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

[RainyDay]

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!.

Please name the hospital which allegedly had no ward clerks up to a few years ago?

 

[Purple]

Rainyday, my experience of the service provided in Hospitals is very good but I think that the value for money is just not there. Do you think all is as it should be in the health service or do you think that things should be better considering the resources available?

I am not disagreeing with your points but you are not allowing those reading them to put them in context, i.e. what are your views on the core issue?

I believe that my view that the cash should follow the patient is the policy of the labour party ( I think you may have pointed this out to me in the past on AAM) and is supported by right-wing commentators such as Moore McDowell.

 

[RainyDay]

I'm certainly not claiming to have all the answers. I would humbly suggest that most of the off the cuff remarks about privatisation or sacking the staff or unions have no sound basis.

I can certainly see benefits from the 'money follows the patient' approach, aka 'universal health insurance'. I have some concerns that we'd end up with the HMO saying 'no' instead of the the HSE saying no, though Liz McManus tells me that the HMO's got undue bad press.

I heard an eminent medical consultant explaining last week the increased funding to the health service over recent years still hasn't filled the gap arising from the starving of resources going to back to McSharry's budget in 1987 (after winning the election with 'Health cuts hurt the old and the handicapped' posters).

 

[southsideboy]

I'm certainly not claiming to have all the answers. I would humbly suggest that most of the off the cuff remarks about privatisation or sacking the staff or unions have no sound basis.

You have to realise that there is a big distinction between utilising the private sector for public gain and privatisation. There are currently no politicial parties that are advocating the privatisation of the health service. Instead what is being suggested by Mary Harney and others is that the state can pay the private sector to treat public patients. This is already happening under the National Treatment Purchase Fund which has been very successful where consultants have implemented it. It makes perfect sense to use the private sector as they are more efficient. Just look how quickly state of the art hospitals can be built by the private sector compared to the public sector. Anytime I've used a private hospital I haven't had to endure the long waits that one has to in the public sector. How often do you see private hospital staff going on strike? Morale is a lot higher in these hospitals because the are more efficiently run and they are being run by high class management and not by unions. I'm not saying that we should become over reliant on the private sector but surely it makes sense to utilise what is there rather than let people suffer at the hands of an ailing public system.

The reason why the left, in particular Liz McManus is so against the use of the private sector is because the Labour Party is based on a socialist/marxist ideology whereby everything should be public and the private sector should not be allowed at all. If you listen to Liz McManus' speeches it sounds like she would close down the likes of Blackrock Clinic or Beacon or Mount Carmel tomorrow if she could. She hates private enterprise in the health service. The reality is that for non a&e cases the wealthy generally choose to use the private sector. Why would they do this? Clearly because they believe it to be better and more efficient. So my point is why don't we allow people who can't afford this luxury use it at the expense of the tax payer instead of discriminating against them based on income! Surely the most socially caring option is to use the private sector whereby the rich pay for it and the poor are subsidised by the tax payer. This will help end a two-tier system unlike the left's option which effectively would allow the rich still use the private sector or travel abroad for treatment while the poor are left to suffer on trolleys as a result of years of inefficiency and vested interests. People need to stop looking at the health service from ideological perspectives and need to look at practical solutions.

 

[RainyDay]

Whoa, let's take a reality check.

1) The so-called private hospital sector in Ireland is hugely subsidised by taxpayers money, yet is is only available to about 50% of the population. Harney is pushing the HSE into [broken link removed]. The private hospital developers [broken link removed]. The cost of private beds in public hospitals is nothing near the full economic cost of those beds. If the private hospitals are doing so brilliantly, when are they going to stand on their own two feet. Why is state money going to services which are only available to 50% of the population.

2) Broad comparisons of public to private hospitals are meaningless. I'd love to see any evidence to support your comments about morale and build times. But regardless, you are not comparing like with like. Private hospitals cherrypick the services they provide and the patients they treat. If you want to do a fair comparison, set up a public hospital with no messy A&E department, let the cherry pick the patients who have better diets, better access to other services, better living conditions and see how the comparison works.

3) The NTPF works great for the patient, but not so well for the taxpayer. We are paying twice for the same service. A significant number (30%-40%) of the operations are carried out in the same hospital where the patient was on the public waiting list, so we are paying twice to have this procedure carried out.

4) Your 'ideaological perspectives' are about 20 years out of date. There is no Labour policy around closing down private hospitals or 'hating' private enterprise. There is a determination to get fairness into the system, so taxpayers funds aren't subsiding services only available to the priviliged few.

I wonder how high the morale levels in the [broken link removed] are this week?

 

[Purple]

Whoa, let's take a reality check.

1) The so-called private hospital sector in Ireland is hugely subsidised by taxpayers money, yet is is only available to about 50% of the population. Harney is pushing the HSE into [broken link removed]. The private hospital developers [broken link removed]. The cost of private beds in public hospitals is nothing near the full economic cost of those beds. If the private hospitals are doing so brilliantly, when are they going to stand on their own two feet. Why is state money going to services which are only available to 50% of the population.

A good point. I have no problem with the concept of tax breaks but only when they for an open sector of the economy. Health is far from open and normal market forces do not apply. The only thing worse than a badly run public health system would be a badly regulated private one. I would not like to see the same bunch of insiders making a killing (pun intended) on the health service and fecking off like they seem to do whenever the government come up with a bright idea to use the private sector to save money.

2) Broad comparisons of public to private hospitals are meaningless. I'd love to see any evidence to support your comments about morale and build times. But regardless, you are not comparing like with like. Private hospitals cherrypick the services they provide and the patients they treat. If you want to do a fair comparison, set up a public hospital with no messy A&E department, let the cherry pick the patients who have better diets, better access to other services, better living conditions and see how the comparison works.

No A&E is the main factor but again I agree.

3) The NTPF works great for the patient, but not so well for the taxpayer. We are paying twice for the same service. A significant number (30%-40%) of the operations are carried out in the same hospital where the patient was on the public waiting list, so we are paying twice to have this procedure carried out.

To be more accurate, we are paying the consultants twice.

4) Your 'ideaological perspectives' are about 20 years out of date. There is no Labour policy around closing down private hospitals or 'hating' private enterprise. There is a determination to get fairness into the system, so taxpayers funds aren't subsiding services only available to the priviliged few.

I still think that the Labour party have a "Private sector Bad" mind set, just as the PD's have a "Public sector Bad" one.
The answer is proper regulation. A money follows patient system would mean that it doesn't matter who own the hospital since the government would be the source of funding, not the individual. The only way this would work would be if there was a proper mechanism to set funding levels for each procedure. We could copy the German system for this.
I have no problem with paying more tax in general and more for the health service in particular but I would like it well spent. I see no evidence that this is the case at the moment.
All I see in ineffencies that are defended and protected by the unoins, vested interests such as the consultants that refuse to work in the best interests of the parients and a government that cannot come up with anything other than a band-aid fix for the problems. It's depressing.

 

[shnaek]

I have no problem with paying more tax in general and more for the health service in particular but I would like it well spent. I see no evidence that this is the case at the moment.

Indeed. We came 26th out of 26 in terms of value for money in that recent European Health survey. Hardly encouragement to invest more in it.

 

[ashambles]

I heard an eminent medical consultant explaining last week the increased funding to the health service over recent years still hasn't filled the gap arising from the starving of resources going to back to McSharry's budget in 1987

I've heard an eminent medical consultant mention that point many times now. Unfortunately his level of eminence seems to prevent any questioning of his statements.

At the very least he's distorting the picture. Firstly our funding of the health is much higher now even taking inflation into account, and secondly our staffing levels are higher.

It'd be interesting to know his opinions on why with less funding and less staff the health service was able to provide more critical care beds before the 80s cuts. There are valid reasons for this but it's the sort of question that needs to be asked.

 

[Purple]

Given their behaviour over the last few years I do not take the opinions of medical consultants very seriously. I any of them said that they were a major part of the problem then I would listen with interest to the rest of their comments. Without that admission their opinions hold little value.

 

[RainyDay]

A money follows patient system would mean that it doesn't matter who own the hospital since the government would be the source of funding, not the individual. The only way this would work would be if there was a proper mechanism to set funding levels for each procedure. We could copy the German system for this.

This sounds good in theory, but I'd have concerns about how it would work in theory. How do you measure the quality of care in different hospitals. Will patients be pushed out of hospital before their time to save money? Will we be paying for teams of accountants and IT heads to build 'measurement systems'? Like any measurement system, will the administrators and medics then start 'playing the system'?

 

[Purple]

This sounds good in theory, but I'd have concerns about how it would work in theory. How do you measure the quality of care in different hospitals. Will patients be pushed out of hospital before their time to save money? Will we be paying for teams of accountants and IT heads to build 'measurement systems'? Like any measurement system, will the administrators and medics then start 'playing the system'?

The same system is used in Germany and works well. You as a patient can choose which hospital to use so if their standard of service is not good the patients (and income flow) will not come. Obviously specialist care is less mobile.
It is down to the ability of the HSE or other government agency to regulate and I agree (again) that this is the biggest potential problem.
Until we can get away from the scenario where local pressure groups can derail national policy implementation all of the above is just a pipe dream.