Monday 21st April 2014
Irish Hospitals given an HSE warning in €530m over spends
Cash strapped hospitals have been told by the HSE that they won’t be getting any budget bailout this year.
A confidential government report shows that the health service is heading for a €530m over-run this year, with many hospitals running over budget already.
The HSE document suggests overspends this year at all the major hospitals in Dublin, with St James’ the highest at €24.3m.
The other overspends outlined in Dublin are:
* Mater Hospital, €7m.
* Crumlin Children’s Hospital, €6.8m.
* Beaumont Hospital, €4.3m.
* Tallaght Hospital, €3.2m.
The positions in the hospitals around the rest of the country are not specified, but over-runs are predicted in every region including €22.3m in the Northern Health Area, the Midland Health Area (€22m) and Western Health Area (€20.3m).
The over-spend is being caused by a spill-over of payments from last year, hospital admissions being up and demographic pressures.
But the health budget is also bloated due to the well-publicised problems with savings from medical card probity, and implementing the Haddington Road agreement.
The HSE report predicts “a full-year 2014 potential cash shortfall of €532m”.
Department of Health and HSE sources say the startling projection is on the basis of nothing happening to address the over-run and there is action being taken to fix the budget.
The figures are based on spending in the first few months of the year, which is always higher due to bills hanging over.
These sources say the shortfall will ultimately be in the region of €150m to €200m.
But the HSE has written to hospital managements informing them they must manage spending within their budget allocation and there will be no bailout.
The letter, from HSE chief financial officer Tom Byrne to hospital bosses, was sent in the past week.
THREATENING THE COALITION
The latest black hole in health is now threatening the Coalition’s ability to deliver tax cuts in next year’s Budget.
Tensions are mounting within the Government over Health Minister James Reilly’s failure once again to get spending under control and achieve savings under the Haddington Road agreement.
Mr Byrne said the €530m figure was simply based on the level of cash spent in the first two months, known as the “burn rate”, which would not reflect the year as a whole.
Mr Byrne also said there would be measures taken to contain spending throughout the rest of the year.
Irish teachers focus on pay and pensions at INTO congress
The number one item on the agenda at the INTO conference is the take home pay of teachers.
Union leaders meeting in Killarney from today say they want a commitment in the Haddington Rd agreement for the restoration of pay cuts to be respected, if the economy continues to recover.
They are also calling for the phasing out of the pension levy.
Primary teachers are also concerned about resources for small schools – especially the number of teachers.
Eight Irish schools have only one teacher, and the INTO is warning more schools are likely to follow.
“We want to have a conversation with the minister about proper planning of sustainable school in rural areas,” said Sheila Nunan, INTO General Secretary.
There’s huge uncertainty and a lot of distress in the communities about the future of their schools.”
Psychiatric nurses call for better recording of suicide in cases where help is sought
Psychiatric nurses have called for a more comprehensive recording system to identify patients who died by suicide because they did not get the treatment they needed.
The Psychiatric Nurses Association (PNA) is extremely concerned that the premature discharge of patients, or delays in being admitted to psychiatric facilities had led to people taking their own lives.
PNA general secretary, Des Kavanagh, said a comprehensive reporting system would provide clarity on the statistics in relation to their concerns.
At its annual conference, Mr Kavanagh said many nurses in several parts of the country had told him that the number of suicides occurring in or related to their services far exceeded what it would have been in the past.
In one area spanning Carlow, Kilkenny and South Tipperary, the nurses had identified 14 cases in less than 18 months.
However, last week on RTÉ radio, Minister for State with responsibility for mental health, Kathleen Lynch, said the standard in that area was particularly good.
“I don’t accept that people are prematurely discharged. That is a clinical decision and not one that I have any expertise in, nor, indeed, does Des.”
Ms Lynch said “hard and firm” evidence that such suicides occurred would be investigated “We can’t investigate every public utterance,” she added.
Mr Kavanagh, speaking on RTÉ radio yesterday, said he had hard and firm evidence, as did the minister.
He said consultant psychiatrists in north Dublin wrote to the minister last May and a number of times since then to the HSE about having to discharge patients “precipitously” because of a lack of acute beds.
Senior nurses had also claimed that the discharges were only occurring when there was a shortage of beds.
Chair of the Mental Health Commission, John Saunders, said it could not be assumed there was a relationship between early discharge or late admittance and how people had died.
“Suicide, whenever and wherever it happens, is a very complex process.
Mr Saunders said suicides notified to the commission did not indicate there was a trend suggesting that early discharge or delayed admission was a critical factor in those deaths.
Indian doctors shocked to find 12 gold bars inside a businessman’s stomach
A team of New Delhi doctors were “shocked” to find out a 63-year-old businessman complaining of abdominal pain earlier this month had 12 gold bars inside his abdomen, Indian news publication the Press Trust of India reported.
According to PTI, the man visited the hospital seeking surgery to remove a water bottle cap he claimed to have swallowed, but after doctors conducted an X-ray, they found a dozen gold bars, each weighing 33 grams, in his stomach.
“He approached us on April 7 seeking surgery to remove a water bottle cap which he claimed he had accidentally swallowed,” Dr C S Ramachandran told the Indian news agency. “We got an X-ray done and it didn’t appear to be a cap. As the gold bars got stacked one behind the other it appeared to be a metal.”
“We were shocked to find not one but 12 gold biscuits in his abdomen.”
Doctors operated on the man April 9 and discharged him less than a week later.
“When we asked him he was not ready to speak. We immediately sealed them in a container and handed it over to the medical superintendent,” said Ramachandran, adding that police and custom department officials were also notified.
According to PTI, the man swallowed the gold bars – worth about $22,000 – in an attempt to smuggle them into India from Singapore, but when he landed he was unable to get the bars through his stool and he was forced to see a doctor.
What do you think?
“I am at least happy that I could save his life,” the doctor said. “If it would have stayed inside for couple of more days, it would have led to severe bleeding and rapture of the intestine and septicemia. Moreover, he had severe diabetes.”
“Eating and exercising” here are 5 tips to maximize your workouts
Know when and what to eat to enhance your workouts.
Eating and exercise go hand in hand. When and what you eat can be important to how you feel when you exercise, whether it’s a casual workout or training for a competition. Consider these eating and exercise tips.
1. Eat a healthy breakfast
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If you exercise in the morning, get up early enough to finish breakfast at least one hour before your workout. Most of the energy you got from dinner the previous night is used up by morning, and your blood sugar might be low. If you don’t eat, you might feel sluggish or lightheaded when you exercise.
If you plan to exercise within an hour after breakfast, eat a light breakfast or drink something to raise your blood sugar, such as a sports drink. Emphasize carbohydrates for maximum energy.
Good breakfast options include:
- Whole-grain cereals or bread
- Low-fat milk
- A waffle or pancake
And remember, if you normally have coffee in the mornings, a cup before your workout is probably OK. Also know that anytime you try a food or drink for the first time before a workout, you risk an upset stomach.
2. Size matters
Be careful not to overdo it when it comes to how much you eat before exercise. The general guideline:
- Large meals. Eat these at least three to four hours before exercising.
- Small meals. Eat these two to three hours before exercising.
- Small snacks. Eat these an hour before exercising.
Eating too much before you exercise can leave you feeling sluggish. Eating too little might not give you the energy to keep you feeling strong throughout your workout.
3. Snack well
Most people can eat small snacks right before and during exercise. The key is how you feel. Do what works best for you. Snacks eaten soon before exercise probably won’t give you added energy, but they can help keep up your blood sugar and prevent distracting hunger pangs. Good snack options include:
- Energy bars
- Bananas or other fresh fruit
- Fruit smoothies
- Whole-grain bagel or crackers
- Low-fat granola bars
- Peanut butter sandwiches
A healthy snack is especially important if you plan a workout several hours after a meal.
4. Eat after you exercise
To help your muscles recover and to replace their glycogen stores, eat a meal that contains both protein and carbohydrates within two hours of your exercise session if possible. Good post-workout food choices include:
- Yogurt and fruit
- Peanut butter sandwich
- Low-fat chocolate milk and pretzels
- Pasta with meatballs
- Chicken with brown rice
5. Drink up?
Don’t forget to drink fluids. You need adequate fluids before, during and after exercise to help prevent dehydration.
To stay well-hydrated for exercise, the American College of Sports Medicine recommends that you:
- Drink roughly 2 to 3 cups (473 to 710 milliliters) of water during the two to three hours before your workout.
- Drink about 1/2 to 1 cup (118 to 237 milliliters) of water every 15 to 20 minutes during your workout. Adjust amounts related to your body size and the weather.
- Drink roughly 2 to 3 cups (473 to 710 milliliters) of water after your workout for every pound (0.5 kilogram) of weight you lose during the workout.
Water is generally the best way to replace lost fluids. But if you’re exercising for more than 60 minutes, use a sports drink. Sports drinks can help maintain your body’s electrolyte balance and give you a bit more energy because they contain carbohydrates.
Keep in mind that the duration and intensity of your activity will dictate how often and what you should eat and drink. For example, you’ll need more energy from food to run a marathon than to walk around the block.
When it comes to eating and exercise, everyone is different. So pay attention to how you feel during your workout and to your overall performance. Let your experience guide you on which pre- and post-exercise eating habits work best for you. Consider keeping a journal to monitor how your body reacts to meals and snacks so that you can tweak your diet for optimal performance.
Big concerns over hi-tech toddlers and their use of smartphones
Experts in child psychology have spoken of their concern that almost a third of Irish toddlers could now be using tablets and smartphones before they have even learned to read.
Trinity assistant professor in educational psychology Dr Conor McGuckin (right pic above making a speech) has warned that at an age when children should be learning to communicate, they are glued to screens and not interacting with people.
He was speaking as research in the US and UK has revealed a growing number of young children now using mobile devices, with the number of babies and infants under two using the technology rising to 38pc in the US and 28pc of three to four-year-olds in the UK.
Leading psychologists have warned that the same figures would apply here, and urged policy-makers to look at young children’s access to technology.
“We’re exposing children to developmental levels that they are not ready for,” warned Dr McGuckin.
“Basically, at that age children should be learning the art of conversation, how to take turns and mimicking behaviour. They need to be exposed to social norms. If they are mostly interacting with a tablet, they are not getting that feedback from others.”
Dr McGuckin said the increased use of technology by younger children could be putting them at risk of “nature deficit disorder”.
“In their formative years children should be learning experiences from outside. Now we’re in a situation where many have never collected frog spawn or gone for nature walks,” he said.
“Just because technology has increased doesn’t mean a child’s development has. They still develop at the same rate as our parents or we did.
“In the real world, we teach children to cope. We teach them to wear a coat if they go outside or to take care when crossing the road. We’ve no idea how to teach them to cope with the online world.”
His concerns were echoed by Dr Ciaran McMahon, of the Royal College of Surgeons Ireland, who said the first two years of a child’s life were responsible for a significant amount of development.
“Object permanence is fundamental and this is something they learn early,” he said.
“With tablets, children press the screens and pictures keep changing, then if they are given magazines they are confused.”
However, both experts acknowledged the positive aspect of children using such technology if properly monitored.
Dr McMahon also praised the social advantages of online literacy, but stressed that there must be a debate among the public and among policy-makers about the implications of young children using such technology.
“Society dictates what is not suitable for children and legislates for that,” he said.
“This is in the hands of the people and therefore in the hands of Government.”
Climate change will cost the planet €2bn a year as droughts hit food crops
Climate change will play havoc with our seasons and finely balanced agricultural sector unless serious efforts are made to reduce emissions.
An analysis of the potential impacts of global warming reveals the huge burden the economy will have to shoulder within just 40 years, with annual costs of up to €2bn possible for the agriculture sector alone due to drought, drops in crop yields and pests.
The warning comes as the United National Intergovernmental Panel on Climate Change (IPCC) revealed that immediate action was needed to reduce greenhouse gas emissions from transport, energy and the agricultural sectors to limit global warming to 2C by the end of the century.
Rising sea levels and risk of flooding, food shortages, drought and possible conflict would arise unless the amount of carbon being produced was halted and reductions implemented as soon as possible, its fifth assessment report on the state of the climate said.
The impacts of global warming were “severe, pervasive and irreversible”, it added. Dr Frank McGovern, from the Environmental Protection Agency(EPA), who represented Ireland during discussions to finalise the IPCC report, said the implications of failing to act would be catastrophic. “Unmitigated climate change is not something we like to consider,” he said.
“A scenario of unmitigated climate change, or business as usual greenhouse gas emissions, is likely to have significant consequences for Ireland. It would increase the risk of both direct and indirect climate change impacts. These would evolve over the course of this century and beyond. The details remain uncertain but some elements can be identified.
“For Ireland, reasons for concern include sea-level rise, increases in extreme events, loss of ecosystems and loss of assets and infrastructure.
“They would also include associate risks of loss of life, risks of increasing health impacts and social and economic disruption of key sectors including agriculture.
“Vulnerable groups in Ireland are likely to require on-going assistance or relocation. There may be a movement of peoples to Ireland from other areas of Europe and elsewhere, perhaps on a seasonal basis, due to adverse climate conditions.”
The Government is currently finalising climate change legislation, which is expected to be published in the coming weeks.
The Climate Action and Low Carbon Development Bill will set out how Ireland will become a low-carbon economy by 2050.
Environment Minister Phil Hogan has repeatedly said that Ireland will comply with emissions targets agreed at EU level, however, the bill is behind schedule.
It was due to be published last year and the Government was expected to adopt a national policy setting out the transition to a low-carbon economy by the end of 2013.
There are concerns about the cost of financing the changes needed, including moving away from fossil fuels and producing power from renewable sources.
However, the IPCC says that tackling climate change would shave 0.06pc off expected annual global growth rates of 1.3pc to 3pc.
The report did not factor in the financial benefits of reducing emissions, such as improved energy security and cuts in air pollution.
The most recent figures show that emissions from all sectors currently stand at 57.92 million tonnes of carbon dioxide a year, a slight increase.