Tag Archives: health

Ireland : A picture of health

Health appeared as a big issue in the election. A common tendency is to say “sure we cant keep throwing money at it!”

This presumes, of course, that we have been. And we are “we”. Some we’s are spending more. Theres a creeping privatisation at work from the OECD data.


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Irish Health Expenditure vs the OECD 2013 -We’re in Red

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Even the HSE CIO says PPSN would work as a health ID so why a separate number?

So yesterday, and this was news to me, we got another unique one per person number. Apart form the PPSN, used for pretty much every state and many non state ID purposes, and the new pupil number for the POD database, we are now to have a unique IHI health ID number. This project is uncosted, and hasnt really been told not to mind sold to people.

I asked the Chief Information Officer of the HSE if the PPSN would work. Yes. Ok, there are a host of data protection issues, but the reality is what the new IHI will be is a key to identify patient details on a database. That database, and the access to same, and the security of the key etc, they will all have to be dealt with. So, when the CIO says the existing state system would work, why on earth are we putting in a new one?

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(no doubt this will be classified as an unfair) question to the cabinet about cystic fibrosis

So once again we see the provision of isolated (read, appropriate) beds for Cystic Fybrosis patients coming to the fore. The indefatiguable Orla Tinsley, CF patient, writer and social media exponent, has been hospitalised, and is telling her story.

In  nutshell, Ireland has the highest incidence of CF in the world. I have had family members (and friends) die from this so I dont pretend to be neutral on this one. Anyone who wants to know the appaling mess that is CF inpatient care in Ireland should follow her on twitter @orlatinsley The crux of the problem is that despite this highest incidence there are not enough, not nearly enough, appropriate inpatient beds for these patients. And now it seems that some of the isolation beds for CF are being appropriated for other, no doubt equally ill, patients, with CF patients being placed in mixed wards or sharing facilities. A feature of CF is appalling vulnerability to infection during an acute phase so shared facilities are not a good idea. Patients, desperately ill, are actually better off at home they feel, where at least they have built some immunity to the local environment.  

here are some of Orlas tweets 

  • The shared toilet with no disinfectant or wipes : https://twitter.com/orlatinsley/status/273684606996340736
  • bleeding lungs but no beds available https://twitter.com/orlatinsley/status/273435889865211904
  • a quadruple room (for a patient with compromised immune responses and infection vulnerability) https://twitter.com/orlatinsley/status/273473607257174018
  • CF patients in A&E (emergency room) as no beds available https://twitter.com/orlatinsley/status/273499709862195200

and so on. And this in a country which has a medical doctor as its minister for health

So, here is my question. Jim Reilly (health) and Leo Varadkar (minister for transport) are medical doctors and cabinet ministers. Medically, do they think this is acceptable? Would they be happy with their patients being so treated? Would they think it appropriate?

  If as one hopes the answer is no then we should never have to see this happening again and the full complement of CF beds will be opened and made available. Conversely, if we do so see it happening, then we need to think hard about the quality of our cabinet, medically, morally and politically. No doubt thats going to be cast as unfair. I’ll live with it. 


Its not the points, its the system, thats a problem in the points system

Irish second level school students are now in the early stages of their school-leaving examinations, with oral language  and applied science examinations ongoing and the main written exams starting Wednesday 6th with English Paper 1.They take their examination in a relatively good spot , with a dip in the numbers leaving school likely to result in less onerous requirements for university entry.

In Ireland there is a simple system for the allocation of (the vast majority) of university and related places. Students are allocated points (out of 100 in effect) on up to 6 examinations. Having submitted to the CAO their order of preference for courses the system then matches. Take a course in say Science. Lets say there are 1000 applications who have stated that this is their first choice. The system takes all their grades, and ranks the students in order of points. Lets say that the university can take 200 students on this course. Then te first two hundred students in decreasing rank order of their grades will be offered places. The 201st will not. The publication of the points by the CAO is a day of joy and sorry for tens of thousands of students.  The situation is in essence an auction mechanism : students submit “bids” and the system allocates a price that clears. It is simple, foolproof, not susceptible to being gamed (once the grades are in they are in) and subject to vast criticism. The Hyland Report was quite scathing in its analysis.

Leaving aside the issue of stress, and it is real if not as bad as the situation in china where students are hooked up to vitamin and amino acid drips, there are other issues. The main criticisms are twofold. At the very top there is concern that students are taking and retaking courses to ensure “perfect” scores, which are in effect needed for entry into the leading law, veterinary and medical schools (in Ireland these are mainly entered into at undergraduate level not graduate).  Universities formally do not boast of the number of high points courses or the high points needed for courses but the reality is that students and parents associate high points with academic quality. In reality, as a price, the points for courses reflect the intersection of supply and demand. Courses with low numbers of places available (for example, courses that combine a language with a law/business area) will, ceteris paribus, typically clear at a higher point (have  a higher price) than those with greater places. There is a suspicion in my mind at least that over the years there has been a proliferation of such courses not only in response to consumer/social demand but also to allow universities and institutes of technology to show high point courses.

A study of highpoint achieving students was undertaken by the HEA in 2007. At the bottom there are concerns that the points system can result in students gaining entry (having enough points) to third level courses where they find themselves simply unable to undertake the rigours of third level study. This is most often focused on technology courses and results in dropout levels that are worrisome The HEA publishedin 2010 a study on retention and progression and noted that the 2007 entry cohort showed a) that overall in third level there was a dropoff of 15% from entry to the subsequent year , b) that this was significantly higher in Institutes of Technology and in lower points courses generally and c) that this was highly correlated with prior educational achievement.

More generally there is a significant concern that students have crammed and relied on rote learning for the leaving certificate and cannot then easily undertake independent critical thinking at third level.  While this is not unique to Ireland it is an issue that is increasingly noted by academics (Tom Begley, Brian McCraith ) , Industry representatives (US Chamber of Commerce) even students themselves (Gary Redmond ) and of course my boss (Paddy Prendergast)

These are reasonable criticisms in so far as they go but they to my mind miss the point. The issue is not the points system per se but the way we allocate points. At present we allocate almost all university places on the basis of the points system.  True, there has been a change in how students are allocated to medical schools, with students now not only assessed on their leaving cert points but also having to undertake the HPAT test which tests verbal and other reasoning skills. the HPAT is not without criticism (see the criticism by Dr James Reilly, the Minister for Health and himself a medical doctor) in particular the realisation that as students gain more experience of the test they undertake cramming for and take multiple attempts at the examination. The historic situation of free fees for irish university students has resulted in the monies that would otherwise be spent by families on that being in part diverted to feepaying and cramming schools. Free fees manifestly did not result in a significant number of students from lower socioeconomic cohorts attaining university.

What then is to be done? This blogpost was in some degree prompted by criticism of the transition year. In Ireland students typically spend 6 years in second level ; the first three years, the junior cycle, culminate in a state administered examination, and the last two years , the senior cycle, in the leaving certificate. In between schools have the option of what is called a transition year, aimed at allowing schoolkids the opportunity to undertake a variety of structured tasks with the aim of maturing themselves without examination pressure. Personally, I think its a great idea but Friends of the Elderly think otherwise suggesting that we cant afford it and that we should get students to engage in community service (which I thought was a judicial non custodial sanction for lawbreaking). Community service sounds awfully like national service…

Too often we confuse learning with hard skills, the ability to do things, when in fact what many employers need are some of these and some soft skills. Soft skills are behavioural, interpersonal, skills that are recognized as being perhaps more essential and more conducive to employment. Someone with high degrees of soft skills can learn hard skills. And soft skills matter: see here the work by James Heckman , Nobel Laureate in Economics, on this issue. Maligned though it may be Fas did undertake in 2003 a study on soft skills which  is instructive. Noteworthy is the response from some industry representatives that soft skills would become more important. Soft skills include those that underly creativity and flexibility and as such are key to hightech and knowledge industries. See the comments here from the Digital Hub, here from USI, here for a more general survey and here for a study of the views of employers on soft skills.  Increasingly, universities are aware of and incorporating soft skills into courses, but these are expensive and complex to instill and thus we run the risk that as budgets shrink so too will this provision.

So, back to the leaving cert and points. If we want to include more soft skills in irish graduands and the workplace in general, should we not reward that? We have seen that when we give bonus or additional points for mathematics the number of students taking higher level mathematics rises. People are instinctive economists : as excelling in leaving certificate higher mathematics costs (in terms of time and knock on effect on other courses) more than other courses students will allocate their time wisely and not take it. The reintroduction of bonus points has resulted in a rebalancing with the benefits of taking the higher mathematics course now more closely aligned with the costs thereof. Why not use the market mechanism we have in the points system and introduce points for a variety of  evidenced soft skills? Already there are moves to adapt the examination format to give greater emphasis on continual assessment although this is not without controversy.  But why do we not consider giving points for students that show skills in art through entry to art competitions, in music through bein part of a band, in interpersonal skills through being on a sports or debating team, in creativity through writing or developing apps, etc. Why should students not gain points for being in the scouts, or a political party, or organizing a festival, for being part of a community cleanup day and so on. If we reward people for being rounded, creative, articulate members of society they will adapt to being so. So, my call is for two new leaving cert “subjects” to be introduced in terms of points, one on “community involvement” and one on “personal skill development”.  Let students show evidenced achievement in these, lets crowd source the components and weights and elements, lets use the points system to generate the kind of school graduates we as a society want and need.