squeefulfish (![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
squeefulfish) wrote2009-07-17 05:46 am
squeefulfish) wrote2009-07-17 05:46 am
Snippy snip snip
Bord snip report is out, released 20 minutes after I boarded a bus from Cark and had no reading material but anyhow.
So here, Sarah's reaction to the Department of Health and Children suggestions. Because that's my area.
While there are some things in the report that rankle, knowing full well the difference even €10 a week less can make to someone on the dole, there are some good suggestions in it (it means the difference between being able to afford the odd extra schoolbook and not, for starters. I remember the 80s well.) Even in the DoHC sections it's not all bad. Stick "suggested" in front of words like "cuts" and "cutbacks", I just couldn't be bothered typing it out every time.
Ok, so at first glance, DoHC cuts are awful. 6,168 jobs to go in that department. Frontline staff not to be affected in this regard; as far as I can tell, most of the jobs to be from admin and support numbers such as catering and housekeeping. Admin in the HSE is pretty damn bloated, I can see myself just how many admin staff there are by the numbers of vacant parking spaces in hospital staff car parks after 5 on weekdays and at weekends. Most of the cuts seem to be coming from there and in replacing support staff with contract staff if this is a cheaper option.
The use of taxis is another one I've ranted on in the past. Frequently I've had to accompany a woman to a major Dublin general hospital that's 5 minutes walk from my own maternity hospital. It happens a few times a day, nearly every day, just from my place alone. At at least a tenner a round trip, it's not a cheap option. You do the maths. A midwife, or at least a senior student midwife, has to accompany each woman. There is no fast-tracking once I get to the other hospital so I'm waiting there for up to 4 hours in some cases. That's 4 hours of pay if there's no senior student around plus a tenner for the taxi. Or 4 hours of pay if the student is a postgrad. (They get paid to train.) It has been suggested in the report that this is not ideal and a goal of 20% reduction in the 50m the HSE spends on taxis and the like (non-ambulance transport) each year is to be aimed for. It's a start.
No premium payments to healthcare workers between the hours of 0800 and 2000. Grand. Not entirely sure if Saturday and Sunday now being considered "part of the normal working week" means the premium payment for that vanishes too, though. It probably does. Boo. I'll be keeping an eye on ino.ie over the next few days, regardless.
Location and speciality allowances to be withdrawn. Not exactly grand, but it'll save a few bob.
"Unnecessary demarcation between grades that prevents nurses from carrying out routine medical procedures performed by Non-Consultant Hospital Doctors and Heath Care Assistants carrying out routine nursing duties be removed." I am generally in favour of this one, as long as no-one is expected to work beyond their competency level, for that paves the way to the High Court. Anyone confident and competent in their skills should be able to perform these skills without having to wait for a doctor to come along and do it for you. (I'm thinking particularly in cases of cannulation where despite being trained to do such a thing, hospital policies can dictate that nurses/midwives have to get a doc.) Unsure what the HCAs would be expected to do as part of "routine nursing duties" that would still ensure safe care of patients/women/babies. Taking blood pressure/temps? As an aside to this, nurse/midwife prescribing powers need to be looked at again. As it stands, a nurse/midwife can only undertake the prescribing course if the hospital they are attached to has a distinct need for that person to prescribe and their prescribing powers are lost should they ever leave the named hospital. Which means independent M/Ws cannot prescribe, ever. But that's a different rant for a different day and ain't mentioned in An Bord Snip.
No bonuses to be paid to HSE staff. Excellent. When 111 people received bonuses totalling €1.3m and we can't afford to vaccinate against 4 strains of HPV, there's something very wrong. (Aside: when we can't afford to vaccinate against 4 strains of HPV, at a cost of e10m/year but can somehow find e88m to vaccinate against one strain of the flu, there's also something else very wrong.)
Maternity services not named directly. Which is nice, as the KPMG report suggested the Dublin area alone is understaffed, needing an extra 200+ midwives just to provide safe care to the current numbers of women attending. No mention either, however, of over-reliance on agency staff.
Increase to €125 from €100 on the charge for attending A+E without a letter from a doctor and the cost to treat private patients in public hospitals to increase by 20%. Both of these, not so bad either. However, the same increase in the drugs payment scheme is a bitter pill.
Would have liked to see a "drunk tax" on arriving in A+E drunk and aggressive, but hey.
And so on to medical cards. The numbers of medical cards have been increasing by 9,000 per month for the first 5 months of this year. Not entirely surprising, given the numbers losing their jobs. Cost to the state of medical cards (including capitation fees paid to GPs and cost of drugs dispensed under the scheme) has doubled since 2004. That is unacceptable and as part of the general requirement that generic drugs be prescribed instead of named ones, this should decrease. However, income limits for getting a medical card should, according to the report, be revised down to the maximum amount of jobseekers benefit. Currently certain incomes/allowances are granted when applying for a medical card. That's things like travel to work, childcare, rent and mortgage payments, child benefit, higher education grants. It is suggested that this system of "disregards" be reviewed. Actually, I need information on one thing: Are GPs paid a capitation fee for treating medical card holders on an annual basis, regardless of whether they see the holder in the year? I have a sneaking suspicion they are, but if anyone can confirm this, that'd be dandy.
Furthermore, a €5 co-pay on prescriptions made under the medical card scheme might well be too much for some to pay, given that these are, quite often, the very poorest people. While I accept that drugs are not cheap and pharmacists are not cheap, for someone with a long-term illness this can be the difference between eating well and eating poorly. A fiver can go a long way when you're used to being frugal.
Recommendation that existing contracts between the HSE and GPs/pharmacists be phased out as quickly as possible, in order to better negotiate contracts that provide better patient services at better value to all. Good good.
There's currently a review of mental health services in order to provide better value for money, as such this doesn't come under the scope of the Bord. I'll be watching that with interest, also. However, a general recommendation that services be streamlined to provide better value for money is made.
As regards care of the elderly, the increase in the maximum charge payable in the case of those in nursing homes is galling. Means testing for homecare packages (nursing/therapy, not home help with domestic chores which is already means tested) also offends my sensibilities. At the same time, a recommendation that there be a streamlining of the application procedure, along with a standardised application form, is a good thing.
Last night I walked past the sitting room as dad was watching someone be interviewed on the tellybox. Person was saying that 75% of state expenditure is on education, health and social welfare. Saying this like it's a bad thing. The proposed cuts in education are insane, the loss of 1000 special needs assistants country wide-will have such an effect that I cannot swear strongly enough. While I accept that social welfare is in real need of being overhauled, it is still a vital part of our society. But as regards the DoHC, it's not all bad.
So here, Sarah's reaction to the Department of Health and Children suggestions. Because that's my area.
While there are some things in the report that rankle, knowing full well the difference even €10 a week less can make to someone on the dole, there are some good suggestions in it (it means the difference between being able to afford the odd extra schoolbook and not, for starters. I remember the 80s well.) Even in the DoHC sections it's not all bad. Stick "suggested" in front of words like "cuts" and "cutbacks", I just couldn't be bothered typing it out every time.
Ok, so at first glance, DoHC cuts are awful. 6,168 jobs to go in that department. Frontline staff not to be affected in this regard; as far as I can tell, most of the jobs to be from admin and support numbers such as catering and housekeeping. Admin in the HSE is pretty damn bloated, I can see myself just how many admin staff there are by the numbers of vacant parking spaces in hospital staff car parks after 5 on weekdays and at weekends. Most of the cuts seem to be coming from there and in replacing support staff with contract staff if this is a cheaper option.
The use of taxis is another one I've ranted on in the past. Frequently I've had to accompany a woman to a major Dublin general hospital that's 5 minutes walk from my own maternity hospital. It happens a few times a day, nearly every day, just from my place alone. At at least a tenner a round trip, it's not a cheap option. You do the maths. A midwife, or at least a senior student midwife, has to accompany each woman. There is no fast-tracking once I get to the other hospital so I'm waiting there for up to 4 hours in some cases. That's 4 hours of pay if there's no senior student around plus a tenner for the taxi. Or 4 hours of pay if the student is a postgrad. (They get paid to train.) It has been suggested in the report that this is not ideal and a goal of 20% reduction in the 50m the HSE spends on taxis and the like (non-ambulance transport) each year is to be aimed for. It's a start.
No premium payments to healthcare workers between the hours of 0800 and 2000. Grand. Not entirely sure if Saturday and Sunday now being considered "part of the normal working week" means the premium payment for that vanishes too, though. It probably does. Boo. I'll be keeping an eye on ino.ie over the next few days, regardless.
Location and speciality allowances to be withdrawn. Not exactly grand, but it'll save a few bob.
"Unnecessary demarcation between grades that prevents nurses from carrying out routine medical procedures performed by Non-Consultant Hospital Doctors and Heath Care Assistants carrying out routine nursing duties be removed." I am generally in favour of this one, as long as no-one is expected to work beyond their competency level, for that paves the way to the High Court. Anyone confident and competent in their skills should be able to perform these skills without having to wait for a doctor to come along and do it for you. (I'm thinking particularly in cases of cannulation where despite being trained to do such a thing, hospital policies can dictate that nurses/midwives have to get a doc.) Unsure what the HCAs would be expected to do as part of "routine nursing duties" that would still ensure safe care of patients/women/babies. Taking blood pressure/temps? As an aside to this, nurse/midwife prescribing powers need to be looked at again. As it stands, a nurse/midwife can only undertake the prescribing course if the hospital they are attached to has a distinct need for that person to prescribe and their prescribing powers are lost should they ever leave the named hospital. Which means independent M/Ws cannot prescribe, ever. But that's a different rant for a different day and ain't mentioned in An Bord Snip.
No bonuses to be paid to HSE staff. Excellent. When 111 people received bonuses totalling €1.3m and we can't afford to vaccinate against 4 strains of HPV, there's something very wrong. (Aside: when we can't afford to vaccinate against 4 strains of HPV, at a cost of e10m/year but can somehow find e88m to vaccinate against one strain of the flu, there's also something else very wrong.)
Maternity services not named directly. Which is nice, as the KPMG report suggested the Dublin area alone is understaffed, needing an extra 200+ midwives just to provide safe care to the current numbers of women attending. No mention either, however, of over-reliance on agency staff.
Increase to €125 from €100 on the charge for attending A+E without a letter from a doctor and the cost to treat private patients in public hospitals to increase by 20%. Both of these, not so bad either. However, the same increase in the drugs payment scheme is a bitter pill.
Would have liked to see a "drunk tax" on arriving in A+E drunk and aggressive, but hey.
And so on to medical cards. The numbers of medical cards have been increasing by 9,000 per month for the first 5 months of this year. Not entirely surprising, given the numbers losing their jobs. Cost to the state of medical cards (including capitation fees paid to GPs and cost of drugs dispensed under the scheme) has doubled since 2004. That is unacceptable and as part of the general requirement that generic drugs be prescribed instead of named ones, this should decrease. However, income limits for getting a medical card should, according to the report, be revised down to the maximum amount of jobseekers benefit. Currently certain incomes/allowances are granted when applying for a medical card. That's things like travel to work, childcare, rent and mortgage payments, child benefit, higher education grants. It is suggested that this system of "disregards" be reviewed. Actually, I need information on one thing: Are GPs paid a capitation fee for treating medical card holders on an annual basis, regardless of whether they see the holder in the year? I have a sneaking suspicion they are, but if anyone can confirm this, that'd be dandy.
Furthermore, a €5 co-pay on prescriptions made under the medical card scheme might well be too much for some to pay, given that these are, quite often, the very poorest people. While I accept that drugs are not cheap and pharmacists are not cheap, for someone with a long-term illness this can be the difference between eating well and eating poorly. A fiver can go a long way when you're used to being frugal.
Recommendation that existing contracts between the HSE and GPs/pharmacists be phased out as quickly as possible, in order to better negotiate contracts that provide better patient services at better value to all. Good good.
There's currently a review of mental health services in order to provide better value for money, as such this doesn't come under the scope of the Bord. I'll be watching that with interest, also. However, a general recommendation that services be streamlined to provide better value for money is made.
As regards care of the elderly, the increase in the maximum charge payable in the case of those in nursing homes is galling. Means testing for homecare packages (nursing/therapy, not home help with domestic chores which is already means tested) also offends my sensibilities. At the same time, a recommendation that there be a streamlining of the application procedure, along with a standardised application form, is a good thing.
Last night I walked past the sitting room as dad was watching someone be interviewed on the tellybox. Person was saying that 75% of state expenditure is on education, health and social welfare. Saying this like it's a bad thing. The proposed cuts in education are insane, the loss of 1000 special needs assistants country wide-will have such an effect that I cannot swear strongly enough. While I accept that social welfare is in real need of being overhauled, it is still a vital part of our society. But as regards the DoHC, it's not all bad.