Difficult choices for public services in deep crisis

Faced with the prospect of three successive days on the picket line, which would undoubtedly have dampened some of the warmth towards the nurses from much of the public during the early phases of the strike, the INMO and the nurses were probably quite happy to put the dispute on hold following a pretty decisive intervention by the Labour Court.

While it remains to be seen if the nurses will accept the deal presented by the Labour Court, and the early anecdotal evidence would suggest quite a bit of dissatisfaction with the offer, the deal does represent quite a back down from the demands initially made by the nurses’ union. If the deal is rejected, then we are in for a spring of discontent, especially if early soundings from other unions are to be believed.

The unions representing the forces of law and order are now examining the nurses’ proposed settlement in some detail and the teachers’ unions will not be happy that the nurses are not going to be penalised for breaking the terms of the 2017 public sector pay deal which is due to run to the end of 2020.

The fears of the Department of Public Expenditure and Reform that any concessions to the nurses could start a spiral of relativity-based pay claims would now appear to be very real and very threatening.

The other public sector unions will hardly be swayed by the fact that nurses got quite a raw deal at the time of the benchmarking process back in 2002 or that recruitment and retention is a problem for a profession that is central to the delivery of a proper health service.

The timing of the current nurses’ dispute and the possibility that it might spiral into a broader public sector pay issue could not be more inopportune.

The country is facing down the barrel of a Brexit gun; the public finances are still in a very precarious place, particularly when outstanding government debt is measured against the real rather than illusory measure of economic activity; and there is intense public pressure to increase the quality and quantity of public services.

There will have to be a very difficult trade-off over the coming years between the quantity and quality of public services and public sector workers, and public sector pay. Difficult choices will have to be made.

Viewed from a longer-term perspective, the challenges are even greater. Over the coming years, Ireland will be facing into an expanding and a rapidly ageing population. These trends will have significant implications for the demand for all public services, expenditure on healthcare, pensions and the future tax base. If we cannot cope with the current set of circumstances, then we have little chance of dealing with future circumstances.

Back in the healthcare system, apart from the nursing dispute, the next big crisis facing the sector is the GP service. The GP population is ageing and retiring, with few successors.

As a consequence, GPs are being forced to work longer hours with less pay from the public service part of funding. The result is a crisis in the system.

This is not good because the only real way to take pressure off the hospital service is to have a properly funded and adequately resourced primary healthcare system, where GPs play a very significant role in preventing patients from presenting at A&E.

As we get older, we naturally become more conscious of and unfortunately more exposed to the healthcare system, and that exposure is not always positive. The least that all professionals in the health system deserve is proper leadership from the top and a well-managed system. Unfortunately, neither the HSE or the Department of Health appear capable of doing that at the moment.

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