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Hospital pharmacists warn austerity measures are negatively impacting patient welfare


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Member countries of the European Association of Hospital Pharmacists (EAHP) have issued a jointly agreed statement expressing apprehension about the impact of public spending austerity on services to patients in hospitals.

Amongst the negative impacts of public spending austerity causing concern to hospital pharmacists are: increasing expectancy placed upon patients to meet the up-front costs of their medicines; the unintended impacts national cost-cutting measures are having in respect of medicines shortage; short-staffing in hospitals; diminished opportunities for healthcare professional training and development; and shrinking investment in areas of patient safety enhancement.

EAHP’s members have called for a European Commission review into the potential for greater joint level cooperation between governments in terms of reducing the detrimental health impacts of austerity measures. Such a review could be conducted in the context of both the pan-European aspects of these problems, and the remit of the European Union to take action in the area of public health, as per article 168 of the Treaty on the Functioning of the European Union.

Speaking about the new policy statement, EAHP president Dr Roberto Frontini said, “Hospital pharmacists, by the nature of our profession, are highly attuned to detecting patient safety threats. So with the impacts of public spending squeezes now keenly felt in almost all European countries, we call for greater caution, care and compassion by policy-makers when it comes to the area of health. Too much progress has been achieved in previous decades to be casually discarded in a rush to resolve macro-economic challenges. Sober analysis must made of the patient safety implications of all decisions, as well as the impacts on sustainable health services.”

Dr Frontini further added, “I see significant potential value that could be delivered by the European Commission taking a proactive role in helping member states navigate the current financial challenges to health systems. Ultimately, we all have a duty to ensure that it is not the sick and vulnerable that pays the price of austerity.”

EAHP is an association of national organisations representing hospital pharmacists at European and international levels.

via Hospital pharmacists warn austerity measures are negatively impacting patient welfare.

Four-year wait for over 5,000 Limerick patients …What a disgrace


Over 5,600 patients in Limerick are waiting four years or more for an outpatient appointment, according to the latest figures from the Health Service Executive.

At the end of February, the Mid-Western Regional Orthopaedic Hospital in Croom had 4,148 patients waiting four years or more.

There were 1,473 patients waiting at the nearby Mid-Western Regional Hospital in Dooradoyle.

There were 105,632 patients waiting over a year for a first consultant outpatient appointment across Ireland.

This represents a small improvement on the figures up to the end of January.

The hospitals with the longest overall outpatient waiting lists were:

University College Hospital Galway 41,035 patients

– Waterford Regional 28,625

– Tallaght Hospital 26,119

Limerick Regional 23,098

Cork University Hospital 22,944

Beaumont Hospital 22,206

The HSE West said that it expects to make significant improvements in the outpatient waiting list for services at the Regional Orthopaedic Hospital in Limerick by the end of this month.

It said that all hospitals are validating outpatient waiting lists and historically lists have contained inaccuracies for many reasons.

It said the waiting list at the hospital as of 1 May for an outpatient appointment is 7,477.

The HSE West said that it aims to have the list validated by the end of May and have no patient waiting longer than a year for an orthopaedic appointment by the end of November.

via Four-year wait for over 5,000 Limerick patients – RTÉ News.

via Four-year wait for over 5,000 Limerick patients – RTÉ News.

The Increasing Problem of Religious Hospitals


The needless death of Savita Halappanavar last year, after a Catholic hospital refused to terminate her doomed pregnancy, drew a worldwide outpouring of fury against the religious dogmatism that killed her.

But as I wrote at the time, Savita’s story was only the tip of the iceberg. What happened to her wasn’t a fluke or an aberration: it was and is the official policy of the church that if a pregnant woman’s life can be saved by abortion, it’s better to let two die than to save one.

It’s only by a stroke of good fortune that we haven’t had any Savitas in the U.S. (that I’m aware of, at least). It’s certainly no thanks to the church hierarchy. And that makes it especially ominous that the Catholic hospital system is quietly expanding its reach across the U.S., merging with or gobbling up many of its secular counterparts:

“We are starting to see what was rare in the past,” said Lisa Goldstein, who follows nonprofit hospitals for Moody’s Investors Service and predicts more such partnerships… About one-sixth of all patients were admitted to a Catholic hospital in 2010. In many smaller communities, the only hospital within miles is Catholic. (source)

This is still going on today, as Americans United reported in a blog post from last month about Catholic entities seeking to take over public medical institutions in Texas and Kentucky. And when the church takes over, they’re not reluctant to throw their weight around: Irin Carmon reports on Salon that an astonishing 52% of OB-GYNs at Catholic hospitals have reported clashing with church-run ethics committees over the proper treatment of women with complications from pregnancy.

This is bad for men too, since it cuts off their access to procedures like sterilization that these hospitals no longer provide. But as always, the burden of religious oppression falls most heavily on women, since it’s only women who are denied access to literally lifesaving medical care by Catholic dogma (not to mention access to emergency contraception if they’re raped).

I regard this as a more serious problem than most other manifestations of the anti-choice movement. The noisy protesters who cluster outside reproductive health clinics can frighten and harass, but they can’t actually, legally, prevent anyone from getting an abortion there or otherwise making use of the clinic’s services. On the other hand, buying up hospitals does make it possible for religious zealots to cut off women’s access to legal, essential medical care.

There’s only one solution to this, and it has to be a legal one. Just as businesses that serve the public can’t discriminate by religion in whom they hire or whom they serve, so too should hospitals be forbidden to pick and choose which procedures they’ll offer or which medicines they’ll dispense based on the decrees of a religious authority.

We wouldn’t tolerate a Jehovah’s Witness-run hospital that forbade blood transfusions, even for people rushed into the emergency room dying of blood loss. We wouldn’t tolerate a Muslim-run hospital where doctors and nurses refused to wash their hands based on their interpretation of Islamic modesty laws. We wouldn’t tolerate an evangelical Christian-run hospital that turned gay people away at the door. Just the same way, we should refuse to tolerate a Catholic-run hospital where the imperial decrees of a bishop mean that a woman dying of sepsis or eclampsia can’t get a life-saving abortion as long as there’s any detectable fetal heartbeat.

It doesn’t matter exactly how we implement this – the “hospital within a hospital” created in one case in Austin seems like a reasonable compromise. But this is something we have to insist on. Religious individuals can decide what care they want for themselves based on their beliefs. But in a secular nation like America, it should be absolutely illegal for a religious authority to turn any part of the public square into a private fiefdom and exercise power over the lives of people who haven’t voluntarily agreed to abide by those rules.

via The Increasing Problem of Religious Hospitals.

via The Increasing Problem of Religious Hospitals.

Limerick has longest outpatient waits


Nearly 40% of patients on outpatient lists in one of the country’s main orthopaedic hospitals have been waiting over four years to be seen, new figures show.

Figures for the end of January from the Department of Health’s Patient Treatment Register (PTR) show that there are currently 10,347 public patients on outpatient waiting lists at at the Mid-Western Regional Orthopaedic Hospital in Croom, Limerick.

Of these, 4,109 have been waiting four years or more to see a consultant in an outpatient clinic in order to get assessed for treatment.

Croom Hospital has the highest figure in the country for the number waiting four years or more for an outpatient consultation.

The hospital with the second highest four-year plus waiting numbers for outpatients is the Mid-Western Regional Hospital, also in Limerick, which has 1,716 patients waiting over four years to see a consultant.

This is followed by Waterford Regional Hospital, which 1,086 patients with a four year plus outpatient waiting time.

The Dublin hospital with highest number of long outpatient waiters is Tallaght, which has 876 patients waiting over two years for a consultation.

Nationally, there are now 9,784 patients waiting over four years for an outpatient consultation in a public hospital.

A total of 8,989 patients nationally are currently waiting between three and four years for an outpatient consultation.

The total number of people on outpatient lists, according to the PTR figures for the end of January, is 386,643.

Health Minister James Reilly has pledged that no patient will be waiting more than a year for an outpatient consultation by the end of 2013.

via News stories about the Irish hospital system.

via News stories about the Irish hospital system.

Tallaght Hospital scandal: No need for accountability


Public Inquiry · Examining corruption in Ireland

I wrote recently about the missing link that marks the difference between how things are done in Ireland and how they’re done in functional democracies.

When suspicions of corruption are raised in functional jurisdictions there usually follows an investigation by an independent authority.

If the suspicions are confirmed consequences follow such as sackings, heavy fines or perhaps a trial followed by appropriate punishment.

All this is done under the principle of justice being seen to be done and the whole matter is usually followed up with new rules/regulations to prevent such events from happening again.

All these stages of accountability are also carried out in Ireland with the notable exception of holding anybody to account.

The recent scandal at Tallaght Hospital, as reported in the Irish Examiner, is a great example.

Background:

The hospital is unable to explain why five senior officials received almost €700,000 in non-salary ‘top-up’ fees between 2005 and 2010.

Ernst and Young carried out a financial investigation last year as a result of concerns raised by the Health Information Quality Authority (HIQA).

The investigation found:

The hospital was unable to provide any documents showing why the large payments were made.

The hospital was unable to explain why the supplementary payroll, under which the payments were made, was set up or what approval procedures were followed.

Board members at the time provided inconsistent recollections as to the existence and approval of the fund.

One individual received €225,833 in extra pay. Four other staff members received €104.667, €61,250, €24,000 and 259.000 respectively.

This was all taxpayer’s money at a time when Tallaght Hospital was making severe cutbacks to its budget.

We have now reached the critical point where, in a functional democracy, stronger action would ensue – police investigation, courts etc.

In Ireland this stage is skipped completely and replaced by an excuse stage.

Significant management structure changes have been carried out at the hospital – we’re told.

The new management has ‘noted’ the findings of the investigation.

The external payroll system responsible for the payouts has been abolished.

The new board has appointed a new remuneration and terms of services committee.

The new board said they were disturbed and upset by what happened.

So, no further action, no police, no investigation, no courts.

And, we can ask, is the new board a genuine improvement on its predecessor. Will this ‘new broom’ sweep all the old habits away and act in a professional and responsible manner when it comes to accountability?

No, is the emphatic answer.

When asked if the five members at the centre of the scandal were still working at the hospital and whether any of the paid out money can be retrieved they declined to comment.

Or, in plain English – Take a hike, we’re saying nothing.

The only reason, I suspect, the board of Tallaght Hospital can feel confident in refusing to answer this most basic of questions is because of the missing link in Irish accountability.

It there’s no system of accountability – there’s no need to be accountable.

via Public Inquiry · Examining corruption in Ireland.

via Public Inquiry · Examining corruption in Ireland.

Working conditions in hospitals are so bad that sometimes I get no sleep at all


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I WOULDN’T SAY there’s been a single week since I’ve started working about a year and a half ago in the hospital that I’ve only had to work 48 hours a week – as the 2004 EU Working Time Directive instructs.

It can be anything up to over 100 hours a week. There was a couple of hours where I was working over Christmas where I was on call three times a week and you’d have to work the next day post-call as well.

Generally you wouldn’t get any sleep, or you might get one or two hours. You could end up working anything up to 36 hours in a row.

Thirty-six hours would be a record. But once a week you’d generally have to work 32 hours in a row.

It’s a killer. Adrenaline tends to get you through the first 20 hours. You start to feel the burn at around 4am. You focus then on the ward for a few hours, you make your way through it, you’re generally okay that night, but then the next day is really exhausting.

Is this government committed to media diversity?

 

via Column: Working conditions in hospitals are so bad that sometimes I get no sleep at all.

via Column: Working conditions in hospitals are so bad that sometimes I get no sleep at all.

Reilly Solves Hospital Bed Problem


As always around this time of year, the nation suffers an acute shortage of hospital beds.
Minister Reilly, who loves pulling, stokes, and hates being accused of dodgy deals, has for once come up with a jaw dropping solution, which will insure hospital beds are readily available.
A program of replacing hospital beds with hammocks will begin early next year and will more than double their capacity for patients despite the crippling effects this will have on overstretched staff.
Reilly was disappointed that the HSE were themselves unable to come up with this simple initiative. He did thank the consultancy firm known as the friends of Reilly for their work in this area.
The first thousand hammocks are to be installed in January.

Reilly does not expect fallout from the scheme.

 

12,000 admissions to hospitals are cancelled


Nearly 12,000 patients have had their admission to hospital for treatments such as surgery cancelled between March and September this year.

Although there is a range of reasons for this, the most common problem is that the bed the patient due admission was going to be placed in had to be given to a patient who came through the hospital emergency department.

A lack of intensive care beds can also lead to cancellations because they are already occupied, leaving patients who will need to be admitted after surgery, waiting longer for their operation.

The cancellation can cause major upset and inconvenience as well as being very disruptive for someone who badly needs to have an operation or test.

The figures, supplied by the HSE, reveal that hospitals with the most overcrowded and busy emergency departments also had the biggest number of cancellations.

They include St James’s Hospital (5,289), Our Lady’s Hospital for Sick Children Crumlin (2,432), Beaumont Hospital(2,165), Cork University Hospital (1,228) and Tallaght Hospital (889).

via 12,000 admissions to hospitals are cancelled – Health News, Health – Independent.ie.

via 12,000 admissions to hospitals are cancelled – Health News, Health – Independent.ie.

 

Husband may lodge complaint with Ombudsman


The husband of Savita Halappanavar is considering lodging a complaint to the Ombudsman to assert his ownership of his wife’s medical notes, his solicitor has said.

Gerard O’Donnell said he had taken instructions from Praveen Halappanavar to seek direction from the Ombudsman on whether he or Galway University Hospital owns her medical records.

Mr Halappanavar has objected to the use of his wife’s notes in a HSE inquiry into her death. He has said he has no faith in a HSE-run inquiry and does not want her notes used in it.

Mr O’Donnell had asked that the hospital, where Ms Halappanavar died last month, hand over the original medical notes. However, the HSE has said it owns them.

A spokesman for the Ombudsman said last night it was unlikely her office would have a role in this dispute.

Mr Halappanavar met Minister for Health James Reilly for 25 minutes yesterday in Galway.

Ms Halappanavar died on October 28th, having presented a week earlier at the hospital with back pain. She had been 17 weeks pregnant and had been found to be miscarrying. Mr Halappanavar says she asked repeatedly for a termination and this was refused as the foetal heartbeat was present.

The Health Information and Quality Authority will publish the terms of reference of its inquiry into her death next week.

The investigation, for which no time span is indicated, will make use of outside expertise, a spokesman indicated.

In a statement, the authority said it would investigate the safety, quality and standards of services provided by the HSE at Galway University Hospital to “critically ill patients, including critically ill pregnant women, as reflected in the care and treatment provided to Savita Halappanavar”.

Mr Halappanavar said after yesterday’s meeting with Mr Reilly that he was pleased to finally meet a Government representative four weeks after his wife’s death. He said he stressed to the Minister that he did not believe the HSE or Hiqa investigations would be far-reaching enough. “I’m just glad that we met and he just passed on his condolences to the family,” said Mr Halappanavar.

Mr O’Donnell said his client was prepared to go to the European Court of Human Rights if an independent public inquiry was not set up. Galway University Hospital last night confirmed it would co-operate fully with the Hiqa inquiry.

via Husband may lodge complaint with Ombudsman – The Irish Times – Sat, Nov 24, 2012.

via Husband may lodge complaint with Ombudsman – The Irish Times – Sat, Nov 24, 2012.

Budget overspend of €800,000 each month by Hospital


SPENDING IN Sligo Regional Hospital continues to be €800,000-plus per month over its approved budget, according to the latest figures released by the HSE last night (Tuesday).

However, finances in the hospital improved marginally — by a fifth of one percent — during September.

Sligo Regional is now listed 13th in Ireland — from 119 centres — for rates of absenteeism. General support staff, nursing and management/admin are the grades identified.

St Johns Hospital is also showing a budget overrun in excess of 10% for the year.

The ‘shave back’ and savings in Sligo Regional Hospital helped contribute to a national picture which saw the HSE’s overall deficit for 2012 drop back to €399 million — it’s first drop.

Sligo Regional Hospital has spent €7.4 million more than its allocated budget in the first nine months of 2012, last night’s official statistics confirm.

The Hospital has now exceeded its annual budget by 10.5%, states the HSE Performance Report for September.

Statistics for Sligo Regional Hospital reveal that by September 30th it had spent €78.4 million of its entire 2012 budget of €92.3 million.

The budget allocated by the Department of Health for 2012 suggested that Sligo Regional Hospital should have been able to get by with €70.9 million between January 1st and September 30th.

In St John’s Hospital, the accumulated budget overrun for the year now stands at €1.3 million — a 10.2% overrun.

St Johns show heavy spending on agency costs for staff in medical/dental; it accounted for 23% of payroll costs in September.

The Minister for Health, Dr Reilly, has iterated all year that there will be no bail-out for HSE or hospitals running over budget.

The Government has been under some pressure from The Troika, which oversees Ireland’s bailout. It has criticised spending on health.

The Irish Times reports this morning that the Government has agreed “to comply by the end of the month with a request from the EU-IMF troika for a detailed plan to tackle the spending overrun in the health service.”

Unspent Money

RTE has, however, offered a glimmer of hope; unexpended capital budgets in 2012 may be considered for reallocation to current-side budgets, the station’s Health Correspondent Fergal Bowers indicated last night on television.

Fianna Fáil’s Health spokesman Billy Kelleher separately predicted the Minister “will move to ‘shore up’ his budget failings by moving unspent money from his Department’s capital allocation to current spending.”

A nursing union leader, Liam Doran of the INMO, said that talk of budget overruns was ”an accountants exercise.”  The original budget was wholly inadequate, he said.

Criticism of budget overrun was “unfair, misguided and unwarranted,” added Mr Doran, who praised staff for “heroic” efforts.

The leading Labour Party councillor in Sligo, Cllr Jim McGarry, has also queried in past fortnight whether Sligo Regional Hospital has been under funded by the Government. See SligoToday.ie 5/11/2012

No Specific Reference

There is no specific reference to Cregg House in the Performance Report released last night.

Page 40 deals with an update assessment titled: ”Service Arrangements and Grant Aid Agreements.”

It remains unclear if this section — unlikely — includes any reference to the ongoing impasse between the HSE and the Daughters of Wisdom at Cregg House.

The Performance Report states: ”….Of the 27 Non Acute Agencies in receipt of over €10 million in the non acute sector, 14 have completed, with the remainder all indicating that they will sign with the exception of a single provider.”

This single provider, adds the Report, ”is in negotiations on whether they will continue to provide services.”

The Report speaks of “cost containment issues,” in particular in HSE dealings with disability agencies.

The Daughters six months ago publicly highlighted an issue of under funding in a proposed renewal of its Service Level Agreement (SLA) and said they could not continue.

In the past two months the Daughters again re-stated their commitment to leave after 57 years but offered an extension to January to the HSE.

Most Up-to-date

The Performance Reports provides the most up-to-date picture of what is happening at all levels inside Irish hospitals, community services and the HSE itself.

In comparison, the report released Monday by the Economic, Social and Research Institute (ESRI) — which assessed hospitals including Sligo Regional Hospital — refers only to 2011 and an historical analysis of data.

They Reports are released online each month after all data and commentary for the relevant month has first been sent to the Minister for Health.

Sligo Absenteeism

Sligo Regional is highlighted in the Performance Report for high levels of absenteeism. It is 13th in the country on a rolling assessment over three months up to August.

Cregg House is placed 112th in a list of 119 named centres, while Roscommon County Hospital is 7th in Irish health settings for absenteeism.

The absenteeism issue in Sligo is once again  ‘flagged’ in the summary comment to the Minister.

General support staff (9.75%), nursing staff (7.39%) and and management/admin (6.48%)  absenteeism rates in Sligo Regional Hospital all far exceed the national average of 4.7% for the three month rolling period under review.

No reasons are offered in the Performance Report, or elsewhere, as to why absenteeism — and across several grades — remains high in Sligo Regional Hospital.

The Performance Report indicates that nine in every ten incidents of absenteeism is certified — 89.8%

Finally, 1.8 million medical cards had been issued by October 1st — almost 40,000 more than were planned in budgets for 2012, says the Performance Report.

via Sligo Today News for Sligo County – Budget overspend of €800,000 each month by Hospital.

via Sligo Today News for Sligo County – Budget overspend of €800,000 each month by Hospital.

Woman ‘denied a termination’ dies in hospital –


Savita Halappanavar, who was found to be miscarrying when admitted, died of septicaemia at University Hospital Galway

Two investigations are under way into the death of a woman who was 17 weeks pregnant, at University Hospital Galway last month.

Savita Halappanavar (31), a dentist, presented with back pain at the hospital on October 21st, was found to be miscarrying, and died of septicaemia a week later.

Her husband, Praveen Halappanavar (34), an engineer at Boston Scientific in Galway, says she asked several times over a three-day period that the pregnancy be terminated. He says that, having been told she was miscarrying, and after one day in severe pain, Ms Halappanavar asked for a medical termination.

This was refused, he says, because the foetal heartbeat was still present and they were told, “this is a Catholic country”.

She spent a further 2½ days “in agony” until the foetal heartbeat stopped.

Intensive care

The dead foetus was removed and Savita was taken to the high dependency unit and then the intensive care unit, where she died of septicaemia on the 28th.

An autopsy carried out by Dr Grace Callagy two days later found she died of septicaemia “documented ante-mortem” and E.coli ESBL.

A hospital spokesman confirmed the Health Service Executive had begun an investigation while the hospital had also instigated an internal investigation. He said the hospital extended its sympathy to the family and friends of Ms Halappanavar but could not discuss the details of any individual case.

Speaking from Belgaum in the Karnataka region of southwest India, Mr Halappanavar said an internal examination was performed when she first presented.

“The doctor told us the cervix was fully dilated, amniotic fluid was leaking and unfortunately the baby wouldn’t survive.” The doctor, he says, said it should be over in a few hours. There followed three days, he says, of the foetal heartbeat being checked several times a day.

“Savita was really in agony. She was very upset, but she accepted she was losing the baby. When the consultant came on the ward rounds on Monday morning Savita asked if they could not save the baby could they induce to end the pregnancy. The consultant said, ‘As long as there is a foetal heartbeat we can’t do anything’.

“Again on Tuesday morning, the ward rounds and the same discussion. The consultant said it was the law, that this is a Catholic country. Savita [a Hindu] said: ‘I am neither Irish nor Catholic’ but they said there was nothing they could do.

“That evening she developed shakes and shivering and she was vomiting. She went to use the toilet and she collapsed. There were big alarms and a doctor took bloods and started her on antibiotics.

“The next morning I said she was so sick and asked again that they just end it, but they said they couldn’t.”

Critically ill

At lunchtime the foetal heart had stopped and Ms Halappanavar was brought to theatre to have the womb contents removed. “When she came out she was talking okay but she was very sick. That’s the last time I spoke to her.”

At 11 pm he got a call from the hospital. “They said they were shifting her to intensive care. Her heart and pulse were low, her temperature was high. She was sedated and critical but stable. She stayed stable on Friday but by 7pm on Saturday they said her heart, kidneys and liver weren’t functioning. She was critically ill. That night, we lost her.”

Mr Halappanavar took his wife’s body home on Thursday, November 1st, where she was cremated and laid to rest on November 3rd.

The hospital spokesman said that in general sudden hospital deaths were reported to the coroner. In the case of maternal deaths, a risk review of the case was carried out.

External experts were involved in this review and the family consulted on the terms of reference. They were also interviewed by the review team and given a copy of the report.

via Woman ‘denied a termination’ dies in hospital – The Irish Times – Wed, Nov 14, 2012.

via Woman ‘denied a termination’ dies in hospital – The Irish Times – Wed, Nov 14, 2012.

Mater hospital faces deficit of up to €19m as doctor overtime targeted –


The Mater hospital in Dublin is understood to be facing a financial deficit which, in the “worst-case scenario”, could reach €19 million this year.

The hospital has introduced a number of cost-saving measures and is in talks with the Health Service Executive (HSE) about reimbursements which, if obtained, could see the overrun reduced to €8 million or €9 million, according to informed sources.

A confidential briefing note given to consultants in recent weeks said the Mater was facing a “serious deficit” for 2012. It said about half of the deficit “pertains to items which should be addressed through HSE reimbursements”.

It is understood that the largest element of the “reimbursements” referred to in the note relate to reductions made to the hospital’s budget earlier this year on the basis that the Government would introduce legislation to allow it charge for all private patients treated in public beds. This legislation was not put in place.

The note pointed out that the hospital’s annual allocation from the HSE had been cut by nearly €50 million over the past four years – down from about €250 million to €197 million.

Sources said that at the same time the number of patients increased by about 10 per cent.

The note said that as part of the cuts to be introduced, unrostered overtime for nonconsultant doctors would be restricted to one hour per day or five hours per week.

The note said it was agreed that such cutbacks in unrostered overtime would have an implication for service.

“It was agreed that the first area of cutbacks should be the number of patients attending outpatient clinics,” it said.

It also said a reduction in drug spending was required.

via Mater hospital faces deficit of up to €19m as doctor overtime targeted – The Irish Times – Tue, Nov 06, 2012.

via Mater hospital faces deficit of up to €19m as doctor overtime targeted – The Irish Times – Tue, Nov 06, 2012.

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