My Two Cents

The HSE is facing more than a €1 billion shortfall in it’s finances this year. Are we surprised? I don’t think so. The HSE is a faceless organisation wasting millions of taxpayer’s money every year to fund it’s quagmire of management levels and all at the expense of frontline healthcare. In a bid to address the budget deficit, the HSE is devising a major cost cutting plan to downsize our health service and you can be sure that it won’t be the HSE to suffer the consequences. While waiting to see a specialist yesterday in an over-crowded out-patient clinic at a large public hospital, I came up with some alternative ideas for the HSE to consider. Instead of solely concentrating on cost-cutting measures in our hospitals, I would suggest that the HSE would be well-advised to look at opportunities to complement our health service.

For starters, let’s look at the area of catering in our hospitals. The catering budget  must be astronomical and yet the wastage of food is phenomenal. Over the years, I’ve had many stays in hospital and I’ve often joked that this provides a saving on the family budget as my board and lodgings when in hospital, are fully covered by my health insurance. I pay dearly for health insurance and am fully entitled to this return. bed-occupancy-rateAll medical card holders when admitted to hospital, are entitled to free care in our public health service. Those patients who are not entitled to a medical card and who do not hold private health insurance, pay a small daily levy for in-patient care. The point I’m trying to make here is that everyone regardless of income, has to budget for their daily nutritional expenses so why should the State or an insurance company be expected to pick up the tab for our food requirements when we’re in hospital? I guarantee you that if patients were  charged for their meals, the wastage of food in hospitals would be radically reduced.  Granted a lot of hospital food is inedible but again if patients were subsidising the cost, the standards would automatically improve.

Another aspect of hospital care which should be addressed, is the way out-patient clinics are managed in our public hospitals. There is no charge for appointments or investigations once a patient is in the public system and like all free services, it is open to abuse. By comparison, those who hold health insurance, must pay-as-they-go to be investigated within the private system, the difference being of course that they enjoy the benefit of shorter waiting times. While private health insurance is fairly comprehensive for in-patient expenses, out-patient expenses are generally poorly reimbursed. I would like to propose that all patients should be expected to pay something towards the cost of their appointments. I believe that a small charge for an out-patient appointment in a public hospital, is not unreasonable. It would not only help to offset budget deficits but would also reduce the number of appointments as public patients would take ownership of their healthcare just like privately insured patients are forced to do. This in turn would free-up non-consultant hospital doctors (NCHD) and reduce overtime expenses for the HSE.

I know I’ll be unpopular for these suggestions but I don’t care as I see it as the right way forward. At a time when the government is asking everyone to shoulder the economic difficulties, we can start by taking responsibility for our own health service. Every single person in this country should have equal, speedy, and efficient access to safe healthcare. At the moment, we have a 2-tier, apartheid health system where those that can afford health insurance, have the fastest access to health care.  Let’s use patient power to save our public health service and stop the degradation planned by the HSE.

And before anyone asks why as a privately insured patient, I was seen yesterday in a public out-patient clinic, let me explain. I had no choice in the matter as I required endoscopic investigation and this service is no longer available in private consulting rooms as a result of the boom in MRSA litigation. MRSA has little to recommend it but in this regard, it has worked in my favour. I got to enjoy an appointment with my own choice of consultant, in perfectly adequate facilities and at the expense of the State.  Point taken?

10 Responses to My Two Cents

  1. Annb says:

    I completely understand where you’re coming from here Steph, but rather than broaden the current apartheid even further, might I suggest a proper universal health insurance scheme, as is the case in most European countries. Everyone is obliged to have it and they pay according to their means. That way, when you enter the system you are seen as a paying customer rather than a drain. Another bug bear of mine is that nobody seems to monitor the cost of care here either in the private or public system. I remember a Bupa bill for over 400 euro for “Accommodation” in a hospital where I had spent exactly 30 mins having a mole removed. Nobody questioned the charge. Not to mention jaw dropping waste in Rory’s care, (the whole reason I started blogging in the first place) it has quite literally made me weep at times. We need leadership and accountability here and lets face it Harney and Drumm are not delivering. As a nation it’s time to wake up to this issue – it affects us all and as you well know, as our system currently operates, private health insurance is no guarantee of quality care. But it also represents extremely poor value for money. We have got to get rid the for profit model and come up with an equitable, efficient solution that allows us as patients to be treated with dignity and respect.

    Sorry for ranting but I am exasperated, as far from saving money, this latest round of cuts will cost us money in the long run because there will be no joined up thinking behind them. It’ll be a case of get the budget to add up in time for the next election and hang the consequences.
    ok rant over for now!

  2. Steph says:

    Annb – Thanks for this excellent contribution to the post. I’m all for a universal system of healthcare that is social insurance funded and single tier but I omitted to state it here.

    My suggestions in the above post stem from my belief that as long as we have Mary Harney in control of the health budget, we have no chance of getting a universal system of healthcare. Therefore we have to find ways to protect what’s left of our health service by supporting it and healthcare workers until we get a change in government.

    I agree with you entirely that the latest cutbacks will not be thought through and I’ve no doubt that figures will be more important than patient’s lives. There is no political accountability in Health as neither Mary Harney or her party will contest the next election. Even Prof Tom Keane, the much lauded head of the National Cancer Control Programme, is lukewarm about Harney’s co-location policy, believing that it is a superficial solution to solving the bed shortage problem.

    I just wish my rants were as productive as yours! 😀

  3. Annb says:

    Apologies for ranting to the converted!

  4. knipex says:

    The reason the HSE has been unable to manage its budget (especially for the last few years) is due to a number of factors but the main one being its social welfare role.

    Medical cards should be a social welfare issue but are actually funded by the HSE and as the number of people unemployed grows the number of medical cards provided increases and the cost of funding them increased.

    The budget for the Department Of Social Welfare is not fixed, its demand led so as social welfare costs increase its budget increases not so for the HSE.

    There are similar issues with the drug refund scheme which is again funded by the HSE its a demand led scheme funded from a fixed budget.

    Emergency accommodation is funded by the HSE.
    Civil marriage is funded by HSE

    As a myriad of other services all from a fixed annual budget.

    If one of these demand led schemes has more demand than anticipated then the only way to get more money is to cut it from another division of the HSE budget.

    Its a crazy situation that needs to be rectified you cannot run a demand led scheme such as medical cards and drug refund scheme on a fixed budget, especially not in the middle of a recession when unemployment is on the increase.

    From someone who has seen the carry on in various wards on various hospitals I think there are many areas where the HSE can save money.

    Absenteeism in the HSE is very high particularly in hospitals but as all employees are civil servants they qualify for uncertified sick leave and 6 months on full pay when they are out. Uncertified sick leave should be unpaid.
    6 months on full pay when out sick is a great idea but ripe for abuse. Cut it right back to 2 weeks.
    Any doctor who provides a sick cert should be held responsible if that person is found to be not genuinely sick.

    Management grades should be culled from 7 to 3.

    Nurses should be put back on wards and clerical staff hired to do clerical work.

    All overtime to be authorised and monitored.

    End automatic pay-scale increases (increments)and link them to performance. Any manager not correctly performing assessments and reviews (not just automatically approving increases) should be disciplined.

    Reintroduce 39 hour week for all medical staff. this 35 hour and 37 hour nonsense has to stop.

    Salaried staff do not get paid overtime. If you want the perks of being salaried then loose your overtime payments, otherwise you are hourly paid. Live with it.

    Get rid of subsidised staff canteens. If you want the canteen fine but pay the full cost of the food.

    Introduce clock-in machines on each ward. Clock in when you arrive, clock out when you go on break and when you leave to go home. No there is no trust, it was abused.

    Any staff (all grades from consultants to cleaners including management) who do not follow infection control rules should be warned and offered retraining for a first offence summary dismissal on second.

    End archaic work practices. For example (and this varies from hospital to hospital) nurses are responsible for cleaning beds and lockers, hospital cleaners are responsible for rooms up to shoulder height and cleaners for rooms above shoulder height. 3 different groups have to be organised to clean a bloody room. Its nuts.

    All HSE employees should have to fund at a minimum 50% of the true cost of their state pensions. If they don’t want to then withdraw and set up your own pension fund.

    Sorry for the rant but having a bad day.

  5. magpie11 says:

    It looks like we have similar problems over here in G.B. …I just do not know what we can do about it…I wonder fi the gov’t would pay you for advice?

  6. Caoimhin says:

    Great post Steph! 🙂

  7. Steph says:

    Hi! Knipex – Sorry to hear you were having a bad day. I was too but your rant really cheered me up. You’ve helped me feel more optimistic that the health service can be rescued if managed by the right people. You’ve just made more sense than anything I’ve heard coming out of the HSE in the last four years. You’ve also proved what I’ve long believed, that the problems in the health service should be sorted by people on the ground, not by HSE managers.

    Magpie – Good to see you’re paying attention 😉

    I write entirely from a patient’s perspective and Knipex comes from a professional background. Put our opinions together and I’m sure we could achieve more than any spin doctor! Did someone mention pay? 😉

    Caoimhin – Well, hello stranger! I just knocked you off my blogroll the other day ‘cos I thought you’d done a runner 🙂 Thanks for the compliment, much appreciated. I do my best. Keep in touch!

  8. Caoimhin says:

    Hi Steph, not able to spend much time on here lately; but, I do like to check up on what you’re saying every now and again! 🙂

  9. Steph says:

    Caoimhin – Lovely to see you anytime. Hope all is well with you.

  10. […] topic was the health service. I was very pleased to find that it’s content confirmed my views about the abuse of out-patient clinic appointments in our public hospitals. The contributor […]

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