Review and realignment of NAS clinical grades

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The Irish Society of Paramedicine believes the time has come for an honest and meaningful discussion around the grading, recognition and future sustainability of frontline ambulance services in Ireland.

For many years, ambulance personnel have continued to evolve alongside the wider healthcare system. What was once viewed primarily as a transport-focused service has transformed into a modern mobile healthcare profession delivering increasingly advanced clinical care in homes, communities, roadside environments, and major incidents across the country.

Emergency medical technicians, paramedics and advanced paramedics now operate in highly complex environments, making critical clinical decisions with significant responsibility placed upon them every day. Yet, despite this evolution, many frontline staff feel the structures surrounding ambulance grades have failed to evolve at the same pace.

This is not a new issue, historical benchmarking exercises previously recognised the EMT grade as requiring uplift. The increase recommended in 2008 also acknowledged the ongoing development and upskilling of the profession, even referencing the potential need for future review as the role evolved further.

The evolution has happened: educational standards have increased dramatically, clinical autonomy has expanded, and pre-hospital interventions have advanced. The National Ambulance Service (NAS) has become a central pillar of acute and unscheduled healthcare delivery in Ireland. However, many staff now feel the grading and recognition structures have not kept pace with those changes.

In highlighting these issues, we do not seek to diminish any other healthcare profession. The ISP fully recognises and respects the vital role played by nurses, physiotherapists, specialist clinicians, and allied healthcare professionals throughout the HSE.

In fact, many ambulance personnel point towards those professions as examples of how the wider health service already recognises through structured pay scales, qualification allowances, specialist allowances, and advanced practice pathways. Frontline ambulance clinicians are increasingly asking why those same principles are not being consistently applied within modern pre-hospital care. 

Recent engagement and polling amongst NAS staff has demonstrated a very clear message emerging from the frontline workforce. Many ambulance practitioners are comparing their roles with those of advanced nursing grades, emergency nursing staff, specialist community clinicians, physiotherapy grades, and critical care staff within the wider health service.

The overwhelming majority of respondents believe that any meaningful resolution must include: 

    • recognition of the long-outstanding 5% benchmarking issue

    • substantial modernisation of ambulance grading structures

    • protection of existing terms and conditions

    • fair alignment with comparable healthcare professions across the wider HSE

The most commonly identified acceptable pay uplift from staff fell between 15% and 20%, with many poll respondents making clear that the historical benchmarking element should not form part of that figure, as they believe it remains separately owed.

This conversation extends far beyond pay alone. Frontline ambulance staff are highly sensitive to issues around retention, and protecting clinical experience. They are tired of seeing the loss of highly trained clinicians abroad and into other sectors. A successful resolution, and genuine recognition, would boost morale within one of the most pressured areas of the public health service. 

Ultimately, these issues impact patient care. Every paramedic lost from the service represents years of training, operational experience and a significant investment by the Irish taxpayer. The ISP believes frontline ambulance personnel are not asking for special treatment. They are asking for recognition that the profession has fundamentally changed - and that the structures surrounding it now need to reflect that reality.

The modern ambulance service cannot continue to operate under legacy structures while simultaneously expecting staff to carry continuously expanding clinical, operational and professional responsibility. The ambulance service, frontline staff, and the expectations placed upon them have all evolved. Recognition structures need to evolve too.

Irish Society of Paramedicine

Advocating for staff. Supporting patient care. Strengthening the profession.