TASMANIAN INDUSTRIAL COMMISSION
Industrial Relations Act 1984
s23 application for award or variation of award

Health Services Union of Australia, Tasmania No. 1 Branch (Health and Community Services Union)
(T14020 of 2013)

and

Minister administering the State Service Act 2000
(Department of Health and Human Services)

PRESIDENT T J ABEY
DEPUTY PRESIDENT N M WELLS
COMMISSIONER M A GAY
	
HOBART, 11 April 2014	

Award variation – powers – jurisdiction - wage fixing principles – work value principle – datum point – datum period – professional rates– significant net addition – assessment of change – bargaining – award/agreement consolidation – no disadvantage test – paramedic – paramedic student – paramedic intern – intensive care paramedic – flight paramedic (fixed wing) – flight paramedic (helicopter) – branch station officer – clinical support officer – paramedic educator – extended care paramedic – manager – clinical practice guidelines – protocols – order issued

DECISION

Table of Contents
Introduction
The Proceedings
The Statutory Framework
The Evidence
The Applicant’s evidence
Timothy Jacobson
John Clemhill Richardson
Emily Suzanne Byers
Richard Andrew Bugg
Matthew Christopher Cane
Ivor John Carins
Maciej Jan Samborski
Catherine Sarah McNamara
Dale Gregory Edwards
Dr Louise Colleen Reynolds
Dr Marielle Ruigrok
Paramedics as a Profession
The Respondent’s evidence
Tony Ferrell
Shaun White
Sally Grimes
Andrew O’Brien
Wolfgang Rechberger
Worksite Visits
Submissions
The Applicant’s Opening Submissions
The Work Value Principles
Integration within the Health System
The Emergency Department Interface
Ramping
Independence and Autonomy
Novelty and Complexity
More Complex Patients and Assessments
Job Structure, Overtime and Emergency Responses
Increase in Violence and Anti-Social Behaviour
Changes in the Use of Drugs
Professionalisation of Ambulance Work – Graduate Engagement
Continual Training/New Equipment
The Applicant’s Final Written Submissions
Consideration of ‘Significant’
Education
Changes in Pharmacology
The Protocols v The CPGs
The CPGs as Constraints
The CPGs as Dynamic
In Summary – Protocols as to CPGs
Airway Management and Cardiac Interventions
Pulse Oximetry and Easier Work
‘Other Matters’
Enterprise Bargaining
Increase in Workload – increased pressure on skills and vital decision-making
Professional Rates
Valuing the Work
The Work Value Principles
The Respondent’s Opening Submissions
The Applicant’s ‘Real Aim’
The 1988 Case
‘Incremental’ Change
The Application’s Deficit
Comparison of Rates
‘Industrial Merit’ Considerations
The Public Interest
The Retired Principles
Continuing Utility of the Principle
The Datum Point
The Rates “Unstacked”
Transposing Relativities
Award Powers and Principles
The 1988 Work Value Case
A Significant Net Addition since 1988?
Extended Scope of Practice
The Acknowledgement
Education and Training
Clinical Practice Guidelines
Mentoring
Professionalism
Environmental Factors/Workload
Overtime
The ICP Classification
Expanded Scope of Practice
Specialist Classifications
Branch Station Officers
Paramedic Students and Interns
Post 1988 Pay Outcomes/Bargained for Increases
Wage Comparisons
Capacity to Pay – Wages Policy
Disposition
The Respondent’s Final Written Submissions
The Application as Contrary to the Statutory Scheme
Significant Net Addition
Skills and Responsibilities
Environmental Factors
Workload/Intensity
Overtime
Relativities
Enterprise Bargaining and Work Value
The Applicant’s Wage Comparison
Public Interest
The Respondent’s Final Oral Submissions
Knowledge, Education and Training
Drugs, Clinical Procedures and Equipment
The Protocols v CPGs Comparison
The Value of Change
Environmental Factors
Workload
Overtime
Professionalism
ICPs
Branch Station Officers
Clinical Support Officers
Managers
Paramedic Students and Interns
Transposing Relativities
The 2010 Agreement
Professional Rates
Comparisons
The Public Interest
The Applicant’s Oral Submissions – in reply
The ‘Unaltered Fundamentals’ and ‘Easier Work’
Additional Matters
The ACT Private Arbitration case
Branch Station Officers and Clinical Support Officers
Consideration
The Work Value Principle
Case Law
Powers/Jurisdiction
Significant net addition
The Datum Point
What is Net Addition?
Double-Dipping
Evolutionary or work value change?
Change experienced by the Paramedic Classification
Change experienced by the ICP Classification
Further examples of change
Change experienced by the BSO and BSO (ICP) Classifications
Change experienced by the CSO Classification
Change experienced by the Flight Paramedic Classifications
Change experienced by the Paramedic Educator Classification
ICPs working as ECPS
Change experienced by the Paramedic Intern and Paramedic Student Classifications
Managers
Workload and Overtime
Assessment of change
Change as a regular and systematic feature of a classification
The value of the significant net alteration
Discounting
Sub-principle 9.5
Internal and External influences
Professional Rates
Consolidation of Award
Bargaining and Work Value
Industrial Agreements reflecting Work Value Compensation
Discounting for Bargaining
Conclusion
Public Interest
Professional Rates
Rates of Pay
The Relativities
The New ECP Classification
In Conclusion

Introduction

[1]	On 15 January 2013, the Health Services Union of Australia, Tasmania No.1 Branch (HACSU) (the applicant), applied to the President, pursuant to s23 of the Industrial Relations Act 1984 (the Act) for a hearing before a Commissioner seeking the variation of the Tasmanian Ambulance Service Award (the Award).  The application listed the Minister administering the State Service Act 2000 (the Department of Health and Human Services (DHHS)) as the respondent (the respondent).

[2]	The application seeks for the Award to be varied by including the classification structure for Paramedics employed by Ambulance Tasmania (AT) as contained in the then current industrial agreement registered pursuant to s55 of the Act, known as the Ambulance Tasmania Agreement 2010 (the 2010 Agreement).  The application seeks further for the Commission to conduct a work value review of the above classifications according to the Work Value Principle of the Commission as contained in the Tasmanian Industrial Commission Review of Wage Fixing Principles - July 2008 as were in effect at 26 July 2009.  The respondent agreed that such a work value examination of the classifications set out below should occur and that it be conducted according to the Work Value Principle in effect on 26 July 2009:

•	Paramedic Student
•	Paramedic Intern
•	Paramedic
•	Intensive Care Paramedic (ICP)
•	Flight Paramedic – Fixed Wing
•	Flight Paramedic – Helicopter
•	Branch Station Officer (BSO)
•	Branch Station Officer – Intensive Care Paramedic (BSO ICP)
•	Clinical Support Officer (CSO)
•	Paramedic Educator – Levels 1 and 2
•	Manager – Levels 1, 2, 3 and 4

[3]	We note that the application does not cover all classifications within the Award and specifically excludes Communications Officers.

[4]	The inclusion of this classification structure into the Award provides for a new classification of Flight Paramedic – Helicopter.  This classification was a matter reserved for further consideration in the 2010 Agreement and was the subject of a consent order of the Commission dated 8 January 2013 in T13854 of 2011 following proceedings and an inspection conducted by the President.  The consent order is discussed later in this decision.

[5]	The parties advised through evidence that AT currently employees two ICPs, through a trial project, as Extended Care Paramedics (ECPs).

[6]	The applicant also advanced a claim seeking professional rates of pay for paramedics and associated classifications, on the grounds that paramedics are professionals, now operating with a body of knowledge which they apply when treating a patient.  The respondent, without denying that employees covered by the Award and 2010 Agreement conduct themselves professionally and are well regarded by the community, does not accept that the concept of ‘professionalism’ or ‘professional rates’ is relevant to work value or otherwise warrants a review of pay rates.

The Proceedings

[7]	The application was allocated to Wells DP and a directions hearing was held in Hobart on 26 March 2013.  As a result of that hearing the Deputy President issued an interim decision, regarding how the case would be conducted, and directions on 27 March 2013 which provided for the filing and serving of outlines of submissions, witness statements and any other information on which the parties wished to rely.

[8]	On 24 June 2013, a further conference was conducted and the Deputy President issued amended directions which provided altered timelines providing for 10 days of hearings to commence on 2 September 2013.

[9]	The hearing of the matter commenced on 2 September 2013, continuing on 3 and 4 September 2013.  Mr M Irving appeared as counsel for the applicant together with Mr T Jacobson and Mr L Digney of the HSUA.  Mr R Dalton appeared as counsel for the respondent together with Ms W Fauvel, solicitor.

[10]	The Deputy President formed the opinion that issues had arisen that were of such significance that the matter should be dealt with by a Full Bench and advised the President of her opinion.  The President concurring, issued a decision on 18 October 2013, determining, pursuant to s24(4) and s24(4D) of the Act, to refer the matter to a Full Bench.

[11]	On 20 September 2013 a directions conference was held and further amended directions were issued that day, which centred on the promulgation of an Agreed Statement of Facts, with a view to narrowing the matters in dispute.  At this conference it was proposed by the Full Bench, and agreed by the parties, that the evidence given on 2, 3 and 4 September 2013 would not have to be repeated - President Abey and Commissioner Gay having familiarised themselves with the relevant transcript and associated documentation.

[12]	The Full Bench heard further evidence on 14, 15 and 16 October 2013 with closing submissions heard on 4 and 5 November 2013.

The Statutory Framework

[13]	On 27 July 2009, following a review by a Full Bench of the Commission, the Wage Fixing Principles, then in affect were retired, with the exception of the Principles dealing with incapacity to pay and pay equity.  Notwithstanding this, the parties in the present matter are agreed that the previous Work Value Principle as existed until 27 July 2009, should be applied by the Full Bench in this matter.  The Work Value Principle relevantly provides:

“9.1	Changes in work value may arise from changes in the nature of the work, skill and responsibility required or the conditions under which work is performed.  Changes in work by themselves may not lead to a change in wage rates.  The strict test for an alteration in wage rates is that the change in the nature of the work should constitute such a significant net addition to the work requirements as to warrant the creation of a new classification or upgrading to a higher classification.

	These are the only circumstances in which rates may be altered on the ground (check) of work value and the altered rates may be applied only to employees whose work has changed in accordance with this principle.

9.2	Where new or changed work justifying a higher rate is performed only from time to time by persons covered by a particular classification or where it is performed only by some of the persons covered by the classification, such new or changed work should be compensated by a special allowance which is payable only when the new or changed work is performed by a particular employee and not by increasing the rate for the classification as a whole.

9.3	The time from which work value changes in an award should be measured is, unless extraordinary circumstances can be demonstrated, the date of operation of the second structural efficiency adjustment allowable under the 30 October 1989 State Wage Case decision, or the date of any increase awarded in accordance with this principle since that date.

9.4	Care should be exercised to ensure that changes which were or should have been taken into account in any previous work value adjustments or in a structural efficiency exercise are not included in any work evaluation under this principle.

9.5	Where a significant net alteration to work value has been established in accordance with the principle, an assessment will have to be made as to how that alteration should be measured in money terms.  Such assessment should normally be based on the previous work requirements, the wage previously fixed for the work and the nature and extent of the change in work.  However the Commission will also take account of the relativities and the integrity of the internal award classification structures and the external classifications to which that structure is related.

9.6	The expression “the conditions under which work is performed” relates to the environment in which the work is done.

9.7	The Commission should guard against contrived classifications and overclassification of jobs.

9.8	The conditions under which the work is performed, taken into account in assessing an increase under any other principle, shall not be taken into account in any claim under this principle.”

[14]	Clause 13 Work Value Claims of the 2010 Agreement provides:

“Any future work value claim increases will be taken into account and be offset by the wage increases and structural adjustments contained in this Agreement.”

[15]	For completeness, we note that Clause 13 Work Value Claims of the Ambulance Tasmania Agreement 2013 (the 2013 Agreement) which came into effect on 24 February 2014 provides:

“Any work value claim made subsequent to the registration of this agreement that results in any salary increases will be taken into account and be offset by the wage increases contained in the Agreement.”

[16]	Both parties submitted that the wage and structural adjustment increases contained within the 2010 agreement totalled 11% (including the compounding factor).

[17]	The applicant submitted that the Act allows for the Award variation sought, pursuant to s19, which reads:

“19.	Jurisdiction of Commission

(1)	Subject to this Act, the Commission has jurisdiction to hear and determine any matter arising from, or relating to, an industrial matter.

(2)	For the purposes of subsection (1), the Commission may –

(a)	Make, vary, rescind or correct an award or order; …”

[18]	Further, the applicant contended that s20 of the Act enables the Commission to act according to the merits of the case and having regard to the public interest (see s36).

[19]	The respondent, although mounting a full case in reply, also relied upon a jurisdictional objection, contending that an implied limitation constrained the way in which the Commission should give effect to the powers conferred by s19.  This was said to arise from the ‘long title’ of the Act, providing for the Commission, inter alia, “to encourage workplace bargaining”.

The Evidence

[20]	On 9 October 2013, in accordance with the directions, the parties lodged an Agreed Statement of Facts which provided that the datum point for measuring work value change was to be the date of the last work value decision on 6 October 1988 (the datum point).

[21]	Amongst the wide range of material put into evidence were the following documents:

•	the 2001, 2004, 2007 and 2010 AT Enterprise Agreements
•	the AT Patient Extrication (Preservation of Entitlements) Agreement 2006
•	Extracts from medical journals on professionalism
•	Victorian Inquiry into strategies to reduce assaults in public places and associated correspondence
•	Modelling and statistics on workload (AT Annual Report)
•	Graphs prepared from statistics and tables from the Report on Government Services (ROGS), together with AT memorandums and press releases
•	Comparison of enterprise agreements involving ACT and SA Ambulance Services with Tasmanian Allied Health Professionals
•	Compendium of pharmaceuticals in use with AT
•	AT criteria and assessment led referral protocols and operational resources
•	Correspondence relating to classification of Paramedic – Helicopter, together with photographs of helicopter working conditions
•	Various newsletters and notices involving training of AT volunteers
•	Parliament of Tasmania Joint Standing Committee on Community Development 2003 report on Ambulance services in Tasmania
•	Email correspondence from AT to employees on performance of 12-lead ECG
•	AT’s Triage booklet and isolated branch stations package
•	Agreed statement of facts including attachments showing the agreed “Changes in Equipment from 2000 – 2013”, “Paramedic Ambulance Inventory” which was a comparison of inventory from 1988 and 2013, pharmacology progression for paramedics and ICPs, the parties comparison of AT Paramedics against the comparator report used in the ACT work value case for Paramedics and a graph of AT incident data
•	Details of the Diploma of Paramedical Science (Ambulance) under the Australian Qualification Framework
•	12-lead ECG Paramedic Practice Resource Book from Queensland Ambulance Service, examples of 12-lead ECG readouts
•	Comparison, by the applicant, of Paramedics’ and ICPs’ practice in 1990 and 2013 (which was the subject of cross examination)
•	State of Public Health 2013 report (DHHS publication)
•	Transcript of previous Commission matter involving the parties, namely T13717 of 2010
•	AT letters of authority to practice for Paramedic and ICP
•	AT time sheets
•	Memorandums on Maintenance of Preparedness for Duty – Helicopter & Wilderness and attendance at training activities when off duty
•	Annual Report 2011-12 of the Council of Ambulance Authorities
•	Various correspondence between the parties relating to enterprise bargaining and this application to vary the Award
•	Tables (by the respondent), summarising the outcomes of the 1988 work value case for Ambulance Officers in Tasmania, showing a comparison of Award base wage rates of Paramedics and ICPs against the Enterprise Agreement 1988-2012
•	Comparison (by the respondent) of wage rates in Tasmania to other States of Australia
•	AT Clinical Practice Guidelines (CPGs), together with changes introduced in September 2012, statistics as to AT retrospective case audits December 2012 to July 2013 and graphs showing Clinical Audit Variances from December 2012 to July 2013
•	Table analysing AT call centre data by year
•	AT’s 1991 Protocols
•	Outline of evidence provided by the respondent
•	AT’s Medical Consult Policy, Extension of Shift Policy, Safety for Ambulance Personnel Policy, Dispatch of Dedicated Single Staffed Vehicles Policy, updates relating to Transfer of Patients with Medications, Hospital Bypass, Extension of Shift Policy and Roster Reform Group
•	AT’s 1980 Pharmacological annexure for the 1980 Protocols
•	AT’s Clinical Audit Plan (undated)
•	Copies of Paramedic guidelines for treatment of pain, together with the 1991 and 1980 versions
•	Copies of Paramedic guidelines for use of Adrenaline from 1980 and the current CPGs, together with other specific copies of CPGs
•	Response by the respondent as to applicant witness report on use of pharmacology
•	AT’s Internal Expression of Interest document for Extended Care Paramedic positions
•	Various documents relating to enterprise bargaining between the parties, including minutes of meetings, logs of claim, information bulletins, career restructuring, AT’s own spreadsheet relating to current rates of pay classifications contained in this application and relativities to the base Paramedic Level 1 classification and emails
•	Record of Outcome from T13854 of 2011 relating to Paramedic – Helicopter
•	Operational Research in Health Ltd’s (ORH) final report titled “Service Development Planning State-Wide Emergency and Medical Services” dated 1 December 2010 together with ORH’s second report dated 16 April 2013
•	Excerpt from “Report on Government Services 2013” prepared by the Steering Committee for the Review of Government Service Provision relating to age profile and attrition of AT’s workforce
•	Map of Tasmania showing the location of AT’s response points as at May 2013 and organisational chart for AT
•	Various statement of duties (both current and previous) for Paramedic, ICP, Branch Station Officer, Branch Station Officer (ALS), Supervisor, Paramedic Student, Paramedic Intern, Flight Paramedic, Clinical Instructor (Patient Care) and (Patient Extrication and Driver Training), Clinical Support Officer Levels 1-3, Ambulance Educator, Paramedic Educator, Volunteer Educator, Supervisor (Tactical Operations), Duty Manager, Operations Manager, Regional Manager, bundle of Superintendent roles, Director Clinical Services and Manager Education and Professional Development
•	AT’s Fatigue Management Policy dated December 2010, together with AT’s “Fit for Duty – Staff guidance booklet” (undated) and Service Update No. 5 2012
•	Tasmania’s Sentencing Advisory Council Final Report entitled “Assaults on Emergency Service Workers”, March 2013, together with AT’s submission to that Council
•	AT’s Occupational Violence Working Group recommendations and actions table (undated)
•	Media Release of Acting Premier Paul Lennon dated 19 March 2004 relating to the 2004 Enterprise Agreement negotiations
•	AT document detailing a proposed consultation trial to allow non Advanced Life Support (ALS) Ambulance Officers (Paramedics) to administer certain ALS-only drugs, dated 2005
•	Various decisions of the AIRC/FWA/FWC, TIC, NSWIRComm, WAIRC, NSWCCA and FCA.

[22]	Submissions consistent with the directions were filed by both parties together with detailed closing submissions.

[23]	Witness statements for the applicant were filed by:

•	Mr Timothy Jacobson, Assistant Secretary, HACSU
•	Mr John Clemhill Richardson, Clinical Support Officer, AT
•	Ms Emily Suzanne Byers, Paramedic (now ICP), AT
•	Mr Richard Andrew Bugg, Paramedic (ICP) – Helicopter, AT
•	Mr Matthew Christopher Cane, ICP and Extended Care Paramedic, AT
•	Mr Ivor John Carins, Flight Paramedic (ICP), AT
•	Ms Nicole McLoughlin, Branch Station Officer, AT
•	Mr Maciej Jan Samborski, Branch Station Officer (ICP), AT
•	Ms Catherine Sarah McNamara ASM, Duty Manager (Communications), AT
•	Mr Dale Gregory Edwards, Senior Lecturer, University of Tasmania, Tas
•	Dr Louise Colleen Reynolds, Lecturer, Flinders University, SA
•	Dr Marielle Ruigrok, Director of Emergency, THO-North West, Tas.

[24]	Witness statements for the respondent were filed by:

•	Mr Shaun White, Director of Clinical Services, AT
•	Ms Sally Grimes, Human Resources Manager, AT
•	Mr Andrew O’Brien, Manager – Technical Services, AT
•	Mr Wolfgang Rechberger, Manager – Aero-medical and Medical Retrieval Division, AT.

[25]	Witness statements in reply were filed by:

•	Mr Timothy Jacobson
•	Mr John Clemhill Richardson
•	Mr Richard Andrew Bugg
•	Mr Matthew Christopher Cane
•	Mr Ivor John Carins
•	Mr Dale Gregory Edwards (together with a supplementary statement)
•	Dr Louise Colleen Reynolds
•	Dr Marielle Ruigrok.

[26]	Workplace inspections were carried out on 18 and 19 July 2013 by Wells DP at AT Headquarters, 12 Brisbane Street, Hobart, Hobart Airport, Sorell Branch Station and at a call-out site at Kingston.  These inspections provided a demonstration of skills, equipment and worksite familiarisation.  This included the administration of drugs to a simulation training dummy and the use of the 12-lead ECG.

[27]	Where in this decision we refer to “paramedics”, this term incorporates all classifications which require a paramedic qualification.  Where we refer to “Paramedics”, this refers to the specific classification of Paramedic within the 2010 and 2013 Agreements.  The use of the term “Ambulance Officer” indicates the predecessor role and is the term used for “paramedics” until the mid to late 2000s.

The Applicant’s evidence

Timothy Jacobson

[28]	Mr Timothy Jacobson, Assistant Secretary, HACSU gave his evidence both orally and by statements substantially concerning the history of enterprise bargaining for paramedics, State Government wages policy and comparisons of ambulance employees - both across jurisdictions and with other health professionals in Tasmania.  In particular his evidence was that the wage and structural adjustments achieved in enterprise negotiations had not involved any work value considerations.

[29]	Mr Jacobson’s evidence was that it was incorrect for the respondent to assert that the 2010 Agreement was a ‘professional rates’ agreement.  He said that from the end of the Tasmanian Ambulance Service Agreement 2007 (the 2007 Agreement) and the end of the 2010 Agreement (some 3 years and 11 months), paramedics received an 11% increase which could not reflect implementation of professional rates of pay.  Mr Jacobson’s view was that these agreements did not involve any work value review or exercise.

[30]	It was Mr Jacobson’s evidence that the then current State Government wages policy, in effect since 2011, made it impossible to negotiate work value pay rises of the kind sought in this application.  This was because a pay cap of 2% was in effect with an absolute barrier of .5% to any efficiency or other basis (ie work value) for increasing pay rates.

[31]	Mr Jacobson’s evidence also dealt with an increase in caseload for paramedics at AT.  He said that Government Budget Papers showed caseload over the last 10 years, between 2001/02 and 2010/11, had increased 123% and whilst increases in staffing had occurred between 2002 and 2013, the current staffing profile of AT was inadequate.  He stated this was because the Operational Research in Health Ltd (ORH) Report modelling used by AT did not take account of certain types of leave currently accessed by paramedics that averaged 23.17 days per year per staff member and this in turn led to a high incidence of overtime for staff.  The ORH Report was commissioned in 2010 by the State Government to identify the priority for future emergency ambulance service resources.

[32]	Mr Jacobson provided evidence that in the 1970’s, ambulance officers at AT could undergo a 2 week training course to use the ‘jaws of life’ for serious road accidents (Patient Extrication qualification).  He said that in 2006 patient extrication ceased being performed by Ambulance Officers (AOs), that at that time the skill was rarely being used and that change was quite minor in the scheme of the overall work performed by paramedics.  Mr Jacobson said whilst some older AOs maintained their patient extrication classification level via a preservation agreement, the maintenance of that classification was removed in the 2010 Agreement.

[33]	Mr Jacobson’s evidence also went to an increase in violence against paramedics, it being said that union members had reported increased occurrences of threatening behaviour and aggression and that, as a National Executive member of the union, he was aware that other States’ ambulance services were also concerned about levels of violence.  Mr Jacobson relied on the fact that the State Government was introducing legislation to protect emergency service workers from such behaviour and on similar concerns expressed by AT in its submission to the recent Tasmanian Sentencing Advisory Council Report entitled Assaults on Emergency Service Workers, March 2013.  The AT submission stated in part:

“Although the statistics provided within the report identify only a limited number of assaults on ambulance staff, it should be noted that this is mostly reflective of an ambulance culture of poor reporting or an incorrect acceptance that aggression towards ambulance staff is part of the job.” 

[34]	Mr Jacobson’s evidence also made comparisons of the work and wages of AT paramedics against paramedics in other States and with Allied Health Professionals in Tasmania.  He said that the change, as a minimum entry point, from vocational education and training to tertiary qualifications as a Paramedic (Bachelor of Paramedic Practice), and the increasing range of clinical interventions and complexity, required enhanced technical skills.  It was Mr Jacobson’s evidence that the duties undertaken by AT Paramedics and ICPs are most closely aligned with the work of paramedics in the Australian Capital Territory (ACT) and South Australia (SA).  Further, that when comparing AT paramedic work to Allied Health Professional (AHP) duties in Tasmania, the work accorded with AHP Level 3, due to the bachelor degree entry level, professional development requirements and the requirement to exercise independent judgement while working largely autonomously.

[35]	In cross-examination, Mr Jacobson confirmed the applicant was seeking a 25% wage increase, compounding for more senior classifications, based on work value considerations, above the parties’ agreement to incorporate the 2010 Agreement classifications and remuneration into the Award.  His evidence was that the significant wage increases over three years struck in 2004 to apply to police, nurses and Ambulance Officers, and announced by the Acting Premier in a media statement, was a ‘catch up’ payment due to the public service lagging behind the private sector and public servants in other States.  Mr Jacobson’s evidence was that he exerted no influence over how the Acting Premier chose in 2004 to represent these wage increases.  Mr Jacobson said similar increases were awarded across the public sector in Tasmania in 2008.

[36]	Mr Jacobson’s further evidence provided that the respondent had incorrectly suggested that the creation of the Flight Paramedic – Fixed Wing classification or the consent position reached in 2013 providing for a new Flight Paramedic - Helicopter classification (in matter T13854 of 2011), accounted for work value increases.  Under cross-examination, it was Mr Jacobson’s evidence that the Flight Paramedic - Helicopter classification matter took two and half years to negotiate and that over this time the parties positions changed on a number of occasions, but ultimately was based on an “all-time rate” for Paramedics operating in the helicopter environment.

John Clemhill Richardson

[37]	Mr John Richardson is a Clinical Support Officer with AT.  A Clinical Support Officer provides training and clinical support to paramedics on the road, assessment of patient acuity, assessment of Paramedic Interns, audits of paramedic cases and membership of AT’s Regional Quality Assurance Group.  Mr Richardson commenced employment with AT in 1982 as a Student Ambulance Officer (SAO).  Mr Richardson gave his evidence both orally and by statements for the applicant, which went to the work changes experienced by paramedics from 1988 to the present, the changes in pharmacology, procedures and increased complexity in decision making.  He said that previously Ambulance Officers would administer basic treatment to the patient and quickly transport them to hospital.  In contrast, he said today’s paramedic provides a definitive level of care to the patient, makes a differential diagnosis and even declares the life of a patient to be extinct.

[38]	The evidence of Mr Richardson also dealt with the higher level of complexity paramedics now face due to increases in day surgery cases, people living longer with co-morbidities and surviving with medical conditions that, without medical advances, would previously have been fatal.  He said paramedics assess patients and triage them into either referral or immediate intervention & transport categories.  Where intervention and transport is warranted, it was Mr Richardson’s evidence that doctors and nurses regularly rely on the information he provides them to target their own treatment.

[39]	Mr Richardson’s evidence provided an example of the professional recognition afforded to paramedics by the fact that after he completed the Advanced Paediatric Life Support course, he was selected to become an instructor of this course and now trains doctors in the emergency management of critically ill children.

[40]	It was Mr Richardson’s further evidence that the scope of practice for paramedics is ever-increasing and the Clinical Practice Guidelines (CPGs) are becoming more complex.  He said that in 1991 the AT Protocols covered 32 conditions, whereas, the current CPGs introduced in 2011, cover 97 conditions in far greater detail which requires the exercise of greater clinical judgement by paramedics.  Mr Richardson also stated that where the 1991 Protocols had one protocol dealing with assessment; the CPGs have 9 guidelines governing assessment.  He says the change from Protocols to CPGs requires continuing professional development, higher skill levels and higher levels of clinical judgement.  Mr Richardson also said that at times the CPGs can be deficient or not reflective of best practice.  He gave examples of this and discussed the process for CPG changes.  He said paramedics do not simply follow guidelines they know to be incorrect - they use their clinical judgement.

[41]	Mr Richardson said one of the biggest changes in paramedic practice since he commenced with AT is the new equipment, new medications and new uses for those medications.  He gave the example of the drug Midazolam, which is a sedative and seizure-terminating agent used to treat a wide variety of conditions.  He said it is a complex drug as it has significant adverse effects; for example, it may cause the patient to stop breathing.  Its effectiveness also varies depending on the age of the patient, the route of administration and their medical condition.  It is a drug likely to be administered to agitated patients at risk of harming themselves and/or others.  The CPGs call for a large dosage ranging between 0.05mg per kilogram and 10mg per kilogram, and that a body of knowledge including the human anatomy and physiology, pathologies and trauma, combined with clinical experience, is required to exercise the necessary judgements involved in the administration of such a drug.

[42]	Mr Richardson provided a further example of a drug new to AT, namely, Ketamine, which is another sedative agent used substantially for pain relief.  It is extremely effective but has significant side effects and requires considerable experience to determine dosage and patient suitability.  He said both Ketamine and Midazolam are administered by ICPs only, however the Bench noted that the Agreed Statement of Facts provides that Midazolam can be administered by Paramedics.  Mr Richardson provided examples of Frusemide (ICP only) and Saline and a report on the changing use of drugs for paramedics working at AT.  He said these new drugs and the resultant changes in their use required increased knowledge on the part of paramedics.

[43]	Work changes involving procedures performed by paramedics were also noted in Mr Richardson’s evidence.  This evidence went to a new procedure called Synchronised Cardio-Version which involves an ICP drugging a patient, stopping their heart and restarting it in a more stable rhythm.  Mr Richardson provided a real example of unsuccessful interventions which lead to Cardio-Version being performed by him at the scene of an accident.  He said such decisions were made by him, on his own or with very little help and that complex decisions in time critical environments are made by him at all times of the day and night and in uncontrolled environments.

[44]	It was Mr Richardson’s evidence that the change from a 3-Lead Electrocardiogram (ECG) to a 12-Lead ECG has allowed paramedics to diagnose the different types of Myocardial Infarctions (heart attacks) and to treat them differently.  Depending on the interpretation of the 12-Lead ECG read out, a patient may or may not be administered the drug Glycerl Trinitrate (GTN), depending on whether or not they have a right-sided infarction.  He said that although the CPGs tend to suggest that this drug should be administered to all cardiac patients, paramedics have the knowledge to make informed decisions about when, and critically, when not, to administer GTN.  He also stated the new Pulse Oximeter equipment used by paramedics to determine oxygen saturation levels and the changed science on administration of oxygen to patients, required the use of greater knowledge and skill.

[45]	Mr Richardson gave comprehensive examples of changed procedures for management of ventilation and airways in cardiac patients since 1988 (most of which occurred post mid-1990s), and also the administration of cardiac drugs, including broader treatment and Paramedics being able to administer drugs which previously were by ICP administration only.  Mr Richardson stated that new administration routes for drugs were also available should an Intravenous (IV) line fail.  He said these included an ICP only invasive process known as the intraosseos method.  This method involves the ICP drilling a hole into the bone of the patient and administering the drug via that route.  He said this is a more important procedure for children, where it can be more difficult to establish an IV line.

[46]	Mr Richardson also gave evidence as to the further range of treatments paramedics deal with including Pulmonary Oedema, Continuous Positive Airway Pressure (CPAP) and intubation of patients (ICP only).  He said these treatments are broader, more complex and required greater clinical judgment than previous treatments by AO-ALSs.

[47]	Mr Richardson’s evidence was that 5 to 10 years ago AT made a significant change in triaging of patients so that paramedics are now trained to negatively triage.  He said this may require a paramedic, in some circumstances, to leave a patient to die to enable treatment to be administered to a patient who may be saved.  He said this involved a clinical judgement call on the part of the paramedic and that there are few or no decisions more onerous.  Mr Richardson said AT’s multi-casual incident plan calls for paramedics to triage patients.

[48]	In cross-examination, Mr Richardson said the CPGs require a paramedic to make a preliminary diagnosis, as the CPGs are not set up under signs and symptoms, but are categorised by medical conditions.  This allows the paramedic to follow particular ‘treatment pathways’, but not all scenarios are catered for in the CPGs.  He confirmed there was no authority granted by AT for paramedics to operate outside the CPGs, but he said it happened regularly and these cases were reviewed by the Regional Quality Assurance Group as a ‘variance’ to the scope of practice.

[49]	Under cross-examination there was some conjecture as to whether the CPGs allowed a Paramedic, as opposed to an ICP, to read and interpret 12-Lead ECG readouts.  It was Mr Richardson’s evidence that Paramedics regularly interpreted these readouts and he understood that particular guideline was being rewritten to allow for readout interpretation by Paramedics.

Emily Suzanne Byers

[50]	Ms Emily Suzanne Byers, now an ICP (previously a Paramedic) with AT, gave her evidence both orally and by statement for the applicant concerning the role of a Paramedic, changes in the scope of practice, work design, intensity of the work and the varying work environment.  Ms Byers is also a Registered Nurse having graduated in 2001.  She stated that her work as a Paramedic is more complex than that of a Registered Nurse, due to the breadth and scope of paramedic work, such as differing patients, jobs and environments.  Ms Byers said paramedics are no longer Ambulance Drivers providing a rapid transport to hospital; rather they are now pre-hospital health care providers.  She said that she often has to work extended shifts and that she rarely knocks off on time.

[51]	Ms Byers’ provided evidence as to her attendance at a GP surgery to assist the GP with his treatment of a patient.  It was found that an ECG previously performed at the surgery had been taken incorrectly.  Ms Byers then obtained a further 12-lead ECG read out which was interpreted and allayed the concerns of the GP, who then decided he could manage the patient.  This evidence was not challenged in cross-examination.

[52]	The evidence of Ms Byers also dealt with the professional relationships between paramedics and the Tasmanian Fire Service, specialist medical teams such as aged care and emergency department staff, referral of patients to other medical services, and described the social work aspect of the role when dealing with a patient’s family members.

[53]	Ms Byers stated that since commencing with AT in 2005, the publication of AT’s CPGs greatly enhanced the scope of practice for paramedics and that a paramedic must continually learn to keep up-to-date with modern practice and changes to CPGs.  She gave examples of changes to oxygen administration and management of pain in patients which involved the administration of new drugs.

[54]	When cross examined, Ms Byers confirmed that her evidence related to her observations since commencing employment with AT.  She confirmed her understanding of the “Authority to Practice” letter she received from AT’s CEO and that paramedics can, through a medical consult, work outside of the scope of the CPGs.  Ms Byers also stated she was not in possession of statistics but she had observed an increase in intensity of work which, in her opinion, related to patients calling an ambulance when they were unable to access appropriate resources elsewhere in the medical and aged care areas.

Richard Andrew Bugg

[55]	Mr Richard Andrew Bugg, an ICP and member of the helicopter squad with AT, gave his evidence both orally and by statements for the applicant.  He advised that he qualified as an Ambulance Officer in 2001, an ICP in 2004 and joined the Helicopter and Wilderness Squad in 2007.

[56]	The evidence of Mr Bugg went to the unique work environment, types of cases undertaken by Flight Paramedics - Helicopter, the physical requirements of the role, intensity, additional specialised training, changes in qualifications, equipment and practice, lone decision making requirements, the CPGs and the history of the role’s classification.  Mr Bugg said that whilst he and others worked within the helicopter squad, they spent most of their time working “on the road” like other ICPs.

[57]	Mr Bugg’s evidence also went to the additional specific skills that are required to be part of a small rescue team including above average physical fitness, skills in camp-craft, navigation, abseiling, rope rescue, river crossing and survival above the snowline.  He said that the usual configuration of the small rescue team is a pilot, a police officer (known as the winch-man) and an ICP.  He provided examples of collaborative team work through Crew Resource Management and provided evidence about having been winched down and left by the rescue crew, in rugged conditions, to care for a patient who could not safely be extricated due to weather conditions.  He also advised of Civil Aviation Safety Authority (CASA) regulations requiring him to have responsibilities for safety and emergency procedures.

[58]	Mr Bugg stated that he is required to undertake six-monthly winch training, vertical rescue training courses and bi-ennial Helicopter Underwater Escape Training (HUET).  HUET training involves being dropped upside down into open water whilst strapped to a seat and blindfolded.  This is designed to simulate an aircraft cabin and escape is to be made through a closed door with, and without, the use of compressed air.  He also stated that in 2009 he undertook a special course for helicopter crew members related to flying amongst power lines and other structures.

[59]	The evidence of Mr Bugg provided that to work in the helicopter squad an ICP must have completed a Graduate Certificate in Emergency Health (Aeromedical Retrieval), have certification in Cabin Safety under CASA regulations and hold a current Aviation Security Identification Card.  In contrast he said that in the early 1990’s there was no additional training requirement to work on aircraft.  He also advised of the change to a larger aircraft and resultant training requirements and the capacity for night flying which did not exist before.  He said it required a Flight Paramedic - Helicopter to be familiar with the operating conditions and limitations of two aircraft rather than one.

[60]	Mr Bugg said there had been new or additional equipment introduced in recent years that included personal EPIRBs, harnesses, satellite phones, SCUBA devices on life jackets, Capewell emergency release buckles, inflatable life jackets, ballistic flares, strobes, GPS devices and survival equipment, some of which have required specific and ongoing training for additional skills.  In addition, Mr Bugg’s evidence went to changes in winch site procedures and the use of unique equipment which is only provided to a Flight Paramedic - Helicopter which includes, specialised leg fracture splints and finger blood oxygen meters.

[61]	In relation to the creation of the classification of Flight Paramedic - Helicopter, it was Mr Bugg’s evidence that the agreement negotiated before the Commission in T13854 of 2011 was largely based around the appropriate classification for the role, rationalisation of various allowances and the elimination of structural inequities in the method of payment.  He said that matter T13854 came out of a Leave Reserved clause in the 2010 Agreement, and that the T13854 agreement outcome delivered a helicopter squad of four full-time permanent positions, although at the time of this hearing the squad had still not been established.  He said that because of the T13854 agreement, some Flight Paramedics – Helicopter received a slight increase and some received a slight decrease in wages.  Mr Bugg stated that the reserved matter was never to contest the rate of pay for a Flight Paramedic - Helicopter, but rather, to examine the merits of establishing a separate classification for ICPs operating in the helicopter squad.

[62]	Mr Bugg gave evidence that he had audited some 2,000 AT paramedic cases and provided examples of when a paramedic may need to operate unauthorised outside of the CPGs in the best interests of the patient.

[63]	Under cross-examination Mr Bugg agreed that the operation of the helicopter winch is the responsibility of the Tasmania Police Officer in the crew, and that in his role he sometimes operates under additional time pressures in certain scenarios.  Mr Bugg also agreed that part of the argument advanced by the applicant, in reaching an agreement in matter T13854 of 2011, included the additional training, difficult environment, time pressures and the requirement of a Flight Paramedic – Helicopter to be physically fit.

Matthew Christopher Cane

[64]	Mr Matthew Christopher Cane, an Extended Care Paramedic (ECP) with AT gave his evidence both orally and by statements for the applicant, largely concerning the expanded scope of practice of an EC Paramedic, the additional skills he exercises, AT’s CPGs and a comparison between paramedics, nurses and pharmacists.  Mr Cane advised he holds a Bachelor of Nursing and Bachelor of Pharmacy and is a Registered Pharmacist.

[65]	Mr Cane’s evidence provided that the role of ECP requires additional skills as against an ICP, that it is an expanded role to reduce the need for patients to present to hospital and gave examples of the type of work undertaken.  He advised that an ECPs skills include suturing, insertion/removal of catheters (indwelling and supra pubic), replacement of nasogastric tubes, starting of antibiotics (usually on Doctor consultation), anti-inflammatory therapy and additional pain relief drugs.  Mr Cane stated that ECPs are trained to interpret basic blood pathology, assess and address wound care, interpret x-rays and undertake additional patient assessments and procedures other than those of a Paramedic or ICP.

[66]	It was Mr Cane’s evidence that an ECP’s skills include working as a single responder, together with skills essentially thought of as nurses’ and doctors’ area of expertise.  He said that when he first started as a Paramedic (in 1995) these skills were never considered an area of paramedic practice.

[67]	In relation to the CPGs, Mr Cane said paramedics do not identify a specific guideline and then work their way through that guideline when treating a patient.  Rather, they continually assess and if the treatment is not working, they use their independent clinical judgment to determine another course of treatment, perhaps using a multitude of different guidelines, often jointly, before settling on the likely diagnoses.  He said with further assessment of the patient the original diagnosis may be abandoned based on evidence presented.  Mr Cane said the difference between the CPGs and previous Protocols is that paramedics now have the ability to interpret information and determine a course of action.

[68]	Mr Cane provided evidence of him having conducted over 2,000 audits of paramedic cases with AT, most recently in 2012.  He said that in almost every case he had audited, involving a variance from the CPGs, the Ambulance Service Medical Officer raised no issues with the case and/or treatment despite the fact that it was a clear variance.  Mr Cane was able to provide an example of what he termed as “good practice” variance from the CPGs, which involved increased administration of Morphine.

[69]	Looking at pharmacology, it was Mr Cane’s evidence that AT’s CPGs are no different to the therapeutic guidelines written for doctors.  He said it was up to the paramedic to consider the benefit of the drug against any possible side effects, and the outcome this may have for the patient.

[70]	Mr Cane said that paramedics could administer high level drugs (eg Ondansetron and Fentanyl) that most nurses and even some doctors can only give under direction or after consultation with more senior clinicians.  He said the extensive list of available drugs evidences the additional skills required of ICPs and ECPs.  He also said that paramedics have to carry out complex drug calculations in adverse conditions and environments and in short time frames.  Mr Cane categorically stated that the level of pharmacological knowledge expected of an ICP and an ECP is considerably more than that of a regular nurse.  Mr Cane stated that paramedics use skills such as intubation, cannulation and defibrillation which are not skills most nurses need to use.

[71]	Mr Cane also stated that previous work of paramedics was basic, unsophisticated and not always evidence based, but he says this has changed over the last decade to evidence based treatment paths.  He says this is evidenced by the fact that GPs will now call an ambulance in an emergency and are happy for treatment of the patient to be undertaken by the paramedic crew.

[72]	Under cross-examination, Mr Cane agreed that the role of an ECP was not a budgeted role within AT and was funded, on a trial basis, by the Commonwealth until 30 June 2014.  He said an ECP operates with a more expanded scope of practice than that contained in the CPGs.  It is not clear, on the evidence, whether the ECP role will continue past June 2014.

[73]	Mr Cane advised that in his role as an ECP, Co-Chair of the National Rural Health Student Network and Rural Chairperson of the Health Workforce Australia’s Future Health Leaders forum, he has observed a reduction of the availability of GP’s to the general public in Northern Tasmania and this in turn has placed increased demand on paramedics.  He confirmed his evidence on these points is anecdotal based upon his observations.  Mr Cane also provided evidence that in those roles he has observed an increase in violence toward paramedics in the last few years and that alcohol violence has risen significantly.  He said this has an effect on how he feels at work, especially when working as a ‘single responder’.

[74]	Cross–examination of Mr Cane also had Mr Cane confirm that paramedics make a provisional or differential diagnosis as opposed to a definitive diagnosis and that the CPGs specify the scope of practice within which a Paramedic or ICP has authority to act.  He said whilst there is a requirement for a paramedic to obtain a medical consult to act outside the guidelines, in practice that isn’t always what happens, particularly in exceptional circumstances.  Mr Cane said that usually the paramedic would do a post-consultation (usually with a medical practitioner at the hospital) or self-report to AT on the variance.

[75]	During re-examination, Mr Cane gave an example of the audit process at AT, reporting on circumstances of the variation to the Medical Director of the Southern Region and what may constitute an adequate explanation to a variance from the CPGs.

Ivor John Carins

[76]	Mr Ivor John Carins, a Flight Paramedic - Fixed Wing with AT gave his evidence both orally and by statements for the applicant, dealing with the work of a Fixed Wing Flight Paramedic, the work environment, training and changes in duties and practice.  He advised that he commenced employment with AT in 1998, qualified as Paramedic in 2002, an ICP in 2004 and a Flight Paramedic in 2008.  In 2009 he was Acting Regional Education Co-ordinator for Northern Operations and has seven years experience as an Acting CSO.  Mr Carins has completed a Bachelor of Health Science – Paramedic through Victoria University and a Graduate Certificate in Emergency Health (Aeromedical Retrieval) through Monash University.

[77]	Mr Carins’ evidence provided that a Flight Paramedic must be an ICP who works in a multi-disciplinary team to safely and efficiently transfer patients mainly from a hospital in Tasmania (including Bass Strait Islands) to a hospital on the mainland, as the sole paramedic on the flight.  A Flight Paramedic must have completed a Graduate Certificate in Emergency Health (Aeromedical Retrieval) which involves four university subjects with a 3 hour written exam proceeding to a practical component, have certification in Cabin Safety under the Civil Aviation Regulations and hold a current ASIC card.  Whilst stating that in the 1990s there was no training requirement to work on the aircraft other than being employed as a qualified Paramedic or ICP, he conceded in his in-reply statement that in 1994 AT provided a two day in-house training program to paramedics to work on aircraft.  It should be noted however, the introduction of this training was after the datum point of 1988.

[78]	Mr Carins stated that a Flight Paramedic is also utilised “on road” in an ambulance when the plane is not flying which includes a component of single officer response.  He said however that aeromedical services have evolved from an on-call service to a dedicated roster of over 1,000 cases a year.

[79]	Mr Carins said it is common for a Flight Paramedic - Fixed Wing to be responsible for more than one patient and sometimes their relatives.  Mr Carins advised that at times he has requested extra assistance in the form of another paramedic or retrieval doctor and sometimes he needs to take additional equipment or medication, depending on the patient.  He said it is a requirement to wear a headset so communication is possible between the paramedic and pilot.  Mr Carins said the safe loading of the patient onto the aircraft requires teamwork between the paramedic and the pilot.

[80]	Mr Carins said that if it is considered necessary for a patient to be accompanied by a doctor, then this has occurred.  He said that whilst patients were transferred from hospital to hospital, a flight paramedic needs to ensure treatment is continued, that they monitor for expected and unforseen outcomes and they ensure the patient’s safety, together with any other treatment directions advised by medical practitioners.  However, Mr Carins said that on occasions, depending on the circumstances, Flight Paramedics - Fixed Wing may be the first response to a case.  He was able to provide examples related to events on the Bass Strait Islands in 1992 and 1998.

[81]	It was Mr Carins’ evidence that a lot of tasks, when in the aircraft, are performed on hands and knees and that he was required to plan ahead to set up drugs that may need to be administered urgently to the patient.  He advised that the flight environment has to be considered and gave examples of aero-medical transfers involving clinical judgement on whether to transfer the patient.

[82]	Mr Carins said that the aircraft is routinely subject to turbulence which affects the patient and crew with fatigue, insecurity, motion sickness and an increase in pain relating to some conditions.  He said that one of the routine cases he has to deal with is spinal injury patient transfer to the mainland which requires specialist equipment.

[83]	Mr Carins’ evidence went to the Flight Paramedic - Fixed Wing being required to ensure the cabin was safe during flight, and that it was not unusual for him to be asked to “look out” for another aircraft to visually confirm its position on approach to landing.  Mr Carins gave an example of a threatened “gear up” landing when the landing gear had failed to deploy and his role in that situation.

[84]	Mr Carins said that Flight Paramedics – Fixed Wing are frequently contacted by the Duty Manager of Communications at AT to speak about flight planning.  He said this consultation involved the level of care required, the number of patients that can be accommodated, depending on the patient’s particular condition, together with sequence of patient transport, specialist equipment required and the most appropriate hospital destination.  He said it is also common for the Medical Retrieval Co-ordinator (a doctor) to contact him to discuss a case, and he provided an example of this.

[85]	Mr Carins said that the aircraft is basically a mobile Intensive Care Unit and training is done in the area of medical retrieval equipment and drugs, which involved training for skills involving syringe drivers (due to the trouble-shooting required for their operation) and critical care transport ventilators.  Mr Carins was able to provide an example of the use of this equipment.  He said prior to centralised specialist hospitals in the late 1990s, the need for medical retrieval was infrequent and flight paramedics received no training in specialist equipment.  Mr Carins stated that in the 1990s there was no specific aircraft equipment used, whereas now they use the Propaq MD, which allows a paramedic to monitor the patient’s heart rhythm, oxygen levels, breathing, expired carbon dioxide, blood pressure, brain pressure and temperature.  He advised that his knowledge of operations in the 1990s came from discussions with Mr Nicholas Chapman and Mr Greg Edsall.  Mr Carins said flight paramedics have competencies in the setup and operation of transport ventilators.

[86]	Mr Carins said that there had been an increase in the number of drugs able to be administered by ICPs and one example was Midazolam.  He said this was a potent drug which was an excellent pain reliever when used in conjunction with Morphine.  He said it takes a high level of clinical judgement to use this drug safely.

[87]	It was Mr Carins’ evidence that some Flight Paramedic – Fixed Wing cases can take up to 9 hours, with the long duty times being exacerbated by fatigue through noise, vibration, dehydration and turbulence associated with flying.  Mr Carins provided an example of a complex shift involving a number of cases.

[88]	Mr Carins said the new aircraft brought into operation by AT in May 2013 is an improvement to the aircraft used in the 1980s and 1990s, however the working environment still includes low humidity and results in increased fatigue.

[89]	Under cross-examination Mr Carins agreed that where a Flight Paramedic – Fixed Wing is required to administer medications outside the scope of practice in the CPGs, they do so under approval of a Clinical Co-ordinator.  However, he confirmed that whilst the AT policy provides that a doctor should be present on all ‘high risk’ cases, it was not always the case that a doctor was available.  Mr Carins agreed that 80% would be the approximate number of aero-medical cases for lower acuity patients.  He also agreed that the remaining 20% of cases involved medical retrieval cases (with a doctor) or paramedic retrieval cases (paramedic only), which are considered rare.  Mr Carins confirmed that the pilot in aero-medical cases has the ultimate responsibility for safety, although the paramedic also has a role.

Maciej Jan Samborski

[90]	Mr Maciej Jan Samborski, a Branch Station Officer (BSO) - ICP, based at Smithton with AT, gave his evidence both orally and by statement for the applicant, concerning chemical and biological response training, maintenance of branch stations, volunteer training and shift coverage at branch stations and new procedures undertaken.  Mr Samborski obtained an Associate Degree in Paramedic Studies with the University of Tasmania (UTas) in 2009 and an Advanced Diploma in Paramedical Science through AT in 2012.

[91]	Mr Samborski stated that it is incorrect for AT to say that no Chemical and Biological Response (CBR) training has been undertaken by paramedics in the last three years.  It was Mr Samborski’s evidence that he undertook CBR training in March 2010 and also annual refresher courses in 2011 and 2012, and was awaiting his 2013 refresher training at the time of providing his witness statement.  He said he was aware a number of other paramedics in the North West region had also undertaken the same training and refresher courses.

[92]	The evidence of Mr Samborski was that whilst some branch station maintenance was contracted to external parties, a significant number of functions still remained his responsibility, although it was a very small portion of his role (approximately 3%) and that this is not a significant function.  The maintenance duties include cleaning the station, mowing the lawns and arranging and attending periodic working bees.

[93]	In relation to Volunteer Ambulance Officer (VAO) shift coverage, Mr Samborksi said that the number of shifts covered by VAOs varies from branch station to branch station, depending on the percentage of VAO coverage.  He said that during the 2012/13 year, Zeehan branch station had less than 35% coverage on its volunteer shift roster.  Mr Samborski also said that whilst BSOs were involved in training VAOs as at the datum point, the level of training now provided by BSOs was significantly higher.  He estimated this was approximately 10% of his role.  His evidence was that in 1988 VAOs were not permitted to use a defibrillator and the main pharmacological agents used by them were oxygen and Entonox.  In comparison, he said VAOs were now able to use an automatic external defibrillator and can administer additional drugs such as Asprin, Methoxyflurane, Glucose Paste, Salbutamol, Panadeine Forte and Adrenaline (via an Epi-pen).  Mr Samborski said that VAO training was now a competency based curriculum put together by AT’s Volunteer Educators, but that most training was still delivered by BSOs.  He said in 2001/02 there was a substantial increase in VAO numbers from 380 to 530.  He said the current number of VAOs was 578.  He also said that an additional training burden had been placed on BSOs when Volunteer Educators transferred to BSOs the majority share of driver training/final assessment of VAOs, modules for work health and safety, infection control and medical terminology.

[94]	Mr Samborski provided evidence that the position description of BSOs had changed since 1988 with the inclusion of “satisfactory completion of Certificate IV in Assessment and Workplace Training” to the selection criteria.

[95]	It was Mr Samborski’s evidence that 12-lead ECG’s are used by all paramedics and that this is the base standard taught at university and assessed by AT at Paramedic level.  He said that ICPs are trained at a higher level with 12-lead ECG interpretation, as reflected in the CPG authorities to practice.  Whilst a 12-lead ECG includes the basic information of a 3 lead ECG, he said it also provides additional information which is then factored into the decision making of the paramedic.  He was able to provide an email from an AT educator, sent to all paramedics, encouraging them to use the 12-lead ECG.

[96]	Mr Samborski provided an example of him making a decision to bypass the nearest emergency department (Smithton Hospital) in the best interests of the patient.  He said those judgements do not require authorisation by a higher officer at AT.  He said it is not unusual for him to determine that a patient may be better off to be seen by their GP, rather than transported to hospital, and that in these instances he has transported the patient to the GP’s surgery.  His evidence also went to the Mersey Bypass policy which he said requires paramedics to make an assessment of the patient and then implement AT’s policy.

[97]	Mr Samborski gave evidence on the triaging role of paramedics at AT and AT’s pre-hospital Triage booklet.  He stated the triaging categories were not categorised using numbers but rather with words; Alpha, Bravo, Charlie, Delta and Echo (meaning categories of priority).  He explained that the role of a triage sieve at a multi-casualty incident was to triage patients in accordance with the seriousness of their injuries.

[98]	Mr Samborski said the Isolated Stations Package (the IS Package) was not introduced in the 2010 agreement, rather the 2010 agreement provided that the application of it was at the sole discretion of the CEO.  His evidence provided that a subsequent AT policy has limited the application of the IS Package to either offset it completely or by allowing discretion to simply refuse to apply the package to employees.

[99]	Finally, Mr Samborski adopted a witness statement that was prepared and filed by Ms Nicole McLoughlin.  Ms McLoughlin is a Branch Station Officer – Paramedic with AT based at George Town and was unavailable to give evidence at the hearing.  Mr Samborski acknowledged the statement of Ms McLoughlin in its entirety with some modifications as those matters relate to her personal experiences.  The respondent was content for the statement of Ms McLoughlin to become an attachment to Mr Samborski’s witness statement.

[100]	The respondent declined to cross-examine Mr Samborski, therefore his evidence, including that evidence he adopted from the witness statement of Ms McLoughlin, was unchallenged.

[101]	Ms McLoughlin provided in her witness statement that rural branch stations operate with a salaried/permanent officer (paramedic) working with a VAO, on a four consecutive day roster (11.5 hour day) with on call requirements overnight (12.5 hour nights).  Ms McLoughlin stated she does not live in the community in which she works, so the roster requires her to live at the Branch Station to complete the on call requirement, which effectively means that for 4 out of every 8 days, she is separated from family.  She said, in her role, she is responsible for recruiting and training all volunteers and is currently responsible for managing 30 volunteers.

[102]	Ms McLoughlin’s evidence provided that if a VAO is not available (which she said often occurs), she must respond as a single officer, which requires the next available ambulance resource to be dispatched to back her up.  She said, however, this backup is often delayed due to operational requirements and the travel time to reach her. She said this increases the autonomy of her role as a BSO.

[103]	Ms McLoughlin stated a dramatic change had taken place to clinical practice at AT since she commenced.  She specifically referenced the change from “quite rigid” protocols to practicing within the boundaries of the CPGs.  She said the CPGs allowed for more flexibility and clinical judgement to be exercised by paramedics.  She also referenced the changes in pharmacology in recent years and the greater options available to use these drugs under the different CPG pathways.  She cited the increase in the scope of practice for Paramedics, over recent years, through drugs such as morphine and antiemetic drugs (used to stop vomiting) drugs and the use of the 12 lead ECGs.

[104]	Ms McLoughlin stated that in addition to the 4 day roster she also sometimes works overtime shifts, however she tries not to complete too many of these overtime shifts due to the stresses it can create.  She stated that it is her observations that workload and scope of practice has increased since she became a Paramedic in 2002.

[105]	Ms McLoughlin’s statement provided that the entry level requirements are now more demanding with AT than when she commenced prior to 2002.  She said to be eligible for a role with AT students now must complete all formal university undergraduate studies prior to applying/obtaining a post-graduate position.  They must then complete additional graduate training before being authorised to practice independently.  Ms McLoughlin also provided evidence on the difficult and emotional cases sometimes faced by paramedics, stating that she never really recovered from a case on the West Coast, which still affects her.

Catherine Sarah McNamara

[106]	Ms Catherine Sarah McNamara, a Duty Manager (Communications) with AT, gave her evidence by statement for the applicant.  The respondent was content to allow her statement to be tendered, without cross-examination, on the basis that some material was struck out.  Those amendments were noted and the balance of her evidence was admitted unchallenged.  Ms McNamara was, in 2010, awarded the Ambulance Service Medal.  She commenced employment with AT in 1985 and became a Ambulance Officer (now Paramedic) in 1988.  She worked as a Paramedic Educator with AT from 2004 to 2012 and is also a Registered Nurse and Midwife and a qualified ICP having completed a Certificate of Applied Science, gained through Hobart TaFE in 1985.  Ms McNamara also holds a Diploma of Teaching (Adult and Vocational) through UTas and a Certificate IV in Training and Assessment.  At the time of her witness statement, Ms McNamara was completing a Master in Education with UTas.

[107]	Ms McNamara’s evidence went to the history of Paramedic education in Tasmania and developments in post-graduate education and learning.  She stated that in the early 1980’s Tasmania entered an education arrangement with Hobart TaFE and began providing apprenticeship styled education to student paramedics.  She said this is how she was trained which involved much “rote learned” information and that they were provided with some rudimentary theory of anatomy and physiology.

[108]	It was Ms McNarama’s evidence that in 1990, AT commenced training Paramedic Educators through UTas.  She said, in 1995, paramedic education for all paramedics at AT moved to the tertiary sector, with Charles Sturt University (CSU) providing the first university degree in paramedic education.  AT formed an alliance with CSU and delivered Associate Diploma and Diploma level qualifications.  CSU staff delivered anatomy, physiology and clinical conditions education, whilst AT educators taught clinical subjects.  Ms McNamara stated this was the beginning of ‘clinical enquiry’ for paramedics.  This arrangement remained in place from 1995 to 2004.

[109]	Ms McNamara said due to the increase in AT intake numbers, a ‘critical mass’ of student paramedics was achieved and a viable partnership began with UTas.  In 2006 a local Associate Degree programme commenced, with the assistance of Monash University.  AT taught, administered and assessed the ‘clinical practice’ subjects.  This arrangement continued until 2010, when UTas commenced its inaugural pre-employment Bachelor Degree in Paramedic Practice.

[110]	It was Ms McNamara’s evidence that all new paramedics employed by AT have a base qualification of a tertiary Bachelor Degree, as was ratified in the 2010 Agreement.  She says it is this tertiary qualification that ensures that paramedics are now instilled with ‘clinical enquiry’ and versed in the processes of research.

[111]	In relation to post-graduate education, Ms McNamara said changes have also occurred, in that Monash University allowed AT to utilise their curriculum for a Graduate Diploma (Mobile Intensive Care Ambulance/MICA).  She said from 2007 to 2011, every course she ran involved learning challenges around thinking critically, questioning, and how to research and develop a professional body of knowledge.  She said the difference between her education and current education practices, is that paramedics are encouraged to think and question, and may even fail the programme if they cannot demonstrate an ability to do this.

[112]	In addition, Ms McNamara stated that since 2007, ICPs who work on the fixed wing aircraft at AT have completed the Graduate Certificate in Emergency Health (Aeromedical and Retrieval) from Monash University.  She said through participating in this tertiary education programme, these paramedics have significantly increased their scope of clinical practice, whilst allowing for formal recognition of the specialisation of the role.

[113]	To assist in describing the difference between a skills based, rote learned trade and an evidenced based, ‘clinical enquiry’ model, Ms McNamara relied on educational theorist, B S Bloom’s Taxonomy of Educational Objectives, Handbook I: The Cognitive Domain (1956) New York: David McKay Co Inc.  She said Bloom’s Taxonomy described how people learn and that “These levels progress in complexity, with rote learning and remembering at the bottom, understanding and applying what is learned as one moves up through the levels, to higher order learning at the top.  Simply put, when you can take what you have learned, break it down into component parts, and then synthesise it to find solutions for new and unique situations, you are learning at the higher levels of analysis, synthesis (creation) and evaluation.”

[114]	Ms McNamara stated that today’s paramedic is no longer required to learn at lower orders and to remember, understand and apply protocols; but rather is now expected to analyse, synthesise and evaluate a body of knowledge.

Dale Gregory Edwards

[115]	Mr Dale Gregory Edwards, a Senior Lecturer with UTas, School of Medicine, gave his evidence both orally and by statements for the applicant concerning the changes in the role of paramedics, the impact on the education, teaching and supervision of paramedics, post-graduate education, the scope of practice in the CPGs and a comparison of pharmacology between AT and the ACT Ambulance Service.

[116]	Mr Edwards is the Course Coordinator of the Bachelor of Paramedic Practice at UTas.  He holds qualifications as an ICP, a Bachelor of Health Science (Paramedic), Graduate Certificate in Education (Workplace Education) and a Master’s Degree in Education (Curriculum and Pedagogy).

[117]	It was Mr Edwards’ evidence that paramedic practice has evolved from an emergency response role to that of a clinician where they are making diagnosis and implementing interventions.  He said there has been a nationwide increase in the primary care role of paramedics due to declining GP services, in terms of rural health and after hours services.  He said that increased pressure on the health system required paramedics to find alternative pathways for their patients, which requires an increased capacity for assessment and critical decision making.  He also said the changing nature of the public health systems and the demands placed upon it means a paramedic might need to consider alternative treatments or referral to other health professionals, rather than transport to an emergency department.

[118]	Mr Edwards said paramedic practice had grown alongside medical research and advancement, such that what were once hospital based interventions were now practiced by paramedics.  Examples were the administration of thrombolytic agents to patients and skills such as rapid sequence airway management (although he confirmed under cross-examination that AT paramedics do not perform these skills).  He said the introduction of performance, and interpretation, of 12-lead ECGs in Tasmania required new clinical assessment and clinical skills for paramedics and the depth of information provided by the 12 lead ECG was much greater than the 3 lead ECG (ie 12 pictures of the heart rather than 3).  He confirmed both Paramedics and ICPs are trained to perform a 12 lead ECG.

[119]	Mr Edwards stated that the introduction of new equipment in itself, such as the 12 lead ECG, does not improve the quality of care or the work of paramedics.  They are required to have a higher level of education which allows them to draw conclusions from the information they receive from this new technology.  He said technology had actually increased decision making and critical analysis requirements as evidenced in his reply statement:

“Returning to the 12 lead ECG as an example, there is a saying that if you get 12 cardiologists in a room, you give [sic] them the same ECG, you’ll get 12 diagnosis.  The same thing might be said with paramedics.  That is in part because what is missing from merely reading the ECG (and what is largely missing in the guidelines) is the patient, the information obtained during clinical examination and all of the other evidence that informs the critical analysis required to achieve a provisional diagnosis.  Education provides the paramedic with the skill set to be able to make that provisional diagnosis.”

[120]	Mr Edwards said it was the same with the introduction of the Pulse Oximeter, in that the equipment provides a greater depth of information relating to oxygenation of the patient; however it also requires underlying knowledge of the oxygen disassociation curve, so as to accurately interpret the information taken from the equipment.

[121]	It was Mr Edwards’ evidence that, to understand such information, paramedics need to engage in evidence based practice and, in the case of the 12 lead ECG, make that differential diagnosis.  Mr Edwards said a differential diagnosis requires a paramedic to identify a spectrum of clinical signs, interpret them and identify potential causes for those signs.  He said to make such a diagnosis requires a good sound level of underpinning knowledge, diagnostic skills, interpretation and continual assessment of the evidence.  He said it is incorrect of AT to suggest that paramedics do not differentially diagnose a patient.

[122]	Mr Edwards stated that the scope of practice in Tasmania in 1996 was substantially different to the current scope of practice.  He said a number of pharmacological interventions and clinical skills were substantially less in 1996 and that many of the interventions which were previously limited to ICPs were now routine practices for Paramedics.  He said the scope of the ICP has also increased over this time to incorporate more clinical skill interventions and pharmacological agents.

[123]	It was Mr Edwards’ evidence that a greater degree of communication was now required between paramedics and other health professionals via referral processes for low acuity patients and also for higher acuity patients such as ST segment myocardial infarction (STEMI) patients, which required paramedic bypasses, in some areas, and transport directly to a cardiac catheterisation lab.  He said the paramedic no longer simply treats and transports patients, but they now work with their health professional peers and the patient, to provide the most appropriate health care.

[124]	Mr Edwards said the increasing complexity of the role of paramedics had taken the role away from the vocational education model to a tertiary Bachelor Degree, and that this was the minimum entry standard for new paramedics in all but one state in Australia (NSW).  He said the greater level of clinical intervention practices, the greater the requirement of understanding of biological sciences, including a higher level of understanding of anatomy, physiology, pathophysiology and pharmacology.  He said the unsupervised clinical work environment of paramedics meant that they must have the level of knowledge suitable to interpret and respond to complex patient presentations and changes, and that the Bachelor Degree model provides them with the required depth of knowledge.

[125]	Mr Edwards said the tertiary education model provides graduates with sound foundations in decision making, which assists them in future clinical leader roles and assist them in initiating research in their own practice.  He also provided evidence that there are an increasing number of paramedics undertaking higher research degrees at master or doctorate levels.  Mr Edwards said paramedics are doing their own research in their own clinical environment and developing the evidence to support that practice, and that this is part of the increasing complexity of paramedic professionalism.

[126]	It was Mr Edwards’ evidence that whilst the majority of education was conducted in the university setting, increasing demand is placed on paramedics to support students on work placement, as well as post-graduate interns, which makes the role of paramedic more complex.  He said paramedics are required to mentor the modern graduate through a one year internship, where they consolidate their theoretical knowledge.

[127]	Whilst Mr Edwards stated that although the introduction of the Advanced Life Support (ALS) qualification and TaFE level qualification prior to 1990 was significant, he said the move to the university model was more revolutionary.  He said this was because of the migration of the paramedic to high level clinical practice, including the use of drugs that previously were only administered in hospital settings, and the greater level of knowledge required to practice.

[128]	Mr Edwards said the scope of the ICP is also changing with many organisations seeking graduate diploma level programs for the role.  He said there are a range of other post-graduate programs offered or evolving in this field which address the changing nature and complexity of the role.

[129]	Mr Edwards said evidence based practice requires the paramedic (not the employer) to interpret and apply evidence in the patient environment, which means that a paramedic attends a patient and makes a clinical judgement based on their knowledge.  He said a body of knowledge comes from making those judgements every day, for every patient, researching articles and literature and drawing on the depth of their understanding.  He said this in turn allows a paramedic to correctly apply the CPGs to a range of diverse patients and presentations.

[130]	In relation to the scope of practice of paramedics and the CPGs, Mr Edwards said the CPGs are not protocols and are not a step-by-step exhaustive code that are applied as rote reactions to patient presentations.  He said CPGs are a structure, not an exhaustive code.  He provided an example of a paramedic using the 12-lead ECG to gain information and differentially diagnosing a right sided ventricular myocardial infarct in a patient.  He said that whilst the CPGs structure the treatment, they do not include the clinical judgement necessary to differentially diagnose and thereby identify which guideline treatment should be applied.  Mr Edwards said that whilst some CPGs deal with simplistic clinical matters, such as glycaemic emergencies, there are much more complex decision making presentations that paramedics deal with on a daily basis.

[131]	Mr Edwards said the CPGs are not exhaustive and do not inform the paramedic on what to do when the patient does not fit a text book presentation.  He said if the CPGs were hard rules, then currently they are incomplete, as a significant portion of patients are atypical.

[132]	Mr Edwards provided evidence that in addition to the matters referred to in the Agreed Statement of Facts document, a list of a further 16 drugs are used in both Tasmania and the ACT.  He said he verified this comparison by reference to the ACT Ambulance Services (ACTAS) Guidelines document which listed those drugs and also by confirming with an ACTAS Duty Officer that each of the drugs were currently in use.  Mr Edwards also confirmed that the drugs Ergometrine, Panaedine Forte, Prochlorperazine and Water for injection are in use in Tasmania, but not in the ACT.  This was also confirmed through discussions with the same ACTAS Duty Officer.

[133]	Under cross-examination, Mr Edwards confirmed that the CPGs set the scope of practice for Paramedics and ICPs and that there were differing authorities for the two roles, relating to the type of drugs used and methods of administration.  Mr Edwards also confirmed that he was not aware if AT were currently practicing bypasses to catheterisation labs in the case of STEMI patients.

Dr Louise Colleen Reynolds

[134]	Dr Louise Colleen Reynolds, a Lecturer at Flinders University, South Australia gave her evidence both orally and by statements for the applicant.  Dr Reynolds is a former Paramedic, holds an advanced certificate in medical laboratory science, a Diploma of Applied Science in Ambulance Studies, a Bachelor of Health Science in pre hospital care and a PhD in Business and Management.

[135]	It was Dr Reynolds’ evidence that there has been a change in the educational requirements and standards of work of paramedics and that the demands of the role are greater than they were 10 years ago, due to the increasing knowledge base of paramedics.  Dr Reynolds provided evidence that the role had diversified beyond treat and transport, and that the change in education model delivers the critical enquiry skills that comes with tertiary education.  She said the amount of work for paramedics is increasing over time, with increasing complexity.  Dr Reynolds also said that paramedic work is complex due to it straddling public safety, social justice and health and emergency services, and that it doesn’t fit neatly into a category like other allied health professions.

[136]	Dr Reynolds stated that paramedics are called upon, in a vast array of novel situations, to undertake critical analysis, critical thinking, critical appraisal and critical judgement.  This, she said, made the role unlike that of any other health professional, as they are required to work in settings that are always different, autonomous and time critical, which adds complexity to the tasks undertaken.

[137]	Dr Reynolds said that paramedics now operate as part of an integrated health care system and that their increasing body of knowledge allows them to treat patients without necessarily having to transport them to hospital.  She said this extended scope for all paramedics is reducing the impact on the overall health care system.

[138]	It was Dr Reynolds’ evidence that the introduction of university based education was more significant that the introduction of the ALS TaFE qualifications in the 1980s.  She referred to the differences in those qualifications by referencing information on the Australian Qualifications Framework (AQF).  Dr Reynolds also stated that the change to CPGs from the previous protocols meant that the work of a paramedic in Tasmania was now less prescriptive, with guidelines providing a framework, as opposed to the script of the Protocols.  She said:

“Few professions are structured to require the rapid fire, high pressured, time critical, complex decision making functions that are now required of paramedics.  Pilots [are] one.  Medical staff in an Emergency Department is another.”

[139]	Under cross-examination, Dr Reynolds confirmed that she has never worked in Tasmania as a paramedic and that she has never produced any qualitative research within AT.  She also confirmed that her ‘in-chief’ witness statement drew heavily on her witness statement filed in the ACT paramedic work value case in 2009 and that her observations are also based on her research of the South Australian Ambulance Service from 2001 to 2005.  Dr Reynolds stated she was unable to confirm whether STEMI bypass procedures were carried out in Tasmania or the ACT, but said that South Australia have bypass procedures.

[140]	During cross-examination, there was some dispute in relation to workload figures used by Dr Reynolds in her ‘in reply’ statement.  Dr Reynolds stated she was unfamiliar with the figures quoted by the respondent in cross-examination, however the difference may depend on the different categories of data collected by the Council of Australian Ambulance Authorities.  The respondent quoted figures from the Council of Ambulance Authorities Annual Report 2011-12 showing incidents in Tasmania had decreased by 9.1% in that year.  Dr Reynolds confirmed that she had not undertaken a calculation of the number of cases associated with the number of operational staff at AT, and that that would need to be done to properly ascertain any increase in workload.

[141]	In re-examination, Dr Reynolds stated that in the 2010-11 Annual Report of the Council of Ambulance Authorities, AT had experienced response growth of 10.4%, with patient growth of 4.8%.  Dr Reynolds stated that she is familiar with the work of paramedics across different jurisdictions in Australia and internationally.  She said that the research she had undertaken in South Australia accords with international studies on the move from vocational training to tertiary higher education and that this research is translatable to what has occurred at AT.

Dr Marielle Ruigrok

[142]	Dr Marielle Ruigrok, Director of Emergency at the Tasmanian Health Organisation North West, provided an ‘in chief’ witness statement and a statement ‘in-reply’ on behalf of the applicant.  Following an amendment to the ‘in-chief’ statement, the respondent did not seek to cross-examine Dr Ruigrok and accordingly her evidence was admitted unchallenged.

[143]	It was Dr Ruigrok’s evidence that she has worked in her current position as Director of Emergency since October 2012, previously as Director of Emergency at Mersey Community Hospital in Tasmania from 2009 to 2012 and before that, as Director of Emergency at Calvary Hospital in the ACT.  To that end, much of the evidence provided by Dr Ruigrok pertained to the work of paramedics in Tasmania and the ACT.  She stated that she had informed herself as to the practices of Ambulance Officers in both Tasmania and the ACT.

[144]	Dr Ruigrok stated that when she was an intern in 1986, the scope of practice for an Ambulance Officer was limited and, as a result, significant numbers of people died, due to getting to hospital too late for treatment.  She said the scope of work of a paramedic is similar to an emergency department, but with them having to work in uncontrolled environments.  She said that in situations requiring intubation of patients, paramedics are allowed to use sedating drugs normally reserved only for use by anaesthetists, emergency physicians and ICU practitioners which, 20 years ago, paramedics were not permitted to use.

[145]	Dr Ruigrok provided evidence as to the critical judgements paramedics are required to make, such as whether to continue resuscitation, and the care they are required to give to family in these situations.

[146]	Looking at comparisons, Dr Ruigrok stated that the ICP skill set would best equate to that of a Nurse Practitioner, with a paramedic role sometimes requiring they act as an Anaesthetic Consultant using specialist drugs, together with a very broad set of skills.  She said the work of a paramedic is at least as complex and important as that of nurses and other health professionals, however they work in an uncontrolled environment which adds further complexity.  She said that, in an uncontrolled environment, paramedics were able to obtain a patient’s history, undertake interventions, stabilise and transport the patient (who sometimes does not speak English) to hospital.  She said to achieve this successfully every time is a real skill.

[147]	Dr Ruigrok stated that over the last 20 years, the distinction between pre-hospital care and emergency department care has become more seamless with AT now involved in reviewing cases with hospital staff and reviewing practice.  She says paramedics are integral to developing and implementing patient care plans for patients with complex needs.  She said that in 1986 an Ambulance Officer would deliver a patient to the hospital where they would be triaged and treatment would begin.  However, she stated that now for a large range of conditions the triage commences with the paramedics, including the performance of provisional diagnoses and emergency treatment instituted.  Dr Ruigrok stated that she relies on paramedics to provide detailed history of incidents (for example “What did the car look like?”) to help put the whole patient story together on arrival at hospital.  She said compared with 20 years ago the modern paramedic in Tasmania is much better trained in providing more complex levels of care and much better in ascertaining and communicating the relevant medical history of patients and their findings based on initial assessments.

[148]	The evidence of Dr Ruigrok also went to the type of diagnoses delivered by paramedics.  She said a diagnosis is simply a means of identifying the nature of an illness and that a paramedic does not need to make a ‘definitive diagnosis’ to be engaged in the practice of diagnosing patients.  She said diagnosis is not the sole preserve of doctors.

[149]	Dr Ruigrok gave an example of what she considered were enormous changes in pre-hospital care over the last 20 years which involved a drowning patient, intubation practices, administration of fluids and drugs and a range of treatments, prior to the patient arriving at hospital.  She said the introduction of drugs such as Frusemide and Amiodarone has increased the paramedic scope of practice and delivered better outcomes for patients and the health system.  Dr Ruigrok said she has seen advances in people being treated at the scene, left and then staying in their own environment, due to the appropriateness of paramedic care.

[150]	It was Dr Ruigrok’s evidence that hospitals in Tasmania practice a procedure called ‘ramping’, which involves the paramedic treating the patient outside the emergency department (for up to 3 hours) until a position becomes available in the emergency department.  She said if it wasn’t for the fact that the paramedics are skilled enough to be able to manage that function, they would not be able to employ that practice.  She said there has been a significant change in the amount of trust hospitals place in paramedics.

[151]	Dr Ruigrok said:

“In contrast with nurses and health professionals, paramedics are isolated in terms of when they’re treating the individual patient.  It can be very, very lonely on a stretch of a road when you’re just there with one other Officer.  They are called on to make quick appropriate decisions that can have a life or death consequence.”

Paramedics as a Profession

[152]	Mr Jacobson, Mr Richardson, Ms Byers, Mr Cane, Ms McNamara and Dr Reynolds all gave evidence that the modern paramedic was engaged in a profession.  One element of the applicant’s case was that paramedics should be recognised and remunerated as professionals.  The evidence tendered substantially relied on the establishment of a professional association known as Paramedics Australasia (PA) representing practitioners of paramedic services, and more particularly, the move to professional standards of education, training and continuing professional development of paramedics.  As can be seen from the applicant’s evidence provided by their witnesses, paramedics no longer learn and administer a simple skill, they are required to have a thorough body of knowledge, understanding the risk or problems depending on the course of treatments chosen and have a plan to deal with possible adverse effects, all whilst working independently.  It was said that this reflects the professional nature of the work of a paramedic.

The Respondent’s evidence
Tony Ferrell

[153]	Mr Tony Ferrell, the Assistant Director of the Department of Treasury for the State of Tasmania, gave his evidence via written statement for the respondent concerning the budgetary position of the State.  The applicant did not seek to cross-examine Mr Ferrell and his evidence was admitted unchallenged.

[154]	It was Mr Ferrell’s evidence that the Tasmanian Government is expected to return operating deficits until 2016-17, that the Fiscal Surplus for the Government is expected to continue to be in deficit for the Forward Estimates through to 2016/17 and that the Government is not expected to return to a negative Net Debt position until 2016/17.  Mr Ferrell stated that actual and projected GST receipts are significantly lower than were previously projected for Tasmania with all States’ revenues having felt the negative impact of current economic conditions to varying degrees.

[155]	Mr Ferrell said that the Tasmanian Government had responded to these difficult financial circumstances by implementing constraint of expenditure growth, which included the implementation of the Government’s Wages Policy as detailed in the 2011/12 Budget.  He said this policy provides a maximum non-productivity based wage increase of 2% per annum.  In addition, productivity gains may be included in a wage negotiation with a further 0.5% increase per annum being available.  The policy remains unchanged since inception.

[156]	Mr Ferrell stated that significant additional funding had already been provided to AT (particularly in the 2009/10 year) for staffing, new equipment, new ambulance stations, fleet replacement and infrastructure upgrades.

[157]	It was Mr Ferrell’s evidence that the Government Budget and Forward Estimates had been formulated on the existing wages policy and no allowance has been made for wage increases above the level contemplated by the wages policy.

Shaun White

[158]	Mr Shaun White, the Director of Clinical Services at AT gave his evidence both orally and by statement for the respondent, concerning ECPs, the contents of the CPGs and related processes at AT, the previous Protocols, and how they are applied.  Mr White has worked with AT since late 2011 and in his current role since March 2013.  In his previous role, Mr White facilitated the release and development of the current CPGs, which he said were closely aligned to the Victorian Ambulance Service CPGs.  He is a qualified ICP and has undertaken training in Helicopter Emergency Medical Service.  Mr White has worked in the ambulance service in Qatar, in NSW for 6 years and as an ICP in the ACT from 2004 to 2007.

[159]	It was Mr White’s evidence that the role of a paramedic has not changed as the core of what they are required to do is to respond, assess, treat and transport patients where appropriate, within the scope of practice set in the CPGs (or previous Protocols) or under the direction or approval of a qualified medical practitioner.  He stated that new drugs, equipment and techniques are included in the CPGs, sometimes replacing previous ones, and that these developments have made the job of a paramedic easier (example given was drug administration via nasal spray).

[160]	Mr White stated that a paramedic does not determinatively diagnose a patient as this is the role of the emergency department staff following handover.  He said that paramedics have no role in triaging patients or directing emergency department staff as to the appropriate course of treatment for a patient.

[161]	As to ECPs, Mr White provided evidence that this role operates under a distinct set of guidelines which do not apply to Paramedics and ICPs, that the ECP program was run through fixed term Federal Government funding and that there is no funding committed beyond 30 June 2014.  He stated that only two ICPs were released for this trial program, that training was provided for the additional skill set and that the positions were obtained through an expression of interest process.  He said the expression of interest documentation that was circulated, clearly indicated that their substantive position would remain as an ICP and their pay would be similarly maintained.

[162]	Mr White stated that the current CPGs were introduced in February 2012 and that they replaced a series of previous clinical practice protocols and the original version of the CPGs.  He also provided evidence that the CPGs had undergone changes in September 2012, and further changes were made in relation to the drug Ondansetron and antiemetic drugs to provide further guidance to paramedics.   Mr White was unable to provide a full copy of the 1980 Protocols which were in operation at the time of the datum point (1988).  He said that since 1991 the Protocols and CPGs have provided different levels of practice for Paramedics and ICPs, including permissible drugs and methods of administration.

[163]	Mr White provided evidence on the process of establishing the CPGs, their continual review, the professionals involved in the Tasmanian Ambulance Clinical Council and the approval required by the CEO of AT prior to CPGs being distributed and becoming operational.  He described the process undertaken by the Clinical Practice Development (CPD) group, as it relates to the continual review process for the CPGs, which is largely the same process as was involved in the establishment of the CPGs.  He stated a review of a guideline may be instigated through current clinical research or through feedback from paramedics.

[164]	Mr White stated that if a paramedic is found to have operated outside the boundaries set by the CPGs (known as a ‘clinical variance’), without the express approval of an authorised medical consult, that clinical case is subjected to a further audit process.  He provided examples of how and when audits were conducted (including retrospective audits which total a minimum of 15% of cases).  He advised that clinical variances are rated from 1 to 4, with a rating of 1 being given to major variances that have resulted in major harm, death or a permanent increased level of care being required, as a result of the variance.  He provided examples of what disciplinary action may be taken against a paramedic, depending on the frequency or rating attributed to variances.  He confirmed he was not aware of any Level 1 variances and stated there were three level 2 variances in the last year at AT.

[165]	Mr White’s evidence was that a Paramedic can acquire a 12-lead ECG printout under the scope of practice of the CPGs, however only an ICP can interpret a 12-lead ECG printout.

[166]	When questioned on whether paramedics exercise an evidence based practice, Mr White said he expected paramedics to treat signs and symptoms in accordance with the scope of practice set by the CPGs, treat them in “good faith” and then transport them to hospital.

[167]	It was Mr White’s evidence that the changes made to the CPGs and Protocols were stylistic changes and only resulted in a difference in the way the information was grouped and presented to paramedics.  He said the information in the 1991 Protocols was presented in a listed dot point summary and the ALS only treatment (now ICP only treatment) was not always clear.  He said there were limited descriptions of signs and symptoms and that adult and paediatric treatments, drugs and dosages, were described within a single protocol.  He said, by comparison, the CPGs have distinct separation of ICP only interventions, greater information about the drugs and procedures available for treatment and diagrammatic charts to assist in the ‘decision pathways’ for paramedics.  He said this provides operational staff with clear guidance in the exercise of clinical judgement when identifying the signs and symptoms and initiating treatment.  Mr White gave an example of a glycaemic emergency in a patient under CPG A0702 and the steps contained within the guideline to help guide the paramedic.  This was contrasted with the 1991 Protocols, which he said provided limited guidance.

[168]	Mr White said that whilst additional drugs have been added to the CPGs, paramedics are only able to make a decision on the appropriate drug to use within the boundary of the CPGs.  Mr White gave a comparison of the drugs available to treat pain from the 1980 pharmacology list, the 1991 Protocols and the current CPGs, together with the modes of administration.  He indicated both Fentanyl and Ketamine are new pain drugs available to AT operational staff with Ketamine being an ICP only drug.  He also provided a comparison of how the use of the drug Adrenaline was presented in the previous Protocols as opposed to the CPGs.  Mr White also provided evidence that a new drug, Midazolam, was introduced to AT for the treatment of seizures and that the administration of this drug was easier than the drug it replaced.  He also stated that seizure cases only account for 1.5% of paramedic case load.  He stated that whilst there were changes to drugs and additional drugs added to the CPGs, many of the drugs stayed the same.  

[169]	Mr White stated that whilst the skill of cannulation (inserting a tube into a patient’s arm) was introduced into the 2004 CPGs for Paramedics, the Regional Education Co-ordinator for AT has advised him that cannulation was a skill practiced by ALS paramedics (ICP equivalent) in 1980.  He said the 1991 Protocols list the intravenous administration method as available for ALS paramedics.

[170]	Mr White’s evidence provided a table relating to the use of drugs by operational staff at AT and addressed evidence provided by Mr Richardson for the applicant.  This table provided a comprehensive commentary to the drug report provided as an annexure to Mr Richardson’s witness statement and other witness evidence of the applicant.

[171]	Mr White stated that whilst paramedics at AT are encouraged to undertake professional development, they are not expected to read research papers or to keep up to date with current medical knowledge.

[172]	It was Mr White’s evidence that the practice of ramping still requires the paramedic to practice within the boundaries of the CPGs and that there may be less responsibility for a paramedic when ramping, as they are within the emergency department and can seek the assistance of trained medical personnel if required.

[173]	Mr White stated that paramedics employed with AT do not perform STEMI bypass or rapid sequence intubation (RSI), as is performed by ICPs in the ACT.  He said that AT paramedics identify and treat STEMI patients but they do not implement the thrombolytic agent and they do not bypass emergency departments.  He also stated that whilst a paramedic can declare the life of a patient to be extinct in certain circumstances, they do not have the authority to pronounce the death of a patient.  During his examination-in-chief, he stated that AT paramedics do triage patients when demand outstrips resources, but he thought that that only occurred on about 1% of cases.  Mr White provided evidence that the CPGs provide limited circumstances in which a paramedic can withhold or cease pre-hospital resuscitation.

[174]	Under cross-examination, Mr White confirmed that the equivalent of the 1991 Protocols is the current CPGs.  Mr Irving put to Mr White that the 1991 Protocols covered some 32 clinical conditions, whilst the CPGs now covered more than 100 clinical conditions.  Mr White did not dispute that representation.  He also confirmed that he had assisted in the preparation of the Agreed Statement of Facts and more particularly attachments C and D (changes to pharmacology since 1991 for Paramedics and ICPs) and attachment E (a comparison report on skills and pharmacology of paramedics in Tasmania, ACT, SA and NSW).  Mr White confirmed that there were 16 new drugs which had been introduced for use of Paramedics at AT since 1991.

[175]	Mr Irving submitted a document to Mr White detailing the applicant’s comparison of procedures undertaken by Paramedics and ICPs in the 1990s and now.  Mr White advised he hadn’t practiced under the 1991 Protocols and as such he could only speculate on their content.  Mr Irving also provided a training package document to Mr White which related to training undertaken by AT paramedics on the operation of the 12-lead ECG.  Mr White confirmed the training package was a resource they used from the Queensland Ambulance Service, but he stated he was unaware as to whether AT paramedics were trained in carrying out a 15-lead ECG (ie use of three of the ECG leads across the back) as provided for on page 70 of that document.  He said this was because he was not employed at AT at the time of introduction of the 12-lead ECG equipment.  Mr White stated that the CPGs provide for the acquisition and interpretation of a 12-lead ECG.

[176]	Mr White confirmed under cross-examination that a paramedic may be required to stop a course of treatment to a patient and embark on another treatment pathway.  He also stated that the CPGs do not cater for “every single thing”, referring to clinical conditions and personal attributes of a patient.  Mr White agreed that a paramedic exercises discretion in relation to what drug is most appropriate to administer to a patient.

[177]	Mr White confirmed under cross-examination that, in multi-casualty incidents (where the situation has outstripped ambulance resources), paramedics can make triage decisions if a patient’s injuries may be incompatible with life.  He also stated that paramedics treat patients on the signs they are presented with and that that may be classified as a provisional or differential diagnosis.

[178]	Mr White stated that he had not conducted a comparison of the pharmacology, procedures and equipment between the Tasmanian and Victorian Ambulance services.  However under re-examination by Mr Dalton, Mr White stated that AT paramedics were more closely aligned with Victorian paramedics.  He said he based this opinion on AT’s use of their guidelines as a template.

[179]	Under questioning from the bench, Mr White indicated that the guidelines for paramedics are different to the guidelines for medical practitioners in an emergency department, in that the drug dosages for paramedics are more conservative, as the emergency department environment is more stable.  Mr White also confirmed that whilst a Paramedic’s scope of practice is to acquire a 12-lead ECG printout and not to interpret the printout, the ECG printout can be very helpful in the further treatment of the patient after handover to the emergency department.

Sally Grimes

[180]	Ms Sally Grimes, the Human Resources Manager at AT gave her evidence both orally and by statement for the respondent concerning enterprise bargaining, aspects of the Award, issues of recruitment and general human resource matters.  Ms Grimes has held her current position since June 2013 and she was involved in implementing key changes from the 2007 and 2010 Agreements.

[181]	It was Ms Grimes’ evidence that the 2007 Agreement delivered a 7% wage increase to employees over two years, along with an increase to long service leave entitlement by way of change from the base hourly rate to the composite hourly rate.  Ms Grimes said this was a “big ticket item” during negotiations and delivered a significant benefit for those employees on a roster.  The 2007 Agreement also committed to a classification structure review at clause 8 (which subsequently became part of the 2010 negotiations), together with a salary increment restructure, which shortened the time required to progress to the top pay point of a classification.  Ms Grimes said there were no trade-offs in the 2007 Agreement.

[182]	Ms Grimes’ evidence went to the 2010 Agreement, stating that she was present at all the negotiation meetings.  She stated that the applicant lodged a Log of Claims in December 2008 and the agreement was concluded in March 2010, with the agreement providing for no productivity off-sets and an 11% salary increase for base level Parmedics over three years and between 12% and 37% for employees in other classifications.  It also introduced a Paramedic Intern classification.  Ms Grimes stated that the larger increases (up to 37% over three years) were for roles such as Paramedic Educator and Managers, where they were finding it difficult to attract paramedics for promotion, due to the wage rates for these positions.  The weighted average of the increases for these roles was approximately 16% over three years, or 5.4% per annum.  Ms Grimes said that the Department wished to sufficiently compensate the supervisors and managers at AT for their management duties and aligned them to the Health and Human Services (Tasmanian State Service) Award (HAHSA) rates of pay.  She said the HAHSA classification descriptors already contained the duties and responsibilities of the managers at AT.

[183]	It was Ms Grimes’ evidence that DHHS wanted to ensure that the 2010 Agreement wage increases and structural adjustments were off-set against any future work value claim, which led to the creation of clause 13 of the agreement.  She said the intention of the applicant as to its work value claim can be found in a bulletin to their members and the respondent’s position was captured in an email from AT’s CEO to all staff.  These documents also contain paramedic wage rate comparison information with other States.

[184]	Ms Grimes said the 2010 Agreement also included a 1% lump sum payment for structural adjustment to reflect changes agreed in the 2007 Agreement, some paid training leave and an increase in leave loading for day workers.  The 2010 Agreement introduced the isolated stations package and some increases in allowances for paramedics carrying out non-paramedic duties.  Ms Grimes said there was also agreement to implement a fatigue management policy.  

[185]	It was Ms Grimes’ evidence that the 2010 Agreement classifications and pay rates were struck in recognition of the Bachelor degree entry level requirements for Paramedic Intern roles and also the Advanced Airway Management qualification.  She said the applicant argued during negotiations that the career restructure was to recognise relevant tertiary training and additional qualifications.  Ms Grimes said that the Department of Health and Human Services’ objectives in the career restructure were, among other things, to align the Award classifications with the AQF, formally introduce the paramedic nomenclature into the Award and to recognise the ‘trend’ towards tertiary entry level.  She stated that the outcome of the career restructure was the implementation of a new classification structure in the 2010 Agreement.  This is where the Bachelor of Paramedic Science was introduced as the entry level qualification requirement for paramedics.  The Paramedic Intern classification was for graduates of that qualification.  Previous to the 2010 Agreement, the entry level was Student Ambulance Officers (SAOs), who were without a qualification and completed an Associate Degree over three years.  She said the intention is that the SAO classification is to be phased out once all SAOs are qualified.

[186]	Ms Grimes’ evidence referred to the removal of the patient extrication function from AT paramedics, when those duties were transferred to the Tasmanian Fire Service in 2006.  She said that whilst AOs and ALSs were no longer performing those skills, AT preserved the patient extrication wage rates until the 2010 Agreement, pursuant to clause 14 of that agreement.  Ms Grimes said the new classification structure provided further advancement for paramedics and in particular, ICPs, through the removal of previous skills barriers.

[187]	In relation to the negotiations for Paramedic Specialist Allowances in the 2010 Agreement, Ms Grimes stated that the parties envisaged the creation of a Specialist Paramedic classification to fit between the ICP classification and the CSO classification, however they were unable to reach agreement with employees, and the issue became a Leave Reserve matter as per clause 25 of the agreement.  Ms Grimes said the parties then decided to negotiate an increase to the hourly rate for the Paramedic Specialist Allowance applicable to a number of skills which included mentoring, Wilderness/Helicopter, driving instructor and some urban search and rescue.  She said the respondent did not agree to the inclusion of a number of other allowances sought by the applicant.

[188]	Ms Grimes said there were two reserved matters in the 2010 Agreement, one of which related to the establishment of a Paramedic Specialist classification for the Helicopter squad, and which was subsequently resolved by way of consent order on 8 January 2013, in matter T13854 of 2011.  Ms Grimes gave evidence that the consent order introduced a new classification of Flight Paramedic - Helicopter and that; this recognised the specialised skills and qualifications required for the role; it established a permanent helicopter squad of four full-time permanent ICP positions, with remuneration of $71,452 per annum (as at 8 January 2013); and four additional ICPs for relief Helicopter crews.  The consent order did not provide for payment of the Paramedic Specialist Allowance of $3.20 per hour which was discussed above.  Ms Grimes stated that the consent order also provided that; they establish a permanent fixed wing paramedic squad of seven full-time positions and five relief positions; the wage rate was as contained in the 2010 Agreement ($71,452 per annum); the qualifications required for the role were clarified; and took into account the skills required for the role.

[189]	In relation to recruitment, Ms Grimes stated that in her experience, AT has never had trouble recruiting people into the role of Student Ambulance Officers or Paramedic Interns, with applications far outstripping available positions.  She said whilst there had been a nationwide shortage of paramedics when she started with AT in 2006, resulting in some States employing large numbers of overseas paramedics, AT had not undertaken this practice, with their recruitment difficulties being alleviated during 2009.  Ms Grimes stated that since the implementation of the comparable wage rates in the 2010 Agreement, AT has not experienced any staff attraction and retention issues.  She also stated that they regularly receive applications from interstate candidates with a number of these candidates taking up employment offers.  Ms Grimes also stated that with the creation of an employment register within AT and large numbers of graduates from UTas, AT is not expecting difficulties in filling vacancies in the future.

[190]	It was Ms Grimes’ evidence that the new classification structure, contained in the 2010 Agreement, brought with it attractive career progression for paramedics and a recruitment and retention package for BSOs at the more isolated branch stations.  She stated this package is offered at the discretion of AT’s CEO and that at the time of the hearing two branch stations had these packages attached to them.  The package does not exceed 10% of the base rate of a BSO.  Ms Grimes said they have not had difficulty filling BSO positions since the implementation of the 2010 Agreement.

[191]	In relation to overtime worked, Ms Grimes stated that it is not possible to eliminate overtime altogether and that whilst AT has experienced increased overtime figures in the South previously, this was alleviated by the recruitment of eight additional staff and accreditation of eight students as Paramedics.

[192]	Ms Grimes stated that in 2010, Operational Research in Health Ltd (ORH) conducted a comprehensive review by way of a report into ambulance infrastructure and staffing in Tasmania.  This report was commissioned for future planning of the ambulance service in Tasmania.  The report identified a need for increased staffing figures, so as to meet the 75% emergency service response targets for 2014/15.  She stated the outcomes in this report assumed there were no budgetary constraints on AT where, in reality, AT is subject to government funding.  Ms Grimes said a second ORH report was commissioned by AT to calculate and recommend a relief rate to account for unplanned leave, given the current operational requirements and budgetary constraints.  This relief rate would be on top of the fixed 36.7% relief rate provided for in the first ORH report for planned leave.  The second ORH report recommended a further 4% relief rate was required.  It was Ms Grimes’ evidence that AT has recruited in accordance with the recommendations made in the second ORH report and that at the time of hearing they had additional (with respect to the target establishment figures) full-time equivalent paramedics in each of the regions.

[193]	Ms Grimes stated that in the Report on Government Services (ROGS) 2013, the Productivity Commission Report shows that Tasmanian ambulance staff attrition rates are comparable to other State and Territory ambulance staff attrition rates.

[194]	Under cross-examination, Ms Grimes confirmed she was not involved in negotiations for the 2007 Agreement, that she drafted the first version of the agreement from notes that were provided to her and that the agreement delivered a 4% pay rise in the first year and a 3% pay rise in the second year of its operation.  She also confirmed that the increase in long service leave payment to the composite wage rate was effective from 1 January 2008 and any accrued leave, as at that date, remained at the base wage value.

[195]	When questioned about what motivated the salary increment restructure in the 2007 Agreement (Schedule 2), Ms Grimes confirmed that the structure leading into the 2007 Agreement had a remuneration range of about $900 from the top to the bottom of each classification.  She said she was unable to state whether this was out of step with other modern State Sector employment conditions.

[196]	Ms Grimes confirmed that the parties agreed to replicate the 2010 Agreement changes in the Award, including the new classification structure, as provided for in Clauses 7 and 11.

[197]	Ms Grimes stated, under cross-examination, that the highest percentage wage increases contained in the wage table at attachment SG-5 of her witness statement (that being Paramedic Educator level 2 and Managers level 2, 3 and 4) were roles that were limited in number, with a total of 18 employees occupying them.  She also confirmed that due to the Managers at level 1 being paid a composite rate for working a rotating shift roster, level 1 managers were, at that time, paid the same as level 2 managers and this led to the decision to increase the wage levels for managers at levels 2, 3 and 4.  When questioned by Mr Irving, Ms Grimes confirmed that the classification of Paramedic year 1 had received an 18.7% wage increase from 2007 to the present day.

[198]	Ms Grimes stated that clause 13 of the agreement was inserted into the agreement after being agreed by the parties and that it does not refer to a claim for professional rates.  Under questioning from the bench as to an email from AT’s CEO, Mr Morgan, to all staff which stated: 

	“…There is only 1 state in Australia that will have a higher base rate at the end of the Agreement being South Australia and the Agreement does not preclude any future professional wages claim…”;

Ms Grimes gave evidence that she thought the words “professional wages claim” meant, “work value”, but then said “Well – yeah, well I mean it says professional wages claim, so it says what it says”.

[199]	It was Ms Grimes’ evidence that regardless of the amount of productivity increases that might be proved by the applicant through work value, any industrial action taken or any community or media pressure applied, AT were bound by the State Government wages policy and they could only offer a maximum of 2.5% per annum wage increase.

[200]	When questioned about the ORH reports by Mr Irving, Ms Grimes confirmed that AT were planning to staff their establishment based on the “group leave” recommended figures, which did not cover the requirements of 15.6% relief for “unplanned leave” as contained at table F1 of the second ORH report.

Andrew O’Brien

[201]	Mr Andrew O’Brien, the Manager of Technical Services at AT gave his evidence both orally and by statement for the respondent concerning AT’s operational matters.  Mr O’Brien commenced employment with AT in 1980 as a Student Ambulance Officer, completed a Certificate of Applied Science and advanced to the ALS classification and Wilderness/Helicopter Paramedic.  He has held positions within AT of Clinical Instructor (Patient Extrication), Supervisor (Tactical Operations), Manager of the Southern Region, Acting Manager of Support Services, Acting Director of Emergency and Medical Services and he holds an Advanced Diploma in Business Management.

[202]	It was Mr O’Brien’s evidence that the four principal components of paramedic work, were to respond, assess, intervene and transport or refer, and that they have not significantly changed since the datum point.  He said there has been change in the introduction of formal tertiary level qualifications that equip paramedics with greater knowledge, the use of additional diagnostic and assessment tools, the introduction of the 2012 CPGs that provide more detailed practice information, consultation procedures that provide more formalised clinical support and changes to drugs and procedures that have not resulted in any real increase in duties and responsibilities, and that have made the role easier to perform.

[203]	When dealing with the ‘respond’ component of the paramedic role, Mr O’Brien said the changes made to the response process since 1988 have made the process more systematic and safer for responders and patients.  This involves detailed information gathering, under the AMPDS system, when a caller requests ambulance assistance and they are given a priority rating.  He said whilst the AMPDS system was not available at the datum point, the prioritisation system was the same and there have been no other changes to the response aspect of the role since 1988.

[204]	Mr O’Brien said that the fundamental steps a paramedic takes in relation to the primary and secondary assessment of patients has not significantly changed since the datum point.  He stated that whilst the majority of conditions afflicting patients have not changed since the datum point, there have been developments that have resulted in better knowledge of conditions and improvements in treatment options and methods.  Mr O’Brien stated that the improved standard of training has not resulted in any additional duties for paramedics.

[205]	It was Mr O’Brien’s evidence that whilst paramedics have to undertake additional steps in treatment due to new diagnostic and measurement tools, this equipment has made it easier for a paramedic to determine how to treat a patient.  He stated these new tools either provided more information than the predecessor equipment or they were entirely new tools that have never been used before, such as the 12-lead ECG or the Pulse Oximeter.  Mr O’Brien stated the 12-lead ECG now provides an ICP with the same information as a 3-lead ECG, plus more detailed information as to permanent or potentially permanent heart damage.  He said the Pulse Oximeter was not available at the datum point; however the assessment process to determine the patient’s blood oxygenation is the same as it was in 1988.

[206]	Mr O’Brien stated the 2012 CPGs were revised to ensure evidence-based practice and to provide additional information to paramedics.  He said that paramedics have always had to display complex decision making in their work due to their uncontrolled work environment.  He confirmed that trauma cases have always been a small case load of the total responses in both 1988 and present day.  Mr O’Brien said it was his experience that the work environment of paramedics had become more controlled through AT policies and procedures, work health and safety legislation and the wearing of safety vests, which were not available in 1988.

[207]	It was Mr O’Brien’s evidence that the lowest level of independent practice within AT in 1988 was an AO and at present is a Paramedic.  He said both of these roles were and are trained to work independently without the immediate assistance of other staff, and that whilst they do not have the same support as a doctor or nurse, this has always been the situation.  Mr O’Brien stated that a paramedic is not required to definitively diagnose a patient and that should a paramedic require clinical assistance, they can contact a Clinical Co-Ordinator or use another professional consult under AT policies.  He stated that whilst additional assistance was available to AOs and ALSs in 1988, there was not the formal consult process that is now in place at AT and therefore there is no greater autonomy, independence or empathy and support required in the role of a paramedic now, as compared to the datum point.

[208]	Mr O’Brien stated that the increased standard of training for paramedics has not resulted in any additional work or duties as compared with 1988, and that new equipment has made the job of a paramedic easier.  He said that AOs in 1988 administered much more than basic first aid through use of the 1980 Protocols, drug therapies and interventions to treat patients.  Mr O’Brien stated that in 1991, 2003, 2004, 2007 and 2012 the Protocols/CPGs introduced new drugs and procedures, but that these changes were more a result of evolutionary advancements in health care.  He also tendered a complete copy of the 1991 Protocols as part of his evidence.  It is Mr O’Brien’s view that wage increases in 2004 and 2010 recognised the expanded scope of practice of paramedics due to the increases being around 25% or higher.  He said the increase in drug administration and procedures is not as significant as the introduction of the ALS skills.

[209]	In relation to the changes experienced in how paramedics treat a cardiac patient, Mr O’Brien disagreed with evidence provided by the applicant’s witness, Mr Richardson, and said that the changes from the datum point to present involved improved assessment and diagnostic tools (12-lead ECG), evolutionary changes in the drugs available and who can administer them and CPR procedures (changes in ratio and patterns between compression and ventilation).

[210]	Mr O’Brien provided an example of the level of trust that doctors have had with AOs since before the datum point, which related to his diagnoses of a patient in ICU before a group of medical students.  He said whilst the practice of ramping is unsatisfactory from AT’s perspective, paramedics are not required to practice any additional skills when managing a patient while ramped.  Mr O’Brien stated that cooperation with GPs and other health professionals has always been a key component of the role of an AO and paramedic.

[211]	It was Mr O’Brien’s evidence that non-emergency cases have reduced due to the establishment of the Health Transport Unit.  He stated that AT have developed referral protocols for paramedics to help them with the decision of referral or transport to hospital.  He said that whilst paramedics are able to find suitable alternatives to transporting a patient to hospital, this has always been a key part of the role.  Mr O’Brien confirmed during examination that paramedics are trained to recognise death and in certain situations are able to declare life extinct, or hand the scene over to the Police as a coronial matter.  He also confirmed that in the wake of a major incident where AT resources were completely overwhelmed, a paramedic can make a triage choice of “deciding who lives or dies”, but that during his 33 years of service with AT he was not aware of that triage choice ever having been made, which included the Port Arthur massacre incident.  It should be noted that the Port Arthur massacre occurred in 1996, some 9 years prior to the implementation of the AT triaging policy and as such this process of triaging would have been possible at that time.

[212]	Mr O’Brien provided a comparison of the classifications from the datum point to present day, together with a comparison of the duties and responsibilities of those classifications.  The Paramedic classification now is the equivalent of the AO and AO (Patient Extrication) in 1988.  He said prior to 1988 these roles have been required to mentor SAOs, Paramedic Students and Paramedic Interns.  Mr O’Brien acknowledges there has been an expansion of the scope of practice as a result of health advancement and technology.  The ICP classification now is the equivalent of the AO (ALS) and AO (ALS/Patient Extrication) in 1988.  Mr O’Brien did not provide a Statement of Duties for AO (ALS) or AO (ALS/Patient Extrication).  He stated that both ICPs and AO (ALS) had to undergo further training to obtain those classifications.

[213]	Mr O’Brien stated that the BSO classification now is the equivalent of the BSO and BSO (Patient Extrication) classifications in 1988.  The BSO (ICP) classification now is the equivalent of BSO (ALS) and BSO (ALS/Patient Extrication) in 1988.  He said that in addition to the normal paramedic role, BSOs have some additional duties and responsibilities which attract the additional pay grade and that the duties have not changed since the datum point, with the exception of some maintenance of branch stations now being provided by external providers.  Mr O’Brien stated that BSOs have greater access to support than at the datum point as additional resources, such as Volunteer Educators, to assist with training and new branch stations being established at Wynyard, Sheffield, Queenstown, Scottsdale, Scamander, Nubeena, Triabunna and Sorell.  Mr O’Brien did confirm during examination-in-chief that the training for VAOs is different now than it was in 1988 but he was unable to say whether the level of training was significantly higher now.

[214]	In relation to the current Paramedic Intern and Paramedic Student classifications, that is now the equivalent of the SAO classification in 1988.  Mr O’Brien stated that the duties and responsibilities of a Paramedic Intern have not changed since that classification was created on 1 July 2010.  Both Paramedic Interns and Paramedic Students can administer drugs and undertake procedures under direct supervision and this has not changed since the datum point.

[215]	As for paramedics performing helicopter duties, Mr O’Brien stated that from the datum point until present, various AOs (ALS) and (ALS/Patient extrication) and ICPs have been trained to undertake helicopter operations and are paid an allowance accordingly.  He referred to the consent order agreed between the parties on 8 January 2013, which created a new classification and pay rate for Flight Paramedic - Helicopter.  He said the consent order recognised the various changes in skills, training, work and work environment of paramedics working in AT’s helicopter operations, which he said included the work from the datum point.  He discussed the changes in helicopter aircraft and the changing relationship between the paramedic and other rescue crew members.  Mr O’Brien stated that paramedics undertaking helicopter duties had always played an important role in rescue scenarios and liaising with the Pilot, and that this was no different in 1988.  He said formal training was given to helicopter paramedics in 2000 relating to observing for hazards and appropriate actions to take to warn the Pilot and maintain aircraft safety.  However, he stated it is the Pilot’s responsibility to determine whether it is safe to fly in particular weather.  In relation to training for helicopter Paramedics, Mr O’Brien acknowledged training now required for the role, but did not address the CASA training or the Monash University qualification.  Mr O’Brien stated that there have been developments in the equipment used by staff in helicopter operations, such as EPIRBs, strobe lights, survival equipment, new harnesses, but that this equipment does not require them to perform additional complex skills and makes their job safer.  He stated that night vision goggles have not been introduced for use in helicopters as at the date of the hearing.  Mr O’Brien stated that the requirement for helicopter Paramedics to cooperate with other health professionals, paramedics, emergency agencies and stakeholders, has not changed since the datum point.  

[216]	Mr O’Brien said the CSO classification is now the equivalent of the Clinical Instructor (Patient Care) and Clinical Instructor (Patient Extrication and Driver Training) classifications in 1988.  Mr O’Brien stated that CSOs are responsible for teaching, assessing and quality assurance of paramedics and in particular Paramedic Students, Interns and Student ICPs.  They also deliver an advanced level of pre-hospital care for patients and that their duties have not changed since the datum point.  He said previously, Clinical Instructors were required to be part of the on-road roster as well as teach, but that now all CSOs work an off-road roster and are not normally rostered to work in a crew.  They work as first responders.  He said the transfer of the patient extrication duties to the Tasmanian Fire Service also meant CSOs are no longer required to advise on the equipment maintenance and efficiency of the rescue unit.

[217]	In relation to the Paramedic Educator and Volunteer Educator classifications, these roles are the equivalent of the Course Co-ordinator classification in 1988 and the Ambulance Educator classification in the 1990s.  He said Paramedic Educators research, develop and implement training programs for ambulance practitioners and volunteer staff and that these duties and reporting structures have not changed since the datum point.  They are also required to maintain and apply their clinical knowledge by working on-road on a regular basis.  He said Course Co-ordinators previously were required to report on clinical practice but this role is no longer undertaken by Paramedic Educators, that Ambulance Educators had a greater role in tasks involving partnership programs with universities, but with the advent of the Bachelor degree as a base entry level at AT, that work had decreased.  It was Mr O’Brien’s evidence that there are two levels of Educator.  Level 1 Paramedic Educators can be either Volunteer Educators, which involves working a shift and planning and implementing VAO training; or Paramedic Educators who are day workers, qualified Paramedics and who research, develop and implement training for paramedics.  Level 2 Paramedic Educators can be either Regional Education Co-ordinators who are day workers that facilitate and co-ordinate education in their region, teach programs and sometimes undertake operational duties; or Paramedic Educators who are day workers qualified as ICPs who research, develop and implement training programs for paramedics.

[218]	Mr O’Brien provided evidence that the Duty Manager classification is now the equivalent of the Duty Officer classification in 1988 and the Supervisor (Tactical Operations) classification in the 1990s.  He stated that Duty Managers are responsible for the day to day management of operational resources and maintenance of links with other health professionals and emergency services, and that the role has not significantly changed since the datum point, with some structural reporting differences.  Mr O’Brien stated these employees must also maintain their clinical skills by working on-road on a regular basis.

[219]	It was Mr O’Brien’s evidence that between the datum point and 2009, the role of Operations Manager was created in the Northern region.  From 2009 Operations Manager roles were also established in the Southern and North West regions.  He stated the duties for these roles have not changed since the first Operations Manager role was established.  The role provides advice and support to ensure ambulance services comply with AT standards.  These employees must also maintain their clinical competencies by working on-road on a regular basis.

[220]	Mr O’Brien stated that the current Manager Level 3 classification is the equivalent of the Superintendent classification in 1988.  He said that different types of Superintendents and Managers have evolved over time, since the datum point, due to new operational units and the AT structure, but that the duties and responsibilities have not significantly changed during that time.  Mr O’Brien also stated that a new classification of Manager Level 4 (Director of Clinical Services) was created in the 2010 Agreement, that it has not changed since its inception and that there was no equivalent for this position in 1988.

[221]	Mr O’Brien acknowledged in his evidence that the base qualifications for the above classifications have changed with the introduction of a base tertiary qualification, but stated this was recognised and compensated for in the 2010 Agreement.  It is noted that quite a number of Statements of Duties which were in operation as at the datum point, were not available for tendering as evidence.  

[222]	Mr O’Brien said that the changes that have occurred since the datum point are transition from TaFE to tertiary qualification, removal of patient extrication duties and an expansion of the scope of practice in the use of drugs and procedures, all of which have been compensated for by AT.

[223]	In relation to AT’s workload, Mr O’Brien stated that since the datum point, there has been a significant reduction in the number of motor vehicle fatalities and serious injuries which has reduced the number of paramedic responses to these trauma cases.  Mr O’Brien stated that unfortunately the role of paramedic has always carried with it inherent risks in relation to stress, manual handling, risk of violence and infectious diseases and that a mechanism for dealing with these risks is in place by way of fatigue management systems being introduced since the datum point.

[224]	Mr O’Brien described the structure of AT, the three regional areas and types of ambulance stations and operations located state-wide, together with a description of the activities undertaken by the five divisions incorporated within AT.  He confirmed that the normal crewing arrangement for rural ambulance stations contains a BSO and a Volunteer Ambulance Officer (VAO).  Normal crewing arrangements in urban areas involve a Paramedic or ICP with a person of any other classification (ie Paramedic Student, Paramedic Intern, Paramedic or ICP).

[225]	Mr O’Brien stated the Aero-Medical and Medical Retrieval Unit has two distinct services, the Fixed Wing Service that provides inter-hospital transfers, medical retrievals and emergency response to Bass Strait Islands (crewed by a pilot and a Flight Paramedic – Fixed Wing, that is an ICP); and the Rotary Wing Service that provides a rescue service for patients in inaccessible areas, or in situations that are time critical or where the fixed wing service is unavailable (crewed by a pilot, a Tasmania Police Officer and an ICP with helicopter training).

[226]	Mr O’Brien provided data analysis relating to workload and staffing numbers at AT and stated that, whilst incident responses have increased (relating to aging population, chronic disease, co-pathologies and co-morbidities, increasing total population and changing community expectations), so too have staffing levels; the operational staff ratio has been close to the national average particularly in the last three years.  These statistics are based on data from July 2004 to June 2012.  Operational staff at AT have increased from 166 in 2004 to 230 in 2012 and Mr O’Brien states therefore the ratio between staffing and incident levels has been maintained.  For the period covered by the statistics, a high of 319.7 incidents per operational staff member was recorded in 2005/06, which reduced to an average of 272 incidents per operational staff member over the years 2007/08 to 2011/12.  During examination-in-chief, Mr O’Brien stated that the differences between the data provided by him and that provided by the applicant (as it related to the number of incidents per operational staff member) was a result of a different interpretation of what an “incident” was, as opposed to a “response”.

[227]	It is noted this data only shows a pattern from 2004 and is not illustrative of the period post the datum point to 2004.

[228]	In relation to the levels of overtime worked by paramedics, Mr O’Brien stated that whilst AT has policies in place to manage ‘controllable’ overtime, there are some types of overtime that are “uncontrollable” such as extended shift overtime, where a paramedic cannot immediately leave a patient and works after the end of their roster to complete their involvement in that incident response.  He said air ambulance overtime worked by the helicopter and fixed wing paramedics is unavoidable where they are mid-air at the end of their shift.  He said extended shift overtime represented less than 5% of all overtime worked in the last eight years.  Mr O’Brien stated the resources that would be required to eliminate extended shift overtime is not feasible based on AT’s funding allocation, and that AT sought to introduce (unsuccessfully) an Extension of Shift Policy in 2012.  Mr O’Brien said AT have always recognised fatigue as an issue for staff and that the 4 by 4 shift pattern of 4 days on and 4 days off (8 day cycle), has not changed since the datum point, but that they implemented a formal fatigue management system in 2012.  He described the two types of rosters and the shift patterns operating at AT, together with the Fatigue Management Package and other policies that contribute to fatigue management.

[229]	It was Mr O’Brien’s evidence that the nature of paramedic work exposes those AT employees to a higher risk of stress than non-emergency workers, but that this has always been the case.  He stated that he did not agree with Dr Reynolds’ evidence that the work of paramedics is much more emotionally demanding now than 10 years ago, due to the decrease in SIDS cases and motor vehicle trauma.  He also said that AT has a formal CISM scheme which triggers after the occurrence of a notifiable incident and provides assistance to staff to address accumulative stress.

[230]	In relation to the risk of violence in the workplace, Mr O’Brien stated that paramedics assessing and requesting assistance in these circumstances, has not changed since the datum point, although a formal policy was introduced in 2005.  Mr O’Brien described the reporting system for aggressive incident occurrences and provided a table of data relating to incidents.  Unfortunately no accurate data is available pre-2009/10 financial year, but Mr O’Brien states that there does not appear to be an increasing trend of violence from 2009-2013 with very few serious assaults on emergency service workers in Tasmania.  He did acknowledge that aggressive incidents against paramedics have probably increased from 1988 to 2004 and that not all incidents of aggression are reported by AT staff.  Mr O’Brien stated that in late 2009 AT organised an Occupational Violence Working Group who made 36 recommendations about minimising the risk and impact of violence in the workplace, and that 35 of those recommendations have been addressed by AT.

[231]	Mr O’Brien stated that the risks associated with infectious diseases in the workplace has not changed since the datum point, other than it is now more culturally acceptable for paramedics to use precautions in every treatment of a patient, and that some communicable diseases have become rarer.  He also said that the role of paramedic has always been physically demanding, but that contemporary practice, such as allowing some patients to ambulate themselves to response vehicles and the introduction of bariatric and other equipment, had made this part of the job easier.

[232]	Mr O’Brien tendered a full copy of the 1991 Protocols and stated that whilst these were the oldest version of Protocols available, they only contained subtle variations from the previous version.

[233]	Under cross-examination, Mr O’Brien was asked to compare his full copy of the 1991 Protocols, against the applicant’s document comparing the scope of practice in the 1991 Protocols and the 2012 CPGs for Paramedics.  Specifically, he was asked to compare airway intervention procedures and drug administration routes for 1991 and 2012.  He stated foreign body choking and upper airway obstruction (paediatric) were carried out by Paramedics in 1991.  There was some dispute over the inclusion of inhaled drug administration being ALS (now ICP) only in 1991.  Mr O’Brien stated inhaled drug administration was not ALS only, however this was sharply contested in cross-examination as was Mr O’Brien’s statement that intramuscular injections were given by AOs (now Paramedics).  He confirmed that with the inclusion of foreign body choking and upper airway obstruction (paediatric) to airway interventions and the inclusion of inhaled and sub-lingual to the drug administration routes of the applicant’s comparison document for Paramedics, the comparisons in the document were accurate.

[234]	When cross-examined on the Protocols and CPGs as they related to cardiac interventions, Mr O’Brien confirmed that the giving of oxygen therapy and placing a patient on a cardiac monitor had been undertaken by Paramedics in 1991, although it might not have specifically stated that in the Protocols.  He also stated that intermittent positive pressure ventilation (for pulmonary oedema) should be included as a paramedic procedure under the 1991 Protocols and 2012 CPGs.  He then confirmed with those inclusions, the comparison undertaken by the applicant, as it related to cardiac interventions, need no further amendment.  He confirmed the accuracy of the Clinical Guidelines and Pathways within the 1991 Protocols as compared to the 2012 CPGs with the inclusion of positioning, supraventricular Tachycardia, high grade PVCs, conscious ventricular tachycardia, bizarre arrhythmias, unconscious ventricular, electro-mechanical dissociation, seizures and carbon monoxide poisoning pathways, to the 1991 Protocols.

[235]	Mr O’Brien was then referred to the applicant’s comparison document as it related to an ICP and the scope of practice under the 1991 Protocols and the 2012 CPGs.  In relation to airway intervention, Mr O’Brien stated that nasopharyngeal airway, inhaled and sub-lingual administration was practiced by ALS prior to 1991 and should be included in the applicant’s comparison document.  In relation to drug administration routes for ICPs, Mr O’Brien stated that intramuscular and rectal methods should be included as administration routes in the comparison document for ICPs in 1991.  Likewise for cardiac intervention, he confirmed that morphine was administered as pain relief by ICPs in the 1991 Protocols and that he could see no other inclusions required in the comparisons for cardiac interventions.

[236]	Mr O’Brien acknowledged that with the higher standard of tertiary qualification now undertaken by paramedics, paramedics are now in a position to provisionally diagnose a far greater range of ailments than was the case 20 years ago.  However, he said he could not quantify the number of conditions that may involve.  He also confirmed that Paramedics in 1988 were not able to use defibrillators, although they could now.

[237]	In dealing with Mr O’Brien’s evidence which provided that there was no fundamental change to the way a Paramedic treats ventilation in a cardiac arrest patient in 1988 and now, Mr Irving questioned Mr O’Brien as to whether the patient in 1988 would have died had the bag valve mask airway intervention not been successful.  Mr O’Brien conceded that the patient would have died also confirming that a Paramedic can now also use a Laryngeal mask.  He further confirmed that an ICP is able to use other airway interventions such as endotracheal intubation, capnography, intubating laryngeal mask, cricothyroidotomy and some additional steps if the patient is a child.  Mr O’Brien stated the fundamentals are still the same, which is to ventilate a patient, but that more tools, processes and procedures are now available to help.  He did concede that these additional steps all involve new skills that have been acquired by ICPs.

[238]	Under cross-examination Mr O’Brien confirmed changes in the application of CPR in cardiac arrest patients since 1988, in that a paramedic must ensure that CPR does not stop after 10 seconds and is continually administered during the course of treating the patient.  He also confirmed that the requirement of paramedics to change position to share the administration of CPR, made the administration of drugs, airway management, scene control and acquiring and interpretation of ECGs a more complex and intense experience for paramedics.  Mr O’Brien also confirmed that a Paramedic is now able to administer, to a cardiac patient, the drugs Adrenalin, Oxygen, Metoclopramide, Glycerol Trinitrate, Morphine, Normal Saline and Ondansetron, whilst an ICP is able to administer the drugs Adrenaline, Adenosine, Amiodarone, Asprin, Frusemide, Glycerol Trinitrate, Magnesium, Metoclopramide, Morphine, Normal Saline, Ondansetron, Oxygen and Prochloreperazine. 

[239]	Mr O’Brien stated that the 12-lead ECG provided paramedics with a substantially greater depth of information, which allows for a greater depth of informed decision making and required a greater understanding and underpinning knowledge as to what the infinite number of ECG readouts might mean.  He said this is what he meant when he said the new equipment made the job easier.  Mr O’Brien also stated that the use of pulse oximetry also required a greater depth of knowledge and understanding for a paramedic to accurately interpret the information provided by that equipment and use the information in a clinical setting.  He agreed that the use of the wide range of introduced equipment over the last 20 years relies on its proper use and utilisation, built up on the depth of knowledge of paramedics as compared with their knowledge 20 years ago.

[240]	Mr O’Brien stated that CSOs are now required to be on top of a deeper and broader range of clinical knowledge than was the case 20 years ago, as part of their educative role.

[241]	Mr O’Brien acknowledged that his witness statement provided that 22.1% of overtime worked by operational staff at AT involved uncontrollable overtime which included, workers compensation, long term sick leave, personal and carer’s leave and that AT did not currently cover this leave as there is only finite funding resources for staffing levels.

[242]	Under cross-examination Mr O’Brien confirmed that when looking at the incident data produced by AT in his witness statement and comparing that data with the ROGS definition of incident and the Tasmanian State Budget settings definition of incident, there had been a reduction of some 2,700 responses from the figures provided by AT.

[243]	Under re-examination Mr O’Brien confirmed the format of the 1991 Protocols and what was entailed in undertaking “Basic Support” under those Protocols involving airway, breathing and circulation.  He was asked by Mr Dalton if he was able to explain the divergence of data involving the ambulance incidents and what might have caused the difference in statistics.  Mr O’Brien stated he was unable to provide a conclusive explanation.

Wolfgang Rechberger

[244]	Mr Wolfgang Rechberger, Manager of Aero-medical and Medical Retrieval Operations at AT gave his evidence both orally and by statement for the respondent, essentially concerning the scope of paramedic practice from the 1970s through to the time of hearing.  Mr Rechberger began with AT in 1970 as a volunteer ambulance attendant and commenced his employment as an AO in 1974.  He has held positions within AT of AO (ALS and Patient Extrication), Regional Training Officer, Regional Duty Officer, Deputy Superintendent, Acting Superintendent and Superintendent.  He also undertook Flight Paramedic duties from 1974 to 1995 as part of standard AO duties.

[245]	Mr Rechberger advised he was a member of the Senior Officers Group with responsibility for management of some industrial relations matters and he was part of negotiations for the Tasmanian Ambulance Service Enterprise Agreement 2004 (the 2004 Agreement).  Mr Rechberger stated that in 2004 the Police Union, the Australian Nursing Federation and the applicant all lodged a claim for wage increases, essentially, on work value grounds.  He said these pay rises were awarded in response to a public campaign centred on the role of AOs being undervalued.  The 2004 Agreement also created a classification for Flight Paramedic – Fixed Wing, a $20 allowance per shift for wilderness rescue duties and a Preceptor (mentoring) Allowance.  Mr Rechberger said that it was acknowledged during those negotiations that paramedics had an obligation to provide informal mentoring when working with junior peers.  In the 2010 Agreement the Preceptor Allowance was combined into the Specialist Paramedic Allowance (SP allowance).  Likewise, the allowance payable for urban search and rescue was also combined into the SP allowance.

[246]	It was Mr Rechberger’s evidence that 1974-1988 saw significant changes in the education and skills of AOs with the introduction of the ALS, Patient Extrication and TaFE level qualifications, all of which were compensated for in the 1988 work value case.

[247]	Mr Rechberger stated that from 1988 to 2013, there have been three significant changes in education standards for paramedics, namely the change from TaFE level to Associate Degree level in 1994; subsequent to that, the change to a Bachelor Degree level in 2011; and specialist skills in chemical and biological response in 2004 and urban search and rescue in 2005.

[248]	Further, Mr Rechberger stated that over this same period there was an expanding of the scope of practice for paramedics in the Protocols/CPGs which include, for ICPs, intubation skills (2000), external cardiac pacing (2011/12), interpretation of the 12-lead ECG printouts and the administration of some new drugs.  For Paramedics, he said the expanded scope of practice included the skill of intravenous cannulation in the mid-2000s and some new medications such as asprin and GTN spray in 2004 and morphine for pain relief in 2011.  He said these changes only reflected incremental advancements in clinical practice and have made the work of a paramedic easier.  It was his evidence the fundamentals of the role of a paramedic have not changed since 1988, in that the role of a paramedic has always been to respond, assess, intervene/treat, and transport/refer.  Mr Rechberger said, if anything, the response for a paramedic has probably been made easier due to the patient categorising system now used and that they can rely more heavily on a Paramedic Intern, than on a recently commenced SAO.  In relation to assessment, Mr Rechberger said assessment had become easier for paramedics due to advancements in technology, due to the 12-lead ECG and electronic blood pressure monitor equipment.

[249]	In relation to treatment, Mr Rechberger said there had been some changes since 1988.  In 1988 AOs only provided advanced level first aid treatment and were able to administer two forms of pain relief those being Trichlorethyline and Entonox via inhalation.  He said by mid-1990s Trichlorethyline was replaced by Penthrane administered via inhalation and that these were the only two drugs available at that time for that purpose.  He did state that in 2005, Paramedics were able to apply intravenous cannulation and in 2011 the CPGs were amended to include additional drugs for the use of Paramedics.  Mr Rechberger also advised that ICPs now perform some additional treatments, as a result of advancement in medical technology, such as external cardiac pacing and intubation.  However, he stated that these changes are merely evolutionary and will always continue to occur.

[250]	As for transport or referral, Mr Rechberger stated that paramedics have always had an ability to refer patients, rather than transport them to hospital.  He stated an ALS was able to not transport after consulting with a doctor.

[251]	Mr Rechberger stated that the 2004 Agreement provided a pay increase of around 28% over three years and this was in recognition of the increase in the value of their work, together with a specialist skills allowance.  He said also that the 2010 Agreement classification and increases were negotiated in recognition of paramedics being considered a professional group and the Bachelor Degree level qualification required.  He said the 2007 Agreement condensed the classification scales, making progression for paramedics quicker and paramedics could reach the upper pay scales without having to possess the patient extrication skills (see below).

[252]	In his evidence, Mr Rechberger confirmed, due to a decision of the State Government, the patient extrication duties of a paramedic transferred to the Tasmanian Fire Service in 2006.  He said that the Patient Extrication pay rates were maintained for relevant paramedics (approximately 60% of paramedics in 2006) until the 2010 Agreement.  Mr Rechberger said that the composite rate for paramedics in Tasmania is comparable to other States and Territories and that AT is not experiencing difficulties in attracting or retaining staff.

[253]	Mr Rechberger provided a history of the ambulance service in Tasmania, including the changes to its structures from 1984 and the reviews undertaken.  He gave a particularly detailed narrative of the early history of the paramedic classification structure and associated qualifications, which was helpful in a general fashion, but was well prior to the datum point.  This included the Certificate of Applied Science (CAS), ALS and patient extrication qualifications.

[254]	In relation to fixed wing ambulance services, Mr Rechberger stated that as at the datum point, there was no additional training required for an AO to perform air ambulance duties and they were not paid anything additional to their normal rate of pay.  Their only function was to accompany and care for the patient in flight.  He said that in 1994, the State Wide Retrieval Service was introduced to coordinate the transfer of critically ill patients and to ensure an adequate level of care.  He said a two day in-house training program was run for interested paramedics in the North and that from that time on, only those who had undertaken the training could complete air ambulance work, which involves airport to airport transfers, paramedic retrievals and medical retrievals.

[255]	Mr Rechberger said that since the classification of Flight Paramedic – Fixed Wing was created in the 2004 Agreement, no one has been appointed to the role, but that paramedics receive a higher duties allowance for undertaking that work.  He stated that the classification was in recognition of the increased qualifications AT now required for that work which includes a Monash University course, involving a three week course, two written assignments, a skills log book recording their previous experience and a final written examination.  The course covers aviation medicine (ie the differences in clinical treatment at altitude) and aircraft safety.  A Flight Paramedic – Fixed Wing must also undertake CASA flight crew training.  They also require an ASIC card, which provides them with aviation clearance, although Mr Rechberger was scant on details as to the requirements to obtain their ASIC card or the content of the CASA training.  Mr Rechberger stated that as a result of completing the Monash qualification and a two week in-house course, paramedics were able to administer higher level medications than regular Paramedics or ICPs, as part of a continuing medical treatment regime.  It was acknowledged by Mr Rechberger that Flight Paramedics – Fixed Wing now had a greater level of skill.  However, Mr Rechberger stated that aero-medical duties have remained the same, that is, to accompany and care for a patient, to continue the administration of a treatment regime already prescribed by a doctor, maintaining infusions and central lines and to assist the pilot with emergencies.  He stated they are not involved in flight planning.

[256]	Mr Rechberger said that there has been an evolution in aircraft used for ambulance work.  In 1988 it was a modified civilian aircraft.  By 1998 it changed to a King Air B200 and finally in May 2013 he said they had taken over a newer aircraft which represents an upgrade in equipment which has made loading and unloading of patients easier, although he didn’t explain how it made it easier.

[257]	It was Mr Rechberger’s evidence that in 2008, AT began utilising the Flight Paramedic – Fixed Wing in some road retrievals, but only in conjunction with a doctor.  He said this decision was made due to the training they had undertaken in the Monash course and the types of equipment and treatment they were able to use (such as maintain infusions and central lines).  He stated that there are some changed procedures for Flight Paramedics – Fixed Wing which relate to equipment such as syringe drivers, different cardiac monitors, vacuum mattresses, central (arterial) lines and ventilators, with extensive training being provided on this equipment.  Mr Rechberger stated that Flight Paramedics – Fixed Wing also undertake around 12 to 16 weeks per year on road to help maintain their skill levels.

[258]	In relation to workload for Flight Paramedics – Fixed Wing, Mr Rechberger said that from 2001/02 until 2009/10, AT moved between 800 and 900 patients by air ambulance each year.  Since 2010/11 they have averaged approximately 1,000 cases, but the time taken in each of those cases has decreased.  He said the air ambulance is not a primary response resource with approximately 10 paramedic retrieval cases taking place each year.  As for overtime, Mr Rechberger stated that Flight Paramedics – Fixed Wing do have more extended shift overtime than road paramedics, because transfers are often extended length transfers, however their rostered overtime is the same as road paramedics and they are paid at overtime rates.

[259]	It was Mr Rechberger’s evidence that in 1994, due to a national shift in the industry, AT determined to change the paramedic qualification from CAS to the Bachelor of Health Science (Paramedic Studies).  In 1998, AT and the applicant determined to remove the mandatory nature of the ALS qualification.  He stated that in 1998 the Clinical Instructor classifications were changed to the CSO classification with CSOs now being required to complete a Certificate IV in Training and Assessment.

[260]	In relation to Urban Search and Rescue (USAR) Training, Mr Rechberger stated that this was introduced by AT in 2005.  USAR training was conducted over four weeks and these paramedics formed part of the Tasmanian Fire Services’ urban search and rescue team.  As for Chemical and Biological Response (CBR) Training, he said it was introduced in 2005 and was federally funded.  He stated whilst AT intended to roll the training out to all paramedics, no CBR training has been undertaken in the last three years, that no refresher training has been provided and AT has no paramedics who are qualified to perform CBR work.  This evidence was in direct conflict with that of Mr Samborski.

[261]	Mr Rechberger stated that in 2006, AT started the transition to UTas for the provision of the paramedic tertiary qualification.  The qualification was still an Associate Degree program.  In 2009, UTas developed their own Bachelor program (Paramedic Studies) and by 2010, the Associate Degree was no longer offered.  He said a graduate programme was introduced in 2009 and that since 2011, AT stopped recruiting SAOs and now, only recruits graduates of the Bachelor degree course, into the classification of Paramedic Intern.

[262]	Mr Rechberger provided some detailed evidence about professional association memberships available to AT and its employees.

[263]	It was Mr Rechberger’s evidence that if there has been a seismic change in paramedic work, it was the ALS qualification, which was compensated for in the 1988 work value case.

[264]	Mr Rechberger stated that AT pays its paramedics on a composite basis, that is, to smooth out the differences normally experienced by a rotating roster.  It is calculated on a roster rotation of 64 weeks.  He said overtime penalty rates, calculated on the base rate, for work performed outside normal rostered hours, is still payable.  He stated some ambulance services in other states pay a ‘rolled-up’ rate.  He said as each State may include different entitlements in the rolled-up rate, no sensible comparison can be made between the pay rates of the different States.  Mr Rechberger stated that whilst a more accurate comparison would be between base rates, this would provide a distorted view depending on each State’s treatment of other penalties and loadings such as overtime, or whether the working week was 38 or 40 hours.  He said that “…I do not believe that Paramedics in Tasmania are underpaid compared to other States in Australia, but rather that remuneration of Paramedics in Tasmania is around the middle of the market in comparison with that of other States.”

[265]	It was Mr Rechgerger’s evidence that the Protocols in place at AT, as at 1988, were almost identical to the 1991 Protocols, save for some minor differences in drugs.  During his examination-in-chief, Mr Rechberger stated that the applicant’s comparison documents relating to the scope of practice under the 1991 Protocols and the 2012 CPGs showed that the CPG information was unpacked, whereas the 1991 Protocols was still in a “packed” format.  He said that the Protocols were developed as a little pocket book, so the amount of information that could be incorporated was limited.  He said that didn’t mean that certain treatments weren’t carried out in 1990.  Mr Rechberger stated that intravenous administration was not available for Paramedics in the 1990s, but that they did administer drugs by the inhaled method and orally.  He said IV cannulation was introduced to Paramedic practice in 2004.  When questioned about why AT changed from Protocols to CPGs, Mr Rechberger stated it was a terminology change.

[266]	Mr Rechberger stated that BSOs have always had to train volunteers and that back in 1988 they also had to train volunteers from adjoining volunteer only stations, (using Campbell Town and Avoca as an example) and that they put together their own training packages and lesson plans.  He said these training packages are now put together by the Volunteer Educators and picked up by the BSOs to undertake a consistent level of training across the State.

[267]	Mr Rechberger confirmed that he was involved in the drafting of Attachments A to D of the Agreed Statement of Facts.

[268]	Under cross-examination, when taken again to the applicant’s comparison document relating to scope of practice from 1991 to 2013 for Paramedics, Mr Rechberger said that the nasopharyngeal airway procedure was practiced by Paramedics at the datum point, however in relation to drug administration routes, he said intramuscular, intravenous injection/infusions and intranasal were all new methods of drug administration for Paramedics.

[269]	In relation to the comparison document for an ICP’s scope of practice from 1991 to 2012, Mr Rechberger stated that some of the procedures listed under airway interventions were only parts of the general skill of intubation and were not, in themselves, discrete skills (such as Capnography).  Under further questioning on this point, Mr Rechberger confirmed he was not intubation trained, that the procedures listed under the comparison document for airway interventions, were all separate techniques that have been taught to ICPs at different times, however he viewed those techniques as part of the evolution of the skills of treatment.

[270]	When questioned about Dr Reynolds’ evidence relating to the difference between Protocols and CPGs, it was Mr Rechberger’s evidence that the CPGs were more prescriptive now than the Protocols.  He said this was because the CPGs contained more information.  However, he did agree with that part of Mr Edwards evidence, relating to a significantly higher need for knowledge in the underlying biological sciences in paramedic practice, including anatomy, physiology, pathophysiology and pharmacology.  Under questioning from the bench, Mr Rechberger confirmed there is a greater level of clinical intervention practiced now by paramedics than was the case in 1988.

[271]	Under cross-examination about the increased off-road component of work for current CSOs, Mr Rechberger acknowledged that CSOs now have more time to carry out the audit process and also to research world’s best practice on treatments.  However, he stated that the CSOs predecessor role, the Clinical Instructor, had always undertaken this work, albeit in a less regular fashion, due to the Clinical Instructor being formally rostered as part of an ambulance crew.  Mr Rechberger did confirm that CSOs were required to hold a Certificate IV in Training and Assessment and that previously, the Clinical Instructors were not required to hold that qualification.

[272]	Mr Rechberger confirmed that the changes in educational standards from TaFE level to Associate degree and Bachelor degree levels were revolutionary.  He said he also considered the introduction of specialist skills such as Chemical and Biological Response (CBR) and Urban Search and Rescue (USAR) as revolutionary developments.  Mr Rechberger stated that he was now aware that continued CBR training was occurring in the North West region, but that no paramedic had ever used the skills in a response.  When questioned about the USAR training and skills, Mr Rechberger confirmed that the allowance payable by AT is only paid for a shift when the paramedic is required to use those skills and that the allowance had never been paid for work in Tasmania.  He stated it might have been paid to one paramedic for maintaining urban search and rescue equipment.

[273]	In relation to pharmacology, under cross-examination, Mr Rechberger agreed that whenever the scope of administration, or dosage, of a drug changed (using normal saline as an example), paramedics were required to undertake training and this equipped them with additional skills.  Mr Rechberger also confirmed that with the introduction of the 2012 CPGs, Paramedics and ICPs were educated on new skills, drugs and intensive care equipment that put Tasmania at the forefront of pre-hospital care in Australia.

[274]	Mr Rechberger confirmed that Tasmania has the oldest population in Australia, that the proportion of Tasmanians aged 65 and over is projected to grow further over the next 45 years, and that that shift has profound implications for AT’s ambulance service.  Under re-examination, Mr Rechberger clarified that the profound implications for AT involved increased workload only.

[275]	When cross-examined on his characterisation of paramedics exercising “first-aid skills”, Mr Rechberger agreed that he had understated the role of today’s paramedic, agreeing that “…today’s paramedic is certainly different to the 1988 paramedic.  I would certainly agree with that yes.”  However, Mr Rechberger did not agree with the evidence of Ms McNamara as it related to rote learning undertaken by Ambulance Officers in 1988.  He also disagreed that, with Ms McNamara’s background in education, she was in a better position than him to make such an assessment.  He did concede however, that the tertiary education now undertaken by paramedics has equipped them with a higher level of learning.

Worksite Visits

[276]	On 18 July 2013, Wells DP attended AT’s headquarters in Hobart to witness simulation training by a Paramedic and an ICP.  During the course of this simulation, the paramedics undertook three simulated cases, based on a cardiac patient; a trauma case from a mountain bike accident and; a co-morbidity case involving alcohol and drug dependence.  These simulations evidenced the use of the 12-lead ECG, the scope of pharmacology in use, procedures undertaken by paramedics and their decision making skills.

[277]	On that and the following day, visits were also made to the Hobart International Airport to view the air ambulance, the wilderness rescue helicopters and also a Branch Station at Sorell (25km east of Hobart).  Wells DP was able to access the inside of the air ambulance and to speak with the Flight Paramedic – Fixed Wing on roster.  An inspection of the helicopter facilities was also conducted, including viewing the HUET equipment and general rescue equipment used by Flight Paramedics - Helicopter.  At the Branch Station, the BSO provided a tour of the station showing the personal facilities and accommodation and explained the requirement, due to location, for some BSOs to live at the Branch Station during their four days at work on the 4 x 4 roster.  The BSO also explained that they deliver training to volunteers working in their station and they also produce their own small training packages to train those volunteers.

[278]	It was regrettable that, due to a change in AT policy immediately prior to the scheduled workplace visits, Wells DP was unable to accompany a paramedic crew on any ‘real life’ patient responses.

Submissions

[279]	The Full Bench was advantaged by the presentation of detailed written and oral submissions.  In providing a broad outline of the respective contentions it is not intended to duplicate that considerable body of material or repeat the evidentiary basis upon which the submissions were said to rely.  A great deal of both parties’ written submissions set out below were referenced to the witness statements tendered in evidence and it is unnecessary to here again cross-reference the evidence to submissions.

The Applicant’s Opening Submissions

[280]	HACSU sought for paramedics (other than Communications Officers) to be paid at a ‘professional rate’ as a consequence, principally, of work value change.

[281]	Existing relativities were sought to be retained as they had been the subject of agreement between the parties.

The Work Value Principles

[282]	The application, made under s23 of the Act, was sought to be also governed by principles 9 and 11 of the Commission’s previous Work Value Principle.  It was said that the Work Value Principles as previously enunciated should, as a matter of ‘principle and discretion’, apply “in the light of, and to [the] effect to, the statutory scheme established by the Act.”

[283]	It was submitted that there had occurred a ‘monumental increase’ in the knowledge and expertise required of paramedics, demonstrative of an increase in work value.

Integration within the Health System

[284]	As a component of the integrated health system and reflective of the paramedics’ evolving and expanding role (beyond treatment and transport), the capacity for diagnosis, for clinical judgment as to a patient, was said to mean that no longer was an Emergency Department the necessary delivery point and rather, the patient might be referred to other services or remain in the home.

[285]	It was submitted that “This requires both an increased capacity for health and physical assessment and critical decision-making, as well as a more detailed understanding of the health system.”

[286]	As part of this change in paramedic practice, said to reflect an increasing level of clinical care, there had been “a greater degree of communication and collaboration with other health care professionals” which was demonstrative of “a significant growth in the clinical decision making and diagnostic role of the paramedic”.

[287]	It was put that with greater integration within the health system, paramedics have been required to develop new or altered relationships, including:

•	a notably changed relationship with doctors, whereby the views of paramedics are sought, valued and respected;

•	changed relationships with volunteers by Branch Station Officers; and

•	increasing demands placed on paramedic preceptors, or mentors, with the graduate interns recruited by Ambulance Tasmania.

The Emergency Department Interface

[288]	There was said to be a changed relationship between paramedics and the emergency departments of hospitals, so that where in the 1990s the primary function was to transport patients to hospital (where relevant under CPR) to permit triage (the initial diagnosis of the problem), now the triage begins with the paramedic and immediate steps are taken to institute emergency treatment.

Ramping

[289]	The newly adopted practice of ‘ramping’, whereby patients are held for up to three hours under the predominant care of the ambulance crew in or adjacent to the ambulance, reflected, in HACSU’s submission, the trust given by the emergency departments to the paramedics as to “the ongoing care and assessment…” of “sometimes quite acute patients…”.

Independence and Autonomy

[290]	The operating autonomy of paramedics was emphasised.  Having acknowledged that telephone contact support is generally available and that the work was always performed without supervision, it was submitted that the job had changed such as to increase its complexity.  The argument was put in this way:

“But now the job has changed, and the work being performed remotely is different, and this affects its complexity.  The paramedic works in an unsupervised clinical environment often quite remote from any additional assistance.  The need therefore to understand what is happening with their patient, and what the impact of their clinical interventions will be is paramount.  The paramedic must now have the level of knowledge suitable to interpret and respond to complex patient presentations and changes.  The new educational foundations of the work of paramedics provides this depth of knowledge.”

[291]	Considerable emphasis was placed by HACSU on the CPGs becoming increasingly more complex and demanding with new drugs and the requirement for new skills introduced each year.

Novelty and Complexity

[292]	Changes in the nature of the work, even over that obtained a decade ago were relied upon, it being argued that the work was more complex, challenging and intense, being “physically taxing, psychological (sic) taxing, fatiguing, entails shift work, has become increasingly violent, is time critical…”.  These factors were cited as having increased the pressure on paramedics’ skills and the speed with which vital decisions were required to be made.

[293]	An increasing ‘knowledge base’ was put as causing paramedic work to be more demanding than that 10 and more years ago, it being contended that applying rote learned information was less tiring than thinking imaginatively about novel situations and applying critical judgement.

More Complex Patients and Assessments

[294]	It was HACSU’s submission that over the last 10 or 20 years treatment of patients has become more ‘complex’ because:

•	patients were sicker (either because they could not see a CP or waited until they were significantly unwell) requiring paramedics, as a consequence, “to treat patients that would have historically been transported to a hospital for assessment and management”;

•	patients wait longer for nursing home accommodation requiring paramedics to see patients and their families not coping at home with attendant complex care requirements for paramedics to address;

•	patients have more co-morbidities – a factor of the incident of increasing chronic illness in the community.  More co-morbidities was said to render the assessment and treatment of patients’ conditions more complex than in the past;

•	there had been a decline in the number of rural GPs.  What was given as the corollary for paramedics of this occurring, relevant for work value purposes, was a greater primary care role for paramedics encompassing “a wide range of community health care needs beyond the traditional paramedic role including, but not limited to, assessment, referral and management of low acuity patients; treat and discharge of patients that would have historically been transported to a hospital for assessment… health needs assessment for targeted priority areas such as falls assessment and referral; health education and health promotion on an as required basis.” 

Job Structure, Overtime and Emergency Responses

[295]	Workload was said to have increased significantly which in turn had had an effect relevant to work value;

(a)	With Tasmanian State Budget Papers showing an increase in actual Ambulance Emergency Responses from 18,397 in 2001-02 to 41,100 in 2010-11;

(b)	With Tasmanian emergency departments growing at the highest national annual growth rate;

(c)	With annual average overtime rates ranging from 173 hours for Paramedics to 420 hours for BSOs.

Increase in Violence and Anti-Social Behaviour

[296]	It was put that a range of societal changes had, in turn, affected paramedics relevantly for present purposes.  These included:

•	an increasing level of violence and frustration levelled at health workers, which anti-social behaviour required new strategies and working methods;

•	an increase in illegal drug use and trend to ‘polypharmacy’ drug overdoses which factors were said to have changed the way in which the work is performed.

Changes in the Use of Drugs

[297]	HACSU submitted that prior to the mid-1990s there had been substantially fewer pharmacological interventions with many clinical skills then limited to ICPs now routine practice for paramedics.  The scope of duties for ICPs “has also increased over this time to incorporate more clinical skill interventions and pharmacological agents.”  As an example it was put that, “in situations involving intubation, Paramedics are (now) permitted to use sedating drugs that usually only anaesthetists, emergency physicians and ICU practitioners would use.”  Reliance was placed upon the statements of witnesses Richardson, Carins and Cane and the ‘report’ compiled describing a selection of the drugs now used by paramedics and the training and understandings now required.

Professionalisation of Ambulance Work – Graduate Engagement

[298]	The applicant’s case stressed the change, said to have occurred within the period under review, from the previously applying vocational education model to a ‘tertiary model’, where, in respect of AT, employment was contingent upon a candidate holding a Bachelor of Paramedic Science.  This was said to have aligned paramedics with Nurses and Allied Health Professionals such as physiotherapists.  The field of paramedic practice was said to now be a ‘discipline’ in its own right.  ICPs were said to now occupy a consultative and clinical leader role within the paramedic workforce.  Those ICPs electing to work in the fixed-wing air ambulance, have since 2007, been supported by AT in completing the Graduate Certificate in Emergency Health (Aeromedicine and Retrieval) offered by Monash University.  As part of its case as to the development of the current reflective and critical enquiry process (in substitution for the rigidity of the rote-learning of the early 1990s and the skills based model which had preceded it) the applicant argued that today’s greater level of clinical intervention by paramedics reflected the need to understand “the underlying biological sciences in paramedic medicine, including…of anatomy and normal physiology, pathophysiology and pharmacology.”  Consistent with these developments was said to be the existence of the UTas Honours program in paramedic practice and the fact of “increasing number of paramedics undertaking research higher degrees at master or doctorate levels.”

Continual Training/New Equipment

[299]	It was submitted that a significant change from the past practice, where the maintenance of protocols and skills competency was said to be sufficient, was the “greater degree of continuing professional development.”  Paramedics were said to be expected to take responsibility “for their own continuing learning and to read relevant research to maintain currency of their knowledge and skills in a rapidly changing research climate.”

[300]	The evolution of the role of the paramedic into one of professional standing was said to be complemented by the establishment of Paramedics Australasia, which body conducts professional programs, lobbying and representation to universities and publishes a peer review journal.

The Applicant’s Final Written Submissions

[301]	Provided after the conclusion of the evidentiary cases, the Applicant’s written Final Submissions supplemented those set out above in the following manner.  Reliance was placed on the 2005 decision of the Federal Commission in The Child Care Industry ACT Award 1998, (PR954938, 13 January 2005, Ross VP, Marsh SDP and Deegan C) (the Child Care case) which set out some of the relevant considerations in assessing changes in work value, including:

•	qualifications required for the job, quality or work required or and attributable to employees;

•	teaching period required, versatility and adaptability/performing a multiplicity of functions;

•	attributes required to perform the work;

•	responsibilities for the work skill exercised;

•	acquired knowledge or overall process/importance of work to the overall operation of the plant/enterprise. 

Consideration of ‘Significant’

[302]	As to the meaning of ‘significant’ in the term “significant net addition” within the Work Value Principle, attention was directed to the Full Bench of the NSW Commission in Australian Workers Union v BlueScope Steel (AIS) Pty Ltd ((2008) NSW IR Comm 1071) (the Blue Scope Steel case) where it was said that in the work value context, ‘significant’ did not require a change to be dramatic, sudden or eye-catching, nor had it to be major and, rather, could refer to change to a meaningful degree which was not insignificant, not immaterial or not trivial.  It was said by that Full Bench that, “A change, as in this case, may occur subtly, gradually, even covertly, but on examination prove to be significant.”  The Bench also commented to the effect that changed work may signal increased work value, notwithstanding the basic psycho-motor skills being unchanged if the mental processes involved in the task involved increased mental demands.

Education

[303]	Reliance was had by HACSU for the decision of the Full Bench in the Child Care case, at [190] that “as a general proposition, an increase in the knowledge or other expertise required to adequately perform work duties will be taken to demonstrate an increase in work value.”

[304]	Much attention was given to the development, over time, of Tasmanian ambulance paramedics’ education – particularly in the evidence of Mr Edwards, Ms McNamara, Dr Reynolds and Mr Rechberger.  The historical narrative of the variations in the educational curriculum was instructive and detailed.

[305]	Shortly stated, it was the Applicant’s position that from the “skills based trade” persisting until the early 1990s, the present paramedic undertook rigorous tertiary training according to an evidence based, clinical enquiry model.  Where the former trade model (itself having replaced the advanced First Aid/driver requirement subsisting well into the 1980s) had been characterised by rote learning and accurate regurgitation of a set body of knowledge, students were now required to understand and apply protocols.  Much emphasis was placed on the intellectual demands and responsibility now required of paramedics by virtue of their training.

[306]	It was said that paramedic students were now required to analyse their teachings, to synthesise their training and clinical observations of a patient in order to “find solutions for new and unique situations.”  The submission was put in these terms:

“This reflective and critical enquiry process informs how paramedics can perform the work better and is one of the matters that distinguishes the profession of paramedics from a trade.  Students are learning at, and paramedics are operating at, the higher levels of analysis, synthesis and evaluation.  Further, with a greater level of clinical intervention there is a significantly higher need for an understanding of the underlying biological sciences in paramedic practice, including a higher level of understanding of anatomy and normal physiology, pathophysiology and pharmacology.”

[307]	The consequence of this higher learning was given as providing a ‘springboard’ to permit the achievement of a “…deeper and broader understanding of anatomy, physiology, pathophysiology and pharmacology”  which in turn permitted paramedics to initiate treatment with a wide range of new drugs (for paramedics as well as ICPs) and according to new procedures.  The capacity of paramedics to perform in such a readily adaptive way meant that by applying critical thinking in an analytic fashion, within a technologically changing environment, their value within the integrated health system increased.

Changes in Pharmacology

[308]	The empirical fact of the changes in pharmacology used by Paramedics and ICPs was set out in the Agreed Statement of Facts, Attachments C and D.  The changes were summarised by the applicant as, for Paramedics, where 9 drugs had been used, now 22 were used, whereas for ICPs, over the comparison period where 24 drugs had been used, 3 had been discontinued, 5 had been replaced and 15 new drugs introduced.  Particular reliance was placed on;

•	the way the drugs were administered – so that where at the beginning of the comparison period paramedics administered drugs by the following means:  oral, nebulizer, rectal, inhaled and sublingual, now those routes had been supplemented, where appropriate, by administration through intramuscular injection, intravenous injection and intra-nasally.  ICPs, additionally, administer drugs intra-osseously; 

•	to whom the drugs are administered;

•	the circumstances in which drugs are administered;

•	the amount of the drugs to be administered, now permitting a discretionary judgment in the paramedic’s diagnosis/triage. 

[309]	Mr Richardson’s report was relied upon and the Full Bench was pressed to not prefer Mr Rechberger’s evidence, which, amongst other things, was that the significant amount of detail provided now in the CPGs was encapsulated in a ‘pocket’ form in the earlier protocols.

[310]	For HACSU the training involved in learning the contemporary drugs, and the responsibility shouldered for exercising the discretion in dispensing the new drugs, pointed to adaptability and the acquiring of relevant new skills and responsibility. 

The Protocols v The CPGs

[311]	HACSU relied upon the work value implications of the changes reflected in the transition from the earlier operating protocols to the CPGs.  Where previously the protocols at the commencement of the comparison period provided for 32 procedures, there were now 97 described in the CPGs and it was said that, in performing their duties, “…paramedics can now provisionally diagnose and treat a far greater range of ailments than was the case 20 years ago.  The CPGs require the exercise of greater clinical judgment by paramedics.”

[312]	Where now paramedics were armed, it was submitted, with “a greater knowledge of… ailments and symptoms,”  to make these provisional diagnoses they then proceed to apply the required emergency treatment.  Reliance was placed upon the evidence pointing to the fact of patients not fitting ‘neatly’ into the CPGs.  It was put that after diagnosis, paramedics “often have to apply multiple CPGs simultaneously and move between CPGs during a treatment.”  Where the Protocols had been a series of directives, the CPGs were more in the way of guides to clinical practice.

The CPGs as Constraints

[313]	The applicant’s case acknowledged the evidentiary conflict apparent between the characterisations of the CPGs given by Mr White for AT and that of the paramedic witnesses.  Where Mr White’s evidence was given as portraying the CPGs as a ‘Bible’ to be closely followed in the field, we were urged to accept Mr O’Brien’s ‘more realistic’ assessment.  This alternative depiction acknowledged that:

•	the CPGs are not the final word as to what paramedics can or cannot do;

•	there are techniques and procedures used which are not found in the CPGs;

•	paramedics jump steps in the CPGs, rather than follow them slavishly.

The CPGs as Dynamic

[314]	HACSU’s case emphasised the evidence supporting the ongoing ‘fairly frequent amendments to the CPGs currency (over the past year more than 100 CPG pages had been altered) and that their advent had placed Tasmania at the national forefront of paramedic practice, requiring the ICPs to be “educated in new skills, drugs and intensive care equipment.”

In Summary – Protocols as to CPGs

[315]	The applicant’s case stressed evidence supportive of the following comparative assessment of the new and old regimes:

•	CPGs less prescriptive, less exhaustive and more permissive of the paramedic’s clinical judgement;

•	Protocols more in the way of rote reactions to particular presentations – far less open to adaptation or flexible implementation.

Airway Management and Cardiac Interventions

[316]	Dealt with both in rebuttal and in the parties’ primary submissions, it is convenient to address this important element of the evidence in some detail, notwithstanding that in a case with such a plethora of detailed evidence including with multiple witness statements in reply, it is unnecessary to canvass all the witness evidence.  We do, however, propose to deal in some greater detail with these aspects of the work.  HACSU urged that we not accept AT’s portrayal of change to the work under these important headings as either reflecting ‘unchanged fundamentals’ and/or that changes have made the work ‘easier’.

[317]	Where in 1991 there had been 7 airway management procedures for paramedics, in 2013 they remain, supplemented by 4 additional procedures.  For ICPs, the 9 procedures of 1991 continue, but with 12 additional procedures now used.  Where Mr Rechberger’s evidence was that all were part of one skill – that of intubation, the applicant submitted that the procedures were introduced at different times, with different equipment utilised and each requiring new skills to permit its application.

[318]	Cardiac intervention by paramedics, particularly in the face of a cardiac arrest, was also an important part of the applicant’s case with much evidence led.  For HACSU the changed work, its complexity and its demand for critical judgment from paramedics was given as work value change of a high order.  AT’s position was given as, “the fundamentals of treating a patient with cardiac arrest have not significantly changed since 1988.” 

[319]	To the contrary, in the applicant’s case, relevant work value indicators/elements highlighted were:

•	Defibrillation, in 1988 performed only by an ICP, is now also performed by Paramedics.

•	Ventilation/airway management – that there had been, as agreed by Mr O’Brien, a significant expansion in the number and the range of tasks available to be undertaken by both paramedics and ICPs.

•	The approach to CPR has altered in dealing with cardiac arrest.

•	The administration of drugs for airways management had seen an expanded role for both ICPs and Paramedics.  In 1991 for Paramedics engaging in airways management, 7 procedures were used, supplemented in 2013 by a further 4.  For ICPs similarly engaged in 1991, there were 9 procedures which, by 2013, had been supplemented by an additional 12 procedures.

•	The application and widespread use of 12-lead ECGs from the late 2000s, requiring significant training and understanding (with posterior use rendering the machine as a 15-lead ECG, provided substantially more information and permitted its corollary, far more informed decision-making.  Emphasis was placed upon the need, in 12-lead ECG use, for the paramedic “to have a greater understanding and underpinning knowledge of what this infinite number of ECG readouts mean…[a] greater capacity to understand what the ECG readouts are telling them.”

Pulse Oximetry and Easier Work

[320]	Much evidence was led as to pulse oximetry – the technological advance by which the recording of a patient’s oxygen desaturation is now measured by a small device clamped to a finger.  For AT this was an example of work made ‘easier’, while for the applicant it reflected new demands made upon the paramedic, as it required new understandings and high-order thinking – all directly relevant to work value.

[321]	While in one sense merely the physical action of applying and reading the finger clamp and understanding its result, it was submitted that properly appreciated, “the data provided by that machine is fed into a more complex formula used by the paramedic or ICP to judge the appropriate approach to the patient.”

‘Other Matters’

[322]	Also called up in the Applicant’s case were the following considerations:

•	The paramedics were said to work an extraordinary amount of overtime, which level is said to have been institutionalised by the employer’s business model.  For example, no cover is said to exist for sick leave.

•	The applicant contended that an increase in the number of cases per paramedic was not a ‘crucial’ measure, pointing to definitional discrepancies between the parties’ cases.

•	There was said to have been change in the patient cohort from that of 20 or 10 years ago with patients now being ‘significantly sicker’ than in the past – said to be referrable to the GP shortage.  With older patients than all other states, many disabled and with more co-morbidities, it was put that their assessment by paramedics was more complex, and the decision-making more demanding.

•	There was said to be unanimity in that the array of post 1988 equipment had, for its proper use, called upon “the broader range and depth of knowledge…compared to 20 years ago.”

•	Infrequent, multi-casualty incidents the triaging role had altered to one where the paramedic gave prime emphasis (our term) to the patient who it was thought, in the paramedics’ assessment, most likely to survive if provided that treatment – rather than invariably treating the most grievously injured patient – given that in many instances that patient was likely to not survive.  Although rarely exercised, this responsibility was given as a reflection of the true responsibility of the modern paramedic role.

•	Increasing verbal and physical aggression.

•	The removal from paramedics of the patient extrication role (to the Tasmania Fire Service) was not of significance given its infrequency, some 250 jobs of over 70,000 per year.

Enterprise Bargaining

[323]	It was put that the average pay rise, said to be 2.7% per annum over the previous 6.9 years, provided “no warrant for the view that those increases involved a work value evaluation of the work.”  The significant pay increases in the 2010 agreement were said to have only involved some 20 employees and to have been granted for reasons not related to work value.

Increase in Workload – increased pressure on skills and vital decision-making

[324]	The Applicant relied on the AIRC Full Bench in the Child Care case at [188] “Observing that where an increase in workload leads to increased pressure on skills and upon the speed with which vital decisions must be made then it may be a relevant consideration.”  Paramedics were portrayed as making multiple decisions and making increased use of new technology which provides new and increased amounts of information.  This was compared with the position of twenty years ago where, in Dr Reynolds’ terms, “paramedics following a simple protocol, with less skill, lacking a depth of knowledge and without critical judgments make fewer decisions.”

Professional Rates

[325]	The Applicant’s proposition was said to be simple; as a professional group they should be paid as professionals.  It was alleged that at the time of introducing a professional classification structure the 2010 agreement did not reflect professional wages.  The Commission was urged to have regard for the pay amounts of Tasmanian health professionals and paramedics in other states.

Valuing the Work

[326]	HACSU contended that relevant to the Work Value Principle, the changes over the last 20 years were monumental, not evolutionary, and it followed that the increase sought of 25% ought to be awarded.

The Work Value Principles

[327]	The changes in work set out in the above materials were said to easily satisfy the requisite test within the Work Value Principle.

[328]	Sub-principle 2 (of the Work Value Principle) was said to have no application in that the work justifying a higher rate is not performed from time to time and, rather, the change relevant to work value is “embedded deeply within the nature of the tasks now performed…”

[329]	As to sub-principle 3, it is submitted that change is to be measured from the datum point, with most of the changes having occurred over the past decade.

[330]	Sub-principles 4, 6, 7 and 8 were said to have no application.

[331]	Sub-principle 5, dealing with the quantification in money terms of any significant net alteration to work value, was not dealt with in any depth.  It was submitted that there were no ‘external classifications’ to which the classification structure is related and, further, that there was ‘no prospect’ of a flow on of any increases awarded.  The Commission was urged to maintain the agreed internal relativities.

The Respondent’s Opening Submissions

[332]	In detailed written submissions, the respondent’s case made clear that, consistent with the provisions of Clause 7 Award Consolidation of the 2010 Agreement, it was agreed that the Tasmanian Ambulance Service Award be varied by “replacing the classifications with those in schedule 1 of the 2010 Agreement and inserting the rates of pay currently paid to the classifications under the 2010 Agreement”.  In all other respects the application was opposed.  As a matter of ‘sound principle’ the Commission was urged, in very similar terms to those of the applicant, to apply its former Work Value Principle but in the context of the statutory scheme.

The Applicant’s ‘Real Aim’

[333]	It was put by AT that by the application “what HACSU really wants the Commission to do here is to relieve HACSU of the difficulties it faces in bargaining under the prevailing economic and political circumstances.”  This was given as a purpose for which the wage fixing principles were not designed.  It followed that it was in the public interest for the Commission’s award variation powers to be maintained, for their integrity to be assured.  The public interest was given as having implications beyond paramedics and interests beyond those beneficial to paramedics.

The 1988 Case

[334]	AT submitted that the applicant had failed to do more than ask for an increase on work value grounds and failed to embrace the discipline and challenge required by the Work Value principles.  The applicant was said to have failed to demonstrate a case for an increase, certainly not one of 25% and had failed to deal with the fact of the 1988 case – as many of the factors now relied upon were dealt with in 1988.

‘Incremental’ Change

[335]	It was conceded that there had been some change affecting the base paramedic classification since 1988 and the entry level tertiary degree acknowledged.  There were said to be “some new skills” as a consequence of “incremental advancements in clinical practice, but the basic functions of the role have not changed.”

The Application’s Deficit

[336]	Similarly for ICPs, it was acknowledged that there had been some changes “with the evolution of clinical practice” but they were said to be not significant.  The applicant’s case for supervisory, managerial and educator roles was given as “virtually non-existent” and accordingly, were an increase to be awarded on work value grounds (notwithstanding the Respondent’s submissions), relativities should not be maintained.

Comparison of Rates

[337]	Comparison with other actual paramedic pay scales or other health professionals rates was said to be of limited utility, given that those rates had been bargained for and therefore were not necessarily representative of ‘work value’ considerations.  In any event, the Tasmanian rates were said to compare with the other States and Territories, “based on a proper comparison of pay”, and there were no attraction/retention difficulties being currently experienced.

‘Industrial Merit’ Considerations

[338]	The Commission was urged to not exercise its award variation powers as sought for a range of reasons including:

•	Since the early 1990s the Applicant has had opportunity to negotiate wages and conditions in line with work value;

•	There have been increases negotiated to the relevant agreements under the varying arrangements operating since early in the 1990s;

•	There had been very substantial improvements in wages, both in money and structural terms, to new classifications and allowances which “recognised any changes to work value.”;

•	Clause 13 of the 2010 Agreement acknowledged that increases then agreed in pay and the classification structure, “were to offset further award level increases based on work value.”;

•	The State wages policy was designed to address “a difficult financial position.”;

•	Workplace bargaining was to be encouraged “even in tough times.”

The Public Interest

[339]	In essaying the role and powers of the Commission, in considerable detail not here repeated, it was put that pursuant to s36(1), before making an award, the Commission must be satisfied that the award to be made is consistent with the public interest.

The Retired Principles

[340]	The action of the Full Bench in the 2009 State Wages Case (Transcript page 13, paragraph 471) in ‘retiring’ the then Wage Fixing Principles (other than for pay equity and economic capacity) was noted by the Respondent and it was put that, “It is unclear from the decision or transcript of the proceedings why the view was taken that the other principles served no relevant purpose.”  Notwithstanding this, the Respondent submitted that there was no indication or reason to believe that by its act in relation to the then operative Wage Principles the Commission was intending in the future to abandon a principled approach to any application for an increase in wages based on work value, which application was otherwise consistent with the statutory scheme.

Continuing Utility of the Principle

[341]	While bargaining had assumed a statutory and practical pre-eminence since the early 1990s, it was put that when relevant to do so, when arbitrating on work value grounds, industrial tribunals have generally used the earlier Work Value Principles “as a matter of sound policy and principle.”

[342]	The Commission was urged to rigorously apply the Principle so that the net addition to the work requirements of a classification were to be identified to ensure there had occurred a significant net addition to work requirements to justify an arbitrated increase.

[343]	In urging care in assessing the fact of change it was put that the work of a classification at a particular level not be compared with or confused with that at another level, as to do so would ‘skew’ the comparison.  This was given as a weakness of the HACSU case as there is not a sufficiently clear distinction in the evidence “between the work requirements of the base level paramedic classification and the work requirements of an Intensive Care Paramedic and other specialist classifications.”

The Datum Point

[344]	While the applicant contended for 1990 as the point from which change is to be measured, for the respondent, 1988 as the time of the last Work Value fixation and its alteration to the classification structure, was the correct datum point.  It became common ground, through the creation of the Agreed Statement of Facts document, that the datum point would be 6 October 1988.  The respondent’s submission dealt in some detail with the intersection in 1988 of the Structural Efficiency Principle, the Work Value Principle, the operation of the Anomalies Conference mechanism and the requirement that award rates be properly fixed minimum rates with residual amounts accommodated as Supplementary Payments.

The Rates “Unstacked”

[345]	The AT case proposed that for there to be a “proper assessment and comparison of work value between 1988 and now requires the pay rate to be “unstacked” and all extraneous or non-work value components” of the pay rates to be removed.  By this means, it was submitted that, the “base pay” of the paramedic could be established by the ‘de-coupling’ of the many post 1988 increases arising under agreements.  It was further said that “such increases are the product of bargaining and therefore cannot be assumed to have been wholly or partly directed at changes in the work value of particular classifications.”

Transposing Relativities

[346]	The respondent opposed the ‘transposing’ of the relativities arising from the 2010 Agreement, asserting that to do so was an impermissible approach to a determination of higher classifications using work value.  As part of this argument it was concluded that “what is to be assessed and compared between 1988 and now is the value of the higher work responsibilities not part of the base paramedic classification.”

Award Powers and Principles

[347]	It was said that the major ‘problem’ with the applicant’s case was it sought to “use the Commission’s award level powers to address what in reality is a bargaining issue.”

[348]	The current bargaining environment, where there was a governmental policy strictly limiting the scope of increases, was no justification for departing from the Principle.  The operation of minimum rates awards was stressed and reliance placed on the decision of a Full Bench in MASSA v United Firefighters Union of Australia T13176 of 2008, 7 April 2009 (the 2009 Firefighter’s case) where it was observed that:

•	The parties to an award could vary pay rates and conditions as they may agree; (T13176 of 2008, at [115])

•	It followed that “public sector awards may no longer reflect rates based on work value,” as had in earlier times been determined by the Commission.

The 1988 Work Value Case

[349]	The Commission was alerted to the danger of ‘double dipping’, given that in the respondent’s view there was much duplication of argument from the 1988 case to these proceedings, ranging over heads of argument including the change from patient transporters to professionals, the stress of a hazardous environment, prone to worsening violence and the increasingly academic professionalism.

A Significant Net Addition since 1988?

[350]	In addressing this fundamental issue, AT provided a comprehensive critique of the application, developing the following matters:

•	HACSU was obliged to discharge its onus to establish a “significant net addition to work value in relation to each relevant classification.”

•	The onus called for a disciplined and rigorous approach in comparing the work requirements within a classification as performed in 1988 and today.

•	Much of the applicant’s case concerned environmental factors relevant to the work and no attempt made to identify change vis a vis 1988.

•	There was a failure to delineate the requirements of an ICP over a base grade Paramedic; with this omission requiring a cautious approach by the Commission.

•	Increased workload and overtime were not relevant work value factors, with the former not supported by evidence.  The AT data as to workload indicated “a stable relationship between the number of incidents and the levels of staffing since at least 2004.”

•	Overall there was a lack of evidence.  Rather than individual anecdote and opinion the case would have been advanced by a comparison of “classification descriptors, job descriptions, documentary procedures…and other empirical evidence as to the general work requirements.”

[351]	As to the base level Paramedic classification, it was the respondent’s position that there is no significant net addition to the value of this classification.  Further, if there has been any significant net increase in work value it had been “fully recognised through enterprise bargaining.”

Extended Scope of Practice

[352]	To the claim that paramedics employed at the base classification have an expanded scope of practice with increased knowledge and expertise, required to diagnose, exercise independent clinical judgment, treat and if appropriate refer the patient to an alternative “rather than simply transfer them to the hospital emergency department”,  it is said that the fundamental elements of the role at the base level have not changed since 1988.

[353]	It was also put that at all relevant times, base level paramedics have been required to:

•	Respond in a timely way.

•	Assess the acuity of the patient based on signs and symptoms.

•	According to their ‘scope of authority’ decide pain management or stabilisation and, if necessary, have the Communication Centre call upon an ICP for assistance.

•	Transport the patient to hospital or not.

The Acknowledgement

[354]	It was, however, acknowledged that there had been some changes in that there had been:

•	An expansion in the ‘scope of authority’ of the base paramedic in “administering drugs and some other clinical techniques”, whereby “in some instances, this involves acquisition of new skills.  However, in many respects, this is a result of evolutionary advancements in clinical practice” and makes the job easier to perform.

•	Introduced new or improved diagnostic and assessment tools which assist the assessment process and better equip the paramedic “to plan the treatment regime…”

•	New and improved policies and procedures which make it safer for the patient and provide support for the paramedic.

•	An increase in ramping, which does not require paramedics to exercise any additional skills by virtue of their waiting.

Education and Training

[355]	The respondent acknowledged there had been  “changes in the education requirements”  as a consequence of the transition from TaFE level education to a Bachelor Degree.  It is said that the qualification equips paramedics with “greater knowledge to assess the patient, develop treatment regimes and deal with the complexities associated with the uncontrolled work environment…”  This change in educational requirements was said to have been recognised by the 2010 Agreement acknowledged then by the Commission.

Clinical Practice Guidelines

[356]	The CPGs were said to provide ‘parameters’ within which the paramedics are required to work.  The CPGs were said to facilitate and reduce risk as the paramedics are guided “to and through the drug and treatment options available to them by diagrammatic decision pathways” and by “colour coding to assist paramedics in identifying key information” as to drugs and treatment to particular categories of paramedic or elements of practice requiring immediate intervention.

[357]	The CPGs were depicted as being “far more simple and effective in guiding paramedics through assessment and treatment than they were in 1988 and 1991.”

[358]	The submission as to the CPGs concluded that “changes to drugs, tools and methods of administration… do not alter the ‘core’ of what a paramedic does…in accordance with defined parameters.”  It was said that “any new or different drugs or treatment methods are evolutionary changes that in many cases make the job of a paramedic easier.”

Mentoring

[359]	AT did not accept that there was an increasing demand placed upon paramedics to support/mentor students and post-graduate interns arguing that there had always existed a coaching role.  From the advent of the ALS classification there had been “some formal mentoring duties” which were compensated for in the Preceptor Allowance introduced in the 2004 Agreement and increased in the 2010 Agreement.

Professionalism

[360]	In reply to the emphasis placed upon the claim for paramedics to be recognised as ‘professionals’, with their own scientific literature and professional institution, it was said:

•	Paramedic associations have existed since 1988 and have not had “any day-to-day impact or influence on the work of a paramedic.”

•	In any event paramedic professionalism had been recognised through the wage increases offered in the 2004 and 2010 agreements.

•	While professional development was to be encouraged, there existed no expectation for paramedics to keep up-to-date with professional “literature or the current state of medical knowledge themselves.”  This was a task of the Clinical Practice Review Group.

•	It was submitted that paramedics could not act outside the CPGs “or without the express authority of an approved medical practitioner.”  To do so was to potentially trigger audit and lead to disciplinary action.

Environmental Factors/Workload

[361]	To the submission that paramedics, over the period in question, faced a more intense, complex, challenging, physically taxing, psychologically taxing, violence in the workplace and risk of contracting an infectious disease, AT relied on such environmental or workload factors as having always been part of the paramedics’ lot.  Most of these aspects of the work were relied on in the 1988 case and had been addressed by support mechanisms and improved safety for paramedics.  Data provided was relied upon and said to support this reply.

Overtime

[362]	It was submitted that overtime worked is not relevant to work value.

The ICP Classification

[363]	The respondent’s submission was succinct; “there has been little or no change to the work value of this classification not already covered by the work value of the base classification.”

[364]	It was put for the Respondent that the ICP classification reflected the ‘revolution’ in the Tasmanian Ambulance Service, represented by the 1981 introduction of the ALS qualification.  It was this advance, recognised in the 1988 Work Value case, which transformed the previous role to the “emergency health service provider” seen today.

Expanded Scope of Practice

[365]	The ICP was acknowledged as having always had a broader scope of authority than the base classification.  The developments in clinical practice involving ICPs were said to mostly not involve an expansion of the scope of their authority to practice.  Changes that had occurred were said to be evolutionary or incremental and, in many respects, to have made the job easier to perform.

[366]	As an alternative submission it was put that any change found to have occurred had been fully recognised in enterprise bargaining.  As a further alternative submission, it was put that should there be found justification to increase the base paramedic classification such an increase should not apply to ICPs.  Simply ‘transposing relativities’ was said to be wrong in principle.

[367]	No net addition to work requirements had affected ICPs in relation to education and training, CPGs, mentoring, professionalism, environmental factors and overtime.

Specialist Classifications

[368]	While it was acknowledged that some changes had occurred in the duties and scope of practice of Flight Paramedics – Fixed Wing and Flight Paramedics - Helicopter (and in their qualifications and training) any value associated with these factors was recognised in the 2004 Agreement and the 2013 consent order.

Branch Station Officers

[369]	There was said to be no evidence of any net addition to the value of this classification’s work.  Remote station issues are dealt with by way of an allowance and in other respects for this classification and for Clinical Support Officers, Paramedic Educators and Duty Managers there had been some reduction in responsibilities.

Paramedic Students and Interns

[370]	It was put there is no evidence of any net addition to the work performed by these classifications.

Post 1988 Pay Outcomes/Bargained for Increases

[371]	The changes to the Award rates, agreed to in the 2010 Agreement, were said to have more than covered any net increase in work value.  Detailed material was provided setting out the movements in wages, allowances, new classifications (Flight Paramedic and Volunteer Educator) and wage costs including favourable variations to the incremental structure and method of calculating long service leave.  There was said to be no proper basis to arbitrate wage increases at the award level beyond the 2010 Agreement rates.

Wage Comparisons

[372]	Work value was said to be not about comparative wage justice and further, tribunals had not accorded weight to pay rates in other awards.  It was submitted that ‘bargained for’ rates, unless ‘unpacked’ to reveal a base rate to assist comparison, were irrelevant to work value.

Capacity to Pay – Wages Policy

[373]	The Tasmanian Government’s wage restraint policy was described as reasonable and necessary and a relevant discretionary factor in the case.

Disposition

[374]	AT supported the 2010 Agreement classifications and existing wage rates being consolidated into the Award.  In other respects it was submitted that the Application ought be dismissed.

The Respondent’s Final Written Submissions

[375]	The respondent’s final written submissions suggested that the applicant was relying on the ‘professional rates’ element of its claim as “the primary merit consideration.”  This was said to be because the applicant sought to find a wage comparison with paramedics in other States and Territories and with other health professionals.

[376]	In submitting that the concept (of ‘professional rates’) lacked clarity and was ultimately of little assistance in pay assessment, it was noted that the parties had not treated the notion of ‘professional rates’ as a concept separate from ‘work value’.  Acknowledging that clause 13 of the 2010 Agreement reserved the union’s right to bring a work value claim, it was submitted that both parties appeared to have acted on the basis that “anything logically connected to assessment of work value (including ‘professional rates’) could be raised.”

[377]	It followed in the respondent’s view, that the concept of professional rates was of no benefit to these proceedings, steeped in comparative wage justice and generally lent no assistance to the Commission.

The Application as Contrary to the Statutory Scheme

[378]	In terms similar to those ventilated in the primary submission, AT suggested that the success of the application would be to adversely affect bargaining because it would be in substitution to bargaining.  Success for HACSU would not serve to “encourage workplace bargaining” the term used in the ‘Long Title’ of the Act, a summary of the Commission’s functions found prior to the commencement of the Act (termed the ‘Preamble’ by the respondent) but not subsequently found within the provisions of the Act.

Significant Net Addition

[379]	The applicant had erred by overstating work requirements, the extent of change and its significance, it being necessary for a close comparison to be made as between work requirements in 1988 and currently to determine whether a significant net addition to the work was to be found.  As earlier emphasised, in these submissions the Commission was again cautioned as to the risk of double-dipping.

Skills and Responsibilities

[380]	The respondent acknowledged that there had been ‘additions’ to work value for the base paramedic classification in terms of their education and knowledge, citing the move from vocational training to the tertiary degree qualification, and further, in relation to “additional skills and techniques”.

[381]	The fact paramedics exercise a degree of judgement in assessing the patient and selecting a treatment option (or ‘pathway’) was conceded in the same breath as was put that, “they must operate within a defined scope of practice which sets the boundaries.”  That there are limits and controls to the scope of practice, as there were in 1988, was submitted to be “an important fundamental aspect of the paramedic role that has not changed since 1988.”

[382]	It was said that care was necessary in comparing the ‘old’ Protocols with their successor CPGs as, without a sophisticated approach, a comparison of the lists set out in Exhibits A26 and A27 could have one mistakenly overvalue the greater detail (more numerous steps) of the CPGs.

[383]	The Commission was urged to adopt a common sense approach in considering what constitutes a new skill, in determining whether new skills had been acquired, and when an existing practice or skill had so altered as to qualify.  The work value’s principle’s ‘significant’ threshold was given as important.  In this context the changes that had affected the ICP classification were said to represent insignificant increases in work value.  In relation to the managerial, supervisory and educator roles, the evidentiary case for the applicant was given as virtually non-existent.

[384]	Worthy of particular note was the respondent’s submission that “the most significant and complex clinical interventions performed by paramedics in Australia are not carried out in Tasmania.  For example, in the ACT paramedics (who are almost all ICP qualified) are authorised to perform rapid sequence intubation and are also authorised to implement or instigate and implement the STEMI bypass procedure.”

Environmental Factors

[385]	Of these aspects of paramedic work and its environment it was put that there was no reliable evidence that there occurred any qualifying significant increase over the relevant period.  With AT better managing risks that did exist, the fact that such issues were raised in the 1988 case was again brought to notice.

Workload/Intensity

[386]	Said to be irrelevant to work value, the uncertain evidentiary foundation for any conclusions as to workload and its impact was given as speculative at best.

Overtime

[387]	Overtime was also described as being irrelevant to an assessment of work value, there being no nexus in logic (or in the evidence) between a pay increase and a solution for the problems alleged to accompany a surfeit of overtime.

Relativities

[388]	In urging that relativities be not ‘transposed’ from the 2010 Agreement, as to do so offended work value principles, it was necessary for the work requirements of each classification to justify an increase.

[389]	A closely related argument was also put, premised on the proposition that the higher classifications “encompass the work requirements of a base paramedic and involve additional work requirements”.  Only those elements of the higher classifications’ work value not part of the base classification were permissible components to be compared with the equivalent 1988 work.

Enterprise Bargaining and Work Value

[390]	It was submitted that there was no basis for elevating the Award wages beyond those in the 2010 Agreement.  Reliance was also had for the ‘bargained for’ pay rates reflected in the post 1993 agreements.  The scale of the wage increases are said to have been understated by HACSU.  It was put that even though no formal work value exercise was undertaken, this does not mean that in agreeing to pay movements no account was taken of any increase in the value of the work.  Reliance was particularly placed in this regard for the 2004 and 2010 negotiations and their accompanying Agreements.

The Applicant’s Wage Comparison

[391]	The respondent described comparisons of wage rates as being of little relevance to work value.  The only directly relevant comparison to be had was of work and responsibility of paramedics in 1988 and the present time.  There was said to be insufficient evidence upon which “the ‘Allied Health’ industry, let alone ‘level 3 of the relevant Allied Health agreement’” might be considered an appropriate comparator.  Mr Jacobson’s acknowledgement of the different bargaining foundation of such classifications was noted.

[392]	Comparisons sought to be made by the applicant with paramedic rates in the ACT and South Australia were not accepted, not only because of the high level of the rates, but because:

•	There were major differences in the respective scope of practice of each;

•	Comparing bargained rates for the purpose of valuing work is ‘not useful’ – as had been noted by Deegan C in the ACT Private Arbitration case (the ACT Private Arbitration case).

•	The ACT Private Arbitration case by the terms of its parties’ compact, had the arbitrator obliged to give some particularised factors weight and relevance.

Public Interest

[393]	The Tasmanian Government’s Wages Policy was emphasised as an important part of its Budget strategy.  It represented a rational, non-arbitrary position the maintenance of which should be recognised as a relevant and significant discretionary factor.

[394]	Broader public interest considerations were put; that HACSU were seeking to have the Commission relieve it of a bargaining difficulty.  It was said the application sought to significantly increase award rates in a way at odds with Government wages policy.  The spectre of leap-frogging, or flow-on claims was put also as “a powerful discretionary factor weighing against HACSU’s application”.

The Respondent’s Final Oral Submissions

[395]	In their final oral submissions given on 4 November 2013, Mr Dalton for the respondent, suggested that the Award might be varied to include classifications and pay points found in the 2010 Agreement by which the parties’ contemplation at the time of making that agreement would be given effect.  It was also the position of AT that such variation could include the Flight Paramedic - Helicopter provisions “being reflective of the 2013 consental (sic) order outcome”.  To do so was also specifically approved of in the Commission’s former wage fixing principles, amended in 2007 to provide under principle 13.3 that Public Sector Awards may be varied to reflect salary rates and conditions of employment as may be agreed between the parties.

[396]	In otherwise opposing the application, Mr Dalton again relied upon there being a s23 powers issue precluding the Commission increasing actual award rates.  This was said to be so because, “The Commissions (sic) award variation powers even when they’re exercisable by a full bench do not extend to imposing wages outcomes as a substitute for bargaining because that’s contrary to the scheme and purpose of the Act.”

[397]	Aside from the powers question it was submitted that the application could not succeed because it fails on the merits.  It followed that the Commission should, as a matter of principle and industrial merit, refuse the contentious part of the claim.  There were four reasons relied upon.  The first was that the applicant had not discharged its onus relative to work value.  Mr Dalton addressed this point’s two sub-headings in the following way:

“The first is that while there’s been a significant net addition to the work requirements for the base classification HACSU’s case on significant net addition to work requirements is overstated in a number of respects.”

[398]	Said to be a complete answer, was that should there be found to have occurred a significant net increase to work requirements, when a value was sought to be attached to it “at the Award level, this would be more than generously covered by the current rates payable under the 2010 Agreement, the incorporation of which my client consents to as part of this award variation application.”

[399]	The second broad reason given was that “the concept of professional rates has no free standing industrial merit here.”  It was considered to have ‘traction’ only when embedded in valid work value considerations.

[400]	The third broad reason given in opposition was that HACSU’s wages comparisons were misplaced and finally, that it was not in the public interest to impose award level increases beyond those agreed in the award consolidation exercise.

[401]	As has been noted above, the respondent’s case placed particular emphasis upon the words found in the ‘long title’ of the Act said by Mr Dalton “expressly states the objectives of the Act”, which in part read, “to encourage work place bargaining and to provide for related and other matters.”

[402]	Mr Dalton quite properly tempered his depiction of those words as “an express legislative purpose” as requiring recognition, but also caution, as expressed by the High Court in IW and City of Perth 1977 (191 CLR1 at 12).  In examining the provisions of the Act giving context to such purpose, s35(1)(d) was noted in its provision that only a Full Bench could consider “making provision for or altering rates of wages generally.”

[403]	It was the submission of the respondent that the term “wages generally” was likely to refer to wages beyond the Award.  This submission was developed to suggest that, unlike the federal system with a more express indication, the Act does not restrict the Commission “to maintaining awards to a bare minimum rates level…but one still had to understand what – what the act intends in terms of the maintenance of an award…” and its interaction with other relevant provisions.

[404]	The construction of awards as essentially providing a basis for application of the no disadvantage test meant that the award variation power in s23 must, it was put, be exercised in a fashion that encourages, not impedes, bargaining.  In this regard s8A of the Acts Interpretation Act 1931 was called up, in that the bargaining scheme provided for in the Act, was promoted in the construction advanced by the respondent.

[405]	What the Commission was urged not to do, whether on jurisdictional or discretionary grounds, was to step “directly into the space that the Act reserves for the parties to - to achieve through bargaining.  The role of the Commission is to consider whether to approve such bargains applying the test and that test is to be applied against an underpinning instrument…”

[406]	On discretionary grounds the application should be refused as no increase on work value grounds beyond the rates provided under the 2010 Agreement had been shown and further, even if a significant net addition in relation to any of the classifications was found to have occurred, “how can they say that the 2010 Agreement rates do not adequately value that increase…”

[407]	Mr Dalton distinguished between ‘on-going changes’ of an evolutionary nature, “in the sense that they’re gradual changes that have happened over a significant period of time that are part of intrinsic requirements to the role – to the classified role on the one hand and on the other hand demonstrable changes in the value of the work.”

[408]	Bargained rates were said to contain “…industrial, pragmatic forces at play in any bargain…” which unless ‘unpacked’ did not permit a sensible valuation exercise and reduced the exercise into an unjustified comparative wage justice exercise.

[409]	Detailed aspects of the 1988 work value case were given as examples of duplication on the applicant’s part, for example (as put by the Union’s advocate in the 1988 case) as to how “professional performance has been established through the development of academic, medical and technical base qualifications,” and through the violence they could encounter at work and increased clinical responsibility stemming from the introduction of ALS.

Knowledge, Education and Training

[410]	It was put that the respondent has “always recognised in this case, formal in [sic] both in terms of the evidence that’s filed and also the outline of submissions in July 2013 that this is a significant net addition to the work requirements of the base classification, less so for ICP’s [sic] having regard to the fact that in 1988 they had moved to the ALS qualification…but the respondent recognises that the move away from a TAFE level education towards a bachelor degree equips paramedics with greater knowledge – to assess the patient, to develop treatment measures and to deal with the complexities of the environment in which they work.”

[411]	In acknowledging, further, that these changed elements of the paramedics’ work requirements, and the work thereby performed, were of significant value to AT it was said to require more to be understood in its proper perspective.  Mr Rechberger’s evidence as to the 1988 position of the education required of paramedics and of how the work was performed (rote learning/regurgitation) was given as to be preferred in light of its Tasmanian specificity and because it runs counter to the work value case then presented. 

[412]	As to some of the technological advances required to be understood and applied by paramedics, the Commission was alerted to the need to ensure weight was given to an alteration which made the work in some ways easier, “whether it’s less lifting or less intrusive interventions… or whether it’s a diagnostic tool that makes it very easy to identify…a person’s core temperature or oxygen saturation levels in their blood – that’s where the net comes in.”  This was said to be a balancing exercise in the assessment of work value.

[413]	Reliance was also had for Ms Grimes’ evidence to the effect that interstate recruits had been employed recently whose qualifications (associate degree/TaFE) had been recognised by the respondent such as to qualify for engagement.

[414]	It was put that while the paramedic degree (the typical entry standard) did equip paramedics with “propensity to learn through their careers…they are not required to continue that learning.”  Although encouraged to keep abreast of things, to read journals and articles, ultimately they were required to work within the CPGs.

Drugs, Clinical Procedures and Equipment

[415]	On the basis of the statement of agreed facts and the evidence led it was said that insofar as drugs and equipment were concerned there was agreement as to what was available and used.  As to clinical procedures the respondent submitted that there is a ‘fairly clear’ picture; that the 1991 Protocols (Exhibit R14) reflected the practices as applied at the time of the 1988 case. 

[416]	It was put that, for the base paramedic classification, “there are a number of increases in terms of new pharmacology and clinical procedures that have occurred since 1988 in respect of ICPs, again, less so and also taking into account where things were at with ALS Paramedics, the nature and significance of those changes is significantly less than it is for the base classification.”

[417]	That said, the respondent did take issue with the portrayal of the CPGs as setting loose guidelines, with much latitude left to paramedics to decide how they would carry out their duties.  Clearly, if there exists such latitude the new drugs, procedures and equipment “can take on more significance…”

[418]	It was put that the paramedic must, in relation to substances to which the Poisons Act 1971 applies, conform to the CPGs and, without the direct consultation with a medical practitioner, was not able to unilaterally divert from the guidelines.  The evidence was said to reflect the need for clinical practice to conform to the CPGs and, importantly, that the evidence of Messrs Richardson and Cane, discloses an acceptance of the guidelines.  Mr Richardson’s evidence was that should he feel it necessary to step beyond the guidelines in a particular situation, he would “not do it lightly” and that he would self-report to the regional quality assurance groups.

[419]	In Mr Cane’s evidence he was said to have acknowledged that to practice beyond the CPGs would be “exceptional and rare” and that AT would be advised.

[420]	It was said to follow that the instances where the confines of the CPGs were breached, were “really limited to examples and those examples are on the fringes and…actually not very convincing…”.  It was put that the CPGs do set the boundaries of clinical practice and it follows that it is within the CPGs’ scope that the interventions and drugs must be examined.

The Protocols v CPGs Comparison

[421]	Where it was put by the applicant that the Protocols were directives that were required to be followed without exception and that the CPGs required greater, more flexible clinical judgment, it was said for AT that, “Like a lot of this the position is probably somewhere in between what the parties have put.”  Where the Protocols, upon examination, are said to not contain directives, to not be didactic, the CPGs are described as dealing with the interventions covered in 1991, “They’re just dealt with differently and it is new techniques replacing old techniques.”

The Value of Change

[422]	In acknowledging that there have been changes in drugs, procedures and equipment over the past 25 years, particularly for the base classification, the assessment of the significance of the change was said to require a ‘characterisation’.  Too macro an analysis, as to the fundamental requirements of the job, will mean that no change will serve to register a net addition to the requirements of the job and, equally, too micro an approach will mean everything is significant.  Common sense was said to be required in considering the tertiary entrance qualification together with detailed CPGs that set boundaries, and with some changes fairly to be said to be evolutionary.  These included new drugs for old, with less side effects, with more effective procedures (as for example in airways management), and with new tools and equipment (which should not be twice accounted for, as a tool and as a part of a procedure) and which, in some cases, may make the job easier.

Environmental Factors

[423]	The inherent features of the often uncontrollable work scene were said to be unchanged; so fatigue, stress, manual handling, the risk of violence and infectious disease which were had regard to in 1988 have not been shown to have changed.  Fatigue is said to be better managed than in 1988 with a fatigue risk management policy in effect.  There was said to be no quality data or evidentiary base, other than sweeping observations based on national trends, supporting a finding that an increase in ‘intensity’ had occurred. 

[424]	The incidence of violence was described as very low in Mr O’Brien’s evidence, not increasing and better managed, as there now exists a policy designed to ensure individual officers are not sent out in certain circumstances.  We note, that under cross-examination, Mr O’Brien confirmed that an increase in violence had likely occurred post the datum point.

Workload

[425]	Workload was again said to be irrelevant as to an assessment of work value.  It was submitted that varying workloads should not be linked to varying wages.  High workloads might raise industrial issues, but they were said to not be work value based.  The evidence of Ms Byers as to her work in Hobart was said to be essentially anecdotal and impressionistic, without supporting ‘figures’.

[426]	As to overall workload, the growth figures of Dr Reynolds were said to have been in error with Mr Dalton highlighting an historical trend of 6.6 per cent increase in demand.

Overtime

[427]	Overtime was submitted as being irrelevant to work value.  In any event AT replied by submitting:

•	Excessive overtime was not remediable by engaging additional staff, as the nature of the industry precludes shift handover as applies almost universally elsewhere;

•	The respondent does not have a problem in attracting or retaining staff;

•	A pay increase would not resolve the problems HACSU alleges – as Mr O’Brien’s evidence is said to establish, such overtime is not curable by more hiring and the cost would be prohibitive.

Professionalism

[428]	The notion of paramedics as professionals, maintaining currency with academic literature and peer publications and further, that there is a culture of learning, was said to be an “adjunct of the…high point of the Union’s case that I mentioned yesterday which is that there is a significant net increase to the value of the work carried out by base paramedics in particular as a result of a move to tertiary education.”

[429]	AT’s position re-submitted, was that paramedics are not required to engage in such professional development or private continuation of learning and that, while it is encouraged, such functions are entirely given over to the respondent’s clinical services division.  Those staff filling clinical practice review groups, maintain currency as to paramedic literature and the current state of medical knowledge and they are obliged to keep all paramedics “across what they need to be across”.

ICPs

[430]	The final oral submissions of the respondent as to the ICP classification was, that there had been no net additions to the value of the ICP work.

[431]	As to the ‘specialist classifications’ it was agreed that there have been net additions to the value of that work, but that such additions have been ‘amply’ covered by the 2010 Agreement and the 2013 Consent Order.  It was submitted that the ICP, with that position’s broader scope of authority, contains within such scope, “everything that we’re talking about in the context of the base classification is encompassed within the ICP role or its historical equivalent.  Their additional skills and experience allows them to carry out work requirements within that broad scope of authority and that’s the intrinsic value of that classification over and above the base…”

Branch Station Officers

[432]	In again emphasising the dearth of evidence for BSOs, supervisory and the educative roles, it was put for the former group that the job description is unaltered.  It was acknowledged that as either paramedics or ICPs, everything that had been said as to work value affects them also.  Mr Samborski’s evidence, that BSOs were required to be ICPs, was said to be wrong, as evidenced by Schedule 1 to the 2010 Agreement which provides for BSOs at both the Paramedic and ICP levels.

[433]	BSOs were described as having always been involved in training volunteers – a function which has been substantially taken by the Volunteer Educators.

Clinical Support Officers

[434]	The CSOs were described as having fewer responsibilities given that they:

•	no longer train in patient extrication;
•	no longer form part of a rescue unit;
•	have a lower level of involvement in the planning and coordination of incident training programmes;
•	no longer perform an on-road function.

Managers

[435]	There was said to be no evidence in relation to managers.

Paramedic Students and Interns

[436]	It was submitted that there was no evidence as to there having been any net addition to the value of the work in the above classifications for Paramedic Students (previously Student Ambulance Officers) and Paramedic Interns.

[437]	Mr O’Brien’s statement was relied upon in their summary of the development of the SAOs and Paramedic Interns and particularly that:

•	Since 1988 their duties have been supervised by a qualified paramedic and they have been required to be on-call as needed.

•	The ‘differences in duties and responsibilities’ were that Paramedic Students now have a base tertiary qualification prior to commencing their employment, which in Mr O’Brien’s view provides a “higher” level of knowledge than that of the 1988 SAO.

•	Paramedic Interns have a tertiary qualification and complete the Transition to Practice internship programme which are qualifications and training not possessed by the 1988 SAOs “and provide them with a level of knowledge when they commence employment with AT that is of a higher level”. 

Transposing Relativities

[438]	The AT submission stressed that “You have to demonstrate varied pay rates at the award level based on work value for each classified role.”  Several examples were given where the pay relativities between classifications were affected by industrial and non-work value considerations, after being struck.

[439]	The Commission was also alerted to the compounding potential if a percentage was awarded at the base and maintained within the hierarchy of classifications.

The 2010 Agreement

[440]	Mr Dalton’s submission was that if an increase is felt warranted on work value grounds, “the Union cannot demonstrate that the valuation of that significant increase should translate into award rates that go beyond the rates in the 2010 Agreement.”  The 2010 Agreement rates were some 80% higher than the award rates, last ‘maintained’ in 2008.  The contention was that, even allowing for a five year lag, any work value addition awarded must fall within the 80%.

[441]	Mr Jacobson’s reluctance to accept that the wage increases over time must contain an element of work value was noted and described as “too narrow a view to say that it’s got nothing to do with work value.”

Professional Rates

[442]	The respondent’s position continued to be that a ‘professional rates’ case raised no merit that is not otherwise grounded in a work value consideration.

Comparisons

[443]	It was put that because work value was not ‘about’ comparative wage justice, it would be a mistake “to make wage comparisons with other jurisdictions and grade three allied health professionals…”  The argument was put that “the only directly relevant comparison to be drawn is between the duties performed by paramedics in each classification now as against the duties performed in the equivalent classification the last time the work value was assessed in 1988…”

[444]	There were said to be obvious reasons in seeking to make comparisons with the higher paramedic pay rates in the ACT and in South Australia.  There were said to be significant differences in duties between paramedics in those states and Tasmania.  The STEMI-bypass and intubation procedure operating in the ACT was highlighted as not practiced in Tasmania.

The Public Interest

[445]	In considering the public interest the Commission was urged to give full weight to s36(2) requiring us to consider the economy of Tasmania.  Linked to this submission was the argument that the State Government’s policy of wage restraint was a considered and responsible position to which regard should be had.  To substitute work value for bargaining was given as contrary to the Act and a misuse of process.

The Applicant’s Oral Submissions – in reply

[446]	Mr Irving submitted that applying the test raised by AT, that is, that the fundamental tasks of an ambulance officer have not changed other than by gradual or evolutionary development since 1988, the present claim must fail.  It was put that a response to change at such a level of generality could not reasonably apply and rather, that the tests as to the recognition of change of the Full Bench in the Child Care case should be applied by the Commission.

[447]	As to the structure of the Award, it was submitted that it was the contemplation of the parties, in arriving at the 2010 agreement, that in the future there could be an assessment of the rates in an exercise variously headed ‘work value’ or ‘professional rates’.  Such exercise was available to be conducted by the parties, to then apply to the newly agreed structure, with recourse to the Commission.

[448]	In response to AT’s argument that no encouragement should be given to HACSU’s bargaining complaints, or to the Union which finds itself in a difficult bargaining position by virtue of the current policy of the Tasmanian Government, Mr Irving submitted that the importance given to bargaining in the statutory scheme should not mean that the paramedics’ case not be heard and that, rather, the Work Value Principles of the Commission should have application.

[449]	As to the agreements after the 1988 Work Value case taking up or recognising work value elements of the paramedic work, it was said:

•	“In relation to the 2010 agreement it’s crystal clear that what the parties contemplated was further work value consideration…”

•	That in relation to the 2007 agreement “it was just a bulk [bog] standard public sector wage increase as Ms Grimes confirmed…a three per cent and a four per cent wage increase.”

•	As to the substantial wage increases provided for in the 2004 agreement, in the evidence of Mr Jacobson, “I’m not suggesting to you that the Government required HACSU to step through a work value case in the 2004 bargaining process and I’m not suggesting to you that the parties undertook that exercise.”

[450]	It was then submitted by Mr Irving, (although, it is likely, incorrectly attributed to Mr Jacobson in the transcript) that it was not said anywhere in the evidence that what happened in 2004 was a work value exercise and further, that on no account could it be said there had been such an assessment since 1988.

[451]	As to the significance of the change affecting paramedics, Mr Irving adopted Mr Rechberger’s description of them as revolutionary.  In brief survey, the applicant’s case stressed that the evidence disclosed:

•	There was discernible a greater level of clinical intervention by paramedics, a factor, in the evidence of UTas paramedic lecturer, Mr Edwards, of the “increasing degree of clinical decision making resulting from previously outlined changes in scope or complexity of practice the education [of] a paramedic needs to incorporate a far higher degree of critical analysis and problem solving.”

•	The understanding and application of new techniques and apparatus required training, readily triggering consideration consistent with the Full Bench’s decision in the Child Care case.

•	That orthodox or ‘rote’ application of the Protocols of the previous era had been displaced by multiple decision-making upon the receipt of the increased information now available to the paramedic.

•	That there had occurred a “massive expansion” in the number and nature of the drugs now used by paramedics – easily satisfying the criteria set out in the BlueScope Steel case.

•	Many drugs previously restricted for ICPs only to administer were now available to paramedics for dispensing.

•	Drugs were now more widely available for paramedic dispensing, across a range of criteria, than was previously the case; so restrictions as to whom drugs might be administered had been eased, the ways in which the drugs are given have widened, the circumstances in which they might be given have altered and the amounts capable of being given have been increased and, in some cases, rendered discretionary quantities in the judgement of the paramedic.

•	Where under the ‘old’ Protocols there were prescriptive limits over these criteria, the impact of the change became clearer, particularly when the new knowledge is considered; whether reflected in accompanying written examinations, training packages, in-house workshops, practical skills assessments or professional development tutorials.

•	There is a far broader range of procedures affecting the work of paramedics; from some 32 procedures in the earlier protocols to the 97 odd now encompassed in the CPGs.  In a conceptual sense, Mr Irving likened the CPGs to a fence around the field of paramedic practice where, over time, the fence had been moved to incorporate more area into its enclosed space – the expanded scope of general paramedic practice.  Reliance was placed upon AT’s description of the importance of the adoption of the CPG conceptual framework, where it was said that the new approach put Tasmania at the forefront of pre-hospital care in Australia; referring to “new skills, the new drugs, the new education in skills, the new education in drugs, and new education in intensive clinic equipment which accompanied the introduction of these CPGs.”

The ‘Unaltered Fundamentals’ and ‘Easier Work’

[452]	The issue of some developments, whatever else might be said about them, making the work easier, was taken up by the applicant in reply – particularly as to cardiac interventions and pulse oximetry.  It will be recalled as to the latter development, that there now exists a small clip or finger clamp which gives an accurate reading of the oxygen saturation level in the blood and in doing so supplants the previous observational techniques which included being alert to blue lips.  Without repeating what is earlier recorded as to the understandings necessary to make full use of the information it provides, Mr Irving relied upon the overall use of the new device, and, as to pulse oximetry being a function now more easily performed (as suggested by Mr O’Brien), it was submitted:

“Is that part of the job easier?  Well that part of the job requires a far greater depth of knowledge, far greater clinical assessment, …far greater drawing together of four or five different pieces of scientific understanding to reach the conclusion rather than just looking at someone and say they’ve got blue lips…”

[453]	As to cardiac intervention, the subject of considerable evidence, a further response was given to the evidence of Mr O’Brien in relation to the five sub-sections into which Mr O’Brien divided the function.  These were, first, defibrillation; in 1988 performed only by an ICP and now performed by Paramedics; second, ventilation – airways management.  As to this sub-set of tasks it was put in reply that there had been significant change in that there had been an increase in airways management procedures for ICPs from some 9 to 21 currently and for Paramedics an increase from 7 to 12 procedures.  Attention was drawn to Mr O’Brien under cross-examination having agreed that there had occurred a significant expansion in the range of tasks performed by paramedics in relation to airways management.

[454]	The applicant relied as to the new procedures, including tracheal intervention capnography, cricothyrotomy and others, having been conceded by Mr O’Brien and Mr Rechberger as involving new, additional skills – even though Mr Rechberger held his ground in averring that all remained part of the basic intubation skill.  The third part of cardiac intervention in Mr O’Brien’s testimony related the CPR procedures.

[455]	The fourth part of the cardiac intervention is the administration of drugs.  The marked increase in the available drugs has been dealt with above.  It is sufficient to note that the applicant relied on the overall impact of the considerable increase in the number of drugs available for use in the event of cardiac arrest.  It was agreed by Mr O’Brien that where in 1991, Paramedics had 2 drugs to potentially administer in such circumstances; they now have 7, while ICPs then had 7 drugs and now have 13.

[456]	The fifth aspect was the utilisation of 12-lead ECGs, that equipment having been introduced in 2009 with its significant attendant training.  The applicant’s case was that the evidence disclosed that, in contradistinction to the prior 3-lead ECG machine, the 12-lead ECG provided for an infinite variety of ‘information packages’ about the heart.  It was said that with the education involved considered, the evidence supported a conclusion that the 12-lead ECGs “provide more information and they allow for greater depth of informed decision making.  Paramedics need to have a greater understanding and underpinning knowledge of what these infinite numbers of ECG readouts mean.  They need a greater capacity to understand what readouts are telling them.”

[457]	The oral submission also dealt again with the evidence of Mr Rechberger, at pages 378 and 379 of the transcript, as to Exhibits A26 and A27.  This element of the case deals with an important contention of the respondent; that the work of the 1990s Paramedic and ICP, as set out in the comparative summary of tasks, equipment and devices reflects some change and development, but the fundamental skills and responsibilities were already to be found ‘packed up’, in the less explicit, less detailed summary of the 1990s work vis-a-vis that of the present.

[458]	The applicant’s response in its oral reply was to rehearse the lists of new drugs, procedures and responsibilities, with their training, that did not exist in 1988.  Mr Rechberger’s agreement, at pages 403 and 404 of the transcript, that various work was not being done in the earlier period was given as counting against the contention that the expanded modern roles of the ambulance officers should be understood as ‘unpacked’ or ‘fleshed out’ renditions of the roles and skills as earlier practiced.

Additional Matters

[459]	Triage/Fatality – In their oral submissions the applicant again placed emphasis upon a particular aspect of the triage role, said to have changed from that applying prior to 2005, in the very difficult situation where in an accident, crime or mishap to which paramedics responded, there was more than one seriously injured patient, including one whose injuries were very grave.  The change was for paramedics to now provide primary resources to the patient capable of being saved over the patient near to death – when, as to the latter patient, it was the view of the triaging paramedic that death was the most likely outcome.  While such occurrences were conceded to be very rare, the level of responsibility conferred upon paramedics required to make such a determination, was said to have few equals.

[460]	Violence and Aggression to paramedics – While it was conceded by the applicant that there is ‘very little’ data to support the proposition that there is more violence than 20 years ago, it was said to be common ground “that there’s an increasing amount of acts of verbal and physical aggression against paramedics…” and that it is not disclosed through poor reporting.

The ACT Private Arbitration case

[461]	Many of the elements found by Deegan C to be representative of change such as to satisfy the Work Value Principle in the ACT Private Arbitration case - Transport Workers Union v Department of Justice and Community Safety [2010] FWA - were adopted by the applicant as present and reflected in the evidence before the Commission.  Despite differences in the work performed by AT and ACT paramedics (acknowledged by Mr Irving as ‘not insignificant comparative imperfections’), which were brought to notice in the course of the case, it was nevertheless put that “the similarities are so great that a sensible comparison can be drawn between the two.”

[462]	It should also be noted that the applicant’s case acknowledged that the ACT parties’ original compact providing for such an assessment occur, charged the private arbitrator with a capacity to quantify any work value discerned according to a wider ranging field of comparative vision than would be likely under the usual strict application of work value precepts.

[463]	Not repeated here, though stressed by the applicant, are those parts of Deegan C’s decision rejecting the submission favouring evolutionary change as subsuming new skills and techniques, so that work value change be not found.  A similar conclusion was urged upon us.

Branch Station Officers and Clinical Support Officers

[464]	The applicant stressed that BSOs and CSOs were also Paramedics and ICPs and entirely integrated into the work of mainstream paramedics.

Consideration

The Work Value Principle

[465]	As outlined earlier in this decision, the parties have agreed that we undertake this work value assessment wholly and solely according to the Work Value Principle of the Commission again reproduced below:

“9.1	Changes in work value may arise from changes in the nature of the work, skill and responsibility required or the conditions under which work is performed.  Changes in work by themselves may not lead to a change in wage rates.  The strict test for an alteration in wage rates is that the change in the nature of the work should constitute such a significant net addition to the work requirements as to warrant the creation of a new classification or upgrading to a higher classification.

	These are the only circumstances in which rates may be altered on the ground of work value and the altered rates may be applied only to employees whose work has changed in accordance with this principle.

9.2	Where new or changed work justifying a higher rate is performed only from time to time by persons covered by a particular classification or where it is performed only by some of the persons covered by the classification, such new or changed work should be compensated by a special allowance which is payable only when the new or changed work is performed by a particular employee and not by increasing the rate for the classification as a whole.

9.3	The time from which work value changes in an award should be measured is, unless extraordinary circumstances can be demonstrated, the date of operation of the second structural efficiency adjustment allowable under the 30 October 1989 State Wage Case decision, or the date of any increase awarded in accordance with this principle since that date.

9.4	Care should be exercised to ensure that changes which were or should have been taken into account in any previous work value adjustments or in a structural efficiency exercise are not included in any work evaluation under this principle.

9.5	Where a significant net alteration to work value has been established in accordance with the principle, an assessment will have to be made as to how that alteration should be measured in money terms.  Such assessment should normally be based on the previous work requirements, the wage previously fixed for the work and the nature and extent of the change in work.  However the Commission will also take account of the relativities and the integrity of the internal award classification structures and the external classifications to which that structure is related.

9.6	The expression “the conditions under which work is performed” relates to the environment in which the work is done.

9.7	The Commission should guard against contrived classifications and overclassification of jobs.

9.8	The conditions under which the work is performed, taken into account in assessing an increase under any other principle, shall not be taken into account in any claim under this principle.”

Case Law

[466]	We were referred to a number of decisions dealing with work value and s170MX (of the Workplace Relations Act 1996) arbitrations.  It is unnecessary to comment on each of these cases, however they have been considered and we intend where appropriate in our findings to indicate a decision upon which particular reliance has been placed.

Powers/Jurisdiction

[467]	A range of submissions were made which concerned the Commission’s powers and accordingly, how we should deal with the application.  These included arguments developed on the following grounds.

•	The long title to the Act, which in providing a broad summary of the functions of the Commission, includes the words, “…to encourage workplace bargaining…”;

•	The framework of the Act as to the making and varying of awards, the approving of industrial agreements, including ensuring that there be no disadvantage for employees to be bound by an agreement by reference to an underpinning award, was said to have created “consistent with the Federal industrial legislation since the early 1990s, …a system whereby the award powers are designed to maintain minimum wages and conditions…”;

•	The role of the award as an underpinning instrument serves the statutory objective of encouraging workplace bargaining by facilitating application of the no disadvantage test;

•	It was said that the application seeks to resolve what is basically a bargaining issue; an approach which should not be encouraged by the Commission.

[468]	Having considered these matters, we are not of the view that there is an inhibiting factor arising from the operation and interaction of the various parts of the Act referred to by the respondent such as to affect our capacity to deal with the present application.  We have reached this view for a number of reasons.

[469]	As a starting point, we note the respondent’s submissions supporting the consolidation of the Award classifications and pay rates with those of the then current 2010 Agreement.  In what was said to be consistent with the parties’ agreed “Award consolidation process” we were advised that the respondent agreed to the variation of the Award by substituting for its classification and pay rates those set out in Schedule 1 of the 2010 Agreement.  We understand the Award consolidation process to refer to the agreement between the relevant authorities and HACSU, to bring the rates and conditions of paramedics in Tasmania, prescribed in the 2010 Agreement (and its successor) and the Award, into alignment.

[470]	We note further that the 2010 Agreement and the current 2013 Agreement provide for “Award Consolidation” (at clause 7 of both agreements) by which, to the extent practicable, the parties have committed to consolidate all terms and conditions of employment into a single instrument.

[471]	Unlike the position pertaining in the Federal jurisdiction, the Commission had, as late as 2009, (when the wage fixing principles were, with several exceptions, retired), provided at principle 13.2, the following:

“…public sector Awards may be varied from time to time to reflect salary rates and conditions of employment as may be agreed between the parties bound by relevant public sector Awards.”

[472]	We are mindful that since that time, the Tasmanian public sector Awards have, with differing degrees of urgency, been varied by the consent of the parties and at their initiative to reflect agreements in the public sector, with some particularised as work value agreements.

[473]	As indicated earlier, it was argued that the long title words “to encourage workplace bargaining” meant that in hearing this application, and determining to award an increase based on work value, were that our view, doing so would serve to inhibit bargaining.  This was because the application was said to be a consequence of difficulties experienced in bargaining by the applicant, given the wages policy of the then State Government.  It followed that the hearing of an application to vary an award was subject to the implied bargaining term; that sufficient “space” be left for bargaining and accordingly, the scope of an award variation on work value terms, should be considered subject to an implied bargaining encouragement term.

[474]	As to the Award, it is the policy of both AT and the HACSU to have the Award consolidation proceed promptly.  It is noteworthy that the parties, in the 2013 Agreement, have given themselves a shortened timeframe (reduced from 12 months in the 2010 Agreement to 6 months in the 2013 Agreement) in which to have this policy objective achieved.

[475]	We cannot reconcile the submission put on behalf of AT that such a policy, that is “to consolidate all terms and conditions of employment into a single Industrial Instrument”, in the terms of clause 7 of the 2010 and 2013 Agreements, which forms a not unimportant goal of its recent and current agreements, is inimical to the bargaining scheme or at odds with an encouragement to bargain.  It seems to us that the parties’ ‘consolidation’ policy arises wholly from bargaining and has as a principle consequence the elimination of that “space” between award and agreement which counsel for AT sought to have us maintain.

[476]	We are reminded that the present application reflects an issue, the mounting of work value claims, which is also specifically acknowledged, in the sense of it being remarked upon and dealt with by the parties’ agreement in clause 13 of both the 2010 and 2013 Agreements.  We are aware that the parties, being experienced bargainers, had included some matters in a Reserve Matters provision at clause 25 of the 2010 Agreement.  ‘Work value claims’ was not one of them and yet there was no objection taken to the hearing of the application upon its lodgement on the basis that it was a new matter or otherwise proscribed as an extra claim.  Instead, as adverted to above, the respondent urged that we take a principled approach and in essence, reinvigorate the Work Value Principle to assist in the proper hearing of the matter.

[477]	We are, of course, also aware that AT had throughout the negotiation of the 2010 Agreement been aware of the union’s desire to press a work value application and indeed, Mr Morgan, the respondent’s CEO, had acknowledged to staff in his email correspondence of 15 January 2010, that the capacity remained for paramedics to have their professional rates/work value case heard.  (As to nomenclature Ms Grimes’ and Mr Rechberger’s evidence was the concepts were synonymous).

[478]	The submission now before us is that that position did not extend beyond an acknowledgement from AT that the application could be made and that the employer was free to oppose the application.  

[479]	To the question, “Is there power for the Commission to vary the Award to replace the classification structure and rates of pay with those of the Agreement at the time of the hearing?”  The answer is; yes.

[480]	Deriving, as the claim does, in part from the agreed Award consolidation process, reflected ultimately in both the 2010 and 2013 Agreements, making reference to the potential consequence of a work value case, there is no ground for holding there exists an impermissible impediment to bargaining in the determination of this application.  The parties are able to utilise the various courses available to them under the Act seeking the Commission’s assistance in resolving their disputes, including their disputes relating to bargaining.  Indeed, it is a course regularly availed of and does not serve as an impediment to bargaining.  (See generally the discussion as to Enterprise Bargaining in the decision of the Full Bench in Review of Wage Fixing Principles, TIC, T8413 of 1999 and T8483 of 1999. 6 July 2000, per Westwood P, Johnson DP and Watling C, at page 15).

[481]	We are not approaching this work value determination as a substitute for bargaining.  We are conscious of the work value provision at clause 13 of the 2010 Agreement and which we note was agreed some 12 months prior to the commencement of the then State Government wages policy.

[482]	As to the legislative scheme, we note that there is no reference in the Act to the minimum rate nature of awards of the Commission, as may be referenced in other jurisdiction, and to this extent, the submission put was overstated.  We add that, contrary to the thrust of the respondent’s submission, by maintaining the classification structures of awards to reflect the work as actually performed, with relevant position descriptions and up-to-date classification levels, proper meaning is given to the no disadvantage test and by so doing, fair and informed bargaining is encouraged.

[483]	In our view the application of HACSU, supported by the respondent through agreement of clause 7 of the 2010 Agreement, is clearly within powers conferred by Part III, Division I and Part II, Division 3 of the Act.

Significant net addition

[484]	In this closely contested case, both parties were represented by experienced counsel and decisions were made by both parties not to cross-examine some witnesses.  As such the evidence of those witnesses was uncontested.  Generally speaking, we accepted the evidence before us as conscientiously given.

The Datum Point

[485]	We have noted that as to the time from which work value change should be measured, “unless extraordinary circumstances can be demonstrated, [the date is] the date of operation of the second structural efficiency adjustment allowable under the 30 October 1989 State Wage Case decision, or the date of any increase awarded in accordance with the Principle since this date.”  In the s170MX matter Queensland Department of Health v Mater Misericordiae Health Service Brisbane Limited PR931289 [2003] AIRC 518 per Munro J, Marsh DP and Deegan C, a bargaining period had been terminated and the bargaining was subsequently arbitrated.  We note the observation of that Full Bench at [76] where it said:

“In our view, the appropriate starting point for the measurement of work value changes for RN’s is the period since the second structural efficiency principle increase for RN’s that is 1990.  For EN’s, as acknowledged by the ANF, the appropriate datum point is the date of the last work value decision, namely 10 June 1992.  In its decision the Full Bench [in the Safety Net Review Wages May 2002 decision] stated:

“There is a requirement when determining rates and relativities under the work value changes principle that ‘structural efficiency exercises should incorporate all past work value considerations’.  As in other special cases we have found it unnecessary to compartmentalise the requirements of each principle.”” (citation omitted)

[486]	Whilst both parties agreed, through the Agreed Statement of Facts, that the datum point would be 6 October 1988, we received no submissions relating to extraordinary circumstances. Accordingly, we find that the strict application of the Principle requires us to apply a datum point from the second structural efficiency adjustment for the relevant Ambulance Award, which occurred on 13 August 1991.  Having made this finding, we add that based on the evidence led by the parties, there is no advantage or detriment to either side.

What is Net Addition?

[487]	What is important in any work value consideration is ‘does the work involve a new understanding or knowledge?’ such as to reflect a change in the nature of the work, skill and responsibility required in the necessary degree.  It follows that grab-bags of inconsequential changes or even of some changes of greater moment will not necessarily be capable of aggregation to satisfy the test.  Almost all work changes over time to some degree, with some work changing very regularly.  What are often termed ‘evolutionary changes’ are reflective of this type.  Ultimately, any change to be recognised under the Work Value Principle must be tangible in the sense of it being identifiable and significant as to the work.  Not all change will translate over time to an increase in work value.  HACSU relies upon the professionalism of paramedics and sees the quality of their being professional as warranting recognition in their pay levels.  We note the observation of the Full Bench of the NSW Industrial Commission in the Public Hospital Nurses (State) Award (No. 4) Re [2003] NSWIRComm 442, per Wright J President, Boland J and Patterson C, (the Public Hospitals Nurses case) where, considering the matter claimed work value changes for nurses, it was said at paragraph 18:

“…In many occupations, particularly professional occupations, change, and the requirement to cope with it by coming to terms with new methods and new technology, is an inherent and accepted characteristic of the employment and rarely will this evolutionary process attract extraordinary wage increases under the work value principle.  In this respect, we note the observations of Fisher P in Re Medical Officers – Hospital Specialists (State) Award (1990) 33 IR 79 at 84 where, after referring to the work value principle, his Honour said:

“One of the Problems with the application of the “strict test” to professional or managerial employment lies in the nature of the change.  Change must be accommodated; being an essential part of what professional practice is all about.  It does not follow therefore without more, that changes even spectacular changes, necessarily fall within the work value principle.””

[488]	It is against this high test that in the present matter the Commission is satisfied that there has been a tangible increase in the understanding, knowledge, and skills of paramedics since 1991.  There is also a significant increase in the responsibility attaching to these functions.  In a simplistic sense, the responsibility relating to this work, at its highest, the stabilisation and treatment of life threatening conditions, has not changed.  However, as the work has changed with its interventions, pharmacological discretions and complexities, the resulting responsibilities are, in our view, even more onerous.

Double-Dipping

[489]	We acknowledge that a number of features of the work, relied on by the applicant, were also canvassed in the 1988 Work Value case, but say that the mere fact that those features were addressed previously, does not necessarily mean that change under that heading cannot be considered in a future work value assessment.  We have sought to strictly apply this approach; that the only matters to now be taken into account are changes in the nature of the work, skill and responsibility required, or the conditions under which the work is performed, as are identified in the evidence as having occurred in respect of the features of the work, since 1991, and not changes occurring prior to that date.

Evolutionary or work value change?

[490]	Whilst AT submitted that the fundamentals of the work were still the same, that any change was either evolutionary or merely the same skills applied using upgraded equipment, this was not borne out by the evidence.  The final submissions of AT acknowledged change particularly at the ‘base’, that is at the Paramedic level, and we found these submissions candid and constructive.  That submission acknowledged, in a modest way, the extensive change that has occurred over the datum period effecting AT’s Paramedics and to a much lesser degree ICPs.  We propose to set out a range of the changes which have affected the work of paramedics at AT since the datum point and upon which we have reached our conclusion.

[491]	We find that since the datum point AT has encouraged and introduced change and advances across all the areas of paramedic service from the university entrance requirement to supporting the far more complex diagnostic triaging and consequential treatment options available to paramedics when at scene.  The advances in medical knowledge and the technologies to aid its introduction, to which our attention was drawn, have caused many new methods and ways of thinking to suffuse ATs’ paramedic practice.

[492]	In doing so we are conscious that merely citing new equipment, ambulance inventory, pharmacology and procedures cannot adequately cover the breadth of evidence given, but will, we anticipate, provide an indication of the swath of change we have found to have occurred and to have affected the work value of paramedics.

Change experienced by the Paramedic Classification

[493]	Since the 1991 datum point, Paramedics at AT have gained skills and responsibility in the use and understanding of defibrillators, the 12-lead ECG, IV cannulation, the practice of more complex triaging and a significant increase in the number and application of new drugs, including Midazolam, GTN and Morphine.  We are also satisfied there has been a significant net addition to the nature of the work constituted by the increase in the methods of drug administration available to Paramedics.  These changes are often accompanied by more onerous decision making – assisted, we acknowledge, by the CPGs.  We have also recorded the place of the Paramedic in their advisory role with practitioners and other health professionals in the non-transport and referral of patients.  Not the least of these changes is the major advancement in education standards from TaFE level qualifications to that of a Bachelor degree, with, we have found, an accompanying higher level clinical knowledge and capacity.

[494]	AT now requires the tertiary qualification Bachelor of Paramedic Science for new entrants into the industry.  We accept, on the evidence, that this change in educational standards provides a basis for improved clinical reasoning skills with a greater underpinning knowledge of physiology and pharmacology.

[495]	There was uncontested evidence as to the professional recognition offered to paramedics, with one example being the evidence of Mr Richardson, that following his further training, he now instructs doctors in emergency management of critically ill children.

Change experienced by the ICP Classification

[496]	Examples of changes of skills and responsibility for ICPs coming squarely within the scope of the Work Value Principle include:

•	a range of intubation interventions
•	the use and interpretation of 12-lead ECGs (conscious of the implications of determining the type of infarction presented and the appropriate clinical response, that is, whether to administer or not administer GTN)
•	the application of external cardiac pacing
•	a substantial increase in the use and application of new drugs including Frusemide and Ketamine
•	the method of intraosseous administration of drugs;

with this being acknowledged by the evidence of Mr Rechberger and Mr O’Brien.

[497]	As for the drugs Ondansetron and Fentynel, the unchallenged evidence of Mr Cane provided that ICPs could administer these high level drugs, when in comparison, some doctors could only administer them under direction or after consultation with more senior clinicians.

[498]	We will give the intraosseous administration method as an illustrative example of the new techniques/skills in which ICPs are now trained.  This method involves the giving of a drug by drilling a hole into the bone of the patient which, it was stated, was an important addition to the skills inventory of an ICP in resolving the difficulty previously experienced in establishing an IV line in a young child.

[499]	We find these skills and responsibilities, the result of many changes and advances in the work of ICPs, to reflect a significant net addition to their present work as compared to that at the datum point.

Further examples of change

[500]	There was considerable evidence given as to the role of paramedics in triaging patients.  Some of that evidence was contested; however following cross-examination of the respondent’s witnesses it was, in our view, established that paramedics do have a role of generally triaging patients.  Further, since 2005, they now carry the heavy responsibility set out in the evidence as to, fortunately infrequent, serious multi-casualty incidents, where critical demand outstrips resources, to prioritise treatment away from a patient they know to be not saveable.  We consider there can be few societal decisions more onerous than that exercise of judgement.

[501]	Further, it was Mr White’s evidence that the CPGs provide limited circumstances in which a paramedic can now withhold or cease pre-hospital resuscitation, another substantial increase in responsibility and judgement.

[502]	The evidence of Mr Edwards and Ms Byers, as related to the use of the new 12-lead ECG, disclosed that the quality of the clinical interventions now practiced by paramedics was of a far higher standard than that in 1991, and the use and particularly, interpretation, of the equipment required critical analysis and decision making, which we find has contributed to the change in work value.  It also requires of paramedics a much deeper knowledge of human physiology and heart function.

[503]	We found the Agreed Statement of Facts and Attachment JR-1 to Mr Richardson’s statement to be particularly useful in illustrating the very substantial change in pharmacology for paramedics over the last 20 years, together with the respondent’s reply to this document, Attachment SW-9.  This change was accompanied by the discretionary quantities of some drugs administered through the judgement of the paramedic.  One example given by the applicant was that of Normal Saline, a drug which underwent some six changes in 2007 and nine changes in 2012 under the CPGs, several of which required a basic re-consideration of the previous practices.

[504]	Another important example was the application of the mask and bag previously used by Paramedics for airways management, and that were that procedure unsuccessful, the patient would not survive.  Paramedics now have other procedures, skills and equipment to assist in patient survival, which were not part of the skill-set in 1991.  They are now required to be cognisant of the different effects that drugs have on different patients.

[505]	The drugs Midazolam and Ketamine are both administered under the scope of practice at AT, with Ketamine being ICP scope of practice only.  It is significant that both of these drugs possess particular features which require greater knowledge, experience and judgement in determining their use.  We are aware that findings were made in relation to these two drugs and their implication for increased work value in the ACT Private Arbitration case by Deegan C.

[506]	Evidence provided on the implementation and importance of the 2012 CPGs was extensive.  Messrs White, Rechberger and O’Brien’s evidence effectively described the CPGs as a set of steps to assist paramedics in treating the signs and symptoms of a patient in “good faith” and emphasising their transport then to hospital.  In this portrayal the change to the CPGs was merely terminological, stylistic or reflective of formatting changes.

[507]	In contrast, AT launched the 2012 CPGs by announcing in a media statement:

“Cutting Edge Skills and Education for Tasmanian Paramedics

Every clinical paramedic will be armed with updated skills and education as part of a new program that puts the state at the forefront of clinical pre-hospital care in Australia.

Ambulance Tasmania CEO Dominic Morgan today unveiled a new set of clinical practice guidelines for paramedics and intensive care paramedics that will see them educated on new skills, drugs and intensive care equipment.

…

As part of the training, paramedics acquire a greater understanding and learn new skills in medication administration, respiratory diseases and cardiac problems.” 

[508]	While we acknowledge the occasionally practical nature of such public announcements, we have no reason to discount Mr Morgan’s description of the CPGs as requiring a paramedic to achieve greater skills in medication administration, respiratory diseases and cardiac problems.  On the evidence before us of the CPGs in operation over a reasonable period, we consider Mr Morgan’s statement to be an accurate anticipation of the changes heralded by the CPGs at introduction.  Such an understanding is consistent with the concessions elicited under cross-examination of the respondent’s witnesses.  Mindful of the evidence of Messrs Edwards, Richardson and Cane, as to the nature and application of the CPGs (that is that they now cover some 97 medical conditions as opposed to 32 conditions as at the datum point), we are of the view that the introduction of the CPGs has imposed a significant increase in the complexity and quality of Tasmanian Paramedics work, and we so find.

[509]	We are satisfied that there is now a far greater body of knowledge required of a paramedic than 20 years ago, which brings with it, improved clinical reasoning skills.  This, coupled with the contemporary iteration of the CPGs imposes enhanced responsibilities and increased mental demands on paramedics through increased complex decision making and critical analysis requirements.

[510]	We are conscious that the issue of increased violence towards paramedics was a matter raised in the 1988 work value case about which it is said there now is evident an increased incidence of aggression.  To this end we note that such behaviour is lamentable, however, we are not convinced that the solution to this vexed issue lies in an increase to pay rates.

[511]	On the issue of ‘ramping’, we concur with the argument of the respondent as, however imperfect a practice it might be thought to be, ramping requires the paramedic to continue to practice within the boundaries of the CPGs.  Were it to be suggested that the nature of the care given by paramedics changes over time, as the patient is held in the ambulance for quite lengthy periods, direct and detailed evidence would be required permitting that conclusion to be reached.  No such evidence was available to us.  It follows that our determination in this regard, which has the effect of excising this area of practice from that found to have contributed to an increase in work value, should not be thought of as conclusive.  Dr Ruigrok opined that the practice of ramping, allowing for management of resources, would not be possible were it not for the skills of the modern paramedic.  We concur with this observation.

[512]	The unchallenged evidence of Dr Ruigrok was that a deeper incursion of paramedic treatment of patients, in understanding and acting upon their conditions, had occurred over the last 20 years.  This treatment required, over that which it progressively replaced, more complex diagnostic and triaging understandings - relying fundamentally upon paramedics’ deeper cognitive capacity.

[513]	Whilst it was AT’s evidence, through Mr Rechberger, that the introduction of the CBR and USAR skills were revolutionary we are satisfied that the new skills displayed as described above by paramedics at AT, coupled with the increase in education standards, are of a higher order and far outweigh the CBR and USAR skills.  This is not to say that those skills are not important and have not made an incremental contribution to work value in this case.

[514]	Mr O’Brien conceded the use of the Pulse Oximeter required a greater depth of knowledge and understanding in a clinical setting.  Many changes in contemporary work practice may make the performance of some tasks safer and/or easier, however a process being made easier of performance does not, in itself, diminish an otherwise evident change in work value.  An example of this would be the use and understanding of pulse oximetry equipment.  We are alert to the work value principle requiring that there be a significant net addition to the work.

Change experienced by the BSO and BSO (ICP) Classifications

[515]	We note that BSOs are full-time operational paramedics either at the Paramedic or ICP classification.  It was the evidence of Mr Samborksi that BSOs have been transferred some of the functions from Volunteer Educators relating to training of VAOs.  Our conclusions as to the work value change of Paramedics and ICPs, applies to BSOs as they are operational in nature and have experienced the same significant net addition to the work Paramedics and ICPs are to perform.  As to the additional training provided by BSOs, we see this as a time management rather than work value issue and they do not require additional skill and responsibility, as the predecessor role also provided training to VAOs.

Change experienced by the CSO Classification

[516]	Despite a submission to the contrary, we have accepted the evidence given from both parties that CSOs do perform operational duties as first responders and are “on road” for approximately one third of their time.  Further, CSOs now have an essential requirement for Certificate IV in Training and Assessment, which was not a requirement of the predecessor role as at the datum point.  We consider the additional Certificate IV qualification now required for a CSO has contributed to the significant net addition that we have found for this role.

Change experienced by the Flight Paramedic Classifications

[517]	Whilst it was conceded by the respondent’s witnesses, that there had been some developments in the use of equipment by Flight Paramedics - Helicopter and some additional skills utilised by Flight Paramedics - Fixed Wing, in applying the strict test of the Principle we are of the opinion that the additional rescue equipment utilised by Flight Paramedics – Helicopter is evolutionary in nature and therefore falls outside the Principle.  The additional skills utilised by Flight Paramedics as it relates to the additional equipment and medications they use and the maintenance of infusions and central lines, (central line being a catheter inserted by a medical practitioner into the right atrium of the heart), is relevant for work value purposes and we have taken account of this addition.

Change experienced by the Paramedic Educator Classification

[518]	The evidence, particularly of Mr O’Brien, as it related to Paramedic Educators, provided that they were operational in nature, requiring to be regularly ‘on-the-road’ to maintain their skills and also to research, develop and implement training programs for paramedics and volunteer staff.  An aspect of the Paramedic Educator role is also to review, evaluate and recommend accreditations and competencies for paramedics.  We have concluded that undertaking these educational and oversight functions requires of the Educators, maintenance of clinical skills, and to have sufficient elevation to undertake these important teaching positions.  We do not accept the respondent’s submissions that there was no evidence to support a work value change for any position other than Paramedics.

ICPs working as ECPS

[519]	There are currently two ICPs seconded into ECP positions.  There is no classification for this position under the Award or the current Agreement.  The evidence of Mr White was that the ECP positions were funded through the Federal Government with no funding commitment past 30 June 2014.  However, the respondent did not state that the positions would not be maintained.  An ECP operates as a single responder and has received additional training and skills involving suturing, the insertion and removal of indwelling and supra-pubic catheters and replacement of nasogastric tubes.  In light of this and the evidence of Mr Cane and Mr White and for the sake of clarity, we have determined that the duty undertaken by ICPs in the role of ECPs are of a significantly higher value than that of an ICP and thereby meets the strict test of the Work Value Principle.  As such we find the work undertaken and responsibility borne in the role of ECP warrants the creation of a new classification.

Change experienced by the Paramedic Intern and Paramedic Student Classifications

[520]	Paramedic Interns and Paramedic Students have clearly undergone, a proportional increase in responsibility commensurate with that required by the new CPGs, as evidenced by the Authority to Practice Matrix which provides:

“Student Paramedics and Student Intensive Care Paramedics will be progressively authorised by the Director of Ambulance Services to practice under either direct or indirect supervision in accordance with Clinical Practice Guidelines as they progress through their academic programs”.

[521]	The historical changes that have occurred since 1991; more particularly the move away from TaFE level education to the earlier phase of tertiary training and ultimately to the Bachelor Degree of Paramedic Science in 2009 for Paramedic Students and Paramedic Interns, together with the expanded scope of paramedic clinical practice that is now undertaken is, in our view, considerable.  This position was demonstrated not only in the evidence of the applicant, but also that of Mr Rechberger, albeit he said the changes were only incremental.  Accordingly, we find there has been an increase in the skills and responsibility of these grades of the requisite order.

Managers

[522]	Mr O’Brien made reference in his written statement that Duty Managers and Operations Managers do work operationally to maintain their clinical skills, on a regular basis.  We note the applicant led no evidence as to the operational role undertaken by these Managers.  Accordingly, our findings in relation to work value increases do not extend to all Managers within the classification structure.  This is not to say that the roles of Manager level 1 and 2, based on the respondent’s evidence, would not attract the same significant net addition if sufficient evidence of their operational currency was provided.

[523]	Relevant to our finding is the consideration of the Full Bench in the Public Hospitals Nurses case where at [22] it was said:

“We consider that the important point to be drawn from The TAFE Case is that if an applicant seeks wage increases for all classifications under an award the applicant carries the onus of demonstrating work value change in respect of each classification.  It is not sufficient to contend, for example, that there have been changes in technology over the relevant period that have impacted on the work value of employees generally.  It must be demonstrated how that impact has led to a significant net addition to the work requirements of each award classification in respect of which the increase is sought.”

[524]	We are cognisant of the fact that our findings (or lack of them in relation to Managers) may create some difficulties for AT bearing in mind the long agreed relationships between the classifications.  However, we note there is a ‘vehicle’ within the 2013 Agreement to address such an issue.  Given all the evidence provided in this case, any further application could be a focused exercise.

Workload and Overtime

[525]	We accept the position advanced by AT, that in the circumstances before us, staff numbers have kept pace with increases in the number of incidents since 2004.  We also accept, on the available evidence, overtime of itself, has no bearing on work value.

[526]	We are aware that AT are expecting continuing growth in demand, referring to the ORH report No. 1.  It was the evidence of both parties that Tasmania experiences complex patient cases due to co-morbidities, disablement, mental health and an ageing population.  We are of the opinion that AT appears well placed to deal with these pressing public interest issues in a positive manner.  Nevertheless, the confluence of characteristics referred to above makes for a complex set of issues with which paramedics must contend.  Notwithstanding, we note that there was no evidence put before us to indicate whether this was also the case at the datum point and whether there has been any increase or decrease in these work related factors.  Accordingly, these factors have not formed part of our conclusions as to significant net addition.  We simply note them.

[527]	In the decision Australian Workers Union v BlueScope Steel (AIS) Pty Limited [2008] NSWIRComm 1071, a case involving hot strip mill (HSM) steelworkers and the Work Value Principle, it was relevantly found by Connor C:

“…that, as I perceive it, is not the nature of Mr Hatcher's claim on behalf of the HSM operators. He refers in his written submissions to the fact that the Level 3 HSM operators "...are now required to mentally process a significant amount of new or additional information for the purpose of solving problems and making decisions..." which he described as "...a new, or enhanced, work responsibility..." and suggests that "...the mental demands upon the operator have increased, meaning that the nature of the work has changed...".  It is not HSMICS, and the new computer systems associated with it, which counts in a work value assessment, but the demands those computers now place on the employees being assessed. I am satisfied that there has been a significant net addition to work requirements flowing from that new technology.”

[528]	For all of the above reasons we find that there has been a change in the nature of the work, skill and responsibility required of Paramedics and also of ICPs, when their work is compared to the work undertaken by AOs and ALSs as at the datum point.  We find that this change constitutes such a significant net addition to the work requirements of Paramedics and ICPs as to warrant the creation of a new classification.

Assessment of change

[529]	HACSU submitted that the most appropriate wage rate comparison in assessing the work value in this case was that of the ACT Ambulance Service or the South Australian Ambulance Service.  This was on the basis that those States had already undertaken their own work value cases.  The South Australian work value case was heard in 2009; however the matter was settled shortly after completion of the hearing rendering a decision unnecessary.  The ACT work value case decision is available to the Full Bench in this matter, through the agreement of the parties in that matter, the Transport Workers Union and the Department of Justice and Community Safety (ACT).

[530]	We consider it noteworthy that Mr Edwards’ evidence, whilst referring to the Agreed Statement of Facts, listed a further 16 drugs that are used in both Tasmania and the ACT by paramedics and a further three drugs that are in use in Tasmania, but not in the ACT.

[531]	We refer to the proceedings before Abey P in T13854 of 2011, which produced a consent order relating to Flight Paramedics. We are unable to accept the characterisations of the respondent, that those proceedings were a ‘de facto’ work value exercise. The consent order represented the resolution of a dispute, the substance of which involved a consideration of whether an allowance, which had hitherto be paid on a ‘per shift’ basis, should form part of salary and hence be paid irrespective of whether the paramedic was engaged on helicopter, fixed wing or on road duties. The outcome of the dispute addressed this issue and also established permanent and relief squads for both helicopter and fixed wing operations. The consent order did not involve any element which might be styled as a work value consideration.

Change as a regular and systematic feature of a classification

[532]	The significant net addition we have found can be transposed to each classification above that of Paramedic or ICP, where the operational work of such classification requires a Paramedic or ICP qualification and where that operational work is a regular and systematic feature of that classification.  Without repeating the submissions, we include in this category, Flight Paramedics – both Fixed Wing and Helicopter, BSOs, BSOs ICP, CSOs and Paramedic Educators.

The value of the significant net alteration

[533]	We now turn to the assessment of the value in money terms of the significant net alteration to work value we have found has occurred.  The Work Value Principle deals with this function at sub-principle 9.5.

[534]	It was AT’s position that, although change had occurred affecting Paramedics only, no significant net addition had occurred in any of the roles covered by the application and accordingly, no increase was warranted.  To the extent that the Bench were to find an increase in work value, AT submitted that it had already compensated its employees through bargaining.

Discounting

[535]	As is clear from the outlines of argument given above we have been pressed by AT to give full effect to clause 13 of the 2010 Agreement.  That provision is in the following terms:

“Any future work value claim increases will be taken into account and be offset by the wage increases and structural adjustments contained in this Agreement.”

[536]	The approach contended for by the respondent was that an increase deriving from a work value claim, in the event one be awarded, should be decremented to the extent of the increases granted in the 2010 Agreement.  This would mean that an increase awarded on work value grounds up to 10.5% would, through the offsetting mechanism, be to no effect.

[537]	On 24 February 2014 Wells DP issued a decision approving the Tasmanian Ambulance Service Agreement 2013 in matter T14187 of 2014.  The Date and Period of Operation clause of the 2013 Agreement provides for the agreement to take effect on and from the date of registration until 30 November 2014.  In the same way, its predecessor, clause 5 of the 2010 Agreement, in its equivalent Date and Period of Operation clause, provides for it to remain “in force until 30 November 2012 or until replaced by a further agreement.”  Whilst it is strongly arguable that the 2013 Agreement had, on 24 February 2014, replaced the provisions of the 2010 Agreement, with the former’s quite different offsetting clause, we note the applicant had reduced the quantum of its work value claim in line with clause 13 of the 2010 Agreement.

Sub-principle 9.5

[538]	Whilst attention is more frequently given to the capacity for an arbitrator to have regard for certain external influences, it will be seen that much of the focus of sub-principle 9.5 is directed at “…the previous work requirements, the wage previously fixed for the work and the nature and extent of the change in work”, together with what might be termed the secondary internal relevancies, namely, “the relativities and the integrity of the internal award classification structures.”  The good sense of such an approach is readily apparent in cases such as this where, given the highly specialised nature of the vocation, there is a limited number of external comparators.

[539]	In giving effect to this exercise of judgement, we have had regard for the increasingly demanding and responsible nature of the work and the far reaching extent of the change.  In gauging the degree by which these influences have impacted the work of AT’s paramedics, we have considered the extent of such change and the degree of its impact, to be of a high order.  Such quantification is based fundamentally, as sub-principle 9.5 mandates, on the previous work requirements in comparison with those of what is now the ‘modern era’, some 22 years later.

[540]	We have dealt with each of the considerations specified in sub-principle 9.5.  Accordingly, we have, as an integral part of our task, also had close regard for the wage “previously fixed for the work”.  Given the datum point of 1991, we have had regard for the classification structure and its component pay scale having application some 22 years ago.  Naturally, we are also mindful of the rates currently applying by the agreement of the parties, which also by their request, are to now constitute the single award/agreement rates of pay.

[541]	We accept the respondent’s submission that comparisons of wage rates are of little relevance to establishing the fact of work value and that the relevant comparison to be had was of work and responsibility of paramedics in 1991 and the present time (see sub-principle 9.1).  This is the process we have undertaken.

Internal and External influences

[542]	Before moving to the permissible external influences, we will comment briefly on the remaining ‘domestic’ factor requiring to be taken into account, namely, “…the relativities and the integrity of the internal award classification structures.”  In having regard for the current relativities we note that no party sought for the agreed relativities to be altered and it is our intention, by the method of increase we propose to award, to not do so.

[543]	There is reason to question the integrity of the ‘internal’ Award classification structure, as in light of the evidence before us, we are of the view the Award does not sufficiently reflect the work as currently performed.  This will be remedied by the effect of the parties’ determination to consolidate the current agreement and the Award.  Apart from its importance for work value purposes, ensuring the Award classifications reflect the work that is actually performed also has a vital implication for the proper application of the ‘no disadvantage test’.  Clearly, the existing Award classification structure is, at the least, outmoded.

[544]	The applicant’s submission emphasised comparisons with paramedic practice in other jurisdictions.  We are mindful however of the countervailing differences between the work of paramedics in Tasmania, SA and the ACT, as it relates to STEMI bypass and Rapid Sequence Induction, and the difference in tertiary qualification requirements in NSW.

[545]	Dr Ruigrok, in her unchallenged evidence, equated the skills of an ICP to be at the same level as that of a Nurse Practitioner in the Tasmanian State Service.  Her evidence continued that the work of a Paramedic is at least as complex and responsible as that of nurses and other health professionals.  It should also be recognised that paramedics work in an uncontrolled environment adding further complexity and responsibility to their role.

[546]	Mr White’s evidence provided that an appropriate comparator would be Victorian paramedics as AT used the Victorian guidelines as a template for the 2012 CPGs.

[547]	Having found that there has been change in the terms of sub-principle 9.1, we also, consistent with sub-principle 9.5, have taken account of the external classifications to which the Award structure is related.  These include nurses and health professionals in Tasmania, the SA ambulance service, the ACT ambulance service, the Victorian ambulance service and the arbitrated rates contained in the Operational Ambulance Officers (State) Award for NSW.  As will become clear, in applying 9.5, we have had primary regard for the internal elements of the sub-principle.

Professional Rates

[548]	In giving our reasons as to this aspect of the application, it is unnecessary to repeat much of the material and argument relied on by the parties.  Some care has been taken to outline the substantial scope of that supporting material, together with the competing arguments advanced by the parties.

[549]	The applicant’s case was that paramedics should be recognised and remunerated at a level which reflects the professional nature of their work, the new standards of education and the elevated academic standing of the profession.  This involved evidence of a professional association, continuing professional development of paramedics and an appreciation of the academic literature which reflects the research said to be an important influence on their work.  An awareness of some of these points reveals the overlapping nature of at least a part of the material as also supportive of work value.

[550]	We have accepted the submission put by the respondent that “the concept of professional rates has no free standing industrial merit here” and further, that the notion had industrial traction only when embedded in valid work value considerations.

[551]	We are unable to agree that an increase in pay can result from the factors relied upon under the heading ‘Professional Rates’.  It should not be forgotten that aspects of the professionalism claim also went to support the work value application, with the requirement for a specialist tertiary degree, particularly relevant.  We reach this conclusion without in any way denying that paramedics, covered by the Award and the 2013 Agreement, conduct themselves professionally and justifiably occupy a high place in the public estimation.

Consolidation of Award

[552]	We note the respondent’s alternative submission that should work value change be found to have occurred, its quantification should apply to the award rates as last varied by the parties in 2008.  Taking the example of the classification of an ALS with Patient Extrication skills at their 6th year of service and thereafter, the respondent’s submission would require, for any increase to have an actual effect, findings of work value change in the order of 67.6% to affect a wage increase of $1.00 per annum.

[553]	We are not inclined to adopt such an approach, particularly in light of the parties’ determination to unify the Award and the Agreement rates.  Ms Grimes’ evidence made this clear in the following exchange:

“But the parties are agreed, for example, about the – the changes to the classifications in this EBA should be replicated in the award?……Yes.”

[554]	We are of the view that the parties could not have consolidated the new classification structure into the Award in any meaningful way without it reflecting the pay rates that have been agreed as appropriate to the work as it is currently performed.  The parties have ensured, by their agreed Award Consolidation Process, that the Award will reflect the current rates and contemporary classification structure.  It would seem strange to now value change in the currency of 1991.

[555]	It also seems to us that unfairness would result in applying the approach contended for by the respondent.  In practical terms this means that there would be no advantage to employees found to have undergone substantial work value change.  It is unlikely that this could be a result consistent with Mr Morgan’s public acknowledgement to AT employees that paramedics could take their work value/professional rates case for determination.  Even acknowledging ATs capacity to contest the case on its merits, we understood ATs position at the time to mean that in the event the Work Value Principle was found to have been satisfied (in the face of AT opposition), the result could have practical application.

[556]	In any event, the approach to be preferred in giving effect to the agreement of the parties to consolidate the Agreement and the Award, is to first vary the Award to reflect the classification and remuneration structure of the 2013 Agreement.  Having achieved this part of the parties’ Award Consolidation Process, unified rates of pay, the Work Value Principle 9.5 requires “an assessment as to how the alteration should be assessed in money terms”.  We have then applied, to the relevant classifications, (found to have been effected by work value), the worth in money terms of the ‘alteration’ we have found.

Bargaining and Work Value

[557]	We are conscious of the fact that over the period from the early 1990’s, the parties have been fully engaged in enterprise bargaining.

[558]	We have examined the assertion, put by HACSU, that all wage movements were not identified as work value based, with some reflecting community movement and that those which exceeded the standard increases were motivated by ‘catch-up’ payments to overcome recruitment and retention issues for AT.  Ms Grimes, Mr O’Brien and Mr Rechberger all contend the 2004 Agreement outcomes reflected work value, however both Ms Grimes and Mr Rechberger conceded there had been recruitment issues for AT, particularly in the early 2000s.  More than one factor may have been at large.

Industrial Agreements reflecting Work Value Compensation

[559]	We note that in early 2004 industrial agreements were struck between the Minister and paramedics, nurses and police.  All three agreements delivered significant pay increases with the quantum for paramedics and police being of a similar order.

[560]	The reasons given for these increases in the media statement of then Acting Premier Lennon cited a number of reasons including, but not limited to, the importance the Government placed on these professions, skills, training, realities of market forces, recruitment and competitiveness.

[561]	In that same year, the Minister required the registration of an industrial agreement covering radiation therapists, known as the (Public Sector) Wages Agreement 2004, under the work value principles (see T11614 of 2004).  Clearly, the Minister was alive to the issue of work value at that time, with the decision of Leary P, in approving the agreement, indicating comprehensive witness statements were provided with workplace inspections having taken place.  Further, both the 2004 and 2007 industrial agreements struck between the United Firefighters Union and the respondent included work value clauses which provided examples of what might be termed orthodox work value acknowledgement provisions:

“Work Value:

The parties agree that the salaries and conditions provided for in the Agreement and previous award and agreements reflect that employees have been fully compensated for all work that is currently being undertaken within their classifications and Statements of Duties…”

[562]	We note the different approach adopted by the respondent in bargaining with paramedics.

[563]	Whilst it is difficult to ascertain any work value factors influencing the bargained for increases since the 1990s, either through written statements or, like the radiation therapists, registration under the Work Value Principle, it is likely that at least some of the increases agreed by AT would have involved recognition of additional work/skills.  We consider it appropriate to apply a discount to the quantum of the significant net addition we have found, whilst considering relevant external classifications, to which reference has previously been made.

Discounting for Bargaining

[564]	It is necessary to make an assessment on the basis of the information before us. While in some circumstances it may prove possible to turn back the clock to establish a pristine rate for the purpose of work value, absolute precision is likely to be mired in partisan controversy. As commented earlier we are particularly alert to the danger of double-dipping, the potential for including in our considerations change already acknowledged and compensated.

[565]	In this respect we are mindful that the respondent, while agreeing to the fact of changes to its operations, does not accept that the work has been affected to the degree and in the way claimed. Rather, that change acknowledged by AT is generally given as the unexceptional evolutionary change which is part and parcel of modern work practice.  Seen in this light, it is contended that we can be confident that over the datum period recognition and valuation of changes to the work as characterised by the applicant, that is, as of fundamental import, did not occur.

[566]	The assessment required is similar to that facing the NSW Commission Full Bench in the Public Hospitals Nurses case - although in that case the discounting consideration was in the face of previous work value recognition within the datum period. (See paragraph 241(3) of that decision).

[567]	As in that case, we have determined to apply a significant discounting factor in our assessment of the value of the change determined to have occurred.  The discount, or offset, arises in substantial part through the operation of clause 13 of the 2010 Agreement.  By the careful design of the parties in drafting the 2013 Agreement, the work value offsetting provision in its clause 13 does not have application to this case.

[568]	We are mindful that the 2010 Agreement provided significant increases to a small number of employees of AT which included the Paramedic Educators and Managers.  It was the respondent’s own evidence that these increases related largely to attraction issues, as they were unable to recruit paramedics from operational roles, due to the remuneration levels of the management roles.  We accept the position of the respondent that these increases were in recognition of attraction and retention difficulties.  To the extent that any of these classifications are required to routinely undertake operational duties as a paramedic, it is necessary for our findings to have application.

[569]	We note the paramedic classifications, from 2007 to 2013, received an increase in the order of 18.7%, an average of just over 3% per annum.  Annual increases of this dimension do not indicate increases substantially in excess of CPI and we were presented with no material reflective of a work value exercise having been conducted at any time since the datum point.

Conclusion

[570]	This matter is pursued by the applicant by way of a variation to the Tasmanian Ambulance Award, pursuant to s23 of the Act.  Section 36 of the Act requires that the Commission must be satisfied that the making of an award is “consistent with the public interest”.  Sub-section (2) of that section reads:

(2)	In deciding whether a proposed award or a proposed industrial agreement would be consistent with the public interest, the Commission shall –

(a)	consider the economic position of any industry likely to be affected by the proposed award or proposed agreement;

(b)	consider the economy of Tasmania and the likely effect of the proposed award or proposed agreement on the economy of Tasmania with particular reference to the level of employment; and

(c)	take into account any other matter considered by the Commission to be relevant to the public interest.

[571]	We note that due to the specialist nature of the role of paramedics, there can be no linkage or flow-on to external classifications.  Certainly, we were not addressed on the existence of such a classification.

Public Interest

[572]	We have considered the economy of Tasmania in the fashion required by s36(2)(a) and (b).

[573]	The evidence of Mr Ferrell provided an overview of the State Government Wages Policy which was established in 2011 and is still in effect.  Whilst it provided that the Budget forward estimates to 2016/17 had been formed on this wages policy, there was no evidence to suggest that the economic position of the State displayed incapacity to pay for work value wage increases.  We did not receive any submissions on incapacity to pay.  Therefore, we are of the view that such a policy cannot displace the Commission’s obligations under a range of statutory factors to which it must have regard.

[574]	As to s36(2)(c), we have had regard for the need for employees in the public sector of Tasmania to have awards reflective of the work as it is performed.  We have already noted the importance of safety net awards being maintained to reflect the contemporary work in order to encourage enterprise bargaining and ensure the no disadvantage test operates as it is intended.

[575]	It is in the broader interests of the Tasmanian community for work value applications to be appropriately addressed and we have concluded that our decision is consistent with the public interest.

Professional Rates

[576]	The professional rates case, in our view, raises no issue of substance that is not already grounded in work value.  Accordingly, it cannot succeed.

Rates of Pay

[577]	Having regard for all these considerations, it is our view that the base rate of pay for a Paramedic Intern should be $56,800, a Paramedic Year 1 should be $62,998 and an ICP Year 1 should be $75,597.  The current incremental structure and the existing value of the increments will be maintained in our order and such variation will be operative from the first full pay period on or after this decision.

The Relativities

[578]	We have also determined that the relativities between the pay points within those classifications and the classifications above ICP, as they appear in the 2013 Agreement, that are also effected by the work value change, by virtue of that changed work being a regular and systemic part of their role, will not be disturbed.

The New ECP Classification

[579]	Whilst it is unclear whether the role of ECP will continue post 30 June 2014, we have determined a new classification of Extended Care Paramedic be established in the Award with a single remuneration point of $87,463, having regard for the ECP’s additional training, skills and responsibility.  This Award classification would be applicable to any ICP at AT undertaking ECP duties.  This inclusion will not affect the right of the respondent from disbanding these roles in the 2014/15 year, should it see fit to do so.

In Conclusion

[580]	Finally, we note the onerous evidentiary obligations attaching to any work value aspirant and caution against any application lacking the substantial material recognised by the Full Bench, and ultimately in part by the Minister, in this case.

[581]	An order giving effect to this decision is issued separately.

T J Abey
PRESIDENT

Appearances:
Mr M Irving, Counsel for the applicant
Mr T Jacobson for the applicant
Mr L Digney for the applicant
Mr R Dalton, Counsel for the respondent
Ms W Fauvel, Solicitor for the respondent
Mr R Doyle, Solicitor for the respondent

Date and place of hearing:
2013
September 2, 3, 4 (before Wells DP only)
October 14, 15, 16
November 4, 5
Hobart