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THE COST OVERRUN of the National Children’s Hospital has brought public healthcare spending in Ireland into sharp focus.
The causes of the overrun have been attributed to a myriad of factors including inflation, design changes, underestimation of ICT costs and, most damning of all, the contentious decision to locate the hospital at St James’s.
The figures associated with both the cost overrun and its review are staggering. PwC has been commissioned to undertake a review of overspending between now and the end of March and that review alone will cost €450,000.
As we cry in frustration over the recurring ineptitude of the state to deliver a decent public healthcare service for citizens, it might be useful to cast our eyes back over a history of decision-making in healthcare and ask whose purpose is being served?
How did we get here?
When Irish citizens voted in favour of the Treaty establishing the Irish Free State, our independence was only half-won.
I’m not referring to the oath of allegiance, or the selling out of Northern Irish Catholics, but to key state functions which were ‘entrusted’ to Catholic religious orders, namely education and health.
The legacy of those decisions and their consequences are sharply felt to this day.
Since Ireland became a Republic, we have pursued a very different path to our closest neighbour in our policies and actions to safeguard citizen’s health.
The British NHS was set up in 1946 when Labour MP Aneurin Bevin faced down the wrath of the British Medical Association, whose members strongly challenged the idea over fears of loss of private income.
Bevin had public support; the country was experiencing a period of post-war solidarity as war veterans returned, many with severe disabilities. The NHS was highly progressive in that it was funded entirely through taxation. This eliminated user fees or out-of-pocket payments, which were susceptible to commercial interests.
Around the same time, Dr Noel Browne tried to introduce the less ambitious plan of free healthcare for mothers and children under 16 years in Ireland.
Despite widespread public support for the scheme, it was ultimately blocked by politicians in the vice-like grip of the bishops and under the influence of the powerful medical profession.
The Church’s stance, that the state should have limited involvement in ‘family issues’ including healthcare, became embedded in national policy.
In the new Free State, healthcare was delivered by family doctors, in people’s home if they could afford it or in religious and charitable hospitals.
Responsibility for public health activities such as sanitation and provision of clean water lay with local authorities. The very first Minister for Health was appointed in 1946 and the Department of Health was established the following year to take over responsibility for all aspects of public healthcare.
The Department focused its resources fighting infectious diseases such as TB and ushered in a period of intensive hospital building with funding from the National Sweepstakes.
Investment in hospitals and public health generally succeeded in reducing the burden of TB and improved national health indicators such as infant mortality. Serious questions remain to this day, however, over the ownership of institutions funded primarily by the state and run by religious orders.
Two-tier system
In 1957, the government established the VHI in its current form, a subsidised semi-state company that provided health insurance to those who could afford it. This policy decision resulted in the creation of a two-tier health system and remains in place today.
The VHI is a critical impediment to the implementation of a system of universal healthcare, which the government has committed to under the SDGs and is envisaged in Sláintecare.
While services expanded, there was little significant reform of our health system in the subsequent decades. The church and medical profession maintained their grip and no national conversation took place around the core values underpinning our systems such as equal access, equitable allocation of resources and good governance.
One significant development, however, was the introduction of tax reliefs for private hospitals, a direct result of government lobbying by private interests.
This policy change, by the Department of Finance, had enormous ramifications for the public hospital system. It encouraged private for-profit operators into the system which increased the complex mix of publicly and privately funded services.
The UK fought to prevent this occurring as it understood the symbiotic nature of public and private systems: if one is strong, the other has to be weak. In other words, if our public health system was strong, there would be no demand for private hospitals.
Universal Healthcare
The Department’s 2001 policy Towards Quality and Fairness, introduced by Minister for Health Micheál Martin, espoused the need for stronger care in the community. It went nowhere.
With Charlie McCreevy holding the purse strings in Finance and calling health a ‘black hole’, the plan never stood a chance.
From 2011-2015, the main policy pre-occupation in the Department of health was Universal Health Insurance. Based on the Dutch model, it proposed a competitive, multi-payer insurance model for the whole population.
An ESRI report in 2015 which costed this approach finally ruled Universal Health Insurance out as a viable policy direction. Between 2015 and 2017 when the Sláintecare report was published there was a policy void with no clear direction for our public health system.
What can be learned?
This is a whistle-stop tour of Irish health policy. There are stark lessons to be taken, however, from the experiences outlined here.
A hospital-focused, insurance-led system may have made sense in the middle of the last century but healthcare and health system indicators today stress the need to change this high cost, overly complex and bureaucratic model.
Ineffective policy decisions since the foundation of the state have at best, curtailed system improvement, and at worst harmed it.
Despite Tory-inflicted damage, the NHS has many distinct advantages over our public system, and it does vastly better on key performance indicators.
It should be pointed out the NHS has benefited from independent evidence-based research and policy advise produced by philanthropic bodies such as The Health Foundation, The Kings Trust and The Nuffield Trust which are entirely absent in Ireland.
More importantly, it has Public Health England (PHE) an executive agency of the Department of Health and Social Care that provides government, local government, the NHS, Parliament, industry and the public with evidence-based professional, scientific expertise and support.
PHE employs over 5000 scientists, researchers and public health professionals looking at all aspects of healthcare systems and services. Ireland has no equivalent.
Policy of inaction
Scandals such as the massive cost overrun of the National Children’s Hospital are damaging to public health on so many levels, not just now but long into the future, through the deferral of other necessary capital projects, the clear lack of governance and accountability and the loss of trust and hope for the future of the public health system.
In the 1920s the Irish people overthrew one oppressor only to hand over the shackles to another. The influence of the church and some self-interested medical professionals on public health policy has never been adequately addressed.
A hundred years after the first meeting of the Dáil, it might be interesting to ask, what an independent health system might look like?
What values would we like to see underpinning our health and social care systems?
Every student of public policy knows that all policy decisions, including a policy of inaction, have winners and losers.
As our public health system continues to be led in a chaotic fashion it begs the question, who is fighting for the public system? Is it failing because we have, consciously or unconsciously, chosen the path to failure for a long time?
Maebh Ní Fhallúin has a Masters in Public Health. She is a public health policy researcher and advisor with a background in media and communications.
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Everything is failing, being taxed or privatised because we don’t put any pressure on our elected officials and they know it. Switching from FF to FG wasn’t a seismic step in our political system. It was a reflection of a people who don’t know what they want or are too afraid to achieve it.
@Carlin Ite: are you saying neither party has an interest in the Health Service. I don’t agree as otherwise why is there one?
@Carlin Ite: we want world class everything here, except we won’t pay the taxes to pay for world class.
@James Wallace: we are top 5 https://www.statista.com/chart/amp/13366/eu-healthcare-expenditure-relative-to-population-size/
@James Wallace: totally wrong James. We pay premium taxes, we don’t however get a premium service for that. Nobody seems to care in our administration because it’s not their money, it’s ours.
The author is also totally wrong, while she’s correct that the church should have no say in health policies, the blame for our poor performance lies almost completely in the hands of those the control health spending.
@Rory: yes, but a very inadequate system.
@James Wallace:
Are you out of your mind? We don’t pay enough taxes? Seriously? Almost half my earnings is confiscated by the government and what do folks get in return? What do they get? The squeezed middle? I’ll tell you that the squeezed middle is FFG’s honey pot. They staple diet where they gorge themselves regularly. F@&k them, I’ll be voting SF in my attempt to oust the cronies.
@James Wallace: We get third world services for first world rates you lemon.
@James Wallace: Incorrect. We currently pay first world taxes and in return get third world services. You think we should pay EVEN MORE with no guarantee of improvement? Very foolish.
@Milk The Drones: I think the point being made wasnt necessarily that individual taxes should be increased, but rather our tax net covers too few people, to many tax exemptions, hence the term Squeezed Middle
@Vocal Outrage:
No. In fairness you’re making that up on behalf of him. No such point was even remotely made.
Emma Mhic Mhathúna was amongst the squeezed middle. Thousands of more women like her are biting their nails as we speak. I don’t know who he had in mind making that post but lads like him will never, ever speak for “most” people or self employed lads like me. Infuriating horse shyte.
@Milk The Drones: well, it’s the point I’m making, as one of the squeezed middle. But I do note how you tried to twist the thread from tax to terminal cancer diagnosis, an argumentative flip worthy of a government Minister
@Vocal Outrage:
I didn’t try anything. I wasn’t even replying to you. You jumped in here looking for a debate no?
@Milk The Drones: if you weren’t replying to me my friend why did you use @Vocal Outrage in your reply? So no, I didn’t jump in.
@Milk The Drones: Exactly. A stronger SF is the only way change happens. Either with them in power or as main opposition. The status quo of FFG has to be broken.
@James Wallace: money isn’t always the problem. We pay as much per capita as New Zealand does they have a much more disperse population and their services is better, they have more nurses and doctors and they are better paid. —— Organisation and Management is the problem.
Having worked for both the NHS and HSE I think the problem with the health system is accountability. It’s also run by Doctors who don’t know how to run a business and will target their own medical interests. It needs to be run by proper businessmen (if there are any) who will control consultant pay, introduce standardization, and not allow private hospitals so close to public ones. Ireland pays more money per person to the health system than the UK, which has a free health system!
@C M: Great point.
Failing because there being run down to force people into private health company’s
@C M: facepalm. Doctors (or nurses) running the HSE is what we actually need but have never had. Health minister isn’t an HSE boss FYI.
The scary thing is, is how many people ‘thumbed up’ your comment.
@C M: doctors don’t run the HSE!!, nurses, moved into management actually do. You have no idea what you are talking about. Usual tripe that while problem can be explained because consultants paid too much. Grow a brain
@Ciaran Bolger: Nurses got into their profession to care for patients, not to try and balance budgets! Hospitals get a ridiculously huge pot of money without any accountability for how it’s spent. A tiny example of this is if you attend A&E in an NHS hospital, they have to hit a 92% rate of treating people within 4 hours. If they don’t reach that target, people get fired and the NHS bring in specialist people to sort it out. Over here nobody gets fired if patients wait for days on beds in corridors while doctors and nurses are looking at spreadsheets in an office somewhere.
@C M: I completely disagree with your sentiment that “businessmen” need to run a health system.
Indeed, much of the staggering waste and ineptitude I’ve encountered is precisely because the funds are controlled and “strategies” are implemented by non-medical professionals who, not working in the system and having no experience with it have no idea what is needed and we end up with massively expensive facilities not fit for purpose.
I’m insulted by your insinuations, there’s not a doctor in the goddamned country who’d prioritise their pet projects over important much-needed resources.
Handing the control over to people in business would just allow them to squeeze more money from the upper echelons of the system preventing trickle down and result in micromanagement and a series of obstructive, bureaucratic nonsense in the name of “efficiency” how do I know this? Because it’s already bloody happening, sometimes I think the people running the show have never actually set foot inside a hospital.
We are in the top 5 spend wise in the EU
https://www.statista.com/chart/amp/13366/eu-healthcare-expenditure-relative-to-population-size/
Surely the problem is not the spend but the organisation. It needs bold leadership, however this will not be popular. We should be world leading.
@Rory: NHS two admin staff per patient the land of the unionized leprechauns 5….probably something similar with management, its one big feeding trough and the grub ain’t going to where it should be….
@Peter Hughes: Unless Public Servants are accountable and sackable throughout the public service then we are going nowhere.
Just look what a country we could have if it was run properly
@Peter Hughes: Unions have fought to keep staffing levels that management want slashed.
Admin and management are the big issues. It is being run incorrectly and the patients and the staff suffer.
Spend time in the hospital system and you see it at first hand
@Peter Hughes: allow me to be boring. I was a nurse in the HSE and the NHS system
When I started in 1968 we had matron and her 2 assistant matrons. Manigment was minimal. Matron seemed to run the show. Matrons were better than generals in an army. Then ‘BRAINS’ got in the.way and reorginized the system into chaos
I then witnessed how stupid some change can be. And this was change in a.big way. Nothing seemed to function anymore
Hospital.systems became top heavy with management and inevitably.capsized.
@Peter Hughes: you’re dead right. Too many Chiefs and not enough Indians.
Very good article, way above the Journal’s usual standard. One way to send a message that we as a nation have moved on would be to name the new children’s hospital after Noel Browne RIP. He was so far ahead of his time.
@John Considine: Excellent idea
@John Considine: Great suggestion for NCH name.
@John Considine: The aspirin I pay for. Sorry should the taxpayer pay for this. Seriously I want a great primary care. It would elevate a hell of a lot of this issue.
@Rory: Pay for your aspirin. Sure why not? You’re a real pain.
My goodness the late dr noel browne must be turning in his grave, to see the overpaid guys who has come after him. People would still be dying in Ireland only for him from TB!
Anybody should read his book #AgaistTheTide.when he made a promise he kept it.
@James Reidy: James who is overpaid. The nurses, the doctors, the cleaners, Reception staff, consultants, cooks, admin staff, managers? What’s fair pay?
Another dog whistler.
@Rory: Middle/Top Management, advisors, Consultants, When the consultants get paid for what they do for a short week, then double their money with private healthcare patients, often using public healthcare property , THEY are overpaid by a long shot.
PS, i`m pretty sure he was alluding to the top of the food chain, as the Guys that came after him.
Hows the service in the NHS over there for you ?
do you have the same problems as us?
@Rory: He’s referring to the government…
@Rory: The guys who took dr dr noel brownes job, i know that NURSES & MIDWIFES are under paid, even with what they agreed to,
Every minister for health has a trail of broken promises after him,
It is one thing you can’t say about Noel Browne he had to take on his own profession, church & his “collegues” in goverment.
@Pixie McMullen: consultants have contracts with HSE.
They must fullfill these contract conditions before attending to their private practise.
A major issue is the shortage of consultants in the HSE.
The newly qualified hop off abroad same issue as with nurses
@Rory: U use dog whistler a lot, watching your comments, of we know what it means 1person on this particular issue does not know,
I have a feeling it could apply to yourself!
@Rodney Williams: Except a lot of them don’t, didn’t you see the RTE Investigates programme which showed some of them only putting in a fraction of the public hours they were being paid for.
There should be a productivity clause in their contracts.
@Pixie McMullen: Pixie. As a taxpayer in Ireland You still haven’t answered my question, are you a tax payer in Rep of Ireland.
@Pixie McMullen: so consultants in the NHS are allowed even more scope for private practice than here!!
When public children’s hospitals are asking for private insurance details, that’s a problem. When private consultants are working in public hospitals, that’s the problem. When hospitals are hiring employees from agency’s, that’s the problem. If this new shame of a hospital is not stopped and a private ward is built into it, that’s the problem. The main problem is privatization. Having lived in Germany. The whole system is privatized. Everyone pays in their wages but don’t have to had over extra money in consultation fees. The hospital and insurance companies fight it out between them.
@Niall Donnelly: I think that’s a great point.
@Niall Donnelly: In Germany the hospitals are organised in coops which means they have much greater bargaining power when dealing with suppliers. We don’t have the critical mass in Ireland to allow for that, which is why it is left up to the incompetence and vested interests of HSE/Department of Health.
@Niall Donnelly: Realistically, we are stuck with a Public Health Service which is in fact controlled & manipulated by private interests, but managed by a state organisation which is purely functionary, effectively to carry out fluctuating government policies, & sign the cheques.
Also, due to the haemorrhage of medical skills to foreign services, capacity is perpetually behind demand.
It may now be best to fully merge the public & private services, by establishing a German style funding model, assigned by the individual to a health insurer, & PPP contract the provision, management & administration of hospitals, medical supply & ancillary health services.
Let the Health professionals & pension funds put their know how into the Health industry, &compete for the business from insurers.
How about taking the politics out of running health altogether ? Too many vested interests for it ever to be run properly.
@Declan Moran: They tried. HSE was set up to excuse politicians of blame. It’s always Civil Service to blame. Problem is, whoever is Health Minister, it’s doomed.
I am not suggesting privatisation!!
They do a good job elsewhere. Why not learn from them?
@Rory: The only thing worse than so called “public servants” running the health care system is politicians running it. Public hospitals should be run like private ones – with a competent management team hired based on track record and experience, who are paid well but who will be held to account for failure.
Good article. Lifts the lid on a few things. The fact the right wing FFG have been leading every government of the last few decades and that we have a disfunctional third world type health service are not co-incidences. We need to choose a different path if things are going to change.
@Toon Army: And SF are doing a great job up North. Paid politicians idle…
@Rory: Quick…..look over there !!!
@Rory: it always comes back to Sinn Fein. A whipping boy to deflect from FF and FG. Give Sinn Fein a chance before condemning them.
@Shakka1244: I have no party affiliations. Happy to make up my own view of the world.
@Rory: Westminster holds the purse strings for NI, ye haven`t a clue lad, you`ll say anything to get a dig in, even if it means being wrong
@Rory: Are you on duty in the fraperoom tonight.
@Pixie McMullen: That’s very untrue comment. I wish the executive was alive and working.
@Rory: You must be on treble time for a Sat night eh?
@David Corrigan: Health Service gets me going. Politicking make me sick.
@David Corrigan: Health Service gets me going. Politicking make me sick.
@Rory: What health service?
@Rory: A skewed blinkered view. Attempting to equate the mess of northern sectarian politics with ours is ridiculous. And in case you hadn’t noticed SF are demanding equality in the north. We don’t have equality in any of our systems and SF has never been responsible for that.
Coming from Belgium, I’m always baffled (though I’m not) that Ireland can’t copy a well working system.
Belgium has premium health care, one doesn’t have to wait longer than 1 hour in A& E.
A visit to the GP costs € 30 and is further subsidised so that you can claim most of that back too, consultant visits cost marginally more, less than € 100, and appointments can be obtained without GP referral. Moreover, one can trust the care that one receives, something that ALL of my fellow European friends lament here, in case if emergency, we go back home. I’ve lived in different countries and have had good care, everywhere, except in Ireland. The ONLY exception have been the nurses, which are exemplary.
As always, it boils down to the simple things: who is getting paid for it and how much. As long as the country is in the grip of overpaid doctors particularly consultants, it’s not going anywhere.
But then we live in a country where the Taoisoch is paid vastly more than other leaders including the US president. No wonder we have issues with the cost of the new children’s hospital. Ireland is run by “the boys club”.
@Marianne Creyf: so well paid that the HSE are failing to full consultant vacancies.. makes sense
@geraldo: *fill
@Marianne Creyf: the consultants in Belgium are actually paid more than the consultants here!
I spoke to my Norwegian friend about their public health service. They really have their sh*t together over there. She was changing her GP and all she had to do was to go online and click on a new GP and it was sorted.
We spend a lot on the HSE but we just can’t seem to manage to fix it. It’s the most inefficient thing I’ve ever seen. My GP submitted a referral to a neurologist last year and I’ve yet to get as much as a letter to give me a timeframe for an appointment. The last time I had to see a neurologist, it took my four years. They had messed up my appointment somehow.
It just feels like anything that CAN go wrong WILL go wrong.
It’s clear FG can’t fix it. Time to try something different. But what?
Too many vested interests and a focus on commodisation of health provision so that money goes to certain recipients. Patients are apparently regarded as an unavoidable impediment to ‘efficient market implantation of healthcare’ in terms of statistical analysis….or something. No Minister of Health will change status quo and probably has little real chance of doing so. Likely another ‘Vision’ document forthcoming from Oireachtas and time frame of 10 to 20 years to ‘implement’…..see I could be Minister for Health. Put me on the front bench, Taoiseach.
@David A. Murray: Your a dog whistler!! A lot spoken here. Where’s the proof of vested interest that undermine the Health Service. Who?
Don’t understand the term ‘dog whistler’s. Never heard it before. Look at the breakdown of Health department budget. Look up news stories on pharmaceutical industry (specifically failure to address Troika advice re same), look up Brendan Howlin’s statement about running down public system to make private/ health insurance profitable; look up news stories on HSE structure & staffing, look up consistent failures of government oversight, look up lobbying of ministers…in fact just acquaint yourself with info already in public domain….you live in Ireland presumably and really should know already how things operate here….also, read the article again.
@Rory: *You’re
@David A. Murray: So in essence you state something but cannot back it up.
A dog whistler is a distraction with no evidence to support there claim.
@Rory: Also please don’t where I reside.
@Rory: FFG and Labour have long ago decided that privatisation is the way to go in public health. All we see in the debacle the public health service is in is down to that, and nothing else.
@Rory: You reside in the UK according to your Twitter account, and you tweet loads about Greenwich
@David A. Murray: It’s the new buzzword the fraperoom have been told to use as an insult.
@Rory: ?? I can’t understand your last comment. As I said if you think back over the reports in the mainstream Irish print media about health service, health insurance service, private industry and government it is clearly established already.
@Rory: Of 49 comments here so far, 14 appear under your account. Why?
@Pixie McMullen: Dear Pixie (whoever you are) I pay my taxes. Where do you pay them?
@David A. Murray: because I hate comments that are not backed up. I know would suit you otherwise. Please give clear proof of your earlier statement. Then I will happily shut up.
@Rory: Is that you sir Bob?
Very good read,its politicians that are the cause of all our problems.
@@mdmak33: not so.i believe you get what you deserve
We voted them in SO we too are to blame.
(1) Declare Ireland a secular State
(2) Nationalise all school & hospital buildings
(3) Audit world’s best practices in Education & Health and adopt the best models
(4) Tax corporations at the EU average
(5) Offer GP’s free rooms and secretarial services in hospitals in lieu of a bulk billing standard charging system.
(6) Adopt a secular education system.
Say bye bye Pope, bye bye Bishops, priests & nuns. You have had a nice century and
you now have reached your use by date!
Pssssst: That will also appease Protestant anxiety on Unity
IMHO health services are too highly biased towards reactive delivery. Shift additional investment towards health promotion and illness-prevention to help dramatically reduce the flow of people showing up (unnecessarily in many cases) at primary care with highly preventable (primarily lifestyle-related illnesses like diabetes type II, heart disease, stroke, dementia, alzheimer’s, COPD and even come cancers).
Please Dept of Health and HSE, please invest more heavily in existing illness-prevention and Health promotion programmes led by Healthy Ireland, Safefood (other agencies like Diabestes Ireland, Heart Foundation, Irish Cancer Society) and by developing additional incentives for corporates (large and SMEs) to engage and drive employee wellness initiatives (IBEC’s KeepWell Mark is a great example of one such initiative that is dedicated to improving awareness of the importance and bottom-line benefits of healthier, more-present and more productive employees).
@Seamus Power: Lastly a person who makes sense.
@Seamus Power: great idea. But Ireland has a strong pharma lobby, and plenty of jobs in the sector, not to mention the revenue of pharmaceuticals…
@Seamus Power: They invest massively in health prevention. If it one thing the HSE do its shiny brochures and campaigns. Running and building hospitals the are not much use but brochures and campaigns they are the best.
@Gary Kearney: there us no question there is current investment in health promotion and illness prevention. My argument is that there should be significantly more than current levels. From what i have been able to find it us currently around 2%of total DOH budget….i would argue it should be ~20% to be truly effective
Words fail me will this Doltish government!
Using the debacle known as the construction of the children’s hospital to serve as a step off about our healthcare system is wrong. The children’s hospital is an indictment of our procurement process and management.
@John Flood: Isn`t it the HSE management that has squandered this money?
@Pixie McMullen: to me it was the procurement manager, not the healthcare staff. Should never have been an HSE project, but an independent procurement office to manage all government capital projects.
The issue is primary care. Needs to be invested in properly and securely. It’s effects us all if we think about it.
@Rory: Don’t have to think about it Rory. It’s affecting us now.
Was it the Church or the private Medical profession or indeed a conflict of interest in the Dail or the fear that the church would loose the mother and baby homes that lead to the collapse of free healthcare for mothers and children up to the age of 16…. ?
This was the start of the road to the current crises… we got rid of the regional health boards for the HSE and tried to fix the system and failed…. and they are talking of going back to that system…. but there are other issues, the cost of living and accommodation in Dublin high resulting in the need for higher wages, not just to nurses but for everyone living in the capital.
We created the two tier system that allows some people fast track – but more importantly it created a market that allows the professionals make money from healthcare – and some to divide loyalty between the two…
The biggest issue however is the lack of primary care for lower and middle income people who are above the medical card threshold and struggling to pay the GP fees… and end up in the public system unless they can afford private medical cover.
One way or another it will take a lot of money and outside the box thinking, as well as a change in attitudes, to fix the system.
I have no idea of the administrative spend over the medical spend or the capital expenditure spend so I am not really in a position to know where sayings and reassignment of resources could take place – but we are responsible for our own mess collectively.
A major US healthcare organisation offered to share its world class expertise and help reform Irish healthcare. The Minister, Department of Health, Taoiseach and HSE blanked them for nearly two years. They gave up to focus on their own patients.
The Press know. The Opposition know.
It was an opportunity to jump forward 15 years in terms of healthcare improvements.
No one cares enough to investigate, tell the story and let the public know of the shambles that is Irish healthcare.
No, i’ll tell you why our healthcare system is so bad. Its because its run by a state agency thats why!
The health care system should reflect that of a country with 4 million people and we should not compare ourselves to the rest of the world. We are a small island and what we can afford is what we can afford and they need to get tight with the budget. When it runs out then we are left with just private work until the start of a year again.
@Robert Deane: But surely for such a small nation, it should be at least 15 times easier to implement an efficient and effective health service than the NHS. The HSE is a complete basket case. Overstaffed by jobsworth pen pushers and at the behest of unions. Chucking more money at it solves nothing – it needs a complete overhaul from the top down.
@Robert Deane: We are in the top 5 in EU spend wise. It’s not a money but an issue of stopping changing policy at every issue that occurs.
@Robert Deane: Iceland, Lichtenstein are small countries. Have a look at their system
Destined to fail, no solution in the horizon. FG and FF have both tried without luck. SF plans to limit civil servants salary and limit costs, everything with Venezuelan economic success in mind.
The lack of knowledge about the HSE of the journalists is abismal.
Multiple reasons.
For example, no enough doctors, no enough nurses doing proper nursing work and lots and lots of unaccountable people.
Consultants paid well? Probably, but if you pay less, plenty will go abroad. The only reason many have not gone, in the awful state of the HSE, is the salary.
No excuse to mix private and public. Again shocking managerial control.
The hospitals are so badly run, management high and middle is so incompetent that beggars belief.
Useless people in permanent jobs.
@Jo Buckley: why aren’t the vastly lesser paid European consultants exiting their countries???
@Marianne Creyf: Because
1. This notion that European “consultants” are vastly less well paid that they’re Irish counterparts is nonsense. The career structures are different so the pay comparisons rarely compare like for like, there is no such title as consultant in Germany or France. But if you compare Irish consultant salaries to that of a chief specialist say in Germany or the equivalent in France (which is the right comparison) you will see a very different picture. In those countries there is also unlimited private practice.
2. Germany, France etc have huge issues with doctors giving up practice for more lucrative and less stressful jobs in the private sector (esp jobs in pharma, sales, drug development etc). Germany actively imports doctors from the former Soviet bloc as it has a huge shortage of doctors. Same is true for France.
450 k for the review, will it even come in on budget?
The appointment system in the HSE deserves a TV series. I’m not sure if a comedy or horror sitcom. Because nobody is fired, there is continuous internal promotion of incompetents rather than looking for an outside better candidate. Much of the HSE is run by trade unions.
For example if a consultant announces he/she is leaving a vital position for a hospital, the public appointment office might take months to publish the job looking for candidates, it will take many more months to arrange interviews and once offered the post , it will take months for the successful candidate to say yes or no and then more time to actually start to work. Imagine that in a private company. It would be considered unacceptable.
In Irish hospitals fax machines are still used routinely (many depts refuse to accept emails as they believe faxes are somehow more secure!). There is no or very poor Wi-Fi in most hospitals and the computers (at least those available to frontline workers) are a throwback to the 90′s and as slow (that’s if you can find one that actually works!) All of a patients important medical information is stored in (often) volumes of stuffed paper charts (which are more often than not falling apart, who’s job is it to fix them? who knows!). What’s contained within the charts is usually illegible anyway. Whole crews of workers are hired to file, store, retrieve and transport these files. Massive technical revolutions are around the corner – personalised medicine, the use of augmented reality in performing surgery, wide spread use of genotyping, use of stem cells etc. If we can’t even get the most basic things right in our hospital system – like internet and electronic files – what hope have we of taking advantage of these major revolutions in medicine.
I became very ill and was taken to Beaumont Hosiptal and I was treated so well .If you are very ill the hospital staff will look after you .❤
A friend set up a company 4 years ago, it has 17 staff and since starting it has let 5 people go for underperforming and not being up to the job. I worked as a manager in the HSE and could do absolutely nothing with staff who arrived late, abused sick leave, sat on their phones or booked holidays on their computers. These little things had to be let go as the kickback when you tried to deal with these issues had to be seen to be believed. One staff member stole 50,000, suspended on full pay for two years, was investigated, demoted to basic grade but on appeal by using a Barrister, was reinstated back to the higher grade and the only consequence was a move to a different facility where there was no financial access. Another staff member who walked out of the facility with their weekly supermarket shopping each week (caught on CCTV) had no consequences because the Union argued and won the point that CCTV evidence was inadmissible. These are but very small examples of a multiple of issues I faced as a manager by a minority of staff but this minority becomes significant when you extrapolate it to the size of the organisation that is the HSE. It is at the core of what is wrong as managers cannot manage, good staff become disillusioned watching what the minority get away with and morale is sapped across the board. Why the media never looks at the human resource issues escapes me, why private companies can let people go with two weeks notice and payment in lieu while the HSE rarely if ever sacks anyone seemly makes no sense. Time to lift the lid on what rots below and maybe then we can start to fix this mess:)
What a rambling incoherent article with the usual object in the crosshairs, The Catholic Church, which apparently had the Irish politicians in a vice like grip. Those same politicians who had in the previous war of independence totally ignored excommunication and threats thereof.
Is there any “columnist” in Ireland today capable of writing an article without taking a cheap and inappropriate shot at RC.???
A brilliant article. The history of a health system outlined so well. Every word so true. It doesn’t appear as if it’s really an ambition if any party to run a successful health system. The VHI being set up by the government is very telling!!!!
Change comes from people working in the system. The best hope for improvement comes from a free flow of staff in and out of the Irish system from abroad, bringing with them best practice they have seen elsewhere. This is an appropriate for a small country. Is is very difficult for people to change anything after they’ve been in post for years, our brains are just not wired for it.
I returned to live in Ireland after living in uk for 40 years ,stayed 13 years had to return to England because of Irish public health system ,had been waiting for ,a urologist for 4 years ,ortropedic appointment for 5 years ,within 6 weeks of returning seen both consultants and treated.also had cataracts done after waiting 3 years in ireland .ireland is only good for the rich now .
All our governments since the foundation of the state to date are quite useless We need another TJ WHITEGAR
I loved the article but felt the anti-Tory bias was a bit cherrypicked. It was the Conservative Party who initially proposed the NHS system, not Labour. And just last year the Tories have proposed plans to give the biggest injection of funding to the NHS since its inception.
Great article, but felt the subtle jabs at the Brits was unnecessary.
@Rory is a crap stirrer!
@James Reidy: is this the James Reidy that wait for itJjameRe86665556. Dog whistier.
@Rory: was never on twitter you #brit
Resources spread too thin. Too many substandard local hospitals. Three hospitals alone in the midlands, no need for places like Roscommon or Mullingar to have one each when their only an hour from Dublin or Galway. Consolidate all medical services into five / six hospitals nationally.
The Irish simply cannot run their own noses
Not sure but I think many things which going wrong her in Ireland have to do with nepotism.
Interesting article but you fail to mention the considerable investment Ireland makes in health and health services research via the Health Research Board (HRB), in excess of €45million per annum.
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