# Hospital Trolleys



## Purple (19 Dec 2016)

We keep hearing about the long lists of people waiting on trolleys in A&E departments for days and weeks.

Every time I am in a hospital with kids and other relatives who are in-patients we seem to spend the last day to day and a half waiting to be discharged. Why don’t the HSE measure that? If discharge decisions can be made every few hours instead of every day of two we could probably sort out a large chunk of the problem. How come this is never mentioned?


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## Purple (3 Jan 2017)

RTE sent me a notification to say that the INMO total for patients on Trollies is 612. 
Why do they keep publicising this meaningless BS without backing it up with any analysis into the causes? Why do journalists not do their job any more? Why do media outlets report press releases from biased self-interest groups as if it is news?


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## Delboy (3 Jan 2017)

They report it because it saves them having to pay for real journalism. And then they'll have an Opinion piece or Primetime special on fake news!


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## Firefly (3 Jan 2017)

RTE publishing figures from a trade union. Well, I never


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## ashambles (3 Jan 2017)

It's an easy first week in January story for RTE. Just copy and paste the 2015 report in. 

What's more interesting is why is there an increase in numbers on trolleys every single January. Just as a sneak preview It'll happen in Jan 2018 as well.

The answer is partly to due seasonal factors such as flu, but what's more important and the unions or HSE won't tell you is that hospitals are surprisingly expert at reducing capacity over Christmas. Wards start being cleared out in early December - they get cleared out by having no elective or non-emergency patients being treated. 

I've been in hospitals around Christmas and you'll see a lot of empty wards or one or two patients per ward. Partly it's patients don't want to get a non-emergency treatment around then, partly it's to allow staff time off. 

So on January of every year you're dealing with the patients you'd expect and 3-4 weeks worth of backlog. So you're guaranteed to have around double the trolley number.


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## Purple (3 Jan 2017)

ashambles said:


> So on January of every year you're dealing with the patients you'd expect and 3-4 weeks worth of backlog. So you're guaranteed to have around double the trolley number.


Yes, but as the wards are empty post-Christmas why are they not being transferred? And back to my original point; where's the list of people sitting around waiting for a Consultant to bother their backside to do a Ward round and discharge them?
Every hour someone spends waiting to be discharged is an hour someone else spends on a trolley.  Why is that never focused on? Well we know why; we cannot criticise so-called "Front Line" staff and anyway, it doesn't suit the INMO's narrative, parroted by RTE, that the problem is lack of beds and lack of "Front Line" staff.


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## jjm (4 Jan 2017)

Why do you never focus on getting the people you support/ elect to do there job, Time to stop sitting on your back side criticising the wrong people.Do you not realize the minister already knows what is going on.Discharge all the Dail Eireann Deputies/Ministers  at the next General Election no need to change parties just replace them with there running mates.They need to fear the people when the don't do there job .Right now the Minister fears change more than he fears the people.Don't blame INMO / RTE /MEDIA/JOURNALISTS/ FRONT LINE STAFF.Look.You ought to look in the mirror and face reality. Consider self Examination before continuing to criticising front line staff.Change will only come when people stop voting for the same Ministers/Parties who do not stand up to pressure groups/special Intrest groups on behalf of the people.We need to start voting on there record in office/oppisition and stop voting on there promises.They need to know that there will be an extra 157 people waiting on trolleys to be discharged after the next general election going by there record so far.


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## Purple (4 Jan 2017)

jjm2016 said:


> Why do you never focus on getting the people you support/ elect to do there job, Time to stop sitting on your back side criticising the wrong people.Do you not realize the minister already knows what is going on.Discharge all the Dail Eireann Deputies/Ministers  at the next General Election no need to change parties just replace them with there running mates.They need to fear the people when the don't do there job .Right now the Minister fears change more than he fears the people.Don't blame INMO / RTE /MEDIA/JOURNALISTS/ FRONT LINE STAFF.Look.You ought to look in the mirror and face reality. Consider self Examination before continuing to criticising front line staff.Change will only come when people stop voting for the same Ministers/Parties who do not stand up to pressure groups/special Intrest groups on behalf of the people.We need to start voting on there record in office/oppisition and stop voting on there promises.They need to know that there will be an extra 157 people waiting on trolleys to be discharged after the next general election going by there record so far.


So it's the fault of TD's that the HSE, Hospital Management, Doctors and Nurses etc can't manage to run the health service at anything like the same levels of efficiency as just about every other health service in the OECD? It's the fault of TD's that RTE and Newstalk and other media outlets refer to the INMO figures as being compiled by "officials"? It's the fault of TD's that no journalist asks for the "why" after reporting the "what"? You think we should replace the people we have now with the populist far left ideologues whose economic policies are based on Trotsky and Marx? Give me a break! Do you think those clowns are going to stand up to the Public Sector Unions, the strongest and most damaging vested interest groups in the country?


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## Firefly (4 Jan 2017)

ashambles said:


> The answer is partly to due seasonal factors such as flu, but what's more important and the unions or HSE won't tell you is that hospitals are surprisingly expert at reducing capacity over Christmas. Wards start being cleared out in early December - they get cleared out by having no elective or non-emergency patients being treated.
> 
> I've been in hospitals around Christmas and you'll see a lot of empty wards or one or two patients per ward. Partly it's patients don't want to get a non-emergency treatment around then, partly it's to allow staff time off.
> 
> So on January of every year you're dealing with the patients you'd expect and 3-4 weeks worth of backlog. So you're guaranteed to have around double the trolley number.



I never thought about this before. Would be interesting to hear Liam Doran offer his opinion on this.


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## Leo (4 Jan 2017)

jjm2016 said:


> Why do you never focus on getting the people you support/ elect to do there job



So which elected official decides the work practices, detailed budget allocation across departments/ cost centres, staffing levels, rostering, etc. at my local public hospital?


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## ashambles (5 Jan 2017)

Firefly said:


> I never thought about this before. Would be interesting to hear Liam Doran offer his opinion on this.


Doran's own INMO figures for trolley watch show why we've an annual January crisis.

https://www.inmo.ie/trolley_ward_watch

Pick any year and look at the December trolley numbers and watch how they nosedive for Christmas as the nation suddenly become healthy.

Illustrative are the 2015 numbers as they go to the 24th of Dec with a mere 50 people waiting on trolleys. Chances are this 50 number is the base average figure for patients in A&E who are emergencies opposed to patients who've no option but to use A&E as the method to get into a ward for diabetes treatment or whatever.

It is impossible to not have a dramatic trolley increase in January with the way the Irish system works.


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## Purple (5 Jan 2017)

ashambles said:


> Doran's own INMO figures for trolley watch show why we've an annual January crisis.
> 
> https://www.inmo.ie/trolley_ward_watch
> 
> ...


It looks like our multi billion Euro hospital system is grossly under utilised for  one twelfth of the year. That equates to a waste of hundreds of millions of Euro. A large part of the solution is to keep the hospitals busy over Christmas with elective procedures. If you don't want to be in hospital over that period then you can go to the back of the queue.


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## Delboy (5 Jan 2017)

I don't think its the Patients now wanting to be in the hospitals during xmas, more likely the Consultants and Nurses.

And it's not just 1/12th of the year thats wasted. How much work is done at weekends, evenings,nights throughout the years. Hospitals seem to operate at most for about 1/3 of the year at a max


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## Leo (5 Jan 2017)

Delboy said:


> I don't think its the Patients now wanting to be in the hospitals during xmas, more likely the Consultants and Nurses.



Anecdotal evidence from family in the health service says there's a significantly higher volume of no-shows for elective procedures in the run up to Christmas, even for serious cases, with a lot of them walking in early in the new year claiming to have forgotten about the appointment or not having received the notice.


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## PMU (5 Jan 2017)

ashambles said:


> The answer is partly to due seasonal factors such as flu,


  Why is influenza an issue?  It's a virus so flu vaccination is the preventative measure.   It's free to those with a medical or GP visit card, so why don't people take it, and if they don't surely it's reasonable to charge them the marginal costs of taking up a trolley and subsequent costs? Also is it actually correct to say that flu is responsible for the 'trolley' issue?   Flu can be detected by influenza diagnostic tests, so why are 'flu patients' not so tested and shifted out if the results are negative?  Why are they taking up trollies? If positive, why are they not prescribed antivirals and then shifted out? What else can you do?
I don't want to turn this into a rant, but having put my late mother, my late aunt and family members through the Irish public hospital system - it is a disaster (and I'm being charitable here).  It's not that the health services staff in it are competent and hard workers etc. and are screwed by the system.  IMHO they are not that good -  if they worked really hard they could become second rate, but they have a long way to go; going into a public hospital is like going into a monkey house but I've seen better managed zoos. If you are a professional, can talk to doctors etc., in my experience you have a reasonable chance of survival but if you kowtow you will end up dead.


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## Delboy (5 Jan 2017)

Docs on the radio over the day all seemed to be saying that the free GP care for under 6's has contributed to the mess. More kids now showing at their GP's, no extra GP's. So some patients not getting appointments on tiem and ending up in hospital.
2.1m with medical cards, nearly half the population. Castro, Chavez would be proud of a stat like that


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## Purple (6 Jan 2017)

PMU said:


> I don't want to turn this into a rant, but having put my late mother, my late aunt and family members through the Irish public hospital system - it is a disaster (and I'm being charitable here).  It's not that the health services staff in it are competent and hard workers etc. and are screwed by the system.  IMHO they are not that good -  if they worked really hard they could become second rate, but they have a long way to go; going into a public hospital is like going into a monkey house but I've seen better managed zoos. If you are a professional, can talk to doctors etc., in my experience you have a reasonable chance of survival but if you kowtow you will end up dead.


I agree with the thrust of your post but why would a solicitor or a doctor have a better chance of surviving than an engineer, an IT consultant or a business owner (or anyone else who was reasonably confident, intelligent and a good communicator)?


I don’t think our doctors and nurses are particularly bad but I certainly don’t think that they are particularly good either. Having dealt with doctors and nurses in the USA and Britain I would certainly rate ours behind both but not by much.


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## Firefly (6 Jan 2017)

Purple said:


> It looks like our multi billion Euro hospital system is grossly under utilised for  one twelfth of the year. That equates to a waste of hundreds of millions of Euro.





ashambles said:


> Doran's own INMO figures for trolley watch show why we've an annual January crisis.
> https://www.inmo.ie/trolley_ward_watch
> 
> Pick any year and look at the December trolley numbers and watch how they nosedive for Christmas as the nation suddenly become healthy.



This is shocking and given the state of things deserves an investigation by the HSE in its own right. If the HSE hired more agency staff I am guessing this would be less of an issue..




Leo said:


> Anecdotal evidence from family in the health service says there's a significantly higher volume of no-shows for elective procedures in the run up to Christmas, even for serious cases, with a lot of them walking in early in the new year claiming to have forgotten about the appointment or not having received the notice.



If this is true (and it sounds plausable to me) I would think the HSE, in its defense, should publish this information. At least it might give the honourable Liam Doran something to chew on.


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## Purple (6 Jan 2017)

Firefly said:


> If this is true (and it sounds plausable to me) I would think the HSE, in its defense, should publish this information. At least it might give the honourable Liam Doran something to chew on.


Yes, and he knows the solution; hire more nurses and pay them more. That will also sort out global warming and that bother in Aleppo.


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## mathepac (6 Jan 2017)

Purple said:


> It looks like our multi billion Euro hospital system is grossly under utilised for  one twelfth of the year.


When investigating a NHS hospital some years ago, Gerry Robinson, former TESCO boss from Mayo, drilled down to find out why there were excessive delays for certain operations. He discovered that an operating theatre was closed every Friday. No-one knew why, but it was "custom and practice". Re-opening the theatre solved the problem permanently.

God only knows what wasteful customs and practices obtain within the HSEs. An hour off to cash a cheque anyone? But you're paid by credit transfer now. Ah yes sisters, but custom and practice dontcha know.


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## Purple (6 Jan 2017)

mathepac said:


> When investigating a NHS hospital some years ago, Gerry Robinson, former TESCO boss from Mayo, drilled down to find out why there were excessive delays for certain operations. He discovered that an operating theatre was closed every Friday. No-one knew why, but it was "custom and practice". Re-opening the theatre solved the problem permanently.
> 
> God only knows what wasteful customs and practices obtain within the HSEs. An hour off to cash a cheque anyone? But you're paid by credit transfer now. Ah yes sisters, but custom and practice dontcha know.


Custom and practice only works one way in the Public Sector; teachers did supervision and substitution for 70 years but then suddenly had to be paid extra for it. Nurses took blood and monitored patients after antibiotics for decades but could suddenly stop.


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## Purple (6 Jan 2017)

Operating Theaters, as well as MRI Machines, X-Ray Departments and CT Scanners, should be running from 6am to 10pm 6 days a week. A shorter day could be worked Sunday.

Why is it I can get a X-Ray straight away from an A&E department if I have insurance but have to wait weeks if I don't? The people are there. They are getting paid. Why not keep them busy?


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## cremeegg (6 Jan 2017)

mathepac said:


> When investigating a NHS hospital some years ago, Gerry Robinson, former TESCO boss from Mayo,



Any relation to the former Granada TV boss from Donegal


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## Duke of Marmalade (7 Jan 2017)

The NHS solved their trolley problem in 2012.  They achieved this by issuing a new NHS dictionary in which the definition of "bed" was changed to include "a trolley is a bed if is is used as a bed".  Sounds a bit Irish to me but if Simple Simon thinks he sees this as a path to legendary status, guess what?,  the NHS now has a beds crisis


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## mathepac (7 Jan 2017)

cremeegg said:


> Any relation to the former Granada TV boss from Donegal


Apologies, bios crossed. Terry Leahy is Tesco, Gerry Robinson Cocacola, Allied Domecq & Granada


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## ashambles (11 Jan 2017)

Interestingly and slightly surprisingly some in the media are starting to gently ask the correct questions about the annual January trolley crisis. Could they have read this thread? Probably not, but still it's encouraging that the reasons aren't known only to hospital workers. 

http://www.irishtimes.com/opinion/p...se-to-a-predictable-hospital-crisis-1.2928017

_The truth is that every recent minister for health believes that the interest groups in the healthcare area use and sometimes manipulate real difficulties to agitate for more funding and more staff. One senior official asked last week: how come the “crisis” never hits on December 28th, 29th, 30th._​
http://www.irishtimes.com/opinion/k...risis-has-to-be-kept-in-perspective-1.2931665

_Those damned winter bugs know nothing about holidays, so the official asks a legitimate question, though lacking the courage to say precisely and out loud what he/she means by it._​
However Kathy Sheridan seems a little hypocritical here in saying the official lacks courage as presumably she does know what the official means but doesn't give her opinion on the reason to readers. It's an odd omission from the column.


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## Delboy (11 Jan 2017)

Not really an odd omission from the Irish Times. You won't get their opinion writers saying anything too critical about the angels that are nurses and doctors - those who cannot be questioned.
Easier to go at the 'system' , the over staffed admin sections or even the politicians.


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## Purple (11 Jan 2017)

The Irish Times is a left wing newspaper and so rarely criticises unions or unionised employees.

They continue, as does RTE, to use Dickensian terms such as “workers” when referring to the employees of an organisation.


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## Gerry Canning (13 Jan 2017)

Not wishing to be morbid but.

It seems some of those in A&E are people who years ago would be dead before getting there .
Given our ability to do stints/hips/kidney stuff /heart stuff , these compromised people catch (simple) illnesses easily .
+With number of beds that were taken out years ago and not replaced.
+With no clear leadership over who runs Health.
+ With no long term plan.

The best we can hope for is that things muddle on !


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## Purple (13 Jan 2017)

Gerry Canning said:


> Not wishing to be morbid but.
> 
> It seems some of those in A&E are people who years ago would be dead before getting there .
> Given our ability to do stints/hips/kidney stuff /heart stuff , these compromised people catch (simple) illnesses easily .
> ...


I had a hernia operation 20 years ago. I was in hospital overnight. I had the same operation 6 years ago. I was in and out in 8 hours.
Heart Surgery used to mean cracking open your chest and weeks in hospital. Most procedures are same day or overnight now. We don't need as many beds as before.


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## Gerry Canning (13 Jan 2017)

Purple .

Forgive my medical knowledge (lack of) !


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## mathepac (24 Jan 2017)

Up to his appointment as DG HSEs, Tony O'Brien was the "Trolley Man" tasked with getting patients off trollies and reducing the queues in clogged up A&Es. He failed totally at that job so he was the obvious choice for DG. Is that what Harris is hinting at with the root and branch examination of managerial performance in the HSEs?

The organisations and the overpaid help supposedly managing them are now a huge embarrassment to Inda & Co.  Although he was their man whose appointment "behind closed doors" led to a lot of FF bluster about the lack of openness and transparency, a fair old bit of guff from the Soldiers of Destiny, is it curtains for "Trolley Tony"? Next please.

http://www.irishexaminer.com/ireland/hse-appoints-insider-tony-obrien-as-new-director-202237.html


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## mathepac (24 Jan 2017)

Firefly said:


> If this is true (and it sounds plausable to me) I would think the HSE, in its defense, should publish this information. At least it might give the honourable Liam Doran something to chew on.


I can supply the bould Liam with mastication material. Why are his nurses absences from work running at 3 to 5 times the rate of medical staff? Why is it that 12.5%, 1 in 8, of his nurses' absences from work are uncertified? Are they using uncertified sick days as a perk or an entitlement? Figures and graph from official HSE documents.

[broken link removed]


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## Firefly (24 Jan 2017)

mathepac said:


> I can supply the bould Liam with mastication material. Why are his nurses absences from work running at 3 to 5 times the rate of medical staff? Why is it that 12.5%, 1 in 8, of his nurses' absences from work are uncertified? Are they using uncertified sick days as a perk or an entitlement? Figures and graph from official HSE documents.
> 
> [broken link removed]



I've heard it mentioned before that nurses get sick more often as they are, by nature, in contact with sick people more often. I think it would be interesting to see if there is a difference in sick leave rates between staff nurses and those who work through agencies. Also, it would be interesting to see the sick rates during the first 2 weeks of January when the hospitals are under such pressure.

Sick rates running at 3 to 5 times the rate of medical staff seems totally crazy. If this alone was addressed there would be many more nurses available to treat the paying public. The nurses themselves would be less burdened too as there would be more of them to shoulder the burden.


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## mathepac (24 Jan 2017)

Based on the numbers above, again I stress they are HSE numbers up to Oct 2016, the "HSE Absenteeism League Table 2016" reads as follows by staff group:-

1 Other Patient & Clinical Care, 5.5%
2 General Support, 5.1%
3 Nursing, 4.9%
4 Management & Admin, 4.1%
5 Health & Social Care, 3.5%
6 Medical/Dental, 1.2%

Nurses get sick more often? I don't know but all the heavily unionised non-medical groups seem prone to high levels of absenteeism with shocking level of absences uncertified.

Maybe the answer is to employ more medics, they seem tougher and healthier. Remember this group includes the so-called "junior doctors" working 80 hours per week, twice the hours on average of other group with 1/3 to 1/5 the absenteeism rates. Without this group everything stops.

The numbers reflect increased absences in Jan/Dec and another peak around March (Easter/Paddy's Week-end on the lash anyone? Or is that my inner cynic showing?)


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## Purple (24 Jan 2017)

mathepac said:


> emember this group includes the so-called "junior doctors" working 80 hours per week, twice the hours on average of other group


 Nurses were on a 37.5 hour week but under Croke Park they had to work 39 hours. The overtime for Sundays seems very high according to this link. I presume that's wrong.


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## mathepac (24 Jan 2017)

@Purple I'm not sure what the relevance of the O/T post is or the nurses hours, but remember that when a nurse shows up for an 8 or 12 hour shift, his meal breaks count as work time. Other staff groups must be at work for 9 hours to get paid for 8, in other words they are not paid for break- or meal-times.


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## Purple (24 Jan 2017)

mathepac said:


> @Purple I'm not sure what the relevance of the O/T post is or the nurses hours, but remember that when a nurse shows up for an 8 or 12 hour shift, his meal breaks count as work time. Other staff groups must be at work for 9 hours to get paid for 8, in other words they are not paid for break- or meal-times.


That can't be right; people don't get paid for their meal breaks.


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## mathepac (24 Jan 2017)

Nurses most certainly do as do clinical staff members, including nurses, in certain residential treatment facilities. How do I know, first hand experience.


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## Purple (24 Jan 2017)

mathepac said:


> Nurses most certainly do as do clinical staff members, including nurses, in certain residential treatment facilities. How do I know, first hand experience.


So in real terms that's what, an hour a day of extra pay? That would be the same as a 10% pay rise... or if they were like everyone else we could have 10% more nurses for the same cost.


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## Delboy (24 Jan 2017)

mathepac said:


> The numbers reflect increased absences in Jan/Dec and another peak around *March (Easter/Paddy's Week-end* on the lash anyone? Or is that my inner cynic showing?)


School holidays!


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## mathepac (24 Jan 2017)

or that, so non-medical HSE staff take their perks at the same time.

@Purple, no they have always been paid that way.


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## Purple (24 Jan 2017)

mathepac said:


> @Purple, no they have always been paid that way.


My point is that if they got paid the same way as the vast majority of other working people we could have 10% more nurses for the same total spend; no more staff shortages, big improvement in A&E etc. Little Liam is always talking about the lack of nurses. How come he doesn't suggest this change? Could it be that he's really only interested in getting as many nurses employed on as much money as he can screw out of the tax payer? If so that's fine; that's his one and only job.


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## Purple (10 Feb 2017)

The new Gut Tough approach to ineffective and incompetent managers in the Health Service will not result in anyone losing their job or getting a pay cut. What a joke. The insidious influence of the ultimate vested interest groups is seen again. More talk but nothing will change. People will suffer and people will die but nobody will be sanctioned in any meaningful way. We'll just get more strikes and more pay increases.


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## Dan Murray (10 Feb 2017)

Bang on de money, Purple.

The other weird one that caught my attention last night/this morning was the Tusla debacle - where it was reported that........"a counsellor identified the error." Like, really? Sean Spicer - watch and learn, brother.

Whatever about the errors in the Tusla mess - which are almost beyond belief - the timescales involved are simply bewildering. My belief, unfortunately, is that these delays are simply a reflection on the general lack of any sense of urgency in many public sector environments.


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## Delboy (10 Feb 2017)

> "Ultimately where improvement in line with the performance improvement plan is not achieved, the process may ultimately culminate in the removal of the named manager from the post."


But they'll still keep the grade,pension and allowances that came with the post.
As it is and as it always will be.

The Unions won't allow change. And neither will the body politic- I heard Ged Nash Labour on radio during the week saying he 'hoped' that compulsory redundancies would never have to be used in the HSE


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## jjm (10 Feb 2017)

There is no New government Get Tough approach to ineffective and Incompetent managers in the health service.There is a long record  of the main political parties pulling the wool over the eyes of there supporters and robbing them .Come the next Election Lots of posters will be Backing the same Political Parties Re Election The TDs and supporters of Vested Interest Groups  . At the next Election I will have sitting TDs and there supporters Knocking on my door looking for my vote. I will be telling them I will not be voting for sitting TDs who did not stand up to Vested Interests I will be giving there party running mates a chance to represent  me and there will be repercussions if the do not.I work in the Private sector Unions not allowing change is a cop out .From  late1998 I had to depend on the Health service (Child With Cancer) In 2002 I seen the Government of the day make the mess which today is the Hospital Trolley crisis.


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## thedaddyman (10 Feb 2017)

Dan Murray said:


> Bang on de money, Purple.
> 
> The other weird one that caught my attention last night/this morning was the Tusla debacle - where it was reported that........"a counsellor identified the error." Like, really? Sean Spicer - watch and learn, brother.
> 
> Whatever about the errors in the Tusla mess - which are almost beyond belief - the timescales involved are simply bewildering. My belief, unfortunately, is that these delays are simply a reflection on the general lack of any sense of urgency in many public sector environments.



My experience of dealing with the public sector as a supplier is that is not a general lack of a urgency but instead a lack of ownership and responsibility and accountability. It's all pass the buck. As someone with some involvement with Tusla elsewhere (relating to voluntary work), my view is that as an organization they are a shambles. I've been at meetings where they failed to record minutes and came to us weeks (indeed months) afterwards looking for notes and have cancelled annual review meetings numerous times.


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## Firefly (10 Feb 2017)

Dear Liam Doran,

*Ireland has more nurses than any other rich country*

https://www.theguardian.com/society...worlds-best-healthcare-system-this-is-the-nhs

Let's not cod ourselves that we need more nurses. 

Firefly.


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## Firefly (10 Feb 2017)

_"Ultimately where improvement in line with the performance improvement plan is not achieved, the process may ultimately culminate in the removal of the named manager from the post."_

So poor performance is actually rewarded! The poor performer will be moved to a (presumably) lesser demanding post but still keep the benefits. Someone else will then be (again presumably) promoted to the existing post. More money. If and when healthcare is privatised in this country those running the HSE and unions will have nobody to blame but themselves!


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## Dan Murray (10 Feb 2017)

Firefly said:


> _"Ultimately where improvement in line with the performance improvement plan is not achieved, the process may ultimately culminate in the removal of the named manager from the post."_



In the HR manuals of Irish public sector entities, this methodology is described in detail and are known as the "good cop, good cop" and the "carrot and carrot" approaches.


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## PMU (10 Feb 2017)

Firefly said:


> *Ireland has more nurses than any other rich country*
> 
> .


I think we covered this point before at http://askaboutmoney.com/threads/nurses.194950/#post-1441397


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## Marion (10 Feb 2017)

Nurses are only one aspect of the HSE. 


Marion


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## Marion (10 Feb 2017)

Tusla errors are a disgrace. 


Marion


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## Dan Murray (10 Feb 2017)

Marion said:


> Tusla errors are a disgrace.
> Marion



I fully agree - When Zappone gets back into the country, we might get some answers - she has this strange habit of telling the truth and not telling it slant!


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## Leper (11 Feb 2017)

Hi Mathepac.  Can you say what perks the non medical staff of the HSE get?

Hi Firefly.  OK! Let's not have any more nurses? (i) Can you explain why the HSE hospitals and the Private Hospitals are actively seeking to recruit nurses from anywhere even those who have not practised nursing for many years? (ii) Why are nurses still leaving our hospital system in droves?

Hi Purple. Newsflash !!!!! Liam Doran's remit is to represent the members of his union (nurses + midwives).  He is not the conscience of the HSE hospitals or the private hospitals or the tax payer.

Hi Dan and Marion.  I agree also.  Will we have the responsible person or persons from Tusla resigning as a result of the recent debacle? Did any member of staff in Tusla resign from previous debacles?


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## Leper (11 Feb 2017)

mathepac said:


> @Purple I'm not sure what the relevance of the O/T post is or the nurses hours, but remember that when a nurse shows up for an 8 or 12 hour shift, his meal breaks count as work time. Other staff groups must be at work for 9 hours to get paid for 8, in other words they are not paid for break- or meal-times.



That is not correct. Nurses do not get paid for meal breaks on day or night duty and are not regarded as work time.


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## Delboy (11 Feb 2017)

Dan Murray said:


> I fully agree - *When Zappone gets back into the country, we might get some answers - she has this strange habit of telling the truth and not telling it slant!*


I know we're going off topic here but have you been following the whole Tusla/McCabe debacle!!!


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## Dan Murray (11 Feb 2017)

Delboy said:


> I know we're going off topic here but have you been following the whole Tusla/McCabe debacle!!!



Indeed, I have - what's your point?


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## jjm (11 Feb 2017)

Rte last Monday night Simon Harris  Minister for Health out of the Country.  Son of the former 2 term Minister for health on for the HSE .Cosy cartel. FG  Should Kick Start Real Reform and stop Protecting Old Labour/FF/FG/ Vested Interests .They Should be wiped out at the next Election if they fail to do so.


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## mathepac (11 Feb 2017)

Leper said:


> Hi Mathepac. Can you say what perks the non medical staff of the HSE get?


Based on Health Service Employment Census: Section 1 National Overview December 2016, 9.1% are classified in the Medical/Dental  Staff category. The other 90.9% enjoy perks such as

nurses /others being paid for meal breaks,
unionised workers getting an hour off per week to cash non-existent pay or expenses cheques,
operatives getting paid gate allowances for closing non-existant gates,
and forklift drivers who get a forklift driving allowance for driving forklifts
5 uncertified "sick-days/absences" per year.
[broken link removed]


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## Leper (11 Feb 2017)

mathepac said:


> Based on Health Service Employment Census: Section 1 National Overview December 2016, 9.1% are classified in the Medical/Dental  Staff category. The other 90.9% enjoy perks such as
> 
> nurses /others being paid for meal breaks,
> operatives getting paid gate allowances for closing non-existant gates,
> ...



1. Nurses and others do not get paid for meal breaks. Fact.
2. I never heard of anybody getting paid gate allowance for non existent gates
3. I don't know any fork lift drivers and having worked in 3 large hospitals in payroll, I cannot ever remember paying such an allowance. But, to the fair I am not too sure of your assertion.
4. 7 uncertified "sick days" in two rolling years are given where necessary. Not five in one year. Fact.

Does anybody know any fork lift driver working in the HSE? I wonder how many forklift drivers are there?

I can categorically vouch for items 1, 2, 4 as answered by me.  Mathepac means well but his points made are not correct.


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## Leper (12 Feb 2017)

Let's bring up some more facts:-

1. A nurse is due to come on duty at 8.00am to take over from the Night Staff.  The nurse will attend earlier because there is a "hand over" of patients and their ailments to the day staff.  The hand-over time encroaches on the staff going off duty and the staff going on duty.  Hand over time is not paid either. In some wards (e.g. Cardiac, Cancer etc) the hand-over period can be anything up to an hour. They are handing over human beings with illness, not inanimate objects. The same thing happens when the nursing day staff are handing over to the night staff later. In the more serious wards the hand-over is word exact by the giver and the receiver.

2. Nurses get paid for working a 39 hour week.  Lunch breaks are not included in this. Nurses work overtime e.g. night duty 8.00pm - 8.00am.  This is not 12 hours of overtime.  The meal time is deducted.

3. Nurses like the Gardaí were treated pretty badly for years.  The Gardaí got their act together and got organised.  Remember one Presidential Candidate attributed some his failure to get elected due to a Late Late Show outburst that he had offered Gardaí "a pint or a transfer" (meant to be funny, but backfired).  The nurses are no different.  They were getting nowhere so they organised and Liam Doran probably has the easiest of trade union jobs representing them.  The nurses will take no more of what was hitherto dished out to them.

Nurses are voting with their feet.  They go to work in the UK where they are more appreciated e.g. receive generous relocation allowances, availability of "free" nursing courses that they would have to pay for in dear ol' Ireland.  Irish nurses are on demand in the Middle East.  Australia wants them.  So does the USA.  Nurses can earn quite a lot of money abroad, come home later, get a job outside or inside of the hospital systems and pay cash for good housing while the rest of us must beg for mortgages. The public and private hospital systems are losing nurses at an alarming rate.  Who would blame the nurses? A shortage of nurses is detrimental to patients.


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## Purple (14 Feb 2017)

Leper said:


> Hi Purple. Newsflash !!!!! Liam Doran's remit is to represent the members of his union (nurses + midwives). He is not the conscience of the HSE hospitals or the private hospitals or the tax payer.


I agree. I wish he would stop pretending to be it though. He has no professional interest in sick people or the quality of medical or nursing care in the health service.


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## Purple (14 Feb 2017)

Marion said:


> Nurses are only one aspect of the HSE.
> 
> 
> Marion


True, if the only problem in the Health Service was whatever structural shortcomings there are with how nurses work we would have a much better health service.
For the record I think nurses generally do a good job and are competent and capable. My issue is with the ridged and seemingly inefficient work practices in the Health Service generally. It doesn't matter how hard someone works or how skilled they are, if the structure they are working within in inefficient then they are inefficient.


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## Purple (14 Feb 2017)

Leper said:


> having worked in 3 large hospitals in payroll


Can I ask if the nursing contracts were exactly the same in each hospital, how many grades of nurses there were and if they clocked in and out using a scanner/reader and their wages were calculated automatically?
Have thinks improved or is the HSE's payroll system still as shambolic as this?


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## jjm (14 Feb 2017)

Purple the problem is not the unions.Have you being Reading the papers /Watching Television.See how much Support there is when someone tries to do there job correctly .


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## Firefly (14 Feb 2017)

Marion said:


> Nurses are only one aspect of the HSE.
> 
> 
> Marion



Hi Marion,

I agree, however it's all I'm hearing..."we need more nurses, we need more nurses"...


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## Leo (14 Feb 2017)

Firefly said:


> I agree, however it's all I'm hearing..."we need more nurses, we need more nurses"...



Mainly because the people doing most of the shouting and getting most of the air time are those who make more money in subs when more nurses are hired. If their income was capped, I wonder would they spend more time focusing on conditions and practices in order to try improve the working lives of their members rather than simply focus on increasing numbers.


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## jjm (14 Feb 2017)

Firefly/Leo Google .No magic wand' to recruit nurses says Harris .


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## Leo (14 Feb 2017)

jjm2016 said:


> Firefly/Leo Google .No magic wand' to recruit nurses says Harris .



I'm looking for the magic wand that would allow the health service make efficient use of the resources it has. Maybe that wand is actually more like a big stick that will break the stranglehold the unions currently have over working practices.


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## Leper (14 Feb 2017)

Purple said:


> I agree. I wish he would stop pretending to be it though. He has no professional interest in sick people or the quality of medical or nursing care in the health service.



Hi Purple.  Can you say when Liam Doran ever pretended to be the conscience of the HSE, the hospital system or the taxpayer? You seem to be harping away at him like he was some kind of devil. His job is to represent nurses, nothing else.  

Leo said:-
"I wonder would they spend more time focusing on conditions and practices in order to try improve the working lives of their members rather than simply focus on increasing numbers."

Please read my posts.  Nurses work extra time nearly every day of their career without any payment. Nurses were treated badly for years and now they are trying to make sure that the same will never happen again. Nurses are leaving our hospitals almost in droves by the day and if more nurses are not found we could shortly be without sufficient nurses in our hospitals. Why is this point being continually missed here?

I notice my questions on "perks" has been shelved here.  Pity, because of the amounts of wrong information provided.


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## Leper (14 Feb 2017)

Purple said:


> Can I ask if the nursing contracts were exactly the same in each hospital, how many grades of nurses there were and if they clocked in and out using a scanner/reader and their wages were calculated automatically?
> Have thinks improved or is the HSE's payroll system still as shambolic as this?



I have never seen nursing contracts. Nurses don't clock in. Every hospital has a roster dictating the working days and hours of each nurse. I don't know of any ward nurse who does not work extra time on a daily basis outside of the roster hours.  You don't think nurses just show up when they like?


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## Leo (15 Feb 2017)

Leper said:


> Leo said:-
> "I wonder would they spend more time focusing on conditions and practices in order to try improve the working lives of their members rather than simply focus on increasing numbers."
> 
> Please read my posts.  Nurses work extra time nearly every day of their career without any payment. Nurses were treated badly for years and now they are trying to make sure that the same will never happen again.



Where did I say they didn't? But what's happening now and for years has very little to do with improving the working conditions of nurses and all to do with lining the union's pockets. Every attempt to review practices has been stonewalled unless there's more money in it.


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## Leper (15 Feb 2017)

Good Man ! there, Leo.  A person shows up at a Garda Station and reports that he/she has been raped and the Gardaí tell 'em to go home and focus on cleaning up the bedroom which will improve his/her life.


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## Purple (15 Feb 2017)

Leper said:


> I have never seen nursing contracts. Nurses don't clock in. Every hospital has a roster dictating the working days and hours of each nurse. I don't know of any ward nurse who does not work extra time on a daily basis outside of the roster hours.  You don't think nurses just show up when they like?


OK, so you don't know if the payroll system is efficient. I have a friend who worked in payroll in Premark and then in the HSE. She said that the HSE is grossly inefficient in every aspect of how it is run from a payroll and contracts perspective and is decades behind the private sector and had hundreds of people who would be unnecessary if they have an efficient structure.


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## Leper (15 Feb 2017)

Now Purple, whether the payroll system in the HSE is efficient or not, has no bearing on how nurses are rostered or hired and some of their own time that nurses give freely nearly every day to the system.  I reckon the failure to have PPARS installed was a huge mistake costing millions to the taxpayer.  PPARS (computerised personal and payment system)  failed because the consultant private sector firm cocked up the project from even before the start. You will have differing opinions here because the consulting firm was a well known one. But, no doubt about it, from where I sit, that firm is almost solely responsible for the non provision of PPARS. The project cost somewhere between €140M - €240M.  I'm sure this delighted the Irish taxpayer.

Nurses Contracts:- As far as I know they have been the same for eons.  I don't have daily contact with such written contracts.  Contracts are a means to an end and if there is one thing nurses protect is their right to work as nurses.  In the system it is called their "registration" and if a nurse loses this he/she may not work as a nurse. Therefore, they protect the registration. Please note that several nurses lose their registration every year too and when they do they are out of the job probably forever.  This indicates the way nurses are answerable. Just a thought:- Have the contracts of consultants and hospital doctors been changed over the years?  Sin Scéal eile.

The bottom line here is we need nurses because they are in short supply. They are being snapped up by hospitals abroad and in the pharmaceutical firms who give pretty better wages and conditions to nurses.  I'd love to be facing a hospital consultant informing him we don't now have enough nurses for his patients.  I can only imagine his reaction "Listen Lep. I'm the one who faces the war of litigation.  Get me nurses and be quick about it."
Sounds simple but can anybody suggest something different that will work?


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## mathepac (16 Feb 2017)

Leper said:


> I notice my questions on "perks" has [sic] been shelved here.  Pity, because of the amounts of wrong information provided.


By no means. You've conceded the weekly hour off to cash non-existent cheques and you've conceded you don't see nurses contracts so you don't know the T&C's of their working arrangements which 





Leper said:


> have been the same for eons [sic]


Meal breaks form part of their duty hours.

One thing you will of course be aware of is the cosy arrangement whereby nurses in the 3 years leading up to retirement go back on rostered duties if they are allocated to a full-time day job. The reason for doing this is to increase pensionable earnings because rostered duty allowances count in calculating "final salaries". There is no business need for this. It simply increases the golden handshakes at the taxpayer's expense.


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## Leper (16 Feb 2017)

No Mathepac - get it straight - I have never heard of a weekly hour off to cash non-existent or even existent cheques. Therefore, how could I "concede" what you said. Believe me I do know the terms and conditions of nurses working arrangements. Meal breaks do not form part of their duty hours during day or night.

The retirement issue:- I don't see this as a big deal.  Nurses pay into the pension fund.  Furthermore, they continue to pay other pension levies because a previous government squandered the Public Service Fund and could not pay back the money it stole.  I can speak for myself when I say my pension contributions and levies do not even come up to the amount of the pension I will get from the HSE.

OK Mathepac, for the sake of argument, let's say you are right:- Many, many nurses are due much back money payments for many years of unpaid meal breaks which you say are paid. Oh! Yes - and an hour payment each fortnight for going to the bank.  I'm sure any nurse looking in here will be delighted.

Let's keep the discussion to the truth folks.


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## Purple (16 Feb 2017)

Leper said:


> The retirement issue:- I don't see this as a big deal.  Nurses pay into the pension fund.  Furthermore, they continue to pay other pension levies because a previous government squandered the Public Service Fund and could not pay back the money it stole.  I can speak for myself when I say my pension contributions and levies do not even come up to the amount of the pension I will get from the HSE.


The cost of funding state pensions is equal to the total of all taxes paid by state employees. When you look at it that way they pay no tax at all, they just fund their own pension, or they do pay tax and they don't fund their own pension. There are good arguments in favour of hiring more nurses and paying them more but you are on very dodgy ground when you bring pensions into the discussion.

My issue is with inefficient structures, duplication of activities, unnecessary activities, the paper based nature of so much activity, long decision making chains, demarcation (I was told by a nurse not to wipe up a small amount of a drink my child spilled on the ground in a ward in Tallaght hospital as that was someone else's job), restrictive work practices and general labour inflexibility within the health service. Pay levels are not the big issue. Get everything running efficiently and remove unnecessary staff after you remove unnecessary activity and there will be more than enough money for as many nurses as we want. We probably won't need any extra anyway if they are working within an efficient system.  Of course the Unions won't let that happen as they will never countenance staff cuts and so the hypocrisy will continue and we will continue to have the wrong discussion.


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## Firefly (16 Feb 2017)

Leper said:


> The bottom line here is we need nurses because they are in short supply.



This article below would suggest we have more than enough nurses....

*Ireland has more nurses than any other rich country*

https://www.theguardian.com/society...worlds-best-healthcare-system-this-is-the-nhs


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## mathepac (16 Feb 2017)

Leper said:


> Let's keep the discussion to the truth folks.


I don't like your implication that  I'm lying.

I recently re-read a book from about ten years ago and this excerpt leapt out at me:

"Working in medical care has an almost irresistible tendency to numb practitioners to the realisation that they are treating and tending individuals who are just like themselves. Many claim that they have to dissociate themselves from their feelings if they are to function in the wards, which is plainly not the case. There is more to good care than ethical principles and staff training. It also requires an organisation that accords priority to and accordingly finds room for empathy and humanity without any loss of professional standards. I have seen many places where this has been achieved. It is very much a matter of wanting and being sufficiently courageous to break away from ingrained attitudes. An organisation in which truly humane care is not feasible is a bad organisation."*

The HSE by that definition is a bad organisaton, serving not the needs of the client but the greed of the employees as evidenced by my personal experience and observation of custom and practice in a Health Board and one of the HSEs.

*Psychoses, An Integrative Perspective
First published 2006 by Routledge, 27 Church Road, Hove, East Sussex BN3 2FA
Simultaneously published in the USA and Canada by Routledge, 270 Madison Avenue, New York, NY 10016
Routledge is an imprint of the Taylor & Francis Group
Originally published in Swedish as Psykoser: Ett integrerat perspektiv by Natur och Kultur, 2000, 2004 © Johan Cullberg and Borkförlaget Natur och Kultur, Sweden
Translation © Johan Cullberg and ISPS Copyright © 2006 Johan Cullberg

And of course we don't need more nurses, we need the nurses we have to do the correct work as defined by client need.


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## cremeegg (16 Feb 2017)

Leper said:


> I reckon the failure to have PPARS installed was a huge mistake costing millions to the taxpayer.



Absolutely, €200m in direct costs and further large costs in terms of not gaining the expected efficiencies. Probably the single biggest ever cock-up in the history of the public service. 



Leper said:


> PPARS (computerised personal and payment system)  failed because the consultant private sector firm cocked up the project from even before the start. You will have differing opinions here because the consulting firm was a well known one. But, no doubt about it, from where I sit, that firm is almost solely responsible for the non provision of PPARS.



It appears to me that the blame lies with the nexus of incompetent management and inflexible unions. A system can only be computerised if there is a coherent system in place. In fact health service pay has many overlapping and contradictory provisions, management/unions were unable/unwilling to resolve these, hence the system could not be automated. That's my reason for blaming the actors in the health system.  Why do you think it was Deloitte's fault


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## Gerry Canning (16 Feb 2017)

We have less beds , cure the less beds and hay presto ! = less trollies.
From what I read we should have 2000 more beds.

I tire of the union bashing , if the unions were the REAL issue ,they would have closed the Hospitals years ago .
I tire of management bashing , I really think they too try their best.

Surely the BIG issue is the refusal of our 4 yearly cycle of government that refuses to grasp and enact a longer term vision for our health services.
Surely another issue is our (love) affair with the latest genuinely sad case , and our refusal to accept that Health care must be rationed to help the many and not to highlight those  more extreme type cases.(sad though they are)

Hard decisions need to be made , and made in the interests of the majority ,  and  made in a reasoned manner that is fair..


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## Leo (16 Feb 2017)

Leper said:


> Good Man ! there, Leo.  A person shows up at a Garda Station and reports that he/she has been raped and the Gardaí tell 'em to go home and focus on cleaning up the bedroom which will improve his/her life.



That makes no sense whatsoever....in any context. Care to explain how it's appropriate to what I said?


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## Leo (16 Feb 2017)

Gerry Canning said:


> We have less beds , cure the less beds and hay presto ! = less trollies.
> From what I read we should have 2000 more beds.



Reducing the ~700 delayed discharge number would go a long way towards addressing that issue.


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## Purple (16 Feb 2017)

Gerry Canning said:


> We have less beds , cure the less beds and hay presto ! = less trollies.
> From what I read we should have 2000 more beds.


We have the same amount as the UK and more than Sweden, New Zealand and Canada. 
With such a young population we should need less than most. Perhaps there should be more but I would be very surprised if that solved the issue of structural inefficiency which is at the heart of all of this.

Unlike most other countries we do not count beds in Private hospitals in our statistics, except for psychiatric beds where private beds are counted. In other words we under report the number of hospital beds per head of population. The type of bed is also important but instead we concentrate on meaningless headline figures and emotive personal stories. It's tabloid journalism from our TV stations and tabloid politics from our politicians and Union leaders.


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## Purple (16 Feb 2017)

Leo said:


> Reducing the ~700 delayed discharge number would go a long way towards addressing that issue.


Yes, but that doesn't fit in with the populist narrative so it is ignored.


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## PMU (16 Feb 2017)

Leper said:


> I reckon the failure to have PPARS installed was a huge mistake costing millions to the taxpayer.  PPARS (computerised personal and payment system)  failed because the consultant private sector firm cocked up the project from even before the start. You will have differing opinions here because the consulting firm was a well known one. But, no doubt about it, from where I sit, that firm is almost solely responsible for the non provision of PPARS.


This is totally wrong and it's also unfair on a major company. Groupe Bull Ireland was awarded a contract for implementation of the system at a fixed price cost of just over 9 million euros. Two years into the project the basis of the contract was disputed and was subsequently brought to a conclusion. Then rather than continue with a single system as originally envisaged the project was changed by the health boards to meet each health agency's individual requirements. At this stage Deloitte was brought in on a 'time & materials' basis, despite a recommendation that a third party scope up the system before further contracts were made to ensure it represented value for money. This recommendation was not acted upon. Things then went from bad to worse and you can read all about the litany of disasters in the C&AG's VfM report on PPARS http://audgen.gov.ie/documents/vfmreports/VFM_51_PPARS_Report.pdf.


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## cremeegg (16 Feb 2017)

I have looked at the Comptroller and Auditor General's report linked by PMU above. From page 9 in the summary, it identifies features that had a bearing on the outcome. The bits in italics are mine.


   A failure to develop a clear vision of what strategic human resource management actually meant for the health service as a whole and for its individual operational units.

_We don't know what we want._


 An urgent need in the Department of Health and Children (the Department) for accurate information on health service employee numbers and pay costings and a consequent desire to see the system implemented as speedily as possible.

_We dont know how many people we employ or what we pay them_


 A complex governance structure defined by a consensus style of decision-making.

_The nexus of incompetent management and inflexible unions_


 Substantial variations in pay and conditions, organisation structures, cultures and processes which existed between and within agencies, the full extent of which was not known before the commencement of the project.

_We still don't know what we pay our employees._


 The lack of readiness in the health agencies to adopt the change management agenda.

_The nexus of incompetent management and inflexible unions_

 An inability to definitively ‘freeze’ the business blueprint or business requirements at a particular point in time in accordance with best practice.

_The nexus of incompetent management and inflexible unions cannot afford to let the project succeed_


 A failure to comprehensively follow through on its pilot site implementation strategy before advancing with the roll out to other HSE areas. 
_
The nexus of incompetent management and inflexible unions cannot afford to let the project succeed_

*Leper* this was clearly a failure of the public sector and until the problems behind it are admitted and rectified the health system will continue to be dysfunctional,


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## Sophrosyne (16 Feb 2017)

I also read this report and found this this excerpt from page 11 and 12 interesting.

"*Governance of the Project*

The examination found that, while nominally there was a single responsible owner for the project in the 'lead CEO', this person did not have the power to make and enforce decisions across the range of autonomous agencies.

Likewise, neither the National Project Director nor the National Project Team had the authority to direct when or how the implementations would take place in the individual agencies.

In fact, there was evidence of a lack of ‘buy-in’ to the project in some agencies. Moreover, decision-making was cumbersome due to the size and composition of the National Project Board. Difficulty was experienced in getting agreement on binding decisions with members often unsure of their authorisation to make decisions.

This was further exacerbated by the often patchy pattern of attendance and the frequent changes to personnel attending board meetings.

*In addition, several factors, some of which relate to the fact that 2005 was a year of significant change in the health sector generally, were identified as having contributed to the less than satisfactory outcome on the project to date.

These included a void in decision making caused by an uncertainty among senior management of their future roles and authority with the health service and, at agency level, a shift in project sponsorship and frequent changes in team leadership.*" [Emphasis mine]

I think that timing greatly contributed to the failure of this project.

The health boards had just been amalgamated, with all of the fallout and initial chaos that would have entailed. 

In fact, it was probably the worst time to introduce PPARS.

However, that was then.

There should be no reason why it cannot be fully rolled out today.


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## mathepac (17 Feb 2017)

I would argue that the reasons for failure and the reason for not restarting the project are encapsulated in the last sentence in the first paragraph of the report   "Hence, the PPARS project involved much more than the implementation of a computer system – *it was part of a change management drive*."  which is always a problem and why the expected benefits of ERP systems never materialise.

The rules are simple

Understand/define/clarify the purpose of the organisation
define and design the work needed to deliver on the purpose
design the organisation needed to do the work
Automate/systemise in support of the work.
PPARS started at 4 and expected the improvements that only the preceding 3 steps could deliver. 

The project team were destined to fail from day 1. The report said they had responsibility without authority. The project team(s) should have refused their brief. If they had known more about OD/change management or technology, they'd have known spectacular failure would be the only outcome.

In the 80's I was interviewed by a bunch of consultants to head a team who were going to "implement MRP" (small ERP!!)  in Waterford glass. I predicted that the project would fail and disengaged from the interview process.


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## Leper (17 Feb 2017)

Wow!  -  When I turned on my lap-top a few minutes ago, I noticed 6 Alerts which probably need reply from me. A personal record, and I will answer each in the next few days.  Please bear with me as I have no access to fora such as this during working hours.  

. . . and there was that sentence in one of Mathepac's posts:- "I don't like your implication that I'm lying."

I'll address Mathepac's post as a matter of priority today or tomorrow because I never implied that anybody was lying. Furthermore, I will point out some of his untruths regarding sick leave "perks" etc and I will have references to back up the full truth as presented by me.


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## Purple (17 Feb 2017)

cremeegg said:


> I have looked at the Comptroller and Auditor General's report linked by PMU above. From page 9 in the summary, it identifies features that had a bearing on the outcome. The bits in italics are mine.
> 
> 
> A failure to develop a clear vision of what strategic human resource management actually meant for the health service as a whole and for its individual operational units.
> ...


Excellent post.
Hard data is the enemy of incompetent management and inefficient work practices. It strikes me that it was in nobody's interest within the Health Service for the project to work at it would have highlighted true pay levels and been an excellent vehicle for looking at process flows and doing good value stream mapping. The only people who would have benefited from that would have been the sick and vulnerable and they have no voice within the Health Service.


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## jjm (17 Feb 2017)

Purple said. The only people who would have benefited from that would have been the sick and the vulnerable should also have included the people in the Health Service  directly looking after the sick and Vulnerable .


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## Purple (17 Feb 2017)

jjm2016 said:


> Purple said. The only people who would have benefited from that would have been the sick and the vulnerable *should also have included the people in the Health Service  directly looking after the sick and Vulnerable* .


Then why do they resist change? An efficient Health Service would mean fewer slackers and far less restrictive work practices. Demarcation is a sacred cow for the Unions. There is no way they would allow efficiency and flexible work practices as it would mean many of their members losing their jobs. The staff who see the benefits and would support the changes are not going to oppose the Unions as they would be the target for Union bullying and exclusion.


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## jjm (17 Feb 2017)

Not so sure you are correct Purple .There was a time when Nurses ran the hospitals .There would be no trolley Problem today and the cost of running the HSE would be a lot less Today if Nurses had more of a say.The busy fools who don't Add Value are a bigger problem than the so called slackers.


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## Purple (17 Feb 2017)

jjm2016 said:


> Not so sure you are correct Purple .There was a time when Nurses ran the hospitals .There would be no trolley Problem today and the cost of running the HSE would be a lot less Today in Nurses had more of a say.


Really? What makes you think that?
There was a time when religious orders ran hospitals and nurses were kept in line by the Nuns. They cleaned up minor messes, took blood, monitored antibiotics, made beds etc. and the place was clean and tidy. Now there is no such oversight and the hospitals are rife with MRSA.


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## jjm (17 Feb 2017)

Check your so called facts and come back and correct  Lots of Hospitals were run  by Nurses (Matrons)


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## Purple (17 Feb 2017)

jjm2016 said:


> Check your so called facts and come back and correct  Lots of Hospitals were run  by Nurses (Matrons)


The Mater Hospital, St. Vincent’s Hospital, Temple Street, The National Rehabilitation Centre, St. Michaels Hospital,  Crumlin Children’s Hospital, Holles Street Maternity Hospital, Lourdes Hospital in Drogheda, St. James’s Hospital etc. were all run by religious orders. I don't know about Cork or Galway etc but I presume they are similar. Most are still owned by trusts which are controlled by those Orders but run by the State (the worst of both worlds).  
What other facts are you looking for?


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## cremeegg (17 Feb 2017)

Don't feed the trolls !


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## jjm (17 Feb 2017)

You left out a lot of Hospitals  go check again .Are you correct in saying they Were ran  by Nuns.Some may be ran by Nuns Who were Nurses.Are you telling Me that the other Faiths got Nuns to run there hospitals.Just for the record  other faiths had nuns but got Nurses to run there Hospitals.


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## Gerry Canning (17 Feb 2017)

Purple,
I had understood we had less beds as a % than our neighbour ! so your comment helps me consider.
I see they too have  (bed blocker) issues and it appears that if bed blocker ie proper step down facilities were in place ,the problem would be near sorted.

I still contend that Government continues to short term health needs and are blown off course by the (newest) crisis.
To blame Unions is unhelpful and to castigate management in the absence of a Government long term adaptable plan misses the target .


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## jjm (17 Feb 2017)

cremeegg The worst trolls are the people who google something Don't understand the numbers may not tell the whole story then troll like hell Quoting something the don't understand.


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## Purple (17 Feb 2017)

jjm2016 said:


> You left out a lot of Hospitals  go check again .


I listed Hospitals in Dublin and a few others I know about. What point are you trying to make?


jjm2016 said:


> Are you correct in saying they Were ran  by Nuns.


 Yes I am.


jjm2016 said:


> Some may be ran by Nuns Who were Nurses.


 Any Nun running a hospital ward was also a nurse. Obviously.


jjm2016 said:


> Are you telling Me that the other Faiths got Nuns to run there hospitals.


 No.


jjm2016 said:


> Just for the record  other faiths had nuns but got Nurses to run there Hospitals.


 That's right.
The point is that the people running the hospital were interested in the care of sick people first. They had the power to control staff and get things done and they have the authority to ensure that people did their job. I know older nurses who feared the Nuns and made sure everything was in good order before the Matron was on the Ward.


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## jjm (17 Feb 2017)

You listed a few Hospitals and a few others you know about . I know lots of Hospitals ran by Nurses who were not Nuns who did a very good job.The point I am making is When Hospitals were Ran by Nurses they were well Ran . Until they have a say again we are in trouble. List me out  the people you think  who could do a better Job/Who are more interested in caring for they sick.


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## Purple (18 Feb 2017)

jjm2016 said:


> You listed a few Hospitals and a few others you know about . I know lots of Hospitals ran by Nurses who were not Nuns who did a very good job.The point I am making is When Hospitals were Ran by Nurses they were well Ran . Until they have a say again we are in trouble. List me out  the people you think  who could do a better Job/Who are more interested in caring for they sick.


You are missing the point, not for the first time. When management has the authority and ability to manage then places are well run. Now, thanks to Union demarcation and the sure and certain knowledge that nobody can lose their job for doing a bad job there is no culture of excellence within the health service. Mind you, that's a broader societal problem in Ireland in many sectors from house building to customer service in shops to public services in general.

As for nurses having a say in how things are run; they already do.


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## jjm (18 Feb 2017)

Purple Unions had very little to do with it.I do some Voluntary work,.One of the people I work with is a nurse who could have taken the HSE Early Retirement Scheme Or Voluntary Redundancy Scheme back in 2010.She along with her colleagues who started training to be nurses same year would actually earn more If they took Early Retirement.The HSE management Were very Disappointed with the take up of the Scheme.Some Nurses took up the offer and Retired .Those who retired and wanted to work again found work straight away which Speak for itself.Bed closures followed.Overtime followed Agency Nurses followed.Chaos followed.HSE paying Nurses to Retire Early so they could close Beds only to find the needed More Nurses In the Accident and Emergancy Because of the Backlog '


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## Delboy (18 Feb 2017)

ANyone who believes that Unions have very little to do with the day to day operations of the HSE or indeed any other public service organisation in this country is either very naieve or heavily involved with a union themelves


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## Leper (19 Feb 2017)

mathepac said:


> I don't like your implication that  I'm lying.





mathepac said:


> Based on Health Service Employment Census: Section 1 National Overview December 2016, 9.1% are classified in the Medical/Dental  Staff category. The other 90.9% enjoy perks such as
> 
> nurses /others being paid for meal breaks,
> unionised workers getting an hour off per week to cash non-existent pay or expenses cheques,
> ...





Leper said:


> 1. Nurses and others do not get paid for meal breaks. Fact.
> 2. I never heard of anybody getting paid gate allowance for non existent gates
> 3. I don't know any fork lift drivers and having worked in 3 large hospitals in payroll, I cannot ever remember paying such an allowance. But, to the fair I am not too sure of your assertion.
> 4. 7 uncertified "sick days" in two rolling years are given where necessary. Not five in one year. Fact.
> ...



The above are the part/contents of two Mathepac's posts and one of mine. What I am concerned about are his words "I don't like your implication that I'm lying"

Here is an extract from IMPACT union's website regarding sick leave:-
. . .  all civil and public servants can take up to 7 self-certified sick days in a rolling 24-month period. The current arrangement is for 7 self-certified days in a rolling 12-month period. Management’s original proposal was for 3 self-certified days in a rolling 12-month period.

This is the truth and it is something I police every week as part of my normal working week. Consequently whatever source Mathepac got is wrong information must be considered suspect.


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## mathepac (19 Feb 2017)

Delboy said:


> ANyone who believes that Unions have very little to do with the day to day operations of the HSE or indeed any other public service organisation in this country is either very naieve or heavily involved with a union themelves


See @Leper 's post preceding as proof positive of unions running the public service, and that's just IMPACT. INMO, PNA, and others have much deeper penetration and influence.


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## Leper (19 Feb 2017)

No Mathepac.  My posts were proof positive that your below-the-belt allegation of me "I don't like your implication that I'm lying."

You did not address your allegation. You now choose to ignore the issue.  I cannot understand why. But, carry on . . . I'm off the subject.


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