Mr Ruddy Spencer might not have been aware that some of his portfolio responsibilities had been shifted to the Office of the Prime Minister, but that does not mean we do not take him at his word that the health system is ready for today's abolition of fees for most services at government health-care facilities.

Our confidence in Mr Spencer and other health system managers notwithstanding, this newspaper must pay attention to the concerns of the people on the ground - those who actually have the job of delivering health care. In that regard, we would suggest that Mr Spencer listen to Mrs Edith Allwood-Anderson, the president of the Nurses Association of Jamaica (NAJ), and use her remarks as a measure of what is deliverable, lest they run the risk of lifting public expectations beyond the practicable.

Indeed, we sense that the latter may already be in place. It is not, however, yet too late for the authorities to adjust the pitch.

Mr Spencer and his technocrats, in their public discourse on what the minister has described as the most significant social policy in Jamaica in 30 years, have focused primarily on the cost of delivering the planned service. The Government has already allocated more than $3.5 billion to the project.

In any event, the minister has pointed out, in the past, only 15 per cent of the people who turned up at public institutions actually paid for the service they received. In effect, therefore, 85 per cent of the patients were already getting the service free; so the shortfall to be covered is only for the 15 per cent who will now join their ranks. In last year's Budget, the Government had projected to collect $1.75 billion in health-care fees, but it is not clear whether this would have represented the entire proceeds if everybody had paid.

Mr Spencer may have the money, but does he have the personnel? According to Mrs Allwood-Anderson, therein lies the rub.

The NAJ boss has long complained about the shortage of nurses in the system, which is exacerbated by the poaching from developed countries that can afford to pay better. She says that there are a little over 2,000 nurses in the public health system, which, before this policy shift, needed more than twice as many. That's one side of the equation.

Last year, health officials expected more than 1.3 million Jamaicans to visit hospitals and clinics for outpatient, casualty and dental services. These figures do not include all the other reasons why people descend on public health facilities; nor did they take into account the crush that was to follow former Prime Minister Simpson Miller's announcement of free health services for people under 18. The anecdotes of harrowing waits at hospitals and attacks on nurses by irritable patients are well known.

Longer opening hours with insufficient staff, including doctors, won't of itself solve the problem. Indeed, it is likely that the projection of a 30 per cent increase in hospital and clinic visits will be vastly exceeded.

Our intention is not to undermine or belittle this project, but to ensure that the authorities inject a degree of realism, so that they can better manage expectations. For as the education system has shown, increased excess does not necessarily equate to improved quality.