Evidence is growing that hospital services will be curtailed from now on by staff shortages. Last week the postponement of an operation on two-year-old Dillon Smyth because of a shortage of intensive care and theatre nurses brought the problem into sharp focus.
Heart surgery, too, has been affected. The Mater Hospital in Dublin has addressed this problem by employing Filipina nurses. But even this option may not be as easily available in future.
Recently announced plans for Britain's National Health Service mean the Republic now faces major competition for scarce health professionals. The Blair government has pledged to employ 7,500 extra consultants and 20,000 extra nurses.
Meanwhile the Medical Manpower Forum established by the former minister for health and children, Mr Brian Cowen, to suggest ways to improve the recruitment of doctors has still to report. When it does, later this year, it will be making its recommendations in a situation in which doctor shortages are likely to get worse rather than better.
For instance, the Irish hospitals have always had a heavy reliance on non-consultant hospital doctors from outside the EU. In 1996 and 1997, 1,066 such doctors registered with the Medical Council to work here. Then the Medical Council introduced an examination which such doctors must pass before they can get temporary registration. The result was a sharp fall in recruitment: in 1998 and 1999, only 141 non-EU doctors got temporary registration to train here.
Most doctors who came to train here from 1993 onwards will be leaving the system from next year as their seven-year temporary registration ends. As Prof Gerard Bury, president of the Medical Council, has pointed out, this is when the effects of the fall-off will become obvious.
The effects of shortages are being felt in a very real way by women giving birth in certain hospitals, including Kilkenny and Letterkenny. This week these hospitals were unable to provide epidurals on demand to women in labour because of a shortage of anaesthetists.
Nurse shortages are particularly crucial. Our Lady's Hospital for Sick Children in Dublin can staff only 12 of its normal complement of 16 beds in its intensive care unit, according to its chief executive, Mr Paul Kavanagh.
Another group affected are cancer patients. Anti-cancer drugs for chemotherapy must be prepared by pharmacists.
But a shortage of hospital pharmacists means many patients cannot get chemotherapy locally and must find a hospital which has a fully-resourced, fully-staffed service, according to Mr Andrew Barber, president of the Hospital Pharmacists' Association of Ireland.
The State has up to 160 posts for hospital pharmacists and could do with up to 50 more, says Mr Barber. But of the 160, up to 30 are vacant.
The solution to shortages across the health services seems likely to include a mixture of better pay and a better career structure. Appointing substantially more consultants - and estimates of the extra numbers needed go as high as 1,000 - would greatly improve career structures and the quantity and quality of training available for hospital doctors.
While career structures and salaries have been substantially improved for nurses as a result of last year's dispute, it is clear that more needs to be done. According to Ms Phil O'Shea, industrial relations officer with the Irish Nurses' Organisation, nurses undertaking postgraduate training in such specialised areas as intensive care are penalised by a drop in salary for the duration of the course.
There is also a rigidity in the remuneration system which does not, for example, allow the extra stress involved in working in such areas as intensive care and theatre work to be recognised in the form of extra pay.
Career structures for hospital pharmacists do not allow for much movement between hospitals, Mr Barber says. In addition, community pharmacies in the private sector can offer more attractive pay to pharmacists.
The Minister for Health and Children, Mr Martin, faces an enormous task in coping with the challenges posed by problems in recruiting staff. The solution will almost certainly mean higher spending with consequent higher costs for the taxpayer.
email: pomorain@irish-times.ie