Late last week, after a three-day strike by public sector doctors across New South Wales (NSW), the Australian Salaried Medical Officers Federation (ASMOF) leadership vowed to ban any further industrial action for at least the next three months.

This is just the latest instance of many, in NSW and across the country, of a health union collaborating with Labor governments and industrial courts to suppress the struggles of medical workers. It highlights the urgent need for workers in every section of the health system to take matters into their own hands and build their own democratic workplace rank-and-file committees, politically and organisationally independent from Labor and the unions.

Health workers everywhere confront similar attacks on their wages and conditions, as a result of the increasing privatisation and financialisation of healthcare. Through a network of rank-and-file committees, health workers can take up a unified struggle against the continuing evisceration of their wages and conditions, and the public health system as a whole.

This perspective, advanced only by the Socialist Equality Party and its sister parties overseas, is the polar opposite of that peddled by the unions. These bureaucratic organisations use every method at their disposal to divide workers, profession by profession and workplace by workplace, and suppress their struggles.

ASMOF’s strike shutdown is a blatant violation of the intentions of doctors, made clear in the unprecedented turnout to rallies last week at numerous hospitals and outside NSW Health. Defying an anti-strike order from the Industrial Relations Commission (IRC) and threats of de-registration, thousands of medical professionals walked off the job to protest the state Labor government’s miserly pay rise offer of just 10.5 percent over three years.

This was the first NSW-wide strike by doctors, once considered a privileged layer of the population, in more than 25 years. Their coming into struggle points to the breadth of the cost-of-living crisis, a major question in the coming federal election for which none of the parliamentary parties have an answer. It also reflects the impact of decades of cuts to the public health system by Labor and Liberal-National governments, at the state and federal levels, enforced by the corporatised health unions.

As a result of previous union-government deals, NSW public sector staff doctors are already paid an average of 30 percent less than those in the rest of the country. They are concerned that yet another nominal pay increase barely above the official inflation rate will worsen staff shortages, as doctors come under growing financial pressure to move interstate or into private practice.

In NSW, medical interns—who have already completed at least 4–6 years of university education, racking up enormous debts—are paid a base rate of $76,000 per annum, or just over $38 an hour.

NSW doctors also face onerous and unsafe working conditions, with unpaid overtime so rife that NSW Health last year settled a class action with 20,000 junior medical officers for $230 million over the practice.

While ASMOF initially advanced a demand for a 30 percent pay rise, this was never more than posturing. Last Monday night, just hours before the strike began, union officials offered to cancel the walk-out in exchange for a paltry 10 percent “interim” pay rise.

The state Labor government, led by Premier Chris Minns, refused this deal for two reasons: First, it is completely hostile to any deviation from its de facto wage cap policy, and second, because it was confident the ASMOF bureaucracy would do everything it could to help impose an even deeper sell-out.

ASMOF was compelled by both the determination of doctors and the intransigence of the Minns government to proceed with the three-day strike. But the bureaucracy ensured that this was nothing more than a temporary venting of frustration that could not be allowed to happen again.

The ASMOF-Labor strike ban also extends to staff specialist psychiatrists. Earlier this year, ASMOF orchestrated their mass resignation, based on the lie that threatening such action would prompt an improved pay offer from the Minns government. When such an offer was not forthcoming, ASMOF left psychiatrists to decide alone, as individuals, whether to quit or remain in the job, with no improvements to wages and conditions and no plan to fight for them.

It follows the NSW Nurses and Midwives’ Association (NSWNMA) pledging to shut down all substantive industrial action by its more than 50,000 public sector members until at least September—18 months after their pay dispute began. The thousands of nurses and midwives who took part in multiple mass strikes across the state have been sidelined by the union bureaucracy, in favour of pathetic “own-time” protests and calls for workers to appeal to individual members of the very government that is attacking their wages and conditions.

Moreover, the Health Services Union (HSU), which covers broad sections of other health workers, rammed through a pay “rise” last year that was identical to the one workers had decisively voted down months earlier.

Taken together, these acts of suppression and betrayal by the union bureaucracies are preventing public health workers throughout NSW from fighting the Labor government’s attack on their real wages and conditions.

ASMOF and the NSWNMA are instead fostering illusions that workers’ demands can be won in the IRC. This is a fraud. The IRC, which has declared illegal virtually every strike by health workers in recent years, resulting in tens of thousands of dollars in fines against unions, is a thoroughly anti-worker institution. It functions as an instrument of big business and the state government to enforce their demands and suppress opposition from workers.

The unions promote the IRC, and its federal counterpart, the Fair Work Commission, as “independent umpires,” precisely because they rely on the draconian powers of the industrial courts to intimidate workers and shut down struggles. As well, the protracted timelines with which the tribunals operate serve to drag out disputes interminably, allowing the energy of workers to dissipate.

For NSW doctors, nurses and midwives, the immediate effect of these union-enforced delays is to effectively impose the Labor government’s de facto wage cap for at least the first year, despite the overwhelming opposition of staff.

It underscores that what all NSW public health staff—from cleaners to nurses to specialist doctors—are up against is not just a hostile and intransigent state government, but a union apparatus that is hell-bent on enforcing all of Labor’s demands.

This is not by any means confined to one state. What is taking place in NSW is just one expression of the austerity agenda of every Labor government and the ruling class as a whole. But the health unions—among the most stridently campaigning for Labor in the federal election—are desperately trying to cover this up, presenting the Minns government as some kind of unique aberration.

It is worth recalling that the health unions, especially the NSWNMA, campaigned vociferously for Minns himself in 2023. They falsely claimed that electing a Labor government would bring about an end to the public sector wage cap as well as nurse to patient ratios and other improved conditions in health.

What this illustrates, above all, is that the interests served by the union apparatus are not those of workers, but of big business, Labor and the political establishment. It poses the urgent need for health workers to build new organisations of struggle, rank-and-file committees, in every hospital and health facility.

Through such committees, doctors, psychiatrists, nurses and midwives, and all other health workers can take up a fight for improved wages and conditions based on their actual needs, not what governments and union bureaucrats say is affordable.

This is inseparable from the fight against the decimation and privatisation of healthcare, and for a high-quality public health system, accessible to all. This poses fundamental political questions.

The increasingly dire conditions in health care, for staff and patients alike, all stem from the incompatibility of capitalism—under which every decision is based on the profit interests of big business—with social needs, including the preservation of human health and lives.

The alternative is the fight for a socialist program, aimed at establishing a workers’ government to place the banks, corporations and healthcare under democratic workers’ control and ownership. Only then can society’s vast resources be directed towards meeting human needs, including free, high-quality medical treatment, with fair wages and conditions for all staff, instead of the demands of the financial and corporate elite.

To fight for this, workers need a new party! The Socialist Equality Party is the only political organisation advancing such a perspective in the coming federal election, and fighting to build a mass socialist party, independent from and opposed to all of the capitalist parties.

Authorised by Cheryl Crisp for the Socialist Equality Party, Level 1/457-459 Elizabeth Street, Surry Hills, NSW, 2010, Australia.