In a timely statement on May 1st, nurses in Cork city's A & E service poured scorn on the HSE. Part of the reason why they did this was because of the ongoing situation at Cork's Mercy Hospital. In their statement, the nurses said that it was their "collective view that patient care is being compromised and that it is only a matter of time before there are serious issues and incidents ..." A month on from that statement there has been no resolution in the Cork area. The Workers Solidarity Movement look at the issues and how the impasse could be resolved.In March of this year a leaked memo from a doctor at the Mercy Hospital in Cork revealed a startling situation. A new Accident and Emergency unit, commissioned to meet the expanding needs of one of Cork’s busy city centre hospital, was lying idle and unused. The new A & E, part of an elaborate extension to the Mercy Hospital’s facilities, had been completed and equipped in early 2007 but a year later it still hadn’t seen a single patient. 

The upshot of the travesty, highlighted in the leaked memo, saw the Health Service Executive (HSE) come under scrutiny. Some local public representatives spoke up about the situation and questions were raised in the Dáil. On April 8th, a report in the Irish Times revealed that a short fall in funding was the basis for the problems at the Mercy. The article quoted the head of the HSE, Brendan Drumm, as saying that the Mercy Hospital in Cork had to meet the staffing costs of the new A & E unit from its existing budget. If it couldn’t do that, then he was not in a position to do any more about the situation. In effect, Drumm was saying there would be no change. He also went to suggest that if the Mercy’s A & E situation was to be resolved, it could only be done so at the expense of other existing A & E units in the city.

Cork city nurses, via the Irish Nurses Organisation (INO) responded quickly with their own assessment of the situation in the city (Cork Independent, May 1st ). In a statement they called for a ‘health forum’ to discuss the “acute shortage of beds for emergency patients in the Cork area”. The nurses, mainly from Cork University Hospital (CUH), pointed out that services at CUH were already restricted due to the HSE’s refusal to employ new staff. Staff were overwhelmed and demoralised with the chronic underfunding of the service, a problem that was exacerbated by the delays in opening the new Mercy hospital unit – a unit initially intended to meet the increased demand in the city due to the city’s population growth. The nurses went on to say that “it was their collective view that patient care is being compromised and that it is only a matter of time before there are serious issues and incidents. Therefore immediate, radical, dramatic and determined action is now required to deal with this crisis.”

By early May, there was no resolution of the impasse - but there was a bizarre development. A compromise deal was reached between the HSE and the Mercy Hospital’s management. This “face saving” deal – face saving for the bosses in other words - proposed that the new A & E unit at the Mercy would open its door ‘part-time’ from the summer onwards. At present the Mercy has an older and smaller A &E in operation for 24 hours of the day. Under the new “deal” the 24 hour operation would be closed down and the costs saved diverted to give “12 hours” in the new A & E building. The deal in other words was in line with Drumm’s dictat: services can only be reorganised within existing budgets.

The upshot was widespread criticism. It was immediately pointed out by a range of health workers that all sorts of logistical and safety problems would arise with practical restriction of the A & E hours in the Mercy to just 12 per day. For example, it is estimated that the Mercy sees just 40% of its patients during the 12 daylight hours. With the new arrangement the other 60% or almost 10,000 would have to go to CUH (where nurses and A & E are already over stretched – as per the INO nurses statement above). Moreover the new arrangement would also mean a diversion of the ambulance and other services at night-time to the CUH. And what would happen with patients who arrived just before the Mercy facility closed at 8 pm in the evening? Would they be told to make their own way to CUH – a couple of miles way? Or would they be ferried by ambulances? An A & E doctor at the Mercy lambasted the arrangement, stating that he was “extremely concerned that if the new Mercy University emergency department was to only open on a part-time basis, the impact of diverting ambulances to the already overstretched emergency department at Cork University Hospital would be exceptionally dangerous and difficult to deal with at CUH"

Right now there is no resolution to the problem in sight. It has emerged however that the sum of money involved in the dispute at the Mercy’s A & E is a mere €1.5 million. This amount of money would pay for a total staffing of 25 persons, to include 15 nurses which would see the new A & E unit working 24/7.

The standoff at Cork’s Mercy comes as, nationally, IMPACT union workers in the health service begin a prolonged work to rule. The action by IMPACT (backed by 85% of members in a ballot) will involve health professionals, therapists, social care workers, as well as administrative staff. IMPACT members will stop “co-operation with HSE advisors, block non-emergency overtime and out-of-hours work, and halt co-operation with the HSE’s so-called ‘transformation programme’”. The aim of the action is to put pressure on those HSE and hospital managers to end the ongoing recruitment embargo in the health service. The embargo has led to a drop in the number of health workers in the service at a time when many services are stretched to their limit. The primary purpose of the embargo on recruitment is to assist HSE bosses in their enthusiasm to balance the budgets. Although the IMPACT action is national, it is the same recruitment embargo and budgetary concerns that has led to the current crisis at the Mercy Hospital’s A & E unit.

With the IMPACT work to rule now underway, a key question must be asked. Can the action by IMPACT alone have the desired effect? To answer this question, a central consideration must be brought into picture – this is Government policy. The HSE may well be the employer body that health workers have to deal with, and Brendan Drumm may well be its head, but the real culprit in all of this is the Government and its policies. It is at Government level that the decisions are being taken about the very budgetary matters that are, say, affecting services on the ground in Cork’s Mercy. So, in other words, it is Government policy that is at issue here and, ultimately, it is Government policy that must be challenged and overturned. But this leads on to a second consideration: what sort of action would it take to do this?

There is no avoiding the reality that nurses and health workers cannot win if they go out on all out strike on their own. Apart at all from huge media barrage they would face, significant danger would accrue to patients. There is always the possibility that some patients would either have their health compromised or would die. So an all out strike by nurses and health workers, while dramatic and potentially effective, is high risk and could backfire. It is perhaps in part for this reason that IMPACT workers are for the moment only taking limited action – action that will target HSE management but leave patients unaffected. In some way this is a wise strategy but is it, ultimately, ineffectual?

So what’s to be done? Clearly there is a huge need for action. But as the INO nurses at CUH pointed out: not just any action will do. It is time for radical and dramatic action. But what is the nature of this action to be? This is a key question and it must be faced up to by all of us over the next period. Health workers in particular are in the invidious position of doing valuable and vital work. If they strike, a lot of ordinary and vulnerable people can suffer. This is something no one wants to see, nor is it a road that can easily be gone down.

The solution in the longer term must involve solidarity. What sort of solidarity, you might ask. The key solidarity that must be looked for and must be won is the solidarity of those strong and powerful elements of the workforce who can very easily get results by stopping work. In other words, workers who can affect private business and private profit. We are talking here about the power workers, workers in the docks and workers in transports, to name just a few. Such workers, if they link up with health workers, can force the sort of “radical and dramatic” solution to the problems that we need.

Winning this solidarity will take time, but what is important to remember is that it can be done. Part of the process of building this solidarity must involve rebuilding the networks of rank and file links that have existed among sectors of workers at different times in the past but that have disappeared under the prolonged and debilitating influence of ‘partnership’. Such networks are the key to the independent direct action needed to tackle Government policy face on. Such links can and must be rebuilt and the process of doing just that must begin now.

In recent week the gravity of the situation faced by hospitals such as the Mercy in Cork has been highlighted once more by the revelations that the Mercy is actually cutting more wards and bed numbers to “balance its budget”. The most recent announcements concerns bed numbers in the area of women’s surgery. So as things go right now, the situation is not even stable. Rather it is worsening and we have the Government to thank for that. As the INO nurses said, it is time for radical and dramatic action.