Only a liar or a fool would suggest that if the hospital doctors' strike goes ahead later this month it will not affect patients in a serious way.
The fact is that diagnoses will be delayed, tests will be postponed, and people who need hospital treatment will be back further in the queue.
And it is instructive for anyone (and that should be everyone) who has an interest in how the health service works, as to why we are at such an impasse.
This is one of those few issues in which money is not the main issue. It is about the length of time that doctors work, which also has implications for patient safety.
At the moment, junior doctors in hospitals can be working for up to 24 hours consecutively and for up to 68 hours a week.
The accumulated tiredness of someone under that kind of regimen would be dangerous in any job – it would be illegal, for example, in the case of a truck driver, but somehow, somebody in the health service thinks it's okay for doctors making life and death decisions.
But therein lies the problem. There is no one person in the health service who is responsible for this. It is everybody's responsibility and no-one's. So nothing has been done about it, the doctors have reached breaking point, and, as always, the patients are going to pay the price.
Not that the doctors are completely absolved of responsibility, but the main stumbling block is the HSE's inability to come up with a plan to end the practice of tired doctors trying to give proper medical care.
It's been 15 years since I first started writing about the European Working Time Directive (EWTD).
When the EU brought the directive in first for everyone, an exemption was given in the case of hospital doctors because they were so far over the guidelines, changes would take time. Much time has passed and some improvements made, but suggesting to hospital doctors that they are much better off than their predecessors is not a very good or logical argument.
The fact is they are still working for too long to be effective or safe, and they are subject to losing not just their jobs, but the right to practise medicine if they make an error – even if that is due to tiredness. The Irish Medical Organisation (IMO) told the HSE it was going to take a vote on industrial action on June 28, and on August 6 gave the HSE a deadline for that action. Since then the IMO has had seven meetings with the HSE, but no proposals or plans (it says) to end this practice.
Eric Young, who represents the doctors on behalf of the IMO, says that the strike and subsequent industrial action could be averted if the HSE provided the IMO with a plan that would show a template for how it was going to introduce the EWTD – a regulation that it is bound by law to introduce.
He says that the IMO is prepared to defer action if such a plan is presented to it. It is not looking for every doctor working in hospital in Ireland to have reasonable hours by September 25, merely that the HSE would have a plan by then that would show when this could be achieved within a reasonable time.
Many people would believe that doctors should never go on strike. But, after 15 years of waiting, many are at the end of their tether.
They are seeking what every other worker in the country is entitled to: working hours that are not unsafe by virtue of their length. In their case, it is not just their own safety that's at stake, but that of their patients.
For over two weeks now I have regularly asked the HSE to provide a spokesperson to explain what is being done about this. The HSE has repeatedly been unable or unwilling to do that. It has issued statements that detail some locations where it has been successful in reducing doctors' hours, but no plan for implementing this across the hospital sector.
The reality of modern media is that if you have a 'meeting' it is supposed that constructive talks are going on, and to a certain extent, this limits the antipathy of the public to HSE management because it is seen to be trying to solve the problem.
But since what the doctors are seeking is obvious and fairly simple to understand, and they have been looking for it for 15 years, it is not unreasonable to think that there's a certain amount of stalling on behalf of the HSE in the hope of using the unpopularity of industrial action to force doctors to accept a delay.
Young admits that the EWTD could be a financial issue in a few instances, but that in 80 per cent of cases it would not require any extra money at all. If that is so, then there is no reason not to address the issue now. In fact, it should be a proud boast of the HSE that it has sorted this out. Not alone could it claim to have made hospitals safer, but it would also attract people into the profession and retain the people that it has.
Unfortunately, the HSE is not flexible enough in its management structures to allow for any one person to cut across the bureaucratic lines and solve a relatively simple problem of management. But coming up with the template of a plan now would, and should be the HSE's priority to avert industrial action, and take one small step toward improving hospital care.
The doctors may be hoping people blame the HSE for any industrial action, and the HSE may be hoping the opposite, but in the event of a strike, the public is likely to say 'a plague on both your houses'.
Brinkmanship is not acceptable in this scenario. Patients due to receive hospital care on September 25 will worry and possibly defer their own care. This could all be avoided if the HSE simply produced a plan now to deal with this problem, and time is of the essence to protect patients – which, after all, is its job.
The patients are the only ones in this fight who aren't sitting at the table – but their voice should be heard by all those who are.