Back to the future - HSE becomes Health Boards again

Disillusioned democrat

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Are we to infer from this that the HSE has, effectively, been declared a complete failure and that we should have stayed with the Health Boards all along?


I worked on a few IT projects in the public healthcare sector and witnessed the bizarre launch of the HSE, led by a former banker no less, who went on a 12 month roadshow to sell the idea of the HSE and watched as new empires were formed, new roles created as jobs for the boys and gals and watched as national project after project went over budget and failed...not it seems it was all for nothing.

Is this a genuine initiative to try to tackle the healthcare crisis once and for all or just a cynical way to break the endless series of national controversies into smaller, regional, bite-sized, controversies so they don't get so much air time?
 


Uganda

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Are we to infer from this that the HSE has, effectively, been declared a complete failure and that we should have stayed with the Health Boards all along?


I worked on a few IT projects in the public healthcare sector and witnessed the bizarre launch of the HSE, led by a former banker no less, who went on a 12 month roadshow to sell the idea of the HSE and watched as new empires were formed, new roles created as jobs for the boys and gals and watched as national project after project went over budget and failed...not it seems it was all for nothing.

Is this a genuine initiative to try to tackle the healthcare crisis once and for all or just a cynical way to break the endless series of national controversies into smaller, regional, bite-sized, controversies so they don't get so much air time?
It's called moving the deckchairs around. It will result in even more highly paid "managers". It will do nothing to address the featherbedding which is institutionalised in the hse.

It's announced that its to facilitate Slaintecare - which in itself is the greatest scam since benchmarking.
 

redmonite

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We spend 17bn on on public healthcare, we spend 4 bn on private healthcare, I know there is some crossover but it's not massive. Half the population go private and half the population go public yet there are no ques in the private system despite the lesser cost.
And Roisin Shortles committee tell us the solution is to get rid of the private system!
 

fifilawe

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Let me guess, the Dept of Health /Dept of Finance/Dept of An Taoiseach called in some Consultants from some Big Financial Services Company(EY,Accenture,Deloitte ,Standard Charter,Goldman Sachs ........) and they recommended this for a fee of €5- €10m.So now the future is 6 CEOs and 6 replication/duplication of management layers and pen pushers that will cost more than present HSE , but the outcome for failures and foul-ups will still be the same as present HSE.Pass the buck,pass the responsibility and no one will get fired for gross negligence/failure. Same old, same old but more expensive than present Shambles.
 

Orbit v2

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Are we to infer from this that the HSE has, effectively, been declared a complete failure and that we should have stayed with the Health Boards all along?
No. We are to infer that we are a nation of headless chickens, and we only see the disadvantages of the present structures, but not their advantages. So, we are forever destined to see-saw between centralisation and decentralisation, because we only see the downsides of each approach as we do it, and we lose all institutional memory of what it was like before.
 

Massey

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So much has been achieved by the health service , the begrudgers and the mob never see that .
 

Disillusioned democrat

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No. We are to infer that we are a nation of headless chickens, and we only see the disadvantages of the present structures, but not their advantages. So, we are forever destined to see-saw between centralisation and decentralisation, because we only see the downsides of each approach as we do it, and we lose all institutional memory of what it was like before.
Ah - the "we all partied" excuse.

Like Irish Water, the principle is sound, it's the execution was flawed.

Centralised or decentralized doesn't really matter - it's the outcomes that REALLY matter, but for decades now the HSE has been a pre-retirement home for many of the old guard of the Health Boards, many of whom got jobs they were unsuited for by the nod and wink system that used to work where TDs and councilors got jobs for kids in their constituencies and then who went on to management roles, etc.

Now the HSE should have been massively positive - common systems, BKMs, shared services, etc., pools of clinicians and centers of excellence with the critical mass of patients to make them effective - but still local politics intervened....hospitals in every town and so many red circle jobs that NO common practices could ever exist.

The Irish people don't get to vote on this - we didn't get a referendum to decide how we wanted the system run, so you can feck off with the "nation of headless chickens".
 

Disillusioned democrat

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So much has been achieved by the health service , the begrudgers and the mob never see that .
The "mob" can see the cost and the outcomes.

The Irish two tier system is the second or third most expensive in the world yet has among the worst outcomes in the EU based on mortality, waiting time and patient satisfaction surveys, we have massively paid consultants with unclear distinctions between public and private practices and hoards of middle managers making work for themselves.

Where does the begruddgery come in?
 

Patslatt1

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Are we to infer from this that the HSE has, effectively, been declared a complete failure and that we should have stayed with the Health Boards all along?


I worked on a few IT projects in the public healthcare sector and witnessed the bizarre launch of the HSE, led by a former banker no less, who went on a 12 month roadshow to sell the idea of the HSE and watched as new empires were formed, new roles created as jobs for the boys and gals and watched as national project after project went over budget and failed...not it seems it was all for nothing.

Is this a genuine initiative to try to tackle the healthcare crisis once and for all or just a cynical way to break the endless series of national controversies into smaller, regional, bite-sized, controversies so they don't get so much air time?
The HSE's creation was justified by accountancy delusions that centralisation would result in economies of scale and cost control. It wasn'trealised that increases in management levels slowed or mismanaged communications up and down the organisation,requiring extra layers of bureaucracy to try and improve communication. That resulted in excessive bureaucracy and poor management.

The one advantage of centralisation was the concentration of certain very expensive medical technologies such as cancer care in "centres of excellence". With the plan to revert to regional groupings, hopefully the function of these centres won't be diluted.
 

Patslatt1

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We spend 17bn on on public healthcare, we spend 4 bn on private healthcare, I know there is some crossover but it's not massive. Half the population go private and half the population go public yet there are no ques in the private system despite the lesser cost.
And Roisin Shortles committee tell us the solution is to get rid of the private system!
Doctrinaire socialists dislike the private sector and want it regulated to a government lapdog.
 

Patslatt1

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Let me guess, the Dept of Health /Dept of Finance/Dept of An Taoiseach called in some Consultants from some Big Financial Services Company(EY,Accenture,Deloitte ,Standard Charter,Goldman Sachs ........) and they recommended this for a fee of €5- €10m.So now the future is 6 CEOs and 6 replication/duplication of management layers and pen pushers that will cost more than present HSE , but the outcome for failures and foul-ups will still be the same as present HSE.Pass the buck,pass the responsibility and no one will get fired for gross negligence/failure. Same old, same old but more expensive than present Shambles.
Depending on the nature of the business, decentralisation often saves money on top heavy bureaucracy compared to centralisation and permits more rapid responses at the decentralised level. One big Japanese company over decades went through phases of centralisation and decentralisation as business conditions changed.
 

Patslatt1

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Ah - the "we all partied" excuse.

Like Irish Water, the principle is sound, it's the execution was flawed.

Centralised or decentralized doesn't really matter - it's the outcomes that REALLY matter, but for decades now the HSE has been a pre-retirement home for many of the old guard of the Health Boards, many of whom got jobs they were unsuited for by the nod and wink system that used to work where TDs and councilors got jobs for kids in their constituencies and then who went on to management roles, etc.

Now the HSE should have been massively positive - common systems, BKMs, shared services, etc., pools of clinicians and centers of excellence with the critical mass of patients to make them effective - but still local politics intervened....hospitals in every town and so many red circle jobs that NO common practices could ever exist.

The Irish people don't get to vote on this - we didn't get a referendum to decide how we wanted the system run, so you can feck off with the "nation of headless chickens".
POOR LONG TERM PLANNING
Thanks to extreme proportional representation voting,the Irish government is hypersensitive to local village pump politics that makes long term planning and the delivery of complicated welfare state services very difficult.
When crises occur inevitably, the government goes into crisis manager mode that for a limited time exploits the powerful centralised powers of the combined executive and parliament to deal with the crisis.
A simplistic solution would be a referendum to reduce the number of choices of TDs on ballot papers to two in order to reduce the number of useless small political parties and footloose independents that splinter politics.
 

Barroso

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Vastly overpaid and overpensioned staff?
We're told on the one hand that the medical staff - doctors anddentists - are vastly overpaid; on the other hand, we are told that large numbers of our doctors and dentists will decamp to the US, Oz and Canada if we don't overpay them.

It would be interesting to see actual figures, including reasons why they leave - assuming that they do.
 

Brera

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Ireland is fairly small country with a small population. It should be possible to deliver a decent health service over seen by one national body. Which is where the HSE made sense, the issue was in the delivery. Instead of cutting out layers of management and setting up a decent management structure, we got a bloated system with jobs for all the boys and money thrown around to cover up the cracks.

The only way you’ll ever get a proper functioning health care system is when we end up with a government and a minister health with the balls to take on the system and rebuild it. But I don’t see it ever happening. A small bit happened with Mary Harney and the reform of cancer services and in the case of the A&E in Roscommon but they were really exceptions.

This new structure makes no sense to me. I know it was proposed in Sláintecare but what’s it based on ? It’s it copied from a system that works elsewhere ?

The idea of integrating social care and hospital care makes sense and is welcome but going back to the a model similar to the health boards is regressive step.

Health boards after all we’re only setup as fudge originally instead of hospital groups as politicians of the day feared the rationalising of care. It wasn't until James Reilly came along decades later that the hospital groups were formed. While there Initial setup was less than ideal they could have been reformed and made work.

We really should be cutting out layers of management and having the money follows the patient and invest in primary care. We need proper primary care centres not the rubbish we’re building at the minute. Proper centres with actual out patient diagnostic facilities etc which is something a proper national body would have expertise on and have the mass to deliver efficiencies with procurement etc.

Are we now going to end up with a situation where watch of these health boards will starting tendering individually for equipment and supplies. If so it will be a complete farce.

Unless we end up with a decent minister for health I fear we’ll have to wait until the next economic crash and the government of the day is forced to make the hard decisions.
 

Patslatt1

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We're told on the one hand that the medical staff - doctors anddentists - are vastly overpaid; on the other hand, we are told that large numbers of our doctors and dentists will decamp to the US, Oz and Canada if we don't overpay them.

It would be interesting to see actual figures, including reasons why they leave - assuming that they do.
The relatively small number of non consultant doctors makes for high pessure work and burnout. Although Ireland is overnursed, nurses are scarce in A&E.
The time it takes to become a hospital consultant seems to be a lot longer in Ireland than in other English speaking countries.
With a communist equal pay policy for all salary only consultants, some are vastly overpaid and some vastly underpaid. The latter would be likely to emigrate.
 

Patslatt1

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Ireland is fairly small country with a small population. It should be possible to deliver a decent health service over seen by one national body. Which is where the HSE made sense, the issue was in the delivery. Instead of cutting out layers of management and setting up a decent management structure, we got a bloated system with jobs for all the boys and money thrown around to cover up the cracks.

The only way you’ll ever get a proper functioning health care system is when we end up with a government and a minister health with the balls to take on the system and rebuild it. But I don’t see it ever happening. A small bit happened with Mary Harney and the reform of cancer services and in the case of the A&E in Roscommon but they were really exceptions.

This new structure makes no sense to me. I know it was proposed in Sláintecare but what’s it based on ? It’s it copied from a system that works elsewhere ?

The idea of integrating social care and hospital care makes sense and is welcome but going back to the a model similar to the health boards is regressive step.

Health boards after all we’re only setup as fudge originally instead of hospital groups as politicians of the day feared the rationalising of care. It wasn't until James Reilly came along decades later that the hospital groups were formed. While there Initial setup was less than ideal they could have been reformed and made work.

We really should be cutting out layers of management and having the money follows the patient and invest in primary care. We need proper primary care centres not the rubbish we’re building at the minute. Proper centres with actual out patient diagnostic facilities etc which is something a proper national body would have expertise on and have the mass to deliver efficiencies with procurement etc.

Are we now going to end up with a situation where watch of these health boards will starting tendering individually for equipment and supplies. If so it will be a complete farce.

Unless we end up with a decent minister for health I fear we’ll have to wait until the next economic crash and the government of the day is forced to make the hard decisions.
You have far too much confidence in economies of scale from centralisation which as I discussed has a tendency to create massive bureaucracy to cope with communications up and down the multilayered chain of command.
Regional groupings of hospitals and related services are more likely to work better than the HSE system because they can look after their own purchasing and services needs without going through layers of inefficient bureaucracy. As a country, Ireland has little experience of efficient management of huge government operations,unlike big countries. In addition, Ireland's extreme proportional representation voting makes long term planning very difficult of a kind that is needed for delivery of services such as state financed health care and big infrastructure projects. The emphasis is on short term measures geared to general elections, with public sector pay and old age pensions the main priority.
 

Massey

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The relatively small number of non consultant doctors makes for high pessure work and burnout. Although Ireland is overnursed, nurses are scarce in A&E.
The time it takes to become a hospital consultant seems to be a lot longer in Ireland than in other English speaking countries.
With a communist equal pay policy for all salary only consultants, some are vastly overpaid and some vastly underpaid. The latter would be likely to emigrate.
Are psychiatrists underpaid ?
Big shortage of them.
 


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