The major Dublin acute hospitals are expected to be hardest hit by the failure yesterday of health managers and nursing unions to agree on grounds rules for emergency cover in the event of a State-wide strike.
The Minister for Health, Mr Cowen, bluntly told nurses there was no avenue left open to him to avert their threatened strike action.
Because most of the specialist treatment centres are in Dublin there are few elective admissions. But because of stress levels, Dublin nurses are among the most militant in the health service and the least likely to agree the high levels of emergency cover being sought by management.
Day-long talks between the Health Service Employers' Agency and the Nursing Alliance leaders failed to make any headway yesterday, but both sides have agreed to let local discussions begin on cover for emergency and essential services.
If progress at local level is satisfactory, national talks are likely to take place again in seven to 10 days' time.
After yesterday's talks senior SIPTU nursing official Mr Oliver McDonagh said: "There wouldn't be enough nurses in the health service to provide the sort of cover management want. We will now have to talk about cover hospital by hospital."
The chief executive of the HSEA, Mr Gerard Barry, said that even with a national plan there would be serious curtailment of services. "We have to be in a position where we can inform the general public what is in place. Without a plan at national level, fleshed out locally, we are not going to be in a position to do that. The public has a right to know what level of service to expect."
However the chairman of the Nursing Alliance, Mr Liam Doran, said management was asking nurses to continue duties such as supervision of non-nursing staff, which could not be considered essential. "We will be providing nursing services without pay during the dispute and on that basis we will determine patient needs from day to day," he said.
He pointed out that strike committees would liaise closely with consultants and always be mindful of patient needs. As an example of the approach that would be adopted he cited maternity hospitals, where cover in labour wards would be high cover, but ante- and post-natal care services might be severely reduced.
There are between 35,000 and 36,000 residential patients in the hospital and community-care system at any given time. For many of the 9,000 long-stay geriatric patients and 7,500 mental handicap patients, their hospital is effectively their home. The same applies to a high proportion of the 5,000 psychiatric patients, 1,500 in the non-acute sector and 1,000 in welfare homes. However, many of these patients' short-term needs can be met by non-nursing staff.
The major acute hospitals accommodate at least 10,000 patients a day, of whom around a third are elective. It is here that nursing care is indispensable and the greatest difficulties are likely to be encountered in agreeing staffing levels.
The Minister appealed to nurses to consider the "full implications" before voting for a strike which would inflict considerable hardship on patients and their families.
Mr Cowen rejected claims from Opposition deputies ail that he has adopted a "confrontational style" in relation to the nurses' dispute and said the Government has met its commitments and abided by procedures.