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 What are the defects of the Irish Health system and how should it be reformed?

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PostSubject: What are the defects of the Irish Health system and how should it be reformed?   Sun May 25, 2008 2:31 pm

I am starting this thread as there seems to be a concensus that there are serious defects in the Irish Health System and I am inviting anyone who has positive suggestions for how it should be reformed to set out their stall. I will have a go myself later.
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PostSubject: Re: What are the defects of the Irish Health system and how should it be reformed?   Sat May 31, 2008 1:13 pm

At least this didn't happen in Ireland:

Quote :
US: Hospital settles over 'dumped' homeless paraplegic Print
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Share31/05/2008 - 10:29:24
Two lawsuits against a hospital for allegedly leaving a homeless paraplegic man on Skid Row without his wheelchair have been settled, attorneys said today.

Under a preliminary settlement agreement, Hollywood Presbyterian Medical Centre and Empire Transportation, Inc, a patient transportation company, will pay an undisclosed amount to Gabino Olvera, who was seen dragging himself across the pavement in a soiled gown in February 2007, said Olvera’s attorney, Steven Archer.

Mr Archer said settlement details were confidential but “it’s not an insignificant amount of money”.

Mr Olvera’s lawsuit alleged the hospital was negligent in its treatment, failed to diagnose and treat his urinary tract infection and mental illness, and discharged him in a helpless condition.

The incident also prompted the city attorney’s office to file a related suit.

In settling that lawsuit, the hospital agreed to adopt protocols for discharging homeless patients, train their staff, and keep statistics, Chief Assistant City Attorney Jeffrey Isaacs said.

The hospital will also allow a court-appointed referee to monitor implementation of the settlement for five years, Mr Isaacs said. The agreement requires the hospital to pay $1m (€640,000) to two Hollywood social service agencies that provide medical services and beds to homeless people recovering from hospital stays.

Empire Enterprises, whose driver was accused of leaving Olvera, agreed to a $10,000 (€6,400) civil penalty.

“We have now done everything we told the community last year we would do in response to this incident,” Hollywood Presbyterian CEO Jeff Nelson said in a statement.

“From the first day we promised to take action to review our policies, procedures and services for homeless patients and improve them where needed. Much of that we accomplished months ago.”

After the incident, the hospital did an investigation, expanded its social services staff to help place homeless patients and retrained emergency room personnel on the special needs of the homeless, Nelson said.

A city law takes effect in July that will make it a misdemeanour to take patients anywhere other than their home without written consent.
Bn.ie
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PostSubject: Re: What are the defects of the Irish Health system and how should it be reformed?   Sat May 31, 2008 7:54 pm

cactus flower wrote:
I am starting this thread as there seems to be a concensus that there are serious defects in the Irish Health System and I am inviting anyone who has positive suggestions for how it should be reformed to set out their stall. I will have a go myself later.

1. Make the government stop sabotaging it.
2. Increase investment
3. Increase decision making power of health workers and patients.

In much greater detail, an anarchist analysis of problems of the health service: http://www.wsm.ie/story/3612
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PostSubject: Re: What are the defects of the Irish Health system and how should it be reformed?   Mon Jun 23, 2008 5:48 pm

http://www.breakingnews.ie/ireland/mhgbqlkfkfsn/

I'm reactivating this thread as the current situation of the health service is causing anxiety and distress. I remain of the belief that health services will emerge as a make or break political issue for the electorate.

After a number of weeks of rumours and announcements of cuts in different hospitals, a surgeon in Cork University Hospital sent an email that was leaked to the press that presented the state of services in that hospital as disastrous. The email said that a woman waited 5 hours for an emergency amputation of her arm and that another woman waited hours with bad burns without morphine or proper dressings.
The hospital spokesman vigorously denied that on the lunchtime news, but now the Irish Nurses Organisation has backed the surgeon up. The Campaign for a Real Health Service is holding a demonstration on Saturday.

The row is centred on the proposal by the HSE to move more Breast Cancer Patients to CUH from another service that is planned to be closed down. Nurses and doctors say the capacity is not there.

When are we going to wake up to the reality that rationalisation of public services is not the government objective, and that decimation and privatisation is ?
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PostSubject: Re: What are the defects of the Irish Health system and how should it be reformed?   Tue Aug 05, 2008 12:52 pm

Quote :
05/08/2008 - 09:09:58
A government-commissioned audit has reportedly found that the HSE is wasting more than €20m a year through bad financial management.

Reports this morning say the study found that millions of euro is being lost because the health service's bank accounts are not earning interest, while the HSE is paying out around €2m a year in bank charges.

Wastage has also been found in the way claims are made to the VHI and in the processing of invoices.

Elsewhere, the audit has also found that around 1,000 people are managing the HSE's finances, with many of them carrying out the same duties.

(breaking news.ie)

Pax over on P.ie has suggested that the HSE Board is heavily weighted with private sector interests. I've looked at the Board and most of them seem to have some relevant background, but my concern would be that I couldn't see any Patient organisation representation or representative of front line medical staff.

Is the HSE gearing the health services for privatisation?
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PostSubject: Re: What are the defects of the Irish Health system and how should it be reformed?   Tue Aug 05, 2008 12:55 pm

The HSE is gearing up for semi-privatisation and it is going to be an unmitigated failure. Especially given the economic period which we are entering where the numbers holding private health insurance will fall, not rise.
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PostSubject: Re: What are the defects of the Irish Health system and how should it be reformed?   Tue Aug 05, 2008 4:34 pm

johnfás wrote:
The HSE is gearing up for semi-privatisation and it is going to be an unmitigated failure. Especially given the economic period which we are entering where the numbers holding private health insurance will fall, not rise.

It is much worse than that, johnfàs. The General Agreement on Trade in Services, a main pillar of WTO Law, allows for the inclusion of all public services to be "liberalised" (privatised). Only health is specifically included in the General Exceptions in Article XIV which would enable our government to ring-fence health and keep it, in the public interest, out of the hands of the profiteers. No chance of that happening under Harney. When we list services under the special commitments schedule, we commit to allowing services to be supplied in any one of four specified ways form anywhere, inside or outside the country. When we draw up our rules on domestic regulation in the field of qualification requirements and procedures, technical standards and licensing requirements, we cannot include rules which may be construed as"more burdensome than necessary to ensure the quality of the service", as stipulated in Article VI.

Once we commit specific health services to become open to privatisation, there is NO going back. The GATS commits us to enable market access and, crucially, to progressive liberalisation (privatisation) of the services. There is no possibility of a trial period or anything like that. No review after 2 years to assess the effect on the services. Once it's done, it's written in stone.
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PostSubject: Re: What are the defects of the Irish Health system and how should it be reformed?   Tue Aug 05, 2008 9:59 pm

Slim Buddha wrote:
johnfás wrote:
The HSE is gearing up for semi-privatisation and it is going to be an unmitigated failure. Especially given the economic period which we are entering where the numbers holding private health insurance will fall, not rise.

It is much worse than that, johnfàs. The General Agreement on Trade in Services, a main pillar of WTO Law, allows for the inclusion of all public services to be "liberalised" (privatised). Only health is specifically included in the General Exceptions in Article XIV which would enable our government to ring-fence health and keep it, in the public interest, out of the hands of the profiteers. No chance of that happening under Harney. When we list services under the special commitments schedule, we commit to allowing services to be supplied in any one of four specified ways form anywhere, inside or outside the country. When we draw up our rules on domestic regulation in the field of qualification requirements and procedures, technical standards and licensing requirements, we cannot include rules which may be construed as"more burdensome than necessary to ensure the quality of the service", as stipulated in Article VI.

Once we commit specific health services to become open to privatisation, there is NO going back. The GATS commits us to enable market access and, crucially, to progressive liberalisation (privatisation) of the services. There is no possibility of a trial period or anything like that. No review after 2 years to assess the effect on the services. Once it's done, it's written in stone.

Would you be able to say when it was that we voted for this?
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PostSubject: Re: What are the defects of the Irish Health system and how should it be reformed?   Tue Aug 05, 2008 11:04 pm

cactus flower wrote:
Slim Buddha wrote:
johnfás wrote:
The HSE is gearing up for semi-privatisation and it is going to be an unmitigated failure. Especially given the economic period which we are entering where the numbers holding private health insurance will fall, not rise.

It is much worse than that, johnfàs. The General Agreement on Trade in Services, a main pillar of WTO Law, allows for the inclusion of all public services to be "liberalised" (privatised). Only health is specifically included in the General Exceptions in Article XIV which would enable our government to ring-fence health and keep it, in the public interest, out of the hands of the profiteers. No chance of that happening under Harney. When we list services under the special commitments schedule, we commit to allowing services to be supplied in any one of four specified ways form anywhere, inside or outside the country. When we draw up our rules on domestic regulation in the field of qualification requirements and procedures, technical standards and licensing requirements, we cannot include rules which may be construed as"more burdensome than necessary to ensure the quality of the service", as stipulated in Article VI.

Once we commit specific health services to become open to privatisation, there is NO going back. The GATS commits us to enable market access and, crucially, to progressive liberalisation (privatisation) of the services. There is no possibility of a trial period or anything like that. No review after 2 years to assess the effect on the services. Once it's done, it's written in stone.

Would you be able to say when it was that we voted for this?

I don't recall anybody voting for this but it became international binding law in 1995 and our very own Peter Sutherland, failed Fine Gael candidate for Dublin North-West in 1977 (a certain B. Ahern got the seat Sudsy was fighting for) was very much involved in the birth of the WTO and the body of international law that arrived with it.

The GATS is an extraordinary document. It is so badly written it deserves some sort of a prize. However, it can and will be used to deadly effect by the privateers because the critical paragraphs I mentioned above (Progressive liberalisation is covered by Article XIX) are basically an agenda for privatisation. Despite the escape clause in Article XIV, health will be privatised by Harney. Specific commitments under Schedule 8 (Health) can include Hospital Services, Other Human Health Services, Social Services and Other, so anything can be caught under these terms. Harney can privatise the whole lot and then turn around and clain that our mambership of the WTO requires to "progressively liberalise" the health service. The entire clumsy GATS structure and deliberately vague phraseology used in it leads to a high level of confusion. But this will suit Harney down to the ground.

I don't know how the workings ofthe WTO gets covered by the media in Ireland. It gets a lot of coverage here and I am not just talking about the farmers. Because of the very large Swiss pharmaceutical industry, the workings of the TRIPS gets major coverage. I would be interested to hear of how the Irish media covers the WTO apart from the predictable stuff about farmers.
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PostSubject: Re: What are the defects of the Irish Health system and how should it be reformed?   Tue Aug 05, 2008 11:19 pm

My impression is that things like the GATT and WTO are covered if at all mainly on the business pages. Any other coverage tends to be about the "success" or "failure" of talks rather than the substance of what is being talked out. The farmer's lobby is most likely source of critical comment.

Over the past fifteen years there has been great positivity about benefits to Ireland of being one of the world's most open economies. As far as I recall there has not been a political debate at any stage about the push for privatisation and deregulation. The neoliberal agenda has penetrated our lives without any real public debate.

I think this is one of the many reasons for the No vote: people sense that important things we had have been given away, and when we saw another badly written document, we assumed that it was booby trapped.
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PostSubject: Re: What are the defects of the Irish Health system and how should it be reformed?   Tue Aug 05, 2008 11:37 pm

cactus flower wrote:
My impression is that things like the GATT and WTO are covered if at all mainly on the business pages. Any other coverage tends to be about the "success" or "failure" of talks rather than the substance of what is being talked out. The farmer's lobby is most likely source of critical comment.

Over the past fifteen years there has been great positivity about benefits to Ireland of being one of the world's most open economies. As far as I recall there has not been a political debate at any stage about the push for privatisation and deregulation. The neoliberal agenda has penetrated our lives without any real public debate.

I think this is one of the many reasons for the No vote: people sense that important things we had have been given away, and when we saw another badly written document, we assumed that it was booby trapped.

Quite amazing really, that so much hot air has been expended on Lisbon and yet the body of WTO law (close to 60 international agreements in all of which the GATT, the GATS and the TRIPS are the most important), which will have a direct and lasting effect on our economy, which will shape the manner by which we receive services and has the power to influence directly to determine the nature of those services, is not debated at all. Except, of course, for the concerns of farmers, which are really a sideshow in the greater scheme of things.
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PostSubject: Re: What are the defects of the Irish Health system and how should it be reformed?   Tue Aug 05, 2008 11:49 pm

Slim Buddha wrote:
cactus flower wrote:
My impression is that things like the GATT and WTO are covered if at all mainly on the business pages. Any other coverage tends to be about the "success" or "failure" of talks rather than the substance of what is being talked out. The farmer's lobby is most likely source of critical comment.

Over the past fifteen years there has been great positivity about benefits to Ireland of being one of the world's most open economies. As far as I recall there has not been a political debate at any stage about the push for privatisation and deregulation. The neoliberal agenda has penetrated our lives without any real public debate.

I think this is one of the many reasons for the No vote: people sense that important things we had have been given away, and when we saw another badly written document, we assumed that it was booby trapped.

Quite amazing really, that so much hot air has been expended on Lisbon and yet the body of WTO law (close to 60 international agreements in all of which the GATT, the GATS and the TRIPS are the most important), which will have a direct and lasting effect on our economy, which will shape the manner by which we receive services and has the power to influence directly to determine the nature of those services, is not debated at all. Except, of course, for the concerns of farmers, which are really a sideshow in the greater scheme of things.

Where should we start?
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PostSubject: Re: What are the defects of the Irish Health system and how should it be reformed?   Wed Aug 06, 2008 12:04 am

If I was in Ireland, I would ask Varadker or someone like him to table a written PQ to ask the Minister for Health the extent of the specific commitments which Ireland has committed to in the GATS schedules, the nature of the services delivery outlined in the specific commitment, the form and extent of the domestic regulation we stipulated if any under Article XI and, if we have given no specific commitment to date, whether the government will consider exercising the general exemption clause under Article XIV.

At least it would get an answer out of her in the Dail. She would never answer this in an interview or, indeed, anywhere else.
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PostSubject: Re: What are the defects of the Irish Health system and how should it be reformed?   Wed Aug 06, 2008 12:22 am

Does Ireland negotiate this directly or through the EU? Is there somewhere we can read the ABC of this up, so I won't have to bother you with stupid questions?
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PostSubject: Re: What are the defects of the Irish Health system and how should it be reformed?   Wed Aug 06, 2008 8:32 am

cactus flower wrote:
Does Ireland negotiate this directly or through the EU? Is there somewhere we can read the ABC of this up, so I won't have to bother you with stupid questions?

Cactusflower, your questions are by no means stupid and I find it interesting that somebody as well-informed and clued-in as yourself finds the whole WTO thing a bit foggy. That is understandable when it is portrayed in our media as a struggle between our brave farmers and Peter Mandelson.

There is no ABC per se on this and the best place to start getting information on this is here

http://www.wto.org/

In book form, the best I have come across is "The Law and Policy of the World Trade Organisation" by van den Bossche published by Cambridge. It explains in the clearest terms what is, after all, a very complex body of law.


The web is full of pages and sources of criticism of the WTO and its legal structures, particularly from international organisations representing public services. Reading Klein, Stiglitz, Bakan, Saul, Hertz and so on gives one the big picture but nailing down the insidious nature of the GATS in one source is next to impossible. But you can ask me questions on this anytime, cactusflower, and I will do my best to answer them.
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PostSubject: Re: What are the defects of the Irish Health system and how should it be reformed?   Wed Aug 06, 2008 3:17 pm

Frankly, there are a few answers, public OR private, but I doubt we'll see much action under Harney.

Has anyone read Squandered??? Interesting book written about British over bureaucratization that is probably very relevant to the HSE as well

Reforms (improve care and cut the budgets!):

1) get rid of half of the bureaucrats. The NHS has 1 manager per 5 beds, and all they seem to do is find more jobs for bureaucrats while patients are neglected, to say the least. I doubt the HSE is much different, although I don't have the figures. Might not be a bad idea to insist that all hospital managers, in future, have previously worked as nurses/physios, doctors in the past... might result in patient centred care and less form filling. Increase visual inspections, reduce the number of reports required. This would also mean that in the event of a 100 car pileup on the M50 say, everyone could pitch in and help.

2) Bring back Matron/ Mother Superior, and employ dedicated hospital cleaners as part of the team. Reward the cleaners with bonuses every time the MRSA/VRSA/C. diff infection rate goes down.

3) Change the law to reduce regulatory burden, increase visual inspections

4) in exchange for lowering bureaucrat numbers, start staffing underutilised facilities to make more room for patients

5) lets see the Opposition actually make some noise about cutting bureaucratic load and increasing front line staff numbers. Where are they?? Harney needs to get the boot and the job should be given to any FF/Green who can demonstrate a previous medical or scientific background... NOT another ex-lawyer or accountant.
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PostSubject: Re: What are the defects of the Irish Health system and how should it be reformed?   Wed Aug 06, 2008 9:46 pm

Great post, expatgirl.

I've taken the liberty of copying the posts about the WTO into "WTO-wtf?" in the hopes that we can get stuck into clarifying this foggy area.
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