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NHWU: TIME TO FIX HEALTH CARE SYSTEM

posted 5 May 2015, 20:34 by Gerry Kangalee   [ updated 5 May 2015, 20:49 ]
On 2015-05-05  the National Health Workers Union wrote the following letter to Kamla Persad-Bissessar, the Prime Minister of Trinidad and Tobago

The National Health Workers Union (NHWU), an affiliate of the National Workers Union
(NWU),which is in the process of organising health care workers throughout the Regional Health Authorities (RHAs), issued a media release dated April 30, 2015, making a public call for the dismissal of the Minister of Health.


We are now corresponding with you as to why, not only is this absolutely necessary, to avoid the complete breakdown of the health care system, but what can be done in the short term to give the system the kiss of life, so that the people of Trinidad and Tobago can benefit from an efficient, and affordable system, something from which they are certainly not benefitting now.

The minister has begun to backpedal on the ridiculous changes he announced, only because of the stiff resistance his measures faced across the health sector from the unions and professional associations.

Under the watch of Minister of Health Dr. Fuad Khan the health system, dysfunctional since the 1950’s, has reached a new low. When the person who is charged with the responsibility for ensuring that citizens have a reliable and affordable public health system blames the people he leads for his inability to do so, then he is an abject failure as a manager/leader and must be relieved of his responsibility.

If you don’t like the job, Minister Khan tells health workers, you can leave! What a simple, elegant solution! How will the workers leaving solve the problems of the public health system? According to official statistics, in the North Central Regional Health Authority alone, there are, at least, six hundred and fifty vacancies to be filled, and in the South West Regional Health Authority (SWRHA) there are three thousand four hundred and thirteen (3413) vacancies, nine hundred and ninety-two (992) of them being nursing vacancies. 

NURSE TO PATIENT RATIO

According to the World Health Organisation, the nurse to patient ratio should be one nurse to six patients. This is the recommended ratio to ensure quality care is given. At San Fernando General Hospital the nurse to patient ratio is most times closer to one nurse to twenty two patients and this has been made worse since the advent of the Teaching Hospital. This is unsafe and puts both nurse and patient at risk.

In a statement issued on 2014-12-31 by nursing personnel at the San Fernando General Hospital and the Teaching Hospital it is stated that the staff shortages “result in long hours, excessive overtime, tired workers, denial of legitimate leave etc. and this must negatively impact the quality of health care to the population.”

The statement goes on to say: “Overwork, frustration and a total lack of respect by those in authority for our efforts coupled with a lack of appreciation for all of us who work overtime and extra duty for minimal compensation in order to keep the hospital running is what we tolerate every day.”

If in the midst of such debilitating shortages, the goodly Minister can rant and rave at health care personnel and attempt to show them the door! On the surface it makes no sense, but when it is considered that in some quarters the minister is referred to not as the Minister of Health but as the Minister for the advancement of private health care controlled by his medical entrepreneur colleagues, it does begin to make sense.

It is becoming clearer that the Minister is not really interested in ensuring in the words of the Health Sector Reform Programme Project Completion Report dated July 1996 in improving “the health status of the population of Trinidad and Tobago by promoting wellness and providing affordable quality health care in an efficient and equitable manner.”

Instead, this Minister who did not know he could not maintain his private practice while sitting in Cabinet, is most interested in promoting the External Patients Programme (EPP) which has been described as benefitting a clique of medical doctors masquerading as public officers in the public health system while actually operating a private hospital sector funded by the state.
This scandalous situation has moved from one where medical capitalists masquerading as doctors would whisper in patients ears that they should attend their private hospitals to one where public health institutions have become a gathering station for those in need of medical procedures. 

Public health institutions now play the role of holding bays and clearing houses for the routing of patients into the arms of the medical mafia and the state pays – all very legal and above board as are many instances of looting public funds for private enrichment. 

This situation will continue to plague the system as long as these masqueraders are allowed to work in both the public and private health systems. As the election approaches there seems to be a mad scramble to squeeze out every cent from the public coffers as the system is now being extended to sixteen private dialysis centres and through the nefarious public-private partnership two centres are slated to be built in collaboration with Comprehensive Nephrology Services Ltd and Biomedical Medical Technology Ltd. The first company, which very few know anything about, is based at Lamp Post 105 Monroe Road and the other at 137 Eastern Main Road, St. Augustine. The terms of the public-private partnership have not been revealed; neither have the track records of the two firms, which seem to exist only on paper.  

In his speech on Public Private Partnership at the Hyatt on Tuesday November 1st, 2011 the Minister of Finance spoke of privatising public utilities, ports, airports, health care provision and pensions.

When it is taken into consideration that from the very early days of your administration your government opted for a policy of widespread divestment/privatisation, it would be naïve of us to believe that Minister Khan’s position is peculiar to himself and not to your government.

According to the Alma Ata declaration coming out of the International Conference on Primary Health Care in September 1978 and which was co-sponsored by the World Health Organisation Health: "which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal …”

Your government seems prepared to violate this fundamental human right at the altar of filling the pockets of your supporters and friends with public funds which are supposed to be utilised for the public good and not for the private accumulation of capital.

The Minister was cited in a newspaper article as saying: “You can’t be tired or frustrated from the time you enter to when you leave…there are a lot of people who want to come in as caregivers.”

How come with the horrendous shortages in staff and with so many people wanting to come in as caregivers, the staffing situation has not been improved. Does the Minister not realise that the very people who come into the health system with high ideals and expectations quickly become demoralised and burnt out when they have to operate under the horrific conditions subsisting in the public health system? 

SERIOUS DEFICITS

These conditions in all the Regional Health Authorities include: serious deficits in terms of equipment staff, medication, utensils and everyday products. According to Senator Dr. Victor Wheeler, in moving a motion at the fifteenth sitting of fifth session of the tenth parliament on Tuesday January 20th 2015, calling for a comprehensive review of the regional health authority system.

"There is also a shortage of midwives; shortage of foetal monitors...The system clearly is not efficient. But in spite of all of these problems, I should state that there are many committed personnel in the health sector. There are many committed doctors, nurses and midwives who will still perform above and beyond the call of duty, and they are given little recognition for this.


With respect to the other powers of the RHA—operating, construct, maintain equipment—this certainly has been substandard. It is not adequate…We have in 2014 new hospitals being built, when currently, for the hospitals that are in existence we have a shortage of specialists, shortage of nurses, shortage of midwives, shortage of lab managers, shortage of staff. My concern is, when these new hospitals that are planned to be built are opened, I am just wondering where we are going to get the staff from” Dr. Wheeler is himself an employee of a regional health authority.

Dr. Wheeler also stated: “Because many of the workers in the Regional Health Authority system were on contract, the environment for victimization flourished, and the introduction of the RHA system in Trinidad and Tobago brought a lot of uncertainty and instability,” and also said: “the manner in which permanent appointment was given to health care personnel did not demonstrate any logic or basis by which some people were given permanent employment, and others were not.”

This assessment of Dr. Wheeler’s dovetails with a statement issued by the National Workers Union on June 6th 2014 which stated: “Management of the RHA’s is based on political allegiance and not on providing a first class health service to the citizens. The industrial relations are abysmal and lead to low morale and frustration on the part of employees who are not connected to the party in power...”

Because there are no recognised majority unions in the RHA’s, except for the National Union of Government and Federated Workers which represents daily paid employees throughout the RHA’s and the Medical Professionals Association, which represents doctors in the South West Regional Health Authority, compensation packages are falling behind and terms of work do not evolve to raise the standards of the conditions of work. Because of the political intervention in day to day operations of the RHA’s hiring and promotions are not transparent. Incompetent management and horrible industrial relations also contribute to the backlog.

Dr. Khan announced thirteen new regulations at health institutions which are to take effect from May 1st (two days after his grand announcement). He boasted: “I have to formulate a system and a plan if the system is not working which was there for 20 or 30 years. I have to find something in the interim to fix patients’ safety.”

FOUNT OF ALL WISDOM

This is precisely where the problem lies! Government Ministers believe that because they sit in cabinet, they suddenly become the fount of all wisdom! Instead of consulting with those who are in the kitchen and feeling the heat, he rolls out grand plans that he has plucked from the air and attempts to impose them upon those who have to implement them.

Fuad Khan playing the fool with the nation's health
With whom did Dr. Khan consult to come up with his new rules? Certainly not with the health care workers! This is not surprising. This has always been the style of those who are charged with managing the health care system. According to the statement of the nursing personnel in San Fernando cited earlier: “Anyone who understands the structure of the SWRHA and by extension the Ministry of Health would know that nurses are not consulted on any decision, even those that directly affect us”.


According to the newspaper report (Daily Express April 30th 2015) “Khan said the Regional Health Authority system was supposed to address issues regarding the professionalism of the health care worker through appraisals and contracts, but the system has failed...The RHA system has collapsed, because everyone is being made permanent. At the end of the three or four years you are now called a permanent employee to continue your permanent behaviour,” he said.

The contempt with which the Minister holds the employees of the health system has now become pellucidly clear. The Minister believes that workers should have a master-servant relationship with their employers. He believes that workers must not have job security and should be kept in a situation of limbo when it comes to being able to plan for their future.

The truth is that throughout the RHA’s and more and more in the public service and in the private sector, employers are opting for a contract labour system which eschews permanent employment in favour of rank exploitation and which also makes it difficult for these workers to exercise their constitutional right to join a trade union.

In the RHA’s contract employment is the favoured form of employment and contracts are varied at will making these workers incapable of organising their business going forward in terms of bank loans, mortgages, significant investments etc. Instead of advancing the interests of health care workers by moving them away from the contract system, the Minister whinges about permanent workers’ behaviour and moans and whines as if to imply that permanent employment should be done away with.

SHOCKING IGNORANCE

The Minister exposes his shocking ignorance about the situation in the health sector over which he presides by making the unbelievable statement that in offending situations, doctors could be suspended, but nurses could not since they were protected by unions. Does Dr. Khan not know that except for the daily paid workers and the doctors in the South West Regional Authority, there are no unions in any of the RHA’s that have recognised majority union status, which means that these workers are not covered by a collective agreement that spells out their terms and conditions of work?

The Public Service Association is prohibited by the Industrial Relations Act from gaining recognised majority union status for health and hospital workers, the Registered Nurses Association which was recently transformed into a union seems to be concentrating on only organising nursing personnel and the National Health Workers Union is in the process of organising monthly paid workers throughout the RHA’s but has not yet reached critical mass in order to make an application to the Recognition Board, although that time is not too far away.

In any case if disciplinary action is to be taken against any worker in this country, whether unionised or not, whether working in a fast food restaurant or as a doctor in a public or private institution, it has to be demonstrated that the action is for just cause, the worker has the right to be heard in her own defence and to be afforded due process in pursuing the matter. It is embarrassing to say the least that a minister in the government of Trinidad and Tobago has no clue about basic matters like these.

Dr. Khan said he would authorise the use of cameras by patients or relatives to capture footage of the care they receive by health care personnel. Is he also going to authorise health care personnel to capture footage of the treatment meted out to them by frustrated members of the public or footage of the shady dealings taking place at senior management level on an everyday basis when it comes to dealing with equipment and violation of procedures in the hospitals.

While much has to be done to provide an efficient, reliable and affordable health system which would involve a comprehensive review of the health system and radical action to bring it up to scratch, in the interim, there are many short term measures that can be taken. 

-The National Health Workers Union, therefore, calls for the dismissal of Dr. Fuad Khan as Minister of Health. If he remains in the portfolio, do not be surprised if a massive revolt erupts throughout the public health care sector with consequences which can only be described as catastrophic. To be forewarned is to be forearmed!

-The dual track system of senior medical personnel operating in both the public and private health care systems must be abolished. 

-The horrendous contract system must be done away with, so that our workers may enjoy job security, without which they cannot properly plan the future of their families and have no access to mortgage loans etc. 

-Mechanisms must be put in place to fill the thousands of vacancies in the public health care system.


In the service of the working class.

Dave Smith
General Secretary
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