# The Peoples opinion on the Irish Public Health System



## Jaid79 (29 Jul 2007)

Let us all know of your experiences "good" and "bad"? with regard to the Irish public health system.

In my opinion, the Irish public health system is the worst in Europe and maybe one of the worst in the world.


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## ClubMan (29 Jul 2007)

Moved from Good Deals,Bad Deals & Consumer Issues.



> the Irish public health system is the worst in Europe and maybe one of the worst in the world.


What precise comparative data do you base your opinion on?


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## irishlinks (29 Jul 2007)

In my experience the Public Health system is OK - but could be better. I have had experience of the system in the UK - I lived there for most of my life.
Myself and my wife and our 4 children do not have any private health insurance - partly because of the cost  and partly because I have a  built in dislike of the idea of money getting you better / faster treatment. 
In the UK - private health insurance is used by the minority. Here in Ireland over half the population have been persuaded to take out insurance. I had private cover for about 4 years in the UK because my employer gave it to me - I had no choice.
Luckily here in Ireland we have had nothing major happen to us - but we have had a few visits to casualty, and a  few appointments with consultants. Overall - compared to the UK - I feel the system is as good , maybe better. Waiting times in casualty were not too bad - couple of hours maybe less.  Consultant appointments have been reasonable in terms of delays - but nothing too bad. An MRI scan for my son was transferred to a private hospital under the  Treatment Purchase Fund - at no cost to us because we were waiting 3 months. I don't know if this scheme is being used to it's full extent all over the country - but people should be told about it and push for it to be used more. It is supposed to be "automatic" .
The visit to the private Hospital (Galway Clinic) - was an eye opener. It is like a hotel. Grand piano in the foyer, landscaping, no queuing, nice cafe,carpets. It showed me that there is a 2 tier system and that the Public health system - whilst coping - needs to be better.

There was an article in the Irish Times recently by a consultant I think - and she was saying that she feels that doctors and consultants could be actually trying to make the public health system worse - in order to drive more people over to the private system and therefore increase their income.
When the major health insurer is a semi state body - it makes you wonder what the government would prefer? 
The UK NHS system - free for all - is a great idea but they are struggling. I would hate to think that the Irish system is heading towards the system in the US where health insurance is essential if you want healthcare.

GP's here seem less rushed - and we have always got to see a GP on the same day we call them. In the UK we often had to wait a day or 2 to be seen!  Yes it was free in the UK - and the fee here soon mounts up with a family - but the GP visit card or Medical card (we don;t qualify for either) are a good help for many people. 
Prescription charges can also be expensive - but the 85 euro cap per month  for a family stops it getting too bad.

In terms of Nursing Homes - we have direct experience of these - both Private and Public - because one of us has worked in both. The Public ones we have seen are better equipped, better staffed and have generally better standards than the Private ones we have worked in. Of course - this is based on a small sample of nursing homes.

All my experiences in Ireland have been in the West. I understand that things might not be as good in Dublin or other large cities.


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## Jaid79 (29 Jul 2007)

ClubMan said:


> Moved from Good Deals,Bad Deals & Consumer Issues.
> 
> 
> What precise comparative data do you base your opinion on?


 
My opinion is based on mainly friends, family and my experiences of Irish, European and other world wide health systems. 

Each person including myself have had the chance first hand to compare the Irish Public Health System directy with others. In every instance the Irish health system comes out bottom, from the simple little things to the most major.

My opinion is not based on any surveys or World Health Organisation facts and figures, it based on direct experiences. I do also think that there is a vast amount of data out there that would comfirm my opinion as correct and of sound judgement.

What I had hoped is that other AMM members would share their views and opinions. To see if indeed my friends, my family and I are only people that have been left with a less than good view of the HSE, I doubt it

I will start researching the data out there to see what I come up with.

What about you Clubman, what have your experiences of the Irish Public Health System?

Jaid


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## ClubMan (29 Jul 2007)

Jaid79 said:


> My opinion is based on mainly friends, family and my experiences of Irish, European and other world wide health systems.


Fair enough - it would have saved at least two posts if you had said all of this in the first place instead of just stating your opinion with no background.


> What about you Clubman, what have your experiences of the Irish Public Health System?


 Yes - as an _A&E _patient twice, my wife with the _Rotunda _twice, my father with the _Mater _while terminally ill, my mother with a few other hospitals over the years etc. I/we had no major problems other than with the billing/administrative departments of a few hospitals.


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## Jaid79 (29 Jul 2007)

ClubMan said:


> I/we had no major problems other than with the billing/administrative departments of a few hospitals.


 
Public or Private?


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## ClubMan (29 Jul 2007)

Both.


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## lukegriffen (29 Jul 2007)

i have been hospitalised 3 times over last 5  years (for non-emergency surgery and other tests) and each time was waiting for very short times, maybe 2 to 3 months at most.  I don't have insurance and  I don't believe i could have got better treatment anywhere else in Europe.

I think one of the main issues is not necessarily more beds, but having a quicker turn-around.   Too many patients should be recuperating in convalescent homes rather than hospitals,  and too many patients are taking up beds just waiting for an operation to be done which may only be done on certain days of the week.   Doctors seem to be worried that beds will be gone when they need it, so they get their patients in earlier than need be and they have to sit it out.


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## !RAY (29 Jul 2007)

Hi ALL
My Father passed away 10 years ago off cancer .We aways had VHI .The treatment my father recived was firat class.If we did not have VHI i feel he would not have got this level of treatment.Is this wrong ? YES  But Ireland is following the USA , and i cant see this changing. My father in law passed away 4 weeks ago.His level of treatment was supberb.He had VHI. In the private sector hospitals most of  the nurses are irish and the public most foreigners.All Nurses do a great job but the irish nurses are supberb.I have heard they get paid more may be this is the reason.
Cheers
!RAY


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## joe sod (30 Jul 2007)

Has this topic not already been beaten to death by the irish media


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## Purple (30 Jul 2007)

joe sod said:


> Has this topic not already been beaten to death by the irish media



and on this site...

To answer the OP, it's good but could be better. There is huge waste but there is huge waste in every public health system. 
I don't accept that we have the worst health system in Europe, or even the EU.
I have had very good, average and very bad experiences with the health system. What I will say is that it's much better than it was 15 years ago. Treatment, training, facilities and waiting times are all better.
Irish people want to pay taxes like the Americans and get public services like the French. The bad (but obvious) news is that we can't have both.


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## efm (30 Jul 2007)

I agree with Purple - I don't think we have the worst health system in the world and you can't pay nothing but have everything - I have VHI and all my experiences to date in Ireland have been fine

As an aside how is "best and worst" to be defined in this annecdotal survey?  Is a hospital that cures you but treats you like crap better than a hospital that doesn't cure you but treats you very well?


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## Northerngirl (30 Jul 2007)

As someone who worked in the NHS in UK for many years, and now working here, I feel there is huge waste here, particularly within the management structure - little accountabilty, lack of foresight and imagination, and knee-jerk reactions to public outcrys with managers constantly being promoted to other areas inthe HSE, therefore not implementing recommendations effectively, and other managers just waiting until they retire.


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## ClubMan (30 Jul 2007)

!RAY said:


> My Father passed away 10 years ago off cancer .We aways had VHI .The treatment my father recived was firat class.If we did not have VHI i feel he would not have got this level of treatment.


He would have received exactly the same medical treatment. He may have received different accommodation and may have had to endure longer waiting times for certain admissions/procedures.


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## capall (30 Jul 2007)

Jaid79 said:


> Let us all know of your experiences "good" and "bad"? with regard to the Irish public health system.
> 
> In my opinion, the Irish public health system is the worst in Europe and maybe one of the worst in the world.


 
That kind of statement really makes me mad.
Try comparing having cancer with no health insurance in ireland compared to if you were in the USA or even the UK


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## Tarquin (30 Jul 2007)

To answer


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## BillK (30 Jul 2007)

There was an article in the English press today about a lady of 108 years being told she had to wait 18 months for an upgrade of her hearing aid!

On a personal level, I went to my GP because my back had jammed up and was told there was a 19 week waiting list to see an NHS physiotherapist.
(I have had spinal surgery four times.) Not surprisingly, I went to the local Chiropractic clinic and paid £27 (sterling) for each session to unjam it.

How do those two examples compare?


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## Jaid79 (30 Jul 2007)

Northerngirl said:


> As someone who worked in the NHS in UK for many years, and now working here, I feel there is huge waste here, particularly within the management structure - little accountabilty, lack of foresight and imagination, and knee-jerk reactions to public outcrys with managers constantly being promoted to other areas inthe HSE, therefore not implementing recommendations effectively, and other managers just waiting until they retire.


 

Accountabilty is a major issue and people that are actualy bad at their job seem to keep their job. The good thing about private sector, people that are not good at the job they do generally get sacked.

I`ll be going private in a private hospital from here on in, my family and I are just lucky that we can afford it. 

I was in a public hospital one week ago. That hospital had a new wing on it that was filthy. One example was in the shower area. The builders pencil marks from four years ago where still on the wall. I counted eight lines in total. Why is the cleaners not sacked?


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## Jaid79 (30 Jul 2007)

capall said:


> That kind of statement really makes me mad.
> Try comparing having cancer with no health insurance in ireland compared to if you were in the USA or even the UK


 
Which statement and why?


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## Jaid79 (30 Jul 2007)

joe sod said:


> Has this topic not already been beaten to death by the irish media


 
joe sod,

There seems to be members that have an intrest in this thread. So if it some thing you do not want to contrabute too, don't! Simple! 

Jaid


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## RainyDay (30 Jul 2007)

Jaid79 said:


> The good thing about private sector, people that are not good at the job they do generally get sacked.


Do you have any research or data to back up this claim? Is it really a good idea to sack people like this? What about things like training? or coaching? or other development approaches?



Jaid79 said:


> One example was in the shower area. The builders pencil marks from four years ago where still on the wall. I counted eight lines in total. Why is the cleaners not sacked?


How do you know the pencil marks are from four years ago?


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## ClubMan (30 Jul 2007)

BillK said:


> There was an article in the English press today about a lady of 108 years being told she had to wait 18 months for an upgrade of her hearing aid!


How does she know what they said?


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## Sn@kebite (30 Jul 2007)

efm said:


> I agree with Purple - I don't think we have the worst health system in the world and you can't pay nothing but have everything - I have VHI and all my experiences to date in Ireland have been fine


Would it also depend on the individual hospital(s) you go to? Not the whole Irish Health Dept. overall?


BillK said:


> There was an article in the English press today about a lady of 108 years being told she had to wait 18 months for an upgrade of her hearing aid!


 Did this take place in Ireland or England?


ClubMan said:


> How does she know what they said?


Probably upgraded her hearing aid to tell her, then downgraded again.


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## Purple (31 Jul 2007)

ClubMan said:


> How does she know what they said?



Maybe she could lip read.


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## zephyro (31 Jul 2007)

Purple said:


> There is huge waste but there is huge waste in every public health system.


 
Do you think a privately owned and operated health system with universal health insurance would be more efficient?


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## Purple (31 Jul 2007)

zephyro said:


> Do you think a privately owned and operated health system with universal health insurance would be more efficient?


I am in favour of a public health insurance system where hospitals are paid a fee based on the procedure that the carry out or the ailment that they treat. That way both private and public patients would be a source of revenue for the hospitals. At the moment only private patients are a source of revenue whereas public patients are a drain on resources. 
Both the PD's and the Labour party have voiced their support of this sort of system in the past so I don't see it as an ideological issue.
 I don't have any objection in principle to all hospitals being private, that's not important as long as the HSE can licence the way they are run and audit them effectively to make sure that the rules are followed. Whatever system we have is will need to be regulated by the HSE or some branch of government. That's the theory but in practice we could not pull it off so we should stick with what we have. If and when the state becomes able to regulate a public service that is delivered by the private sector then things can and should change but I think that is a long way off.


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## BillK (31 Jul 2007)

Sn@kebite:

Took place in England.

Clubman:

 I believe the old lady could read.


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## Marie (31 Jul 2007)

Purple said:


> I am in favour of a public health insurance system where hospitals are paid a fee based on the procedure that the carry out or the ailment that they treat. That way both private and public patients would be a source of revenue for the hospitals. At the moment only private patients are a source of revenue whereas public patients are a drain on resources.
> Both the PD's and the Labour party have voiced their support of this sort of system in the past so I don't see it as an ideological issue.
> I don't have any objection in principle to all hospitals being private, that's not important as long as the HSE can licence the way they are run and audit them effectively to make sure that the rules are followed. Whatever system we have is will need to be regulated by the HSE or some branch of government. That's the theory but in practice we could not pull it off so we should stick with what we have. If and when the state becomes able to regulate a public service that is delivered by the private sector then things can and should change but I think that is a long way off.


 
Hi Purple.  All well and good so long as people recognise that when you go down the route you swiftly encounter the problems the UK system is now experiencing with the future health of the nation mortgaged to PPP's (public-private partnerships) and taxpayers' money already in the coffers of private equity.  There is beginning to be a research-base showing that after a year or so the pace of improvement declines.  For example contracted-out minor surgery units initially mop up overspill from the hospital system but there are logistical difficulties when the immediate geographic population has been sorted.  These are huge national systems and the administration is as complex and as costly as the present - public - systems.

There are also difficulties with concepts like 'audit', 'clinical governance' and 'evidence based practice'.  Who audits the auditors?  These are usually government quangos.  From experience I can confirm the 'evidence based practice' is a euphemism for cost-cutting and implementation of politicial decisions at local level.  The UK now has a quango called (ironically!) NICE (National Institute for Clinical Excellence) which decides what treatments will be available from all possible treatments and rations them out, deciding who will receive them.  

The problem is - there is no utopia.  Without objective deep analysis of current systems any replacement for them will contain the same - or worse - elements.

My own experience of the Irish healthcare system is that it is patchy; some parts work very well, sometimes.  There is definitely a 'two-tier' system in operation which ironically may lead to a reinstatement of the old "Union" system for the have-nots.


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## RainyDay (31 Jul 2007)

Purple said:


> I am in favour of a public health insurance system where hospitals are paid a fee based on the procedure that the carry out or the ailment that they treat.


I'm not so sure that you can commoditise health services in this way. What happens when a particular patient needs 5-days instead of the 3-day agreed fee? Will the accountants be discharging the patients?

What happens when the patient has a mental health condition? How do you set a fee for treating depression, or schizophrenia?


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## Purple (1 Aug 2007)

RainyDay said:


> What happens when a particular patient needs 5-days instead of the 3-day agreed fee? Will the accountants be discharging the patients?


No, the accountants will not be discharging the patients. That's not what happens in other countries that use a reimbursement system. I'm surprised that you didn't know that. I do not know the mechanics of how the system should work here but I support the idea that private patients are treated as a source of income for hospitals, not a drain on resources. 
Why do you think there would be a three day agreed fee for a procedure? Why not a cost per day or a cost per day and a top up for medication and tests? All of which can be audited on a regular basis. 



RainyDay said:


> What happens when the patient has a mental health condition? How do you set a fee for treating depression, or schizophrenia?


 The same way you set the fee now in the private wings of our mental health hospitals. It's been done for decades.



Marie said:


> Hi Purple.  All well and good so long as people recognise that when you go down the route you swiftly encounter the problems the UK system is now experiencing with the future health of the nation mortgaged to PPP's (public-private partnerships) and taxpayers' money already in the coffers of private equity.


 I'm not suggesting that we go down the UK route. Why did you think that? 



Marie said:


> There are also difficulties with concepts like 'audit', 'clinical governance' and 'evidence based practice'.  Who audits the auditors?  These are usually government quangos.  From experience I can confirm the 'evidence based practice' is a euphemism for cost-cutting and implementation of politicial decisions at local level.  The UK now has a quango called (ironically!) NICE (National Institute for Clinical Excellence) which decides what treatments will be available from all possible treatments and rations them out, deciding who will receive them.


Auditing is carried out across many sectors and industries. The FDA in the USA probably the most famous body that sets standards and enforces them through auditing. The FDA carry out hundreds if not thousands of audits in this country every year.
The NSAI (National Standards Authority of Ireland) carries out thousands of audits every year. They are a government body that audits private and public companies very successfully in many sectors. Why do people think that it's any more difficult to establish a matrix for the health sector? The idea that an auditing body will just become a political quango does not stand up. It will have to be subject to parliamentary oversight, an all party committee for example, but it's up to our legislator to construct a system that does not allow that to happen.



Marie said:


> The problem is - there is no utopia.  Without objective deep analysis of current systems any replacement for them will contain the same - or worse - elements.


I agree.



Marie said:


> There is definitely a 'two-tier' system in operation which ironically may lead to a reinstatement of the old "Union" system for the have-nots.


I also agree


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## Jaid79 (3 Aug 2007)

Do you have any research or data to back up this claim? Is it really a good idea to sack people like this? What about things like training? or coaching? or other development approaches?

*Private hospitals are far less tolarent of unprofessional behavour and poor attitudes and work ethics than most public hospitals, I have a number of firends that are nurses. It has been their personal experiences of the above.*

How do you know the pencil marks are from four years ago?

*I asked two members of staff when the new build had been completed and if any further refubishment works had been carried out.*


*I personaly have had on a vast number of occasions seen nurses, care aisistants, cleaners wearing their uniform in and out of hospital, this in its self is a major issue due to potental contamination of the hospital. *

*MRSA is increase at an alarming rate in Ireland, this is largley due to bad procdures and pactices by Irish public hospitals and lack of staff training.*


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## RainyDay (3 Aug 2007)

Jaid79 said:


> *Private hospitals are far less tolarent of unprofessional behavour and poor attitudes and work ethics than most public hospitals, I have a number of firends that are nurses. It has been their personal experiences of the above.*


To be honest, I'd suggest that firmer, independent evidence would be required before any policy decisions could be based on this approach. The only people that I know personally who got MRSA were in private hospitals, but I wouldn't attempt to draw definite conclusions from this anecdotal experience.


Jaid79 said:


> *I asked two members of staff when the new build had been completed and if any further refubishment works had been carried out.*



Flimsy, at best.


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## Jaid79 (4 Aug 2007)

RainyDay said:


> To be honest, I'd suggest that firmer, independent evidence would be required before any policy decisions could be based on this approach. The only people that I know personally who got MRSA were in private hospitals, but I wouldn't attempt to draw definite conclusions from this anecdotal experience.
> 
> Flimsy, at best.


 

RainyDay,

Ì wasnt suggesting a new policy nor was I suggesting my opinions where based on hard facts. They are based on my personal and friends experiences.

Irish Public hospitals are below par on most levels, MRSA and cleanliness are major issues in Ireland. I'm unaware of any other EU country (apart from the UK, possibly!) that have a problem quite as big as Ireland. 

Below is a quote from the last minister for health last year.

*"The Tánaiste and Minister for Health, Mary Harney, has described hygiene standards in Irish hospitals as unacceptable.*

*Ms Harney was speaking at a conference on hospital hygiene in Dublin today arranged by the Irish Patients' Association.*

*She said it was incumbent on every hospital to ensure that cleanliness is improved, particularly in relation to hand-washing, which is regarded as vital to tackling the spread of illnesses like MRSA.*

*Ms Harney also suggested that hospitals should consider restricting visiting hours in an effort to improve hygiene.*

*A recent audit found that just 9% of Irish hospitals meet basis standards of cleanliness and hygiene, with the other 91% falling short of the mark."*

If the people at the top can see a problem, why cant you?

Do you really think Ireland has a good health system, if so I think your a bit Purple has made some great points and if such things come to past, Ireland in the future may have the chance of having a health system to be proud off.

Jaid


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## RainyDay (6 Aug 2007)

Purple said:


> Why do you think there would be a three day agreed fee for a procedure?


Because you suggested "where hospitals are paid a fee based on the procedure that the carry ou"


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## Purple (6 Aug 2007)

RainyDay said:


> Because you suggested "where hospitals are paid a fee based on the procedure that the carry ou"


 Fair enough. AFAIK the way the system works in Germany is that if this happens the hospital will loose money on that particular procedure but over a year it should balance out.


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## aircobra19 (16 Aug 2007)

RainyDay said:


> To be honest, I'd suggest that firmer, independent evidence would be required before any policy decisions could be based on this approach. The only people that I know personally who got MRSA were in private hospitals, but I wouldn't attempt to draw definite conclusions from this anecdotal experience.
> 
> Flimsy, at best.



My personal experience and those of people that I know, is that MRSA is very common, and people I know died from it. My opinion of the hospitals I've seen is that they are poorly cleaned, and audits are in the main paper exercises that are not carried through on the ground. The standard of caring is poor unless you happen to get the "right" person working. Everyone seems to do things to cover themselves from a legal point of view, and if patient care suffers so be it seems to be the attitude. 

The Irish health service is in dysmal state in my opinion. Its badly managed and run. Thats from the Govt down to the lowest level. Huge budgets and money is wasted at every turn and yet patients are suffering from low resourcing.


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## Purple (17 Aug 2007)

aircobra19 said:


> My personal experience and those of people that I know, is that MRSA is very common, and people I know died from it. My opinion of the hospitals I've seen is that they are poorly cleaned, and audits are in the main paper exercises that are not carried through on the ground. The standard of caring is poor unless you happen to get the "right" person working. Everyone seems to do things to cover themselves from a legal point of view, and if patient care suffers so be it seems to be the attitude.
> 
> The Irish health service is in dysmal state in my opinion. Its badly managed and run. Thats from the Govt down to the lowest level. Huge budgets and money is wasted at every turn and yet patients are suffering from low resourcing.


 So what's you suggestion on how to fix it?


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## aircobra19 (17 Aug 2007)

Bring in accountablilty. Bring in someone from another countries hospital that has a proven track record of running hospitals properly. People like Maurice Neligan make a lot of good sense too. But no ones listening. The Govt and especially the minister have proved in inept. We needed to vote them out.


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## Caveat (17 Aug 2007)

aircobra19 said:


> accountablilty


 
Hasn't the title/role of 'matron' largely been done away with?

Older relatives who formerly worked in the health service have told me that "this was one person you did not cross" & "God help you if things weren't up to scratch" etc etc.

Sounds like the reintroduction of a role like this, together with less contracted services (e.g. catering, cleaning) would help with accountability.

And of course have people who actually know about management managing a hospital - not a 'promoted' consultant or something - with respect, what would they know about running a hospital?


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## zephyro (17 Aug 2007)

aircobra19 said:


> Bring in accountablilty.


 
I can't see this being possible in our public health system. What it requires it that there are consequences for underperformance/incompetence up to and including dismissal. It is effectively impossible to be dismissed in the public sector, and certainly not for such a ridiculous reason as incompetence!


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## aircobra19 (17 Aug 2007)

I'd agree with most of the above. 

One thing that was said to me was that when the religious orders were a positive force in the health services. I'm too young to have direct experience of that, but its would make sense that the religious ethos is 
more in line with patient care and cleaniness than pure commercial concerns. "Cleaniness is next to Godliness" etc. I'd have a more jaundiced view of religions but I remember hospital being better in the past.


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## Jaid79 (17 Aug 2007)

aircobra19 said:


> I'd agree with most of the above.
> 
> One thing that was said to me was that when the religious orders were a positive force in the health services. I'm too young to have direct experience of that, but its would make sense that the religious ethos is
> more in line with patient care and cleaniness than pure commercial concerns. "Cleaniness is next to Godliness" etc. I'd have a more jaundiced view of religions but I remember hospital being better in the past.


 
Its crazy to think in a "developed country" cleaners, careworkers, nurses, doctors and other members of staff, need to told the on an ongoing bases the importance of washing their hands. 

I was in a dublin hospital and seen the "cleaner" rub the floor with a wet cloth, she then used the same cloth to "clean" areas of the wall. She then pulled a chair up and sat down telling me how all the forgeiners are taking their "jobs" Pleople like her make me sick!

Jaid


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