition. The UK is often put up as a poster boy for universal health care, but it is pretty much entirely run by the state through the tax system, and they have the same cost problems and very long waiting lists.



The reports I'm hearing from Netherlands, Germany etc are that the jury is still very much out as to whether Universal Health Insurance models (Bismarck models) provide care any cheaper than systems like the UK and Canada (Beveridge systems). Competition certainly is not working at driving down costs in Netherlands.


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## Purple (26 Sep 2012)

I would have thought that Germany had enough experience with their current model for the jury to be in.


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## Firefly (26 Sep 2012)

Complainer said:


> The *reports I'm hearing from Netherlands, Germany* etc are that the jury is still very much out as to whether Universal Health Insurance models (Bismarck models) provide care any cheaper than systems like the UK and Canada (Beveridge systems). *Competition certainly is not working at driving down costs in Netherlands*.


 
Linky?


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## Sunny (26 Sep 2012)

Now we can add Phil Hogan to the list.

Is there no end to politicians stupidity? What exactly do WE pay for these advisors for?

http://www.rte.ie/news/2012/0926/phil-hogan-traveller-family-house.html


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## Chris (26 Sep 2012)

Purple said:


> I would have thought that Germany had enough experience with their current model for the jury to be in.



You beat me to it. The german system has been in place for decades. The problem in Germany is that they have thrown many barriers to entry in the way of private hospitals and clinics and do not close down underperforming hospitals. But as a resident of Germany you can shop around for your health insurance just like you would for your car insurance.

I found one list of health cost inflation. Not sure what the source is, but this would show the UK at the top end of the scale.


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## amtc (28 Sep 2012)

my dad's a former industrial engineer and entitled to a medical card as he is over 70. Recently he was diagnosed with a clot in his leg. Just as a matter of interest he documented the clinic he goes to (public service, Connolly Hospital) and even at 74 came up with 6-7 incidents of waste....he has to go every 2 days so multiply that by the amount of people....he said administrators were falling over each other but the clinical care was scarce - for example, he dared to refer to the doctor (whom he has met three times) by his first name and was told that he would only answer to Dr....

For a different procedure I took him to Beaumont Private - in and out in 15 minutes, and couldn't be nicer. 

I voted FG and Labour and think the whole thing is a disgrace. I'm not a natural Labour voter and who knows, Roisin Shortall could be difficult to deal with, but a quick search of planning apps shows James Reilly has many in. still.


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## Purple (28 Sep 2012)

amtc said:


> for example, he dared to refer to the doctor (whom he has met three times) by his first name and was told that he would only answer to Dr....


That’s incredible; people are still going on with that rubbish in this day and age!


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## Complainer (2 Oct 2012)

Chris said:


> You beat me to it. The german system has been in place for decades. The problem in Germany is that they have thrown many barriers to entry in the way of private hospitals and clinics and do not close down underperforming hospitals. But as a resident of Germany you can shop around for your health insurance just like you would for your car insurance.



Why would you want to close down underperforming hospitals? Doesn't that great 'free market competition' that you keep going on about make sure that only the efficient hospitals survive?

Would these barriers to entry have anything to do with little inconveniences like quality, or patient safety?


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## Purple (3 Oct 2012)

Complainer said:


> Would these barriers to entry have anything to do with little inconveniences like quality, or patient safety?


No, in a competitive market, particularly one where the quality of service is such a major selling point, hospitals would prioritise patient safety and quality in order to attract customers.
The only potential problem is whether the public sector is competent and capable enough to audit hospitals to the required standards. Evidence so far in this country suggests that’s the area where we need to focus our attention.


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## cork (3 Oct 2012)

*Minister denies any impropriety in friendship with owner of health centre site*

How anyone can have confidence in Reilly is strange.

FG/Labour need a reality check.


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## werner (3 Oct 2012)

cork said:


> *Minister denies any impropriety in friendship with owner of health centre site*
> 
> How anyone can have confidence in Reilly is strange.
> 
> FG/Labour need a reality check.


 
Apart from his demonstable failure as a minister, in any other society he would do the honourable thing and resign but they don't do resignations in Ireland for such things do they?


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## Purple (3 Oct 2012)

cork said:


> *Minister denies any impropriety in friendship with owner of health centre site*
> 
> How anyone can have confidence in Reilly is strange.
> 
> FG/Labour need a reality check.



I agree Cork but your own unquestioning defence of Fianna Fail when they were in government does leave you with limited credibility when criticising the current government. They have a long long way to go before they drop to the levels of Bertie and Co or Brian Clown.


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## Chris (5 Oct 2012)

Complainer said:


> Why would you want to close down underperforming hospitals? Doesn't that great 'free market competition' that you keep going on about make sure that only the efficient hospitals survive?


I'm talking about closing down underperforming public hospitals. Private hospitals that underperform and cannot attract patients lose money and go out of business, just like ay other business would.
In a competitive environment only those hospitals that can attract sufficient patients will survive. Economic laws of supply and demand and competition are universal, just like gravity is to the physical world. It doesn't change from industry to industry.



Complainer said:


> Would these barriers to entry have anything to do with little inconveniences like quality, or patient safety?


No, it has to do with restricting the number of licenses that cost millions for no reason. And do you honestly believe that people, who are free to choose what hospital they go to are not able to decide for themselves what level of quality and safety is acceptable? Why would a private hospital, that would go out of business if the public shunned it, not provide the highest level of quality and safety?
And you can hardly argue that our public hospitals are clean or perfectly safe, can you?


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## Complainer (6 Oct 2012)

Chris said:


> I'm talking about closing down underperforming public hospitals. Private hospitals that underperform and cannot attract patients lose money and go out of business, just like ay other business would.
> In a competitive environment only those hospitals that can attract sufficient patients will survive. Economic laws of supply and demand and competition are universal, just like gravity is to the physical world. It doesn't change from industry to industry.


For the record, I know next to nothing about the German health care system. But the definition of Universal Health Insurance is where every hospital becomes a private hospital, and every citizen gets private health insurance either by paying for it, or by the State providing it for those who can't afford it. That's the universal bit.

So if they have a good working UHI system, then by your definition, the bad hospitals don't get any money and go out of business. Or am I missing something?



Chris said:


> No, it has to do with restricting the number of licenses that cost millions for no reason.


So for absolutely no reason then? Would you to give the reason that the German Dept Health give for restricting licences?



Chris said:


> And do you honestly believe that people, who are free to choose what hospital they go to are not able to decide for themselves what level of quality and safety is acceptable?


It's not a matter of what I honestly believe or not. It's a matter of fact. The average citizen is in no position to assess the level of quality or safety of a hospital. It's not an amateur sport. Healthcare quality is a fairly tricky area. In Ireland, healthcare is very dependant on key individuals. So the record of any hospital last year may have little relationship to their current delivery.




Chris said:


> Why would a private hospital, that would go out of business if the public shunned it, not provide the highest level of quality and safety?


Possibly because the CEO's bonus is based on their profitability this year, not next year.


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## Purple (7 Oct 2012)

Complainer said:


> In Ireland, healthcare is very dependant on key individuals. So the record of any hospital last year may have little relationship to their current delivery.


 Why do you think that's the case? Quality can only be delivered through a robust and auditable system. If the quality of our healthcare system is really reliant on individuals rather than systems, and I don't believe it is, then we have even bigger problems than I thought.


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## Chris (9 Oct 2012)

Complainer said:


> For the record, I know next to nothing about the German health care system. But the definition of Universal Health Insurance is where every hospital becomes a private hospital, and every citizen gets private health insurance either by paying for it, or by the State providing it for those who can't afford it. That's the universal bit.
> 
> So if they have a good working UHI system, then by your definition, the bad hospitals don't get any money and go out of business. Or am I missing something?


Unfortunately that is not the definition of universal health system. The only thing that is universal is that everyone has private health cover. Hospitals are majority state owned with some completing private hospitals and clinics either run for profit or by charities.
But I would love to see a system of private health insurance where there are only private hospitals where the patient/customer is free to choose where he goes for medical attention.



Complainer said:


> So for absolutely no reason then? Would you to give the reason that the German Dept Health give for restricting licences?


It's for political reasons due to lobbying from public and private healthcare providers who do not want competition. There is no reason whatsoever to stop a hospital from being built with private funds or to charge millions for a licence.



Complainer said:


> It's not a matter of what I honestly believe or not. It's a matter of fact. The average citizen is in no position to assess the level of quality or safety of a hospital. It's not an amateur sport. Healthcare quality is a fairly tricky area. In Ireland, healthcare is very dependant on key individuals. So the record of any hospital last year may have little relationship to their current delivery.


The average citizen also has no idea how to asses the quality or safety of a computer, but is perfectly capable to research this through consumer or expert reviews. You are painting a picture of a public entirely made of children rather than adults that are perfect capable to do their own research. If the average citizen is so dumb then he can go to a public hospital if he is free to choose. But that should not be a restriction on allowing private hospitals from being built.



Complainer said:


> Possibly because the CEO's bonus is based on their profitability this year, not next year.


And in an open and competitive environment he can only be profitable this year if his patients choose his organisation's services over those of others. In a truly competitive environment profit is proof of valued service.


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