The fallacy of private health care efficiency

Good discussion below of private v public health care in Canada. It exposes the madness of privatisation. We are being sold an enormous pup.

http://www.nupge.ca/news_2007/n24au07a.htm

What we are doing to our health service in Ireland should be a matter of national outrage - it already is for many - but people really need to mobilise quickly about this issue before Ms Harney completely destroys any possibility of retrieving the situation.

A good Indymedia article here about a recent meeting of various groups who are merging their efforts to highlight and protest at what is happening:

http://www.indymedia.ie/article/86219

Aragon wrote:

Good discussion below of private v public health care in Canada. It exposes the madness of privatisation. We are being sold an enormous pup.

http://www.nupge.ca/news_2007/n24au07a.htm

What we are doing to our health service in Ireland should be a matter of national outrage - it already is for many - but people really need to mobilise quickly about this issue before Ms Harney completely destroys any possibility of retrieving the situation.

A good Indymedia article here about a recent meeting of various groups who are merging their efforts to highlight and protest at what is happening:

http://www.indymedia.ie/article/86219

Leftfemme22 on P.ie posted this today:

Marie O’Connor Health Services Action Group PRO has warned that over 40 public hospitals are set to close if the HSE continues on its current course. This course was set out by the Hanley Report in 2003 and upheld and expanded by the TeamWork report of 2006. The list was released prior to a major rally in Monaghan on Saturday which has been organised in protest to what the organisers say is the Governments plans to close Monaghan Hospital to in-patients. This closures along with others are designed to facilitate and compliment both Co-location and Centres of Excellence

Community groups have named the hospitals recommended for closure by reports to Government ahead of a major rally in Monaghan on Saturday, May 10th. Monaghan Community Alliance Chairperson Peadar McMahon says if Monaghan loses its hospital, other hospital closures will follow ‘as night follows day’. ‘As OECD confirmed last week, the North-East is the pilot for the Government’s National Hospital Plan––the elimination of over 40 acute inpatient facilities.

The following general acute public hospitals are due to close as inpatient facilities, if the Hanly/Teamwork recommendations are implemented in full:

1 Our Lady’s, Navan, Co Kildare
2 St Columcille’s, Loughlinstown, Co Dublin
3 Naas General, Co Kildare
4 St Michael’s, Dun Laoghaire, Co Dublin
5 Mullingar General, Co Offaly
6 Portlaoise General, Co Laois
7 Ennis General, Co Clare
8 Nenagh General, Co Tipperary
9 Our Lady’s, Cashel, Co Tippperary
10 St Joseph’s, Clonmel, Co Tipperary
11 St John’s, Limerick
12 Cavan General
13 Louth General, Dundalk
14 Monaghan General
15 Our Lady of Lourdes, Drogheda
16 Letterkenny General, Co Donegal*
17 St Luke’s, Kilkenny
18 Wexford General
19 Bantry General, Co Cork
20 Mallow General, Co Cork
21 Mercy University, Cork
22 Kerry General, Tralee*
23 St. Finbarr’s, Cork
24 South Infirmary/Victoria, Cork
25 Merlin Park Galway
26 Mayo General, Castlebar*
27 Portiuncula, Ballinasloe, Co Galway
28 Roscommon General

The following single specialty acute public hospitals are also set to close as inpatient facilities, if the Hanly/Teamwork recommendations are implemented in full:

1 St Luke’s, Dublin
2 Coombe Women’s, Dublin
3 Clontarf Orthopaedic, Dublin
4 National Maternity, Holles St, Dublin**
5 National Rehabilitation, Dun Laoghaire, Co Dublin
6 Our Lady’s Children’s, Crumlin, Dublin
7 Peamount, Newcastle, Co Dublin
8 Rotunda, Dublin
9 Royal Victoria Eye and Ear, Dublin
10 St Mary’s, Baldoyle Co Dublin
11 St Mary’s Orthopaedic, Cappagh Dublin
12 Temple St Children’s, Dublin
13 St Nessan’s Orthopaedic, Croom, Co Limerick
14 St Munchin’s Maternity, Limerick
15 Our Lady’s, Manorhamilton, Co Leitrim
16 Orthopaedic, Kilcreene, Co Kilkenny
17 St Mary’s Orthopaedic, Gurranebraher, Cork

Notes: * Hospitals such as Letterkenny General Hospital, Tralee General Hospital and Castlebar General Hospital, are likely to remain open, due to their geographic location.
** The National Maternity Hospital, Holles St, has been seeking to ‘transfer’ to St Vincent’s Hospital, Dublin 4, for a number of years.

The hospital that treated my daughter last week is on that list. A building development programme at a cost of millions is on site there at the moment. Planning like that would fill you with confidence about what we might end up with.

16 billion Euros spent and all those hospitals closing. Maybe they need more money

youngdan wrote:

16 billion Euros spent and all those hospitals closing. Maybe they need more money

Do you think that all health care should be private, youngdan?

cactus flower wrote:

Aragon wrote:

Good discussion below of private v public health care in Canada. It exposes the madness of privatisation. We are being sold an enormous pup.

http://www.nupge.ca/news_2007/n24au07a.htm

What we are doing to our health service in Ireland should be a matter of national outrage - it already is for many - but people really need to mobilise quickly about this issue before Ms Harney completely destroys any possibility of retrieving the situation.

A good Indymedia article here about a recent meeting of various groups who are merging their efforts to highlight and protest at what is happening:

http://www.indymedia.ie/article/86219

Leftfemme22 on P.ie posted this today:

Marie O’Connor Health Services Action Group PRO has warned that over 40 public hospitals are set to close if the HSE continues on its current course. This course was set out by the Hanley Report in 2003 and upheld and expanded by the TeamWork report of 2006. The list was released prior to a major rally in Monaghan on Saturday which has been organised in protest to what the organisers say is the Governments plans to close Monaghan Hospital to in-patients. This closures along with others are designed to facilitate and compliment both Co-location and Centres of Excellence

Community groups have named the hospitals recommended for closure by reports to Government ahead of a major rally in Monaghan on Saturday, May 10th. Monaghan Community Alliance Chairperson Peadar McMahon says if Monaghan loses its hospital, other hospital closures will follow ‘as night follows day’. ‘As OECD confirmed last week, the North-East is the pilot for the Government’s National Hospital Plan––the elimination of over 40 acute inpatient facilities.

The following general acute public hospitals are due to close as inpatient facilities, if the Hanly/Teamwork recommendations are implemented in full:

1 Our Lady’s, Navan, Co Kildare
2 St Columcille’s, Loughlinstown, Co Dublin
3 Naas General, Co Kildare
4 St Michael’s, Dun Laoghaire, Co Dublin
5 Mullingar General, Co Offaly
6 Portlaoise General, Co Laois
7 Ennis General, Co Clare
8 Nenagh General, Co Tipperary
9 Our Lady’s, Cashel, Co Tippperary
10 St Joseph’s, Clonmel, Co Tipperary
11 St John’s, Limerick
12 Cavan General
13 Louth General, Dundalk
14 Monaghan General
15 Our Lady of Lourdes, Drogheda
16 Letterkenny General, Co Donegal*
17 St Luke’s, Kilkenny
18 Wexford General
19 Bantry General, Co Cork
20 Mallow General, Co Cork
21 Mercy University, Cork
22 Kerry General, Tralee*
23 St. Finbarr’s, Cork
24 South Infirmary/Victoria, Cork
25 Merlin Park Galway
26 Mayo General, Castlebar*
27 Portiuncula, Ballinasloe, Co Galway
28 Roscommon General

The following single specialty acute public hospitals are also set to close as inpatient facilities, if the Hanly/Teamwork recommendations are implemented in full:

1 St Luke’s, Dublin
2 Coombe Women’s, Dublin
3 Clontarf Orthopaedic, Dublin
4 National Maternity, Holles St, Dublin**
5 National Rehabilitation, Dun Laoghaire, Co Dublin
6 Our Lady’s Children’s, Crumlin, Dublin
7 Peamount, Newcastle, Co Dublin
8 Rotunda, Dublin
9 Royal Victoria Eye and Ear, Dublin
10 St Mary’s, Baldoyle Co Dublin
11 St Mary’s Orthopaedic, Cappagh Dublin
12 Temple St Children’s, Dublin
13 St Nessan’s Orthopaedic, Croom, Co Limerick
14 St Munchin’s Maternity, Limerick
15 Our Lady’s, Manorhamilton, Co Leitrim
16 Orthopaedic, Kilcreene, Co Kilkenny
17 St Mary’s Orthopaedic, Gurranebraher, Cork

Notes: * Hospitals such as Letterkenny General Hospital, Tralee General Hospital and Castlebar General Hospital, are likely to remain open, due to their geographic location.
** The National Maternity Hospital, Holles St, has been seeking to ‘transfer’ to St Vincent’s Hospital, Dublin 4, for a number of years.

The hospital that treated my daughter last week is on that list. A building development programme at a cost of millions is on site there at the moment. Planning like that would fill you with confidence about what we might end up with.

That's utter rubbish and typical of Hospital Action Groups.

The Hanly Report only dealt with 2 regions and was shelved in 2005. The Teamwork Report does not make recommendations about lists of hospitals like this.

My local Hospital Action Group has been telling me that my local hospital has been closing for 20 years, but the only thing that has actually happened in the last 5 years is that a new A&E opened there in 2004.

To suggest that hospitals like Naas and Mullingar will no longer provide in-patient facilities is absurd beyond belief.

These Hosptial Action Groups have a lot to answer for in stirring up unnecessary opposition to vital reform.

I'm inclined to be sceptical too. Portlaoise has a new A&E (though not open yet), Mullingar Hospital is in Westmeath, not Offaly, Naas has a huge catchment area THREE maternity hospitals in Dublin to go....

Peamount may go - I wouldn't be surprised at that.

I've always supported free universal healthcare for everyone at the point of delivery - however we are getting further away than ever from that model in Ireland. Funny enough, on wikipedia there was a poster that stoutly defended Ireland as a model of socialised medicine. It's socialised alright, if you call giving private investors in hospitals a little gravy socialism for the stock market classes.

This is one issue I'm an absolute lefty on.

Ronald Binge wrote:

I've always supported free universal healthcare for everyone at the point of delivery - however we are getting further away than ever from that model in Ireland.

I don't think small, open economies have a choice in the matter.

We can't produce the raw materials for a health service indigenously, which means we have to be able to afford to buy them from other countries. That means we have to be wealthy, and the only way we managed to be wealthy so far is by turbo-charging the private sector, which means low taxes and low public spending.

Hence you have 2 options:

1. Centralise you resources so that you can achieve maximum economies of scale and therein have more to spend on the delivery of care. Politically problematic in the extreme.

2. Maintain a skeleton public system that provides essential day to day care and buys specialist care from the private sector. Risky and diminishes the strategic imperative of having a publically owned system.

From what I can see, the Government is going with a bit of both.

At the moment Irish health spending is about average for a developed country but the services being provided and the outcomes are in many cases way below average. This can't all be accounted for as a legacy. There is shocking disfunctionality in planning and management of the health services. There is a long way that could be gone in improving services on the present budget.

The HSE recently gave out "awards" for improved services - one interviewee on RTE described how their department team had cut waiting times for a neurology clinic from 18 months to 10 weeks over a short period. They were doing twice the work load and were happy to do it.

Bet they are popular down at the canteen.

cactus flower wrote:

At the moment Irish health spending is about average for a developed country but the services being provided and the outcomes are in many cases way below average.

I don't think the quality of care is an issue. The amount of time you have to wait to get it is, as is its availability nationally.

cactus flower wrote:

This can't all be accounted for as a legacy. There is shocking disfunctionality in planning and management of the health services.

There is, but a lot of that arises from political sources.

There has been a seismic change in the operation of the Health Services in the last 2 years. Previously, politicians wielded a lot of power, but the HSE is now strictly off-limits.

A tidal wave of local grievances has been created as a result, but the overall effect is positive.

seinfeld wrote:

cactus flower wrote:

At the moment Irish health spending is about average for a developed country but the services being provided and the outcomes are in many cases way below average.

I don't think the quality of care is an issue. The amount of time you have to wait to get it is, as is its availability nationally.

cactus flower wrote:

This can't all be accounted for as a legacy. There is shocking disfunctionality in planning and management of the health services.

There is, but a lot of that arises from political sources.

There has been a seismic change in the operation of the Health Services in the last 2 years. Previously, politicians wielded a lot of power, but the HSE is now strictly off-limits.

A tidal wave of local grievances has been created as a result, but the overall effect is positive.

In the last bench marking exercise, the reporters found that there were still, after two years, a significant number of HSE Managers who weren't able to say what their job entailed. This is no fault of the Managers, they didn't design the system and presumably have no power to change it.

cactus flower wrote:

seinfeld wrote:

cactus flower wrote:

At the moment Irish health spending is about average for a developed country but the services being provided and the outcomes are in many cases way below average.

I don't think the quality of care is an issue. The amount of time you have to wait to get it is, as is its availability nationally.

cactus flower wrote:

This can't all be accounted for as a legacy. There is shocking disfunctionality in planning and management of the health services.

There is, but a lot of that arises from political sources.

There has been a seismic change in the operation of the Health Services in the last 2 years. Previously, politicians wielded a lot of power, but the HSE is now strictly off-limits.

A tidal wave of local grievances has been created as a result, but the overall effect is positive.

In the last bench marking exercise, the reporters found that there were still, after two years, a significant number of HSE Managers who weren't able to say what their job entailed. This is no fault of the Managers, they didn't design the system and presumably have no power to change it.

They're the sort of claims you should really back up with some sort of source.

I imagine you're probably right, but the issue with the duplicity of management in the HSE arises from IMPACT holding a gun to our heads to say that the HSE would never come into existence if a single administrator was fired.

Quote :

They're the sort of claims you should really back up with some sort of source.

Yes, I agree, but my source was RTE radio and I haven't managed to locate the report on the internet. With luck I may turn it up yet, if available on line. It was the last bench marking report published earlier this year.

Ronald Binge says he supports free health care. The problem is it is not free but costing 16 billion Euros a year.

youngdan wrote:

Ronald Binge says he supports free health care. The problem is it is not free but costing 16 billion Euros a year.

Free at point of service.

Cactus Flower - the dysfunctionality that you refer to is no accident. The health service is being quite deliberately run down. I posted something on the Brian Cowen thread about how Harney is handing out gazillions in subsidies to private health care providers and schemes - while starving front line patient care services - recruitment freezes and so forth.

I'll fetch a link to it and bring it back here in a mo.

Some interesting facts and figures contained in reports quoted below:

I wondered when I first read this in the Irish Times this morning if Cowen was heralding a more socialist approach to government:

“The ultimate test of our progress will be the extent to which we can mobilise all of the people to think and behave in a manner that puts the interests of society as a whole ahead of their own private interest,” he said.

http://www.ireland.com/newspaper/frontpage/2008/0508/1210199732964.html

This appeal to a collective sense of responsibility might more realistically be interpreted to mean 'us and our IBEC chums have got us all into a fine mess and now you lot can lookforward to paying the price of it.'

If money has to be found to make up for declining tax revenue then how about taking a long cold look at tax subsidies to the so-called 'wealth creators'. A good place to start would be at the Department of Health where the ideological privatisation zealot Mary Harney is handing out subsidies to private investors like smarties:

"Mary Harney claims that the public sector can’t provide 1,000 extra hospital beds as fast and as cheaply as the private sector. This is a blatant lie. Co-located hospitals are the most expensive way to provide extra beds. Private investors will get tax breaks that will cost the state €500 million over seven years. On top of this the income lost to public hospitals from the transfer of private patients will be €700 million, which makes a minimum cost to taxpayers of €1.2 billion (about 44% of the cost) to build hospitals that will belong to private companies!

The new private hospitals will also treat public patients through the National Treatment Purchase Fund - more taxpayers’ money going into the coffers of private healthcare companies. In fact, there will be an incentive on the part of the government not to invest in the public health system to overcome the shortfalls that lead to waiting lists because they can just pay the private hospitals to do the job. This system will also be open to abuse by consultants who could transfer patients from the public to the private hospital for their own financial gain. "

http://www.socialistparty.net/pub/pages/socialist026jul07/1.html

The problem with what is called 'reform' of the public sector is that it is a euphamism for getting rid of the public sector entirely and franchising it out to the business buccaneers, at enormous expense to the rest of us on the basis that these people are more 'efficient' at doing things than the rest of us. We already have an absolutely dire situation within the health service, where private management consultants and other publicly funded parasites are leeching vast sums of money out of reserves that should be going directly into patient care.

Instead of identifying the patent lunacy and inefficiency of this situation, a recent OECD report has called - wait for it- for more of the same, rather than less.

C:\Documents and Settings\Administrator\Desktop\Sunday Business Post Irish Business News.htm

The report calls for increased involvement of private sector 'reformers' in public administration . What is really being advocated here is the dismantling of a sizeable element of what claim we can make to being a democracy. We already have a situation where, with virtually zero public discussion about what is going on, unelected and unaccountable IBEC representatives are crawling all over government quangos and committees. From these positions they are wreaking absolute havoc on many aspects of the public sector - deregulation of various sorts is creeping in by stealth. It's a barnyard auction of the public sector.

tonys wrote:

A mix of private & public is I think the way to go. There needs to be substantial private health facilities built and run efficiently to cut out waiting times in the first instance and secondly to benchmark the public services against in the interests of badly needed reform, otherwise that long overdue reform is never going to happen.

For far too long the public services in general, not just in health, have been run for the benefit of those employed in those services, that has to stop.
I also think it’s short sighted to say that tax incentives are a cost to the taxpayer, when used correctly and taking into account the economic activity & therefore extra tax revenue generated by the building & operation of these facilities, they should be, broadly speaking, revenue neutral in the short to medium term & positive in the long term.
My tax free tuppence worth.

I've worked in the public sector, and I couldn't agree more about that aspect.

A problem we have here is that we don't have a coherent public system. G.P.s are private and a lot of hospitals are run by / controlled by religious or by private trusts. I think we should sort out the public system first and foremost and should certainly not be building new private hospitals with tax rebates at the same time as closing hospitals down.

ibis wrote:

youngdan wrote:

Ronald Binge says he supports free health care. The problem is it is not free but costing 16 billion Euros a year.

Free at point of service.

Exactly.

Any chance of a Beveridge Report in this country sixty five years on? In any case how can we remotely contemplate a united Ireland if we don't let on that it will cost you €60 to visit your GP in the brave new Ireland due by 2016 according to some?

cactus flower wrote:

I think we should sort out the public system first and foremost and should certainly not be building new private hospitals with tax rebates at the same time as closing hospitals down.

We are not building private hospitals; the private sector is, to serve the 52% of the population who want private health care.

Name one hospital that has closed in the last 5 years.

Strangling public health care to death

2,500 unfilled vacancies in Health since beginning of recruitment freeze

http://www.ireland.com/newspaper/frontpage/2008/0512/1210503983364.html

Aragon wrote:

Strangling public health care to death

2,500 unfilled vacancies in Health since beginning of recruitment freeze

http://www.ireland.com/newspaper/frontpage/2008/0512/1210503983364.html

So much for the HSE being 'bloated' with administrators.

Quote :

The report says while some of the job reductions in the service are due to seasonal factors and the ending of some student nurse placements, "the majority would have resulted from the recruitment pause put in place on September 4th, 2007, and the tight employment control process in place from the start of 2008".

How many administration/managerial posts are unfilled ?

The report appears to suggest that nursing staff numbers have been cut.

seinfeld wrote:

cactus flower wrote:

I think we should sort out the public system first and foremost and should certainly not be building new private hospitals with tax rebates at the same time as closing hospitals down.

We are not building private hospitals; the private sector is, to serve the 52% of the population who want private health care.

Name one hospital that has closed in the last 5 years.

How many new hospital units remain unopened?