Solving A&E crisis will cost more money - Nurses’ strike averted

IF the arrangements agreed between the Health Service Executive and the Irish Nurses’ and Midwives’ Organisation avert industrial action in the country’s overstretched emergency hospitals, they are to be welcomed.

That welcome will be even warmer if a deal can be reached within the limits of the Lansdowne Road Agreement and from current HSE resources — as has been promised by the HSE. However, the as yet unratified deal brings into play the perennial problem afflicting every settlement in the public sector.

Almost as soon as the talks had got to the point that INMO members might vote on proposals, SIPTU warned that it might seek similar concessions for its members. Once again, a straitened, challenged health service may have to deal with the domino effect provoked by measures for dealing with a very specific situation. In these circumstances — the tide that must lift all boats all of the time — any solution may be multiples of the actual cost of solving a specific problem. This is, as everyone involved must know, an example of unsustainable opportunism. It should be resisted forcefully.

The concessions offered to the INMO are, as everyone involved must know, just a sticking plaster on a system that has been dysfunctional for many years. Resolving it, and restoring sanity to emergency medicine in Ireland — for the clients, the providers and the taxpayers who fund it — has eluded health minister after health minister, HSE leader after HSE leader, and has become a leitmotif for seemingly incurable failure and disappointment. It is stating the obvious that the current situation satisfies no-one, except possibly politicians, who will, in the forthcoming election campaign, promise, with a straight face, to introduce the change needed to bring equiblibrium to the situation. This will be, of course, the most cynical exploitation of a dreadful situation, but utterly unsurprising and disingenuous.

Two positions have come to be accepted as immutable truths in this debate: we need more hospital beds — the INMO puts the figure at 1,000 — and we need more nurses and doctors to properly staff today’s A&E wards. We need even more nurses and doctors to staff those badly needed beds. We also need still more nurses and doctors to end the bizarre — and illegal — work shifts still imposed on junior hospital doctors.

The only way to achieve this, whether we like it or not, is by paying for it, as we are unlikely to find squadrons of unemployed nurses or doctors under the Christmas trees in hospital hallways.

This requires extra resources and there is only one way a Government can get extra resources. There are management issues — too many bureaucrats, not enough footsoldiers — but if we want to end the Dunkirk-all-day-every-day chaos that characterises much of our emergency medicine, there seems to be few enough options and nearly all of those have been tried. In so many ways, this dispute cuts core to the core of one of the defining characteristics of our Republic. We want better hospitals, schools, police services, colleges and flood-prevention schemes, but demand lower tax bills. This is not a realistic position.