Nurses have a point, but it is not the one that they are making most loudly, writes Marc Coleman
If the Government wants an answer to the present dilemma facing the health services, it should look back 100 years to the writer George Russell. Under the pseudonym of AE, Russell wrote The North Began, one of his best pieces, in response to the landing of rifles at Larne in 1912 by the Ulster Volunteer Force. Thanks to the indulgence of the British government, the initiative was successful. But instead of expressing moral outrage, Russell urged nationalists to accept the new rules of the game and follow suit.
For him the only thing worse than a unionist with a rifle was a nationalist without one. It was the first crack in the faith previously held by nationalists in the democratic process. The rest, as they say, is history. Almost 100 years later, we are at a different turning point.
As hospital consultants and nurses use their considerable muscle to gain better working conditions, history might just be about to repeat itself, except that this time the players are different.
Like many public sector workers, Irish nurses have a point in their complaints, but it is not the point that they are making most loudly. 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.
No, the real causes of grievance lie elsewhere. For a start, 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.
There is, of course, just one problem with the nurses' case: the benchmarking process. In 2002, the Government raised public sector pay by about €1 billion a year - over and above national pay agreement increases - to put an end to such comparisons. In return for generous pay increases, workers in the public sector were supposed to put aside comparisons with other public sector workers doing different tasks.
Only now are the chronic flaws of the exercise coming to light. As the ESRI later discovered, public sector workers in 2001 were already earning on average 40 per cent more than their private sector counterparts. But the more serious flaws relate to pay increases granted to different types of public sector worker.
Looking at the schedule of pay increases granted under the exercise, there is an unhealthy correlation between the political power of its greatest beneficiaries, ie those with the potential to cause most political embarrassment by striking, and the rates of pay granted. Among 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. The highest increases went to those already earning handsome salaries, senior civil servants for instance.
These problems might have been forgotten but for an event which occurred soon after the benchmarking award was granted, an event which is a real and genuine cause of grievance to nurses: the chronic increase in the cost of living. 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.
Like some modern-day Oliver Cromwell, Rip-Off Ireland has driven Ireland's lowest-paid public servants into the shadowlands of the Pale around Dublin.
This is not to say that the Government is not spending enough money on public servants. Rather, it is spending it in the wrong way. 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.
There are now more than enough cooks to spoil the broth. But, according to the nurses at least, there is still not enough broth.
A higher cost of living is not the only thing that has changed. In the past 15 years of exchequer plenty, buying off public sector unrest with pay rises was an easy election stratagem. Like the nationalists 95 years ago, the taxpayers and patients who use the health service are watching the progress of consultants and nurses as they increase their claims on the public purse.
Having seen billions poured into a barely-reformed health service, the sight of generous consultant contracts may lead them to the conclusion arrived at by George Russell. And if the second benchmarking commission, due to report after the election, awards knock-on pay increases to others in the public sector, something in them might just snap.
A summer of discontent in the public service may be followed by a winter of discontent among the other two-thirds of the electorate.
• Marc Colemanis Economics Editor of The Irish Times