The nurses' strike was called off this week following an intervention by the Labour Court, which made a number of key recommendations to address the dispute over pay, recruitment and retention issues in the sector.
But what was contained in the Labour Court document setting out a new deal for nurses?
The recommendations were centred on what is described as 'phase one' in an overhaul of the role of a staff nurse. It also includes a new salary scale, a revision of the pay increments for those remaining on the existing scale, an extension of an allowance to take in more nurses, and new measures aimed at increasing productivity.
Let’s take a closer look at the deal struck in the Labour Court yesterday.
Enhanced practice in nursing and midwifery
The Labour Court said that a range of "tangible and specific" enhanced nursing practice measures constitute the basis for a "fundamental change" in the role of the staff nurse.
This would be regarded as phase one of "the development of nursing" - basically, an overhaul of the profession and the roles within it.
A new nursing contract, focused on the delivery of improved patient and service delivery outcomes, should be finalised within three weeks, the court said.
It specified the following "productivity measures" that should be implemented in relation to the change in contract:
- Part of the new contract will be to shift certain types of work to a community support setting. The contract will support the implementation of Sláintecare and other health strategies that are concerned with the development of community services, particularly in relation to the management of chronic conditions.
- The parties will agree to flexibility and the assessment of rosters in the context of the Framework on Safe Staffing.
- There will be a review of staffing and the skill mix in all areas, including ambulatory and outpatient areas.
- Integrated care organisations will be implemented.
- The parties will cooperate fully with the implementation of the Health Care Assistant review.
To go along with the roll-out of these "productivity measures", and as part of the new contract, there will be an Enhanced Nurse Practice salary scale. Not all nurses will be able to migrate to the new salary scale. The final details will be worked out as part of the new contract discussions.
The above productivity measures will apply to the nurses who go on to this new salary scale. Nurses who remain on the existing contract will stay on the existing nursing salary scale.
The court also said there should be a commitment to providing continuous training support to nurses, to facilitate this "fundamental change" to the role of nurses.
Revision of the 'new entrant' pay increments
The ‘new entrant’ agreement, under the Public Service Stability Agreement, currently provides for accelerated increments at point 4 and point 8 of all entrant scales. The cost of this deal is over €30m, of which €23m is within the first two years, the court noted.
In future, the court recommended that nurses and midwives will instead skip point 2 of the salary scale altogether. This measure applies to the staff who are staying on the current salary scale. The court said this measure would produce savings that would offset the cost of nurses moving over to the new contract and new salary scale.
Migration of staff to the 'enhanced nurse practice salary' scale
The option to move to the new salary scale - which goes from €35,806 to €47,201 - should become available on 1 March.
Staff currently on points 1-3 of the existing salary scale will not be able to move to the new salary scale, and will instead "benefit from the revised new entrant measure" (i.e. they will get to skip point 2 and go straight to point 3 of the scale).
Once they reach point 4 on the existing scale, they can move over to the new scale, "if they meet the qualifying conditions", the court said.
Nurses and midwives on points 4-13 of the existing scale will be able to move on to the new scale straight away.
Staff on the existing senior nurse/midwife scale will be able to move to a new senior enhanced nurse/midwife practice scale (€49,471).
Expert review of the nursing profession
The Labour Court recommended that an expert review of the nursing profession be carried out before the end of the Public Service Stability Agreement, which runs out in 2020.
The outcome of the review can inform any future engagement or negotiation between the parties, as well as informing any future pay deal that may be struck after the end of the Public Service Stability Agreement.
The court made recommendations on a range of the INMO’s concerns that, it said, should be addressed as part of the resolution of this dispute.
One of these is an extension of the location/qualification allowance. This allowance will now be extended to public health nurses who work in midwifery services, and nursing and midwifery staff working in medical and surgical areas, under the new deal.
The existing allowances would also continue to apply to the nurses who are currently eligible for them, and will include those who go on the new salary scales.
The Labour Court also recommended that the number of advanced nurse practitioners should be increased. They should represent a minimum of 2% of the overall nursing workforce, it was noted.
Other measures include:
- The national roll out of the Safe Staffing and Skill Mix Framework in medical and surgical care and Emergency Department areas in acute hospital settings. This new framework should be in place by the end of 2021. The employer must commit the funding to implement this, the court said.
- The HSE and the Department of Health should review an anomaly (identified by the Public Service Pay Commission) that relates to the banding of hospitals.
- The union’s claim in relation to the grades of clinical nurse managers and community nursing grades cannot be accommodated in phase one, the court said, but should still be examined in the expert review.
- The implementation of the Registered Nurse Intellectual Disability element of a 2017 Workplace Relations Commission agreement on recruitment and retention.
To deal with the costs associated with implementing the recommendations, the Labour Court set out a number of arguments for where money could be saved.
Money-saving measures included a reduction in spending on agency staff in healthcare settings.