How to resolve doctors’ strike
The standoff over junior doctors’ hours is not caused by union rivalry, but by DHBs’ refusal to collaborate, argues Ian Powell, executive director of the Association of Salaried Medical Specialists.
Blaming rivalry between health unions for the resident (junior) doctors’ strikes (Editorial, Jan 11) rather misses the point about who is responsible for the turbulent period of industrial strife that public hospitals now find themselves in.
The editorial over-states the importance of the new much smaller union, Specialty Trainees of New Zealand (StoNZ), and fails to recognise the complexity of the problem.
Resident doctors are in training, usually either to become GPs 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. It is a strength of our system, producing quality senior doctors.
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 continuity of training, along with effects on 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 its national collective agreement with district health boards (DHBs) by introducing two additional requirements: a maximum of 10 consecutive working days, and four consecutive night shifts. After acrimonious negotiations, an agreement known as Schedule 10 was added to the national agreement, further deepening the dilemma.
The 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 doctors’ working hours less safe.
ASMS proposed a collaborative and non-confrontational process to figure out how to deal with this dilemma. We invited the DHBs and RDA 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, 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 they 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; but is it a cunning plan akin to that of the hapless Baldrick character in the Blackadder TV 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 February 28.
In their negotiations with the RDA, the DHBs are seeking clawbacks of a range of entitlements and rights that they know the RDA would never accept. This alone means 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 SToNZ, which includes the clawbacks the DHBs are seeking, and the removal of Schedule 10. This means that, from March 1, the only collective agreement the DHBs will be legally required to offer resident doctors who change DHBs to further their training is the SToNZ one.
The DHBs have foolishly embarked upon a bargaining strategy that requires a ‘‘winner takes all’’ outcome.
The DHBs will have, through their strategy, greater legal strength from March 1. But this is not enough. The RDA has the membership numbers to fight this, providing it maintains its internal solidarity. Further, the RDA also finds its leverage 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 the RDA to address the predictable 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.
Is the DHBs’ cunning plan akin to one of the hapless Baldrick’s?