SIPTU members in the National Ambulance Service (NAS) are being balloted for industrial action, up to and including strike action, in a dispute over salary scales.
The union has accused management of failing to implement the recommendations of an independent report on updating staff salary scales in recognition of changes in their responsibilities and workload over the last 15 years.
The dispute involves members working as emergency medical technicians (EMT), paramedics, advanced paramedics, paramedic specialists and paramedic supervisors whose roles, responsibilities and necessary qualifications have changed in recent years.
"These changes involve the service moving away from just a patient transport model to a higher degree of pre-hospital care," said SIPTU Ambulance Sector Organiser, John McCamley.
"EMTs and paramedics have increased their responsibility for administering various medications by 89% and 83%, respectively, since 2011."
"The Independent Review of Roles and Responsibilities report published in May 2020 was to address these ongoing changes, including updating salary scales. To date, its recommendations have yet to be implemented."
"Our members have been left with no other option but to ballot for industrial action, up to and including strike action, due to the length of time it has taken to rectify pay disparity between ambulance personnel and other health professionals," Mr McCamley said.
SIPTU said it is calling on the HSE and the Department of Health to review their position of trying to introduce additional workplace changes without addressing historic issues.
The trade union Unite, which also represents members working for the National Ambulance Service, said it is also balloting members for industrial action on foot of the ongoing failure to implement the 2020 'Roles and Responsibilities Review'.
"It is scandalous that EMTs and paramedics who perform lifesaving services have been waiting for over five years for management to deliver on promised pay increases," said Unite General Secretary Sharon Graham.
"Our members have now been left with no option but to ballot for action," Ms Graham said.
Previous recommendations rejected by unions
The HSE said previous recommendations from the Workplace Relations Commission and the Labour Court on this issue have been rejected by Unite and SIPTU members.
"The HSE met with SIPTU and Unite on the 17 February 2026 and confirmed it was committed to entering further discussion on the substantive elements of the WRC proposals, which included new pay scales for relevant grades that recognise past, present and future transformative change, subject to the financial envelope approved by the Department of Health and with the consent and sanction of the Department of Public Expenditure and Reform," a spokesperson said.
"This proposal was rejected by SIPTU and Unite, who immediately advised of their intention to ballot for industrial action."
"The HSE remains committed to engagement through the dispute resolution processes set out in the Public Service Agreement 2024 - 2026 and calls upon both SIPTU and Unite to also commit to doing so."
"In this regard, the HSE's position is that a ballot for industrial action is unwarranted and presents a potential for impact on service delivery to patients," the HSE said.
