Labour Court Database __________________________________________________________________________________ File Number: CD88200 Case Number: LCR11840 Section / Act: S67 Parties: DEPARTMENT OF HEALTH - and - THE IRISH MEDICAL ORGANISATION |
Claim on behalf of non-consultant hospital doctors (NCHDs) for revised hourly overtime payments.
Recommendation:
6. The Court has given careful consideration to the arguments of
the IMO and the representatives of the Managements of the
Hospitals.
In the first instance the Court wishes to point out that arising
out of the terms agreed for the deferment of the threatened
dispute on 6th October, 1986, the employers have an obligation to
agree to the implementation of a more equitable system of payment
for hours necessarily worked by NCHDs in excess of 40 hours per
week.
Management have now had ample time to assess the implications of
such payments and the IMO are agreeable to the implementation of
proper management controls on expenditure under this heading.
In order to achieve full application of this proposal it is
imperative that considerable changes in well established practices
be effected. It is an implicit part of the recommendation that
there be new rosters and working arrangements including the
pooling of resources in order to achieve better utilisation of
medical manpower. In this endeavour the full co-operation of the
Hospital Consultants is required and the Court recommends that
such co-operation be forthcoming.
The Court therefore recommends that a new system of payment for
overtime be introduced to operate from 1st January, 1989.
The key features of the system are:
a) Before the end of 1988, in each hospital, the consultants, the
NCHDs and the management will draw up rosters which will
accurately reflect the service requirements in that hospital,
taking into full account the organisational/roster change
options as provided in the PA Report and having regard to the
resources available to the hospital. The purpose of this is
to ensure that for each NCHD post there will be prior
management approval on the hours for which NCHDs will be
rostered and paid.
b) The aim should be to ensure that all rosters are for not more
than 65 hours per week but where this is not achieved the
matter may be referred to the Monitoring Committee.
c) There must be recognition of the need for flexibility in the
pooling of doctors across teams and specialities.
d) Payment for hours in excess of 40 should be paid on the basis
of the approved and agreed rosters only.
e) Half of all hours worked over forty should be paid at time and
a quarter subject to a maximum of 10 hours. All other hours
in excess of 40 should be at the rate of half time subject to
a maximum of 65 hours in total.
f) A Monitoring Committee should be established to oversee the
implementation of this recommendation. The Committee should
be composed of equal numbers representing the IMO on the one
hand and the Department of Health and other management
representatives on the other. There should be an independent
chairman.
g) Payment during annual leave will be basic salary plus average
rostered overtime at the lower rate, i.e. half time.
h) Interns should be rostered to work 65 hours or less and
overtime payments should continue to be paid on the existing
basis. Where it is not possible to roster interns for 65
hours or less, their case should be examined by the Monitoring
Committee.
The Court recommends that both parties accept this Recommendation
because it represents a further step on the way towards a fairer
payment system for overtime while at the same time reducing the
excessive hours which doctors have been required to work.
Division: CHAIRMAN Mr Shiel Mr O'Murchu
Text of Document__________________________________________________________________
CD88200 RECOMMENDATION NO. LCR11840
INDUSTRIAL RELATIONS ACTS, 1946 TO 1976
SECTION 67
PARTIES: DEPARTMENT OF HEALTH
HEALTH BOARDS AND VOLUNTARY HOSPITALS
(Represented by the Local Government Staff Negotiations Board
and the Federated Union of Employers respectively)
and
THE IRISH MEDICAL ORGANISATION
SUBJECT:
1. Claim on behalf of non-consultant hospital doctors (NCHDs) for
revised hourly overtime payments.
BACKGROUND:
2. This claim has already been the subject of three Labour Court
Recommendations (LCR6007, LCR10408 and LCR10674 refer). The IMO
rejected LCR10674 in September, 1986, and served strike notice to
take effect from the 8th October. This industrial action was
deferred on the basis of proposals put forward by the Labour Court
on the 6th October.
As part of these proposals, it was agreed that a Steering Group be
established to conduct a "review of existing organisation of
medical activity in hospitals". This Group, comprised of
representatives from Management and the IMO, held its first
meeting on the 29th October, 1986, where it was agreed to:
(a) issue a detailed questionnaire to each hospital,
(b) engage management consultants to complete a detailed
study (an analysis to determine how NCHDs spend their
time and a parallel study of how the work of NCHDs is
organised and controlled).
The report of the management consultants was presented to the
Steering Group on the 21st July, 1987.
3. Following the failure of the parties to agree a method for
negotiating a revised payment system, the IMO, by letter dated
23rd February, 1988, gave notice to Management of its intention to
refer the issue back to the Labour Court, in accordance with the
deferment proposals of 1986.
The Labour Court investigated the dispute on the 14th and 26th
April and the 2nd May, 1988.
ORGANISATION'S ARGUMENTS:
4.1 The Organisation referred the claim back to the Labour Court
because the central issue, i.e. a new payment system, was
never seriously discussed by Management. Whenever the
Organisation raised the issue of payment it was clear from
the brief Management response that it wished to relieve
itself of the commitment given in 1986. Management stated
that it would favour an all inclusive salary payment system
but when pressed for details of this proposal it was not in a
position to give any. In relation to control of NCHD
overtime hours and in particular unrostered overtime
Management indicated that it had proposals which would
resolve this issue but again when pressed for details, were
unable to give any.
4.2 In situations where the Organisation disagreed with
Management proposals these objections were either ignored or
Management threatened that if the proposals were not
proceeded with, the Government would be advised to reject a
Labour Court recommendation on the issue. The
representatives of the Organisation were accused on several
occasions that they were not taking the pilot studies and/or
negotiations seriously. This of course is totally untrue
given that the Organisation participated fully for a period
of nine months longer than was intended.
4.3 At the meeting of 18th January the Organisation decided to
refer the claim back to the Labour Court for adjudication.
It was clear from the discussions that Management were not
going to make a serious effort at resolving the dispute.
Management's proposals when put in the proper context
demonstrate clearly that it did not take these negotiations
seriously. Firstly it was proposed that the pilot study
continue at the Mater Hospital to attain workable rosters.
This proposal was made against the background of separate
negotiations at the Mater Hospital which were going on at the
time. At no stage during these negotiations did the
Management of the Mater attempt to resolve the dispute.
Secondly, the Management side did not appear to understand
the proposals put forward by the Organisation on a new
payment system even though these were taken from the P.A.
Management Consultants report. Thirdly, inferences of an
adverse Government decision in relation to the implementation
of a Labour Court recommendation were again made. Taking
these proposals together with the fact that the projects
which were undertaken had already been carried out in earlier
negotiations, it was clear to the Organisation's
representatives that Management was only interested in
prolonging the dispute rather than resolving it. It is in
this context that the Organisation has requested the Labour
Court to review its previous recommendation.
4.4 In the light of the October 1986 Labour Court Agreement and
the P.A. Management Consultants Report the Organisation
propose the introduction of the following revised payment
system together with the appropriate control and review
mechanisms. The new system would accurately reflect the
existing Organisation of medical activity in Hospitals.
Basic Salary
The salary of NCHD's covers a basic commitment of 40 hours
per week worked between 9 a.m. - 5 p.m. Monday to Friday.
Unrostered Overtime
The majority of NCHD's work on a regular basis in excess of
the basic 40 hour week. This work takes place prior to 9.00
a.m. and after 5.00 p.m. and is additional to the required
on-call commitment.
It is also noticeable from the P.A. Report that the amount of
time taken by NCHDs in personal breaks during the basic
working week is quite small.
The non payment of unrostered overtime is a source of
continuous dispute between NCHDs and local management. The
work undertaken during these periods is generally routine and
stems from ward rounds, out patient clinics, theatre, patient
admissions and proper patient management. The emphasis on
day care and closure of hospital beds have re-inforced the
requirement on NCHDs to routinely work unrostered overtime.
In recognition of this the Organisation proposes a similar
system to the one that exists under the Consultant Common
Contract whereby a Consultant receives payment for an
additional ten hours per week to compensate for time where
his basic commitment extends beyond finishing time.
Therefore each NCHD should receive an additional payment for
10 hours per week. As these are overtime hours worked, the
level of payment should be at time and a half for each hour.
Where the level of unrostered overtime exceeds this level, as
it may in a number of cases, the review mechanism which will
be set out later should deal with each case individually.
On Call Payments
As the basic salary covers a commitment of 40 ours per week
9 a.m. - 5 p.m., Monday to Friday, the new payments proposed
in this section will relate to hours of duty outside 9 - 5
and at weekends and public holidays.
In line with the commitment given at the Labour Court in 1986
the Organisation accepts that payments under this heading
should be based on an individual doctor's activity level and
the degree of attendance liability required in each case.
Therefore the Organisation proposes that compensation should
be made under three broad headings. These are as follows:
(a) On call but not engaged in activity.
(b) On call and engaged in activity.
(c) Attendance liability.
(a) The Organisation proposes that the basic hourly rate be
paid for each hour under this heading. This rate will
compensate the individual doctor for working during unsocial
hours and for the serious intrusion on private time and
family life.
Where an NCHD is required to be on call from home additional
expenses will be reimbursed by hospital management. These
are telephone rental, installation and calls. Travelling
expenses to the hospital and home where a doctor is required
to attend for duty. In the case of Sundays and public
holidays, on-call payments will be doubled.
(b) The Organisation proposes that payment for hours while
engaged in activity will be at premium rates as agreed at the
Labour Court in October 1986. The premium rates will be as
follows:
5.00 p.m. - 9.00 a.m. Monday - Friday Time plus half
Up to 1.00 p.m. Saturday Time plus half
After 1.00 p.m. Saturday, Sunday
and Public Holidays Double time
(c) Compensation for attendance liability for NCHDs on the
more onerous rotas, i.e. 1:1, 1:2, 1:3, 1:4, should be made
in the same way as it applies to Consultants under paragraph
13.6 of the Consultants common contract. This paragraph
allows for time off in lieu of weekend attendance liability.
As is the case for Consultants these days off should be
aggregated and availed of together thereby causing minimum
disruption to the service. Where, because of the exigencies
of the service it is not possible to avail of this leave the
appropriate monetary compensation will be made at the end of
the contract period. The implementation of this proposal
will ensure that NCHDs on very onerous rotas are given an
adequate level of off duty time.
MANAGEMENT'S ARGUMENTS:
5.1 Although the Steering Group did not issue a report as set out
in the October 1986 proposals, the Management side agreed to
enter into discussion with the IMO on a revised payment
system. While the IMO wanted the negotiations to centre
entirely on a revised payment system, the Management side
were of the view, having considered the P.A. Report, that
further information was required to ensure that any work
undertaken by NCHD's was both necessary and properly
organised. In this connection, the Management side indicated
that a number of pilot projects should be carried out while
discussions on a revised payment system would continue.
Pilot projects were carried out in the Midland Health Board
and Galway Regional and particular attention was focused on
the situation in the Mater Hospital. Discussions were held
with all 'teams' in the Mater Hospital and it quickly became
apparent that many problems existed in the hospital although
the NCHD's themselves have to take a portion of the blame for
these problems.
5.2 The issue of necessary work has always been a critical area
to the Management side and numerous attempts to identify what
work carried out by NCHDs was actually necessary were
unsuccessful. It was emphasised by the Steering Group to
P.A. Consultants that this was a critical area that required
attention. However, despite its best efforts, P.A. were
unable to resolve the matter.
5.3 Management has, in its previous submissions, referred to the
fact that NCHDs are trainees. The organisation of work in
major teaching hospitals significantly reflects this reality.
It would seem unreasonable to force Management to pay for
work which is primarily for training purposes.
5.4 Allied to the complex matter of necessary work is the issue
of Management controls of the number of hours worked. It is
very clear from the P.A. findings that Management's
involvement in determining the number of hours for which
NCHDs are rostered is very limited. Examples are also
provided in the P.A. Report of NCHDs being resident who felt
that this was unnecessary although required by their
consultants. Similarly in discussions with NCHDs in the
Mater Hospital, it became apparent that many NCHDs did not
avail themselves of days off/half days, etc because they
"felt" they should stay in the hospital. The position of
NCHDs in this regard must be considered in the light of their
trainee status. In relation to the existing arrangements for
monitoring hours rostered the consultant on each team signs
the NCHD's claim form. It is clear that in many cases,
consultants would not be fully aware of what his NCHD's
actual rostered hours would be, yet forms are generally
signed without question.
It is therefore contended by the Management side that these
two critical issues, i.e. necessary/unnecessary hours and
control over number of hours rostered have not been
satisfactorily resolved and doubt must be cast on a solution
ever being found.
5.5 The final phase of the interim award granted under Labour
Court recommendation 10674 will be implemented from 1st July,
1988, and will result in only one on-call rate, i.e. existing
rate for over 70 hours per week. The effect of this interim
award has been significant in that on-call rates have been
increased by between 11% and 37% while overall payments have
increased by between 3% and 9%. The additional annual cost
to the exchequer in a full year is £1.93m.
5.6 The average earnings of an NCHD at present, based on a 70
hour rostered week, is £19,650 giving a total annual payment
of £35.34m. When one includes PRSI costs, the total annual
cost would rise to over £39m which represents in excess of 3%
of the total health budget. No one needs reminding of the
critical state of finances in the health services.
5.7 The Management side wish to draw the attention of the Court
to the general economic and financial difficulties prevailing
in the country and particularly in the health services.
These difficulties point to the continuing need to control
the level of public expenditure of which public sector pay
forms such a significant part. The Management side would
expect that the determination of the appropriate level of
remuneration for a public service grade would reflect an
awareness of financial realities and a sensitivity to the
economic and social environment at the present time.
5.8 The proposals from the IMO as outlined in the Court on the
14th April will cost an estimated £20m to fund. In addition,
any concession in this claim could have repercussive effects
in the health services and in the wider public sector.
RECOMMENDATION:
6. The Court has given careful consideration to the arguments of
the IMO and the representatives of the Managements of the
Hospitals.
In the first instance the Court wishes to point out that arising
out of the terms agreed for the deferment of the threatened
dispute on 6th October, 1986, the employers have an obligation to
agree to the implementation of a more equitable system of payment
for hours necessarily worked by NCHDs in excess of 40 hours per
week.
Management have now had ample time to assess the implications of
such payments and the IMO are agreeable to the implementation of
proper management controls on expenditure under this heading.
In order to achieve full application of this proposal it is
imperative that considerable changes in well established practices
be effected. It is an implicit part of the recommendation that
there be new rosters and working arrangements including the
pooling of resources in order to achieve better utilisation of
medical manpower. In this endeavour the full co-operation of the
Hospital Consultants is required and the Court recommends that
such co-operation be forthcoming.
The Court therefore recommends that a new system of payment for
overtime be introduced to operate from 1st January, 1989.
The key features of the system are:
a) Before the end of 1988, in each hospital, the consultants, the
NCHDs and the management will draw up rosters which will
accurately reflect the service requirements in that hospital,
taking into full account the organisational/roster change
options as provided in the PA Report and having regard to the
resources available to the hospital. The purpose of this is
to ensure that for each NCHD post there will be prior
management approval on the hours for which NCHDs will be
rostered and paid.
b) The aim should be to ensure that all rosters are for not more
than 65 hours per week but where this is not achieved the
matter may be referred to the Monitoring Committee.
c) There must be recognition of the need for flexibility in the
pooling of doctors across teams and specialities.
d) Payment for hours in excess of 40 should be paid on the basis
of the approved and agreed rosters only.
e) Half of all hours worked over forty should be paid at time and
a quarter subject to a maximum of 10 hours. All other hours
in excess of 40 should be at the rate of half time subject to
a maximum of 65 hours in total.
f) A Monitoring Committee should be established to oversee the
implementation of this recommendation. The Committee should
be composed of equal numbers representing the IMO on the one
hand and the Department of Health and other management
representatives on the other. There should be an independent
chairman.
g) Payment during annual leave will be basic salary plus average
rostered overtime at the lower rate, i.e. half time.
h) Interns should be rostered to work 65 hours or less and
overtime payments should continue to be paid on the existing
basis. Where it is not possible to roster interns for 65
hours or less, their case should be examined by the Monitoring
Committee.
The Court recommends that both parties accept this Recommendation
because it represents a further step on the way towards a fairer
payment system for overtime while at the same time reducing the
excessive hours which doctors have been required to work.
~
Signed on behalf of the Labour Court
4th May, 1988 John M Horgan
DH/PG Chairman