It could be an item in one of those TV programmes designed to fill airtime cheaply – a "strange but true" eyebrow-raiser.

Last week, the Labour Court recommended the country's 4,000 junior doctors should be rostered to work their 39-hour week shifts across a seven-day week and within daily hours ranging between 8am and 9pm during the week and 8am and 7pm at weekends before qualifying for overtime.

The surprise to most people who ever worked in a career that requires 24/7 cover is that the medics' normal shifts cover only standard "office hours" – nine to five, Monday to Friday – guaranteeing substantial overtime for every hour worked early in the morning, later in the evening or at the weekend.

The work practice is so clearly unacceptable that the doctors' represent­ative body, the Irish Medical Organisation, has recommended they accept the new rosters, and they are now being voted on.

The deal is being hailed by the HSE as one of the most significant advances in the management of our hospitals since their foundation and it hopes it will lead to greater efficiency – as well as patient safety.

It's a measure of just how barmy the health services, and huge swathes of our public service practices, have become that basic and perfectly reasonable working practices have to be fought for in such a protracted, bureaucratic way – and then hailed in superlatives when they are achieved.

This week, the review body set up by the finance minister last December to cut public spending is due to publish its first report.

Initial signals are that Colm McCarthy's An Bord Snip Nua will recommend major efficiencies in the way our public services are run, but also cutbacks in social welfare and child benefit. It had been thought he would find ways of lopping off a few hundred million from day-to-day spending. But his review, which has rummaged around in every dark corner of every government department, is thought to be targeting billions in wasteful practices and spending we cannot afford.

McCarthy, a UCD economics professor who would have some insider knowledge of the lavish terms and conditions bestowed on those working in the upper levels of academia, has gained a reputation as an outspoken advocate of efficiencies in the public services.

So it stands to reason we should brace ourselves for fundamental reforms in public sector management structures and work practices. With one euro in every three spent on public services now borrowed, the credibility of the government again hangs on the ability of Brian Lenihan and the Taoiseach to sell the reforms likely to be recommended.

Unfortunately, this government is not overly endowed with leadership skills but the stakes are too high to let this descend into another public-sector-bashing exercise.

Brian Lenihan last week said there was "a great deal of denial" among people over the economy, though a greater sense of realism was starting to prevail. Reforms of our public services won't be easy, and we can expect a titanic clash with public sector unions, but if change starts at the top and works its way down it might stand some chance of gaining acceptance among the wider public service and the electorate generally.

RTÉ director general Cathal Goan won a narrow majority among RTÉ staff for graduated pay cuts among the station's staff because he insisted the so-called "stars" take the biggest reduction first and lead by example. Of course nobody is happy, but where there is a measure of equity, it makes the pay cuts just about digestible.

The same needs to happen across the public sector. The review body on public expenditure will look at how the public sector can be managed more efficiently. But before anything happens, the massively inflated salaries of the top echelons of civil servants – whose competence has at times been questionable given the state of the economy and the mismanagement of so many of our public services– must be the first target.

Highly paid refuseniks – including serving TDs who were clinging on to ministerial pensions – are undermining the cause of reform across the public sector and need to be faced down if efficiencies are to be gained on a wider scale.

It may turn out that our public finances are so dire, cuts will have to impinge on the least well off. But before social welfare payments are cut, before hospital wards are closed, before the contracts of carers for the elderly in their homes are terminated, and before vulnerable children are left without adequate standards of care, it would be preferable that those with the power to effect change – including highly paid medical consultants, HSE managers, top-ranking civil servants, academics, teachers, nurses and other well-paid public servants – take a measure of responsibility and agree to the sort of flexibility and efficiency that decades of agreements about work practices, grades and increments have squeezed out of the system.

Writer and film maker Mark O'Halloran produced a searing indictment of the Celtic Tiger two years ago with Prosperity, his award-winning television series about people on the margins of the boom. These days, he says, "it would be very good for Ireland if everyone were to understand the importance of personal responsibility which is something we give up too easily. It is always somebody else's fault... we need to face up to the fact that we also allowed ourselves to be conned. I think, particularly throughout the boom years, our society was drunk."

We are a small enough country to feel just a little bit ashamed about the effect our personal excess is having on everyone else, particularly if that excess is funded at the taxpayer's expense.