Strike action by senior medical staff has never occurred in New Zealand until now. It has been underway in Timaru Hospital since 3 February 2003, in the form of withdrawal of elective services one day a week, progressing through the days of the week over a five-week period.

The decision by senior medical staff to take formal industrial action was not taken lightly, and was preceded by long and heated debates until all alternative avenues of dispute resolution were exhausted.

How did this situation come about?

The collective senior medical staff contract at Timaru Hospital expired on 1 July 2002. Negotiations for a new contract were immediately instigated with the aid of the Executive Director of the ASMS, Ian Powell. Right from the beginning, it was clear the negotiation was going to be difficult, with management dismissing outright the senior medical staff’s concerns and also rejection of their new contract offer. A counter offer tabled by Timaru Hospital management was in fact a disguised reduction in salary with no attempt to address the senior medical staff concerns. Over a period of six months, repeated discussions clearly showed that the Timaru Hospital management team was not even prepared to offer a salary increase to cover the inflation rate and they had no intention of changing the status quo on any other issue.

The salary of the senior medical staff at Timaru Hospital is at the lowest end of the national pay range, with the majority of the staff at the lower end of the scale, eg, a staff member with 25+ years’ continuous service with Timaru Hospital would be at Step 7 of the 15-step scale. These low remuneration rates have largely come about as the result of the archaic and heavy-handed management approach to contract negotiation over the years and the threat of closure of the Hospital if it exceeded its fiscal budget allocated by the Government.

Associated with this are years of systemic dismissal by hospital management of the concerns and problems of senior staff. More recently, these included issues such as the lack of hospital beds to meet clinical demands, the lack of modern equipment, the onerous nature of the on-call roster, the failure to agree on an updated job size and description, the poor rate of remuneration resulting in retention and recruiting difficulties, and the lack of junior staff support. Previous dialogue with management on these issues had fallen on deaf ears. The senior medical staff felt it was time to make a stand, as these issues had reached a crisis point and could not be dismissed again.

The main issues that needed addressing were:

We were able to come to an agreement with management that they would look into employing more staff to address the onerous nature of the rosters in the areas in which the highest call back occurred, namely orthopaedic surgery and general surgery.

Management also made an undertaking to go into formal negotiations on updating job sizing and job descriptions.

Management also agreed to address the pay issue by agreeing to an increase equivalent to our neighbouring DHBs, but would not address the issue of our position at the bottom of the national pay scale.

The lack of registrar cover and junior staff support was not considered to be worth any offer by management, despite our insistence that this was the key issue. Despite multiple requests by senior medical staff for independent arbitration, or for the Board and Board Chairman to become involved, management were not prepared to discuss these options or even contemplate other methods of arbitration. This left us with no choice but to resort to industrial action.

Previous votes of no confidence in hospital management by senior medical staff were of no merit, so this avenue was not pursued. Mass resignation was considered, but it was agreed that industrial action in the form of one-month rolling strikes of all elective services (all acute services would remain unaffected) would be the most effective course of action and the least disruptive to our patients.

Strike action was not entered into lightly and has not been without its toll of the senior staff. On instigation of the strike action, we were overwhelmed by the enormity of the support from the people of South Canterbury. We received full support from the public, the local media, and all of our patients.

Unfortunately, after two weeks of strike action, management remained intransigent, and their new offer was a retrenchment of a previous offer, so drawing us further apart. By now, public support on the doctors’ stance was swelling, with independent bodies, including the local chapter of Grey Power, City councillors, and the Mayor of Timaru, calling for a public meeting to bear pressure on hospital management to resolve the issues and to help clarify the issues for the general public.

The toll of senior staff became evident, with one of our most senior staff members tabling his resignation as the industrial action, which he supported, seemed to make no difference regarding concerns over lack of junior staff support. This increased the public support for the doctors and put pressure on the District Health Board to either get involved or to instigate independent arbitration.

The medical staff also implored the Minister of Health to require the DHB to become involved. We believe as a result of this intervention that headway was again achieved. Informal talks with the Chairman of the Board were instigated within 24 hours of our request to the Minister. This dialogue included instruction by the Chairman to management to improve their offer, resulting in a new offer, which is under consideration and goes some way to addressing issues. It includes a minimal compensation package, while the possibility of the introduction of registrars and more junior staff is being contemplated.

However, whatever the outcome of this latest offer, the net result has been a complete breakdown of any confidence and trust the senior medical staff had in the hospital management team. These wounds will take years to heal.

Author information: John A Rietveld, Orthopaedic Surgeon, Timaru Hospital, Timaru

Correspondence: Mr John A Rietveld, Orthopaedic Department, Timaru Hospital, Private Bag 911, Timaru. Fax: (03) 684 1532; email: jarcer@xtra.co.nz