Which sectors of the Irish public sector are most in need of radical reforms-the Gardai and the HSE?

Patslatt1

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Clearly, the Garda Siochana and the HSE and health service need radical reforms.
The appointment of an outsider from Northern Ireland as head commissioner of the GS increases the chances that recommendations in reports on past investigations of GS failings will be implemented. To facilitate this implementation, apparently he has requested or will request the resignations of senior garda officials who have ignored recommended reforms for decades. This raises the question of whether the commissioner has the power to appoint a team of gardai committed to reforms. What are the signs of progress so far?
As for the HSE and the health service, a strategic mistake was made in thinking there would be great savings from creating a centralised HSE monopoly on health care, a pipe dream of spread sheet accountancy. Such centralised organisations tend to have have too many layers in the chain of command that slow down communications across the layers and impede decision making. The typical solution is to add large numbers of bureaucrats at each layer to assist with communicating to the layers above and below.
The HSE didn't necessarily have to add bureaucrats since under pressure from trade unions Health Minister Harney,without objection from all the political parties, at taxpayers' expense awarded jobs for life to all the employees of the health boards in their consolidation into the HSE. In a privte sector consolidation of that magnitude, a sizable proportion of the workforce would have been made redundant. So the HSE was stuck with a huge number of redundant workers that had no useful role.
The HSE's key strategy in recent years has been to create regional grouping of hospitals and health services in a similar set up to the old health boards. Cooperation between hospitals in the group could lead to great efficiencies. However,implementation of the strategy seems to be proceeding too slowly possibly for lack of financial incentives.
On the issue of public sector reform in general, columnist Philip Collins,formerly Tony Blair's leading speech writer, has written an excellent article in today's Times ofLondon,Dominic Cummings is right about civil service failings .Historic reports show that the UK civil service favours promoting generalists into top leadership positions at the expense of scientists, engineers and specialists. He favours a structure from the Blair government "...in which the best 50 people are responsible for strategy and implementation., should be followed in every department. There should be cross-disciplinary teams that report to the prime minister on issues that departments fight over. " And "The best people should be paid more. It is stupid to ask people to look after vast public programmes and begrudge them a good pay package". Since project failure can kill a career, civil servants should be rewarded with very large bonuses for taking responsibility for projects instead of dodging responsibility in interlocking committees, a favourite trick in Ireland.
 
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Patslatt1

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Clearly, the Garda Siochana and the HSE and health service need radical reforms.
The appointment of an outsider from Northern Ireland as head commissioner of the GS increases the chances that recommendations in reports on past investigations of GS failings will be implemented. To facilitate this implementation, apparently he has requested or will request the resignations of senior garda officials who have ignored recommended reforms for decades. This raises the question of whether the commissioner has the power to appoint a team of gardai committed to reforms. What are the signs of progress so far?
As for the HSE and the health service, a strategic mistake was made in thinking there would be great savings from creating a centralised HSE monopoly on health care, a pipe dream of spread sheet accountancy. Such centralised organisations tend to have have too many layers in the chain of command that slow down communications across the layers and impede decision making. The typical solution is to add large numbers of bureaucrats at each layer to assist with communicating to the layers above and below.
The HSE didn't necessarily have to add bureaucrats since under pressure from trade unions Health Minister Harney,without objection from all the political parties, at taxpayers' expense awarded jobs for life to all the employees of the health boards in their consolidation into the HSE. In a privte sector consolidation of that magnitude, a sizable proportion of the workforce would have been made redundant. So the HSE was stuck with a huge number of redundant workers that had no useful role.
The HSE's key strategy in recent years has been to create regional grouping of hospitals and health services in a similar set up to the old health boards. Cooperation between hospitals in the group could lead to great efficiencies. However,implementation of the strategy seems to be proceeding too slowly possibly for lack of financial incentives.
On the issue of public sector reform in general, columnist Philip Collins,formerly Tony Blair's leading speech writer, has written an excellent article in today's Times ofLondon,Dominic Cummings is right about civil service failings .Historic reports show that the UK civil service favours promoting generalists into top leadership positions at the expense of scientists, engineers and specialists. He favours a structure from the Blair government "...in which the best 50 people are responsible for strategy and implementation., should be followed in every department. There should be cross-disciplinary teams that report to the prime minister on issues that departments fight over. " And "The best people should be paid more. It is stupid to ask people to look after vast public programmes and begrudge them a good pay package". Since project failure can kill a career, civil servants should be rewarded with very large bonuses for taking responsibility for projects instead of dodging responsibility in interlocking committees, a favourite trick in Ireland.
Health service reforms should interest all P.ie readers, especially reforms that drive a desperate need for efficiencies. It's very doubtful government finances depleted by the pandemic can afford free universal health care as promised by political parties.
 

Lumpy Talbot

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No
personally I'd rather see an opposition TD table a question to the Minister for Health asking in general and non-specific to any individual case terms how much the HSE has paid out in (a) compensation for negligence claims over the last ten years (b) how many Non-Disclosure Forms have been issued by the HSE's legal department as part of settlement of disputes and/or negligence claims over the last ten years (c) how much insurance costs have risen for the HSE as a public body and employer since 2000.

The fact that such questions never seem to occur as a possibility in the Dail is an interesting question in itself. Then again both main parties are heavily linked to the operation of the HSE down the years so I think it is safe to assume FG/FF wouldn't want to be on the receiving end of those queries. So probably wouldn't table them.
 

Ardillaun

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Health service reforms should interest all P.ie readers, especially reforms that drive a desperate need for efficiencies. It's very doubtful government finances depleted by the pandemic can afford free universal health care as promised by political parties.
The Canadian model of UHC is crumbling. Nobody should be recommending it. We’re still more efficient than the Americans but that is a sad boast. Our private health care sector will have to expand despite the legal obstacles faced. Ireland should look to the likes of Germany and the Netherlands.
 

Patslatt1

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personally I'd rather see an opposition TD table a question to the Minister for Health asking in general and non-specific to any individual case terms how much the HSE has paid out in (a) compensation for negligence claims over the last ten years (b) how many Non-Disclosure Forms have been issued by the HSE's legal department as part of settlement of disputes and/or negligence claims over the last ten years (c) how much insurance costs have risen for the HSE as a public body and employer since 2000.

The fact that such questions never seem to occur as a possibility in the Dail is an interesting question in itself. Then again both main parties are heavily linked to the operation of the HSE down the years so I think it is safe to assume FG/FF wouldn't want to be on the receiving end of those queries. So probably wouldn't table them.
The HSE has a hardline policy to discourage ambulance chasing, a policy that makes it look hard hearted at times. Medical litigation can be extremely lucrative, with some awards in the millions.
 

Patslatt1

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The Canadian model of UHC is crumbling. Nobody should be recommending it. We’re still more efficient than the Americans but that is a sad boast. Our private health care sector will have to expand despite the legal obstacles faced. Ireland should look to the likes of Germany and the Netherlands.
Influence peddling federal politicians in need of campaign money and hard right wing ideology explain the failures of the expensive US system.
Private equity acquisitions of hospitals now threaten real damage. PE companies are exploiting exemptions of hospitals from antitrust laws by taking over hospitals concentrated in a local area they can dominate. The exemptions, designed to achieve economies of scale in very expensive high tech medicine,have been exploited by non-profit and for profit hospitals alike.The PEs bring calculated financial ruthlessness to the table. They borrow huge sums to pay for the acquisitions. Once in control of the acquired hospital companies they sell off the land and buildings and get hospitals to borrow heavily,using the proceeds to pay themselves dividends. The dividends are used to pay off the bank loans. The hospitals lease back the land and buildings and are saddled with both leases and big bank loans. Hospital employees and managers are put under great pressure to pay the loans and leases by imposing extreme cost controls. If a hospital goes bankrupt, the PE can still gain if the patients have no choice but to move to other hospitals owned by the same PE in the area.
By contrast, France, the Netherlands and Germany have very tight regulations of hospitals that prevent profiteering. A disadvantage of those systems is financing the very high cost of medicine through payroll taxes on wages which essentially are a tax on job creation that contribute to high unemployment.
In Canada, I assume it must be getting hard to control waste without any pricing signals in the socialist system. Wages of doctors in scarce specialties may be mispriced,leading to shortages.
Ireland's difficulty in introducing universal free health care will be the inability of the government to control vested interests among trade unions, nurses unions and hospital consultants. Unionised pay is about 40% higher than the UK hospitals,pensions are gold plated and restrictive practices are like those that destroyed UK manufacturing in the 1970s and 1980s. The psychiatric nurses union begrudgingly allowed nurses helpers only a few years ago under very restrictive conditions.
Vested interests run rings around our coalition governments by exploiting their weaknesses and need for trade union support.
In time, this inability to manage the public sector will cause another massive economic crisis and we may be in one already with Covid.
 
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Ardillaun

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Canada has many problems. Unlike many countries we frequently view our healthcare system as better than it is, partly because we have the chaotic US example next door. We are at last beginning to systematically assess key indicators across the country and it’s clear we are falling behind even Australia, let alone the top European countries.

I think most doctors remain fee-for-service here although the younger generation is moving quite rapidly to salary, alternate funding plans and mixed models. With FFS and AFP, doctors are responsible for paying locums, health and disability insurance and their own pensions. Salaried pensions increase by a modest amount per year, often less than the inflation rate.

We have a massive shortage of GPs and millions of Canadians don’t have their own. The provincial and federal governments have little incentive to sort this out as more access will mean more costs. We could import huge numbers of excellent doctors but a quiet alliance of local interests headed by the medical schools fights to stop this under the guise of maintaining standards, and make immigration so onerous good people apply elsewhere. The result is lots of Canadian grads in the cities while outback medical centres struggle to fill their posts, often with foreign grads.
 
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Old Mr Grouser

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Clearly, the Garda Siochana and the HSE and health service need radical reforms.
I'm in entire agreement except that in regard to the AGS it needs to be a total reform of the entire Justice and Law Enforcement industries.

First steps would be a reform of the lawyers, and tthe establishment of a well-funded stand-alone Crime Prevention Authority.
 


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