In 1981 South Australia’s Ambulance Employees Association (AEA) was formed after breaking away from the Miscellaneous Workers’ Union (MWU). Ambulance officers felt they were not receiving the service they needed from the MWU and that they were confronting many significant issues including lobbying for professionalisation of the service; the lifting of clinical standards; a proper career and wages structure; increased
312 Ibid. 313 Ibid.
staffing and acceptable rosters.314 In 1989 the AEA had all its members suspended from duty without pay because of an ongoing dispute with the government over professional standards, but within six months its demands had been met and the discipline began transitioning to become a professional service with a supported shift to tertiary education and associated improved clinical standards. The AEA claims that without its action:
The Ambulance Service … would still be run by St John, still have inappropriate levels of volunteer involvement, still have Third World clinical standards and still be the worst paid Service in Australia.315
On 4 February 1993 the National Committee of Ambulance Unions (NCAU) determined, among other things, that there should be national training standards and, possibly, a pursuit of consistent classifications and rates of pay to ensure that conditions and pay were not eroded by various iterations of state government or ambulance employers. This would preserve a minimum standard of pay for a ‘qualified’ ambulance officer and not have that reduced by non-qualified competition in the market.316 This action was significant in establishing a key issue that had plagued other professions such as nursing. The stratification of qualifications required to undertake the job and the multitude of titles that allowed employers to skirt around title protection legislation was something that ambulance officers needed to avoid to ensure that they did not make themselves redundant. This was because at this time there was only one avenue for employment as an ambulance officer and that was with state-based ambulance services. The trade-off for negotiating the preservation of the ambulance officer role and credential was pay and conditions that lagged behind other comparable health practitioners.
This changed in April 2010. Intensive care paramedics (ICPs) in the ACT received a substantial pay rise as a result of a three-year application by the Transport Workers’ Union to Fair Work Australia. Significantly, the Fair Work Commissioner referred to submissions made by the union based on research into paramedic work by paramedic scholar Dr Louise Reynolds. Reynolds had published a paper identifying the significant change in a number
314 South Australia Ambulance Employees Association, About the AEA
<http://www.aeasa.com.au/index.php/about/aboutaea>.
315 Ibid.
316 See details in The State of Victoria and the Minister for health for the State of Victoria and the
Honorable Joseph Martin Riordan and the Australian Liquor Hospitality and Miscellaneous Workers Union [1995] IRCA 293; 63 IR 317 <https://jade.io/article/327609>.
of areas to the nature of the work by paramedics that were consistent with the criteria associated in the sociological literature as being common to the work of professionals. The decision by Fair Work Australia acknowledged that over time and in response to technological and clinical scientific developments, ICPs were now required to:
(i) critically think, appraise, judge and act independently in novel and complex situations;
(ii) the fact that ICPs have an increasing body of specialist knowledge, are working in a multi-disciplinary and integrated health care system, and are required to exercise clinical judgement;
(iii)the move to undergraduate degree pre-employment education; and
(iv)community acceptance and recognition of paramedics in terms of trust and authority.317
In accepting the claim for an increase in entitlements and conditions for ICPs in the ACT, Fair Work Commissioner Deegan found, and the parties agreed that, ACT ICPs are:
required to perform their work in a professional manner and are required to exercise professional judgment when performing their duties. The parties acknowledge that the work of the ACTAS ICPs currently has many of the recognised hallmarks of a profession. The ambulance paramedic industry in Australia is currently in a period of transition towards formal professional recognition. This appears broadly based on the industry:
developing a systemic body of theory and knowledge
introducing formal qualifications based on education and examinations by tertiary institutions and required by employers with
support of the peak body representing Australasian ambulance services now engaging with a number of tertiary institutions which to provide undergraduate degrees in Paramedicine Science with this qualification now forming the minimum entry level point into some services
317Transport Workers Union v Department of Justice and Community Safety (unreported Determination,
Fair Work Australia, Commissioner Deegan, 29 March 2010) <http://www.fair- go.com/docs/FWA2010decision.pdf>.
the emergence of regulatory bodies with codes of ethics and powers to admit and discipline members
ongoing work to establish common guiding principles and standards of nationally accredited education and continuous professional development for ICPs.318
The agreement between the parties went further to say that:
consistent with the requirements of professional recognition, it is agreed between the parties that the expectations of ICPs as professionals are that they engage in:
work-based learning (including reflective practice, clinical audit and significant event analysis);
professional activity (including mentoring, expert witness and teaching); formal education (including courses, involvement in research);
self-directed learning (reading journals, updating personal knowledge); and other activities including public service and volunteer work.
The parties also acknowledged that it would be the responsibility of individuals (not their employer) to undertake ‘self-directed professional development’. All the elements relied upon by the union to make their case and by Commissioner Deegan in making her decision were consistent with the characteristics associated with a profession as identified in the sociological literature, bar self-regulation. Although paramedics were not yet recognised under the National Law as health professionals the way other equivalent health practitioners were, they were acknowledged in employment law, in at least one Australian jurisdiction, as transitioning ‘towards formal professional recognition’.
The ACT decision was closely followed by paramedic industrial action in Victoria. In 2011 in an attempt to remedy the pay inequity and to restore the status of paramedics, the Victorian Ambulance Association commenced a two-year industrial action against the government over pay, conditions and staffing. This action included opposing the plan by
the government to expand its use of ambulance community officers (who only have around 96 hours of training) in rural areas because Ambulance Victoria deemed it uneconomical to maintain stations staffed with fully qualified paramedics.319 The campaign by the paramedics was so successful that it contributed significantly to a change of state government.320 This gave paramedics, and indeed the entire community, an insight into just how politically powerful the discipline had become, due in no small measure to the level of trust and endearment in paramedics held by the public.321 With the establishment of a new Labor government the dispute came to an end. The new Premier Daniel Andrews stated:
Paramedics are some of our most trusted professionals and an Andrews’ Labor Government will treat them that way. They are what’s right with our ambulance system and we need to fix what’s wrong.322
In 2016 Victorian paramedics received a massive pay raise of 20–28% after the Fair Work Commission heard evidence of the decade-long increase in skills and responsibilities that paramedics were required to obtain to practice. The commission found that paramedics have had their qualification requirements increased to degree level; and have had their responsibility for the care and treatment of complex patients including mental health patients extended along with an expansion in the range of medications and other treatments. As such, the commission recommended and the government agreed that those changes warranted a wage increase.323 The success of this campaign highlighted how the discipline had continued to professionalise in response to a number of factors including technological and medical advancements and associated shifts in educational requirements, along with an increased demand for and recognition of the unique and critical role that paramedics
319 Julia Medew, ‘Paramedics Set to Take More Industrial Action’, TheAge (online, 3 February 2014)
<http://www.theage.com.au/victoria/paramedics-set-to-take-more-industrial-action-20140203-31x16.html>.
320 Barrie Cassidy and Alison Savage, ‘Cue the blame game’, ABC News (online, 28 November 2014)
<http://www.abc.net.au/news/2014-11-28/cassidy-and-savage-cue-the-blame-game/5922818>.
321 Andrew Korner, ‘Annual poll reveals angels and demons of professions.’ Queensland Times (online, 24th
June 2014) <https://www.qt.com.au/news/annual-poll-reveals-demons/2296210/#10 Most Trusted>
322 Victoria Labor, ‘Premier to Paramedics: The War is Over’ (Media Release, 1 December 2014)
<https://www.viclabor.com.au/media-releases/new-premier-to-paramedics-war-is-over>.
323 United Voice v Ambulance Victoria (unreported, Recommendation, Fair Work Commission, President
Justice Ross, Senior Deputy President O’Callaghan, Commissioner Cribb and Commissioner Lee, 23 March 2016) <https://www.fwc.gov.au/documents/sites/ambulance2016/decisions-
statements/c20153378-recommendation-230316.pdf> 7; Richard Willingham, ‘Victorian Paramedics
Handed Huge Pay Rise’, The Age (online, 23 March 2016) <http://www.theage.com.au/victoria/victorian-
play in the healthcare workforce. However, the campaign also highlighted the fact that paramedics were not and still are not regulated the same way as other similar professions. The industrial campaign raised awareness of the job that paramedics do and the change of government in Victoria provided an opportunity for the professional associations representing paramedics to successfully lobby for support from the Victorian government for paramedics to be included under the NRAS.324