expectations from the community.

On the one hand, they have been expected to provide the type of medical care normally only found in major cities. On the other hand, they have been expected to make this care available at a reasonable cost.

The news that nurses at King Edward VII Memorial Hospital intend to issue a 21-day strike notice highlights this dilemma because many of the concerns of the nurses come about directly as a result of this twin challenge.

In the last few years, the hospital has worked hard to improve the quality of patient care and the facilities available, including building new surgical wings and providing hi-tech equipment such as CT-scans which the community says it needs.

At the same time, the hospital has had to grapple with soaring costs, both in equipment and drugs as well as in salaries.

In order to provide these services and to meet the aspirations of its own staff, it would appear that the hospital has developed a top-heavy management structure and suffers from overstaffing by modern standards.

The plans last year to introduce a system of programme management, which would reduce the number of managers on the wards and operating areas of the hospital, were aimed at reducing some of those layers of management, making the hospital more flexible and efficient and also saving money for the Hospitals Board.

Programme management was supposed to remedy this problem by reducing the number of managers and merging certain wards and areas, such as paediatrics and the children's ward. That would have enabled more teamwork between different departments and eradicated duplication, according to the hospital.

In doing so, the Board told the managers being squeezed out that they could either return to the wards as staff nurses or leave.

For many of these displaced managers, the choice was unpalatable, despite inducements from the hospital including the retention of their current salaries if they stayed or "enhanced early retirement'' benefits.

Some of those now opting to leave want bigger redundancy payments. They also seem to have the support of their colleagues.

Strike action by nurses would have a devastating effect on the community, potentially putting lives at risk. That is why the nurses are an essential service and are required to issue a strike notice before taking industrial action.

We have to assume that the nurses have only come to this decision after long and serious thought and their views should be taken seriously. Certainly it is this newspaper's understanding that morale has been shattered at the hospital in the last year.

Home Affairs Minister Paula Cox has a few options to deal with this: She can allow the strike; she can refer the matter to arbitration; or she can order an inquiry into the state of labour relations at the hospital.

It would seem that the third option may be the best one. It could delay the process of programme management, but this dispute goes deeper than the question of uniforms or the fate of the ten nurses. A full, independent inquiry would air all the concerns of management and the nurses and enable the hospital to get off to a fresh start.