Outdated pay structure creates ‘real risk’ of ambulance strike, HSE document says

There is a “real risk” of ambulance drivers and paramedics going on strike unless outdated pay structures are overhauled, according to an unpublished HSE document.

Proposals for pay modernisation in the National Ambulance Service (NAS), drawn up earlier this summer and seen by The Irish Times, find that the current pay structure is “considerably out of line” with comparable professionals and is “heavily and disproportionately reliant on allowance and overtime driven culture”.

The document outlines a series of risks stemming from the current arrangements, including the “real risk of industrial action due to the lack of progression of a modernised agreement since 1997″, as well as an “ongoing risk” of issues due to inconsistent grading and the salary structure.

Sinn Féin health spokesman David Cullinane said the documents were a “wakeup call” and there was a need for urgent action to reform NAS. “It is evident from the report that morale is low and recruitment and retention of key personnel is an identified risk,” he said.

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The current structure acts as a “clear barrier to progress”, according to the document, with different roles within the NAS not recognised within official designations or pay scales. Staff are instead rewarded with allowances which leads to “inconsistent” salary structures.

The document, drawn up under the auspices of the Workplace Relations Commission between the HSE and the main unions representing ambulance workers, outlines how the role of so-called “road staff” has changed rapidly, with ambulance workers providing more complex and urgent care. It outlines that this is “not reflected in terms of appropriate remuneration or status as health and social professionals”.

For example, no salary grade exists for the role of advanced paramedic, with an allowance paid instead, while no salary structure or grade exists for paramedic supervisors. The last pay agreement was struck in 1997 and, since the early 2000s, ambulance staff have moved from using a basic set of standard operating procedures, in which they were “merely carrying out orders”, to a situation where they were clinically trained and operate more independently.

Salary and grade reviews were carried out in 2002 and 2007, but the report finds that “the present structure does not reflect the professionalisation and clinical advancements of clinical NAS staff since this time”. It is also “inconsistent, confusing and poorly aligned” to the wider HSE system and the needs of NAS now and in the future.

Mr Cullinane said there is an identified need to double capacity in NAS over the next five years. “This presents real challenges and will not be possible unless the service is modernised and steps are taken to address the recruitment barriers.”

A spokeswoman for the HSE said that, following a review into the roles and and responsibilities of some grades in NAS, it and trade unions with negotiation rights for those grades “are currently working in partnership to respond to the recommendations of that review”.

Under the plan, historical pay structures would be reformed and grades would be reorganised, while many allowances would be removed from pay structures, as well as introducing “greater accountability” – all of which is designed to overhaul the system and make it better suited to the rollout of Sláintecare, the document outlines.

It also risks contributing to poor staff retention, bad morale and inhibiting the service’s “ability to continue to roll out important progressive plans”. The proposed pay scales range from €33,683 annually for a Level 1 Emergency Medical Technician, up to €60,500 for a level 9 Clinical Paramedic Supervisor. This is higher than the existing pay scales, which start at €31,723 and top out at €57,416. The estimated cost of implementing the new structures is €24.6 million annually.

However, the proposals also envisage the abolition of various qualification, location and weekend, unsocial and holiday premium payments. It also envisages the creation of new roles of Station Managers and Clinical Practice Facilitators.