The spectre of another major strike in the health services within seven months raises serious questions about how industrial relations are conducted in the sector. It is now generally accepted that the nurses' dispute could have been settled for a fraction of the final cost, in terms of pay and disruption to patients, if more meaningful negotiations had begun sooner. A similar scenario seems to be emerging with the non-consultant hospital doctors.
Like the nurses, the doctors will attract enormous public sympathy if they do go on strike. It is widely accepted that they work horrendous hours and, for the first time, the health services are beginning to encounter serious problems in filling non-consultant vacancies in specialties such as obstetrics, paediatrics, accident and emergency, psychiatry and anaesthesia.
The Irish Medical Organisation (IMO) is concerned that the worst excesses (and abuses) of the existing overtime system need to be addressed before July 1st, when contracts are renewed. At the same time, the Health Service Employers' Agency is right to seek a "fundamental review" of the existing system rather than a quick fix that will only see discontent recur within a few years. As the agency suggests, there is no reason why doctors should not operate a shift system similar to nurses and paramedics within our hospitals.
Such a system should not only make it easier to protect doctors from excessive hours and pave the way for the shorter 48-hour working week required by the EU, but ensure a better service for patients. The IMO says it has no problem in principle with shifts and points out that the doctors are already organised on this basis to cover Accident and Emergency departments in many major hospitals. However, it argues that it wants excessive exposure of members to overtime dealt with now and not relegated to yet another review.
These two positions are far from irreconcilable. The failure of both sides to engage meaningfully after six months of negotiation, suggests that the real problem is a lack of trust based, regrettably, on experience. The principal tensions are local, as the recent report by former ICTU president, Mr Phil Flynn, on University Hospital Cork showed. Mr Flynn found that the doctors were being forced to work excessive hours without pay. But he also found that they were not invoking the grievance procedures set out in their contracts to resist such pressures.
The fragmented nature of management structures creates further problems. It is the Health Service Employers' Agency which negotiates nationally with the health service unions. But implementation is at health board and voluntary hospital level. The nursing unions are complaining that elements of the pay deal which ended their nine-day strike last October have still to be implemented by some local managers six months later.
If there is a need for a "fundamental review" of the way the doctors' work is organised, then there is an equally pressing case for a similar review on health service management. The Minister for Health, Mr Martin, must not only persuade the relatively youthful negotiators for the non-consultants to buy into the negotiating process, but he must also persuade the administrators - including medical administrators - to turn their backs on the control mechanisms that have passed for management in the past.