What is going on in the emergency departments of our hospitals? So far this year we have had reports of miscarriages in the corridors at St Luke's in Kilkenny; of the death of a man after a weekend on a trolley at the Mater in Dublin, and of a man dying after being sent home in a taxi from St James's Hospital in Dublin.
And then there are the common-or garden ordeals: heart attack and stroke patients spending the best part of a weekend, or indeed a whole weekend, on trolleys, to their own distress and that of their families.
In all this, we have heard little from our political parties. By and large they have maintained their composure suspiciously well in the face of lamentable circumstances. The suspicion is that they are not able to bring themselves to care because they are not willing to contemplate the sort of spending it will take to put the system right.
The most high-profile reaction to what is going on has come, not from a politician, but from one of those most pilloried of health professionals, a hospital consultant.
Patrick Plunkett has worked in the emergency department of St James's Hospital for 13 years. He is not given to broadcasting his complaints through the media. Now, however, he has resigned, in a very public manner, from the board of the hospital because he says he can no longer stand over the "mess" he finds every morning.
In essence, he sees one core problem in the system: there are not enough beds.
Hospital beds fill up in two ways: from the waiting list (elective admissions) and from the emergency department. When there are not enough beds, these two sources of patient have to compete.
A conference organised by the Royal Academy of Medicine in Ireland heard recently that up to half the planned gynaecological surgical operations at Tallaght Hospital are cancelled the night before as beds are taken up by admissions through the emergency department.
That's one example of how the competition for scarce beds can disadvantage the patient.
Mr Plunkett gives the example of a person coming off the waiting list to have varicose veins done or a tattoo removed "and leaving somebody who's in congestive heart failure on a trolley for 24 hours in an emergency department".
NOW the person with varicose veins or with a tattoo that seemed a good idea at the time is entitled to be looked after, too.
But the shortage of beds has forced choices which should not have to be made. And they will go on having to be made. Politicians love waiting-list "initiatives" in which they earmark £10 million or £20 million at a time to reduce the waiting lists.
The initiatives work, for a time at least, but at a price. The price, as Mr Plunkett sees it, is paid by patients marooned on trolleys or on chairs when the trolleys run out in emergency departments.
The real price of waiting-list initiatives should be more beds. The bad news is that our political parties take the same attitude to requests for more beds that the master of the orphanage took to Oliver Twist's request for more gruel.
For instance, the Labour Party proposals on the health service list 12 points regarding acute hospital services, not one of which promises more beds.
The party does, it should be said, mutter darkly about "gross inefficiencies" such as "bed-blocking".
That's your granny and mine - and one day you and me - having the audacity to occupy an acute hospital bed for longer than is approved by the planners.
Fine Gael's health document runs to 63 pages on our computer and, when we searched for the word "beds", we found only one occurrence. That was about ensuring "the efficient use of hospital beds".
There is, to be fair, a single phrase in the 63 pages which includes an unspecified increase in bed numbers as part of the promised annual £500 million increase in health spending. It is not a lot and it holds out little hope that things are going to improve, especially as beds are not mentioned in the document's 16 "key points".
As for the Government, we have a Minister for Health and Children launching think-tanks and studies to beat the band. There is a value-for-money study, a beds study, a health strategy forum, a medical-manpower forum, a benchmarking process, and groups working away on matters relating to nurses and paramedics.
What we haven't had is a strong statement that the 3,000 beds taken out of the system in the 1980s by Fianna Fail, Fine Gael and Labour will be restored.
The Minister, Mr Martin, is believed to consider that the system is short about 2,000 beds. It may be that the "beds initiative", when it sees the light of day, will include proposals to restore those.
There again, it may not.
But without the extra beds, the high sounding policies of the parties will be no more than tricks with smoke and mirrors.
And the sick will continue to have to fight each other for scarce beds.
pomorain@irish-times.ie
