When the heart of a hospital stops working

By MARTIN JOHNSTON health reporter

New Zealand's four most-specialised hospitals are preparing for a potentially crippling strike next week by workers who are at the heart of healthcare.

Rapidly advancing technology has made radiographers virtually indispensable.

Their x-ray and scanning skills are vital in diagnosing the condition of most hospital patients.

Virtually all radiographers at National Women's, Green Lane, Starship children's and Auckland hospitals plan to strike for four days from next Tuesday after the latest round of mediation in their pay dispute failed yesterday.

The hospitals' operator, the Auckland District Health Board, goes to court today to challenge the strike.

From Wednesday until today, Green Lane and to a lesser extent Auckland Hospital have been struggling through a strike by another group of technical staff, heart and lung technicians.

Talks to end their action have also failed, and the 36 workers involved will resume an overtime ban for more than a fortnight.

Hospitals throughout the country are on standby to take emergency cases by ambulance, helicopter or plane from Auckland.

And the health board is cancelling more than 1200 patients' appointments for non-urgent surgery, investigative procedures and outpatient visits.

Middlemore Hospital has cancelled some non-urgent surgery to make space for patients affected.

SERVICES AFFECTED

All services are affected, says the Auckland board's chief operating officer, Marek Stepniak. Even those such as mental health, which require less surgical intervention, require x-rays or scans for some patients.

Sick or premature newborn babies may be sent to Waikato Hospital, and patients needing urgent brain treatment may go to Wellington.

Stepniak has criticised the union involved in both disputes, the Association of Professional and Executive Employees - known as Apex - for its "unprecedented" stance on providing emergency cover.

It has agreed to provide limited cover in the heart and lung technicians' dispute. The board says the union wants triple time for any workers involved, but the union says it will cost no more than normal and the money will go to a charity.

No agreement has been reached on emergency cover in the radiographers' dispute, pending the outcome of today's court action.

Earlier the union wanted to see the board's contingency plans before deciding on cover, but the board refused to reveal them.

Emergency departments

The sickest or worst injured patients arriving at the board's two emergency departments, at Auckland and Starship hospitals, will be sent straight to Middlemore Hospital in South Auckland, where workers are not involved in the strike.

Those not quite so badly off will be assessed by the Auckland or Starship doctors before being referred to Middlemore if radiography is needed.

Intensive care units

If intensive care doctors decide they cannot provide the necessary care without radiography, patients will be transferred to Middlemore or other hospitals.

If they need lung ventilation - most patients in intensive care units do - they could go to Middlemore, Hawkes Bay or Wellington.

Middlemore will be the only hospital capable of handling major trauma in a region of 1.3 million people, Stepniak says.

Orthopaedic surgery

Some patients could be diverted to North Shore Hospital, but major cases will have to go to Middlemore.

Cardiology

Nine patients were sent yesterday to a private clinic for angioplasty procedures in their hearts, and several more were to go today.

Liver transplants

These are usually performed only at Auckland Hospital, but the team may fly to Christchurch Hospital if a donated liver becomes available to transplant into an acutely sick patient.

CLAIMS AND OFFERS

Radiographers, also called medical radiation technologists, operate x-ray machinery and other scanning equipment, such as magnetic resonance imaging (MRI) machines and CT (computed tomography) scanners, which are specialised x-ray machines.

They are needed to diagnose up to 80 per cent of hospital patients. About 100 radiographers are going to strike.

They were seeking a 10.3 per cent average increase, with those at the lower end of the pay scale receiving proportionately bigger rises. A confidential, lower figure was put to the board yesterday.

The heart and lung technicians' work includes helping with surgery, diagnostic tests and procedures such as angioplasty, where a tube is inserted into the heart through a vein from the groin to widen heart arteries.

Before their strike, they asked for an increase of nearly 8 per cent, but they reduced their claim during talks on Wednesday night.

The board has offered both groups 2 per cent. This is in line with Health Minister Annette King's directive last December that costs growth for some boards with big deficits must be capped at this level.

But the Auckland offer is above what it gave to nurses in July - increases of 2.5 to 3 per cent annually in a 35-month deal.

Ms King refused to comment on the dispute yesterday, saying health legislation prevented her becoming involved in industrial negotiations, which were a board management responsibility.

A planned radiographers strike at North Shore and Waitakere hospitals has been averted by a settlement between the union and the Waitemata health board. Neither side is giving details; the union says this is to avoid any appearance of trying to pressure the Auckland board.

THE ISSUES



Current pay

The radiographers' basic rates, before overtime and penalty payments, range from $31,000 to $53,000 a year. (The union recently negotiated a 10 per cent increase for radiographers at the Waikato health board, taking their pay range to $40,000 to $67,800.)

The range for the heart and lung technicians is from $28,000 to about $60,000.

Staff shortages and complex jobs

The Government's Health Workforce Advisory Committee says a survey last year of 60 radiology departments found 13 per cent of radiography jobs were vacant.

"This illustrates the recruitment difficulties facing the sector, with expected increased requirements in the public and private arenas," the committee says in its "stocktake" report on the health workforce.

It notes that radiography is one of the fastest-growing health professions, and says the technology has advanced so much that postgraduate qualifications are needed in many areas, including magnetic resonance imaging and mammography.

The union says there has been a 300 per cent increase in interventional radiology - using scanning techniques to guide needles in removing tissue samples, for instance.

But Stepniak denies the increase is as big as this.

Union secretary Deborah Powell says only one of the Auckland board's radiographers who qualified five years ago is still on the job.

The average age of staff was 45 to 50, and retaining younger staff was a problem.

"They get three times the pay in England, and quite a lot more in London."

They were also paid significantly more at home in private radiology clinics.

The workforce committee says a number of health boards have reported difficulties in attracting heart technicians.

Training

Radiographers need a specialised, three-year degree, such as a bachelor of health science (medical imaging) from Unitec, as their basic qualification.

Many of the Auckland board's heart and lung technicians came to the job with degrees.

Once employed, they do two years of fulltime training and study, then further part-time training in more-specialised areas.

What is Apex?

The union representing the radiographers and heart and lung technicians, Apex, also represents radiation therapists, who went on strike last summer and won big pay rises to help to stem the loss of staff to overseas jobs.

Powell says radiation therapists and radiographers are among the core groups of Apex.

It has represented radiographers at other health boards for a number of years. Those in Auckland, previously represented by the Nurses Organisation, began joining about 18 months ago.



Asked if they saw Apex as a more militant organisation, Powell suggested this was not the case, saying the shift was part of a trend back to occupation-based health-union groupings under the Employment Relations Act.

"They were a minority group among the nurses."

Stepniak says Apex is taking a far tougher line on emergency cover than other unions.