Thirty-six health service facilities face the threat of disruption early next month, as SIPTU prepares to announce the result of a ballot for strike action by 17,000 health support personnel tomorrow.
The dispute centres on the refusal of the Government to proceed with a job evaluation scheme for 7,000 support personnel including health care assistants and chefs, which would assess roles to see if they had expanded in such a way as to warrant a pay rise.
However, SIPTU argues that as up to 17,000 workers in total potentially stand to gain from job evaluations, and stand to lose because of the Government position, they have balloted all of them - with informed sources anticipating an overwhelming result in favour of strike action.
Sources also suggested that with the Government showing no interest in engaging with the 17,000 workers, industrial disruption could get under way as soon as early June.
SIPTU Health Division Organiser Paul Bell said workers had told him they felt alienated and disrespected, and that the Government was more interested in talking down to them than in talking to them.
He said they were particularly annoyed in light of the overspends on the National Children's Hospital and the National Broadband Plan, adding that the "little people" would always come last.
If strike action were sanctioned, it is likely that some level contingency support would be put in place.
However, further industrial disruption is the last thing the HSE needs in the wake of the INMO strike by nurses and midwives earlier this year, which led to the cancellation of thousands of operations and outpatient appointments.
It is also facing two 24-hour strikes by ambulance personnel belonging to the Psychiatric Nurses Association in late May/early June in a long-running dispute over union recognition.
A comment on the SIPTU job evaluation schemes is awaited from the HSE.
The Department of Public Expenditure and Reform which oversees public service pay said it had no comment at this time.
However, potential pay rises for health support grades would undoubtedly increase pressure on the Government's pay bill, which some view as spiralling out of control.
Around €900m was originally set aside for pay rises from 2018-2020 under the Public Service Pay Agreement.
However, since the PSSA was finalised, the Government has conceded pay rises for up to 40,000 nurses, which will cost up to €50m in 2019 and 2020 alone - and will cost significantly more if the Government fails to secure productivity savings intended to offset the cost of the nurses' pay hike.
As yet the HSE and the INMO have neither quantified those savings, nor indicated where they will be made.
A similar dispute involving €6,000 psychiatric nurses has yet to be resolved - but any resolution is likely to see similar pay rises.
In addition, the Government has allocated €200m up to 2026 to partially address the two-tier pay system for so-called "new entrants" introduced in 2011.
However, at Easter the Minister for Education and Skills Joe McHugh held out the possibility of further pay rises when he acknowledged that there was "unfinished business" on pay inequality, which would be given "full consideration" at either a mid-term review of the PSSA or the negotiations on its successor.
The Irish Medical Organisation has secured a €200m deal for GPs, while hospital consultants are also seeking restoration of the 30% cut in pay for their grade which they argue has led to a significant shortage of consultants in the Irish health service.
A number of unions have also sought the rollback of additional unpaid hours imposed on public servants during the recession.
However, replacing those hours would mean recruiting almost 11,700 staff at an additional cost of €621m.