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Editorial - It’s all about ceilings but where is the floor?

At this stage, all of us are very familiar with the term ‘employment ceiling’ and the oft repeated argument, by management that it is over its ceiling and cannot fill even the most essential of frontline posts. In recent months this argument has been accompanied by health employers saying that where they have dropped below their employment ceiling their overall financial situation does not allow them to fill vacant posts.

In essence, you either have the argument about ceilings, or the argument about budgets or, indeed, both arguments from management as the excuse for not filling nursing/midwifery and other frontline posts. The difficulty with this approach is that it fails to acknowledge or respond to the ever-increasing demand for healthcare. Official figures also confirm that the number of people attending emergency departments has increased again this year, the number of out-patient appointments has increased, the number of admissions and day cases has increased and the number of home visits has increased – yet demand cannot be met and waiting lists continue to rise.

Added to this you have ministerial announcements establishing the ‘Special Delivery Unit’ that will be charged with the function of increasing the throughput of hospitals, minimising waiting time for treatment in EDs and initiating other structural changes. Then you also have the ministerial commitment that all people, on an elective waiting list for treatment in excess of 12 months, must have their treatment provided before December 31 this year.

All of these commitments are laudable. However they are, quite frankly, just commitments that will not be realised without a serious policy shift, regarding protecting services in the Irish public health service as it is today, regardless of the current austerity programme and financial challenges facing the country as a whole.

The stark reality, to patients and those working in the frontline, is that our health service is now under unbearable pressure, standards of care are inevitably dropping and patient outcomes are being compromised arising from shortage of staff, increased patient dependency and delays in accessing treatment.

Despite this patent truth we still have managers (yes, some of them remain as removed from the frontline as they could ever be) telling us that more cuts are on the way, further frontline posts will be left unfilled and the only thing that matters, regardless of impact, is that the health service comes in on budget. So, when government and management continue with their mantra about employment ceilings and financial limits, we must, louder than ever before, ask the question “where is the floor?”

We must focus on forcing the political system and management to answer these questions. When will we reach the minimum level of staffing that is required to provide safe care? When will we reach a level of staffing that will require local management, regardless of their budgetary difficulties, to fill posts so that care needed will be supplied by the right person, in the right place, with the right qualifications and competence at the right time?

It is no longer acceptable for this Minister, this government and health service managers to only speak about employment ceilings and financial limits. They must demonstrate that they understand the damage to the very core and fabric of our public health service that is taking place on a daily basis. They have an obligation to recognise that the health service has been cut enough and that if care is to be provided safely then current policy is flawed, disjointed and contradictory.

Healthcare must always be delivered efficiently and effectively. However the scalpel, cutting deeply, and the sledgehammer, being used without mercy, can no longer continue to be wielded. This new government, with its commitment to transparency, must accept this immediately and act to protect what is left of our public health service.

Liam Doran
General Secretary, INMO

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