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How to Vote Progressive in Australia: Labor or Green?

Chapter 13

Progressivism at an Industry Level: Reflections on a Successful Unaffiliated Trade Union

James Tierney

at the end of the day, while the political insiders may be obsessed with the union movement’s relationship with Labor – or any other political party – it is really a second order issue to our members.1

Ged Kearney, ACTU President
Former President of the nurses’ union

To be a ‘progressive’ is a title often claimed but rarely defined. Politicians as different as Nick Clegg, Jeremy Corbyn and Hillary Clinton all claim to be progressives, presumably to avoid the pejorative title of ‘liberal’ (or perhaps more accurately in the case of Clegg and Clinton, ‘weather vane’). Both the ALP and the Greens have claimed to be, in almost identical language, ‘the force for progressive change in Australia’. While the parameters may be unclear, in a modern context, progressive politics appears to consist of socially liberal political model underpinned by research based, expert-driven policies. Progressives may differ in their view of capitalism and the role of government, but there is general support for reducing income inequality through an expansive social safety net, universal health care and universal access to affordable quality education. Perhaps the most salient feature of progressivism as opposed to traditional liberalism is the commitment to constant research, review and renewal of policy aims in an attempt to find pragmatic solutions, rather than basing policy around more nebulous moral or ethical arguments.

The making of a progressive government is a product of many forces. The decisions made in the ballot box are obviously central, but the influence of social movements, research organisations and lobby groups is often substantial.

In the context of political analysis and debate, however, the influence of non-political groups is largely downplayed. As political commentators and politicians themselves bemoan the perceived ‘hollow core’ of the Labor party or the unrealistic idealism of the Greens, one could be forgiven for thinking that progressive policy has its origins in the party room alone. Scant attention is paid to the role progressive organisations play in promoting ideas and pressing left-wing parties, sometimes unwillingly, towards a progressive agenda. To elect a truly progressive government, rather than one that is nominally left-wing, progressive social movements must be active and influential.

Like other social movements, strong, independent trade unions can help to elect a progressive government. In one sense, trade unions are by their very existence of force for prog ress ivism, serving as a bulwark against the unequal bargaining power between employers and employees.2 Trade unions can also aid progressive politics through direct campaigning for progressive political parties and by providing support for broader progressive policies and initiatives. But an under-appreciated aspect of trade unions’ role in progressive politics is how unions can develop meaningful policy within their own industry. Strong unions build coalitions, commission or engage in research and form policies based on that research. These policies often form the focal point of enterprise bargaining and political campaigns.

Strong unions, of course, are in shorter supply than they once were. Over the last 30 years, union membership has dropped from almost half of the working population to just 15 per cent.3 Some unions have suffered catastrophic drops in membership and density (the percentage of employed workers in an industry who are members of the union). Even among those unions free from scandal and with stable membership, many have been affected by ‘institutional sclerosis’ – a rigid hierarchy has formed, dedicated to ensuring factional representation within Labor party caucuses and protecting incumbents, which stifles democracy within the union, detaches the leadership from its members and diminishes the union’s ability to adapt and promote change. To quote David Peetz, ‘if unions were once part of a solution, then their decline and the problems they face in arresting that decline now constitute part of the problem itself’.4

The Australian Nursing and Midwifery Federation (ANMF) has largely managed to avoid these pitfalls. Its membership and density has soared during this period, and the union has been able to mobilise its increased base during successful industrial campaigns. The branch has been agile and democratic enough to support its members’ interests and respond to a variety of challenges within the health sector.

The nurses’ greatest success is the story of how it fought for and won legislatively mandated nurse-patient ratios in Victorian public hospitals. The process that led to the passing of the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 in Victoria is worth closer analysis. From the inception of the policy, through industrial campaigns to the lobbying of the Andrews Labor government, the 15 year history of nursing ratios in Victoria provides an excellent example of the influence that mobilised, powerful, independent trade unions can have in promoting progressive policies, and dragging the government along with them.

In recounting the nurses’ progress towards promulgating nurse-patient ratios, it will be important to note the significant advantages it had over other movements in fomenting change. The nurses’ advantages as a movement can be, to varying degrees, instructive to other trade unions and social movements that seek to promote a progressive agenda within their own areas of influence. First, the nurses’ institutional power and resources allowed them to mobilise and negotiate from a position of strength. The nurses also maintained strong public support, which enabled the union to frame the claims in ways that had universal resonance. The final advantage – the most contentious and the most germane to the question that enlivens this book – is the union’s freedom from the constraints of the Labor party.

The Nurses’ Union and Nurse-Patient Ratios

The Australian Nursing and Midwifery Federation (ANMF) is the biggest union in Australia (it overtook the Shop Distributive and Allied Employees’ Association in 2012). It has over 230,000 members nationally and more than 70,000 members in Victoria. Its membership is more than 90 per cent female.5 The membership growth of the union has been remarkable. In 1989, ANMF membership stood at 15,712. ANMF membership density in 1989 stood at 28 per cent.6 By 2014, of the 92,891 nurses and midwives in Victoria, 70,328 were members of the union – a density of 76 per cent.7 In a period where trade union density has collapsed across Australia, the Victorian nurses’ union has increased its membership sixfold.

In addition to membership growth, the Victorian Branch has experienced 25 years of internal stability. The Branch has only had two Secretaries in this time – Belinda Morieson and Lisa Fitzpatrick, who took over when Morieson retired – both of whom were nurses who became officers within the Branch. The current ACTU Secretary, Ged Kearney, is a former President of the Victorian Branch. While the leadership has been stable, democracy within the union has been enhanced through yearly delegates’ conferences, special interest conferences and the voting power of individual members. Many key branch policies and grievances have emerged from delegates’ conference discussions.

While the branch was stable from the early 1990s onwards, nurses in Victoria faced increasing pressures in their workload, and in keeping their job. Under the Kennett government, Victoria moved towards competitive market models of service deliveries and a new range of service providers from the private sector entered the public health market. Two thousand nursing positions in the public sector were eliminated. Many registered nurses were replaced by patient-care assistants, and the Kennett government encouraged providers to fill rostering gaps with agency nurses. Public health providers moved to a ‘case mix’ funding model, whereby providers received funding on the basis of the number of a particular type of patients they treated. It was in this fraught climate that the ANMF and the Health Services Union (HSU) sought to renew the public sector enterprise agreements that were to expire in September 2000.

For the first time, nurse-patient ratios were to feature as an issue for debate during the negotiations. A nurse-to-patient ratio is the number of patients assigned to each nurse within a given ward. Using this ratio as a measure to determine staffing is a relatively new concept in nursing. In the 1990s, American researchers, led by Linda Aitken, stopped looking purely at nurse staffing numbers at institutions and began to focus on nurse-to-patient ratios as a means for understanding patient outcomes and addressing why nurses believed themselves to be understaffed. Researchers observed that nurse-to-patient ratios were an accurate predictor of risk-adjusted patient mortality rates and incidents of ‘failure to rescue’. The more patients any given nurse had to oversee within a given ward, the more patients died.

Ratios was plainly an industrial issue. Higher ratios meant greater employment for registered nurses and greater restrictions on unqualified hospital assistants performing nursing duties. It was also a professional issue – nurses suffer from one of the highest rates of burnout and stress across all professions, and greater staffing levels were shown to improve job satisfaction and retention rates. But ratios was also a policy issue of universal resonance – research clearly showed that higher staffing rates ensured a greater level of patient care and reduced the risk of avoidable fatalities and other complications on the ward. As a pragmatic (but undoubtedly expensive) policy goal, it was in everybody’s interest.

The leaders of the ANMF, Morieson and Fitzpatrick, were heavily influenced by Aitken’s work, and the issue of ratios was receiving increasing traction within the membership as a solution to a crisis in recruiting and retaining nurses. Members and ANMF leaders agreed to include nurse-patient ratios in the union’s log of claims. During negotiations and the industrial action that followed, the ANMF framed the dispute around patient care – that proper wages for nurses and the implementation of nurse-patient ratios were essential in ensuring adequate patient care. Morieson stated:

Nurses don’t get their job satisfaction out of a glamourous lifestyle or big money. They get their job satisfaction out of being able to care for their patients properly but also able to pay their mortgage. That means you’ve got to have enough nurses and you’ve got to pay them properly. And I know that the community supports the nurses in this campaign. You can’t argue against that, can you?8

The campaign built around patient care was progressive, evidence-based and founded in universal public concerns around health care. Improving conditions for patients had broad social resonance. The government could not rely on typical challenges to industrial action, decrying nurses as militant or greedy, because the nurses had framed their claim around an issue of fundamental importance to all Victorians.

The government unexpectedly changed hands during the dispute. In the State election in November 1999, after trailing by almost 20 points in opinion polls, the Labor Party, led by Steve Bracks, took power. After the election, the ANMF sought to hold the ALP to its pre-election promise that it would abide by ‘the independent umpire’s decision’ and agree to private arbitration in the Australian Industrial Relations Commission. Perhaps not recognising the cost implications until it was elected; the Bracks government expressed staunch opposition to nurse-patient ratios once it took office. When negotiation between the government and the ANMF broke down, nurses voted to take industrial action, closing 1 in 5 beds in public hospitals. After a period of intense industrial action, the parties agreed to arbitration.

The arbitration was heard before Commissioner Blair, who, after hearing submissions from both sides, determined that ‘those who choose to say that there is not a nursing crisis are, in the Commission’s view, in a state of denial’. He found that the only way to overcome the crisis in nursing and provide high quality patient care was to implement nursing ratios in all major hospitals. By framing their industrial claims around broader concerns for public welfare, the ANMF was able to convince the Commission that ratios were in the best interests of the State. Victoria became the first place in the world to implement enforceable nurse-patient ratios.

The union has remained active in conducting research and commissioning reports to buttress its claims regarding the benefits of ratios. It has also built coalitions with other nursing bodies to increase its influence and fight for other progressive healthcare policies. The union worked with the Nurses Board of Victoria (NBV) and the Nurse Policy Unit in the Department of Health to introduce a private counselling service, available only to members. The ANMF launched a ‘No Lift’ campaign in public hospitals, which led to the creation of the Department of Health and Safety Victorian Nurses Back Injury Prevention Project. No Lift programs have since been adopted in all public hospitals. The Nursing and Midwifery Health Program Victoria was set up in 2006, largely as a result of the union’s lobbying, to treat nurses and nursing students experiencing substance abuse and mental health problems. All of these programs were grounded in research and drawn from grievances raised by members.

Despite the proven benefit to patients, nurse-patient ratios have been called into question in each round of public service enterprise bargaining negotiations, and are a constant source of tension between nurses and their State government employer. In 2011, the union fought an intense battle with the Baillieu Coalition government over ratios. Negotiations began in October 2011. The government, the Department of Health and the Victorian Hospital Industry Association all sought to cut ratios and substitute registered nurses for low-skilled ‘health assistants’. A leaked Cabinet-in-Confidence document revealed that the government’s strategy was to force the union into arbitration in the Fair Work Commission, to stretch the union’s resources and rely on the Commission being sympathetic to the employer’s demands. The nurses initially took protected industrial action in November, but no agreement was reached. After the Commission suspended protected industrial action, the parties negotiated further, but these negotiations also broke down over nurse-patient ratios. In February 2012, the nurses took unprotected industrial action, risking substantial fines against the union and its leaders. Following further consultation with the government and the VHIA, an agreement was reached in May. The agreement retained all existing ratios and included wage increases of between 3.5 per cent and 4 per cent per annum.

The nurses sought to circumvent this constant fight over ratios by having ratios legislatively protected. In the lead-up to the 2014 Victoria State Election, the nurses lobbied the ALP to commit to passing legislation that would protect nurse-to-patient ratios as part of its election platform. Having the ratios enshrined in legislation would ensure that ratios were no longer a contested element of enterprise bargaining negotiations. The nurses were heavily involved in negotiations with Emergency Services Minister Jane Garrett and Health Minister Jill Hennessy. The Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Bill 2015 was passed into law by the Legislative Council on 9 October 2015. The nurses’ progressive agenda had become the ALP’s.

It is of note that the Greens, in particular Coleen Hartland MLC, have advocated the nurses’ cause for a number of years, Coleen Hartland MLC in particular, and with greater enthusiasm than the ALP. In 2007, Victorian Greens MPs donated to an ANMF welfare fund for nurses whose pay had been docked for taking industrial action. Steve Bracks had tacitly supported the fines. The Greens also made legislatively mandated nurse-patient ratios an element of its platform in 2014. It took both parties until 2014 to support a policy that had been an industrial reality for 15 years. This is not an indictment of either party, it merely reinforces the fact that progressive policy often comes from below.

The Nurses as a Blueprint: Organisational Strength, Framing and ALP Affiliation

In assessing whether the nurses can serve as an example to other unions and social movements seeking to formulate and fight for progressive policies, it should be noted that the nurses can draw on three distinct advantages that other movements may not possess: its organisational strength, its influence in public debate, and its independence.

The first advantage is the most obvious. The Branch has more than 70,000 members and more than 75 per cent of nurses in Victoria are members. It has 500 workplace delegates, most of whom have industrial experience and are well trained in union organising principles. It has extensive branch resources, including numerous organisers, industrial officers and media staff. Most unions could only dream of that level of density and organisational strength. It also has the benefit of being able to organise a large percentage of its base around a single public sector campaign. The branch can draw on significant industrial strength during campaigns.

The second advantage relates to the nurses’ ability to put their case positively in the public forum. By having a deep understanding what they are talking about, the nurses have a significant advantage in framing public debate around patient care. While few professions are as trusted as nurses (they have been ranked the most trustworthy profession in the Roy Morgan Poll of Profession Perceptions for 21 years in a row), all movements can benefit from framing their debate around an issue grounded in research and public support. A federal government debate about the future of health care will be fought in the sort of vague, plenary rhetorical area where progressive movements may flounder. The Institute of Public Affairs (IPA) and The Australian and the Samuel Griffith Society and Andrew Bolt and Sussan Ley may be able to confidently assert that unions are greedy and that the health sector needs less red tape, less bureaucracy, less cost and more free-market incentives. But being forced to debate specific, research-backed proposals like nurse-patient ratios is often beyond the purview of generalist commentators or politicians. The nurse’s proposals have withstood criticism and proven persuasive with judicial officers and the public.

The final advantage is the most contentious – the extent to which the nurses have benefited from being an unaffiliated trade union. The ANMF is affiliated with the ACTU and Victorian Trades Hall Council, but is not affiliated with the ALP. The current Secretary, Fitzpatrick, explains that although the debate over affiliation is raised from time to time, most notably in 1998, it has never gained much traction, mainly because the members are not as a whole aligned with left-wing politics. Also, Branch Council and the leadership see little value in affiliation:

There was a time that we thought about whether or not we should affiliate… given that many other unions are, and really, I think the decision was that we have to work with whatever government was in power.9

The ANMF’s decision not to affiliate is not an ideological stance per se, but a pragmatic recognition that regardless of which government is in power, they will be drawn into negotiations where the parties have conflicting interests.

While each affiliated union’s relationship with the ALP varies, there is no question that certain unions and their leaders prioritise their role within the ALP to the detriment of member concerns and building broader coalitions within their industry. Party elder John Faulkner decried unions within the Labor Party as ‘large, faceless institutions controlled by union secretaries, who are in turn obedient to factional cartels’.10 Rather than pushing the Labor party towards progressivism from within the party, Labor party factions oversee union elections and drag the unions away from flexible, innovative thinking, as these factions seek to influence policy and those chosen to execute it. These factional heads have no experience or relationship with the rank and file. Instead, as Barbara Pocock described, they become ‘ghosts in the machine of unions, with voices, agendas and interests quite different from those of many members’.11

No leader in the nurses’ union has ever held office with the ALP. All of the leaders are former nurses. With the exception of a couple of experienced industrial officers, all of the industrial-professional staff are also former nurses. No-one within the organisation has an agenda other than improving the working conditions of its members. The nurses have avoided the factional squabbles and the consequent policy inertia that often comes with ALP affiliation. They have a leadership that is wholly committed to advancing nurses’ aims, and a membership with an active role in driving branch policy. Moreover, despite lacking the ‘insider access’ often extolled by advocates of the union-Labor relationship, or perhaps as a consequence of this independence, the nurses have forged coalitions with other peak health bodies to increase its knowledge, influence and organisational strength. The nurses, free to battle on their own terms, have thrived.

There are progressive critics on both sides of the Labor–union alliance. Some critics reject the current relationship on the basis that staunchly pro-market members of the Labor Right undermine the union movement from within the party. Other critics who see the Labor Party as the vehicle for left-wing, progressive change, the primary alternative to the Coalition, condemn the influence within the party room of socially conservative right-wing unions, which prevent the Labor Party from implementing progressive reforms, particularly on social issues such as gay marriage.

There may be merit in both claims. But to focus on the ALP–union relationship (or to suggest, as Guy Rundle and other commentators have, that progressive unions like the ANMF, National Tertiary Education Union and Electrical Trades Union could form their own progressive bloc) is to miss the lesson of the nurses’ union.12 Where other movements obsess over electoral politics, factional alliances and their place in the progressive political landscape, the nurses have achieved progressive change at an industry level by simply getting on with it.

The union is not actively involved in electoral politics, nor does it seek to be. It is not an advocate for broader progressive political aims. It has no professed preference for the Greens or the ALP. But it can serve as a model to both unions and other social movements for the way in which it has increased democracy within its own branch and for its successful lobbying for change within the health industry based on practical, research-based policy. The story of the nurses also serves as a reminder that left-wing governments must sometimes have progressivism forced upon them.

___________________

1    Ged Kearney, ‘ALP must show respect to union base’, The Australian, October 13, 2010.

2    It is of course not a given that a trade union will support progressive policies. Conservative unions that use their delegate power to block progressive policies in the Labor party is the most commonly decried example, but unions will take a protectionist stance when trade liberalisation or structural shifts in the economy are likely to adversely affect or deplete their membership.

3    Australian Bureau of Statistics, ‘Trade union membership falls’, 17 October, 2015, Last modified May 13, 2013. Accessed April 2, 2016, http://www.abs.gov.au/ausstats/.

4    David Peetz, ‘Are Australian trade unions part of the solution, or part of the problem?’, Australian Review of Public Affairs, February 2015.

5    Nursing and Midwifery Board of Australia, Nurse and Midwife Registrant Data: October 2013, Melbourne: NMBA, December 2013.

6    Australian Nursing Federation (Victorian Branch), ‘Membership Figures’, Annual Report 1989–90 (internal publication, ANMF Archives, Melbourne, Victoria, 1990), 8.

7    Australian Nursing and Midwifery Federation (Victorian Branch), ANMF Annual Report 2013–14, (internal publication, ANMF Archives, Melbourne, Victoria, 2014), 2; Nursing and Midwifery Board of Australia, Nurse and Midwife Registrant Data: June 2014, Melbourne: NMBA, December 2013, 3.

8    Belinda Morieson, conversation with author, December 23, 2009.

9    Lisa Fitzpatrick, conversation with author, December 15, 2009.

10  John Faulkner, ‘Public pessimism, political complacency, restoring trust, reforming labor’, Address to the Light on the Hill Society, Revesby Workers’ Club, Revesby NSW, October 7, 2014.

11  Barbara Pocock, ‘Institutional sclerosis: prospects for trade union transformation’, Labour and Industry, Vol. 9 , No. 1, 1998, 26.

12  Guy Rundle, ‘Why the union movement should divorce the ALP’, Crikey, April 3, 2014. Accessed April 2, 2016, http://www.crikey.com.au/2014/04/03/rundle-why-the-union-movement-should-divorce-thealp/?wpmp_switcher=mobile&wpmp_tp=1.

How to Vote Progressive in Australia: Labor or Green?

   by Dennis Altman and Sean Scalmer