The move by nurses to go on strike in the weeks ahead presents the Government with its biggest challenge to public pay policy since gardaí threatened to take unprecedented industrial action in late 2016.
Work stoppages by about 40,000 nurses would seriously hit a health service which is already struggling to cope.
If the industrial action goes ahead, emergency care will continue to be provided but many other parts of the hospital service will be severely restricted.
Taoiseach Leo Varadkar acknowledged on Tuesday that a strike by nurses would lead to the cancellation of procedures for patients, driving up waiting lists and putting further pressure on emergency units and GP practices.
In 2016, a €50 million deal by the Government to head off the threatened Garda dispute ultimately cost it a further €120 million
The Irish Nurses and Midwives Organisation (INMO) is effectively seeking special increases, of up to 12 per cent, to bring nurses’ pay into line with other graduate-entry health professionals such as therapists. The union argues such pay rises are needed to recruit new nurses to join the public health system and to discourage existing personnel from leaving.
However, increases on such a scale are much larger than those set out in the current public service agreement.
Nurses argue strongly that there is provision in the existing public service agreement to allow the Government to provide them with additional money as part of a process to tackle recruitment and retention without bringing down the entire edifice.
However, Ministers believe the pay claim by nurses would cost €300 million and lead to knock-on demands by other staff across the public service. A cast-iron rule of public service industrial relations is that any benefit or gain secured by one group will be immediately sought by others.
In 2016, a €50 million deal by the Government to head off the threatened Garda dispute ultimately cost it a further €120 million as it had to bring forward a scheduled pay rise to assuage the anger of other groups in the public service.
Last month, hundreds of staff in emergency departments secured additional leave as part of knock-on claim lodged in early 2016 after nurses received a comparable concession.
The largest public service trade union, Forsa, has already warned that other staff will seek additional payments if nurses secure benefits that are outside the current agreement.
Promotional posts
The Government hoped a €20 million package of measures, including increased allowances and greater access to some promotional posts, which was recommended by the Public Service Pay Commission in September, would address the nurses’ pay demands.
The Government also contended some 10,000 nurses could benefit from a second initiative aimed at dealing with lower pay rates paid to public service personnel recruited after 2011. However, while these measures would boost pay for many nurses, a significant number would receive no benefit at all.
In any event INMO rejected the Government's pay proposals, as have members of the Psychiatric Nurses Association.
The Public Service Pay Commission did suggest that there could be a future review of nurses’ pay at some stage in the future.
Talks with health service management next week are likely initially to look at contingency arrangements if the strikes go ahead. However, the commission’s recommendation for a future pay review may come into play at some stage. It is understood the Government, particularly the Department of Public Expenditure, is not at that stage at this point.
It also remains to be seen whether nurses would be prepared to settle for a process offering potential pay increases at some date in the future.