Publications
The Specialist
Issue 69 - December 2006
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- National stopwork meetings authorised
- “Annual Conference votes overwhelmingly to authorise ASMS negotiating team to organise stopwork meetings if the current impasse in MECA negotiations continues.”
- How not to negotiate: The RMO MECA
- Response of Health Minister to crisis 'inadequate'
- Conference remit condemns DHB's approach to MECA negotiations
- Conference remit authorising national stopwork meetings
- ASMS Annual Conference
- Nurses on strike action
- DHB Chief Executive salaries
- I've changed my mind!
- BMJ Careers advertising campaign continues...
- A big thank-you to our sponsors for their contributions to another successful conference
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National stopwork meetings authorised
The Association of Salaried Medical Specialists 18th Annual Conference on 2-3 November in the delightful premises of
The resolutions
Stopwork meetings are not strikes. Instead they are a lawful entitlement agreed to by DHBs and provided under the current MECA; an entitlement of two 2-hour stopwork meetings per annum. Unlike strikes they are paid. They are special meetings, sparingly used, to discuss and deliberate on exigencies that must be addressed. How to respond to a belligerent industrial strategy from representatives acting in the name of DHBs which threatens medical recruitment and retention and the future medical workforce development in
Past stopwork meetings have involved continuing to provide emergency cover during this limited period of time. Although there has been a small number of stopwork meetings by ASMS members in the past they were mainly in the 1990s and involved disputes with individual crown health enterprises as the predecessors of DHBs were then known. What is unprecedented is the national scope reinforced by the overwhelming vote by ASMS delegates at the Annual Conference.
There were in fact two resolutions adopted by Annual Conference (published elsewhere in this issue). The first, voted unanimously, set the scene and summarised the ASMS’s concerns while the second, adopted by an overwhelming majority, authorised the ASMS’s negotiating team to organise national stopwork meetings should the impasse continue.
What led to the resolutions
ASMS delegates were appalled by the fact that although the negotiations had commenced in late May and had gone on for 13 days, the position of the DHBs negotiating team has remained unchanged on key issues, particularly fiscal. Instead the DHBs representatives are sticking to a predetermined rigid position that they held on day one which ignores New Zealand’s serious vulnerability to our ability to recruit and retain senior doctors.
They are ignoring significant settlements in
One area where
But the threat to
DHBs state of denial
All this reality has passed the DHBs negotiating team by, as they instead operate in a state of denial. Much of this denial seems to have to do with the relatively shorter shelf life of managers compared with doctors; they do not have to live with the consequences of ignoring reality and instead leave it to the medical and other professions to have to do their best in coping with the mess they leave behind. Demonstrating one of the worst aspects of the culture of managerialism (managers who know best and who mutate with ostriches) the DHBs negotiating team has elected to adopt an intransigent approach to these negotiations. This approach threatens the ability of the public health system to provide accessible high quality patient care.
If this was not bad enough they have also elected to attempt to devalue the professionalism of senior doctors and to seek to increase managerial control over them. Their means for this includes attempting to: frustrate the importance of providing sufficient time for non-clinical duties consistent with professional standards; restrict eligibility for sabbatical; water down the current consultation clause in order to reduce senior doctors’ influence in service and other reviews; and increase the already high accountability requirements of senior doctors (already much higher than those who seek to increase it).
Consequently it is hardly surprising that the second resolution authorising national stopwork meetings was also adopted and by such an overwhelming majority.
Whether these stopwork meetings proceed depends on whether the impasse continues. This in turn very much depends on whether DHBs come out of their corner and recognise the essential contribution that senior doctors make to the healthcare and well-being of patients. If their negotiating team continues with the intransigent position that they have held since late May then these unprecedented national stopwork meetings are likely to be held as early as next February.
Ian Powell
Executive Director
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“Annual Conference votes overwhelmingly to authorise ASMS negotiating team to organise stopwork meetings if the current impasse in MECA negotiations continues.”
Amongst the ambit of possible actions, amidst the angst, anger and anxiety, we tread a delicate and deliberated middle ground. Contemplating our possible paths, owning our own behaviours, holding our resolve when the time turns to implementation, we demand leadership. Leadership by those who see strength in the threads that link skills, knowledge, apprenticeship, experience, wisdom and respect.
In troubled times, what fabric protects us, protects our patients, protects the systems we inhabit to look after them? Not power-serving falsehoods competing for hegemony. Rather our resolve, our solidarity.
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Solidarity - and certitude We are such a special society, With diverse interests, Achievements that thrill When given rein to reform, But how easily discouraged, When ignored and isolated. Into silos of sincerity. Your shout tonight - |
Dripping silver into pockets, Blowout. While the tears of the dumped Until the trickles of trust Tributes to care Standards and standings Duties of care and Not the moral frivolity |
Of all succour or salve. Action and emotion - “There’s a hole in my heart Some body couldn’t plug the gap, Expansive, feeling Special interests, Different priorities And solidarity. Jeff Brown |
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How not to negotiate: The RMO MECA
Members will recall that the controversial Memorandum of Understanding proposed by the DHBs in their negotiations with the Resident Doctors’ Association for a new national RMO collective agreement was the factor more than anything else that led to the intense and stressful five day RMO strike back in June. Further, it was the issue that generated the most heat and acrimony in the protracted negotiations.
The recently settled new MECA includes a Memorandum of Understanding about which it might be assumed superficially that the DHBs had succeeded and the RDA failed.
But having read the new agreed Memorandum of Understanding an opposite conclusion is called for. I was struck by two things. First, it reads well as a pragmatic, matter-of-fact and plain language document. It reads like it was written by the RDA! Second, it bears little resemblance with the controversial Memorandum first proposed by the DHBs national negotiating team. The main similarity is the title.
The early versions of the DHBs negotiating team’s proposed Memorandum were characterised by (a) a decision-making process that was first draconian (DHBs had a voting majority) and subsequently cumbersome and confused, and (b) emotional lengthy wording loaded to favour the DHBs if ever it was to be interpreted through a legal process. All in all, it was an inflammatory red-rag to a bull.
In contrast, the final agreed Memorandum is characterised by (a) a decision-making process that requires all proposals to vary the application of the MECA in reference to rostering to be unanimous and (b) shorter wording that is neither loaded nor emotive.
This highlights how unsuccessful the DHBs negotiating team’s strategy was. Their team was on a high, hyped on their own ‘success’ and self-seduced by their own rhetoric when it withstood the five day RMO strike. Their success at that time can be measured by the fact that albeit a minority a significant number of RMOs continued to work for at least part of the strike and that the RDA was forced to abandon its follow-up industrial action strategy. At that time the RDA’s position looked shaky with speculation (aspirations in some quarters) of a pending implosion.
The objective of the DHBs was to significantly reduce the influence and control of the RDA over RMO rosters (an unstated objective was to ‘smash’ the RDA); emotive rhetoric of ‘reclaiming our rosters’ was used with some success by DHB representatives in an effort to generate senior doctor empathy for their objective. However, their lack of clarity of objective led them to rigidly and obsessively lock themselves into one means only of achieving it rather than being sufficiently adept at considering other means.
However, over time the experience of a regrouped RDA, well placed to anticipate the effect of this bitter dispute on the distinct RMO labour market and reported serious RMO shortages emerging in 2007, have now produced an outcome which at the very least sees the RDA’s influence maintained and arguably increased. The DHBs negotiating team’s post-strike strategy paper promoted taking advantage of the disappearing of the right of newly appointed RMOs to be covered by the expired MECA (12 months after its expiry date). This aggressive and foolish action further undermined the trust and confidence of RMOs in the DHBs and most likely intensified RMO shortages. The cumulative effect was to increase the RDA’s relative bargaining leverage.
The fact that the RDA did not achieve the quite different rostering changes it sought does not diminish the fact that the ‘non-negotiable’ position of the DHBs negotiating team was turned on its head. The fact that their negotiating team will provide an alternative spin, so important for one’s CV and subsequent career aspirations, does not diminish what the plain written word of the recent settlement actually says. To use a boxing analogy, inappropriate of course for medicine, while there were no knock-outs, the RDA scored a unanimous points victory.
But of three things there is no doubt, despite the DHBs negotiating team’s boomerang outcome. First, this acrimonious dispute has done serious longer-term damage to relationships between DHBs and the country’s younger doctors and has made New Zealand a less attractive place to recruit and retain them than before the negotiations commenced. Second, this detrimental effect will also damage for sometime the capacity for a trust and confidence relationship between RMOs and DHBs which is essential if senior doctor concerns over RMO rostering arrangements are to be resolved. The legacy of the DHBs negotiating team’s approach to this negotiation is to set back medical workforce development for some time as well as failing miserably to achieve the objective they so assertively and publicly claimed was non-negotiable.
Third, exploiting the concerns of many senior doctors over aspects of RMO rostering arrangements, the DHBs negotiating team raised their expectations of resolving them in this negotiation. This was used to foster a degree of empathy from a number of senior doctors towards the DHBs position in this dispute especially during the five day strike. But having raised expectations the DHBs’ negotiating team within their own description of success failed to deliver and have left a challenge that may now be more difficult to resolve because of the bad will than before the negotiations commenced.
Ian Powell
Executive Director
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Response of Health Minister to crisis 'inadequate'
Below is a media statement released by the
Specifically, the RCPA has called for:
- The immediate cessation of further tendering arrangements for the delivery of Pathology services in
- The establishment of a high level National Pathology Advisory Council to advise the Minster and District Health Boards on pathology issues; and
- The National Pathology Advisory Council to work with government to develop a National Framework for Pathology Service delivery by Christmas 2006.
Despite a concerted effort on the part of the RCPA, and other medical organisations and associations such as the New Zealand Medical Association, the Minister of Health does not appear to be taking notice.
Of particular concern is the Minister of Health’s recent comments in Parliament that there isn’t a problem – in fact, he stated that the Pathology workforce in New Zealand is increasing at the present time, rather than being in crisis.
The Minister appears to have been badly advised on this issue as this does not reflect the reality of the situation.
According to the Minister of Health’s own statistics – the methodology of which the College questions –
These projections have been developed without taking into account any possible losses of Pathologists from
This is especially worrying as a recent survey of Pathologists in
Compounding the current crisis with an exodus of this size from the pathology workforce would be an unprecedented disaster on any scale, anywhere.
The Minister of Health must stop denying the problem and start dealing with it, to ensure a workable medical system for the future of
The RCPA is concerned that the current changes and restructuring of pathology services in
Pathology is an integral part of the medical process. Without very high quality pathology services, the medical system, as we now know it, will virtually cease to exist.
The problem stemmed originally from the fact that some District Health Boards supported the tendering out of pathology services without adequate consultation with the pathology profession or other medical experts. They have acted as if pathology services were “commodities” such as laundry or food services, rather than the vital medical services that they are.
The College urges the Minister to respond immediately to the medical community’s call for an appropriate national plan for tenders or other procurement arrangements to be conducted within strict and realistic pathology delivery parameters.
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Conference remit condemns DHB's approach to MECA negotiations
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The ASMS Annual Conference voted unanimously to condemn the DHBs current approach to re-negotiation the national MECA because of the serious threat it poses to the ability of the public health system to provide accessible high quality patient care. The full resolution is reprinted below: That Annual Conference condemns the DHBs current approach to re-negotiating the national DHB collective agreement (MECA). This approach threatens the ability of the public health system to provide accessible high quality patient care, because of the DHBs’:
Comment The DHBs’ negotiating team is in denial over the vulnerability of The DHBs negotiating team’s counter-claims including attempting to water down the MECA consultation clause, frustrate recognition of sufficient time for non-clinical duties, restrict eligibility for sabbaticals, and increase the already high levels of accountability of senior doctors are all about seeking managerial control and devaluing professionalism. |
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Conference remit authorising national stopwork meetings
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The ASMS Annual Conference voted overwhelmingly to authorise the ASMS’s negotiating team in the national DHB MECA negotiations to organise national stopwork meetings. The full resolution is reprinted below: That, should the impasse in the re-negotiation of the national DHB collective agreement (MECA) continue, Annual Conference authorises the Association’s negotiating team to organise national stopwork meetings to consider appropriate means and forms of action for resolution. MECA clause on stopwork meetings Al Macdonald |
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ASMS Annual Conference
The 18th ASMS Annual Conference was held in
The underlying feature of the Conference was discussion on the impasse in the negotiations for the national DHB MECA. This included a background report by Executive Director Ian Powell and the two resolutions adopted reported elsewhere in this issue.
Other Features of the Conference:
- Dr Jeff Brown’s Presidential Address which is also avail
- Hon Ruth Dyson, Minister of Labour and ACC, on workforce empowerment and treatment injuries.
- Health & Disability Commissioner Ron Paterson on the responsibility of doctors and DHBs for unseen patients.
- Newly appointed Solicitor-General Dr David Collins (formerly chair of the Health Practitioners Disciplinary Tribunal and ACC) on reflections on discipline of health professionals.
- Former Director-General of Health Professor George Salmond on medical workforce development and the management of change.
- Dr Carolyn Russell from the Cognitive Institute on the theme of ‘doctors behaving badly’.
- Senior Industrial Officer Henry Stubbs on job sizing.
- Martin Stokes (Medical Assurance Society) and Dr Aine McCoy (Medical Protection Society) on the support service for doctors, the MAS-MPS relationship and KiwiSaver.
Membership Subscription: Delegate Empowerment
The National Executive had recommended to Annual Conference to increase the annual membership subscription by $30 to $630 (GST inclusive) for the 2007-2008 financial year. This was in response to a number of factors, additional to inflation, including the decision to increase the number of our industrial staff, anticipated significant increased rental accommodation, and other increased activities including the national DHB MECA negotiations. This would have left the ASMS with a tight budget.
In a surprise and unprecedented move a delegate from the floor proposed an amendment increasing the subscription by $50 to $650. The amendment motion was adopted overwhelmingly.
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Nurses on strike action
[Below are extracts from an address to the ASMS Annual Conference by Geoff Annals, Executive Director of the NZ Nurses Organisation, who was commenting on Dr Jeff Brown’s Presidential Address which has been sent electronically to members and is also available on the ASMS website www.asms.org.nz.]
Thank you for the opportunity to comment on your Presidential Address. It’s an honour, but also a challenge; I don’t want to be the swine feasting on pearls at a banquet of royals. And Jeff, I’ve got to say you deliver a finely turned phrase; ‘treasure the strands of connectedness with the luminous layers of professional responsibility’ indeed!
But I was awoken from my gossamer-word-spun reverie by Jeff’s pungent challenge to this Conference to take up the task of leadership in the face of intransigence across the negotiating table. This is the challenge that defines a union; and when that union is a union of workers holding a special social contract incorporating unusual professional rights and responsibilities, then that challenge is all the more exacting.
Calling a spade a spade
Industrial action; no let me use the term ‘strike action’, by doctors or nurses is, in the analysis of some, beyond the pale. But that is what Jeff is challenging this Conference to be conscious of, to consider, to be prepared for. I applaud Jeff’s decision to do so. Whether we readily accept it or not, a union that does not consciously and conscientiously develop and guard its capability to take effective strike action is a union that will be consigned to industrial irrelevancy.
Of course, it is always a bad thing that a strike takes place but that is not to say that a strike can never be the right thing to do. Indeed there are times when, in my view, it would be wrong not to strike. Yes, a strike is a weapon. A strike is the ultimate means a group of workers has to assert its determination to bargain for a desired objective. And if that objective is principled and its attainment is necessary to the delivery of a substantial social good, then workers faced by an employer’s persistent refusal to bargain, surely must exhaust every avenue available to them. That ultimately may mean they strike. So I support Jeff’s call for this Conference to give careful thought to the issue and I want to pick up on this aspect of his address.
Tasks of leadership
The leadership task Jeff has put before us begins with ensuring the bargaining objective is principled and that its attainment is necessary to the sustained delivery of proper patient care. I suspect this can be readily established in your case and your leadership will ensure it is so.
The next task of leadership is more difficult. Good union leadership requires that strike capability is very carefully constructed so that it can be deployed to clear and incisive effect. This requires first and foremost that a strike action is planned to which all members will commit and then maintain that commitment throughout the duration the action requires. Unions of health professionals also have to plan our action allowing for the fact that, even when the objective is clearly socially principled, and every proper arrangement is made to safeguard patients, a minority of committed members will decide they cannot refuse to provide patient care.
Planning to enable such members to support the strike, while adhering to their own ethical dictates, is in my view one of the leadership tasks that is critical to building an effective strike capability within a union of health professionals. The notion of union solidarity is fundamental and requires special attention in unions like ours. The upside of this complication for us is that when we do it well it also tends to shape an action that promotes public support.
The second leadership task is to achieve absolute clarity of purpose. Not only must every member of the union readily understand what exactly is the reason for the strike but also so must related unions, the public and the employer. Without such clarity, solidarity is at risk, broader worker support may not be forthcoming, public opprobrium may erode union solidarity and the employer will use false or even genuine confusion to his advantage.
The final leadership task is to design the action so it has maximum effectiveness in bringing an intransigent employer back to the bargaining table with a genuine desire to achieve fair settlement. It may seem obvious; this is the purpose of a strike after all. But without careful thought a strike action may create more difficulty for members than for the employer. Consider what will target most accurately that which is valued most by the employer but will cause least disruption to patients. In other words, target revenue not patients.
The most effective strike
And be aware that the most effective strike of all can be the well developed capability that is available but never used. An employer conscious of a union’s willingness and capability to deliver an effective strike is unlikely to choose bargaining intransigence over principled, good faith negotiation.
As union leaders, know also, that the strike can be an appropriate and effective instrument for good but like any potent instrument, can also be wielded ineptly, or prepared poorly. Whether the outcome of a well developed strike capability is good or ill depends not only on the decision when it should be deployed but also on how it is deployed.
Learning from the RMO experience
In conclusion, and by way of illustration, let me consider for a moment the strike by our junior medical colleagues earlier this year. I single out this strike because of its relevance to the issues before this Conference, not because the Resident Doctors’ Association are the first to ever run, what was in my analysis, a failed strike. NZNO too, has had failed strikes.
This is why I consider the recent junior doctor strike was a failed strike:
- The objective as I understood it was principled; DHB advocates wanted the RDA to agree to managers having the ability to change resident doctors’ conditions of practice more or less at will. However, this objective was poorly articulated within the membership and beyond.
- The action chosen was crude and failed to adequately engage the commitment of the whole membership.
- The strike had relatively limited impact on the employer relative to the duration and breadth of the action. As a result DHB managers were left with a much reduced level of anxiety about their ability to withstand future strikes. As an instrument it has been blunted.
Nurses and the NZNO supported their junior medical colleagues through this action but that doesn’t mean we were happy about the way it was conducted. A failed strike is very serious for every union. A failed strike reduces our own ability to achieve principled and socially constructive bargaining outcomes through a well constructed strike capability.
The capability to strike is an instrument or perhaps a vehicle for a particular and important purpose. The nature of that purpose is such that it is best kept visible and polished, ready to run but only occasionally run out of the garage and rarely ever taken onto the road. I fear that as a result of poor industrial leadership by the RDA, unions like the ASMS and NZNO are much more likely to have to exercise our own capability to strike.
We initiated for bargaining in DHBs yesterday. You’re up first. We are ready to support you as you take up the task of leadership Jeff has laid out before this Conference. Your success is important to us. It will reduce the likelihood we will have to strike to achieve settlement of our claims but you can be sure we will be ready to do so if we must.
Geoff Annals
Executive Director, NZ Nurses Organisation
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DHB Chief Executive salaries
In considering the ASMS’s fiscal claims in the national DHB MECA negotiations a sense of perspective is required. The table below is a comparison of the average national salaries of DHB chief executives over a two year period from 2002-03 to 2004-05. Please note that this is a conservative calculation. Chief Executive salaries are reported in $10,000 bands and we have used the lower end of the band.
| 2002-03 | 2003-04 | 2004-05 | |
| Salary ($) |
263,333 |
274,285 |
299,000 |
| Increase ($) |
- |
10,952 |
24,714 |
| Increase (%) |
- |
4.12 |
9.01 |
As can be seen from the table, while recognising that it covers a different period of time, the increases have no relationship with the ‘future funding track’ (estimated inflation minus 0.5%).
The table summarises the annual increases. Over the two year period salaries increased by $35,667 (13.5%).
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I've changed my mind!
[Dr Al Macdonald, National Executive member, renal physician at Capital & Coast DHB, and mover of the second Conference remit authorising national stopwork meetings should the impasse in our national DHB MECA negotiations continue.]
I come from a family with a strong nursing and medical background. Sadly they have all died; however the influence of their traditional values probably explains why I have previously been implacably opposed to any kind of industrial action in the public hospital system.
As I write this piece; Canterbury DHB board members have indicated that the right to strike should be abolished for health workers. This is an understandable reaction to the increase in industrial action taken by various health unions. It is the wrong reaction.
Any form of industrial action taken by a health union such as ASMS needs to be thought through carefully at many different levels. Of the utmost importance is the covenant that we have with our patients and the trust that they place in us as a profession. This trust is at the heart of the survival of a strong public health system.
Survival of the ospedale
This trust has been gained from almost one thousand years of public service by our predecessors. I had the good fortune to visit an institution called Santa Maria della Scala during a recent visit to
In more recent times
ASMS’s obligation to the public health system v DHB negativity and intransigence
When we come to the negotiating table we bring with us this sense of obligation to preserve all that is best in our public health system. It is timely to reflect that the first two days of the negotiations were almost entirely spent on discussing the terms of engagement. I only returned to the negotiations a couple of weeks ago. In the interim; in spite of further negotiations it seemed as if nothing had happened. I found it depressing to witness the defensive, risk adverse attitude that the DHBs had to our non-fiscal claims. We haven’t even negotiated over money yet.
The DHBs bring an attitude of an overwhelming negativity and intransigence to the negotiating table. This is in stark contrast to our previous negotiations which, amongst other things, ensured that consultation between management and SMOs was more likely to occur. Our last two days of negotiations have clearly indicated that the DHBs feel that involvement of SMOs in consultation is viewed as an irritation, a process that is likely to slow down the implementation of service changes.
In our current MECA, the provisions for consultation provide the basis for clinical governance. If we really feel this is an important concept, then it is highly unlikely that an agreement with the current DHB position would enhance clinical involvement in the DHB decision making.
Advice from a wise offspring
For ASMS members not involved in the negotiations it may be hard for me to convey the gloom that surrounds these negotiations. My son often has an economic way of summing things up. Perhaps I can be permitted to paraphrase him by saying, “I guess you had to be there”.
I would therefore close by urging all ASMS members to reflect on some of the above when they come to consider the possibility of stopwork meetings (which are not industrial action) being held should the impasse in our MECA negotiations continue. Such a nationally coordinated undertaking would be a very significant first for ASMS members.
Alastair Macdonald
ASMS National Executive
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BMJ Careers advertising campaign continues...
On completion of a very successful 12-month advertising campaign with BMJ Careers the Association has decided to strengthen the international advertising campaign by increasing the placement frequency. The decision was based on the growth in international traffic volume to the ASMS website and support of employers.
The ASMS advert is now published on a fortnightly basis in the Clinical Research edition of BMJ Careers which has a circulation of 68,000 mainly doctors working in hospitals or academic environments. The advertisement also appears as an electronic placement on www.bmjcareers.com.
The ASMS initiative is unique in that it is the union, rather than an employer, encouraging qualified candidates to apply for jobs in
Support for the initiative has been very encouraging with two thirds of district health boards utilising the service to date. The Association encourages employers to take advantage of its offer of unlimited online advertising for a whole year at a generous annual cost. The greater the take up of this exciting venture the greater the chance of filling medical/dental vacancies; and at a much lower cost than DHBs advertising directly in BMJ Careers
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A big thank-you to our sponsors for their contributions to another successful conference
The Annual Conference was launched at a well-attended cocktail function on 2 November, generously funded by the Medical Assurance Society.
The Conference dinner, again generously supported by the Medical Protection Society, was another most enjoyable occasion for delegates and national office staff.
Ricoh kindly provided the enclosures.
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