Political scientist Hugh Heclo put together what he calls a learning theory of public policy. He examined the fact that the income security systems of Britain and Sweden, noting that despite their commencement at the same time and with not dissimilar social, economic and political fundamentals, developed in fundamentally different ways. Governments don’t only “power”, he says, they also puzzle. The way that social and political systems develop relates less on the rational consideration of evidence than on what went before. Precedence is the great predictor of the future.
The same might be proposed with respect to the current round of health enterprise bargaining in the Victorian health sector and the nurses’ industrial dispute that has closed many hospital beds.
The current dispute has its origins in the savage cuts to the health budget initiated by the first Kennett government in 1993-4. That government was elected on the back of the “guilty party” advertising campaign, which threw out the supposed profligate Cain-Kirner government. In the pre-GST, pre-poker machine era, state governments were largely dependent upon stamp duty and payroll tax. In a recession, both diminished markedly and state budgets collapsed.
Victoria’s financial position suffered in the 1991-2 “recession that we had to have” and also because of the Pyramid collapse, which saw $1.4 billion taken out of the state’s economy. A hapless government had no response to the crisis and despite the fact that the economy was already recovering by late 1993 and with some relatively minor pruning would have recovered entirely within a few years, the Kennett government was elected with a claimed mandate to slash the public sector.
In health, cuts of 13% were applied in the first year, using casemix funding to apply these rationally. Hospital managers made the cuts where they could. Medical services were largely protected because they drive activity and in fact doctors did very well out of the deregulation of their wage fixing that occurred at the same time and that allowed pattern bargaining. Hotel services (laundry, cleaning, catering) were cut savagely; reserve capacity was removed and nursing numbers slashed.
Hospitals were increasingly claimed to be “dirty”, patients spent more time on gurneys because there were no beds available for admissions and nurses wilted under the increased workloads. Many apparent economies were ephemeral as direct care staff were replaced by an army of contract managers and outsourcing consultants, who produced no services.
In order to reduce the workforce, retrenchment packages were offered for public servants and these were taken up in the main by younger staff who had other prospects. The effect was to aggravate the structural problem of ageing in the health and education sectors, the core of which was a workforce recruited in the 1960s and ’70s. At the same time, the tertiary education sector was undergoing structural change with the out workings of the Dawkins amalgamations and the deregulation of course profiles.
Universities found themselves gifted with large numbers of student places in education and nursing, which were largely taken by students with middling entrance scores. Prestige in the higher education sector is in part founded on exclusivity and many vice-chancellors moved to convert these places to more highly sought courses with high entrance cut-off scores and for boutique programs that were in vogue, without regard to the workforce implications. The result was that by the end of the 1990s, the public sector was facing a largely self-imposed workforce crisis. The core of the workforce was edging towards retirement or was leaving because workplace stress was intolerable; wages and conditions were unattractive and there were insufficient replacement staff being trained.
By the time the Victorian electorate had concluded that its government was too arrogant and self-satisfied and replaced it with the Bracks government in 1999, radical action was required to repair the health workforce system. Wages were improved and government became very active in workforce planning. Victoria’s initiatives at this time have formed the basis of the Commonwealth government’s approach and the creation of Health Workforce Australia.
The most significant development, however, was the adoption of nurse-patient ratios. The ANF, which had seen the workforce slashed in the Kennett years and the development of intolerable workloads, fought a successful battle for ratios to be included in the enterprise bargaining agreement. The Blair arbitration of this agreement secured a 1:4 ratio requirement across the system. It is the cornerstone of the industrial settlement from the union’s perspective and Victorian nurses have accepted lower base wages than their interstate colleagues over two enterprise bargaining agreements in order to preserve it.
EBAs come up for renegotiation once every four years. This is the point at which government gets an opportunity to negotiate change. For government nurse-patient ratios are an inflexibility and a cost. While they acknowledge that they have been instrumental in the recovery of nursing numbers, they see the ratios as in impediment to the flexible deployment of the workforce to respond to variability in demand. Their current position is to argue to retain the ratios but with increased flexibility. There is some merit to the argument.
For nurses, however, the lessons of the 1990s are too current. They have seen that when faced with short-term financial constraints patient care and staff well-being can too easily be abandoned. An uncompromising ratio that is universally applied and easily monitored is a defence against an employer that cannot be trusted when the times get tough. Nurses will go to the wire for the ratios as they have demonstrated in their defiance on two occasions of directions by Fair Work Australia to lift bans.
The current industrial conflict is not merely an expression of the ritualistic process of negotiation by the parties. It carries the weight of its precedents. The Victorian government health policy during the 1990s was based upon assumptions of the expendability of the public sector workforce and the subservience of patient care to politically determined budget constraints. Now, almost two decades afterwards those assumptions form part of the precedent conditions of current policy stances and conflicts.
Unfortunately there is no free lunch. Nurses wages, like all public sector outlays have to be funded. Chest beating about increasing wages is fine if the economy can afford it. Politicians can never be trusted to tell the truth, but fundamentally union leaders are as much politicians as those in Spring Street.
It is ultimately the decision of elected government to do the trade-off between patient welfare and resource implications, not the nursing profession, as unions are traditionally focused on the welfare of their members not the members clients. It is government that represents the clients in the health system, and if trade-off is required that as a government decision and that is why we have democratic elections.
More than just democratic elections, it is also why we have unions, Mr Blower. Otherwise the government – any government – like any other employer – would find that time and time again – the time for a decent pay rise is just not quite now.
When was the last time anyone heard an employer of any calibre say it was well nigh time to hand out a pay rise? I’m old and I can’t recall a single one.
And Governments are no different. What is different about Governments is that, as you point out, they are more or less answerable to us. Which means that when they take a chainsaw to the health system or the schools or the police they should know what they are doing and be acting on more than just employers’ instinctive meanness.
Hopefully policies involve planning and developing a modern system – you know the sort staffed by professionals, where staff are not exhausted and resentful, where they are treated with respect and are recognised for their social role and importance.
Sadly this is rarely the case. Most governments are driven by electoral cycles and short term thinking rather than strategic plans and considered thought. And it shows – in hospitals, schools, fire brigades, ambulance services you name it. They are considered as costs not assets. And they have been butchered successively for decades and it really has to stop.
Whatever drives government decision-making, is governments that we elect to make decisions in relation to resource allocation, and trade unions are the omay operate in a self-interested manner representing their narrow sectional interest rather than the community as a whole. When was the last time you saw a union offer to reduce wages as a consequence of a reduced the work value situation?
If they take a “chainsaw to the health system”so be it because at the next election the electorate can make alternative decisions about who it wants to manage the system.
Tom,
I expect that it doesn’t alter the thrust of your argument, but Kennett was elected in late 1992; I’m not sure if the economy was recovering prior to that.
I find significant that the new Government has readily acceded to the demands of the Police Association (vying with the AMA for the status of the most powerful union in Victoria/Australia), yet is absolutely adamant in his rejection of the nurses’ claims. I sense that most Victorians would see the nurses as at least equally deserving.
The generous assumption is that as an inexperienced Government, they didn’t realise that the concessions in negotiations with police would constsitute something of a precedent for other public sector employees.
Surely community representation is more complex than the simple election of governments to take policy and resource allocation decisions. There are multiple legitimate representational mechanisms that interact to ensure a balanced perspective on issues that affect the community. In some cases these represent defined sectional interests and sometimes they take a broader social interest. Churches for instance represent the interests of their members but also take a broader interest in political and ethical issues that impact upon society. I would argue that Unions have long had a focus upon both the interests of their members and society as it is affected by the industries with which they are engaged. The “greenbans” movement involving construction Unions is a case in point.
Governments are charged with taking decisions on behalf of us all but they do so in negotiation with a range of other legitimate representative organisations. I assume that the ANF would see itself as representing the industrial interests of its members; as having a legitimate interest in the wellbeing of the health system as a whole and being in a position to represent the needs of health consumers. There are tensions between these roles but no fundamental contradiction.