Public Sector pay in Budget 2019

[Purple]

Is there no consideration to be made that perhaps low paid private sector workers are underpaid?

No. We have very high minimum wage levels and even higher levels of social transfers. We also have a large cohort of the workforce which is very underskilled. That's where we should be spending money.

Considering increasing homelessness, considering the amounts of people in receipt of rent supplement, FIS, etc is it not becoming apparent that the incomes of low paid are increasingly insufficient?

No, it's apparent that there is a shortage of housing and it is blindingly obvious that increasing money supply without increasing housing supply will just push up prices even more.

Certainly DOB only last June pointed to a growing lean, competitive economy that wasnt manifesting in wage increases in the private sector.

Okay, so?

That sounds like you were part of a lobby group?

Nope, just asked to participate as someone from industry who worked with University Start-up's and had some dealings with Science Foundation Ireland. T'was a brief affaire.

 

[TheBigShort]

Right, so structural deficiencies in the day to day running of hospitals, the failure to identify, define and implement best practice is a failure of policy and not management... and that’s not bogus?

Every organization has inefficiencies. If you can identify specific examples then those can be addressed if valid. What is bogus is the broad sweeping generalisations and the emotive clap-trap.
If a&e units are overcrowded every Saturday night because of an influx of intoxicated drink and drug revellers, what is the answer? Build bigger a&e units? Or spend money on education? Open new wards?

Why, does nobody in the health service or local authorities have the wit or intellect to improve anything?

There are some 60,000 people working in the HSE. Your generalisations are simply hyperbole. Take a look at UK or US, and you hear about the same problems, overcrowding, waiting lists etc, occurring in those countries as we have here.
Is this a coincidence?

 

[Firefly]

Why, does nobody in the health service or local authorities have the wit or intellect to improve anything?

Don't worry. We have the solution:
"The health budget is being increased by €1.05 billion next year, bringing the total to €17 billion".
17 big ones. Wait until you see what we'll get for that!!

 

[TheBigShort]

No. We have very high minimum wage levels and even higher levels of social transfers. We also have a large cohort of the workforce which is very underskilled. That's where we should be spending money.

Why should 'we' be spending the money on educating people for jobs that can barely pay the rent?
In my opinion we need to increase incomes of working people to reduce the cost of social transfers that should not be required for working people in the first place.

No, it's apparent that there is a shortage of housing and it is blindingly obvious that increasing money supply without increasing housing supply will just push up prices even more.

Granted we need more housing. But if incomes increase and welfare payouts reduce this wont increase pressure on prices.
If I earn €500 and get €200 rent supplement im effectively earning €700. If my income increases to €700, disqualifying me from rent supplement, im still only earning €700.

Don't worry. We have the solution:

You certainly dont.

 

[Purple]

Every organization has inefficiencies. If you can identify specific examples then those can be addressed if valid

Typical default answer by people who are unwilling to admit that they are part of the problem. Contemptible.

If a&e units are overcrowded every Saturday night because of an influx of intoxicated drink and drug revellers, what is the answer?

A&E unit are overcrowded because there isn't anywhere to put the people who have been seen, not because they can't get through the workload in the A&E departments. We spend more than just about everyone else on healthcare and, despite having a very young population, have some of the worst waiting lists and overcrowding problems. And you're telling me there's nothing wrong with the structures, the processes and the work practices; it's all down to ideology. You're telling me that having consultants on call to discharge patients and better step-down facilities won't alleviate the problem and save money, no, it's all down to ideology. Claptrap.

There are some 60,000 people working in the HSE.

There are 102,000 people working for the HSE (about 1 in every 20 people who works in Ireland). 67,000 are direct employees and 35,000 work for agencies which are funded by the HSE. That doesn't include those working in the multi-billion Euro private healthcare sector in this country.
I have never spoken to a nurse or doctor or other employee in the HSE who thinks it is a well structured and well run organisation. I have never spoken to any nurse or doctor or other employee in the HSE who thinks there isn't massive duplication of process and vast amounts of wasteful activities. You seem to know better though.
Go through the admission process in a few Irish hospitals and you'll see that some are much more efficient than others. Why is best practice not being identified and used everywhere?
The same applies to how outpatient clinics are run.
The same applies to administration processes.

etc.

etc.

 

[TheBigShort]

And you're telling me there's nothing wrong with the structures, the processes and the work practices; it's all down to ideology.

I never said that. Quite clearly I stated that that all organisations have inefficiencies. My point is that I dont tar everyone with the same brush.

You're telling me that having consultants on call to discharge patients and better step-down facilities won't alleviate the problem and save money,

See, you have identified an apparent inefficiency in the system. One that in no way shape or form could relate to all 60,000 staff, 35,000 indirect staff etc.
Im sure the system you are recommending would be of benefit, but im wondering how much it would cost?

I have never spoken to a nurse or doctor or other employee in the HSE who thinks it is a well structured and well run organisation

Of course not. Its massive and unwieldy. Im guessing however that none of the nurses or doctors identified themselves as inefficient? Im guessing that very few would describe themselves as inefficient. Im guessing that they can spot inefficiencies, which is different.

Go through the admission process in a few Irish hospitals and you'll see that some are much more efficient than others.

I have had very little opportunity, mostly with my kids and elderly parents. By and large the service is excellent if not transparent (too many repeat visits for elderly for different ailments).
I had a back injury once, unable to sit down. I was examined by a trainee doctor who let me go home recommending Solphadine on the basis that I was still able to walk.
On call doctor had to come next day as I was laid out flat at home. He gave me an injection into the back. Loosened everything up and I was up and running again. I paid €100 a&e charge because I wasn't admitted to hospital and then €120 for on-call. It could have been sorted in a&e.

 

[Purple]

Im guessing that very few would describe themselves as inefficient. Im guessing that they can spot inefficiencies, which is different.

If you work in an inefficient system or process then you are inefficient. Being inefficient is not the same as being slow or being lazy or being bad at your job. It is a reflection of the process or activity, not the person carrying out that activity. You seem to be unable to understand that. Why?

 

[TheBigShort]

If you work in an inefficient system or process then you are inefficient.

Ok we are in danger of splitting hairs here. I would suggest differently.
If a worker can carry two boxes at a time but the system says he should only carry one, then if the worker carries one box at a time they themselves are not inefficient. They are simply doing what it is that they are required to do.
The system is inefficient, but the person working in it is not (take your nurses and doctors for example).
The inefficiency lies with the job holder (typically management) who decided only one box is to be carried even though two could be carried.
That is why I dislike your broad sweeping generalisations.
There are many thousands of different processes throughout the health service. Between providing best available care and value for money I would imagine it is a huge task. That said, no reason why it cannot be achieved.

 

[Purple]

Ok we are in danger of splitting hairs here. I would suggest differently.
If a worker can carry two boxes at a time but the system says he should only carry one, then if the worker carries one box at a time they themselves are not inefficient. They are simply doing what it is that they are required to do.
The system is inefficient, but the person working in it is not (take your nurses and doctors for example).

No, the person working an inefficient system is inefficient. They may well be getting the best possible output from the system as constructed but their output is still much lower than it could be. Therefore they are inefficient. They can be working their ass off but they are still inefficient.

The inefficiency lies with the job holder (typically management) who decided only one box is to be carried even though two could be carried.

The root cause of the inefficiency is the process (job holder is a new term to me) but everything that happens after that is inefficient. It is not possible to be efficient while operating in an inefficient process.

That is why I dislike your broad sweeping generalisations.

You just don't understand what I'm saying.

There are many thousands of different processes throughout the health service. Between providing best available care and value for money I would imagine it is a huge task. That said, no reason why it cannot be achieved.

Agreed; the big solution is usually thousands of small solutions. There aren't just many thousands of processes within the health service but there are many versions of each of those processes. The first step it to identify them and decide which version is best and just use that version. The hospitals under the RCSI are doing this, to a limited extent, but no others. I think there is a role for HIQA in that area since quality should mean the process quality. I often point out to people that ISO:9001 isn't about the management of your quality system, it's about the quality of your management system. A good management system looks for efficiency on an ongoing basis. Anything else is not fit for purpose.

 

[TheBigShort]

You just don't understand what I'm saying.

Nothing unusual there

I get what you are saying Purple, systems and processes are inefficient, thus making the worker inefficient. You are not criticising the application to the work, but rather how the work is set out.
That is my sentiment, only if a worker is signed up to do a process a certain way, and they complete that process I would describe them as efficient at what they are tasked to do.

 

[Purple]

That is my sentiment, only if a worker is signed up to do a process a certain way, and they complete that process I would describe them as efficient at what they are tasked to do.

That's because you have an ideological problem with a criticism of a process or procedure without a caveat explicitly exonerating the "wurker" carrying out the task. It's just public service defensiveness.
I'd add that if you are being asked to do a task in an inefficient way you should point that out and suggest an alternative. If the structures are not there to adopt that suggestion then it is a structural failure of management and shows management process inefficiency.

 

[Opus2018]

Hi lads,

One question relating to the HSE - what happened to managment of the various health boards once the HSE was set up? I'm sure some of them got a management role in the new organisation but what happened to the others? (There were 8 health boards so far as I remember).

I wonder how much this adds to the inefficiency of the health system?? I could also mention the power of the consultants, but maybe that's another story.... Two things to consider and examine, mind!

Best,

Opus 2018

 

[Delboy]

What do you think happened to them! They were all given new roles on the same packages or better in the HSE.
Not 1 job was lost when the Health Boards rolled into the HSE except by someone leaving of their own choice.

Job for life rules apply

 

[AlbacoreA]

I've lost count the number of times efficiency is blocked for no good reason, public and private. Some people (often management) are simply change proof.

 

[Purple]

I've lost count the number of times efficiency is blocked for no good reason, public and private. Some people (often management) are simply change proof.

I agree. It is usually management who resist change. Add to that Unions in the Public Sector who want more money for every change and the chance of improvement is minimal.

 

[AlbacoreA]

Its not unusual for management to antagonise staff and unions causing conflict where none is required. I've no love for unions but its not always initiated by unions.
I think its just human nature. Its like a child or parent or sibling won't take advice from another family member but will take that same advice if given from a stranger.
I think lateral thinking and an open mind to new ideas isn't that common.

Which is why if you frequent some health services you quickly work out the facilitators and the blockers.
In one consultants office I've dealt with, one secretary takes months to process paperwork the other a week or two.