The right to strike is good for your health, by Jason Edwards

Essential service legislation not only subverts collective bargaining, it is bad for health care altogether

This article was originally posted in Rank and File - Canadian labour news and analysis from a critical perspective

A Look At The Health Impacts Of The Nova Scotia Liberal’s Attack On Workers’ Rights

The legislation came as somewhat of a surprise. As the province’s New Democrats have been quick to point out, the Premier has voiced opposition to subverting public sector workers’ collecting bargaining in the past. In response to Conservative essential service legislation tabled in 2007, McNeil said: “It has been proven from one end of this country to the other – this legislation will not work.”  It is also worth noting that while both other parties voted against the bill, Conservative and New Democrat consent was given to hold the weekend session where the bill was passed.

The government’s heavy-handed approach is presumably an effort to slow the rise in the province’s healthcare costs.  The larger part of that effort is not the attack on nurses’ and home-support workers’ wages, however.  Rather, by attacking health-workers’ right to strike, the government will be able to circumvent Halifax nurses’ demands pertaining to their working conditions. In particular, the government is likely trying to avoid instituting mandatory nurse-patient ratios, which will force them to hire more front line health-workers.

Is the effort to undermine health-workers’ ability to strike a good thing? Will it improve the provision of healthcare in Nova Scotia?

The answer to this question is a resounding no.

The Evidence
The evidence overwhelmingly suggests that essential service legislation results in a less responsive, less effective provision of health care.

Is Compulsory Arbitration a Good Substitute for the Right to Strike in Health Care? was released in 2008. Concerning recruitment, retention and morale of health-workers, the authors conclude: “Removal of the right to strike will allow health care managers to ignore or delay addressing serious problems and will drive those problems underground, only to resurface in ways, many of them unpredictable, that will even more seriously harm our health care system.”  By removing health-workers’ best avenue to air workplace grievances and problems with the provision of health care—the bargaining table—a government bends its jurisdiction into one where health care concerns don’t have to be addressed, and where employment is much less desirable, thus driving away potential health professionals.

A Tale of Two Provinces is a 2007 study comparing numbers of job actions in Nova Scotia to those in Alberta over the past three decades.  The authors explain how making strikes illegal in the health sector doesn’t necessarily result in less frequent job actions. Despite its tight restrictions on health-worker strikes and a political climate that is relatively unfriendly to organized labour, Alberta has had an abundance of job actions.  Based on the data, the study found:

“So what we have, in a province where strikes are illegal, is a strike volume more than fifty times that of a province where strikes are legal.  More speculatively, we might even suggest causation, i.e., that banning strikes may well contribute to more strikes.”

Health Care Strikes: “Pulling the Red Cord”, released in 2007, makes several more important findings.  The most notable is that the ability to strike is the most effective method healthcare workers have to warn their employer and the public of impending problems with health services.  Strikes provide healthcare workers with a last course of action—a red chord they can pull—that will force employers to recognize problems in the provision of health care.

The authors also find that more voluntarism in healthcare labour relations leads to better outcomes. “The more we remove voluntarism, the more we infantilize the parties… the less practical and responsible” they become.  Parties will not make serious efforts to come to solutions when they expect that their position will be ignored, and an alternative solution will be imposed on them by government.

The study also notes that healthcare strikes are not total withdrawals of service, leaving patients to die in the streets.  “[W]e question just how disruptive labour disputes are to the health care system and determine that it is too easy to confuse inconvenience with disruption and to overstate the level of disruption.”  Collective agreements that govern the relationship of health care employers and their workers make clear that, during lawful work stoppages, health workers will continue to provide emergency services.

The Right to Strike and the Provision of Emergency Services in Canadian Health Care is an older study that surveys different models of labour relations in health care. Again, the study’s findings strongly support the notion that health workers’ right to strike improves the provision of health care services. Allowing both parties input into who is designated “emergency” (and continues working) results in “a shorter, sharper drop in health services,” which is ultimately “less harmful to the health care system than the deterioration that accompanies a longer, corrosive dispute.”

Even the right-wing C.D. Howe Institute released a study supporting this conclusions entitled No Free Ride: The Cost of Essential Service Legislation. Using a large set of government data, this study concluded that essential services legislation tended to increase the day-to-day costs of employing health-workers. It found: “While government officials may wish to be seen to ensure essential public services by way of legislation, the designation is costly for taxpayers and increases the length and likelihood of partial strikes.”

Conclusions
The evidence overwhelmingly shows that respecting health-workers’ right to strike has a positive impact on the provision of health care services.

This argument makes perfect sense when considered in conjunction with the concerns of Nova Scotia’s healthcare workers.  The primary concerns of nurses in Halifax revolve around their working conditions, including nurse-patient ratios. If nurses’ workloads are lessened and more frontline health professionals are hired, this will result in better care for patients and cut costs on things like readmissions, infections, complications, and other negative outcomes.

As a Nova Scotian, my friends, family, and I all are potential patients of these health care professionals. Their employment conditions are our health care conditions.  In light of the overwhelming evidence, I would feel much better if their right to strike were respected.

As one of the above-mentioned studies concludes:

“If [healthcare workers] are too important to be allowed to be absent on strike, then their terms and conditions of employment are too important to be ignored.”

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