July 2, 2022

ramsay health care

New Ramsay EA after company-wide campaign

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Member leaders played a vital role in negotiations.

NSWNMA members at Ramsay Health Care have overcome pandemic-related disruptions and obstacles to finalise a new, two-year enterprise agreement.

The NSWNMA started negotiating with Ramsay in April 2021 and staff voted to accept the company’s improved offer in October.

During this six-month period, COVID-19-related lockdowns in NSW forced a shift from face-to-face to Zoom meetings and created other campaign difficulties.

Despite this, a total of 12 Ramsay members from hospitals in Sydney and the regions joined with NSWNMA officials to coordinate the campaign and take part in negotiations.

These bargaining representatives from across NSW ensured members from all Ramsay hospitals had a voice in the campaign.

The new agreement protects all existing conditions and provides a pay and allowance increase of 3.5 per cent over two years with back pay to July 2021.

After the company withdrew its claims for cuts to nurses’ and midwives’ working conditions, Ramsay members voted to accept the agreement.

In the run-up to negotiations the NSWNMA surveyed members to find out what changes they wanted in the new agreement.

A record number of surveys were returned, showing members’ top concerns were improved staffing levels and improved pay.

Missed meal breaks and insufficient notice of rosters were also priorities to be addressed.

The NSWNMA drew up a set of claims focusing on staffing ratios, fair rostering and better pay.

Three negotiation meetings were held before the COVID-19 lockdown in June 2021, which then forced negotiations to go online.

Ramsay wanted cuts to conditions

NSWNMA General Secretary, Brett Holmes, said the meetings gave member leaders the opportunity to speak candidly about staffing and other concerns.

“Despite a hostile attitude from the company during negotiations, our bargaining reps raised many situations where staffing was an issue, backed by examples in support of the claims,” he said.

“During the campaign over 2200 Ramsay nurses and midwives signed a petition calling for staffing ratios, a safer skill mix, ACORN standards, the ability to take meal breaks and fair rostering.

“However, Ramsay flatly refused to consider any of our claims relating to ratios.

“They maintained that their existing staffing arrangements provided safe patient care but refused to provide information on the formula, citing ‘commercial-in-confidence’.”

Ramsay came to the table with their own demands for cuts to working conditions, including greater “flexibility” in rostering, but later withdrew them after members stood together to reject them.

The new two-year agreement will expire on 31 March 2023. It includes the following pay and allowance increases:

  • 1.5 per cent increase backdated to the first pay period on or after 1 July 2021
  • 0.5 per cent increase from the first pay period on or after 1 January 2022
  • 1.5 per cent increase from the first pay period on or after I July 2022.

Ramsay is the largest private hospital operator in Australia, with 72 private hospitals and day surgery units.

‘A lot of people were happy to put their names to the petition, which was signed by over 2200 people.’— Deanna Hayes

COVID-19 lockdown hindered Ramsay negotiations

An NSWNMA member representative on the enterprise agreement (EA) bargaining committee, Deanna Hayes from St George Private Hospital, said COVID-19 made it harder for members to campaign for a better agreement.

“I think the public health regulations and general level of uncertainty during the pandemic made nurses less likely to take action to press their claims. People didn’t know what was happening to their hours, and how COVID-19 would impact the community.

“The COVID-19 lockdowns in NSW interrupted our bargaining process and forced us to meet with management online. COVID-19 caused a hiatus in the middle of negotiations.”

Deanna said it was disappointing the company “cried poor” and claimed it could not afford to pay a substantial wage increase, despite Ramsay’s share price rising through most of the negotiation period.

“Yes, some procedures were postponed, but every Ramsay nurse like me who got redeployed to vaccination hubs or rural areas had their costs covered by NSW Health. And a lot of private hospitals took public patients by agreement with NSW Health.”

According to the Australian Financial Review, Ramsay CEO Craig McNally’s pay tripled to $5.9 million in the 2021 financial year, and the company’s statutory profit is up 58 per cent despite lockdowns.

The Commonwealth government’s $1.3 billion rescue package more than compensated for bans on elective surgery, with Ramsay receiving almost $1 billion in subsidies from governments in Australia and Europe. Even without these subsidies, revenue was up 3.9 per cent.

Around 430 Ramsay nurses and midwives were deployed to support the public health system during the COVID-19 outbreak.

“They claimed Ramsay had their own method for working out safe staffing but wouldn’t say what this was, because it was ‘confidential’,” said Deanna.

“A lot of people were happy to put their names to our petition, which was signed by over 2200 people, because they don’t always get meal breaks due to inadequate staffing.

“They tell stories of being on night duty with just one other staff member and 20 post-op patients.”

She said the company was dismissive of these examples of staffing shortages that the bargaining reps passed on to them from their workplace colleagues.

“We tried to explain it to them numerous times, but they wouldn’t accept that what we were saying
was true.”

COVID-19 lockdown hindered Ramsay negotiations

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An NSWNMA member representative on the enterprise agreement (EA) bargaining committee, Deanna Hayes from St George Private Hospital, said COVID-19 made it harder for members to campaign for a better agreement.

“I think the public health regulations and general level of uncertainty during the pandemic made nurses less likely to take action to press their claims. People didn’t know what was happening to their hours, and how COVID-19 would impact
the community.

“The COVID-19 lockdowns in NSW interrupted our bargaining process and forced us to meet with management online. COVID-19 caused a hiatus in the middle of negotiations.”

Deanna said it was disappointing the company “cried poor” and claimed it could not afford to pay a substantial wage increase, despite Ramsay’s share price rising through most of the negotiation period.

“Yes, some procedures were postponed, but every Ramsay nurse like me who got redeployed to vaccination hubs or rural areas had their costs covered by NSW Health. And a lot of private hospitals took public patients by agreement with NSW Health.”

According to the Australian Financial Review, Ramsay CEO Craig McNally’s pay tripled to $5.9 million in the 2021 financial year, and the company’s statutory profit is up 58 per cent despite lockdowns.

The Commonwealth government’s $1.3 billion rescue package more than compensated for bans on elective surgery, with Ramsay receiving almost $1 billion in subsidies from governments in Australia and Europe. Even without these subsidies, revenue was up 3.9 per cent.

Around 430 Ramsay nurses and midwives were deployed to support the public health system during the COVID-19 outbreak.

“They claimed Ramsay had their own method for working out safe staffing but wouldn’t say what this was, because it was ‘confidential’,” said Deanna.

“A lot of people were happy to put their names to our petition, which was signed by over 2200 people, because they don’t always get meal breaks due to inadequate staffing.

“They tell stories of being on night duty with just one other staff member and 20 post-op patients.”

She said the company was dismissive of these examples of staffing shortages that the bargaining reps passed on to them from their workplace colleagues.

“We tried to explain it to them numerous times, but they wouldn’t accept that what we were saying was true.”

Ramsay backs down on cuts after staff resistance

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Ramsay management came to the bargaining table with their own claims to downgrade nurses and midwives’ working conditions.

Amid the pandemic, Australia’s biggest private hospital operator, Ramsay Health Care, opened negotiations with the NSWNMA by demanding greater “flexibility” in rostering and other measures.

The flexibility, however, was all in the company’s favour.

Ramsay HR sought the right to change rosters with as little as 24 hours’ notice and to roster contracted hours over an eight-week period instead of the current two weeks.

It also wanted:

  • reduced breaks between shifts after overtime from the current 10 hours after overtime to eight hours
  • the right to direct staff to take annual leave with just two weeks’ notice during periods of low activity
  • further restrictions to when meal breaks can be taken
  • an increase in the kilometre range from 20 km to 50 km when asked to work at another site.

Jacky Soucoulis, a theatre nurse in Sydney’s Inner West, was one of 12 NSWNMA members to take part in the negotiations.

She said management was unable to explain how its “flexible” rostering proposal would work.

“It didn’t surprise me that they were trying to take people’s conditions away from them. They seem to care only about their bottom dollar and not their staff,” she said.

“I think they were trying to avoid paying overtime. I wouldn’t be surprised if it raises its head during the next EA.

“It’s not right to force you to take a day off when it only suits the company.

“Nor is it right to work a two-week period and still not get your contracted hours in, so you have to claim annual leave to get
your money.”

Ramsay withdrew its demands at the third round of negotiations.

Members ‘visual’ presence at talks.

Management representatives arrived at that meeting to find the negotiation room at North Shore Private Hospital packed with posters showing nurses holding signs in support of the union’s log of claims.

The signs included “Ratios Save Lives”, “Ratios Not KPIs”, “Enough Staff to Cover Meal Breaks”, “People Before Profit”, “In Charge Without a Patient Load”, and “No to Forced Roster Changes”.

“The staffing issue meant a lot to us because we were fighting for ourselves, our colleagues and our patients to be safe.

“Members have consistently rated staffing as one of their top concerns for a number of years.”

She said management representatives also ignored evidence from NSWNMA members of EA breaches at some hospitals.

“For example, when members raised the issue of some hospitals refusing to pay for missed meal breaks, the company denied such practices ever happened – even when they were given concrete examples.

“Or they claimed these were rare and isolated site issues.”

The COVID-19 lockdown in Greater Sydney and elsewhere put an end to face-to-face negotiations, which were followed by one Zoom negotiation.

Jacky said the lockdown weakened the campaign and made it easier for Ramsay to wind up negotiations.

“Before the lockdown we managed to get over 2200 Ramsay nurses to hand-sign a petition calling for guaranteed safe staffing ratios, safe skill mix, ACORN theatre standards, fair rostering and the ability to take meal breaks.”

Hospital branch meetings also relied on Zoom meetings and online chat services.

Jacky used a WhatsApp group for her branch members, to keep them informed of developments in bargaining meetings.

She said some members were left confused by the company’s communications, especially about the pay offer, thinking it was a 3.5 per cent one-off payment. In fact, it is to be paid between July 2021 and July 2022.

“This shows the need for crystal clear communications,” Jacky said.

Disciplinary process at Ramsay Hospital

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I work in a hospital operated by Ramsay. I have been invited to a meeting to discuss a complaint. What can I expect? 

Clause 2.5 of the Ramsay Health Care Australia Pty Limited, and NSW Nurses & Midwives’ Association /ANMF Enterprise Agreement 2015–2018 sets out the expected process. In short, a staff member has a “right to be provided with the details of any complaint made against them and have the right of reply before any decision will be made”. You also have the right to have a support person present at any disciplinary meeting held with you. In cases that do not involve gross misconduct, in which the process can be circumvented, you would normally expect to be counselled at first instance. The facts of the matter would, of course, determine the approach adopted. 

Private hospital patient numbers drop

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A recent report by investment bank Credit Suisse found that private patients were increasingly opting to join public waiting lists.

The report says one of the main reasons patients are fleeing private health is the cost of surgeon’s fees.

Credit Suisse says that on average private elective surgical patients pay around 50 per cent of the surgeon’s fee in addition to the private health insurance excess. They also pay for any anaesthesia fees, radiology and pathology tests or hospital stay costs.

“As affordability remains a key issue for consumers we believe the primary reason for the under-utilisation of private health insurance is the rise in out-of-pocket costs associated with a surgical procedure,” the report said.

“While longer-term drivers of demand for private hospital services remain in place – ageing population – we think it is unlikely that we will see a recovery in utilisation in the short term as long as affordability pressures continue to shift patients into the public system.”

Ramsay Health Care took a $1 billion dollar hit on its share value last month after the company admitted that rising costs and affordability were causing their patient numbers to drop.

Ramsay CEO Craig McNally said there had been a significant drop 
in their maternity patients during May alone.

“I don’t have the absolute answer for that at the moment but I’m sure affordability is a part of that,” he told The Australian.

He said there was a “ramped up trend” of privately insured patients electing to have their babies in public hospitals because out-of-pocket costs could be as high as $10,000 in a private setting.

“In May there was a surprising 12 per cent decrease in maternity and I believe that is an out-of-pocket issue,” he said.

Complaints against insurers on the rise

The public’s decreasing enthusiasm for private health insurance because of affordability can also be seen in polls and the number of complaints.

A Galaxy poll of more than 2000 respondents in March found that over half of Australians with private health insurance say it is no longer worth the expense.

The same month the Private Health Insurance Ombudsman reported that there had been a record 30 per cent increase in the total number of complaints in 2016-17.

“The increase of over 1300 complaints within one year is the largest rise we have experienced over the last 10 years,” it said.

Economic commentator Ross Gittens says it is clear why 
people have a declining interest in private health insurance.

“Most people under 60 only get a fraction back of what they pay. Often when you do claim you don’t get what you expected because you don’t get choice of doctor or a private room, you’re caught by ever changing exclusions from your policy, or because no one warned you about a huge gap payment,” he said.

“Private insurance is so counter productive the best thing would be to end the ($6.5 billion of government) subsidies and use the saving to improve the performance of the public system.”

Changing rosters at Ramsay

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I work at a hospital operated by Ramsay. There is some talk of changes to rosters and hours of work. How should this be managed?

Under Clause 2.3 of the Ramsay Health Care Australia Pty Limited, and NSW Nurses & Midwives’ Association/ANMF Enterprise Agreement 2015-2018, local managers have an obligation to consult with staff on major change, which includes changed rosters and working times. If a decision is made, they are required to provide staff with all relevant information and genuine consideration must be given on staff feedback. Of course, staff can nominate the Association to be their representative in such discussions.

It is especially important to note that when a change to a regular roster or ordinary hours of work is contemplated, hospital management must invite affected staff to give their views about the impact of the change (including any impact in relation to their family and caring responsibilities).