The news that people with no Leaving Certificate will be employed in clerical jobs in the health services is about more than filling administrative posts.
It is also a clear signal that coping with staff shortages at all levels - doctors, nurses, paramedics, porters, care attendants, secretaries - will be the major preoccupation of health managers in the next three to five years.
The need to attract and keep staff will mould our hospital services more than any other force at work in the system. Opening up clerical jobs to people without Leaving Certificates but who are able to do the work is not, however, a sign that the qualifications demanded in other areas will fall.
Instead, the whole aim of hospitals will be to attract and keep qualified people who are in a position to demand good quality working conditions and good quality training.
From conversations with people in the health system for this week's Hospital Watch series, a picture of what needs to change begins to emerge. The components of that picture include:
Family-friendly policies to attract back the thousands of nurses who are registered but not practising - of the 51,000 registered nurses, only 31,000 work in the public health service. These policies could include pensionable part-time work and "term time" working, in which a nurse could work, say, nine months of the year but have the nine months salary spread over a full year;
Some matrons and other health managers believe Dublin hospitals should be funded to pay a special allowance to nurses working in the capital. This is because there is a flight of nurses to hospitals or public health nursing posts outside Dublin;
Recruiting nurses from abroad is likely to be a permanent feature of our hospital system. Other countries are also recruiting from outside the EU. Britain, in particular, is embarking on a huge expansion of the National Health Service and will need many more nurses;
Create many more posts for consultants. We have about 1,000 consultants of whom about 700 are active in the public health service. Without more consultant posts, non-consultant hospital doctors will find their career paths blocked and will be drawn to the NHS or elsewhere to get promotions;
Tackle factors which keep medical staff away from certain hospitals. These include bullying; underdeveloped services; poor training and low staffing levels which put a big strain on staff;
Upgrade the skills and pay of porters, care attendants, theatre attendants and other staff to take on more of the work for which nursing skills are not needed.
Where, it may well be asked, is the patient in all of this? The patient is stuck on a waiting list unless we are prepared to invest more money in the system.
The problem with the measures outlined above is that they are needed, in the first instance, to stop things from getting worse. Operations are being cancelled or rationed because of staffing shortages. This threatens to make already-lengthy waiting lists even longer. If we stop that worsening of the situation, the waiting lists will still be too long.
Reducing them sharply - and reducing the queues in casualty departments - means spending far more money on the health services by providing far more acute beds for those who need them.
The Irish Nurses Organisation also strongly advocates the development of a network of "stepdown" facilities for people who don't need to be in an acute bed and don't need long-term care. These would be nurse-run convalescent facilities which could also provide day care for people living at home - there is evidence that day care provided by nurses and paramedics helps to keep people out of hospital in the first place.
Ensuring that the treatment of patients gets better and not worse should be a key part of the debate about the staffing of our hospital services.
e-mail: pomorain@iol.ie