Ireland 2nd out of 19 countries for nurses per capita

[thedaddyman]

A much better estimate would be the nurses in FTE (Full time equivalent) per capita. I know quite a few nurses, both family, ex schoolfriends, neighbours etc and none of them are full time or have any interest in working full time.

As for inefficiencies, CUH are paying PWC €2m+ to try and come up with better practises but when they spend that money, certain politicians give out stink about it, even if it is having a positive benefit overall. (or so the hospital says).

 

[Purple]

Has any body, an individual or an organization, measured outcomes for the "medical industry"?

There's an international drive to improve this. The medical industry is the same as any other industry in that "efficiency" is the ration between inputs and outputs, in this case the inputs are capital and human resources and the outputs are key health indicators such as mortality rates, waiting times, cancer survival rates, etc.
The OECD's 2018 Health at a Glance report said that 20% of all healthcare spending in the EU could be reallocated to other areas without any reduction in healthcare access or outcomes. In other words it was wasted. I suspect that number is higher in Ireland. That's at least €4.6 billion a year. That's two National Children's Hospitals a year. That's serious money. And that's a conservative number.

We need to stop having the wrong conversations.
We need to stop talking about capital project over runs.
We need to stop with all the emotive nonsense about "heroes" and "Front Lines".
We need to start talking about the boring stuff like structures and processes and measurement.

 

[Purple]

A much better estimate would be the nurses in FTE (Full time equivalent) per capita. I know quite a few nurses, both family, ex schoolfriends, neighbours etc and none of them are full time or have any interest in working full time.

As for inefficiencies, CUH are paying PWC €2m+ to try and come up with better practises but when they spend that money, certain politicians give out stink about it, even if it is having a positive benefit overall. (or so the hospital says).

The European Commission commissioned this report. It's aa EU wide issue.

 

[Salvadore]

To paraphrase another saying, it’s not about the number of nurses you have. It’s about what you do with them.

 

[arbitron]

Given that women are far more likely to want to be the one to spend more time with young children, for obvious biological/evolutionary reasons...

Whatever about the other discussions we are having here, I have to call this out again as pure opinion that detracts from any valid points you may make.

... finding ways to keep them working as much as possible makes good economic sense ... and it's not the same as "making them work more hours" but workforce participation rates should be part of the discussion when you are discussing a workforce.

You said "getting them to work full time is the problem". That means getting them to work more hours. No other way to interpret it.

At least we have settled the false premise that doctors working part-time is an issue.

I don't have detailed knowledge of nursing FTEs and part-time figures so I will leave that to others who do.

 

[arbitron]

Has any body, an individual or an organization, measured outcomes for the "medical industry"? Efficiency measures costs for the same activities irrespective of outcomes. Effectiveness turns the equations on their heads and measures the product of all this activity across all disciplines and professions, nursing, medical, physiotherapy, etc, and identifies how many patients were treated, how many were "cured", returned to good health, either in the home or outside it or both, how many avoided death or severe disability?

The reason for all these frenetic measuring jags people get involved in is quite frankly irrelevant unless and until effectiveness is measured. It seems the only measure that matters is cost (efficiency). Why not focus on outcomes (effectiveness) for a change?

"Quantity of output" is an efficiency measure, not an effectiveness measure, IMO as you're attempting to do more for the same or lower cost without measuring outcomes.

You are spot on @mathepac, outcomes are crucial, which is why focusing on who works part-time or full-time doesn't get us far. There are doctors who see 30 patients a day with excellent outcomes. Then there are others who see 50 a day, get mediocre outcomes but on paper they are working harder and doing a better job. Volume is often required to remain effective (the more hip replacements a team do in a year the better they are likely to be at them) and efficient (you can create economies of scale and small improvements will have a bigger impact) but there are many factors in delivering high-quality, affordable, accessible care.

There are myriad internal and external measures of outcomes, e.g. life expectancy, infant mortality, cancer survival rates, etc. Ireland ranks modestly in some and high in others.

Three major pressures that healthcare must deal with are: increasing patient expectations (a good thing), increasing quality/safety standards (a very good thing), and as a result of these there are increased litigation and insurance costs (definitely bad). These changes really complicate workflow, for example if a new standard comes in you may have to double the amount of time you spend with a patient in clinic - where does that time come from? Where do the resources come from?

I had a colleague who recently declined to see a patient in clinic because there were no notes - no referral letter, no files, nothing saying why the patient was there, zero information. The patient didn't know either, so they apologised and rebooked the patient for another day (it was not an emergency). The patient quite rightly complained to the hospital. My colleague was reprimanded for not seeing the patient - she explained that her Medical Council registration would have been at risk if she had missed something, made an error, etc. and that it was the hospital's responsibility to make sure patient information was made available to staff. You can't spend 30 minutes in clinic looking under desks for chart. She asked them if they would guarantee in writing that she had full indemnity if she saw patients in future with no documentation - they said no, it's not appropriate to see patients without a file!!! These are the multiple daily hurdles seen in healthcare and they occur everywhere, not just Ireland.

 

[mathepac]

I had a colleague who recently declined to see a patient in clinic because there were no notes - no referral letter, no files, nothing saying why the patient was there, zero information. The patient didn't know either, so they apologised and rebooked the patient for another day (it was not an emergency). The patient quite rightly complained to the hospital. My colleague was reprimanded for not seeing the patient - she explained that her Medical Council registration would have been at risk if she had missed something, made an error, etc. and that it was the hospital's responsibility to make sure patient information was made available to staff. You can't spend 30 minutes in clinic looking under desks for chart. She asked them if they would guarantee in writing that she had full indemnity if she saw patients in future with no documentation - they said no, it's not appropriate to see patients without a file!!! These are the multiple daily hurdles seen in healthcare and they occur everywhere, not just Ireland.

As a patient, I had a similar experience recently. Referred from hospital A to hospital B, part of the same "hospital group", the consultant asked me why I was in hospital B. I responded that the only information I had was in my appointment letter and I had no files, progress notes, discharge summaries, or information over and above what he had. He seemed pretty annoyed, originally I thought with me.

He did what the letter asked, a cystoscopy which required the removal of one medical device, the insertion of a camera, and the insertion of a new medical device, post investigation; no drugs or other treatments.

Simple-minded me thought that as the hospitals were part of the same group, notes, images, diagnoses, treatment plans, and other medical files would have been available to consult online, or at least that hard copies of the relevant notes were attached to the referral letter. Potentially a waste of my time (180-mile round trip), two doctors' time, that of a nurse, receptionist, car-park attendant, porter, etc because an admin somewhere in the chain failed to do something very simple.

Measure the efficiency of that incident and the consequences for the blood pressure and mental states of the actors.

 

[arbitron]

That is unfortunately an everyday occurrence. I wish hospitals were fined for these sorts of errors, it might move them to act.

One thing I found excellent in the NHS was that we dictated a letter for every single patient visit - a copy went to the patient and another to the GP. Letters arrived within a week. It meant patients had a summary they could bring with them if they were going to another clinic/hospital and they would sometimes call us to correct errors or ask for more details. I think it made clinicians more mindful as well. When I came back to the HSE I was told letters were a luxury and an urgent one would be done within a month Really you should get an email copy but that's wishful thinking.

 

[Purple]

Whatever about the other discussions we are having here, I have to call this out again as pure opinion that detracts from any valid points you may make.

I don't know why you are taking issue with something that a totally uncontentious fact. As a cohort women work fewer hours over their working life than men. There are loads of very good (and bad) reasons for that but it's indisputable.

You said "getting them to work full time is the problem". That means getting them to work more hours. No other way to interpret it.

If we are not going to fix the gross inefficiencies within the medical industry then the solution it to train more doctors or get the existing doctors to work more hours.

At least we have settled the false premise that doctors working part-time is an issue.

I've posted the Maths on that. It appears to be true, assuming that GP's are telling the truth about the hours they work. I'm certainly open to correction but the evidence suggests that it's true. I also know a full time GP (female) who struggles to get female doctors to work full time in General Practice.

I don't have detailed knowledge of nursing FTEs and part-time figures so I will leave that to others who do.

Either do I but there are almost 76,000 currently practicing nurses in Ireland, of whom 66,500 are patient facing. The HSE employs a little over 42,500 Nurses and Midwives (Whole Time Equivalent). Then there's the nurses in private Hospitals, private nursing homes etc. I'm not sure how the nurses in GP practices which are paid for by the HSE are counted (Yes, that's right, the HSE pays for your GP's nurse with a grant if the GP has a big enough practice). The NMBI have details statistics on Nursing but never gives details on what proportion work part time as that doesn't suit the narrative they wish to present. What we do know is that around 25% of HSE employees work part time. As of 2022 there were 153,282 total HSE employees and 134,101 WTE employees.

 

[Purple]

You are spot on @mathepac, outcomes are crucial, which is why focusing on who works part-time or full-time doesn't get us far. There are doctors who see 30 patients a day with excellent outcomes. Then there are others who see 50 a day, get mediocre outcomes but on paper they are working harder and doing a better job. Volume is often required to remain effective (the more hip replacements a team do in a year the better they are likely to be at them) and efficient (you can create economies of scale and small improvements will have a bigger impact) but there are many factors in delivering high-quality, affordable, accessible care.

Absolutely, outcome is crucial. That's why good oversight is also crucial. That's what a quality system and good procedures and practices are for.

Efficiencies and economies of scale all point to a well structured Public Healthcare System rather than a private one. The US has one of the most inefficient Healthcare systems in the world because it is fragmented and privately structured with around 30% of total spend going on administration.

 

[arbitron]

I don't know why you are taking issue with something that a totally uncontentious fact. As a cohort women work fewer hours over their working life than men. There are loads of very good (and bad) reasons for that but it's indisputable.

The problem is your claim that women working less is "mainly driven by biology, It's just the way we're made."

That's not true and it's not a helpful myth to spike what could be a productive discussion. The main determinants of women's participation in the labour force are socio-economic (including cultural norms). If we were to accept your incorrect premise then we would end up ignoring the very real barriers that exist, to the detriment of our healthcare system and indeed economic growth.

I've posted the Maths on that. It appears to be true, assuming that GP's are telling the truth about the hours they work. I'm certainly open to correction but the evidence suggests that it's true.

I already addressed your claim in detail, with several references, and indeed some maths.

 

[mathepac]

Efficiencies and economies of scale all point to a well structured Public Healthcare System ...

I'm not picking on you @Purple but I'm losing the plot reading about and hearing about people go on about the highlighted bit in the quote above. Politicians witter on about having or putting "appropriate structures in place to dah di dah di dah" demonstrating they have not got one clue what they're talking about.

What I think you and they mean is that "well organised" Systems, which will have excellent, measurable, superlative outcomes, best-in-class cost control, be nimble in response to new challenges, and have an empowered and accountable work-force. [EDIT: an organisation is an example of a System, hopefully an Open System, that produces outcomes/outputs in compliance with its purpose which it places in its environment and accepts feedback.]

Charles Handy in his book "Understanding Organisations", lists 64 attributes or characteristics of organisations. "Structure" is just one and is not even the most important. He and I would argue that "Purpose" is the single most important attribute of an organisation. Anyone inside or outside can look at what's happening within the organisation and ask the question, "What has this got to do with purpose?" and if there is no clear link between the purpose and the activity, then the activity needs to cease as it is irrelevant and a serious distraction and a diversion of the organisation's resources.

A few examples from the HSE's disastrous admin history. PPARS should have been handed over to the Department of Finance at the start. Procurement for the HSE and other government departments should be handed over to the OPW or a specialist procurement department for the government. The hacking of the computer systems in the HSE and their reliance on an antiquated, unsupprted version of the OS of choice - need one say more?

Let me give you a recent example from today. I get paid a small HSE pension having worked as a contractor for two periods in the past. I was paid the rate appropriate for my grade and contributed to the pension scheme. Last Friday a deposit from the HSE to my bank shows an amount > 3 times the usual, predictable amount. As I had no pay-slip, I consulted one of HSE's proliferation of web-sites and was given a phone number to ring. I eventually got through today to be told that the person on the other end of the phone line could not discuss my payment with me due to GDPR!

Let me explain. The HSE maintains a website directing me to a department staffed and maintained by them to answer questions about payments to employees and retirees, the staff of which refuses to answer questions about their reason for existence as advertised on the organisation's websites. How come I can talk to Revenue, Social Welfare, my bank, about money-related matters without encountering the old GDPR obstacle?

Utter madness and a waste of time, money and effort, the HSE's claim to fame.

 

[Purple]

The problem is your claim that women working less is "mainly driven by biology, It's just the way we're made.


That's not true and it's not a helpful myth to spike what could be a productive discussion.

Of course it's true. Sweden has a bigger Gender pay gap than the UK or USA and it's bigger again when women have children. That despite Sweden having much more supports and equal paternal and maternal leave. Equality in the context of the workforce is everyone having the same choices, not everyone being the same.

The main determinants of women's participation in the labour force are socio-economic (including cultural norms). If we were to accept your incorrect premise then we would end up ignoring the very real barriers that exist, to the detriment of our healthcare system and indeed economic growth.

If we ignore reality we'll make bad choices. It's really important to keep talented people in the workforce and half of the talented people are women. When formulating policies to do that we need to take into account that as a cohort women and men have slightly different priorities and make slightly different choices. One size doesn't fit all. Men and women are equal but not the same. That doesn't mean there should be any discrimination at an individual level or that one gender is better than the other. It means that the things that encourage women to stay in the workforce are not all the same as the things that keep men in the workforce. If we put lots of things that women want into place for one job then that sector will attract more women and if we put lots of things that men like into a different job then that sector will attract women.

I'm a man working in a male dominated sector but I'm also a single parent. The pay is good and it's technically challenging but there's very little flexibility in the hours. I'd prefer to have the things that women like to have such as flexible hours and longer holidays so I'm not criticising the choiced women are more likely to make, I'm more likely to make them too. I'm also in touch with my emotions, have always talked to my friends about mental health, do the housework, love to cook, can sew and blow dry my daughters hair so I'm definitely not the stereotypical man.

I already addressed your claim in detail, with several references, and indeed some maths.

Which I showed to be incorrect in later posts.

 

[Purple]

I'm not picking on you @Purple but I'm losing the plot reading about and hearing about people go on about the highlighted bit in the quote above. Politicians witter on about having or putting "appropriate structures in place to dah di dah di dah" demonstrating they have not got one clue what they're talking about.

What I think you and they mean is a "well organised" Systems, which will have excellent, measurable, superlative outcomes, best-in-class cost control, be nimble in response to new challenges, and have an empowered and accountable work-force.

Charles Handy in his book "Understanding Organisations", lists 64 attributes or characteristics of organisations. "Structure" is just one and is not even the most important. He and I would argue that "Purpose" is the single most important attribute of an organisation. Anyone inside or outside can look at what's happening within the organisation and ask the question, "What has this got to do with purpose?" and if there is no clear link between the purpose and the activity, then the activity needs to cease as it is irrelevant and a serious distraction and a diversion of the organisation's resources.

A few examples from the HSE's disastrous admin history. PPARS should have been handed over to the Department of Finance at the start. Procurement for the HSE and other government departments should be hand over to the OPW or a specialist procurement department for the government. The hacking of the computer systems in the HSE and their reliance on an antiquated, unsupprted version of the OS of choice - need one say more?

Let me give you a recent example from today. I get paid a small HSE pension having worked as a contractor for two periods in the past. I was paid the rate appropriate for my grade and contributed to the pension scheme. Last Friday a deposit from the HSE to my bank shows an amount > 3 times the usual, predictable amount. As I had no pay-slip I consulted one of HSE's proliferation of web-sites and was given a phone number to ring. I eventually got through today to be told that the person on the other end of the phone line could not discuss my payment with me due to GDPR!

Let we explain. The HSE maintains a website directing me a department staffed and maintained by them to answer questions about payments to employees and retirees the staff of which refuses to answer questions about their reason for existence as advertised on the organisation's websites. How come I can talk to Revenue, Social Welfare about money-related matters without encountering the old GDPR obstacle?

Utter madness and a waste of time, money and effort, the HSE's claim to fame.

I agree 100% and I'm also a fan of Charles Handy. I particularly agree on an organisation having a mission or purpose. I like to think of it as a destination. In the case of the Health Service that's a

well organised" Systems, which will have excellent, measurable, superlative outcomes, best-in-class cost control, be nimble in response to new challenges, and have an empowered and accountable work-force

When someone suggests a change the first question is "does that bring us further along the path to our destination?"

What bugs me is when people think employees in an inefficient organisation aren't working hard. The opposite is often the case.

 

[Purple]

@arbitron, I don't understand what the laughing emoji is meant to mean there. Is there something you think is factually incorrect or do you have an unusual sense of humour?

 

[arbitron]

There was no emoji for going around in circles, so I chose to laugh instead of cry!

 

[Purple]

There was no emoji for going around in circles, so I chose to laugh instead of cry!

Fair enough.

I'm a facts and data guy. I used to believe that the school year should be longer and the school day shorter as I believed that kids would do better but the studies I read suggest that it makes no difference. I was wrong and changed my view accordingly.
I also accepted that women worked less and earned less because of sexist structures but the data suggests otherwise so I changed my view. I still think that many structures within society are sexist for the obvious reason that they were constructed by men for men but if the data tells me that I'm wrong about a specific opinion then I have to change my mind.
If you can show me data that is counter to my views on this topic I'll certainly change my mind but outcomes are not causes. I like being wrong because when I am my revised view is more strongly grounded in fact.

 

[arbitron]

Fair enough.

I'm a facts and data guy. I used to believe that the school year should be longer and the school day shorter as I believed that kids would do better but the studies I read suggest that it makes no difference. I was wrong and changed my view accordingly.
I also accepted that women worked less and earned less because of sexist structures but the data suggests otherwise so I changed my view. I still think that many structures within society are sexist for the obvious reason that they were constructed by men for men but if the data tells me that I'm wrong about a specific opinion then I have to change my mind.
If you can show me data that is counter to my views on this topic I'll certainly change my mind but outcomes are not causes. I like being wrong because when I am my revised view is more strongly grounded in fact.

I don't think we are even discussing the same things at this stage. Lay out the main claims/questions in bulletpoints and I will do my best to clarify.

 

[Purple]

I don't think we are even discussing the same things at this stage. Lay out the main claims/questions in bulletpoints and I will do my best to clarify.

Just tread the thread.
You seem to think that workforce participation rates between men and women make no difference to output but the facts and the maths suggests otherwise.
You also see to think that those differences in participation rates are all to do with societal constructs and pressures but the facts and the empirical evidence suggests otherwise.
Really talented people are rare and a valuable commodity both societally and economically. Half of those people are women.

Keeping them participating in the workforce as fully as possible is, in the context of this discussion, a problem.

It's hard to fix a problem when you don't understand the root causes.

 

[MOB]

...can sew and blow dry my daughters hair so I'm definitely not the stereotypical man.

Stop sewing the kid's hair.

It's not just medical workers. My own experience is that my profession (law) is pretty much 50-50 in practitioner numbers but that the solicitors who call to a Garda station at 1 in the morning for someone in custody are predominantly male. In the UK they are learning to cope with so-called legal deserts--- sections of the community that have no out-of-hours legal advice readily available. We will start to see this soon enough here.