Representativeness of the European social partner organisations: Hospitals – Ireland
The aim of this representativeness study is to identify the respective national and supranational actors (i.e. trade unions and employer organisations) in the field of industrial relations in the hospital sector in Ireland. In order to determine their relative importance in the sector’s industrial relations, this study will, in particular, focus on their representational quality as well as on their role in collective bargaining.
1. Sectoral properties
Employment in Ireland’s hospital sector has expanded in the last decade and constituted over 6% of total employment as at December 2007. The main employer body, the Health Service Executive (HSE), is the largest single employer in the sector in Ireland. The sector has extremely high trade union density and collective bargaining coverage, and a number of tripartite bodies have been established specifically to improve industrial relations in the sector.
| 1994 | 2005** | |
|---|---|---|
| Number of employers | n.a. | One single employer – the HSE – is responsible for operating the Irish public hospital system. In addition, there are about 10 private hospitals. |
| Aggregate employment* | 81,500 in 2000 | Approximately 130,000: 110,400 of whom worked in Ireland’s public health hospital system as at March 2007. The remainder work in the country’s private hospitals. |
| Male employment* | n.a. | No breakdown available |
| Female employment* | n.a. | n.a. |
| Aggregate employees | n.a. | 130,000 employees |
| Male employees | n.a. | No breakdown available |
| Female employees | n.a. | n.a. |
| Aggregate sectoral employment as a % of total employment in economy | n.a. | 130,000/2095,400 = 6.2% |
| Aggregate sectoral employees as a % of total number of employees in economy | 130,000/1738,300 = 7.5% |
Notes: * employees plus self-employed persons and agency workers; ** or most recent data; n.a. = ‘not available’.
Source: Survey data (S) provided by the Central Statistics Office (CSO) for the public hospital system; personal estimates for private hospitals
In recent years, a significant increase has occurred in the number of people employed in the Irish hospital system. This has corresponded to an increase in the general population and in overall employment levels in the Irish economy.
2. Sector’s unions and employer associations
This section includes the following trade unions and employer associations:
- trade unions which are party to sector-related collective bargaining;
- trade unions which are a member of the sector-related European federation – in this case, the European Federation of Public Service Unions (EPSU);
- employer associations which are party to sector-related collective bargaining;
- employer associations which are a member of the sector-related European employer federation – in this case, the Hospital and Healthcare European Employers’ Association (HOSPEEM).
2a Data on the unions
There are six main unions representing different grades of staff in the Irish hospital system, as follows:
- the Services, Industrial, Professional, Technical Union (SIPTU);
- the Irish Municipal Public and Civil Trade Union (IMPACT);
- the Irish Nurses’ Organisation (INO);
- the Psychiatric Nurses’ Association (PNA);
- the Irish Medical Organisation (IMO);
- the Irish Hospital Consultants’ Association (IHCA).
A number of other trade unions have a small proportion of blue-collar members in the hospital sector; these include Unite and the Technical Engineering and Electrical Union (TEEU). However, there are no details on how many members these unions have in the hospital sector.
2a.1 Type of membership (voluntary vs. compulsory)
Trade union membership in the hospital sector consists of a mixture of voluntary and compulsory membership. Generally, it is expected that employees of the Irish public hospital system will join a trade union; therefore, there is a large element of compulsion in this respect.
2a.2 Formal demarcation of membership domain (e.g. blue-collar workers, private-sector workers, service sector employees, etc.)
In relation to the representativeness of the aforementioned trade unions in the hospital system, the following has been found:
- SIPTU is a general union representing a wide range of mostly ‘lower-level’ manual grades in the Irish hospital system – including hospital porters, catering staff and other support staff/healthcare assistants;
- IMPACT represents white-collar administrative, clerical and managerial grades in the hospital system;
- the INO and PNA represent nurses;
- the IMO represents all levels and types of doctor;
- the IHCA specifically represents hospital consultants;
- Unite and TEEU represent a small number of blue-collar/craft workers in the health sector.
2a.3 Number of union members
It is estimated that the trade unions have the following numbers of members:
- SIPTU: 225,000 members;
- IMPACT: 55,000 members;
- INO: 33,000 members;
- IMO: 5,800 members;
- IHCA: 1,800 members;
- PNA: 5,000 members;
- Unite: 50,000 members;
- TEEU: 40,000 members.
2a.4 Number of union members in the sector
Based on trade union estimates (E), it is estimated that there are a total of 111,800 union members in Ireland’s hospital sector. This total can be broken down as follows:
- SIPTU: 38,000 members;
- IMPACT: 26,000 members;
- INO 33,000 members;
- IMO: 5,800 members;
- IHCA: 1,800 members;
- PNA: 5,000 members;
- UNITE: 2,000 members;
- TEEU: 200 members.
2a.5 Female union members as a percentage of total union membership
In relation to the trade union IMPACT, it is estimated that 66% of its members are women. No gender breakdown figures were available for the other trade unions.
2a.6 Density with regard to the union domain (see 2a.2)
The IHCA represents approximately 80% of hospital consultants in Ireland. No domain density details were available for the other trade unions. Many of the unions would also represent members outside of the hospital sector.
2a.7 Density of the union with regard to the sector
Overall, the hospital sector employs a total of 130,000 people. As outlined, total trade union membership in sector amounts to 111,800 persons, which is the equivalent of a total sectoral density of 86%. Density is higher in the public health system than in private hospitals.
On this basis, density for each union with regard to the sector is as follows:
- SIPTU: 29.2%;
- IMPACT: 20%;
- INO: 25%;
- IMO: 4.5%;
- IHCA: 1.4%;
- PNA: 3.8%;
- Unite: 1.5%;
- TEEU: 0.15%.
2a.8 Does the union conclude collective agreements?
Yes, all of the trade unions conclude collective agreements and engage in collective bargaining activities at national, sectoral and local level.
2a.9 For each association, list their affiliation to higher-level national, European and international interest associations (including cross-sectoral associations)
Apart from the PNA and IHCA, the other trade unions are affiliated at national level to the Irish Congress of Trade Unions (ICTU) and at European level to the European Trade Union Confederation (ETUC).
In addition, IMPACT, SIPTU, the INO and the IMO are affiliated to a number of international trade union bodies, including Public Services International (PSI) and EPSU.
2b Data on the employer associations
2b.1 Type of membership (voluntary vs. compulsory)
A single employer, the HSE, took over full operational responsibility for running Ireland’s public hospital and social services on 1 January 2005, following the government’s disbandment of the old health boards that previously existed. Accordingly, it is compulsory for public hospitals to be ‘members’ of the HSE. However, a number of private hospitals exist as separate entities from the HSE and so are not members. The Health Service Executive Employers’ Agency (HSE-EA) is the representative arm of the HSE, and is responsible for representing health employers in industrial relations and collective bargaining matters. The Irish Business and Employers’ Confederation (IBEC) also has a number of health service employers in its membership – in particular, the voluntary hospital sector, a large number of intellectual disability agencies and the majority of private hospitals. IBEC works in partnership nationally with the HSE-EA on industrial relations and collective bargaining issues, and represents its health sector members in local negotiations and industrial relations issues.
2b.2 Formal demarcation of membership domain (e.g. SMEs, small-scale crafts/industry, health services, etc.)
The HSE is the main representative body for Ireland’s health services. IBEC’s membership domain covers most sectors.
2b.3 Number of member companies (i.e. the total number of members of the association as a whole)
There was no data available on the exact number of hospitals that come under the auspices of the HSE.
IBEC provides a wide range of services to over 7,500 member companies and organisations from all sectors and of all sizes across Ireland. It is the umbrella body for Ireland’s leading industry groups and associations and is the national voice of Irish business and employers.
2b.4 Number of member companies in the sector
No data available
2b.5 Number of employees working in member companies (i.e. the total number of the association as a whole)
The largest employer in Ireland, the HSE, employs more than 65,000 workers in direct employment; a further 35,000 workers are funded by the HSE – for instance, in voluntary hospitals. Therefore, a total of 100,000 people are employed under the auspices of the HSE.
There were no data available in this respect for IBEC.
2b.6 Number of employees working in member companies in the sector
As outlined, the HSE has 65,000 employees in direct employment as well as employing some 35,000 persons indirectly: or 100,000 in total.
There were no data available in this respect for IBEC.
2b.7 Density of the association in terms of companies with regard to their domain (see 2b.2)
Not applicable
2b.8 Density of the association in terms of companies with regard to the sector
Not applicable
2b.9 Density in terms of employees represented with regard to their domain (see 2b.2)
HSE: 76.9%
IBEC: No data available
2b.10 Density in terms of employees represented with regard to the sector
HSE: 76.9%
IBEC: No data available
2b.11 Does the employer association conclude collective agreements?
Yes. The representative arm of the HSE, the HSE-EA, represents health service employers in national negotiations on pay and employment conditions for all categories of workers. It also supports and, where appropriate, represents health service employers in local collective bargaining issues. IBEC works in conjunction with the HSE-EA in national negotiations; at the same time, it represents its member hospitals and agencies in local collective bargaining issues.
Furthermore, the HSE-EA is represented on the Health Service National Partnership Forum (HSNPF), which leads, develops and facilitates the partnership process within the country’s health service. In addition, the HSE-EA is responsible for engaging with the health service unions in the Health Service National Joint Council (HSNJC) – a forum where matters of common concern to all health service employers and employees are discussed and progressed. IBEC is also represented on the HSNJC.
2b.12 For each association, list their affiliation to higher-level national, European and international interest associations (including the cross-sectoral associations).
At European level, the HSE/HSE-EA is affiliated to the representative sectoral employer organisation – namely, HOSPEEM. The latter is a sectoral member of the European Centre of Enterprises with Public Participation and of Enterprises of General Economic Interest (CEEP) and is the EU sectoral level equivalent of EPSU on the trade union side.
IBEC is the Irish member of BusinessEurope (formerly UNICE).
3. Inter-associational relationships
3.1. Unions covered whose domains overlap
The most noticeable union domain overlap relates to the fact that the IMO competes with the IHCA, which is the main consultant representative body, for members.
Moreover, while the INO is by far Ireland’s largest nursing union, the PNA, SIPTU and IMPACT also represent nurses. Thus, the INO’s domain overlaps with these other unions.
3.2. Do rivalries and competition exist among the unions, concerning the right to conclude collective agreements and to be consulted in public policy formulation and implementation?
Yes. Rivalries have periodically emerged between health unions over various collective bargaining issues. For example, tensions emerged in early 2007 between the INO and other health service unions – most notably IMPACT – after the INO pursued a pay claim outside the established public service pay determination mechanisms, that is, national agreements and public sector pay benchmarking, which the other unions had abided by and did not want to see damaged. However, following a deal on pay and working hours, the INO agreed to return to the established public service pay mechanism, although it still expects delivery of a significant pay increase for nurses under a forthcoming public service pay benchmarking report – there is a view in the INO that nurses’ pay has fallen behind comparable grades.
A row also emerged between the INO and SIPTU over the future role of healthcare assistants. SIPTU wants healthcare assistants to assume an expanded role, but the INO was concerned that this would encroach on the terrain/role of nursing. However, this row appears to have been resolved.
To a large extent, such periodic rivalries between the respective health unions stem from a perceived need to boost the status of their respective memberships.
3.3. If yes, are certain unions excluded from these rights?
–
3.4. Same question for employer associations as 3.1
While the HSE-EA is the main employer representative for the HSE hospitals, as stated previously, the voluntary hospitals are also members of IBEC and are represented either jointly by the HSE-EA and IBEC, or either one of these bodies depending on the issue at hand.
3.5. Same question for employer associations as 3.2
No competition or rivalry is evident among employer associations in the sector. Instead, their roles are complementary and supportive.
3.6. Same question for employer associations as 3.3
No. While the HSE-EA takes the lead on national collective bargaining issues, IBEC is usually party to these negotiations.
4. The system of collective bargaining
Trade unions and health employers engage in collective bargaining at national, sectoral and local hospital level.
4.1. Sector’s rate of collective bargaining coverage
Collective bargaining coverage is estimated to be at 100% in the public hospital system.
4.2. Relative importance of multi-employer agreements and of single-employer agreements as a percentage of the total number of employees covered
Multi-employer bargaining is most relevant given that all 110,000 employees in Ireland’s public hospital system are covered by some form of multi-employer pay determination.
Single-employer bargaining takes place at individual hospitals over various aspects of pay and terms and conditions of employment. However, multi-employer bargaining sets the parameters for pay and employment conditions across the whole public hospital system.
4.2.1. Is there a practice of extending multi-employer agreements to employers who are not affiliated to the signatory employer associations?
Yes.
4.2.2. If there is a practice of extending collective agreements, is this practice pervasive or rather limited and exceptional?
The practice of extending collective agreements is limited given that most of the hospital system is covered by multi-employer collective bargaining arrangements of some sort. In many instances, private hospitals would ‘shadow’ and apply whatever is agreed under multi-employer collective bargaining; however, as previously stated, the majority of private hospitals are members of IBEC.
4.3. Sector-related multi-employer wage agreements* valid in 2005 (or most recent data)
There are a number of examples of national-level multi-employer collective bargaining arrangements covering hospital employees in Ireland. Separate specific wage bargaining arrangements at sectoral level do not exist in the hospital sector. Instead, pay is governed by national-level pay determination.
Firstly, the national multi-employer wage agreement in place since 2007 – the 10-year framework social partnership agreement called Towards 2016 (2.86Mb PDF) – covers the whole unionised sector in Ireland, including employees across the hospital sector.
In addition, like the vast majority of Ireland’s public servants, hospital employees are also covered by a separate national-level pay determination mechanism – known as ‘benchmarking’. Benchmarking originates from a perception that the pay of public servants had fallen behind their private sector comparators. In view of this, the first benchmarking exercise delivered average pay increases of 8.9% for public servants – on top of whatever is agreed under national pay agreements above. The difference between the two mechanisms is that national pay agreements are a negotiated consensus, whereas, under benchmarking, unions and employers make their respective submissions; however, ultimately, the final decision rests with an independent Public Service Benchmarking Body (PSBB).
Thirdly, senior public servants, including hospital consultants and senior hospital management, are not covered by ‘normal’ benchmarking. Rather, their pay is periodically reviewed by the Review Body on Higher Remuneration in the Public Sector. In essence, nevertheless, it operates in the same way as conventional benchmarking.
5. Formulation and implementation of sector-specific public policies
5.1. Are the sector’s employer associations and unions usually consulted by the authorities in sector-specific matters? If yes, which associations?
Yes. All of the aforementioned trade unions and employer associations would usually be consulted by the authorities in relation to sector-specific matters.
However, as at November 2007, there was an ongoing dispute between health unions and the HSE over a perceived lack of consultation by employers regarding recent financial cutbacks and a jobs freeze. In essence, the unions were unhappy about the unilateral nature of the announcement, claiming that it constituted a breach of Ireland’s social partnership process. However, the HSE denies this claim.
5.2. Do tripartite bodies dealing with sector-specific issues exist?
Yes – see the following table for details
| Name of body and scope of activity | Bipartite/tripartite | Origin: agreement/statutory | Trade unions with representatives | Employer associations with representatives |
|---|---|---|---|---|
| HSNPF | Tripartite | Agreement | IMPACT, SIPTU, INO, IMO, IHCA, Unite, TEEU | HSE-EA |
| HSNJC Health Service Forum on work practices | Tripartite Tripartite | Agreement Agreement | IMPACT, SIPTU, INO, IMO IMPACT, SIPTU, INO, IMO, IHCA, Unite | HSE-EA/IBEC HSE-EA/IBEC |
Note: * Sector-specific policies specifically target and affect the sector under consideration.
As Table 2 shows, tripartite bodies dealing with sector-specific issues are present in the Irish hospital sector. Their domain of activity is industrial relations. Firstly, the HSNPF seeks to develop and facilitate partnership between employers and trade unions throughout the public health services. The HSNPF is a joint management/trade union steering committee for workplace partnership in the Irish health service. The forum was established in 1999 following the provisions of Partnership 2000, the national agreement on social partnership then in place. It has continued to promote a partnership approach to change and problem-solving in the health services under the subsequent national partnership agreements.
The role and purpose of the HSNPF includes the following aims:
- to provide leadership to the health service partnership process;
- to champion partnership within health services management and within the trade unions;
- to ensure that the interests and objectives of the HSNPF’s constituent groups are discussed at the partnership table;
- to provide a national-level forum where health service management and trade unions can agree the broad parameters within which workplace partnership is advanced at national, regional and local level;
- to support the partnership process within agencies and, if appropriate, support initiatives with service wide application;
- to provide the partnership process with resources, as needed, including the provision of suitable training and facilities;
- to assist in the development of best practice communications in the health services;
- to communicate the partnership message;
- to promote and develop measurement and evaluation with a view to learning and sharing information and to develop protocols based on this learning – for example, a protocol on best partnership practice in the implementation of change;
- to continue to monitor relevant developments at national and international level in areas within and outside of the health services and to develop strategic links;
- to formally verify progress in the health service context in relation to implementation of the modernisation programme as set out in all national agreements since Partnership 2000.
Secondly, the HSE-EA engages with the health service unions in the HSJNC, which is a forum where industrial relations matters of common concern to all health service employers and employees are discussed and progressed. The HSNJC continues to play a significant role in managing industrial relations conflicts. In reflection of this, Section 4.2.2. of the current national social partnership agreement, Towards 2016, states that the HSNJC will continue to be the primary forum for managing industrial relations in the health service. It has been reported that the procedures of this forum have been revised to ensure the attendance and participation of senior managers across the health service, including the HSE national directors of human resources (HR), finance and so on, in addition to representatives of IBEC, the Department of Health and Children (DOHC) and senior representatives from the health service trade unions. However, the IHCA and the PNA are not part of the HSNJC, as they are not affiliated to the ICTU.
Thirdly, the ICTU, with the backing of the Irish government, is attempting to implement a new tripartite Health Forum, designed to tackle common problematic work practice issues across the health service. However, the forum was only at the initial stages as at November 2007, as it was delayed by a number of industrial relations disputes involving nurses and consultants. The forum has a remit to apply the problem-solving tools of social partnership to the complex work practice issues in the health sector. It will be chaired by the secretary-general of the Department of the Taoiseach (Irish Prime Minister), and will address non-pay issues and new work practices concerning groups of workers across the health sector. The forum will involve health employers and representative bodies, along with trade unions representing a diverse range of health workers – including doctors, nurses, clerical and administrative grades, therapists and laboratory staff, and various support grades.
6. Statutory regulations of representativeness
6.1. In the case of the unions, do statutory regulations exist which establish criteria of representativeness which a union must meet, so as to be entitled to conclude collective agreements?
Yes, statutory regulations exist in Ireland establishing criteria for representativeness. Trade unions must have at least 1,000 members to act in a representative capacity and must register and apply for a negotiating licence with the Office of the Registrar of Friendly Societies.
6.2. In the case of the unions, do statutory regulations exist which establish criteria of representativeness which a union must meet, so as to be entitled to be consulted in matters of public policy and to participate in tripartite bodies?
As already outlined and, as a general rule, trade unions have to be affiliated to the ICTU to be consulted in matters of public policy and to participate in tripartite bodies. As the umbrella body for Irish trade unions, the ICTU represents all affiliates at national level. Therefore, because they are not ICTU affiliates, the PNA and the IHCA are excluded from certain tripartite bodies, including the HSNJC.
6.3. Are elections for a certain representational body (e.g. works councils) established as criteria for union representativeness?
Yes, trade unions in Ireland must hold elections for their executive council and for senior positions.
6.4. Same question for employer associations as 6.1
The HSE-EA – the representative arm of the HSE – is a statutory employer representative agency entitled to conclude collective agreements on behalf of employers across the hospital sector. IBEC is also a statutory employer representative agency.
6.5. Same question for employer associations as 6.2
Yes, as outlined in 6.4, the HSE-EA as a statutory employer representative agency is entitled to be consulted in matters of public policy and to participate in tripartite bodies in the hospital sector. The same applies for IBEC in most circumstances.
6.6. Are elections for a certain representational body established as criteria for the representativeness of employer associations?
–
7. Commentary
Trade union density is extremely high in the Irish hospital sector, with a number of unions representing a substantial number of different grades, each with their own respective interests. In view of this, inter-union disputes have arose periodically. The main employer in the public health service is the HSE, whose representative wing is the HSE-EA. IBEC, meanwhile, represents Ireland’s voluntary hospitals, which, while being funded by the HSE, have retained a degree of autonomy that differentiates them from HSE hospitals. Industrial relations between employers and trade unions in the hospital sector have tended to be highly adversarial, traditional and defensive, with frequent disputes arising over any changes. Negotiations over change proposals are usually lengthy, despite much talk of partnership between trade unions and employers. In recent years, conflict has become increasingly institutionalised, with the introduction of tripartite forums designed to tackle the many industrial relations problems that exist.
Tony Dobbins, IRN Publishing