Health Employees Pharmacists (State) Award and other Awards [2003] NSWIRComm 453 - NSWIRComm 2003 case summary — Zoe

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Health Employees Pharmacists (State) Award and other Awards [2003] NSWIRComm 453

[2003] NSWIRComm 453

Industrial Relations Commission (NSW)|2003-07-01|Before: Walton J, Grayson DP

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Court

Industrial Relations Commission (NSW)

Decision date

2003-07-01

Before

Walton J, Grayson DP

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Original judgment source is linked above.

Judgment (536 paragraphs)

[1]

CITATION : Health Employees Pharmacists (State) Award and other Awards [2003] NSWIRComm 453 PARTIES : The Health Services Union The Health Administration Corporation FILE NUMBER: IRC 6920 of 1999, 655 of 2000, 2730 of 2002 CORAM: Walton J Vice-President; Grayson DP; McLeay C CATCHWORDS : Union application for new award - Employer cross-application for new award - Three occupational streams reviewed - Balance of union application and employer cross-application (as amended) stood over pending this determination - Increased rates of pay and changed classifications sought - Wage fixing principles - Special case principle - Work value principle - Relevance and significance of staff shortages in consideration of special case and work value principles - Blanket repudiation of union application by employer, industrially unsatisfactory especially in light of acknowledged deficiencies in existing classification structures and gaps in operation of awards under consideration - Partial resolution by employer administrative action - Existing classification structure in certain cases demonstrably inoperative in any legal or practical sense - Causal link between shortage of employees and changes in the nature of work - Devolution of functions and percolation of skills and responsibility within classification hierarchy - Changes in range and scope of professional roles - Intensification of work by increase in volume and frequency and pressure of work - Compounding effect of anomolies and inequities in classification structures and corresponding rates of pay - Public interest considerations in favour of addressing undervaluation of work particularly where labour shortages exist - Special case made out - Work value principle satisfied - Adjustments to classifications and rates of pay ultimately dependent upon precise nature and extent of work value change and impact of special case features generally - Principles concerning shortage of employees - Increases to be considered in context of increases which have sequentially flowed from 1999 memorandum of understanding - Union contentions as to to wage adjustments based on comparable classifications treated with great caution - Regard had to external classification only where there is some demonstrable historical or other appropriate basis - Union application granted in part in certain respects and in full in others - Awards varied Dental Technicians Registration Act 1975 (NSW) Dental Technicians Registration Act 1975 (NSW) LEGISLATION CITED : Industrial Relations Act 1996 National Health Act 1953 Pharmacy Act 1964

[2]

Crown Employees (Administrative and Clerical Officers) State Award (No 2) (1993) 52 IR 243) Crown Employees (Teachers in Schools and TAFE and Related Employees) Salaries and Conditions Award (2002) 116 IR 361 Employers First v The NSW/ACT Independent Education Union and Another (2002) 115 IR 8 Equal Remuneration Principle Re (2000) 97 IR 177 Health and Community Employees Psychologists (State) Award (2001) 109 IR 458 Health and Research Employees' Association, (application by) for a new Hospital Technical (State) Award, (unreported, Matter No 296 of 1976, 25 August 1977). Hospital Employee - Technical (Metropolitan) Award & Anor [1971] AR NSW 272, Hospital Employees - Pharmacists (State) Award, unreported, (Matter No. 188 of 1980, 23 May 1980) Hospital Employees - Technical (Metropolitan) Award ([1971] AR (NSW) 272) Hospital Employees Medical Technologists (State) Award, unreported, (Matter No. 293 of 1976, 28 June 1978). Hospital Employees Medical Technologists (State) Award, unreported, (Matter No. 11 of 1979, 27 March 1979) Hospital Employees Pharmacists (State) Award (1974) 202 IG 1416 Hospital Employees Pharmacists (State) Award, unreported - (Matter IRC 6536 of 1997 24 March 1997). Hospital Employees Pharmacists (State) Award, unreported, (Matter No. 295 of 1976) Hospital Employees Pharmacists (State) Award, unreported, (Matter No. 304 of 1989, 11 October 1989) CASES CITED : Local Courts Anomaly Case [1989] AR (NSW) 638 Metal Trades Award, Re State Electricity Commission of Victoria (1964) 106 CAR 535. Operational Ambulance Officers (State) Award (2001) 113 IR 384 Public Hospital Nurses (State) Award (2002) 115 IR 183 Public Hospital Nurses (State) Award (2002) 115 IR 183 Public Hospital Nurses (State) Award (No. 3) (2002) 121 IR 28 Public Hospital Social Workers Award (unreported, Full Bench, 86/264, 20 December 1988) Public Service Association of New South Wales (application by) for a New Crown Employees (United Dental Hospital of Sydney) Award, (unreported, Matter No 642 of 1980, 26 September 1980), Railways Professional Officers Award (1958) 89 CAR 40 Social and Community Services Employees (State) Award (2001) 113 IR 119 State Wage Case 1989 (1989) 30 IR 107 State Wage Case 1991 (1991) IR 362 State Wage Case 2001 (2001) 104 IR 438 State Wage Case (2003) 121 IR 446 Transport Industry (State) Award (1996) 95 IR 126 United Dental Hospital of Sydney and Public Hospitals Dental Technicians Salaries (State) Award, (unreported, Matter No 522 of 1989, 14 November 1990). HEARING DATES: 11/11/2002; 11/12/2002; 11/13/2002; 11/18/2002; 11/19/2002; 11/20/2002; 11/22/2002; 11/25/2002; 11/26/2002; 12/04/2002; 12/06/2002; 12/19/2002; 03/11/2003; 03/12/2003; 04/23/2003; 04/24/2003; 04/28/2003; 04/29/2003; 05/05/2003; 05/06/2003; 05/07/2003; 05/09/2003; 07/29/2003; 08/26/2003 DATE OF JUDGMENT: 12/12/2003

[12]

5 Whilst the HAC ultimately adjourned its cross claim for the inclusion of certain conditions of employment provisions and did offer in a very limited way alternative definitions for some employment classifications caught by the application, it essentially engaged in a blanket repudiation of the application by resisting outright any substantial reclassification, redefinition of classifications or adjustment to rates of pay. We consider that that approach (of essentially outright opposition) to be quite unsatisfactory in this matter for three reasons: 1. We refer to the recent observations of a Full Bench of this Commission in Re Health and Community Employees Psychologists (State) Award (2001) 109 IR 458 at [61]: 61 In reaching our conclusion, we are not unmindful of the traditional rigidities in public service structures which are no doubt reflected in the psychologist's scale as set over 30 years ago. Such a scale, in our view, does not meet the new demands and wholly different nature of the work of public hospital psychologists as we have identified. That issue was not dissimilar to that discussed by a Full Bench of the Commission in Re Public Hospital Social Workers Award (unreported, Full Bench, 86/264, 20 December 1988) where the Industrial Commission in reviewing the salary scale for social workers commented (at pp8-9): Historically, traditional rigidities in the public service structure have resulted in salary scales which have had to satisfy two different functions, firstly to provide a management and supervisory hierarchy to satisfy the requirement of control and secondly to provide appropriate salaries reflecting skill and responsibility. In this case, however, whilst there would appear to be deficiencies in the structure the employer has not sought to put forward by constructive submissions as to how the difficulties might best be overcome from the employer's point of view. Clearly, society, the employer and the social workers themselves consider that social work and social worker roles have progressed from adjuncts to the provision of medical and hospital services to an integral and professional service provided not only to the individual patients but also the other health professionals. Stresses which modern society has placed upon the individual within that society have led to a greater range of professional work than has been necessary or desirable in the past. We consider similar comments are apposite in the present case. The respondent's position was to oppose any change in the classification structure or any increase in salaries; it proposed no alternative to the applicant's claims. As unfortunate as that approach may be in not providing the Commission with an arguable alternative, we have to say it has compelled us to accept more forcefully than we might otherwise have done the evidence led in these respects by the applicant. These remarks are apposite in the present matter. 2. There were aspects of the application which on a reasonable assessment of the competing positions of the parties required a different approach by the HAC. There was revealed in the evidence some deficiencies in the existing classification structures and gaps in the operation of the awards under consideration in this matter (which, in fact, had been partially resolved by administrative action taken by the HAC) which should have resulted in the HAC putting an alternative position with respect to various aspects of the application. For example, the HAC opposed outright the application for a new Perfusionist classification and offered no proposal as to an appropriate rate of pay for any existing or new classification in that respect, notwithstanding that it had been demonstrated during the proceedings that the existing classifications for that occupation were entirely redundant. Further, the HAC did not propose any alternate classification structure for Pharmacy Technicians, notwithstanding that the evidence demonstrated that the existing classifications and definitions were so grossly inadequate as to be inoperative in any legal or practical sense. 3. In the result, the Commission was left without any real assistance by the opponent to the primary application as to the appropriate resolution of the issues raised by it, in circumstances where it was reasonably clear that at least some alternative to the form of existing awards would be required. One consequence of this approach, as was observed by the Full Bench in the Psychologists case, is that, where there is a clear indication in the proceedings that some wage or classification adjustments are appropriate (in accordance with the wage fixing principles) the Full Bench is left without any 'arguable alternatives' from the HAC as to the form of the award, that is, the actual adjustments to the award which may be appropriate. Thus, we have been compelled, where classification and wage adjustments have been found to be warranted under the wage fixing principles in relation to a particular aspect of the application, as in the Psychologists case, to "accept more forcefully than we might otherwise have done," the position advanced (on the evidence) by the HSU.

[15]

8 The awards sought to be amalgamated by the HSU and the HAC were: 1. Health Employees' Conditions of Employment (State) Award made 3 March 1998 (307 IG 88) and all variations thereof; 2. Public Hospital (Professional and Associated Staff) Conditions of Employment (State) Award made 16 December 1983 (265 IG 1430) and all variations thereof; 3. Health Employees (State) Award made 19 May 1998 (307 IG 29) and all variations thereof; 4. Health Employees General Administrative Staff (State) Award made 19 May 1998 (307 IG 44) and all variations thereof; 5. Health Employees Administrative Staff (State) Award made 19 May 1998 (307 IG 15) and all variations thereof; 6. Health Employees Technical (State) Award made 19 May 1998 (307 IG 56) and all variations thereof; 7. Health Employees Engineers (State) Award made 19 May 1998 (307 IG 47) and all variations thereof; 8. Health Employees Pharmacists (State) Award made 19 May 1998 (307 IG 21) and all variations thereof; 9. Health Employees Medical Radiation Scientist (State) Award made 19 May 1998 (307 IG 63) and all variations thereof; 10. Health Employees Computer Staff (State) Award made 19 May 1998 (307 IG 52) and all variations thereof; 11. Health Managers (State) Award made 19 May 1998 (307 IG 73) and all variations thereof; 12. Health Employees Interpreters (State) Award made 19 May 1998 (307 IG 67) and all variations thereof; 13. Public Hospital Residential Services Assistant (State) Award made 19 May 1998 (307 IG 70) and all variations thereof; 14. Royal Rehab. Service-Weemala Unit Residential Care Staff (State) Award made 19 May 1998 (307 IG 26) and all variations thereof; 15. Dental Therapists (State) Award made 3 February 2000 (320 IG 1133) and all variations thereof; 16. Health Employees Dental Officers (State) Award made 17 March 1999 (310 IG 1156) and all variations thereof; 17. Health Employees Dental Technicians (State) Award made 17 March 1999 (310 IG 1153) and all variations thereof; 18. Public Hospital Dental Assistants (State) Award made 3 February 2000 (320 IG 1136) and all variations thereof; 19. Public Hospital Dental Staff (State) Award made 3 February 2000 (320 IG 1130) and all variations thereof; 20. Public Hospital Librarians Award made 30 November 1989 (257 IG 907) and all variations thereof; 21. Public Hospital Medical Record Librarians (State) Award made 17 August 1973 (193 IG 1691) and all variations thereof; 22. Public Hospital Physiotherapists, Occupational Therapists & Speech Pathologists (State) Award made 12 June 1986 (251 IG 308) and all variations thereof; 23. Public Hospital Social Workers (State) Award made 17 November 1999 (315 IG 731) and all variations thereof; 24. Public Hospital Professional Engineers (Biomedical Engineers) Award made 7 February 1982 (234 IG 444) and all variations thereof; 25. Scientific Officers (Public Hospital Dieticians) Award made 14 October 1976 (204 IG 1488) and all variations thereof; 26. Hospital Scientists (State) Award made 31 August 1988 (276 IG 1) and all variations thereof; 27. Public Hospital Medical Officers (State) Award made 15 December 1977 (209 IG 2771) and all variations thereof; 28. Public Hospital Medical Superintendents (State) Award made 3 December 1976 (265 IG 1417) and all variations thereof; 29. Health Professional & Medical Salaries (State) Award; made 12 October 1998 (312 IG 516) and all variations thereof; 30. Food Inspectors-Determination and all variations thereto. 9 The HAC's application also affected the Health Employees Status of Employment Interim (State) Award.

[17]

12 There were also a series of 'streams' or claims related to conditions of employment in the sector generally brought by both the HSU and the HAC. These included: - Termination of Employment - Transfers between Hospitals - Grading/Credentials Committee - Infectious/Nauseous/Contaminated Work Allowance - No Extra Claims Clause - Typing Allowance - Hours of work (for radiographers and health managers) 13 In addition to seeking award consolidation, the HSU sought both an increase in rates of pay and the creation of new classifications or the re-classification of work within the various occupational streams. For example, the HSU sought the creation of nine new graduate Pharmacist grades (in addition to new Pharmacy Assistant and Pharmacy Technician grades), six new Cardiac Technologist grades (to replace former provisions for Heart/Lung Technicians and Assistants) and the creation of a new 'Laundry Worker' classification. The HSU also claimed wage increases (of different amounts and proportions across the areas of the claim). These were based in part on work value increases and in part on special case considerations, in particular endemic staff shortages and staff retention difficulties. As to conditions of work, the HSU sought changes in consequence of the amalgamation of the many different awards and various other amendments going to such things as payable allowances, termination and gradings. For example, the HSU sought the deletion of the medical terminology and typing efficiency allowances, the variation of the infectious cleaning allowance clause and the termination of employment clause and the insertion of a new clause regarding grading and credentials. 14 In contrast, the HAC's claims did not have a wide compass (other than, of course, the consolidation of the awards earlier referred to). As we have mentioned above, it compressed the provisions of many awards into four (two awards regarding conditions and two regarding rates of pay), but did not otherwise alter existing classifications or alter wages. It did, however, seek to alter conditions of work by the deletion of the infectious cleaning clause (and allowance), the introduction of a 'no extra claims' clause and the increase of maximum hours for radiographers. 15 The hearing was commenced in relation to the first three streams. We do not propose to track the variations in the HSU's position in the proceedings. It is sufficient to note that the HSU advised at various times during the hearing of the first three streams substantial revisions to its claim in relation to those initial streams (thereby reducing the amount claimed with respect to this aspect of its application). Both parties ultimately filed amended applications early this year in relation to those streams. 16 At this stage of the proceedings the parties reached agreement in seeking the consolidation of the many health sector awards into two awards, being one each for professional and non-professional staff (salaries and conditions both contained within the one award for each group). However, the HSU persisted with its application regarding classification changes and wage increases and variations to conditions of work. The HAC maintained its opposition to the aforementioned changes and pressed its own application with regard to conditions changes and in relation to Radiographers. 17 Evidence and submissions in the first three streams (pharmacy, dental, perfusion) were then heard to completion and some evidence was received regarding the fourth stream: Cardiac Technicians. 18 At this point the proceedings took a dramatically different course. By short minutes of order tendered on 29 April 2003, the parties jointly sought to constrain the proceedings (for the time being) bringing them to the aforementioned juncture, wherein we consider the HSU's application for variation of just six awards with respect to three streams. By virtue of this confinement of the claim (and the nature of its original application) no new application was filed by the HAC. Its claims were likewise stood over generally to a date to be fixed after the giving of this decision.

[56]

46 The HAC submitted that it is a well established industrial principle that wage rates should not be set to address labour shortages. To do so would cause rates to be set other than on the basis of the true value of the relevant work. In this regard, the HAC referred to the decision in Re Equal Remuneration Principle (2000) 97 IR 177 at 215, where a Full Bench noted its approval of the observations of the Full Bench in Local Courts Anomaly Case [1989] AR (NSW) 638 at 645 that: Attraction rates as such are inconsistent with State Wage Principles as they reflect the problems of management and not the true value of the work required. Furthermore, they can set up within a wages structure pressures towards defensive increases designed to retain staff under challenge from rates elsewhere. Indeed, in part, this exercise under review is in reply to competitive rate challenges available in the private sector and elsewhere in the public sector which are drawing off staff from local courts. There can arise a circular self perpetuating process of wage enhancement against which we should be on guard. 47 In further support of this position the HAC cited Re Railways Professional Officers Award (1958) 89 CAR 40 and Re Metal Trades Award; Re State Electricity Commission of Victoria (1964) 106 CAR 535. In those cases, the Commission considered claims for wage rates which were generally referred to as "attraction wages" or "attraction rates". In both cases, the Commission maintained the position that setting wage rates in order to attract labour to address a shortage is an inappropriate basis for wage fixation. In the Railways Professional Officers case the Commission held (at 48): The first aspect of the Association's case, that is, that the grave and special conditions existing to-day justify an unorthodox approach, really an unprecedented approach, forces me to face this fact, that if the situation is as serious as the Association asserts, then it is certainly placing a major responsibility on the Commission to attempt the solution of what must be only regarded as a national problem. A problem which, no matter how one viewed it, could only be regarded as a major and socio-political problem and one which, to say the least, should not be the responsibility of the Commission. In my opinion the solution to the problem does not rest solely on the recruitment of engineers to the railway industry, or to any of the major industries for that matter, through inflated attraction rates, but rather by orderly recruitment of sudents [sic] and apprentices in numbers determined by accurate examination of the needs of industry and for national requirements. To suggest that a higher margin in the railway industry is the answer for this national problem is too unreal to warrant serious consideration. I can only regard the Association's request on these points as being one for an attraction rate. I do not intend to review the decisions of Commonwealth Arbitral Authorities rejecting attraction rates as a proper basis for fixing wages. Mr Marlin fully referred to the many decisions recorded on the principle. I have already made a decision on this point, and I now repeat what I said in my 1954 Railway Professional Officers decision 15th April, 1954: - I am not asked by the respondents, who have the responsibility for staffing and administering efficiently their respective organisations, to provide rates to attract staff and consistent with my attitude in previous cases by other organisations, I am not prepared to award arbitrarily attraction rates.

[61]

52 The Full Bench in the Public Hospital Nurses (No 3) case emphasised that changes in work value did not form part of the basis for their decision. In this respect, we note the findings of the Full Bench in the Public Hospital Nurses (No 3) case as follows: [24] There has been a great deal of evidence tendered in the proceedings regarding the work of nurses and how it is said the value of that work has increased. The HAC contended that there has been no increase in the value of work of nurses having regard to the relevant wage fixing principle. [25] We are yet to hear the submissions of the parties in relation to all of the evidence regarding changes in work value and so we are not in a position to make any final determination in that respect. We do consider, however, that sufficient material has been put to the Commission to allow us to form the view that since 1996 the work value of nurses in public hospitals has increased. … [28] The Commission will proceed to hear the parties' outstanding submission in respect of the work value aspects of the claim, the retention and qualification allowances and other outstanding issues, on the dates that have been set aside for that purpose in 2003. However, if there are to be any further adjustments to wages arising out of the work value claim and the claim for allowances, any relevant award variation should not operate before 30 June 2004. One possible exception that might allow an earlier operative date relates to the success or otherwise of initiatives to overcome the problem of attracting and retaining nurses in order to maintain a viable public hospital system. We address this question later in the decision. … [125] We have commented earlier that wage increases are not the whole answer to the nursing shortage but we consider that they can play an important part in a broader strategy that we are told is now being put into place to alleviate the shortage. We intend to monitor the effectiveness of this strategy, and its success or otherwise may be an important consideration in assessing the claims for qualification and retention allowances and in determining whether or not it is appropriate to apply any additional wage increase that might be awarded on work value grounds from a date earlier than 1 July 2004. If it can be demonstrated, for example, that the various initiatives implemented by the respondent to overcome the difficulties in attracting and retaining nurses in the public hospital system are working and that wage increases that have been awarded in this decision have had a limited impact, then it would be most unlikely that the Commission would be convinced to grant further increases prior to 1 July 2004. On the other hand, if the initiatives are having little or no effect and there is evidence that the wage increase has had a positive effect, there may be a case for any increase to be payable earlier than 1 July 2004.

[134]

87 By reference to the documentary evidence produced by the HSU and by the evidence of Mr Craft (who was called by the HAC) the history of and antecedents to the Pharmacists Award are as follows: (i) On 27 May 1971 in Re: Hospital Employees - Technical (Metropolitan) Award ([1971] AR (NSW) 272) Sheppard J awarded rates of pay to Hospital Pharmacists which reflected an agreed position between the parties that the base grade rates should equate to those paid to Scientific Officers employed in the Government Service. This agreement came about because the qualification to become a Pharmacist had, by virtue of the Pharmacy Act 1964, become a regular graded course of at least three years duration at university. As a consequence of this judgment the rates for Registered Pharmacist were aligned precisely with the first five years of the eight year Scientific Officers' scale. Sheppard J adopted the rate proposed by the then Health Commission for the classification of Graduate Assistant Pharmacist. This rate was substantially below the rate for Scientific Officer year 1 and was slightly higher than the rate for a Trainee Scientific Officer fourth year who was a person employed as such pursuing a part-time degree. Sheppard J awarded a two-year scale of Deputy Chief Pharmacist and Chief Pharmacist in charge of three or less registered or unregistered assistants which equated to the rates of Scientific Officer years 6 and 8. For Chief Pharmacist, in charge of four or more assistants, the two-year scale awarded equated to the rates for Senior Scientific Officer years 1 and 3. The rate awarded for Chief Pharmacist - Royal Prince Alfred Hospital fell between the rates for Senior Scientific Officer years 5 and 6 (see [1971] AR (NSW) 272 at pp287-288). There is no reference in Sheppard J's judgment to any examination by him of the work performed by, or work value of, Scientific Officers and Senior Scientific Officers (of the type said by the HAC to be necessary in this case) to support the alignment between the rates for the two groups that resulted from that judgment. The range of increases awarded by Sheppard J to Pharmacists was from "nearly 20 per cent" up to "nearly 40 per cent" (1971 AR (NSW) 272 at 303).

[202]

129 The test of whether there have been changes in work value such as to satisfy the relevant wage fixing principle is necessarily a global one. It is not amenable to microscopic evaluation of discrete functions of the particular classification or classifications under review and we agree in that regard with the HSU submission that although a thorough and exhaustive analysis of the work in question is required in each case, the application of an unduly rigid or function specific approach to changes in the work of professionals such as Hospital Pharmacists (which in our view are amply demonstrated by the evidence) would render it virtually impossible for a professional classification to satisfy the test. We do not consider such a result to be a fair and just one, and nor do we consider such a result to be consistent with the spirit and intention of the Commission's wage fixing principles. 130 We would, emphasise that those principles would dictate that such a realistic evaluation of the nature of the work of professionals would be tempered by the requirement to avoid the double counting of features said to constitute the elements of work value change (so as to avoid compensation for features of the work that merely arise from ordinary professional development or have been previously taken into account in wage reviews). However, we do not agree with the HAC's submission that changes in work value that have occurred since 1 July 1996 have been or will be adequately compensated by existing arrangements. 131 It is also important to note that, whilst the consideration of work value per se occupies much of the submissions of the parties in this matter (and naturally this judgment), it should not be overlooked that for the most part, work value considerations were an important factor in the HSU's case for, and our findings in favour of, a special case. 132 We note again the HSU's submission that, if the Commission were minded to grant the claim advanced in respect of Pharmacists, there would be no flow-on implications for Hospital Scientists. We are satisfied, as previously discussed, that there is no likelihood of leapfrogging arising out of the changes in the position of Pharmacists rates relative to others.

[379]

231 In comparing the rates of pay of Dental Technicians employed by the University of Sydney with those at the UDH, the HSU did not compare other elements of the industrial instrument applying at the University with the conditions under which the UDH Dental Technicians are employed. The HAC submitted that the HSU submissions on this point were meaningless in terms of demonstrating any anomaly and/or inequity, as: No comparison was made between the Public Hospital Professional & Associated Staff Conditions of Employment (State) Award which sets out conditions of employment for UDH Dental Technicians, among others, and the enterprise agreement which governs the terms and conditions under which work is performed by Dental Technicians employed by the University of Sydney, namely, the University of Sydney General Staff Enterprise Agreement 1999-2002. Further, the HAC submitted that the existence of disparities between these two groups of Dental Technicians was before the Commission in previous work value cases. The HSU submitted that Dental Technicians are paid at rates lower than those paid to employees in classifications requiring lower levels of qualifications. For example, the "thereafter" rate for a Dental Technician is lower than the highest rate for a Technical Officer Grade 1 established when that position required only a TAFE Certificate, compared with the Associate Diploma required for a Dental Technician (by $29.80). Further, it was submitted by the HSU that progression for a Technical Officer from Grade 1 to Grade 2 was automatic for holders of a Higher Certificate or Associate Diploma, while the current award prescription requires that certain criteria are met for progression of Dental Technicians from Grade 1 to Grade 2. The difference between the highest rate for a Technical Officer Grade 2 and that for a Dental Technician Grade 2 is $166.50, despite the Dental Technician having an equivalent or higher qualification and having to satisfy criteria for progression. The current award provides no definition for Dental Technician Grade 3 nor any guidance for progression to Grade 3, submitted the HSU.

[480]

311 The role of the Perfusionist was described as follows (at 308 - 309): [Mr Robertson] is the person who operates what is known as the heart-lung machine and is responsible for its preparation before an operation in which it is to be used takes place. The machine is a pump oxygenator which mechanically takes over the functions of the heart and the lungs during an operation in which it is necessary that the patient have no cardiac action of his own. Open heart surgery involving the use of this machine takes place at St Vincents Hospital 3 or 4 days per week. The machine is prepared and assembled under sterile conditions and this process takes one and a half to two hours. When the machine is assembled it is thoroughly tested and primed, that is filled with blood, physiological solution and plasma to the volume of the patient and with a chemistry equivalent to that of the patient. The surgeon inserts a cannula in through the aorta and a second connection is made through the machine into the right side of the patient's heart while the machine is kept clamped on. When the surgeon is ready the Perfusionist removes the clamp and the perfusion period commences. This is the period during which the machine is the patient's life support. The longest period of perfusion Mr Robertson has experienced is 6½ hours, the average being between 2 and 3 hours. During the perfusion period changes which must be made are made by the Perfusionist. These changes control the blood pressure, return of blood to the heart, depth of consciousness of the patient, intake of oxygen, quantity of anaesthetic, blood gas situation and blood chemistry. The Perfusionist has to administer the anaesthetic by injecting it into the blood circulating through the machine because, in the absence of any lung capacity, the patient cannot be kept anaesthetised by conventional procedures. This does not mean that Mr Robertson takes over from the anaesthetist who remains completely in charge of the anaesthetization of the patient. The type of anaesthetic, the volume used and the overall condition of the patient continue to be his responsibility.