GUEST BLOG: Ian Powell – Senior doctors strikes and New Zealand’s health system

By International Labour Organisation standards, the right of employees through their unions to lawfully strike in Aotearoa New Zealand is limited.

In summary, there are only two lawful grounds – in negotiations for a collective employment agreement (whether multi or single employer) and on health and safety grounds.

New Zealand’s first senior doctors strike

The first strike undertaken by senior doctors was during negotiations for a single employer collective agreement between the South Canterbury District Health Board and the Association of Salaried Medical Specialists (ASMS).

The dispute centred on inferior remuneration compared with senior doctors in the other DHBs. Health and safety was not a factor.

There were four six hour strikes during the normal working week in February-March 2003. As ASMS Executive Director I was the union advocate for South Canterbury’s senior doctors.

South Canterbury strikes consistent with Hippocratic Oath

At that time there were no life preserving services agreements required by legislation. However, consistent with the Hippocratic Oath of ‘first do no harm,’ only scheduled elective (planned) procedures, including surgery, and treatments were affected.

Acute treatment that could not be clinically deferred continued. Further, additional notice to than required by law was given. This meant that no elective procedures were cancelled because they had yet to be scheduled in the first place.

The strikes were successful in various respects. Subsequently I discussed this in an academic article published later that year in the Journal of Employment Relationstitled ‘Downing Scalpels and Stethoscopes’ (unfortunately it didn’t prove possible to locate a link).

The almost first national senior doctors strike

In 2007-08 ASMS came close to holding the first national strike by senior doctors. This was over a national collective agreement covering all the district health boards (DHBs).

Paediatrician Dr Jeff Brown as ASMS President provided forceful leadership during this dispute

The issues were improving remuneration and other conditions and preventing employer attempts to clawback existing consultation rights and weaken a non-clinical time entitlement.

However, the protracted dispute was unexpectedly complicated midstream by the increasing loss of specialists to Australia, beginning with Queensland, following mind-bogglingly large salary increases ‘across the ditch.’

ASMS’s strategy was gradual escalation always leaving the employers with the opportunity to reconsider.

Highly publicised and massively attended stopwork meetings (similar but technically different from two-hour strikes focussed on non-acute services) were held in each of the DHBs (two in some) over a concentrated period.

They were followed by a resounding national postal ballot, with a high response rate, authorising ASMS’s National Executive to organise strike action.

This proved to be the tipping point. The publicised and membership supported escalations arguably had more effect than had senior doctors gone straight to strike action without this staged escalation.

Strike ballot result led to risky and brave but successful intervention by Health Minister David Cunliffe

It led to new Labour Health Minister David Cunliffe intervened by directly collaborating with the parties to facilitate a satisfactory resolution without having to proceed with strikes.

Owing to the high profile of his intervention it was both brave and risky for Cunliffe. It could have easily gone ‘belly-up.’ But it didn’t; instead, it worked.

In addition to the withdrawal of consultation clawbacks and weakening the non-clinical time entitlement employer claims, the settlement included positive improvements to employment entitlements (including salaries) and inclusion of a strong engagement provision.

What is notable about both these two disputes, one leading to strikes and the other using the gradual escalation towards a strike to good effect, is that health and safety issues were not at the forefront of the narrative (although it was starting to emerge towards the end with the start of the increasing loss of specialists to Australia).

Gisborne Hospital senior doctors strike

On 28 May 50 senior doctors employed by Health New Zealand (Te Whatu Ora) at Gisborne Hospital “walked of the job” at midnight for a 24-hour strike.

Similar to their above-mentioned South Canterbury colleagues over 20 years earlier, cover continued to be provided for acute care, including emergencies.

Gisborne Hospital: an unwanted and undeserved record

One could be forgiven from the media coverage for believing that this was a strike over health and safety concerns.

Highlighted was the fact that while all public hospitals suffer from severe senior doctor shortages, Gisborne Hospital had the unwanted record for having the highest rate.

The extent of these shortages and the dismissive government response had been previously reported by Marc Daadler in Newsroom (23 April): Gisborne doctors expose Government’s inaccurate staffing claims.

Radio New Zealand’s Morning Report covered the strike that same day in a piece that included interviews with senior doctors: Gisborne Hospital senior doctors strike.

In response to a disingenuous criticism from Minister of Health Simeon Brown that the strike was delaying treatment for patients, physician Dr Alex Raines noted that the strike would cause only minor disruption compared to ongoing delays from chronic understaffing.

The striking senior doctors also received full support from the Gisborne community including Mayor Rehette Stoltz, again in Morning Report, on the day of the strike: Gisborne Mayor supports striking senior doctors.

Senior doctors themselves went the extra mile to connect with the public with the organisation of donations to a local food bank, including a free sausage sizzle, as reported by the Gisborne Herald (30 May): Striking senior doctors support Gisborne foodbank.

Recognising the level of community support for the doctors, Dr Raines observed that “There’s a warmth and solidarity in the community that’s very special.”

In turn, the head of the food bank said they “…supported the doctors in their kaupapa of supporting the unwell and vulnerable of the community.”

Important health system issues

The strike action by Gisborne Hospital’s senior doctors raises important issues for our health system.

First, and foremost, this strike was the first of a series of local hospital-based strikes in pursuit of a new national collective agreement. They are not on the grounds of health and safety. These local strikes follow last month’s national strike.

However, in contrast to the South Canterbury strikes of 2003 and the staged escalations of the national dispute in 2007-08, health and safety is directly linked to this dispute.

Today’s dispute is in response to the uncompetitive conditions of employment, particularly salaries (there is a pay gap with Australia of around 65% on base 40-hour salaries).

This sits behind the severe widespread senior doctor shortages which, in turn, sits behind high levels of fatigue and burnout.

It means that Health New Zealand is required by the Government to continue to underpay its senior doctors who are left having to make up the deficit by paying for the health system with their health. Patients also pay for the deficit by being put at greater risk of harm, even death.

Another health system issue is that senior doctor strikes receive strong community support (the same can be seen for nurses). While the Government does not value the health system’s senior doctors (and nurses), the public does.

In South Canterbury on 2003 Grey Power were actively and publicly supporting the striking senior doctors. Strong public is occurring right now for striking senior doctors in Gisborne as articulated by the city’s mayor and foodbank.

EP Thompson: from struggle comes consciousness

Finally, providing they don’t completely flop, strikes are empowering for those undertaking the action. This was certainly the case in South Canterbury.

In fact, the strikes contributed to improving the relationship between senior doctors and senior management (without any change in personnel).

There is every reason to believe that the strike actions being undertaken and planned by Health New Zealand’s senior doctors won’t be similarly empowered.

In this context it is timely to recall the observation of British working class historian EP Thompson that from struggles comes increased consciousness.

 

 

 

 

Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion