Time for Martin to take action

CRISIS management is now the order of the day in a creaking health service where hospitals are so overcrowded and staff shortages so acute that overtime payments to nurses are running at almost €10 million for the first six months of 2003.

And that figure does not take into account the staffing situation in major hospitals such as the Mater, St Vincent's, Beaumont and Our Lady's at Crumlin.

Despite pumping billions of euro into the service, Health Minister Micheál Martin is beset by problems that will not go away. It is time for him to take action.

In the latest twist of this depressing saga, all planned surgery admissions were cancelled at Dublin's Beaumont Hospital yesterday after the weekend's overcrowding left 60 patients on trolleys and chairs in the accident and emergency unit. In a bid to free up desperately needed beds, consultants had to be called in to carry out ward rounds in order to discharge a quota of patients. Meanwhile, nursing staff, who play such a crucial and often unsung role at the coalface of the health service, have called on Beaumont's management to implement measures aimed at alleviating overcrowding.

However, this recurring problem looks set to continue unless beds which have been closed in order to save money are reopened. On the political front, pressure is growing on Mr Martin to publish the Hanley Report on the configuration of hospitals and their manpower needs, a crucial document expected to be presented at tomorrow's Cabinet meeting.

The final chapter in a three-part analysis of Ireland's health crisis, the Hanley document promises to be the most controversial as it puts the spotlight on the role of consultants, the powerful vested-interest group at the heart of the system.

While the introduction of stop-gap contingency plans may ease the overcrowding problem for a time, bed shortages and the lack of adequate nursing staff will continue to put severe pressure on Beaumont and other acute hospitals.

This appalling situation has a particularly sad resonance at the country's main hospital for sick children, Our Lady's in Crumlin, where additional intensive care nursing staff are suddenly being recruited, a decision enforced upon the Government by the public outcry over the treatment of two-year-old Róisín Ruddle whose tragic death, following cancellation of her heart operation because of staff shortages, shocked the nation.

Undeniably, the crisis facing Beaumont, Our Lady's and several other hospitals is symptomatic of the swingeing cutbacks biting throughout the system, with essential services increasingly affected.

The sheer scale of the overtime bill for nursing is further proof, if it were needed, of the chronic shortage of staff. And because of the Government's ceiling on employing temporary nurses, hospitals are forced into employing large numbers of agency nurses, sending the overtime bill through the roof. The alternative is to close beds, with a domino effect on the public's access to emergency facilities.

There is an onus on Mr Martin to immediately put the Hanley Report into the public arena in order to focus more light on the health debate. He should also proceed without delay to undertake major structural reforms of the whole system pruning regional boards top-heavy with management; removing health from the local party political arena; taking on consultants and ending their dominance of cheque book medicine and, above all, delivering a truly patient-oriented service.