DOUBTS about the opening of Cork University Maternity Hospital have hung over the southern region for some time now, forcing the Health Service Executive (HSE) to yield to the demands of nurses and midwives and delay the opening until this weekend.

All the same, the HSE had insisted that if the hospital did not open this weekend, it would not open this year. It finally opened yesterday, following a dispute that had both failed to capture the public's imagination and, like most healthcare rows, left patients stranded. The Sunday Tribune goes back to the beginning to examine why the dispute started and whether it's been worth it.

Why has Cork been given a new maternity hospital?

For years, Cork women have given birth in one of the three Cork hospitals . . . St Finbarr's, the Erinville and the private Bons Secours. In 2002, the then minister for health, Micheal Martin, announced plans for a new 150-bed maternity unit adjoining Cork University Hospital. Costing 75m to construct and 60m a year to run, the new maternity hospital would have world-class facilities and the added benefit of being co-located with Cork's primary hospital.

Recommendations from the British Paediatric Intensive Care Society and international midwifery expert Marie Washbrooke were taken into account in the planning of the hospital, and it was built on time and under budget.

On Saturday 24 March, it was ready to start delivering a new generation of Cork babies, who would arrive into a world of walnut and maple furniture, flat -screen TVs and en-suite bathrooms.

But when a row over staffing levels between the Irish Nurses' Organisation (INO) and the HSE was not resolved by Saturday of last weekend, the opening of the hospital had to be deferred for a week. As the welcome bouquets wilted, the HSE decided to play hardball, announcing that if the hospital was not opened this weekend, it would not be opened this year, meaning 200 people would lose their jobs.

Why are we having a dispute five years on?

An amalgamation steering group, involving employees from each of the hospitals, has been meeting for the last five years to ensure a smooth changeover. However, at the start of February this year, nurses and midwives of the INO informed the HSE that they would be "unavailable for transfer" to the new hospital until staffing levels were improved.

"The hospital may be decorated beautifully, but the unit will not be clinically viable until the HSE has delivered on the number of midwives necessary to run a safe service, " said INO industrial relations officer Patsy Doyle.

In the Labour Court, the INO and Siptu argued that the HSE was not adequately staffing the 144-bed unit and was including nursery nurses in its numbers. In its defence, the HSE said that just seven of the 375-strong staff were nursery nurses.

The unions also sought upgrades for night sisters, retention of paid meal breaks for staff transferring from St Finbarr's, retention of free parking for staff from the Erinville and, crucially, relocation compensation of 3,000 per worker.

In its decision, the Labour Court said that 375 was an adequate staffing level for the new hospital, once this didn't include nursery nurses. It rejected the unions' claim for cash compensation, instead granting one extra day of leave on a one-off basis in 2007/08. Staff at St Finbarr's were granted paid meal breaks until the end of 2008, while Erinville staff could retain access to parking for as long as was feasible.

When it was revealed just days before the opening that, in fact, the HSE had only 315 nurses available to it, the nurses refused to start work in the new hospital and eleventh-hour negotiations began.

Was it all about the money?

As talks continued furiously between the unions and the HSE over Friday, Friday night and Saturday morning of last weekend, the Saturday noon opening of the hospital was first put back to 4pm, and finally postponed for a week.

Although the HSE offered to open the hospital at a reduced capacity of 128 . . . just 12 more beds than is currently available in Cork's existing maternity hospitals . . .and the INO urged its members to accept this deal, over 98% of nurses and midwives voted against it.

Minister for Health Mary Harney immediately jumped into the fray, claiming that the nurses were failing to cooperate for purely mercenary purposes.

"It is an absolute disgrace that a 75m state-of-the-art hospital funded by the taxpayer cannot be opened for mothers in Cork, " she said. "The issue here isn't about safety, but about money for individuals."

The INO reacted furiously to these claims, saying it was thinking only of patient safety.

"The only issue that was the problem was the failure of the HSE in the south to deliver the 375 qualified nurses and midwives that had been recommended by the Labour Court, " said INO general secretary, Liam Doran.

Sadly for the INO, these lofty claims were seriously dented when it emerged on Saturday morning that it had indicated to Harney that if a compensation of 1,000 was paid to each member, the midwives would work in the hospital at the reduced capacity of 128 beds. This has left it wide open to claims that, in fact, patient safety has not been the nurses' priority.

What was the point?

Public sympathy seems to have long since dried up for the nurses and midwives of Cork University Hospital. If they had accepted their union's initial recommendations and took up the HSE's offer of an opening at reduced capacity, the hospital would have opened on schedule and with an acceptable level of staff.

"The number of midwives at this new hospital will be significantly higher than heretofore in Cork, the highest in the country and among the highest in the world, " Prof Brendan Drumm, CEO of the HSE, said last Saturday, adding that he "deplored" the attempts that had been made to portray the issue to the public as one of patient safety.

The fact that pregnant women have been left in a state of uncertainty over which hospital to present to has also been detrimental to the midwives' campaign and their efforts to blame the HSE (usually an easy target) have been futile in the face of their demands for money.

"I have been to the Labour Court not once but twice, " said assistant national director of human resources for the HSE South, Barry O'Brien. "And my position has been endorsed not once but twice. There are no other options open."

For the midwives, as negotiations dragged into their hundredth hour last week, it seemed that there were. By Friday, everyone was getting a bit cranky.

"Safety, safety, safety, safety, safety, " Doran snapped at RTE when asked if the dispute was still about money. "Is that clear enough for you?"

By then, both sides were haggling like fishwives over eight beds. The HSE wanted to open yesterday with 124. The INO was pitching for 116. Insiders said progress was being made, but that it was happening at a snail's pace. A resolution was finally reached late Friday night.

It has been clearly established that patients presenting to Cork University Maternity Hospital will not be at risk.

Meanwhile, over 200 pregnant women were inconvenienced, and 200 jobs threatened. The single biggest investment in obstetric care since the foundation of the state was at risk of lying empty for the rest of the year. And all because of eight beds.