Health service unions representing about 100,000 staff have said that they are considering work stoppages or public demonstrations to protest against controversial cutbacks introduced by the Health Service Executive (HSE) earlier this month in an attempt to reduce a €245 million financial deficit.
In a joint letter to members, which is to be issued today, the unions have advised staff not to co-operate with the HSE's plans, which introduce a temporary recruitment ban and a moratorium on promotions, "acting-up" arrangements or the additional use of locum or agency staff.
The unions - which include Impact, Siptu, the Irish Nurses' Organisation, the Irish Medical Organisation, Unite, the Medical Laboratory Scientists' Association and the health service craft group of unions - have sought a meeting of the national implementation body, the main trouble-shooting group under social partnership, to outline their concerns at the cutbacks.
The letter says that the unions are united in their determination to see the HSE measures reversed.
The move comes as Tallaght Hospital in Dublin announced that, following a HSE request, it was undertaking an "urgent review" to implement cost-curtailment requirements. It said that it would be seeking to do this without affecting patient care.
The HSE board was told in June that the hospital had overspent its budget by 10 per cent.
Elsewhere in the country, doctors at the Midland Regional Hospital in Mullingar have been asked to cut medical day cases by 55 procedures a month. They have been asked to reduce return visits by patients to the out-patients' department by 30 per cent and told that out-patient clinics must finish at 5pm.
At South Tipperary General Hospital in Clonmel staff have been informed that one operating theatre is to be shut and six surgical in-patient beds are to go.
They have been told that day cases should be restricted, the number of endoscopies limited and only essential day-case and emergency gynaecological operations performed.
In their letter, the unions say that a short pause in recruitment would not make any significant contribution to the overall financial problems and that the management's approach would only lead to services becoming more chaotic.
They advise members that they should confine their duties, roles and responsibilities to those in place up to the introduction of the cutbacks.
Members should "refuse to undertake duties, roles and responsibilities of other positions, in particular those affected by the HSE decision not to fill posts, provide agency or overtime cover".
The unions urge members to resist any attempts to redeploy them to other duties arising from the implementation of the HSE cost-saving measures and advise that they should refuse to co-operate with the opening or expansion of new or existing services while others were being curtailed or suspended.
Members should refuse to "act up" or take on additional responsibility in any informal or voluntary arrangement as an alternative to the normal acting-up arrangements.
The unions advise that members "resist attempts to have any member of staff work on an overtime basis, including unrostered hours, without the appropriate agreed payments for such duties".
A HSE spokesman said that the measures would be reviewed in the coming weeks. The measures were not about cost-cutting but about the delivery of services within budget.
Impact national secretary Kevin Callinan said that the unions were likely to await the HSE review of the measures at the beginning of October before taking any action.
He suggested that any industrial action was likely to begin with lunchtime or other types of protests which did not involve walking off the job, but he said that work stoppages were an option.