A Winter of Discontent could be on the way in the health services, witha wide range of workers threatening, or already taking, strikeaction, writes Padraig O'Morain.
The likelihood of health service strikes during the winter grew yesterday with the news that Non-Consultant Hospital Doctors had voted by a 97 per cent majority for industrial action over hospital rostering.
The issue is currently the subject of talks at the Labour Relations Commission, but the Irish Medical Organisation vote underlines the worsening industrial relations situation in the health services.
Doctors, nurses, attendants and clerical and administrative workers are all now either in the course of having industrial disputes or have issued threats of strike action.
Benchmarking, rosters, pay increases and cutbacks all threaten to lead to industrial action of one kind or another. It may be that limited action, such as working to rule or strikes occurring during certain hours only, are more likely than all-out strikes, but these have the potential to cause severe disruption to patients.
A look at the potential sources of industrial action shows just how rocky the road ahead is for the health services this winter:
Nurses - benchmarking: At their annual conference in May, the Irish Nurses' Organisation promised to bring the health service "to a standstill and leave it at a standstill", in the words of its general secretary, Mr Liam Doran, if benchmarking did not deliver a 30 per cent pay rise.
In the event, the benchmarking body did not recommend 30 per cent; it recommended 8 per cent for staff nurses.
At the end of September, the INO will hold a delegate meeting to decide what to do next. For some time now, the organisation has been streamlining its use of the work-to-rule, and this is the more likely route if the organisation decides to fight the benchmarking award.
Doctors - rostering and cutbacks: NCHDs are opposing attempts by health employers to change their basic working week so that part of it at least takes place outside previously normal daytime hours.
The issue has already seen limited strike action at Waterford Regional Hospital and at the Midland General Hospital in Tullamore. If current talks at the Labour Relations Commission fail - and it is difficult to see where the compromise lies in this one - further industrial action seems inevitable.
Cutbacks also have the potential to lead to industrial action by hospital doctors if health boards seek to save money by reducing overtime.
Clerical and administrative staff - cutbacks: These appear to be the prime targets for the cutbacks ordered by the Government. These savings were to be achieved by not filling planned new posts. One conclusion which can be drawn from the recent row between the Minister and the Western Health Board is that this way of cutting spending may not be based in reality.
If health boards are already exceeding their budgets, how can they save money by not doing new things? The only way to save money - and the Western Health Board has left little doubt about this - is by cutting back on things they are already doing.
The easiest targets for such cutbacks are temporary clerical and administrative workers whose contracts began less than 12 months ago and who have not acquired any employment rights. This could bring IMPACT and SIPTU into direct confrontation with health employers, and both unions have warned that they will resist job cuts.
A strike by clerical and administrative workers could close out-patient clinics if doctors were denied access to notes of previous consultations with patients and could not send test results and other correspondence to patients' GPs.
Ward attendants and other health workers - pay: Ward attendants in some non-acute psychiatric and long-stay hospitals in Dublin and at St Colmcille's Hospital in Loughlinstown have embarked on a series of disputes in pursuance of an 8 per cent pay claim. This is an example of a dispute involving categories of health service workers who do not have the profile of doctors and nurses. Some health workers such as porters are awaiting the outcome of a separate benchmarking process - different to the one which reported in July - later this year. What the outcome of this will be, in terms of industrial relations, remains unclear.
The Minister, Mr Martin, has up to now led a charmed existence, backed by enormous ability. He left the Department of Education and Science before the ASTI strike and arrived at Health and Children after the nurses' strike.
But now his turn may have come and his ability may be about to be put to the test in a deteriorating industrial relations climate.