A social movement history of public opposition to New Zealand‟s health reforms, 1988-1999.

Abstract: This thesis examines opposition to the reform of New Zealand‟s public health system between 1988 and 1999. Between 1988 and 1990 the Fourth Labour Government began more market reforms of the New Zealand public health system and this accelerated after 1990 with the election of the Fourth National Government. Reforms included the introduction of hospital part-charges, the closure of over eighty public hospitals, funding cuts to health services and a reduction in the wages and conditions of health workers. The effect of the health reforms was to leave health services throughout the 1990s fragmented and underfunded. The first chapter traces the opposition to hospital part charges 1992-7; the second chapter examines the effectiveness of community responses to hospital closures and cuts to health services; the third chapter describes the general effect of workplace resistance to the health reforms from health professionals and the fourth chapter specifically analyses the resistance of nurses to the health reforms. The fifth chapter applies social movement theory to the rise of the health protest movement and analyses how in spring 1997 it pushed the National-New Zealand First coalition government to the brink of collapse. Chapter Six discusses the 1998 Anglican Church-led „Hikoi of Hope‟ and its political legacy. The seventh and final chapter describes the opposition to the income and asset testing of elderly long stay hospital patients and the growth of the New Zealand Superannuitants‟ Federation – „Grey Power‟. The thesis supports the conclusion that the health reforms were vigorously opposed by health workers and the public and that this opposition contributed to the failure and eventual abandonment of more market reforms from 1997 to 2000.

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Contents

Introduction

Section 1: Community responses 1.1 „I will not pay‟ 1.2 Save our Hospital

Section 2: Industrial responses 1.3 Workplace resistance 1.4 „Third world health, Third world pay‟ Section 3: Political responses 1.5 „A popular uprising‟ 1.6 Hikoi of Health 1.7 Revolt of the elderly

Conclusion

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Introduction
Between 1988 and 1999 New Zealand‟s health system was dramatically reformed and rereformed towards a more commercial, partially privatised, health system. It was an age of permanent revolution in health policy as politicians radically re-designed the administration of the public health care system, cut funding and closed scores of hospitals around the country. It is clear from the Government documents of the late 1980s and early 1990s that the final destination many politicians and Treasury technocrats wanted was a fully privatised hospital system paid for not through personal and corporate taxes but by individuals purchasing health insurance. By 1999 this dream of health care privatisation lay in tatters and a Labour and Alliance Government was elected promising to fix what was widely perceived to be a broken and demoralised health system. It was a major blow for the Fourth National Government and the supporters of Roger Douglas‟s „more market reforms‟ of the Fourth Labour Government. Yet through these eleven years of the health reforms New Zealand became the scene for a political conflict between the Government reformers and a public opposition movement that took to the streets in their tens of thousands. The reformers in Government were assisted by their consultants and the health managers who controlled the health system from the top. The opposition was rooted in dozens of community campaigns against hospital closures, newly radicalised unions of health professionals and the rise of a nationwide social movement which united superannuitants boycotting hospital fees, nurses closing beds in protest and patients, church groups and political parties marching in the streets up and down the country. This political history follows the rise of this social movement as tens of thousands of New Zealanders were drawn into a movement against the health reforms. This is the history of the boycotts, protests and strikes which derailed the destruction of New Zealand‟s public hospital system by the New Right.

Neo-liberalism in New Zealand Neo-liberal restructuring of New Zealand‟s economy and society began in 1984 and has continued through to 2012 at a combined but uneven rate. At times the neo-liberal reforms have progressed quickly, at other times they have been slowly reversed. The main features of neo-liberal reform have been the elimination of trade and industry protections and the ongoing development of a global free market, the dismantling of the welfare state and
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deregulation of the economy and industrial relations, the privatisation and/or commercialisation of large parts of the economy and state services, and a massive redistribution of wealth and power away from citizens and civil society and towards transnational corporations, industrial and managerial elites and financial speculators. State economic policy has been reoriented almost completely towards ensuring corporate profitability and New Zealand‟s post-war, bi-partisan economic philosophy was abandoned in this era. The Reserve Bank of New Zealand Act which had once defined the bank‟s role as „the maintenance of and promotion of the economic and social welfare of New Zealand‟, and achieving full employment, now focused solely on „the objective of controlling inflation, free from government direction‟.1 As David Harvey describes neo-liberal ideology and policy,

Neoliberalism is in the first instance a theory of political economic practices that proposes that human well-being can best be advanced by liberating individual entrepreneurial freedoms and skills within an institutional framework characterized by strong private property rights, free markets, and free trade. The role of the state is to create and preserve an institutional framework appropriate to such practices. The state has to guarantee, for example, the quality and integrity of money. It must also set up those military, defence, police, and legal structures and functions required to secure private property rights and to guarantee, by force if need be, the proper functioning of markets. Furthermore, if markets do not exist (in areas such as land, water, education, health care, social security, or environmental pollution) then they must be created, by state action if necessary. But beyond these tasks the state should not venture. State interventions in markets (once created) must be kept to a bare minimum because, according to the theory, the state cannot possibly possess enough information to second-guess market signals (prices) and because powerful interest groups will inevitably distort and bias state interventions (particularly in democracies) for their own benefit.2

The implementation of this ideology in New Zealand after 1984 progressed alongside increasing social and economic dislocation for many working people. A prominent critic of neo-liberalism, activist and legal academic, Professor Jane Kelsey, summarised the most
1

Jane Kelsey, Rolling back the state; privatisation of power in Aotearoa/New Zealand, Wellington, 1993, pp.19-20. 2 David Harvey, A Brief History of Neoliberalism, Oxford, 2005, reprint, 2007, p.3.

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dramatic effects of the reforms in the early 1990s; „Marginal farmers quit the land. Investment shifted from the labour-intensive manufacturing sector to the less productive finance and service sectors. Massive lay-offs, boosted by commercialisation of government operations, raised unemployment to levels reminiscent of the 1930s Depression.‟3

This thesis is based on the premise that historians of New Zealand have an important responsibility to honestly and objectively record and interpret the events of what Kelsey has coined, „the New Zealand experiment‟.4 The experiment, outlined by Kelsey, is that after 1984, „Successive governments applied pure economic theory to a complex, real-life community, with generally cavalier disregard for the social or electoral consequences‟.5 For the reformers, „Rolling back the state is a fundamental tenet of any structural adjustment programme. In New Zealand the desire to corporatise and privatise central and local government operations spread from overtly commercial enterprises and assets to include previously non-commercial activities of health, housing and government research, and ultimately the policy, regulatory and service delivery roles of the state.‟6

This thesis describes and analyses the opposition to the structural adjustment programme in the specific circumstance of the public health care system. In the late 1980s and 1990s the international business press- Economist, The Times, Financial Times, Wall Street Journal – joined together in lauding the „success‟ of the free market reformers.7 Yet as this thesis will show, due to the strong opposition of trade unions, communities, churches and the political opposition the thrust of the health reforms towards privatisation of the public health service was thwarted and eventually reversed. New Zealand‟s health reforms

By 1988 the 29 locally elected Hospital Boards which provided hospital and population health services were gradually being amalgamated into 14 two-thirds elected Area Health Boards.8 All Hospital Boards were recomposed as Area Health Boards by the end of 1989.9
3 4

Kelsey, Rolling back the state, p.10. Jane Kelsey, The New Zealand Experiment; A World Model for Structural Adjustment?, Auckland, 1995, p.1. 5 Ibid., p.1. 6 Ibid., p.115. 7 Ibid., p.8. 8 Pauline Barnett and Ross Barnett, „Reform and chance in health service provision‟, in Peter Davis and Toni Ashton, eds, Health and Public Policy in New Zealand, Auckland, 2001, pp.219-234.

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Since 1983 funding for services provided by these boards came from the Department of Health and was based on the population living in the area the board catered for.10 Each Hospital Board was managed by a triumvirate composing a head doctor, chief nurse and administrator and health workers such as doctors, nurses and cleaning staff had their pay set in national agreements.11 In 1987 there were 171 public hospitals with 24,488 hospital beds available.12 Public hospital services such as inpatient stays and the cost of prescription medicines had been free to all New Zealanders since 1939 and 1941 respectively.13 General practitioner (GP) services were provided on a fee-for-service basis subsidised by the government through a general medical services (GMS) benefit paid to the doctor for each patient seen.14 In 1988 the Fourth Labour Government guided by the ideas of the New Right began a new cycle of reforms to the health service. The core ideas of the New Right, a political ideology known as neo-liberalism, were that where possible government services such as health care should be governed by market mechanisms, compelled to be profitable, run by general managers focused on reducing costs, privately provided and subject to user charges.15 The ideas of the New Right were comprehensively adopted from 1984 onwards in New Zealand as part of what Auckland University Law Professor Jane Kelsey describes as the „New Zealand experiment‟, whereby „Successive governments applied pure economic theory to a complex, real-life community, with generally cavalier disregard for the social or electoral consequences‟.16 In August 1987 the Fourth Labour Government won a second term in the general election and in the wake of the share market crash of October 1987 faced a budget deficit of $3.2 billion

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Ibid., p.223. Derek A. Dow, Safeguarding the Public Health; A History of the New Zealand Department of Health, Wellington, 1995, p.221. 11 Hospital and Related Services Taskforce, Unshackling the Hospitals; Report of the Hospital and Related Services Taskforce, Wellington, 1988, pp.19-20. 12 Peter Quin, New Zealand Health System Reforms, online, 29 April 2009, available at: http://www.parliament.nz/en-NZ/ParlSupport/ResearchPapers/e/d/1/00PLSocRP09031-New-Zealand-healthsystem-reforms.htm (19 November 2012) 13 Elizabeth Hanson, The Politics of Social Security; The 1938 Act and some later developments, Auckland, 1980, p.125. 14 Peter Quin, New Zealand Health System Reforms, online, 29 April 2009, available at: http://www.parliament.nz/en-NZ/ParlSupport/ResearchPapers/e/d/1/00PLSocRP09031-New-Zealand-healthsystem-reforms.htm (19 November 2012) 15 J Ross Barnett, „Hollowing out the state? Some observation o n the restructuring of hospital services in New Zealand‟, Area, 1999, 31(3), pp.259-270. 16 Jane Kelsey, Rolling back the state; privatisation of power in Aotearoa/New Zealand, Wellington, 1993, p.10.
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for the 1988 to 1989 year.17 It was in this context that the new cycle of reforming health services began in April 1988 with the passage of the State Sector Act and the release of Unshackling the Hospitals; Report of the Hospital and Related Services Taskforce.18 The State Sector Act replaced the Area and Hospital Board management triumvirates with appointed chief executives.19 However protest action and strikes by public sector unions stopped the Act from removing their right to retain nationally negotiated employment agreements (awards).20 Unshackling the Hospitals, also known as the Gibbs Report, proposed the health system be re-organised so that the funding and the provision of health services be separated, that six regional funders of health services contract with both public and private providers, public hospitals be re-organised as corporations and open to private as well as public patients.21 Although the government did not adopt these proposals it imposed austerity measures in the health sector. User charges for health services began with the introduction of a $1 prescription charge for medicines in 1989.22 That same year the Auckland Area Health Board was dismissed by the Minister for Health Helen Clark and replaced with an appointed commissioner charged with making significant cost savings after the Board projected it would overspend its budget by $23 million.23 Between 1987 and 1990 many health boards began closing rural hospitals to meet funding constraints and because of underuse.24 These measures represent the start of a trend towards corporatisation in the health sector. Labour lost power in the 1990 general election and a new National Government with Simon Upton as Health Minister pressed on with the direction of the reforms begun by Labour. In 1992 Upton introduced means-tested, part-charges for hospital services, but these only lasted until 1993 and1997 for inpatient and outpatient services respectively.25 Means tested charges for elderly people in public rest homes and hospitals were introduced in 1993.26 The GMS subsidy paid for GP services was gradually replaced with capitated funding for low income
17

Malcolm McKinnon, Treasury: the New Zealand Treasury, 1840–2000, Auckland, Auckland University Press, 2003, p. 343. 18 Hospital and Related Services Taskforce, Unshackling the Hospitals; Report of the Hospital and Related Services Taskforce, Wellington, 1988. 19 John Robson, „The State Sector Bill – implications for nurses‟, New Zealand Nursing Journal (NZNJ), January 1988, 81(1), pp.8-9. 20 Ibid., pp.8-9. 21 Hospital and Related Services Taskforce, Unshackling the Hospitals; Report of the Hospital and Related Services Taskforce, Wellington, 1988. 22 Toni Ashton, „The Influence of Economic Theory‟, in Peter Davis and Toni Ashton, eds, Health and Public Policy in New Zealand, Auckland, 2001, pp.107-126. 23 Geraldine Johns, „Clark strips area health board of its powers‟, NZH , 22 March 1989, p.3. 24 H Karcher et al., „Hospital closures‟, British Medical Journal, 309, 6960, 1994 , p.973. 25 Brendon Wood, „An analysis of the hospital part-charge debate in New Zealand, 1991 to 1993‟, Research Essay, University of Auckland, Auckland, 1996, p.40 26 „Aged patients to face means testing‟, NZH, 2 April 1993, p.5.

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patients enrolled in a GPs clinic through the 1990s.27 However the most significant move came when the Fourth National Government passed the Health and Disability Services Act 1993 which completely restructured the public health system along the lines proposed by the Gibbs Report. Under the Act the 14 elected Area Health Boards were replaced on 1July 1993 by 23 Crown Health Enterprises (CHEs) centred on large hospitals with government appointed boards of directors.28 Crown Health Enterprises were set up as government owned companies with the requirement to become profitable through contracting their hospital and health services to four Regional Funding Authorities (RHAs) who would purchase health services from the CHEs in a competitive market that included private providers.29 The four RHAs and the populations they served in 1994 were the Northern Regional Health Authority covering Auckland and Northland (1,076,685), the Midland Regional Health Authority covering from the Waikato to Taupo including Taranaki (683,350), the Central Regional Health Authority covering the lower North Island from Wanganui to Wellington including the Hawkes‟ Bay and Nelson-Marlborough region (857,229), and the Southern Regional Health Authority covering the rest of the South Island (752,292).30 The industrial environment that health workers operated in also changed. On 15 May 1991 the Government passed the Employment Contacts Act (ECA) abolishing the award system, shifting power away from unions and paving the way for health unions to maintain employment agreements only with single employers such as CHEs.31 By the end of 1993 all of the core ideas of the New Right were being applied to New Zealand‟s health system. From their establishment in 1993 RHAs and CHEs began to progressively centralise expensive services such as surgery, close rural hospitals, and seek reductions in the wages and conditions of health workers in negotiations.32 Through the mid-1990s waiting lists for surgery grew, public hospitals became overcrowded, standards of care declined and CHEs became heavily indebted and in need of government bailouts.33 National had had narrowly won the 1993 general election but the 1996 general election, the first under proportional representation, resulted in a centre-right National and New Zealand First Coalition
27

Peter Crampton, Frances Sutton, Jon Foley, Capitation funding of primary care services: principles and prospects, online, 7 June 2002, available at: http://journal.nzma.org.nz/journal/115-1155/43/content.pdf (19 November 2012) 28 Barnett and Barnett, p.224. 29 Ibid., p.224. 30 Ministry of Health, Audit of Trauma Care Services in New Zealand (1994), Wellington, 1994, pp.1-2. 31 Ellen J. Dannin, Working Free; The Origins and Impact of New Zealand‟s Employment Contracts Act, Auckland, 1997, p.167. 32 Barnett and Barnett, pp.220. 33 New Zealand Nurses Organisation, The Inside Story of the Health “Reforms”, Wellington, 1995.

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Government.34 New Zealand First was opposed to the corporatisation of health services and as a result of coalition negotiations the Health and Disability Services Amendment Act 1998 was passed.35 This slightly eased the CHEs requirement to be profit orientated, renamed them Hospital and Health Services (HHSs) and replaced the four RHAs with one central purchaser.36 However a running conflict continued between the Coalition partners over the direction of the health reforms, especially contracts with private providers, which contributed to the sacking of the New Zealand First, Associate Health Minister Neil Kirton in August 1997.37. The Coalition collapsed a year later in August 1998 although National remained as a minority government until it was defeated in the 1999 general election and replaced by a centre-left, Labour-led, Coalition Government supported by the Alliance Party.38 In 2000 the Labour and Alliance Coalition Government passed the New Zealand Public Health and Disability Act (PHDA) which replaced the HHSs with majority elected District Health Boards (DHBs) who funded and planned their health services. The orientation of the health system was shifted towards public health outcomes and away from profitability and the funding-provider split was removed.39 Economist Brian Easton described Labour and the Alliance‟s changes as „giving a system close to what might have been envisaged had the commercialisation reforms not been attempted in the early 1990s. There were further increases in public spending on health, in effect reversing the cuts of the first half of the 1990s to the prior trend relativity as a proportion of GDP.‟40 The passage of the Employment Contracts Act of 2000 allowed health workers to renegotiate collective agreements covering multiple DHBs. In 1998 there were 109 public hospitals with 14,298 beds, a reduction of 62 hospitals and over 10,000 beds from 1987.41 Thus although New Zealand‟s public health system had been significantly shrunk, the New Right experiment in health reform was effectively abandoned. This thesis seeks to understand why this experiment was abandoned. The heath reforms undertaken as part of „the New Zealand experiment‟ can be broadly broken up into four periods that sequence with changes in the makeup of Government. The
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Jack Vowles et al., Voters‟ Victory? Peter Quin. 36 Ibid. 37 New Zealand Herald, 8 August 1997, p.5. 38 Jonathan Boston, et al., eds, Left Turn; The New Zealand General Election of 1999, Wellington, 2000. 39 Peter Quin. 40 Brian Easton, The New Zealand Health Reforms in Context, online, 18 June 2002, available at: http://www.eastonbh.ac.nz/?p=35 (19 November 2012) 41 Peter Quin.

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first three periods share a common trajectory which Pauline Barnett and Ross Barnett described at the end of 1999,

In New Zealand, as in other developed counties, the welfare state is undergoing substantial change. Hospital closures, waiting lists for surgery, and problems of access to primary care are all symptomatic of an environment in which different forms of rationing have become the norm. As these examples suggest, the guarantees of universal coverage and unlimited access to services can no longer be taken for granted as they were during the long boom of economic prosperity following World War II. 42

1988-1990 The first period of the health reforms began under the Fourth Labour Government of David Lange with the passage of the State Sector Act and the release of Unshackling the Hospitals; Report of the Hospital and Related Services Taskforce in April 1988 and focused on creating a more business oriented, inexpensive and manager-driven health service.43 This period also saw the beginnings of prescription charges for medicines, hospital closures in rural areas and the amalgamation of hospital services in Auckland and Wellington as real health funding declined.

1990-1996 The election of the Fourth National Government in 1990 inaugurated the second phase of reforms. Guided by the vision of Your Health & the Public Health; A Statement of Government Health Policy, published in July 1991 the health reforms under National took on five distinct directions. Firstly, the introduction of hospital part-charges in 1992. Secondly, the acceleration of rural and regional hospital closures and cuts to services. Thirdly, the restructure of the Department of Health and elected Area Health Boards into a Ministry of Health comprising four funders of health named Regional Health Authorities and twenty three providers known as Crown Health Enterprises. Fourthly, there was a financial reduction in public health spending. Fifthly, new industrial relations laws and an aggressive approach by the Ministry to negotiating with health workers‟ unions resulted in worsening working conditions. This was the most vigorous era of reforms,
42

Pauline Barnett and Ross Barnett, „Reform and change in health service provision‟, in Peter Davis and Kevin Dew, eds, Health and Society in Aotearoa New Zealand, Auckland, 1999, pp.219-234. 43 Hospital and Related Services Taskforce, Unshackling the Hospitals; Report of the Hospital and Related Services Taskforce, Wellington, 1988.

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Like Thatcherism and Reaganomics, the newly elected National Party had quite a different agenda, stressing New Right „solutions‟ to crisis. Encouraged by Treasury advice, and despite contrary election manifesto promises, health reform now embraced the internal market and elements of corporatisation (ie the commercialization of public-sector enterprises). Although begun under Labour, such policies were now extended into the social arena. In restructuring public hospitals into Crown Health Enterprises (CHEs), as limited liability companies subject to the Companies and Commerce Acts with a requirement to return a dividend to their shareholding ministers (which did not include the Minister of Health but rather the Ministers of Finance and State Owned Enterprises), the government chose a governance model that signalled a preference for private rather than public solutions and a commercial rather than public service culture (Easton 1997).

The goals of these reforms were: to introduce more competitive processes into the hospital system; to foster further service integration (primary care was now included under the purchasing orbit of the (four) new regional purchasers, or Regional Health Authorities (RHAs)); and greater accountability by devolving control from the centre to the regions. In reality, however, central control remained, with locally elected area health boards abolished and replaced by non-elected government-appointed boards of directors for both RHAs and CHEs.44

1996-1999 The third episode of the health reforms begins with the election in 1996 under Mixed Member Proportional representation of a coalition Government led by National and supported by New Zealand First. During this phase the market-oriented structure of the Ministry of Health was pared back, funding for health was increased, and in September 1998 a stay on hospital closures announced.45 Despite this the health system was still plagued by problems and the perspective of groups such as trade unions and Grey Power still considered the eventual destination of the health reforms to be privatisation. As Grey Power‟s health spokesperson, retired General Practitioner, Ron Barker wrote in June 1998,
44

J Ross Barnett, „Hollowing out the state? Some observation on the restructuring of hospital services in New Zealand‟, Area, 1999, 31(3), pp.259-270. 45 Ibid., p.266.

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The 23 crown health enterprises (hospitals) were set up in 1993 as corporate entities in a convenient form for ultimate private sale. They were burdened from the start with crippling debt and they were so underfunded that it was impossible for them to achieve their instructed business objectives of making a profit out of the nation's health. [...]

Senior ministers Simon Upton, John Luxton and Max Bradford have all said, on radio or television, that the next logical step in the deregulation and privatisation process includes health and education.

The one true common factor in the international destruction of a health service that was once the envy of many much wealthier countries has been underfunding. In their determination to apply a market model to public health, the architects of the health "reforms" had no appreciation of the difference between a commodity and a service.46

1999-2000s The final period of the health reforms covered began with the election of the fifth Labour Government in 1999 and the passage in 2000 of the New Zealand Public Health and Disability Act and the Employment Relations Act. In 2005 Labour eased the income and asset testing of elderly rest home residents. These laws, an increase in funding for health and the reversal of income and asset testing for the elderly form the basis of the health care system in New Zealand in 2013.

Social movements against neo-liberalism

The reforms of the post-1984 period set in motion a number of interrelated social movements opposed to neo-liberalism. Trade unions in 1991 staged a wave of protests against labour market deregulation and sought to oppose the liberalisation of the economy. Unemployed workers formed themselves into associations to highlight the spread of poverty and joblessness. In education, primary and secondary school teachers campaigned against cuts to their pay and moves to devolve education funding to the school level. Tertiary students

46

Ron Barker, „Saturday Forum‟, TDN, 6 June 1998, p.6.

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campaigned vigorously against the introduction in 1989 of user-pays education and protested the rising fees in the 1990s through protest marches and the occupation of registry buildings. State housing tenants undertook a rent strike to protest rising rents and occupied houses the Government was selling off. The end of the 1990s saw a mobilisation in Auckland region to protest against the commercialisation of Council owned water companies. There were local campaigns by trade unions and community groups against reform of the fire service, corporatisation of electricity and the privatisation of state owned assets such as forests and council owned assets such as transport companies.

This thesis focuses on the social movement that contested the health reforms between 1988 and 1999. This social movement was based in community campaigns against hospital closures, the national unions of health workers, the Superannuitants Federation, and the Local Government and Anglican Church led protests of 1997 and 1998 respectively. The separate campaigns, the various unions and political parties and the divergent motives were all united by a common cause – protecting a good quality, public health system. The main endeavour of this thesis is to turn the current literature on New Zealand‟s health reforms on its head. Instead of investigating the effect of Government policy making on the public health service it instead examines the effect of social movement activity on Government health policy. Were campaigns against hospital closures effective? Did street protests against cuts to health care influence policy making? Are health workers able to resist neo-liberalism in health? What role do opposition parties play in social movement activism?

The secondary aim of this thesis is to in the context of this movement evaluate social movement strategies, individual and group agency, the framing of political issues and the relationship between social movements and larger economic, social and political processes. This analysis connects the history of the opposition to the health reforms in New Zealand with the large body of international work that studies social movements and their impacts at „individual, cultural and structural levels‟ where „Meaning, consciousness, interaction, organization, cultural contexts, and political opportunities are all important to understanding how people work to change the world.‟47 In Australia, the United States, and Europe there have been similar conflicts over health reform where social movements have responded with
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Nancy Whitter, „Meaning and Structure in Social Movements‟, in David S. Meyer, Nancy Whittier and Belina Robnett, eds, Social Movements: Identity, Culture and the State, Oxford, 2002, pp.289-307.

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varying degrees of success. By comparing these social movements can a stronger understanding of the ability of social movements to influence state health policy be created?

Structure

The thesis has been structured so that each chapter focuses on a discrete part of the opposition to the health reforms. The chapters are grouped together in three sections.

The first section focuses on the wider community response to hospital part-charges and closures. Chapter One describes the successful boycott movement against hospital partcharges between 1992 and 1997. Chapter Two looks at the campaigns against hospital closures and cuts to services that took place around New Zealand between 1988 and 1998. This chapter examines the effectiveness of these campaigns and evaluates the efficacy of community protest to halt hospital closures.

Section two analyses the opposition to the health reforms which took place in the public hospitals by the health workforce. Chapter Three describes the response of hospital workers to the health reforms. The chapter highlights that far from being passive receptors of the health reforms hospital workers undertook to oppose and resist the direction of the reforms through industrial action, collective intervention s and whistle blowing. Chapter Four focuses on the opposition to the health reforms by public sector nurses. This chapter analyses the campaigns mounted by the nurses‟ unions against key parts of the health reforms including the State Sector Act 1988, the Employment Contracts Act 1991 and the breakup of the national nurse‟s employment award. This chapter demonstrates the mistakes made by the nurses‟ union in its failure to take industrial action and compares the timidity of the nurses‟ response to the more effective resistance mounted by post-primary teachers in New Zealand to education reforms at the same time and by nurses in Victoria, Australia against cuts to working conditions and health services in 2012.

Section three examines the formation of a broad based and politically powerful social movement in New Zealand opposed to the health reforms. This section in contrast to the discrete focus of chapters in sections one and two describes the amalgamation of political, workplace and community resistance to the health reforms. Chapter Five describes the growth of a movement opposed to the health reforms, the large protests of spring 1997 and
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their effect on Government policy. This chapter utilises the political process model developed by Doug McAdam to explore how discontent with the health reforms was generated. Moving beyond an analysis of the events this chapter looks at the role played by political parties and trade unions in contributing to the growth of this social movement. Chapter Six investigates the 1998 „Hikoi of Hope‟ and the subsequent u-turn on the direction of the health reforms undertaken by the National Government of Jenny Shipley. This chapter makes the case that the Hikoi was a pivotal turning point in the history of the opposition health reforms and contributed to the change in both policy direction on health and the electoral defeat of the National Party in the 1999 election. Chapter Seven considers the opposition to the health reforms by the Superannuitants‟ Federation, „Grey Power‟, and their role in campaigning to save hospitals from closure. This chapter also deals with the struggle of pensioners against income and asset testing policies for health care.

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Chapter I

‘I will not pay’

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Hospital Part-charges Boycott, 1992-7

In early February 1992 a woman from the small town of Levin, north of Wellington, walked into the local Transport Ministry office and removed organ donor consent for her kidney and eyes to be used after her death.49 The woman, described simply as „middle-aged‟, said she would not „allow the Government to use them for free while people had to pay health and hospital charges‟.50 Two months later, Sabina Harangozo, a retired factory worker, died of cancer in Wellington Hospital, owing around $600 in unpaid hospital part-charges.51 Harangozo‟s husband, a taxi driver, said his wife, „left strict instructions for me not to pay‟.52 And on 25 April 1992, at a small protest outside Dunedin Hospital, Rosalie Dobson ripped up a $31 bill her nine-year-old son had received from the Otago Area Health Board for an outpatient visit to check his tonsils.53 With Labour Member of Parliament and Opposition Social Welfare spokesperson Clive Matthewson beside her, Dobson told the Otago Daily Times, „I will not pay. I will take the matter to court if necessary.‟54

It is unlikely that these three women ever knew one another but in early 1992 they were united in their opposition to the introduction of means-tested, part-charges for outpatient and inpatient public hospital services by the fourth National Government. As part of its commercialisation of the public health system the government began charging public hospital patients on 1 February 1992 but by April 1993, the number of New Zealanders with unpaid hospital bills had swollen to more than 20,000 and the Minister of Health announced the removal of all inpatient hospital part-charges.55 By the time the remaining outpatient charge

48 49

Otago Daily Times (ODT), 26 April 1992, p.3. Dominion, 12 February 1992, p.6. 50 Ibid. 51 Evening Post (EP), 21 April 1992, p.1. 52 Ibid. 53 ODT, 26 April 1992, p.3. 54 Ibid. 55 New Zealand Herald (NZH), 13 July 1993, p.1.

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was removed by the National and New Zealand First Coalition Government in 1996 the number of New Zealanders with unpaid hospital bills was 50,000.56 This chapter analyses this mass boycott of hospital part-charges and explains the importance of one of the largest and most effective movements of civil disobedience in modern New Zealand history. The first section traces the history of New Zealanders paying for health care in order to contextualise the part-charges, examines the part-charges in the context of National‟s health reforms and explains how public fears of health service privatisation overshadowed their introduction. The second section describes the three aspects of the movement against part-charges, the professional and political criticism of the charges, the encouragement of the boycott by various organisations and individuals and the decisive refusal of tens of thousands of people to pay their bills. The third and final section explains the National Government‟s eventual abandonment of part-charges and the effect this had on the evolution of the health reforms.

Despite forcing the fourth National Government to reverse what had been a central plank of its health reforms and being part of the largest civil disobedience campaign in modern New Zealand history, Harangozo, Dobson, the Levin woman and the actions of tens of thousands of other boycotters are completely absent in the historiography. The importance of historicising the boycott is that it shines a light on another side of neo-liberalism, one in which not only were there struggles against neo-liberalism, but there was a struggle which the neo-liberals lost. Many works dealing with the health reforms mention the abandonment of part-charges but none makes more than a brief reference to the boycott movement. Robin Gauld‟s history of the health reforms, Revolving Doors does not mention the organised boycott movement merely stating that, „hospitals were finding it difficult to extract payments from around one-third of patients‟.57 Another example of this, Robert H. Blank‟s New Zealand Health Policy, explained the removal of inpatient charges in April 1993 as the result of „high rates of non-compliance‟ without describing how or why the non-compliance was widespread.58 Brendon Wood‟s Master‟s essay in Political Studies, „An analysis of the hospital part-charge debate in New Zealand, 1991 to 1993‟, is the only academic work on the

56 57

Dominion, 22 July 1996, p.3. Robin Gauld, Revolving Doors; New Zealand‟s Health Reforms – The Continuing Saga, Wellington, 2009, reprint, 2011, p.94. 58 Robert H. Blank, New Zealand Health Policy; A Comparative Study, Auckland, 1994, p.141.

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introduction of part-charges.59 And although Wood carefully explains the discourse and debate that accompanied the introduction of part-charges he made no attempt to quantify the size or qualify the depth of the boycott movement. Wood does not examine the organisations behind the boycott or even attempt to discover the consequences for those who refused to pay. Thus the boycott movement, despite its effectiveness, has not yet been analysed. For this reason, and in order for us to understand the dynamics that have shaped New Zealand‟s public health system, uncovering the history of the part-charges boycott is important.

Health care in New Zealand Paying for hospital care in New Zealand Prior to 1939, central government mostly funded New Zealand‟s public hospitals with some partial voluntary contributions and patient part-charges. 60 It was a system where, wrote health historian Derek A. Dow, „it was anticipated that every patient should meet part, if not all, of the cost of hospitalisation, each according to his or her means.‟61 The history of these early patient part-charges and their collection in the New Zealand hospital system demonstrates the difficulties of this method of fund raising. As Dow explains of patient part-charges between 1882 and 1910,

The level of patient payments fluctuated considerably from hospital to hospital and from year to year, reflecting both the respective wealth of different communities and the ability or determination of hospital administrators to collect dues. In 1884, for example, four hospitals (Coromandel, Grey River, Masterton and Wanganui) received no monies from patients. At the other extreme, 68.93 per cent of Auckland Hospital‟s revenue came from this source.62

59

Brendon Wood, „An analysis of the hospital part-charge debate in New Zealand, 1991 to 1993‟, Research Essay, University of Auckland, 1996. 60 Derek A. Dow, „Springs of Charity?: The Development of the New Zealand Hospital System, 1876 -1910‟, in Linda Bryder, ed., A Healthy Country: Essays on the Social History of Medicine in New Zealand, Wellington, 1991, pp.44-64. 61 Ibid., p.45. 62 Ibid., pp.53-54.

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Collecting unpaid patient fees had proved difficult for hospital boards prior to the 1938 enactment. Patients with outstanding debts had to be prosecuted and the Auckland Hospital Board went so far as to pursue arrest warrants for five defaulters living in Sydney in 1896.63 In June 1908 the Star reported that Auckland‟s Hospital Board had had to write off close to £39,000 in unpaid patient part-charges in the three years prior.64 Whangarei Hospital Board in 1929 charged Maori patients over two years £1937 in part-charges and collected just £300.65 Hospital part-charges in New Zealand‟s public hospital system pre-1939 were widely unpaid and often uncollected.

In the years before the election of the first Labour Government in 1935 the only support for people to pay the costs of public hospital stays and doctors‟ visits came from friendly societies, voluntary organisations providing insurance to members. 66 But these covered less than twenty percent of the population.67 Thus the 1930s depression and the enactment of social security systems, including health benefits, in many European countries stimulated a widespread public desire for the government to provide free health services in New Zealand.68 The rising costs of new medical technology, the increasing costs of hospital buildings and the inability of many patients in the depression to meet their „legal and moral obligation‟ to pay their hospital fees meant hospital boards between the world wars also needed a new way of financing hospital care.69 The Labour Party argued in the 1935 general election campaign that the solution to these problems was a free, taxpayer funded, universal health service, „Disease represents not only human suffering, but waste, and its prevention and cure is in the interest of both the nation and the individual.‟70 Once elected, inspired by socialist ideals, the Labour Government passed the Social Security Act of 1938, creating the world‟s first, free universal system for public hospital care.71

63 64

Ibid., p.56. Star, 16 June 1908, p.2. 65 Auckland Star, 11 September 1929, p.3. 66 Elizabeth Hanson, The Politics of Social Security; The 1938 Act and Some Later Developments, Auckland, 1980, p.26. 67 Ibid. 68 Ibid., p.14. 69 Iain Hay, The Caring Commodity; The Provision of Health Care in New Zealand, Oxford, 1989, p.78. 70 Hanson, p.38. 71 Christine Cheyne, Mike O‟Brien and Michael Belgrave, Social Policy in Aotearoa New Zealand; A critical introduction, Auckland, 1997, reprint, 2000, p.210.

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On 1 April 1939 the Act came into effect and general public hospital care became free for all New Zealanders on 1 July 1939.72 Funded mostly by central government (which had raised a new tax to cover the costs of funding social security), alongside ratepayer contributions to hospital boards until 1958, public hospital use expanded as New Zealanders enjoyed a greater degree of access to medical services than ever before.73 The public hospital system came to take up an important role in the social life of the country. „Instead of illness being treated in the home, increasing reliance came to be placed on doctors and hospitals.‟74 After 1941 the cost of medical prescriptions was free and after 1949 doctors‟ visits although costing patients a small sum were heavily subsidised.75

The free provision of hospital care survived various attempts at reorganisation of health services throughout the second half of the twentieth century and by the late 1980s was an entrenched part of New Zealand‟s welfare state. However, the fourth Labour Government‟s introduction in 1989 of $1 part-charges for medical prescriptions began a rolling back of state funding of the public health system and an increased reliance on user charges.76 This development occurred in tandem with other neo-liberal reforms including means testing of social welfare benefits such as family assistance and superannuation and increasing costs of tertiary education.77

Private hospital services in New Zealand had existed since the 1840s but by 1949 the proportion of beds in private hospitals was just fifteen percent.78 In New Zealand during the second half of the twentieth century, alongside the growth of the public health system the private hospital care system, based on individually paid for or employer provided health insurance also developed. In the 1950s, the first National Government „encouraged‟ the growth of these private hospitals by giving private health care providers, „attractive state

72 73

Hay, p.113. Ibid., pp.130-132. 74 Ibid., p.130. 75 Ibid., p.161. 76 Toni Ashton, „The Influence of Economic Theory‟, in Peter Davis and Toni Ashton, eds, Health and Public Policy in New Zealand, Auckland, 2001, pp.107-126. 77 Chris Rudd, „The New Zealand Welfare State: Origins, Development, and Crisis‟, in Brian Roper and Chris Rudd, eds, State and Economy in New Zealand, Auckland, 1993, pp.226-245. 78 Alun E. Jospeh and Helen Flynn, „Regional and Welfare Perspectives on the Public -Private Hospital Dichotomy in New Zealand‟, Social Science and Medicine, 26, 1, 1988, p.102.

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loans to establish them and subsidies on the basis of the number of occupied beds.‟79 Iain Hay‟s history of health care The Caring Commodity argued that within New Zealand‟s health policy between British settlement and the 1980s there is a continuous tension between the government‟s provision of services and its ability to fund those services and that, „Although this social predicament was addressed early, it has remained, in different guises, at the heart of changes in New Zealand‟s health care services.‟80 Because of the tension between the Social Security Act which promised universal, free hospital care, fiscal constraints and ideological motivations post-World War Two governments faced, National governments from the 1950s to 1980s attempted to solve increased demands on government finance by public hospitals by encouraging the growth of private hospitals and insurance schemes. 81 By doing this, Hay argues, National was drawing the „provision of health back into the realm of the market-place. The caring relationship of medicine is being restored to the market‟.82 In 1991, around forty-five percent of the population had private health insurance in New Zealand.83 However the majority of those covered by health insurance obtained it as an employment benefit.84 And despite the high level of health insurance the vast majority of health spending, eighty-two percent in 1990, was by the government.85 The fourth National Government‟s health reforms aimed to change this by significantly reducing the proportion spent on health by the government and correspondingly increasing the private contribution. The introduction of hospital part-charges in the public system in 1992 can be seen as a continuation of this pattern of National governments restoring the market to medicine, in order to cut state health care costs .

National‟s health reforms

79

Alexander Davidson, Two Models of Welfare; The Origins and Development of the Welfare State in Sweden and New Zealand, 1888-1988, Uppsala, 1989, p.214. 80 Hay, p.182. 81 Ibid, p.180. 82 Ibid. 83 Patricia Danzon and Susan Begg, Options for Health Care in New Zealand, Wellington, 1991, p.17. 84 Ibid., p.18. 85 Caroline J. Tuohy, Colleen M. Flood and Mark Stabile, „How Does Private Finance Affect Public Health Care Systems? Marshaling the Evidence from OECD Nations‟, Journal of Health Politics, Policy and Law, 29, 3, 2004, pp. 359-396.

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The introduction of patient part-charges was signalled in the 1988 Unshackling the Hospitals: Report of the Hospital and Related Services Taskforce.86 The taskforce, inspired by Roger Douglas, then Labour‟s Finance Minister, and led by prominent businessman Alan Gibbs, recommended the corporatisation of the hospital system in order to lower the cost of a ballooning health system.87 The proposals were driven by a desire to contain the cost of an increasingly expensive public health system. Between 1980 and 1988 the real cost increase of public health services had risen 14 percent, hospital admissions increased 12 percent, outpatient admissions 16 percent and day services 150 percent.88 As Dow noted in his history of public health, this „urge for reform‟ in New Zealand was in line with the rest of the OECD where 18 of the 24 countries „were planning or implementing major changes to health services by 1991.‟89 Receiving the report was David Caygill, Minister of Health, who rejected the corporatisation recommended in Unshackling the Hospitals. 90Although Labour did not act on the bulk of recommendations contained in Unshackling the Hospitals, the report would inspire the next National Government‟s health reforms.

Elected at the end of 1990 in a landslide, the fourth National Government‟s Minister of Health Simon Upton announced comprehensive health reforms and the start of hospital partcharges alongside the government‟s July 1991 Budget. 91 The Budget became known as the „mother of all budgets‟, for Finance Minister Ruth Richardson‟s significant cuts to welfare benefits and social spending.92 Richardson was a strong believer in the neo-liberal policy prescription.93 The health reforms became the subject of extensive public debate in the leadup to their implementation in 1992.94 The proposals for health reforms were published in Simon Upton‟s Your Health & the Public Health; A Statement of Government Health

86

New Zealand Government, Your Health & the Public Health; A Statement of Government Health Policy by the Hon. Simon Upton Minister of Health 1991, Wellington, 1991, pp.188-189. 87 Derek A. Dow, Safeguarding the Public Health: A History of the New Zealand Department of Health, Wellington, 1995, p.221. 88 Ibid., p.242. 89 Ibid. 90 Gauld, p.62. 91 Wood, pp.15-17. 92 Peter Starke, Resilient or Residual? From the Wage Earners‟ Welfare State to Market Conformity in New Zealand, Bremen, 2005, p.15 93 Ibid. 94 Wood, pp.15-17.

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Policy.95 This document proposed the complete restructuring of New Zealand‟s public health system, „one of the Government‟s top priorities for the next two years‟.96 The reforms aimed to introduce market mechanisms to reduce health service spending, corporatise the management of public hospitals and extend user charges from primary health care (GP visits, dental care, prescriptions) into the hospital system.97 It also outlined changes to the health services that would become the Health and Disability Services Act 1993, which completely restructured the public health system along the lines proposed by the Gibbs Report by replacing the 14 two-thirds elected Area Health Boards (AHBs) by 23 Crown Health Enterprises (CHEs) centred on large hospitals, with government appointed boards of directors in charge.98 In 1991 appointed commissioners replaced the elected board members on AHBs in order to prepare the health boards for the commencement of corporatisation in 1993.99 Crown Health Enterprises became operational in July 1993 as government-owned companies with the requirement to become profitable through contracting their services to four Regional Health Authorities (RHAs) who would provide health services to residents in their area by purchasing health services from the CHEs in a competitive market that included private providers.100

The aim of the government in 1991 was to implement all of the health reforms before the 1993 general election.101 Hospital part-charges were a key part of the reform process and would complement a move away from taxpayer-funded health care towards a system of „social insurance‟ where people would be given vouchers which they could then, after opting out of coverage by their RHA, use to buy Health Care Plans (HCPs) from private health companies who would then pay for hospital services in either private hospitals or CHEs.102 The key message to the public that the government focused on in Your Health & the Public Health was that user-charges would help to finance an increasingly expensive hospital system
95

New Zealand Government, Your Health & the Public Health; A Statement of Government Health Policy by the Hon. Simon Upton Minister of Health 1991, Wellington, 1991. 96 Ibid., p.127. 97 Ibid., pp.3-4. 98 Pauline Barnett and Ross Barnett, „Reform and Change in Health Service Provision‟, in Peter Davis and Kevin Dew, eds, Health and Society in Aotearoa New Zealand, Auckland, 1999, pp.219-234. 99 Peter Quin, New Zealand Health System Reforms, online, 29 April 2009, available at: http://www.parliament.nz/en-NZ/ParlSupport/ResearchPapers/e/d/1/00PLSocRP09031-New-Zealand-healthsystem-reforms.htm (19 November 2012) 100 Ibid. 101 New Zealand Government, Your Health & the Public Health, p.5. 102 Ibid., p.89.

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„and so reduce the burden to be borne by other financing mechanisms.‟103 Upton also believed the charges would send „price signals‟ encouraging people to ration their use of already stretched public hospital services.104 The government initially estimated that the introduction of part-charges would raise $95 million a year.105 By enacting the health reforms and redesigning the welfare state with targeted and not universal social welfare, Bolger, Richardson and Upton were breaking with National‟s traditional policy in the four decades after the Second World War of „largely managing Labour‟s welfare system, rather than dismantling it‟.106

The hospital part-charges that took effect on 1 February 1992 were initially set at the following rates: beneficiaries, students and families whose incomes were low enough to receive the maximum income support tax credit, known as Family Support, were part of „Group 1‟ and still received free hospital care on presentation of a „Community Services Card‟; „Group 2‟ were families with incomes qualifying them for some Family Support would pay $19 for outpatient care and $35 for hospital care per day, and those families classified as „Group 3‟ had higher incomes ($40,000 or more) and were expected to pay $31 for outpatient care and $50 per day for hospitalisation. The maximum a family would have to pay per annum was for ten inpatient and five outpatient worth of fees each.107 With the introduction of hospital part-charges the government also issued those in Group 1 and 2 with cards entitled „Community Services Cards‟, to be presented when accessing hospital care to entitle them to free care or lower rates respectively. 108 The government issued frequent users of hospital services and those with a severe medical condition „High Use Health Cards‟ entitling them to free hospital care.109 However the government saw these charges as an „interim targeting regime‟ which would be charged only until the RHAs were established and able to set and vary their own patient charges in competition with private health insurers.110

103 104

Ibid., p.95. Dominion, 7 February 1997, p.7. 105 Kelsey, The New Zealand Experiment; A World Model for Structural Adjustment?, p.216. 106 Gregory R. Stephens, „Electoral reform and the centralisation of the New Zealand National Party‟, MA thesis, Victoria University of Wellington, 2008, p.30. 107 Department of Social Welfare and Department of Health, Health Care Charges and Subsidies, Wellington, 1992, pp.9-10. 108 Ibid. 109 Ibid., p.13. 110 Blank, p.128.

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Fears of privatisation The fourth National Government was undertaking the most far reaching reforms of the public health system since socialisation in 1939, both in restoring user charges to hospital care and setting in motion the corporatisation of the public health system. By undertaking these actions the government aroused public fear of the privatisation of the health system, which dominated the public debate over the introduction of part-charges in 1992. At the time, the New Zealand Business Roundtable (NZBR), a neo-liberal think-tank based in Wellington, was advocating full privatisation of health services. In April 1991, the NZBR published a report called Options for Health Care in New Zealand. 111 The report advocated the corporatisation and eventual privatisation of health services and compulsory private health insurance for New Zealanders.112 Although these were not the views of the government, they influenced the direction of the health reforms. The National Interim Provider Board, set up by the government to oversee the transformation of health boards into CHEs, was chaired by Sir Ronald Trotter, also chairman of the NZBR at the time Options for Health Care was published.113 CS First Boston, the consulting company which had written Options for Health Care, were the Interim Provider Board‟s own consultants.114 Even government ministers were unsure whether the health reforms‟ eventual destination would be privatisation. In 1992 Associate Minister of Health, Maurice Williamson during questioning on talkback radio by a caller, refused to rule out privatising public hospitals after the 1993 election, allowing Labour MP Elizabeth Tennet to declare, „the government would start selling hospitals after the 1993 election‟.115

With the influential lobby NZBR advocating full privatisation of the health system and an Associate Minister for Health refusing to rule out its possibility on radio, the New Zealand public had very real fears in the early 1990s that part-charges were the first step along the road towards fully privatised medicine. In November 1991 only ten percent of a polled group of voters approved of the government‟s handling of health issues and in February 1992 one newspaper columnist summed up health policy as overshadowed by the „clumsy and administratively expensive charges...a softening up process for insurance-based health care.
111 112

Patricia Danzon and Susan Begg. Ibid. 113 Brian Easton, The Commercialisation of New Zealand, Auckland, 1997, p.158. 114 Kelsey, The New Zealand Experiment; A World Model for Structural Adjustment?, p.218. 115 Press, 1 February 1992, p.3.

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Unfortunately for Mr. Upton, New Zealanders are not in a mood to be softened up.‟116 Upton strenuously denied throughout his term as Minister for Health that the eventual aim of the health reforms was privatisation. But this did little to dampen criticism from Labour politicians who focused on encouraging public fears of privatisation to encourage opposition to the charges.117 After being relegated to the opposition in the 1990 election Labour vehemently opposed the commercialisation of the health system under the National Government. Labour leader Michael Moore in February 1992 said privatisation was „definitely‟ on the agenda and that after the abolition of Area Health Boards, „the introduction of user part-charges marked the second stage of the government plan to privatise health‟.118 Labour health spokesperson Helen Clark told the Dominion, the government wanted partcharging introduced, „so it could then move to a fully privatised system‟.119 As Heather Buchan, senior research fellow at the Otago University Medical School wrote in the British Medical Journal in 1993, „Fees for hospital care were introduced earlier than other [health reforms] and provided fuel for those concerned about possible privatisation.‟120 By the end of the debate about part-charges many believed they were the first step towards a privatised health system, a system that most people did not want.

The movement against part-charges Unhappy with the direction of the government‟s health reforms and fearing health privatisation, the introduction of part-charges ignited a widespread movement of opposition. The first form it took was criticism of the charges‟ fairness and their administrative problems. Doctors, nurses and politicians opposed part-charges through public comment, and street protests against their introduction took place across the country. This opposition to the charges, especially from health professionals, was important in legitimising what would become the boycott movement. The second form of opposition came from local community groups concerned with health issues, Labour MPs, the Superannuitants‟ Federation and trade unions who all promoted a boycott of hospital part-charges. The final activity undertaken by the participants in the movement was the boycotting itself: individuals refusing to pay the hospital or the debt collector.
116
117

Dominion, 7 February 1992, p.7. Press, 1 February 1992, p.3. 118 NZH, 3 February 1992, p.5. 119 Dominion, 4 February 1992, p.2. 120 Heather Buchan, „New Zealand‟s health care reforms‟, British Medical Journal, 307, 6905, 1993, p.635-636.

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Criticising the charges Senior medical professionals were amongst the most ardent critics of part-charges. After their implementation Dr Tessa Turnbull, College of General Practitioners‟ spokeswoman, and Dr Colin Feek, Chairman of the Wellington Hospital Medical Group, both expressed their frustration to the media at the hours of administration work the user charges were taking, noting that patients and staff resented the charging regime.121 Dr Peter Roberts, Chairman of the Wellington Hospital‟s intensive care unit and President of the hospital doctors‟ union, the Association of Salaried Medical Staff (ASMS), explained their opposition in an Evening Post column in July 1992,

There are other reasons why the vast majority of professionals oppose this unfortunate user-pays experiment. Some have seen the blue white mottled skin of a dead child whose parents heeded Mr Upton‟s „price signals‟ not to seek help until too late. Some have seen resources wasted by BMW-driving consultants who are skimming the cream from a system going sour. Some simply know how much sick people suffer already and know that financial worry burdens the ailing spirit. The heart of the matter is a change in philosophy from shared responsibility for community services to the simplistic monetarist (user-pays) theories which found fertile ground in the minds of Roger Douglas, Treasury and this Government.122

Roberts was also a medical spokesperson for the Coalition for Public Health, an organisation which economist Brian Easton described as a critically important opposition organisation to the government‟s health reforms by „linking the medical heights to the public plains‟.123 Formed in 1991 the Coalition for Public Health brought together a vast array of opponents to the health reforms including the country‟s biggest trade unions, the Public Service Association and Engineers Union, medical workers organisations such as the ASMS, nurses‟ unions, and sundry community and religious organisations that spanned from the National

121 122 123

Dominion, 5 February 1992, p.2. Ibid. p.3. Easton, p.160.

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Council of Women to the Anglican Church.124 Public criticism of the charges by medical professionals, such as by the Coalition‟s main spokespeople, Roberts and Dr Alan Gray, Medical Director of Wellington‟s Mary Potter Hospice, gave medical opponents of the charges an outlet for their frustration at part-charges.125

Nurses also played an active role in opposing the charges. Wellington Hospital‟s nurses refused their manager‟s request to issue invoices to patients after administration staff finished at 5pm and all the unions on site had resolved to „support any staff disciplined for refusing to invoice patients or collect money‟. 126 The Nurses‟ Association reported to the media two days after the charges introduction that patients were discharging themselves from hospitals in the Wellington region against medical advice, „The Nurses‟ Association spokeswoman said if early discharges became common, costs would soar, and readmission rates rise.‟127 The spokeswoman said that some patients at Hutt Hospital who „knew they had to pay for outpatient care had been belligerent when they had to wait for up to two hours for treatment‟ and other patients went home „presumably to put plasters on cuts that should rightly have been stitched‟.128

The disapproval by politicians focused on the unfairness of the part-charges and came from both Labour and National MPs. National MP, Michael Laws, criticised the system, saying „rich people with clever accountants could rip off the system‟.129 Laws was referring to examples such as one publicised on the front page of the Dominion on February 5, of a Northland businessman with a business worth $1.5 million, yet who had received a card entitling him to Group 2 reduced fees, had said it was „unfair‟ that asset rich farmers and business people like himself were entitled to cheap visits while those earning $40,000 who had children had to pay full cost.130 Labour leader Mike Moore declared that 1 February 1992 would „go down in infamy as the day New Zealand declared war on itself. ... National has brought back the class war and hundreds of thousands of New Zealanders are carrying
124
125

Coalition for Public Health, The Government‟s Health Experiment, Wellington, 1992, p.1. EP, 9 June 1992, p.5. 126 Dominon, 22 January 1992, p.2.
127 128 129 130

Dominion, 3 February 1992, p.1. Ibid. Dominion, 5 February 1992, p.2. Ibid.

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cards to prove it.‟131 National MP and former Prime Minister Sir Robert Muldoon, traditionally a supporter of social welfare, in a speech to the Orewa Rotary Club in January 1992, used hospital part-charges to explain how government ministers had become „prisoners of Treasury‟ and their user-pays, lower taxes policies.132 Journalists helped keep opposition to the charges in the media by covering the negative reaction of politicians to their introduction.

Two days of protests at public hospitals across the country opposed the introduction of partcharges. The Federation of Women‟s Health Councils of Aotearoa organised many of the protests which took place outside hospitals from Whangarei to Timaru on 31 January 1992 to mark the last day of free hospital care.133 The councils had been set up to provide advocacy on women‟s health issues in the wake of the release of the Cartwright Report in 1988 on cervical cancer treatment at New Zealand‟s National Women‟s Hospital.134 The Federation, formed in 1990, had broadened their scope to become a national organisation of women who lobbied the government on health issues and raised concerns over the direction the health reforms would have on women.135 In Auckland there were vigils outside four hospitals and in Wellington health workers wore black armbands „to symbolise the death of the old health system‟.136 Protests continued the next day, February 1, with a protest gathered in opposition to the part-charges outside Wellington Hospital holding placards reading „Free Quality Medical Care‟ and „Health Cuts Don‟t Heal‟.137 In Hamilton 250 demonstrated against the part-charges and in south Auckland around 150 rallied outside Middlemore Hospital.138 These protests and the criticisms by medical professionals and politicians formed the backdrop against which the charges were introduced.

Publicising the boycott
131 132 133
134

Press, 1 February 1992, p.1. Dominion, 22 January 1992, p.2.

NZH, 1 February 1992, p.2. Linda Bryder, A History of the „Unfortunate Experiment‟ at National Women‟s Hospital, Auckland, 2009, p.174. 135 Sandra Coney, „Health organisations‟, in Anne Else, ed., Women Together; A History of Women‟s Organisations in New Zealand, Ngä Röpü Wähine o te Motu, Wellington, 1993, p.252-3. 136 Dominion, 1 February 1992, p.1.
137 138

Dominion, 3 February 1992, p.2. NZH, 3 February 1992, p.3.

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The campaign encouraging non-payment had a modest start as the part-charges came into effect, and was locally, not nationally, co-ordinated, taking different forms in different regions. Political journalist Jane Clifton noted that the calls for non-payment were a „British poll tax-inspired civil disobedience campaign‟ and she described how, „There has been effective encouragement from some debt collection agencies, who say the Hippocratic oath protecting patients‟ treatment details will make court action against defaulters difficult‟.139 Local groups formed around the country, encouraging non-payment through protests and giving out leaflets and preparing for the expected prosecutions of non-payers.

Across the North Island small community groups began to organise publicity for the boycott. In Auckland, Percy Allison, spokesperson for the Poverty Action Coalition, a group formed in 1990 in response to cuts to social welfare spending and with seven branches across Auckland, encouraged members not to pay their part-charges, „We did [encourage refusal to pay] at the time. It was a very hard thing to do [because it is] very, very dicey one to expect people to individually do that‟.140 On the North Shore, National MP for Glenfield, Peter Hilt decried the role that a recently set up group called the Community Action Network played publicising the boycott in early 1993. It had, he told Parliament, put out a document counselling people not to pay part-charges, „This crowd of thugs has counselled people not to pay those bills even if they are in receipt of proper and lawful processes that require them to attend either a disputes tribunal or the North Shore District Court.‟141 In addition the Community Action Network also „launched a trust fund for people who want to challenge hospital bills‟ in court.142 However, the Community Action Network was not a „crowd of thugs‟ as Hilt had said in Parliament, but an ad hoc group of activists who were spontaneously organising the boycott within the North Shore area.143 In Northland, the Dominion reported a protest publicising the boycott on 1 February, „Several Whangarei people cut up their community services cards at a demonstration in the city on Saturday against the introduction of health charges.‟144 Similarly in Wellington in late January 1992, 33 „health, community and church groups‟ formed a group called the Sunday Forum to
139 140 141
142

Dominion, 28 January 1992, p.2 Percy Allison interviewed by Omar Hamed, 9 June 2011, Disc 1.

NZPD, 1993, 534, p.14689. North Shore Times Advertiser, 3 December 1992, p.5. 143 Ibid.
144

Dominion, 4 February 1992, p.2.

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encourage non-payment and „support people who refused to pay, and health workers who refused to administer the new system‟.145 The group also administered a trust fund to be used to assist non-payers who faced court action.146

Canterbury Health Coalition organised the most vigorous campaign in support of the boycott. In Christchurch, the day before the part-charges came into effect, thirty people from the Canterbury Health Coalition (CHC) handed out pamphlets in the city centre entitled „Can‟t pay. Won‟t pay. Don‟t pay twice‟.147 The slogan „Can‟t pay. Won‟t pay!‟, had been borrowed from the British anti-„poll tax‟ movement which had used it between 1988 and 1991.148 „Don‟t pay twice‟, referred to the CHC‟s belief that New Zealanders had already paid for their hospital treatment through taxation. The CHC claimed backing from health workers‟ unions, former Area Health Board members, Labour and left-wing NewLabour Party (which became part of The Alliance in 1992) members, and unemployed and women‟s organisations.149 It was typical of the types of local groups which were promoting the boycott. Locally organised groups of activists who came from across the trade union movement and political left were determined to play a role in defeating part-charges. They garnered publicity through newspaper stories and handing out leaflets. On February 1, a large picture of one of the CHC activists in Christchurch with a sign „Defeat Health User Charges‟ accompanied a Press article detailing the CHC‟s plan to sabotage the part-charges by asking „people to pay slowly, or to hold off paying the Canterbury Area Health Board as long as they felt comfortable‟, mooting the idea of a fund for boycotters facing legal action, and the enlisting of a lawyer to provide boycotters with advice.150 The CHC spokesperson told a reporter that the civil disobedience they encouraged aimed, „only really to try to create havoc within the administrative system as a protest, but certainly not to take it as far as prosecution, unless they really wanted to go that far‟.151

145 146 147
148

Dominion, 27 January 1992, p.3. Dominion, 27 January 1992, p.3.

Press, 1 February 1992, p.3. Danny Burns, Poll Tax Rebellion, Stirling, 1992, p.43. 149 Ibid., p.3.
150 151

Press, 1 February 1992, p.3. Press, 18 January 1992, p.1.

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In Dunedin, a group called the Dunedin Forum organised a protest outside Dunedin Hospital on 25 April 1992 where Rosalie Dobson publicly tore up a $31 bill for an outpatient visit her 9-year-old had received. Clive Matthewson, Labour MP and their social welfare spokesman, attended to support the demonstration and endorse the civil disobedience.152 During the protest, picketers handed out flyers encouraging the boycott.153 Across the country small groups of activists organised demonstrations to publicise the boycott, handed out leaflets outside hospitals and made preparations for the prosecution of non-payers. These groups, although small, formed the backbone of the campaign and with the support of some Labour MPs gave the boycott movement a national audience.

Labour MPs‟ support for the boycott campaign was perhaps the most critical factor in its success as it allowed the campaign to promote the boycott across the country. As well as the support Matthewson had given the movement in Dunedin, Labour MPs David Lange, Helen Clark and Graham Kelly all showed their support for the boycott movement either directly or indirectly. Three months before the introduction of part-charges former Labour Prime Minister and sitting MP, David Lange, wrote a newspaper column entitled „Sabotage requires the subtle touch‟ in which he called for „civil intransigence‟,

If conveyed while conscious to the hospital, offer the ambulance driver payment in cash. Pay the bill as slowly as possible. Given our legal system your estate will probably end up handling the litigation, which cannot but look bad for the government. Bombard the Minister of Health with enquiries under the Official Information Act. It is prudent, here, to make sure that the information you are seeking does not exist.154

Three days after the introduction of the part-charges, Labour, „pledged to abolish all hospital charges if it won the next election‟.155 Helen Clark, as Labour‟s health spokesperson, went very close to encouraging non-payment and civil disobedience in comments the Dominion
152 153

ODT, 26 April 1992, p.3. Ibid. 154 Dominion, 21 October 1991, p.8.
155

Dominion, 4 February 1992, p.2.

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reported on 4 February 1992, saying „she could not encourage people to break the law, but she understood sentiments that would make people refuse to pay the charge‟ and „public disobedience could make the hospital charges unmanageable‟. 156 Clark compared the issue to the British „poll tax‟, „This will not go away. There will be people who refuse to pay the fees. The British courts are bogged down with poll tax non-payers. If there was a definite campaign here not to pay the system could not cope. They couldn‟t send bailiffs in to everybody.‟157 Although Clark may not have told people not to pay the charges, by drawing attention to the success of the „poll tax‟ boycott in Britain she was giving them inspiration.

Labour MP for Porirua, Graham Kelly, went one step beyond encouraging non-payment when, just a month into the part charges introduction, he flatly refused to pay a $31 bill of his own for surgery and the New Zealand Herald accused Kelly of „wilful disobedience of the law‟.158 As David Lange noted of Kelly‟s act, „His crime was that he simply gave one in the eye to the establishment. He compounded his offence by observing that he would rather pay more taxes on his income to fund an accessible health system. Rich people find that very threatening.‟159 Through Lange‟s encouragement, Clark‟s comments and Kelly‟s action the Labour Party gave the non-payment campaign a media profile and political legitimacy.

It is important to note that Labour‟s promotion of the boycott movement was not simply altruistic. The boycott generated a significant amount of negative publicity for the government and Labour capitalised on this to present itself as a party with similar views to the New Zealand public on health care. For example, the day after inpatient part-charges were abandoned a headline on the front page of the New Zealand Herald read, „Clark on attack over Bolger‟s health mistake‟. The story highlighted the Prime Minister Jim Bolger‟s personal support for the part-charges and quoted Clark‟s description of the government‟s admission that the part-charges were an error as „laughable‟.160 The large volume of negative media coverage National received over part-charges contributed towards public disquiet with the direction of the health reforms, a significant factor in National‟s dramatic drop in support
156
157

Ibid. Ibid. 158 Dominion, 9 March 1992, p.6.
159 160

Ibid. NZH, 29 March 1993, p.1.

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in the 1993 general election.161 In the New Zealand Election Study (NZES) of 1993, which surveyed the views of 2251 electors immediately after the election, health was rated most often as an „extremely important‟ election issue.162 Of those surveyed 37% ranked the Labour Party as having the views closest to them, 21% ranked the Alliance as closest in health views, and only 11% ranked National as being the party closest to them in terms of health views.163 Seventy-five percent of those surveyed supported free health care for all, including 58% of National Party voters.164 As the political scientists behind the NZES concluded, „The attitudinal profile of 1993 voters is one of strong endorsement of a universalist rather than a residualist welfare state‟.165 As Brian Easton described the political fallout, „Jim Bolger specifically mentioned the government‟s health policies as a major reason for the substantial loss (a quarter) of National voters in 1993.‟166 Labour helped generate the negative media coverage part-charges created for the government, negative coverage which helped convince a substantial number of voters not to abandon National in 1993.

One of the other key promoters of the boycott nationally was the Grey Power movement, the popular name for the Superannuitants‟ Federation. On 14 February 1992 a meeting of 2,000 Grey Power members at Auckland Town Hall applauded Neville McLindon, vice-president of the Superannuitants‟ Federation calling for a „fight until we‟ve won‟ against hospital partcharges because, „If we don‟t, all we‟ve fought for in war and peace, what we‟ve built with our hands. And what we‟ve paid taxes for will mean nothing‟.167 In the two years between 1991 and 1993 Grey Power grew rapidly from a membership of 25,000 in 37 branches to 60,000 in 73 local associations who would regularly fill town hall protest meetings around the country.168 One of the central reasons why the elderly proved strident opponents to partcharges was that as a group they were high users of hospital services which made them

161

Blank, p.141. Jack Vowles et al., Towards Consensus; The 1993 General Election in New Zealand and the Transition to Proportional Representation, Auckland, 1995, p.64. 163 Ibid., p.64.
162 164 165
166

Ibid., p.87.

Ibid., p.97. Easton, p.163. 167 Workers Voice (WV), 25 February 1992, p.17. 168 NZH, 25 June 1993, p.9.

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sensitive to changes in health services.169 Grey Power played a critical role in organising and encouraging elderly people to not pay their part-charges.

Trade unions also played a role publicising the boycott to their members and the public. One of the nurses‟ unions, the Nurses Society of New Zealand, openly suggested non-payment as a form of patient protest, and the Society‟s spokesman, David Wills, said, „It is up to people to make their own judgement about user-part charges but they should be assured that health professionals will not deny them treatment if they refuse to pay‟.170 The Service Workers‟ Union, with 45,000 members, one of the largest in the country, also urged their members to boycott hospital part-charges, as well as offering the legal support of union officials to boycotters if they needed it.171 National secretary Rick Barker said, „Our members neither voted for nor were consulted about these charges and therefore we should feel no obligation to pay them.‟172

As well as organisations, some individuals undertook to publicise the boycott by publicly ending blood and organ donations to highlight their opposition to the charges. In early February 1992 some blood donors stopped freely donating blood and began demanding payment as a political protest against the part-charges in Wellington.173 Other blood donors, in Christchurch and Blenheim, publicly announced that they would also stop donations in protest.174 On Wednesday 12 February, the Dominion published the story of a Levin woman who „has protested against the recently introduced health charge by withdrawing permission for her organs to be used after her death.‟175 These individual acts of civil disobedience can be seen as examples of the resistance that David Lange sought to encourage in his newspaper column calling for „civil intransigence‟. 176

169

Alun E. Joseph and A.I. Chalmers, „„Residential And Support Services For Older People In The Waikato, 1992-1997: Privatisation And Emerging Resistance‟, Social Policy Journal of New Zealand, 13, 1999, pp.154169. 170 Dominion, 9 January 1992, p.1. 171 Service Worker, March 1992, p.5. 172 Ibid. 173 Dominion, 5 February 1992, p.2.
174 175 176

Press, 1 February 1992, p.20. Dominion, 12 February 1992, p.6. Dominion, 21 October 1991, p.8.

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Refusing to pay The largest obstacle facing the government implementation of part-charges was the refusal of a significant section of the population to pay the bills they received for hospital care. Some people were quick to predict that there would be widespread support for the boycott. Dr Alister Scott, the New Zealand Medical Association Newsletter editor, can be said to have predicted the rapid growth of the boycott. In February 1992 Scott called the chorus of protest against part-charges the „low rumble that presages an earthquake‟.177 Similarly a participant in the protest outside Middlemore Hospital on the day the charges began, reported his view in the magazine of the Auckland unemployed workers‟ movement,

The predominant theme of each rally was that the people had had enough. February 1 marked not only the end of public health but the emergence of a mass movement to stop this Government and its attacks on the people of New Zealand. Campaigns to boycott payment of the health part-charges are under way, and look likely to gain considerable public support.178

When the statistics became available they showed in some regions there were more people boycotting the part-charges than paying. Clark could ask the Minister of Finance and Treasury as early as June 1992, „Were Treasury estimates of the proportion of patients who would pay the user charges as low as the 9 percent in the Hawke‟s Bay who are paying at present; if it was not 9 percent, what was the assumption of the numbers who would pay?‟179 As a result, in July the government revised the expected revenue from part-charges down to $14.4 million.180 The scale of the boycott varied across the country. Between 1 February 1992 and 31 December 1992 Middlemore Hospital collected 61 percent of part-charges, suggesting a boycotting population of around 39 percent.181 During the first two months of user partcharges Taranaki‟s Health Board faced a non-payment rate of 63 percent; Northland‟s rate over the first four months was 62 percent unpaid.182 Other rates of non-payment included
177 178 179
180

New Zealand Medical Association Newsletter, 12 February 1992, p.4. Mean Times [Newsletter of the Auckland Unemployed Workers‟ Rights Centre], February/March 1992, p.8.

NZPD, 1992, 525, p.8745. Kelsey, The New Zealand Experiment; A World Model for Structural Adjustment?, p.216. 181 NZPD, 1993, 533, p.13423.
182

NZH, 18 June 1992, p.1.

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Waikato at 47 percent, Hawke‟s Bay 51 percent and Bay of Plenty 31 percent.183 As pointed out by Clark in Parliament, when these figures were looked at as a proportion of the entire patient population, many of whom were actually exempt from part-charges, the number of fee payers was very small. Upton himself said in August 1992 that a quarter of bills were three months outstanding.184

By September 1992, the government had begun refusing Clark‟s requests for information on the amounts of unpaid part-charges to health boards and she could justly say, „the boards are shrouding themselves in secrecy because the level of outstanding bills is so high‟.185 In December 1992, North Shore Hospital reported that more than one third of bills were outstanding even though around three quarters of the people who used the hospital were exempt from the part-charges.186 Denis Snelgar, general manager of the Health Board, claimed North Shore Hospital‟s collection rate was the highest in Auckland.187 Nationally, the numbers of non-payers fluctuated between February 1992 and April 1993 as some people paid their bills and new patients joined the boycott. However, the statistics recorded at the time paint a picture of mass revolt. The final, April 1993 tally of those who did not pay the hospital part-charges while the inpatient part-charges were in force was at least 20,078.188 In the Auckland area alone over 7000 people had been referred to debt collectors by April 1993.189

When the non-payment rate of twenty-five percent is compared to the boycott of the Community Charge or „poll tax‟ in Britain a rough estimation of the significance of the partcharges boycott movement can be gauged. In 1990 Margaret Thatcher‟s Conservative Government introduced a new payment system for local government services in Britain, called the Community Charge but commonly referred to as the „poll tax‟ because it was a

183 184 185 186
187

Ibid. NZH, 7 August 1992, p.3. NZH, 3 September 1992, p.5.

North Shore Times Advertiser, 3 December 1992, p.5. Ibid. 188 Dominion, 13 July 1993, p.2.
189

NZH, 13 July 1993, p.1.

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flat-rate charge on every adult.190 To oppose the „poll tax‟ a mass movement of over 1000 Anti Poll Tax Unions were organised across Britain to encourage non-payment to make the collection of the tax impossible.191 The boycott movement was extremely successful. In England non-payment at the end of January 1991, shortly before the government announced the Community Charges repeal in April 1991, „non-payment averaged 18% in shire district councils, 27% in metropolitan districts, 23% in outer London boroughs and 34% in inner London boroughs.... In Scotland, non-payment had almost doubled from 18% in the first year to nearly 35%.‟192 Thus in rough terms of scale, part-charges non-payment was equivalent to the percentage of Britons who refused to pay their Community Charge. Britain‟s „poll tax revolt‟ has been historicised as an important social movement in British history that contributed to Thatcher‟s ousting as Prime Minister and Conservative Party leader by John Major.193 New Zealand‟s part-charges boycott and its success, in contrast, has been almost completely forgotten.

Why did so many people boycott paying their bills? In the 1990 New Zealand Election Study, seventy percent of all voters and seventy-one percent of National voters surveyed wanted increased government spending on health.194 In response to a specific question on the funding of health services, the average voter wanted more public provision of health care and less user pays.195 The average National voter surveyed thought the National Party was less committed to user pays health care than Labour.196 As political scientists Jack Vowles and Peter Aimer concluded, „Clearly, many voters for National in 1990 did not anticipate the policies which the National Government announced in 1991, including much higher health care charges for middle and upper income families.‟197 This fact and the result of the NZES in 1993 with its strong polling in support of free health care for all demonstrate a tangible connection between New Zealanders‟ attitudes towards citizenship and health care. This link perhaps explains the strong response and the high level of non-cooperation with hospital part190

David Deacon and Peter Golding, Taxation and Representation; The Media, Political Communication and the Poll Tax,London, 1994, p.38. 191 Deacon and Golding, p.101. 192 Burns, pp.176-178. 193 Ian Hernon, Riot; Civil Insurrection from Peterloo to the Present Day, London, 2006. 194 Jack Vowles and Peter Aimer, Voters‟ Vengeance; The 1990 Election in New Zealand and the Fate of the Fourth Labour Government, Auckland, 1993, p.115. 195 Ibid., p.118. 196 Ibid. 197 Ibid.

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charges as New Zealanders perceived the government not just to be changing social policy but abrogating a right of citizenship.

Public health services (as well as other welfare sectors such as education) were strongly supported by people from many social classes. As Peter Taylor-Gooby, professor of Social Policy at the University of Kent, noted in 1991 about support in the United Kingdom for their National Health Service, „middle- and upper-class people do well out of collectively provided mass services, when these meet needs that they share with poorer groups. Material interest does not impel them to abandon state provision in such areas.‟198 As Brian Easton put it, „Health is the part of the welfare state which most touches everyone, including the articulate middle class and the swinging voter.‟199 But although higher income groups may have been better able to afford the cost, as Taylor-Gooby noted, this does not imply they saw free public health care as less of a right. In short, the boycott movement showed that the public was strongly committed to continuing a policy of free public hospital care and any rollback of this universality was perceived as a suppression of the rights of citizenship in New Zealand. As Lyndon Keene, co-ordinator of the Coalition for Public Health, said of the boycott,

That didn‟t need any organisation really, that just happened on its own. It was just a natural response from people.... It just rapidly grew, once a few people started to oppose it, it just snowballed very quickly. It was just a reaction from people who felt that it was plainly wrong. It was just morally wrong, it was philosophically wrong. In some respects it reminded me of the Springbok Tour.200 ... People just were so morally outraged by it they felt so strongly that this was wrong that they were prepared to break the law, to voice their opposition to it. And that‟s of course what happened.201

With the number of unpaid bills snowballing it became increasingly difficult for the charges to be collected. When debt collection agencies followed up on unpaid bills they were often
198

Peter Taylor-Gooby, Social Change, Social Welfare and Social Science, Hemel Hempstead, 1991, pp.127128. 199 Easton, p.165. 200 During the 1981 rugby tour of New Zealand by the South African rugby team, more than 150,000 people took part in over 200 demonstrations against Apartheid in South Africa. 201 Lyndon Keene interviewed by Omar Hamed, 1 July 2011, Disc 1.

39

met with intransigence. Socialist activist Grant Morgan, although not active in campaigns promoting the boycott, supported it. Morgan described his reaction to a debt collector telephoning him at home,

So I had to go get a series of tests done and some treatments for a serious condition. And I kept on getting these bills, after every hospital visit and I think there were warning notes attached. ... And then out of the blue one day I get a phone call from a debt collector who said if you don‟t pay, you‟ll be taken to court, blah, blah, blah. And this was the first time I‟d had an actual opponent. A direct, someone that could be confronted over this issue. And I just said, „Come on, come for me. I want to be taken to court. I want to go to jail over this issue.‟ I was screaming down the phone, some of which can‟t be printed in your family history.202

Morgan‟s response to the telephone call was one of many similar responses from patients. The Auckland Area Health Board Commissioner confirmed that collectors had received rough treatment collecting fees, „People get angry and upset. They have abused our staff and threatened them, which we can all do without.‟203 However the debt collectors had very little recourse if reminder letters and telephone calls failed to solicit the funds. As Morgan continued,

And I remember thinking as I was saying this, he is either extremely professional, as a debt collector, I suppose you get a very thick skin. Or he has had similar responses from many other people, who‟ve been rung up about health user charges. So our call was hot, torrid, and reasonably short. And the important thing was I never heard another word.204

202 203 204

Grant Morgan interviewed by Omar Hamed, 9 June 2011, Disc 1. NZH, 2 April 1993, p.1. Grant Morgan, Disc 1.

40

This is probably typical of the experience of the majority of non-payers. The only reported prosecution of non-payers took place in Dunedin in 1994 over outpatient charges and this had next to no effect on payment rates. The Otago Daily Times reported in February 1993 that „at least eight people have been threatened with court action if they do not pay their outstanding health charges, but the threats have not been acted on and some bills are a year old.‟205 Although the eight had all received multiple letters threatening court action over nonpayment, the Otago Area Health Board general manager said that „people who refused to pay their hospital bills would be taken to court at some stage, but the board had not yet decided exactly who and when this would happen‟.206 However, it was not until May 1994 that prosecutions were heard in the Dunedin District Court against two non-payers.207 Healthcare Otago won its case against Joanne Hinton, who was ordered to pay $93 plus costs for three outpatient visits but lost its case against Thomas Makinson who claimed to have not been told of the outpatient charge before his visit.208 Healthcare Otago reported that in the wake of the court cases some unpaid debts had been paid.209 However, with enforcement of payment becoming impossible due to the rapidly growing boycott, by March 1995 Healthcare Otago had 19,000 unpaid patient debts.210 The tardiness of health boards and then CHEs in dragging non-payers through the courts to win payments of as little as $31 is understandable. Further court action would only increase negative publicity for the part-charges and fuel more publicity for the boycott movement.

By refusing to pay their bills the boycotters made the collection of charges more expensive than the government had originally planned. The cost of using private debt collection companies eroded the government‟s financial rationale for the charges. Even when debt collectors collected charges they claimed up to 70% of the bill in collection fees.211 By the time of their abolition the amount of money being spent on collection of inpatient fees was often more than the funds raised. „Northland Area Health Board, for example, spent $122,000 last year to raise $115,094 while the Bay of Plenty board spent $402,000 to raise

205 206
207

ODT, 18 February 1993, p.3.

Ibid. ODT, 6 May 1994, p.1. 208 Ibid. 209 ODT, 10 June 1994, p.1. 210 ODT, 29 March 1995, p.2. 211 Gauld, p.94.

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$311,000‟.212 For the Auckland Health Board area, the Commissioner would admit that administration costs consumed „between a third and half of the revenue finally collected.‟213 People dying with money owing in part-charges was another financial loss for the system. One example was Sabina Harangozo, who died in Wellington Hospital in April 1992 with „strict instructions‟ that her husband was not to pay the $600 owing.214 Before her death, „Mrs Harangozo had sent her bills to Prime Minister Jim Bolger and received a reply saying her objections had been noted.‟215 The success of the boycott was not that it convinced everyone not to pay, but that it got enough people not to pay so that the cost of collecting the charge was higher than the revenue many of the health boards collected.

Abandoning part-charges and health care plans With over 20,000 unpaid hospital bills accruing in over a year and the collection of partcharges costing some boards more than they earned, the government was forced in early 1993 to either enforce payment which would have been politically unpopular or abandon the charges. On 25 March 1993 Bolger replaced Upton as Minister of Health with Bill Birch.216 Labour MP David Caygill said of the reshuffle in Parliament the day it was announced, „He lost his head because of the unpopularity of his policies. But the policies are not unpopular because the government failed to sell them; they are unpopular because they are wrong.‟217 With an election looming by the end of the year the government chose to soften the health reforms by reforming the unpopular charges. On 1 April 1993 Birch announced the immediate removal of all inpatient part-charges and most of the outpatient charges.218

After 1 April 1993 hospital outpatient part-charges remained for those in „Group 3‟ (although the charges for „Group 3‟ children were reduced to $16) but these too were heavily boycotted and finally removed on 1 July 1997 by the National and New Zealand First Coalition Government.219 New Zealand First, a conservative political party formed by a former
212 213 214 215
216

NZH, 2 April 1993, p.1. Ibid. EP, 21 April 1992, p.1.

Ibid., p.3. NZPD, 1993, 534, p.14328. 217 Ibid., p.14329. 218 NZH, 2 April 1993, p.1. 219 Wood, p.39.

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National MP, Winston Peters, to oppose the neo-liberal reforms, pledged outpatient partcharges removal as an election promise and in coalition government with National after the 1996 election it secured their abolition.220 New Zealand First can claim part of the credit for their removal. Professor Michael Belgrave described the „populist‟ challenge of Peters to the health reforms during the 1996 election campaign as a push for the „return to the universalism of the 1960s and 1970s and was aimed at maintaining the universal principles of middle-class access to the system, particularly for older people.‟221 But the unenforceability of the charges in the face of mass boycott and the cost of administering the charges meant they probably would not have survived long anyway. Some protest activity continued after the removal of inpatient charges. In 1996 thirty ex-patients gathered in Christchurch‟s Cathedral Square to „burn their bills‟, some from fees charged in 1992.222 This protest was merely symbolic as the boycott was already widespread. In July 1996 the Dominion reported that debt collectors were chasing 50,000 hospital users for an average $34.50 each.223 And by their abolition the percentage of hospital bills outstanding was rising to twenty-five percent, and Whakatane‟s CHE had already wiped its outstanding patient debts.224 Between July 1996 and July 1997 the Wellington CHE, Capital Coast Health, spent $490,000 trying to recover $964,059 of patient charges from Wellington and Kenepuru hospitals, and roughly a third of that total ($345,972) was still outstanding when outpatient part-charges were axed.225 The cost to the government of axing the remaining outpatient part-charges was just $6.2 million nationally. 226 Dr Leo Mercer, chief executive of Capital Coast Health, described the benefit to the public of removing the part-charges claiming „the charges had discouraged some people from coming to hospital‟.227

Perhaps the most significant legacy of the boycott movement was not the government‟s abandonment of part-charges but the simultaneous abandonment of plans for people to be able to purchase health care plans (HCPs) from private insurers instead of utilising the public
220
221

Sunday Star-Times, 27 October 1996, p.2. Michael Belgrave, „A Historical Perspective on the Politics of Health Care‟, in Kevin Dew and Anna Matheson, eds., Understanding Health Inequalities in Aotearoa New Zealand, Dunedin, 2008, p.78. 222 Socialist Worker (SW), 19 February 1996, p.5. 223 Dominion, 22 July 1996, p.3. 224 Nelson Mail, 7 July 1997, p.3.
225 226 227

EP, 12 July 1997, p.2. Ibid. Ibid.

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health system, which had been outlined in Your Health & the Public Health.228 Most academics and commentators agreed at the time that the government proposed HCPs as a move towards creating a United States-style insurance based private health care system. As public health sociologist Geoff Fougere described their role in the health reforms in 1994, „Newly created Regional Health Authorities and eventually private Health Care Plans are charged with purchasing a specific range of primary and secondary health services (the „core‟) for their members. These services are provided by a mix of public and private providers the largest of which are publicly owned Crown Health Enterprises (CHES).‟229 Fougere believed the HCP and RHA system of funding would lead to increased health costs, and „wide inequalities of health service entitlement‟ as providers of HCPs would select to insure the wealthy and the healthy, and RHAs burdened with rising costs of health care would fund a declining level of services for the poor, sick and elderly.230 However, proposals for HCPs were abandoned as government policy in 1993. Brian Easton has described the abandonment of the proposal for HCPs, „Not surprisingly the health care plan proposals were later dropped as unworkable‟.231

However, Easton‟s explanation that they were dropped because they were „unworkable‟ is only partly accurate. Certainly there were problems yet to be worked out, „concerns that the RHAs would be left with high-risk patients, along with logistical problems of assessing individual entitlement and overall health needs, and planning integrated services‟.232 But technical complexity, logistical problems and chaotic planning of services did not stop the government progressing the health reforms‟ purchaser provider split. Yet at some point between July 1992 and March 1993 the government dropped the HCP proposals. The answer by Simon Upton to a question in Parliament from Helen Clark inquiring whether the government was abandoning the introduction of HCPs in July 1992 demonstrates this. Upton responded, „The answer is no, but I have made it quite clear that they are not an early prospect because of the complexities involved and the priority that the government wishes to give to other elements of the health reforms.‟233 Just eight months later, on 31 March 1993,
228 229

New Zealand Government, Your Health & the Public Health, p.89. Geoff Fougere, „Health‟, in Paul Spoonley, David Pearson and Ian Shirley, eds, New Zealand Society; A Sociological Introduction, Palmerston North, 1990, reprint, 1994, pp.146-160. 230 Ibid., pp158-159. 231 Easton, p.157. 232 Kelsey, The New Zealand Experiment; A World Model for Structural Adjustment?, p.218. 233 NZPD, 1992, 527, p.10170.

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Upton‟s replacement, Bill Birch, told Clark in Parliament that „It is not the intention of the government to implement alternative health-care plans.‟234 Birch‟s response to Clark is unequivocal; HCPs were not on the health reform agenda anymore. Upton‟s dismissal had coincided with the government‟s abandonment of part-charges and introducing HCPs. March 1993 effectively marks their end as an option for New Zealand‟s health system. After 1993 they are scarcely heard of again. A contributing factor to the abandonment of HCPs would have been the complexity of integrating them with the new health system but another significant barrier posed in 1993 to their introduction was the success of the boycott movement. If hospital part-charges had generated significant revenue for CHEs then legislating requirements for New Zealanders to purchase HCPs would not have been a major problem. However, in 1992 and 1993 a government that had failed to enforce payments for hospital visits knew it would be unable to force the public to purchase what was essentially private health insurance.

Conclusion A Press editorial declared on 25 June 1992 of the non-payment movement, „To say that there is a mass revolt might be going too far, but not much too far‟.235 The evidence presented in this chapter supports the conclusion that the boycott campaign was in fact a „mass revolt‟.236 By the time all the charges were removed in 1997 there was a non-payment level of at least twenty-five percent nationally and 50,000 boycotters were being pursued by debt collectors. It is important not to underestimate the stand of these 50,000 boycotters; many who participated initially expected that by not paying the charges they would eventually end up in a courtroom and the local organisations that had sprung up to promote the boycott were prepared to offer legal support and advice. In terms of participants alone though, this was one of the largest and most successful civil disobedience campaigns in New Zealand history. It was not a completely spontaneous boycott movement. The boycott was encouraged and strengthened by the critical reception the charges received. The outspoken criticism of the charges by medical professionals and politicians was important because it helped legitimise the popular boycott. And organisations that publicised the movement and prepared to support non-payers in court paved the way for its rapid spread. There were local groups in all the
234

NZPD, 1993, 534, p.14508. Press, 25 June 1992, p.12. 236 Ibid.
235

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major metropolitan areas organising against the charges and the Labour Party, trade unions and Grey Power all encouraged the boycott to their members and supporters. An organised opposition initiated the boycott movement but the scale of the boycott was the result of spontaneous decisions by tens of thousands of people to not pay their charges. Both the organised resistance and spontaneous boycott were important to the movement. Without the support of organisations like the Labour Party the boycott would not have received the publicity it received. And without the rapid spread of the boycott, non-payers would have been in a precarious position if the government had decided to prosecute them. There were also people who supported the movement by boycotting blood and organ donation. These acts symbolise one of the consequences of popular movements for social welfare, „Individuals are released from their fate to be passive, submissive, obedient, grateful objects of social policy to become more active, confident, articulate agents of political, institutional and professional change.‟237

In spite of the importance of this movement to the shape of the health reforms it has not been given the place it merits within the historiography. Histories of the fourth National Government‟s health reforms and the trajectory of neo-liberalism should include this movement made up of those people, who like Sabina Harangozo, Rosalie Dobson and the Levin organ donor opposed the „New Zealand experiment‟.238 The government wanted to begin privatising the funding of health care and were prevented on the issue of hospital charges by direct action protest. This direct action movement helped scrap part-charges, put the brakes on government plans for HCPs and the possible full scale privatisation of the public health service. Consequently, the boycott of part-charges resulted in a significant victory for the opposition to the health reforms in New Zealand. By beating part-charges, public opposition had created a limit on how far the government was able to take the corporatisation of health services. As a columnist in the business newspaper, the National Business Review, reflected the day after the abolition of inpatient charges in April 1993,

People power might be reasserting itself. The arrogant should take care if that is happening, because people power in New Zealand is usually based on common sense.

237 238

Annetts et al., p.250. Kelsey, The New Zealand Experiment; A World Model for Structural Adjustment?, p.1.

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Thwart that common sense and one runs the risk of other outlets for frustration. The new aristocrats of the market economy could then discover the irony that the market is what the majority of the market's participants decide it will be. 239

239

National Business Review, 2 April 1993, p.23.

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Chapter Two

Save our Hospital
Campaigning against hospital closures and cuts, 1985-1998
This chapter of the thesis analyses the community protest campaigns against hospital closures and cuts around the country from the mid-1980s to 1998. The chapter describes the major successful and unsuccessful campaigns against public hospital closures or against cuts to surgical services. Firstly, it gives the historical background to the development of New Zealand‟s public hospital system. Next it looks at the context in which hospital closures occurred between 1984 and 1998. Thirdly it describes and examines the significant campaigns against hospital closures between 1985-1998. It groups these campaigns into four groups. The first group of campaign took place in the period between 1985 and 1992, when local communities campaigned against underfunded health boards closing hospitals and cutting services. In this period eleven hospitals were saved from closure (although one was closed in 1994 and another in 1997) and one from significant cuts by protest action. One campaign to stop a hospital closure was unsuccessful. The second group of campaigns took place between 1994 and 1996, and were mounted against CHEs and RHAs closing hospitals and reducing services. During this period successful campaigns stopped the downgrading of Kaitaia hospital, cuts to surgical services at Ashburton hospital; and the closure of Darfield, Ellesmere, Lincoln and Rangiora hospitals in Canterbury. The third group are the unsuccessful campaigns mounted between 1989 and 1997 against cuts to surgical services at Seddon Memorial Hospital in Southland; Northland‟s Bay of Islands and Dargaville hospitals; Otago‟s Balclutha and Oamaru hospitals; and against the closure of Napier hospital. The fourth group of campaigns took place in spring 1997, when the campaigns organised by local communities facing cuts to health services were accompanied by the emergence of a nationwide movement of opposition to the health reforms. This group of campaigns provided the foundation of the nationwide movement against health privatisation that became the street protests of 1997 (Chapters Five). Thus between 1988 and 1998 protest campaigns against hospital closures saved fourteen public hospitals from closure, the reduction of surgical services in two hospitals and contributed to the development of a nationwide anti-health reforms movement.
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New Zealand and international perspectives Although some academics have analysed specific campaigns against hospital closures and health cuts there has not been a comprehensive study produced which describes these campaigns and their effectiveness in their entirety within the context of New Zealand‟s health reforms. Scholarship on the health reforms has recognised that these campaigns have taken place it has not examined their efficacy as a whole. University of Canterbury academics Ross Barnett and Pauline Barnett have examined the factors influencing success in the retention of health services by community trusts in nine rural communities in Otago and Southland before late 1998.240 Barnett and Barnett draw the conclusion of from their survey that, „While protest actions were instrumental in the formation of the trusts, such direct forms of protest, in themselves, seem to have had little impact upon the eventual form of hospital rationalisation.‟241 This chapter shows a contrary pattern outside Otago and Southland, where community protest campaigns often did have an impact on whether hospital services were cut or closed. Histories of specific hospitals often include description of specific protests against cuts in the 1980s and 1990s. But these histories, with their divergent focuses on local or regional health services, do not help us understand the broader context in which this movement existed and the political effects this movement had outside the local context. This chapter describes the significant campaigns against hospital closures because understanding New Zealand‟s health system and the health reforms requires an understanding of this movement.

The main academic studies, locally and internationally, of hospital closures and community campaigns against hospital closures have been by urban geographers. This has been both a strength and a weakness of the literature. Geographers have paid close attention to the local effects of closure, the motivations of communities, discourses used and the relationship between the hospital and wider health systems and restructuring process. This type of literature enables historians to understand the dynamics involved in specific campaigns against closures. Graham Moon and Tim Brown‟s article on the different discourses used by campaigners mobilising to save St. Bartholomew‟s Hospital in London from closure in the
240

Ross Barnett and Pauline Barnett, „„„If you want to sit on your butts you‟ll get nothing!‟‟ Community activism in response to threats of rural hospital closure in southern New Zealand‟, Health and Place, 9, 2, 2003, pp.59-71. 241 Ibid., p.65.

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1990s is one example of this.242 The weakness of this literature from a historical perspective is that has not studied movements against closures in New Zealand or overseas (such as in the United Kingdom) as a whole and its overall effect on the health reforms. Thus in New Zealand the political importance of the anti-closure campaigns, in terms of overall success in stopping closures and contributing to the nationwide protest movement against the health reforms in 1997 has been overlooked. As Tim Brown wrote, Studies that remain at the micro- or the macro-level are simply that, they do not allow for the complex interweaving of social, cultural and political processes that occurs between them. Thus, in the case of hospital closure, it is important that we gather an understanding of the context within which protest emerges. However, it is equally important that we understand the tactics employed, the actors involved, and the national policy arena within which such protest emerges.243 Sociologists frequently reference campaigns against hospital closures as a form of grassroots resistance to neo-liberalism. Paul Chatterton, University of Leeds, and Jenny Pickerill, University of Leicester, discussing the rise of neo-liberalism and the citizen response have described hospital closures in Britain as part of the „New Enclosures‟ which „poses a fundamental challenge – a critical threat – to people and planet. It is nothing short of a systematic assault on democratic values and institutions.‟244 In Germany the 1997, community occupation of the Hafenkranenhaus Hospital in Hamburg is seen as an important part of the tradition of social movement activity that in the late 2000s gave rise to a social housing and environmental movement known as „Recht auf Stadt‟ (Right to the City).245 As a result of this occupation and protest demonstrations of between one and four thousand people, part of the hospital was converted into a community health centre.246 Yet sociologists have not examined the effectiveness of anti-closure campaigns. This chapter examines the movement against hospital closures during the health reforms in order to assess the overall

242

Graham Moon and Tim Brown, „Closing Barts: community and resist ance in contemporary UK hospital policy‟, Environment and Planning D: Society and Space, 19, 1, 2001, pp.43-59. 243 Tim Brown, „Towards an understanding of local protest: hospital closure and community resistance‟, Social and Cultural Geography, 4, 4, 2003, p.503. 244 Paul Chatterton and Jenny Pickerill, Our project, online, nd, available at: http://www.autonomousgeographies.org/ourproject (2 November 2012) 245 Elodie Vittu, „The “Right to the City” in Hamburg : a Network that Should be More Widely Know‟, Passerelle, 7, August 2012, pp.-95-100. 246 Ute Albertse, re: Looking for someone, online, 11 September 1997, available at: http://www.driftline.org/cgi-bin/archive/archive_msg.cgi?file=spoon-archives/aut-op-sy.archive/aut-opsy_1997/aut-op-sy.9709&msgnum=64&start=7356 (3 November 2012)

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historical effectiveness of the campaigns against closures both as a form of resistance to neoliberalism and as community protest. Historical background, 1846-1984 Between 1846 and 1851 New Zealand‟s colonial government constructed its first five public hospitals in Auckland, Wellington, New Plymouth, Wanganui and Dunedin to serve Maori and the growing immigrant population.247 The gold rushes of the 1860s led to a massive expansion of hospitals in the goldfields and by 1882 New Zealand had 37 public hospitals.248 As New Zealand‟s population continued to expand so too did the public hospital system. The Hospitals and Charitable Aid Act 1885 entrusted the administration of these hospitals to locally elected boards.249 This Act established the beginning of public funding of hospitals from a mix of sources. Between 1886 and 1910 hospitals gained between thirty to forty-one percent of their funding from central government; between twenty-eight and thirty-nine from local authorities and hospital boards; between six and twelve percent from voluntary contributions; and between seven and fourteen percent from patient payments.250 By 1910, wrote Derek A. Dow, there were „56 public hospitals caring for a population in excess of a million‟.251 From the passage of the Social Security Act 1938 to the 1980s the public hospital system continued to grow. Hospital boards were partly funded by hospital rates until 1958, „with the early agricultural wealth of New Zealand ensuring that residents of rural areas generally had better access to hospital services than those of the larger cities.‟252 In the 1960s and 1970s some small hospitals, often maternity hospitals, in rural areas were closed, such as Amuri Maternity Hospital in north Canterbury in 1967, despite community protests.253 Yet despite these closures the public system was expanding. In 1937 the public system comprised 8876

247

Derek A. Dow, „Springs of Charity?: The Development of the New Zealand Hospital System, 1876 -1910‟, p.46. 248 Ibid., p.47. 249 Michael Belgrave, „A Historical Perspective on the Politics of Health Care‟, in Kevin Dew and Anna Matheson, eds., Understanding Health Inequalities in Aotearoa New Zealand, Dunedin, 2008, p.70. 250 Derek A. Dow, „Springs of Charity?: The Development of the New Zealand Hospital System, 1876-1910‟, p.55. 251 Ibid., p.48. 252 Ross Barnett and Pauline Barnett, „„„If you want to sit on your butts you‟ll get nothing!‟‟ Community activism in response to threats of rural hospital closure in southern New Zealand‟, p. 61 . 253 JG Laurenson, „Amuri Hospital‟, in Alice Silverson, ed., The Last Thirty Years; 1963-1993, The History of the Canterbury Area Health Board, Christchurch, 1995, p.166.

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beds in 130 public hospitals including 69 general hospitals and 44 maternity hospitals.254 By 1982 there were 26 472 beds in 185 public hospitals including 107 general hospitals and 44 maternity hospitals.255 The yearly funding for health boards by the Department of Health had since 1967 been based on the expenditure of the health board the previous year with allocations for „price and wage increases, the construction of new buildings, and general growth‟.256 As the rural population declined and the urban population rapidly expanded the problem of adjusting health resources to the changing country had to be addressed. The introduction of population-based (but age, sex, mortality and fertility weighted) funding for hospital boards by the third National Government in 1983 represented an attempt to ration the supply of resources for health care.257 Another part of the formula meant that if private hospitals increased in a hospital board area the public hospitals would receive less Government funding.258 However after November 1984, private hospital expansion required Government approval.259 Population based funding meant that after 1984 health boards and then CHEs serving rural areas faced significant financial constraints that forced them to cut costs. Closing the hospitals, 1984-1998 The health funding policies of successive government‟s gradually shrunk New Zealand‟s public health services between 1984 and 1998. The reduction in public hospitals and bed numbers in New Zealand after 1984 was consistent with an international trend of tightening public spending and the closure or merger of small hospitals in the last two decades of the twentieth century.260 Rural hospital closures began in the late 1980s under Labour as the introduction of population based funding in 1983 reduced the amount of money hospital boards had to pay for services. Some hospitals were closed down with little or no protest but other hospitals were kept open by community campaigns exerting sufficient pressure on the Government. In the decade after 1984 rural hospitals bore the brunt of service rationalisation

254

New Zealand Official Year-Book, 1939, available at: http://www3.stats.govt.nz/New_Zealand_Official_Yearbooks/1939/NZOYB_1939.html 255 New Zealand Official Year-Book, 1983, available at: http://www3.stats.govt.nz/New_Zealand_Official_Yearbooks/1983/NZOYB_1983.html 256 Hay, pp.171-172. 257 Ibid., p.172. 258 Ibid., p.173. 259 Ibid., p.174. 260 H Karcher et al., „Hospital closures‟, BMJ, 1994 (309), p.973.

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as hospitals in towns such as Te Puke, Cambridge, Picton and Geraldine were closed.261 For example, in 1988 in the Waikato seven maternity hospitals were closed across the region as part of cost cutting despite protests from some communities such as Raglan.262 These closures continued up until July 1991 when National replaced area health boards with appointed commissioners in the transition to governance by Crown Health Enterprises. The situation by 1994 was of a steadily shrinking public health service, Since 1990, 17 hospitals have been closed and 2700 beds lost in New Zealand. In the six years before that 30 public hospitals and facilities closed and more than 3000 beds in hospitals that remained open disappeared.263 The following years, between 1994 and 1998, saw an escalation in the speed of hospital closures. Between1 July 1994 when Crown Health Enterprises were allowed to begin closing hospitals and wards and September 1998 when the National Party announced a moratorium on closures and the downgrading of hospitals 32 public hospitals were closed, privatised or transferred into the ownership of a community trust.264 The Government‟s position was clearly articulated by Jim Bolger in May 1994 just before the expiry of the Government‟s guarantee of services, „Every medical professional knows we have too many hospital beds and that change was, and still is, necessary.‟265 Health Minister Jenny Shipley, „made it clear the emotional and parochial attachment people have towards their hospital is out of place in a health environment seeking to focus on services provided rather than the institution that provides them.‟266 In the lead up to 1 July 1994, doctors and hospital campaigners from all around the country met in Wellington where they identified 17 hospitals at risk – Balclutha, Oamaru, Waimate, Ashburton, Hokitika, Reefton, Westport, Greytown, Dannevirke, Waipukarau, Wairoa, Taumarunui, Hawera, Bay of Islands, Kaitiaia, Dargaville and Napier.267 By 1998, some form of community mobilisation against health service cuts or hospital closures had taken place in almost every major city and large town including where the 17 at risk hospitals were located. In centre after centre as RHAs and CHEs announced cuts, community groups would band together to protest closures and cuts. In some centres
261

Chai Chuah, Ref: OIA H201202603, online, August 2012, available at: http://fyi.org.nz/request/461/response/2936/attach/3/OIA%20H201202603%20Mr%20Brendon%20Mills%20res ponse.pdf (20 December 2012) 262 SST, 11 September 1988, p.3. 263 H Karcher et al., „Hospital closures‟, BMJ, 1994 (309), p.973. 264 Chai Chuah. 265 NZH, 30 May 1994, p.1. 266 Cheryl Lilly, „The Big Chop; Fighting for rural medical services‟, North & South, August 1994, pp.92-100. 267 NZH, 30 May 1994, p.1.

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this mobilisation was enough to stop or delay the cut, in others it was not enough and services were cut anyway. The reduction in public hospital services in New Zealand during the health reforms has been studied by a number of social geographers. Lars Brabyn and Paul Beere have used geographic information systems to determine the impact of the closure of hospital emergency departments in Hokianga, Te Puia, Opotiki, Napier, Dannevirke, Oamaru and Gore between 1991 and 2001.268 Brabyn and Beere‟s study shows that between 1991 and 2001, „the number of people living further than 60 minutes from an ED increased by 63,834.269 Living further than an hour from an ED is defined as „poor accessibility‟ as „empirical studies demonstrate that the likelihood of mortality increases dramatically if a trauma patient does not receive hospital treatment within 60 minutes of an accident event...‟270 Brabyn and Beere also draw attention to research showing that distance from health care provision „negatively impacted on health service utilization‟.271 However the impact of this reduction would have been even more severe without the movement against hospital closures. Against underfunding, 1985-1992 Between the introduction of population based funding in 1983 which constrained the amount of money hospital boards had in the late 1980s and the replacement of health boards with commissioners in July 1991 there were successful campaigns against the closures of Reefton Hospital and Westland Hospital (closed 1994) on the West Coast; Helensville Hospital, Pukekohe Hospital, Franklin Memorial Hospital, Howick Maternity Hospital and Otara Spinal Unit in Auckland; Christchurch Women‟s Hospital in Canterbury; Masterton and Greytown Hospitals (closed 1997) in the Wairarapa and Queen Elizabeth Hospital in Rotorua. Hutt Hospital was also spared from significant cuts after community protests in 1991. Thus during this period eleven hospitals were saved from closure and one from significant cuts by protest action. All of these hospitals apart from Westland Hospital and Greytown Hospital are still operating in 2013, although two of these hospitals are now operated by community trusts, Helensville (since 1989) and Queen Elizabeth (since 1993) and Howick Hospital was replaced with the Botany Maternity Unit in 1990. During this period there were two significant unsuccessful campaigns, the 1989 campaign against the
268

Lars Brabyn and Paul Beere, „Population access to hospital emergency departments and the impacts of health reform in New Zealand‟, Health Informatics Journal, 2006, 12(3), pp.227-237. 269 Ibid., p. 230. 270 Ibid., p.230. 271 Ibid., p.234.

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closure of St Helens Hospital in Auckland which is discussed in the sub-section on Auckland‟s hospital campaigns, and the 1989 campaign against cuts to surgical services in Gore which is dealt with in the section on unsuccessful campaigns. In Hokitika Westland Hospital‟s geriatric long stay unit the Mandl Ward came under pressure in June 1985 when the West Coast Hospital Board announced it would close it as part of its plan to gradually close Westland Hospital.272 The response from the community was a continuous sit-in protest in the ward for sixty-six days through the winter of 1985 that involved 800 individuals occupying the ward in four hour shifts of four to six people.273 The sit-in was the idea of left-wing activist and nurse Peter Neame who gained the idea when a friend gave him a copy of a pamphlet Occupy and Win, produced by the London Health Emergency group to help aid campaigns against local hospital closures in England.274 „We produced this booklet rapidly so that every person involved would understand the underlying strategy. Copies were kept permanently in the annex beside Mandl Ward in which the occupation took place.‟275 The campaign planned to mobilise the entire community to forcefully but peacefully stop the removal of beds from the ward and the campaign was supported by all sections of the community, „Among offers of support to the Save Our Hospital Committee is one from the Catholic Church to ring the church bells should the West Coast Hospital Board attempt to empty out the ward, said committee chairman, and Hokitika Mayor, Mr Henry Pierson, today.‟276 An agreement was made at the end of August that secured the future of geriatric care at Hokitika Hospital and bed numbers.277 Westland Hospital was again slated for closure in late 1988.278 In September 1988 the West Coast Hospital Board voted to close Reefton and Hokitika Hospitals. At both hospitals sit-ins were immediately begun and plans for community-wide mobilisations to stop beds being removed were made.279 At Hokitika church bells would mobilise the community while in „Reefton protesters plan to use three blasts on a fire siren to summon the whole town if any moves are taken to move patients from the hospital. A protest spokesman, Rae Armstrong, said: “The sirens will attract the whole population to physically prevent any patients being

272 273

Peter Neame, Save Our Hospital; Hokitika fights back, Greymouth, 1987, p.65. Ibid., p.88. 274 Ibid., p.81. 275 Ibid., 1987, p.81. 276 Ibid., 1987, p.87. 277 Ibid., p.153. 278 People‟s Voice, 5 December 1988, p.15. 279 People‟s Voice, 10 October 1988, p.6.

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moved out. If the prosecute us they will have to jail the whole town.”‟280 Five hundred people led by coalminers and loggers in work gear marched in Greymouth on the day the Hospital Board voted for the closures.281 A banner read, „Reefton miners won‟t dig this closure‟.282 As a result of protests by April 1989 the People‟s Voice could report that Hokitika and Reefton hospitals had been saved from closure, The “Save Our Hospital” committee organised a well attended rally at the Hospital Board offices in Greymouth to put pressure on the Board to reverse its decision. Hokitika people, who were also fighting for their hospital, joined in. As a further demonstration of their resolve, almost the whole population of the Reefton district turned out in pouring rain to hold hands around their hospital. Faced with the mobilisation of the whole district to save their hospital the government was forced to back down. Reefton still has its hospital and remains on alert against any further attempts to take it away.283 The end result of the battles over hospital closures on the West Coast came in 1994 „when a list of 17 endangered hospitals was published in May, and Hokitika was on it, no one protested – Hokitika had been so thoroughly dismembered there was virtually nothing left.‟284 Westland Hospital was closed in 1994.285 Reefton was also on the list of endangered hospitals but the community was prepared for another battle as Jimmy Foster, a local miner involved in the 1988-89 campaign, told the Listener, „We showed there‟s a choice. You can fight them off. I don‟t think we‟re under any near threat. But no one believes anything anyone says these days. Things have changed. If people want to keep these things, they‟re going to have to fight.‟286 However Reefton was not proposed again for closure and Reefton Hospital remains open at the time of writing.287 On 21 March 1989 the Helen Clark Minister of Health in the fourth Labour Government suspended the Auckland Area Health Board and replaced it with an appointed Commissioner,

280 281

Ibid., p.6. People‟s Voice, 10 October 1988, p.7. 282 People‟s Voice, 10 October 1988, p.6. 283 People‟s Voice, 3 April 1989, pp.5-6. 284 Bruce Ansley, „Reefton: a town enraged‟, Listener, 9 July 1994, pp.23-24. 285 Ibid. 286 Ibid. 287 West Coast District Health Board, Reefton Health Services, online, nd, available at: http://www.westcoastdhb.org.nz/services/buller/reefton_health_services/default.asp (8 November 2012)

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Harold Titter to cut costs. 288 The Area Health Board had projected it would overspend its budget that financial year by 3.8% or $23 million.289 This was only the second time a hospital board had ever been suspended by a Minister.290 The severity of the sacking may also have been to send a message across the country to „Hospital and area health boards face[ing] further funding cutbacks totalling $56 million as a result of the Government‟s decision not to compensate them for inflation.‟291 By acting harshly in Auckland the Government was showing its new fiscal ruthlessness in the public service. Juliet Ashton, the Herald‟s health reporter between 1985 and 1987, her comment the day after the suspension was that, noted that the hospital board‟s population-based funding grew rapidly after 1982 but when population growth began to slow in 1987 and funding was frozen the ability of the board to work within its budget unravelled.292 Compounding this were three political scandals which undermined public confidence in the board. „Meanwhile against this leaner, bleaker background three major crises were beginning to unfold – the Cartwright inquiry, the Mason inquiry and the Whare Paia saga.‟293 On the 17th of May 1989 Titter unveiled to the public a plan to cut the $46 million budget deficit on what the Herald dubbed „The Day of the Scalpel‟.294 The original plan was for four maternity hospitals to be closed outright; St Helens, Pukekohe, Helensville and Howick.295 Carrington psychiatric hospital would also close and the region‟s other hospitals would see deep cuts, especially to geriatric long stay units; Auckland, Green Lane, Middlemore, North Shore, Waitakere and National Women‟s Hospital. 296 The public backlash began immediately in the media as Area Health Board staff and the public began organising to fight the cuts. One of those hospitals Titter planned to close was the St Helens maternity hospital in Mt Albert. It was here that the most high-profile but ultimately unsuccessful campaign was waged. Gabrielle Bourke in her MA thesis on St Helens details the beginning of the campaign,

288 289

NZH, 22 March 1989, p.3. Ibid. 290 Ibid. 291 NZH, 22 March 1989, p.2. 292 NZH, 22 March 1989, p.3. 293 Ibid. 294 NZH, 18 May 1989, p.1. 295 Ibid. 296 Ibid.

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The „Save St Helen‟s Committee‟ was formed within ten days of Titter‟s announcement, headed by Ann Clark, with former St Helens midwife Laura Hatfield as its secretary. St Helens social worker and activist Maire Leadbeater was its spokesperson; „I remember hearing about it going to be closed and feeling shocked. And I thought, “I‟ve got to try and stop that!” It was just a crime to lose something that worked so well, that served the needs of the community.‟297 Maire Leadbeater recalled the scope of the community campaign against the closure, When I got involved I found it a very interesting campaign to be involved in because it brought together so many different areas of activism and so many different kinds of people. There were the many mothers. Just mothers who had had a good experience at St Helens and wanted to have the facility preserved for their future babies or their sisters having babies. Just thought it was a really worthwhile place and had a warm attachment to it. There were the staff; the staff were quite a big component of the campaign actually. Sometimes they had to be a little bit careful or thought they had to be a little careful about their involvement. But they were definitely backing us, almost all of them I believe. The unions gave good strong support, the specific campaigns that were going at that stage against the closure of hospitals. Political groups, the range of the left-wing political groups all got involved.298 Through the winter months of 1989 the Save St Helens campaign used a variety of tactics to mobilise the opposition to the closure. In June a public meeting was organised and the Star reported „Mothers fighting the planned closure of St Helens Hospital have invited Health Minister and local MP Helen Clark to their public meeting on Sunday.‟299 The meeting included speakers from the nurses‟ unions and Neil Hefford, secretary of the nationwide lobby group Community Health Coalition.300 The response from Clark in the media to the meeting was to draw attention to Leadbeater‟s involvement in the New Labour Party, „The minister who did not attend the meeting, held in Grey Lynn on Sunday, said the chairwoman

297

Gabrielle Bourke, „Mothers and midwives: Auckland‟s St Helens Hospital, 1906 -1990‟, MA thesis, Auckland University, 2006. 298 Maire Leadbeater interviewed by Omar Hamed, 8 March 2012, Disc 1. 299 Auckland Star, 9 June 1989, p.5. 300 Ibid.

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introduced herself as an executive members of the New Labour Party and “then proceeded to describe that party‟s health policy”.‟301 On July 16 150 people marched to the hospital „where protesters delivered to staff a copy of their pledge to fight for the continuation of services.‟302 On 20 August „Hymns and flickering candles lit up the hopes of more than 100 people gathered in a vigil outside St Helens Hospital last night to protest against its closure. Staff and patients joined in the candlelit vigil with torches shining from every window. Those inside leaned out to listen to blessings given by the Rev John Markham, of St Columba Church in Grey Lynn, and Rev Leao Siitia, of the Samoan Presbyterian Church in Avondale.‟303 On 6 October „200 people took part in a march down Queen Street‟.304 On 30 October the Herald reported, „Save St Helens campaigners handed a 14,000 signature petition to the Minister of Health, Helen Clark, on Saturday in an effort to stop the maternity hospital from closing.‟305 In November 1989 the 26,000 member Northern Hotel and Hospital Workers Union, lent their support to the campaign, even going so far as to write to Helen Clark threatening „industrial action would be taken if necessary and the union would develop whatever political protest possible with other community groups.‟306 Even the deputy leader of the National Party, Don McKinnon, lent his support to the campaign.307 However the campaign was unsuccessful in stopping the closure and St Helens last day open was 15 June 1990.308 Although the Save St Helens campaign did not succeed other community campaigns against Titter‟s cuts did. In two semi-rural communities on Auckland‟s margins, Pukekohe and Helensville, mobilisations helped stop their local hospitals from being closed down and the small Howick Maternity Hospital and Franklin Memorial Hospital were also saved from closure. Just eleven days after Titter‟s cutbacks were announced in south Auckland, About 1400 people crowded into the Pukekohe Town Hall yesterday and voted unanimously to oppose the closure of their hospital and the Franklin Memorial Hospital in Waiuku. The town hall was not big enough to hold them all and the audience spilled out on to the grass outside during the meeting, said to be Pukekohe‟s
301 302

NZH, 13 June 1989, p.3. NZH, 17 July 1989, p.5. 303 NZH, 21 August 1989, p.2. 304 Bourke, p.211. 305 NZH, 30 October 1989, p.3. 306 Auckland Star, 15 November 1989, p.2. 307 Ibid. 308 Bourke, p.216.

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largest turnout since Selwyn Toogood took his quiz show to the town about 20 years ago. The plan to close the hospitals as part of Auckland Area Health Board budget restraints also prompted the meeting to establish an action committee to fight the closures. It is possible the town will mount a campaign similar to those conducted in Reefton and Hokitika, where communities staged sit-ins in hospitals to try and save them from closure because of cost cutting.309 On 6 September the decision to close the Pukekohe and Franklin hospitals was reversed by the Auckland Area Health Board, although some services were still cut and the Board hoped to find private operators for both hospitals. 310 In February 1990 the Board backed away from privatisation and the Herald reported the victory of the community campaign, The Auckland Area Health Board has withdrawn the surgical knife yet again on costcutting closures with the announcement yesterday that it would keep Pukekohe and Franklin Hospitals under board management... ”This is a victory of commonsense,” the chairman of the local action committee, Mr Peter Aitken, said yesterday.... Mr Aitken said a review committee, made up of the action committee, staff, unions and board management, had shown the two hospitals could make savings and keep all the existing services running.311 St Helens was closed but two obstetrics hospitals were kept open by opposition in what can be seen as partial victories for small communities. In Helensville on Auckland‟s northwest fringe a community committee „had earlier resolved not to accept the loss of obstetric services‟ and proposed a community trust taking over the management of the hospital.312 By 14 June this committee as confident that it could negotiate with Titter to save the hospital, „”I believe our negotiations will lead us to salvage Helensville Hospital,” said the committee chairman, Mrs Alison McKenzie, last night.‟313 In August 1989 the Health Board decided not to close the Howick Maternity Hospital in Auckland‟s south-east but to keep it „open on a private basis operated by a community trust headed by the Mayor, Mr Morrin Cooper‟ and to

309 310

NZH, 29 May 1989, p.4. NZH, 7 September 1989, p.1. 311 NZH, 3 February 1990, p.3. 312 NZH, 14 June 1989, p.2. 313 Ibid.

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move to manage Helensville hospital as a „community health centre on a partnership basis between the board and a newly formed community trust.‟314 During winter 1990 a newly elected Auckland Area Health Board proposed the closure of the specialist Otara Spinal Unit was reversed after an outcry from patients. A prominent, front page, New Zealand Herald article reporting a public meeting of 200 people on 26 July to discuss the closure of a unit opened in 1977 and catering for between 60-70 patients annually was headlined, „We are pawns say patients‟.315 Less than a month later, on 17 August, the Auckland Area Health Board announced it would not close the unit.316 Board chairperson Gary Taylor in announcing his decision admitted the role of public outcry in making the decision, „I received 150 letters from members of the public. It is beyond doubt that it was an influence.‟317A petition of 40,000 Aucklanders was collected in support of the unit and a protest march on Queen Street had been planned along with a wheelchair relay from Otara to deliver the petition to the board‟s central Auckland office.318 Canterbury Area Health Board on 27 February 1991 met and considered a proposal to close Christchurch Women‟s Hospital and transfer the services to Princess Margaret Hospital in southern Christchurch to save $1.7million a year.319 The board decided to evaluate this proposal, consult with affected groups and the community and „After much debate, board members also endorsed the principle that it was essential to reduce the number of institutions in Christchurch.‟320 The only dissenting voice on the board was Dr Jocelyn Hay who said the closure of Christchurch Women‟s would „generate an enormous amount of ill feeling‟.321 The proposed closure was opposed by the Canterbury Obstetrical and Gynaecological Society because it would lead to a fragmentation of services for women and their babies and waiting lists for surgery would increase as gynaecological surgery banked up at Princess Margaret‟s theatres.322 When a protest meeting, chaired by MP for Sydenham and Leader of NewLabour Jim Anderton, was held on 14 July 1991, 2000 „angry‟ people filled the Christchurch Town

314 315

NZH, 17 August 1989, p.2. NZH, 27 July 1990, p.1. 316 Auckland Star, 17 August 1990, p.1. 317 Ibid. 318 NZH, 18 August 1990, p.20. 319 Press, 28 February 1991, p.5. 320 Ibid. 321 Ibid. 322 Press, 15 February 1991, p.5.

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Hall.323 The acting Chairman of the Health Board, June Gardiner got up to speak, „At times she could hardly be heard amid calls for the board‟s resignation and for Canterbury‟s health services to be retained.‟ 324 After the meeting, 1000 people marched to Christchurch Women‟s Hospital where they formed a human chain around the building.325 The protesters included staff, city councillors, Maori community workers and many families who had used the hospital over the years, A young couple, Mr Greg and Mrs Claire Milne, linked hands with their three daughters as part of the chain. Mr Milne carried their 20-month-old son in a backpack. “Three of my four children were born here, and our son was rushed from Burwood Hospital to the neo-natal unit here, where he stayed for 10 days. I‟d hate to think what might have happened if he had had to be rushed to Princess Margaret Hospital,” Mrs Mile said.326 A reprieve came for Christchurch Women‟s on 4 September 1991 when Brian Stokes, the Canterbury Health Commissioner, announced no closure of the hospital should be made by the health board, and the decision was best left to the National Interim Provider Board which would take over the management of services after the Health Boards ceased existing on 1 July 1993.327 The corporatisation of Health Boards into CHEs had been announced in the 1991 budget.328 But the decision, according to Stokes, was also because of the „strong community preference‟ for keeping the hospital open.329 Stokes‟ September decision not to close the hospital overruled a plan made by the health board in August which planed to close the hospital in March 1992.330 Keeping Christchurch Women‟s open was certainly justified by its utility. In September 1992, Christchurch Women‟s Hospital‟s neonatal unit was so overworked that mothers with prematurely born babies had to be transferred to hospitals in Auckland, Hamilton, Wellington and Dunedin.331 The Area Health Board could not afford to

323 324

Press, 15 July 1991, p.1. Ibid. 325 Press, 15 July 1991, p.1. 326 Ibid. 327 Press, 5 September 1991, p.1. 328 Ibid. 329 Ibid. 330 Press, 4 September 1991, p.6. 331 Dominion, 3 September 1992, p.9.

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add extra capacity to the unit as the board‟s manager told NZPA, „Added capacity requires capital expenditure and staff numbers and we just don‟t have the dollars at the moment.‟332 People in Wellington and the Wairarapa in 1991 also mobilised successfully to prevent cuts to Hutt Hospital and the closure of Masterton and Greytown hospitals (Greytown Hospital was eventually closed in 1997) when it was floated as a solution to a significant budget overspend by the Wellington area health board.333 On 22 January 1991 16,000 protesters surrounded Masterton Hospital and 6000 surrounded Greytown Hospital.334 Two thousand Wairarapa residents went to Wellington by train in February to protest on the steps of Parliament and presented a petition of 22,332 signatures calling for the hospitals to remain open. 335 Mr [Garry] Daniell, then a district councillor, started publishing the idea of a "Hands Around the Hospital" protest in his Mitre 10 newsletter. Mr [George] Groombridge said it was "an amazing sight to see", watching the streets fill with people as they travelled from as far away as Ngawi and Castlepoint.336 On 12 October 1998 when Health Minister Bill English visited Masterton during a time of proposed cuts to the hospital, „...several hundred protesters lined the driveway of the hotel where he was to speak and, shouting anti-hospital- closure slogans, rushed the car he and Deputy Prime Minister and Wairarapa MP Wyatt Creech were in.‟337 In Masterton in 1998, „Opponents to cuts at Masterton Hospital are considering mounting a legal challenge to stop them. The Alliance‟s Wairarapa candidate said the only hope for Masterton Hospital was an injunction to stop Wairarapa Health going ahead with cuts to services.‟338 On a cold Sunday morning in July 1991 a protest of 20,000 Hutt Valley residents, „helped to avert the decimation or worse of Hutt Hospital Services, and influenced the decision to establish the Hutt Valley Health as a separate enterprise.‟339 The Communist Party noted the protest was the biggest in the Hutt‟s history, and completely rejected „Wellington health

332 333

Ibid. Gerald Ford, Fight for hospitals recalled, online, 23 February 2012, available at: http://www.timesage.co.nz/news/fight-for-hospitals-recalled/1282250/ (Accessed 1 May 2012). 334 Ibid. 335 Ibid. 336 Ibid. 337 Dominion, 13 October 1998, p.3. 338 Dominion, 11 November 1998, p.10. 339 Joint Methodist Presbyterian Public Questions Committee, Wellington, Health Services Reform in Aotearoa; A Christian Perspective, Wellington, 1999, p.15.

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board plans to downgrade the busy general hospital in favour of one major hospital for the region, probably sited in Wellington and a number of 30-bed “community health bases”.‟340 Another hospital saved from closure was Rotorua‟s public hospital for arthritis sufferers – Queen Elizabeth Hospital. In 1991 a thousand people attended a protest rally to stop the local health board closing the spa facilities.341 In 1992 the facilities at Queen Elizabeth Hospital passed into the control of a publicly funded community trust; Bay of Plenty president of the Arthritis Foundation said the retention demonstrates „the perhaps surprising political power of protest. It shows that the outrage of people can change things‟.342 Against the CHEs and RHAs, 1994-1997 Between 1994 and 1997 successful campaigns in Canterbury stopped the closure of four hospitals in 1994 and Ashburton from losing surgical services in 1995. The hospitals saved from closure, Darfield, Ellesmere, Lincoln Maternity and Rangiora hospitals remained open in 2013.343 Kaitaia‟s community mobilised successfully against the possible closure loss of medical and surgical services in 1995. The institutional context in which these struggles occurred was the implementation of National‟s health reforms and the beginnings of the RHA/CHE structure. This institutional context was significantly affected by the financial non-viability of CHE‟s between 1993 and 1998. This financial crisis for CHEs, which the reforms aimed to turn into government-owned companies operating at a profit, was severe. For the three years of the CHEs operation to 1996 they had made nearly a $200 million loss each year. 344 It was in this context that CHE‟s made decisions to cut services, and close or downgrade hospitals. RHA‟s in choosing which CHE services to fund, were also under pressure to rationalise services and close hospitals. As Brian Easton explains how the commercial pressures which forced CHEs to cut costs on the funding side were, „exacerbated by the government cutting the public funding on health relative to gross domestic product (GDP) from 1991/2 to 1995/6‟.345 Easton explains that in the years after 1992 health spending as a proportion of GDP increased across the OECD on average, except in New Zealand where

340 341

People‟s Voice, 15 July 1991, pp.1-3. Catherine Watson, „Determination saves spa and dismisses ill advice‟, New Zealand Doctor, 17 September 1992, p.7. 342 Ibid. 343 Canterbury District Health Board, Facilities, online, available at: http://www.cdhb.govt.nz/facilities/hospitals.htm 344 Brian Easton, The Whimpering of the State; Policy After MMP, Auckland, 1999, p.131. 345 http://www.eastonbh.ac.nz/?p=35

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it declined.346 The gap between where New Zealand‟s health spending was and where it should have been based on 1991 trends was „around $2.3 billion for the last six years [to 1999], almost six months of the health vote, equivalent to closing down the entire public health system one month every year.‟347 On 1 July 1994 the Southern Regional Health Authority released a document proposing massive cuts to hospital services across the region especially in rural areas.348 This „watershed document‟ proposed for the first time that Canterbury‟s hospital services be organised based on travelling times of populations to health services rather than on the wishes or needs of the community.349 Lincoln Maternity and Rangiora hospitals, two rural hospitals near Christchurch, faced losing their maternity services and closure as they were deemed more expensive than those at Christchurch Women‟s Hospital.350 Two other small Canterbury hospitals, Darfield and Ellesmere, were also threatened with closure in July 1994 and these hospital closures became the main issue in the Selwyn by-election held on August 13 and triggered by the resignation of local MP Ruth Richardson.351 Both Labour and the Alliance campaigned on the issue promising not to close hospitals and to return decisions about health services to community control during a by-election which threatened National‟s one seat majority in Parliament.352 Jim Bolger said he would call a snap general election if National lost the Selwyn by-election.353 Peter Stott, a retired farmer living in the electorate told the SST he saw the by-election as „”lever” which should be used to push the Government to retain the hospital‟s services.‟354 Seven hundred people took part in a march against hospital closures on 24 July ending at the Lincoln Maternity Hospital.355 The march was organised by the group, Friends of Lincoln Hospital, and was addressed by Jim Anderton, local doctors, an NZNO official and the chief executive of the local CHE, Paul Wylie, who said, „We intend to do what we have said all along – to work with the staff, the people who use the hospital, and the Friends of the hospital. Hopefully we will work out something so there is some choice (for women) and it
346 347

Brian Easton, The Whimpering of the State; Policy After MMP,p.139. Ibid. 348 NZH, 4 July 1994, p.10. 349 Rebecca Orr, „Rural Hospitals: The Politics of Institutional Change in the Health Sector‟, MA Thesis, University of Canterbury, 1997, p.124. 350 Press, 1 September 1994, p.1. 351 SST, 17 July 1994, p.1. 352 Ibid., p.1. 353 SST, 17 July 1994, p.4. 354 SST, 17 July 1994, p.4. 355 Press, 25 July 1994, p.3.

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will continue.‟356 The same day as the march was happening, Jim Bolger addressed the opening rally of the National Party candidates Selwyn by-election campaign with a call for Lincoln not to be closed, “It would seem logical that the Regional Health Authority and the local Crown health enterprise should be able to find a way ...to retain that facility.‟357 However Bolger describes keeping Darfield open as „more difficult‟.358. On the 31 August 1994 the CHE responsible for Lincoln and Rangiora hospitals, Healthlink South, announced it would not close the two hospitals or remove their maternity services.359 In announcing the decision, the CHE‟s obstetric services manager, Mary Sawers, said „the CHE had been “very impressed” with the community support in both Lincoln and Rangiora and the commitment of healthcare providers to actively support the services at Lincoln and Rangiora hospitals.‟360 Canterbury Health, the CHE responsible for Darfield and Ellesmere hospitals also agreed to continue services at the two rural hospital sites. In Darfield, a subcommittee was formed to bring the Canterbury Health and the SRHA together to discuss options for keeping the hospital open.361 The sub-committee was initiated by „a small group of older women in conjunction with the principal nurse of the hospital who were all members of the district health committee‟ and included local councillors, the mayor, local GPs, the principal nurse of the hospital, representatives from Federated Farmers, CHE and RHA representatives, and Ruth Richardson, National‟s former Minister of Finance.362 Although this committee made progress when by mid-1995 no funding contract had been agreed Canterbury Health announced its decision to close the hospitals.363 This prompted the intervention of central government to help negotiate a contract which kept the Darfield and Ellesmere hospitals open and operated by Canterbury Health.364 Rebecca Orr in her MA thesis argued the situation showed the weakness of the RHAs because, „political pressure that can be generated by negative publicity over rural hospital closure. The mobilisation of the Darfield community was crucial to this pressure, because it armed the CHE with an entirely credible threat.‟365

356 357

Ibid. Press, 25 July 1994, p.3. 358 Ibid. 359 Press, 1 September 1994, p.1. 360 Ibid. 361 Orr, p.144. 362 Ibid., p.145. 363 Ibid., p.153. 364 Ibid., p.154. 365 Ibid., p.155.

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One of the most vigorous and successful campaigns against cuts to health services was between 1994 and 1995 in the Canterbury town of Ashburton, where residents, local councillors and hospital staff from amongst the nearly 25,000 people living in the town and surrounding district formed a Hospital Support Group to campaign against the Southern Regional Health Authority (SRHA) plan to remove specialist medical and surgical care. 366 As the Sunday Star-Times described it, Elsewhere, similar protests ultimately foundered against intransigent health cuts in rural areas. But in Ashburton, a persistent, imaginative, people-powered fight galvanised the community. Its success – in May the SRHA backtracked by agreeing to stake Ashburton health services at comparable levels for the next three years – was a rare triumph against what seems an inevitable march towards centralising hospitals.367 The campaign to save Ashburton hospital began in July 1994 when cuts to surgical services were proposed by SRHA. The community responded in two ways. Firstly, by organising a sustained protest campaign in Ashburton to mobilise residents. Secondly, community residents and hospital staff systematically refuted the SRHA‟s arguments for the removing of inpatient surgery during consultation.368 The protest campaign began on 12 July when the author of the SRHA document proposing cuts came to Ashburton, „About 300 vocal picketers braved the cold in Ashburton to vent their anger over proposed cuts to surgical and medical services at Ashburton.‟369 On 15 July a 30 person protest delegation met Health Minister and local MP Jenny Shipley to plea for the future of Ashburton Hospital. 370 On August 10, „Emotions ran high yesterday when almost 4000 Ashburton people filled the town‟s streets to protest about proposed cuts to medical and surgical services at Ashburton Hospital. Waving banners and holding red heart-shaped balloons, people from all walks of life and of all ages marched along the town‟s main street.‟371 The protest included, „About 50 Ashburton RSA members marched, many wearing service medals.‟372 One of the veterans, „Dr Baker who wore his service medals, told the crowd the RSA had asked members to wear their medals because it believed it was defending true democracy by supporting the hospital. He had only
366 367

SST, 3 September 1995, p.5. SST, 3 September 1995, p.5. 368 Stephanie Prosser, Ross Barnett and Pauline Barnett, „Case Study 7.2 Downgrading rural hospitals: Ashburton, Mid Canterbury‟, in Richard Le Heron and Eric Pawson, eds., Changing Places: New Zealand in the Nineties, Auckland, 1996, pp.224-225. 369 Press, 13 July 1994, p.4. 370 Press, 16 July 1994, p.5. 371 Press, 11 August 1994, p.4. 372 ODT, 11 August 1994, p.3.

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ever worn his medals on Anzac Day.‟373 In September 300 protesters presented Jenny Shipley with an 11,700 signature petition against any cuts to health services.374 On October 25, 8000 people marched in Ashburton against health cuts as part of a Grey Power coordinated day of action that saw 23 protests across the country.375 In December, „Ashburton residents came out in force yesterday for the town‟s third show of strength against health changes. More than 3000 people turned out for the Hands around Our Hospital rally and formed a human chain around the hospital they are fighting to retain.‟376 In April 1995 Ashburtonites even wrote to the Queen, “We just don‟t seem to be getting anywhere, so last week we wrote to the Queen saying we were concerned about the way health policy was being manoeuvred, and that the Government was just not listening to the people."377 Residents also worked hard to counter the SRHA‟s arguments for cuts. The SRHA argued that Ashburton hospital because served a catchment area of only 24 7000 people (under the 25,000 threshold SRHA had set for future funding of specialist surgical services), was within ninety minutes travel time of surgical hospitals in Christchurch and Timaru and alleged that medical services in smaller hospital are more expensive and less safe than those performed in larger hospitals.378 In response, the community argued before a consultative committee, (established as a requirement of the Health and Disability Services Act), that the surgical services at Ashburton could be used to reduce waiting lists across the Canterbury region, Ashburton‟s population swelled over 25,000 during the holidays, local GPs were untrained to do emergency stabilisations surgeons did and that there was no evidence showing smaller hospitals were less efficient or less safe than larger hospitals.379 „When asked through the consultative committee to provide evidence to support [their] contentions, the SRHA was unable to do so in the absence of reliable data.‟380 The protests and counter-arguments proved persuasive. In May 1995 the SRHA announced that there would be no cuts to surgical services at Ashburton but called for the hospital to trim its annual budget by $2 million.381 In

373 374

Ibid. Press, 9 September 1994, p.2. 375 Press, 26 October 1994, p.1. 376 Dominion, 12 December 1994, p.9. 377 Dominion, 4 April 1995, p.1. 378 Stephanie Prosser, Ross Barnett and Pauline Barnett,p.225. 379 Ibid. 380 Ibid. 381 Dominion, 9 May 1995, p.11.

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2012 Ashburton hospital continued to provide a wide range of surgical services to Cantabrians despite earthquake damage to the operating theatre. 382 Kaitaia Hospital in the far north had been threatened with cuts since the early 1980s. In 1981 the nursing school in the hospital had been closed despite nurses marching in Kaitaia and striking against the cuts.383 In 1986 hospital staff throughout Northland struck against the contracting out of hospital catering.384 In 1989 the community mobilised against budget cuts of $300,000 at the Hospital and there was „standing room only in the main auditorium of the Far North Community Centre as speaker after speaker condemned the cutting of services and reductions in staff.‟385 In the early 1990s there was ongoing speculation and debate over the downgrading of medical and surgical services in Kaitaia and centralisation at Whangarei. 386 Throughout 1994 Northern Regional Health Authority (NRHA) officials refused to assure continuity of 24-hour surgical services at Kaitaia.387 In late1994, the NRHA announced it was considering options for health services in Northland, including downgrading Kaitaia Hospital to a „superclinic‟ and removing in-patient surgical services and specialist medical and child health services.388 Around 400 „angry‟ residents gathered in December to consider their options to influence Northland Health‟s final decision in March 1995.389 On 9 February 1995 most businesses closed for the day and a march of at least 7000 flooded Kaitaia‟s main street behind a „Save Our Hospital‟ banner.390 The march, estimated by the NZH to be equal to three-quarters of Kaitaia‟s population, was supported by „Maori and Pakeha, old and young, children in school uniform and elderly returned servicemen, older women in bowling dress and younger women in shorts‟ as well as local National MP John Carter and Labour‟s Maori vice-president, Dover Samuels.391 The protest had both national and local implications. The large march, the work of a 35-strong action group, turned the issue of rural hospital downgrades into a national issue and three days after the protest Minister of Health Jenny Shipley „backed away from her previous hard line advocacy of downgrading and closing
382

Angus McKay, Hospital: Mayor Calls for Calm Heads, online, 10 February 2012, available at: http://www.ashburtondc.govt.nz/NR/rdonlyres/ECAD6F58-A439-4F95-B1A66AC7147913D0/80901/MSAshburtonHospital120211.pdf 383 Keith Parker, Kaitaia‟s Hospital; A glimpse at hospital services and volunteer health care in the Far North, Kamo, 2005, p.88. 384 Ibid., p.89. 385 Ibid., p.91. 386 Ibid., p.104. 387 Ibid., p.105. 388 NZH, 21 December 1994, p.19. 389 Ibid. 390 Parker, p.105. 391 NZH, 10 February 1995, p.1.

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rural hospitals. She told a medical conference in Whakatane that rural hospitals would continue to be important‟.392 As Socialist Worker reported it, „The sheer scale of the Kaitaia demonstrations, following on from similar protests in other small towns, has forced the government to back pedal a little.‟393 Annette King, Labour MP and Health Minister in the fifth Labour Government described the protest, The symbolism of that march reverberated around the country, and it had an immense impact on health professionals and planners and, of course, on politicians. It certainly was one of the events that convinced me that hospitals could not just be seen as bricks and mortar; they represent security and comfort to small communities and if you threaten these hospitals or take them away, then you are also threatening or taking away the very soul of those communities.394 The march also had a significant effect on the retention of Kaitaia‟s health services. NRHA general manager of client relations and leader of NRHA‟s review of health services, Shenagh Gleisner, told the march, „North Health could not fail to be affected by the extent of community support up here.‟ On 24 March the Herald reported the decision of NRHA that Kaitaia‟s hospital would not be closed and its 24-hour surgical services would be retained.395 The protest campaign had prevented the closure of Kaitaia hospital. However the fifth Labour Government in 2002, after an independent review by clinicians established there was no longer a need for 24-hour surgical services reduced surgical cover to normal working hours.396 Unsuccessful campaigns, 1989-1997 In Gore, Bay of Islands, Dargaville, Balclutha and Oamaru significant campaigns against cuts to surgical services were mounted and in Napier the local community fought to retain their hospital. However these campaigns were all unsuccessful. The effect of losing these campaigns was that by the end of the health reforms in 2000 Gore, Dargaville, Balclutha, Oamaru and Napier hospitals had all been closed down and replaced health centres, most run by community trusts.
392 393

Socialist Worker, 27 February 1995, p.14. Socialist Worker, 27 February 1995, p.14. 394 Annette King, Opening of redeveloped Kaitaia Hospital, online, 4 December 2007, available at: http://www.beehive.govt.nz/node/31558 395 NZH, 24 March 1995, p.1. 396 Health Committee, 2001/02 Financial review of Northland District Health Board, online, 2002, available at: http://www.parliament.nz/NR/rdonlyres/FD0373FD-6C9E-45D9-905729BD33180065/13714/DBSCH_SCR_2382_2696.pdf

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In the Southland town of Gore in 1989, the community mobilised to stop cuts to Gore‟s Seddon Memorial Hospital services. The Southland Area Health Board, faced with having to make budget cuts of $4.2 million wanted to end surgical services, laboratory and sterile supply services at Seddon Memorial and reduce the accident and emergency, X-ray, physiotherapy and occupational therapy services.397 Gore‟s community fight against the cuts saw a July 1989 protest rally of 5000 outside the Hospital, an 8000 signature petition collected by the Lions Club, and the formation of a local committee which raised $60,000 and „employed a fulltime co-ordinator and engaged an accounting firm to do a detailed analysis of hospital running costs.‟398 The community mounted a spirited and imaginative defence, Sergeant Dan, the mascot on the Flemings Cremota factory, wore a sling on his arm and a sign saying: “Please don‟t send me to Kew”, a reference to the hundreds facing trips to hospital in the Invercargill suburb if services at Gore are pruned. Save-the-hospital songs were composed, including one by country and western singer Dusty Spittal. The radio station played a version of the Dad‟s Army song called “Who do you think you are kidding, Mr Blaikie?”, a dig at area health board chairman Lance Blaikie. Less than five weeks after it began work, the liaison committee completed a 273-page submission outlining the impact of the board‟s proposals.399 Southland‟s medical profession was divided over the Health Board‟s cuts to Gore Hospital; thirty doctors at Southland Hospital fundraised to hire a PR consultant to „boost the image of the region‟s base hospital‟; a move described by the Dominion Sunday Times as „Infighting over which hospitals should bear the brunt of budget cuts‟.400 In spite of the protests the 1989 cuts by Southland Area Health Board to Gore services went ahead and the community campaign was forced to seek a judicial review of the decision in 1990.401 Despite strong community opposition through the 1990s Gore Hospital services were steadily shrunk. In May 1995, Southern Health announced it would replace Seddon Memorial

397 398

Dominion Sunday Times, 27 August 1989, p.5. Ibid. 399 Ibid. 400 Ibid., p.5. 401 ODT, 2 December 1989, p.14.

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Hospital with a new hospital building.402 However despite plans having been made up for the new hospital Southern Health announces in September 1997 that to reduce its $15 million deficit as a result of a $9 million funding drop it will end health services in Gore and the Gore District Council sets up a community trust to take over the running of health services in the area.403 Gore‟s former-Mayor Ian Tulloch saw the logic of the withdrawal of services thus, „If this Treasury-type thinking is allowed to continue unchecked in Gore and a health trust is formed with no guarantees from the Government, then it is only a matter of time before it fails.‟404 Two small rural communities in Northland mounted strong campaigns in defence of surgical services being retained in their hospitals. Northland Health cut surgical services except outpatient surgery at Dargaville and Bay of Islands hospitals in 1994 despite protests from the towns. At the time Northland Health was renegotiating its funding contract with the Northern RHA and attempting to write off some of its $23 million in debt to Treasury. 405 In June 1994 the Bay Hospital Action Group, laid a complaint to the Ombudsman, in response to Northland Health‟s proposal to reduce surgical services to outpatient services at the Bay of Islands Hospital in Kawakawa.406 Dr David Jennings, chair of the Action Group, said, „Consultation should be a reality, not a charade‟.407 On 11 August, led by a vintage steam locomotive, 600 people marched in Kawakawa against cuts to surgery and at a public meeting that evening 200 people „unanimously supported the formation of a trust‟ to run the community hospital.408 Jennings in May 1994 had told the Herald, „If it comes to it and they bring in the bulldozers there will be a flying squad of wheelchairs with me at the head. [...] We expect to see a lot of action here –people are very angry. [...] We won‟t give them any warning.‟409 In Dargaville people were outraged by the decision of the CHE and mounted a vigorous opposition to the removal of the surgical equipment from the hospital. In March, 1300 people attended a meeting at Dargaville Town Hall and a committee to campaign against the cuts was reactivated by Peter Brown, Mayor of Kaipara who saw the surgical cuts as possibly

402 403

Southland Times( ST), 20 September 1997, p.1. Ibid. 404 ST, 29 September 1997, p.8. 405 NZH, 5 September 1994, p.4. 406 „NZH, 3 June 1994, p.5. 407 Ibid. 408 NZH, 12 August 1994, p.3. 409 NZH, 30 May 1994, p.1.

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marking the beginning of the end for the small hospital.410 Although inpatient surgery ended in mid-1994, on 2 September 1994 the NZH reported that people in Kaipara had announced plans to blockade Northland Health‟s planned removal of surgical equipment. 411 Peter Brown said, „They are trying to get the equipment out of here to make it too difficult for us to reopen the full hospital. But they are just not going to get that equipment.‟412 Three days later, on 5 September, the NZH reported, Northland Health has postponed plans to move surgical equipment from Whangarei to Dargaville in the face of a threatened blockade. Last Friday a spokesman for the crown health enterprise, Mr Charles Martin, said the theatre equipment would be moved to Whangarei today. If necessary the police would be asked to assist the health body in “legally going about its business”. In a statement released yesterday, however, Mr Martin said the move would not take place, pending a meeting on Friday between the enterprise, the Auckland-based regional health authority and community health groups from Dargaville and Kawakawa. [...] [Kaipara Mayor Peter Brown] believed the crown health enterprise had backed down in the face of threats by Dargaville people to stage a sit-in at the hospital if attempts were made to remove the equipment.413 At the same time as the inpatient surgical services were transferred away from Dargaville and the Bay of Islands to Whangarei‟s base hospital, it was experiencing a „crisis point‟ shortage of nursing staff.414 Kaipara Mayor Peter Brown told the NZH in response to the cuts to surgical services, the community was exploring the possibility of a community trust contracted the RHA to run the hospital.415 By the end of 1994 surgical services except outpatient surgery ended at Bay of Island‟s Hospital.416 1996 the surgical equipment had been transferred out of Dargaville and the newly formed Kaipara Health Trust was negotiating an agreement with Northland Health to run health services including outpatient surgery out of

410 411

NZH, 17 March 1994, p.2. Ibid., p.3. 412 Ibid., p.3. 413 NZH, 5 September 1994, p.1. 414 NZH, 2 September 1994, p.3. 415 Ibid. 416 NZPD, 24 November 1994,

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Dargaville Hospital.417 In 2000 the hospital site was reopened as Kaipara Total Health Centre partially owned by the community and partially owned by Northland Health soon to be the Northland District Health Board.418 In the Otago provincial towns of Oamaru and Balclutha determined communities fought unsuccessfully through the early 1990s to retain their hospital services in the face of RHA cost-cutting and service rationalisation. On the evening of 6 December 1991 at the Balclutha Memorial Hall a meeting took place in response to proposed closure of Balclutha‟s surgical services which a reporter described as „probably the largest gathering seen in Balclutha and ended in the formation of a Friends of the Balclutha Hospital Trust.‟419 The closure would lead to the loss of between 35 and 50 jobs and David Hogg, who helped lead Gore‟s unsuccessful fight against the loss of surgical services, told the meeting that withdrawing Balclutha‟s surgery would be the „biggest robbery‟ in New Zealand‟s history.420 On 15 February 1992 „Up to 4000 people took to the streets in Dunedin to protest against the proposed cutting of surgical services at Balclutha Hospital.‟421 In the lead up to the protest the Balclutha Business Association recommended its members ensure their staff could attend the demonstration.422 Of these demonstrations the ODT editorial wrote, „...the Otago Area Health Board, at which the protest over possible withdrawal of surgical services was directed, must also be mindful that these usually conservative, undemonstrative people have been moved to take what is for them quite extreme action to fight for the continuation of a vital local service.‟423 Oamaru Hospital also faced cuts to surgical services and at the end of January 1992 „A solemn crowd of more than 13,500 – almost equal to the population of Oamaru –turned out for a public march yesterday in support of retaining surgical services at Oamaru Hospital.‟424 It remains the biggest march ever held in the town. Reg Denny, the Mayor of Waitaki said during the march, „Today we have given a message of exceptional clarity with a voice which

417 418

NZH, 26 August 1996, p.7. Brian Eastwood, Total Care Health Centre – A Decade of Success, Kaipara Lifestyler, online, 10 March 2010, available at: http://www.kaiparalifestyler.co.nz/Of_Interest.cfm?NewsID=2763 (8 November 2012) 419 ODT, 7 December 1991, p.2. 420 Ibid. 421 NZH, 17 February 1992, p.5. 422 ODT, 5 February 1992, p.22. 423 ODT, 5 February 1992, p.8. 424 Dominion, 1 February 1992, p.2.

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must be heeded. We will not stand quietly by while the social fabric of our district is dismantled.‟425 The turnout was even higher than the population of Oamaru, Many marchers spoke positively about the service and staff at Oamaru Hospital, where spouses, children, parents, or friends had undergone surgery. Significant messages came in small comments. Hannah Green (10) said she “cried all the time” her mother had to go to Dunedin Hospital and she was unable to be with her. Mr Don Allen (46) and his family were able to wave to their son, Dene, when he was in Oamaru Hospital a few years ago. “We couldn‟t do that in Dunedin.” Mrs Maisie Walsh (76), wheeling her grandchild along in a pram, said she would “hate to see” surgical services lost because it would affect everyone in the district, making it very difficult for elderly people and those with young children.426 Despite the demonstrations in late 1992 the Crown Health Enterprise Advisory Committee recommended that major surgery be centralised in Dunedin but that Balclutha and Oamaru retain the ability to carry out minor surgical services.427 The Royal College of Surgeons also recommended that full surgical services at the hospital be reduced.428 In October 1992 the Balclutha Hospital Support Committee acknowledged the need to investigate the possibility of taking the hospital over through a Council owned community trust.429 In June 1994 the ODT summarised the attitude towards community opposition of Jenny Shipley conveyed in a speech to a National Party conference, „The relentless drive towards radical reconstruction of the health system is not about to falter in the face of pockets of public opposition. That message hammered home by the Minister of Health, Mrs Shipley, in Invercargill last weekend, holds little solace for the residents of South and North Otago, who might still be clinging to the hope that they can retain their hospitals in configurations similar to the present.‟430 In July 1994 the Southern Regional Health Authority released its „Planning for the South‟ document which set out the end of surgical services at Oamaru and Balclutha Hospitals. Both communities reacted furiously. In Oamaru the plan was seen as an affront to the June 1993 accord between hospital campaigners and the Southern Regional Health Authority which agreed on basic surgical and accident and emergency services that were to
425 426

ODT, 1 February 1992, p.1. ODT, 1 February 1992, p.12. 427 ODT, 9 October 1992, p.1. 428 Ibid. 429 ODT, 10 October 1992, p.2. 430 ODT, 3 June 1994, p.8.

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have been increased there as a result of negotiations.431 In Balclutha the proposal not to fund any surgery there led the Balclutha Hospital Support Group to condemn the plan as creating a „totally inadequate hospital service‟.432 Thus in late August 1994 health authorities notified the Balclutha and Oamaru communities that surgical services would end.433 The struggle over surgical services for the hospitals dragged into the mid-1990s with protest marches and public meetings rallying the opposition to every new proposal to shrink services. Shortly before the 1996 election Oamaru‟s town crier and two bag pipers led a march of 1500 in support of surgical services being retained.434 Yet eventually surgical services were centralised in Dunedin despite community opposition. In 1995 Balclutha‟s surgery ward was closed and in 1997 surgical services reduced to those able to be done under local anaesthetic.435 On the night of 22 August 1994 when the closure of Balclutha‟s surgical services was announced 4000 people rapidly gathered in protest.436 „The feelings of the people of the district were made apparent by the fact that the member of Parliament for Clutha, Sir Robin Gray, was deemed to be under some threat for the first time during his time in office....Sir Robin was accompanied by members of the diplomatic security force.‟437 Similarly by 1997 no surgery requiring anaesthetic was being undertaken at Oamaru hospital.438 In both communities vigorous and sustained but ultimately unsuccessful campaigns were waged to retain surgical services. In the late 1990s both communities formed community trusts and the hospital services were replaced by community health centres owned by the community and funded on contracts with the Government‟s health funding authorities.439 In Napier there was a long running conflict throughout the 1990s between the local community and the CHE Healthcare Hawke‟s Bay over plans to downgrade and then close the Napier Hospital as services were centralised at nearby Hastings Hospital. In 1980 the Hawke‟s Bay Hospital Board (HBHB) reviewed the services it was providing and Doctor Winston McKean, the board‟s medical superintendant-in-chief, wrote a paper in support of a
431 432

ODT, 4 July 1994, p.1. ODT, 4 July 1994, p.1. 433 Press, 2 September 1994, p.3. 434 ODT, 11 October 1996, p.1. 435 ST, 21 June 1997, p. 3. 436 ODT, 23 August 1993, p.1. 437 Ibid. 438 The history of Oamaru hospital, online, nd, available at: http://www.oamaruhospital.co.nz/?about (4 December 2012) 439 Ross Barnett and Pauline Barnett, „„„If you want to sit on your butts you‟ll get nothing!‟‟ Community activism in response to threats of rural hospital closure in southern New Zealand‟.

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„new acute hospital midway between Napier and Hastings‟.440 George Gair, Minister of Health in the third National Government opposed the proposal for its expense and impracticality and it was dropped.441 In 1986 before it became an area health board the HBHB, noting that it had two „acute base hospitals 12 miles apart serving a population of approximately 114,000‟ as unique, proposed in a discussion document a single general hospital based at the Hastings site.442 A consultants report commissioned by the Hawke‟s Bay Area Health Board (HBAHB), in 1990 proposed the closing of Napier Hospital and centralising services at Hastings.443 Simon Upton, Minister of Health, intervened after the HBAHB had taken submissions on the report including strong opposition from Napier residents, saying the cost of closure of Napier hospital was too high.444 As the Waitangi Tribunal The Napier Hospital and Health Services Report summarises, „The cycle of 1980 – a medical and financial proposal for a single hospital, strong local opposition, ministerial intervention, and deferral or abandonment of the proposal – had been repeated once more.‟445 In August 1993 the newly established CHE, Healthcare Hawke‟s Bay announced its intent to establish one regional hospital at either the Napier or Hastings site.446 In March 1994 a consultants‟ report recommended that Hastings Hospital be the regional hospital and Napier Hospital be downgraded.447 Napier deputy mayor Anne Tolley told 3000 people who marched on Napier‟s Marine Parade in May 1994 in opposition to the reports proposal to reduce beds and cull 400 jobs at Napier Hospital, the downgrade was „the most massive threat to the well-being of this city and these people since the 1931 earthquake‟.448 The protest was held 200 metres from a National Party conference in the city and Tolley told the crowd, „Again, the health bureaucrats, accountable to no one, ignore social consequences and human costs, dismissing their responsibilities to a community of 55,000 people who have had a hospital for 130 years.‟449 In July 1994 Healthcare Hawke‟s Bay announced it would have a

440

Waitangi Tribunal, The Napier Hospital and Health Services Report , online, 2001, available at: http://www.waitangi-tribunal.govt.nz/scripts/reports/reports/692/F848D441-5B11-4E14-90100B9FF8800E23.pdf 441 Ibid. 442 Ibid. 443 NZH, 15 December 1990, p.16. 444 Waitangi Tribunal, The Napier Hospital and Health Services Report , online, 2001, available at: http://www.waitangi-tribunal.govt.nz/scripts/reports/reports/692/F848D441-5B11-4E14-90100B9FF8800E23.pdf 445 Ibid. 446 Ibid. 447 Ibid. 448 Dominion, 16 May 1994, p.2. 449 NZH, 16 May 1994, p.12.

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single acute regional hospital at Hastings. 450In May 1995, there was a rally in Napier of 8000 people against the downgrading of services addressed by speakers including, Alister Scott of the Medical Association, Napier GPs, the city‟s Mayor Alan Dick and a representative of tangata whenua Heitia Hiha.451 Dick told the crowd, „”We are the biggest challenge they (the Government) face. They have managed to downgrade and dismantle rural hospitals.” The crowd yelled “yes” and clapped when Mr Dick asked whether they wanted the council to continue its fight against Napier Hospital‟s downgrading.‟452 And despite the community campaign in December 1997 Napier Hospital‟s closure was announced for early 1998 with acute medical, surgical and inpatient services centralised in Hastings and the remaining accident and emergency and outpatient services transferred to a new health centre in central Napier.453 The sting in the tail of the campaign against the closure occurred when the chairman of the CHE and its chief executive received death threats in letters sent in January 1998 by an anonymous disgruntled person.454 Napier Hospital ceased all services in early 2000.455 Dunedin triggers a mass movement, spring 1997 Cuts to health services in Otago announced in spring 1997 were significant, not because the community were successful in reversing the cuts, but because protests against them helped trigger the nationwide outburst of protests against the health reforms dealt with in Chapter Five. In late 1997 Dunedin became a flashpoint when on September 5 Healthcare Otago, the local CHE, announced plans to reduce staff by 100, withdraw from all rural health services and operate with $5 million less in funding.456 The plan was met with outrage response and the pages of the ODT document the mobilisation of the community against the government. As this section shows, the focus of the campaign organisers shifted in mid-September from fighting Healthcare Otago to galvanising a national coalition to protest the health reforms.

450

Waitangi Tribunal, The Napier Hospital and Health Services Report , online, 2001, available at: http://www.waitangi-tribunal.govt.nz/scripts/reports/reports/692/F848D441-5B11-4E14-90100B9FF8800E23.pdf 451 Press, 8 May 1995, p.6. 452 Ibid. 453 Dominion, 7 January 1998, p.12. 454 Dominion, 29 January 1998, p.3. 455 Waitangi Tribunal, The Napier Hospital and Health Services Report , online, 2001, available at: http://www.waitangi-tribunal.govt.nz/scripts/reports/reports/692/F848D441-5B11-4E14-90100B9FF8800E23.pdf 456 ODT, 6 September 1997, p.1.

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On 8 September the ODT reported, „Dunedin city councillors may adjourn their monthly meeting tonight to attend a public rally protesting against cuts to health services in the province, Mayor Sukhi Turner said last night. Mrs Turner, who is urging all Dunedin citizens to attend the meeting, says she will ask for a 30-minute adjournment from council business to allow councillors to join the protest gathering in the Glenroy Auditorium in the Town Hall complex.‟457 At the protest meeting on 8 September, „The future direction of Healthcare Otago‟s health services – and the Government‟s health policies in general – were emphatically rejected by about 1000 people who attended a protest rally in the Dunedin Town Hall last night.‟458 The Green Party Mayor of Dunedin, Sukhi Turner, took a strong stand against the cuts and told the meeting, „The best way for the disenchanted public to rid itself of unpopular health policies was to vote the present Government out of office at the next election‟.459 The meeting was used as a springboard to build a protest march on 19 September backed by the Council, health unions and the Otago Daily Times itself, „”Enough is enough” – that was the clear message from a determined crowd of between 5000 and 7000 people who yesterday marched against cuts to Otago‟s health services.‟460 The protests themselves did very little to alter Healthcare Otago‟s plan for rural services and after 1997 rural hospitals were progressively transferred out of Government ownership and management and devolved to community health trusts. Despite warnings from opposition MPs and local councils of reduced funding and privatisation community trusts took over the running of all of the rural hospitals in Otago and Southland including Gore, Balclutha, Clyde and Oamaru.461 By 1999 nine hospitals in the Southern Regional Health Authority area had been transferred into the control of community trusts. Despite the active response by the Otago public the cuts to health and hospital services provided by the CHE continued almost completely unabated. In April 1998 the Otago Daily Times listed the reduction in services from neurosurgery to public health that was due to occur in a new round of cuts as a result of continued underfunding from the Health Funding Authority.462 For example, „There was also insufficient money allocated for haematology (blood) services and the treatment of leukaemia.‟463

457 458

ODT, 8 September 1997, p.1. ODT, 9 September 1997, p.1. 459 ODT, 9 September 1997, p.2. 460 ODT, 20 September 1997, p.1. 461 ODT, 12 September 1997, p.3. 462 ODT, 30 April 1998, p.1. 463 Ibid.

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However, in September 1997 the success of the government imposing these cuts and indeed the ability of it to hold together the coalition was not assured. However in order to have an impact beyond the decision makers within Healthcare Otago on the funders of health care and the legislators of policy a shift of focus by the protest movement was needed. The rally in Dunedin on the 19th of September can be seen as a pivotal turning point for the opposition to health cuts. The leaders of local governments, trade unions, professional groups and opposition parties had become united at the grassroots in the various local struggles. Yet there was awareness that the struggle over the health cuts had to escalate and an offensive had to be generalised on a nationwide basis. A week before the rally the ODT‟s front page led with the headline „Unite to fight cuts – Clark‟ above a report of a press conference where Helen Clark called for a united front and, „urged a mobilisation of community protest in Otago against the proposed cuts to health services, calling on regional and local government heads to lead the way.‟464 Some of this new focus and combativity is reflected in the editorial line of the ODT the day after the Dunedin rally, „The Dunedin march and rally organisers are to be congratulated for their efforts. So too are the Mayor and Dunedin City Council for finally taking a lead this week – but all that has been achieved so far is rhetoric. The battle is only begun.‟465 As will be discussed in Chapter Five, the Dunedin struggle over health cuts was unsuccessful but it marks a turning point in that the opposition to health reforms began to assume a national character openly aimed not at stopping this or that closure, or this or that policy, but in being what Denis Welch described in the Listener in November 1997 as „antigovernment‟.466 The turn towards a national orientation with co-ordinated protests is evident in the statements made in the midst of the Dunedin health rebellion from unions „Yesterday‟s strong protest action against health cuts was the beginning of national action, Dunedin union organisers said yesterday.‟467 As well as this, opposition party councillors on the Dunedin council pushed for sustained mobilisation, „Dunedin city councillor David Benson-Pope will tomorrow call for the council to fund a campaign to retain Otago‟s health services.‟468 As the health cuts in Dunedin bit the scale of organisation of the opposition to health cuts was broadened and the political pressure increased as new forces took on the National Government in spring 1997. Before Dunedin‟s September 1997 protests against hospital cuts
464 465

ODT, 12 September 1997, p.1. ODT, 20 September 1997, p.8. 466 Denis Welch, „The nation‟s health‟, Listener, 1 November 1997, p.20. 467 ODT, 20 September 1997, p.3. 468 ODT, 15 September 1997, p.1.

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are un-coordinated and locally focused on specific issues. After September 1997 protests take on a broader focus of opposing the health reforms and the Government. Although the community protest campaigns against cuts to health services in Dunedin did not stop the cuts they helped inspire and organise the spring 1997 wave of protests discussed in Chapter Five. Discussion Campaigns against hospital closures during the health reforms were a form of class struggle between neo-liberal state and the working and middle class communities of urban and rural New Zealand. This class struggle was not carried out in the workplace between workers and bosses but over the „urban question‟ between an urban social movement and a neo-liberal state. Annetts et al. apply the work of urban sociologist Manuel Castells to social welfare movements to understand the systemic cause of conflict over the provision of public services like hospitals, Castells argues that the key contradiction that lies at the heart of the urban situation arises out of the inbuilt tension between the allocation of resources to the need of the productive and profitable industrial sector of the economy and to the needs of the nonproductive and hence non-profitable sector of collective consumption. The state‟s main source of finance is taxation and lending but because both are subject to restraints and limits, fiscal crisis is endemic to the system. The state is forced constantly cut public spending because, although both sectors are vital to the system, the productive sector must take priority due to its profitability and is therefore able to siphon off resources whenever economic needs dictate. This causes conflicts to arise in the urban environment where over time the need of both sectors have intensified and where the local state‟s administration of collective needs has been increasingly subject to the battle for democratic accountability. [...] Because the means of collective consumption are managed by public authorities, the entire urban area becomes politicised since the organisation of schools, hospitals, housing and transportation and so on are fundamental determinants of everyday life.

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Urban contradictions do not necessarily result in forms of working-class struggle – this depends entirely on the issue at stake and certain issues may even draw sections of the middle class into conflict with the local state.469 Castells theory is useful here in helping to understand the logic driving the closures. The primary reason why many hospitals were proposed for closure was to reduce the financial burden of the public health system on the state and thus allow for tax cuts for high income earners and corporations. For example MidCentral Health in 1997 made the decision to close Pahiatua Hospital in the Tararua district after facing a $9 million funding shortfall.470 Similarly when Coast Health Care was faced in the same year with a debt of $3 million it considered the possibility of closing Reefton hospital and various wards in West Coast hospitals.471 Most of the decisions to rationalise services was not being planned at a local level but forced from above by steadily increasing budgetary constraints. Within the campaigns against closures local government Mayors and Councillors often played a leading role. Local politicians gave the campaigns political leadership, media coverage and often funding. The lines between local government and the social movement were often blurred. Nelson‟s city council had been active throughout the mid-1990s campaigning for better services and in September 1997 provided the initial support for a public referendum campaign on health funding.472 Pippa Mahood, in 1997 was both the spokeswoman for the Waikato Coalition for Public Health and a Hamilton city councillor.473 The issue of hospital cuts affected not just the health sector but the entire community. Proposed closures drew in local representatives who used their political stature to support community campaigns. This relationship strengthened not just the community campaigns but would pave the way for a local government alliance in support of public health that would be pivotal to the social movement activity of 1997. The campaigns came to symbolise the struggle between New Right and the left opposition in the 1990s. Leftist Alliance politicians frequently framed the issue of hospital closures as part of a wider Government abandonment of provincial New Zealand and lent their support to campaigns against closures to win votes in rural areas off the National Party. Alliance leader

469 470

Annetts et al., p.71. Evening Standard, 15 November 1997, p.13. 471 Press, 24 April 1997, p.4. 472 NM, 26 September 1997, p.1. 473 Waikato Times (WT), 5 November 1997, p.14.

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Jim Anderton wrote a column in the Taranaki Daily News during the Taranaki-King Country By-Election in 1998 about the recent closure of Stratford Hospital, When I see hospitals like Stratford run into the ground, when I see closed shops, foodbanks in Inglewood, empty school rooms, disused post offices, this so-called future has the smell of 19th century decay. [...] Stratford Hospital stands today, a memorial to lack of vision. Its empty rooms and its cold, still buildings warn us of the costs of closure to patients, to accident victims who won't be treated locally, to the staff who lost their jobs, to those people in the future who will choose not to live in a town with inadequate essential services. Our challenge for the 21st century is to shout out a new vision that includes working rural hospitals in working rural communities. Our fight is for the spirit of New Zealand, still flickering in the faces of Stratford Hospital's ex-staff.474 Frame theory can be applied to analyse the way in which social movement organisations [SMO] communicate an issue „in order to gain membership and support‟.475 For Snow et al. social movement organisations undertake a process called frame alignment in order to link „individual and SMO interpretative orientations, such that some set of individual interests, values beliefs and SM activities, goals and ideology are congruent and complementary‟.476 This agitation can be seen as a method of frame alignment described as „frame extension‟ in which the Alliance Party sought to extend the view of rural communities from seeing hospital closures as an injustice to seeing the Government‟s as lacking vision and the Alliance Party as fighting for „the spirit of New Zealand‟.477 As political commentator Chris Trotter pointed out of the Alliance‟s campaign to win political support through frame extension in rural communities which became a dedicated strategy after the 1998 By-Election, The Taranaki-King Country result removed the scales from the eyes of Alliance strategists. In the rural villages and decaying provincial towns they discovered a ready-made audience for the Alliance's message of betrayal and neglect. The wonder is that it took them so long. The effects of New Right policies would always be more serious in the countryside. Population-based policies in health and education mean
474 475

Taranaki Daily News (TDN), 16 April 1998, p.6. Annetts et al., p.65. 476 D.A. Snow, E.B. Rochford, S.K. Worden and R.D. Benford, „Frame alignment processes, micromobilization and movement participation‟, American Sociological Review, 51 (1986), pp.464-481. 477 TDN, 16 April 1998, p.6.

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school and hospital closures. Privatisation and downsizing in the railways, telecommunications, and other infrastructural services mean fewer jobs, fewer pay packets, fewer sales and fewer shops. If the Alliance can't get a hearing in the heartland, it can't get a hearing anywhere.478 The Alliance Party turned anger over single-issues such as hospital closures into a broader discontent over the direction of New Right policies and gained support for their social democratic alternative by supporting campaigns against hospital closures and drawing the political links between the issues affecting small towns and the ideology of the New Right. Conclusion Hospital closures have always occurred as health resources have been reshuffled to meet the changing needs of New Zealand‟s population. However beginning in 1983 New Zealand‟s hospital services began to be drastically reduced as the introduction of population based funding put pressure on area health boards in the late 1980s and early 1990s to cut costs by closing rural hospitals and rationalising urban hospitals, perceived by Government to be under-utilised and inefficient. Between 1984 and 1991 community protest campaigns successfully stopped eleven hospitals from being closed but failed to keep St Helens open. After the introduction of the CHE/RHA system in 1993, another wave of closures began as heavily indebted CHEs and RHAs attempted to cut costs by closing hospitals and cutting surgical services. In this period community campaigns saved four hospitals from closure and stopped cuts to surgical services in Ashburton and Kaitaia. However there were also unsuccessful campaigns against cuts to surgical services in Oamaru, Balclutha, Gore, Kawakawa, Dargaville and a failed campaign to keep Napier Hospital open. Greytown and Westland hospitals, both saved from closure by community campaigns before 1993, were both closed in this period. On balance, this overview of the movement against hospital closures shows that these community protest campaigns were effective mobilisations that often succeeded in their goal of stopping cuts and closures. As Chapter Five shows, Dunedin‟s community mobilisation in 1997 against hospital job losses and cuts would inspire a nationwide mobilisation against the health reforms that would contribute to the collapse of the National –New Zealand First Coalition Government and a moratorium on closures in September 1998.

478

Independent, 10 March 1999, p.13.

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Chapter Three

Workplace resistance
Health workers‟ strikes and interventions, 1988-1999

One of the consequences of the health reforms was that it had a huge impact on the working conditions of health workers employed in the public health system. After 1993 profit orientated CHEs were encouraged to cut pay and conditions of workers to stay within budget and the breakup of national awards into regional collective agreements gave CHEs an opportunity to squeeze concessions from workers. Throughout the 1990s there was industrial action throughout the public health system in defence of working conditions and also in defence of standards of patient care. The first part of this chapter examines this struggle between health workers and their employers and the impacts this had on the health system. The second part of this chapter looks at collective interventions by health workers made during the health reforms, often at the CHE level, to protect the public health service. This part of the chapter highlights how health workers sought to bring to public and Government attention perceived problems with the health reforms and to correct them. The third part of this chapter covers the prominent whistleblowers in the 1990s, examines their role in defending patient care and analyses the response of Government to them. The fourth part of this chapter looks at the protest exodus of health professionals from the public system after 1991. Nurses and the health reforms in particular are dealt with in Chapter Four. Industrial action The rise of medical militancy The late 1980s saw a rise in industrial action and organisation as the new public sector austerity Rogernomics had ushered in began to bite. In July 1985 Wellington junior doctors‟ union made a nationwide agreement with the Government to reduce hours for doctors working up to 85 hours a week. 479 The agreement narrowly averted strike action.480 In 1987 the closure of psychiatric hospitals and their incorporation into the general hospital system
479 480

NZH, 27 July 1985, p.3. Ibid.

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had psychiatric nurses plan stop work meetings over losing their union cover and work conditions, which were superior to general nurses.481 In 1987 as cash strapped health boards began cutting services doctors came under pressure from an increasingly censorious Government, „Health Minister Michael Bassett wants a clampdown on public hospital doctors who publicly criticise the system they work in.‟482 In 1988 underfunded health boards were pushed into more confrontational negotiations with health sector unions, „Health workers will have to sacrifice hard-won conditions of employment if they want pay rises this year, financially strained hospital boards have decided.‟483 The Resident Medical Officers Association told the Dominion in 1989 that as a result of the health cuts, „New Zealand faced a critical shortage of hospital doctors next year‟.484 Doctors were being steadily politicised by the cuts as this 1989 letter to the Dominion indicates, „At a recent meeting of a large representation of Taupo doctors, considerable concern was expressed about politics in New Zealand medical hospital and allied services.‟485 As a result of the austere industrial environment and the beginnings of radical change in the hospital sector in November 1989 salaried medical specialists organised themselves into a trade union for the first time in New Zealand and held a conference to found the Association of Salaried Medical Specialists (ASMS).486 The founding of the ASMS and the growing tensions between doctors and health boards were the beginnings of a new combative relationship between doc tors and health boards and the Government. The early 1990s saw this activism, or medical militancy, continue to grow as doctors and other health professionals engaged in protracted disputes over wages and conditions with cash-strapped health authorities after the commencement of National‟s health reforms. The commercialisation of the health system began in tandem with the relaxing of labour regulation caused by the passage of the Employment Contracts Act (ECA) in 1991. In an attempt to control labour costs government–appointed, Commissioners of Area Health Boards before 1 July 1993 and the CEOs of CHEs afterwards resorted to extreme lengths to break up collective agreements, casualise workers conditions and reduce wages. This combination of legislative change and employer militancy forced health workers‟ unions into dramatic confrontations with their employers, which they sometimes won and sometimes
481 482

Auckland Star, 26 February 1987, p.4. Ibid. 483 Sunday Star, 11 September 1988, p.2. 484 Dominion, 21 November 1989, p.1. 485 Dominion, 24 June 1989, p.8. 486 Dominion, 4 November 1989, p.7.

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lost. When the last pre-ECA negotiated national award for junior doctors ran out at the end of 1991, health boards sought to break the agreement into regional agreements with reduced wages and conditions.487 This led to industrial action. On 5 November 1991 a nationwide series of strikes by resident doctors broke out with first Canterbury and then Auckland and Otago doctors striking after being offered regional agreements with no limit on hours worked and salaries 30 per cent lower than they were currently on.488 The following week planned strikes by junior doctors in the Waikato, Wellington and the Bay of Plenty were called off after protracted eleventh hour negotiations but strikes again hit Auckland, Canterbury and Otago regions.489 The strikes were the first time doctors had been out on strike action in New Zealand ever before and reduced hospitals to providing emergency and acute services only.490 By the end of November another round of strikes was called off as doctors settled across the country for either compromise agreements that reduced wages (Auckland, Canterbury, Otago) or a rollover of the existing award into a regional agreement (Wellington).491 In Waikato and the Bay of Plenty action by doctors had won some improvement in their contracts as well.492 By December 1991 New Zealand‟s first major doctors dispute was over but Auckland‟s resident doctors in early 1992 had to threaten industrial action again when the Area Health Board introduced new rosters and remuneration systems created a situation where „many doctors were being under paid because the number of hours they worked had been underestimated.‟493 In late 1992 the Southland Health Board attempted to move junior doctors from their collective agreement to individual agreements. Labour MP and health spokeswoman Helen Clark called the dispute, „a prototype for breaking a union in the State sector‟.494. In response to the refusal of the CHE to negotiate a collective agreement, at the end of October 1992 thirty-five junior doctors at Southland Hospital in Invercargill began a strike in defence of their collective agreement.495 „The doctors want a collective contract but the health board general manager, Mr John Pannett, wants them working on individual contracts.‟496 The month long strike came to an end at the end of November with doctors returning to work on
487 488

Dominion, 25 September 1991, p.3. Dominion, 5 November 1991, p.3. 489 Dominion, 13 November 1991, p.3. 490 Dominion, 6 November 1991, p.3. 491 Dominion, 29 November 1991, p.8. 492 Dominion, 13 November 1991, p.3. 493 NZH, 19 February 1992, p.3. 494 NZPD, 25 March 1993. 495 ODT, 31 October 1992, p.1. 496 NZH, 6 November 1992, p.4.

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individual agreements the Resident Doctors‟ Association spokesman Dominic Rillstone saying, „We‟ve utterly failed. We can‟t pretend otherwise.‟497 Rillstone was in late December warned that he „will be summarily dismissed if he speaks to the news services again.‟498 However the strike had serious long term implications for Southland Hospital. Professor Frank Frizelle, the editor of the New Zealand Medical Journal described the impact in a 2006 article,

The strike was over individual contracts versus collective contracts. The strike was near the end of the year, and when the RMOs [Resident Medical Officers] finished their year, the new RMOs took up the individual contacts, however within 2 years almost all were back in the collective contract. The results of the strike meant that the general manager left, a large number of SMOs [Senior Medical Officers] felt disillusioned by the pathway the management had taken with dealing with the RMOs, and the hospital struggled to obtain and retain New Zealand RMOs for years afterwards, instead relying heavily on overseas RMOs. This required special packages and extensive (and expensive) advertising to facilitate recruitment.499 These negative impacts of the strike on the hospital may have helped prevent further moves to deunionise doctors in hospitals in the early 1990s. In 1994, senior doctors union, ASMS, were able to negotiate a collective agreement for doctors at Southland Hospital (now under new management) with a clause guaranteeing the right to arbitration during a dispute.500 The mixed experience of Invercargill doctors shows that the stance taken by Health Board management was a decisive factor in the ability of workers to retain working conditions or collective agreements. The wages and conditions of junior doctors was a recurring issue throughout the 1990s as doctors found they were working longer and longer hours in understaffed hospitals. This led to continuing strikes from junior doctors. In November 1994 in Whakatane during a successful 18 day strike by junior doctors to retain an hourly wage instead of a weekly salary, replacement doctors were recruited by the CHE and flown in from Australia.501 But when the Australian doctors, who included a union branch president of the Public Service Association
497 498

Press, 1 December 1992, p.5. NZH, 26 December 1992, p.4. 499 Frank Frizelle, „Is it ethical for doctors to strike?‟, New Zealand Medical Journal, 119(1236), 23 June 2006, pp.6-8. 500 NZH, 26 October 1994, p.3. 501 NZH, 23 November 1994, p.5.

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of New South Wales discovered the reason for their contract they sought legal advice to have their temporary contracts with Eastbay Health annulled.502 This helped the Eastbay doctors retain their hourly wage. A threatened strike by junior doctors in Whangarei during 1994 secured a 3 per cent wage increase.503 There were strikes by doctors in Hawke‟s Bay in August 1996504 and one in October 1996 in the Wellington region.505 The Wellington region strike involved 250 junior doctors striking on the eve of a general election over concerns about understaffing and long hours of work.506 In September 1997 Healthcare Otago was said to be taking a „hard-line approach‟ to negotiations with junior doctors.507 In October 1997 the Herald described how CHEs were being told to approach negotiation, Industrial strife threatens to sweep battered hospitals which have been told to freeze pay unless they can get rid of staff or cut wage bills elsewhere. The medical wage freeze and advice to “stand firm” against strikes is set out in a letter to crown health enterprise board chairmen, obtained by the New Zealand Herald.508 In March 1997 the Herald reported, „Public hospitals are under massive pressure to cut staff and limit pay rises to curb budget blowouts.‟509 In April 1998 about 1800 junior doctors „voted in favour of industrial action because of lack of progress with their pay talks. They are claiming 3 per cent.‟510 In early July 1998, 300 junior doctors in Wellington, Hutt Valley and Wairarapa issued a strike notices for two weekends in July.511 The junior doctors are seeking a 2 per cent wage rise, stricter adherence to hourly working limits and improved training. At present they may legally be required to work up to 16 hours a day and up to 72 hours a week. Association delegate Linda Pirrit confirmed the notices had been issued, but said talks were continuing. Dr Pirrit said the main problem was compliance. Though there was a limit of 16 hours a day, many doctors worked far more than that. Doctors say the long

502 503

NZH, 12 November 1994, p.3. NZH, 11 November 1994, p.3. 504 Dominion, 20 August 1996, p.2. 505 Dominion, 4 October 1996, p.3. 506 Dominion, 10 October 1996, p.3. 507 ODT, 18 September 1997, p.3. 508 NZH, 4 October 1997, p.1. 509 NZH, 16 March 1998, p.1. 510 NZH, 15 April 1998, p.3. 511 Dominion, 3 July 1998, p.1.

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hours mean they are being put in the position of having no choice but to compromise safe practices. Junior doctors in other centres are also planning strike action.512 By mid July contract negotiations for Junior doctors had been settled everywhere except Nelson, Blenheim, Otago, Wanganui and Timaru where the workers walked off on July 17 for 10 days seeking a „2 per cent pay rise with stricter adherence to working hours and improved training‟.513 Some CHEs claimed not to be able to afford the wage rise but junior doctors contended that, for example, Nelson-Marlborough doctors were paid 12 per cent less than in some other areas. 514 Health workers‟ strikes Doctors were not the only health workers taking industrial action against the impacts of the health reforms. In October 1992, 700 Canterbury health domestic workers struck over claw backs from Canterbury Area Health Board.515 In December 1992 more than 1000 Canterbury hospital workers struck, „angry that the board had refused to budge on a clause that would allow the gradual casualisation of staff.‟516 In Auckland the Herald described laboratory staff as „restless‟ and that, „Striking laboratory staff returning to work this morning at two Auckland public hospitals may walk out again on Friday unless their pay dispute is settled.‟517 In August 1994 the Employment Court ruled that Capital Coast Health is in „contempt of court by bypassing unions and issuing illegal suspension notices‟ to laboratory staff in a dispute.518 On 15 September 1994 the Herald reported, „Rotorua medical laboratory workers have cancelled a four-day strike because they believe their employer has brought in Australian strikebreakers.‟519 In October 1997, the Herald reported „Auckland Healthcare has threatened radiation therapists with a lock-out in two weeks unless they withdraw the threat of strikes next week and accept an offer over a new evening shift to work the [new] machines.‟520 The unrest came just months before Auckland nurses were considering strike action.521

512 513

Ibid. Dominion, 17 July 1998, p.2. 514 Ibid. 515 ODT, 31 October 1992, p.3. 516 Press, 11 December 1992, p.7. 517 NZH, 16 November 1993, p.2. 518 ODT, 16 August 1994, p.20. 519 NZH, 15 September 1994, p.2. 520 „NZH, 4 October 1997, p.4. 521 NZH, 20 December 1997, p.3.

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Many duties being undertaken by cleaning and catering staff were outsourced to private companies during the health reforms of the 1990s. Service workers‟ unions and their members who had been employed by the hospitals directly would sometimes try and strike to stop the outsourcing. The contracting companies paid lower wages and had worse conditions for workers and thus contracting out meant redundancy for many workers. In July 1994 the company Command Pacific got the contract for cleaning and food services in Southern Region hospitals.522 At Gore Hospital orderly and kitchen staff began picketing after being fired after contract discussions with their new employer broke down.523 During the pickets a van carrying in replacement workers „had a nail shoved into one of its tyres, graffiti sprayed down its sides, and a wiper arm ripped off. Picketers banged and kicked the doors and windows.‟524 Another bitter dispute occurred in Burwood and Christchurch hospitals in 1995 when cleaning services were contracted out to a private company. The local union mounted a picket of the hospitals. According to one of the managers from the cleaning company, P&O Health Services, „P&O cleaners faced a “tirade of abuse” [...]. One worker had her cars slashed and a puncturing device was placed under another car. Eggs were thrown at staff and some of their houses were defaced with graffiti‟.525 The Hotel and Hospital Workers‟ Union head, Susan Stewart, said, „This dispute is about health reforms and the Employment Contracts Act and we knew it would be a long-running battle‟.526 Some interesting observations can be made about the patterns of industrial action in the public health sector in the 1990s. To start with we can see the roots of the sharpened tensions in the Labour Government reforms of the late 1980s, particularly the underfunding of health boards and the State Sector Act which broke up national awards and removed clinical control over hospital management. In the early 1990s as hospital boards became CHEs and the ECA was passed we see a large amount of attacks on workers‟ wages and conditions which forced health unions to fight hard to defend conditions. The viciousness of the attacks is underscored by the lengths health authorities took to break strikes and decollectivise various agreements. In early 1994, Ian Powell, executive director of the ASMS told the NZPA, the rise in hospital strikes was a direct result of the Employment Contracts Act and funding cuts to public hospitals which he said, ‟has helped to build an atmosphere of frustration, mistrust and

522 523

NZPA, „Van damaged at picket line‟, Press, 8 July 1994, p.3. Ibid. 524 Ibid. 525 Press, 14 November 1995, p.1. 526 Ibid.

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conflict.‟527 The story reported. „Mr Powell said hospital doctors feared that industrial crises would be a permanent feature of the public health service unless the Government altered funding and legislation to improve the industrial climate.‟528 Doctors‟ fears would be proved largely correct as through the mid-1990s industrial action continues with the CHEs and health workers continually at loggerheads over pay and increasingly contracting out. In the late 1990s we see an upsurge in doctors‟ strikes but not only are these workers claiming their wages need to be protected through industrial action but also that understaffing and standards of care need to be addressed. This change over the decade of the 1990s represents the changing needs of union members as health authorities first tried to save money through aggressive approaches to collective bargaining and then to save money by understaffing. It also shows that health unions were forced to industrially confront not only the conditions of their members‟ contracts but the wider problems of health underfunding that were leaving health workers overworked and wards unsafe. Interventions As well as taking industrial action health workers repeatedly intervened through union or professional associations to raise concerns within the health system and publicly about the direction of the health reforms and the impacts it was having on their place of work. These interventions represent attempts to engage with and resist the process of health reforms. Against Titter‟s cuts, 1989 When Harold Titter announced the massive cuts to health services in Auckland in 1989 as well as a community response based around neighbourhood campaigns to save various hospitals threatened with closure there was a wider industrial response from health workers in the Auckland health system. Unions and their members lobbied Titter, joined action committees, participated in protest actions and even threatened industrial action in an attempt to stave off the health cutbacks. The Nurses Society warned in May 1989 that, „Two hundred surgical beds will be lost under Auckland‟s new health budget, meaning hospitals will perform 4000 fewer operations in the next 12 months‟.529 There were threats of industrial action over the cuts in the immediate aftermath of the announcement of cuts. For example the Herald reported on May 29, „Workers in Auckland public hospitals may take industrial action

527 528

Dominion, 1February 1994, p.3. Ibid. 529 NZH, 18 May 1989, p.3.

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in the form of a mass stopwork over the cuts in public health expenditure.‟530 On 30 May angered by „new rosters under the Titter regime, reducing shifts and doubling workloads‟ Auckland‟s junior doctors announced industrial action.531 The spokesperson for the Resident Medical Officers‟ Association Deborah Sidebotham said, „We will strike because of the effect of these cuts on members and patients.‟532 The strike planned for 13 June 1989 was called off two days before it was due to take place after the Area Health Board abandoning its attempt to introduce a new roster system.533 Health workers through their union alliance, the Combined Health Employees Committees, also launched a public relations offensive in July, „The Combined Health Employees Committee will put information into letterboxes next month telling Aucklanders how the workers would like to see services stretched.‟534 In almost every hospital health workers defied a „gagging order‟ by Titter to speak out over stretched or cut services. These interventions were often successful. In September 1989, staffing levels were so low that „Senior nurses at Middlemore Hospital have disavowed any responsibility for patient care.‟535 The next day, „Middlemore Hospital nurses have cautiously welcomed news that staffing levels are to be increased.‟536 However the pressure of understaffing forced nurses repeatedly to plead in public for more staff. In early October,

Another Auckland Area Health Board hospital is facing a nursing shortage so acute that nurses say patient safety cannot be guaranteed. Nurses at National Women‟s Hospital say mothers and children are especially at risk. [...] The National Women‟s nurses will today deliver a letter to the board, saying they can no longer cope with their staffing crisis. They say pressure in the hospital delivery suite contributed to the death of a patient. That death is under investigation by hospital authorities.537 Health workers also linked with patients threatened by the cuts to prevent the changes. A 50strong public meeting of health workers and the families of long-stay patients at Waitakere hospital on July 16 unanimously passed the motion, „This meeting indicates to the Auckland

530 531

NZH, 29 May 1989, p.1. NZH, 30 May 1989, p.3. 532 Ibid. 533 NZH, 12 June 1989, p.3. 534 Auckland Star, 17 July 1989, p.3. 535 NZH, 19 September 1989, p.1. 536 NZH, 20 September 1989, p.3. 537 NZH, 3 October 1989, p.3.

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Area Health board that we want to maintain public health care, and long-stay patients at Waitakere should not be moved.‟538 At North Shore hospital People‟s Voice reported in July, Parents of multi-handicapped patients at North Shore Hospital have won a major victory in halting the plans of the Auckland Area Health Board to move their children out. The strong stand of the parents and their supporters, backed by the health unions at the hospital, forced an apology from the Health Board and Minister of Health Helen Clark.539 Through the winter months there were repeated calls from some union members and leftwing activists especially those in the Communist Party for combined action to be taken by unions against the cuts. Yet no mass industrial action was taken and a split on tactics between a moderate faction in the Auckland union movement around the Socialist Unity Party (SUP) and Public Service Association and a radical faction around the Communist Party (CP) and the Nurses‟ Association hardened as Titter‟s cuts bit. After a public meeting of unionists at Ellerslie Racecourse in May, PSA official and SUP member Joe Tonner told CP members, according to Communist Party newspaper the People‟s Voice, that engagement with the cuts through a protocol of consulted change was the preferable option and that „marches and rallies never achieved anything‟.540 Despite the attitude of SUP members and some union officials rank and file health workers were beginning to see the need for a political mobilisation against the Government‟s attacks on health. Mass action by the combined unions and with community support arguably could have sunk not just some but all of Titter‟s cuts and also reasserted the right of communities to have democratic control of their health resources. The day after Titter announced his cuts the Herald editorial praised the „surgical solution‟ to the hospital boards‟ underfunding and warned the country, „The shock may not be confined to Auckland. Though it is by no means the first locality to feel the bite of deflationary policies on health services, the retrenchment in Auckland is comparable in scale and lost jobs to the businesslike reorganisation of state enterprise. It will be harder henceforth for some to pretend that social services can somehow remain sacrosanct when all else is striving for maximum efficiency.‟541 Indeed, Titter‟s Auckland cuts can be seen as an experimental prelude to the closures and cuts that would become nationwide after the replacement of area health boards with the CHE/RHA structure.
538 539

People‟s Voice, 24 July 1989, p.4. People‟s Voice, 24 July 1989, p.5. 540 People‟s Voice, 12 June 1989, pp.5-6. 541 NZH, 18 May 1989, p.8.

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Against the health reforms Health workers throughout the period of the health reforms post-1988 undertook industrial interventions to raise concerns about their perceptions of declining standards of care. One of the earliest examples of this was in 1991 when Wellington doctors met over cuts to staffing levels to prepare a response and went public with their concerns.

Senior Wellington Hospital doctors had suggested closing the doors if management went ahead with “blatantly unsafe” proposals to save more than a million dollars by cutting the number of doctors on duty at night, Geoffrey Horne, head of the medical school‟s surgical department, said last night. [...] Dr Mulgan said junior doctors at a stopwork meeting on Tuesday were unanimous in their condemnation of the proposals and intended to challenge them in the Labour Court if necessary. “There is no ground for compromise. Patient care is not negotiable,” he said.542

These interventions, which often involve talking to the media about concerns, when they are reported in the newspaper record appear spontaneous and look like a last resort for the health professional‟s involved. They can be contrasted with whistle blowing because they are focused primarily not on releasing secret information but in changing the decision of decision makers within health institutions (CHEs, RHAs, health boards) and the government. Some examples include: in August 1994 a leading eye surgeon told the media, „Elderly people in Otago are being severely disabled by eye disease because national health authorities refuse to acknowledge the incidence of cataracts and glaucoma is higher in the southern region‟;543 in December 1994 the departing Nelson-Marlborough crown health enterprise board chairman called the Government‟s reforms a „shambles‟;544 and in 1995 Health Waikato staff called for the whole CHE board to be sacked.545 One of the most dramatic interventions was in September 1996 when Auckland Hospital staff „embarrassed the Government on the eve of the election by cancelling many surgical operations on funding grounds.‟546 The closure had

542 543

Dominion, 11 April 1991, p.3. ODT, 17 August 1994, p.2. 544 Dominion, 12 December 1994, p.7. 545 NZH, 12 August 1995, p.3. 546 NZH, 26 September 1996, p.3.

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the obvious effect of raising the public profile of health underfunding but economist Gareth Morgan was less than impressed,

The causes of public hospital disarray include poor quality management teams in some enterprises‟s B teams from the private sector; and a concerted campaign of sabotage by some of the medical practitioners who will not accept that public hospital doctors are accountable to anyone apart from their own profession. What other employer would tolerate a cabal of surgeons shutting down an operating theatre days before the election blaming lack of money, only to reopen it the day after. Such industrial sabotage should have been rewarded by instant dismissal as it would have in any private firm.547

After the 1996 election and the re-reforms of the National and New Zealand First Coalition the interventions continued apace. For example: in 1997 senior doctors „pleaded‟, „with the Government to spare provincial hospitals from more severe cuts‟;548 and in 1998 Capital Coast Health senior medical staff, „voted overwhelmingly to reject the hospital‟s draft business plan‟.549 In 1997 at Health Waikato five surgeons quit saying, „patient safety was compromised by the crown health enterprise by not providing [ear, nose and throat surgery] facilities equal to other similar units.‟550 A secret report written by Waikato doctors was released two weeks later,

Hospital funding cuts will result in early death, blindness, deafness, undiagnosed cancer, increased abortions, infertility, amputations, and strokes, says a secret health report. Written by doctors at Waikato Hospital, and leaked to the New Zealand Herald, the report outlines in detail the effects of the latest Government clampdown on health spending.‟551

CHMSA and Patients are Dying The most high-profile intervention by clinical staff around workplace reform in hospitals was in Christchurch Hospital in the mid to late 1990s. In December 1996 the Christchurch
547 548

NZH, 16 November 1996, p.11. ODT, 23 September 1997, p.3. 549 Dominion, 25 August 1998, p.8. 550 Monique Devereux, „Five surgeons may get senior staff backing‟, NZH , 26 September 1996, p.7. 551 Theresa Garner, „Hospital hit-list nobbles surgery‟, NZH, 11 October 1997, p.1.

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Hospitals Medical Staff Association (CHMSA) released a report called Patients are Dying: a record of system failure and unsafe health care practice at Christchurch Hospital.552 The report details the deaths of four patients because of systemic failures within the management and clinical structures.553 The staff at Christchurch Hospital grouped the hospital managements failures into four categories; „1) understaffing, 2) inappropriate staffing or mix of skill levels, 3) inappropriate patient location, combined with a predictable and preventable bed shortage, 40 loss of quality indicators or practice falling below stated standards.‟554 The release of the report came after two years of nursing and medical staff making „strenuous efforts to stop standards of care at Christchurch Hospital deteriorating to the point that potentially avoidable deaths occur‟.555 Examples given in July 1996 to the Ministry of Health by the New Zealand Nurses Organisation of understaffing include,

1. Night shift, 28 patients, one permanent staff nurse and one casual. Only the permanent staff nurse was IV certified, yet 23 of the 28 patients were on IVs. There was no nurse available to special a seriously ill patient. A bureau aid was sent to special a patient with end stage COAD, on IV Ventolin, IV Aminophylline infusions, IV antibiotics and oxygen. 2. Night shift, one registered nurse with IV certificate to cope with 17 IV antibiotics, 5 IV infusions including 1 blood. Assistance was provided by two junior nurses, one a Canterbury health casual and one a bureau nurse, neither familiar with the ward.556 The Health and Disability Commissioner Robyn Stent investigated the staff concerns and in March 1998 reported on back on the safety of patients. As the Lancet reported the „Stent report‟, The Health and Disability Commissioner's first major report has found that Canterbury Health, one of New Zealand's 14 crown health enterprises, failed to provide services "with reasonable care and skill". Robyn Stent's criticisms may have wider ramifications for impending health reforms. Stent‟s investigation followed a 1996 report The Patients Are Dying by staff at Christchurch Hospital.
552

Christchurch Hospitals Medical Staff Association, Patients are Dying: a record of system failure and unsafe health care practice at Christchurch Hospital, Christchurch, 1996. 553 Ibid., p.5. 554 Ibid., p.3. 555 Ibid., p.3. 556 Ibid., p.100.

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Stent's report supports their allegations that unnecessary deaths occurred in the emergency department. The current report points to a lack of qualified staff, space, and resources that resulted in treatment delays and in patients being deployed to inappropriate units. Stent indicates that Southern Regional Health Authority did not purchase sufficient services for the population. And she singles out the Crown Company Monitoring Advisory Unit, a Treasury group, for foisting onto Canterbury Health a high-risk, aggressive business plan to reduce its operating deficit. At all levels, says Stent, there was a preoccupation with "efficiency, funding, and financial performance", and a lack of clinical involvement in decision-making.557 The release of the Patients are Dying report, the intervention of clinical staff and a new CEO in November 1996 did lead to significant improvements in patient care at Christchurch Hospital as a new management team sought to implement seventy-six recommendations in the Stent report.558 Yet although there were improvements the clinical staff continued their campaign in early 1998 for safer systems, „Christchurch Hospital medical staff have released a new report on patient safety, just days before the long-awaited report from the Health and Disability Commissioner.‟559 The concerns detailed in this second report, The Addendum: Lesson Unlearned, Problem unresolved, detailed the minutes of meetings and the correspondence involved in CHMSA attempts to win agreement from Canterbury Health for more input from medical staff over the hospitals clinical management.560 In one letter from CHMSA‟s chair to Canterbury Health‟s CEO the health workers view of relationship between hospital management structure and patient safety is laid out,

The only way to ensure adequate patient safety standards in this hospital is to receive the distilled concerns and recommendations from your nurses, allied health professionals and doctors. In regard to the latter, it is essential that there is a system which brings up concerns and positive suggestions as early and efficiently as possible,

557

Sandra Coney, „Report blames business plan for unnecessary deaths in New Zealand‟, Lancet, 351, 9110, 18 April 1998, p.1188. 558 Bruce Ansley, „Cut and run; Patients had to die at cash starved Christchurch hospital before anything changed. But funds are still shrinking and lives remain at risk.‟ Listener, 2 May 1998, pp. 18-21. 559 SST, 29 March 1998, p.3. 560 Christchurch Hospitals Medical Staff Association, Patients are Dying: a record of system failure and unsafe health care practice at Christchurch Hospital: The Addendum: Lesson Unlearned, Problem unresolved, Christchurch, 1998, p.54.

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in a democratic fashion to an Executive Committee Planning and Policy. If such a committee is not established, we foresee ongoing safety problems in this hospital.561 CHMSA‟s and nurses ongoing concern with corporatized hospital structures is underscored by a 700 strong petition of nurses in March 1998 changing rosters and the comments of one of CHMSA‟s leaders, surgeon Phil Bagshaw, made to the Listener in 1998, „Are we as concerned as we were in 1996? The answer is yes. Because the structure is flawed.‟562 The activism of health professionals undertaken at Christchurch Hospital proved financially and professionally costly. Two leading CHMSA doctors spent $40,000 each on the campaign, „much of it on legal fees‟ and,

[Doctors Phil] Bagshaw and {Stuart] Gowland were threatened with the sack. Medical staff were reminded of their contracts and told to be “loyal”. Jane O‟Malley, highly qualified and regarded as potentially one of the best nurses in the country, spoke out and was sacked, or at least made redundant. She had complained about charge nurses being restructured out of existence, a critical decision later recognised as a bad mistake and reversed by [Canterbury Health CEO Richard] Webb.563

The intervention at Christchurch Hospital also spilled out into a wider public push from health sector workers against understaffing and corporate management of hospitals. In April 1998 NZNO wrote to, „Minister of Health, Bill English, saying that the catalogue of safety and staff woes at Christchurch could easily be repeated elsewhere. The organisation‟s chief executive, Brenda Wilson, said hospitals across the country were still haunted by low staff numbers, insufficient beds, low morale and impossible workloads.‟ 564 One newspaper columnist described the Stent report as „more than any other [event] in recent memory demands a response not only from the Government but from all of the ideologues and advocates of new-right thinking‟, but lamented „no major fallout has yet occurred‟.565 Through the 1990s as the health reforms created unsafe hospitals and the government seemed to be ignoring health workers, the attention of hospital staff interventions was often towards
561 562

Ibid., p.54. Bruce Ansley, „Cut and run; Patients had to die at cash starved Christchurch hospital before anything changed. But funds are still shrinking and lives remain at risk.‟ Listener, 2 May 1998, pp. 18-21. 563 Ibid., pp. 18-21. 564 NZH, 4 April 1998, p.21. 565 NZH, 19 May 1998, p.13.

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increasing public protest and mobilising the public. In Auckland‟s overcrowded hospitals in 1990, „Some nurses were telling women to complain to their local MP.‟566 In 1997, „Dr Galler lives in hope that “Bill English will sit down and listen to what people are saying and take it on board.” “But I think the public need to become a little more switched on. They need to start vocalising their fears.” Does that include street demonstrations such as last Friday‟s march in Dunedin? “Hitting the streets is not such a bad idea. What else do you do? ...They are not listening.”‟567 In the late 1990s the coalition of health worker and patient activism exploded in anger at the Government‟s health reforms. Whistleblowers Another important way health workers opposed the market reforms of the 1990s was through leaking confidential or embarrassing documents to the public and whistle blowing on issues of concern. The stories below relate some of the whistle blowing and also the lengths that CHEs went to in order to prevent their staff from speaking out. In May 1994, „A nurse with several years experience in Wellington Women‟s Hospital neonatal unit has reiterated parents‟ concerns about dangerous conditions, saying demands on too few skilled staff have led to several near-misses.‟568 In July 1995, former Medical Association chairman Dr Alister Scott faced a „professional misconduct charge after criticising the standards of care of a child.‟569 The complaint was laid by Wanganui CHE‟s chief executive and was dismissed by a medical disciplinary tribunal in August.570 In August 1996 Health Waikato set up a system, „to stop staff publicly blowing the whistle on problems in the organisation.‟571 In March 1996 Sandra Coney described in a newspaper article the lengths that Otago‟s CHE was taking to discredit comments from staff about the failure of mental health services, „Healthcare Otago is suing Dr Janet Wilson, the Director of Mental Health, and barrister Robb Newberry, who was brought from Wellington to inquire into mental health services at Dunedin and Wakari Hospitals. The action came after Mr Newberry provided the Otago Crown Health Enterprise with a draft report of his findings. Now John Ayling, the chief

566 567

Auckland Star, 25 September 1990, p.1. NZH, 25 September 1997, p.14. 568 Dominion, 30 May 1994, p.3. 569 SST, 30 July 1995, p.3. 570 NZH, 31 August 1995, p.13. 571 NZH, 23 August 1996, p.14.

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executive officer of the CHE, says it should have been allowed to cross-examine witnesses.‟572 In 1997 faced with another round of Government cuts to funding it was CHE managers speaking out, „Most health enterprise managers contacted would talk only off the record. But in the face of burgeoning waiting lists, they say they are unsure where the savings will come from.‟573 In October 1997, „A leaked independent report on Health Waikato paints another grim picture of clinical services, some of which is describes as deficient, unsatisfactory and unsafe.‟574 In May 1998, „A senior South Island doctor was banned from work for a week and told his job was on the line after speaking to the media about fears Timaru Hospital services were under threat.‟575 In June 1998 it was a New Plymouth surgeon threatened with the sack for speaking out over cuts to Taranaki Hospital, A doctor threatened with the sack last week for protesting about hospital cuts is determined to keep fighting for public health services. [...] In an exclusive interview with the Sunday Star-Times, Taranaki Base Hospital surgeon Fridtjof Hanson said while he was angry about his treatment, it would not stop him battling to preserve the beleaguered hospital. [...] Last Wednesday, Mr Hanson was threatened with the sack if he continued his protest. The action followed news that Timaru pathologist Duncan Lamont was suspended for a week and told his job was on the line after speaking out about threats to Timaru Hospital services. [...] Medical Specialists‟ head Ian Powell described the action as disgraceful and said both instances were “a direct attempt at muzzling these people”.576 As health authorities began to become run along more corporate lines, health workers found themselves having to negotiate their right to express concerns about the health system. For example in 1994 during negotiations with their CHE, „Senior doctors in Northland hospitals are seeking a contractual right to speak out on matters of professional and public concern.‟577 Some health workers never got the chance to vocalise fears about the changes to the health
572 573

SST, 16 March 1996, p.C5. NZH, 21 August 1997, p.1. 574 NZH, 17 October 1997, p.7. 575 SST, 31 May 1998, p.1. 576 SST, 7 June 1998, p.3. 577 NZH, 16 February 1994, p.1.

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system. In June 1994, „Starship hospital staff opposed to proposals that adults be treated in the national children‟s hospital say they risk being sacked if they speak out against the plan.‟578 The use of contractual gagging orders, suspensions and disciplinary actions against health workers who spoke out was a constant threat to whistleblowers but it did not stop all actions and the disciplinary actions against health professionals often hardened workers opinions against CHEs and the Government‟s attacks. There was some attempt by the Government to remedy the perceived lack of protection for whistleblowers in 1995 when it „indicated that it will support legislation to protect “whistleblowers” who release information about dangerous or corrupt practices.‟579 Psychiatric nurse Neil Pugmire hit the headlines in 1994 when he was suspended from his job for publicly criticising the release of a dangerous, psychiatric patient who went on to reoffend once released. 580 The suspension sparked heated political debate in Parliament and Labour MP Phil Goff, ‟accused [Minister for Health Jenny] Shipley of involvement in the issue, saying she had tried to suppress the truth rather than protect communities.‟581 In the end the Wanganui CHE spent $30,000 on legal costs in disciplining Pugmire before he was reinstated.582 In 1995 Peter Neame, who led the campaign to save Hokitika hospital in 1988, became a second whistle blowing psychiatric nurse to be disciplined by their CHE, A senior psychiatric nurse has been suspended for breaching patient privacy in what health campaigners claim is a second Neil Pugmire case. Peter Neame was suspended in Friday night after speaking to a Grey Power meeting the day before over the planned closure of Seaview psychiatric hospital in Hokitika, where he works. At the meeting, he described what had become of several patients he believed had been prematurely discharged, and alleged the country‟s rising suicide, murder, arson and sex attack rate was caused by people with mental illness forced out of hospital or not having access to care.583

578 579

SST, 19 June 1994, p.2. NZH, 15 December 1995, p.5. 580 NZH, 4 February 1994, p.1. 581 Ibid. 582 NZH, 16 March 1994, p.1. 583 SST, 11 June 1995, p.3.

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For this, Neame was forced out of his job and moved to Australia for work after being, in his view, „blacklisted‟ from nursing in New Zealand.584 The Coalition for Public Health also became a covert platform for health workers to undermine the reforms, especially the moves to corporatise service delivery. The corporatisation of hospitals was described in the Your Health & the Public Health paper as; „Most big public hospitals will be established on more business-like lines as Crown Heath Enterprises (CHEs), with appointed boards of directors drawing on business as well as health sector expertise.‟585 Health sector workers often sent the Coalition documents that could embarrass the Government. The Coalition would then release the documents into the public arena, further undermining public trust in the reformers. Sabotage of the reforms extended to the highest levels, as Keene noted,

People who had never done anything wrong before in their lives. Senior people working within the system would leak information to us. We were always getting leaked information both from government departments and from hospitals about consultants‟ reports, about where services were really struggling, or where waiting lists were increasing or where there was any danger to patients. We‟d get that information. Plain brown envelopes would arrive on the desk. [...] There was also very senior public servants, both current and former, who were coming to us and providing advice to us.586 The Coalition‟s media hits took a toll on the morale of the Government and in the end the Government sent representatives to news editors to discredit the Coalition. Keene remembers,

The Government was going around talking to editors and news editors to discredit the Coalition. We have no proof of this, just simply journalists told us this, that that had been happening. Because news editors were saying to journalists, “Be wary of this group...who do they represent?”587

584 585

SST, 26 October 1997, p.3. New Zealand Government, Your Health & the Public Health, p.4. 586 Keene, Disc 1. 587 Ibid., Disc 1.

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The Coalition for Public Health played an important role, as a non-party political counterpoint to the Government‟s viewpoint and provided the institutional legitimacy and framework for health service managers to undermine their own organisation. This fed the mass resistance of health workers and patients. Throughout the 1990s health workers attempted to highlight perceived concerns with the state of the health system by speaking out and articulating their concerns in the media and politically. The response of CHEs was heavy handed and designed to intimidate and quiet criticism from their employees.

Exodus Throughout the 1990s health professionals left the public health system in droves. This is an often overlooked form of protest and resistance and although the effect in opposing the reforms was minor reporting of resignations in the news media highlighted the anger health workers felt about cuts to services and corporatisation. The timeline below represents some of this exodus and its reporting in the newspapers. April 1991 - „The resignation of Dr Robert Crawford, the medical superintendent of Hanmer‟s Queen Mary Hospital, is likely to spark strong protest, says the man who organised the campaign to save the hospital from health cuts two years ago.‟588 April 1992 - „A day after a recommendation was made to partly close Sunnyside Hospital, the Canterbury Area Health Board‟s professional adviser for psychological services has resigned.‟589 October 1993 - „Resignations by five senior psychiatrists at Capital Coast Health would leave mental health services in the region in crisis, psychiatry professor Graham Mellsop, one of those leaving, said yesterday.‟590 March 1994 - „The outspoken head of surgery at Capital Coast Health, Geoff Horne, is going private for the first time because he says restructuring means he can no longer do his best for patients in the public system.‟ 591

588 589

Press, 26 April 1991, p.1. Press, 25 April 1992, p.8. 590 Dominion, 14 October 1993, p.1. 591 NZH, 16 March 1994, p.1.

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March 1994 - „A senior surgeon is quitting Dunedin Hospital and other colleagues are in despair because of serious surgical delays which they say could endanger patients‟ lives.‟592 October 1997 - „Wellington medical school surgery professor William Isbister has resigned because health cuts have “destroyed” his unit at Wellington Hospital.‟593 The timeline above shows a series of resignations from doctors in protest at public health restructuring. This exodus of doctors was matched by nurses leaving their profession. The history of the New Zealand Nurses Organisation describes the loss of experienced staff thus, With the patient profile changing, the need for staff, particularly specialist and with advanced expertise, became desperate. Often this vitally necessary experience had walked out the door. Shirley McGuinness had been thirteen years in ICU at Taranaki Base Hospital when she accepted a voluntary redundancy package. She was the last of seven senior staff to leave the unit within eight months, to be replaced by new staff.594 Conclusion Throughout the 1990s health workers sought to resist the health reforms in their workplaces. The health sector became plagued by industrial action as workers sought to resist attacks on their wages and conditions. Health workers also sought to intervene collectively to improve patient safety. The most dramatic intervention was at Christchurch Hospital where medical and nursing staff sought to take on not only the content but also the substance of the health reforms – the removal of clinical staff from managerial positions, the underfunding, understaffing and casualisation that was slowly destroying the ability of health professionals to do their job. Some health workers sought to combat the reforms and their most unsafe consequences by getting confidential and embarrassing information into the public domain, while others resigned in protest at the reforms, often citing their personal frustration with the reforms making it unbearable for them to remain in the public system. All of these forms of workplace resistance played a role in shaping the health structures of the 1990s and preventing the worst attacks on health workers collective agreements, patient safety and underfunding. They were not in themselves enough to stop the reforms progression and
592 593

Ibid. Dominion, 7 October 1997, p.1. 594 Mary Ellen O‟Connor, Freed to care, proud to nurse; 100 years of the New Zealand Nurses Organisation, Wellington, 2010, p.244.

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increasingly health workers sought to build a national movement to challenge the National Government‟s health reforms. Based on their industrial experience health workers and unions allied with local government leaders and local community campaigns against hospital closures to try and change the direction of the health reforms in the late 1990s with a wave of what can be described as social movement unionism.

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Chapter Four

‘Third World Health, Third World Pay’595
Public health nurses‟ opposition to the health reforms, 1988-1999
Public sector nurses and their principal union, the New Zealand Nurses Association (renamed the New Zealand Nurses Organisation in 1992), played an important role in opposing the health reforms from 1984 to 1999. During the period of the health reforms nurses vigorously protested and advocated against the health reforms and sporadically took industrial action over employment conditions. This chapter of the thesis examines in detail this fight by the NZNA/NZNO and nurses in the public health system. The role of the nurses in the struggle against neo-liberalism in health care merits special attention as nurses make up the largest section of the workforce in the public hospital system. The first part of this chapter looks at the nurses‟ union campaigns against the State Sector Act in 1988 and the Employment Contracts Act in 1991, the second part looks at the important 1992 bargaining round by the NZNA when the national nurses award was broken up into regional agreements, the third part looks at the strike wave of nurses between 1993-4, the fourth part describes the NZNOs responses to cuts to services and closures in the 1990s. Lastly this chapter presents a comparison of the nurses‟ unions‟ industrial actions with that of nurses in Victoria, Australia, 2011-12, and with New Zealand secondary school teachers in 1992. State Sector Act, 1988 By the middle of the 1980s nurses in New Zealand were becoming increasingly activist in their approach to trade unionism. In July 1985 the Herald reported, „Nurses need wage increases of between 22 and 42 per cent in New Zealand hospitals are to keep enough staff, the Nurses Association says.‟596 Nurses were becoming increasingly frustrated with low pay and „Several thousand Auckland nurses silently carried torches in a protest march up Queen St, Auckland, last night in a bid to convince the public that “nurses are worth more.”597 The

595 596

Press, 30 September 1992, p.1. NZH, 18 July 1985, p.16. 597 NZH, 27 July 1985, p.3.

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rise in nurse activism and trade unionism was caused by the increasingly aggressive attempts by the Fourth Labour Government to reign in public sector spending through attacking the wages and conditions of nurses. However this attack on the work rights of nurses did not begin in earnest until 10 December 1987 when the Labour Government introduced the State Sector Bill to Parliament.598 The Bill, in line with the more market reforms of the Fourth Labour Government, had the following implications for nurses, said the NZNA‟s industrial officer John Robson,  Introduced Prime Minister appointed chief executives to run the public sector, replacing the non-political appointments of head of government departments in place since 1912.   Introduced chief executives as the top manager of health and hospital boards, replacing the tripartite managerial structure. Repeals the State Services Act Conditions of Employment Act 1977 and subsequent amendments, allowing for possible regional pay rates, making applying for arbitration conditional on the agreement of both union and employer parties,  Forcing the renegotiation of many „day-to-day realities of working life in the state sector that had been set out in agreements, manuals and various undertakings. All of this is wiped at a strike and has to be renegotiated. For public servants this means that maternity leave has gone. For nurses, superannuation is threatened, along with the equal opportunities agreement and childcare arrangements.‟  Abolishes the Health Services Personnel Act 1977 which „keeps the state services free from corruption and nepotism‟.599 The mood in public hospitals around the country was of anger at the State Sector Bill. NZNA regional organisers reported in the New Zealand Nursing Journal (NZNJ) the feedback from nurses at public hospital stop work meetings in the lower North Island, „We discussed the pay round but it was the State Sector bill which left people stunned. The first reaction seemed to be “What can we do about it?”‟600 A report on a round of nurses meetings in South Island hospitals nurses shows similar sentiments, „All well attended and expressions of disgust and anger aired. Support for the NZNA position on salary claim, ie: to seek 7% with
598

John Robson, „The State Sector Bill – implications for nurses‟, New Zealand Nursing Journal (NZNJ), January 1988, 81(1), pp.8. 599 Ibid., pp.8-9. 600 Chris Collins, „Central‟, NZNJ, January 1988, 81(1), p.10.

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improvements to rosters etc. Strong opposition to Bill with some questions emerging at meetings over what action nurses can take.‟601 The NZNA executive director, Gay Williams, warned, „It seems peculiar that Government actually desires a group of its workers, who traditionally have preferred to continue to provide a service to their patients and take their chances before a judge, to be placed in the situation where greater militancy is an increased possibility.‟602 As nurses learnt more about the effects the State Sector Bill would have their anger grew. Shona Carey, Chairperson of the Chief Nurses of New Zealand wrote in a NZNJ editorial in February 1988, „The State Sector Bill, if enacted as presently written, transforms chief executives of hospital and area health boards into all-powerful beings who will control the destiny of the many thousands of employees in the health service. The general manager has arrived.‟603 Gay Williams in the same issue, called for the State Sector Minister to „withdraw the State Sector Bill and reword it so that the nursing service does not degenerate into a plethora of regional documents which will inhibit nurses from competing for promotions across a national service‟.604 Williams also threatened, „Our members are very disturbed by this Bill and have been reacting with concern up and down the country. A normally conservative workforce has been giving us „blank cheques‟ for industrial action at well attended stopwork meetings.‟605 The passage of the State Sector Bill in 1988 caused a „nurses‟ revolt‟ as the Listener described it.606 Nurses were concerned firstly, about the removal of the chief nurse from the hospital board management trio (chief nurse, head doctor, administrator) and their replacement by a chief executive „with an almost unlimited power to hire, fire and to set staff levels, conditions and pay rates‟. 607 Secondly, they were angry the law „removes the national award protections that public sector nurses currently enjoy in this country, Once the various area health boards are up and running, they will negotiate their own separate agreements...[and nurses worry] will open the door to variations around the country in wages and work conditions.‟ 608

601 602

Trevor Warr, „Southern‟, NZNJ , January 1988, 81(1), p.10. „Government‟s Christmas package to the state sector‟, NZNJ , January 1988, 81(1), p.5. 603 Shona Carey, „Nurses in top management‟, NZNJ , February 1988, 81(2), p.2. 604 „Minister „not totally honest‟‟, NZNJ, February 1988, 81(2), p.4. 605 Ibid., p.4. 606 Gordon Campbell, „The nurses‟ revolt‟, Listener, 26 March 1988, pp.16-18. 607 Ibid., pp.16-18. 608 Ibid., pp.16-18.

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When it eventuated, the campaign from nurses against the State Sector Bill in early 1988, „Nurses Say No‟, was widespread but short lived. Between 7 and 18 March direct action in the form of stop work meetings, work bans and all out nurses‟ strikes had taken place in over 58 hospitals and health units.609 On March 16 the NZNA reported „Improvements gained as a result of nurses‟ industrial action included: the right to have awards, the right to maintain conditions outside determinations in our award, some improvement in the equal employment opportunities provisions; clearer provisions regarding health administration.‟610 These concessions from the Government were significant and represented a partial victory for nurses in protecting their employment conditions. As a result however the mobilisation began to be called off. On March 17 the executive of the Combined State Unions ‟vote[d] to withdraw industrial action from 5pm Friday March 18 and a new phase of activities to be planned‟ and the same day the NZNA executive followed suit, voting that members call of industrial action.611The next day the NZNA „issue[d] urgent circular to members calling off action and explaining the situation‟.612 A fourteen person executive had called off the industrial action of some 27,000 workers on the recommendation of the peak body of the alliance of public sector unions.613 The State Sector Bill became the State Sector Act on 1 April 1988. Days after its passage the Government released the report of the Taskforce on Hospitals and Related Services, known popularly as the Gibbs report.614 The Gibbs report proposed, as the NZNA Editorial in May 1988 put it, „a wholesale shake-up of the hospital service based on the premise that marketled strategies must take precedence over all our social obligations to provide a health service for New Zealanders, regardless of their ability to pay.‟615 With managerial reform of the public sector entrenched the Government was beginning the process of corporatisation of the public health care system. 24-hour strike, 1989 The effect of the market-led reforms in the public sector was to push workers and the state into conflict over employment conditions as Government Ministries looked to cut costs in
609 610

„Diary of the opposition to the State Sector Bill: what was won: what was lost‟, NZNJ , May 1988, p.10. „Ibid., p.11. 611 Ibid., p.11. 612 Ibid., p.11. 613 „Report of National Executive meeting‟, NZNJ , April 1988, 80(5), p.20. 614 Hospital and Related Services Taskforce, Unshackling the Hospitals; Report of the Hospital and Related Services Taskforce, Wellington, 1988. 615 Editorial, „How valid is the Gibbs report?‟, NZNJ , May 1988, 81(5), p.2.

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line with political expectations. This created a pushback from affected workers, such as nurses, who were forced to defend their working conditions. On February 14 1989 nurses undertook the first nationwide public hospital strike in New Zealand history.616 The combined 24-hour strike by the health sector unions (NZNA, Public Service Association, Service Workers‟ Federation, Local Government Officers‟ Association) was against general managers of hospital and area health boards attempting to claw back conditions and offset wage increases with redundancies. After the strike and threats of a further 48-hour action on February 21-22, a settlement was reached with a very modest wage increase of $12 for full time nurses, no redundancies to occur as a result of the increase, no claw backs and provisions for consultation with unions over health changes.617 Nurses had once again flexed their newly discovered industrial strength and won a victory. The new political and economic environment in the late 1980s required new tactics by nurses in order to win their demands and make their voice heard by a Labour Government. In September 1989, „Nurses voted unanimously at their annual conference to launch a national political campaign in defence of the public health system.‟618 The election of in 1990 of a National Government which aimed to curtail the power of unions and the right of workers to go on strike would force nurses into even more difficult circumstances. Employment Contracts Bill, 1991 The NZNA‟s next big challenge came in early 1991, when Jim Bolger‟s National Government passed the Employment Contracts Act into law. The ECA removed all awards, abolished compulsory unionism and forced unions into site or company bargaining. Cybele Locke notes the significant effect of the ECA and the removal of awards on unions covering large industries and on their ability to negotiate collective agreements, „Crucial to the award system had been blanket coverage, according to which unions had the right to represent workers in a particular industry and make collective contracts that bound all employers in that particular occupation or industry. Under the ECA, statutory procedures governing negotiations were removed and employees could negotiate a collective contract only if employers were willing to do so.‟619 Almost every historian of trade unionism in New Zealand views the failure of the Council of Trade Unions to declare a general strike in April 1991 to defeat the Employment Contracts Bill as a turning point in labour relations. As Otago
616 617

O‟Connor, pp.207-208 „Striking results‟ NZNJ, March 1989, 82(2), p.10-11. 618 People‟s Voice, 13 November 1989, p.14. 619 Locke, p.187.

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University political scientist and socialist activist Brian Roper summarised this position, „The struggle for and against the ECB is crucially important because, although the union movement was actually decisively defeated, the outcome could have been very different if general strike action had forced the Government to either withdraw or substantially amend the legislation. If the latter had occurred, then the continuing implementation of neoliberal policy reform would have been severely disrupted and stalled.‟620 Nurses with two consecutive years of successful industrial action and facing the breakup of a national award into regional pay agreements were both well placed to oppose the ECA and expected to be impacted greatly. As a result of decisions made by the NZNA leadership their opposition to the bill was muted and their leaders decisions helped scupper any possible general strike. The first week of April 1991 was billed as a „Week of Action „ and „included strikes, stop work meetings, rallies and marches involving 300,000 to 500,000 New Zealanders out of a population of 3.2 million.‟621 On 3 April 1991, „Workers at 15 Auckland public hospitals held a two-hour stopwork meeting yesterday in protest at the Employment Contracts Bill. They braved pouring rain to march to Aotea Square as part of the Council of Trade Union‟s week of action against the bill.‟622 The Auckland Star called it, „a mass protest against the bill and any plans for [health] privatisation.‟623 There were calls from many union members and union officials for a 24hour or indefinite general strike but on 18 April 1991 when the affiliates of the Council of Trade Unions met to determine a course of action, an amendment to a resolution from Rick Barker, secretary of the Service Workers Federation, calling for a 24hour general strike, was defeated.624 „In the conference itself the national office holders in major unions (PSA, Engineers, Post Primary Teachers Association (PPTA), Nurses Association, Post Office Union, New Zealand Educational Institute (NZEI), Financial Sector Union) block voted 250,122 to 190,910 against the Service Workers Federation‟s proposal for a 24 hour nationwide strike.‟625 The Nurses Association in voting against strike action were going against the will of their membership, 87% of their membership had voted across the country in stop work meetings in favour of a 24-hour strike on April 29-30.626 The 11

620

Brian Roper, „The New Zealand Council of Trade Unions and the struggle against the Employment Contracts Act; Lessons for activists today‟, Red & Green, 2007, 6, pp.10-32. 621 Ellen J. Dannin, Working Free; The Origins and Impact of New Zealand‟s Employment C ontracts Act, Auckland, 1997, p.146. 622 „Two-day strike at hospitals likely soon‟, Dominion, 4 April 1991, p.2. 623 Auckland Star, 3 April 1991, p.4. 624 Roper, pp.21. 625 Ibid., pp.21. 626 Ibid., pp.21.

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March 1991 issue of People‟s Voice carried a survey of union activists views on the fight against the Employment Contracts Act included comments from Helen MacKenzie, Nurses Association national president, reflecting the tactical conservatism and reluctance for industrial action at the top of the NZNA; „As for actions, there‟s the submissions to the parliamentary select committee, education and information campaigns using the mass media and things like talkback shows, rallies, meetings and marches. And it may become necessary to have some industrial action.‟627 The mood amongst rank and file nurses and health workers was much more energetic on April 9 at a Wellington stop work meeting of 2500 hospital workers from health sector unions. The People‟s Voice reported, „A resolution was put from the floor which “recommended that the health sector unions initiate an indefinite national strike of all union members from the earliest possible date and urge the CTU to extend the strike to a General Strike of all its affiliates until the Employment Contracts Bill is defeated”. This resolution received strong support and was carried by the meeting.‟628 However even the 24-hour strike by health unions planned for the end of April was called off. On 26 April the leadership of the Nurses Association and other health unions cancelled the strike after the Labour Court ruled on the 25 April in favour of the Auckland Area Health Board that a strike by 900 nurses at Middlemore Hospital was „unlawful and would put patients lives at risk‟.629 The union officials were rattled by the ruling. Gay Williams, executive director, told the Auckland Star the day of the court decision, „We will abide by the ruling and will look at what other options are available to us.‟630 The calling off of the strike was never to be debated or voted on by the Nurses Association rank and file. On 30 April three hour stop work meetings were held instead. The meetings marked the effective end of the Nurses Association campaign against the ECA. Negotiating regional agreements, 1992-1993 Following on from the failure of the nurses association to defy injunctions or ballot members for action in April 1991 came the failure of NZNA to maintain one collective agreement covering all public sector nursing staff across the country. Faced with health board opposition to a national contract the NZNA agreed to health board level bargaining with mixed results for members. As journalist Gordon Campbell put it, the NZNA „made the tactical decision
627 628

People‟s Voice, 11 March 1991, p.25. People‟s Voice, 17 April 1991, p.44. 629 Auckland Star, 26 April 1991, p.3. 630 Auckland Star, 26 April 1991, p.1.

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that it could not win a strike to defend its national award, and thus the door opened to regional wage bargaining‟.631 The Employment Contracts Act made strikes for multiemployer collective agreements illegal and with industrial options „restricted‟ the other major health sector unions – the Public Service Association (PSA) and Service Workers‟ Union – headed into regional bargaining.632 The PSA in particular was very supportive of regional bargaining, going so far as to tell public health workers, „Penal rates and rosters and hours of work will be attacked this year. Significant groups of members rely to a large extent on penal rates, and those penal rates are better maintained under a regional contract.‟633 Yet the NZNA did not attempt to defend nurses‟ conditions even at the regional level, „In an effort to save the nursing budget, the NZNA has produced “cost-neutral” packages around the country. Although some nurses win in these packages, others – like those on weekend night rates, who depend heavily on penal rates – still stand to lose large sums of money.‟634The NZNA was not just sacrificing nurses working conditions; it was doing so in such a way that divided its own members.635 Campbell, met with a group of Wellington nurses and picked up on a mood of defiance amongst certain sections of the nursing workforce, „Older nurses, the group agrees, have been among the strongest supporters of strike action – because the wage round is trying to roll back advances that they struggled all their lives to achieve.‟636 Southland and Otago were the first to reach agreements in the 1992 negotiations but these settlements which stripped out penal rates were ratified controversially. Southland nurses settled an agreement in August 1992 that stripped out penal rates in the early hours of the morning after an all day, all night bargaining session.637 Southland nurses ratified the deal but the Southland Hospital worksite convenor for the NZNO, Anne McFarlane, told Nursing New Zealand, „People were apathetic, which is why 70% voted to accept it. They didn‟t realise until they got their pay packets what it meant.‟638 However Southland nurses voted on the agreement without seeing the full document because the NZNO under pressure to do a deal before the old contract ran out and staff were put on individual contracts.639 Nurses in Otago were also divided on ratification of the agreement. Nurses Association organiser in Dunedin,

631 632

Listener, 17 October 1992, pp.28-34. PSA Journal, April 1992, p.7. 633 Ibid., p.7. 634 Listener, 17 October 1992, pp.30. 635 Ibid., pp.32. 636 Ibid., pp.32. 637 NNZ, April 1993, 1(1), pp.23-25. 638 Ibid., pp.23. 639 Ibid., pp.23.

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Glenda Alexander, told the ODT, „a small but vocal group believed that Otago nurses should have “put up a better fight” to achieve the desired working conditions in their collective employment agreement...‟640 Yet although the national leadership was not prepared to lead industrial action to defend the conditions of the award, many nurses at the ward level were prepared to. Strikes broke out in a number of health boards as nurses sought to defend their wages and conditions. The health boards area managers had been encouraged by Labour Minister Bill Birch to seek „greater flexibility in working hours and modification in penal rates‟ when they met with him in March 1992.641 Campbell describes Birch‟s „instructions‟ to the health managers, „Moreover, Birch made it clear he was willing to risk industrial disruption of the hospitals: “I do not expect you to throw up your hands in horror at the challenge of negotiating productivity increases in a tight fiscal environment without provoking a militant reaction from employees.”‟642 The outbreak of industrial action was a consequence of the health reforms economist Brian Easton wrote in The Commercialisation of New Zealand,

What went wrong? From one perspective, the model was wrong. The reforms were based on the assumption that health was a generic product, which could be administered by generic managers. Even the CHE boards, packed with businessmen (and the occasional businesswoman) who have little experience of the medical industry, quickly recognised the first point. [...] This culture clash is not only a recipe for worker demoralisation, poor productivity, and industrial disputes. It overflows into public perception. It was reported that „Capital Coast Health is short of blood because donors believe their blood will be sold‟.643

One place where strike action did break out was in Canterbury in September 1992 where 2500 nurses and 700 hospital workers (orderlies, cooks and cleaners) struck after rejecting an offer that the Area Health Board‟s general manager described as „better than those made to nurses in the Otago, Southland and Northland boards, where settlements have been reached‟.644 During the strike 800 people marched through the Christchurch CBD, one

640 641

ODT, 3 October 1992, p.3. Listener, 17 October 1992, pp.28. 642 Ibid., pp.28. 643 Easton, p.164. 644 Press, 30 September 1992, p.1.

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placard read, „Third World Health, Third World Pay‟.645 On a picket line outside Christchurch Women‟s, mothers who had had their babies in the neo-natal unit showed their support for the nurses. Joanne Brown, a mother of a six-month-old cared for by the nurses said, „I felt so angry about what was happening that I had to come down. Corey spent five months in the unit when he was born 25 weeks premature. His twin didn‟t make it. The nurses were brilliant and they deserve everything they ask for. I saw the conditions they have to work in, and they are atrocious.‟646 Strike action also took place through September and October 1992 in Wellington where nurses struck over pay and to ensure the inclusion of charge nurses in their agreement.647 Nelson nurses also struck.648 Although there is no sign of membership fury over the NZNA head office‟s decision to pull the plug on strike action against the ECA or the decision in favour of regional bargaining, the same was not true in the PSA where between 500 and 1000 members, mainly psychiatric nurses and social workers in the health sector in Canterbury and Nelson broke away to form a new union, the National Union of Public Employees.649 Unhappy with the lack of resistance to the breakup of health worker collective agreements by the Public Service Association, a new National Union of Public Employees was formed in April 1992 with health workers at its core, ‘Canterbury, Nelson and West Coast psychiatric workers are continuing to ditch the Public Service Association in favour of a breakaway union of public employees.‟650 In June the Press reported, “Crash firemen at Christchurch Airport and some health workers at Lake Alice psychiatric hospital near Wanganui have joined the ranks of the new breakaway union of public servants.‟651 New Zealand‟s psychiatric nurses have a tradition of democratic unionism and industrial radicalism. In 1972 they were the first health professionals to take strike action, a move which prompted their union, the PSA, to change its rules to ensure subgroups of workers within the union, (like psychiatric nurses), could not strike without permission from the central union.652 In 1992 Val McClimont, chair of the Canterbury branch of the PSA and a Christchurch social worker told the PSA Journal the main issue discontented union members had was the ECA campaign, „Health workers wanted to take

645 646

Press, 30 September 1992, p.1. Ibid., p.8. 647 ODT, 3 October 1992, p.3. 648 Ibid. 649 PSA Journal, May 1992, pp.8-9. 650 Press, 25 April 1992, p.5. 651 Press, 11 June 1992, p.10. 652 Catherine Prebble, „Ordinary Men and Uncommon Women: A History of Psychiatric Nursing in New Zealand Public Mental Hospitals, 1939-1972‟, PhD Thesis, University of Auckland, 2007, p.289.

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industrial action to defeat the bill, but believe they were stopped from doing so by the PSA national executive.‟653 PSA Journal also noted psychiatric nurses were angry over the decision by the PSA to adopt regional bargaining and felt their penal rates would be washed away in the new environment.654 And just as the NZNA signed up to agreements without penal rates without a fight in 1992 so too did the PSA which entered regional negotiations in the health sector with a policy of accepting reductions in penal and overtime rates in exchange for compensation payments.655 This industrial perspective was echoed in the words of David Thorp, PSA General Secretary, whose editorial in the PSA Journal of November 1993 was titled, „Adversarial unionism on the way out‟.656 The editorial elicited a response from Val McClimont in the next issue that „If David is uncomfortable with being our advocate, and with the conflict that it inevitably brings, then he should resign and seek employment as a mediator or some such thing. His views have no resting place in a trade union... Adversarial unionism is unionism.‟657 The experience of PSA members at Seaview psychiatric hospital in Hokitika would seem to contradict the perspective of the PSA head office. At Seaview the psychiatric nurses and allied health workers rejected contracts cutting penal rates and allowances and threatened strike action with a unanimous vote in favour of action.658 In June 1993 the PSA members there ratified an agreement they had begun negotiating over a year earlier.659 The new contract was described by psychiatric nurse and PSA delegate Peter Neame as „close to break even‟ and negotiations involved members at all stages through mass meetings.660 Strike wave, 1993-1994 Auckland Area Health Board nurses were the last to settle their first post-award collective agreement in January 1993 ratifying a 10% wage increase. In August 1992 nurses facing pay cuts of up to $7000 a year had been close to strike action in Auckland.661 Strike threats in December 1992 by Auckland nurses for January 1993 had hospital management prepare to force medical specialists to do some nurses tasks which angered doctors who said they were

653 654

PSA Journal, May 1992, pp.8-9. Ibid. 655 PSA Journal, November 1992, p.6. 656 PSA Journal, November 1992, p.4. 657 PSA Journal, December 1992, p.5. 658 PSA Journal, July 1993, p.5. 659 Ibid. 660 Ibid. 661 NZH, 6 August 1992, p.3.

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unqualified to do the jobs and unwilling to break the nurses strike.662 Mary Ellen O‟Connor described the battle in Auckland by nurses in her history of nurses‟ unions, „In the circumstances it was a triumph bit it had taken eight months and repeated industrial action to defend themselves from the wage cut.‟663 This experience of holding out and winning and increasing possibility of political change in the lead up to the 1993 election created a much different situation for nurses bargaining in 1993 in comparison to 1992. Mary Slater, NZNO industrial officer, wrote in the September 1993 Nursing New Zealand, The atmosphere is different from that in 1992. Government funding to CHEs is lower than it was to area health boards. But most CHEs seem to be conscious of the need to build relationships with nurses and perhaps more importantly, are conscious of the Government‟s wish to minimise “bad news” in an election year where health is a hot topic. Demands from the CHE management for cuts in nurses‟ pay are few and far between.664 Nurses as a result were stroppier in their industrial opposition to CHEs and began to push back around the country. At Waikato Hospital‟s surgical ward, united opposition from nurses stopped announced cuts to staffing levels, proposed by a private consultancy firm. At mass meetings, 200 nurses rejected the cuts and vowed not to co-operate with the consultancy firm brought in by CHE management to propose cost cutting measures. 665 NZNO used the October election campaign as a political platform for a national day of action in support of the public health system. Nurses held rallies in Auckland, Wellington, Christchurch, Dunedin and held public display and gave out leaflets in smaller centres.666 Strikes broke out around the country over pay between November 1993 and early 1994. The first came when four hundred nurses in Nelson and Marlborough struck in October after management refused to offer a 5% wage increase, „This was the first time public health sector nurses in New Zealand have voted to strike three days in a row.‟667 In Otago and Southland 1600 nurses struck in late October for 48-hours for a 5 percent wage increase.668 In Otago the
662 663

NZH, 28 December 1992, p.1. O‟Connor, pp.231. 664 Nursing New Zealand (NNZ), September 1993, 1(6), p.11. 665 NNZ, October 1993, 1(7) p.24-25. 666 NNZ, November 1993, 1(8), pp.5-6. 667 NNZ, November 1993, 1(8), pp.12-14. 668 ODT, 28 October 1993, p.3.

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strike had 90 percent support from nurses.669 In November 1993 nurses at Otago were able to make an agreement with their employer but strikes continued elsewhere, „A nurses‟ strike planned in Wanganui today was called off yesterday, as a two-day stoppage by 350 South Canterbury nurses began uneventfully.‟670 There were also strikes by Wairarapa and Wanganui nurses that same month. 671 In Auckland the Herald described laboratory staff as „restless‟ and that, „Striking laboratory staff returning to work this morning at two Auckland public hospitals may walk out again on Friday unless their pay dispute is settled.‟672 In December 1993 nurses‟ strikes continued in Manawatu, Horowhenua, Wairarapa and Wanganui.673 In Manawatu the ballot was 94% in favour of strikes.674 Some nurses were being offered agreements by health authorities that gave them „a $2500 pay cut because of cutbacks to the nurses‟ superannuation scheme.‟675 In January 1994 nurses and allied staff in Northland and Rotorua voted for a four day strike to win 5% and 6% pay rises respectively.676 During the strike in Northland there were „pickets and rallies and a candlelight procession encircling Northland Hospital on the night the strike ended in a gesture of protection for the public health system.‟677 By February 1994 contracts had been ratified in Wellington, Southland, South Canterbury, Wanganui, Manawatu and Wairarapa.678 Deals were also being ratified in February by nurses in the Hutt Valley and Otago.679 Throughout the strikes there was a lack of co-ordination between the various areas. Nurses at Midcentral Health took strike action in support of a claim of a 5% increase at the same time as nurses‟ officials proposed a settlement of 2% over an 18-month term at South Canterbury Health.680 Yet this industrial activity quickly tapered off. After the strikes of 1993-4 nurses at many CHEs ratified long agreements with modest wage increases. One example was in the Hawke‟s Bay Health where nurses ratified a contract in February 1994 with a 4% wage increase and due to expire in April 1996.681 Nurses at Western Bay Health in Tauranga also
669 670

NNZ, November 1993, 1(8), pp.12-14. NZH, 3 November 1993, p.3. 671 Dominion, 17 November 1993, p.7. 672 NZH, 16 November 1993, p.2. 673 NZH, 16 November 1993, p.5. 674 NNZ, November 1993, 1(8), pp.12-14. 675 Dominion, 1 December 1993, p.1. 676 Dominion, 31 January 1994, p.3. 677 NNZ, February 1994, 2(1), pp.16-17. 678 Ibid., p.17. 679 Ibid. 680 NNZ, December/January 1993/1994, 1 (9), p.4. 681 NNZ, March 1994 2(2) p.34.

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ratified an 18 month deal the same month.682 With half of the CHE contracts (12 of 23) settled in April 1994, the NZNO industrial officer, Mary Slater reported, Two CHEs – Southern Health and Healthlink South – have settlements which are short extensions, with any changes being minor. Of the other settlements, only one has the traditional 12-month term-the others are all between 18-months and just under three years, with an average of around two years. In many cases the decision to have longer terms was one made at the initiative of both the CHEs and NZNO – both seeing the benefits of not having the annual “bunfight,” but rather freeing everyone up to “get on with the job.”683 Some nurses were unhappy about how the union‟s ratification processes were followed. Nurses at Northland Health rejected two offers in early 1994 and took four days of strike action over the CHE‟s refusal to improve allowances. 684 In early May NZNO officials, without the approval of Whangarei Hospital delegates and the Tai Tokerau regional chairperson, recommended Northland nurses individually signing onto a collective agreement that would expire in December 1996. In late month Whangarei nurses balloted members for indefinite strike action, the turnout was 40%, with 80% of those voting in favour.685 This did not reach the level set by delegates and in early June, nurses were signing up individually to the collective agreement around the region.686 A letter to union journal Nursing New Zealand from one of the NZNO members on the negotiating team expressed the anger nurses felt with their union over its undermining of the ratification process, „Instead of supporting your members and their needs, NZNO management seem to have their own agenda. No wonder every Whangarei nurse is questioning the value of NZNO and there is a growing lack of confidence in NZNO.‟687 The reply from the national director, Gay Williams to the letter, highlighted the pressure on the NZNO to conclude an agreement offered to members, „However on Tuesday evening Northland Health informed us that they would not negotiate further with NZNO. They told us they would send an individual letter to each of their nurse employees offering them the opportunity to join the collective contract, with a deadline of 22 May.‟688 In 1997 Northland Health nurses ratified a 20 month contract with a 5% wage
682 683

NNZ, March 1994 2(2) p.34. NNZ, April 1994, 2(3), p.11. 684 NNZ, June 1994, 2(5), p.6. 685 Ibid. 686 Ibid. 687 NNZ, June 1994, 2(5), p.3. 688 NNZ, June 1994, 2(5), p.3.

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increase, increased shift and on-call allowances and improvements in their leave and rosters.689 Advocacy everywhere, actions sometimes and co-ordination nowhere, 1991-1999 Yet apart from the strike wave of summer 1993-94 the period between 1991 and 1999 represents a period of retreat for the nurses as closures and cuts bit deeply into the country‟s public health infrastructure and when the unsafe levels of staffing reached crisis point. The role of the NZNO was to provide advocacy for nurses across the country, support action from nurses when it occurred but not to provide any nationwide, co-ordinated industrial or political fight against redundancies, closures and overstaffing. Advocacy everywhere Nurses unions did provide advocacy for nurses around the country facing closures and staffing issues as a result of the health reforms. For example in 1993 the NZNO highlighted the growing use of casual nurses with a survey of 11 area health boards, showing the number of casual nurses employed had increased from 1433 to 2303 nurses.690 In September 1993 the union released another survey showing public hospitals „treated 66% more day patients and 6% more in-patients between mid-1990 and mid-1992, while funding was cut $350 million or 11%.‟691 Over the same period, said the NZNO, nurses had their pay cut an average of 11.4%.692 In 1995 NZNO carried out interviews with public sector nurses and published excerpts, „as an attempt to start opening up the health system to public scrutiny‟.693 The report, The Inside Story of the Health Reforms, had stories of unsafe staffing, the erosion of experience within the nursing profession and cuts to services from across New Zealand. As one nurse in a South Island provincial hospital‟s geriatric unit described the cuts, „Because of staffing restrictions, we cannot always provide safe care. One enrolled nurse is now left overnight with 19 Alzheimer‟s patients. Seven enrolled nurses have been replaced by nurse aides.‟694

689 690

Kai Tiaki, February 1997, 3(1), pp.30-31. NNZ, July 1993, 1(4), pp.12-14. 691 ODT, 21 September 1993, p.14. 692 Ibid. 693 Brenda Wilson, „Introduction‟, in New Zealand Nurses Organisation, The Inside Story of the Health “reforms”, September 1995, p.1. 694 New Zealand Nurses Organisation, The Inside Story of the Health “reforms”, September 1995, pp.6-7.

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And unsafe staffing levels in CHEs became a high-profile issue in 1996 when the NZNO focused publicity on it. As Brenda Wilson, NZNO national director, said, „Late last year I was attending a Bay of Plenty/Tairawhiti regional meeting. Of all the issues discussed, concern for patient safety due to poor staffing policies was the topic members wanted NZNO to address.‟695 In March 1996 the NZNO undertook a survey of members over staffing issues – „Over a fifth of the nurses said they did not have sufficient staff in their ward or workplace to provide safe care.‟696 The 120 nurses out of 553 surveyed answered „No‟ in response to the following question, „In general, do you believe there are sufficient nursing staff on your ward or workplace to provide safe care?‟697 The 120 nurses who identified unsafe conditions were, when compared with the sample as a whole:     more likely to have experienced an increase in patient admissions/client contacts over the past three years; more likely to have had cuts in nursing numbers over the past three years; more likely to report a decline in the experience of nurses at their work; and more likely to report a range of other factors including increased use of casual staff, a high rate of unfilled vacancies and working a lot of unpaid overtime.698 Additionally, Out of the total sample of 553 nurses:     36 percent reported a cut in nurse numbers within the past three years. 41 percent said the overall level of experience of nurses had decreased at their work; 37 percent reported unfilled vacancies for nurses and 54 percent said their workplace had been understaffed because of delays in replacing nurses. 22 percent had experienced an increase in the number of patient admissions/client contacts within the past year.699

695 696

Kai Tiaki, July 1996, 2(6), p.2. Ibid., p.2. 697 Kai Tiaki, July 1996, 2(6), pp.18-19. 698 Ibid., p.18. 699 Ibid.

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Nurses also provided the NZNO with anecdotal evidence of staff shortages and Waikato Hospital acute care nurse Howard Brown, penned a diary, „Nightmare on night shift‟, of a night shift with one other nurse looking after 23 patients in acute care. 700 Brown writes, „0330: I prepare for the next lot of IV medications due at 0400. I clean the patient who‟s been lying in faeces since 0100 and apologise for leaving him for so long. His reply: “You bastard!”‟701 Brown‟s diary caused a stir in public consciousness. As Kai Tiaki reported, „When the media became aware of Brown‟s revelations, they were the leading item of news on all radio bulletins for a day. They also received wide television coverage and the issue was hotly debated in Parliament by Government and Opposition MPs.‟702 Crucially, the publicity also quickly eased the staffing shortage as Brown told Kai Tiaki, „I feel our chief executive Garry Smith has acted appropriately. He agreed there were staffing problems at the hospital and is now getting more nurses for some wards and for the casual pool. He seems genuine in his concern for staff and patients.‟703 The NZNO was a vocal and consistent advocate for nurses across New Zealand on health care issues, but its officials failed to lead a sustained response to the attacks on public health, leaving it up to members to organise and take action at the local level. Actions somewhere Throughout the period between 1991 and 1999 some sections of the nursing workforce did organise and fight back albeit in a haphazard manner the underfunding and corporatisation of the public health system. Nurses had proved in July 1990 they were able to carry out industrial action to protest short staffing when Middlemore Hospital nurses closed beds to new patients forcing the cancellation of elective surgery on some days.704 The action taken in the hospital meant half of all non-urgent surgery on 23 July was cancelled as „charge nurses on each ward had decided how many patients could be looked after safely with the number of nurses available‟.705 On 25 July nurses and management agreed to reopen the 60 closed beds out of the hospitals 600 beds after an agreement was reached on surgical lists and ward staffing

700 701

Kai Tiaki, July 1996, 2(6), p.20. Ibid., p.20. 702 Kai Tiaki, August 1996, 2(7), p.7. 703 Ibid. 704 NZH, 23 July 1990, p.3. 705 NZH, 24 July 1990, p.4.

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levels.706 But in early August the Nurses Association again refused new patients to be admitted to Middlemore with organiser Sue Hine saying, „We are no longer prepared to compromise patient safety.‟ Although it did not work completely Middlemore nurses action was effective in highlighting the risks of understaffing to the public and helped ensure patient safety, but bed closures as a form of industrial action were never again used at the same scale as the July 1990 action. The Employment Contracts Act and the health reforms created a much harder legal and managerial environment for nurses to push back against short staffing and after 1991 there are very few examples of nurses closing beds or taking unprotected industrial action. Dental nurses employed by the Auckland Area Health Board, part of the PSA, in 1992 were faced with the threat of 47 job losses, one third of the workforce, proposed by a private consultants report.707 The nurses submitted their own 15-page report to the board and reduced job losses by 28 to 19.708 One of the nurses commented, „Without our input, management may have taken the consultant‟s report far more seriously than it did.‟709 In July 1993 the Auckland report noted that after four years of underfunding and staffing cuts charge nurses were now confident enough to respond to unsafe staffing levels by closing beds and cancelling surgical lists.710 In September 1994, mental health unit staff protested at Whangarei hospital over a lack of resources and this gained the intervention of an Auckland „crisis team‟ to help set up community services.711 In January 1995, „Nurses at the North Shore and Waitakere hospitals in Auckland [...] served notice that they will not pick up extra duties if service staff numbers are cut.‟712 In April 1996 the NZNO‟s Rotorua organiser, Gwenda Brodie, reported, Safe staffing levels is a critical area for members. One area has taken a principled stand in the interests of patient and staff safety. Members have told management they will decline admission and theatre cases if inadequate staffing puts quality care and safety in danger. We have offered to work with management to resolve the issues, and

706 707

NZH, 26 July 1990, p.2. PSA Journal, May 1992, p.3. 708 Ibid. 709 Ibid. 710 NNZ, July 1993, 1(4), p.32. 711 NNZ, December/January 1994/1995, 2(11), pp.37-38. 712 NZH, 14 January 1995, p.2.

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at the time of writing are awaited their response. It is most encouraging to see members taking such a positive stance on this important issue.713 In 1992 the Nurses Association condemned cuts to Plunket services for mothers and babies, including „plans for cutting the South Auckland Plunket budget by 40 per cent and laying off some nurses‟.714 When Midland Health RHA cut funding for Plunket family centres in Hamilton, Tauranga, New Plymouth and Gisborne NZNO led a 400 person protest in April 1996 outside the RHA‟s Hamilton offices and collected 26,000 signatures in the affected communities.715 The NZNO also weighed up the possibility of a legal challenge to keep the centres open and the possibility of reopening them with volunteers.716 Professor Linda Bryder in her book on Plunket, A Voice for Mothers, describes how in 1990 Labour‟s Health Minister Helen Clark introduced bulk funding of Plunket services and in 1994 the RHAs became responsible for contracting Plunket services in a competitive environment were all funding was contestable. 717 Bryder details the cuts to these funding services; in 1992 69 nurses are made redundant; in 1996 a Plunket nurse highlighted the dramatic drop in Plunket nurse family visits since 1982 from 22 to 8.718 The introduction of bulk funding of Plunket services was in many respects no different to the attempts to introduce bulk funding of first the operations grant and then teachers‟ salaries into primary and secondary schools by the Ministry of Education in the 1990s. Yet teachers took co-ordinated, illegal strike action when schools entered bulk funding. Left-wing teacher activists like John Minto understood the consequences of bulk funding and campaigned against it. As part of their campaign they lobbed schools Boards of Trustees to refuse bulk funding, And we explained to parents who are on Boards of Trustees just what the issues were. We said, look what has happened with the operation grant. The Government set it up bulk funding from 1990 and then froze it, and so over several years bulk funding, parents could see, the operations grant was disappearing. This is what is going to happen with teachers‟ salaries and that‟s why teachers are opposed to it. Because we

713 714

Kai Tiaki, April 1996, 2(3), p.32. Dominion, 5 February 1992, p.9. 715 Kai Tiaki, May 1996, 2(4), p.6. 716 Ibid. 717 Linda Bryder, A Voice for Mothers: The Plunket Society and Infant Welfare 1907-2000, Auckland, 2003, p.256. 718 Ibid., pp.257-8.

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are going to end up with us fighting you for money you don‟t have, and the Government saying it‟s nothing with us we‟ve given schools the money.719 Essentially the same problem eventuated for Plunket services. Bryder‟s history of Plunket details the vocal opposition of Plunket organisers and managers to the health reforms of the 1990s and the inadequate funding.720 Yet Plunket nurses, just like teachers, had the ability to take industrial action to stop bulk funding. But the failure of the nurses‟ unions to fight bulk funding beyond street protest and petitions and to understand and explain to mothers and communities the threat bulk funding of nurses‟ salaries had, left services in the 1990s hanging on the whims of underfunded RHAs under pressure to privatise and introduce competitive health services. There were some spontaneous outbreaks of nurses self-organising activity to oppose the health reforms. For example in December 1996, „around 300 nurses and supporters marched from Napier Hospital to the Sound Shell to protest against HCHB‟s[HealthCare Hawke‟s Bay] plans to do away with ENs [Enrolled Nurses] in its “patient-focused care model”, replacing them with cheaper, unlicensed caregivers.‟721 In 1997 in Dunedin NZNO nurses formed into a rank and file group, „Nurses in Action, of 15-20 nurses meeting fortnightly focused on both political and professional issues affecting nurses.722 Nurses could and did organise themselves in a hap hazard manner to exercise political and industrial leverage over their local CHE but the development of this response was uneven nationally. Nurses in some cities and regions showed more initiative in organising themselves than in others. From time to time nurses did take strike action but it was always regionally rather than nationally based and reactive to the pay cuts demanded by managers rather than proactively pushing for wage rises. In March 1999 Health Waikato was hit by a strike of 2000 nurses, the first nurses‟ strike in Waikato since 1989.723 Nurses Organisation area manager James Ritchie said members did not want to strike, but were frustrated by nine months of contract negotiations. “Nurses have witnessed declining standards of care and quality and have experienced deteriorating working conditions,” he said.
719 720

John Minto interviewed by Omar Hamed, 26 May 2011, Disc 1. Linda Bryder, A Voice for Mothers: The Plunket Society and Infant Welfare 1907-2000, Auckland, 2003, pp.258. 721 Kai Tiaki, February 1997, 3(1), p.7. 722 Kai Tiaki, February 1997, 3(1), p.6. 723 NZH, 24 March 1999, p.1.

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Outstanding issues included safe staffing levels, educations, family-friendly policies, pay, the backdating of any increase, and salary protection without strings. The nurses wanted a 2 per cent salary increase; the hospital had offered 1 per cent. 724 Nurses did take action and organise at the ward and hospital level to push back against the health reforms. These actions lacked co-ordination from the NZNO or with other health unions and were not embedded in a coherent industrial strategy to target area health boards that put patient care at risk by short staffing hospitals or regional health authorities that undermined rural hospitals and cut funding to services. Co-ordination nowhere As NZNO national director Brenda Wilson commented in February 1997, „Organisers are often too busy dealing with industrial issues to be able to provide delegates with information on current issues, NZNO campaigns or trends in the health sector‟.725 Evaluating the problems that had dogged the NZNO, Wilson referenced the need to focus on an „organising approach‟ as opposed to a servicing approach in the union, sharing organisers‟ workloads out, and „Having data on when collective contracts around the country are due for renewal, for example, would help us enormously.‟726 There was a failure by the NZNO to fight redundancies and cuts in provincial and rural hospitals. For example in Timaru, where the number of in-patient beds went from 85-40 in early 1997 with the loss of 20 nursing positions there was no NZNO resistance.727 David Tranter, Alliance Party spokesperson on rural health and 1993 candidate in the rural Clutha electorate in Southland, winning 3250 votes, penned an insightful piece for Nursing New Zealand in 1994 on the importance of nurses in rural hospital campaigns.728 In the article, Tranter urges nurses to speak out against closures, „While it is difficult for nurses to speak out locally, who else is there to do this when rural MPs, rural service organisations, local leaders and even local health committees seem to be collaborating in a conspiracy of silence?‟729 Yet there was no industrial pressure from NZNO against the closures and transfers to community ownership that was happening in early 1994 in the Otago region. Dunedin NZNO organisers bemoaned the uncertainty of the future of Milton, Balclutha,
724 725

Ibid., p.1. Kai Tiaki, February 1997, 3(1), p.25. 726 Ibid. 727 Kai Tiaki, February 1997, 3(1), p.31. 728 NNZ, February 1994, 2(1), pp.13-15. 729 Ibid., p.15.

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Oamaru and Ranfurly hospitals but did not push for actions that could have stopped the cuts.730 The NZNO left the leadership of fights to save local hospitals to the communities themselves, which meant that where there was strong community leadership to fight the closures there was much stronger resistance than where there were resigned or exhausted communities, unable to put up a strong opposition. Yet nurses and other health workers were often unable on their own to lead the type of campaigns needed to stop hospital closures. Part of the cause of this may be that once a service, ward or hospital had been identified for closure staff became depressed. The demoralisation of medical staff in a Melbourne hospital identified for closure was recognised in research by Paul Valent, Staff felt a kind of despair, alienation and apathy. Increased worries alternated with forced complacency and even detachment, which could be mistaken for callousness. Demoralization manifested in decreased punctuality and increased sick leave days, unofficial leave and resignations. Symptoms of burn-out such as poor sleep, fatigue, lack of concentration, decreased functioning and irritability were common.731 Nurses and the NZNO did not play a strong role in leading a ward by ward, hospital by hospital fight against the reforms. Part of what caused this problem was identified by Steph Breen, former NZNO national director in a Nursing New Zealand editorial in November 1994, „Many members still voice concern that there is a lack of relevance between issues at the workplace and issues addressed at regional council level. Time is precious and they can only be expected to attend meetings if those meetings are relevant to them.‟732 This gap between what nurses needed from and what the union‟s official structures provided reflected the lack of a co-ordinated, member controlled campaign against the health reforms. Alternatives The NZNO and other nursing union officials, delegates and members chose certain actions and campaign strategies during the 1980s and 1990s to respond to the reforms being instituted in the health system. It is the contention of this chapter however, that the overall strategy taken by nurses‟ unions was flawed and that at critical moments the leadership chose to back away from nationwide industrial action which had the ability to severely curtail the
730 731

NNZ, August 1994, 2(7), p.33. Paul Valent, „The human costs to staff from closure of a general hospital: an example of the effects of the threat of unemployment and fragmentation of a valued work structure‟, Australian and New Zealand Journal of Psychiatry, 2001, 35 (2), pp.150-154. 732 NNZ, November 1994, 2(10), p.2.

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ability of successive governments to underfund, under staff and cut health services in the 1990s. Between late 2011 and early 2012 nurses in Victoria, Australia ran a sustained campaign against a right-wing state government led by Liberal Premier Ted Baillieu plans, „ to remove the ratio system (which ensures minimum nursing numbers), introduce split shifts, replace many nurses with lower paid “health assistants” and effectively slash funding to the nursing budget by hundreds of millions of dollars.‟733 Yet nurses were able to beat back the claw backs, retain safe staffing ratios and win a 4% wage increase by organising a campaign that included thousands of nurses taking illegal strike action.734 A 2012 article by socialist nurse activist Eric Le Roy on the campaign is worth quoting at length, Last November industrial action began in hospitals across Victoria. Nurses closed hundreds of beds across the state, most of them in major public hospitals. Many elective surgeries were cancelled or postponed. This was probably the high point of the campaign. Festival Hall was almost full with nurses at the mass meetings. When the bed closures began, they were legal. Every day, hundreds more beds were being added and the industrial strength of the campaign was growing. When the first court orders came out to stop industrial action, the union leaders argued that they applied only to ANF staff and officials, leaving the door open for nursing staff to continue the action. Yet once the officials and organisers were effectively out of the equation, nurses were left to organise bed closures on their own at a ward level, without the explicit backing of the union, and without any clear lead or strategy as to how the campaign would continue. This gave hospital management the opportunity to bully, harass and threaten nurses into reopening beds. Nurses would come back for a morning shift only to realise that beds had been reopened over night, when there were only half as many

733

Eric Le Roy, „Nurses‟ victory a blow against slash -and-burn agenda‟, online, 19 March 2012, available at: http://www.sa.org.au/index.php?option=com_k2&view=item&id=7257:nurses%E2%80%99-victory-a-blowagainst-slash-and-burn-agenda (19 October 2012) 734 Ibid.

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nurses on the ward and no other staff at all. This is when most of the intimidation took place.735 Another article published in March 2012 by an Australian socialist, Feiyi Zhang, describes the use of illegal strikes, Nurses in Victoria have staged weeks of rolling strikes in defiance of anti-strike laws as they fight to defend staffing ratios in public hospitals. Nurses were expecting a new offer on pay and conditions from the Baillieu government as Solidarity went to press. The rolling stoppages involving over 1000 nurses, midwives and mental health nurses across 15 hospitals have shown their power to defend the health system. The Australian Nurses Federation (ANF) has now suspended strike action after the government agreed to fresh negotiations, saying it is confident of reaching agreement. Nurses showed how to take “illegal” strike action in spite of the threat of fines from Fair Work Australia of $6600 against individual nurses and up to $33,000 against the union for breaching Federal Court orders. But employer group the Victorian Hospitals‟ Industrial Association agreed to drop legal action pursuing fines to return to talks with the union. Baillieu wasted more than $1.4 million on legal costs fighting the ANF in court. This was the second time during the dispute that nurses have defied Fair Work orders to continue industrial action, after they voted to defy orders in November last year. The return to rolling stoppages followed the failure of a stunt in which nurses threatened mass resignations if the government refused to give in.736 On 16 March 2012 Victorian nurses learnt at a mass stop work meeting that their campaign had been successful, After what the A[ustralian Broadcasting Corporation] said was Victoria‟s longest running industrial dispute, nurses have won 14-21% pay increases and kept their nurse-to-patient ratios in return for minor productivity offsets.

735 736

Ibid. Feiyi Zhang, Nurses defy the law to defend the health system and jobs, online, March 2012, available at: http://www.solidarity.net.au/43/nurses-defy-the-law-to-defend-the-health-system-and-jobs/ (19 October 2012)

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Australian Nursing Federation (ANF) secretary Lisa Fitzpatrick said: “This is a bittersweet victory for nurses and midwives after an unprecedented industrial marathon with the Baillieu government to protect patient care and secure a fair pay rise." The agreement has not led to steep wages rises, but it means none of the Baillieu government‟s plans to worsen conditions for nurses and patients will be carried out. Fitzpatrick said: “Health assistants will not replace nurses as part of the ratios and hospitals will not be introducing unlimited four-hour shifts or split shifts.” There were also some improvements in the agreement. Nurse-to-patient ratios have been improved in rehabilitation wards and oncology units. A professional development allowance has been introduced, which gives nurses an extra $1000 this year and $900 in later years.737 It is a long way from Melbourne 2012 to New Zealand in the late 1980s and the 1990s but a comparison of these two nurses‟ struggles over staffing is illuminating. Illegal, mass strike action was able to beat the Victorian government‟s attempt to worsen nurses‟ employment conditions. If New Zealand‟s nurses unions had provided a clear campaign against the health reforms and encouraged nurses to take industrial action, including illegal action the Government may have backed away from the hospital closures, semi-privatisations and funding cuts of the early 1990s. In addition to the Victorian nurses‟ campaign, there is another example of illegal, mass strikes beating a right wing government attacking public services. Secondary school teachers in New Zealand in the 1990s repeatedly took illegal, wildcat, strike action to stop schools from entering bulk funding. The union, the PPTA, also campaigned and was able to retain a national collective agreement against the wishes of the National Government in 1992-3. As three PPTA organisers described their unions 1992 battle to retain a national collective agreement, In 1992 (the 1990 Award round having been settled quickly in the year of an election the Labour government was looking likely to lose) the SSC initially refused to negotiate a collective contract. This was the first negotiation round under the

737

Sue Bull, Victorian nurses celebrate victory over Baillieu, online, 17 March 2012, available at: http://www.greenleft.org.au/node/50377 (19 October 2012)

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Employment Contracts Act. There was a real concern in the union that the power the Act gave the government would cause it to promulgate individual employment contracts (IECs) and simply walk away from collective bargaining. In the event, when the collective expired members simply refused to sign IECs and sat on their existing terms and conditions for nine months until a new collective employment contract was negotiated. There after threats of IECs, while always a component of the industrial planning, were no longer viewed with trepidation. PPTA knew that it could sit out the government and that the membership would be solid in their refusal to move out of collective coverage.738

Teachers in July 1992 also took rolling industrial action around the country, held nationwide rallies and even blocked roads in the suburban Hutt Valley near Wellington.739 As a result the PPTA held onto their national agreement faced with similar pressures to the NZNA/NZNO. Unlike the NZNA/NZNO the PPTA and its membership did not buckle to demands for individual or site based contracts from the government. Instead they mounted a campaign of industrial action, protests and disruption that secured a collective agreement and held bulk funding mostly at bay. When in August that year Cambridge and Melville High Schools boards of trustees entered into bulk funding wildcat strikes immediately broke out in both schools. Bronwyn Cross in a union journal article analysing the PPTA‟s campaign believes that over winter 1992 „industrial activity and public frustration was now reaching a level that was politically unsustainable for the Government. PPTA too, was stretched organisationally and the evidence was that the campaign was wearing teachers down.‟ 740 A working group was set up and in 1993 secondary school teachers settled a nationwide collective agreement with no pay rise and some claw backs.741 Teachers took militant tactics and held onto their collective agreement at the same time nurses lost theirs with no fight. Nurses, like teachers could have fought and may have won the 1992 national agreement conflict.

738

Judie Alison, Bronwyn Cross and Rob Willetts, Bloodied But Unbowed – the effect on NZ secondary school teachers‟ work and lives of the neoliberal reforms of the 90‟s – a union perspective, online, 2003, available at: http://www.aare.edu.au/03pap/ali03038.pdf (19 October 2012) 739 David Grant, Those who can teach: a history of secondary education in New Zealand from the union perspective, Wellington, 2003, p.255. 740 Bronwyn Cross, Bulk Funding in New Zealand: a retrospective, online, September 2003, available at: http://old.ei-ie.org/statusofteachers/file/(2003)%20Bulk%20Funding%20in%20New%20Zealand%20%20%20A%20Retrospective%20en.pdf (19 October 2012) 741 Ibid.

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In many ways New Zealand public hospital nurses were in a stronger position in 1992 than Victorian nurses in 2011-12 or the PPTA in 1992. Nurses could have united with doctors and other health sector workers like orderlies, cleaners and clerical staff to maintain their agreements. In 1992 public anger over hospital user part charges was building and public opinion would have been strongly in support of nurses‟ strikes. Auckland nurses had built up a strike fund as a result of the 1985 „Nurses are worth more‟ campaign that put nurses in the country‟s largest city in a strong industrial position. 742 Crucially all sections of the public and private sector workforce could have been united in 1992 in mass strikes against the breakup of national awards into site agreements. Nurses, like teachers, had the potential to create a situation in 1992 where „industrial activity and public frustration was now reaching a level […] politically unsustainable for the Government‟ but nurses leaders flinched in the face of potential conflict.743

Conclusion Nurses as the largest group of public hospital employees, deserve special consideration of their role in opposing the health reforms. Many of the other chapters in this thesis, such as the chapter detailing the boycott of health user charges, deal with victories in the social movement opposition to the health reforms. This chapter details a defeat, or a series of defeats, for the opposition to the health reforms. The defeat was the failure to fight and beat a series of key attacks on the public health system. If nurses and the rest of the trade union movement had chosen to take industrial action they may, and may not, have been able to sink the SSA, the ECA, the breakup of national awards, and the underfunding of public health in the 1990s. The experience of psychiatric nurses at Seaview, secondary teachers in 1992 and the Victorian nurses 2011-12 campaign is that if you strike, or threaten strike action, you are in a significantly stronger bargaining position than if you negotiate without the threat of action.

As this chapter shows nurses voted repeatedly in large numbers (80% to 90%) to strike against the State Sector Act, Employment Contracts Act and employer attacks on the nationwide collective agreement in 1992. Strikes, when nurses were finally balloted in 1993, broke out across the country but the nurses‟ union had already paved the way for their
742 743

NZH, 27 July 1985, p.3. Bronwyn Cross, Bulk Funding in New Zealand: a retrospective, online, September 2003, available at: http://old.ei-ie.org/statusofteachers/file/(2003)%20Bulk%20Funding%20in%20New%20Zealand%20%20%20A%20Retrospective%20en.pdf (19 October 2012)

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industrial defeat by inconsistently supporting action and even collaborated with employers to end industrial action in Northland against the will of the rank and file. Even though national unions did not lead on this; when nurses did threaten strikes, like at Seaview in 1992, they were able to keep hold of conditions. And there are a few reports of nurses, at their own initiative, taking unprotected action to close beds and decline admissions. If national nurses unions had decided to fight the attacks on health then they may have been able to retain safe staffing levels, like Victorian nurses did in the 2011-12 campaign and retain a nationwide collective agreement, like secondary teachers did in New Zealand in 1992.

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Chapter Five

‘A popular uprising’744
Patient activism, protests against the health reforms and the collapse of the Coalition Government

Between the late 1980s and the late 1990s a nationwide social movement opposed the corporatisation and downsizing of New Zealand‟s public health system by both Labour and National Governments. This social movement had its beginnings in the responses of communities to closures and cuts, the movement against user charges and health workers resistance to the reforms. It was also built out of the emergence of spontaneous, grassroots activism by patients that spread as health services were cut and waiting lists lengthened. This chapter of the thesis follows the emergence of a social movement from these beginnings at a local level to the development of a national movement that in 1998 helped splinter the National – New Zealand First Coalition Government. Understanding how and why the movement against the health reforms developed in the 1990s can be enriched by social movement theories in general and the political process theory in particular. Political process theory, pioneered by Doug McAdam in Political Process and the Development of Black Insurgency 1930-1970 holds that a social movement requires three necessary preconditions, insurgent consciousness, organisational strength and political opportunity.745 In the 1990s the interaction of patients with the changing health system created the required insurgent consciousness, the drawing in of the movement against hospital charges, the mobilised communities and workplace actors against the health reforms represented the emergence of the necessary organisational strength and the post-1996 MMP environment and Coalition between the National Party and New Zealand First provided the increasing political opportunity for the forces resisting the health reforms to become a powerful, broad based, nationwide social movement. As we follow the rise of the movement against the health reforms in New Zealand politics through the lens of social movement theory we can not only describe how it developed in the way it did but also explain its eventual success. However it

744 745

NM, 3 October 1997, p.1. Doug McAdam, Political Process and the Development of Black Insurgency 1930-1970, Chicago, 1982.

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is not enough to simply describe the rise of a movement against the health charges as „insurgent consciousness‟ plus „organisational strength‟ plus „political opportunity‟ equals social movement. We need to also tell the story of how movement activists were able to utilise the conditions of movement emergence and grow it into its historical trajectory. As Hanspeter Kriesi writes, The transformation of a potentially explosive situation into the unfolding of the events within the interaction context is historically contingent, and, therefore, quite unpredictable. [...] In addition to the “opportunity set”, the unfolding of the events crucially depends on the second filter mentioned by Elster – the choices made by actors on the basis of their preferences [...]746 Development of discontent Insurgent consciousness is a concept of political process theory that is used by scholars to understand how movements begin to form. As Doug McAdam described its role in the formation of social movements, To summarize, movement emergence implies a transformation of consciousness within a significant segment of the aggrieved population. Before collective protest can get under way, people must collectively define their situations as unjust and subject to change through group action.747 Patients‟ responses to the health reforms were well documented in the media through the 1990s. What the responses of patients demonstrate is that the corporatised, underfunded public health system politicised patients who had an interaction with it. This politicisation was a result of patients‟ ongoing frustration with waiting lists, cut services and the effects of closed hospitals. This theory of movement formation is key to understanding the development of insurgent consciousness in the movement against the health reforms. Here we see an insurgent consciousness based not on ethnic, sexuality or religious difference but based on a shared political vision of what public health care should and should not be.

746

Hanspeter Kriesi, „Political Context and Opportunity‟ in David A. Snow, Sarah A. S oule and Hanspeter Kriesi, eds, The Blackwell Companion to Social Movements ,Malden, MA, 2004, pp.67-90. 747 McAdam, p.51.

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From the very beginning of National‟s health reforms there was an aggrieved response from patients who perceived their relationship with the health system to have deteriorated because of the reforms. Many of these patients went to the media to raise their concerns and we can see in the news stories how individual responses to the system began to generate the beginnings of group protest and went on to become politicised by parties and unions and eventually channelled into the wider discontent that mobilised the health movement. This part of the chapter looks at how the political process model explains the development of a movement against the health reforms by focusing on a number of different geographic and clinical situations. Maternity care in Auckland Maternity care in Auckland had been under pressure since the closure of St Helens and through the 1990s patient complained at levels of understaffing. In 1991 one couple whose baby suffered severe brain damage at birth spoke to the Herald, „The Hohaias believe the birth was mismanaged by staff at National Women‟s Hospital and they want explanations for long delays which they suspect are caused by shortages of staff and resources.‟748 Patient advocate Lynda Williams told the Herald in 1991 there had been an increase in complaints about inadequate care given during birth since 1989.749 However it was not until 1996 that the understaffing and lack of maternity care resources reached crisis point. At National Women‟s Hospital in early 1996 patients had raised concerns over „squalid conditions‟ in wards and the hospital manager admitted there had been „discontent‟ with cleaning contractors.750 In May 1996 nurses and midwives at South Auckland‟s Middlemore Hospital‟s maternity unit protested to management over the reduction of postnatal beds from 50 to 32.751 A letter from the NZNO delegate to management cited concerns including, „In some incidences postnatal women have been transferred to a Surgical Ward which is a likely breach of the law, and more importantly, is a hazardous situation for maternity patients.‟752 Labour and Alliance MPs turned standards of maternity care in Auckland into a political issue during the 1996 election campaign. „First Labour leader Helen Clark exposed problems at Middlemore, citing women sent home before their babies were introduced to the mother‟s breast. Alliance‟s Phillida Bunkle visited Middlemore midwives and centred concerns on a shortage of beds.
748 749

Karen Holdom, „Couple‟s life shattered by hospital nightmare‟, NZH , 5 October 1991, p.9. NZH, 5 October 1991, p.9. 750 NZH, 25 April 1996 p.3. 751 Manukau Courier, 29 October 1996, p.4. 752 Mary Minto, „Re: Postnatal bed numbers, Middlemore Hospital‟, 17 May 1996, Joan Donley Papers.

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Mangere‟s new MP Taito Phillip Field has examined CHE records and found care at satellite units is of a much higher standard than for women at Middlemore.‟753 As the case of maternity care in Auckland demonstrates, although there were patient concerns over short staffing since the late 1980s it was not until health unions began to organise within the hospitals and political parties intervened that the issue became a wider public issue. McAdam wrote that an aggrieved population would not be able to conduct „successful insurgent action‟ without an indigenous organisational base and political opportunities that improve the „bargaining position for the aggrieved population‟.754 Just after the 1996 election Middlemore‟s maternity unit received an extra seven beds restoring the level to 39.755 The timing and success of the resistance to the cuts to bed numbers can be explained through McAdam‟s model of movement formation. It required both the organisational resources and political opportunity that were available in 1996 to those contesting cuts to maternity beds. The organisational resources and political opportunity were arguably not available in the early 1990s as health unions focused on protecting collective agreements from attack and the National Party was not vulnerable to electoral defeat in the same way as it was in 1996 under an MMP environment. Waiting lists Lengthening surgical waiting lists in the public hospital system developed into another key aggravator of the movement in the 1990s. Previous chapters focused on localised or sporadic action by New Zealanders in response to the health reforms but the debate over waiting lists was qualitatively different – it was a political issue that affected people regardless of geographical location and was directly linked to a key political issue – health funding. Being sick or disabled on a waiting list heightened a patient‟s discontent with health reforms. It led to a disgruntlement such as when a man waiting for an operation told the Herald in 1994, „a heart attack will kill him before he receives a heart bypass operation.‟756 The circulation of stories amongst the public of patients dying on waiting lists gave the discontent personal urgency. As the same patient told the Herald, „A Wellington friend who was on the list recently received surgery, but died on the operating table. At the funeral, Mr Murphy said, another man waiting for an operation keeled over and died from a heart attack.‟757 In 1996 the
753 754

Manukau Courier, 29 October 1996, p.5. McAdam, p.43. 755 Manukau Courier, 7 November 1996, p.5. 756 NZH, 9 December 1994, p.9. 757 Ibid.

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National government did respond to pressure on surgical waiting lists days out from the 12 October general election when it released $39.4 million in targeted funding.758 This opening gave another opportunity for the CPH to deliver its message in the media However, Coalition for Public Health spokesman Lyndon Keene said the extra surgery and assessments would fail to make a dent on surgical waiting lists at the two CHEs because the majority of the procedures, 1279, were for assessments rather than surgery. [...] “So there has been an increase in the surgical waiting lists at both CHEs of over 1700 people and now Mrs Shipley is talking about putting in another 690 operations over the next 18 months,” Mr Keene said. “That won‟t go anywhere and may not even cover increases to waiting lists over this period.” 759 As Lyndon Keene of the Coalition for Public Health said of their organisation‟s strategy around waiting lists, But probably in the public‟s mind what was and something that we actually played a big role in was that where services were being cut, where services were being increasingly rationed and so on. So we would get involved in debates like the waiting lists. Prior to 1990 I don‟t think you‟ll read very much about waiting lists in the media, in the nineties you‟ll read a hell of a lot about surgical waiting lists and so on in the media. And that was partly because we started to pay a lot of attention to them because we saw that as a way of showing that what we saw as part of the strategy of increasing involvement of the private sector, and increasing arguments for a more of a private insurance type system was to actually undermine the effectiveness of the public system. I mean if the public system is working well then it is hard for a government to argue to uproot it and change it to something else, particularly a private model. So part of what they needed to do really was to ensure, and of course they would never say this, but part of what they were doing was ensuring that the public system didn‟t work very well. And part of the strategy was to basically cut the funding all the time. You know they had to squeeze the funding. And that‟s what they were doing.

758 759

Dominion, 10 October 1996, p.3. Ibid.

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The Crown Health Enterprises were getting incredibly debt ridden. They were cutting services all around the place, and of course what that meant was that waiting lists were increasing. Nurse numbers dropped and so people weren‟t having the same access to hospital care as they were getting in the past. And all this initially was all happening it was hidden really. There was no information about it. So we started to do a lot of work in that area through the Official Information Act, also through getting leaks and so on. And we did that regularly so we were able to track a trend. So we were able to track the waiting lists for example. We would get all the waiting list information under the Official Information Act from all of the Crown Health Enterprises and we would do it regularly. Or we would get the staffing numbers from under the Official Information Act and produce reports on those regularly. And those very quickly, after a few years, became a media issue as well. Because the media could see what was happening, so those became regular like six monthly or annual like issues.760 The issue of surgical waiting lists became a key mobilising issue that the movement built around. For campaigners like Keene it connected an aggrieved population‟s individual concern with the organisation being built to protect services from closure and underfunding. By focusing their activism on waiting lists the movement grew as waiting lists lengthened. In May 1996 a group of 40 people waiting for operations held a sit-in in the lobby of North Shore hospital to protest the waiting lists and the stopping of orthopaedic surgery for three months from March 1996.761 One protester from Milford told the Herald she had been on a waiting list for a hip replacement for two years, „I‟m in continual pain .[...] I started off with a [walking] stick but I now need two crutches and home help because I can‟t put any weight on my leg.‟762 The lengthier the waiting lists got, the more ammunition critics of the health reforms had. In 1997 the Press reported, „Christchurch woman Philippa Main may have to wait 120 years for varicose veins surgery.‟763 In the Waikato in 1998, „Hamilton woman Jaqueline Leinhardt has been told she faces a year‟s wait for the CT scan that would tell doctors whether she has a brain tumour.‟764 Oncology staff at Palmerston North hospital went public in October 1998 over patients dying on radiotherapy waiting lists. As oncologist Percy Bydder told Taranaki Daily News about the case of a man requiring urgent radiotherapy, „It is
760 761

Lyndon Keene interviewed by Omar Hamed, 1 July 2011, Disc 1. NZH, 14 May 1996, p.3. 762 Ibid. 763 Press, 14 October 1997, p.4. 764 Dominion, 11 November 1998, p.8.

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extremely distressing for staff to know that the facilities are there to help patients but they are not getting the treatment they need.‟765 The radicalisation of the public around waiting lists destabilised the political environment providing a steady stream of anger towards the Government‟s health policy. In 1997, 18,397 people had been on surgical waiting lists for more than two years.766 Standards of care Another process that contributed to the development of the health movement was the perception by the public that standards of care received in hospitals was at risk as a result of underfunding. This perception was particularly acute in cases where emergency care was slower than the patient expected. Throughout the 1990s there is a record of growing concern about the levels of care received by patients coming from patients, health professionals, community organisations and eventually within the political establishment. In Christchurch in 1994 a new mother shifted from Christchurch Women‟s Hospital to Rangiora Hospital two days after giving birth because of a lack of beds told the Press, „They made me feel so bad in Christchurch because they didn‟t have enough staff. There were not enough beds. The atmosphere was just appalling.‟767 Another Press report from 1994 detailed how ‟Health cuts are immobilising a handicapped 10-year-old Bryndwr boy because his guardian cannot afford treatment to help him walk.‟768 This general disquiet amongst the public was echoed by health workers. The NZNO put out a report in 1995, The Inside Story of the Health Reforms: A report of interviews with nurses, which included anecdotes from working nurses such as; „Not long ago a man phoned his hospital emergency department and asked what he should do about crushing chest pains and other symptoms indicating a heart attack. “Where are you?” said the nurse who answered the phone. “In the emergency waiting room,” he said.‟769 The individuals affected by this of course were embedded in the matrix of social relationships constituting New Zealand society. The impact of poor treatment of one member of the community inflamed many more. A letter to the ODT from a Catholic nun shows how community institutions like churches were politicised by the deteriorating public health system,

765 766

TDN, 26 October 1998, p.1. EP, 10 July 1997, p.2. 767 Press, 2 July 1994, p.3. 768 Press, 27 August 1994, p.3. 769 NZNO, The Inside Story of the Health Reforms: A report of interviews with nurses, Wellington, 1995, p.15.

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Recently one of our elderly sisters was taken ill in the early hours of the morning. An ambulance was called and took her to the Oamaru Hospital. On arrival they were told that she could not be admitted as there were no beds... This is the real face of our socalled better health system. Not good enough: let us have a human face again in our hospitals.770 The anger and pressure coming from the grassroots was sufficient to create anxiety amongst the political establishment. National MPs were increasingly torn between their Cabinet‟s commitment to the reforms and the mood of their constituents. In Auckland in November 1996, „Mrs Christine Fletcher, MP for Epsom, said there was a growing disquiet among her constituents about limited health services, particularly for elective surgery, rest home care and help for the disabled.‟771 As Fletcher explained, „I am increasingly disturbed that the new health system...which I fully supported...is showing serious signs of overemphasis on efficient administration based on financial grounds at the expense of what the patients considers his or her needs to be.‟ 772 As the level of concern rose in the public about standards of care, more organisations took political positions on the issue of public health adding institutional strength to the mobilisation against health changes. Chris Cresswell‟s march, 1995 The beginnings of nationwide mobilisation against the health reforms can be seen in the 1995 march of Chris Creswell against the health reforms. Between 15 September and 21 November 1995 28-year-old Wanganui doctor Chris Cresswell marched from Hokianga to Parliament with a petition for increased health funding.773 Cresswell was accompanied by a small group of supporters called the „Wanganui Health Action team‟.774 Cresswell „said his protest march was triggered off by the 25 percent reduction in staff at Wanganui Hospital. He found it was happening all over New Zealand.‟775 Cresswell‟s march helped stir up dissent and strengthened local hospital campaigns across the country as he trekked towards Wellington but it was not universally well supported. In Auckland just 200 turned out to support Creswell and a letter writer to the Evening Post bemoaned, „This is Kiwi apathy at its best.‟776 In Masterton the walk linked in with a local hospital campaign and Cresswell told a rally of 500
770 771

ODT, 12 September 1997, p.8. NZH, 16 November 1996, p.5. 772 Ibid. 773 EP, 21 November 1995, p.2. 774 EP, 13 November 1995, p.4. 775 EP, 18 November 1995, p.10. 776 EP, 17 October 1997, p.4.

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people, „For God's sake, hold on to your hospital‟ and encouraged them to join protests, lobby MPs and sign petitions.777 The Masterton protest rally was against a CHE proposal to amalgamate the women‟s and children‟s wards and was supported by the members of the Wairarapa branch of the Medical Association „angry at the way health services were being run down by stealth, without consultation, under the banner of health restructuring.‟778 Outside Greytown Hospital Creswell told protesters, „Regional health authorities and CHEs had so far had a two-year period to find their feet, and they would now start their real work of slashing services and what was to come would be "hell".‟779 At Parliament on 21 November Cresswell, and 340 Wairarapa protesters who trained in for the day, presented MPs with a 60,000 signature petition against cuts to health funding.780On ending his march Cresswell noted that in many communities „people were tired of battling to keep services‟.781 Cresswell told a reporter he hoped the march raised public awareness of the health reforms and that „We really want to stop the privatisation of health, which is going to cost us more in the long run than putting more money in to the public health system will.‟782 These were long term aspirations but in the short term Cresswell‟s protest helped stir the embers of grassroots opposition to the health reforms. As another letter writer to the Evening Post wrote after Cresswell‟s march, Dr Chris Cresswell and his companions who walked from Hokianga to Wellington over nine weeks on their crusade against the health reforms should be congratulated for their great achievement. It should not be forgotten that some psychiatric patients are being put out on the streets to fend for themselves, with tragic results. Would it not be reasonable to ask New Zealand's silent majority to be more vocal and continue with Dr Chris Cresswell's crusade against the failed health reforms? Irish-born political philosopher Edmund Burke had this to say: "Nobody made a greater mistake than he who did nothing because he could only do little.783" In addition to Cresswell‟s hikoi, a left-wing action group, the Next Step Democracy Movement, collected 138,000 signatures on a petition in support of public health care, not

777 778

EP, 18 November 1995, p.10. EP, 13 November 1995, p.3. 779 Dominion, 18 November 1995, p.2. 780 EP, 22 November 1995, p.3. 781 EP, 21 November 1995, p.2. 782 Ibid., p.2. 783 EP, 2 December 1995, p.4.

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enough to trigger a Citizens initiated referendum, between February 1995 and July 1996. 784 The petition question was, „Should all New Zealanders have access to comprehensive health services, which are fully government funded, and without user charges?‟785 The build up of public discontent between 1993 and 1996 meant that after the 1996 election changes to the direction of the health reforms was inevitable. As Toni Ashton contends, In the lead-up to the 1996 election, there was a widespread perception that the health reforms were not working as intended. Whichever party (or parties) was elected, it was clear that something would have to be done to recapture the public‟s confidence in the public health system.786 The National – New Zealand First Coalition As a result of the 1996 election, the first under MMP, New Zealand First and National formed the first coalition government in New Zealand history in October 1996. This coalition was unpopular with the public and with New Zealand First voters who mostly expected NZF to support a Labour-led Government in 1996.787 Twenty-two months later on 14 August 1998 the coalition ended when National‟s Prime Minister Jenny Shipley dismissed Winston Peters from his position as Deputy Prime Minister ostensibly over a dispute around the privatisation of Wellington Airport.788 Throughout the rocky period of Coalition government health issues were at the heart of the political instability as pressure mounted over the direction of health policy. This politically unstable period of the National and New Zealand First Coalition created an expanded opportunity for health campaigners to mobilise public opinion around what were perceived as broken promises made by New Zealand First. With growing numbers of discontented patients, a well organised and resourced CPH and a politically weak Coalition Government coupled with the rising expectations voters had in MMP and the Coalition Government to resolve the problems in the public health system all necessary preconditions in the political process model for the generation of social movements was present at the end of 1996.

784 785

Kai Tiaki, 2 ,6, July 1996, p.10. Jonathan Boston et al., eds, Left Turn; The New Zealand General Election of 1999, Wellington, 2000, p.288. 786 Toni Ashton, pp.134-153. 787 Bryce Edwards, The 1996 coalition decision, online, 1 December 2008, available at: http://liberation.typepad.com/liberation/2008/12/nz-first-party-history-17-the-1996-coalition-decision.html (8 November 2012) 788 WT, 14 August 1998, p.1.

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NZF had campaigned against National‟s corporatised health service and its coalition agreement with National included the abolition of hospital outpatient charges, free doctors visits for under sixes and the rollback of market delivery mechanisms in health funding through the restructuring of health funding authorities and the abolition of CHEs. The concessions won by NZF instead of pacifying the movement, encouraged it to increase the pressure. These concessions to New Zealand First‟s voter base were important but three substantive problems kept the coalition from stabilising over health policy. Firstly was the introduction of a form of „rationing‟ aimed to reduce hospital waiting lists, second was the creeping privatisation of health services and third was the continued underfunding of the health system forcing hospitals to repeatedly cut services. These problems stemmed from the tension over the programme to corporatise health being driven from within the National Party caucus to continue the 1990-1996 reforms. The Coalitions growing instability over these key issues provided the political opportunity for the health movement that broadened the size of the mobilisations against the Government. The extension of this programme would generate movement activism just as it had since 1988 but there were crucial differences that made this period different. These were, 1) the coalition was perceived by the public to be one that would improve the public health system and would be responsive to public opinion. 2) The rationing of health care through „booking‟ as the case of Rau Williams, below, shows turned into an inflammatory issue that polarised views. 3) As chapter two shows as the corporatisation programme continued piecemeal after 1996 new communities were spurred into defensive mobilisations against the health reforms. The unfolding of events between the formation of the coalition in October 1996 and its collapse in August 1998 followed shortly by the „pause‟ in restructuring of the health system followed a cyclical pattern. As protests continued around health issues, they created ongoing tensions at the top; this in turn prompted more protest action and again increased the level of tension within the ruling parties. The coalition caught between the expectations of the public and the expectations of the market liberals the friction of opposing views of the shape of health services eventually engulfed New Zealand First parliamentary wing and contributed to the undoing of the coalition. Kirton‟s sacking, August 1997 The first really important event for the growth of the health movement was the sacking of New Zealand First MP Neil Kirton from his role as Associate Minister for Health in August
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1997. Kirton‟s sacking on 7 August 1997 came after a dogged eight months of campaigning for public health care and against initiatives being pushed by National‟s Minister for Health Bill English. Some of the highlights of this activism were published in the Herald the day after his sacking. In February 1997 „He uses his maiden speech to spell out to Health Minister Bill English that he regards the coalition health policy as the political bible‟.789 Between March and June, „Kirton and English clash over private involvement in a Christchurch heart unit.790 In June, „Tensions flare again between Kirton and English over a joint public-private health initiative in Wanganui.‟791 The August sacking was ostensibly over the awarding of a government advertising contract to Kirton‟s brother-in-law.792 Kirton‟s adviser Michael Laws demurred from this, suggesting on television, An orchestrated campaign by the Minister of Health and others in the National Party was the real reason for the Associate Minister, Neil Kirton, being dumped, says Mr Kirton‟s close adviser, Michael Laws. The minister, Bill English, had “got off scotfree” while Mr Kirton had lost his job for trying to uphold the coalition agreement on health, Mr Laws told the Holmes television programme.793 The running conflict over the direction of the public health system while both English and Kirton led the Ministerial portfolio is reflected in statements given to an NZH reporter on the day of Kirton‟s dismissal. The head of Auckland Healthcare, Graeme Edmond, said the ministers‟ conflicting philosophies made running hospitals very difficult. „As a chief executive, you never knew whether to proceed in one direction because it would probably be blocked by the other minister... it frustrates decision-making, which is slow at the best of times. The Coalition for Public Health spokesman, Dr Alister Scott, said the sacking further signalled the move towards a privatised health system. And the Alliance health spokeswoman, Phillida Bunkle, said the way was clear for the closure of small and medium-sized public hospitals in line with National‟s direction.794 Rau Williams, September 1997
789 790

NZH, 8 August 1997, p.5. Ibid., p.5. 791 Ibid. 792 Ibid. 793 NZH, 8 August 1997, p.5. 794 NZH, 8 August 1997, p.15.

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Even as the dust was settling from the firing of Kirton another crisis in health policy began escalating in Whangarei when renal dialysis patient Rau Williams and his family began to take on Northland Health over denial of care. On Wednesday 17 September Northland Health ceased providing a 64 year old Maori man with renal dialysis citing William‟s mild dementia as a reason for denying treatment. 795 „„Why are they letting him die?‟ Tears as favourite uncle is refused kidney treatment‟, read the front page of the Sunday Star-Times on 21 September after a High Court judge refused to grant an injunction forcing Northland Health to continue dialysis.796 The decision was politically controversial and on 23 September NZ First MP, „Tau Henare rocked Parliament by criticising Government health policy over the “death sentence” imposed on one of his constituents.‟797 Henare‟s position was a further blow to the governing coalition‟s unity on health issues. Kirton‟s replacement as Associate Minister for Health was another NZF MP Tuariki Delamere, who defended the Northland Health decision.798 On 24 September the political crisis intensified when National‟s own „Back bench MP John Banks was ejected from Parliament yesterday afternoon during a heated argument about Northland Health‟s decision to deny life-prolonging kidney treatment to 64-year-old Rau Williams.‟799 Banks, MP for Whangarei, was expelled from Parliament after shouting at Prime Minister Jim Bolger, „If you‟re a Christian, save his life.‟800 During the same Parliamentary session Kirton voted twice against the Government in support of Alliance Party introduced Bills; „It was the first time a coalition MP had broken ranks and crossed the floor of the House.‟801 The divisions in the coalition were being widened by the Rau Williams decision at the same time as concern in the community mounted; with the Human Rights Commission announcing its support for Williams‟s family‟s challenge to Northland Health‟s decision.802 As well as dividing the coalition the Rau Williams crisis severely weakened the confidence of a section of National and NZ First MPs in the direction of National‟s health reforms. NZ First MPs, Deborah Morris and Jenny Bloxham both backed Henare‟s criticism of Williams‟ whanau. 803 Bloxham said, „This is the time to have a full and open debate on health. If we are going to privatise 50 per cent of the public health system,

795 796

SST, 21 September 1997, p.1. Ibid. 797 NZH, 24 September 1997, p.1. 798 Ibid. 799 ODT, 25 September 1997, p.10. 800 NZH, 25 September 1997, p.1. 801 ODT, 25 September 1997, p.10. 802 NZH, 25 September 1997, p.3. 803 NZH, 25 September 1997, p.1.

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let‟s tell them [the public].‟804 Pressure for NZ First MPs during this period was especially severe, public opinion polling showed they had dropped to just 2 percent support.805 Opinion columns in newspapers joined in the condemnation. On 28 September in the SST, Sandra Coney described the destination of the health reforms, „This is where it was leading: A man who is condemned to die. State euthanasia.‟806 The letters pages of newspapers filled with outraged denunciations of the decision, „Have we, as a country and people now become so inured and desensitised to real life that we allow this monstrous nonsense to continue?‟807 The Maori Council also lent its support to Williams, raising the possibility of an urgent claim to the Waitangi Tribunal to keep a taonga.808 The unfolding of the crisis continued when on 2 October Williams‟ family laid a complaint with Police „against the crown health enterprise under section 151 of the Crimes Act for failing to provide the necessities for life‟ and John Banks discussing appealing to the United Nations Human Rights Committee.809 On 3 October „About 200 people, young and old, Maori and Pakeha, marched to Whangarei Hospital yesterday morning demanding Northland Health “stop playing God” and give 64-year-old Rau Williams a chance.‟810 On 5 October, Rau Williams‟ condition worsened yesterday as supporters gathered in the rain outside Whangarei Hospital to plan protest action aimed at making doctors rethink their dialysis decision. [...] ”The response of the public is mounting by the day,” said a Rau Williams Support Group member, Don Ross. “A woman has offered one of her kidneys. Offers of money have been received and various groups have lit candles and are praying.” Their campaign was strengthened yesterday when one of the doctors who had backed Northland Health‟s decision earlier in the week admitted treatment could extend Mr Williams‟ life by a year or more.811 On 11 October the Court of Appeal ruled against Williams‟ family‟s legal challenge to Northland Health‟s decision.812 Williams died the same day, just after being told he had lost
804 805

Ibid. Ibid. 806 SST, 28 September 1997, p.C7. 807 Dominion, 30 September 1997, p.6. 808 ODT, 30 September 1997, p.7. 809 NZH, 3 October 1997, p.1. 810 NZH, 4 October 1997, p.3. 811 NZH. 6 October 1997, p.3. 812 NZH, 11 October 1997, p.1.

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his appeal.813 On 19 October, David Seedhouse, a medical ethics lecturer, had a column published in the SST slamming the „nasty experiment‟ of a society run on free market policies, „Unless we persuade our representatives to enact humane policies we will soon become a ruthless society.‟814 Jan Corbett in the NZH described Williams as „the icon of a health system in crisis‟.815 Behind the scenes in the Rau Williams crisis, was Lyndon Keene and the Coalition for Public Health, But with the rationing debate which happened increasingly during the nineties there were one or two particular incidents which really focused a lot of media attention on those. And one of them you might have read about or heard about was a guy called Rau Williams, who lived in Northland. And there was a whole debate, he needed dialysis treatment and his likelihood of living much longer wasn‟t all that great and dialysis is expensive. So there was this whole rationing debate around this guy, about whether he should have this or not. And I think there was this suggestion that he shouldn‟t have it, because there were criteria being introduced for certain types of procedures and if you didn‟t have the points you didn‟t get it. But his family protested and his physician was supportive of him. His name was Martin Searle, he was a renal physician. And he was supportive of this guy Rau Williams and he felt that if he needed, he certainly needed the treatment, he wanted it, so therefore he should have it. And his family wanted it. And I had a lot of contact with Martin Searle, he used to ring me up just about every day and I used to give him media advice and so on. And we got quite involved in those sorts of debates.816 Spring 1997 protests The Williams crisis was crucial to the health movement growing in spring 1997 into the key political issue. Instability at the top of the coalition, powerful institutional allies in the form of MPs, the Maori Council and Human Rights Coalition and a media savvy strategy designed to turn the Williams‟ case into a broader debate over the problems with the rationing system helped turn Northland Health‟s denial of treatment into a movement building event. By the time Williams died on 11 October his death had helped contribute to calls for a wave of nationwide mobilisations against the health reforms. The story of the spring 1997
813 814

Press, 13 October 1997, p.5. SST, 19 October 1997, p.C6. 815 NZH, 27 October 1997, p.11. 816 Lyndon Keene interviewed by Omar Hamed, 1 July 2011, Disc 1.

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mobilisations against the health reforms is captured in the New Zealand Listener‟s front page of 1 November 1997. With a background image of a march protesting health cuts the headline reads, „The nation‟s health – Why one issue will crush the coalition‟.817 All the preconditions for successful social movement growth existed in spring 1997 against the health reforms. As local communities mobilised to defend health services tens of thousands joined protest marches for the first time in their lives with the sense they could stop the attacks. Local governments, trade unions, Grey Power and the Coalition of Public Health had the organisational muscle to lead mass mobilisations. The coalition relationship was rocky and their reform agenda was perceived to be particularly vulnerable to derailing by confrontation. Previous back downs on hospital closures encouraged it. During spring 1997 local protest marches against health cuts took place across the country with thousands marching in Dunedin, Whakatane and Tauranga. „It‟s springtime again in New Zealand,‟ said Jim Bolger on 2 October 1997.818 Labour leader Helen Clark said the same day, „New Zealand was experiencing a popular uprising against the Government‟.819 Labour MP Steve Maharey said, „The issue of healthcare will bring down the government. However, there's a real chance that the Coalition will kill the health system first.‟820 The local mobilisations and protests fed the broader movement against the Government. The size and anger of the protest in Dunedin discussed in Chapter Two triggered within the movement a new dynamism and reinforced the perception that the public could mobilise and win.

Following the Dunedin mobilisation big protests took place in early October in the Bay of Plenty against health cuts. In Whakatane on 2 October, „More than 5000 people gathered in the hospital grounds for a spirited rally protesting at a feared reduction in the Eastern Bay of Plenty health services. Many had marched the 3km from the town centre through streets lined by hundreds of supportive onlookers.‟821 The political reaction was swift from the Associate Health Minister, „the tone of Mr [Tuariki] Delamere towards Whakatane Hospital changed dramatically, with his saying he “could never stand by and allow anything less than what my family benefited from earlier this year when one of my children underwent emergency

817 818

Denis Welch, „The nation‟s health‟, Listener, 1 November 1997, p.1. SW, 13 October 1997, p.3. 819 NM, 3 October 1997, p.1. 820 SW, 13 October 1997, p.3. 821 NZH, 3 October 1997, p.3.

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surgery one night.” He also gave a personal guarantee that the closing of Thames and Masterton hospitals was not an option.‟822 Just a few days later in Tauranga 2000 people at a protest meeting against hospital cuts booed and jeered Winston Peters, local MP, Treasurer and New Zealand First leader. 823 John Jefferson, the meeting organiser said, „the only time he could remember seeing people so incensed was during the 1981 Springbok tour.‟824 Tauranga Hospital faced a $4 million funding cut and the downsizing of a unit for the elderly.825 The protests catalysed the formation of local Coalition for Public Health groups in the Bay of Plenty during spring 1997. In Whakatane, „A steering group has been set up to establish a Coalition for Public Health in the Whakatane area. A Nurses Organisation delegate at Whakatane Hospital, Desiree Kelly, said the aim was to lobby all political parties to maintain a public health service and to ensure the public health service and to ensure the public were kept informed about health reforms.‟826 The Listener reported that in October 1997, In a basement room at a Tauranga hall, about 40 representatives of community health agencies gather to form a Coalition for Public Health, as like-minded people in Hamilton and Dunedin have done. The mood is one of frustration hardening into anger. They all work at the coalface of healthcare where, daily, they hear the sound of pit props crumbling.827 The back down over the Whakatane Hospital downgrading won from Tuariki Delamere and polls showing Winston Peters polling third in his Tauranga electorate with only 12% support reinforced the political vulnerability of the coalition to protest.828 Without the local mobilisations there would not have been the necessary base from which a national movement could succeed. The perception that local mobilisations had won through sheer determination in the spring of 1997 and in the years before, lent credence to the idea that national mobilisations could win in the same way. Another key element in the development of a nationwide street movement was the new institutional allies swinging in behind the protests. Most significant were local government
822 823

NZH, 6 October 1997, p.1. Ibid., p.5. 824 Ibid., p.5. 825 SST, 5 October 1997, p.4. 826 NZH, 8 November 1997, p.10. 827 Denis Welch, „The nation‟s health‟, Listener, 1 November 1997, p.18. 828 SST, 5 October 1997, p.4.

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organisations. Angry Nelson-Marlborough residents facing privatisation of their hospitals into community trusts in September 1997 pushed for joint civic action, „Nelson Mayor Philip Woollaston, the city council and a public meeting of 700 people have united behind a plan to hold a referendum on health policy.... Next week, Mr Woollaston will fax every mayor and council in New Zealand , seeking backing for the petition, which will call on the Government to undergo proper public consultation on its health policy and to stick to the resulting policy.‟829 By the end of September 1997, Woollaston‟s plan for a referendum had received the backing of „A meeting of about 35 civic leaders from the Waikato, Bay of Plenty, Taranaki and the Manawatu‟.830 This campaign to trigger a citizens-initiated referendum, after consulting economist Brian Easton, agreed on the referendum statement, „that Government should increase its spending on health services to at least 7 percent of GDP, if necessary by increasing personal tax‟.831 The figure of seven percent was decided because that was where New Zealand‟s government health spending would have been projected to be in 1999/2000 if it kept rising alongside OECD levels of health spending.832Dunedin City Council, led by Green Party Mayor Sukhi Turner also pushed for joint action after their September protests against local cuts. A newly formed Dunedin Health Action Group, with support from the city council added its voice to calls for nationwide action after its polling showed 71% of New Zealanders „dissatisfied‟ with public health care and 81% prepared to pay more tax to fund it adequately.833 Hospital workers‟ unions, the Coalition for Public Health and Labour MP Pete Hodgson were also represented in the action group.834 Wairarapa‟s three mayors, including high profile transgender Alliance politician Georgina Beyer also formed a working party in September 1997 with health professionals and their local National MP to defend Masterton hospital after Greytown‟s closure was announced.835 As Beyer told the Evening Post, "We know we have got a bit of a struggle on our hands, considering what's happening with health in rural New Zealand. But we have got to get in there.‟836 These new allies at a local government level and within the union movement did not emerge spontaneously. The Alliance Party had worked hard to win elections at a local government level as its support broadened through the 1990s. Once elected they could use

829 830

Dominion, 27 September 1997, p.2. NZH, 30 September 1997, p.7. 831 Brian Easton, The Whimpering of the State; Policy After MMP,p.142. 832 Ibid., p.141. 833 ODT, 1 November 1997, p.1-2. 834 ODT, 27 September 1997, p.4. 835 EP, 27 September 1997, p.25. 836 Ibid.

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their new found positions to criticise the government and to use council resources to aid the movements. Unions also reached a high point in co-ordination during the mobilisations. On 17 October health unions and associational groups met in Wellington to co-ordinate national action, an unprecedented combination in the period of the 1990s.837 This transformation of local campaigns into a nationwide movement came at a time when hospital closures had been going on for a decade. Once the campaigns transformed themselves into a movement however the change was not just quantitative (in terms of numbers demonstrating) but qualitative – the rhetoric and language of the leaders moved from setting out the importance of a particular hospital to becoming more aggressively antigovernment, and more politically anti-privatisation. This transformation is not a unique phenomenon as Alf Gunvald Nilsen and Laurence Cox point out, A similar process [to the experience of Irish anti-pollution campaigners] took place in Norway when, in 2003, a network emerged between groups throughout the country campaigning against the closing of local hospitals. With the formation of a national campaign, their activities are no longer merely directed against the closing down of this or that hospital, but towards current changes towards centralization and corporatization in Norwegian health policy. In both cases, we see first of all the articulation of a locally-grounded rationality rejecting the latest move “from above” (see Barker 2004 on this process in comparable health care campaigns in Britain), secondly its organisation as a militant particularism in a specific place, and finally its articulation as a general campaign.838 The instability at the top of the coalition intensified as the local mobilisations against cuts began to spread. In turn the instability and lack of government leadership encouraged the mobilisations. On 4 October at Tauranga‟s rally against health cuts Peters was „booed, jeered and shouted down by the crowd‟, estimated at 2000 and upset at long hospital waiting lists and the planned downsizing of a unit for the elderly‟.839 On 6 October Peters announced „The Government is planning to introduce community representation on CHE boards by April 1

837 838

SST, 21 September 1997, p.2. Alf Gunvald Nilsen and Laurence Cox, “At the heart of society burns the fire of social movements”: What would a Marxist theory of social movements look like?, online, nd, available at: http://eprints.nuim.ie/460/1/AFPP_X_redux.pdf (3 November 2012) 839 SST, 5 October 1997, p.4.

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next year as it seeks to stem the public anger over health.‟840 Henare also called for the government to rethink planned tax cuts and „whether the money would be better spent on health and education.‟ 841 The government‟s move on CHE representatives and concern from a coalition Minister on tax cuts would reinforce the publics‟ perception that they were right to challenge the direction of the reforms. However it also gave ammunition to critics of NZF such as Helen Clark, that they should leave the coalition, „if they have a shred of decency left‟. 842 Disappointment with NZF joining National in coalition was compounded by a feeling that Peters had personally betrayed voters. Winston Peters would lose Tauranga in an election tomorrow, says local Grey Power president John Jefferson, "and yet I would never have said that two years ago. I thought he'd be here for the rest of his life." Many felt betrayed by his decision to go with National. "They wouldn't have worried about that except that he said he would bring down the National government, that they weren't fit to govern." Mr Jefferson, a former office-holder and parliamentary candidate for New Zealand First, says: "I still, in my own mind, think Winston's fairly honest, but a lot of people don't see him that way." Mr Peters was "starting to fail to listen, like a lot of politicians". Tauranga people were incensed that the Government was cutting the city's hospital budget while proposing to spend $160 million on Parliament.843 With his support base deserting him NZF leader Winston Peters called for an end to the coalition in early November in the wake of Jenny Shipley‟ leadership coup deposing Jim Bolger as Prime Minister. However the majority of NZF‟s Ministers and MPs supported staying in the Coalition.844 This led to a perception the coalition was within breaking point in the final months of 1997 leading to an outpouring of protest. By the end of October health protests were spreading across New Zealand. On 18 October two thousand people rallied in Invercargill giving their MP, Mark Peck, a 15,100 signature petition for him to take to Parliament, „demanding a halt to cuts to public health services‟.845 On 6 November, „In Nelson about 1800 marched through the city at lunchtime. Organiser
840 841

EP, 6 October 1997, p.3. Ibid. 842 EP, 6 October 1997, p.3. 843 SST, 28 September 1997, p.5. 844 Dominion, 7 November 1997, p.2. 845 NZH, 20 October 1997, p.5.

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Nicki Green, an education consultant, said Nelson people were keen to voice their concerns about the state of health services. In Masterton about 4000 people turned out at a rally to protest against a plan to downgrade Masterton Hospital which would see many patients travelling to Wellington or Palmerston North for operations.‟846 On 11 November 3000 marched on Queen Street and „cheered wildly when the Government was urged to fix a “sick health system”‟.847 „The strongest words came from Dr David Galler, Middlemore‟s director of intensive care, and one of eight speakers to address the crowd. He labelled the Government‟s policies as destructive and short-sighted and said they had rendered hospitals less able to help patients.‟848 The march was initiated not from any of the established health sector groups or unions but by Janne Witt, an Auckland mother of four who six months before the march had founded her own group, Action to Improve Maternity Services, „because she was frustrated with changes to the maternity system and had noticed its deterioration since she gave birth to her first child, Rebecca (7).‟849 On 14 November „A health cuts protest march in Hamilton yesterday drew about 2000 people, many fired by news this week of government plans to spend an extra $650 million on defence.‟850 The protest which included large contingents of health workers was the largest in Hamilton since the 1981 Springbok tour.851 In Thames over a thousand people marched against the downgrading of their hospital on 28 November.852 The Herald reported, The vocal crowd clutched song sheets and placards and sang a raucous protest song about their right to healthcare as they marched from the hospital into the centre of town at noon. [...] Thames surgeon Paul Silvester said the community had to fight a “bunch of Treasury people” not only for Thames, but for all rural New Zealand. Hospital nurse Ann Daniels said she loved her job, but found each day a struggle. “This experiment has failed,” she said. “We are pushed to the limit every time we go to work.”853

846 847

Dominion, 7 November 1997, p.2. Dominion, 11 November 1997, p.6. 848 NZH, 12 November 1997, p.5. 849 SST, 9 November 1997, p.8. 850 NZH, 15 November 1998, p.7. 851 WT, 14 November 1997, p.1. 852 NZH, 29 November 1997, p.7. 853 Ibid.

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On 5 December Labour MP Damien O‟Connor and Alliance spokeswoman Phillida Bunkle joined 250 people marching in Takaka in Golden Bay.854 On 12 December, labelled a national day of action for health there were protests across the South Island „More than 2000 people marched in Ashburton yesterday, almost 700 on the West Coast, and 180 in Motueka, while Christchurch people queued to sign a petition calling for an extra $1 billion in public spending.‟855 Invercargill protesters followed up their October march with a December 12 rally and the laying of flowers outside their local hospital „as a sign of their grieving for the health cuts‟.856 Added together the protests against the Government‟s health reforms totalled around 30,000 people by newspaper accounts. These were the biggest wave of popular mobilisation since the union protests against the Employment Contacts Act in 1991.857 The largest protests in this period were in provincial centres where services were being cut. Dunedin‟s 7000 marchers, Whakatane‟s 5000 and Masterton‟s 4000 were the biggest. The sheer breadth of the mobilisations is also notable, Auckland‟s 3000 in the north, Invercargill‟s 2000 in the far south. The scale of mobilisation reflected the scale of public opinion. An October 1997 opinion poll taken during the Rau Williams crisis for the NZH showed health was the „most important political issue in the country at the moment‟ for 33.2 per cent of voters followed by 27.3 per cent with „Government, leadership and the honesty of politicians‟.858 No other issue concerned more than 10 per cent of voters polled. 859 The NZH noted, „only the “very wealthy” (earning over $67,000 a year, many of them with private medical insurance) do not see health as their key concern.‟860 Additionally, „Nine out of 10 New Zealanders say the Government should spend more money on health services.‟861 The political effect of this on voters‟ party preferences was also strong. During this time Labour would poll at 50 percent and National was seen as a weak and divided party after Christine Fletcher resigned her ministerial post and Banks criticised Bolger‟s leadership.862 Grant Brookes, a psychiatric

854 855

NM, 6 December 1997, p.1. Press, 13 December 1997, p.4. 856 ST, 11 December 1997, p.3. 857 Toby Boraman, The Myth of Passivity; class struggles against neo-liberalism in Aotearoa in the 1990s, online, 2004, available at: http://vomitingdiamonds.files.wordpress.com/2011/07/myth-of-passivity.pdf (7 November 2012) 858 NZH, 18 October 1997, p.1. 859 Ibid. 860 Ibid. 861 NZH, 22 October 1997, p.1. 862 NM, 3 October 1997, p.1.

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nurse and activist in the small left-wing group, Socialist Workers‟ Organisation, in 1997 participated in the Auckland health march and remembered of their effect, Omar Hamed (OH): What were your memories of the protests as a participant? Grant Brookes: (GB) Well they were big, and they had people marching who I hadn‟t seen marching before. Grey Power were quite a big chunk of that movement. There were lots of people who didn‟t look like students marching down the street, and that was a new experience for me. OH: Do you think they were successful protests? GB: They were not nationally co-ordinated, they appeared to be quite spontaneous, organised separately in each centre, spreading almost via contagion effect rather than through a coordinated national structure. So they differed a lot from city to city. In some places they were successful in stopping hospital closures, but in general I think the major effect was to destabilise the ruling National Party coalition with New Zealand First. OH: And eventually pushed that towards a split do you think? GB: Yeah, there were a number of factors. Obviously New Zealand First had a constituency among older New Zealanders and this group were protesting in significant numbers. So that created tension between the coalition partners and was one of the factors that pushed them towards a split.863 The protest movement and the plummeting poll results for NZ First created a political crisis for the Coalition Government. Sunday Star-Times journalist Ruth Laugesen described in late September1997 how NZ First MPs were panicking with their poll rating dropping to 1.9%, With hospital closures, drug subsidy cuts, and kidney patient Rau Williams in the news, many MPs talked fiercely behind closed doors about how they must force National to pull back on health policy. [...]

863

Grant Brookes, interviewed by Omar Hamed, 1 March 2012, Disc 1.

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As [NZ First MP] Jenny Bloxham put it: "When you feel like you're losing the plot, you've got to put your foot down. We have found our identity and we are sticking with it. We have had to compromise enough already."864 The Coalition Government in spring 1997 was on the verge of collapse as pressure from below created stress within and between the coalition parties. Only the threat of NZ First MPs to leave their party when Peters considered exiting the coalition and the replacement of Bolger by Shipley held the coalition together into 1998. New Zealand‟s historiography recognises the potential power street protests and social movements had in years such as 1913 during the general strike, 1951 during the waterfront lockout and 1981 during the Springbok Tour to defeat the government. In late 1997 a similar situation existed for the National NZ First Coalition government. It was taken to the brink of collapse by the storm of health protests. As it was the coalition was able to continue into 1998. The collapse of the Coalition, 1998 Summer lull, December 1997-April 1998 Between the 12 December 1997 protests and April 1998 there was a lull in activity for the health movement. There are a number of contributing factors. The summer months are traditionally a time when most New Zealanders are holidaying, when Parliament is not sitting and politics are of low priority. A five week power blackout in Auckland in February 1998 took the focus off political issues. Crucially they are also a time when trade unions, community organisations and city councils lapse into inactivity as staff take annual leave and the regular tempo pauses. There were no big health stories or issues early in the New Year such as Rau Williams or announcements of major cuts. Jim Bolger had been replaced by Jenny Shipley and NZF‟s internal arguments had subsided. NZPA reported that up until May 1998, „National has enjoyed a honeymoon period with voters since the installation of Mrs Shipley as Prime Minister, its support steadily rising while Labour support has declined.‟865 The political opportunities, sense of collective anger and utility had contracted quickly. Only in Taranaki in early 1998 did protests continue, in response to the announcement of substantial cuts to the regions services.

864 865

Dominion, 28 September 1997, p.2. Press, 19 May 1998, p.3.

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Yet these are mostly external pressures. Decisions made by movement activists also had a crucial impact. Firstly, the decision by health authorities to focus on gaining enough signatures for a citizens‟ initiated referendum. Collecting signatures for a petition took the focus of activists away from mobilising. In hindsight, the movement leadership may have regretted the decision. In July 1998 with just 100,000 signatures of the 300,000 needed collected the petition drive ended.866 As the petition‟s formulator Easton wrote of the campaign‟s failure, „In the end the task proved too onerous. The various voluntary organisations exhausted by day-to-day matters were unable to find the energy to pursue longterm ones.‟867 Secondly there were no new dates set for protest mobilisations in the New Year. As a result of this and with Bolger‟s resignation in early 1998 triggering the TaranakiKing Country by-election campaign in April and May 1998, the next political flashpoint of the health movement would come in Taranaki. Colin Morrison, February-April 1998 One exception to this lull in activism was in Southland in April 1998 where the heart attack death while on a waiting list of a 42 year old Riverton farmer for heart surgery triggered an outpouring of anger at the Government.868 The farmer, Colin Morrison, did not qualify for surgery under the points booking system introduced in 1997 for a range of surgery including the type Morrison needed.869 Morrison had been told in December 1997 he would be waiting for more than a year for his operation and his family went public in January 1998 to raise awareness of the plight of people on waiting lists.870 Between then and his death there was an outpouring of disgust at how the health system treated patients like Morrison from the Southland community. A Southland Times editorial on 19 February 1998 said, There are, of course, others like Mr Morrison, but there is another dark, disturbing aspect. Is Mr Morrison penalised because of where he lives? Labour health spokeswoman Annette King has pointed out that Auckland cardiologists are working

866 867

EP, 25 July 1998, p.3. Brian Easton, The Whimpering of the State; Policy After MMP,pp.142-143. 868 ST, 6 April 1998, p.1. 869 Deborah Jenkins and Stuart Birks, An economic assessment of the priority criteria for elective surgery in New Zealand, online, July 1998, available at: http://www.massey.ac.nz/~wwcppe/papers/cppesp02/cppesp02.pdf (8 November 2012) 870 ST, 13 February 1998, p.1.

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on a threshold of 35 points. Mr Morrison's condition equates to 55. In other words, if Mr Morrison lived in Auckland, he would qualify for elective heart surgery.871 Claims by Labour‟s health spokesperson that the Government was „spooked‟ by Morrison‟s death on April 3 are certainly plausible - just a week later it put an extra $1.5 million funding towards heart surgery operations in Southland and Otago.872 The Government also promised that week an extra $252 million for 30,000 more elective surgery operations over the next three years. 873 Bill English said, „My commitment to Mr Morrison's family, and to all other New Zealanders waiting for surgery, is that in future people will know what they can expect from the public health service.‟874 The Riverton funeral of Colin Morrison was used to criticise the Government, Held at the Riverton Union Church, the Rev Clive Haliday said Mr Morrison's death was unnecessary. The means which could have extended his life existed but were not made available to him. “Colin was not taken by chance. People have been left with feelings of anger and betrayal but there's nothing now that anyone can do or say to bring him back," Mr Haliday said. The grief of loved ones could be eased by their hoping that others with Mr Morrison's illness received the treatment he was denied."It's important to use our feelings, not for bitterness but for good," he said.‟875 Eighty people at a public meeting in Invercargill on 14 April 1998 lambasted Bill English, as the local MP and Minister of Health who was present and „at the end of the meeting moved a resolution seeking him to make way for a "true Southlander" and resign as Clutha-Southland MP.‟876 Morrison‟s GP, Russel Pridgeon, also wanted English to resign and Healthcare Otago‟s consultant cardiologist Gerard Wilkins said Morrison was „a martyr in a sense‟.877 Outside a shopping centre in Invercargill on 2 May a group of Southlanders protested the health system by displaying a mock guillotine. Their spokesperson said, „The guillotine was

871 872

ST, 19 February 1998, p.6. Press, 9 April 1998, p.9. 873 ST, 9 April 1998, p.1. 874 Ibid. 875 ST, 9 April 1998, p.1. 876 ST, 15 April 1998, p.1. 877 Evening Standard, 7 April 1998, p.5.

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possibly more humane than the health system, which kept people hanging on waiting lists for years‟.878 In the weeks after Morrison‟s death a number of protest songs were recorded around Otago and Southland. One was entitled „Accountability‟ and another was called, „Not Enough Points‟.879 At the end of April „more than 70 people in Riverton and a smaller crowd in Invercargill turned out to help record the chorus to the song [„Accountability‟] as their tribute to Mr Morrison, a response that humbled and encouraged Mr Johnston.‟880 A letter writer to the ST two months after Morrison‟ death quoted a lyric of one of the protest songs written for Morrison, „You with the blood on your hands, it's you who made the system, you're the ones to blame‟ and called for Bill English to be held accountable.881 Ross Johnston, the songwriter of „Accountability‟ said any the song would be sent to radio stations and any funds raised would be sent to the Morrison family or the Coalition for Public Health.882 The death of Colin Morrison, like that of Rau Williams, highlighted the deficiencies of an underfunded public health system and radicalised the local community. Morrison‟s wife after his death „vowed to get the hospital system changed‟.883 Morrison‟s sister joined a Dunedin health lobby group called Healthwatch that was active in the lead up to the 1999 election organising public meetings on health issues.884 The death mobilised the Southland branch of Federated Farmers to write letters of concern to MPs, English and health officials.885 The death of Morrison and calls for English to resign did it seems „spook‟ him, hundreds of millions of dollars was poured into elective surgery in the days afterwards. The very public nature of Morrison‟s tragic death on a waiting list fed the growing discontent about the health reforms and in those lull months of early 1998 gave a focus to health activism in the southern most provinces of New Zealand Taranaki King Country By-election, May 1998 The Taranaki King Country by-election campaign in April and May 1998, triggered by Bolger‟s resignation from Parliament was hotly contested by all major parties and its outcome had an impact on the parties‟ attitudes towards health policy. Protests against health
878 879

ST, 4 May 1998, p.2. EP, 24 April 1998, p.9. 880 ODT, 29 April 1998, p.3. 881 ST, 29 May 1998, p.4 882 ST, 23 April 1998, p.1. 883 ST, 6 April 1998, p.1. 884 ST, 30 June 1999, p.6. 885 ST, 14 April 1998, p.3.

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reforms took place during the by-election. In New Plymouth in May 1998, 5000 people took part in a “Save Our Hospital” protest march which „led by Taranaki woman Chantel Hewitt and her daughter Verity, stretched for more than two kilometres.‟886 Taranaki Healthcare prompted the protest when plans were announced that, „a radical redesign of it hospital was on the cards, and that staff would be slashed by 160 in the coming months‟.887 As a result of the community‟s concern with health issues and hospital cuts the Waikato Times described health as the „killer issue‟ in the by-election, „Candidates and their party leaders know that impressing people with their blueprint for rural health is a sure way to win votes.‟888 The result of the by-election confirmed this importance of health to voters. Running on a „platform of saving rural health‟Act‟s candidate took second place in the by-election with 24.52% of votes, just 957 votes short of beating National.889 Act had exploited a loop hole in electoral law to spend a whopping $80,000 on this campaign far more than the $40,000 limit on parties by-election spending.890 Act also won votes from conservative farmers by campaigning against National‟s treaty settlements process which affected Maori land leased to farmers.891 As one reporter who interviewed a group of farmers in the by-election found, their views matched the message Act was putting out, „When pushed, they express concern about the reduction in health and other rural services, the ease with which people receive benefit...‟.892 This well funded campaign and platform of „saving rural health‟ won votes even though Shipley would attack it at National‟s by-election launch, Mrs Shipley said her friend and former colleague Ruth Richardson, now an ACT member, was urging the Government to drop spending to 20 percent of GDP while ACT candidate Owen Jennings was saying he would not change the health sector at all in the electorate."Ladies and gentlemen, it's not credible," Mrs Shipley said. "You can't come here and say that you will take 15 percent of Government expenditure in terms of GDP and then say that nothing will change."893 Like Act, Labour chose to focus on rural health as well. Their candidate, a farmer from the Waikato, said, „people must make a clear choice about whether all key services, such as

886 887

SST, 17 May 1998, p.2. SST, 17 May 1998, p.6. 888 WT, 23 April 1998, p.7. 889 WT, 7 May 1998, p.7. 890 EP, 13 August 1998, p.2. 891 Evening Standard, 16 June 1998, p.1. 892 EP, 1 April 1998, p.5. 893 EP, 15 April 1998, p.2.

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health, education and roads, should be in a free market climate‟.894 The Alliance candidate Kevin Campbell‟s campaign also tapped into a deep discontent with health services and won 15.46% of the vote. During the by-election the Alliance planted 54 small white wooden crosses along the main streets of the electorate‟s towns and on Stratford‟s hospital lawn to represent the 54 New Zealand hospitals closed since 1984.895 Campbell used his candidacy in the by-election to raise the profile of Stratford‟s Save Our Hospital Campaign.896 The Alliance also highlighted lengthening waiting lists highlighting in the media the long delays a 75-year-old woman faced waiting for skin cancer to be removed.897 Additionally, Campbell used the by-election to articulate the Alliance‟s alternative policy to the health reforms, „He blames the commercialisation of services for the closure of rural hospitals. The Alliance wants to establish community health centres, run by elected councils. It would cancel tax cuts and use the money for health and other social services.‟898 However the main impact the by-election had was on the orientation of the competing parties for the rest of 1998. A comparison of by-election results for the party candidate in 1998 to party votes in the 1996 general election within the Taranaki-King Country electorate is a key measure of changing voter attitudes. Alliance went from 8% of the party vote in 1996 in the electorate to 15% of the candidate vote in the by-election.899 Labour rose from 15% to 17%. National dropped from 46% to 29%. Act went from 7% to 24%. The NZF candidate‟s vote in the by-election was 2.75%, prompting Winston Peters to say, „The public perception of NZ First has not been good, I understand that. If any party got a message in this by-election, long before it even started, we did . . . but there are lessons we can learn and that's the name of the game. I assure you that by the next election we'll have learned them.‟900 NZF‟s loss of support was significant. In 1996 the same NZF candidate had come second in the electorate with 17.2% of the vote.901 The result is thus a significant swing of voters towards left-wing parties with the Alliance taking the lion‟s share of disaffected NZF voters. And National had been delivered a strong message from its farmer and small business base - Act was a

894 895

TDN, 9 March 1998, p.3. TDN, 22 April 1998, p.1. 896 Ibid. 897 TDN, 15 April 1998, p.2. 898 WT, 23 April 1998, p.7. 899 Electoral Commission, Electorate Summary of Votes for Registered Parties, online, 1996, available at: http://www.electionresults.govt.nz/electionresults_1996/pdf/4.1%20Votes%20for%20Registered%20Parties%2 0by%20Electorate.pdf (8 November 2012) 900 WT, 7 May 1998, p.7. 901 EP, 1 April 1998, p.5.

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preferred coalition partner to NZF.902 With a one seat majority and ebbing support in the wake of the by-election, Shipley‟s message to her fellow National MPs was „not to rock the boat because New Zealand was “delicately poised” in the international economy‟.903 Shipley and Peters had been delivered a strong message in the by-election to end the coalition by their respective constituencies. Just three months later, the coalition government would end. Coalition collapses, August 1998 On 14 August 1998 the Coalition Government ended when Shipley dismissed Peters as Treasurer for his opposition to the privatisation of Wellington Airport.904 In return Peters and NZF ended the coalition and „NZ First list MP Jenny Bloxham said the party would now give very serious consideration to supporting a Labour-led Government.‟905 Peters‟ actions were labelled as opportunistic but his action was in line with what the membership and supporters of NZF wanted.906 As one newspaper editorial labelled it, „His actions have all the hallmarks of a gamble for public support by a leader whose party has lost nearly all backing, a party which is otherwise heading for extinction.‟907 As a result of Peters‟ leaving the coalition NZF split. Led by Tau Henare, eight MPs left NZF to become independent MPs supporting Shipley‟s government. The impact of this split and the coalition‟s demise was to again create a period of political opportunity favourable to social movement activism. In early September an Anglican Church backed „Hikoi of Hope‟ (see Chapter Six) left from Kaitaia and Bluff heading for Wellington on October 1.908 Social movement unionism and partyism One of the interesting dynamics of the health movement in the 1990s was the role played by the trade unions and political parties. Paul Almeida, a US social movement sociologist has examined the impact of „social movement unionism‟ and „social movement partyism‟ as factors in the success of a struggle against the partial privatisation of El Salvador‟s public health system between 1999 and 2003.909 Social movement unionism describes union

902 903

EP, 16 May 1998, p.1. Dominion, 18 May 1998, p.2. 904 WT, 14 August 1998, p.1. 905 EP, 14 August 1998, p.1. 906 Grant Brookes, interviewed by Omar Hamed, 1 March 2012, Disc 1. 907 NM, 13 August 1998, p.11. 908 NZH, 17 September 1998, p.1. 909 Paul Almeida, „Social Movement Unionism, Social Movement Partyism, and Policy Outcomes: Health Care Privatization in El Salvador‟, in Hank Johnston and Paul Almeida, eds, Latin American Social Movements: Globalizations, Democratization, and Transnational Networks, Lanham, Ma., 2006, pp.57-76.

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campaigns that involve both wider mobilisation of the community and the use of „noninstitutional tactics‟ such as street protests and civil disobedience.910 Social movement partyism is a term to cover the activism of political parties both inside political institutions and outside in the community to support social movements. Alameida draws on the history of Latin America‟s anti-neoliberal social movements in the 1990s and 2000s to assert, To summarize, unfavourable public opinion alone is unlikely to stop neoliberal policy reform and such reforms are rarely put to a popular referendum. Labor unions in sectors most threatened by economic liberalization will be more successful if they can move to a social movement unionism organizing strategy-that is, mobilizing other sectors beyond their own organizational boundaries. Such widespread mobilization is difficult to generate, but if achieved, will help pressure for policy change. Finally, a strong oppositional political party that practices social movement partyism in concert with social movement unionism may provide the kinds of coalitions and accumulation of social forces necessary to compel the government to rescind its unfavourable policies.911 Throughout the period of the late 1980s and all through the 1990s within the health movement we see elements of social movement unionism and partyism. Social movement unionism – Coalition for Public Health If social movement unionism is characterised by both wider community mobilisation and the use of non-institutional tactics then the Coalition for Public Health represented a partial realisation of this model of union campaign. As detailed in the first chapter of this section, the Coalition was backed by a vast array of trade unions, religious and community organisations. This allowed community organising against the health reforms to be done through public meetings alongside supporting organisations. As Lyndon Keene remembers, Well I was the only paid employee really but we had a lot of voluntary help as well. So we produced a lot of submissions on various bits of legislation and proposals and so on. We went to lots of community meetings, I attended meetings all over the country. Grey Power especially were pretty good about organising big meetings. You go to small, relatively small towns like Blenheim for example I remember going there

910 911

Ibid., pp.57-76. Ibid., pp.57-76.

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and went to a meeting with about 400 people there. And this was just to partly talk about hospital charges but mostly the health policy itself. So we‟d be raising awareness through meetings as well. A lot of the time, we‟d get approached by the media, or by other organisations to clarify if something was announced what does this mean and what is your comment on it. So a lot of the work was actually focused around the media, not necessarily proactive but often it was the media approaching us, because we had established ourselves as a voice there. Through the 1990s in various regional centres local branches of the Coalition for Public Health were set up. The local branches were able to adapt their activism to suit their regions requirements. In Palmerston North the local branch organised a „health summit‟ and „public hearing‟ into the shortcomings of the health system in July 1996.912 The West Coast branch allied with an intellectual disability support group to protest the closure of Seaview psychiatric hospital in August 1997.913 The Waikato branch was led by NZNO organiser James Ritchie organised the Hamilton protest against the health reforms in November 1997.914 A month earlier the Waikato branch leaked documents from Health Waikato (a CHE), showing that „Health Waikato‟s surgery budget will drop 6 per cent this year. They also show a 12 per cent cut next year if more funding is not available‟.915 When Taranaki residents mobilised to stop service cuts they quickly formed themselves into a Taranaki branch. Keene travelled to speak to a locally organised public meeting in May 1998 or around 100 people. Keene advocated the group to liaise with local doctors and nurses, „find examples of deterioration in service and publicise them‟, and make coalition with Grey Power and local councils.916 The Taranaki branch was able to help temporally stop the closure of a child and youth health centre.917 In December 1998 the Wellington branch was focused on conveying public concerns to the local CHE over plans to centralise the regions hospital services.918 Although the locally generated activity was effective in coalescing at the grassroots campaigns against health service cuts it had a limit as Keene admitted in 1998 at the Taranaki

912 913

Manawatu Standard, 4 July 1996, p.2. Press, 4 August 1997, p.4. 914 WT, 29 October 1997, p.2. 915 WT, 11 September 1997, p.1. 916 TDN, 22 May 1998, p.2. 917 TDN, 25 July 1998, p.8. 918 EP, 5 December 1998, p.2.

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public meeting, „The Coalition for Public Health has been going since 1991 and at best we have slowed down the process (of health privatisation)‟. 919 As Chapter Two and this chapter indicate, almost all of the large or effective protest campaigns grew out of the local community responses to cuts or closures. However there were severe limitations to this approach. CPH‟s strategy of organising local groups in areas facing cuts effectively meant they were always reacting to the troubles of the health reforms rather than building the momentum to reverse them. There was no attempt until 1997 at national co-ordination of the movement and during the health reforms there was no coordination of industrial action or protest action undertaken by the Coalition. The CPH‟s approach can be contrasted with the strategy and tactics used by the Coalition for Healthy Communities (CHC), formed by Los Angeles medical and hospital worker unions in 2002 to stop small county public hospitals being closed down during a state government budget crisis.920 Unlike the CPH in NZ the Coalition for Healthy Communities focussed on mobilising the workers with the community in the affected area, „The groundswell began with the summer, and our coalition hit the ground with work-site teach-ins on LA‟s budget history and rallies at each hospital and county clinic slated for closure.‟921 The leading union, the SEIU, trained their members and other coalition members in civil disobedience but also spent over $3million on advertising to successfully support a legislative referendum that raised a new property tax to cover the budget shortfall.922 The CHC and CPH are both examples of health union initiated attempts at social movement unionism. However the CPH in New Zealand never attempted to do what the CHC did in Los Angeles, to lead the community movement against the hospital closures by organising members in the hospitals affected by closure and preparing to launch co-ordinated civil disobedience and electoral based campaigns. Where the movement against hospital closures in LA was centrally coordinated, chronologically planned and led by the health workers union to progress an alternative agenda, the movement in NZ was decentralised, sporadic and did not effectively mobilise the community in a co-ordinated way until 1997. Ian Greer in his comparison of social movement unionism in contestation of health privatisation in various German cities through the 2000s argues that the adaption of new
919 920

TDN, 22 May 1998, p.2. Amy Hall and Dan Schaefer, „The Coalition for Healthy Communities: Fighting to Save LA County Hospitals, Union Jobs and Patient Care‟, Labor Studies Journal, 29 (1), Spring 2004, pp.43-66. 921 Ibid., pp.43-66. 922 Ibid., pp.43-66.

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tactics of a combative mobilisation of union members requires two preconditions – „not only the loss of old channels of [union influence on employers and government], but also some amount of economic stability‟.923 New Zealand‟s health unions in the late 1980s and through the 1990s faced declining influence over state health policy but also operated in an environment of historically high unemployment and state fiscal crisis. In this respect we can see the failure of the health unions to engage in direct mobilisation as the result of political decisions made by union leaders which was conditioned by structural factors embedded in the economic and political organisation of the period. Greer makes the case that in Chemnitz, Germany, „worker representatives there are quiescent due to the economic pressures on their members created by high unemployment‟.924 This same analysis seems applicable to the New Zealand situation in the 1990s. By comparing the CPH with the CHC‟s social movement unionism an assessment of the successes and failures of the CPH‟s approach can be made. However the CPH did make a strong contribution to the movement against the health reforms including for its contributions in the movement against part-charges (Chapter One), in supporting interventions by health professionals (Chapter Two) and providing technical knowledge, advice and an organisational model for communities in Tauranga, Hamilton and Taranaki to oppose the health reforms. When the CPH disbanded in February 2000 Keene went to work for Labour‟s Associate Health Minister Ruth Dyson. Annette King, the new Health Minister said, „The coalition was an effective watchdog of public health on behalf of the community.‟925 Ian Powell, executive director of the Association of Salaried Medical Specialists said, „Future historians are likely to assess the coalition as one of New Zealand's most effective voluntary pressure groups.‟ 926 Social movement partyism – Alliance and Labour parties Through the period of the health reforms we see what Almeida describes as social movement partyism, opposition political parties supporting the health movement. The Alliance Party was formed as an amalgam of a variety of anti-neo-liberal forces that coalesced into an

923

Ian Greer, „Social movement unionism in Germany: the case of Hamburg‟s hospitals ‟, Industrial Relations. 47(4), October 2008, pp. 602-624. 924 Ibid. 925 Press, 23 February 2000, p.4. 926 Press, 23 February 2000, p.4.

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electoral coalition in 1991.927 At its core was the NewLabour Party, formed in 1989 and led by MP for Sydenham Jim Anderton, who left Labour over the privatisation programme of the late 1980s. In its ranks were thousands of disaffected Labour supporters. From its beginning NewLabour and then the Alliance was deeply intertwined at both the level of party support and its grassroots members to union and left movements fighting neo-liberalism. In 1989 it lent NewLabour lent its support to the campaign against the closure of St Helens in Auckland. 928 Maire Leadbeater who was the spokesperson for the campaign was deeply tied to the NewLabour Party, „In 1990 I was the NewLabour candidate in New Lynn and I was actually the health spokesperson for NewLabour. We even put me standing at the closed, barred gates of St Helens Hospital featured in the NewLabour Party advertisement in the election campaign.‟929Alliance MPs attended rallies outside hospitals throughout the 1990s for hospital services and helped organise protests including during a doctors strike in Wellington in 1996.930 Alliance activists in provincial centres also helped mobilise the opposition and use their political skills and experience to deepen the opposition. In 1998 the Alliance‟s Wairarapa candidate and a local councillor Cathy Casey told the Dominion, cuts to Masterton Hospital may have to be fought in the legal courts.931 Casey had in 1995 been active on the Wairarapa Community Health Committee and in the fight to save Greytown Hospital‟s geriatric ward.932 David Tranter was an Alliance Party activist who in 1995 „...sold his home, slapped several anti-health reform slogans on his green Bedford housetruck and whistled his border collie, Emma, into the cab beside him. The former schoolteacher became a rural health networker, travelling to New Zealand‟s heartland to gather information and support small towns fighting to save their public hospitals.‟933 The Alliance also backed the referendum campaign to increase public health spending in 1997-8.934 After its period in Government in the 1980s closing rural hospitals the Labour Party in opposition took part in the health movement. In Otago in 1997 Labour played a strong role campaigning against the cuts to urban services and the contracting out to health trusts in rural areas. 935 Opposition parties also used their presence in Parliament to protest the reforms.
927

Chris Trotter, „Alliance‟, in Raymond Miller, ed., New Zealand: Government and Politics, Auckland, 2001 pp.252-261. 928 Maire Leadbeater interviewed by Omar Hamed, 8 March 2012, Disc 1. 929 Ibid., Disc 1. 930 Dominion, 10 October 1996, p.3. 931 Dominion, 11 November 1998, p.10. 932 EP, 12 October 1995, p.10. 933 SST, 3 September 1995, p.5. 934 SST, 19 October 1997, p.2. 935 ODT, 12 September 1997, p.3.

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Labour‟s health spokeswoman Lianne Dalziel in 1995 called a snap debate in Parliament to highlight cuts to Wanganui‟s services.936 The depth of community anger in spring 1997 over restructuring of Southern Health encouraged Labour Invercargill MP Mark Peck to urge workplace resistance to „obstruct‟ cuts to locally provided surgical services. "I urge health bureaucrats, surgeons and the medical community in Invercargill to be as obstructive as possible during the restructuring process. "There comes a time when even health bureaucrats have to decide whether they carry out the wishes of the Government or stick up for their own communities," Mr Peck said.937 Members of Parliament, due to their representative position have privileged access to the news media and a stature in the community akin to holding a giant megaphone. Although Labour and the Alliance were competing for voters, on issues of health they often presented a united front, such as when Jim Anderton, Alliance MP and health spokeswoman Phillida Bunkle and New Plymouth Labour MP Harry Duynhoven took part in a joint protest at Taranaki hospital against the cuts in 1998.938 Labour and the Alliance parties both enacted a form of social movement partyism through the 1990s on health issues, strengthening, leading and encouraging local mobilisations against cuts and providing political platforms for activists to criticise the reforms and present the political alternative. Conclusion At the heart of the political history of New Zealand in the late 1990s was the conflict between the government‟s health reforms and the emergence of a mass social movement that turned into the „popular uprising‟ of spring 1997. From its origins in local community campaigns to save hospitals and the grievances of patients with the inadequacies of the public health system the movement grew into a political force that helped to force apart the National and New Zealand First coalition government. The protest movement kept the issue of health reform at the top of the political agenda and gave people an outlet for their anger. The growth of the movement was accompanied by the rising electoral support for Labour and the Alliance who when they went into Coalition Government after the 1999 election would commit themselves to fulfilling the protest movement reforms.
936 937

Dominion, 14 June 1995, p.1. ST, 15 August 1997, p.3. 938 TDN, 5 June 1998, p.1.

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The deaths of Rau Williams and Colin Morrison are of historical importance for the political crisis each entailed for the National Government. Unseen in this chapter and essentially unrecorded in history however were the deaths of many other New Zealanders as a result of the health reforms. These included deaths on waiting lists, the suicide of mental health patients given inadequate care and the deaths caused by poor hospital management such as what the Christchurch Hospital Medical Staff Association identified. Each death and the impact on the deceased‟s family, friends and community helped contribute towards the mobilisation of the public against the health reforms. After the 1996 election there was in New Zealand a perception that an unstable, coalition government could be brought down by street protests in late 1997. However the coalition government was able to stumble on into 1998. Yet as the mood of the country hardened against the Shipley Government‟s management of the public health system, a new protest wave was being prepared by the General Synod of the Anglican Church.

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Chapter Six

Hikoi of Health
The Hikoi of Hope, 1998
Through the month of September 1998 Anglican Bishops led protest marches from Kaitaia in the far north and Stewart Island in the far south to converge in Wellington for a protest at Parliament on October 1. The protest known as the „Hikoi of Hope‟ was, organisers said, supported by around 40,000 people and symbolised a popular desire for social and economic change in New Zealand in the late 1990s.939 The Hikoi had five themes under an overarching slogan of „Enough is enough! There has to be a better way‟ – „the creation of real jobs; a public health system which people can trust; benefit and wage levels which move people out of poverty; affordable housing and high-quality, publicly-funded education‟.940 A Hikoi backgrounder on health issues set out the „Ten reasons why New Zealanders have lost their trust in the health system‟.941 The reasons set out by the Anglican Church included long surgical waiting lists, lack of accountability, increased bureaucracy, the „crisis‟ in mental health services and „mediocre funding levels by international standards‟.942 It has been regarded by political scientists, politicians and religious leaders as being one of the most significant protest mobilisations of the 1990s. The Hikoi was the final and largest wave of street protest against the health reforms of the 1990s. It was an important protest mobilisation which tapped into community anger over National‟s social and economic reforms and also set out to link community discontent over health with a mobilisation aimed at changing the government in 1999.This section of the thesis describes and analyses the Hikoi of Hope and its links with the struggle over health care in New Zealand in the 1990s.

Understanding the protest The Hikoi of Hope in involving up to 40,000 New Zealanders was the largest protest wave since 1991. It was larger than the wave of health and hospital protests which had swept New
939 940

EP, 6 October 1998, p.9. Mary Nash and Bruce Stewart, „Spirtituality and Hope in Social Work for Social Justice‟, Currents: New Scholarship in Human Services, 4(1), 2005, http://www.ucalgary.ca/sw/currents/articles/documents/Currents_nash_v4_n1.pdf 941 Social Justice Commission of the Anglican Church, Hikoi of Hope: Health, online, 1998, available at: http://www.justice.net.nz/justwiki/hikoi-of-hope-health/ (29 October 2012) 942 Ibid.

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Zealand in spring 1997 and it ended with a rally of between 5,000 and 10,000 people at Parliament.943 The Hikoi of Hope did not draw in large numbers of people simply because of the depth of anger over the health reforms. It succeeded in generating large amounts of support because it was launched during a time of increasing political instability within Jenny Shipley‟s Coalition Government in the wake of Winston Peters dismissal as Treasurer and it had serious organisational backing in the form of the Anglican Church. As political commentator Gordon Campbell noted just before the Hikoi began that the Anglican Church had the support and trust of a considerable chunk of New Zealand,

When even the Anglican Church takes to the streets in protest on behalf of the poor, the tide of dissent is running very high indeed. [...] The Anglicans are still the largest professed denomination in New Zealand, even though allegiance in slipping: in the 1986 census nearly a quarter of New Zealanders [791,847 or 24.3 percent) professed themselves Anglican. Ten years later, in 1996, the figure was 631,764 or 18.3 percent. 944

At the same time political instability and the possibility of Jenny Shipley having to call an early election were increasing in the run up to and during the Hikoi on Wellington. This instability was primarily in Parliament where Jenny Shipley‟s Government had a two seat majority, dependent on the support of MPs who were unhappy with the broad direction of the government. As Brent Edwards described the situation in the Evening Post on 12 September, „There remains a real question mark over whether the National minority Government can survive, particularly as it relies on the fickle support of independent MPs like Ann Batten and National MP Christine Fletcher.‟945 Doug McAdam explains the importance of instability to the emergence and growth of social movements. „Generalized political instability destroys any semblance of a political status quo, thus encouraging collective action by all groups sufficiently organized to contest the structuring of a new political order.‟946 McAdam‟s third necessary factor in the generation of social movement activism is a shift in consciousness of potential actors, „One of the central problematic of insurgency, then, is whether favourable shifts in political opportunities will be defined as such by a large enough
943 944

SW, 26 October 1998, p.9. Listener, 29 August 1998, pp.30-31. 945 EP, 12 September 1998, p.2. 946 McAdam, p.42.

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group to facilitate collective protest.‟947 The Anglican Church by choosing to organise a Hikoi was drawing connections between its protest and meaningful historical and biblical events. As two Christian social work educators noted in a journal article,

The Church had stepped out into the political limelight and by doing so with a hikoi, it resonated both the biblical sense of restorative justice and the indigenous way of collective solidarity in which time is taken to allow for a sound process to effect change. [...] It highlighted the links between justice, social work and people of spiritual understanding. It reminded people of earlier campaigns by Maori to protect their land rights, in particular, the Hikoi led by Dame Whina Cooper in 1975.

The Hikoi produced the biggest wave of protest since 1991 because the instability within Parliament was at its highest point, the organisational strength behind the protest was the country‟s largest religious organisation and because it tapped into two strong dissident traditions in New Zealand society to mobilise marchers- the Maori tradition of Hikoi and the Christian tradition of bearing witness to injustice.

Rejecting the health reforms The hikoi publicised the five demands of the Anglican Church throughout the country. As marchers passed through cities and towns en route to Wellington they held 60 public meetings.948 The march resonated with peoples‟ widespread disillusionment with the policies of the National Government and supporting the Hikoi was an undemanding form of protest especially for those in rural or provincial New Zealand. One marcher in a poem about the Hikoi‟s southern leg to Christchurch wrote,

Across the great snow rivers of the plains, at dusk, at dawn, walking. The people in the small towns, the quiet villages, coming with tea, Boiling water, cream cakes, small mince pies, egg and parsley sandwiches
947 948

Ibid., p.48. Listener, 29 August 1998, p.30-31.

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Roaring hungi pits full of meat, kumara, spuds, pumpkin. Great roast dinners in halls, marae, peoples homes With mattresses, clean sheets, warm blankets laid out Night after day after night after day of walking. People on the road passing you water saying "Thank you. Thank you for walking this way. It is needed to be done."949

The march was important because it drew together people who worked with those marginalised by the neo-liberal reforms especially the health reforms. It also gave those who worked in and those who used health services affected by the 1990s reforms an opportunity to demonstrate their anger at the Government. Tony Church, an Anglican Priest from Christchurch wrote in an article about the Hikoi,

During a recent gathering to plan the Hikoi, one of my key workers, Tom, a 71 year old rest home resident with a history of psychiatric illness, called out to me several times during the meeting, „Count me in, Tony‟. When we later returned to our horticultural site at Governor‟s Bay, he decided to walk back to the city over the Port Hills with a view to getting himself fit for the „walk for a change‟, which is one of our Hikoi slogans. We are all challenged to walk with Tom and others who have been disenfranchised by the policies of successive governments over the past 15 years.950

As the hikoi marched towards Wellington it collected the personal stories of those affected by the neo-liberal reforms. Some of these stories were peoples‟ personal experiences of unemployment and poverty. Other stories addressed the education reforms. The protest also allowed people to express their anger with the erosion and commercialisation of health services.

By giving provincial New Zealanders a chance to air grievances the Hikoi tapped into the anger in rural communities over hospital closures. One of the personal stories delivered to Parliament read,

949

Kathleen Gallagher, The Silencing of the Hikoi, online, 1998, available at: http://www.wairaka.net/ubinz/Hikoi/SilencingHikoi.html (29 October 2012) 950 Tony Church, The Hikoi of Hope, online, 1998, available at: http://www.catholicworker.org.nz/cg/CG09TheHikoi.htm (29 October 2012)

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My name is Sonia Paliquin. I am a registered nurse. [...]

Being a nurse I am very concerned with the closure of many smaller hospitals, and the general lack of funding and resources available to the health sector. Personally I find my hourly rate of pay to be less than what I was earning ten years ago, with penal rates reduced and working conditions worsened. As the cost of living has increased by at least 50% over the last ten years I struggle to support my husband (who has not found work here) and youngest child. I also find the workload greatly increased to dangerous levels where patient care and safety are jeopardised. [...]

To the politicians I say if you need more taxes then tax the wealthy, they can afford it and if they are Christians should gladly give to the needy.951

The Hikoi also stirred up the resentment at the understaffing in hospital wards. One woman described in her story the state of the Taranaki Base Hospital in June 1998 when her mother was admitted,

We have two main concerns. The cleanliness of the hospital was very sub standard. The waste paper bin in her room remained full of mucous stained tissue and was unemptied for several days. Her locker had tea and food stains on for several days unwiped. The chair in the room had blood on the seat unwiped or attended to for the whole week. The floor was dusty and was swished around by a person with a polisher but not actually removed for the whole week.

The caregivers who are overseen by the nurses could not be expected through lack of training to recognise a patients differing needs and the nurse overseeing such things was too absent too long to effectively monitor same. [...]

The downgrading of the Hospital system is a very shameful thing and those who are arranging it have absolutely nothing to be proud of. It concerns me that they are protected by high wages and insurance policies that give them on call higher standard

951

Sonia Palequin, Hikoi of Hope, online, 1998, available at: http://www.wairaka.net/ubinz/Hikoi/PersonalStories.html (29 October 2012)

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care. I find they are very out of touch with the people they are making all the decisions for.952

The stories also reflected anger at the collapse of mental health services. A Baptist Chaplain working in Kamo said the following in a speech to the Hikoi of Hope at Whangarei, I‟d like to speak also for the young man who came up to our psychiatric ward begging to be readmitted, only to be told that there was “no room at the Inn”. This boy then cut his tongue off. I‟d like to speak of the pain and despair that this young man and his mother must suffer for the rest of their lives by I can‟t, there are no words to describe this kind of pain. Nor can I find words to adequately describe a health service that fails such people.953

Another story presented to Parliament was from a nurse who had personally experienced the collapse of mental health services when her husband, suffering from bi-polar manic disorder, committed suicide.

I am walking the Hikoi of Hope particularly for the mentally ill in Aotearoa-New Zealand. I have nursed for 25 years and while I am saddened by the decline in nursing standards in our hospitals, due, in the main, to cuts in Government funding, I have a particular concern for the way our mentally ill are being treated by Government policy. In short there is no hope for them and their families. They have been abandoned.954

The march also connected with fears over health services for the intellectually disabled. My severely mentally handicapped son will be 41 on 10th September. Since Mangere Hospital closed he has been in private care with a government subsidy. Private care and

952

Dale Plumtree, Hikoi of Hope; To whom it may concern, online, 1998, available at: http://www.wairaka.net/ubinz/Hikoi/PersonalStories.html (29 October 2012) 953 Mike Fish, Speech made at the Hikoi of Hope at Whangarei, online, 1998, available at: http://www.wairaka.net/ubinz/Hikoi/PersonalStories.html (29 October 2012) 954 Kathryn Mary Campbell, Story of Kathryn Mary Campbell – Hikoi of Hope 1998, online, 1998, available at: http://www.wairaka.net/ubinz/Hikoi/PersonalStories.html (29 October 2012)

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the government subsidy end when Boy turns 60. There is as yet no provision for continuing care or further money.955

A smaller Hikoi contingent walked to Wellington from Taranaki, moved partly by the local anger over cuts to the region‟s health services. The day the Hikoi left New Plymouth Taranaki Daily News reported,

The Coalition for Public Health Taranaki said yesterday people concerned about privatisation of public health services must return to the streets to register their protest. Everyone should turn out to support the hikoi, coalition spokesperson Chantel Hewitt said. Further privatisation for Taranaki Base Hospital was a real possibility, she said following Health Minister Bill English's announcement this week that hospital services may not remain solely in public ownership.956

It is clear from the personal stories that the Hikoi was an important event for many New Zealanders, not just because it was a protest march, but because it gave them the chance to share their anguish over the health reforms and the broader economic and social changes with their community. The sharing of these stories helped build the march especially in small communities. Julia Stuart, media co-ordinator for the Hikoi shared the following story in a column in the NZH, “A potluck meal at Edendale School Hall in Southland drew local farmers and their families, whose stories when shared moved everyone to tears,” wrote Jill Karetai. “The next day a hundred people walked out with us.”957

Although the marchers were sharing painful stories they were also empowered by the process of collectivising their hardship. Stuart described the transformation witnessed by one of the marchers, „As Alice Clark of Gore put it, “People here will never be the same again, because now they know they are not alone, and they now have hope.”‟958 People who participated in the Hikoi gained strength from participating in collective action that made the connection
955

„Story for the Hikoi of Hope‟, online, 1998, available at: http://www.wairaka.net/ubinz/Hikoi/PersonalStories.html (29 October 2012) 956 TDN, 19 September 1998, p.3. 957 NZH, 1 October 1998, p.17 958 Ibid.

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between peoples‟ individual situations and the social problems the country faced. They were also connecting the issues together – education and health, unemployment and poverty, housing and wages. In the chapters above, protests and resistance to the health reforms had mostly focused on specific and local problems. For example people mobilised in a community protest against a proposed hospital closure or a strike of some health workers over a specific grievance. The Hikoi represented something qualitatively different, a wholesale protest against the whole direction of the health reforms, from the closures and understaffing to the crisis in mental health care and the rising cost of medical prescriptions. As we shall see below the Hikoi also linked a rejection of the health reforms to an implicit demand for a change in government led by the largest and most traditional non-state actors in the country – churches.

A concession given, 16 September 1998 On 16 September 1998 a hundred marchers in the pouring rain between Auckland and Hamilton were joined by the Maori Queen Dame Te Atairangikaahu. On 16 September, in the wake of the collapse of Shipley‟s coalition with NZF and with another spring of protests sweeping the country the health reforms began in 1988 effectively ended. The Government released a new plan on 16 September, which included a three year stay on hospital closures and cuts. As the Herald reported it, „The Government tried to surgically remove one of its political weaknesses yesterday with a three-year moratorium on hospital cuts and closures.‟959 The impact for public health services was huge and the announcement signalled another uturn on the health reforms – „As recently as March, health officials were drawing up plans to stop elective surgery in all hospitals serving fewer than 75,000 people, including Kaitaia, Whakatane, Gisborne and Wanganui.‟960 The plan was a victory for the retention of strong public hospitals in regional centres like Hamilton.

Earlier reports suggested that the report would mean hospital closures and cuts to services. It was suggested that Waikato Hospital may be downgraded and lose heart and chest surgery and its plastic surgery department.

959 960

NZH, 17 September 1998, p.1. Ibid., p.1.

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Health Waikato chief executive Garry Smith said he had not seen the report but had been assured by Mr English Waikato Hospital would retain all hi-tech services and would remain one of the country‟s top trauma centres.961

In rural areas across the country there was relief. The Press reported hospital campaigners and health workers in Waikari, Ellesmere, Darfield, Waimakariri, West Coast and Greymouth reacting positively to the news.962

Still a year out from an election it wanted to win, National had announced the plan as a move to shore up its rural and provincial base, quieten internal schisms and rebuild its fracturing multi-party coalition. At the same time as Shipley‟s coalition had blown apart an emerging Labour Alliance political bloc were soaring in the opinion polls and openly challenging the weakened coalition to call a snap election.963 A poll of voters in early September showed if an election was held a Labour-Alliance coalition would have a ten seat majority and that National Party strategists thought „the longer the National government can retain office, the more chance it has of overtaking the centre-left‟.964 The political crisis and the risk to the shareholding class of an early election won by a centre left coalition led to „hefty selling of stocks, including Telecom, Brierley, the Fletcher stocks and Carter Holt Harvey‟.965 The health reforms u-turn can thus be seen as a response by Shipley‟s Government to the pressure from the protest movement, from the parliamentary opposition and from its own internal dissent. As Taranaki Daily News summed it up,

The philosophical debate about where limited money and resources go will, however, continue ad infinitum. [...] It is, too, as much a political debate, and hitting New Zealand's rural heartlands potentially erodes the traditional National Party support that has come from large tracts of conservative countryside.

The Hospital Plan seems, therefore, to be as much about expediency at a time of political volatility as it is about providing some degree of certainty in the health sector

961 962

WT, 19 September 1998, p.1. Press, 17 September 1998, p.9. 963 EP, 6 August 1998, p.2. 964 NBR, 11 September 1998, p.1. 965 SST, 16 August 1998, p.6.

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which, given the passions some decisions arouse, is just as volatile, albeit for all kinds of other reasons.966

The Government had pulled away from plans for further hospital closures and service restructuring in the middle of the largest outpouring of popular anger at the direction of the health reforms. Faced with the possibility of an early election and needing to shore up its electoral support National was attempting to „surgically remove one of its biggest political weaknesses‟ as the Herald‟s political reporter described it.967 The abandonment of the policy of hospital closures contrasted with National‟s policy at the start of the year, „As recently as March, health officials were drawing up plans to stop elective surgery in all hospitals serving fewer than 75,000 people, including Kaitaia, Whakatane, Gisborne and Wanganui.‟968 There is no evidence to suggest that the decision to put a stay on hospital closures and cuts for three years, a major financial decision, was discussed with the Treasurer Winston Peters or New Zealand First before the split in the coalition in mid-August. If Tuariki Delamere, New Zealand First‟s Associate Minister for Health before the coalition ended, had any notion the plan was in the wings, he too gave no indication to the public. The evidence suggests then that sometime between mid-August and 16 September the National Party decided to drop its policy of hospital closures and downgrades. The announcement, coming when it did after the Coalition‟s collapse, simultaneous with unpopular policy announcements, in the middle of mass health focused protests around the country, should be seen not just as an attempt to win back rural voters, but also partly as a concession to the aims of the Anglican Church, as an attempt to neutralise the effect of the protest movement. Labour’s Hikoi? Another important feature of the Hikoi in respect to the health reforms is that it channelled the anger at the health reforms into a political movement that explicitly rejected right-wing politics and neo-liberal policies and implicitly endorsed a change in government and support for a Labour-led Government. This was a new feature to health protests in the 1990s and is in sharp contrast to the spring 1997 wave of health protests. The 1997 protests ended with the launch of the failed referendum petition to lobby National to increase health spending. The

966 967

TDN, 18 September 1998, p.8. NZH, 17 September 1998, p.1. 968 Ibid.

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1998 Hikoi ended not with calls to mount a petition to Parliament but with a garland of flowers crowning opposition leader Helen Clark. The Hikoi was the largest protest of the health reforms in the 1990s. By demanding „a public health system we can trust‟ and connecting that demand to a traditional social democratic political programme of change the Anglican Church implicitly harnessed the anger over the health reforms to the groundswell of support for the two parliamentary parties of the centreleft, Labour and the Alliance. It is hard to imagine the Anglican Churches purpose for the Hikoi as anything other than to contribute to this shift in political support away from National. The demands of the Hikoi rejected pretty well all of the National Party‟s policy priorities at the time, from workfare programmes for the unemployed to bulk funding of teacher salaries. The Church leaders must have known Shipley would never concede their demands, they represented a political programme at odds to Shipley‟s New Right ideology. The Hikoi led by such respectable, establishment figures as former Arch-Bishop and Governor General Sir Paul Reeves thus aimed to lend support for a political programme which was being championed by both the Labour and Alliance parties.969 The Anglican Church cannot have failed to understand that the demands of the Hikoi, united under the „Enough is enough‟ slogan would be a bridge between the anger felt by many in New Zealand and the election of a reforming centre-left government in the 1999 election or earlier if the governments majority was lost and a snap election called.

The Hikoi was not a partisan march however it was a political march and as such coded the National Government as responsible for the social and economic problems facing New Zealand. This explicitly political and implicit framing of the National Government is well described by Mike Mawson in his New Zealand Sociology journal article „Believing in Protest: The Liberal Ideal of the Separation of religion and Politics in Two Recent religious Protests‟,

The success of the Hikoi in securing support in traditional National party strongholds such as Southland and North Canterbury is partly attributable to this non‑partisan stance. However, this attempt to promote the Hikoi as outside party politics was often misconstrued. As G. H. Barker wrote to the Waikato Times, “The Hikoi of Hope may
969

Listener, 29 August 1998, pp.30-31.

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claim to be purely pastoral. It cannot possibly avoid being political, naïve and fatally divisive to nation and Church” (Barker, 1998). In spite of such misconceptions, the Hikoi did, in fact, have a clear and articulated political agenda. Organizers throughout called for “balance and alternatives to the politics of the extreme far right” (“Politicians blamed”, 1998). It was this call that complicated attempts to distance the Hikoi from party politics, and implicitly situated it against the incumbent National government (and also against the right wing Act party). As MacIntyre suggested, the Hikoi was an “informal audit” of the Government‟s performance (quoted in “Health theme emerges”, 1998).As the Hikoi progressed it became increasingly difficult to maintain this non‑partisan stance. It received constant endorsement from opposition MPs, particularly those in the Alliance and Labour parties. Alliance leader Jim Anderton, for example, proclaimed that “poverty and hardship are political problems and they demand political solutions” (quoted in “Long walk to capital”, 1998). Labour‟s Social Welfare spokesman Steve Maharey directly asserted that “the Hikoi showed the Government had no mandate to continue with its present social policies” (quoted in “Long walk to capital”, 1998).When the Hikoi did finally arrive at Parliament on November 1st the address of the Social Service Minister Roger Sowry was received with derision, whereas opposition leader Helen Clark was spontaneously crowned with a garland of flowers.‟ 970 This rejection of the National Government and the „politics of the extreme far right‟ from the Anglican Church was a marked turnaround from the view expressed by its Archbishop Brian Davis in 1996 to the Synod, „... but I don‟t believe that it is an adequate Christian response simply to blame the government for our social ills... you don‟t increase employment opportunities by slamming policies that encourage business to prosper and the economy to grow‟.971 Davis retired as Archbishop in July 1997.972 As religious history academic Peter Lineham noted, the Hikoi was a „return‟ to political campaigning after a period of relative quiet for the Church.973 The political campaign the Anglicans undertook was one seeking to channel the outrage of the public on issues of health, poverty and education into a movement
970

Mike Mawson, „Believing in Protest: The Liberal Ideal of the Separation of Religion and Politics in Two Recent Religious Protests‟, New Zealand Sociology,2006, 21 (2), pp.196 -214. 971 Peter Lineham, „The Voice of Inspiration? Religious Contributions to Social Policy‟, in Tennant, Bronwyn Dalley and Margaret Tennant, Past Judgement: Social Policy in New Zealand History, Dunedin, 1998, p.57-74. 972 Anglican Media Services New Zealand, The Most Revd Brian Davis to Retire, online, 1997, available at: http://www.anglicancommunion.org/acns/news.cfm/1997/3/7/ACNS1151 (29 October 2012) 973 Lineham, p.72.

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that explicitly rejected neo-liberalism and implicitly sought a change in Government. For historians of public protest in New Zealand this is an intriguing feature of the Hikoi – it channelled discontent and organised protest not just to change policy but to support a change in Government. Even the key leaders of the Hikoi when discussing the Hikoi would press the need for a „change of government‟. In early 1999 one of the organisers of the Hikoi, Stephanie McIntyre, told an interviewer,

This present government is highly unlikely to come forward with the policies that the Hikoi was expressing the need for. These are contrary to the sort of direction they are taking, and their ideology. I think it is clear that the majority of New Zealanders think it is time for a change of government. At that point, we will still have to advocate for the poor, regardless. There are good indications already. The community sector and the churches have been approached by opposition MPs on how we can work toward a better partnership.974

The impact of the Hikoi It is difficult to measure the real political impact of the Hikoi in isolation from the other political storms raging concurrently. The evidence available however suggests the Hikoi did contribute to the electoral defeat of National Party in the 1999 election and a wave of support for the Labour and Alliance parties at the expense of National. There are three pieces of evidence supporting this conclusion; the evidence of the opinion polls, the partisan commentators and the participants in the hikoi.

The opinion polls support the conclusion the Hikoi had an impact. In a poll taken the week beginning October 1, the day the Hikoi arrived in Wellington had National‟s support slipping since a poll taken a month before 6% to 31% and Labour‟s increasing from 42% to 48%.975 The Alliance party polled 8%.976 The National Party‟s poll result was similar to low poll ratings it was receiving in September 1997 as health protests swept the country and Jim Bolger was about to be dumped as Prime Minister.977 There were other factors playing a role in the poll results. The major one was unpopular cuts to the value superannuation legislated
974

Steven Robinson, The Hikoi of Hope, online, January 1999, available at: http://www.shareintl.org/archives/social-justice/sj_srhikoi.htm 975 EP, 9 October 1998, p.1. 976 Ibid. 977 Ibid.

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for on October 1 by National and opposed strongly by Labour in the debating chamber.978 Another poll taken in December found Labour support had eased to 45% and National‟s rising back to 35%.979 An unpopular policy such as the cut to superannuation could be expected to contribute somewhat to National‟s dive in the October poll but the steepness of this dip combined with the gradual rise months later suggests it was driven by the protest agenda of the Hikoi.

The partisan political commentators also see the Hikoi of Hope as a political turning point for Shipley‟s Government. In December 1998 Alliance Party supporter Chris Trotter writing up the year‟s events wrote of the arrival of the Hikoi at Parliament,

In what turned out to be one of the largest demonstrations of the decade, more than 5,000 people crowded into Parliament grounds. Led by the former Governor-General, Sir Paul Reeves, the marchers chanted "Enough is enough!” Helen Clark, crowned with a garland of flowers, was welcomed like a queen. Social Welfare Minister Roger Sowry was booed into silence. Jenny Shipley, wisely, remained out of sight. In the weeks that followed, Reeves' cry echoed again and again around the country, and the Prime Minister, thrown off balance, responded with a frantic scramble to pull as many offending items off the agenda as her growing bevy of spin-doctors could justify.980

In 2008 National Party supporter and blogger David Farrar indicated his support for this view. Writing about a protest by truck drivers against the Labour Government in 2008 he wrote, „A commenter on this blog suggested today‟s truckie protest may come to be seen in hindsight as Labour‟s Hikoi of Hope – one of those landmark days which cripples a Government.‟ 981 Farrar was working for Shipley in 1998 at the time of the Hikoi and involved in discussions „about how to deal with the Hikoi‟.982 For both left and right political

978 979

Ibid. EP, 14 December 1998, p.3. 980 The Independent, 23 December 1998, p.14. 981 David Farrar, „Is this Labour‟s Hikoi of Hope?‟, 4 July 1998, http://www.kiwiblog.co.nz/2008/07/is_this_labours_hikoi_of_hope.html 982 David Farrar, „Haters and wreckers‟, 4 May 2004, http://www.kiwiblog.co.nz/2004/05/haters_and_wreckers.html

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commentators to agree on the impact of a protest is not in itself proof of the impact but it does suggest that the Hikoi was perceived as a political watershed.

The evidence of those who participated in the Hikoi also supports the conclusion that it played a role in the 1999 election result. As one marcher, Peter Carrell said when reflecting many years later on the Hikoi, „As a protest it changed nothing re the approach of the then National Government, but it contributed to the wave of electoral support for a change of government which led to the Labour-led coalition government of Helen Clark which has been in operation since 1999. If one thing was symbolic of this effect, it was the refusal of then Prime Minister Jenny Shipley to address the final hui on the grounds of Parliament.‟983 Another marcher however, reflecting on the effect of the Hikoi at the end of 1998 was more tentative, ‟In terms of what the Hikoi has achieved I think that its effects are somewhat unseen and may be hard to measure. It has definitely made the issue of poverty more visible and has had many ripples.‟984

Conclusion The 1998 Hikoi of Hope is part of the history of the political conflict over the health reforms. The analysis of the Hikoi above suggests the following conclusions. Firstly, it was successful in involving such large numbers because it came at a time of political opportunity for social movement and started with the serious organisational power of the Anglican Church behind it. Secondly, the Hikoi tapped into widespread anger in the community about the health reforms and turned that individual anger into a collective protest movement. Thirdly, as the Hikoi was en route to Wellington the Government ended its policy of closures, a move the Hikoi probably encouraged. Fourthly, the Hikoi represented a marked change from the health protests of spring 1997 in calling not just for policy change but implicitly for a change in government. Fifthly, the evidence suggests the Hikoi did have an impact in contributing to the swing of support behind Labour and that saw them defeat National in the 1999 general election. If the Hikoi was the largest street protest against the health reforms it was also the final one. With a moratorium on closures, industrial action by hospital workers ebbing and an election on the horizon 1999 was mostly a calm year for the movement against the health reforms.
983

Peter Carrell, Hikoi of Hope reflections, online, 2008, available at: http://www.justice.net.nz/justwiki/hikoiof-hope-reflections/ (29 October 2012) 984 Teresa Windle, A week with the Hikoi, online, 1998, available at: http://www.catholicworker.org.nz/cg/CG10-AWeekWithTheHikoi.htm (29 October 2012)

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Chapter Seven

Revolt of the Elderly
Grey Power, hospital closures and the campaign against income and asset testing, 1993-2005

Chapter One of the thesis briefly touched on the role of the Superannuitants Federation, or Grey Power, and its part in the campaign against hospital user charges. The chapters on hospital closures and patient activism also noted the role of this fast growing organisation in protest activity against the health reforms. This chapter looks at the key role Grey Power played in mobilising for protest activity against the health reforms and organising opposition to the health reforms in provincial centres. This chapter then looks at the role of Grey Power in opposing income and asset testing for long stay hospital residents after the passage of the Social Security Amendment Act (No.3) 1993. This chapter goes on to discuss why the elderly were so vigorous in their opposition to the health reforms and means testing. Grey Power was set up as the NZ Superannuitants federation in 1985 to fight changes to superannuation, the „surtax‟, a tax on superannuation introduced by the fourth Labour Government.985 In the years after the surtax was introduced, Grey Power grew rapidly all over the country, its Otago branch, for instance, grew from 200 to 6000 members between 1988 and 1993.986 Grey Power rapidly expanded in membership across the country mostly as a result of superannuation charges but the growing activism of the aged reflected disaffection with the political system and political parties in general. By 1993 however, with 55,000 members, the Grey Power movement had expanded its focus to as its then President Neville McLindon said, „ Our political and social objectives now cover a much broader base of issues affecting the livelihood of retired people.‟987 This expanded focus saw the Grey Power movement play a central role in local opposition to the health reforms in general, but also saw it campaign vigorously and successfully against the income and asset testing of elderly rest home and hospital residents. As the reforms of the 1990s wore on, Grey Power continued to
985 986

NZH, 10 September 1993, Section 3, p.3 ODT, 21 September 1993, p.14. 987 NZH, 10 September 1993, Section 3, p.3

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grow across the country, in numerical strength and political power. For example, in the three years to 1995, the Ashburton Grey Power association‟s membership tripled to 1015 members.988 Fighting the health reforms Through the whole period of the health reforms Grey Power continually rallied their members in Town Hall protest meetings against the changes. On 25 October 1994, 1000 Grey Power members rallied at Auckland‟s Town Hall and „voted no confidence in the health reform programme‟ as part of a nationwide day of health protests.989 In 23 centres Grey Power members joined marches and public meetings including in Ashburton where the 8000 strong protest helped stop cuts to the local hospitals services.990 In Balclutha, 400 people linked hands to form a human chain around Balclutha Hospital.991 In November 1995 Grey Power members joined Wanganui doctor Chris Creswell‟s march on Parliament against health cuts.992 Seven hundred Grey Power members rallied on 1 April 1996 in Wellington‟s Michael Fowler Centre to launch a „SOS for Health‟ campaign against the health reforms. The rally, joined by Dr Peter Roberts from the Coalition for Public Health, Brenda Wilson from the NZNO, and various opposition MPs, opposed the outpatient charges introduced in 1992 and expressed „fears that the health system will collapse‟.993 Grey Power claimed 60 regional associations would support the campaign.994 It was 1997 however when Grey Power‟s health protests became most effective. In a speech to the 1997 annual general meeting of Grey Power, the President Paul Hobbs told delegates membership had increased to 84,000 from 75,000 in 1996 and that „This has been a year when I believe Grey Power can claim to have achieved much. Grey Power policies on the surcharge, asset testing for long term hospitalisation and improved hospital services are listed in the coalition document. We still have to wait for any significant measure of progress but there is reason for some optimism about our chances.‟995 At the AGM delegates debated and passed motions on a range of issues including health -endorsing maximum surgical

988 989

Press, 22 July 1995, p.6. NZH, 26 October 1994, p.24. 990 Press, 26 October 1994, p.1. 991 NZH, 26 October 1994, p.24. 992 Dominion, 22 November 1995, p.2. 993 EP, 1 April 1996, p.1. 994 Dominion, 8 February 1996, p.2. 995 Grey Power – The Magazine, June 1997, pp.10-12.

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waiting lists, opposing cuts to Plunket Services and plans to lobby the Minister of Health over cuts to nursing services in rural areas. Reports of activism by local Superannuitants Federations in the September 1997 issue of Grey Power – The Magazine and in local media illustrates how sustained local activism led to the sporadic outbreaks of mass protest. Ines Helberg, membership secretary of Grey Power Whangarei wrote of their local committee‟s activity in 1996-7, „In between meetings, committee members were busy writing letters to Parliamentarians and heads of corporations concerned with the rising costs of electricity, the hospital waiting lists, the discharge of elderly patients from hospital at inconvenient hours, the surtax, the rising cost of health insurance for the elderly, conditions in some rest homes, the rising rent in state housing and many more.‟996 On the West Coast, the Hokitika association was active in opposing the closure of a Seaview Psychiatric Hospital in 1997 and lobbying Labour MPs to no avail, „Helen Clark called the threatened closure a grave injustice to the Coast as a whole, but had no possible answers.‟997 In 1997 Taranaki Grey Power picketed Health Minister Bill English visiting New Plymouth‟s hospital after being told of the possibility of two wards being closed the day before.998 Chapter Five described the nationwide health protests that swept the country in the last quarter of 1997. Grey Power members were to the fore as the optimism expressed in the speech by Hobbs at Grey Power‟s 1997AGM turned to anger at the National New Zealand First Coalition Government. Reports from local associations in the December 1997 Grey Power, demonstrate the role the organisation played in the local protests. In Whakatane, John Fergusson reported how Grey Power helped build the 5000 person march against cuts to surgical services at the local hospital in October, „We used our telephone tree to ring over a thousand of our members, we sent each of them a letter inviting them to take part in the rally and march, and we paid for large advertisements in the local paper.‟999 The 2000 strong protest rally in Tauranga against cuts to Gerontology and Accident and Emergency services on October 4 was organised by Grey Power and the well-supported rally encouraged local Grey Power organisers such as Ruth Woodside to continue their activism, „Grey Power must build on numbers and show he Government that we are a force to be reckoned with and if they persist in going against their people, then we must elect a Government of politicians who
996 997

Grey Power –The Magazine, September 1997, p.14. Grey Power –The Magazine, September 1997, p.14. 998 TDN, 11 June 1997, p.6. 999 Grey Power –The Magazine, December 1997, p.9.

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will LISTEN and take some advice from those living in the „real world‟‟. 1000 In Southland Grey Power groups were central to the protests against cuts at Invercargill hospital, organising a public meeting in August 1997 attended by 1200 people and forming a health action group that mobilised the Invercargill protest of 2000 in October.1001 The health protests of spring 1997 would not have reached the size or breadth they did without the local organisation and national co-ordination the Grey Power movement provided. Grey Power provided nearly every local community around New Zealand with a financial, philosophic and numerical base organisation from which to oppose cuts to services and the commercialisation of the health system. No other organisation, including the health sector trade unions, did more to involve the public in opposing the health reforms. Income and asset testing After March 1993 Grey Power also found itself fighting the extension of income testing and the introduction of asset testing policies for elderly people in long term public hospital care and rest homes. Additionally, these reforms extended asset testing to include long term private hospital care, which prior to 1993 only had income testing.1002 The policy for income and asset testing the 1800 elderly living in residential care in public hospitals and the 300 public rest home residents was announced at the end of March 1993 by National as Social Security Amendment Act (no 3) 1993, almost simultaneously with the abandonment of inpatient hospital user charges.1003 The new asset testing of subsidies, (on top of already existing income tests) would cover 4500 people in private hospitals and 16,500 in rest homes.1004 Income testing had been attached to the subsidies provided senior citizens in private rest home and hospital care since the introduction of the scheme in 1961.1005 Since 1967 onwards those in private rest homes faced a charge in return for the subsidy if on their death they had an interest in land or were a proprietor of an estate.1006 The restructuring of the

1000 1001

Ibid. Ibid., p.10. 1002 Sally Keeling, „Treasures on Earth; Housing assets, public policy and older people in New Zealand‟, in Iain R. Edgar and Andrew Russell, eds, The Anthropology of Welfare, London, 1998, pp.209-227. 1003 NZH, 2 April 1993, p.5. 1004 Ibid., p.5. 1005 Susan St John, Retirement policy issues that we are not talking about, online, June 1999, available at: http://homes.eco.auckland.ac.nz/sstj003/misc/Retirement%20Policy%20Issues%20Not%20Being%20talked%2 0About.pdf (8 November 2012) 1006 Human Rights Commission, Report on Income and Asset Testing of Elderly People Requiring Permanent Residential Disability Care, Auckland, 1995, p.5.

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welfare state after 1984 saw a 1987 review of rest home subsidies.1007 In 1990 Labour had created one uniform subsidy for geriatric patients in long-stay private, religious or non-profit rest homes and hospitals subject to stringent income and asset testing.1008 As Maire Leadbeater summarised the pre-1987 subsidies, In the 1960s rest home subsidies were introduced to enable older people to pay for their care in private rest homes. Public hospitals began to contract out long stay care to private hospitals, and to pay for this care the Geriatric Hospital Special Assistance scheme (GHSAS) was set up. Funding from the GHSAS scheme was available to patients but it was subject to an income test. In 1985 81% of Auckland patients in long stay private hospital care were subsidised by the GHSAS.1009 The means testing of the elderly began on 1 July 1993 and meant single elderly with assets above $6500; or a married couple both in care with assets above $13000; or $20000 with a married couple with one partner in care; were not eligible for state subsidies in private hospitals and rest homes, and had to pay for long stay care in public hospitals and rest homes.1010 Dr Alister Scott, chairman of the Medical Association estimated that asset testing affected two-thirds of all elderly, as „The real situation is that about half of all elderly New Zealanders will spend some time in a resthome or private hospital during their terminal illness.‟1011 Those with assets above the levels set and medically assessed as needing long stay care faced paying up to $1000 a week for a bed in a public hospital.1012 The asset testing regime affected a significant chunk of elderly New Zealanders and their families. All through the 1990s thousands of sick and disabled senior citizens were caught by the policy. In December 1996, for instance, the Government had caveats over 1718 houses to prevent houses from being sold until the patients had paid the over $26 million they owed RHAs for their care.1013 Examples were given to Parliament‟s social services select committee in August 1997 by the New Zealand Hospitals Association of elderly people not being admitted to hospitals and rest homes so their children would avoid losing their
1007

Alun E. Joseph and A.I. Chalmers, „„Residential And Support Services For Older People In The Waikato, 1992-1997: Privatisation And Emerging Resistance‟, Social Policy Journal of New Zealand, 13, 1999, pp.154169. 1008 Dominion, 11 February 1994, p.1. 1009 Maire Leadbeater, „Who Should Look After Older People Who Need Residential Care?‟, Foriegn Control Watchdog, available at: http://www.converge.org.nz/watchdog/25/09.htm 1010 NZH, 2 April 1993, p.5. 1011 Dominion, 5 March 1994, p.2. 1012 NZH, 15 January 1994, p.2. 1013 Dominion, 11 April 1997, p.7.

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inheritance. „It gave the example of "Mr A", a severely disabled, wheelchair-bound man living at home with his bedridden wife. The couple were cared for by their son, who worked fulltime and was difficult and impatient and often verbally abused his father.‟1014 The reaction by Grey Power members to the announcements was swift. The Herald reported on 6 April 1993, „Grey Power has received a flood of calls and letters from elderly people scared by the Government‟s decision to asset-test long-stay patients in public hospitals.‟1015 Two thousand pensioners filled Auckland Town Hall on 13 April for a Grey Power meeting where they were urged by their President George Drain not to vote for Labour or National in the general election as neither could be trusted and told „the Alliance could provide an alternative for voters‟.1016 One Christchurch businessman set up a pay-per-minute telephone hotline where elderly could hear a taped message giving them taped advice prepared by lawyers on how to avoid asset testing through family trusts and wills.1017 The Evening Post reported the hotline was receiving 12 to 15 calls a day in August 1993.1018 On 10 February 1994, thousands of Grey Power members held town hall meetings across the country. About 2770 at Auckland Town Hall, 1000 in Timaru, more than 900 in Christchurch, hundreds in Invercargill passed resolutions of opposition to means testing. 1019 In Auckland, „Jeering, stomping and slow hand-clapping drowned out much of [Social Welfare Minister Peter] Gresham‟s speech as he tried to defend his government.‟1020Labour leader Helen Clark speaking at the Auckland meeting announced her party was reconsidering party policy supporting asset testing private rest home residents but not public hospital patients, „Labour was now considering backing a removal of asset testing for resthome residents as well.‟1021 The next day 1000 turned out in Tauranga where local MP Winston Peters told them, „the nationwide level of protest against the Government‟s asset-testing policy could not be ignored.‟1022 And 1000 elderly filled Regent Theatre in Dunedin and „jeered and decried the Government‟s policy on asset testing and demanded the legislation be repealed‟.1023

1014 1015

Dominion, 18 August 1997, p.2. NZH, 6 April 1993, p.3. 1016 NZH, 14 April 1993, p.20. 1017 EP, 21 August 1993, p.13. 1018 Ibid., p.13. 1019 Dominion, 11 February 1994, p.2. 1020 Ibid. 1021 Dominion, 11 February 1994, p.1. 1022 NZH, 12 February 1994, p.3. 1023 ODT, 12 February 1994, p.1.

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National MP for Waitaki Alec McNeill came in for the most heckling and interjections, with several members of the audience yelling out “we‟ve heard enough” as soon as the MP started to speak.1024 In the aftermath of the protest meetings National Party Hawkes‟ Bay MP Michael Laws would not rule out voting for opposition bills revoking asset testing.1025 Grey Power hit the streets of Wellington on 3 March 1994. Dominion reporter Jane Clifton, estimated more than 2000 marchers; „They came in a thick grey line up the hill, brandishing placards like battle-shields, medals glinting in the sun...Many had actually seen battle the Returned Servicemen‟s Association Grey Power battalion of about 550, from as far away as Invercargill.‟1026 When they got to Parliament the Social Welfare and Senior Citizens Minister Peter Gresham was jeered and booed.1027 „Any mention of Health Minister Jenny Shipley brought forth ugly noises from the crowd. One banner read: “Are you human, Jenny?”‟1028 Astonishingly, just after the protest at Parliament the Government partially retreated on income and asset testing. As Ruth Laugesen and NZPA reported in the Dominion, The Government has bowed to the elderly lobby and amended its income-testing regime for long-term care. The policy changes, to take effect in just four days, will cost $21 million. Yesterday, hours after between 1000 and 2000 elderly people marched on Parliament in anger at asset testing for long-stay care, Health Minister Jenny Shipley announced the changes to the controversial policy. The announcement follows a round of at-times raucous public meetings protesting at the regime, and 155 public submissions to the Government.1029 The main changes, to take effect the next week, were that hospital charges for elderly with assets above the threshold were now capped at $636 per week, prior to that they were between $800 and $1100 a week; the asset threshold for those elderly with a spouse went

1024 1025

Ibid. NZH, 12 February 1994, p.3. 1026 Dominion, 4 March 1994, p.2. 1027 Ibid. 1028 Ibid. 1029 Dominion, 4 March 1994, p.1.

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from $20,000 to $40,000, excluding house and car; and prepaid funerals were exempted from asset tests.1030 However the concessions did nothing not appease Grey Power, „Wellington Area Superannuitants‟ Associations co-ordinator Joan Clegg said members were not impressed by the Government‟s move and would continue fighting charges for long-stay care, particularly those of public hospitals. “As far as we are concerned hospital care is something we paid taxes for and it should be free,” she said.‟1031 Pressure on income and asset testing also came in Parliament the same week the concessions were passed, when both Labour and Alliance politicians introduced private members‟ bills into the ballot for private members‟ bills rescinding asset testing.1032 With a majority of just two, and Michael Laws refusing to say whether he would support the bills or not, the bills passing if drawn from the ballot was possible.1033 The Alliance bill to abolish income and asset testing, introduced by the party‟s deputy leader Sandra Lee, was drawn in May 1996 but did not pass its first reading, being defeated 49-47, with Labour and NZF supporting it.1034 In June 1996, a bill from Labour MP Annette King that would scrap asset but not income testing did pass its first reading with support from the United Party.1035 However it was ultimately defeated in Parliament in 1998.1036 Following a complaint from Grey Power and the New Zealand Medical Association the Human Rights Commission (HRC) investigated whether income and asset testing of those elderly requiring permanent public sector care, constituted discrimination, and released a report on the issue in May 1995, Report on Income and Asset Testing of Elderly People Requiring Permanent Residential Disability Care.1037 During the public consultation by the HRC around 3000 submissions were received from individuals and groups, and all but one, called for a re-appraisal of the human rights implications of the law.1038 The HRC also received 17 petitions on the issue including one with 2653 signatures from the Te Awamutu

1030 1031

Ibid. Dominion, 5 March 1994, p.2. 1032 Dominion, 8 March 1994, p.2. 1033 Ibid. 1034 Dominion, 23 May 1996, p.2. 1035 Dominion, 13 June 1996, p.4. 1036 Dominion, 18 June 1998, p.2. 1037 Human Rights Commission, Report on Income and Asset Testing of Elderly People Requiring Permanent Residential Disability Care, Auckland, 1995. 1038 Ibid., p.4.

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branch of Grey Power.1039 The HRC report dealt with a variety of legal issues and included anonymous summaries of some of the submissions, F – A 69 year old son has lived with his 93 year old mother for many years and has put work and money into the house on the understanding that the house will be his in due course. This work has included re-roofing, building a garage, replacing joists, landscaping, surface maintenance (painting), water pipe replacement, and interior maintenance. He has made no other provision for his retirement because he thought he was secure in the house. He now faces the prospect of the house being subject to asset testing. S- Two sisters care for their patents for 20 years, borrowing money equivalent to 75% of the value of the house for improvements. They paid the mortgage for 20 years on the understanding that the property would eventually be transferred to them. Social Welfare has allowed them an interest only for the amount they originally borrowed, excluding the interest they paid on this amount. C – Worked her entire life on her father‟s farm property on the understanding that it would be hers eventually. The property is now subject to asset testing in respect of her sick mother.1040 Asset testing of elderly receiving long term care affected not just the residents‟ rights but also their children rights. The conclusions reached by the HRC in its report were scathing of Social Security Amendment Act (no 3) 1993 and of the National Government‟s handling of the issue. The Commission said the law „raised questions of human rights breaches‟ and advocated „the Government take measures to bring its legislation and policies into compliance with domestic law‟.1041 As a result of the HRC report and the negative publicity it generated for the Government in November 1995 the „34-million-strong American Association of Retired People‟ offered to help Grey Power take a case against income and asset testing to the United Nations.1042 The introduction of this asset testing was an important agitator to the mobilisation of senior citizens into the Grey Power movement and once mobilised the movement campaigned
1039 1040

Ibid., p.4. Ibid., p.11. 1041 Ibid., pp.21-22. 1042 Dominion, 21 November 1995, p.2.

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vigorously against asset testing. With support in Parliament from Labour, the Alliance and NZF, asset testing remained on the political agenda, but in 1996 a Northland pensioner would choose to escalate the issue further by publicly defying the law. Harry Findlay’s boycott, 1996-8 The highest profile act of resistance to the income and asset testing regime came in Kaitaia where in 1996 an 81-year old man, Harry Findlay, refused to pay his local CHE, Northland Health, $58,000 demanded of him for his 84-year old wife Ila‟s Kaitaia Hospital care. 1043 The Findlay‟s had already paid $21,000 to the CHE and Harry Findlay „refused to pay any more, saying that the policy penalised him for being elderly and having the foresight to have saved for his retirement.‟1044 In Kaitaia on 24 August 1996 „A march of 1500 people and 80 minutes of speeches yesterday pledged support for his battle against Northland Health‟s efforts to get him to pay.‟ The support for the protest from the local community – „the local bowling club put off a match to come‟ - was enough to make Findlay cry in front of the crowd.1045 Findlay‟s refusal to pay his wife‟s bill became a cause celebre for the Grey Power movement when „Northland Health took Mr Findlay to court to recover the money, but in an out-of-court settlement, the bill was eventually paid by the Health Funding Authority.‟1046 The damage to the Government had been done however. Findlay‟s struggle was a lightning rod in the minds of some. Popular Auckland talkback radio host Pam Corkery had been sought after repeatedly by the Alliance Party leaders as a candidate in the 1996 elections but Corkery repeatedly declined the offer, "I thought it looked like a shit life and everyone was telling me that politics corrupts."1047 The Government‟s chasing of Findlay spurred Corkery into accepting the Alliance‟s offer. Corkery told an interview she took the position of number 6 on the Alliance list after seeing Health Minister Jenny Shipley dismiss the plight „saying “rules are rules”, „And I was so embarrassed about New Zealand, I thought 'who am I to walk out on this opportunity?‟1048 Ila died in 1997 and when Harry Findlay died in October 1998, „Kaitaia Hospital Action Group spokesman Millie Srhoj said the Far North hero was an example to all New

1043 1044

Sunday News, 25 August 1996, p.3 Press, 29 October 1998, p.5. 1045 Sunday News, 25 August 1996, p.3 1046 Press, 29 October 1998, p.5. 1047 Independent, 14 June 1996, p.17. 1048 Ibid., p.17.

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Zealanders.‟1049 One of Findlay‟s friends, Sylvia Adin, told television news after his death, „He will go down in the history of the North.‟1050 Certainly Findlay‟s action was widely supported in his community. In 1996 Findlay said, „I got tapped on the shoulder the other da y and a lady asked for my autograph. [...] Wherever I go I have people saying, „Go for it, Harry. Stick to your guns.‟ I‟ve had letters from people who have lost their homes. It‟s a terrible business.‟1051 Findlay‟s defiant act was just one expression of the radicalisation of senior citizens. Similar anti-parliamentary, almost revolutionary sentiments were evident in the ideas expressed to a journalist by one Grey Power member at the conclusion of one town hall meeting in October 1998, After the meeting finished Stan, a 65-year-old who did not give his last name, said he was so angry at the way the National Government was treating people, he wanted to organise an occupation of Parliament by the elderly. ``I'm going to get all the fit elderly people of New Zealand, normal, law-abiding people and take over Parliament for 24 hours to teach the politicians a lesson,'' he said.1052 Findlay‟s refusal to pay was part of a broader radicalisation of the elderly during the 1990s over income and asset testing that tapped into a broader societal unease about austerity measures that targeted sick and disabled elderly. This unease is evident in the newspaper editorials published in the wake of the Findlay skirmish. As the headline of the Dominion editorial of 7 May 1996 read, „Asset testing should end‟.1053 The editorial labelled the policy, „flawed‟, „unfair‟, and hoped the private members bills introduced by Labour and Alliance Mps would help end the policy.1054 The Evening Standard echoed the Dominion‟s sentiments in August 1998 when it celebrated Northland Health‟s decision not to take Findlay to court „it takes no account of the understandable desire of many elderly people to be able to leave a little in the bank for their families when they die. It is a family-unfriendly and uncaring policy‟.1055

1049 1050

Press, 29 October 1998, p.5. EP, 30 October 1998, p.15. 1051 Karen Holdom, „Asset revolt‟, Listener, 5 October 1996, p.25. 1052 Press, 2 November 1998, p.9. 1053 Dominion, 7 May 1996, p.8. 1054 Ibid. 1055 Evening Standard, 20 August 1996, p.11.

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Findlay was not the only boycotter. Retired truck driver 66-year-old Roy Fisher decided to stop paying for his wife Sylvia‟s treatment at Thames Hospital in September 1996 after having paid $53,424 over 21 months.1056 Fisher told the Listener, „I‟m not fighting Waikato Health. It‟s the government that brought in this policy in 1993 and they hide behind Waikato Health. It‟s absolutely degrading. This is Hitler-Mussolini-type rules in our own country. I see so many old people and I think: „How many of you people are going to get caught up in this bind and won‟t be able to fight?‟‟1057 Another case of civil disobedience came from Dunedin in 1998 where Gaye and Ross Davies refused to pay an outstanding debt of $7550 to a private hospital for care received by Gaye Davies‟ 76-year old father because they „philosophically opposed asset-testing‟.1058 The Davies were then living in a house gifted to them by Gaye Davies‟ father in 1994, which the government department‟s which undertook the means testing, wanted sold so the proceeds could pay for the hospital care.1059 The Davies stand against income and asset testing came after they had already spent $20,000 on hospital bills.1060 People telephoned their support to the couple after their fight was published in the ODT, Ross Davies said, „Many of the total strangers who called us told us about their battles with the system too. It really brought home to us the grief that asset-stripping has caused so many people.‟1061 Unwinding income and asset testing, 1997-2005 In February 1997 the National and New Zealand First coalition agreement was published in New Zealand newspapers revealing a readjustment of health policy away from commercialism. This agreement included two measures around income and asset testing, (d) Equity of access to health and disability services across generations will be assured by removing income and asset testing for older people needing long stay geriatric public hospital care services and asset testing for long stay geriatric private hospital care.

1056 1057

WT, 7 September 1996, p.3. Karen Holdom, „Asset revolt‟, Listener, 5 October 1996, p.25. 1058 ODT, 9 December 1998, p.3. 1059 Ibid. 1060 Ibid. 1061 Ibid.

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(e) By 1999/2000 introduce an exemption of $100,000 on the family home on the income and asset test on rest home care for single people and for married couples where both are in care.1062 The agreement estimated these measures would cost the Government $197 million over the three years of the agreement.1063 The repeal of income and asset testing for long stay public hospital patients, numbering around 550, and asset testing of those in long term private hospital care, around 5400, was announced in the 1997 Government budget.1064 The repeal of means testing was to come into effect from October 1998 and would not affect income and asset testing of elderly in rest homes.1065 In early May 1998 the Coalition Government introduced into Parliament a bill to remove income and asset testing of public hospital long stay patients and asset testing of those in private care.1066 The October 1998 repeal of income and asset testing of long stay public hospital patients and asset testing of long-stay private hospital patients was funded in the budget announced by Winston Peters on 14 May 1998.1067 But this bill would never reach Parliament as in August the Coalition broke up with Peters sacking from cabinet and Jenny Shipley‟s new minority National Government declared itself not bound by Coalition Agreement. Yet even had the Coalition not broken over the Wellington Airport privatisation it may have found itself dissolving over the repeal of income and asset testing. Winston Peters told Parliament in August 1998 after the coalition‟s demise Shipley had asked for the repeal to be deferred again, “I refused to defer the income and asset testing regime past October 1 to July 1 next year, or some later date, at which point she said „This might be a coalition breaker‟, to which I said „so be it‟,” he told Parliament. He later explained that National had pushed to drop the income testing bill when the Cabinet was discussing its saving to cope with the Asian financial crisis.1068 Previous chapters of this thesis have assessed the effect of the health reforms on the coalition Government. This statement, which went unchallenged by Shipley, sheds further light on the
1062 1063

EP, 13 February 1997, p.8. Ibid. 1064 SST, 23 June 2002, p.7. 1065 SST, 6 July 1997, p.4. 1066 WT, 6 May 1998, p.3. 1067 Winston Peters, The Treasurer‟s Statement & Overview Economic & Fiscal Forecast Summary, online, 14 May 1998, available at: http://www.treasury.govt.nz/budget/1998/pdfs/st-ov-summ98.pdf (8 November 2012) 1068 Press, 26 August 1998, p.3.

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demise of the coalition. If Peters‟ statement is correct, and we have no reason to believe it is not, we may conclude Jenny Shipley most probably never had the intention of honouring the coalition‟s agreement to repeal means testing and sought to endlessly defer it, and that the disagreement over means testing encouraged the coalitions collapse in August 1998. Thus on 30th September 1998, the day before International Day for Older Persons, as the Hikoi of Hope approached Wellington; the Health Minister Bill English announced the abandonment of the Coalition promise to abolish income and asset testing.1069 It did however lift the asset thresholds slightly for those in care – but this lift affected just 630 people in private hospitals and just 2700 in private rest homes – the Coalition‟s policy would have benefited 5200 and 5500 respectively. 1070 The abandonment of the policy followed the announcement on 29 September that the Government would allow the value of superannuation to fall from 65% to 60% of the average wage and the twin cuts inflamed Grey Power activists.1071 Grey Power Southland President Geoff Piercy told Southland Times the cuts were „morally indefensible‟ and Invercargill‟s Mayor David Harrington organised a protest meeting the next week on the issues.1072 Piercy also told the Southland Times Grey Power was growing „thanks to the Government‟ and in Southland, „We have had 17 new people join today, 15 more rang wanting to join and six who have back-slid rejoined.‟1073 Elderly people were not passive in the face of National‟s cuts to superannuation and the backtracking over income and asset testing, they collectivised quickly into a political, activist, campaigning organisation to fight the Government. Winston Peters, now in opposition, called the Prime Minister a liar for last year saying removing income and asset testing was „sustainable‟, „Today she says otherwise. Either she wasn‟t telling the truth last year or she‟s not telling the truth today. Which is it? She can‟t have it both ways.‟1074 The repeal of income and asset testing for the 20,000 plus rest home residents was promised in 1999 by the Labour Party but not fulfilled in its first term.1075 This annoyed Grey Power members who felt they had had promises betrayed once again by politicians. In 2002 Timaru Grey Power President Les Howard said Labour had „showed disregard for those people who voted for it. “I call it the „do nothing‟ Government. They simply sit on their hands and do
1069 1070

Press, 1 October 1998, p.1. Ibid. 1071 ST, 1 October 1998, p.1. 1072 Ibid. 1073 Ibid. 1074 Dominion, 30 September 1998, p.2. 1075 SST, 23 June 2002, p.7.

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nothing.‟1076 However in April 2003, in the Fifth Labour Government‟s second term it announced an end to asset testing but not income testing of elderly requiring resident care in public or private institutions.1077 Grey Power‟s health spokesman, Dennis Paget, told the NZH, although Grey Power sought the total removal of asset testing, the moves were, „a step in the right direction‟.1078 As Susan St John and M. Clare Dale describe the lifting of asset and income tests for the elderly, In 1999, an incoming Labour-led government promised to remove asset testing but new legislation was slow to emerge and did not take effect until 6 years later in July 2005 (Social Security (Long-term Residential Care) Amendment Act 2004). This time around, the thresholds for the asset test were raised quite considerably, with the rise being most significant for a single person, less so for a married couple in care, and least significant for a married couple with one in care although the exemption for their house was retained (Table 2). The effect of the changes was immediate with a spike in the numbers of residents who suddenly became eligible for the residential care subsidy (Grant Thornton, 2010). The exemption thresholds are raised by $10,000 each year for all groups so that by 1 July 2010 the exemption levels were $200,000 for a single person and for a married couple if both are in care, and $105,000 (with the house exempt) for a couple with one in care. Initially there was no intention to change the income test but after submissions were heard, the government decided to exclude from the test any income earned by a spouse from personal effort whose partner is in care.1079 The politics of Grey Power The Grey Power movement often described itself as apolitical or non-political but in effect, although the organisation did not endorse particular parties, the leadership and the rallies often did. During marches and rallies between 1990 and 1996 support was high for Labour and the Alliance but particularly also for NZF. For instance of the August 1996 Kaitaia rally in support of Harry Findlay, where the local National Party MP was jeered, the organiser said, „I never thought I would live to see the day when the Labour Party was cheered in
1076 1077

Timaru Herald, 20 September 2002, p.3. New Zealand Government, „Asset testing of older people to be removed‟, online, 2 April 2003, available at http://www.scoop.co.nz/stories/PA0304/S00027.htm (8 November 2012) 1078 Mark Fryer, „Easing the test of time‟, NZH, 12 April 2003, p.28. 1079 Susan St. John and M. Claire Dale, Funding the long goodnight: more intragenerational risk sharing, online, June 2011, available at: http://nzae.org.nz/wp-content/uploads/2011/Session1/16_St_John.pdf (8 November 2012)

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Kaitaia and National was booed.‟1080 After the collapse of the Coalition in 1998, the rank and file members and leaders of the Grey Power movement swung their support in for a Labour and Alliance coalition Government in 1999 partly because of the health reforms. As journalist Guyon Espiner reported in October 1998, Grey Power president Don Robertson is personally endorsing a Labour-led Government and believes his view is "in tune" with the organisation's 73,000 members. He was speaking after the launch in Wellington yesterday, to an audience of about 40, of Grey Power's health policy - in which it slammed the Government for what is said was the near collapse of the health system. Mr Robertson urged the Government to go to the polls. “....they're stomping on the farmers, they're stomping on the young, they're stomping on the elderly. So really, please go to the country and let's have a new Government and look at the whole thing again,” he said. “I would endorse a coalition of the Left myself, on the grounds that we need (to put) the people first rather than the economy.”1081 The support of the Grey Power leaders and members for Labour represented a swing away from support at the 1996 election for New Zealand First as „many members could still not accept the difference between Mr Peters‟ 1996 election campaign speeches and his decision to go into coalition with National‟.1082 The unofficial support for Labour by Grey Power was logical; Labour and Grey Power‟s health platforms after 1996 are almost identical. As the movement restated in 1998 on behalf of their 73,000 members, „Grey Power wants public health funded at a level which delivers appropriate services within a “reasonable” time, elected representatives on health bodies and an end to private involvement in health and the centralisation of services.‟1083As well as health policies, Labour‟s late 1990s promise to reverse cuts to national superannuation also fit with Grey Power. At an Auckland Town Hall meeting in October 1998 of 1300 senior citizens „wildly cheered‟ during a speech by Helen Clark and heard her promise to restore superannuation.1084 During the meeting National‟s Senior Citizen Minister David Carter, „got a rowdy reception, with many people in the audience standing up and turning their backs to him.‟1085 The anger of the elderly at National
1080 1081

NZH, 26 August 1996, p.6. EP, 16 October 1998, p.14. 1082 Ibid. 1083 Ibid. 1084 Press, 2 November 1998, p.9. 1085 Ibid.

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was fuelled by many austerity measures including the underfunding and commercialisation of the health system. The elderly, in the main, did not draw the conclusion from the betrayals of various political parties that voting was not important or influential. Yet here we see the opposite amongst the elderly – anger at politicians who institute austerity measures combined with support for political parties of the left promising to reverse the austerity measures. The depoliticisation of citizens did not seem to be affecting the membership or support base of Grey Power. Why was it that senior citizens turned into the most determined opponents of the health reforms in New Zealand? Was there a generational gap in attitudes that made the elderly predisposed to oppose the health changes? There are two factors attributable to Grey Power‟s prominent role in the fight around health. One is the elderly‟s high use rate of health care, second is the way the elderly perceived the neo-liberal reforms as a whole and their experiences of health care in particular. The first attributable factor to the elderly‟s leading role in the fight against the health reforms has been set out by academics Alum E. Joseph and A.I. Chalmers in their article „Residential and support services for older people in the Waikato, 1992-1997: Privatisation and emerging resistance‟, It is arguable that older people are much more sensitive to changes in social policy than are the great majority of younger New Zealanders. This sensitivity amounts to virtual "dependency" for many in the areas of income support and age-targeted accommodation and caring services (Saville-Smith 1993), Older people, as disproportionate users of services, are also affected by shifts in policy on health care and social support in general (Richmond et al. 1995). 1086 The second and most important factor influencing the elderly‟s role in the movement against health reforms is in how they perceived the health reforms. Clues to how the Grey Power generation perceived the reforms come from anti-fascist rhetoric returned to again and again in opposing the health reforms by members of the last generation that went to war in great numbers. In 1998 1300 senior citizens rallied on 31 October – „E –Day (Enough Day)‟ – in Auckland Town Hall.1087 The Sunday Star-Times reported, „They came to talk about superannuation, free education, good health care, and having enough police officers and firefighters on the streets. They asked for the right to live in dignity and security, and

1086 1087

Alun E. Joseph and A.I. Chalmers, pp.154-169. SST, 1 November 1998, p.2.

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demanded an election.‟ The „E-Day‟ branding for their protest rally is a pun on „D-Day‟, the day Allied forces landed on the coast of Normandy during World War Two and began to roll back German Nazi leader Adolf Hitler‟s occupation of Europe. The „E-Day‟ branding was a deliberate framing of the opposition to the health reforms as analogous to the opposition to fascism in the Second World War. Throughout the 1990s many elderly returned servicemen indicated that they saw a good quality public health system and social welfare as something they had fought for in the Second World War. On a march in support of Canterbury nurses striking in 1992 the Press reported, Possibly one of the oldest marchers in the procession to the Square rally was 76-yearold Mr Ralph Blacklock, who served during the World War II with the New Zealand Medical Service in Africa and Italy. “I just don‟t want to see everything we fought so hard for disappear. We sweated long and hard for a free health, education and welfare system,” he said. “It‟s a backward step, and does nothing for the future of our children and grandchildren.”1088 In the January 1992 march against cuts to Oamaru Hospital services RSA members marched together and one placard read, „We fought for good hospitals.‟1089 On a December 1997 health protest march in Takaka led by Grey Power and Age Concern a journalist met the following sentiment, „Among the marchers, returned serviceman Len Bishop said there was “little left of what we had fought for” and he had felt compelled to come along to support the march.‟1090 One of the returned servicemen on the March 1994 income and asset testing march raised a similar sentiment. Dave Tomlinson, carrying an RSA pennant on the march, told a reporter, „”They‟ll be wanting to sell these next,” he said, slapping his chestful of medals. “No, you couldn‟t really print what I think of them.”‟1091 George Drain, Grey Power President in 1994, gave a speech to the crowd about the sacrifice made fighting in wars, but now they were having their homes stolen off them.1092

1088 1089

Press, 30 September 1992, p.1. ODT, 1 February 1992, p.1. 1090 NM, 6 December 1997, p.1. 1091 Dominion, 4 March 1994, p.2. 1092 Ibid.

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References to the depression of the 1930s were also common in framing the issues. For example when Harry Findlay talked to the Sunday Star-Times he explained, „Next month we will have been married for 55 years and all that time we valued our money -- when you have been through the Depression you learn that. Now they are trying to take it away from us.‟1093 Other Grey Power activists discussed a yearning for a country without large inequalities of wealth. Wellington Central Grey Power chairman Hugh Price said during a rally in 1994 when drawing attention to the rising salaries for politicians and shrinking superannuation payments, „What has happened to egalitarian New Zealand?‟1094 American public policy scholarship has in recent years focused on, „policy feedback effects‟, or how past public policies affect present public and policy maker attitudes.1095 This analysis can perhaps account for some of the reason senior citizens were so active in opposition, so philosophically hostile to the health reforms. As Andrea Campbell writes, Scholars have shown how generous, visible government benefits and ratifying messages of deservingness had positive effects on the political participation of Social Security and G.I. Bill recipients (Campbell 2003; Mettler2005). For example, senior citizens‟ political efficacy grew over time as Social Security became more widespread and generous and as seniors saw that their efforts to protect their programs were successful: politicians listened to them (Campbell 2003). Other members of the public strongly supported the program as well, its recipients viewed as deserving of benefits.1096 A 65-year-old New Zealander at the beginning of the neo-liberal phase of reforms, in 1984, would have been born in 1919 and would have childhood memories of the great depression of the 1930s, if male would most probably have served in the military during World War Two and would remember the establishment of Labour‟s universal hospital care system in 1938 and the expansion of the welfare state after 1972. „Welfare spending as a percentage of GDP increased from 15.4 per cent in 1970/71 to 27.3 per cent in 1990/91 and as a proportion of total government expenditure from 56.3 to 62.5 per cent‟.1097 They also had grown up and raised families in a time when the health system and many other community resources such
1093 1094

Dominion, 11 April 1997, p.7. EP, 25 October 1994, p.3. 1095 Andrea Louise Campbell, „Policy Feedbacks and the Impact of Policy Designs on Public Opinion‟, Journal of Health Politics, Policy and Law, 36 (6), December 2012, pp.961-973. 1096 Ibid., pp.961-973. 1097 Chris Rudd, p.229.

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as ports and electricity generation were under the control of democratically elected administrative boards. Campbell notes in her discussion of policy feedback effects in the US from post-WWII social security measures that the size of benefits influences political participation rates, the way programs are administered sends messages to recipients influencing political participation and how benefits are „earned‟ influences the „perceptions of deservingness‟ of these benefits.1098 The Returned Servicemen‟s Association, with 142,000 members across New Zealand, played an important auxiliary political role in the fight against the health reforms.1099 RSA representatives for example often spoke at Grey Power rallies.1100 The RSA provided a unique political voice for veterans and widows and framed cuts to social welfare for the elderly as attacks on rights of citizenship. The RSA united veterans against cuts to health and social services for the elderly. For example in the wake of the late September 1998 announcements of cuts to superannuation and the retention of income and asset testing, in Winton, Southland in November 1998, a meeting of 180 RSA members and widows was addressed by organisation President David Cox who „said care of the elderly and infirm was a right of citizenship, not a privilege. It was the responsibility of the community through policies developed by the MPs.‟1101

Conclusion Grey Power proved a relentless opponent of the health reforms and provided the backbone for many of the local campaigns against hospital closures, the 1997 mobilisations and also waged their own decade long campaign against income and asset testing policies. Their opposition to the health reforms was based in their experiences of war, depression and a strong social welfare system. The elderly are also a demographic that relies on the public health system and this reliance makes them more sensitive to changes in access to health care. Reliant on the public health system and shaped by shared sacrifices which informed their ideals of citizenship and solidarity made the elderly fierce opponents of the health reforms. In the area of health reforms Grey Power succeeded in achieving their objectives with the eventual

1098 1099

Andrea Louise Campbell, pp.961-973. ST, 2 November 1998, p.2. 1100 WT, 28 October 1998, p.10. 1101 ST, 2 November 1998, p.2.

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rollback of income and asset testing and the Grey Power organisation contributed to the success of the health protests which shook the body politic in 1997 and 1998.

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Conclusion
After the 1999 General election Labour and the Alliance formed a coalition government and began to rollback National‟s reforms. As the Parliamentary Library‟s research paper on the health reforms sets out, The release of Labour‟s 1999 health policy reinforced its pre-election pledge to restructure the health system. [112] Focus on patients: Labour on health became the basis for the Coalition Government‟s new District Health Board system. Labour considered the previous Health Funding Authority system to be overly competitive, low in community input, and lacking adequate efficiency and accountability. Through the New Zealand health strategy 2000 the Labour – Alliance Coalition Government set about change. With the introduction of the New Zealand Public Health and Disability Act 2000 the Ministry of Health became the principal agency responsible for policy advice, funding and monitoring the health and disability sector; the Health Funding Authority was abolished, with its functions transferred to the newly restructured Ministry of Health; 21 District Health Boards (DHBs) replaced the Hospital Health Services and took responsibility for the purchase and provision of health services. The Primary Health Care Strategy 2001 guided the reorganisation of GPs and IPAs into Primary Health Organisations (PHOs).1102 With the election of a centre-left government the neo-liberal health reforms of the last decade came to an abrupt end. With Labour and the Alliance‟s reforms the health protests, strikes and save our hospital campaigns also ended. A new consensus between the public health protest movement and the state was created with the restoration of democratically elected representatives to health board and the replacement of the Employment Contracts Act with the Employment Relations Act 2000.

This thesis has shown how the health reforms were opposed by patients and local communities, by health workers and their unions and eventually by a social movement that involved local government, churches and the elderly. Chapter one described the victory of the boycott movement against hospital part-charges and the impact of the health reforms in
1102

Peter Quin, New Zealand Health System Reforms, online, 29 April 2009, available at: http://www.parliament.nz/en-NZ/ParlSupport/ResearchPapers/e/d/1/00PLSocRP09031-New-Zealand-healthsystem-reforms.htm (8 November 2012)

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growing support for the Alliance Party. Chapter two demonstrated that community campaigns against hospital closures sometimes succeeded but this success was not guaranteed or universal. The campaigns against closures were a form of class struggle between the working and middle-classes and the neo-liberal state over the redistribution of wealth. This chapter also showed how the local campaigns against closures provided the core of support for the nationwide health protests of 1997-8. Chapters three and four explained the impact of resistance by health workers to the reforms in opposing deteriorating wages and conditions, in intervening to protect patient safety and raising public awareness of deficiencies and problems within the corporatised health system. It showed how many doctors and nurses risked their careers in the 1990s to blow the whistle on unsafe care or highlight problems with the reforms. In chapter five, we saw how patients were radicalised by their experience with the public health system and how this radicalisation led them into social movement activism opposed to the health reforms – circulating petitions, raising grievances with local MPs and eventually joining demonstrations. This movement had two phases, the first phase between 1993 and 1996 can be seen as one in which discontent was developing with the beginnings of protest marches and a public awareness that the health reforms were harming the public health system. In the second phase between 1996 and 1998 the discontented groups united in a wave of street protests in response to growing political opportunities created by increasing Government instability. These protests aimed to halt the cuts to the public health service which they partly did. Their more significant legacy was their effect in pushing the National New Zealand First Coalition Government towards its eventual collapse in August 1998. Chapter six demonstrated the power of the Hikoi of Hope and sketches out the probable, political effects this protest movement had – winning a stay on hospital closures, building support for a centre-left government and framing the health reforms as morally unjust. In chapter seven we saw how the Grey Power movement grew out of elderly peoples‟ disenchantment with the health reforms and in particular income and asset testing. Grey Power contributed to the strength of the movement against the health reforms and also succeeded in lifting the income and asset testing by maintaining political pressure on the issue. Within these chapters is an analysis of the power of social movements and an awareness of the role boycotts, strikes and protests have played in the development of New Zealand‟s health system. However, the main contribution of this thesis to New Zealand‟s historiography is to rescue the existence of the movement against the health reforms and its impacts from what the
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Marxist historian EP Thompson in The Making of the English Working Class described as the „enormous condescension of posterity‟.1103 Social movement resistance to the health reforms ensured universal free access to hospital care, saved many hospitals from closure, won extra funding for surgery and staffing and thwarted the push for full privatisation of the health system. It would not be going too far to state that this movement helped save the lives of some New Zealanders in the 1990s. In 1997 and 1998 the protest movement developed into a powerful political force that brought the first MMP Government in New Zealand to within a whisker of collapse and contributed to the undoing of the National and New Zealand First Coalition Government. This thesis hopefully has opened up new avenues for exploring the impact of social movements on government policy and social welfare in New Zealand and overseas. Further research could examine the effect of social movements in New Zealand after 1984 on mental health services; housing and education policies. The beginning of the global financial crisis and the election of a National-led Government in 2008 has thrown up new protest movements in New Zealand concerned with social welfare from state housing protests to campaigns by early childhood teachers against funding cuts. There has even been a renewal of protests against cuts to health services with marches in 2012 in Whanganui and Southland against cuts to maternity services and complaints by nurses of short staffed hospital wards.1104 Globally there are new public health protests and campaigns against hospital closures contesting the reform of public health systems in countries facing massive welfare austerity such as Greece and the England. Researching the impact of these movements on influencing austerity policies and political shifts may help the next generation of activists build more effective social movements. As Annetts et al. conclude, Social welfare movements are always related to concrete struggles over immediate demands for resources in one form or another. Social movements and the contentious politics of social welfare will be continually replenished by renewed patterns of economic recession and new round of mass unemployment and welfare austerity. It is therefore imperative that social movements are more adequately absorbed into our understanding of the essentially contested nature of contemporary social policy.1105

1103 1104

EP Thompson, The Making of the English Working Class, New York, 1963, reprint, 1966, p.12. Socialist Aotearoa, What‟s happening to our health system?, online, 19 March 2012, available at: http://socialistaotearoa.blogspot.co.nz/2012/03/whats-happening-to-our-health-system.html (8 November 2012) 1105 Annetts et al., p.257.

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