Your Health - Whose Business?

national | anti-capitalism | news report

Tuesday April 11, 2006 12:35

by Cathy Swift - People before Profit

Catherine.Swift at may dot ie

086-0679708

4th People before Profit information evening

On April 7th, the fourth in a series of information meetings organised by People before Profit was held in the IFI in Dublin. This meeting - on the issue of privatisation of the Irish health service - was addressed by Louise O'Reilly of SIPTU, Peadar O'Grady of the SWP and Dave Hughes of the INO. Participants were urged to support the Patients Together Lie In at the Dáil on Good Friday at 12.00.

Your Health – Whose Business?

The fourth in the current series of People before Profit information sessions took place in the IFI, Dublin on Friday 7th April. Speakers were Louise O’Reilly, Assistant Branch Organiser of the Nursing Unit in SIPTU, Dr Peadar O’Grady of SWP and author of Why the Irish health service is in crisis and Dave Hughes, Deputy General Secretary, Irish Nurses’ Organisation. The evening was chaired by Cathy Swift of People before Profit.

Louise O’Reilly began by referring to the context of current moves towards privatisation of the Irish health service. As Minister for Health, Mary Harney is leader of the PDs who are on record as favouring inequality in society as this gives those of us, who are not currently top of the social heap, aims to aspire towards. The system which this government currently favours is one in which health is organised on a for profit basis and that the best solution to the current crisis is one in which can be sorted out by opening it up to the commercial market, as has been done in the States.

In the opinion of SIPTU, such a scenario will foster a two-tier health system where the richer one is, the healthier one will be. At the same time, the health services will be asset-stripped and essential tasks such as cleaning will be outsourced. Instead of cleaners being a key and valued part of the institution, they will be hired by private companies who seek to make profit out of their employment by cutting corners. This also has the effect that the authorities governing the health system (now the HSE) will no longer be responsible to the public for this aspect of the health services.

In a similar vein, the HSE is absolving itself of the State’s traditional duty of care for the elderly by outsourcing home helps to private companies such as “Comfort Keepers”. Although this is often described as increasing efficiency, a brief look at the costs make a nonsense of such claims. The current cost for home helps employed by HSE is 14 euros per hour. Comfort Keepers are paid by the HSE at 20 euros per hour while at the same time paying their staff an average of 9.50 euros per hour. The only gainers are Comfort Keepers share-holders, not the elderly, nor the staff nor the Irish tax-payer.

The system currently being designed is one in which the Irish public has to subsidise private health care which, in turn, can cherry-pick its patients from the young, the wealthy and those without a medical history of extreme need. It is a system which marginalises the most vulnerable. To reverse the damage, a partnership approach to all workers in the health industry is needed where resources go to those who need them. The Irish taxpayer has already paid for such a system and it deserves one going forward.

The second speaker as Dr Peader O’Grady who spoke of the sense of crisis engendered by the remarks of Brendan Gleeson. He saw the fundamental problem in the Irish health care system as being one of capacity with not enough beds in the health service and he also argued that a system when payment was required of someone who had fallen sick was the most inefficient system of health provision possible. (As initial charges, Irish patients have to pay fees to the GP, the pharmacist, and to casualty before they receive any treatment whatsoever.)

Dr O’Grady argued that the number of patients on trollies in the Irish system were not a mark of failure but rather of deliberate policy to run down public services and limit the capacity of the public services. (The HSE has recently announced that the system does not require more beds although others feel that a further 3000 beds are required to bring us up to normal European levels.) The government’s aim instead is to send patients to private hospitals whose construction is funded by enormous tax breaks. These private companies will include large multi-national corporations who see involvement in health primarily as a way of gaining government money for its share-holders. This focus on profit-making opens the door to waste of public funds: according to the FBI, 5-10% of American health spending disappears because of fraud. The company involved at the new Beacon health centre in Sandyford is a spin-off of Columbia Health-care which has recently been charged 1.5 billion dollars for false-billing and claiming cash for procedures not done.

There are already private hospitals in the Irish system, some of which are very successful. Traditionally these have been maternity hospitals and were located close to public hospitals. The care in such private hospitals is usually provided at consultant level with very few junior doctors although the types of treatment on offer are usually fairly limited in comparison to those available in the public hospitals. (Patients requiring more complicated procedures would be sent to the public hospitals which, because of the greater numbers going through their doors and their duty of care to all, have wider experience.) In the public hospitals, however the consultant/junior doctor ratios are reversed with many of the staff being at junior doctor level. Crises occur in public hospitals outside of normal hours when there is little or no coverage by the consultants.

In short, in O’Grady’s view, construction of more private hospitals will not move public patients to private care and thus free beds as the government are currently arguing. Instead extremely large sums will be spent which will allow investors to create provision for the less complicated procedures – he quoted Wren and Tussing’s forthcoming book that for every 22 million euros of private money invested, the government pays over 39 million. Public hospitals will be left to carry the burden of all the more complicated care that the private hospitals will avoid on the grounds that it is impossible to make profits for the investors out of the difficult cases. Instead of going health-for-leather down the road to privatisation which has been shown in America to produce inequalities, Ireland should be aiming for free health care at the point of need, funded by progressive taxation of the healthy (i.e. the richer you are, the more you pay.)

Dave Hughes began his talk by pointing out that 276 people were on trollies on April 7th and asked the audience to consider the human misery that each such person would be experiencing. The system is in such crisis that ancecdotes are being reported to the INO about an individual VHI payer who had been told by his GP that an invasive surgical procedure was necessary to check for the existence of a disease; in order to gain access to the hospital, it was suggested that the man go to hospital with a mythical pain and tell lies in A & E. He asked that people remember that in the 1970s and before, many people had not been covered by the public health care system and had joined VHI under some degree of compulsion – what are such people now getting for the many years subscriptions which they have paid over the course of their careers?

If one looks back over the course of Mary Harney’s term in office, one sees a constant attempt to blame individual groups within the sector for the current problems. In the beginning, she blamed the patients for being “bed-blockers” who were unwilling to leave their hospital beds. Then nurses were blamed for pursuing bench-marking payments and now she is blaming the consultants for refusing to renegotiate their contracts. There is a calculated campaign of diversion by picking on scrape-goats and as a strategy it’s working. Even in the last week, Brendan Drumm has been emphasising that the problems are essentially those of industrial relations within the health-care sector. Such remarks are a comfort to the average tax-payer who is made to feel that the problems can be sorted out by better management and without higher taxes as the private investor will pay for all reforms needed.

The solutions to the current Irish health care crisis are unlikely to be cheap and, in the INO’s opinion, should be state funded rather than run by and for private organisations. A person’s health should be the criteria on which they receive aid – not the amount of money they have available to pay for care. Support must be offered for all campaigns which seek to put the patients first. In that regard, Dave Hughes concluded, he would like to draw attention to the forthcoming Lie-In by Patients Together at the Dáil on Good Friday and urge everybody present to support it.

Discussion from the floor ranged widely over a large number of issues. Questions were asked about the admission system of St Lukes in Co. Kilkenny which has recently received great praise. Both remaining speakers (Louise O’Reilly had to leave) stressed that the numbers involved in Kilkenny were considerably less than in Dublin and that there were relatively large numbers of district hospitals around it. It would be necessary to know what their capacity was and what their patient numbers were (especially in Casualty) before being able to endorse the Kilkenny system as a solution to Dublin’s problems. A speaker from the Continent asked whether the “third way” of health co-operatives designed not to make a profit which had proved successful in some European countries had been investigated in Ireland. (The reply was that Ireland’s mixed system of doctors involved in both public and private work simultaneously made the Continental systems difficult to replicate here.) References were made to the costs of billing private consumers which can result in the creation of huge administrations – in a publicly-run system this cost is avoided. The situation in Waterford was referred to where the newly promised Oncology units will be delayed until 2011 because the government wishes to pay for the service via a PPP (Public Private Partnership).

On the issue of money to pay for a publicly funded health service, two points were made from the floor. One was that if Ireland had not handed over control of its gas and oil reserves to oil companies, it could, like Norway, fund an extremely good health service at little cost to the private citizen. The second point was that the Irish tax system had been created with a review to subsidizing wealthy institutions. Personal taxation, for example, was at 20-42% but taxation of banks was at 12%. Why should this be so? And given the profits made by banks, was there not something to be said for upping their contribution and using the resulting funds for community welfare such as a public health system?

The upshot of the meeting was a decision to do their best to publicise the Patients Together Lie In at the Dáil on Good Friday at 12:00 and to urge all present to attend. It was also agreed that volunteers would commence working towards a large Health Conference in the autumn which would involve a wide-ranging discussion of issues currently facing Ireland and attempt to produce alternatives to the solution of private health care on the American model which is being so strongly pushed by the current government. In the meantime, a working group was formed to produce a fact sheet on health and to develop further arguments and policy ideas on health. Anybody wishing to be involved in this project is asked to contact Cathy Swift 086-0679708.

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Comments (12 of 12)

Cathy

by Curious

Tue Apr 11, 2006 13:06

Were any motions or messages of support passed at the meeting? I am genuinely interested in this as I wish to contrast what happens to motions which the SWP are in agreement with to those that the SWP disagree with. I thought that there might be an update of what had happened to motions passed at the last meeting. I know it was only four weeks and you could hardly expect a letter or email to be composed in such a short span but will that letter of support ever br sent to the Iraqi women?

Thanks

by James

Tue Apr 11, 2006 16:08

Cathy, Thanks for a very detailed report on the meeting. Sound like a great initative and I'm annoyed I missed the meeting. Maybe next time. Keep up the good work.

Please read comments on women's issues report

by cathy - People before Profit

Tue Apr 11, 2006 16:50

Dear Curious,

If you read through the various comments on the women's issues report, you will see that the arrangement was that Mary was going to pass on the message of support. I don't personally have Mary's number and the woman who organised the meeting is away at the moment so I can't investigate this further. I assume that since it was Mary who initiated the request for support she did indeed pass it on but I cannot confirm that. In answer to your question, no formal motion of support was passed on Friday's meeting but it was generally agreed that all support possible should be given to initiatives such as Patients Together.

Cathy

Further points and questions on state of our health system

by Terence

Tue Apr 11, 2006 18:06

First off, that was a very good article.

1) As suggested above it would appear by having people on trollies and all the surrounding publicity, that this may be designed to scare people into taking out private health care and or upping their rate with VHI/Bupa so that if anything happens then they will be going straight to a private hospital.

2) Last week Brian Drumm said that the fact that the X-ray dept closes at 5.30 can be a cause of some of the inefficiencies and wasteful use of beds. I can concur with this to some degree, because I have heard of people being kept in (hospital bed) until the next day when the x-ray dept or whatever is open again.

So I think there is some merit in having at least two shifts for ancillary services like X-ray, ultrasounds, pathology labs and whatever else open for longer periods during the week and presumably for part of Saturday too. However I don't think it should be the argument for people to work even longer hours.

Norway

by John - dunaree2000

Tue Apr 11, 2006 19:47

Some of your comments are absurd. For example, you talk about 'if Ireland hadn't handed over its oil reserves like Norway ....'. Could you please tell us what oil reserves you're talking about. Norway produces 150million tons of oil a year. Ireland produces none, for the simple reason that, despite 30 years and billions of euros spent exploring Irish waters, no oil fields have yet been discovered. In this respect Ireland is similar to most European countries. Hardly any have oil reserves. France, Spain, Portugal, Italy, Belgium, Austria produce no oil. The difference is that political organisations in those countries don't fantasise about what could be done with the money if only the non-existent oil reserves hadn't been handed over to private enterprise.

Private v. Public health costs

by P1

Wed Apr 12, 2006 11:02

Teaching/training of doctors, nurses and other staff is another area that private hospitals will not touch. All teaching hospitals are public hospitals and the cost for these activities comes out of the public health budget.

No oil or gas reserves

by Cathy - People before Profit

Wed Apr 12, 2006 17:43

Dear John,
The speaker from the floor was talking in the context of the CPI report on the Corrib gas field which describes how the original set up by Justin Keating (which would have given the Irish government a % control of profits) has been watered down in the interim to the point where we no longer get any of the profits and the oil companies can claim their exploration expenses against tax. I have to say I found the detail in the report very convincing - do you not agree with it? If so, may I ask why?

Cathy

Keating

Wed Apr 12, 2006 18:59

During the 15 years or so that the Justin Keating tax regime for Irish oil and gas exploration was in operation not one commercial discovery was made in Irish waters, not one drop of oil was found and not one cubic foot of gas was found. By the late 1980s exploration in Irish waters had ground to a complete halt. Immediately upon relaxation of the tax terms imposed by Keating, exploration in Irish waters took off again and within a few years the Corrib field was discovered. Does it never occur to you that returning to the Keating tax regime will have the same effect as before, namely causing exploration in Irish waters to grind to a complete halt? Whatever leftists may say, Irish waters are not teeming with oil and gas fields. Exploration has been going on for 35 years, billions of euros have been spent by oil/gas companies and hundreds of wells have been drilled, but only 2 small gas fields and no oil fields have been discovered. The North Sea it is not. It is because Irish waters are so barren of oil and gas that relatively generous tax terms are required in order to retain even a modicum of interest on the part of oil/gas companies in exploring Irish waters. If Ireland imposed the same tax terms as Norway, what possible interest would any oil/gas company have in deciding to explore Irish waters rather than Norwegian waters, given that hundreds of oil and gas fields have been discovered in the North Sea and hardly any at all in Irish waters? Of course exploration costs should be taken into account for tax purposes. If you spent 10 billion euros drilling 10 exploration wells and found absolutely nothing, then made a modest commercial discovery on the 11th exploration well, you'd be pretty cheesed off if the 10 billion you'd spent was simply ignored for tax purposes. Come into the real world and recognise the commercial realities of oil/gas exploration in Irish waters. Its not the El Dorado for oil/gas companies that you make out. If it was, do you not think there'd be far more exploration going on in Irish waters than the relatively small amount currently taking place?

Evidence?

Wed Apr 12, 2006 21:02

No doubt I'm one of your leftists but I wouldn't be as sanguine as you are that nothing was found. My understanding is that what was found was deemed "uncommercial" by he oil companies themselves. We don't have indpendent assessments which would be a lot more convincing but in any event, "uncommercial" is a movable feast; in times of high oil prices, they could well be deemed worth exploiting and I suspect will be. As far as I know, none of these "uncommercial" fields were ever given back to the Irish state - the oil companies hung on to all the places for which they had drilling licences and that strikes me as probably significant.

But if you don't like putative oil as a possible means of paying for health - what system do you think would be best? Higher taxes for PAYE workers? Rejigging tax systems to be less favourable to business interests? Cutting out the vanity projects like Punchestown (sorry, maybe that one's below the belt.) Or do you endorse the Mary Harney line that privatisation will work? Can't see that last working myself - given the gloriously obvious case study provided by the States.

Cathy

Funding health.

Wed Apr 12, 2006 21:43

No, Cathy, high taxes are not the way to fund the health service. The best method of funding the health service is a rapidly-expanding economy spurred on by low taxes. In case you hadn't noticed, that's exactly what's happened in Ireland. In the 1980s taxes in Ireland were the highest in the EU and per capita spending on health was the lowest in the EU because the high taxes had ground the economy to a halt. The situation is the reverse today. Taxes are the lowest in the EU but per capita spending on health is now way above the EU average and increasing by leaps and bounds each year, made possible because the low taxes have generated economic growth at a rate which the high-tax countries in the EU can only dream of. As for privatisation, what's your gripe? Most services are provided better and more efficiently when provided by the private sector rather than by the public sector. Remember when telecommunications in Ireland was provided by Dept of Posts and Telegraphs? What a shambles that was, look at the contrast with today. Compare Ryanair and Aer Lingus. Why should health be any different? To illustrate the point, might I suggest you do a comparison of mortality rates and life in expectancy in Ireland and Denmark. Denmark has an almost totally public health service while Ireland's is semi-private. If your arguments were correct, Denmark should be outperforming Ireland in relation to mortality rates and life expectancy. But, it isn't. Mortality rates in Ireland are now about 10 per cent below those in Denmark (having been 10 per cent above in the mid 80s) and life expectancy in Ireland is now almost 2 years above that in Denmark (having been 2 years below in the mid 80s). Anyway, I will be unable to continue this debate tonight. Off now to watch The Apprentice and Alan Sugar. I doubt if its your favourite program, Cathy, but you should give it a try and you might learn something.

Sad creature that I am

by Cathy

Thu Apr 13, 2006 13:33

Unfortunately I don't have a TV but I'm sure I would. Whether it would be the same as what you learn from it, of course, is another matter. You seem to have an interestingly positive view of Irish health services - do you find many people agree with you?

Cathy

Discussion on Irish health dot com

Thu Apr 13, 2006 13:45

Readers of this string might be interested in the posted comments in a debate concerning Irish A & E on www.irishhealth.com. I've copied them below,

Cathy

Online poll (of subscribers to the website) - what would improve matters?

More beds
23%

Greater efficiency
32%

Better community services, e.g. out-of-hour GPs
45%

Catherine,Thank you for participating in our online poll.

Click here to see our previous polls, or go to your main page.

* Please note that the results of the online poll represent just a snapshot of opinion from the site members who participate. The results of each poll do not necessarily represent the national picture. Participants are only allowed to vote once in each poll.

Anonymous Posted: 04/04/2006 10:38
To address the excessive number of people on trolleys, the greatest need is for more beds and more staff to care for the people in those beds. In turn these beds (and staff) will need to be managed with greater efficiency. To address the problem of people turning up in A&E with minor illnesses, better out-of-hours services are needed. But these are not the people on the trolleys. Those on the trolleys need to be admitted, ie. they need to be in hospital, not with a GP.

Anonymous Posted: 05/04/2006 10:32
I think it's a combination of all these elements. A&E cannot operate without being efficient but also cannot be efficient without having sufficient beds and other resources. Out of hours GPs, etc. are important and essential, but people are more likely to go to A&E with certain conditions, or after accidents. There's still the belief that you must go to A&E. People being on trolleys is not a good situation but some of those people are not as ill as others and should be treated elsewhere, but it at their GPs practice or in a smaller ward/A&E area.

Anonymous Posted: 06/04/2006 12:18
I have to aggree with the below - i think at this stage, people who actually bother to hang around A&E are those with conditions that cannot be treated by a GP. As a nation, we are all too aware that A&E means long waiting times and if the condition can wait to be seen by a GP then most people will do so. The departments are grossly understaffed and running in a massively innefficient system. Let's get management consultants in to implement a streamlined system that gets people seen to and either sent home or admitted. Come on lads, it's not rocket science. I think we need more beds but again to use these where they are most needed. Out of hours GP services are improving but the DoH needs to look at the bigger picture to try and solve this mess rather than one small part.

Sue Posted: 06/04/2006 13:33
better community service in particular inceased number of GP co-ops to be set up and implemented for out of hours services

Anonymous Posted: 06/04/2006 14:10
I believe we need a better community services, that do not require a fee of more than 20euros, out of hours GP clinics and an oncall rota would take the pressure of A+E, freeing up space and time for genuine emergencies.

Joan(GRV17813) Posted: 06/04/2006 14:19
I think Mary Harney should resign. If it weren't for Fianna Fail's reliance for power on their coalition partners she would be long gone. If it were anyone else they would have done the decent thing long ago.

claire Posted: 06/04/2006 14:49
I read yesterday in a kildare newspaper that most doctors in the region are not taking on new privite or medical card patients. If a medical card patient is refused by 3 doctors they are assigned one.obviously, if private , paying patients are refused by 3, they ring around again? its no wonder the A&Es are jammed when the first point of call, GP's, are not readily available. i think a combination of mgmt.,more resources and community services are req'd. But will it ever happen? i dont think so. Governments do not have the will to do what it takes. if they were in private business, and not sloshing public funds around, they would be sacked long ago.

Chuckles Posted: 06/04/2006 15:44
I think we need a decent out of hours gp service to start with plus additional beds would also help. However I know a friend of mine contacted Shannondoc (out of hours service in Clare/Limerick) recently and she was told to go to a&e. She knew she did not need a&e, she had a bad flu and needed an anti-biotic. However knowing that she faced a manic queue at a&e, she waited until she could get to her own doctor. I think the out of hours services should only refer genuine hospital cases to a&e.

Joan(GRV17813) Posted: 06/04/2006 15:49
I agree with anonymous, smaller local clinics with more facilities for minor accidents would take enormous pressure of A&E departments why cant Harney see whats staring her in the face?

Eibhlin Posted: 06/04/2006 16:22
It is an absolute disgrace. My son got knocked off his bike on the Luas track. He broke his arm. He waited all day in A&E (having first attended his GP). He was told it was quite a bad fracture on the top of the humerous and that he might have to have surgery. It was X-rayed on that day. A scan was needed. Over two weeks later he got the scan that was last Thursday (the scanning dept was on half staff). He reported back to the hospital on Tuesday last they could not find the scan. How is that for efficiency? Today he has been told that they would not recommend surgery & that he won't be able to lift his arm over his head. Would anyone recommend a second opinion?

Anonymous Posted: 06/04/2006 16:24
The population is growing really quickly, we need more beds (& staff) not management consultants.

Anonymous Posted: 06/04/2006 16:43
Management consultants are professionals who are hired by huge multi nationals to increase efficiency and streamline operations. Seems like a no brainer to me. Half the time the people on these trolleys and in these beds don't need them but are not evaluated to the point that they can be dealt with and sent home. Also, what ever happened with the 'pilot' schemes of Primary Health Centres? Having visited a few around the country (more remote areas, further from large hospitals), they work to great efficiency and are a one stop shop for varying degrees of medical care. I thought this was laid out in the plan for Primary Care back in 2004... Anyone know anything on this??

Joan(GRV17813) Posted: 06/04/2006 16:46
My neighbour sliced off three of his fingers in a gardening accident and attended Tallaght Hospital where he was told to 'come back on Tuesday' luckily his wife was more vociferous than he!

Winnie Posted: 06/04/2006 16:58
To Eibhlin. I sympathise with your son and your frustration with the total lack of competence/efficiency in the hospital system in this country. One thing that I would recommend is that you get on a cheap Ryanair flight to Brussels and go to any hospital there. They will give you highly efficient and extremely reasonable treatment. You won't regret the expense of sussing it out. After all it's your son's health that's at stake. No use hanging around in this country. They won't deliver any satisfactory results.

Amanda(MDG44609) Posted: 06/04/2006 17:01
my grandad suffered a series of mini strokes prior 2 his death i remember sitting in an a&e waiting room with him for 5 hrs before he was even seen by a doctor then he spent a 2 days on a trolley before a bed became available and that was in 2000. obviously nothing has changed in 6 yrs

Anonymous Posted: 06/04/2006 19:00
Ireland should have out of hours GP's especially to help the A&E Crisis. If GP do not want to work longer hours they should employ workers for evening and weekend hours.

colm(pulsar) Posted: 06/04/2006 19:16
G.P.s must come into the modern world and start working a 24 hour rote. The notion of the 9 to 5 was alright when locals could call to the doctor at any hour in the locality. However the medical profession has become a career rather than a vocation just like teaching and policing and people are isolated in their homes nowadays dealing with a beauracracy face .

Homer Posted: 06/04/2006 19:44
Hello Some time ago I already asked questions, answered some questions,Supported and stood at the main gates of Beaumont with the Irish nurses organisation,Alon with the labour party,Mr.Richard Bruton,Mr.Larry O'Toole.I will repeat my opinions again.The Accident and emergency departments are doing there best.Now all of Ireland can help further by I they become or are unwell they should asess how bad they are,Do I need to go to hospital? BY AMBULANCE if it is serious,Taxi if it is not serious and get avail of an out of hour locum DOCTOR.BY CALLING AN AMBULANCE THE CRISIS GETS WORSE AND YOU START USING HOSPITAL RESOURCES ALREADY UNDER CRISIS.Think before you act on medical attention.I am chronically ill and medically Retired I call out my locum when in need or hold out til the morning and see my G.P.How far would this suggestion go?THINK ABOUT.AND DONT TAKE CHANCES BE RATIONAL IF YOU CAN AFFORD TO.

Patient Posted: 06/04/2006 19:52
1.)Some people find it very hard to get a doctor at night -I think doctors hate night work - so why are they working in medicine? So when you can't get a Dr. you have no choice except A&E. 2)We also have these tight fisted patients who are too mean to pay a DR's. fee if they can avoid it...but if it was a question of money for a night out or anything else there's no problem.

General Posted: 06/04/2006 20:02
To Eibhlin. Get a second opinion. Only after you tell current team that you can not accept the poor result suggested. A and E needs all three solutions. Most important of all is consultant a and E opinion around the clock. this will only work if there are enough beds.

william(billyralph) Posted: 06/04/2006 20:25
As A GP working in the UK and soon to come home I am shocked by the arcane way in which general practice is set up in Ireland.Its about 20yrs behind British general practice.Whilst working in Bradford I never saw a single person on a trolley in A+E.Most of the people attending A+E usually had GPs who ran badly organised practices ,providing poor chronic disease management and poor access to daytime services.Many would not have had experienced nurse practitioners,physiotherapist,minor surgery etc.It would seem that much of Irish general practice with its inward looking corner shop mentality has not embraced the concept of multidisciplinary working and taking pride in running a good general practice service instead of peddling second rate medicine for top prices and then when it gets difficult asking A+E or hsopital consultants for help.Most of the problems that people attend A+E with can be dealt wth in general practice-but not in a GPs office if that office is in some semi in a housing estate. Another reason why A+E is full is because of the ludicrous system for admission of patients to Irish hospital beds.I believe it goes like this the experienced GP sees his/her patient whom they've known for 20yrs,they feel they need to be admitted urgently to hospital-so instead of ringing the oncall doctor for that particular specialty to arrange admission to their ward ,they send the patient with a letter asking some other doctor who could well be practising medicine for on his or her first day to have a look at the patient and maybe admit them.So all the GPs in Ireland on any one day channel all their urgent admissions through the A+E departments.Do the other specialties not believe the experienced GP when he/she says the patient is unwell?Why have they to be seen by the world and his mother before they can get a hospital bed? The bottom line is that the government are quite powerless to change a powerful profession if they do not want to change.

Morris Posted: 06/04/2006 20:46
I think Private Insurances and G.P' fees should be abolished. Free hospitals for everybody with more beds with a proper service should be introduced. In Italy, for example, there is no charge for hospitals and G.P and if it works out for more that 60 million people, why shouldn't for 5? Will see.

Peggy(EBE40675) Posted: 06/04/2006 22:11
I think that GP's outside are shrugging off responsibility by sending their patients into A&E. For instance I have a local doctor who can stitch but another doctor won't and will send you into A&E instead. Why can't every doctor stitch? People are still having to pay the doctor as well as A&E then which is very unfair. I think as well that if there were mini x-ray machines just for broken fingers and broken legs it would make a huge difference.

Anne(WEG37798) Posted: 06/04/2006 22:50
Good Heavens. Please, no more management levels! They take money away from the areas that need the funding, i.e drug provision and pay for nurses, who spend years of hard work getting their qualifications and then get offered a wage no better than manning the cash tills at Tesco!! Minor injury facilities would be worth expanding to alleviate both volume of patients and waiting time. Could there be a minor injury nurse qualification(sort of stitch and patch only) , if there isn't one already, that could be acheivable for people who might not make the grade as a fully fledged nurse but are very capable of basic aid? Then these people could work in GP surgeries as well as hospitals and clinics.

john(FUS12296) Posted: 06/04/2006 22:58
ALL of these things are needed!!

Hollie Posted: 06/04/2006 23:37
The Health Service is in absolute chaos. There is no forward planning by the powers that be. Why fill in the Census forms if actions are not put in place to counteract what will evidently take place. The Government know there is an aging population - why aren't systems put in place? Tunnel Vision!!!!!It will backfire though - watch next election!!!

liam(lcollins) Posted: 06/04/2006 23:42
i think that the goverment is taking our money for granted, its pouring in at an emormous rate, but the boys in the dail, are only interested in spending it on their pet projects , in their own constituences, for the extra vote etc, if only a a tiny fraction was spent on inproving our health system , we would have the best system, in europe.

liam(lcollins) Posted: 06/04/2006 23:46
question , are nurses , doctors, consultants, etc, employed in our hospidals employed by the state, !

Concerned Posted: 06/04/2006 23:52
Yes, I agree with the majority of the above comments. We need imporved primary care services and more out patient clinics the patients can attend with Minor Injuries and free up A & E for real accident and emergincies. It is embrassing what is going on at bpresent with between Mary harney and Prof. Drum. I think results is needed,neither have shown great promise!!

liam(lcollins) Posted: 06/04/2006 23:53
what crisis, there is no crisis, in the a&e, therefore why all the fuss, its been like this for years, so what is all the comotion for, better to be lying on a trolly than lying on the floor , or on a seat.my mother was lying on a trolly overnight and she was ok, so whats all the bother about , your in safe hands and i think that the irish are beginning to be too cranky .also there are too many people going to the a&e that should just put a sticky plaster on it, such sensationalism about little misadventures, the irish are becomming soooo, soft.

Mary Posted: 07/04/2006 09:10
Unfotunately we cannot time our illnesses between 9 and 5, which is when GP's work. no one wants to sit in A&E for 5 hours but they do not have a choice if they cannot get a Dr. Second, as well as beds, we need STAFF, doctors, nurses and auxillary staff to service those beds. Beds alone are sueless if you still ahve medical staff shortages.

Anonymous Posted: 07/04/2006 10:23
Look at the Continent where the word Hospital still means something serious - here everyone walks straight to A&E for every scratch. Correct, the once on trolleys need to be there but how many in Hospital should not be there ? I agree with the Minister that the extra millions already spend in the health service every year show little emprovement as a lot is absorbed in ever increasing salaries of Hospital management and Consultants with job securities based on 25 year contracts. Modern Hospitals are operating more and more with high technology equipment designed by engineers, but why do doctors feel there salaries should be that much higher then those who designed their tools ?? My final point would be to review those patiens who need a long term recooperation process and find a way to divert those into private beds outsidee the hospitals where they can be taken care of just as well if not even better.

Anonymous Posted: 07/04/2006 10:55
Just an observation. In the 60s in Dublin, where it seems most of the A&E problems are, we had more hospitals with their own A&E departments. These hospitals were in differents areas of Dublin which meant patients who needed A&E service did not have to travel just to one point. There were never lines of trollies in corridors. The population was smaller then, more than 1 million less people. Since Beaumont Hosp. and Tallaght Hosp. were built and many smaller hospitals were forced to close. They were amalgmated into one and not allowed have the same number of beds they had when running these smaller hospitals such as The Meath, Jervis St., Mercers, Harcourt St. Childrens. Of course you are going to have more people and longer queues when everybody has to go to the one centre and that centre is not provided with more staff, more beds in the hospital to take patients who need to be admitted, even if its only for one night.

just-back Posted: 07/04/2006 16:15
Just back from India where my husband had to have an emergency operation, teo days after we arrived. He was seen immediatly, tests the next day, operated two days later and left out during the day for food and fresh air within another 4 days. Ireland is supposed to be a 1st world country yet I have years of experience with my children and parents of 2 and 3 day delays before being seen and several moth waiting lists just for a test. Something is very wrong with this picture, needless to say we are worried sick at the thought of dealing with the Irish system after that.

nk Posted: 07/04/2006 20:28
Please check out the web site www.nhag.ie Small Hospital Big Service may be part of the solution to the national A & E crisis. The HSE and the department of health cannot ignore this report especially with the forthcoming review of the Acute Health Services in the Mid-West. It is a well laid out and sensible approach to a sticky problem and it's put together by people at the coal face with a practial and low and behold it is cost effective.

Anonymous Posted: 07/04/2006 21:57
we need more primary heath care facilities with Gp's working an out of hours shift system. In the hospital we also need consultants working a 24 hr shift system. They should work for the hospital only and not be allowed have a private practice. Consultants are the main cause of the current situation because they have too much power within the hospital structure.

Anonymous Posted: 08/04/2006 19:17
The crisis would be resolved if only public patients were treated in public hospitals. consultants have to much power

Anonymous Posted: 09/04/2006 15:28
the probem in Emergency Departments is NOT THE NUMBER OF MINIOR INJURIES or GP APPROPRIATE PATIENTS attending but the number of patients waiting for a bed AFTER A DESCISION TO ADMIT HAS BEEN MADE. Extra GPs or Consultants will not fix this, only extra beds.

Homer Posted: 09/04/2006 20:44
Hello I agree with you all since my last posting.We are all suffering as a result of the government any one who was lucky to be elected they don't get the poor treatment bec ause they have the money and contacts.

Jim(NIV37941) Posted: 10/04/2006 08:23
Reading the horror stories on emergency treatment recived in the public sector the simplistic advice which springs to mind is dont get sick and be real careful on the roads. Me?, no matter what it costs I would give up all other expenses/luxuries but never the cost of private insurance cover -God bless 'em. Imagine being told come back with your severed fingers 'next week'?!

Eibhlin Posted: 10/04/2006 16:35
My son was seen today in a private clinic for his compound fracture of the humerous. He got this appointment having visited the doc on Friday last. The consultant was more positive than the one he had seen in the hospital. He was more hopeful about his having more mobility after physio. Also was able to negotiate a reduced fee as he is on a disability allowance. It seems to be the case that you have to pay to get the extra resurrance needed. This would be of course to do with pressures in public clinics in hospitals. Would people think it correct that after 7 years free college (that is free to the student but not the tax payer)education any new qualifed doctor or dentist can take off into the blue carrying this very expensive diploma and never have to pay back anything to the state that educated them? I do understanding though why young medics would want to work under far superior conditions, but should it not be stressed to them that they owe society something?

Anonymous Posted: 11/04/2006 12:39
and teachers, engineers, economists, social workers... i suppose we should all work for free?

Mary Posted: 11/04/2006 12:50
Peggy, every doctor CAN stitch - or should be able to. If your Dr. refers you to A&E, you do NOT have to pay twice. Yes, Dr's and nuurses and consultants in Public Hospitals are employed by the state. Liam, open your eyes. There IS a crisis. The point is not that it is better to be lying on a trolley than the floor. The point is that leaving an ill person on a trolley for days is NOT acceptabe. We are paying for a service and we and not getting it. We deserve to be treated promptly and with dignity and respct. Lying on a trolley is NOT IT. Your mother was lucky. People have died while being left on a trolley. While on a trolley you canot be admitted for surgery as they cannot discharge you from surgery without a bed. If demanding your entitlements is "too cranky", I am one heck of a sight sorry we as a nation didn't become a heck of a lot "crankier" a lot sooner. If people thought they could "put a sticky plater on" instead of going to A&E, believe me, they wouldn't sit around for 6 hours and fork out €50 for treatment. If you think not wanting to lie on a trolley awaiting treatment or seriosly ill is "sooo soft" and "little misadventures" then you are welcome to to think that and be as 'un-soft' as you like but you may well risk serious illness or worse in the process but the rest of us want to be treated like human beings. 07/04/2006 21:57 - if you were going to ban consultants form having private practise, then possibly you'd get very few willing to work in the public hosptal system. Also, why should only public patients be treated in public hosptials. Those who can afford it and are responsible enough to pay health insurance pay taxes too and are just as entitled to go to a public hospital if they wish the same as anyone else.

Eibhlin Posted: 11/04/2006 12:56
no suggestion of any one working for free - but there is no such thing as free education - someone has to pay

Matt Posted: 11/04/2006 23:02
GPs should do small procedures in their surgeries. My son had small cysts removed from his head by his GP in Canada. My GP sent me to hospital for a similar procedure.

BrayLady Posted: 12/04/2006 12:04
My mother\'s GP once sent my brother to hospital to have four stitches put in his hand - saying he \'didn\'t have the facilities to stitch\'. To me, that\'s a disgrace.

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