1998 sees widespread labour disputes in the social services

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In the Netherlands, 1998 has seen widespread labour conflict across practically the whole of the social services sector - for example in hospitals, education and daycare centres and amongst home carers. After years of wage moderation and efficiency cutbacks, employees want to benefit from current levels of economic growth and receive recognition for the value of their work in the form of better pay and less work pressure.

In the course of September 1998, the Dutch cabinet became convinced that employers needed to be allocated an extra NLG 180 million in addition to the NLG 1.1 billion already agreed, if the collective agreement covering hospitals was to reflect market forces. The dispute that had dragged on for over six months thereby came to an end (NL9805181N). It was settled through a collective agreement backdated to 1 April 1998 that, awarding a pay increase of 3.2%, reflected market forces. This last point was expressly one of the goals of the government, which found it hard to believe that so much money was actually required. The last few months of the dispute had been spent on investigation after investigation into the financial consequences of a market-driven collective agreement.

There had been no difference of opinion between the two sides over the desirability of establishing such an agreement. This consensus between the government, in its role as money provider, and the employers, in their position as money distributors, can be understood in the context of staff shortages that beset the entire healthcare sector. Several hospital departments even had to close during the 1998 holiday period because they could no longer offer reliable treatment. Waiting lists for admissions and operations still exist, although at the beginning of 1998 the minister responsible promised that they would be reduced as quickly as possible, partly to appease employers who were threatening to start private clinics for their employees (NL9803168N). Finally, healthcare training institutions have seen a steady reduction in the intake of students every year. The picture is clear: if more hospital staff are required, then the sector must become more attractive, and effective recruitment must be based on offering higher pay and better fringe benefits. This is patently clear for both the government and the employers in this sector.

Efficiency cutbacks

At the same time, the government is in the throes of implementing a retrenchment policy that is perceived to threaten to derail the intended recruitment policy in healthcare. For some years, the government has imposed efficiency cutbacks on the sector to keep it in line with developments in manufacturing sectors. Healthcare employees have been up in arms not only because of pay demands, but also because of increased work pressure. The government would appear to have appreciated this second point. Public health minister Else Borst-Eilers, having previously worked in this sector herself, expressed the dilemma of the health sector as follows: "You can play Mozart faster but not much faster". Indeed, this message reached the workplace: the task of washing sick people, for example, is much the same in the 1990s as it was in the 1950s. The imposition on the healthcare sector of "Taylorist" production and efficiency standards fails to take account of the special character of the sector, and very quickly reaches the limits of what is caring, decent and appropriate.

Policy dilemma

At present, the entire care sector is facing this dilemma. The industrial action experienced in 1998 in the daycare (NL9806185N), homecare and educational (NL9802161N) sectors all reflect frustration with the government's perceived "stranglehold" position: efficiency cutbacks due to factors such as increases in operational scale and mergers, demands for improved quality and written accountability for it, organisational changes and its professional implementation. Employees are placed under serious work pressure as a result of these the new tasks and the accompanying paperwork, and all this to create "more and better" while in fact receiving less in return. An example of the problems came on 19 September 1998, when 100 head teachers handed in their resignations because of work pressure, while three days earlier it was reported that secondary schools were attracting ever fewer teachers.

Commentary

In this case, the government department responsible is not the "bad guy", but is faced with the same dilemma as the sector itself, only the dilemma translates itself at government level into a question of money. Both the ageing of the population and the fact that young people are choosing to study more is causing the social services sector to grow every year, so far without a manageable budget in sight. The Netherlands does not rank amongst the top three countries regarding social sector expenditure (taken as a percentage of gross national product) nor do most Dutch people feel that social security contributions and healthcare taxes should increase. However, the government must strive towards achieving a manageable budget. At the same time, the same government wants to eliminate waiting lists, improve the quality of healthcare and ensure that clients get "made-to-measure" care. All of this is generally thought desirable and is expressly promised to the voter during general elections - for example, those held in May 1998 (NL9807190N).

There are, then, two "faces" to the government's policy: one that wants to give and one that wants to take. This is perhaps the main characteristic of government policy. This metaphor of two "faces" must be examined more closely to understand the dilemma in the health sector. The views of the economist William Baumol, who "discovered" certain problems related to the welfare state in the 1960s which appear to apply today as well. What has since become known as Baumol's theory of the "welfare state disease" states, briefly, that because the rise in pay in, for example, the healthcare sector chases after the rise in pay in the manufacturing sector, a greater divergence arises between the production-to-pay ratio in the manufacturing sector as compared with the healthcare sector. After all, pay increases in manufacturing depend on increases in production, and because, for example, computers, CD players, cars and similar goods can be produced increasingly fast and therefore offered more cheaply on the market, a similar pressure arises in the welfare sector. Precisely because of increasing welfare, (health) care seems to become more expensive. This is the economic paradox facing the Dutch government. This paradox can be resolved only if the chain - a rise in production meaning a rise in pay in both the manufacturing sector and the social sector - is broken and care is evaluated on the basis of its own worth. (Marianne Grünell, HSI)