Sector profile: Health Care

This profile is intended to provide CUPE members with basic information about the sector they work in from a national perspective.

OVERVIEW

CUPE represents over 200,000 health care workers from coast to coast. Approximately 190,000 of those members work in dedicated health care locals such as hospitals, long-term care, community and public health, home care, and at Canadian Blood Services and Héma-Québec. The remaining members work primarily in the Municipal and Social Services sectors.

CUPE represents health care workers in every province, with the largest numbers in Ontario (Ontario Council of Hospital Unions members), British Columbia (Hospital Employees’ Union members), Quebec (through the Conseil provincial des affaires sociales), Manitoba, Saskatchewan, and New Brunswick.

Now more than ever, the COVID-19 pandemic is illustrating how critical our health care system and health care workers are to promoting and protecting public health and safety, and the broader public interest. Health care workers across the country are on the front lines of the current health crisis. They work to protect every one of us, while their own health and safety has faced significant risks.

ISSUES

Long-term care

No issue has come to the forefront in Canada throughout the pandemic more than long-term care. Fifty-two per cent of COVID-19-related deaths have occurred among residents of long-term care and retirement homes despite making up only 1.13 per cent of the population. Our governments have done a very poor job of protecting the lives of the most vulnerable among us against COVID-19.

COVID-19 did not create the problems we are witnessing within the long-term care system. Instead, it is shining a spotlight on those issues, and making them worse, especially when it comes to the chronic shortage of staff and inadequate hours of care. A number of CUPE locals and divisions have campaigned in recent years to increase the hours of care in long-term care. After a multi-year campaign by CUPE Ontario and the Ontario Health Coalition, new legislation was introduced in 2021 that will bring hours of care to an average of 4 hours per resident per day in Ontario’s long-term care homes by 2025.

Health and safety

Throughout the COVID-19 pandemic, health care workers across Canada have been hailed as heroes, but they have faced serious health and safety risks, including:

• Lack of access to adequate and appropriate PPE
• High COVID-19 infection rates
• Fear of transmitting COVID-19 to family members and loved ones
• Overwork, exhaustion, stress, burnout, and negative impacts on mental health

CUPE is continuing the work to protect the health and safety of health care workers through mobilization for stronger collective agreement language on access to PPE, pushing for reformed PPE stockpiles that will be sufficient for any future emergencies, and expanded PPE production in Canada. CUPE is also calling for the precautionary principle to be used for public health emergencies, which calls on governments and employers to take every reasonable precaution to protect the health and safety of workers without having to wait for scientific certainty. Health care workers should never again face garbage bags as protective gowns, expired masks, and locked PPE supply cupboards.

CUPE health care workers have also campaigned to raise awareness about violence in the workplace. In Ontario, OCHU/CUPE negotiated new language aimed at identifying and addressing workplace violence and committing employers to training in de-escalation and organizational wide risk assessments aimed at reducing incidents of workplace violence against hospital workers.

Privatization

Private-sector interests are eroding our public health care system bit by bit. Privatization is a major issue in all areas of our health care system including for-profit surgical clinics, long-term care, home care, virtual health care, and plasma collection. Not to mention, the contracting-out of direct-care or support services and increasing use of staffing agencies. Public-private partnerships (P3s) are also used in the sector, which involves a long-term contract to build, finance, operate, maintain, or own public facilities like hospitals or long-term care homes.

CUPE members take on the fight to defend and expand public health care services across the country. In a recent win, the Hospital Employees Union, CUPE’s health care division in BC, was successful in having privatized hospital cleaning and dietary workers brought back in-house as health authority employees after 20 years of privatization. This announcement helps restore equity and justice for more than 4,000 regular and casual workers.

Heavy workload

All areas of health care are experiencing a crisis of understaffing resulting in crushing workloads for workers and a deteriorating level of care for the public. Staffing levels in the health care sector had already been pared down with patients often facing more complex medical conditions. The pandemic exacerbated the situation with many workers leaving the sector for jobs with better wages and working conditions.

The situation is so dire that there simply are not enough workers willing to fill all the health care job vacancies. There’s been a 190% increase in job vacancies for licensed practical nurses / registered practical nurses, 81% increase in vacancies for aides, orderlies, and patient service associates, and a 100% increase in vacancies for Medical Technologists over two years. This means front-line health care workers are always or regularly working short leaving unmanageable workloads and leading to a rise in violence against workers. Much needs to be done to draw workers back into health care including increased wages, safer working conditions, more full-time jobs, and higher staffing levels.

 

BARGAINING

Types of bargaining

There are a range of bargaining structures in the health care sector throughout the country. Members in hospitals, long-term care, and home care bargain together in British Columbia, Saskatchewan, Manitoba, and Quebec. In many cases, the centralized bargaining covers the public sector while separate collective agreements exist in for-profit long-term care and home care. In a number of provinces including British Columbia, Manitoba, and Nova Scotia, separate collective agreements are negotiated for health sector occupational groups (e.g., support services, nurses, etc.).

CUPE health care locals often work closely with other health care unions to push similar demands, sometimes as part of formalized coalitions. In most provinces, health care workers have the right to strike subject to essential services legislation. In Ontario and Prince Edward Island, bargaining impasses go directly to interest arbitration.

The PEI Health Council represents CUPE members in PEI hospitals and public long-term care, while CUPE Local 2523 represents workers at the privately-owned Atlantic Baptist Nursing Home. CUPE’s health care members in Newfoundland and Labrador bargain with the province alongside other CUPE NL public service members in school boards, housing, government house, public libraries, and transition/group homes. Health care locals in Alberta negotiate their own stand-alone contracts in the health care sector.

The New Brunswick Council of Hospital Unions (NBCHU – CUPE Local 1252) negotiates a central agreement on behalf of 22 CUPE locals across the province, and the New Brunswick Council of Nursing Home Unions (NBCNHU) negotiates a central agreement on behalf of CUPE’s 51 non-profit nursing home locals in the province. The newly formed CUPE Local 5446 with 12 sub-units represents members at private long-term care homes operated by Shannex.

In Ontario, most CUPE hospital locals bargain centrally as part of CUPE’s Ontario Council of Hospital Unions (OCHU), setting a pattern for the hospital sector. Long-term care and home care locals mostly negotiate local collective agreements.

Health care restructuring

A number of provincial governments have made major changes to the health care sector in recent years, often forcing mergers and representation votes amongst union members. In Saskatchewan, health care was restructured under one health authority in 2018. CUPE is developing a formal bargaining association with SEIU West to bargain one collective agreement for the sector. In Quebec, the number of local health care and social services centres in the province was reduced from 182 to 34 in 2017. This forced mergers and representation votes gaining CUPE more than 3,000 new members.

In Manitoba, the 2017 Health Sector Bargaining Review Act reduced the number of bargaining units in the province’s health sector to 18. After a series of local mergers and representation votes in 2018, CUPE emerged as the largest health care union in the province representing eight bargaining units and adding 9,000 new members. While in Nova Scotia, nine district health authorities were merged into one in 2015 with four Collective Agreements by occupational grouping. In 2022, the Newfoundland and Labrador Government announced its intention to amalgamate the four regional health authorities into one, against all evidence that such centralization worsens health care service provision.

Key bargaining issues

Wages, health and safety, and workload are key issues being tackled in bargaining by CUPE health care locals. Workers are looking for wage increases that keep pace with inflation and show respect. Health care locals are also bargaining for better mental health supports for members, pandemic-related health and safety protections, and measures to address workload.

Hospital workers in the New Brunswick Council of Hospital Unions took part in the 20,000 plus members general strike in 2021 with workers in the education, trades, transportation, laundry, social services, justice, community colleges, WorkSafeNB and correctional services sectors. Workers made significant wage gains and equalized wage rates for casual workers who were paid less for doing the same work.

In 2022, OCHU/CUPE mobilized members and the public around the hospital staffing crisis, job safety concerns, and repealing Bill 124, which is wage suppression legislation that limits wage increases to a maximum of one per cent total compensation for three years.

Collective agreements that address workers needs for higher wages, higher staffing levels, and health and safety are central to addressing the health care staffing crisis.

Pensions

Almost 90 per cent of CUPE members working in health care participate in a registered pension plan. For 60 per cent of those, it is a defined benefit plan. Most CUPE members working in health care belong to large multi-employer pension plans, some aimed solely at health care workers or related industries, some plans are aimed at municipal workers, and others are general public service plans. Most of these multi-employer plans are defined benefit plans.

CAMPAIGNS

Fix long-term care

CUPE launched a national campaign, Fix long-term care, to put pressure on elected officials to address the problems facing the sector. Our recommendations include bringing long-term care into the public health care system and regulating it under the Canada Health Act with dedicated and adequate funding. We are also calling on the federal government to implement and enforce national care standards, including staffing levels, and eliminate the for-profit ownership of homes. Find out more at fixlongtermcare.ca!