The HSE Tullamore have issued a letter to all suppliers of the HSE, signed by Leo Stronge (head of provurement) and Liam Woods (Nat Dir of Finance) advising them that they expect an 8% reduction in prices for 2010. This is because the National Public Procurement Operating Unit, (yet another layer of senior civil servants) acting on behalf of the Government have advised all Gov’t Dept’s. Local Authorities, Agencies and Public Bodies to achieve a minimum 8% reduction on spending on products and services. Clearly the Government have to employ a unit to pass on their message for them and can’t do it themselves. Is it me or is this not yet another example of public money being wasted on over-paid civil servants?

This price reduction is in addition to price reductions and price freezes demanded by the HSE for the current year (2009).

The reasoning is that this is to achieve savings for the tax-payers purse. Public information shows that the HSE spend @ €4,500,000,000 (4.5 billion) on ‘bought in’ products and services. An 8% reduction would therefore equate to €360,000,000 (360 million). This of course shows that the HSE are taking action to reduce their costs, which on the surface is very commendable.

However, what it means is that more cutbacks will be needed in the private sector, undoubtedly putting more jobs on the line or at the very least / best, more pay decreases for staff. A review of CRO filed accounts of suppliers will clearly show that many suppliers make less than 8%. A reduction of 8% in prices will cost jobs, will result in many supply lines being commercially unviable and will close businesses.

This of course is the Government’s way of ’sharing and spreading the pain’. This is of course is in addition to any forthcomming budgetary measures where the government will undoubtedly decide to tax the majority of the people even further.

In the meantime, figures show that despite the promisses, more civil servants are being employed this year (including midle and higher management - to do what exactly?), that cuts to the pensions and benefits of TD’s promissed in the emergency budget failed to be implemented and were nothing more than cheap talk. And of course, absolutely no cuts are being implemented in the number of civil servants in this country who are still receiving pay increases, thus widening even further, the already ludicrously high differences between public and privtae sector earnings.

If this were not bad enough, Ireland has more quango’s and government agencies / departments than all other countries in Europe. But of course, we don’t see any cuts in the number of these happening either.

When Oh when are the Government going to order the necessary cuts in public employment at senior and middle level civil service staffing? Why does Ireland need more public employees paid six figure salaries than countries such as the UK who have a population of 15 times the size? Does anyone really believe that the likes of Leo Stronge and Liam Woods have to be paid the level of salary they are, otherwise they’d leave and go to work in the private sector? I doubt for one minute that they’d get a job, let alone anything that paid the kind of salary that we the tax-payer are funding. (unless of course they became consultants or is that friends of certain people, that the HSE could employ) When are we going to see duplicated and ineffective government agencies gotten rid of? When are serving TD’s going to endure cuts themselves?

The answer of course, is not until the Government has completely destroyed the private business sector in this country and screwed tha average, law-abiding tax-payer for every last cent that he/she might have. Not until the public finances are so bad that the IMF has to step in and provide funding, which of course will be on the condition that the Government make such above mentioned cuts. Of course, they can then say they have no choice then. In the meantime, they will continue to line their pockets, avoid dealing with the hard decisions, avoid taking on the unions, make future generations pay for their incompetence and target the soft options such as suppliers to the HSE who really cannot afford to drop prices by 8% and stay in business.

Zebedee

An interesting article has appeared which is of good quality and worth reading. It refers to devloping tailored regional health systems to suit the needs of the area:-

http://www.mckinseyquarterly.com/Health_Care/Strategy_Analysis/Developing_a_regional_health_system_strategy_2398

Zebedee

Around the country, it is estimated that the HSE employs @ 900-950 occupational therapists.

A high percentage of these work in the community. Eg they visit patients in their homes and carry out assessments of their needs to assist in their daily living and to improve their quality of life. This of course is very commendable.

Alas, and yes isn’t there always an alas…. currently many of these community occupational therapists are heavily restrcited in therir work by factors such as:-

Mileage Restrictions (severe). They can only cover a very limited number of miles (they’re paid mileage expenses obviously) and once the limit is reached they cannot claim any further mileage for the month. This results in many patients simply not being seen and of course means that many therapists are sitting in the office doing erm, well erm, hmmn, doing what exactly and being paid to do it for up to 3 out of every 4 weeks.

Equipment Budget (lack of). When patients have been assessed by these Occupational Therapists, many of them require aids for daily living or mobility aids and equipment. However, despite the government announcements of commitment to expenditure and not afecting the most vulnerable in society. Let us remember that we’re talking about predominantly elderly and/or disabled people here. The reality is that budgets for equipment have been absolutely slashed and cut to the bone. Not even all of the patients rated as a ‘Priority Emergency’ are getting what they need because there is insufficient funding.

So what’s the wasted resource? Well, if people are being employed and paid to do a job (occupational therapy salaries being quite substantial), plus support / admin staff and they can’t actual perform their duties and even when they do, there is insufficient funding to implement their recommendations; what is the point in employing them all in the first place.

It’s not their fault but here’s a scenario to cut waste and make better use of resource that is available: - lose a percentage of them and re-allocate the salary savings to provide equipment and resources so as those that are left can at least do their job. Yes it means less therapists but overall more patients will get what they need.

Is it me or is there some merit in what I’m saying. Anyone care to comment?

Zebedee

The HSE released the news about about the €80m new renal unit at CUH which is planned to open in 2010.

However, progress on the building project seems to have come to a standstill and many are asking if the main contractor is still viable, having difficulties or quite simply under! The new unit is a major contribution towards improved healthcare for the region.

At the moment the HSE seem very quiet about it and there’s not much appearing in the media.

Perhaps someone can comment on what’s happening or rather what is not happening, why and more importantly, what’s going to be done about it?

Answers anyone?

Zebedee

The HSE (and indeed many other government departments) implement various policies which are intended to gain best value for money and /or save money.

Of course, this is tax-payers money and that is exactly what they should be doing.

A favoured course of action for this is a ‘tendering process’ (see eTenders website for examples) and further down the line within procurement departments, another favoured method is a ‘three quote rule’, whereby if a clinician wishes to order a piece of equipment, he/she must gain three quotes in order that it can be purchased from the most economically advantageous supplier.

So far so good! However…..

Tenders for the HSE can as you may expect be rather lengthy to complete and involve companies providing quite extensive information about not just the equipment / service being tendered for, but also about the company itself.

This sounds sensible if the HSE dept involved is to evaluate each tender entry fairly and effectively. But….

Each time the same company enter another tender, they have to spend time, resources and money providing the same company information over and over again (and it is lengthy and often requires original documentation from accountants, banks, revenue, insurance etc etc).

So can anyone tell me why the HSE and other Govt’d departments can’t operate a system where such ‘company information’ is entered once and updated annually or if significant changes occur? This would save those entering tenders, time, money and effort. It would also allow Dept’s evaluating tenders to have access to information which could simply be evaluated once (and reviewed when changed) confirming standing and suitability of said company as a supplier, thus saving time, money and effort on their part too.

Next, The Cranfield Institute in UK were employed by the UK Gov’t to review ‘Tendering’ as a form of evaluation for procurement. Guess what? Unsurprisingly for anyone ever involved in complex tenders, it’s full of flaws and usually results in complex tenders being awarded for an agreed amount which then escalates and thus actually calls into question whether the ‘most economically advantageous’ award was actually made in the first place. Other methods (and not brown envelopes) are recommended.

Generally, if what’s being purchased is a ‘commodity’ type product, then tendering for the lowest cost supplier can make perfect sense. However, the more complex it is, the less likely the effectiveness of the tender will be in securing the best deal overall. Especially as most tenders are written by people who are in procurement and no disrespect to them, will not know all that there is to know relevant to the subject that they are compiling a tender document for. So the tender document can inherently contain flaws in important areas which means it will lead to problems in service / product delivery. Ultimately, history shows this then leads to increased costs.

Now let’s look at an example of the ‘three quote rule’…

A clinician decides that a patient needs a piece of equipment to help them live their daily lives. Let’s say it’s a wheelchair. The clinician has never been trained in wheelchair assessment and has very little product knowledge (yes really - because they’re trained in identifying clinical needs and nothing further) so they get a specialist supplier to come along to help assess the patient. The supplier sends along a highly trained product specialist with samples of what is likely to be the most relevant type of wheelchair. By advising the clinician, a wheelchair specification and requirement is agreed upon.

So far, so good….

The same supplier sends in a quote. The clinician gets two more quotes from alternative suppliers including one from outside of Rep of Ireland. (yes really, the same gov’t who urge you to only spend in Ireland don’t apply the same rules to the HSE). Of the three quotes, the original company are not the cheapest and the wheelchair is ordered from one of the alternative suppliers.

So let’s summarise then…..The HSE want suppliers to simply be the cheapest. So the original supplier, lays off all the specialist advisers it employed, gets rid of all the stock used for patient assessments and cuts its costs dramatically so it can offer the lowest quotes. Great news as this results in a truly competitive market for the HSE business. But there’s a catch…..

The clinician isn’t trained in the products that their patients will need. The patient can’t be assessed by actually trying out a piece of equipment. How likely is it that the patient will get the most suitable piece of equipment? How likely is it that any equipment purchased does not meet the full and complete specification that the patient needs and will have to be altered / amended at additional expense?

How is this best practice for the patient and best value for the HSE and the tax-payer?

When will the HSE learn that some things such as bespoke and complex equipment / services are not always purchased in the best way by applying ‘one size fits all’ procurement policies such as tenders or three quote rules?

If many of us can see the blatant flaws of many HSE policies, what on earth are we paying six-figure salaries to HSE management and Mary Harney (the highest paid health minister in Europe) for?

Surely, they are supposed to experienced, professional decision makers able to amke the best decisions possible. The reality appears to be very different.

Zebedee

If the HSE is serious about reform, it could do well to start by listening to people from the ground up. Those at the frontline of healthcare are highly likely to know far more about what will work or not than those sitting in offices, reviewing statistics and analysing costs, while wondering how it would be perceived by the public and what’s the best way to dress things up.

An interesting article covers this very well:-

http://www.mckinseyquarterly.com/Health_Care/Hospitals/When_clinicians_lead_2293

Zebedee

Hospital Acquired Infections

Articles frequently appear in the media about hospital and healthcare acquired infections and hygeine standards. In the last few days, two more have been published in medical media as per links below

http://www.irishhealth.com/article.html?src=ez&link=MTI2MzI0%0A&id=15046

http://www.health-enews.ie/e_article001343560.cfm?x=bf7vGmc,bbbw9k7t

At the 2008 Infection Prevention Society Conference, one speaker commented that if she were going into hospital and had to choose between contracting MRSA and C.Diff, she’d opt for MRSA. Given that a prominent speaker at such an event would say such a thing clearly re-iterates the seriousness and threat posed by C.Diff.

Yet to my knowledge and please anyone out there feel free to correct me on this, there is currently no HSE specific policy in place to deal with reporting on and gathering information on C.Diff in the same manner as cases of MRSA. Hence, no HSE policy to deal with the issue and measure progress through-out the health service. Peoples lives are being put at risk by this blatant inaction by the people who run the HSE.

Frighteningly, there is independent evidence to suggest that some of the cleaning protocol in hospitals includes use of detergents and disinfectant which increase C.Diff spores. Of course, there are products on the market that are very effective cleaning agents. Except and again, someone please feel free to come forward with details to show otherwise; the HSE aren’t looking at or trialling any new cleaning agents that are now available on the market.

The  Dept of Microbiology in Leeds University, England and also Chicago University, USA both conducted, independently of each other, research showing that some commonly used hospital cleaning products don’t kill C.Diff spores and actually increase the rate of sporulation.

Links:

http://www.journals.uchicago.edu/doi/pdf/10.1086/519201

http://news.bbc.co.uk/2/hi/health/4871840.stm

Given that such findings were published in the general media and I am aware of, I find it hard to accept that management within the HSE are not aware of this as well. Some would argue that inaction on there part is negligence.

Perhaps someone from HSE management can step forward and advise why the issues raised herein have not been addressed and more importantly, will they be addressed? If so when and by whom?

However, I suspect that heads will find the sand as usual!!!!

Zebedee