Otaihanga Second Opinion
is a health systems blog with a largely New Zealand focus. Otaihanga on the Kapiti Coast and by the Waikanae River is
where I live. It is a Maori name meaning the place made by the tide.
Linking collective bargaining to health systems might seem odd. But not really. Health systems through exigency are
highly labour intensive so workforce is their most vital ingredient. The health system workforce, particularly in
secondary and tertiary care and again through exigency, comprises inter-dependent multiple occupational groups (much
more so than in the education system) many of whom are very specialised and overwhelmingly health professionals.
District health boards (DHBs) are the biggest employers of health professionals (mainly in public hospitals) who, in
turn, are the most important driver of innovation in health systems. Significantly health professionals are also highly
unionised with the Association of Salaried Medical Specialists having the highest membership density.Health labour markets, not labour market
These factors mean that there isn’t a single labour market in DHBs. Instead there are different occupationally based
labour markets often with different drivers. Better pay on its own understandably tends to be predominant for lower paid
occupational groups. Relativity can be a pressure point for some groups. Pay equity will be a new driver especially for
female-intensive occupational groups.
So too can recruitment and retention be a labour market driver in DHBs. It is also the driver most directly linked to
the performance of the health system in ensuring accessible quality patient-centred care. In this situation the focus is
often on retention. However, where the occupational labour market within DHBs is also part of an international labour
market, recruitment becomes equally and sometimes more important.
DHB employed medical specialists are in a distinct labour market, which is also Australasian, whose driver is
recruitment and retention. In previous recent blogs I’ve discussed both the specialist workforce crisis in New Zealand
and the threat to our health system from the trans-Tasman specialist salary gap
massively in Australia’s favour.Two things needed
Those needing public hospital healthcare are faced with the leadership failure to recognise the huge DHB specialist
shortages of around 24% and the consequential fatigue, job dissatisfaction and attrition that follows. This is high risk
territory for patient safety which would be politically criminal to allow to continue and normalise.
The first thing we need is recognition by government and DHBs that this is a priority to address. This should not be
difficult to a government committed to well-being and kindness. It would be difficult for a government lacking in this
The second thing we need is employment conditions that much better enable DHBs to recruit in the international
specialist labour market. This is where collective bargaining comes in because it is a moment in time when there is
close to balance in the employer-employee relationship. Governments and DHBs have rigidly adopted the position that one
size fits all for all these occupational groups. We need flexible thinking from them.
DHBs ability to compete internationally is blocked by the over 60% specialist salary gap with Australia. Quite simply,
except around the margins (no snakes), we can’t. Even though New Zealand has done better in its response to Covid-19,
Australia isn’t far behind and well ahead of the countries we both seek to recruit from. Covid-19 is unlikely to make a
difference especially if both countries are able to further streamline their quarantine requirements in a similar way.MECA negotiations
DHB specialists are covered by the ASMS negotiated multi-employer collective agreement (MECA). It is the single most
important thing that ASMS does. Not to recognise this fails to distinguish between wood and trees.
The MECA covers the minimum core terms and conditions of employment for the overwhelming majority of its members. It is
a powerful foundation that not only provides important ‘pay and rations’ but also essential employment protections
(including hours of work and against unjustifiable actions) and rights (for example, to speak out and to give priority
to responsibility for specialists’ patients when there is a conflict with responsibility to their DHB). A weaker MECA
would make ASMS industrial officers less effective in representing specialists.
Late last year ASMS adopted a bargaining strategy for its forthcoming negotiations that put the salary scale at the
centre of addressing this crisis. The capacity of both its research and communications team had been strengthened for
Putting the salary scale at the centre doesn’t mean claiming for an over 60% salary increase for all specialists. Such a
claim would be confusing (to use the kindest possible word) and make it look like using a crisis to get a massive pay
increase. But constructing a new salary scale would make the MECA much more effective in recruiting internationally and
improving retention. This would mean a salary scale that looked more like an Australian specialist scale (the lowest
Australian state salary step is greater than the highest New Zealand salary step).
The immediate cost would be in the translation to the new scale. The biggest group of specialists are on or near the top
of the current MECA scale. If they translated to the first step or two of the new scale then costs would significantly
reduce. Financially the biggest immediate financial winners would be at the lower end of the current scale but they are
also the smallest in numbers. There might be a relativity concern for specialists in these translations but the benefit
for the health system and their patients should override them. The ‘trade-off’ for this concern and for both Government
and DHBs would be the ability to recruit and retain more specialists for the good of patients, the health system, and
the health of specialists.
Negotiations commenced early this year but the onslaught of Covid-19 required a short-term 12 month settlement without
being able to address it. ASMS will be back in MECA negotiations early next year. It will be important that it continues
with its strategic approach. Collective bargaining requires both aspiration and pragmatism. The former is the objective
to be achieved; the latter is the building blocks that might be needed over time to get there.
Collective bargaining could be the tide that helps make the place that is the health system. It is one thing for
Government and DHBs to be complicit in normalising specialists shortages including the harm this does to patient care
and the health of specialists. That must change. It would be another thing for their union to get cold feet and share
this complicity. That must not happen.