Labour Relations and Health Reform: A Comparative Study of Five Jurisdictions, by Kurt Wetzel with contributions from Stephen Bach, Mark Bray and Nadine White, Basingstoke, U.K.: Palgrave Macmillan, 2005, 230 pp., ISBN 1-403998-65-5

In a widely-reported recent decision, the Supreme Court of Canada ruled that sections of the British Columbia government’s Bill 29 violated the right of B.C. Hospital Employees Union members to collectively bargain the terms and conditions of their employment relationship. By legislatively pre-empting negotiation on contracting out, layoff, bumping rights and other contract provisions, the Supreme Court determined that the bargaining rights of health care workers were restricted, “… either by disregarding past process of collective bargaining, by preemptively undermining future processes of collective bargaining, or both.” The B.C. Government had defended its legislation as being in the interests of creating greater flexibility for the health care sector to restructure in an effort to reign in escalating health care costs. Whatever the broader implications of the Supreme court’s decision, which is sure to be the source of debate by scholars and practitioners for many years to come, it is clear that, in Canada, the age of foregoing consultation and negotiation on restructuring issues that directly affect unionized health care workers has come to a close. Labour Relations and Health Care Reform: A Comparative Study of Five Jurisdictions, demonstrates that health care restructuring motivated by cost pressures is not unique to British Columbia. Nor is the use of legislation, or unilateral action by employers, to compel timely compliance to government’s restructuring vision. As its title indicates, the volume explores the pressures and responses of unions, managers and governments in light of health care sector restructuring in five jurisdictions – Great Britain, New Zealand, New South Wales (Australia), Alberta and Saskatchewan. The choice of this eclectic group of jurisdictions is justified on the grounds that they are all British-style parliamentary democracies with significant public health care sectors, their governments are politically accountable for both quality and funding of health care, each has undergone a major restructuring, their health care sectors are highly unionized and they are diverse with respect to political ideology. Stephen Bach describes the United Kingdom’s experience with the impact of health restructuring on industrial relations, and vice versa. The chapter contrasts the approaches of the Conservative government, which emphasized market-based reforms directed at reducing costs, and the Labour government which sought to increase efficiency – more services provided at higher quality – through infrastructure and human capital investments. The chapter provides a wide-ranging, though necessarily general, discussion of these approaches, and especially the predilection of governments of all stripes to focus on short-term results, as well as for politicians to insert themselves too deeply into the actual execution of reforms. Bach begins the chapter by suggesting that the United Kingdom is distinct in “… the degree to which health sector reform has formed a central component of the domestic political agenda for more than two decades.” The chapters that follow, however, suggest that the U.K. is not at all distinct in this regard. Kurt Wetzel argues that market-based reforms, aided by anti-union legislation, undermined New Zealand’s health sector industrial relations, and thereby impeded reforms. A focus on competition within the sector resulted in decentralized bargaining which led to very different outcomes for different groups of health care workers, some benefiting but many others experiencing significant harm. A new coalition government moved to reinstate to rights of unions and the role of consultation and negotiation as an integral component of the health care reform process. This approach appears to have reduced hostility and led to a more productive industrial relations environment. The two chapters on Saskatchewan and Alberta, both authored by Kurt Wetzel, offer a stark contrast in approaches to health sector restructuring. The Government of Alberta pursued …