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00:01In recent weeks, Trinidad and Tobago's public health care system has come under renewed pressure,
00:07not from a virus or surge in patients, but from within its own ranks.
00:12Nurses across the country have taken to protest action, raising concerns over long-standing issues,
00:19including staffing shortages, working conditions, delayed negotiations, a change in overtime rates,
00:26and what they describe as a lack of respect for the profession.
00:31Their message is clear.
00:32Those on the front line of patient care say they are overworked, undervalued, and increasingly frustrated.
00:38In tonight's Beyond the Headlines, I hand you over now to Irvashi Tiwari Ruparain to discuss these issues.
00:46Anne, thank you very much, Disha.
00:48You're absolutely right.
00:49The message is clear.
00:51The front line of patient care say that they are overworked, that they are undervalued, and increasingly frustrated.
00:58We go beyond the protest lines tonight and into the heart of the issue.
01:03Joining us, we have industrial relations expert Ram Kumar Narainthing,
01:08and industrial relations officer of the Trinidad and Tobago registered national nurses association, Letitia Cox.
01:16Let me thank you both for joining us tonight, for taking the time to be here with us, particularly in
01:22person.
01:23Mr. Ram Kumar, I want to start with you tonight.
01:25Based on what we've seen so far, how do you assess the nurses' actions, and in your views, are there
01:32concerns justified?
01:34So, let's talk about what's happening right now as we speak.
01:39What we have, and I heard the term, protest action being used.
01:45In the first instance, population should be aware, Trinidad and Tobago's nurses fall under the essential services division.
01:54And that means that protest action is actually not allowed outright.
01:59Any form of withholding labor, putting the services under any form of duress, is actually illegal, in accordance to the
02:10provision of the Industrial Relations Act.
02:13The population, in my opinion, the population is absolutely unclear as to what steps the union has actually taken in
02:20treating with the issue,
02:22as it relates to the legal process that exists, and the process that exists falls under the purview of the
02:29Industrial Relations Act, of course,
02:32and it is supposed to be directed to the Ministry of Labor.
02:35So, the natural order of things is if you have an issue, and as I'm hearing, the issue surrounds circumstances
02:46related to wage rates, overtime, whatever, whatever it might be.
02:51The point is that we're not sure right now whether this matter has been reported to the Ministry of Labor
03:00under Section 51.
03:01One, and all the action, as far as we're concerned, as far as the public is concerned, is illegal because,
03:10again, the essential services division.
03:13In addition to that, Rishi, as the population is aware, we currently are in a state of emergency, and all
03:20forms of protest action is disbanded.
03:24It's illegal.
03:25You're not supposed to engage in it.
03:26So, it's interesting that, as far as I'm aware, I've not heard the Minister of Labor say anything about it.
03:34I've not heard anything, I've not seen anything in the media that speaks to a breakdown in the legitimate process
03:43that exists.
03:43But what we have seen is that persons have gone on social media and telling the population to stay away
03:50from the hospitals,
03:51and we've seen the leadership of the union coming out and clamoring for action, response from the employer, the RHAs,
04:00on the issue.
04:01But we've not had any information.
04:03So, I'm hoping my colleague here...
04:04Right.
04:04So, Ms. Cox is here, and that's exactly why she's here.
04:07Now, you've heard Mr. Narang Singh, he meant no words.
04:11He's calling it illegal.
04:13He's questioning whether the process has been followed.
04:16Okay.
04:17So, first thing first, he said protest action.
04:21And there's a...
04:22I want to kind of clarify the protest action as opposed to industrial action.
04:28And the act is clear on what is industrial action, and they speak to lockouts, it speaks to, you know,
04:38sick outs, those different things.
04:39It's very clear, and it defines what that is.
04:42And he also spoke about the state of emergency, and I would have looked over the state of emergency and
04:47the order,
04:48but I did not see anything about not participating in peaceful protests and demonstrations.
04:54And I wanted to be clear that the association, the Trinidad and Tobago National Nursing Association,
05:00has engaged only in peaceful protests, and we would have written the police commissioner for permission for peaceful protests,
05:08which we would have started in San Fernando Teaching Hospital, followed by Sandy Grandy Hospital,
05:15and we have one plan for the 10th of April, and we sent out letters asking for permission to have
05:22those peaceful protests in front of the whatever institution.
05:27We did not make a call for a sick out.
05:31And I just want to say that emphatically to the nation, to Trinidad and Tobago,
05:36the Trinidad and Tobago National Nursing Association did not call for its membership or the nursing fraternity
05:44or the health care workers to participate in a sick out.
05:48So you're saying that the Trinidad and Tobago National Nursing Association is within its rights to partake in the action?
05:56Peaceful protests, action, which we did with the blessing of the police commissioner.
06:04We sent out letters, so we were not acting illegally.
06:07So I just want to make that clear for Trinidad and Tobago.
06:10Now, you mentioned San Fernando Sanca Grande.
06:14Yes.
06:14Was permission also sought for Mount Hope?
06:16Yes.
06:17No, well, actually, we did not organize the Mount Hope action.
06:21What I want to say is that out of the arrogance and the ego of the executive management
06:29of the North Central Regional Health Authority,
06:32there was birthed a group of health care workers, not only nurses.
06:37It expands the other health care workers who would have made a decision to take this revolutionary action.
06:44It had nothing to do with the Trinidad and Tobago National Nursing Association.
06:47Ms. Narain, I'm giving you no opportunity to respond.
06:49So, yes, so I am totally confused.
06:52And this, I think we definitely need this clarity.
06:54Now, the act is very clear when it speaks to industrial action.
06:57And any type of action taken where labor is withheld or services are withheld constitutes industrial action.
07:05Now, I have not seen the association going on the media and distancing itself from the numerous videos
07:13that have been posted online where the videos are claiming that there are no nurses on duty to support the
07:21doctors.
07:21And you see the empty wards and you see the empty work areas.
07:26The association has been very quiet on that.
07:28So, and I've heard my colleague here say, my friend here say, that there has been no seek out action.
07:35But it would then require the RHAs to publish a record of its attendance to really tell the public if
07:43nurses have been coming to work.
07:44I don't remember the exact figures, but I know the Minister of Health said that there's no impasse.
07:48I'm not sure if you remember.
07:49That was Parliament last Friday.
07:50He described there's no impasse.
07:52But he did indicate that, I think it was about 30 nurses.
07:56So, let me tell you what happened.
07:57When TTNNA held their peaceful protest at Sandy Grandy Hospital, which we would have written to the police commissioner for,
08:05after that, the Minister of Health would have said that, you know, there was no impasse between the nurses and
08:13the government.
08:15And only 21 persons stayed home.
08:17But what we would like to make clear, that was not a seek out.
08:20We didn't ask for anybody to stay home.
08:22We asked for persons during their lunch hour to participate in a peaceful demonstration in front of the hospital campus.
08:29That's what took place, right?
08:31So, we have always operated within the line of the law.
08:36Nothing illegal took place.
08:37And I just want to remind my good friend here that we did not call for a seek out action.
08:43And I did not say that there was not a seek out.
08:46I said that the Nursing Association did not call for a seek out.
08:49And I just, one more thing, I also said that a group of healthcare workers that is not constrained to
08:57nurses form themselves together because of the arrogance and the ego of the current NCRHA administration.
09:05They are the fault of this group, not us.
09:09Ms. Cox, Ms. Naira, I'm saying the frustration is clear and our viewers can see that the stakes are high,
09:14not just for nurses, but also for the entire healthcare system.
09:18When we get back, we'll dig deeper to see what exactly are those core issues.
09:45And welcome back to Beyond the Headlines, Ms. Cox.
09:48Let's get right back into it.
09:50What are the issues really driving the frustration of the nurses?
09:55Why have they reached this boiling point?
09:57Okay, so in our interview, I think it was a day or two ago, I would have highlighted that the
10:04nurses at the North Central Regional Health Authority have been under considerable strain for a number of years.
10:13And this whole issue about nursing pool, and I want to let you know it's not over time.
10:18The North Central Regional Health Authority do not pay overtime to nurses.
10:24Okay.
10:25We have something called a nursing pool that the nurse managers would book in advance and put nurses on a
10:33particular area to work when they are short.
10:36And let me let you know, let me, I want to let the nation know that mostly every ward in
10:45Eric Williams, in Mount Hope Women's, they do not have enough registered nurses to take care of patients on each
10:54ward.
10:55So is it that there are a pool of nurses, and that's why it's called pool, so you see that?
10:59Yes, you see, right.
11:00So in advance, you have a group of nurses who are in this pool system, and they will pick them
11:06to come and, well, offer them to come and work these extra hours when they are short.
11:12So this is in addition to their normal schedules.
11:15But let me tell you something, it's not that they have, they go and take it themselves.
11:21North Central needs it, because they don't have enough staff.
11:24They actually have to depend on the pool in order to book enough staff for each shift.
11:31So that's what is happening.
11:32They have to supplement the roster with these pool staff.
11:36So I'm glad that you touched on the pool issue.
11:39When a review of the RHA was done, it was found that the NCRHA was paying nurses above the CPO
11:46approved rates, and that was since 2020.
11:48It was $75 introduced during the pandemic, which has now been reduced, we understand, to the $60.
11:55Why then are we seeing nurses from other RHAs joining NCRHA in this protest action?
12:00Okay, so it transcends the nursing pool.
12:03Now, it goes to a problem that nurses don't have enough to survive.
12:10This is a survival issue.
12:12We are working with salaries from since 2013.
12:15All other public sector workers, their salary has been settled.
12:19It's survival.
12:21When we work long hours on shift, who's taking care of our children?
12:24Don't we have to pay a babysitter if we have no parent to look after them?
12:28Don't we have to pay for lessons if we are not there to go over the work with the child?
12:32And so we have big exorbitant bills, salary is static, taxes going up.
12:39We have to survive.
12:40So they have to depend on these extra duty in order to live day to day.
12:45Mr. Narain Singh, is it fair for the NCRHA to move back from $75 to $60?
12:51Well, I can't answer to the fairness of that.
12:54We just have to follow the logic.
12:56If this was introduced during the pandemic to treat with a situation that was associated with the pandemic,
13:01and the pandemic has been declared to have ended a long time ago, some years ago, two years ago,
13:08so then it is rational for them to revert to what is standard.
13:14But you see, what I think has happened here, Uvashi, my professional opinion,
13:18is that this entire issue, this debacle that has reached its boiling point,
13:22is actually a representation of a critical failure of the entire process that is supposed to manage industrial relations.
13:31You see, when you talk about a breakdown in negotiations, the question immediately comes up.
13:37If it is outstanding since 2013, then is this matter before the court?
13:43Ms. Cox, has the process been followed?
13:46I want to go back to the fact that the Nursing Association did not call this action of a sick
13:53out.
13:53And it's a group of health care workers.
13:56It's catalyzed because of the frustration.
13:58Yes, and we have been going through...
14:01Who have not settled since 2013.
14:02Listen, we are going through all the right processes.
14:05One, to get recognized majority union status in order to represent all nurses.
14:10We currently have recognized majority union status at Eastern, and we're going through the process.
14:15But with the others, the Minister of Labor and the powers that be have not appointed the board.
14:22So that has to happen before you can initiate...
14:24In terms of negotiating and the employer being obligated to sit down with us and meet and treat in a
14:31respectful way.
14:32But they can't do it outside of that.
14:34But in terms of the certification, we need the Minister to appoint the board to go through the process.
14:40With regards to individual grievances, we do that every day.
14:44But what he's talking about, and this entire sick out action, how could we regulate something that is not under
14:51us?
14:52How could we regulate a group who has taken a decision on their own?
14:56Yes?
14:57How could we do that?
14:58So you all have authority?
14:59Let's deal with the issues.
15:00You all have authority to bargain on behalf of the...
15:02The Eastern Regional Health Authority, yes.
15:05And you must negotiate with each RHE?
15:08Yes, we must get certification for each RHE in order to negotiate for them.
15:13How have you initiated with the RHE?
15:14We have applications in all regional health authorities, and our only obstacle is the fact that the board has not
15:21been appointed.
15:21We are actually in the final stages for that.
15:24So then the correct position, really, is not that negotiations for these RHEs outside of the RMU status has outstanding
15:33salaries since 2013.
15:34What my colleague is really saying is that salaries for these people may not have been reviewed since 2013 by
15:40the respective RHEs.
15:42But let me tell you, Oversha, the reality is that in Trantobago, everybody is under pressure.
15:46Everybody is, every single area that's poorer of employment is under pressure.
15:53But we are seeing government has negotiated with some unions so far.
15:57So my question to you as the labor relations expert is that should government have prioritized, and nurses and teachers,
16:05I would say, you know, they provide human service, maybe they should be at the top of the list.
16:10It does call into question what is really happening at the level of the Ministry of Labor and the Minister
16:17of Labor's support and advice to the CPU.
16:20Because I agree with you with that statement.
16:22I could have.
16:22There should have been.
16:23So we saw NUGFW, I want to make this point, we saw the PSA settled under this regime, TUTOR and
16:31other unions, Protective Services and so on, would have settled with the CPU under the previous regimes.
16:37Do you think it is relative to the TTRNNE's non-support of the government?
16:44TTRNNE, but before you go there, right, I want to say that the CPU in his interview, because I watched
16:51his interview after the signing with NUFGW, and he was asked, are the RHAs under your jurisdiction?
16:59And he said, no, they are not.
17:01He also said that the same pool guide, he said it's just a guideline.
17:05He said that the Chief Executive Officer, the Board of Directors and the Ministry of Health can come together and
17:13put together an incentive package for the nurses.
17:17He said he advised that they meet and they deal with it.
17:20I would have listened to Senator McNish, also an expert in industrial relations.
17:25I saw his interview online, and he would have indicated, but the nurses are on salary since 2013.
17:31It is incumbent on the executive management to meet and treat with the issues.
17:38Let me still put it to you again.
17:40We saw the PSA, through their support behind the UNC, prior to the election, the TTRNNE, was primarily unbiased.
17:49Of course, because our Constitution does not allow us to be prejudiced where politics is concerned.
17:56Do you think that this is the reason you all have not been called to the bargaining table?
18:01Or you have not been prioritized?
18:03Maybe, maybe not.
18:04What I can say is that we know that there is a level of dismissive attitude towards the association.
18:12I can say that.
18:14I can say they have been very silent.
18:16We have been always open to dialogue.
18:19The association has been operating.
18:21This is a 96-year-old organization.
18:23And our predecessors and also us, we have always been open to sit down, have discussions.
18:30And we are seeing the executive management and, by extension, the Ministry of Health and the government are to blame
18:37for this group coming together and taking this action.
18:41So here, the irony behind this, from 2013 to now, the records, public records will show how many times recognition
18:50boards have been appointed.
18:51And it will show the last government having appointed a recognition board where they were members of the different trade
19:00union bodies sitting.
19:01There was a legitimate board appointed.
19:05Why no?
19:06Why?
19:07Maybe the board expired.
19:08No.
19:08I'm not up to date to that.
19:10But the point of which is that it was not always expired.
19:12No, no, Ms. Cox, I do have to let you know that critics online are also asking why did it
19:18take 13 years to reach this point?
19:20Why did it take 13 years to reach this point?
19:24I would like to say that there was a straw that broke the camel back on the 22nd of March
19:34when the nurses would have heard a rumor that their extra duty was not going to be,
19:41actually they were going to retroactively change the rate and also there was plans not to pay.
19:48That's not pool rate.
19:50That's the pool, the extra duty, the pool, not overtime, they're not paying overtime.
19:54And the rumor was true.
19:55They were paid later than they would normally get in that week and also they realized that they didn't get
20:01their extra duty and quite a bit of the nurses were depending on the pool to supplement things that they
20:08do on a monthly basis.
20:10How could you make that decision on a last minute?
20:13That is not good.
20:14I would ask my friend there, in terms of good industrial relations practice, shouldn't you get some sort of notification
20:22prior to a decision being made like that?
20:24So normal practice dictates that if you're changing something in a work environment, you should communicate.
20:30But here's the thing, we don't have the RHA here to defend itself.
20:34So we don't really know, we're hearing what my colleague is saying, right?
20:38I don't think Ms. Cox will be disingenuous.
20:39I hear you, but you see, for RHA to run an institution like that and for a total lack of
20:45communication to take place, then something is critically wrong.
20:49Now, Ms. Cox, there also have been, I wouldn't call it allegations, but statements that we're talking about $3 million
20:55at the NCRH in monthly expenditure.
20:59It's alleged there has been overtime of between $68,000 and $88,000.
21:03That's over a three-month period.
21:05And this is at a time when nurses are saying that they are overworked and the system is under-resourced.
21:11How do we reconcile that with reports of substantial overtime expenditure?
21:16So where exactly is the money going?
21:18Should the system be audited?
21:19So let me tell you, I'm going to come back to something I said earlier.
21:25Almost every ward in Eric William has to be supplemented by pool nurses because they don't have enough nurses in
21:33order to take care of the number of patients on each unit.
21:36So of course the extra duty bill will be high because they don't have the staffing in the first place
21:42and they have to supplement it with pool.
21:44And what the previous administration would have approved to try to keep the system going as much as they can,
21:51now the new administration is coming and looking at it and saying, hey, this is too much money spent here.
21:56So you just hire more nurses?
21:58Yes.
21:59And I saw in a document that he, well, the chairman said that he planned to hire 51 nurses.
22:08Mr. Chairman, 51 nurses are dropping the bucket.
22:12You're not going to get the kind of staffing you need.
22:14You need more.
22:15And I think he needs to take a page from the Northwest Regional Editorial Authority who seems to be recruiting
22:19every week.
22:20So our time is very short.
22:22Mr. Chairman, make your point very quickly.
22:23Listen, this is my closing point on this, right?
22:26All of this information, all of this systems failure, these are all things that should have been, could have been
22:34addressed over the years.
22:36So the issue of overtime should be the discussion.
22:39The issue of manpower planning should have been the discussion.
22:42But then, as my friend pointed out, it goes back to the recognition status, which the union has failed to
22:48rigorously post you, in my opinion.
22:51There were multiple boards appointed.
22:53I have to ask you.
22:55That's my closing point.
22:55The union has been asked to meet with the government while they are promising, well, let's say members are promising
23:01continued action.
23:02What would meaningful action from government look like and how soon does it need to happen to prevent any escalation?
23:08The first thing that the government needs to do is make a statement, an open public statement.
23:13To date, we have not heard a real genuine open statement that there are issues and we are willing to
23:19meet and discuss with the nursing association what is going on so that we can now communicate with the nursing
23:24fraternity that, listen, the government is genuine.
23:27The management and the executive management of North Central Regional Health Authority is willing to come and discuss proper terms
23:35and conditions of service within the authority.
23:38We need that.
23:39Ten seconds.
23:40Which they don't have the authority to really do because they don't have recognition status.
23:45So, guys, the path forward will require dialogue, trust, and, of course, agent action because at the end of the
23:52day, it isn't just about nurses.
23:54It is about the quality of care that every citizen depends on.
23:58Thank you, Mr. Nurengsing.
23:59Thank you, Ms. Cox, for joining us for a very healthy discussion.
24:02And, of course, to our viewers, thank you for watching Beyond the Headlines.
24:05I'm Irvashi Tawari Rupnurein.
24:07Good night for me, but there's more news with Tisha up next.
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