The dis­clo­sure by North Cen­tral Re­gion­al Health Au­thor­i­ty (NCRHA) chair­man Dr Tim Gopeesingh that the au­thor­i­ty has been haem­or­rhag­ing some $3 mil­lion a month on pool nurs­ing costs is as re­veal­ing as it is alarm­ing.

Re­ports are that some nurs­es have been earn­ing close to $30,000 a month in over­time, while oth­ers are said to be av­er­ag­ing $80,000 over a nine-month pe­ri­od, fig­ures that de­mand clos­er scruti­ny amid the on­go­ing stand­off be­tween the Gov­ern­ment and the nurs­es’ as­so­ci­a­tion.

Be­hind those num­bers lies the un­com­fort­able truth that our health­care sys­tem is not op­er­at­ing ef­fi­cient­ly and has there­fore be­come struc­tural­ly de­pen­dent on over­time to com­pen­sate, in re­al time, for its own de­fi­cien­cies.

To make mat­ters worse, nurs­es and mid­wives in 2026 are still teth­ered to 2013 salary scales.

Yes­ter­day, nurs­es stepped up their sick-out ac­tion, which be­gan over the week­end, with a ma­jor protest out­side the Er­ic Williams Med­ical Sci­ences Com­plex in Mount Hope as a show of dis­gust over the Gov­ern­ment’s han­dling of the mat­ter.

As Nurs­ing As­so­ci­a­tion pres­i­dent Idi Stu­art has point­ed out, these pro­fes­sion­als are be­ing asked to nav­i­gate present-day de­mands on wages that be­long to a by­gone eco­nom­ic era.

When pool rates are re­duced with­out ad­dress­ing this im­bal­ance, the bur­den will not dis­ap­pear but sim­ply shifts fur­ther on­to al­ready over­stretched work­ers who are, in ef­fect, prop­ping up an in­ef­fec­tive sys­tem.

This can lead to a wors­en­ing of pub­lic health­care de­liv­ery, which re­quires pro­fes­sion­als to be at their best to per­form at their best.

In this con­text, Dr Gopeesingh’s au­dit, which re­port­ed­ly cut pro­ject­ed over­time ex­pen­di­ture from $90 mil­lion to $15 mil­lion, may rep­re­sent a move to­wards fis­cal dis­ci­pline.

But cost con­tain­ment in iso­la­tion is not re­form. It does not an­swer the most crit­i­cal ques­tion: if the over­time cush­ion is sig­nif­i­cant­ly re­duced, who will ul­ti­mate­ly fill the gap at the bed­sides?

That ques­tion must an­chor any se­ri­ous ne­go­ti­a­tion.

It is not enough to re­as­sure the pub­lic with de­c­la­ra­tions of pru­dence; there must be a cred­i­ble plan for main­tain­ing, if not im­prov­ing, the de­liv­ery of care.

Com­pli­cat­ing mat­ters fur­ther is the re­gion­al un­der­cur­rent—shaped in part by ex­ter­nal po­lit­i­cal pres­sures—to phase out Cuban med­ical pro­fes­sion­als.

In a sys­tem where nurs­es are al­ready warn­ing of pa­tients be­ing left un­at­tend­ed due to se­vere un­der­staffing, any move to re­duce for­eign med­ical sup­port must be ac­com­pa­nied by a clear and cred­i­ble strat­e­gy to re­cruit and re­tain lo­cal tal­ent. Any­thing less would be reck­less.

The si­lence of Health Min­is­ter Dr Lack­ram Bo­doe so far on this mat­ter does lit­tle to in­spire con­fi­dence. At a time when clar­i­ty is most need­ed, the ab­sence of a firm, trans­par­ent po­si­tion on­ly deep­ens un­cer­tain­ty.

What is re­quired now is ma­tu­ri­ty on all sides—a con­ver­sa­tion that ad­dress­es the needs of nurs­es but al­so fac­tors in our fis­cal po­si­tion.

Most im­por­tant­ly, we must re-ex­am­ine how we can build a sys­tem an­chored in pre­dictabil­i­ty and pro­fes­sion­al­ism, to avoid a cost that will not be mea­sured on­ly in dol­lars, but in the qual­i­ty of care de­liv­ered, and, ul­ti­mate­ly, in the lives placed at risk every day with­in our hos­pi­tals.