Well said James.

James connolly I must state.

How is it a “crazy idea” ? Competitiveness issues were highlighted by the Troika previously.

Slight correction there James, I work in a hospital, admin on a very busy daycare, not one ‘medical’ person would ever answer a phone, sent a fax, ring for a porter, phone IT about a problem with THEIR PC …in fact they would walk to another admin area to get these things done, they would have done same in half the time!!!!

Joan, due respect, their job is not to answer phones or send faxes or call for porters, their job is to be an NCHD.
It is far easier to gain access to another computer than it is to call someone who may or may not fix the thing.

Joan, have you ever called IT in SVUH?

Wow Joan. Don’t know where you work but I’ve called IT, porters and answered the ward phone on a daily basis. I was shown how to use a fax machine in my first week as an intern (wasn’t shown how to take blood or make up antibiotics for a lot longer but that’s a different story). I’ve never had a problem with my “own PC” but then I’m just an NCHD we rarely get our own computers.
Not our job but we still do it.

James, in the immortal words of Talking Heads ” Stop making sense”.

I know that James, but in your previous post you said why not get enough admin staff in to do the jobs we end up doing…all I’m saying is no medical staff where I work do any admin work of any discription.

Maybe! Though I don’t work in SVUH as such.

Don’t dispute that for a moment Cathy and fair play to u..,only saying where I work it’s very different.

Joan, I can categorically guarantee you that that is an outright lie (whether intentional or otherwise).
There is no NCHD in the country who does no admin work whatsoever, as the system relies on NCHD’s doing admin work, very often at the expense of their own work.
Whether admin work means following up on test results (which in every hospital I’ve worked in bar Irish ones has been done by a clerk), or arranging consults (which in every hospital I’ve worked in bar Irish ones is done by pressing a few buttons), or following up on patient notes from other hospitals (which in every other hospital I’ve worked in Irish ones are computerised).
I don’t know where you work Joan, but it sounds like JoR should pay a visit there to see how it is ye work, because an NCHD should not, but does end up, doing admin work all of the time.
As do I, (as am I right at this moment) for that matter. We are not trained for this. It’s an incredible waste of expensive and valuable resources.

@Joan, admittedly I can only comment on the places I’ve worked so that’s The Mater, Limerick, Temple Street, Crumlin, Tallaght and The Rotunda. I should probably have worked where you work as I’ve spent a LOT of my “training” making endless non-clinical phone calls, hassling IT, faxing… Not to mention portering samples, searching for X-Rays, typing clinic letters…

Joan what do you call the mountains of paperwork we NCHDs fill in every day? I spend about a third of my time with the patient as I do writing about the patient. That’s my admin work, it’s not something anyone else is going to do or should have to do because it’s part of my job. If the ward phone is ringing and I’m sitting by it I’ll answer it gladly even though I probably don’t know the majority of patients on that ward because my patients are spread out over the hospital. If I need the computer and something small and simple is broken on it, I’ll fix it so I can use and and not have to waste ITs time coming to do so. If I need to fax something to a GP or a nursing home I’ll do it because I know then that’s it’s been done. So please don’t tell me that we ‘medical people’ don’t do admin work because that’s what I spend the majority of my time doing every day. It’s just different admin work to what you are employed and paid to do.

Joan, as you yourself say you work ‘on a very busy daycare’ unit. That in it’s self implies that the medics are already very busy, admitting, discharging, reviewing the patients, you can hardly expect them to start answering random phonecalls to the ward/unit? I have seen plenty of docs answering phones. To say It is a complete waste of their time is an understatement and they usually end up having to direct the call to admin or nursing staff anyway.

Joan if the Junior doctors were to do all of that on top of what they are actually employed to do then what would be the point of your job be.

James
Caught out at last. Methinks your talking through your orifice.
In all the times I have been on the wards I never ever saw a nurse queuing for a computer.

Richard, then you work in better funded hospitals than I have!

Wow guys must be a very state of the art hospital… Fax machine on the ward?? Most hospitals that I’m familiar with have a fax machine at main reception, radiology and medical records. Ward clerks to do admin on wards including sending faxes! Admin staff to work on Payroll in Finance dept., Admin in HR to advertise interview NCHDs, who are usually 6 months at each hospital and of course other hospital personnel. Admin staff in the Lab to type results and send to GPs and other hospitals. Admin staff to retrieve old X-rays to compare with new films (not all X-rays are on computers yet). Admin staff to organise admissions, clinical appts, physio appts, blood tests, equipment needs. I.T. staff in most hospitals carry a bleep and are on call during weekends too. Totally agree with you if a NCHD has to do so much admin. Obviously there will be some admin duties eg treatment plans and clinical notes, consent form so patient is aware and understands reason god operation. Nurses too do admin duties, some of which by law admin staff are not allowed to do e.g. Nursing clinical notes, observations , prescribing medications etc. Some hospitals can’t even get phone line to get a fax machine in needy departments and that’s even in Celtic Tigers time!! Is there no ward clerk allocated in your hospital? Most hospitals have one ward clerk on each ward and on surgical and medical day units those clerks are lucky to get a quick lunch by 3 pm and don’t know what a tea break is!!

Richard, I spend 60hours a week average in a hospital, all due respect, I’m not the one talking out of the rear.
Good day to you.

Aurilton, not sure if you’re being deliberately provocative here, but just to remind you that very few admin staff work 24/7 and yet the “admin” work piles up. Phones still ring at 2am. Patients are transferred with typed letters on Sunday mornings. Consults are faxed to specialists in tertiary units on bank holidays. etc etc etc

As an intern last year I was practically a clerical worker, apart from my on call shifts. Endless discharge letters, referrals, faxes, etc. My SHO was constantly at it as well

I would agree. O’reilly is a fat thug and has no humanity.

Totally agree with you Cathy.

Alan, do you mean dictating a discharge summary with reason for referral, treatment and follow-up plan or do you actually mean typing a discharge summary? Obviously as Cathy mentioned if a patient requires transfer during the weekend/evening a transfer summary has to be done but in most hospitals routine discharges have their letter dictated after the medical record is processed by HIPE and discharge office and when the dictation is completed by either NCHD/consultant the medical secretary assigned to that specific medical dept types the letter.

Hi James,
You make very good points (as always) and I agree with what you are saying. Can you clarify though, what you mean by centralising HR? I am working as a physiotherapist. In the HSE, we are employed through a centralised recruitment based in Leitrim and it is a complete disaster. Physiotherapists (as well as occupational therapists, speech and language therapists, dieticians etc) are employed off a panel, which means you get interviewed and then get put on a waiting list for a job. This was supposed to be held every year put the present panel has been in place since March 2008. That’s 5 years of graduates (including me), who are excluded from seeking permanent employment in the HSE. Physiotherapy managers have no power over who they are employing and physiotherapists have no choice but to take jobs they are being offered. The power to refill posts has been taken from managers and this has added to huge staff shortages with physiotherapists. Furthermore, as the contracts are from this central recruitment division, it has often occurred that jobs have been offered to people and then pulled repeatedly by some pencil pusher who doesn’t realise the effect this has on staff and patients. This has occurred to many physiotherapists I know, who had been offered a permanent job, given notice on the job they were in, only for the contract to be pulled. I agree that there are too many managers and office staff in place of frontline workers but centralising areas such as recruitment could only worsen the staffing numbers in my opinion.

Patrick, so true that’s a complete mess – not unlike the teachers panel.

Sadly in uchg and lgh where I worked, actually typing up discharge summaries was my job. That is standard in those hospitals for interns and even SHOs in some departments. I’d say about 20-30 each week, easily

That’s crazy Alan

Patrick, hiring capabilities should be given to each hospital (with the exception of a few positions), what I was referring to was the fact that you have payroll, salaries, contracts, medical manpower and any other number of functions that in any private company are covered by one department: Human Resource.
All of these offices can be centralised to Head Office (which was the point of HSE, lets not forget) with a rep or two of the department in each hospital for queries, and communication purposes.

Aurilton, what Alan has outlined is typical in most hospitals here, not mad at all, more normal!

Thanks for clarifying that James. With the workers in payroll, medical manpower etc. I still wouldn’t be fully convinced that centralising them to head office is the full solution. The reason being, that they would have to cover wages for the whole service and one slip up could see a large proportion of the staff not get paid. As I said, I agree that there are too many of these in each hospital but maybe centralising them to one office for a region would make more sense to save costs but ensure that there are still enough to carry out their duties fully.

No matter where you work, whether your a Doctor, Nurse or Midwife you have to accept that you will have a certain amount of admin, clerical and telephonic, portering and domestic duties. It’s a fact of life and James before you say anything I’ve worked in the UK Australia and New Zealand it’s the same everywhere, I’ve worked in Dublin and Limerick and visited hospitals in Cork and Galway they all operate the same.

Patrick
I agree 100% with you the centralised recruitment has failed on many levels. Also mistakes have been made at local level where payroll are looking after just one hospital god help us if they centralised it. What is required is a business manager to head up the HSE not a Doctor and run it like a business with each unit responsible for their own budget and answerable to one company director like the multinational’s.

Hi Cliodhna, hope you’re well!
I absolutely agree, there will always be a component of admin, it goes with the job, in most cases the admin that nurses and doctors must do has to stand to legal scrutiny (and rightly so). I was referring to work that just shouldn’t exist. I do agree though that admin will always exist, it’s when the admin tends to 1, and the clinical tends to 0 is when we become little more than glorified office workers (no offence to office workers!).

Patric and Cliodhna, again I agree, the centralised recruitment system has failed, and I should add to the above, they’re obviously not the only changes to be made, there’s bazillions more that need to be made.
Also agree with the business leader – doctors doctor, nurses nurse, leaders lead.
I don’t think the problems with the health service are as simple as I’m portraying here, it’s an organisation that has been built up by different people with different points if views, with different goals. Everything changes all if the time, continuity! I’m not sure though how you go about that though!

I’m well James and hope you are too. Point taken and I do agree with you but I do think some people get bogged down by job description’s and not working outside them.
When I worked in NZ the public hospitals were run by companies and we were accountable for everything right down to waste management in our theatres. I was flabbergasted by the amount they saved on a daily basis and how much we wasted in Ireland when I came home I suggested we do the same and was laughed at.
We need the nuns back lol.

Well said James an Cliodhna, I do agree that it needs to be approached as a business with a business manager but with assistance from frontline staff (eg head of medicine, head of nursing, head of allied health etc) to ensure cuts are made in the right areas which minimises the effects on patient care and doesn’t overwork staff.

Hear hear.

Our competitiveness needed to improve, according to the Troika. I’m guessing Structural Reforms will pay off in the long-term.

Whats that Regonald? Our lords the troika think we need competitiveness? Oh well then we must do as they say as our masters only care for the people after all, surely they have our best interest at heart? What’s that u say little Irish people? “Our health service is in crisis”? Do the troika give a phuck? Like phuck they do!

Well in fairness, neither did we. This situation didn’t suddenly get created when the financial crisis started.

Ok who’s going to replace him?

I know most of them aren’t worthy of sweeping the streets, and that’s our main problem, the lack of political choice, but how about Kathleen lynch.

By comparison, would that even make a drop in the ocean?

@Regonold
No, but that’s not really the point. If people felt there was more fairness in the system and everybody – including the so-called ‘elite’ – were doing their bit it would go some way towards reducing the justifiable level of anger that is out there at the moment.

My taxes, as an individual, are also only a drop in the ocean, but does that mean I should refuse to pay them?

Kermie the frog or perhaps gonzo, much better qualified muppets.

what a dip shot

His pay isn’t extortionate

Exactly

But Jean the problem is that the doctors aren’t getting paid overtime or at least are not accurately paid for their overtime so there is no saving to be made here. if NCHD’s were actually paid for the extra hours they work the health service budget deficit would be even worse than it is.

As an NCHD Eimear I have gotten my overtime. While I realise I was very lucky in the hospitals i worked in to get this it can’t be said that no one is getting overtime as that is not entirely true some are.

NCHD’s have no choice but to work overtime in the current setup, besides there is no cut going to cover the additional 2,500 NCHDs required to bring Ireland in line with the EWTD, and that’s before we presume a few of the positions will be training posts.

The Troika have concerns with Ireland’s competitiveness. For example, they recently expressed concern about the fact a doctor’s visit generally costs more here than many other European countries.

What you’re referring to is GP care which will be free in a few years, these doctors are NCHDs. Different issue (non issue now even).

Our competitiveness issue was previously highlighted by the Troika.

I agree with Dr. Reilly’s proposal.

Maybe he is trying to make up for it here, and hopefully he does.

Doctors here are significantly overpaid compared to the rest of Europe and Consultants obscenely so.

Our competitiveness is an issue?!
Hmm, let me see, work anywhere else, yes may for a little less, but you work a humane roster, you receive training, there’s a remote possibility of getting a consultancy post (which can only be obtained here if you boot out the current batch), people respect you and value you, and your employer pays you for all your hours worked.
Open your eyes, we can’t get Irish NCHD’s to stay here, not alone that, we can’t even get the foreign doctors to come in any more – and the majority of them are coming from developing countries! Says a lot when your NCHDs want to leave for (or stay in) a developing country’s health system!!!!

Because all important posts,ie gov senior cabinet positions are filled by people with no track record, no experience but voted in by who?

I’m sorry Regonald, but is there any chance you could possibly repeat your post over and over again.

Are you a robot in disguise Regonald?

I’m sure there are plenty of non-EU doctors to replace them?

There are not plenty of non-EU doctors to replace them.
NCHD’s from all over the world are now realising that they can pretty much work anywhere they choose and be treated like valued members of the organisation.
Ireland is not a place where an NCHD would like to work in a bazillion years.

Do you mean the hours or the pay?

Hours or pay? Sorry?

James. Stop entertaining Regonald. He is only trying to clock the most number of red thumbs in one post.

To be honest Regonold, you don’t sound qualified to be “sure” of anything on this issue. Reiterating a political soundbyte incessantly is not contributing to the discussion. The fact that you are “sure” there are many non-EU doctors to replace them demonstrates a real poverty of factual data, considering that this country spent hundreds of thousands of euro 18 months ago, trawling India and Pakistan to try to convince doctors to take up posts here-incidentally, many of these posts remained unfilled, those which were, were remunerated at a higher pay scale than the equivalent grade of resident NCHD, and travel and temporary housing arrangements for those who travelled here for assessment (not necessarily to take up the positions), was bank-rolled by the HSE. Add to this the fact that these doctors have English as a second language, are less culturally and socially aware, have never worked within the warren of bureaucracy that is the Irish healthcare system, and you need to ask yourself :are you “sure” that this is an appropriate solution?

So unbelievably well said

Reg as the great Shakespeare himself said “shut your hole” and stop your shit talk….oh maybe that wasn’t Shakespeare.

Clearly trolling. That’s not even how you spell Reginald.

John unfortunately the health services has been starved of resources for decades. Hospitals had to fund fifty percent of essential medical equipment and almost plea with the then Dept of Health to pay for the remainder. Patient support groups had to fund for clinical liaison nurses in life threatening specialities and then again practically beg for these posts be funded by the then Dept of Health.

Don’t talk to me. I have a daughter waiting three years for occupational therapy. The last girl left a year ago and now the HSE won’t fill the vacancy because of the embargo. Fine Gael and Labour promised to change things but it has actually got worse since they came into power. It’s no wonder Gerry Adams went abroad for treatment but we don’t all have that option.

Check out the AOTI website John and they may be able to advise you.

Hi Eoin,
I agree with you but for different reasons. Firstly, jobbridge completely undermines and undervalues these professions. JobBridge is suppoesed to allow the person to gain more experience and improve their skills in their area of work. However, due to staff shortages in the HSE, JobBridge staff are simply put to work with little supervision and training as there are no staff to aid them with this. This is dangerous for patients and also stops the person from gaining adequate experience and skills to aid them in finding future employment in their profession. Finally, and most importantly, the purpose of JobBridge is to potentially allow the person to be offered a permanent job the the end of the 6 months. However, due to the present recruitment strategy within the HSE (physios, OTs, SLTs etc are employed from a central panel only), it will be impossible for the person to get a permanent job at the end of the scheme, completely defeating the supposed purpose of the scheme in the first place. While the scheme may work in some sectors, both public and private, it is nothing more than a quick source of cheap labour for the HSE. To move away from agency staff and give even short term (3-6 month contracts) would save alot of money as they wouldnt have to pay agency fees and would allow the HSE to fill much needed posts,. Furthermore, alot of the recruitment has been centralised to Leitrim and this has created huge inefficiencies and unfairness with recruitment. Department managers (frontline managers to clarify) should have more power of who they can recruit to ensure the right staff get the right jobs and that people arent thrown into jobs they arent adequately skilled for.

Pity the fool who became a doctor for the wrong reasons, like money or their pushy mother had to have a doctor as a son or daughter.

Like being a pilot, many of the top paid jobs of yesteryear are becoming commoditized.
A real vocation is truly necessary as the cash and prestige are fading fast.

Great throwaway line kicker! Burn the bondholders!

Yep you’re wrong. Pay in the NHS is equivalent to here. NHS consultants work less hours for the same their salary and have protected time built into their contracts for research and further education. There are more consultants and NCHDS than here to do the same jobs and a better organised and structured health care system. They get top ups on their salary for all committees they sit on and can do do any private work they want after 2 yrs. The days of the fat cat consultants are long gone here. Most jobs awarded in the last 5-6 years are jobs requiring 80-100% public practice and only private work if there is a co-located private hospital (ie no dashing off to other hospitals). All new consultant contracts are 100% public with no private rights and at 60% of the salary of the previous public contracts.
In other words, the UK is much more attractive to work in than here.

Last year I asked a English doctor working in St. James hospital has he been in Ireland long and how does the pay compare. He said the pay is better in Ireland. I got the impression he moved to Ireland for better pay.

Yes you are wrong and this is an urban myth.

There was an excellent piece in last week’s Sunday Business Post by Ronan O’ Sullivan who has worked in both health systems clarifying this myth.

Jack, either you or the doctor is talking bull. Sheer bull.

The pay appears better in the sense that you work many more hours here, usually in excess of 65hrs per week compared to less than 48 in the UK. The overall pay will therefore appear better. The pay for working 48 hours here will be equivalent or less.

Yes Jack, our entire health system is on its knees because of those feckin greedy English doctors. Grow up bud.

I”ve worked in the UK and in Ireland (at NCHD level not consultant) and my take home pay in the UK was better. And in the UK I was working a 48 hour week!

I had heard it first hand, being acknowledged by consultants coming from the UK, that the Irish system is not primarily about Healthcare from a consultant’s perspective, it is first and foremost a money machine designed to be so by consultants, for consultants. The NHS is about healthcare and not as well paid.

Boildyeggs – relax man. I didn’t say anyone was greedy. It’s a good thing that people are coming to Ireland to work. I wish we had more doctors.

Been in UK myself and many of my colleagues here on the blog, we all know how NHS works. NHS consultants on average work 4 days a week. Their roster is entirely different with better life style. Here if you go to any peripheral hospital like Mullingar, Port Laoise, Tralee etc, consultants are working 10 on calls a month in many specialities!! Which means that you are on call every third day and every third weekend. That equals to around 120 days in a year plus 27 weekends plus not to forget to work on Christmas, stevens day etc. In the same hospital settings in UK , there are usually 7 consultants. Yes their salary will be slightly less but they have better quality of life and any one who lived in both countries know that 1 pound is equal to 1.2 euro but on buying power its like 2 euros.

Now by reducing trainee hours, we are expanding longer training time too. Classical example is US and Canada, where trainees clock above 70 hours a week for first few hours so that they can achieve their tasks in a shorter span of time. They are producing safe efficient specialists in three to four years time on attending level. We should not bog down on the debate of Troika , Non EU doctors etc. At the end, the priority should be.. can we run a safe satisfying service or not with the help of doctors who know the system well. By the way reducing hours means more locum as there are not many junior doctors available. So at the end HSE are paying on the locum rate coz of non availability of doctors. Talk about saving ehhh.

Changing doctors and bringing them from all over the world is not the solution. We need to look at the best models of health care and in those models there is no such thing what many people are talking esp the pro govt ones. Keep the talk evidence based not opinion based esp folks who have no idea what 36 hours on calls are like plus sleeping on a bench in a changing room for half an hour before running to labour ward for another delivery!! Not to forget missing your kids, loved ones birthdays, weddings etc etc as hospitals do not close after 5 pm on Friday. Yes we choose this profession our selves coz we are passionate about it and continue to do that with out a drop of regret but we are humans too.

Yeah, you’re wrong.

Perhaps I’m misunderstanding, red thumb if im wrong:

I don’t think the minister is talking about a cut in hourly rate? The phrase pay rates was used I believe?

NCHDs are now used to getting paid a lot of overtime for the last 10-15 years (they didnt used to get paid for overtime, amazingly! And that trend is creeping in again). NCHDs generally do longer weeks than any other frontline worker, 100 hours plus routinely – no disrespect to Nurses Firemen, gardaí etc

As a result, many NCHDs’ fixed outgoings like mortgages have adjusted to this level of overtime dependant income.

Cutting hours to fit EWTD will cut pay by a lot because of the reduced overtime and proportion of income that is overtime for NCHDs

I think he is saying that the hourly rate won’t go up to compensate for this. Ie that they will get paid the same hourly rate and just have to take another big drop in earnings.

On top of this they would lose out on Sunday double time etc with the proposals.

Paul, of that is the case (which I doubt), then there is no problem, as NCHD’s have been fighting for that exact thing for generations.
I do think though that it is a Paycut. Which is wrong.

You would hope more would join the IMO but its scandalously expensive when compared to other unions (upwards of €500 for interns alone). A gesture would be to drop this to something in line with the UK medical union fees of £120, particularly for new doctors, build support and take the fight to the HSE.

Also, I’d love to know exactly what Reilly means by pay cut? An intern is on €15 per hour but if you’re on a 60 hour week with no overtime you’ll be pulling a mighty tenner per hour. Just what you’d want after 8 years of undergrad training and a €100,000 medial school loan.

IMO needs to disclose its finances. Where is the 20 to 30 million a year it collects going? What are the top brass paying themselves?

Who audits their accounts? Why does Union leadership stay the same for decades?

I understand what you’re saying, but as long as people continue to just bicker about the IMO on message boards this sorr of stuff from the hse is going to keep on happening. Join as I have recently done and try to effect change!!

ANP’s and AMP’s won’t be working for 20% less as they are already in posts it’s only new grads that will be offered the 80% pay.

God I can’t even be bothered to entertain the amount of inaccuracies in that post.
I need a lie down.

Lol. I really don’t know. I’ll shut up now.

James, sometimes there really is no point in trying! (I do love your posts though!)

Jack until recently there was a government cap on the number of Irish medical graduates per year – as in they would only pay the universities to train a certain number under the free fees idea. I *think* around 380 divided among the six medical schools. Of course what the government actually paid the universities in no way covered the cost of a five/six year medical education so the universities attracted foreign students to pay fees and overcome the deficit. These foreign students for years paid for us Irish guys to be trained, and we owe them a lot because I certainly could never have gone to medical school if I’d had to pay the fees. Now the problem was that most of them also went home once they graduated and we were left short of Irish-trained medical graduates willing to work here in Ireland. That was what brought graduate entry medicine and a lifting of the cap into play a few years ago, UL being the first course in existence. But the problem with that is that it still takes four years to complete so it’s not exactly a quick fix solution. That said, we’re a few years down the line now and we have more doctors qualifying. The problem today is that the job, its conditions and its prospects are so poor that most of them are leaving for better education, lifestyle and working conditions abroad. The money we earn is not insubstantial and we’re thankful for that, but it’s not what drives the majority of us. Sorry for the essay, I hope I explained some things for you.

What Catriona said.
Thanks Catriona.

I probably shouldn’t encourage him really…

You tried, more than what I did…! :-P

Well said Catriona