“[…] At the San Fernando General Hospital, the nurse to patient ratio is close to one nurse to twenty-two patients and this has been made worse since the advent of the Teaching Hospital.
“Now the Covid situation has further depleted staff, as some medical personnel have been assigned to the parallel health structure. This is unsafe and puts both nurse and patient at risk…”
The following column was submitted by Gerry Kangalee of the National Workers Union (NWU) and warns of growing discontent by healthcare workers at RHAs across the country:
A wave of discontent is sweeping through the regional health authorities (RHAs), kicked off by the action taken by workers of the North Central Regional Health Authority (NCRHA).
Workers at the Eastern Regional Health Authority (ERHA) have joined in the struggle. Government has announced that they will pay 25% of the arrears to NCRHA workers by the end of June. The problem is workers in all the RHAs have the same issues.
Some of the more important issues highlighted by the workers are the failure to pay arrears, payment of overtime for work done during the pandemic, a settlement of all outstanding negotiations, payment of a hazard allowance to all healthcare providers and the exploitation of so-called temporary workers through the contract system.
Let’s look at some of the long-standing issues plaguing public sector health care workers.
There are thousands of vacancies in the public health care system. According to official statistics, the North Central Regional Health Authority, in 2016, had at least 650 vacancies to be filled; and in the South West Regional Health Authority (SWRHA) there were 3,413 vacancies—992 of them being nursing vacancies.
At the San Fernando General Hospital, the nurse to patient ratio is close to one nurse to twenty-two patients and this has been made worse since the advent of the Teaching Hospital. Now the Covid situation has further depleted staff, as some medical personnel have been assigned to the parallel health structure. This is unsafe and puts both nurse and patient at risk.
Staff shortages result in long hours, excessive overtime, tired workers, denial of legitimate leave. Overwork, frustration and a total lack of respect by those in authority—for workers who work overtime and extra duty for minimal compensation in order to keep the hospital running is the order of the day.
The shortage of medical personnel is bad enough, but there are also shortages of laboratory techs, phlebotomists, radiographers, pharmacists, dietetic and nutrition personnel, health, safety and environment personnel, medical social workers and many other specialisations.
Hospitals are being built when there is a shortage of specialists, shortage of nurses, shortage of midwives and shortage of lab managers. A former Minister of Health claimed the Couva Hospital needs 2,500 workers. But there is also the Arima Hospital and the Point Fortin Hospital to staff.
Where are these workers going to come from? Are the other medical facilities to be cannibalised to staff these facilities when they are already short of staff?
The morale of thousands of workers in the RHAs is being undermined by the ridiculous job appointment system in the RHAs, which has as its base what are called cabinet approved positions and board approved positions.
Cabinet approved positions are so-called permanent appointments and board approved positions are short-term contract provisions. These short-term contracts may be month to month or six-month, one-year and two-year contracts.
The short-term contract system is being used as a device to escape management’s obligations to workers. There are workers in the system at all levels who have been subjected to continual rollovers of their short-term contracts and who have been employed continuously for as much as 15 years. Yes, you read right – fifteen years!
Some categories of permanent staff offered promotions are told that they have to resign their positions and go on short-term contracts to accept the promotion. This horrendous contract system affects both workers with professional qualifications and those without.
Short-term contract workers obviously suffer anxiety over their job security and are at a disadvantage when it comes to accessing mortgage and other loans and credit facilities. They cannot properly plan the future of their families or make significant investments and they are not entitled to be members of the Regional Health Authorities’ Pension Plan.
This short-term contract system must be abolished as a matter of priority.
Even if they eventually become ‘permanent’ and eligible to join the Pension Plan, the service they had before they became permanent is not counted as service in the plan. It must be noted that the formula for calculating pensions is based on a worker’s final salary and on years of service.
So-called permanent workers, as a condition of their employment, are members of the RHA pension plan. This is a plan that has been imposed on the workers and not negotiated because there is no recognised majority union in the RHAs. Some workers are retiring on the princely sum of TT$600-$800 per month.
Most of the workers do not have a clue about the pension plan. While it is dubbed the employees’ pension plan most of the workers have never seen the rules, trust deeds, or the financial reports. When workers request copies of these documents, management comes up with flimsy excuses why they cannot be provided—although according to the law, the members of the plan are entitled to these documents. RHA managements break the law with impunity.
Workers have no evidence as to whether their pension deductions over the years are paid into the plan and they do not know if the employers pay their share and on time.
How can workers who are not comfortable when it comes to their quality of life be expected to provide quality health care for the members of the public?
Management of the RHAs is based on political allegiance and not on providing a first-class health service to the citizens. The industrial relations are atrocious and lead to low morale and frustration on the part of employees who are not connected to the party in power.
Nepotism/friend thing reigns unchecked; unqualified personnel are put in positions of responsibility; promotions are based on favouritism; victimisation flourishes. Performance Appraisal is at best a hit and miss affair or at worst a tool of victimisation.
There is top-heavy management in the RHA system with different job classifications having overlapping responsibilities, which is, of course, a recipe for chaos, confusion, and infighting for organisational turf.
Appointments that have been made by the apparently responsible officeholders have been overturned by other management personnel. This is exacerbated by the ever present partisan political cliques within management and board circles.
Job specifications are altered in a whimsical fashion and are not embedded in a proper structure with clear pathways of progression, thus adding another burden on the backs of already stressed out workers.
Many people may not know that there are only two recognised majority unions in the RHA system. They are the National Union of Government and Federated Workers (NUGFW), which represents daily paid workers in all the RHAs; and the Medical Professionals Association of Trinidad and Tobago, which represents doctors, only in SWRHA.
This means that the vast majority of the thousands of workers in the public health sector have no input into what constitutes their wages and their working conditions. They have to wait until the Public Services Association completes negotiations with the chief personnel officer and then the RHAs follow suit with wage increases.
Like, other public sector workers, health care workers are subsisting on 2013 wages.
Is it any wonder that after years of frustration, health care workers have decided to fight for what is theirs; to fight for decent conditions of work; to fight for a people-friendly health care system and not one designed to serve the interests of the medical mafia?
The law of unintended consequences is certainly at work. A measure to bribe SEA teachers and primary school principals has resulted in NCRHA workers demanding their entitlements. To calm down the situation, the government decides to pay a portion of the arrears owing to NCRHA workers.
Other RHA workers have responded by saying ‘if the priest could play who is we’ and are demanding their just dues. The very flame that the government is trying to avoid lighting during this crazy election season, by their actions they have ignited.
Fasten your seat-belts! It’s going to be a rough ride.