The general secretary of the Irish Congress of Trade Unions has accused health board managers of failing to engage with unions on the "real and present crisis" in Accident & Emergency departments.
Mr David Begg said: "I am absolutely certain unions do not want to be involved" in the sort of protest being threatened by casualty nurses today. "There is nothing in it for them but unless they try to force the issue there is no one else who can."
He said the situation in A&E "appears to be getting worse instead of better", adding: "There is so much strategising for the future that there is no engagement with the current problems.
"The nurses feel that the health board chief executives do not want to focus on the immediate operational shortcomings of the health service or to engage with the unions to solve the problem."
Mr Begg was speaking in Galway yesterday as part of a six-part lecture series on the National Health Strategy.
Addressing the issue of change in the public sector, he said it was not easy, noting "of course people will seek to protect earning levels and any other conditions of employment threatened by change".
While these things can be managed, he said, "what will derail implementation of change is management putting forward proposals which people on the ground know will not work.
"That type of thing undermines the credibility of the whole process, and it is a more acute problem if levels of trust are low."
On the proposed greater use of the private sector to shorten waiting lists, Mr Begg said Congress would not be taking an "ideological stand" on the issue. "What we would oppose, though, is using taxpayers' money to build the capacity of the private sector through long-term public-private partnerships relating to service provision.
"Any available investment from the Exchequer should be used to build the capacity of the public sector."
On the issue of access to services, Mr Begg said: "I doubt if there is anybody in the country who does not believe we have a two-tier health system."
He said the ICTU believed the most effective way to get an immediate improvement would be to change medical card entitlement conditions.
"Giving medical cards to children would be a very progressive step which we would urge on Government."
Regarding the strategy as a whole, Mr Begg said ICTU supported the document as the culmination of a serious consultative exercise.
"If we have doubts, they are related not to the strategy, but to the political will to find the resources to underpin it and to the capacity of management to implement it."
Mr Begg's lecture was the fourth of six being delivered for the Buchanan Ingersoll lecture series on the National Health Strategy. The series was hosted by the Office for Health Management, New York.
Senator Hilary Clinton, wife of the former US president, is due to deliver the final lecture in Dublin in May.
