government Health

Health Service Executive has disrespect and sloppiness at its heart

Today I finally understood the reason why our Health Service Executive is unable to deliver a modern health service.

Today I accompanied an elderly relative to hospital for a simple outpatient procedure, and I saw a highly-trained specialist nurse wasting a full half hour transcribing information from one file to another by long-hand. I saw a highly-trained professional struggling to read notes written by a doctor who, in his infinite arrogance, couldn’t be bothered to write clearly and who therefore endangered a patient.

This is the country Enda Kenny claims is at the leading edge of information technology, and yet our health service doesn’t know what its patients are doing unless a vital highly-paid professional laboriously writes it out time and time again.

Database systems have been in existence for many decades. Most developed societies have properly-designed computerised records of patients available to all health professionals at the touch of a button. This is not some sort of groundbreaking new technology, except in Ireland, so why was I surprised at the 1950s technology still pervading our public health system?

I shouldn’t have been surprised, since the reality is that the 1950s technology is also the 1950s mindset.

The people who run the Health Service Executive are trapped in the past and until the government understands this, nothing will change.

I’ve been talking about the malaise at the heart of the system for many years but at the same time it’s easy to blame systems when in reality it isn’t a system that humiliates or disrespects a patient.

The system doesn’t disrespect patients. People disrespect patients. Bad nurses disrespect patients. Arrogant doctors disrespect patients. Slovenly domestic staff disrespect patients. Sniffy administrative staff disrespect patients. And all of those people should know better but many can’t be bothered.

Ultimately, though it isn’t their responsibility, since a properly-functioning system should do three things:

A working system should educate them to understand that respect is vitally important.

It should warn all health employees that they are the employees, not the masters.

A functioning system should impress on medical consultants that they are simply employees paid by the public and that they are obliged to show respect to their customers.

If none of that works, a properly-functioning system should remove people  from their jobs when they fail to meet the appropriate standard, but ultimately, none of this works if disrespect and sloppiness are at the heart of our society.

Is it as simple as that?

Do we tolerate doctors with a god complex (people whose education we paid for) and administrators who treat us like dirt because that sort of thing is embedded in the nature of who we are?

Do we tolerate condescending receptionists and gruff nurses because that’s how it has always been?

Are we simply a disrespectful society? Are we a bunch of ill-mannered boors and is that why we have a boorish, ill-mannered, incompetent arrogant health service?

Sadly, I suspect we are.

I  suspect that the Health Service Executive is no more than a reflection of the sloppy, arrogant, class-ridden, incompetent, slovenly society we have created for ourselves.

Isn’t it time we changed not only the Health Service Executive but the way we behave?

Health Scandal

Reports On Irish Health Scandals Published

Not one, but two reports were published on the disgraceful state of our cancer care, and guess what? Neither report blamed a single individual for the disastrous mistakes that caused the Portlaoise breast-cancer debacle.

Not one!


It’s all systemic this and organisational that and communication the other fucking thing.

Well, would you like to know something? It isn’t.

It’s all about the hundreds upon hundreds of unqualified fools who’ve slithered their way up the Health Service Executive promotional ladder and now call themselves managers despite knowing nothing whatever about health or medicine, but who nevertheless make all the important decisions — or should I say, prevent all the important decisions.

I already said this in November and, having changed none of my opinions I see no reason to rewrite it.

Here’s what I said back then and it’s still true.

Our health service is not run by health professionals.

The Health Service Executive is run by inflated office-boys who have one skill and one skill only: crawling their way upwards through a bureaucracy, grade upon grade, until they arrive at a point where some other office-boy names them Manager. These are the people who, in their unbelievable, ignorant, uneducated hubris have been known to refer to the nurses, physicians and surgeons as the technical staff.

They are not managers. They are only administrators, and bad ones at that.

These people are from the vast ranks of mediocre know-nothings who arrived into the old Health Boards as junior clerks at the age of seventeen with a fair-to-bad school Leaving Certificate. If not for this stroke of luck, they might have struggled to find a job selling shoes.

These “managers” spent their formative years stamping pieces of paper and looking down their noses at poor people huddled outside a wooden hatch in some freezing Victorian health centre.

These are the geniuses who stuff our public service, and strangle the initiative of people with real talent and real vision. These are the dead weight that guarantee our health service is, and will remain, a complete disaster.

Our health service is not run by health professionals. Never forget this. It is run by arrogant office-boys without vision, talent, understanding, skill or sympathy. They have nothing. They are puffed-up windbags without training, without qualifications, without experience, without knowledge. These are the small, empty, self-important, grey, clueless, frightened, boring, semi-literate, arrogant men and women we call “managers” within the health service. The kind of people who have never done a single practical thing in their entire useless lives.

That, my friends, is why you will wait for days on a trolley. That is why ninety-seven terrified women can be herded together for administrative convenience.

The people who make the important decisions about your life know nothing of medicine, or health, or patient welfare or compassion.

They know only two things: statistics and promotion.

This is how small the people are whom we call managers in our health service. Be very fucking angry.



Favourites Politics

Irish Medical Consultants

There’s an almighty row going on at the moment about the contracts being offered to new hospital consultants.

An incredible uproar.

And the reason? Well, the government is going to hire more consultants, but they’ll have to work exclusively in the public health service. They won’t be able to have private patients under the new contract but instead will have to devote their full attention to public work.

This won’t affect the conditions of employment enjoyed by the present consultants, nor will it reduce their income in any way, but they’re not a bit happy. They don’t want their money-making system changed, and they’re not used to being questioned.   You see, Irish consultants have a great set-up, whereby they get a salary from the government and can also treat private patients in public hospitals, using theatre facilities, laboratories and hospital beds provided by the taxpayer. Not to mention all the nurses and junior doctors, also paid for by the taxpayer. On top of all that, many of them behave like arrogant strutting demi-gods, as we saw for instance in the Neary scandal.

They like it that way, and who could blame them?

I had a look around and, as far as I can establish, these are the only group of public-service workers entitled to this kind of working arrangement. As far as I’ve been able to find out, all other professional groups within the civil service and in local councils are barred from doing private work. Lawyers, engineers, veterinarians, architects and a host of others are all explicitly barred from working privately in their own profession.

When you walk into an Irish hospital, you can choose to be a private patient or a public one, and it is a festering scandal in this country that, if you walk into a publicly-funded hospital and choose to go private, you will get faster treatment in the hospital and better attention from the consultant, because you can pay. This is true and it’s a disgrace.

Did you know that in Ireland, by law, there’s a universal entitlement to free healthcare, regardless of whether you have private health insurance or not? And yet, everybody entering an Irish hospital is asked if they have insurance, and if the answer is yes, they’re automatically routed into the private channel.

The Comptroller and Auditor General recently published a report into all of this. He concluded that, even though hospital consultants have, by agreement with the government, a right to use up to 20% of hospital beds for their private patients, they routinely take more. Likewise, they refuse to account for their hours of work though – depending on their category – they receive between €140,000 and €180,000 a year to attend work.   In addition, for their private work, they get all the back-up services available at the hospital, paid for by you and me, including staff to work for them.

Now, I know I made this comparison before, but just let me say it again. It’s the very same as if you walked into your local Council, and you said to the planner: I want to build a house.

The planner looks back at you and says, OK, but you’ll have to wait two years. I’m busy.

So you say, But I can pay!

And the planner takes a step backwards. Why didn’t you say so? Come into my Council office here and I’ll get a Council technician to draw up the plans for you. We’ll print them out on the Council’s printer and you’ll have permission tomorrow morning.

Seriously. Isn’t it exactly the same? And yet, any planner attempting such behaviour would be arrested.

There was an article in the Irish Times last Friday that I thought was very revealing of the sort of elitist condescending mindset at work among some of the medical profession in this country. An outraged sense of entitlement not unlike that of your average welfare scammer.

It was written by a guy called Ronan Cahill, described as a senior specialist registrar at Cork University Hospital.  He’s close to becoming a consultant himself, and no doubt he received all this training from my taxes and yours, but he’s not the slightest bit happy that the gravy train is about to come off the tracks. He thinks that the level of pay on offer won’t attract people to take up consultant posts in this country. Incidentally, the salary is in the order of €200,000 a year, and I heard one English-based consultant on the radio during the week saying it was better than the British rates, and better than many self-employed consultants in the USA could make.

But the real giveaway, I thought, was a nasty little comment embedded in the article where he remarked that the new contracts would prove attractive to clock-punching, detached, disengaged automatons whose ambition is levelled at achieving a reasonable monthly salary.

I had to read it twice to be sure I was right.

clock-punching, detached, disengaged automatons

Hold on. That’s me he’s talking about, isn’t it? And you. And nurses. And junior doctors. And technicians. And radiographers. And physiotherapists. And everyone else inside or outside the health service who holds down a paying job. The very people, in other words, whose taxes paid for Ronan’s training. This is a guy who regards just about the entire world with contempt and I have no doubt he’s a good example of his breed. No wonder he’s peeved: this man is clearly consultant material, in his condescending attitude if nothing else.

Ronan makes the point that exceptionally innovative, educated people – such as himself – won’t train to be consultants any more because the money won’t be good enough. All along, throughout his training, he expected to get the State salary and also have his own private income, and to be fair to him, you can see his point. There is a lot more money in the private work. He’s right.

Aha! I have it!!

Why doesn’t Ronan forget about the public work? Why doesn’t he just go off and work in a private clinic where the rewards are so much greater? That will solve his problem.

Oh! No, sorry, I was wrong. It won’t.

You see, then there would be no €200k from the State. No free beds. No free nurses. No free theatres. No free technicians. No free pathology. But worst of all, there would be nobody at the front desk to tell 20% of publicly-entitled patients that they have to go privately and pay Ronan a big pile of money. That’s what’s pissing him off, the miserable, grasping little prick.
And they accused the nurses of greed?


related article from The Bitter Pill

Health Politics

Nurses’ Pay Claim

I decided to see what all this was about so I went to the Government web site and downloaded an impenetrable document which I spent a couple of hours going through.

I made a list of typical Health Service jobs and laid them out according to their maximum salary. It makes for an interesting comparison. By the way, the nurses work 39 hours a week for their salary. The rest have a 35-hour week.

Here we go. Jesus, the things I do for you, and does anyone give a toss?

Student nurse €23,588

Post registered student nurse €27,035 BSc Degree

Student midwife – diploma €29,745 BSc Degree ; RGN

General labourer €30,037 No qualifications

Beautician €30,037 ?

Nurse attendant €31,495 No qualifications

Health care assistant €31,495 No qualifications. 2 weeks induction

Clerical officer €36,913 Leaving Cert

Clerical grade 4 €42,512 Leaving Cert

Staff nurse €43,430 BSc Degree

Senior staff nurse €45,603 BSc Degree

Clerical grade 5 €48,167 Leaving Cert

Social worker – unqualified €51,379 Leaving Cert

Clerical grade 6 €54,760

Clinical nurse manager ii €55,588 BSc Degree
+ 10 yrs experience
+management course

Clinical nurse specialist €55,588 BSc + Higher diploma + clinical experience

Social worker – qualified €56,634 BSc

Clerical grade 7 €59,089 Leaving Cert

Nurse tutor €62,308 MSc + Higher diploma + clinical experience

Social worker, team leader €65,326 BSc + 5 yrs experience

Principal nurse tutor €68,793 PhD + Higher diploma + clinical experience

Director of Human Resources €152,151 Leaving Cert

kick it on


New Cork maternity hospital

Irish readers will know about the dispute in Cork about opening the new maternity hospital. The nurses’ organisation says the proposed staff levels are too low for safety and they won’t operate the hospital unless numbers are increased. Well and good. I don’t know. (Not being a nurse, or a doctor – or even a hospital manager, which in this country means a pen-pusher with a middling Leaving Cert and a fancy new job description, who knows fuck-all about patient care.)

Professor Brendan Drumm, on the other hand, knows quite a lot about medicine. He’s a professor which means he’s really incredibly smart and probably knows five languages as well as being a doctor, and he can also probably play the saxophone and ride a unicycle.

Brendan made a statement today about the Cork thing. He said this whole action by the nurses isn’t about patient care at all. According to Brendan, it’s all about money.

Now. Wasn’t this the same Professor Brendan Drumm who rejected the government’s job offer because they wouldn’t give him enough money?

Hmm. Not that it has anything to do with it. I was just wondering, y’know?

Irish medical consultants

Nurses’ Pay Claim