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Ireland's healthcare system: What exactly are we doing wrong?

Where is Ireland’s healthcare system going wrong, and what can we do to turn it around?

WHAT IS WRONG with Ireland’s healthcare system?

Long waiting lists, healthcare professionals under pressure, and emergency services at breaking point are some of the most common complaints that we hear about, but what can we do to change it?

And before you say ‘money’, the short response to that is it’s not the main problem – a recent report seriously questioned whether increasing the money going into the healthcare system would make things better by the same proportion.

Using some of the metrics that Ireland scored the lowest on as part of the EuroHealth Consumer Index 2016, we’ve taken a look at what are the worst aspects of our healthcare system, and what we could do to change it (with a quick reminder that it’s not just the healthcare system at fault, either).

What did we score worst on?

In the EuroHealth report, a ‘matrix’ shows how each of the 35 countries surveyed scored under six main headings, marking them with a green, yellow or red mark to represent ‘good’, ‘intermediary’ or ‘not-so-good’ respectively.

EuroHealth Cosumer Index EuroHealth Consumer Index 2016 EuroHealth Consumer Index 2016

To view this image in Full click here.

The matrix is broken down into six headings and the number of subheadings, and out of those six headings, Ireland scored ‘not-so-good’ on the following:

1. Patient Rights and Information (12)

  • No-fault malpractice insurance
  • Right to second opinion
  • Online booking of appointments
  • e-prescriptions

2. Accessibility (6)

  • Direct access to specialist
  • Major elective surgery <90 days
  • CT scan <7 days
  • A&E waiting times

3. Outcomes (9)

  • Abortion
  • COPD mortality

4. Range and Reach of Services (8)

  • Equity of healthcare systems
  • Cataract operations per 100,000 age 65+

5. Prevention (7)

  • Alcohol
  • Physical activity

We were given all ‘intermediate’ or ‘good’ marks under the sixth category; Pharmaceuticals.

Based on this score sheet, we grouped some of those subheadings together, had a look at what we’re doing wrong, and possible ways of fixing it.

Accessibility is the main issue for the Irish healthcare system (we scored badly on 4/6 criteria); patient rights were an issue too.

We also had a quick look at what we scored badly on that don’t have anything to do with the healthcare system: COPD mortality attitudes to alcohol and exercise.

Lastly, there’s a general look at what needs to be done to improve the Irish healthcare system, and Simon Harris’ attitude towards it.

Accessibility

shutterstock_579834757 Shutterstock / GunnerL Shutterstock / GunnerL / GunnerL

Ireland ranked the worst in a survey of European countries for long waiting list times: both in terms of the number of people waiting and the length of time.

This isn’t a problem that can be solved by money or funding (there’s no obvious link between access to healthcare and healthcare funding), but rather it’s an issue of system or management reform.

One major difference between the four countries with the worst waiting times and those with the best is that the latter never had systems where hospitals/clinics were financed beforehand to provide healthcare for citizens.

Dr Arne Björnberg used to be European Manager for healthcare solutions for IBM back in the 1990s and is now Chairman of the Health Consumer Powerhouse. He explains:

On the contrary, their hospitals and primary care doctors were always remunerated for services provided, so that in Belgium, Switzerland, Germany and Austria waiting lists are short or non-existent.

So basically, if people are on waiting lists for prolonged periods of time, it means hospitals aren’t getting money. They have to see and treat patients to get paid by the state.

To show how much of a difference this approach to healthcare makes, Germany’s waiting times to see your primary care doctor were measured in minutes, not weeks.

Again; this isn’t a funding issue as Macedonia, which isn’t a particularly wealthy country has one of the best rates of accessible healthcare, while Sweden has one of the worst.

shutterstock_578931247 Shutterstock / Chaikom Shutterstock / Chaikom / Chaikom

The Irish Nurses and Midwives Organisation and the Irish Medical Organisation say that most accessibility problems come down to staffing issues – that there are simply not enough staff in proportion to patients.

That’s difficult to compare to other countries, but a recent FactCheck from the end of last year showed that there has only been a slight decrease in the numbers of whole time equivalent staff working in the healthcare system.

Patient rights and information

Under this heading, Ireland doesn’t have access to no-fault malpractice insurance, a right to second opinion, online booking of appointments or e-prescriptions.

In countries such as Norway (which topped the list on patients the information and rights) they offer insurance that covers a patient who suffers because of treatment – even though there might be no one at fault.

The Nordic countries are good examples for patient malpractice insurance, where the issue of ’who might have made an error’ is separated from the issue ‘has the patient suffered because of preventive causes?’.
Nordic healthcare institutions are carrying insurance for the latter circumstance, meaning that it is very rare for patients having to enlist expensive lawyers to push malpractice cases.

In Norway, you’re also entitled to a second opinion if your request for a referral has been rejected. You can speak with any doctor for a second opinion including an emergency doctor, private doctor, or online doctor.

Macedonia and Serbia have implemented a system which displays where healthcare specialists around the country are, with their availability displayed to view. GPs can book a patient for a referral if needed, so that the patient leaves the office with a date and time.

Macedonia also have an e-prescriptions facility, meaning patients who have repeat prescriptions can apply for them from their home, meaning patients don’t have to book GP appointments just to get prescriptions.

“These are important,” says Björnberg. “If you agree that patients are grown-ups who should be supported at taking their own decisions on their health.”

It’s not all the healthcare system’s fault though and some things made it to the list that aren’t under the Department of Health’s remit.

COPD mortality

Chronic Obstructive Pulmonary Disease deaths, although recorded included in the report, doesn’t make up the ‘final score’ for countries assessed as part of the Euro Health Index. This is because the data is so poor; very heavy smokers Bulgaria, for example, report very low rates of COPD death, which is simply not possible.

What makes it worth mentioning here, though, is that Ireland and Britain have had the highest COPD death rates in Europe for years – and we’re unsure as to why.

You do have a lot of rain, damp and draughty houses,” says Dr Björnberg. “But the connection of that to COPD is not proven.

COPD is a disease that makes it hard to empty air out of your lungs. This is because the airways get smaller leading to airflow obstruction, which can result in shortness of breath as you try to push the air through a smaller gap.

Most people with COPD are smokers or have smoked in the past. Sometimes COPD is caused by working or living for many years in an environment where there is exposure to smoke, dust or other fumes.

So cold and damp weather is worth being wary of.

Alcohol and exercise

shutterstock_556588570 Shutterstock / milias1987 Shutterstock / milias1987 / milias1987

Ireland also scored badly in terms of alcohol consumption and physical activity, which are preventative healthcare measures.

In Ireland, it’s not the alcohol intake in itself that’s the problem, but rather the massive drinking sessions in one go, compared to the Mediterranean’s moderate intake that’s spread out over time.

“A steady moderate alcohol intake seems to be beneficial against Cardiovascular Disease, and thus having a positive effect on public health,” says Björnberg.

Alcohol intake is the cause of around 900 incidences of cancer in Ireland each year, and 500 of these patients will die of their disease.

Ireland has also a rising rate of obesity: with the Royal College of Physicians warning that Ireland could become the fattest country in Europe by 2030 if urgent action isn’t taken.

Efforts have been made to curb this rate by promoting exercise among young people, and imposing more regulations on sugary and fatty foods.

Health Minister’s mission

Björnberg’s major assertion on how to fix healthcare systems revolves around two key concepts: demanding better management results, something he says all healthcare systems are looking at, and taking politics out of the healthcare system.

If that sounds familiar, it’s because it echoes previous promises made by health minister Simon Harris: who upon his appointment, promised to fix the healthcare system by taking the political element out of it, and more recently, asked for improvements from hospital managers.

Harris clarified that this didn’t mean firing managers, but asking them to improve their way of operating, and looking at other hospitals’ examples of how to improve conditions, like any other business would.

“It’s not difficult,” according to Björnberg. ”You just need to manage in a way that motivates staff, maximises production, keeps costs down, and monitors the output of healthcare.”

Apart from that, just stand in the main entrance of the hospital with a cane to keep amateurs out and let the professionals do their jobs.

“And by amateurs, I mean politicians.”

Read: How Ireland’s hospitals are massaging the numbers of people on trolleys

FactCheck: Nursing union leader Liam Doran’s claims about the Irish health service

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70 Comments
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    Mute Paul Shepherd
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    Sep 21st 2021, 2:53 PM

    Are they sure it’s not 3034? After all, we have to allow for objections, cost over runs, missed deadlines, disputes and legal cases. 2034 seems a bit optimistic to me.

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    Mute Gerry from the Block
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    Sep 21st 2021, 2:55 PM

    @Paul Shepherd: Don’t forget the consultant fees. Please God will nobody think of the consultants fees?

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    Mute Cormac Mckay
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    Sep 21st 2021, 4:16 PM

    @Gerry from the Block: €100 million spent already!

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    Mute The CFC Standard
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    Sep 21st 2021, 3:05 PM

    Forget the MetroLink, build that white water rafting facility instead. Much better for Dublin City – who needs a direct link to the airport when you can just walk anyway? Better for the environment.

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    Mute Disco Inferno
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    Sep 21st 2021, 3:32 PM

    @The CFC Standard: government aren’t building that, city Council want to

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    Mute john smith iv
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    Sep 22nd 2021, 7:46 AM

    @The CFC Standard: build both.

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    Mute Alex Marquis
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    Sep 21st 2021, 2:55 PM

    Typo here I’m afraid. Should read 2134.

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    Mute Sean Stevenson
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    Sep 21st 2021, 3:31 PM

    Ah yes, Irish government projects. Expect this to be pushed further back, and its cost to be octupled by the date it was set to have been completed originally. Also expect the electorate to do nothing about it but moan online because they’re too afraid to vote for an alternative government.

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    Mute Adrian O'Donnell
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    Sep 21st 2021, 3:54 PM

    Another major infrastructure project running well past due date and presumably well over budget? Who saw that one coming?

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    Mute Robert Clifford
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    Sep 21st 2021, 3:32 PM

    Shambles

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    Mute Barry Teehan
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    Sep 21st 2021, 4:39 PM

    How difficult is it to run a train track to an airport Ffs.

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    Mute Shaner Mac
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    Sep 21st 2021, 6:54 PM

    @Barry Teehan: Er, extremely difficult…

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    Mute Barry Teehan
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    Sep 21st 2021, 8:29 PM

    @Shaner Mac: The Brits and the French managed to build a 24 mile tunnel under the sea in 6 years. Could they not just build simple overhead tracks ?

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    Mute Shaner Mac
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    Sep 21st 2021, 8:41 PM

    @Barry Teehan: Overhead tracks? Well no, there’s buildings, roads and, well, a city in the way. This is arguably more complicated as this has lots of stations. Politicians just need to grow a pair, ignore the naysayers and NIMBYs and get it done.

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    Mute Martin Sinnott
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    Sep 21st 2021, 3:15 PM

    Just start digging, get the bore down and ready

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    Mute caelan
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    Sep 21st 2021, 3:23 PM

    @Martin Sinnott: or a Luas line to the airport, sorted

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    Mute Dan Morgan
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    Sep 21st 2021, 3:49 PM

    @caelan: wouldn’t have the capacity. Also, it’s about much more than the airport – it’s about linking swords to the city centre, via the airport, santry, ballymun, dcu & glasnevin.

    Think about how busy the existing luas lines are and neither of them have trip generators as big as swords of the airport.

    Also, even if it did have the capacity, we should be future proofing

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    Mute Longlin
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    Sep 21st 2021, 7:28 PM

    @caelan: Really think a long distance Luas line is a half measure. The Luas is fine for short trips crosslinking various parts of the city, but it is too slow for linking bigger outskirt towns like Swords to the city and also takes up valuable road space that could be used for bike and bus lanes as well as cars. I’ve been over in Tallaght at matches and when I looked it up it was quicker to get into town by Dublin bus than Luas. Hardly what we need to link the airport to town.

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    Mute Paul
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    Sep 21st 2021, 3:40 PM

    Still waiting for the Bertie bowl

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    Mute Patrick O'malley
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    Sep 21st 2021, 5:32 PM

    Living opposite the M 50
    I cannot that no one ever thought of running a rail/ Luas type of system along side the motorway,with stations at where the train line runs underneath it at Clondalkin onto then Finglas then Ballymun with link to Airport from there.
    The planner’s in this country again missed out on a chance to build a modern and much needed multi link system
    The stops I mentioned could have lins to mainline rail into the city as well as serving the outskirts of this expanding City.

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    Mute John Diamond
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    Sep 21st 2021, 5:43 PM

    @Patrick O’malley: There was such a plan – it was called Metro West https://en.wikipedia.org/wiki/MetroLink_(Dublin)#Metro_West

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    Mute Cormac Harrington
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    Sep 21st 2021, 5:33 PM

    Putting Ryan in as transport minister was always going to be a disaster. You think being leader of the Green Party he would be all for a metro. Not our Eamon, he would rather see the roads clogged with fumes from the buses and cars.

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    Mute Eddie O'Neill
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    Sep 21st 2021, 4:17 PM

    We could do with clarity on a huge range of government issues, generally we get spin and outright lies, that’s how you keep the corruption under wraps.

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    Mute Susan O'flaherty
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    Sep 21st 2021, 3:09 PM

    So they are putting in new upgrades but still not even starting the metro. Now wont be completed until 2034!!!!

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    Mute Raver
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    Sep 21st 2021, 4:03 PM

    Just fecking build it

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    Mute Cormac Mckay
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    Sep 21st 2021, 4:14 PM

    Metrolink is obsolete! It’s not good value for money! We can do better with developments and advancements in transport technology and the alternative could serve the whole city not just one single route/line http://www.thedublinloop.ie Don’t be surprised later this year when BusCONnects gets refused planning permission from An Bord Pleanála because of the poor quality of cycling infrastructure! We need to put the majority of all traffic underground!

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    Mute Jonathan O'Riordan
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    Sep 21st 2021, 4:22 PM

    @Cormac Mckay: I remember this Dublin loop and it makes sense

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    Mute Shaner Mac
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    Sep 21st 2021, 6:53 PM

    @Cormac Mckay: Why do you keep pedalling that nonsense?

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    Mute john smith iv
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    Sep 22nd 2021, 8:53 AM

    @Cormac Mckay: that link is very short of specifics, except full pedestrianisation

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    Mute Search Eagle
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    Sep 21st 2021, 9:03 PM

    They won’t have put down a single track in 2034 either. Nothing to do with COVID, or funds, or even local objections… Irish politicians are simply incapable of building public transport, instead choosing to let Irish Rail play with the legacy British Victorian railway they inherited. This is just the latest rotten batch who aren’t up to it. They proudly continue the legacy of wasted hundreds of millions of our money on consultants, PDFs, delay tactics, and waffle. Many of us knew that when Metro North was scrapped (by LEO VARADKAR) and came back to life as Metrolink, they weren’t serious about building it. Governments that are serious about infrastructure don’t scrap plans and keep re-designing it until the end of time. Time-wasters dither and plan. Doers, do.

    It is beyond absurd that in a few weeks time, when the peasants are treated to the reveal of the castrated, shredded National Development Plan, GREEN PARTY MINISTER FOR TRANSPORT EAMON MICHAEL RYAN will be presenting a climate strategy whose first move is to cancel all public transit investment for the next 20 years and divvy out the cash to some motorways. Carbon tax, congestion tax, mega high fuel taxes for the privilege of sitting in traffic.

    And the plans being scrapped aren’t even ambitious. We’re talking about a single, simple basic metro line and the electrification of some existing infrastructure. Basic infrastructure that should have been built in the 70′s when it was first announced. DART+ doesn’t come with the underground tunnel, nor does it even provide any stations. And even that’s beyond our capabilities to consider doing before 2034++.

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    Mute James
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    Sep 21st 2021, 11:01 PM

    @Search Eagle: surely the eu should just step in and run this country and put in the proper infrastructure across the country that it deserves.we have never been capable of governing ourselves here.

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    Mute Paul Cunningham
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    Sep 21st 2021, 5:15 PM

    Maybe they are basing it off Metro 2033 and Metro 2034, or playing the games to get an idea of what it will look like within a year of allowing the scobes and young lads in Canada Goose bomber jackets onto it.

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    Mute Anto H
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    Sep 21st 2021, 4:27 PM

    This government is the BESTEST EVER!

    9
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    Mute Ro-your-nan
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    Sep 21st 2021, 6:00 PM

    Ooooh good, about the same time as the next DART is due

    6
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    Mute Tim Quigley
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    Sep 21st 2021, 8:13 PM

    Eamonn Ryan has. Green TD in Fingal. Seldom heard of and seems to have no interest in Metro.

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    Mute Hugh Mc Donnell
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    Sep 21st 2021, 5:13 PM

    Well at this rate it doesn’t bode well for the navan rail line with the announcement due soon

    5
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    Mute john smith iv
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    Sep 22nd 2021, 8:49 AM

    The Chinese will build 5 new cities in the meantime with 40 new metros.

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    Mute Robert Byrne
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    Sep 21st 2021, 5:31 PM

    Why am I not surprised? Could it be the fact we have inept, self-serving politicians? Or… is it the bureaucratic process that is at fault? Maybe it is because no-one in charge has the ability to coordinate and plan?

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    Mute Genera L Consensus
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    Sep 21st 2021, 10:30 PM

    Add a few more Billion onto the invoices lads

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    Mute Dave Hammond
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    Sep 21st 2021, 11:15 PM

    i think Ireland missed a massive opportunity in the past year and a half to push ahead with so much of the admin and planning works for projects like Metro – i know we werent near being able to get actual construction yet – but all the bodies who were ‘working from home on full pay could easily have progressed with the planning of major projects like this – same with some essential works – i despair driving around Dublin these days looking the the number of cones and roadworks – the Germans designated roadworks and maintenance works essential and brought forward planned works to maximise the opportunity of having low or no traffic thru busy cities like Berlin – we of course didn’t bother use our brains at all and are now watching all city centre grind to a halt as backlog of construction and maintenance works get done …we are so annoying in ireland sometimes

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    Mute Jonathan O'Riordan
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    Sep 21st 2021, 8:13 PM

    There are not enough spurs off both green and red. This would be a start and would increase capacity. There is no reason for every tram to travel cross city. Why is the Shelbourne hotel stop not ever used for example

    1
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    Mute Thomas Smyth
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    Sep 22nd 2021, 1:15 AM

    How government plans, organises and tenders large projects needs a complete overhaul. There’s so much red tape. Some of it makes sense to avoid corruption. But the delays mean that it takes so long that the plans change drastically between governments. Whole stations have been built for this metro that will never be used. The other side is the tenders go to the lowest bidder, who then hammers the government on everything to inflate costs. Look at the Children’s Hospital. And unsuccessful bidders then bring frivolous lawsuits against the government causing further delays. Something you’d never see in the private sector. The government need to outsource the whole process to a third party that can get in the weeds. Maybe on a rolling contact. Like how the Luas is run.

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    Mute The Firestarter
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    Sep 21st 2021, 10:44 PM

    It’s been delayed since the 90s, so what’s another 7 years. Funny thing is the Irish built most of the UK and America, yet they’re incapable of doing it at home, says it all really about the way this country is run.

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    Mute Brian Haines
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    Sep 21st 2021, 9:27 PM

    Dublin airport and surrounding population centres would be better served with hydrogen cell powered buses using upgraded orbital road infrastructure that already exists. The global carbon footprint of another white elephant LUAS style project could be avoided, no CPOs, no army of consultants and lawyers.

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    Mute Search Eagle
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    Sep 21st 2021, 10:22 PM

    @Brian Haines: The Luas has been a massive success, though. Expensive, late, but ultimately a showcase of how people will use good quality transit when provided. Too successful for its own good. The Green Line before COVID was beginning to fall to pieces under the strain.

    There’s no avoiding CPOs, consultants and lawyers if we want to get meaningful infrastructure built, even for our bus systems or using electric vehicles. Bus Connects Dublin (and latterly Cork) represent the painful outlay required to reconfigure our cities, towns and villages for walking, cycling, and bus. Somehow through the painful public consultations and some rather daft initial proposals, a half-decent compromise has resulted. So expect that to hit the shredders soon too.

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