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Irish health service: nurses, poachers and gamekeepers!

25 May 2019

The Stages

The latest developments in the Irish health service lays bare the true nature of the state's plans for health provision. It reveals itself clearly in the latest stage in a series of interdependent developments.

First we had the development of crisis conditions in the health service due to underfunding, to no small extent conditions which the passivity of the trade union leadership allowed to develop. The situation eventually became intolerable for both the workers and the service users and nurses were forced into action at the beginning of the year, staging an impressively enthusiastic campaign. Their planned series of strikes had the objective of both saving the service from decimation and to protect their jobs from increased exploitation and the overwhelming work load associated with the inability of the pay levels to attract and retain the necessary skilled labour.

Following the well-worn path of Irish industrial relations the next stage saw the union bureaucracy almost immediately demobilise the highly successful strike in favour of negotiations which resulted in minimal targeted concessions being granted which fell well short of what was required. The demoralised nurses were next cajoled back to work by their leaders on assurances that conditions would now improve, their disappointment revealing itself in the low turnout to vote in the ballot.

With the nurses carefully ushered back to work the third stage is now being rolled out. The clawing back of any concessions made, no matter how scant, and the rolling out of the next attack on state provided healthcare.


Paul Reid, the new executive officer of the HSE has declared his intentions clearly as “leading the transformation to a new model of integrated care as set out under Sláintecare”. He had been appointed to the implementation advisory council for Sláintecare six months ago and has been kept waiting in the wings until the nurses’ dispute had been demobilised. Reassured by the evidence that the trade union bureaucracy have their membership quelled and under 'control' he comes armed with a programme of cuts.

The Slaintecare programme, in government doublespeak, means moving care “from expensive hospitals to the community”, a euphemism for cutting hospital services and for the nurses it means that the employers will relaunch their attack on their working conditions by seeking to gain; “more flexibility over their work location and shifts”.

The privatisation model that resulted in the smear test outrage is now to be relaunched with vigour. In his introduction to his senior management team he has cracked the whip with “a strongly worded memo” in which he has warned that breaching budgets is “no longer an option”. He has started as he means to go on and is immediately seeking a review of “actions and timelines to bring about a financial break-even” in the Health Service, threatening his senior managers that failure to do so would have consequences and that they would “be held accountable”.

With the proclaimed objective of enforcing a strict adherence to “breaking even”, while the state starves the service of adequate funds, that can only mean a programme that shrinks the service beyond all recognition.

Insult to Injury

The state rewards those who carry out its unpopular tasks well, and Reid is being rewarded handsomely. His very generous pay deal adds insult to injury for the nurses whose campaign focussed on gaining a living wage that would also attract enough new applicants to nursing in Ireland to resolve staffing levels and workload issues. Reid is going to settle in to his new job on €300'000. That is €100'000 more than his predecessor. Almost mocking the nurses campaign the job is described as a re-advertisement due to the lack of “suitable” applicants, that is apparently, applicants who were not Paul Reid.

He is ideally suited to the job having worked as a “senior official of the Department of Public Expenditure and Reform”, the office for removing funding from public services in other words. He was also the Government’s chief negotiator in the Haddington Road agreement in 2013 that resulted in the austerity deal reached in agreement with the chief strategists of the ICTU and Siptu.

Poacher turned gamekeeper

The new chief exec is the ideal candidate for the job in other ways. He understands perfectly his so called 'enemy' across the negotiating table, he used to be one of them. His 'radical' youth was spent in the Workers Party and as a functionary in the Communications Workers Union. Before too long he had made his way to the management side of the table, a well-worn path for many trade union careerists, where he proved his true worth to the state.

It was here, privatising sections of the public services and dismantling the pay and conditions of public sector workers that Reid excelled. Coming from a background in the union bureaucracy he knew exactly the kind of defence that was afforded by that bureaucracy to their members and with the support of his old comrades, also ex members of the Workers Party, who now had found their way into the 'Labour ' party and were in a coalition government propping up Fine Gael. The attack on the working class was being carried out by ex-members of Stalinist influenced left organisations whose strategy had been to infiltrate the trade unions and gradually steer them in a leftward direction. The bureaucracy however had steered them! Very far to the right.

In an age when healthcare, housing and production of the necessities of life are dominated by global corporations, the imperialist age, this short example of life in Ireland exposes the incestuous relationship that exists between the trade union bureaucracy, the reformist left, and the capitalist class. The Irish capitalists attack the workers driven by the need to manage the local economy in the interests of imperialist capital and to protect their own slice of the proceeds; “the labour bureaucracy which is independent of the workers, but in return, completely dependent on the bourgeois state”(1) manages the workers kneejerk reactions, helping becalm them into acceptance of austerity, cuts, the introduction of privatisation or the need to remain within the “narrow parameters of the troika programme”. Every move to the right by the trade union bureaucracy results in the left 'infiltrators' refusing to systematically fight them and ultimately tailing them in a rightwards direction.


For the workers to decisively break out of this impasse the union movement must achieve democracy and it can only come from rank and file workers self-organising. A few of the latest strikes exhibited a real anger and determination to win by the massed ranks of the members, the nurses strike and the series of public transport strikes against privatisation and wage suppression. Without the union bureaucracy the government would not have won those fights. Now with the enthusiastic help of Mister Reid the state plans its next attack knowing that if the workers become angry again they can rely on the well-established relationship with the trade union bureaucracy to quell resistance.

In his career “Comrade” Reid has traversed the spectrum from the workers to the capitalist class, he has been able to do that because the dependency of the trade union bureaucracy upon the capitalist class has become such a close relationship that it has allowed him a bridge. It is this 'bridge' that must be broken down and a genuine workers trade union movement built that does not produce the type of union leader that when they are not seeking a compromise or a way out of confronting capitalism are seeking a way to cross the lines to the management side.

Self Organisation

That begins with the kind of self-organisation that has one basic ambition, to confront the bureaucrats when they sell out. Such a confrontation begins with public criticism coupled to organisation within the unions in democratic rank and file groups, even at micro level, if it was publically organised, this would be a beginning. Organising this way means that the critique presented is not short lived and limited to one incident but survives each episode and builds up to an organisational challenge to the mis-leadership we suffer from. In this way we can begin to defend pay and conditions, to defeat privatisation and to confront capitalism. Until that happens and we reclaim control of our unions at rank and file level the bureaucracy that controls our destinies and has produced defeat after defeat will weather every storm.


(1) Leon Trotsky. 'Trade Unions in the Epoch of Imperialist Decay'.

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