Pay in the health service - 2/3's of budget

[ubiquitous]

I was just reading that in the Business Post that:

".... pay now takes up more than two-thirds of the overall health budget."

and that:

"In most of the major Dublin hospitals, pay costs account for between 75 and 80 per cent of the overall budget."

This is surely unsustainable. Crazy in fact. ....

I don't understand your point. The health service is a service, and a very labour intensive one at that. As such it is no surprise that labour accounts for such a high proportion of overall expenditure. This is no different for many other labour intensive service sectors.

 

[RainyDay]

The crucial point though is that the costs of inefficiency in the private sector are incurred by shareholders who are free to sell their stake, in the public sector the equivalent costs are incurred by taxpayers who don't have the same option. While inefficiency undoubtedly exists in the private sector it is a far greater problem in the public sector primarily because of the absence of incentive: you generally get the same rewards no matter how well or poorly you do your job. Public sector organisations also tend to have more layers of management than in the private sector, an obvious problem in the health system.

Taxpayers do indeed have other options, though admittedly they are slightly indirect. Taxpayers who don't like the current public sector system can
a) move to a different country which suits you better
b) vote and/or become politically active to change the current system
c) join the public sector and 'fix' the system from the inside

I'd love to see the evidence behind your assertions that 'inefficiency...is a far greater problem in the public sector' and 'public sector organisations....have more layers of management'. Your comments on alternative approaches to health insurance are an entirely different topic.

 

[southsideboy]

I'd love to see the evidence behind your assertions that 'inefficiency...is a far greater problem in the public sector' and 'public sector organisations....have more layers of management'. Your comments on alternative approaches to health insurance are an entirely different topic.

Are there really still people who deny that the public sector is completely inefficient??? I thought only the unions and a lot of public sector workers did this!

I think its quite clear that the use of the private sector will ultimately be the only way that the many problems in the health service can ever be sorted.

 

[daithi]

I also work in the Health Service, and IMHO the reasons for inefficiencies can be summarised thus

1.Vested Interests-Medical consultants who were responsible for devising the system we have, and are damn well not going to assist in any meaningful change to their detriment.
2.Civil Service Unions-It would be very interesing to see a breakdown of the wage and pension bill comparing frontline staff to that of administration.I agree with the poster that mentioned layers of beaurocracy within the health service
3.Political expediency-The Hanly report was to be the great panacea for all our ills-until it envisaged the closure of smaller centres in rural areas,or at least their rationalisation..a vote loser if ever there was one!As a result the report was quietly shelved,along with all the other "steering committees" and reports that successive govts have issued throughout the years.

Feck it lads, sure we might as well give Mickey McDowell a go....

daithi

 

[RainyDay]

Are there really still people who deny that the public sector is completely inefficient??? I thought only the unions and a lot of public sector workers did this!

I think its quite clear that the use of the private sector will ultimately be the only way that the many problems in the health service can ever be sorted.

Yet again, just a tad of evidence would be nice.

 

[southsideboy]

Yet again, just a tad of evidence would be nice.

Have you been to an Irish hospital recently???? Have a look around and you'll see plenty of evidence. €12billion being pumped into a health service and people are lying on trolleys...Its not to do with lack of money its to do with vested interests, unions having too much power and poor work practices where nobody seems to ever be responsible!

 

[Purple]

Taxpayers do indeed have other options, though admittedly they are slightly indirect. Taxpayers who don't like the current public sector system can
a) move to a different country which suits you better
b) vote and/or become politically active to change the current system
c) join the public sector and 'fix' the system from the inside

Not the most practical solutions I have ever seen you suggest RainyDay. By that logic the solution to noisy neighbours it to move house, the solution to bad public transport is to become a bus driver and the solution to crime problems is to join the police...

 

[zephyro]

I'd love to see the evidence behind your assertions that 'inefficiency...is a far greater problem in the public sector' and 'public sector organisations....have more layers of management'. Your comments on alternative approaches to health insurance are an entirely different topic.

There have been many reports by academics and consultants in the recent past which have documented public sector inefficiency, some are available on the internet if you have the slightest interest. I would have thought that even anecdotal evidence in the recent past would be sufficient though: e.g. PPARS, train drivers refusing to drive new trains, etc. etc. etc.

Government figures show that administrative staff numbers in the health service increased by 100% in the past 10 years while doctor and nurse numbers went up by between 20% and 40%, with the result that 40% of health service employees are administrative/management staff.

This is not even to get into the area of inflexible work practices which in some instances can only be described as Victorian.

 

[RainyDay]

Have you been to an Irish hospital recently???? Have a look around and you'll see plenty of evidence. €12billion being pumped into a health service and people are lying on trolleys...Its not to do with lack of money its to do with vested interests, unions having too much power and poor work practices where nobody seems to ever be responsible!

My experiences last year with A&E in a major Dublin hospital were pretty excellent, where a broken arm was x-rayed & plastered within 2 hours of arrival. A friend mentioned positive experiences of A&E in Waterford to me only yesterday. But this is really quite irrelevant. This thread does not contain any sensible attempt to identify & resolve the problem. It contains unsubstantiated rants.

Not the most practical solutions I have ever seen you suggest RainyDay. By that logic the solution to noisy neighbours it to move house, the solution to bad public transport is to become a bus driver and the solution to crime problems is to join the police...

I agree - not very practical - but I wasn't attempting to put out solutions. I was pointing out that the complainers have options other than unsubstantiated ranting on bulletin boards.

There have been many reports by academics and consultants in the recent past which have documented public sector inefficiency, some are available on the internet if you have the slightest interest. I would have thought that even anecdotal evidence in the recent past would be sufficient though: e.g. PPARS, train drivers refusing to drive new trains, etc. etc. etc.

Government figures show that administrative staff numbers in the health service increased by 100% in the past 10 years while doctor and nurse numbers went up by between 20% and 40%, with the result that 40% of health service employees are administrative/management staff.

This is not even to get into the area of inflexible work practices which in some instances can only be described as Victorian.

This thread is about the health service, not about train drivers or general 'public sector inefficiency'. The specific points that I questioned were the claims that specifically compared the public sector to the private sector. I'd still like to see some supporting evidence to back up the claims. The PPARS situation was an absolute disgrace, but if you are going to about comparisons to the private sector, you need to back them up. It would be nice if you could confirm your source for the employment figures you quote also.

 

[Gordanus]

Government figures show that administrative staff numbers in the health service increased by 100% in the past 10 years while doctor and nurse numbers went up by between 20% and 40%, with the result that 40% of health service employees are administrative/management staff.

Most of these admin staff are frontline ie in contact with patients ie running the outpatient clinic, supporting ward admin (relieving the nurses who used to have to do this to provide the nursing duties they were trained for!), or are providing direct clerical/secretarial support to doctors and other staff. Have the figures on this elsewhere and will post them later.

 

[zephyro]

This thread does not contain any sensible attempt to identify & resolve the problem. It contains unsubstantiated rants.

On the contrary, I and others have suggested a far greater role for the private sector to resolve the problem.

My experiences last year with A&E in a major Dublin hospital were pretty excellent, where a broken arm was x-rayed & plastered within 2 hours of arrival. A friend mentioned positive experiences of A&E in Waterford to me only yesterday.

The PPARS situation was an absolute disgrace

Do you or do you not think there is a problem in the health service? If yes, what would you suggest?

 

[RainyDay]

On the contrary, I and others have suggested a far greater role for the private sector to resolve the problem.

Yep, like I said, "This thread does not contain any sensible attempt to identify & resolve the problem"

Do you or do you not think there is a problem in the health service? If yes, what would you suggest?

I've no doubt there are many problems in the health services. I would respectfully suggest that the solutions are beyond any of the armchair experts round here (including myself).

 

[shnaek]

I don't understand your point. The health service is a service, and a very labour intensive one at that. As such it is no surprise that labour accounts for such a high proportion of overall expenditure. This is no different for many other labour intensive service sectors.

The health service is indeed labour intensive but we in Ireland seem to be pushing that to the limit. Ireland is ranked 26th in terms of the value for money offered to consumers in the healthcare sector ([broken link removed]) Would you suggest then that the best way to improve the service would be to spend more money on labour? One of the authors of this report stated on Morning Ireland this morning that a lot of health boards and clinics in Ireland seem to have been set up for the purpose of giving people jobs rather than providing a service.

Ireland has come second-from-bottom in an EU league table of most consumer-friendly healthcare systems, and it has also been rated as having the poorest value for money in the EU in terms health consumer-friendliness.

That's a quote from [broken link removed] - maybe this will be the wake up call needed to get our health service in order?

 

[nelly]

If the title "nurse" has been replaced with "clinical nurse managers level X" as I believe it has, then why the need for more administratiors? Elevating nurses to management roles seems to have entitled them to secretaries/ administrators where as before in the bad old days the nurses and matrons had to do all their own work. This would be a reason for the surge in headcount and of course salaries.

 

[Purple]

That's a quote from [broken link removed] - maybe this will be the wake up call needed to get our health service in order?

I think that major changes are taking place. The problem is that they are not high level and structural. The problem is not the staff but government inaction and the unions (nursing, consultant and clerical) that do nothing but put up barriers to change. Why are there still so many (or any) health boards? Why not just have the HSE? If there is a large amount of duplication of services then this has to be resolved by sacking hundreds if not thousands of people and using those resources to hire other people with other skills to improve the service provided. The unions will not allow the sacking of unneeded people so the people that are needed will not be hired. The people who are needed are the ones who can restructure the whole service. 'till then we will pay vast sums of money t consultants for reports that no one can implement.
The main problem with the health service is that public patients are a drain on the fixed resources of our hospitals and private patients are a source of revenue. A proper national insurance scheme would mean that the money followed the patient. At the moment there is no financial incentive to move people through the system quickly and the only way to keep costs down is to keep low cost patients in beds for longer, the so called ”bed blockers”. If this is resolved everything else will follow I time.

 

[RainyDay]

If the title "nurse" has been replaced with "clinical nurse managers level X" as I believe it has, then why the need for more administratiors? Elevating nurses to management roles seems to have entitled them to secretaries/ administrators where as before in the bad old days the nurses and matrons had to do all their own work. This would be a reason for the surge in headcount and of course salaries.

Ward clerks have been a feature of the health system for decades. Now they report to the nursing staff instead of reporting into the admin function - big deal!

 

[Purple]

I think that nelly is siting this as being indicative of a more general problem.

 

[Gordanus]

As promised, information from the HSE:

Staffing in the health service is calculated within six categories for the purposes of regular census reports. One of these categories is Management/Administrative grades.

At end 2005 there were 101,972 staff employed in the health service. 16,699 of these were in the clerical/administrative/managerial category. The remaining 84% were in the other 5 categories such as Medical, Nursing, etc.

It is important to understand that the management/administration category can actually be misleading as it includes, beyond the 3,000 purely administrative posts, a majority within its ranks that are actually supporting frontline service delivery.

Typically these staff would include Consultants secretaries, telephonists and receptionists, Out-Patient Department staff, Medical Records staff and many other functions involving direct contact with patients and clients. The largest group of those involved are at Clerical Officer level. Their work and that of many of their colleagues involves providing support to our Clinicians, supporting the smooth running of hospitals and community facilities in relation to medical records, patient appointments and other such duties which free up medical practitioners to devote themselves fully on patient needs.

Other so-called administrative staff work with the public on processing their applications for Medical Cards, or assisting with applications for Nursing Home Subventions and in areas such as provision of European Health Insurance Cards for people travelling abroad on their holidays.

 

[Gordanus]

and the only way to keep costs down is to keep low cost patients in beds for longer, the so called ”bed blockers”. If this is resolved everything else will follow I time.

I think the reason that the 'bed blockers' aka long term patients are kept is that there isn't anywhere for them to go. Not enough nursing homes and other non-acute care/rehabilitative care. This is the elderly and people with chronic disorders and disabilities. Or should we do an NHS and just toss them out on the street?

 

[nelly]

I think that nelly is siting this as being indicative of a more general problem.

Correct,

My mother retired a few years ago at 65 after nursing in Ireland fulltime for many years and was glad to do so as the quality of nurses in her opinion was falling barring the few exceptions. Having called in to her over the years i can say that the "ward clerk" was the Matron who managed the ward and also carried out nursing duties - try get a clerk to make a bed now!. Now in this ward there is are brand new levels of management when the matron retired. My point is, if they could operate without it for years ( being "under educated" nurses with mere certs and maybe diplomas no sign of degrees in those days) then why do we need it now?

However in balance SOME nurses now and in the past years do many hours overtime unpaid, giving reports to the next shift nurses when theirs are done, these are the ones who should be paid overtime.