Nurses yesterday articulated the views of the public on the state of our hospital services. Their two-hour strike was a measured response from those who see, daily, the unsatisfactory and sometimes shocking conditions in our Accident & Emergency departments.
It was not without cost. Some planned treatments were cancelled to ease the possible strain on A&E departments because of the strike. Similarly, the eight-day work to rule which commenced yesterday could slow down the work of A&E departments for as long as it lasts.
The difficulty is that there is no quick solution to the problems which brought nurses in the Irish Nurses' Organisation and SIPTU onto the picket lines. A solution requires thousands of extra hospital beds and that will take years to bring about. It also requires thousands of extra convalescent and rehabilitation beds and this, again, will take years. Hospitals and their patients are paying the price for the failings of the past - particularly the failure to develop community services, including community hospitals.
Because of that failure the patients who should be at home or recovering in a community hospital are occupying acute hospital beds. Meanwhile those who have somewhere to go are often discharged too quickly and end up having to be readmitted. All this creates a shortage of beds, queues in A&E departments and cancellation of surgery and other planned treatment.
The contracting of more beds in nursing homes could help to a certain extent to address the immediate problems. However there is by no means an unlimited supply of nursing home beds and many nursing homes will not take highly dependent patients. Thousands of beds are to be provided in community hospitals under the national health strategy - an acceleration of these plans could help bring about change in as short a time frame as is feasible. But that is not enough. A way needs to be found for nurses, doctors and hospital managers to work out how to tackle problems in the hospitals at local level in a realistic way. This has been a key demand of the Irish Nurses' Organisation and it should be heeded.
For instance doctors in the Irish Medical Organisation want designated emergency beds and designated elective beds in our hospitals. In this way beds earmarked for planned surgery would be protected from being taken for emergency cases. The Irish Nurses' Organisation wants elective beds turned over to emergency cases without argument and, if necessary, without consultant approval, where necessary. The two stances seem opposed - yet experience at the Mater Hospital in Dublin suggests that designating enough beds for emergencies can help reduce queues in A&E while making it easier to provide elective surgery in a planned way in non-emergency beds. That sort of initiative can really only be worked out between all the parties involved at local level.
If the Minister, Mr Martin, can create the conditions in which the parties can talk at local hospital level, and in which they can implement initiatives, actions like yesterday's may never need to be repeated.