Brendan Gleeson's comments on the Late Late Show

[gearoidmm]

Will someone explain to me, how a lack of investment in the 80`s (over 20 years ago) results in a severe deterioration in services only after an EXTRA
Eur20 BILLION was spent over the last few years.
The Irish Nurses Organisation uses the motto "Nurses for Nurses".Maybe the doctors, porters, cleaners,managers, consultants etc. have a similar attitude.
In my experience this view pervades the Health "Service".
Is there anyone for the patient?

There was a huge reduction in the number of beds in the health service in the 1980s with ward closures and hospital closures. This has never been rectified despite a ~20% increase in the population since then.

Working in the health service can be extremely rewarding and there are days when you go home feeling that you have at least helped someone today. But equally, it is often a smelly and dangerous job with long, irregular hours. Not to mention the stress that goes along with making decisions that may change someones life. There are very few who work with patients who regard this as 'just a job', if they did there would be a lot more people quitting. What has led you to the opinion that doctors and nurses are all in it 'for themselves'?

 

[bearishbull]

gearoid do you think theres enough spent on the health service? what is the problem in your view? there does seem to be a lot of vested interests in the health services all resisting changes etc.

 

[bearishbull]

The budget for the NHS will be £76 Billion (Eur110 Billion) this year .
UK population is about 60 million.
For our population of 4 million this is equivalent to Eur7.4 Billion.
HSE budget this year is Eur12 to 13 Billion.

yes and if you factor in the high level of private health insurance(Around 50% of population has vhi/bupa) which reduces the demands on public health system you get an even higher per capita spend.

 

[Grumpy]

What has led you to the opinion that doctors and nurses are all in it 'for themselves'?

i don`t doubt that there are many workers in the Health service who are or wish to do a good job.However. there is a malaise at the heart of this organisation which has become apparent.
Those in the service, high or low, must see all around them, the dysfunctional system at work.I, as a visitor to family members and as a patient glimpsed an organisation in crisis.
The question I ask is "who`s in charge?", "who`s responsible?"."who monitors performance?"
God help anyone who works there and wishes to serve the patient.It must be hell.God help those working in A & E.

 

[gearoidmm]

gearoid do you think theres enough spent on the health service? what is the problem in your view? there does seem to be a lot of vested interests in the health services all resisting changes etc.

I tear my hair out trying to think of a solution.

Main problem is one of bed capacity I think. 4 causes for this
- bed blocking by patients waiting for placement in long-term care facilities
- lack of rehab facilites in the community meaning that patients stay in hospital getting physiotherapy and OT which could be as easily delivered in a step-down facility
- Very poor access to outpatient diagnostic tests like ultrasound and CT scans for public patients - this means that if you need to get these done urgently on a patient, it means admitting them to hospital which may not be strictly necessary
- Lack of a coherent discharge policy in some places.

There is a resistance to change in the health service but this is not necessarily because the people think that it's working fine the way it is. It's more that there are so many different groups with different priorities that it's hard to get them all to agree on something. I think the Neary report will have a long-term impact on how things work. Consultants will no longer be able to work in isolation and there will be greater accountability which I think will lead to greater flexibility.

 

[Grumpy]

gearoidmm,
why ask for more bed capacity when your four points indicate this is not the problem.In the short term, it looks like we will have to get the JCBs out and shovel more cash into the HSE.
People fear getting sick now.Old people and their families are terrified.
I will not have an operation, due now, in an MRSA infested system.Consultant as much as told me to wait.
The people in charge ie. Fianna Fail/PDs, need to be dealt with.
Who`s in charge of these?
You and me!

 

[bearishbull]

i think we should get in some big wigs from the nhs to advise us then implement a short term strategy to deal with the A&E probs such as bringing in extra doctors nurses from abroad and create temporary emergency units on grounds of existing hospitals, get priavte sector involved(if you can pursuade unions) etc.

i think harney could easily take on the unions/vested interests and implement radical change quickly as theres such a demand for change in the publics minds,if the vested interests strike they would have little if any support from public.

 

[Purple]

geariodmm,
I fully accept that there have been huge and expensive improvements in medical technology and the services offered to patients. This necessitates increases in spending etc. but as bullishbear points out above the real increase in spending on health services over the last 10 years is much higher than the increases in government spending would suggest. I'm not sure of the figure (and would welcome the exact figure) but I think that around 40% of the population is now covered by private health insurance.
The deterioration in service that people speak of seems to centre around A&E in general and levels of cleanliness in hospitals in particular.
Mrs Purple is a Doctor (in GP land) and many of her friends work in Hospitals. The stories that they tell of malpractice, theft, cover-ups and general mind blowing waste beggar belief.
For example why do we have so many health boards? I see no need for more than one.
Why is there a different system for drug payments to Pharmacies in each health board? One would make more sense?
Why can consultants use public hospitals to treat private patients ahead of more needy public patients in order to maximise their income?
Why are patients left in hospitals over weekends at huge extra cost waiting for the consultant to discharge them on their Monday morning ward round?
Why have most of the staff that have been employed in the health service over the last 10 years been clerical and not medical or technical?

 

[gearoidmm]

I agree that there is a problem with the way the public/private system works and I am a strong believer that they should be separated entirely. There are some consultants who abuse this system and spend too much time concentrating on their private patients to the (potential) detriment of their public patients. This is a problem in some specialities more than others. I don't believe that you should have two waiting lists for public hospitals - one public and one private - that said, the money paid to the public hospitals for treating private patients is an essential part of the revenue stream so again it is difficult to see what the answer is.

With regard to the weekend discharges, in the Dublin hospitals at least, most consultants or a member of their teams come in at the weekend to look over their patients (on their time off you must remember). But to be honest, any patient that can be discharged is usually sent out on Friday. Most patients in hospital over the weekend are their waiting for tests etc (it's another argument as to whether the ancillary services such as radiology and other diagnostics should work seven days) and wouldn't necessarily be discharged even if the consultant was there.

A related problem is that in some hospitals, the consultants may not round enough and so discharging decisions are left to more junior doctors like the SHOs who tend to be more conservative in their discharging policy. This is not because they are lazy. At the same time, there is a strong argument that the consultant should not round daily as the more junior doctors (who may have 5-7 years experience, remember) need to be exposed to decision making for the patients so that they will be adequately trained for the future.

I don't honestly know the breakdown of clerical v medical staff employed over the last 10 years but I do know that doctor's call rotas are less onerous than they were and that there is better access to ancillary services than ever before (although it still could be better).

Again I can't comment on the pharmacies as I don't know the situation.