Because there are so many. This past week alone, we've had the electricians' 'lightbulb' dispute affecting services in the south, and the case of the missing hospital porters in Limerick which meant the parents of a seriously ill teenage girl had to wheel her into the operating theatre themselves.

And already this year, hospital consultants have blocked 68 new consultant appointments in their row over pay and conditions; nurses have taken nationwide action over a 10% pay claim and a 35-hour week; and the entire 130,000 health workers are threatening action over a promotion and recruitment freeze imposed by the HSE in its effort to claw back a 250m budget overrun.

What about local problems?

Besides the more public manifestations of industrial turbulence besetting the health service, the secretary general of the Department of Health, Michael Scanlan, last year listed a total of eight local disputes which he considered serious enough to warrant withholding national pay increases from the workers involved.

These local bushfires included a dispute by ambulance personnel in the west over the move to a new ambulance and fire control centre; industrial action by social care workers in the Brothers of Charity services in Bawnmore, Limerick; industrial action by support staff in Waterford regional hospital over the use of outside security staff; a dispute involving public health doctors over out-of-hours service; and the withholding of cooperation by home helps from the introduction of additional homecare packages.

So what's ailing health service staff?

The Department of Health has spent more money on more consultants producing more reports than any other government department trying to answer that question.

But few, if any, of these have got past the implementation stage.

A large part of the problem is that the health service has mushroomed in the last few years and is now almost out of control . . . and neither politicians, employees or management appear to have the ability to steer it in the right direction. Five years ago, less than 93,000 people were employed in the health service, operating on a budget of 7.8bn. Today this has soared to 130,000 and a budget of 14bn. But throwing manpower and money at the service has not helped because the basic problem is a cultural fear of change, not lack of funding.

In the same period, like many other public services, the public's expectations of the health service have also changed. People are no longer eternally grateful when a doctor deigns to see them . . . now they demand it 24/7.

But politicians, management and staff have been too slow to react to this radical change. Doctors still talk about patients, not customers.

Health is also very emotive in that it deals with death and illness. A person who dies on a waiting list is far more likely to hit the headlines than somebody who was delayed getting away on holiday because of inefficiencies at the airport.

So what are the politicians doing?

Very little. Like rabbits caught in headlights, the enormity of the problem in the department that former health minister Brian Cowen dubbed 'Angola' has rendered most politicians motionless.

In fact, less than little has been done in that the favoured line has been to shunt responsibility elsewhere. Micheal Martin passed the problem over to consultants and expert groups, but the most obvious sidestep came when his successor as health minister, Mary Harney, set up the HSE to do the work of the Department of Health.

Demolishing the complicated old health board structure, and replacing it with an even more complicated structure which even the HSE itself doesn't appear to understand, has certainly not helped the health service at a time when it desperately needed a strong guiding hand.

In fact, some unions suggest that the almost two years it has taken for the HSE to bed down has exacerbated the industrial relations problems in the health service because nobody seems to know who is in charge of what areas.

And what are the unions doing?

Engaging in industrial action far too quickly. Even the threat of action is very disruptive to such a critical service which is supposed to operate around the clock.

Another factor which has added to the unrest is rivalry between staff. Staffing in the health service is rigidly hierarchical and everybody keeps a close eye on their colleagues to ensure they don't get ahead of themselves.

The INO's action last March for a 10.6% pay claim was based on the fact that unqualified care workers were paid more than qualified nurses to whom they reported.

The claim for a 35-hour week was also based on the fact that paramedics work a 35-hour week.

Of course, no sooner had the nurses secured some promises of a 35-hour week than support staff . . . such as porters and attendants . . . wanted a 35-hour week.

And management?

They're spending too much time fighting local bushfire disputes without having the necessary authority to take decisive action . . . even if they wanted to. In many instances, management at local level are caught between a stunned government, a confused HSE and a volatile staff, and doing nothing.

The nurses' dispute last March was targeted at a government about to go to the country, not at the health service per se. In short, the dispute became political which meant its resolution was beyond management.

So what, if anything, is being done, then?

Late last year, Ictu leader Dave Begg admitted the health service was facing a number of major industrial relations problems and that the existing partnership agreement was unable to handle the sheer weight of issues involved. In a major departure for a trade union leader, Begg proposed to Taoiseach Bertie Ahern the establishment of a Health Forum under which doctors, nurses, paramedics, porters and managers would come together and agree the major reforms and changes so urgently required.

Ahern told Begg both he and Mary Harney "would be very supportive of such an initiative".

Peter McLoone, head of the Impact trade union which represents a number of professional health workers, has also said staff and management need to embrace change.

If not, the trade unions run the risk of isolating themselves from the public they serve, McLoone acknowledged.

So has this new Health Forum worked?

Bar a couple of 'exploratory meetings' last March, the forum has yet to meet. Ironically, the nurses' dispute last March came too early for the fledgling forum to try and resolve what became a political dispute. The forum was put on hold and there it has remained ever since.

When, if ever, it gets down to business, the agenda will be considerably longer. To the consultants and nurses looking for more money to work less hours will be added the electricians who don't want to see anybody else change a lightbulb and the porters who are too sick to wheel a patient into theatre.