Containing Health Care Spending
Posted March 7, 2014
NSGEU president Joan Jessome would have us believe that she is only thinking of the patients. Of course the real story is rather more complicated.
On page 7 of the collective bargaining agreement (CBA) between NSGEU local 97 and Capital health we find section 5.01, which says: “The management and direction of employees and operations is vested exclusively in the Employer. All the functions, rights, power and authority which the Employer has not specifically abridged, deleted or modified by this Agreement are recognized by the Union as being retained by the Employer.”
The first sentence states what should be obvious. The leaders at Capital Health are accountable for delivering as much health care as possible within the context of tightly restricted budgets. Their job is made even more difficult by the remaining 183 pages of the CBA which considerably limit their freedom to act.
For example, the agreement tightly specifies how jobs are to be posted and filled, how shifts are to be scheduled, and how performance reviews are to be done. The agreement does not make it easy for the employer to make choices based on merit as opposed to seniority.
Now Jessome wants to impose inflexible patient-nurse staffing ratios. As pointed out by Dalhousie professor Kathleen MacMillan “Experiments with fixed nurse-patient ratios in other jurisdictions (e.g. California), which were initially hailed as solutions, have largely been policy failures and have been abandoned.”
In fact the only other instances of such ratios identified by the union in its advocacy are in Australia, where they were implemented as a result of union pressure, not management action.
This is not to say that nurses currently carry a light load. Many report frustration and difficulty in dealing with job pressures. In this they have lots of company across North America. Nurses at the Mayo Clinic in Minnesota demonstrated for increased staffing last September. Nurses are trying to get other states to copy California’s legislated ratios, notwithstanding the lack of evidence supporting their effectiveness.
Capital Health estimates that the union’s proposal would require 800 more nurses and cost $60 million per year. If the union’s proposal was adopted that is $60 million that would not be available for other unmet needs such as more hip surgeries, diagnostic equipment, or primary care physicians.
But these issues are not part of Jessome ‘s narrative. In fact, given her well-honed advocacy one could easily forget that she has no mandate to speak on behalf of patients. Her job is to get the best possible deal for the employees she represents.
She is good at it. Nurses participate in the health system’s defined benefit pension plan. Rates for overtime can be as high as 3.3 times regular rates, for overtime on holidays. Pay rates have been growing more rapidly than the provincial economy’s ability to support them.
Nurses at Capital Health are paid for three weeks of vacation initially, growing to six weeks after 24 years; 12.5 statutory holidays; up to 15 days general leave for things such as family emergencies, medical or dental appointments; bereavement leaves; leaves to attend to union duties; pregnancy and parental leave supplements; and finally a retirement allowance of up to 26 weeks pay. These are in addition to paid disability benefits and various unpaid leaves.
The primary responsibility for choices affecting patient care needs to rest with management at Capital Health. They would be thrilled to have more money to work with than the meager increases of the last few years, and to use some of it to hire more nurses. But imposing inflexible ratios in a collective agreement is not the right way to help patients. In fact patient care could be further improved if some of the existing union constraints on management choice were loosened.
Meanwhile support workers at Northwood Homecare and the VON, also represented by Ms. Jessome, are rejecting generous pay raises that were accepted by other health care workers, arguing that they should be paid the same as some hospital staff.
This follows a well-trodden path of union bargaining tactics. The paramedics tried a similar strategy, although they had to look as far away as Alberta to find the example they wanted. Homecare patients are not as sick as those in hospital. The comparisons are never as simple as advertised.
Government should understand that yielding to the demand for inflexible patient-nurse staffing ratios would set a precedent which other bargaining units would seek to follow. Applied to every nurse in the province it would cost far more than the $60 million estimated for Capital Health.
As pointed out by Finance Minister Whalen, Nova Scotia has the top consumption tax in the country and among the highest personal income and corporate taxes. Further tax increases would drive businesses and people out of the province.
Health care consumes 47 percent of program spending. It just cannot be allowed to grow any more rapidly than the provincial economy. That is the position in which Premier McNeil seems to be adopting, as does opposition leader Baillie more clearly and emphatically. They are right.
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