Minister's Offer and union office analysis

Posted March 20, 2014

Quality health system 

Union analysis

Many clinicians have spoken about their concerns that if doctors sign the contract then the quality of the health system will suffer due to a “command and control” structure that prioritises “profits” and financial considerations over quality of care. A number of senior doctors described to the Minister their concerns that this contact framework would be taking the State back to pre-Foster Review conditions and creating risks such as were notoriously realised in the Mid Staffordshire Inquiry in the UK. 

Patients before profits 

Union analysis

Many clinicians have stated categorically that they will not sign a contract that makes them beholden to profits and not patients. There are many conditions in the contracts that clinicians argue will reduce patient safety.

Director-General’s powers to alter contracts without agreement. 

Ministerial proposal

D-G acknowledged that his powers should not be able to change the terms of the contract unilaterally and he supports that value.

Proposal for a Ministerial Direction under the Hospital and Health Boards Act (HHBA) that says that only changes which do not disadvantage SMO's are permitted, without prior agreement.

The D-G will be required to consult with a newly established Contract Advisory Committee before varying the SMO or VMO HED (which contains the contract and terms and conditions of employment terms).

The membership of the Advisory Committee will be up to the Minister but was proposed to include the AMAQ president as a representative of doctors.

The Minister has also written to the AMA and suggested he will amend the HHBA at some point in the future to put this arrangement in place in this piece of legislation.
The "workaround" from government is a document that can still be unilaterally changed by the Minister or cabinet. Taskforce doctors are concerned that this proposal puts faith in the government not breaking its promise as it has done with MOCA3.

Union analysis

Ministerial direction is just a letter to the D-G from the Minister and while it has force it can be overturned at whim.

Legislative change is required to adequately protect a "no disadvantage" principle and maintenance of conditions. Even the HHBA amendment suggested by the Minister can be overturned by a regulation (unilaterally by cabinet)

An advisory panel which does not involve democratic representation and decision making by affected doctors is not enough protection from unfair disadvantage.

 

Arbitrary Dismissal

Ministerial proposal

D-G clarified that termination for an invalid reason (such as unlawful discrimination) remains subject to the jurisdiction of the QIRC and SMO's can seek reinstatement or compensation.

D-G proposes that an addendum to the contract be issued to set up a process for termination (other than as above) which will provide for:

  • MO to be advised of concern by the HHS in a timely fashion
  • MO has the ability to address the concern
  • If a dismissal results and the MO believes it to be harsh unjust or unreasonable then the MO can appeal to the decision in a review process.
  • The D-G would appoint a Deputy President of the Industrial Commission to undertake the review but importantly the DP would be operating independently of the Commission.

Union analysis 

This is correct, an invalid reason is a reason that is against the law, for example because of someone’s race, religion, marital status, parental status, gender or age, etc.

It does not cover where someone has been terminated for an unfair or unreasonable reason, or without due process.

This process is far less robust than what you currently have as there are no set procedures, precedents or rules that operate to guide the review. The review is not appealable. A regulation endorsed by cabinet, or a change to the contract endorsed by the unelected “Contract Advisory Committee” could remove this protection. It is also adding an additional layer of red tape and cost when there is already an independent body with the funding, staff and expertise to do this. 

 

Rostering 

Ministerial proposal 

The contract addendum would provide that where a HHS proposes a new shift between 6.00pm and 7.00am: 

  • The HHS will call for an expression of interest and if the number of volunteers is not enough they may consult with the MO about working the shift
  • The MO cannot unreasonably refuse
  • The MO may access the dispute resolution process outlined above
  • An SMO will be provided with four weeks’ notice and a VMO 3 months’ notice of roster change.

Union analysis 

Removes limit on circumstances for extended hours e.g., to meet HHS demands, or to deliver benefits to patients where both safe and effective; to address fatigue, or to reduce overtime, on call and recall; demonstrable operational need after 10 pm.

Removes protections to identify fatigue related risks to the patient and the doctor and appropriate control measures including suspension of HHSs due to risks.

Removes right to decline for SMOs employed as of November 2012.

Removes guarantee of a meal break

Fatigue

Union analysis

The contract offered continues to remove the 10 hour fatigue break and relies on a fatigue policy that is vague and can be changed at any time

Transfers

Ministerial proposal

The addendum to the contract will provide that where a HHS proposes to relocate an MO:

  • The HHS will call for an expression of interest and if the number of volunteers is not enough they may consult with the MO about relocating.
  • The MO cannot unreasonably decline and must identify personal circumstances that impact on the ability to change work location.
  • The MO may refer a relocation decision to the D-G for consideration.

Union analysis 

The major problems with the transfer clauses are that the robust independent dispute process has been removed/tampered with. Previously there was an appeal right to the QIRC.

Recommend rejection in the context of the rest of the offer. If the whole package of conditions on offer improves this may be reconsidered.

 

Dispute resolution

Ministerial proposal

The following process is to been added to the contract by addendum:

  • The HHS will agree to dispute resolution and agrees to be bound by the outcome.
  • If the MO seeks arbitration the matter will be referred to the D-G who will appoint a Deputy President of the QIRC.
  • The MO may have a support person or advocate with them

Union analysis

This process is far less robust than what you currently have as there are no set procedures, precedents or rules that operate to guide the process. The arbitration may not be appealable. A regulation endorsed by cabinet, or a change to the contract endorsed by the unelected "Contract Advisory Committee" could remove this protection. It is also adding an additional layer of red tape and cost when there is already an independent body with the funding, staff and expertise to do this.

The advocacy wording is suspicious and may seek to limit advocacy.

KPI's

Ministerial proposal

KPIs will be developed by agreement between the MO and the HHS and will not be linked to income for 2 years for existing SMOs.

Union analysis

This is a significant concession from the Government and doctors have indicated to us that you are not opposed to KPIs absolutely.

However, this still allows a CEO (or locally delegated management) to cut your pay on their own say so with hugely deficient dispute procedures.

CEOs at a number of facilities have already argued for this right to arbitrarily set KPIs back.

"Reversion"

Ministerial proposal

If an MO signs a contract they can choose to "revert" back to MOCA3 conditions applied "administratively" by the D-G.

They will no longer have access to private practice arrangements; and the new contractual dispute and dismissal provisions will apply instead of the MOCA arrangements.

Union analysis

This shows that the April 30 deadline is a hollow tactic to push people to sign. If they were serious they would be allowing people not to sign up, at all for this period. This appears to be a cheap trick to get people to sign.

The bullying tactics of cutting Options A and B is still in place and they still propose to remove access to the QIRC.

Commentary from the D-G indicated this would only be for a 12 month period and then back on to the terrible contract again.

Collective negotiation

Ministerial proposal

HHSs will facilitate local forums where MOs can raise any concerns.

As is the case now, professional associations and unions can request to meet with D-G to discuss any concerns.

No restriction to an SMO having an industrial advocate involved in contract discussions.

The D-G will establish a Contract Advisory Committee to advise the D-G.

Union analysis

These rely on managers who participate in good faith with no proper dispute process these may become meaningless.

The D-G is already pretending that only the AMA were in the room for negotiations and that some sort of deal was already done.

Democratic union processes and representation and ballots of members and employees are required for a robust and transparent process.

The D-G can hand pick this committee and potentially just ignore its advice.

"No disadvantage"

Ministerial proposal

An MO is able to raise any concerns they have with the HHS individually.

The employment framework will be reviewed after 12 months and the review will include consideration of any

financial disadvantage experienced when SMOs moved across to the contract.

MOs asked for a guarantee that they will be no worse off if they move to the contract. This has not been provided.

Union analysis

The proposed solution has no substance and provides no concrete or enforceable protection.

Outstanding matters

There were many other matters raised by doctors that have not been addressed in any way.

Trust and Respect

On Friday last week the Minister conceded that mistakes had been made and that trust had been significantly eroded between the government and doctors. He committed to the doctors in the room that he would seek to rebuild the trust of clinicians in the Government starting with this process.

He said he was not prejudging the outcome and it was up to doctors to consider the offer. Days later when doctors did not immediately accept his offer the Minister had his Government have proceeded to attack, vilify and ridicule the doctors of Queensland in the chamber of State Parliament in a deliberate attempt to bully, victimise and scapegoat hardworking public clinicians for political gain.

Recommendation: Rejection