Compulsory arbitration for health workers?
October 21st, 2010 at 10:00 am by David FarrarThe NZ Herald editorial:
A call by district health boards for the Government to review the right of health workers to strike is, therefore, most timely. They made it clear yesterday that they have had enough of patient safety being compromised.
The chief medical officers of all 20 boards have written to the Health Minister, Tony Ryall, urging him to make disputes over pay or conditions in the health system subject to compulsory arbitration, as is the case with other public safety workforces, such as the police.
The freedom to withdraw labour should never be eliminated lightly. But, whatever the rights and wrongs of the present strike, there is good reason to believe the time has come for compulsory independent arbitration in the sector.
Hospitals provide an essential service. They are the only port of call for the ill. There is no alternative supplier of their services. As it is, sick people must wait impotently as disputes wind their way to a conclusion.
What I find interesting with the current compulsory arbitration for the Police is that the arbitrator can not choose a compromise. He or she must choose the employer offering or choose the union request.
So what does this do? It encourages reasonableness. The more extravagant or unfair your demands/offer and the less chance there is of it being selected. So you often get the two parties quite close to each other.
During the junior doctors’ strike of 2008, the Medical Council suggested the time to move to compulsory arbitration had come. Unsurprisingly, a Labour Government was unmoved.
Now, the push by district health boards has substantially raised the ante. So, too, has health workers’ increasing penchant for industrial action. If the Government acts, as it should, there will surely be no complaints from the public.
I think there is a case for considering hospitals an essential service akin to the Police.
Related posts:
- Herald backs health targets
- Response to Health Changes
- NZ Herald on Health System
- Dom Post on District Health Boards
October 21st, 2010 at 10:13 am
I don’t agree DPF. Encroachment of freedom by the right is just as bad as encroachment of freedom by the left.
What we actually need is privatisation of the health service. There is a reason that the government sector is the most unionised, and it is because the govt is a bad faith monopoly employer. A nurse has few employment options other than the govt or overseas. Many choose overseas, the remainder get screwed.
Privatisation would lead to a range of employers. They would offer different conditions, and nurses could move between them in search of the combination they wanted (maybe a particular location, maybe particular working arrangements, maybe maximum pay). Health organisations that couldn’t attract staff would go out of business.
The right need to look at the underlying problem here, which is the structure of the system, rather than fiddling with the symptoms.
For the record, the underlying problem in education is the same – the govt is fiddling with performance pay for teachers, without realising that if they privatised the schools, they’d automatically get performance pay. Which private school doesn’t pay good teachers more? The problem is govt involvement, not the unions.
Vote:October 21st, 2010 at 10:17 am
I’d agree with PaulL. You never see teachers in private schools or staff in private hospitals striking and most of us would prefer to have our kids in the former and have a stint in the latter when we are sick.
Vote:October 21st, 2010 at 10:39 am
Absolutely not, I wouldn’t agree with eliminating the right to strike in private hospitals so why would I support it in public hospitals..?
The answer for a crappy socialised system is not authoritarianism…
Vote:October 21st, 2010 at 10:40 am
PaulL:
I agree with what you say in principle, but health always seems like a bit of a dangerous thing to play with.
If there is a requirement for 123 private health organisations to service the needs of the nation and 12 of them go out of business tomorrow because of bad management / dodgy books / recession / whatever, what happens to the Health Service who has this unexpected shortfall of 12 providers?
Not quite sure how I’d structure this, but that seems a bit dangerous to me.
Vote:October 21st, 2010 at 10:41 am
I agree that binding arbitration can be a good moderating influence for employers and employees alike. But binding arbitration is usually the quid pro quo for removing the right to strike, and the freedom to withdraw labour shouldn’t be removed simply because it is inconvenient.
Vote:October 21st, 2010 at 10:54 am
And everyone is OK that the Police do not have a right to strike? What’s the difference? there is no alternative and your health is every bit a important as national security. In fact most times the Police wouldn’t be missed for a day or two. But when you’re injured try going without health for an hour or two.
Vote:October 21st, 2010 at 10:59 am
New Zealand has traditionally struggled to fill health roles as it is, and you propose treating them as lesser citizens….do so at your own peril.
Nurses were traditionally the most underpaid profession in New Zealand, and only recently has this been rectified.
This sort of scare mongering is just as bad as some of the shit coming from the left re 90 day right to fire etc.
Vote:October 21st, 2010 at 11:05 am
@Christopher Thompson:
The Police should have the right to strike if you’re okay with a clear Act of Parliament instructing how the Army would fill in (and recuse themselves) during the strike (the Armed forces of course should never have the right to strike) but I’m not really comfortable with the idea of the Army running the Police Stations for any length of time…
The Police
The Courts
The Armed Forces
Messing with these institutions and their continued operation affects our ongoing rights and constitution (such as it is)… As there is no right to healthcare, hospitals are in a different category…
Vote:October 21st, 2010 at 11:19 am
Long time reader, first time poster.
I’m a (junior) doctor in the public system. I am an ex-member of the RDA and have been on strike once in 2006. These are my thoughts alone.
Outlaw strikes. Reduce the size of the health bureaucracy from 21 DHB’s to about a quarter of that for NZ. Streamline the purchasing, IT, payroll, maintenance, typing, HR in to regional areas (Upper north island, central north, lower north and upper south, Canty+ West coast, Otago and Southland).
NZ does not need 21 DHB’s for 4.3 million people. It is an enormous waste of money duplicating tasks. Auckland does not need 3 DHB’s. 3 hospitals under a single management structure – YES.
That savings needs to be re-distributed to the frontline staff being poached from Australia where incomes are easily 60% higher. Make it so that staff required to serve rural areas get perks associated with those areas like baches, ski holidays – to promote the lifestyle factor. I accept that NZ will never reach Australia’s incomes in the public sector but the enormous waste in paying 21 DHB CEO’s and their COO’s and the CFO’s needs to be curtailed. We are smaller than Sydney (population wise) and we have more DHB’s than they have states! It is bizarre for a country where funding is essentially from a single agency (Central Govt), we cross-bill other DHB’s for work done on ‘their’patients, generating more paperwork and employment for numerous accountants.
Not a cure, but a step in the ‘right’ direction?
Vote:October 21st, 2010 at 11:35 am
Jeremy,
“Absolutely not, I wouldn’t agree with eliminating the right to strike in private hospitals so why would I support it in public hospitals..?”
If private health workers strike then critical procedures will be picked by the public health service. Elective surgery, by definition, can be delayed during the action.
The same cannot be guaranteed in the event of a strike by public health workers
Vote:October 21st, 2010 at 11:55 am
@Pascal: food is very important, how could we possibly allow supermarkets to be privately owned? If supermarket workers went on strike, we’d all starve.
If there were multiple service providers in most locations, then someone would pick up the peak during a strike. GPs and clinics are already privately owned, and could pick up a lot of functions.
Also, I think in reality most unions wouldn’t call a strike that impacted public health. They’d go with a work-to-rule, or essential services only, or refuse to fill in paperwork, or some other variant that impacts their employer without impacting public health. Imagine, for example, in a private hospital that the staff agree to keep providing health care, but refuse to take any payment details or process any payments. How long could the hospital operate without cashflow? In short, funnily enough the market usually provides.
I’d also note that not that many private organisations are subject of strikes, and those that are would often be seen as companies that were underperforming already. I don’t think it would be anything like as big a problem as we’re suggesting.
And, not to put too fine a point on it, there are countries that run private healthcare without having massive problems with strikes.
Vote:October 21st, 2010 at 12:13 pm
PaulL,
“And, not to put too fine a point on it, there are countries that run private healthcare without having massive problems with strikes.”
I think the real challenge is that we don’t have the economic scale to create enough true competition for the fully privatised health service model to work effectively and be self-perpetuating. (Which is not to say that the theory is worng.)
Vote:October 21st, 2010 at 12:41 pm
Bhudson, you gotta be joking! What do you mean, we don’t have the economic scale for “true” competition? Do we have more than one hospital? Yes, it just so happens that we do!
Even if we had only one hospital (and everyone lived around it), there’d be all sorts of competition on the sides: from GP clinics, overseas specialists etc. To turn to your statement, I’d respond that we can’t avoid having the economic scale not to have “true” competition! (A double negative) sorry, I mean we definitely have enough size to have “true” competition, whatever (sensible) definition of “true competition” you wish to use.)
Vote:October 21st, 2010 at 12:52 pm
I know a health worker who is striking at the moment. I talked to her yesterday, she said they have taken nine months to get 1% and wanted time in lieu for training in the weekends. DHB’s tend to be hard of hearing so they only had one option left, to strike. She said the system the police use appealed to health workers, they are now trying to talk to the minister or their local MP’s. They want to move on.
Vote:October 21st, 2010 at 12:54 pm
From Facebook….brilliant!
Maggie Fagan: “Never in the history of New Zealand films has so much been lost for so many by so few.”
Vote:October 21st, 2010 at 3:48 pm
mjwilknz,
No joke.
You give the example of GP clinics. We have those today, along with private PHO’s. And people are free to choose between them – subject to the reality that i am not going to have a GP that is out of the geography I live in. Please show me how this private sector competition is driving down cost and customer charges, while delivering better services. That is a true competitive environment and that is also the type of environment that paulL was referring to (although his focus was on what that competition would mean for employee conditions and benefits.)
The problem is far greater with respect to hospitals. Full service hospitals are a large investment. Add scale, in terms of patient bed and operational capacity – the number of services that can be delivered – and the investment demands grow even further.
We are country of about 4m and geographically dispersed. Take Wellington for example. Who is going to invest in a second or third full scale & full service hospital capability for such a small population? (The existing private hospitals are very small when compared to Wellington hospital.)
Even in Auckland the problem exists to only a slighlty lesser degree. There may be over 1m people, but they are still reasonably dispered – to the extent that one or even two more full scale private hospitals would not be sufficient to provide coverage across all of that population (when in competition with the exsiting hospitals – as opposed to carving up the territory between them.)
A competitive private environment either means you have large scale investement to build full scale/full service hospitals in addition to, and in competition with, the existing large hoispitals, or the private sector takes the existing over – which equals same challenges except in private ownership and still no widespread competition.
I repeat – our economy does not have the scale to have a viable 100% privitisation of health services which will deliver true competition to drive down costs & customer charges, while improving services and providing competitive conditions and benefits for potential staff to select from. Import a few more million people and increase population density – then we have a chance
Vote:October 21st, 2010 at 3:49 pm
I have always been in favour of pendulum arbitration.
Vote:Currently both sides initially polarise and after time gravitate to the midpoint for settlement. It starts with intransigence and grudging concession by one or other side. It takes ages.
A different way would be to have both sides submit detailed justified and reasoned claims to an arbitrator who is compelled to choose the better argument in totality, which would be binding. Fear of losing would propel both sides to the midpoint usually to within a few parts of a percentage. It causes realism and faster settlement.The arbitrater has to be respected by both sides.
October 21st, 2010 at 4:57 pm
Bhudson, I take it you live in Wellington, too. Here’s a Google Map of hospitals around us: http://maps.google.co.nz/maps?f=q&source=s_q&hl=en&q=hospital,&sll=-41.207589,174.971695&sspn=0.277406,0.617294&gl=nz&ie=UTF8&split=1&rq=1&ev=p&radius=19.25&hq=hospital,&hnear=&ll=-41.207589,174.971695&spn=0.277406,0.617294&z=11
You seem obsessed with large hospitals. In healthcare, specialist clinics abound. Following a bad traffic accident a number of years ago, I had a very complex operation on my eye muscles in a small clinic in a converted house in Remuera. Why on earth do we always have to get health care from large hospitals?
Vote:October 21st, 2010 at 9:20 pm
mijwilknz,
Ha ha. I’m sure the vets at Wellington Zoo are highly qualified and excellent practitioners, but I wouldn’t go there for a colonoscopy or bypass surgery myself.
Southern Cross, Wakefield and Bowen are all small and none provide the full range or scale of services that Wellington Hospital does.
Porirua Hospital is highly specialised and, while such services are needed in our society, they are not the services of GPs, PMO’s or general hospitals.
Likewise Elderslea, Sprott House (both elderly care), Central Region Eating Disorders Services do not fit the category for any general of specialist (meaning medical specialist, not specialised, services.)
Bloomfield Hospital links to Health Care NZ and likewise does not point to those type of services.
My example is confirmed. One major public hospital in the city and and three small private hospitals (their specialist services are very much valued however.)
The google list neither invalidates my assertion that major investment would be required (which our population size & density would not promote), nor does it illustrate any existing private competition that drives down cost and customer charges, while improving services and providing the sort of competitive employee market conditions and benefits that PaulL was referring to.
You really should have double checked the list first.
Vote:October 22nd, 2010 at 7:44 am
bhudson, I should have read through the list to check if they were all full hospitals, huh? With humble respect, may I refer you to my comment’s second point below the Google Maps link? I was attempting to say that hospitals do not need to be full service to provide effective competition. If one hospital starts offering bad orthopaedic surgery, for instance, there are plenty of other places around that could start offering customers better services to pick up on it.
You seem to rule out the possibility that an already established care unit could offer new services. Why assume the world stays exactly as it is, today? Perhaps you could fill me in on why I should be hung up on your full-service-hospital point.
Vote:October 22nd, 2010 at 8:15 am
mjwilknz,
Somehow I can’t see the Zoo, Elderslea, Sprott House, Porirua Hospital or Central Regional Eating Disorder
Services offering a broader range of health services currently offered under the public health service (and which, given this was all based on PaulL’s original proposition, would be required to privatise that system 100% )
If you care to have your prostate checked at the Zoo, go right ahead. Most of us would not I suggest.
I did address you second point. I noted that there are 3 existing private hospitals – each of them quite small and focused on specialist med & procedures. The point being that switching from to 100% private would still require the large investment I noted as the facilities and staffing in the existing private system are not there today to meet the demand they would then have.
It is possible to have separate investment in smaller units/hospitals to make up a whole, but in anyone’s language that is less efficient use of capital – the underlying infrastructure (e.g. buildings and all of the services infrastructure within them, not to mention medical capital equipment) is duplicated. That investment inefficiencies would exacerbate the population size and density issue, not solve it. It is a principle reason why public hospitals tend to be larger hospital campuses today – more efficient use of capital to provide services across all of the local catchment population.
So, just to be clear – you should be hung up on my full-service-hospital-point because not to structure in that
Vote:way would actually require even greater private sector investment which would damage business cases further due to our small population base and density. (To help with this I will reiterate that my points have all stemmed – and all noted as such – from PaulL’s initial proposition that the public health system be completely replaced with a private system.)
October 22nd, 2010 at 8:18 am
Also, bhudson, can I ask another question? Let’s say the ability of clinics to compete with hospitals is somewhat limited. Do you agree that there is still some competition? If so, doesn’t using that competition make a modified system better than the status quo, which has very little competition (at least for public healthcare)? That is, couldn’t we use a voucher system for public healthcare and patients could decide which place offered them the best service?
Vote:October 22nd, 2010 at 8:44 am
bhudson, in reply to your 8:15 comment, my humble apologies, I had inferred your comments to deny there was any role for competition in the healthcare sector. Instead, I see now you were referring to PaulL’s call for 100% privatisation of healthcare. My apologies for my crossing the wires, there.
I really struggle to see the NZ electorate voting anytime in the near future for a healthcare system that’s 100% private, especially because of the question of how you fund healthcare (i.e. the question of insurance, either private or as in the case of ACC, public). However, I do believe improvements can be had, in this small country of ours, by making better use of competition, even if it isn’t totally effective.
What do you think about a (slightly) increased role for the private sector in healthcare? Might DHBs contract out (and fund) more services privately, for instance?
Vote:October 22nd, 2010 at 8:53 am
mjwilknz,
I agree to some limited competition between public and private today based on quality of service (which includes timeliness.) That competition is somewhat limited to those who can afford the cost of private care. Under the current funding models the competition cannot be a general competition because too many of those who might otherwise participate in the competitive marketplace do not have the means to do so.
Which leads to the voucher consideration. I agree with you but with a very important caveat.
The caveat is with respect to what a voucher represents – If it represents a procedure that you can get done anywhere, then no I don’t think that helps competition. The likely result is everyone will take their vouchers and try to go the private hospitals and the supply/demand equation will mean only some of them can (with current levels of investment.) Unfortunately under that scenario not only the population size and density, but also the continued public service funding would conspire to limit additional investment in the private sector – the competitive landscape might be interesting for a short while but the govt would soon have to decide whether to fold the public service completely – unlikely – or take regulatory action to protect the investments in the public service – not good free market economics, but more likely.
On the other hand… If the vouchers were for a monetary value where the customer could elect to use more of their personal allotment on a procedure in a private hospital, at the expense of the risk of having to have a later, unforseen procedure in the public system (perhaps a procedure they would have preferred to have had privately but now don’t have enough vouchers for), then I think the system could work.
In that case the competitive landscape would not threaten all (perhaps not even most) of the demand on the public service – as there is an opportunty cost trade off each customer has to make when using the vouchers privately), but it would probably stimulate enough additional demand in the private sector to have the private companies competing more rigorously between themselves for those health dollars (which are now discretionary expenses.)
In that scenario I think we could see increased competition in the private sector yielding benefits to customers and not at the level of expense to the public service which might otherwise promote regulation.
I think the voucher system is an arguably feasible alternative (the devil is in the detail of course) where you want ot increase competition but not dismantle the public health system
Vote:October 22nd, 2010 at 8:56 am
mjwilknz,
Thank you. I thought that 100% might have been misread, so repeated it to clear the possible misunderstanding.
“What do you think about a (slightly) increased role for the private sector in healthcare? Might DHBs contract out (and fund) more services privately, for instance?”
Yes, I do see a role for greater private sector participation – and particularly greater consumer choice. I responded to your voucher question with a high-level view of a scenario where that might work.
Bottom line is “yes” I definitely think we should be offering better and more efficient service – and that almost certainly means a greater use of private sector services
Vote:October 22nd, 2010 at 9:03 am
Ok, bhudson. I agree completely that the devil is in the detail. Let’s hope at least that a more pragmatic approach re:private sector participation, such as is held by our present Government, filters through to the DHBs. I daresay, nine years of the previous Government would have done quite a bit of damage to private sector participation and therefore to competition and the quality of NZ’s healthcare, generally.
Vote:October 23rd, 2010 at 5:14 am
“I think there is a case for considering hospitals an essential service akin to the Police.”
Sorry DPF. but I think you need to be more specific.
‘Hospitals’ is not a workforce, unlike the Police- they are a place where some, but probably not the majority of healthcare is provided. There are dozens of professionals that you would potentially need to cover- which workers should be considered essential? Are you just referring to clinicians (doctors, nurses, clinical scientists, etc.), or to all staff emploted by the DHB- IT, orderlies (HCA’s), cleaners?
What about healthcare workers in other workplaces? Greenlane Clinical Centre, for instance, is the very large outpatient clinic centre for Auckland District Health Board- this is not, technically, a hospital- although most of it’s workers (certainly clinicians) work across multiple sites, including usually one of Auckland Hospital, or Starship Health (which after Wayne Brown had his way, is now technically a service within Auckland Hospital, rather than a hospital in its own right).
Should a public hospital’s services be considered essential whilst a private hospital’s services aren’t (aside: the reality is that most large DHBs are currently using un-tendered contracts with providers, whom already work for the DHB, but are being paid separately for the work being done in private due to capacity shortages in public facilities)- should workers in private hospitals therefore be covered by your proposition?
What happens when large amounts of ‘essential’ public services are entirely contracted out to private firms- community lab testing, cervical cytology and breast cancer screening for instance. Or how about private services which receive capitation or other forms of public funding in order to run their services- should workers of private GP or A+M practices, or the previously mentioned services, should be covered? Suggesting the workers of a private company shouldn’t be able to take industrial action is kind of… unusual, isn’t it?
Which services should be considered essential? It’s pretty difficult to argue the absolute necessity of much elective surgery for instance (hence the name)- e.g. hernias and other lumps and bumps. By not including elective services as essential, doesn’t that leave us with what we already have- i.e. healthcare workers which are taking industrial action have to arrange to cover essential services.
Essentially, it’s pretty difficult to conceive of an equitable way to do what you propose, except for the existing way which is to compel provision of ‘essential services’. I suspect the DHBs realise this too, which is why there is never any substantiation to this suggestion, and is simply them blowing off their steam as their negotiators struggle mid-negotiations to ‘maintain formation’ with the restrictive mandates they’ve been given.
Vote: