In an interview on Radio NZ National on the 30th August it was announced that a new Junior Doctors union was being formed, the Specialty Trainees of New Zealand (SToNZ). A group of Junior Doctors (primarily surgical trainees), dissatisfied with the rostering practice established as part of the MECA (Multi Employer Collective Agreement) deal won by the NZ Resident Doctors Association (NZRDA) through industrial action in 2016/2017, have come together to form the union. In the interview, SToNZ chair Heath Lash stated that another health sector union, the Public Service Association (PSA) had been contracted to help establish this new union.
NZRDA took industrial action in 2016/17 as part of their struggle for safer hours to minimise fatigue through improved rostering practices. SToNZ are claiming the rostering schedules agreed to in the MECA between DHB’s and the NZRDA are not providing them with the required weekly training hours, and that they are also unsafe for patients. SToNZ chair Heath Lash has said that while NZRDA were on strike, he crossed the picket line and worked as he was not an NZRDA member and did not support their industrial action.
NZRDA reject the claims being made by SToNZ and released a statement saying that “SToNZ is choosing to ignore the irrefutable evidence directly linking fatigue with poor performance and error. In stating that their actions are in the interests of training they are also ignoring the fact that fatigued trainees do not learn”. NZRDA National president Courtney Brown says: “Advancing our own interests, including getting through training quicker, should never be put ahead of our patients’ rights to safe care”.
There is indeed ample evidence, from peer reviewed meta analyses and reviews, which counter many of SToNZ’s claims regarding hours.
The British Medical Association (BMA) conducted a review of the evidence surrounding fatigue and sleep deprivation in Doctors and produced a briefing paper in January 2018 outlining the body of evidence and provided a framework for managing fatigue in the profession. They conclude early in the paper, citing multiple references, that working longer hours (in relation to long shifts and work outside standard hours) increases the risk of fatigue. The briefing goes on to outline the acute and long-term cognitive and psychomotor impacts of sleep deprivation and fatigue, including diminished working memory capacity, attentional issues, and performance on tasks, which adversely contribute to patient safety and personal risk. They highlight data from a range of studies and reviews that show: long shifts (12+ hours) are associated with a 25–30% higher risk of accidents or injuries than a standard 8-hour shift; 36% more serious medical errors and 5.6 times more diagnostic errors when working 24-hour + shifts compared to shifts less than 16 hours; an increased risk of needlestick injury during extended shifts; and an increased risk of road traffic incidents after long shifts. They also point to impacts on mood and emotional reactivity and other factors affecting bedside manner. The briefing noted evidence that an individual experiencing moderate sleep deprivation can have a reaction time equivalent to an individual with a blood alcohol level of 50mg/100mL (the legal limit in NZ) — clearly relevant for all professions but in particular for surgeons and those carrying out fine technical procedures. Evidence for long term impacts of long working hours and the associated sleep deprivation and fatigue is also highlighted, and include: increased risk of cardiovascular disease, sleep disorders, obesity, depression, anxiety, type 2 diabetes, breast, prostate and colorectal cancers, and dementia.
In light of this evidence, the BMA then makes suggestions for policy and practice, including that job planning and scheduling be organised to minimise fatigue and sleep deprivation. Suggested measures include: built-in rest breaks; adequate recovery time between shifts (not less than 11 hours); and avoiding working weeks longer than 60 hours and shifts longer than 10 hours.
At this point in time it would seem that SToNZ, rather than having a genuine commitment to finding a solution to safer working hours for workers, is seeking to undermine the evidence based, safety focussed demand for better and safer regulation of working hours coming out of the MECA agreement, while also pushing for further pay increases: “We will be asking for a modest pay increase of 6%. This is based on the average STONZ member working approximately 5.5% more than members of our rival junior doctor union.”
Both the Association of Salaried Medical Specialists (ASMS) and NZRDA have written to the CTU Union movement, (ASMS letter & NZRDA letter) expressing serious concerns about what SToNZ could mean for the ability of Doctors to collectively bargain as union members. It is notable that Doctors’ ability to collectively bargain is already compromised by the current separate senior and junior doctors unions.
Another disturbing aspect to the establishment of this new union is the involvement of the PSA. We are seeing one health sector union (PSA) assisting in the establishment of another health sector union (SToNZ) that will, in essence, compete with and act against the interests of a third (NZRDA). This is divisive and contradicts the idea of solidarity and pits one set of workers against another. We need less unions in the health sector, not more.
There has been a letter sent to the PSA executive from individuals of the PSA Socialist Caucus expressing a strong objection to the PSA’s involvement in the establishment of SToNZ.
Animosity between the PSA and another health sector union, the Association of Professional and Executive Employees (APEX) may be fueling this issue. The PSA and APEX compete for members and APEX and the RDA are connected via a business owned by Dr Deborah Powell — CNS (Contract Negotiating Service).
This competition for members has also seen a lack of solidarity and antagonism between other health sector unions. In the recent NZ Nurses Organisation (NZNO) struggle, statements were made by another union, the Midwifery Employee Representative & Advisory Service (MERAS), that distanced themselves from the NZNO struggle. Considering both NZNO and MERAS represent Midwives who work alongside each other and share common interests, this was a disappointing example of the lack of cross union solidarity and cooperation in the health sector. While it is acknowledged that MERAS are advocating for recognition of midwives as a separate workforce from nurses, cross union support should be fundamental. Building power in the union movement rests on the ability of each union to leverage collectively, not against. This is a key tenet of the Health Sector Workers Network (HSWN).
HSWN was established and dedicated to building solidarity and cross union/worker cooperation in the health sector and HSWN have serious concerns as to what this new union (SToNZ) could mean for safe staffing and the impact on patients and staff alike. As with Nursing staff, a shortage of Doctors has exacerbated the issues of safe staffing right across the health sector. It appears the aims of SToNZ run counter to the goals of health sector union solidarity as they are seeking to undermine the conditions ratified in the 2016/2017 MECA. These were hard won gains achieved through the struggle and strike action taken by the NZRDA for safer roster practices. These actions were supported by HSWN.
HSWN questions whether yet another union in the health sector will do anything to build solidarity and cooperation across the sector. We would argue that the number of unions presently competing for members and undermining each other’s struggle has us fighting over scraps and acts to keep us divided. The animosity and lack of real cooperation at the bureaucratic level does not mean we have to accept this as rank and file union members.
It is imperative that as workers with more common interests than not, we rally around that commonality and struggle together. A safe work environment is something we expect for all workers and patients alike.
So let us leave the union bureaucrats to their rivalry. Let us work together, self organise, and build a cross union rank and file movement that fights for a public health system that we can all be proud of. In the words of the Industrial Workers of the World (IWW):
We find that the centering of the management of industries into fewer and fewer hands makes the trade unions unable to cope with the ever growing power of the employing class. The trade unions foster a state of affairs which allows one set of workers to be pitted against another set of workers in the same industry, thereby helping defeat one another in wage wars. Moreover, the trade unions aid the employing class to mislead the workers into the belief that the working class have interests in common with their employers.
Health Sector Workers Network