When the health boards were consolidated into the HSE it was a golden opportunity for reform that FF utterly squandered.
The HSE is a political weapon, and thus, unreformable.
Imagine the Danish parliament is swapped with our own.
The government becomes a coalition of Labour/FF/Alternative FF.
The main opposition is the Greens/Tory Party/Weird Libertarian alliance/Fine Gael/that weird Green offshoot, Rabharta Glas?/kind of the Soc Dems but they admit their just squeamish FF/Fascists with no direct equivalent/another green party, but this one doesn’t support the likes of Mick Wallace/Another Tory party, but more fascist.
(And people moan about the Dáil.)
With your biggest party in government being a Labour equivalent, your main allies in the health system are going to be the unions. If we pretend the major unions want to help reform – and they really, really don’t – the biggest groups are going to be nurses and generic public sector workers, i.e., the dreaded “admin.”
So any reform proposed by government is going to likely rely upon their support.
What do nurses and admin staff want? Generally more money for themselves.
Danish FF will happily go along with this, they’re FF, populism is the name of the game, and this is the most effective way of reaching the most voters.
The main opposition are two parties that are prone to being of the elite. One is a Green Party, one a sort of Tory Party, then a PD-esque bunch, then a FG offshot. All of those tend to have support amongst wealthy people and/or well-educated people.
So who will they naturally support?
Doctors and the other “higher” professions in the HSE.
So now you have your simple cleavage.
Our Labour/FF government proposes reforms at the behest of its allies. These are then opposed by the elit-leaning opposition as being injurious to the health system, and they rely upon their allies – the doctors.
As you can imagine, no reform can happen in those circumstances.
And that’s how the HSE works here. Each group will support its own members and attack the other groups, and anybody who proposes a doctor led HSE will make an enemy of the nurses and vice versa. It’s unfixable outside a dictatorship or technocracy.
Something it is better to redo system from scratch than trying to fix / update it
The health service is first and foremost rent by civil servants for civil servants. Politicians and official’s don’t care about the long waiting lists or massive numbers of appointment cancellations because it doesn’t affect them. Most if not all of their healthcare takes place in private hospitals and is contractually funded by the taxpayer.
Even if there was the political will(, which there isn’t). They can never be touched because of the unions and their protected deals.
Every year more and more public money goes into the health system and every year things get progressively worse. And there is absolutely no accountability, no heads ever roll.
The problem is highlighted in article there have been so many attempts at reform in the past: improvements, action plans, reforms, etc. that failed as they didn’t tackle the root cause, were too big, too small and the big ones: not fully thought out and too slow. Now everyone has a reason not to trust or even try anything new, it failed in the past and everyone distrusts the management layer as they are useless. (And they might not be wrong after all they have a lot of evidence to prove it and it was just a bunch management consultants anyway). The divisions among the staff don’t help (doctors, consultants, nurses, porters, admin) and the culture among the groups. All of this is before the money part comes in: how are reforms going to paid for when it feels like the rest of the service is on its knees?
When I was studying in 2011, our professor was charged with overseeing the transition of the IT systems in the HSE. He discussed what was in place and it was a conceptual and political mess. Bespoke protocols being used for data transfer, incompatible. bespoke software running in different geographical locations etc. Nothing was standardised or from the same vendor. AFAIK they’re still talking about the same problems…
Nominal fees is the best way to avoid cancellations.
The fact the man in charge of the reformation of the health service, which is an utter, utter mess, is now Taoiseach is an example of how someone can fail upward as long as they have the right connections.
Worked in the public health system for the last 20 odd years in the acute hospital system … where to start.
The Positives
– Slaintecare is problematic but the approach politically that got it over the line through cross party committees is the only political approach viable. The election cycle is too short to progress policy without weaponising it. Any one who had watched The Wire or looked at the NHS will get this concept.
– There is plenty of groundwork done in respect of planning for the future and aspirations to where we want to be. Documents like [Healthy Ireland Outcomes Framework are out there waiting to be implemented](https://assets.gov.ie/7626/cb95e0dbb01e4a9fb7ce7affd609507e.pdf)
– We have de-aggregated successfully the management of the upper echelons of the HSE into Regions and above that, the acute hospital sector and the community care sector, public health etc. Anyone who has ever listened to Alan Milburn of ex NHS fame knows you can’t manage a public service the size of even our health service without breaking it up into many constituents parts and then managing them.
The Negatives
– We have a significant infrastructure deficit which we are only addressing now in public policy. This will take a decade to address and that’s being optimistic (see National Childrens Hospital).
– We do and don’t have enough managers and staff. This is entirely site dependent and a direct result of reconfiguration of the acute hospital services at the nadir of our public finances through 2012-2015. Services moved, staff didn’t.
– We pushed through politically popular healthcare policies like free GP care for under 12’s and either didn’t think and plan for potential downstream negative consequences or didn’t think them through enough. Slaintecare consultant contracts could be another example if precedent has anything to do with it.
– The normalised approach both politically and at a hospital level is one of reacting to “crisis”. Good examples of this are/were the NTPF, and typically cancelling all admissions due to a crisis in A&E. We instituted a complex system of metrics like Trolleygar to mange the crisis as opposed to actually dealing with the root issues. This delayed real work and thought into how to solve the structural issues causing the problem.
– We consistently politically and in media ignore the elephant in the room: just under 50% of the population have health insurance. Premiums for this are very low, because we allow the private healthcare industry to cherry pick an easier and healthier casemix and leave the public system pick up the rest as well as the pieces when things go wrong in the private sector. Slaintecare will see this divide sharpen even more. Despite what Donnelly says, Slaintecare will in fact bring the two tier healthcare system into even more sharp focus.
The above are just some of the things I see a problematic overall. I’m used to the acute hospital system so forgive me if I have left the most important overall parts alone – preventative medicine (we should be pouring money into this) and community care medicine.
The troika informed Ireland of this. Also of rampant corruption in many of the professions / guilds. They pointed to the need for immediate reform in health, legal services and insurance.
I work as a community pharmacist. The printer the HSE provides for tax receipts that is a dot matrix printer from the 80/90’s. They invested heavily in the paper apparently and we will not get anything more up to date until the paper is used up….
This is a fairly low level thing but speaks volumes about the kind of IT infrastructure we are talking about
You have to get rid of weeds by the roots, otherwise it doesn’t work.
12 comments
When the health boards were consolidated into the HSE it was a golden opportunity for reform that FF utterly squandered.
The HSE is a political weapon, and thus, unreformable.
Imagine the Danish parliament is swapped with our own.
The government becomes a coalition of Labour/FF/Alternative FF.
The main opposition is the Greens/Tory Party/Weird Libertarian alliance/Fine Gael/that weird Green offshoot, Rabharta Glas?/kind of the Soc Dems but they admit their just squeamish FF/Fascists with no direct equivalent/another green party, but this one doesn’t support the likes of Mick Wallace/Another Tory party, but more fascist.
(And people moan about the Dáil.)
With your biggest party in government being a Labour equivalent, your main allies in the health system are going to be the unions. If we pretend the major unions want to help reform – and they really, really don’t – the biggest groups are going to be nurses and generic public sector workers, i.e., the dreaded “admin.”
So any reform proposed by government is going to likely rely upon their support.
What do nurses and admin staff want? Generally more money for themselves.
Danish FF will happily go along with this, they’re FF, populism is the name of the game, and this is the most effective way of reaching the most voters.
The main opposition are two parties that are prone to being of the elite. One is a Green Party, one a sort of Tory Party, then a PD-esque bunch, then a FG offshot. All of those tend to have support amongst wealthy people and/or well-educated people.
So who will they naturally support?
Doctors and the other “higher” professions in the HSE.
So now you have your simple cleavage.
Our Labour/FF government proposes reforms at the behest of its allies. These are then opposed by the elit-leaning opposition as being injurious to the health system, and they rely upon their allies – the doctors.
As you can imagine, no reform can happen in those circumstances.
And that’s how the HSE works here. Each group will support its own members and attack the other groups, and anybody who proposes a doctor led HSE will make an enemy of the nurses and vice versa. It’s unfixable outside a dictatorship or technocracy.
Something it is better to redo system from scratch than trying to fix / update it
The health service is first and foremost rent by civil servants for civil servants. Politicians and official’s don’t care about the long waiting lists or massive numbers of appointment cancellations because it doesn’t affect them. Most if not all of their healthcare takes place in private hospitals and is contractually funded by the taxpayer.
Even if there was the political will(, which there isn’t). They can never be touched because of the unions and their protected deals.
Every year more and more public money goes into the health system and every year things get progressively worse. And there is absolutely no accountability, no heads ever roll.
The problem is highlighted in article there have been so many attempts at reform in the past: improvements, action plans, reforms, etc. that failed as they didn’t tackle the root cause, were too big, too small and the big ones: not fully thought out and too slow. Now everyone has a reason not to trust or even try anything new, it failed in the past and everyone distrusts the management layer as they are useless. (And they might not be wrong after all they have a lot of evidence to prove it and it was just a bunch management consultants anyway). The divisions among the staff don’t help (doctors, consultants, nurses, porters, admin) and the culture among the groups. All of this is before the money part comes in: how are reforms going to paid for when it feels like the rest of the service is on its knees?
When I was studying in 2011, our professor was charged with overseeing the transition of the IT systems in the HSE. He discussed what was in place and it was a conceptual and political mess. Bespoke protocols being used for data transfer, incompatible. bespoke software running in different geographical locations etc. Nothing was standardised or from the same vendor. AFAIK they’re still talking about the same problems…
Nominal fees is the best way to avoid cancellations.
The fact the man in charge of the reformation of the health service, which is an utter, utter mess, is now Taoiseach is an example of how someone can fail upward as long as they have the right connections.
Worked in the public health system for the last 20 odd years in the acute hospital system … where to start.
The Positives
– Slaintecare is problematic but the approach politically that got it over the line through cross party committees is the only political approach viable. The election cycle is too short to progress policy without weaponising it. Any one who had watched The Wire or looked at the NHS will get this concept.
– There is plenty of groundwork done in respect of planning for the future and aspirations to where we want to be. Documents like [Healthy Ireland Outcomes Framework are out there waiting to be implemented](https://assets.gov.ie/7626/cb95e0dbb01e4a9fb7ce7affd609507e.pdf)
– We have de-aggregated successfully the management of the upper echelons of the HSE into Regions and above that, the acute hospital sector and the community care sector, public health etc. Anyone who has ever listened to Alan Milburn of ex NHS fame knows you can’t manage a public service the size of even our health service without breaking it up into many constituents parts and then managing them.
The Negatives
– We have a significant infrastructure deficit which we are only addressing now in public policy. This will take a decade to address and that’s being optimistic (see National Childrens Hospital).
– We do and don’t have enough managers and staff. This is entirely site dependent and a direct result of reconfiguration of the acute hospital services at the nadir of our public finances through 2012-2015. Services moved, staff didn’t.
– We pushed through politically popular healthcare policies like free GP care for under 12’s and either didn’t think and plan for potential downstream negative consequences or didn’t think them through enough. Slaintecare consultant contracts could be another example if precedent has anything to do with it.
– The normalised approach both politically and at a hospital level is one of reacting to “crisis”. Good examples of this are/were the NTPF, and typically cancelling all admissions due to a crisis in A&E. We instituted a complex system of metrics like Trolleygar to mange the crisis as opposed to actually dealing with the root issues. This delayed real work and thought into how to solve the structural issues causing the problem.
– We consistently politically and in media ignore the elephant in the room: just under 50% of the population have health insurance. Premiums for this are very low, because we allow the private healthcare industry to cherry pick an easier and healthier casemix and leave the public system pick up the rest as well as the pieces when things go wrong in the private sector. Slaintecare will see this divide sharpen even more. Despite what Donnelly says, Slaintecare will in fact bring the two tier healthcare system into even more sharp focus.
The above are just some of the things I see a problematic overall. I’m used to the acute hospital system so forgive me if I have left the most important overall parts alone – preventative medicine (we should be pouring money into this) and community care medicine.
The troika informed Ireland of this. Also of rampant corruption in many of the professions / guilds. They pointed to the need for immediate reform in health, legal services and insurance.
I work as a community pharmacist. The printer the HSE provides for tax receipts that is a dot matrix printer from the 80/90’s. They invested heavily in the paper apparently and we will not get anything more up to date until the paper is used up….
This is a fairly low level thing but speaks volumes about the kind of IT infrastructure we are talking about
You have to get rid of weeds by the roots, otherwise it doesn’t work.