Health strikes: Too many cooks, not enough broth?

The Republic’s health service is currently being convulsed by work to rule and threats of limited strike action by the Irish Nurse’s Organisation. But Marc Coleman, in today’s Irish Times, notes that the issue they are most vocal about is not the underlying cause of a bona fide grievance.In fact, he argues, that in comparison with work and conditions elsewhere in the EU, nurses in the Republic do exceedingly well:

By comparison with most of their European counterparts and in terms of nominal incomes, Irish nurses are not badly paid. Nurses do have causes of grievance, but pay relative to other EU counterparts is not one of them. And although there are staff shortages in some hospitals, on average Ireland is overnursed. According to data from the OECD, there are at least 13 nurses per 1,000 of population in this country. This compares with just 7 for France which, according to the OECD, has the world’s best health system.

The real cause lies with in the massive differential pay rates with other ‘grades’ within the health service:

…despite working barely more than half a nurse’s hours, the average hospital consultant earns six times more pay. Consultants are, of course, highly qualified and deserve a higher remuneration. But six times higher? Under the new proposed contracts, some consultants will earn almost 10 times more than a nurse, so that the best-paid consultant would earn in one year the cost of an average house, now about €320,000.

The success of consultants in attaining the most lucrative working conditions of their kind in Europe has led Irish nurses to the conclusion that, as far as pay in the health sector is concerned, nice people finish last.

Although Fianna Fail’s 2002 benchmarking process (and there’s another due just after the election) was supposed to end all such comparisons within the public sector, the INO now wants to step outside that bounds of that settlement.

Coleman argues these differential correlate with the degree of political clout (and capacity to embarass the government) so that “those gaining the lowest pay increases were those already on the lowest rung of the public sector ladder, including clerical officers, junior gardaí and nurses.”

It is these groups that have since struggled to live with the backdraft of the Celtic Tiger – increased prices:

Since 2002, house prices have increased by almost two-thirds, electricity prices have doubled and the cost of services has risen by one-third (goods prices have fallen, thanks to global competition, but this has not stalled the rate of inflation, which is now among the highest in the EU). For many low-paid workers, public and private sector alike, living in any of Ireland’s larger towns is now financially impossible.

What binds the hands of the government though is the massive increase in public sector employment:

Instead of cutting the number of public servants by 5,000, as promised, the Government has increased their numbers by about 50,000. Exchequer funds which might have gone on increasing pay for the lowest-paid went instead on increasing numbers. That those increases were necessary is at least debatable: overstaffing is rife in many areas of the public sector and root-and-branch reform in at least some parts of it might have yielded better results than increasing staff.

He adds wryly:

There are now more than enough cooks to spoil the broth. But, according to the nurses at least, there is still not enough broth.

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  • Observer

    Good points.
    The latest “transformation” of the HSE is destined to add to the problem by increasing the number admin and managerial posts, without adding significantly to the number of clinicians, who actually deliver the service.
    The last reforms created a new layer of management, without removing the old. The structure resembles an onion, one layer over another. Meanwhile, recruitment of clinical staff remains strictly curtailed, but there is no shortage of managers to explain to people why they can’t have a service.