Beyond intractable conflict

There is more than meets the eye in the State’s dispute with the IMO over a €3,182 living-out allowance per annum for approximately 3,000 NCHDs, writes Lloyd Mudiwa

The tendency of the health management to take outstanding IR matters to the High Court ably highlighted in this column (‘See you in Court, doctor’, IMT 21/10/2016), belies a ‘bury our head in the sand’ approach and belief that the best way of overcoming problems is by tackling them where they occur. This raises the risk of said problems recurring and developing into full-fledged crises.

Just over a week ago now, the IMO confirmed it would ballot its NCHD members on taking industrial action and return to the High Court to have an ongoing dispute about the restoration of a living-out allowance to trainee doctors resolved, following a breakdown in talks at the Workplace Relations Commission with the Departments of Health, Public Expenditure and Reform as well as the HSE.

Payment of the allowance to doctors in public hospitals, which is set out in their employment contract, formed part of a settlement of a High Court case in January 2010, the union says.

Granted, the issue of the ‘living-out allowance’ involves potentially significant Exchequer resources, which have not been provided for in either the current or next year’s budgetary provision. However, there appears to be either a refusal or a failure to see the bigger picture here.

This gives new meaning to IMO President Dr John Duddy’s reaction: “It is just a further example of lack of respect for doctors and ignoring the crisis we have in retaining doctors in Ireland.” Indeed, many NCHDs feel they have actually lost ground, particularly those based in hospitals outside Dublin, since their strike action to right matters taken a few years ago.

As one NCHD posted on Facebook recently, in relation to the living-out allowance dispute: “This is asking for an apple when we should instead be demanding the whole orchard.”

You see, while very little is made of it by the HSE and the two Government Departments, it is psychologically a big deal for NCHDs in return for very little money.

That NCHD listed a brief list of things trainee doctors were owed (presumably by health management) as: the implementation of “transfer of tasks”, payment of late-night and weekend hours at an unsociable hours’ rate, full compliance with EWTD across all hospitals and implementation of a maximum 13-hour shift.

Other debts owed were to do with the restoration of the training/academic grant, proper mileage expenses, full remuneration for postgraduate exams taken successfully, protected in-house training time for those on a formal training scheme and an end to non-medical service-provision rotations being included on medical basic specialist training schemes, the NCHD stated.

But the NCHD issue appears to be bigger still.

This particular NCHD went even further, listing “what we [NCHDs] are not owed, but deserve”, giving one of these demands as a significantly improved base salary, especially given the loss of income incurred by EWTD-induced restructuring of pay packets.

“I see bus drivers, etc., seeking (and achieving) improved terms without improved productivity for no other reason than ‘it’s been a while since our last increase’. I’m sick of being overtaken by other professions in this regard,” the NCHD vents.

Other listed demands (health management are you still with me?) were a return to previous overtime rates “rather than this time-and-a-quarter nonsense”, a formal training programme for those working in state-run hospitals, as well as debt relief plus or minus interest free loans for graduate-entry medical students, and those graduates burdened by debt that can in no way be met by sub-par wages.

Tax incentives for those willing to stabilise the Irish health service at a time of mass emigration by accepting a place on higher specialist training schemes, coverage of medical indemnity and Medical Council registration fees by the Government for all on-scheme NCHDs and improved terms for new-entry consultants “since this is something many of us will suffer with in the not-too-distant future”, were other demands the NCHD listed.

“The IMO surely recognises that doctors deserve far, far more than a simple restoration of the living-out allowance. As a group, we have worked harder for it, sacrificed more for it, and waited longer for it than any other group in the country, private sector or public,” the NCHD fumed.

This shows that the “dispute” in question exists within a “conflict”. Though the dispute involves interests that may be negotiable, the conflict appears to involve non-negotiable deep-rooted differences; by its very nature conflict tends to be drawn out, attritional and highly resistant to resolution, often evolving into intractability.

NCHDs will not simply give up their chance for a better life by submitting to perceived continued injustice. So it might not be too long before the hard-done-by NCHDs regroup in another attempt to prevail.

In my view, health management should be considering conflict resolution rather than the temporary dispute settlement — this disagreement belies an underlying long-running conflict requiring a more long-term settlement.