When the CEOs and senior consultants in Dublin's premier hospitals issue a consensus statement on the health service, it is time to sit up and take note.
The statement by a group of individuals who would normally occupy opposite sides of the administrative fence is an indication that the crisis in the health system has reached an unprecedented level.
The five Dublin Area Teaching Hospitals (DATHS) are, taken together, a pillar of the health service. In association with the university hospitals in Galway and Cork, they are the major repository of medical expertise in the State. Such teaching hospitals help to develop national best practice, ensuring the highest standards are maintained throughout the system.
With a normal complement of 2,800 beds delivering 223,000 treatments a year and some of the busiest accident and emergency departments in the Republic, these hospitals provide healthcare to local populations, including some of the most deprived people in the State. They look after a growing population of older and sicker patients as the State's demographics undergo rapid change. Each has at least one area of national expertise not available elsewhere.
It is a worrying development when such premier institutions issue a lengthy statement, outlining "potential delays in the diagnosis of medical conditions and in the performance of necessary operations" as a result of financial pressures.
Their reference to delays "in the treatment of the sick with consequent unnecessary morbidity because they cannot get into hospital - including disability, deformity and pain (with reduced quality of life)" represents a strength of language not normally associated with senior managers and clinicians.
We are now paying a price for the failure to reverse the severe cutbacks sustained by the health sector in the late 1980s.
The fundamental problem is a lack of hospital beds. If the action forced upon the DATHS is replicated elsewhere in the health system, over 800 beds will be lost nationally. This figure must be compared with the 700 additional beds promised by the Minister for Health by last March and an acknowledgement in the National Health Strategy document that 3,000 additional beds were required.
With a growing number of acute treatment beds occupied by - mainly - older people who are medically fit for discharge but with nowhere to go in the community, it is time the considerable capacity in nursing homes in the greater Dublin area be commissioned to help alleviate pressure on hospital beds.
The current situation in the health service is a national crisis. While reform of the system and the need to ensure better value for money must be vigorously pursued, the Government must also consider transient funding to alleviate the acute shortage of hospital beds.