Pi times nothing equals?

Heart Beat: This morning's gems included two gentlemen arguing over the merits or otherwise of the lap dancing "industry", writes…

Heart Beat:This morning's gems included two gentlemen arguing over the merits or otherwise of the lap dancing "industry", writes Maurice Neligan.

Also there was the outcome of a case to make it compulsory for government health warnings on tobacco products to be printed in Irish as well as English. That'll make a difference.

Across the water, Peter Hain goes, and MPs accept a pay rise less than inflation. Aren't we lucky we live here?

Henrik Ibsen, in The Master Builder, wrote: "Castles in the air - they're so easy to take refuge in. So easy to build too."

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I suppose that could be an explanation for the warriors of the HSE as led by their redoubtable chief Brendan, as they attempt tirelessly to defend the indefensible.

To preserve my equanimity I have not written about the health service for several weeks. I had found that thinking about it was rather like prolonging a bad nightmare into waking hours and living every moment of it.

Such escapism is futile. Just when you think the mandarins have done their worst they exceed themselves and produce more masterpieces to inflict on the suffering (literally) citizens. If you avert your gaze for the briefest time there will be something new to admire when you look again.

"Ask your doctor, did he wash his hands?" Brilliant; don't bother with his excuse that he/she couldn't climb over all the trolleys to get to the single wash hand basin; you know what liars these consultants are.

You must understand, of course, that any trumpeted accomplishment is unlikely to be tangible and that the great successes of this Minister and her legions of acolytes are aspirational and futuristic. They don't do reality.

A long time ago, I discovered that there was no point in trying to make sense of the maelstrom of contradictory policies that are supposed to guide the delivery of healthcare in our community. It is simply impossible. Simplistically, it's like trying to put together a very large jigsaw puzzle in which almost, by design, none of the pieces fit.

For the critic there is an immediate problem. Where do you start or where do you continue? Where do you board this crazy carousel?

This was my problem when I forced myself to look again. I thought gloomily that any one of the points I wish to make would require chapters of their own in this sorry story, and, doubtless in what threatens to be a difficult economic year, they shall get them. It is sufficient now to rub the sleep from my unwilling and unbelieving eyes and focus haphazardly on various aspects of this tangled web.

In no particular order then, here goes. It looks as if the nurses have been fooled again. The powers that be won't lose too much sleep over that. Most of the nurses are women and can be pushed around a little. They're unlikely to create too much trouble. Well, nothing we can't live with any way.

Our nursing colleagues having been conned off the picket line and are expected to sit still and applaud bonuses and awards for the main players, including a bonus for Prof Drumm that is more than most of them earn in a year, and a major rise for the Minister and her colleagues, this latter hike temporarily suspended in the face of public outrage.

The nurses must have wondered had they lost their marbles when they read of a postulated €650,000 salary for the chief executive of the VHI. Even the poor consultants' "Mickey Mouse" money has been fleshed out a bit.

So what did the nurses achieve for their little vagary? A possible reduction of their working week to 37.5 hours provided it could be achieved, as the Minister put it, in a "cost neutral" way.

It can't, but I shall return to that point another time. As for filthy lucre, why did our collection of Florence Nightingales want more money? Isn't their vocation enough for them?

In any case, they were sent to that tired old cash cow, "benchmarking", shamelessly played up as the only game in town. The nurses went reluctantly and their reluctance was justified.

The bench markers quickly tried to pass on this hot potato; "The claims are not in our remit", they chorused, "let the chalice pass". Try the Labour Court, they recommended in a classical Billy to Jack manoeuvre. The end result in the words of the old limerick is the nurses wound up with pi times the square root of **** all.

I wonder if it ever occurred to the mandarins that there could be a connection between this shoddy treatment and the failure to recruit nurses for secure psychiatric units and indeed for wards and medical and surgical teams across the State.

Maybe it's not too bothersome because closed units save money. Dangerous, disturbed patients wandering around because of the lack of secure units are another matter. That doctors and nurses and indeed the public are at risk in consequence of the failure of such provision seems of little account.

TS Eliot wrote that "among all forms of mistake, prophesy is the most gratuitous". Despite this I'll put my hat in the ring and prophesy that the nurses have had enough and they are unlikely to take this lying down.

I will write about beds, the scandal of cystic fibrosis treatment, beds, the northeast, beds, doctors at all levels, beds, community services, beds and, of course, beds. There's lots of time and I'll try and get around to them all.

Maurice Neligan is a cardiac surgeon