IMF could take over and "order" mass dismissal of public servants

[X-ray]

"I dont understand how you run a 24 hour out of hours on call service without extra payments to those covering the extra hours. It would be hugely more expensive to hire additional staff to cover these shifts and on-call duties." X-ray.

From your point of view, if you are paid a very low, less than time flat rate for being available to work, but not actually working, then I can understand this logic.
For a group such as NCHDs, however, who work 80 hours a week average it would be economically more sensible to hire a whole lot more of us, and pay us all flat rate and no-one work more than 40 hours a week. Hiring two people and paying them at flat time and rostering them on at different parts of the day is always going to be cheaper than paying out time and a half to one person, because then you are only ever paying anyone at flat time rate. We would need to almost double the numbers of NCHDs to achieve this, but it could be done, perhaps paying time and a quarter for those doing a week of nights as an unsocial hours premium.

Yes there is some truth in that, however I work very similar hours to NCHDs. They pay me extra when I am busy so it works for the hospital. It they need me I am available. I would love if the hired extra people to work shifts and go rid of on call, particularly if I was the one sat in theartre all nite when there were no operations or whatever. Instead of one person cover the 24hour period you then have three 8 hour shift or two 12 if you like, but it adds up to three time more staff either way. Also my pension is not based on my out of hours payments, but if they were shift and my core hours pensions would be payable.
People in the country cannot get their head around the fact that if you want a service you have to pay for it. If you want a hospital full of staff at 2am it is a very costly business. The way it is structured now is one of the cheaper models but is not very patient or staff friendly.

I would love to work three 12 hour days or nights and say goodbye to the hospital for the week, it will not happy when they cost that option. The costs extend to providing additional training places for all the extra staff the would be required by the system and post grad courses to up skill existing staff to cover multiple clinical areas without back up. It is hugely more costly and complicated than some like to pretend.

Currently you have a 9-5 core system. To even move to 8-8 would at least double the current expeniture and also increase capital costs. Anyone who says otherwise is either not telling the truth or does not understand how the hospital is staffed.

Your point about additional doctors is very true though, the amount of hours worked on a rountine basis are hugely clinically, financially and personally expensive for all involved. Like all these plans that are made it was half baked to start with, badly implimeted and very explained to anyone affected by it. I suspected the recession will be the end of any extended working hours for hospitals. The consultants got a great deal being paid for something that will not happen.

[bormotello]

Yes there is some truth in that, however I work very similar hours to NCHDs. They pay me extra when I am busy so it works for the hospital. It they need me I am available. I would love if the hired extra people to work shifts and go rid of on call, particularly if I was the one sat in theartre all nite when there were no operations or whatever. Instead of one person cover the 24hour period you then have three 8 hour shift or two 12 if you like, but it adds up to three time more staff either way. Also my pension is not based on my out of hours payments, but if they were shift and my core hours pensions would be payable.
People in the country cannot get their head around the fact that if you want a service you have to pay for it. If you want a hospital full of staff at 2am it is a very costly business. The way it is structured now is one of the cheaper models but is not very patient or staff friendly.

I would love to work three 12 hour days or nights and say goodbye to the hospital for the week, it will not happy when they cost that option. The costs extend to providing additional training places for all the extra staff the would be required by the system and post grad courses to up skill existing staff to cover multiple clinical areas without back up. It is hugely more costly and complicated than some like to pretend.

Currently you have a 9-5 core system. To even move to 8-8 would at least double the current expeniture and also increase capital costs. Anyone who says otherwise is either not telling the truth or does not understand how the hospital is staffed.

Your point about additional doctors is very true though, the amount of hours worked on a rountine basis are hugely clinically, financially and personally expensive for all involved. Like all these plans that are made it was half baked to start with, badly implimeted and very explained to anyone affected by it. I suspected the recession will be the end of any extended working hours for hospitals. The consultants got a great deal being paid for something that will not happen.

What are you saying is very well defined mathematical task, described many times. What I can see, nobody from Mary Harney friend didn’t use this approach, when he giving advice to her. They came from centralised model, which is easy to calculate, but it doesn’t giving much improvement and reduces initiative of local managers. Distributed model is very difficult to calculate, because you have in account human factor, geography, road network status and many other things.

See, people want to see value for money, not only money spent without any result
Look in this document
http://www.oecd.org/dataoecd/45/53/38979894.pdf

Despite increasing numbers of doctors in recent years, Ireland continues to have a lower number of physicians per capita than in many other OECD countries. In 2006, Ireland had 2.9 physicians per 1,000 population, compared with an OECD average of 3.1. While the number of doctors per capita in Ireland is higher than in the United States, Canada, the United Kingdom and Australia, it is lower than in many European countries.
On the other hand, Ireland has a very high number of practising nurses, with 15.4 nurses per 1,000 population in 2006, significantly above the OECD average of 9.7.
The number of acute care hospital beds in Ireland in 2005 (most recent year available) [COLOR="Red"]was 2.8 per 1,000 population, below the OECD average of 3.9 beds [/COLOR] per 1,000 population. In most OECD countries including Ireland, the number of hospital beds per capita has fallen over time, due to a reduction of the average length of stay in hospitals.
In most OECD countries, there has been rapid growth in the availability of diagnostic technologies such as computed tomography (CT) scanners and magnetic resonance imaging (MRI) units in recent decades.
With 9.7 MRI units and 12.8 CT scanners per million population in 2006, Ireland lags behind the OECD averages of 10.2 and 19.2, respectively.

As you can see, Ireland has twice as required number of nurses per bed and per doctor. It means, that if somebody will properly organise procedures for nurses, you can fire around 40% of nurses without any loss of services.
There are 19,321 nurses and around 40% of them are not used efficiently, because too many stupid managers in HSE(FG will fix it very soon). I know very well the way, when manager is writing stupid procedures, to keep his staff busy, otherwise his bosses will ask him “What are you actually doing?”
Why not to reduce number of nurses and improve procedures for efficient use of remaining?
[SIZE="3"]Will unions allow it?[/SIZE]
6000 nurses on 30K salary will give us 180,000,000 per year, may be more
6000 less nurses will require 400 less managers. 400 managers on 50K will give another 20 millions.
I am sure that you can reduce clerical staff without any lose of efficiency, if you will redefine procedures. 20% from 7500 is 1500. 1500 on 30K is 45 millions.
See – you can save 250 millions without any loss of performance, just by optimising staff responsibilities and firing unused staff.

[X-ray]

What are you saying is very well defined mathematical task, described many times. What I can see, nobody from Mary Harney friend didn’t use this approach, when he giving advice to her. They came from centralised model, which is easy to calculate, but it doesn’t giving much improvement and reduces initiative of local managers. Distributed model is very difficult to calculate, because you have in account human factor, geography, road network status and many other things.

See, people want to see value for money, not only money spent without any result
Look in this document
http://www.oecd.org/dataoecd/45/53/38979894.pdf

As you can see, Ireland has twice as required number of nurses per bed and per doctor. It means, that if somebody will properly organise procedures for nurses, you can fire around 40% of nurses without any loss of services.
There are 19,321 nurses and around 40% of them are not used efficiently, because too many stupid managers in HSE(FG will fix it very soon). I know very well the way, when manager is writing stupid procedures, to keep his staff busy, otherwise his bosses will ask him “What are you actually doing?”
Why not to reduce number of nurses and improve procedures for efficient use of remaining?
[SIZE=3]Will unions allow it?[/SIZE]
6000 nurses on 30K salary will give us 180,000,000 per year, may be more
6000 less nurses will require 400 less managers. 400 managers on 50K will give another 20 millions.
I am sure that you can reduce clerical staff without any lose of efficiency, if you will redefine procedures. 20% from 7500 is 1500. 1500 on 30K is 45 millions.
See – you can save 250 millions without any loss of performance, just by optimising staff responsibilities and firing unused staff.

I work in a hospital and I cant see too many nurses, not too worried about figures or graphs. I have two eyes.

[bormotello]

I work in a hospital and I cant see too many nurses, not too worried about figures or graphs. I have two eyes.

Are saying that HSE is lying about number of nurses employed and big fat cats in HSE are stealing money.
BTW, anytime I go to hospital, I see a lot of nurses chatting and doing nothing.
Maybe they are hiding from you.

[X-ray]

Are saying that HSE is lying about number of nurses employed and big fat cats in HSE are stealing money.
BTW, anytime I go to hospital, I see a lot of nurses chatting and doing nothing.
Maybe they are hiding from you.

I am saying you dont know what you are talking about and I would take any figures quoted with a very large dose of salt. The HSE has an agenda and it involves alot of cuts to save money for the government.

I find the hospital system to be very badly under resourced in terms of staff and facilities. Seeing a few people "chatting" is hardly a basis for a policy. They are not 18th century coal miners, talking is allowed.

Alot of the reason the health system is arse ways is becuase it reacted to public opinion like yours in the past that demanded all sorts of things that were foolish. The system is very complex and simple one liners will not do it any good. I dont see any reason to believe staff are "stealing money" either.

We can cut the numbers of staff in hospitals and if that is the public demand it will happen. But you as came up with the idea can sort out the result. The result could not be more serious.

There was an exampe recently of nurse levels being cut in a hospital in stafford against clinical advice resulting in hundreds of deaths. Managers following graphs and ignoring patients on teh ground is a very dangerous route to take.

Expect a truely dreadful service over the coming years.

[bormotello]

I am saying you dont know what you are talking about and I would take any figures quoted with a very large dose of salt. The HSE has an agenda and it involves alot of cuts to save money for the government.
I find the hospital system to be very badly under resourced in terms of staff and facilities. Seeing a few people "chatting" is hardly a basis for a policy. They are not 18th century coal miners, talking is allowed.
Alot of the reason the health system is arse ways is becuase it reacted to public opinion like yours in the past that demanded all sorts of things that were foolish. The system is very complex and simple one liners will not do it any good. I dont see any reason to believe staff are "stealing money" either.

As I can see, you don’t know anything about management and you don’t understand how any business system is working.

Performance of HSE depends from
1) number of beds ( lowest in Europe)
2) equipment (lowest in Europe)
3) number of doctors ( lowest in Europe)
4) number of nurses (highest in Europe)
You cannot replace one bed by two nurses. You cannot fit two patients into one bed. You cannot replace CT by nurse. Doctors cannot do more what they can do without overtime.
If you saying that with highest number of nurses per capita, per bed, per doctor and per X-Ray machine you still understaffed, you need to stop everything and go to another country to see how they are handling health system with lower number of nurses per capita and without any huge waiting lists.
You actually confirmed that management in HSE doesn’t deserve even minimum wage, because nobody from them is don’t know anything about performance.
“I got a problem, I need extra staff, if they will be not used full time, we can find something for them”
This is typical approach for state body.
It is government and taxpayers problem to give them money, which they can waste without any result.
And if anybody else will come and will try to introduce procedures, which are working in another countries, nurses will immediately will start to cry, because they never worked with maximum performance. Then unions will start to defend them and as result country will left with rubbish, which called HSE.
Hazlit was right – system must be started from scratch. Nobody from HSE management should be allowed to enter new system. New hospitals must be built. Management for those hospitals must be trained outside of Ireland. Some of critical staff must be trained as well. It should not be private hospitals, as it is now, which actually hotels, charging few grant per night, but using the same lazy staff and stupid doctors as state hospitals.
Have a look on VHI Clinics – they charging two times more then state A&E, but with the same number of staff you will be serviced in 15 minutes, rather then five hours in Tallaght A&E. And I have suspicion that they are profitable as well without any state support. Polish clinics are doing very well. They charge 40% less then irish doctors, but you always can get an appointment within one-two days. Not six months as it state hospitals.
I agree, when system is overloaded – it will lose performance. But it was the job of HSE employees to say to government that they need more hospitals. But in this case they had to work a little bit efficient, may be a little bit harder, what unionised lazy HSE staff cannot afford. They stay on critical path and they will not allow to push them to work harder. Job of unions is to keep all lazy bastards in the critical areas and don’t allow anybody to criticise them.
Crisis is actually is good thing. At least people can have a look for what they are paying money and may be decide do not pay money at all in order to smash unions completely from public services.

There was an exampe recently of nurse levels being cut in a hospital in stafford against clinical advice resulting in hundreds of deaths. Managers following graphs and ignoring patients on teh ground is a very dangerous route to take.

You need to have some brains for implementing somebody ideas. You just proofed that managers in state hospitals doesn’t have any brains, only deep pockets. NHS is not an exception.

Expect a truely dreadful service over the coming years.

Do you think that it can be worse?
People are dieing in hospitals due incompetence of staff, due poor hygiene and think that people can be proud of HSE performance under full financing

[jimmyfour]

There are loads of nurses but very few of those nurses want to actually nurse, despite getting relatively high salaries for the post they are in. Instead, they want to become senrior managersm, nurse managers, hospital managers, basically anything managers as long as it doesn't involve helping doctors provide patient healthcare.

Example: nurses refusing to do tasks that are nursing tasks, like phlebotomy ("I need a special course to do it, and then I need to be paid extra if I ever actually take any blood"), NG tubes ("I don't do it because the INO says it's not a nursing duty"), IV cannulae ("I;m not trained to do it"). all of these bread and butter nursing tasks are done in other countries, but in Ireland, the doctors have to spend an age doing them because the nurses refuse to with union and hospital management support (because hospital management is primarily made up of ex-nurses who didn't really like the whole nursing aspect).

So, when you wonder about why the hospitals run so badly, look at who is managing what and what their background is. The managers used to be from the religious orders; they have been replaced by the "nurse-manager".

Remember this: doctors (NCHDs or Consultants) do not run the health service; they do not decide what services get money and what do not. They do not decide what wards are open or how many trolleys are in A/E. All of these decisions on the day to day running of the wards and logistics of the hosptials and community clinics is primarily by nurse-managers; this is why we have one of the highest number of nurses in the world, all picking up fat bonus paychecks for being Grade V Manager Nurse, etc., but very few actual nurses doing actual nursing, and with most doctors having to do a range of nursing and clerical tasks so they end up claiming huge overtime (e.g., interns running aroudn at 9pm doing IV lines, yet when they make SHO they cannot do a central line as they spent a year doign nursing tasks whereas in the US, the intern will learn the more advanced medical procedures because people are willing to know their role. Hence longer training, more expensive overtime for little return, and why they (doctors) all leave eventually!

[jane5]

Hear hear, Jimmy.
I would say that most nurses I know actually do want to do these things, but are prevented from doing so by ridiculous policies and rules made at nurse management/Bord Altranais/INO level. Two of my best friends from school are nurses, and they are so disillusioned at studying for a degree, doing work experience, becoming a qualified nurse, and then not allowed to do much of anything that constitutes nursing in any other Western country. One of my friends became so drained with the whole thing and felt so undervalued that she left and went to Oz-she was competent to read ECGs and was not allowed to DO one! if you can believe that.

The first doses, IV lines, phlebotomy, NG tubes, ECGs, catheters etc, all being done by nurses in other countries and here they are often not allowed to remove a surgical drain! one nurse on the surgical wards in my current hospital had nursed in the UK for years and was trained so well, she could initiate dialysis when needed, etc. She was not allowed to remove a simple vac drain here in Eire, and was more than pissed off, she was insulted by this.

We don't as a country value our nurses enough to trust them with the tasks that they are highly trained to do and more than competent to do, and it is impacting greatly on our health service and our ability to provide better care.

Down Under when I worked there, I would see sometimes 25 patients in a day, new admissions, when on call to the A&E for my specialty. This would be impossible here, as I would be putting in IV lines, taking bloods, giving first doses, doing ECGs, catheters-I might see and sort out as many as ten, and that would be tiring and take ages.

People are waiting for doctors and for treatment because of these policies. And nurses are leaving because they don't feel respected and valued by being denied the right to upskill and do their jobs well. It is a travesty.

[X-ray]

As I can see, you don’t know anything about management and you don’t understand how any business system is working.

Performance of HSE depends from
1) number of beds ( lowest in Europe)
2) equipment (lowest in Europe)
3) number of doctors ( lowest in Europe)
4) number of nurses (highest in Europe)
You cannot replace one bed by two nurses. You cannot fit two patients into one bed. You cannot replace CT by nurse. Doctors cannot do more what they can do without overtime.
If you saying that with highest number of nurses per capita, per bed, per doctor and per X-Ray machine you still understaffed, you need to stop everything and go to another country to see how they are handling health system with lower number of nurses per capita and without any huge waiting lists.
You actually confirmed that management in HSE doesn’t deserve even minimum wage, because nobody from them is don’t know anything about performance.
“I got a problem, I need extra staff, if they will be not used full time, we can find something for them”
This is typical approach for state body.
It is government and taxpayers problem to give them money, which they can waste without any result.
And if anybody else will come and will try to introduce procedures, which are working in another countries, nurses will immediately will start to cry, because they never worked with maximum performance. Then unions will start to defend them and as result country will left with rubbish, which called HSE.
Hazlit was right – system must be started from scratch. Nobody from HSE management should be allowed to enter new system. New hospitals must be built. Management for those hospitals must be trained outside of Ireland. Some of critical staff must be trained as well. It should not be private hospitals, as it is now, which actually hotels, charging few grant per night, but using the same lazy staff and stupid doctors as state hospitals.
Have a look on VHI Clinics – they charging two times more then state A&E, but with the same number of staff you will be serviced in 15 minutes, rather then five hours in Tallaght A&E. And I have suspicion that they are profitable as well without any state support. Polish clinics are doing very well. They charge 40% less then irish doctors, but you always can get an appointment within one-two days. Not six months as it state hospitals.
I agree, when system is overloaded – it will lose performance. But it was the job of HSE employees to say to government that they need more hospitals. But in this case they had to work a little bit efficient, may be a little bit harder, what unionised lazy HSE staff cannot afford. They stay on critical path and they will not allow to push them to work harder. Job of unions is to keep all lazy bastards in the critical areas and don’t allow anybody to criticise them.
Crisis is actually is good thing. At least people can have a look for what they are paying money and may be decide do not pay money at all in order to smash unions completely from public services.





You need to have some brains for implementing somebody ideas. You just proofed that managers in state hospitals doesn’t have any brains, only deep pockets. NHS is not an exception.


Do you think that it can be worse?
People are dieing in hospitals due incompetence of staff, due poor hygiene and think that people can be proud of HSE performance under full financing

I would agree with alot of what you say and share similar disapointment with the current set up. All I am saying is that the unions are an easy scape goat for a failed management system. There will always be unions and different worker groups in every organisation. Simple ideas like "smach the unions" are silly in the context of a complex modern working enviroment.

I agree a return to the drawing board is required, but it is the peole at the top that must drive that not ordinary union members. The health system is not a democracy.

When staff complain about shortages of resources they are attacked, called lazy or vested interests. Most could not be bothered engaging in a positive way any more. I certainly would not say any of this in my work place or using my real name. Input of any kind is not welcomed.

A major prolem is that the people running the system insist that somethings that cannot be true are true. ie we have enough acute hospital beds. or we can increase the number of hours we are open by 60-70% and it we not cost anything extra. Its very hard to get behind any of these half baked ideas when previous half baked ideas have not worked out(co-location for one).

People blame consultants, nurses and other staff for things that in many cases they do not have the power to change and have never been asked to. I am not saying these are perfect groups of people, but they are no different from the same people in other countries, they are managed differently.