Spreading best practice needed more than more money in health services

Patslatt1

Well-known member
Joined
Nov 18, 2009
Messages
4,294
Every year as the HSE exceeds budgets, it resorts to the begging bowl for more government and insurance money. The bowl is as big as the dome of a great cathedral and on present trends additional funds to cover missed budgets will be greater than the entire budget maybe a generation ago.

Without radical change,even the ruthlessly cost efficient NHS in the UK is likely to experience cost increases that are simply not affordable and according to The Times https://www.thetimes.co.uk/article/spreading-best-practice-can-help-nhs-more-than-extra-tax-spending-cnnp92x2m, spreading best practice is the only feasible solution:

[]There needs to be increased collaboration among hospital consultants to implement continuous improvement in best practice eg Follow up operations for hip replacements in Sweden are a fraction of those in the USA
[]In recent years, the UK has backed such collaboration among 35 specialties under a programme named "Getting it right first time"
[]Technology has a vital role to play:
-When new drugs and treatments are adopted, inefficient ones should be dropped
-Artificial intelligence could replace pathologists*
-Robotics could replace radiologists
-Digital monitoring of patients in their homes could free up hospital beds occupied by people who need social care

An interesting question the Minister of Finance could put to the HSE and hospitals is what they are doing to implement many of the above ideas for best practice.

*I can't envision this but there are many news reports about computerised scans being better than radiologists

PS See http://www.politics.ie/forum/health-social-affairs/261971-uk-nhs-innovative-model-community-care-most-vulnerable-patients-has-revolutionary-potential-irelands-hse-should-emulate.html
 
Last edited:


Brera

Well-known member
Joined
Jan 22, 2011
Messages
548
We definitely need look at greater use of technology and collaboration. Certainly in Ireland we have a system that is disjointed and operating with outdated infrastructure, and any investment in these areas would help.

However we really need to look at the whole picture. Modern medicine is great at treating disease, but we are not great at dealing with prevention. We need to start seriously looking at what people are eating; most of what people eat isn’t real food it’s chemical enhanced crap.

We need to start teaching children in school how to cook healthy nutritious food and start getting them to exercise more. A lot of diseases that cost the health service a huge amount of money such as obesity, diabetes, heart disease and certain types of cancer can be prevented.
 

Patslatt1

Well-known member
Joined
Nov 18, 2009
Messages
4,294
Most of the enemies of good health stack the shelves of the retail grocery industry:cigarettes, fizzy sugary drinks, excessively fatty and salty foods and cheap off licence alcohol that fuels binge drinking. Since many parents are too indulgent towards their children's food habits,school cafeterias should offer a model of basic healthy food and schools should instruct in the basics of nutrition and cooking. As for exercise, for most people over a lifetime, brisk daily walking is by far the most important exercise. Setting aside a tiny portion of the 12% of the economy spent on health care would be highly effective for implementing these preventive measures.
 

Dame_Enda

Well-known member
Joined
Dec 14, 2011
Messages
55,133
What happened to the plans for hospital-trusts and the handing over of failing hospitals to the private sector?
 

Massey

Well-known member
Joined
Jan 7, 2018
Messages
821
What happened to the plans for hospital-trusts and the handing over of failing hospitals to the private sector?
Was not aware of that - handing over state assets to the private sector.

Do you have a link?
 

Hillmanhunter1

Well-known member
Joined
Jan 9, 2009
Messages
2,486
We have the 6th highest health expenditure per capita in the OECD:
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

If we have people on hospital trolleys or long waits for consultant appointments we need to understand why such a high level of expenditure is delivering such poor outcomes.

I spend part of every year in France, which spends 20% less per capita on health but has a far superior public healthcare system.

As an economist my first instinct is to think about efficiency. It seems odd to me that though we are 6th highest for expenditure in the OECD we are only in 31st place when it comes to hospital beds per capita - how does that happen?
https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hospital_beds
 

Brera

Well-known member
Joined
Jan 22, 2011
Messages
548
We have the 6th highest health expenditure per capita in the OECD:
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

If we have people on hospital trolleys or long waits for consultant appointments we need to understand why such a high level of expenditure is delivering such poor outcomes.

I spend part of every year in France, which spends 20% less per capita on health but has a far superior public healthcare system.

As an economist my first instinct is to think about efficiency. It seems odd to me that though we are 6th highest for expenditure in the OECD we are only in 31st place when it comes to hospital beds per capita - how does that happen?
https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hospital_beds
We spend our money in the wrong areas. We treat too many patients in hospital settings, instead of primary care.

In addition to the buildings, that will require a change in work practices from the staff.

But this is Ireland, so whenever we try to change anything each little sectoral interstest pops up.

It decides it’s an opportunity for it to get more money.

Feck the patients and the tax payer.
 

hammer

Well-known member
Joined
Jul 6, 2009
Messages
58,180
Way too much money spent on Healthcare

Exchequer
Prescriptions
DPS payment
GMS payment
Private Healthcare
A&E Charges
Nursing home fees
Fair Deal
Doctors Fees
etc...........
 

Patslatt1

Well-known member
Joined
Nov 18, 2009
Messages
4,294
We spend our money in the wrong areas. We treat too many patients in hospital settings, instead of primary care.

In addition to the buildings, that will require a change in work practices from the staff.

But this is Ireland, so whenever we try to change anything each little sectoral interstest pops up.

It decides it’s an opportunity for it to get more money.

Feck the patients and the tax payer.
TRENCH WARFARE BY VASTLY OVERPAID

The retiring CEO of the HSE said that negotiaing with trade unions was trench warfare.

Like the rest of the public sector, health care workers in the public sector are vastly overpaid, with nurses for instance paid about 40% more than the UK depending on the value of the pound.. The preausterity pay structure of the nurses is on higher levels than that of new recruits since.
 
Last edited:

Uganda

Well-known member
Joined
Aug 17, 2013
Messages
9,617
Way too much money spent on Healthcare

Exchequer
Prescriptions
DPS payment
GMS payment
Private Healthcare
A&E Charges
Nursing home fees
Fair Deal
Doctors Fees
etc...........

One wonders what a manager might do.................

(A real manager.................l)
 

Uganda

Well-known member
Joined
Aug 17, 2013
Messages
9,617
TRENCH WARFARE BY VASTLY OVERPAID

The retiting CEO of the HSE said that negotiaing with trade unions was trench warfare.

Like the rest of the public sector, health care workers in the public sector are vastly overpaid, with nurses for instance paid about 40% more than the UK depending on the value of the pound.. The preausterity pay of the nurses is on higher levels than that of new recruits since.
I once sat at a meeting with a Group MD, and his team of business unit managers. One of these really bellyached about the unions, restrictive practices and all the things he couldn't do as a result.

I always remembered the group mds response

1. Strong unions are a consequence of weak management.

2. Managers are paid to address and manage these issues, find solutions and a way round them.

3. People who can't manage aren't managers, and should be replaced by people who manage.
 

Patslatt1

Well-known member
Joined
Nov 18, 2009
Messages
4,294
Way too much money spent on Healthcare

Exchequer
Prescriptions
DPS payment
GMS payment
Private Healthcare
A&E Charges
Nursing home fees
Fair Deal
Doctors Fees
etc...........
GMS payments haven't prevented the drop in the number of practising GPs.

Nursing home fees reflect the rapid growth in the over 80s population which is far higher than younger age groups thanks to increased life expectancy.

Abuse of prescription drugs needs to be monitored in view of the epidemic of prescription painkilling opiod drugs which has killed thousands in the USA.
 
Last edited:

Patslatt1

Well-known member
Joined
Nov 18, 2009
Messages
4,294
I once sat at a meeting with a Group MD, and his team of business unit managers. One of these really bellyached about the unions, restrictive practices and all the things he couldn't do as a result.

I always remembered the group mds response

1. Strong unions are a consequence of weak management.

2. Managers are paid to address and manage these issues, find solutions and a way round them.

3. People who can't manage aren't managers, and should be replaced by people who manage.
But the managers themselves in the HSE and hospitals are in trade unions, so their management role clashes with their self interest as union members. A good start would be to force managers to quit unions as a condition for a management job but this is public sector Ireland so it won't happen until the system is near collapse.
 

Uganda

Well-known member
Joined
Aug 17, 2013
Messages
9,617
But the managers themselves in the HSE and hospitals are in trade unions, so their management role clashes with their self interest as union members. A good start would be to force managers to quit unions as a condition for a management job but this is public sector Ireland so it won't happen until the system is near collapse.
They are called managers.

They are paid as managers.

They get pay rises for managers.

They get pensions for managers.

But they don't manage.
 

hammer

Well-known member
Joined
Jul 6, 2009
Messages
58,180
They are called managers.

They are paid as managers.

They get pay rises for managers.

They get pensions for managers.

But they don't manage.
There is also a further problem.

I was told by a man carrying two pints that everything needs to get signed off by about 8 different type "managers"
 

Uganda

Well-known member
Joined
Aug 17, 2013
Messages
9,617
There is also a further problem.

I was told by a man carrying two pints that everything needs to get signed off by about 8 different type "managers"
It wouldn't surprise me to learn that the man with 2 pints is a "manager" himself.
 

Brera

Well-known member
Joined
Jan 22, 2011
Messages
548
Aka Slaintecare.
I suspect it has more to do with then fact that government doesn’t have a majority, and any attempt to hand a hospital trust over to a private operator wouldn’t get passed the dail.

While there are issue with a couple of the proposals in Slainte Care, it might actually be the start of a process to fix the system.

If all the party’s commit to implementing it, it could stop health from being used as a vote buying exercise.

That’s assuming of course that all the parties sign up to it and don’t talk out of both sides of their rear end.
 

Patslatt1

Well-known member
Joined
Nov 18, 2009
Messages
4,294
There is also a further problem.

I was told by a man carrying two pints that everything needs to get signed off by about 8 different type "managers"
That's the oldest public sector trick in the book for managing difficult projects-set up interlocking committees so that no one can be blamed for failures. With no clear lines of responsibility, failure is likely.
 


Most Replies

Top