A & E Overcrownding

section4

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In light of the current controversy over A&E departments and over crowding in many hospital nationwide and the fact that there are thousands of empty hotels rooms nationwide and yet we are still building more and more hotels what does this say about the way the proceeds of the celtic tiger have been used and about the people who oversee this, ie the government and big business. Hw come one of the supposed richest countries in the world has to depend on people phoning radio shows to donate equipement and materials. Can Mary Harney Honestly stand there and talk like it is not part of her party and governments legacy when she has been part of the governnment for so long.
 


TheBanned

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As long as the health service is expected to provide every new treatment/drug almost free to all at the point of delivery then the health crisis will never end.
 

FutureTaoiseach

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section4 said:
In light of the current controversy over A&E departments and over crowding in many hospital nationwide and the fact that there are thousands of empty hotels rooms nationwide and yet we are still building more and more hotels what does this say about the way the proceeds of the celtic tiger have been used and about the people who oversee this, ie the government and big business. Hw come one of the supposed richest countries in the world has to depend on people phoning radio shows to donate equipement and materials. Can Mary Harney Honestly stand there and talk like it is not part of her party and governments legacy when she has been part of the governnment for so long.
But she has only been Health Minister since September 2004. The problem is the vested interests in the Health-Service and how they conspire to frustrate every little change, by using them as an excuse to wring financial or other concessions from the Government e.g. remember the health-board staff stonewalling over the abolition of the health-boards. The new vested interests are the GP's stubbornly refusing to cooperate with the proposed doctor-only medical cards, which could if implemented divert people away from A+E to doctors instead. This is a great proposal from Harney and she is not to blame for the greed and pigheadedness of GP's earning in some cases hundreds of thousands of euros and still demanding more in return for cooperation.

We must also ban drunks from A+E. They are selfish and forcing the elderly to wait on trollies. Shame on them!
 

Paraic

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FutureTaoiseach said:
We must also ban drunks from A+E. They are selfish and forcing the elderly to wait on trollies. Shame on them!
Are you suggesting that alcoholics should be refused treatment in A & E departments? Or that people who are intoxicated when admitted should be refused treatment? Or both?

In the latter scenario, what degree of intoxication should disqualify a patient for treatment?

Should the degree of intoxication be established prior to triage for treatment, regardless of clinical urgency? If so, how?

Should intoxication preclude treatment for all conditions or injuries, regardless of seriousness?

If intoxication is established, should the relatedness of intoxication to the primary condition presenting be assessed? If so, to what extent should this be considered in mitigation?

Perhaps you could respond to the above questions with particular reference to how they might be addressed in a busy A & E department with due regard to staff constraints and patient safety.

Paraic
 

jjcarroll

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We must also ban drunks from A+E. They are selfish and forcing the elderly to wait on trollies. Shame on them!
The problem with that, is that it ignores the reason the "drunk" may be in hospital.

If a drunk person suffers injury or medical illness through no fault of their own, anti-drink fascists like yourself will deprive them of medical treatment.


Think about the proposal and then you will realise how f.ucking stupid it is.
 

rockofcashel

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what I say here in this post, I say as an Irish citizen, and not as a member if a political party, but when I listened today to Joe Duffy's show I felt thoroughly ashamed.

To expect that the health care of this country is in the hands of the goodwill of business people, who wish to donate hospital services, that they have already paid tax for, and then listen to the Government tell us that we have the best performing economy in Europe, the highest GDP growth per capita in the world, blah blah blah etc is disgusting.

Is this what the PD's regard as privitisation of the Healt service.

Dont blame sectoral interests. Its the goverments problem full stop. If sectoral interests get in the way, kick their arses. This Government have been in charge long enough. They seek to blame past governments. They push out all their problems to committees.

Yes the drunks in A&E are a problem. Solution : Do something about it.

Charge them penal rates when they sober up.

Increase taxes on alchohol sales to cover the increases in healthcare costs created by alcohol etc.

The doctors won't co-operate: Solution

Create more doctors, and insist as a proviso in their training that they return the economic value of their education in the Health services in this country

Save money in the Health services : Solution

Run the hospitals like proper businesses. Stop practices as simple as having two different companies provide water to the same hospital. Buy bulk, reduce costs, reduce administration.

Stop pandering to every small local company who give a few bob into the coffers of the local election candidates who make up the members of the Health Boards (I know thats changed now, but the same companies donate to the parties to make sure they are looked after)

Not enough nurses to work in speciality fields : Solution:

Give nurses a premium to work in different areas and locations. I know the INO will insist on pay increases across the Board, well sorry, no can do on this one. As much as I hate to say this as a trade union member, and a member of a left leaning party, but healthcare is a priority for the people of this country

Get rid of the stupid new arrangement whereby all nurses must study a degree in nursing. Recognised apprenticeships in nursing have provided this country with the vast majority of nurses in the lifetime of this state, and many suitable applicants for nursing are being put off by the idea of 3,4 or 5 more years in school.

Build state run nursing homes for after-care of patients, where they can be moved to to recuperate without taking up hospital beds. This would save money in the long run.

Create dedicated elective procedural hospitals, which can concentrate on reducing waiting lists, and would speed up the training of consultants. Run the things 24 hours a day if necessary. Another SF heresy, but this would mean the removal of services at local hospitals, and have them centralised.

However local hospitals should retain lower level A&E provisions, with a Health Transport system which would include helicopters to provide for rapid removal to centralised specialised hospitals as required

Re-open the thousands of beds closed in hospitals all round Ireland.

Provide the money for the opening of dormant surgical units such as that at St. Josephs in Clonmel. Millions of pounds (and Euros, took ages) to build a beautiful surgical unit, and no 3.5 million Euros to provide for yearly maintenance costs.

Create integrated Public Health Centres capable of dealing with the majority of low level A&E emergencys, freeing up General Hospital spaces for larger emergencies.

Intrduce first aid into the school curriculum.

All other solutions would be welcome.

Is Joe Duffy really the Minister for Health in this country ?
 

jjcarroll

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Yes the drunks in A&E are a problem. Solution : Do something about it.

Charge them penal rates when they sober up.

Increase taxes on alchohol sales to cover the increases in healthcare costs created by alcohol etc.
So if I beat you up when your drunk, you should be charged a penal rate in hospital?

If a person has had two drinks on them, slips on ice and breaks a wrist should that person be subject to a penal charge?

Should an alcoholic, who as I understand it is suffering from a disease be penalised?

Drunks are not the problem in A&E, violent people are, and your solution will not go anywhere towards solving that.
 

Ronanr

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I was told by someone that works in the area that drunks are only a major problem on saturday and sunday nights in A&E depts.

(I am defining "drunks" here as people whose main problem is that they are intoxicated, not "genuine" cases who happen to have a drink or two on them).

He also stated that the main difficulty with them is not the medical care they need (they take up very little of staff time unless they need their stomach pumped), but the fact that they are often obnoxious and violent and fall around the place pissing and vomiting alongside parents with a very sick child, etc.


So although it is a very unpleasant phenomenon, i do not think that the problem of drunks in A&E is very important in solving the substantive problems A&E has.
 

FutureTaoiseach

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A message to the drunks who keep turning up every weekend at A+E. Cop onto yourselves and think of the elderly and those in much worse state than yourselves! You're a disgrace :oops:

You got yourself deliberately into that state. How dare you waste taxpayer's money on something you chose to do to yourself!

No excuses please...

Should an alcoholic, who as I understand it is suffering from a disease be penalised?

Drunks are not the problem in A&E, violent people are, and your solution will not go anywhere towards solving that.
I imagine many of these violent people ARE drunks.

We need to get away from the culture in this country that glamourises getting drunk and then vomiting all over the place. Theres nothing glamourous about it. Its basically gross. A ban on alcohol advertising is needed NOW Michael. And a ban on alcohol sponsorship of sports. There can be no compromise on this. Do it now!

Someone here said that sectoral interests cannot be an excuse for not solving the problems in the hospitals. Sorry, but if people refuse to cooperate, there isn't much the Government can do to make them. The GPs are an essential cog in the wheel of diverting people from A+E through the proposed doctor-only Medical cards. No politicians have the magic wands some ppl imagine. Vested interests, e.g. consultants, GPs, have contributed to the problems over decades and they have become entrenched and will fight to resist change. Mary should stand up to them but they will drive a hard bargain. At least wait until Mary gets her plan implemented and Im sure well see an improvement.
 

smiffy

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FutureTaoiseach said:
A message to the drunks who keep turning up every weekend at A+E. Cop onto yourselves and think of the elderly and those in much worse state than yourselves! You're a disgrace :oops:

You got yourself deliberately into that state. How dare you waste taxpayer's money on something you chose to do to yourself!
I am very, very sorry. :(

At least wait until Mary gets her plan implemented and Im sure well see an improvement.
Actually, she's been in government for 8 years, and should be judged on that basis. The whole 'I only have a couple of years to implement my plan' approach is just a piece of political sleight-of-hand to distract the stupid and the gullible (and, apparently, is working quite well).
 

Minister3

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Smiffy is bang on on this one the only a few months in office excuse doesn't wear.
As I mentioned a few days ago under a thread entitled The Pds should be dropped-- the situation in A&E has actually worsened. A family member is a doctor in A&E in the Mater and he has said that in his six years in different hospitals and dealing with acute care the situation has declined faster in the last six months than any time in the past.
Apparently the new systems and practices have completely wreaked havoc with an already bad system.
Drunks only come into play as a major problem from 2 am ish on Fridays and Saturdays and they are prepared for that.
He reckons it will only take one major accident and the whole A&E system in the city could be out of action for a week-the major emergency plan for Dublin would be useless if more than 60 acasualties were to occur. ie bus or train crash or a major fire.I ask why now after 6 months of Harneys tenure are staff of A&E at breaking point?.
Had to laugh on Monday when she announced 400 home stay packages for long term patients.
As my cousin said--- great system--you get sick you go to hospital you're sent home-when you need to be in hospital and when you get ill again- which a lot of home care patients do within a few days and need to be sent back in.Youre sent through A&E cramming it up- then back into a ward where you started.
It takes about two months to sort out the beaurocracy of transferring a single home care package so it can be given to another patient.
Who may again only avail of it for a few weeks.As he said no wonder we have more administrators than frontline staff cooking up schemes to keep themselves in work and implementing strategies that practically have no use.
His solution lay off about 4000 admin staff who earn between 45,000 to 65,000 and employ about 2000 frontline staff with the saving in salaries of the other staff about 100 million ayear-- a hell of a lot of beds and wards could be opened.97000 employed in the health sector 49000 in admin-- something wrong somewhere- and Harney tells them they have only to shed 600 jobs.
 

FutureTaoiseach

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Actually, she's been in government for 8 years, and should be judged on that basis. The whole 'I only have a couple of years to implement my plan' approach is just a piece of political sleight-of-hand to distract the stupid and the gullible (and, apparently, is working quite well).
Yes but she hasn't been in the Health-Department for 8 years. She has some good ideas but actually getting them implemented is not simply a matter of waving a magic wand. She has to get the doctors to accept the doctor-only medical-card. Look how hard it was to get the abolition of the healrh-boards through. The health-service, like the public-sector generally, has an industrial relations problem with vested interests out to obstruct every little change. Mary Harney is not the health-service. The health-service are the personnel that work in it and they can make improvements extremely difficult to put into practical affect.

Personally I think that the underlying problem with the health-service is that it has an actualy DISINCENTIVE to treat patients, i.e. the more they treat the greater the costs. My personal view is that we need a more market-oriented solution and that will involve radical and very controversial changes that many of those shouting the loudest about the need for improvements would themselves be adamantly opposed to. But then the Irish Left needs the problems in the health-service to remain in order to make political capital against the Government. Finbar Fitzpatrick was director of elections for Fine Gael and is the boss (I believe) of the Irish Hospital Consultants association, and many of the unions have links to the Labour party including contributing to its coffers. So I sometimes wonder about the motivations of the obstructionist vested interests in the health-service.

My personal view of a long term solution to the problems of the health-service is as follows:

I favour universal health-insurance, to replace most funding from the taxpayer. I believe that competition between health-insurers would keep premiums down, though I accept we need to encourage more health-insurance companies to enter the Irish market to accomplish a true competitive environment. Now, the reason why private patients tend to get treated quicker than others is because the hospitals are getting paid by the health-insurance companies - hence there is a profit motive for the hospitals to treat patients. So I feel that why should some people have an advantage over others? Compulsory universal health-insurance is needed.

Some would argue that the very poor might not be able to afford this. That is why I would use means-testing to decide who has to pay and who will get their premiums paid for them by the state. This would still drastically cut the taxpayer's burden in terms of money paid to the health-service. Instead of funding the health-service through our taxes we would still be mostly funding it through insurance premiums. My personal view is that the greater efficiency of the private-sector would weed out waste in the system. We would therefore not need to pay as much in premiums as we would in taxes to the health-service.

This would allow a big reduction in taxes and in net terms we would be both better off, and getting better health-treatment.
 

Ulysses

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FutureTaoiseach said:
She has to get the doctors to accept the doctor-only medical-card.
Why? What good will that do?
 

Ulysses

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FutureTaoiseach said:
Ulysses said:
FutureTaoiseach said:
She has to get the doctors to accept the doctor-only medical-card.
Why? What good will that do?
It will re-direct people from A+E to GPs.
Yes, but what good will that do? All it achieves is the removal of punters from one shop to the other. The other shop then becomes the overcrowded one.
 

FutureTaoiseach

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Ulysses said:
FutureTaoiseach said:
Ulysses said:
FutureTaoiseach said:
She has to get the doctors to accept the doctor-only medical-card.
Why? What good will that do?
It will re-direct people from A+E to GPs.
Yes, but what good will that do? All it achieves is the removal of punters from one shop to the other. The other shop then becomes the overcrowded one.
Well, at least the hospitals won't be as overcrowded. The GP's have a profit incentive to treat patients as the State is paying them to take the patients.
 

Ulysses

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FutureTaoiseach said:
Well, at least the hospitals won't be as overcrowded. The GP's have a profit incentive to treat patients as the State is paying them to take the patients.
I take your first sentence as meaning that, in policy terms, overcrowded GP surgeries are a better outcome than overcrowded A&E departments. I'm not convinced that this is the case.

I take a number of meanings from your second sentence, but let's deal with one. If the GPs are to be paid to treat the patients, where is the money to come from? Reducing the budgets of the hospitals? Or increased taxation? Before you argue that the money will come from "savings on waste", don't forget that "savings on waste" take months or years to generate - but the cost of switching patients from overcrowded A&E departments to overcrowded GP surgeries will begin to be paid within days of the issue of the doctor-only medical cards.

It seems to me that the net effect of the policy will be to increase the cost of the service, while simply moving the queues from one part of the system to another. Treatment times won't improve, and the taxpayer will have to stump up more.

Net policy outcome: negative.
 


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