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The human face of contracts

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The Queensland public hospital doctor contract saga continues, and emotions are running high.

I have spent much of the past week in intense and involved discussions with the Director General of Queensland Health and his team of advisers to reach a satisfactory resolution.

I have had the support of AMAQ President-elect, Shaun Rudd, and representatives of ASMOF, ASMOFQ, and the Together union. But the most important members of my negotiating team are the ‘human face’ of this contract dispute – some of the doctors whose lives and livelihoods are at stake.

I have personally witnessed the very real personal impact on these doctors as I have travelled around Queensland for meetings. People are not sleeping, and they are questioning their future in Queensland. There are raw emotions on show during these talks. The tears. The exasperation. The desperation.

To recap, the AMA is leading the fight to influence the Queensland Government to come back to the table to try to put fairness and balance back into the contracts they are offering senior doctors – SMOs and VMOs – who work across the State in the public hospitals.

The original contracts had stripped basic hard-won and reasonable workplace rights and conditions. These conditions reflected the seniority of the doctors, their importance in the health system, the demanding hours they work, the sometimes horrific and shocking injuries and illnesses they encounter, and their dedication to saving lives and putting damaged bodies back together.

These doctors provide a valuable service to Queenslanders. The community values them highly. Their patients value them even more highly. The Queensland Government contracts treat them with contempt and disdain.

The contracts are written in the hardest possible language that can only be interpreted in the most negative and unreasonable way. Sadly, Queensland Health has a long history of unreasonable management behaviour.

This is not the way to treat one of the most valuable assets that Queensland has: its highly-trained and dedicated medical workforce. These contracts treat doctors far more like servants than doctors. The contracts are directives, not agreements. The contracts do not encourage a partnership.

There is no evidence anywhere that I know of that harsh contracts extract the best from employees. There is much evidence that true partnership can deliver better outcomes in spades.

While our talks are making incremental progress, it is clear that the Departmental negotiators are constrained by a larger political agenda. They are confined in what they are allowed to do.

There is no doubt that the Director General shares our view that we wish to avoid any more harm to the health system in Queensland.

The major problem we confront is the possible complete collapse of public trust in the health system. This is where Queensland has been in the recent past on a couple of notable occasions, and nobody wants to go there again.

The doctors have been key to rebuilding that public trust in the system. It is not wise for the Government to end that important partnership with the medical profession.

I have been involved in the negotiation and have been filled with pride by the actions of my colleagues in that process. They have been honest and earnest. They have cogently and clearly laid out their concerns.

The actions of the senior doctors throughout this dispute have not been the actions of rabid union thugs, as some in the Government have sought to portray them. These are the actions of highly-qualified and highly-respected clinicians who are trying to protect the quality and safety of the Queensland health system. They are trying to facilitate a partnership with the hospital managers.

But the contracts as currently written diminish the ability for doctors to discharge their ethical obligations to their patients by limiting their power to influence their non-clinical managers.

If driven by pure financial targets, non-clinical managers can impose something that is unsafe or unreasonable. The words of the Francis review of the Mid Staffordshire inquiry in the UK – http://www.midstaffspublicinquiry.com – ring in my ears. Putting financial targets before good medicine is what led to the Bundaberg Patel disaster in Queensland.

The contracts are capable of taking the ‘health’ out of health system.

Our demands on the Government are clear and reasonable. We are calling on the Minister to respond to the causes of the problem – the unfair laws and the unfair contracts. We cannot see that any other response is capable of relaxing the constraints put on the Director General to allow us to put together a framework to allow Queensland Health to build trust with its medical workforce.

If the Government responds positively to the doctors’ needs, the tears will turn to cheers and we will be there standing side by side – doctors with managers, medico-political leaders with politicians.

The beneficiaries will be the people of Queensland.