Blaming rivalry between health unions for the resident (junior) doctors’ strikes rather misses the point about who is responsible for the turbulent period of industrial strife that public hospitals now find themselves in.
A Dominion Post editorial – which also ran in other Fairfax newspapers – over-emphasises the importance of the new much smaller union, Specialty Trainees of New Zealand (StoNZ). The editorial fails to adequately recognise the complexity of the problem.
Resident doctors are in training usually either to become general practitioners or hospital specialists. There is a dilemma in the way New Zealand trains its doctors. It is through an apprenticeship model based on service provision. This model is a strength of our system producing quality senior doctors working in our DHBs. But we also have fatigue leading to a push for making the working hours safer for these doctors in training. The dilemma is that enhancing safer hours requires more resident doctors, which fragments the continuity of training along with affecting handover and patient care.
This dilemma and its unintended consequences has been around for many years. In 2016-17 the Resident Doctors’ Association (RDA) sought to further improve the safety of working hours in their national collective agreement with the DHBs by introducing two additional requirements – a maximum of 10 consecutive working days and four consecutive night shifts. After acrimonious negotiations, which included two national strikes, the RDA succeeded with an agreement known as Schedule 10 to be added to the national agreement. As a result, this dilemma deepened further.
These unintended consequences predate Schedule 10. The Association of Salaried Medical Specialists (ASMS) represents those who train the doctors in training. We recognise that the effects on continuity of training and related matters need to be addressed, but the solution should not involve making resident doctor working hours less safe.
ASMS proposed a collaborative and non-confrontational process to figure out how to deal with this dilemma of managing safer hours obligations without compromising continuity of training. We invited the DHBs and RDA to meet with us to explore how we might do this, as the issues are too complex to address through the blunt instrument of collective bargaining. The RDA responded positively to our initiative, but the DHBs declined, preferring an adversarial process. ASMS and RDA are progressing this work on our own, but it is disappointing that the DHBs have abrogated their responsibility.
Had the DHBs agreed to participate, the industrial confrontation could have been avoided. Instead they are trying to roll back the various advances achieved by the RDA over several years, not just Schedule 10. Their plan is cunning; the question: Is it a cunning plan akin to that of the hapless Baldrick character in the cult ‘Blackadder’ television comedy?
Here’s the plan. Currently the DHBs are required to offer the expired RDA negotiated collective agreement to resident doctors who change from one DHB to another for training reasons. But that legal obligation ends on 28 February.
In their negotiations with the RDA the DHBs are seeking claw-backs of a range of entitlements and rights that they know the RDA would never accept (ones that the RDA has fought hard to achieve over many years). This alone means that the industrial strife will continue well into February at least unless there is a circuit-breaker.
Late last year the DHBs negotiated an alternative collective agreement with the much smaller SToNZ union. That agreement includes the claw-backs the DHBs are seeking in their negotiations with the RDA, and the removal of Schedule 10. This means that from 1 March the only collective agreement the DHBs will be legally required to offer resident doctors who change DHBs to further their training is this new SToNZ agreement.
The DHBs have foolishly embarked upon a bargaining strategy that requires a ‘winner takes all’ outcome, which is disastrous where there is an ongoing employment relationship between the employers and their captive employees (only DHBs can provide the training they depend on).
The DHBs will have, through their strategy, greater legal strength from 1 March. But this is not enough on its own. The RDA has the membership numbers to fight this, providing they maintain their internal solidarity. Further, while the DHBs might have increased legal leverage, the RDA also finds its leverage inadvertently enhanced because attempts to claw-back hard-fought entitlements and rights have an energising effect on vulnerable doctors in training.
Had DHB chief executives accepted our proposal to work with us and RDA to address these unintended (but predictable) unintended consequences of achieving safer hours through a non-adversarial process, the strikes could have been avoided. Instead doctors, nurses, and other health professionals have to cope with the mess created by the DHBs’ attempt to bludgeon their way to ‘victory’. We need a circuit-breaker and we need it soon.