Labour Court Database __________________________________________________________________________________ File Number: CD87136 Case Number: LCR11031 Section / Act: S67 Parties: DEPT. OF HEALTH - and - FWUI |
Various claims concerning radiographers.
Recommendation:
For technical reasons the Recommendation on this case cannot be
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Division: CHAIRMAN Mr Heffernan Ms Ni Mhurchu
Text of Document__________________________________________________________________
CD87136 THE LABOUR COURT LCR11031
SECTION 18 INDUSTRIAL RELATIONS ACTS, 1946 TO 1976
RECOMMENDATION NO. LCR11031
Parties: VOLUNTARY HOSPITALS
(REPRESENTED BY THE FEDERATED UNION OF EMPLOYERS)
DEPARTMENT OF HEALTH
LOCAL GOVERNMENT STAFF NEGOTIATIONS BOARD
and
FEDERATED WORKERS' UNION OF IRELAND
Subject:
1. Various claims concerning radiographers.
General background:
2. The dispute concerns approximately 500 radiographers based in
hospitals throughout the State. The rate of pay of radiographers
has in the past been linked to nursing and other medical and
para-medical staff. In the early 1980's an increase of 8% was
applied to the nursing grades.
3. On 14th May,1985 a meeting took place between the Union and
the Management side.The Union sought the 8% increase on behalf of
the radiographers. The Employers were prepared to pay the
increase provided the Union agreed to the introduction of
'sessions' to replace on-call in some hospitals as it contended
that it was on this condition that the increase was paid to other
para-medical staff. This was unacceptable to the workers
concerned and the Union, advised management in August,1985 that
radiographers would be withdrawing their labour from all hospitals
as and from 23rd September, 1985. At a meeting on the 13th
September, 1985 a settlement emerged to avert the threatened
dispute.The settlement provided for a pay increase of 7% and a
#600 lump sum as a "payment on account". In return the Union
agreed to call-off the strike and participate in a joint
Union/Management working party the primary objective of which was
to devise a revised system of on-call attendance. The working
party did not operate satisfactorily and there were conflicting
views between the parties as to the reason why. In November, 1986
the Union served strike notice to obtain the balance of the 8%
increase and retrospection on it. On 11th November, 1986, in an
effort to avoid the strike, the matter was referred to the
conciliation service of the Labour Court. Conciliation
conferences were held on 22nd and 23rd November, 1986. At
conciliation the following formula for settlement, to avoid the
strike, was agreed.
The Department of Health, the LGSNB (representing the Health
Boards) the FUE (representing Voluntary Hospitals) and the
FWUI agree to recommend acceptance of the following package on
the basis that it is a package and its acceptance involves
acceptance of all items without exception and rejection of any
point means rejection of the full package.
Pt 1.
The Employers' side agrees to pay as soon as possible the
outstanding increases and retrospection due to basic and other
grade radiographers.
Pt 2
All outstanding issues listed hereunder will be referred to
the Labour Court for investigation and recommendation:
1. Staffing Levels 8. Basic Conditions of Employment
2. Grading Structures 9. Maternity Leave
3. Radiation and Toxic Fumes 10. Rates of Pay
4. School of Radiographers 11. Radiotherapy differential
5. Specialised Areas 12. Early Retirement
6. Study Leave 13. Emergency Services
7. Pay Link (a) After hours cover
(b) Staffing/back up
(c) Time off
(d) Duration of Sessions
(e) Hospitals to be covered
(f) Payments.
Pt 3
As and from 1/4/1987, provided that date allows for at least
1 month from date of issue of the Labour Court
recommendation, the option to introduce a form of sessions in
hospitals as Management determine will be available in
accordance with whatever terms will be outlined in the Labour
Court recommendation or any other agreed arrangement.
Pt 4
All parties will co-operate to the fullest extent to
facilitate as early a Court investigation of the matters in
dispute as possible recognising that time will be needed to
prepare detailed submissions on what are very complex issues.
4. In February, 1987 a dispute arose over the interpretation of
the agreement reached in November, 1986. The Union considered
that the workers were entitled to the lump sum payments in advance
of the introduction of "sessions" and that Management were in
breach of the agreement by withholding payment pending agreement
on the introduction of "sessions." Management considered that the
payment was conditional on the workers co-operating with the
introduction of "sessions" and that the Union was in breach of the
November agreement by stating that its agreement to the
introduction of "sessions" was only an agreement in principle and
was contingent on a satisfactory resolution of the other
outstanding claims.The Union served strike notice on the Employers
for 25th February, 1987. A Labour Court hearing was held on 22nd
February, 1987. On 24th February, 1987 the Court issued its
recommendation to the parties by letter. The Union rejected the
recommendation and on 4th March, 1987 proceeded with the strike.
A further Court hearing was held on 30th March, 1987. The Court
issued further proposals for the settlement of the dispute to the
parties by letter on 31st March, 1987 (see appendix 1).
(1) Staffing Levels:
Background:
5. The Union is seeking a system to determine the staffing level
in each hospital. Management proposes a Management/Union working
group to examine this and other matters.
Union's arguments:
6. (i) Since 1980 the number of patients x-rayed each year has
increased without any corresponding increase in staff.
There has been an increase in hospital facilities but
not by the provision of extra staff or equipment in the
x-ray departments. The British health service
recommends 3,000 routine x-rays per radiographer per
year but the Union's estimate is that workers in
Ireland, in hospitals doing routine general work, are
exceeding this figure by 50%.
(ii) Since the introduction of the accident and emergency
service there has been no increase in the level of
radiographer staff allocated to it. This has lead to
depletion of existing staff levels in other areas.
(iii) When the accident and emergency service was introduced
in 1967 an average of five patients per night were
x-rayed. The figure has increased to between seventy
and one hundred patients per night. As a result it has
been necessary to increase the number of radiographers
on-call per night and staff are rostered more
frequently on the rota. This situation is very acute
in smaller hospitals with lower staffing levels.
(iv) The workload at night in hospitals on the accident and
emergency rota in Dublin can vary greatly from hospital
to hospital. It depends on the location of the
hospital, whether there is only one hospital on-call
that night and on the experience and competence of the
casualty officers. It is clear that staffing levels
must be related to the night workload as well as the
day time situation.
(v) The implementation of new techniques means that larger
hospitals with multi disciplinary techniques require
different structures. Radiographers must be trained in
all new techniques so that productivity is maintained.
(vi) The complement of staff is inadequate in all the
specialised areas. A system should be used to find the
correct staffing levels for each x-ray hospital. The
Forresters Hill points system could be used for this
purpose.
Management arguments:
7. (i) Management have indicated to the Union that because of
the predominantly service content of this and other
issues, discussions should take place directly with the
appropriate division in the Department of Health and/or
the employing authorities.
(ii) Specifically Management are proposing the establishment
of a joint Union/Management working group to examine
staffing criteria and grading structure in radiography
departments and the question of intake to the school of
radiographers. This group would also embrace the
safety question i.e. radiation, toxic fumes and the
issue of pregnant radiographers working during the
early weeks of pregnancy.
(2) Salary Differential for Radiotherapy
Background:
8. The Union is claiming a 20% differential above the diagnostic
scale for therapy radiographers. Management rejected the claim.
Union's arguments:
9. (i) Until 1956 radiographers all had the same
qualifications and could work in both therapy and
diagnostic areas. Arising from the introduction of
specialised treatment machines into therapy departments
it became necessary to separate the training courses
for the two areas. While the need for different
qualifications in the two areas has been recognised the
need for two separate systems has not been recognised.
The main areas of difference are in training and in the
range of work. Therapy students may only help run
clinics and act as assistants on the treatment
machines. The School of Radiotherapy provides the
theoretical background and principles needed for
therapy radiographers, but it is the qualified
radiographers who are depended upon to ensure that
practical application is not at variance with
established techniques. The experience and knowledge
radiographers have gained over the years is a valuable
guide to the students.
(ii) There are usually at least five types of machines in a
therapy department and a high degree of proficiency is
required to operate the machinery safely. There are
very few therapy departments as the cost of the
machines and specialised treatment rooms are very high.
(iii) Difficulties are experienced in keeping staff in
therapy departments because staff resign to take up
positions in x-ray diagnostic or in nuclear medicine
departments. The main reasons for this are greater job
opportunities, nuclear medicine is a rapidly expanding
area with good long term job prospects and there is an
opportunity in x-ray diagnostic to do 'on call' duty to
supplement poor basic salary.
(iv) St. Lukes hospital in Dublin treats twice as many
patients per year as a comparable hospital in Belfast
which has the same number of machines as St. Lukes.
The hospital in Belfast also has a higher grading
structure than St. Lukes and has more superintendent
radiographers.
(v) Therapy radiographers must have a good knowledge of
treatment planning, both manual and computerised as
they can be asked to plan a patient's treatment. This
knowledge is also required for the simulator (which
simulates the patient's treatment). As the simulator
has a diagnostic x-ray tube often with tomographic
facilities, the therapy radiographer must also have the
ability to operate this specialised diagnostic x-ray
set. Involvement in theatre in the use of sealed
radioactive sources for interstitial and intracavity
treatment is sometimes, although not often required.
Mould Room work is also another aspect of the therapy
radiographer's work. This entails the making of moulds
for use in beam direction and immobilisation of
patients.
(vi) Therapeutic radiography is a responsible and demanding
job both physically (due to the heavy nature of the
machinery and incapacitated state of patients) and
mentally as continually working with cancer patients
can cause severe psychological strain.
(vii) The difference of providing an essential treatment as
against a diagnostic service should be recognised.
Increased sophistication of equipment has put a greater
onus on the radiographer (therapy) to maintain a
current working knowledge of all techniques but it must
be remembered that radiotherapy radiographers, as well
as providing the treatment, are involved in monitoring
patients reactions too and may equally have to motivate
a patient to continue and complete the treatment
course.
(viii) The ever increasing numbers of patients, and the high
cost of machinery puts even more of a burden on the
already overworked members of this profession including
the Total Body Irradiation treatment started over the
past year which not only disrupts the whole department,
but it is very emotionally involved as it takes a whole
day and in most cases continues after normal working
hours to the one patient.
(ix) In these circumstances an increase of 20% above the
diagnostic scale should be recommended for therapy
radiographers.
Management's arguments:
9. (i) Management rejects the claim for a differential for
therapy radiographers because the entry requirements
for the training in therapy radiographers are the same
as those for diagnostic radiographers. The training
courses are of the same duration. The two branches of
radiography receive the same training for the first
eighteen months when they then branch off and
concentrate on their own particular field.
(ii) The payment of a differential to therapy radiographers
would create a thoroughly bad precedent and could lead
to a fragmentation of the pay structures for numerous
other professional groups in the health service.
(iii) The main basis of the Union's claim appears to be
differences in training and work content vis a vis
diagnostic radiographers. It is interesting to note
that the Halsbury Report in the United Kingdom saw no
justification to separate therapy radiographers from
diagnostic radiographers for structural purposes. The
report recommended the same salary structures for both
groups. The Clegg Report in 1980 did not consider that
there should be any change in this position.
(3) School of Radiographers/Study Leave:
Background:
10. The Union is claiming that the school be expanded and that
educational grants paid to other professions be paid to
radiographers. It also seeks post-graduate facilities.
Management considered this issue should be examined by the joint
working party. The Union is claiming that paid study leave be
granted to radiographers with locum cover provided. Management
contended that radiographers had the same study leave arrangements
as other health service and public service workers.
Union's arguments:
11. (i) The school of radiography should be expanded to allow
for the necessary number of radiographers to be trained
each year, which is estimated to be 5% of the total
number of radiographers, in line with the other
disciplines.
(ii) The educational grants paid to other professions should
be paid to radiographers.
(iii) The school should provide facilities to allow
post-graduates the opportunity to acquaint themselves
with the new methods and advanced technology in
radiography.
(iv) The expansion of the diagnostic imaging and therapy
field over the past 15 years make post-graduate
education essential. There is no formalised leave
granted in this field. This would necessitate release
to study for set examinations with locum cover
provided.
Management's arguments:
12. (i) At present the granting of special leave with pay for
the purposes of attendance at courses, programmes,
seminars etc. is entirely at the discretion of the
hospital authority. This applies to all health service
employees. Radiographers want an automatic entitlement
to paid study leave and it is unreasonable for the
Union to demand concessions that no other group in the
health service or indeed the wider public service
enjoys.
(ii) Concession of the Union's claim would involve the
employment of additional locum cover and payment of
travelling and subsistence in many circumstances.
Furthermore concession of this claim could have
repercussive effects in the case of other health
service grades and the wider public service.
(4) Grading Structures:
Background:
13. The present grading structure consists of the following
grades:
radiographer; worker with less than two
years' experience,
senior
radiographer I; worker with more than two
years' experience,
senior
radiographer II; in charge of a department
supervising 1-3 other
radiographers doing
specialised work or radiation
safety officer,
superintendent
radiographer I; in charge of department employing
4-14 radiographers or deputy to
superintendent II,
superintendent
radiographer II; in charge of department employing
15-20 radiographers.
The Union considers that two additional posts be created,
superintendent III and superintendent IV. These would be in
charge of departments employing between 31-40 radiographers and
more than 40 radiographers respectively.Management considered this
was one of the issues which should be examined by the joint
working group.
Union's arguments:
14. (i) Superintendent radiographers managing the diagnostic
imaging and radiotherapy departments are ultimately
responsible for the achievement of the highest
practical standards of radiography and patient care.
They must ensure their staff are properly trained in
all the new techniques and technologies. As
radiographic managers they are responsible for
expensive and hazardous equipment. They are involved
in checking the safety and efficiency of the equipment
and in commissioning and installing equipment in their
departments.
(ii) The superintendent radiographers have to manage a
comprehensive service that requires an ability to
manage people, to have a detailed knowledge of the
technology and its applications and who must have the
administrative skills required to obtain and utilise
scarce resources in the light of continually restricted
provisions. Above all, they must ensure that the
radiographic service they manage provides the highest
level of patient care that can be achieved.
(iii) Superintendent II was introduced following an
examination in 1981 under the conciliation and
arbitration scheme. This was despite attempts by
management to denigrate the role of the superintendent
radiographers. In 1983, however, the Department of
Health endorsed the introduction of a two year
Management course and thereby recognised the important
role played by the superintendent radiographers and the
long term benefits of training those who actually
manage the radiographic service namely the
superintendent radiographer.
(iv) There is no incentive for a radiographer to take on the
position of superintendent at present because of the
very poor salary scale which exists. This should be
borne in mind when examining the rates of pay of all
radiographer grades.
Management's arguments:
15. (i) Management considers that this issue is appropriate to
the joint working party already outlined in its
arguments concerning staffing levels.
(5) Radiation/Maternity Leave and Toxic Fumes:
Background:
16. The Union is seeking that there be a safety committee in each
x-ray department to report to a national co-ordinating committee
with a view to establishing a national code of practice. The
Union considered that radiographers between the 8th and 15th week
of pregnancy should not be asked to x-ray patients. Management
considered these issues should be examined by the joint working
party.
Union's arguments:
17. (i) Though Radiation Protection Committees have been set up
in all hospitals, due to lack of funding these
Committees are unable to implement the recommendations
laid down by the E.E.C. directive of 1st September,
1984. As a priority, funding should be made available
in order to carry out these recommendations
efficiently.
(ii) Maximum permissible radiation dose to which
radiographers may be exposed are laid down - see
council directive of 15th July, 1980 (Euratom 80/836)
by the council of the European communities. It is,
therefore, essential that accurate and accumulated
doses are recorded so that they are not exceeded.
(iii) Radiographers wear monitoring badges to register any
dose of radiation received. However, this does not
give any warning at the time the radiation is received.
It is possible to receive dangerously high doses
without knowing at the time.
(iv) In the circumstances it should be mandatory to have a
safety committee in each x-ray department to make a
quarterly report on the level of radiation and toxic
fumes and other aspects of safety in the department.
This report should be made to a national co-ordinating
committee with a view to establishing a national code
of practice.
(v) The International Commission on Radiation Protection
recommends that specific operational arrangements
should be made to avoid situations at which a dose to
the foetus could be received.
(vi) It cannot be certain that the radiographer will not
receive a dose during pregnancy. There is surely a
case for removing the potential danger for this period
of pregnancy.
(vii) Radiographers between the 8th and 15th week of
pregnancy should not be asked to x-ray patients even if
this means extending the maternity leave if no other
work is available, with adequate locum cover provided.
(viii) The working environment of radiographers has been made
more hazardous in the past number of years by the
presence of toxic fumes. These fumes are produced by
the automatic rapid developing processors. The
presence of toxic fumes in x-ray departments must be
recognised by the employing authorities and x-ray
departments must be inspected by qualified personnel to
insure, proper ventilation, proper ducting of fumes to
the outside of the building and that the drainage
system follows the recommendations guidelines laid down
in the CHOSE Bulletin of Health and Safety.
Management's arguments:
17. (i) Management considers that these issues are appropriate
to the joint working party already outlined in its
arguments concerning staffing levels.
(6) Specialised Areas:
Background:
18. The Union is claiming that a work study group be set up to
examine the effects of new technology on the radiographers'
duties. Management proposed that the joint working party examine
this issue.
Union's arguments:
19. (i) In recent years new inroads have been made in
radio-diagnosis. X-ray departments now include CT
scanning, isotape scanning ultrasound and magnetic
resonance. Radiographers have taken on these new
skills without cognisance having been taken of them by
the employers. In the interim, to compensate for
radiographers being drawn from the general pool to
train in specialised areas extra staff should be
provided. However in the long term a study group
should be set up to make a report within six months.
Management arguments:
20. (i) The matter of 'specialised areas' can be more
effectively dealt with in direct discussions with the
appropriate hospital managements.
(7) Basic Conditions, Including early retirement:
Background:
21. The Union is claiming that hospitals should provide proper
staff rest rooms, sleeping facilities separate to the rest room
and close to the x-ray department, and shower facilities. A
monitoring committee should also be set up to inspect such
facilities when requested and to make recommendations if
necessary. When a radiographer is working 'on-call' a hot meal
should be provided by the hospital.The Union is also claiming a
reduction of the working week from 35 hours to 30 hours, an
increase in the annual leave entitlement to a minimum of 30 days
and 5 days' service leave for radiographers with 10 years'
service. It also sought that radiographers who had completed 30
years' service should have the option to retire when they reach 55
years of age. Management considered the issue of staff rooms and
meals should be dealt with at local level. It rejected the claims
regarding the working week and annual leave. The claim regarding
early retirement was also rejected mainly on the basis that it
would be too costly.
Union's arguments:
22. (i) Considering that as long ago as 1948 it was recommended
that radiographers should not work more than 35 hours
per week and the changes in the hours of other groups
in the meantime, a working week of not more than 30
hours for radiographers is not unreasonable.
(ii) At present annual leave entitlements vary from 24 to 30
days. All radiographers should have a minimum of 30
days' annual leave and radiographers with 10 years'
experience should be granted an additional five days
per annum.
(iii) Radiographers should be allowed to retire at the age of
55 on full pension provided they have completed a
minimum of 30 years working as a radiographer. The
long hours worked providing a 24 hour service 7 days a
week in a dangerous environment should be taken into
consideration together with the unsocial hours worked
and the loss of leisure time which other groups of
workers are protected from. Radiation has a cumulative
effect, therefore, a worker who is continually exposed
to radiation over a number of years is subject to
genetic cell damage. This risk of damage would be
greater than to a worker who had been exposed to
radiation for a lesser period of time. Consequently it
is necessary that radiographers be allowed earlier
retirement.
Management's arguments:
23. (i) Management would point out that a number of groups in
the health services who are working a 40 hour week have
been unsuccessful in pursuing claims for a reduction in
the working week.
(ii) A claim by psychiatric nurses for a 35 hour working
week was recently the subject of a Labour Court
hearing. The Court did not recommend concession of the
claim (Labour Court Recommendation No. 10,898 refers).
(iii) Craftsmen in local authorities and health boards as
part of their 24th wage round sought a reduction in the
working week to 35 hours without loss of pay. The
Court rejected the claim. (Labour Court Recommendation
No. 9,045 refers).
(iv) The 25th round claim in respect of general
operatives/non-nursing personnel in local authorities
and health boards also included a claim concerning a
reduction in the working week. Labour Court
Recommendation No. 10,667 rejected the claim.
(v) It is significant that of 57,000 health service
employees, 46,000 work a 40 hour week.
(vi) All the evidence available clearly indicates that there
has been no general trend towards a reduction in the 40
hour working week. The Labour Court itself will be
aware that virtually every claim before it for a 25th
round increase included a claim for a shorter working
week. The Court invariably recommended against any
such reduction in the light of the financial
circumstances of many of the companies involved.
(vii) The introduction of a 30 hour week in respect of
radiographers would necessitate the recruitment of
additional staff. This would add #1 1/2 million per
annum to the radiographers pay bill. The extension of
a 30 hour week to other health service employees would
add approximately #200 million per annum to payroll
costs.
(viii) Radiographers are in an extremely favourable position
vis a vis the generality of health service employees.
(ix) It is Management's contention that there is no
justification for a reduction in working hours against
the background of current hospital finances and the
enormous cost implications of any concession not only
for the health service but also for the wider public
service.
(x) Management are of the view that the current annual
leave entitlements of radiographers are generous.
Furthermore they compare favourably with other
paramedical grades.
(xi) Any increase in annual leave would necessitate the
employment of additional staff with a consequential
increase in payroll costs.
(xii) Concession of the claim would have repercussive effects
by way of similar claims from other groups of health
service employees, particularly paramedical staff.
(xiii) The standard of staff accommodation in our hospitals is
generally good. The age of some these hospitals
obviously imposes certain physical limitations on such
accommodation. This issue can only be dealt with in
the context of local Union/Management discussions and
it is totally impractical for the Union to expect to
have it dealt with in the context of national
negotiations.
(xiv) Eating facilities are good and any difficulties that
may exist in this regard should be dealt with at local
level.
(xv) Under the current superannuation scheme, radiographers
in common with other officer grades in the health
services can retire at 60 years of age or remain in
service up to age 65. The Union has made no case as to
why radiographers should be treated any more favourably
than other officer grades in the health service for
superannuation purposes.
(xvi) Concession of this claim would be extremely costly. In
addition to the extra revenue required to fund early
pension and lump sum payments there would also be a
shortfall in revenue because of loss of superannuation
contributions. Early retirement would also necessitate
the recruitment of additional radiographers.
(xvii) The concession of early retirement would have enormous
cost implications if it were extended to other health
service employees and the wider public service.
(8) Rates of Pay/Pay Link:
Background:
23. The Union is claiming that the radiographers' rates of pay be
examined in relation to the rates of other para-medical grades and
that the radiographers be granted an increase to put them on par
with medical laboratory technicians or at least close to their
scale. Management contended there was no justification for any
increase in the rate of pay.
Union's arguments:
24. (i) The level of pay for radiographers has been seriously
eroded when compared to that of other groups with
comparable education and training. Not only should
salary scales' be restored to the level of other
paramedic groups but there should be a further
upgrading of these salary levels.
(ii) During the last decade the role of the radiographers
has changed considerably (details supplied to the
Court). The dynamic nature of this profession has
meant encompassing technological and clinical practices
whose development has been both rapid and extensive.
(iii) The skills required by the new imaging procedures are
not easily acquired but are of such importance that
post diplomatic qualifications are now available. It
is highly probable that in future increasing specialist
qualifications will be available.
(iv) An increasing amount of complex imaging work is now
being undertaken out of normal duty hours and this adds
considerably to the emergency duty responsibilities
that radiographers are compelled to work. This in turn
increases the level of stress under which radiographers
have to operate and perform.
(v) In specialist areas for which courses are not available
in Ireland the training of radiographers is depended on
the goodwill of fellow radiographers who have already
the required skills. This in-house training is not
remunerated financially.
(vi) There have been developments also in conventional x-ray
techniques that have enabled therapeutic treatment to
be carried out under x-ray control for patients who
would have previously needed major surgery. The
scientific and professional abilities of diagnostic
radiographers are thus available to any branch of the
medical profession and are essential in a team approach
to interventional radiology.
(vii) Radiographers holding the Diploma in Medical Ultrasound
are acknowledged to have clinical responsibility in the
diagnosis of obstetrical ultrasound scans. Reports of
these scans are now signed by radiographers. The sum
of #138 per annum now received by these radiographers
is more of an insult than a financial recognition of a
service rendered.
(viii) This is a clearly recognised clinical responsibility.
What is not formally recognised is the value of an
experienced radiographer in the "on call situation."
In the absence of a radiologist advice is often
requested by junior house doctors who may have limited
experience of reading x-rays.
Management's arguments:
25. (i) The present pay levels adequately reward radiographers
for the duties and responsibilities carried out by
them. There is no justification for any increase in
present remuneration over and above that provided for
in the conciliation agreement of the 24th November,
1986.
(ii) Any increase for radiographers would have immediate
repercussions in the paramedical and nursing area.
(iii) Every one percentage increase in the paramedical and
nursing pay roll adds #3.5 million to the health
service pay bill.
(9) Emergency Services:
Background:
26. There was a uniform system of payment for the emergency
services provided by medical laboratory technicians and
radiographers from 1967 until May, 1981. The system known as the
'A' and 'B' system operated as follows:-
A system: on-call with standby
In this system an amount of money is paid for being
available together with a payment for each individual
call serviced #7.01 (fee per call).
B system: on-call without standby
In this system there is no payment for being available
but a higher fee per call is paid.
In 1981 the system of payment for emergency services provided by
medical laboratory technicians was altered to a two tier system
known as the sessional and on-call system. The demands of the
emergency system in major hospitals are such as to warrant
continuous cover after normal finishing time up to midnight,
Monday to Friday and on Saturday and Sunday. This is provided by
way of 10 emergency sessions per week. At all other times outside
of normal working the emergency service is provided under the
original system. Over the past 6 years Management have
consistently sought to secure the agreement of radiographers to
similar changes in the on-call/stand-by system as agreed with
medical laboratory technicians.
Union's arguments:
27. (i) Radiographers are employed in a wide variety of
hospitals and the demands of emergency radiographic
service varies with the type of hospital. It is
important to get a comprehensive picture of a
radiographer at work in the emergency/on-call situation
as it exists to-day.
(ii) Radiographers, almost always work alone, and often in
isolated departments during the night time and weekend
periods. They deal with a wide variety of patients,
making differing and significant demands upon their
radiographic skills.
(iii) Subjects for x-rays examination by virtue of their
belonging to breathing human beings present multiple
problems which not even the use of the most advanced
x-ray equipment can overcome. Hence, the radiographer
must be able to apply his/her skills in patient
management and adaptability in radiographic technique.
It is true to say that these problems are not peculiar to patients being x-rayed outside normal working hours.
However, during the "normal work period" the assistance
of a fellow radiographer, or consultative expertise of
a radiologist is usually available. This is rarely
possible during the emergency session. It is not to be
under rated - the skill and stamina that these problems
pose for a person working prolonged hours. Prolonged
hours in this context often means twenty-four.
(iv) Providing an emergency duty service all too often means
that the radiographer has an inadequate rest period for
the resumption of normal working hours the next day.
In radiographic departments, on most occasions the
radiographers who provide this emergency duty cover,
work a full day in the department and then continue to
work throughout the night alone, until the following
day's staff report for duty. They are therefore on
duty for twenty-four hours with perhaps only a minimal
of rest during that time.
(v) Further evidence will show that many radiographers
having worked hours after mid-night are given no time
off for resting before starting work at the usual time
next day. As can be seen, therefore the provision of
emergency cover, although an essential service of the
health programme, makes demands upon the providers of
the service that are both arduous and stressful.
(vi) Since back up staff are not available during emergency
work the radiographer has to take on many extra duties
including patient documentation, film processing,
nursing care, portering, and managerial
responsibilities.
(vii) There is a wide variation in time-off given for working
emergency duty. This should be standardised and all
brought into line with the time off of the large
accident and emergency hospitals in the Dublin area.
(viii) If the payment to radiographers for emergency duty is
determined by the length of the session rather than the
present situation of a fee per patient there will be a
greater likelihood of abuses by consultants. The
staffing implications of radiographers and the
necessary back-up staff during the emergency period
also need to be considered.
(ix) If the Court decides to recommend the introduction of a
form of sessions the Union considers that the following
procedures should apply:
That hospitals would be taken in three categories.
Category (1) Mater, St. Vincents, Jervis St., St.
James, Blanchardstown, St. Laurences, Dr.
Stevens, Meath, Temple St., Harcourt St.,
and Crumlin Childrens' Hospital, Cork
Regional, Limerick Regional, Galway
Regional.
Category (2) All other regional hospitals and Wexford
General Hospital.
Category (3) All other non-accident and emergency
hospitals, county hospitals, maternity
hospitals and St. Lukes.'
Sessions:- Monday - Friday to commence at 5 p.m.
and end at 9 p.m.
Saturday/Sunday 9 a.m.- 1 p.m.
1 p.m.- 5 p.m.(Total
of 2
sessions
Public Holidays: same as Saturday/Sunday.
Present on call rates with standby allowance to apply
after the end of each session.
Staffing levels:- Category 1 & 2 during sessions
clerical and portering staff to be
provided.
When a hospital in category 1 is "on
take" (i.e. on rota for accident and
emergency) clerical and portering
staff to be provided all night.
Time off:- Staff working after midnight and
before 2 a.m. = .50 day off the
following morning.
Staff working after 2 a.m. = 1 full
day off the following day.
Locums:- When staff is on "time off" locums
to be provided.
Payments:- Category 1 & 2 : #95 per session.
Category 3 : standby rate of
#20 plus present
on call without
Standby of #19.20
fee per call.
Management's arguments:
28. (i) These changes were sought by Management for a number of
reasons. Firstly radiographers were seeking the same
pay increases as those secured by medical laboratory
technicians. The increases paid to the technicians
were on the basis of an agreement to introduce a
revised on-call attendance system. It was at the
radiographers own request that the system of payment
for emergency services in respect of laboratory
technicians was introduced for them in 1967.
Accordingly it is appropriate to maintain a uniform
system of payments for emergency service provided by
both medical laboratory technicians and radiographers.
(ii) Failure to implement a revised system will result in
some radiographers continuing to earn excessive
emergency payments thereby perpetuating the deleterious
effect this has on staff morale in other hospital
departments. While the average payment is #4,000 per
annum, some radiographers earn in excess of #10,000 per
annum in emergency payments.
(iii) Both the Labour Court and an Arbitrator under the
Conciliation and Arbitration Scheme have endorsed
Management's proposal to link the radiographers' pay
claim to proposed changes in the emergency system.
(iv) The existing system for radiographers is no longer
appropriate to the needs of a modern day hospital
service. The Court will be well aware of the state of
health service finances and thus the need to ensure a
more effective system of cost control as part of
Management's overall efforts to curtail escalating
health costs.
(v) Management has already paid a 7% salary increase and a
#600 lump sum to radiographers on the clear
understanding that a joint Union/Management working
party would have resulted in the introduction of a
revised on-call attendance system.
(vi) As part of the agreement reached in November, 1986
under the auspices of a Labour Court Industrial
Relations Officer Management agreed to pay the salary
increases and lump sums claimed by the Union in return
for the Union's agreement to co-operate fully with the
introduction of sessions from 1st April, 1987 provided
that date allowed for at least one month from the date
of issue of the Labour Court Recommendation.
(vii) Management are seeking the option of introducing
sessions as outlined below.
Day of the week Maximum Duration Times
of each session*
Monday to Friday 7 hours Between finishing
time and 12
midnight
Saturday 6 hours Between lunchtime
time and 12
midnight
Sunday 5 hours Between 9.00 a.m.
and 12 midnight
*Sessions of shorter duration would operate where
required by management.
(viii) Management reserve the right to determine in which
hospitals sessional arrangements will operate. It also
reserves the right to introduce sessions of up to 7
hours duration depending on the demands of the service.
It would be unacceptable that sessional arrangements
could only operate in particular hospitals as outlined
by the Union. This restricts the number of hospitals
where sessions might be introduced immediately and it
precludes the introduction of sessions in the future in
hospitals where they may be required due to the needs
of the service. New hospitals coming on stream in the
future would also be excluded.
(ix) It is important to note that the revised system of
emergency services agreed with laboratory technicians
recognised Management's right to determine hospitals in
which sessions would be introduced.
(x) Management are offering the same sessional payments to
radiographers as apply in the case of medical
laboratory technicians i.e. #79.07 for a 7 hour
session. In the case of a 7 hour session carried out
during weekdays this represents a rate per hour of
between 1.52 T and 2.32 T depending on the grade of
radiographer involved. In the case of a 6 hour session
performed on Saturday the rate per hour is between 1.77
T and 2.71 T, and in relation to a 5 hour session on
Sunday the rate would fall between 2.13 T and 3.25 T.
In hospitals where Management deem a reduced session to
be appropriate, the payment would be calculated on a
pro-rata basis.
(xi) The rate payable in respect of sessions is extremely
generous.
(xii) The rates proposed by Management in relation to
stand-by following emergency sessions and to fee per
call are reasonable.
(xiii) The time-off arrangements put forward by Management are
presently in operation for medical laboratory
technicians. These arrangements are reasonable. The
Union has put forward no arguments as to why they
should enjoy superior arrangements.
(xiv) The present level of support staff available outside
normal working hours is adequate. Staffing levels must
be determined by Management having regard to the
demands of the service and the hospital's budget. Any
increase in the level of support staff would have a
consequential increase in payroll costs.
Management's general arguments:
29. (i) In considering the Union's claims due regard must be
taken of the present state of health service finances.
(ii) The overrun in health service budgets for 1986 is
estimated to be #35m. This when added to the carryover
of #20m for 1985 will result in a cumulative deficit of
#55m at the end of 1986.
(iii) The indications for 1987 are that allocations to the
health service in real-terms will be no better than
last year, resulting in health boards and voluntary
hospitals having to operate within very restrictive
parameters as they attempt to stay within their budgets
for 1987 and at the same time effect savings of #55 in
the coming year.
RECOMMENDATION:
For technical reasons the Recommendation on this case cannot be
held in the recommendation field of the database. It is, however,
available on the full document if you choose that display option.
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30. (1) Staffing Levels
The Court notes that the employers have accepted the Union's
request that standard criteria should be established and agreed
for deciding on the correct staffing levels for each hospital.
The Union has suggested that the "Forresters Hill" points system
should be used. The Court recommends that this system be examined
along with any other system which the employer's may wish to
suggest. This should be done through a Joint Working Party, with
an independent chairperson, established for the purpose of giving
effect to this recommendation. The Union and the employers should
agree on an independent chairperson for the working party, but if
they fail to do so within two weeks of the issue of this
recommendation the Court will appoint such a person following
consultation with both sides.
The working party should engage the Irish Productivity Centre to
carry out the examination of the systems and to report on their
appropriateness to the working party which should then decide on
the system to be used and the aim should be to complete the work
by 30th June, 1987.
(2) Salary Differential for Therapy Radiographers
In the short time available to it, the Court has been unable to
form a firm view on the merits of this claim. The Court cannot
therefore make a recommendation one way or the other on it, but
recommends that following the review of the grading and staffing
structures as provided for elsewhere in this recommendation the
claim should be seriously looked at on its merits by the employers
and referred to the Court if necessary before the end of 1987.
(3) School of Radiography/Study Leave
The Court considers that the Union has made a prima facie case for
the expansion of the training and education of additional numbers
of radiographers and recommends that the appropriate authorities
have due regard to those points in planning the future training of
radiographers. Any observations which the Working Party may make
on this matter should also be taken into account.
The Court recommends that the radiographers should be treated no
less favourably in the matter of study leave than other
professionally qualified paramedical staff in the Health Service.
(4) Grading Structures
The Court recommends that a new higher grade be established and
called Superintendent III. The precise duties and
responsibilities should be decided by the Working Party and the
salary attaching to it is detailed below.
(5) Radiation/Maternity Leave
The Court recommends that there should be a safety committee in
each x-ray department and that it should make a quarterly report
on the level of radiation and toxic fumes and other aspects of
safety in the department. The report should be sent to a national
co-ordinating committee which should be empowered to make what
observations it wishes to the Radiation Advisory Board and the
Department of Health. The co-ordinating committee should meet
quarterly under the auspices of the Department and representatives
of the Union, radiographers, superintendents and radiologists
should attend.
Both sides should avail of the best advice and information
available on the issue of pregnant women working in x-ray
departments both here and abroad and introduce whatever safety
systems are deemed necessary.
(6) Toxic Fumes
The Court notes that the employers agreed that where the Secretary
Manager of any Hospital requests it, the Department of Health will
immediately arrange for an inspection by qualified personnel of
the ventilation and other safety aspects of dealing with toxic
fumes originating in the film processors in the department. This
issue should therefore be brought to the attention of the
Secretary Manager where there is a problem.
(7) Specialised Areas
This matter is appropriate to the examination by the Irish
Productivity Centre and the Working Party proposed above and the
Court recommends that it be dealt with in that context.
(8) Basic Conditions
(a) Rest Rooms etc.
The Court recommends that the claim for improved physical
working conditions (rest rooms/sleeping facilities, etc)
should be dealt with at local level and that where they are
inadequate they should be improved.
(b) Working Week
The Court does not recommend any change in the length of the
working week.
(c) Annual Leave
The Court recommends that the following annual leave
entitlements apply in the current leave year. If any
radiographers currently enjoy entitlements more favourable
than those recommended here they should retain them on a
personal basis.
Basic Radiographer 24 Days
Senior Radiographer 25 Days
Supt. I 26 Days
Supt. II 27 Days
Supt. III 28 Days
(d) Early Retirement
Having regard to the current state of finances in the Health
Service, the Court does not recommend concession of the claim
for early retirement.
(9) Rates of pay/Pay Link
The Court recommends that on acceptance of this recommendation the
salary scales of radiographers be brought more into line with the
salary levels and structure of physiotherapists and that the
differentials which apply to the supervising physiotherapists be
reflected in the salary scales for the higher grade radiographers.
This would give pay scales as at 1st January, 1987 as follows:
Basic Radiographer #10,000-#12,540 10 points
Senior Radiographer #12,133-#13,660 5 points
Supt. I #12,800-#14,600 5 points
Supt. II #13,590-#15,600 5 points
Supt. III #14,000-#17,180 5 points
During the course of the hearing of this case it was agreed that
the Court should not make a specific recommendation on the
question of the future pay link of radiographers, as this question
has such major implications for both the radiographers and their
employers. The Court's recommendation should not therefore be
taken to prejudge the resolution of that question.
(10) Emergency Duties
A key issue in this dispute is the management's insistence on
introducing a revised system of payment for radiographers while
doing emergency work outside the normal hours of duty ( 9am to 5pm
Monday to Friday in most hospitals). The present system which is
based on the payment of #7.01 for each patient examined was
appropriate when the number of call outs was small. It is still
the most cost effective way for most hospitals where the incidence
of call outs is slight and it should therefore be retained in
those institutions. However, in the larger city hospitals the
number of x-rays required outside normal working hours has grown
dramatically over the years since the system was introduced, due
particularly to increased usage of the accident and emergency
service. The fee per patient system was not intended for such
circumstances and is now too expensive. The Court considers that,
in the light of the current financial circumstances of the Health
Service, management should have the option of introducing the
system of session working. The Court recognises that the
introduction of the session system will involve a serious loss of
earnings for some radiographers. The effect of such loss will
however be cushioned to some extent by the payment of
retrospection due under salary increases already determined.
The Court has considered the Union's claims relating to the terms
under which session working would be acceptable to it. It has
also examined the terms offered by management and the terms which
have been accepted by other paramedical staff. The Court
recognises that there are differences between the work of
radiographers and medical laboratory technicians and that further
differences emerge in working after hours when the full resources
of the hospital are not available. The Court does not consider
however that such differences would warrant the payment to
radiographers of a higher hourly rate of pay than is paid to
technicians for working after hours. The Court does consider
however that the radiographers should not generally be expected to
work as long as the technicians on regular sessions. The Court
has framed its recommendation on sessions in the light of these
considerations.
The Court recommends that the Union accept that the management
should have the option to introduce sessions of 5 hours duration
in such hospitals as management deem it appropriate. one month's
notice should be given to the radiographers in each hospital. The
payment for each session should be as follows:-
Monday to Friday #56.48
Saturday #65.89
Sunday #79.07
It should be noted that the Monday to Friday payment is the
equivalent of an hourly rate of between 1.52T and 2.32T depending
on the grade of radiographers and that on Sundays the rate is
between 2.13T and 3.25T. These compare favourably with premium
rates paid in the Health Service and industry generally.
There should be 9 sessions each week (one each evening Monday to
Friday commencing after normal finishing time and two each on
Saturday and Sunday, the times to be agreed locally). All
sessions should be five hours duration.
The stand-by payment to cover the period from 10 p.m. to 9 a.m.
should be #5 Monday to Friday. On Saturday the stand-by payment
should be 51p per hour and 76p per hour on Sunday.
The fee per call should remain at #7.01.
The stand-by and fee per call in non session hospitals should
remain the same as at present and there should not be any limit on
the number of calls per week to be paid at the rate of #7.01.
Time off arrangements should be as follows:
Call out between midnight and 2.00 a.m. - the
radiographer need not report for work until 11.00 a.m.
on that day.
Call out between 2.00 a.m. and 7.00 a.m. - the
radiographer need not report for work until normal
starting time on the afternoon of that day.
In addition, where a radiographer has worked
continuously from 12 midnight to 6.00 a.m. she should
be entitled to the complete day off.
When time off arrangements are more favourable than
those above they should be maintained on a personal
basis.
In relation to backup staff, management should ensure that
when a Hospital is "On Take" no patient is at risk by lack of
support staff in the x-ray Department.
Conclusion
The Court recommends that this set of recommendations be
treated as a total package by both parties and be voted on by
all the radiographer members of the F.W.U.I. in a secret
ballot vote and that in the meantime normal work be
maintained.
The Court urges both sides to accept it.
~
Signed on behalf of the Labour Court
John M. Horgan
_____________________________
14th September, 1987
T.O'M./J.C. Chairman.
APPENDIX I
Further proposals for settlement
Proposals for the Settlement of the Radiographers' Dispute
(To be read in conjunction with Labour Court Recommendation
No. 11031)
The Court recommends that in settlement of this dispute the
following proposals should be implemented.
1. Annual Leave for Basic grade radiographers should be
increased to 27 days and to 28 for Senior Radiographers.
Superintendent Radiographers I should have 29 days and
Superintendent Radiographer II and III should have 30 days.
2. Where a radiographer is working on after 5 p.m. on a session
she should be entitled to a meal break as soon as
conveniently possible after 5 o'clock and not later than 7
o'clock.
3. Radiographers should have the option after they have
completed a session of going on call or of being replaced.
There should therefore be no compulsion on any radiographer
to work continuously for 24 hours.
4. Where time off arrangements in a particular hospital are
better than those recommended in the Court's recommendation
they should be retained in that hospital for all
radiographers.
5. Both sides should accept the need to ensure that all
radiographic procedures are organised and delivered on a cost
effective basis. To this end it is agreed that the operation
of the sessional arrangement will be monitored by hospital
management in conjunction with all the staffs involved,
including the Superintendent Radiographers, and a
Radiographer nominated by the staff side. The purpose of
this monitoring is to ensure that work carried out during
sessions will be limited to emergency and non-deferrable work
and that there will be no increase in the volume of work as a
result of the introduction of sessions.
6. Both parties accept that the union is reserving the right to
serve a claim for loss of earnings in respect of the
introduction of sessions and to process the claim to the
Court if necessary after 12 months.
7. Management should provide portering cover when necessary to
the radiographers working in hospitals when "On Take."
8. Both sides agree that Radiography staff should have a say in
the staffing levels to apply outside normal hours.
9. Events subsequent to the issue of the Court's recommendation
have resulted in a back log of patients for x-ray and it is
vitally important to them that the necessary services be
restored as early as possible. Accordingly, on a resumption
of work, the Court recommends that in order to clear the
backlog of work each radiographer should be given the
opportunity to deal with 70 patients after hours and outside
sessions on the existing fee per patient basis.
10. The Court recommends that these proposals be put to a secret
ballot vote of the Radiographers. If they are accepted there
should be an immediate return to work. Concurrent with a
resumption of working, the back money due will be paid out
and sessions will be introduced in the relevant hospitals.
John M. Horgan
31st March, 1987