Nurses

We're getting involved with nurses in nordic countries etc. No doubt somebody else will come up with figures from North Korea or some other "Health Haven." While all this is going on the campaign for what cannot be described as anything else other than the Health Insurance companies taking over the health service drives on. And, of course, this is going to be the answer to all Ireland's health problems. I think not and I see a population looking forward to this like turkeys look forward to Christmas. Then what happens when (almost) inevitably we will have a worse health system than at present?

Like I said earlier, the PEFT people will pay up as usual. Those who do not pay will still not pay. It is like everything else in Ireland those who can cheat the system will. Debt collectors will be more important than medical staff. Accountants will be ensuring the future of hospitals on money issues only. Then, I reckon we can all look forward to self diagnosis and to treating our illnesses at home. But, aren't the health insurance companies advertising this already?
 
Purple said:
If pay and conditions are better in the private sector and they can still compete with the public sector then we should be looking at the structural inefficiencies in the Public Sector which make them uncompetitive. When those are addressed the resources will be there to give pay increases.


Contract staff to not get the same T’s & C’s and full time permanent nurses and, crucially, they do not have tion to a job for life and do not accrue pension entitlements. Taking that pension cost and the lack of labour mobility into account I find it hard to believe that the real total cost of contract staff is higher.

If we are training more nurses than we can employ then we should reduce the number we train.
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Lets face reality. We are training people so that they can get decent employment overseas. When we are in a position to increase nurse numbers and teacher numbers we can do so. In the meantime what do we do? At least this way our children can follow the career they want albeit in another country. Better than having thrm emigrate skill less
 
Leper said:
I'm with you on the poor management issue. I'm with you on the costs of healthcare too. It wasn't the public service that fell down on the job on the computerised payroll issue. "Reputable" consultants were brought in from the private sector and let's be honest cocked up everything that could be cocked up despite early warnings from veteran campaigners. And what I am saying is an understatement.
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The failure of the computerisation of the health service payroll was one of the largest single financial disasters in this country before the bailout. It was comparable in size to PMPA and AIBs UK Insurance bailout (which eventually was recouped).

The reason the project failed was because the pay regulations for some staff are not coherent, there is no clear algorithm. Wage entitlements have been built up over many years and many agreements, there are overlapping allowances and no resolution when agreements contradict each other.

This incoherent pay structure is not confined to the health service. In the construction industry, the agreements covering a banksmans pay are mutually contradictory. In practice employers just guess what they should be paid.

The reasons behind this are a combinations of strong trade unions, weak management and interfering politicians. And lets be honest a public that is too unconcerned to care.

Certainly the consultants were happy to collect a good rate per hour to work on a project that was inherently impossible. They must have realised this, if not from the beginning then at an early stage. If I was a partner in the firm concerned I don't think I would have an easy conscience. However the consultants didn't cause the problem, however much they may have milked it.

On a positive note, the Revenue faced a similar challenge in setting up ROS. Millions of different taxpayers using thousands of different accounting systems needed to be brought into one tax filing system. Instead of spending millions on developing a system to deal with all the complexity, Revenue simply published their requirements and gave taxpayers and their accountants time to develop ways to work with that.

Now could Revenue run the health service ?
 
cremeegg said:
The failure of the computerisation of the health service payroll was one of the largest single financial disasters in this country before the bailout. It was comparable in size to PMPA and AIBs UK Insurance bailout (which eventually was recouped).

The reason the project failed was because the pay regulations for some staff are not coherent, there is no clear algorithm. Wage entitlements have been built up over many years and many agreements, there are overlapping allowances and no resolution when agreements contradict each other.

This incoherent pay structure is not confined to the health service. In the construction industry, the agreements covering a banksmans pay are mutually contradictory. In practice employers just guess what they should be paid.

The reasons behind this are a combinations of strong trade unions, weak management and interfering politicians. And lets be honest a public that is too unconcerned to care.

Certainly the consultants were happy to collect a good rate per hour to work on a project that was inherently impossible. They must have realised this, if not from the beginning then at an early stage. If I was a partner in the firm concerned I don't think I would have an easy conscience. However the consultants didn't cause the problem, however much they may have milked it.

On a positive note, the Revenue faced a similar challenge in setting up ROS. Millions of different taxpayers using thousands of different accounting systems needed to be brought into one tax filing system. Instead of spending millions on developing a system to deal with all the complexity, Revenue simply published their requirements and gave taxpayers and their accountants time to develop ways to work with that.

Now could Revenue run the health service ?
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1.You're right on one of the issues above i.e. the private sector well known consultants were happy to drain the last penny out of the Health Service with their bad advice. I understand some within the Health Service shouted stop and were ignored by the "private sector" consultants and even those making money within. The lot cost €240,000,000.00 - probably the expense of building two new large hospitals.

2. The system being installed was one which worked in several public bodies who had just as much complexities as grades in the HSE. I understand what happened was the equivalent of building a house and putting up the roof first without supporting walls or even a foundation. The whole process was a monumental cock-up from start to finish. I shouldn't have used the word "finish" as the whole plan was jettisoned within a week of being launched. I suppose you could compare it to the launch of the Titanic!

3. The Trades Unions had nothing whatsoever to do with the situation. Trades Unions do not install computer systems. I don't know how you (a poster of some valued posts) could say this. I think Purple is having an unfavourable influence on you!
 
Leper said:
3. The Trades Unions had nothing whatsoever to do with the situation. Trades Unions do not install computer systems. I don't know how you (a poster of some valued posts) could say this. I think Purple is having an unfavourable influence on you!
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That's a bit harsh!... though cremeegg is on the money! :D ;)
What do you think would have happened if the HSE tried to standardise nursing contracts across all the old Health Board areas?
Do you think the Unions would have acted in the common interest or, as they usually do, tried to grab as much cash for their members as possible and damn the rest of us?
 
Sorry but the idea that private consultants were solely to blame for that fiasco is fanciful. Read the Auditor General Report on the matter. That project is now held up as an example of what not to do when it comes to project management. The Health Services at the time didn't even know about roughly 80% of the different pay arrangements and allowances of staff until they had already started the project so the initial scoping was rubbish. The project wasn't clearly defined. It wasn't just a payroll system. It was to facilitate change management in the health service but this was never clearly defined. Because the project wasn't clearly defined, they decided to go on time and material cost basis with outside consultants instead of fixed cost contracts where the risk is shared between the consultants and the client and there is more pressure on both parties to perform.
Even if private contractors were milking the system (which they were and are doing now in banking), the Health Service and the Department of Health were the client. It was up to them to manage it. Once they could see the project over-runs, they should have paused and conducted a proper review. But they didn't. They just threw more money at it. That wasn't the consultants fault. It was the fault of an incompetent organisation who have proved themselves time and time again to be incapable of running the health service.
 
Ah ! Sunny, If, if, if, . . . I agree with you, the fiasco was managed by a shower of inspired nincompoops both in the private and public sectors. But, the advisors would listen to nobody and drove the train off the tracks and continued driving until all had been milked and of course the Irish Taxpayer took up the tab, as usual. Then the train crashed.

The same computer system was installed in several Departments and large Semi-State companies where it worked. These had grades every bit as complex as the Health Service. Be under no illusion the private sector advisors would listen to nobody and the fiasco occurred.

Purple, Good to see ya around these parts again. I missed you; nobody to disagree with me. I don't know the point you are making about standardising nursing contracts across all the old health board areas. Nursing contracts are fairly standardised for years.

Cremegg is not on the money either, but entitled to his opinion.

The Trades Unions had nothing whatsoever to do with the failure of the PPARS project. It was the private sector consultants, they talked big achieved little and made a fortune in the process. There were people within the HSE who made money too. Unfortunately, I wasn't one of them.
 
Leper said:
It was the private sector consultants, they talked big achieved little and made a fortune in the process. There were people within the HSE who made money too. Unfortunately, I wasn't one of them.
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So let me get this straight; the people who set the parameters, initiated the project, hired the consultants and assembled their own internal teams, were in charge of the HSE and delivering the services and whose decision it was to yea or nay every stage of the project and sign off on the final results are not to blame for the waste of €240,000,000 of Irish tax payers money. No, the fault lies with the consultants who they hired to advise them! That's just nuts.

It's like me asking someone to design and build a house for me with while having no idea of what I want but designing it on the hop, during the construction phase, and then blaming the architect when the crazy scope of work I give him cannot be built on the foundation I have already laid and the whole mess cost a fortune.
 
Purple said:
So let me get this straight; the people who set the parameters, initiated the project, hired the consultants and assembled their own internal teams, were in charge of the HSE and delivering the services and whose decision it was to yea or nay every stage of the project and sign off on the final results are not to blame for the waste of €240,000,000 of Irish tax payers money. No, the fault lies with the consultants who they hired to advise them! That's just nuts.

It's like me asking someone to design and build a house for me with while having no idea of what I want but designing it on the hop, during the construction phase, and then blaming the architect when the crazy scope of work I give him cannot be built on the foundation I have already laid and the whole mess cost a fortune.
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You're right Purple, it was just nuts hiring an outside company to mastermind the whole computerised proceedings. And nobody shouted stop. The private consultants had carte blanche to do as they wished and they botched it probably having been advised all they way that things were not going well and they still botched it. Complete nuts. Everybody knew what was wanted i.e a payroll and personnel computerised system and still they got it wrong. Nuts and more nuts . . .
 
Leper said:
You're right Purple, it was just nuts hiring an outside company to mastermind the whole computerised proceedings. And nobody shouted stop. The private consultants had carte blanche to do as they wished and they botched it probably having been advised all they way that things were not going well and they still botched it. Complete nuts. Everybody knew what was wanted i.e a payroll and personnel computerised system and still they got it wrong. Nuts and more nuts . . .
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Having been on both sides of it, consultants are generally good at doing what you ask them to. It's when you have no idea what you want, and hire them in thinking they're going to solve a myriad of problems you don't understand yourself, then you're in trouble. You can't blame the consultants here, buck stops with whoever continued to sign-off on this. A project of that size would have had multiple sign-offs at various stages, the only people with the authority to shout stop here were the same people who continued to sign on the line saying keep on paying them!
 
Generally speaking, people working on a large IT project are actually personally invested in it and viewing such consultants as simply leeching is unfair. They want it to succeed. They are often emotionally attached to it, especially if they are investing long hours on it. On long projects they generally embed with and strongly identify with the internal people on the project. A failed project is good for no-one. There is no positive in a failed project and there can be personal consequences such as loss of reputation and more. It is also emotionally taxing especially if formerly healthy working relationships sour in the dissolution and become marked by negativity, blame and acrimony. Having had to go through one or two debacles on IT projects they all have a few things in common. Weak management with a poor or non-existing understanding of the scope. poor buy in from the senior management (especially if they feel the project has been forced on them). Poor scope and poorer scope control. Ill-defined, vague and partial requirements. It is rare that I could actually point a finger at a consultant and say they are the one to blame for the failure. Sometimes they may have contributed or exacerbated a situation but generally the framework and the direction given are the structural flaws that form the basis of the failure.
 
Leo said:
Having been on both sides of it, consultants are generally good at doing what you ask them to. It's when you have no idea what you want, and hire them in thinking they're going to solve a myriad of problems you don't understand yourself, then you're in trouble. You can't blame the consultants here, buck stops with whoever continued to sign-off on this. A project of that size would have had multiple sign-offs at various stages, the only people with the authority to shout stop here were the same people who continued to sign on the line saying keep on paying them!
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Normally, I enjoy Leo's post, but this post is off the wall. "It's when you have no idea what you want" - the Health Service knew well what it wanted and hired dumbell advisors to execute orders i.e. provide a working personnel and wages computer system. This system worked for several government departments and there was no reason it would not work for our Health Service. The blame of the debacle lies 100% with the Consultants.

Let's say for a moment that the Consultants are blameless; then why hire them in the first place? And to make matters worse the Consultants nearly launched the iceberg stricken ship to cause more mayhem.

Socrates is right " a failed project is good for no-one." But, there were no personal consequences after such a loss. The consultancy just changed its name and moved on leaving a disaster behind. Think of what the waste of money could have done in building full and fully kitted out new hospitals.

Sorry Guys, the consultants cocked up and bigtime! The taxpayer took up the tab of course.
 
Leper said:
Sorry Guys, the consultants cocked up and bigtime! The taxpayer took up the tab of course.
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So there was no oversight, no gated stages, no progress reports, nothing?
They were given a brief and went off to execute it and were told not to come back or bother anyone until it was finished?

Either the people in the HSE gave them the wrong brief and so should be sacked or they gave them the right brief but didn't engage properly and so should be sacked.
They wasted €250,000,000 of the states money. There is no way they get to just blame "the consultants". If they were not competent to oversee the project they should have said so. They didn't and so the buck stops with them.
 
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That's not how hiring consultants works, those doing the hiring are responsible for setting the terms of the contract, and specifying the requirements for the solution they want in clear terms. If those doing the hiring have a good grasp of the issue they are trying to resolve, then they will usually produce good clear and precise requirements with little of no ambiguity.

I've seen it so many times where those bringing the consultants in are not fully informed or knowledgeable of the issue they were trying to solve, but obviously there's no way they can admit that and keep their senior position/ credibility. As they don't fully understand the issue, they have no idea how to go about resolving it, so reaching out and hiring consultants is seen as a prudent way of transferring the problem and saving face for weak management. When things go wrong then they can blame the consultants, 'sure we tried our best but those dastardly consultants just came in and took all our money'. In many cases,

I've seen the hiring side of 'dumbbell consultants', but in my experience, competent hiring managers spotted the problem very quickly and they were sent on their way, contract terminated and very little money wasted. Why is it those in our health service aren't so competent when it comes to spending our money?

I've also seen instances of consultancy hired in to large organisations where no one in management there had any real clue how their own systems worked. The result, vague specifications where accurate cost estimates couldn't be produced due to the number of open questions. Rather than answer all the questions and clarify requirements or admit they simply don't know, weak hiring management just agree to go the cost plus route and work it all out along the way. Then as the work proceeds and they realise the original spec wasn't adequate, and they need to add more requirements, the costs keep escalating and escalating. In all too many of these cases, shrewd managers who realise they're out of their depth move to other roles within the organisation so as to distance themselves from the impending disaster.

To attempt to blame the consultants here while absolving those who hired them, and continued to sign-off on their payments while delivering nothing is out of touch with the reality of business, the buck stops with those writing the cheques.
 
Leo, Purple, we're talking about a computer system to pay wages and record service here; not a space project rivalry with NASA to put a man on Mars. The goal was clear, the route was clear, the non-delivery was disastrous. Why hire consultants in the first place if they hadn't a clue? Why did the consultants accept payment(s) if the job failed? Why did the Health Service people pay them? Were Health Service people sacked as a result ? (I think I can answer 'No' to this last question).

I don't have the answers but from Leo's post above "That's not how hiring consultants work . . ." does not fuel any favourable opinion I have on the performance of consultants. Frankly, I believe those consultants were out of their depth in delivery, professionalism and action. If not, then what were they actually doing?
 
I think we're all aware of that Leper. But you do realise a system like that is in all likelihood a lot more complex than the systems that powered the Apollo missions, or indeed put a man on Mars? Just speaking from the experiences of those in my own family who work in the health service across a number of hospitals and roles, the variations of terms that are involved in a single hospital, let alone the entire system is mind boggling. How these systems were allowed to develop over the years is beyond me, but you can be sure it's the local management and unions who are responsible, not some consultant. From speaking to them when this was hitting the news, the variations and amount of local agreements would be nigh on impossible to implement programmatically, and it was clear senior management within the service didn't understand this.

Just say the consultants were out of their depth as you suggest, then it should have been obvious to even the least intelligent of health service management that that was the case. If that was the case, and it wasn't clear, then the health service management overseeing this fiasco were incompetent. Someone in the health service was regularly reviewing progress and signing-off on the work carried out by the consultants for them to continue getting paid.

If you hire someone to build me a house, and week after week they continue to carry out lots of building-like work without getting anywhere nearer to building a house, would you keep paying them for years on end? Trouble is, what happened here is someone hired a builder to build some stuff, without really being able to tell them what the stuff was, and not knowing the stuff they were building wasn't really the stuff anyone wanted, but continued to pay them all along.
 
Well, Leo both of probably think in the same square, but move in different circles. Both of us probably have loyalties not shared too. You have your opinion and long may you have it, and I have mine too. I hope for the sake of Ireland Ltd, that such cock-ups like that of PPARS will never happen again and that Consultants and Health Service management will listen without recrimination to honest and intelligent people who can tell the truth and listen less to those who shout the loudest.

Regards
Lep
 
I hear you Leper. Unfortunately I think too many people in positions of authority here across public, private and political sectors are more interested in protecting the status quo and seeing what's in it for themselves rather than putting in the very difficult work of resolving the real root of the issues at play here.
 
Leo,

I think you have it in one.

I see little leadership/vision/accountability on any issues.

As a fresh example .
On the Migrant Crisis.
I see our politicians have woken up that their voters have decided, its largely a Refugee Crisis, not a migrant one.
On all our {leaders} I am taken with the Quote about politicians, but applies to all persons in supposed authority..
{there goes the Mob ,I am their leader , I must follow}


I am not being cynical ,just getting tired !
 
Gerry Canning said:
Leo,

I think you have it in one.

I see little leadership/vision/accountability on any issues.

As a fresh example .
On the Migrant Crisis.
I see our politicians have woken up that their voters have decided, its largely a Refugee Crisis, not a migrant one.
On all our {leaders} I am taken with the Quote about politicians, but applies to all persons in supposed authority..
{there goes the Mob ,I am their leader , I must follow}


I am not being cynical ,just getting tired !
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In fairness to Brian Hayes he's been saying it is a refugee crisis and that we should take a considerable amount for weeks.
I know he's an MEP but he didn't wait to see how the wind was blowing.
 
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