On Tuesday the nurses' strike will start. That much seems to be inevitable. As this is being written the arrangements for dealing with emergency patients have not been finalised.
The nurses want to decide who should be admitted, as do the consultants. But neither side wants the other to be involved in the making of that decision.
This doesn't seem to make sense. Both groups are committed to the health of the patients. Both groups would appear to have the same goal in mind. So what's the problem? Suspicion. Suspicion of the motives of each side. The nurses are worried that the consultants will fill the beds with patients whose treatment will, in some way, benefit the consultants.
And the consultants believe that it will not just be the nurses but their unions that will decide who gets into hospital. And the unions, they reckon, will fill the beds with patients the treatment of whom will, in some way, benefit the unions.
These stances might be understandable if the nurses were striking for better pay from the consultants. But they're not. As health professionals, these people should not be divided into factions at all.
Arriving at a system for dealing with those requiring immediate care should not involve conflict. The consultants, as they are the most qualified to judge, should be looking after setting the criteria.
And they should spend some time discussing those criteria with the nurses, adjust them as appropriate and brief all the staff, nursing and administrative, on the rules arrived at.
Suspicion has led to this relatively straightforward solution being buried under the conviction that "the other side is up to something". And the suspicion has been brought about by ghettoisation within the health services. This dispute has highlighted that nurses and consultants are not communicating properly. It is as if they work in the same location but somehow manage to do so without coming into meaningful contact with each other.
Both sides are convinced the other has its own agenda or, worse still, they don't care whether they have an agenda or not. These people who should be working together as a team to save lives are, in practice, members of two separate teams who, up until now, have happened to work together to treat the patients.
This strike is going to worsen the situation and, as soon as it is over, the management of the health service and the Department of Health must implement a strategy to address the issue.
Unexpectedly, the nurses and the hospital management don't seem to suffer this malaise. Anyone involved in that relationship to whom I have talked has expressed the same view: that the nurses have made the distinction between where they work, to whom they report and who actually employs and pays them. It is to be hoped that this level of understanding survives the strike, but this is by no means certain.
ANOTHER area of uncertainty is how this strike will play out. Acres of newsprint and hours of airtime have been devoted to this strike but speculation as to how long it will last and who will come out of it smelling of roses has been limited.
There seem to be two likely scripts.
Script One. The Mortgage Limit. Over half of nurses have mortgages. During the strike they will be getting some strike pay but it will come nowhere near the wages they were on. Even those providing emergency cover have insisted, laudably, that they receive no pay.
The mortgages were taken out on the basis that usually there would be two wage packets coming in each month. At the end of the first month of the strike the mortgage payment will come out of one wage packet. Belts will be tightened but the payment will be made. By the end of the second month, maybe that payment will be made. But the nurses will know there would be no hope of making the third one. At that point they will have to call a halt.
As I've said before, public opinion is not so solidly behind the nurses that they will be able to force the Government back to the negotiating table in those two months. At the same time, public opinion is not against the nurses.
Defeating the strike will do the Government little good except with business people. The longer-term effect on the health services is likely to be disastrous. We are desperately short of nursing staff. Hospitals have been recruiting nurses from abroad. They have had to contact those due to arrive in the next few weeks and explain that they will have to postpone hiring them because of the strike.
When hospitals return to recruiting from abroad, their job will be even more difficult. What nurse will want to leave a job in England to come and work in Ireland and face the prospect of more industrial unrest?
Script Two. The Measles Option. The Taoiseach is a consensus finder. A negotiator. So far he and his Cabinet have been very clear that they will not enter into any negotiation that would jeopardise the partnership scheme. But I suspect that other options have already been quietly explored; that a system may already have been devised to take some of the nurses' grievances out of the partnership scheme altogether, to create a special case, a special method of calculating these claims.
Such a solution would not eliminate the potential industrial relations problems looming with other public sector employees. But it would make it easier to deal with them, as they would have to put forward an equally persuasive argument in favour of their receiving special treatment. And anyway, we don't have a shortage of gardai or teachers at the moment.
Having established a hardline stance, suddenly coming up with this plan out of the blue is not an option for the Government. My bet is that a medical emergency such as the threat of a measles epidemic will suddenly appear. Everyone gets to save face by going back to work and back to the negotiating table in order to protect the health of the public.
The Taoiseach gets to ride in on a white charger with the solution clutched between his teeth (two hands must be kept on the reins of power at all times), and everyone wins. The nurses get their money and their recognition. The Government finds the solution and the strike can be brought to a close within a couple of weeks, thereby rescuing the relationship between staff and administration.