Address to General Assembly of Germany Doctors Union

Ian Powell: Address to General Assembly of Germany Doctors Union (Marburger Bund) in Nuremberg,

19 May 2012

Address to Marburger Bund Autumn General Assembly, Nurnberg 19 MAY 2012

Guten Tag

Kia ora, tena koutou, tena koutou. These words are from the language of New Zealand’s indigenous population, Maori, and in this context roughly translates to hello, greetings, cheers and thank you.

The Association of Salaried Medical Specialists is delighted with the way our relationship with Marburger Bund has developed over the years. I have appreciated the opportunity to previously visit you in Berlin and we were very pleased to host you at our Annual Conference in New Zealand last November. Your representatives were struck by the number of your former members now working in New Zealand and attending our Conference.

I can also report that we followed with interest your form of limited strike action a few years ago, along with similar actions in the Netherlands, over the right to negotiate exclusively on behalf of your members. Again to use an indigenous Maori term I wish to mihi you; in other words, to greet and pay tribute for your successful campaign. In a major industrial dispute in 2007 we balloted our members on a similar strategy for strike action and received an overwhelming mandate of endorsement. As it turned out this ballot was sufficient to achieve a settlement.

Our country

New Zealand is a small country at the bottom of the world. To visualise it think of Italy upside-down although I like to think that our politics are not so upside-down. We were the first country in which women won the right to vote over 110 years ago; we introduced rights of union recognition and collective negotiations in 1894; introduced a universal social security (including health) system in 1938; and profoundly irritated the American government when we went nuclear free in 1984, including banning nuclear powered and armed ships into our ports.

Our population is four million, we have lots of sheep and quite a few cows, we make good films about hobbits and other subjects, and our coffee and wine are very good. We play rugby very well, as good as you play football. While I appreciate that our two countries do not share the same interest in rugby, we do share one common feature – we especially love beating the English and the French on the sports field.

Our national emblem is the indigenous bird, the kiwi. It takes a unique country to have as its emblem a nocturnal bird that can’t fly, hardly run and is not particularly bright.

Our health system

New Zealand’s universal public health system is predominantly publicly funded through general taxation with also a high level of public provision. Secondary and tertiary care is largely publicly provided while primary care, although largely privately provided. is government regulated and subsidised. We have 20 statutory district health boards of various sizes responsible for both primary and secondary care (in the main, funding the first and providing the second).

As evidenced by a recent Commonwealth Fund survey, our public health system is by international standards relatively inexpensive and cost effective. Overall our outcomes compare well suggesting that we punch above our weight. The universal nature of our health system, including its high level of public provision, contribute to this as does the general practice gate-keeper system for access to secondary care, our unitary political system, and relative lack of transaction costs.

There are positive moves to further encourage primary-secondary collaboration and clinical networks led by health professionals. On the other hand, there are threats in the form of too much financial pressure on the system while government expectations continue to increase, the calibre of senior management to avoid unilateral short-sighted decision-making, serious specialist shortages in public hospitals, lack of effective workforce planning and, periodically, privatisation.

We have a public hospital specialist workforce crisis in New Zealand. We are a small geographically isolated island nation. These factors create our vulnerability. New Zealand has, by a long way, the highest proportion of overseas trained doctors in the OECD and this has been increasing over several years (our closest neighbour Australia is the second highest). This is because we can’t retain enough of the doctors we train. A country the size of New Zealand needs a significant emphasis on the generalist nature of specialists. But we largely recruit internationally from larger countries (including Germany) that logically have a greater emphasis on sub-specialisation. The more we depend on international recruitment the more the balance between generalism and sub-specialism gets out-of-hand. We will not overcome this until we are better able to recruit more of those that we train.

Our excessive and increasing dependence on overseas recruitment is an example of irresponsible financial wastage. While it is cheaper to retain more of those we train, the government and our district health boards turn a blind eye leaving taxpayers to fund medical training for developed overseas countries. New Zealand has two medical schools. Such is the level of this excessive dependence on international recruitment that, through a narrow financial lens, it would make more sense to close one of them down. This is something we point out but don’t advocate!

Our vulnerability evolves into crisis partly because of the cumulative effect of not addressing the vulnerability, but also due to the magnet of Australia and, by international standards, poor salaries. Since 2006 Australian specialist salaries have leaped ahead of New Zealand’s. The migration between the two countries is overwhelmingly one way. Aside from proximity, the attraction of Australia is that we have the same training system stemming from the fact that our colleges generally cover both countries. Regretfully our political and managerial decision-makers can only think in the short-term and have a belief in magic bullets and spreadsheet rather than real doctors. Before it was elected our government agreed there was a hospital specialist workforce crisis. Now that it is elected it says that there is not, even though little has changed.

Our collective bargaining

Finally I want to comment briefly on our system of collective bargaining as I know how you negotiate is an important issue for this conference. Unions in New Zealand, including in the health system, generally negotiate on their own on behalf of their own members. In the main we do not have centralised settlements achieved by unions negotiating under the same umbrella (we also do not have arbitration). Our national agreement, for example is negotiated by us on our own. This is also the same for the nursing national collective agreement. The reason is that the more you try to combine with other parts of the workforce, the more it becomes difficult to address the specific issues of the workforce you represent. The relative importance of the specific issues diminishes. There are important differences and needs between the professions as well as between the professions and trades.

There was an exception in 2009 when the other health unions affiliated to the Council of Trade Unions and our district health boards agreed on a centralised settlement for a modest salary increase. The main factor that led to this was the impact of the global recession. However, our union did not participate because, in contrast with the other health professional workforces, the medical workforce faced serious shortages. This was accepted positively by both the health unions and employers. It would simply be impossible for us to address the issues we need to address if we were part of a wider negotiating process. Attempts to repeat this combined process with the other health unions late last year failed because of the differences, in part at least, because the needs and priorities of the professions and trades were too great.

I can fully understand your strong opposition to the attempt of the German Federation of Employer Associations to seek a law change so that the collective agreement of the union with most members in the enterprise should have precedence over all other collective agreements. This would introduce labour market inflexibility. Fortunately this does not form part of New Zealand’s industrial law and, further, many of our collective agreements have different expiry dates and therefore are negotiated at different times. We would vehemently oppose such a move in New Zealand.

In conclusion, I commend another Maori word to you – rangatira. Again in context I wish you a successful Assembly which will further enhance the esteem and nobleness of your union to your members and of your members to their patients. Rangatira also includes being revered. It would be an extraordinary union to be revered by its members but best wishes for your Assembly assisting this aspiration.

Finally I can advise that that one of my daughters lived in Munich for several years and so there should be no doubt who I am supporting in the European football club final tonight.

Danke schoen

Ian Powell
Executive Director
ASSOCIATION OF SALARIED MEDICAL SPECIALISTS

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