KUALA LUMPUR, March 7 – Ipoh Timor MP Howard Lee Chuan How told doctors to give the government time to solve “legacy” issues, despite rising anger in the health service across professions.
In an interview last Tuesday in Parliament, CodeBlue asked the government backbencher from the DAP whether he supported strike action in the public health service, how long he would urge health care workers to wait for even just one solution before organising a walkout, whether he supported doctors’ demand to raise their weekend on-call claims to RM25 per hour, and whether he acknowledged that the public health service is in crisis.
Last February 22, following increasing talk of a potential strike by doctors in the public sector, Health Minister Dr Zaliha Mustafa organised a town hall with government doctors, during which she did not propose substantive measures with timelines for many of the problems raised by participants. Neither did she commit to adopting most of the specific solutions proposed by doctors, according to a recording of the closed-door meeting that CodeBlue obtained.
Lee, as well as Bandar Kuching MP Dr Kelvin Yii, also attended the doctors’ town hall with Dr Zaliha and Deputy Health Minister Lukanisman Awang Sauni.
A medical specialist, who attended the town hall, later wrote to CodeBlue to express “bitter disappointment” with the outcome of the meeting, questioning if the town hall was to reduce political pressure on the minister or to help doctors.
Last January, CodeBlue’s survey among more than 1,600 health care workers in the public health service revealed that 95 per cent believe the public health care system is currently in crisis. Seven in 10 said they were currently thinking of quitting their jobs, while half were willing to go on strike. Most respondents (86 per cent) were doctors across seniority, from house officers to subspecialists; the rest were pharmacists, dentists, nurses, and allied health care workers.
This is a transcript of CodeBlue’s interview with Lee, a first-term MP who previously served as the Perak state executive councillor in charge of youth, sports and human capital development, as well as Pasir Pinji state assemblyman.
Strike Action
Do you support a strike among doctors and health care workers in the public service for better wages and better working conditions?
I’ve spoken about this extensively and I don’t think I need to elaborate on this. I’ve spoken about this.
So do you support a strike that’s organised according to the Industrial Relations Act?
I have spoken about this. The right to strike is everyone’s right but how, under what conditions, what for, the strategic objective, how it’s organised, how it’s not organised, and this is coming from someone who’s no stranger to strikes.
I think critical sectors like health care, like care, like health care professionals, I think there are different considerations.
Under no circumstances would I ever even consider supporting an unannounced strike.
Yeah, we’re not talking about that, Howard.
But I’m talking about that. You’re asking me questions, right? So I talk about what I wanna talk about and perhaps, in response to your questions.
The Industrial Relations Act guarantees the right to strike.
Well, then your question is a non-question because it’s law, so therefore everyone has the right to, in accordance to the Industrial Relations Act. So why are you asking me, am I in support of the law? Of course I’m in support of the law.
Whether you will support a strike that’s organised according to the law?
Well, I don’t have the right not to support it; it’s the law.
You can choose whether you want to support the strike. If you don’t wanna support doctors who wanna go on strike, that’s entirely up to you.
I have said, on many occasions, asked or un-advocated, that I wouldn’t support an unannounced strike, but everyone, including doctors, including every Malaysian under the sun, have the right to strike. And who am I, a Malaysian citizen, to say I don’t support it.
So, if it’s announced in advance?
I’ve given you my response.
Waiting for Solutions
How long would you urge health care workers to wait for even just one solution before launching a strike?
What was the question?
Um, so…
I don’t entertain emotive questions, because that’s an emotive question.
No, no, no. It’s – how long do you expect them…?
No, it is. I’m the recipient of the question. I feel it’s an emotive question, so I’m not going to answer that.
You don’t want to answer that?
What do you mean, how long do I want them to wait?
For solutions.
Well, there are solutions; it’s the implementation of the solutions, right?
That’s what I mean.
Exactly, you didn’t ask that.
Okay, so how long do you want them to wait for the implementation of the solutions?
I would like them to wait for the government to look into all the necessary measures to ensure all stakeholders are taken into account, into policy, before they strike.
So how long is that?
Do I look like a minister? Do I look like I’m in the executive? Do I look like I have the power to dictate?
Should they wait for the entire term? You were there at the town hall. So one of the solutions that the doctors brought up was that, that don’t require funding, is publishing the selection criteria for permanent and JUSA positions. It doesn’t require funding, so is it something that you would push to be done within the government’s first 100 days?
What makes you think I didn’t push for it?
Well, I’m asking you to say it on the record.
There are different ways of pushing for things, right? For example, it’s not just about the publication of the guidelines and I’m sure if and when the minister decides, and the necessary procedures are done and the necessary legal considerations are made and covered, then perhaps it’ll be done.
But number one, if you’re asking me how long should the health care workers wait. Number one, it’s clearly an emotive question.
Number two you’re not seeking – from the words that you use and the structure of sentence that you employed – you’re not seeking an outcome. You’re seeking a political talking point. And I’m not going to entertain that.
No, I do want to hear about outcomes, Howard.
The outcome is, I think the Ministry needs to be given the room to do everything that’s necessary and legal to make sure it’s done.
And quite frankly, you mentioned I was at the town hall. And the doctors that I did speak to, during and after, there and outside, have said that, actually, it made sense. What was spoken and what the minister did commit to, and of course it’s Chatham House rules, plus I don’t think I’m in a position to talk about what was discussed there.
I think what I can tell you is the doctors I’ve spoken to – some who are key players within that room – whatever that was said, was, well, made sense, satisfactory, though not perfect, and it’s a step forward.
So what solution would you like to see in the first 100 days, or in the next one month?
I think you should be speaking to doctors about that.
They have already put forth their solutions, on the record.
Use what they’ve said. They are the stakeholders. I’m a lawmaker, and I’ve already made my position very clear. I’ve contributed what I can, and I’ll continue to contribute my ideas, my views, my expertise, the intelligence that I get from the field. And I think it’s time for the Ministry to be given room and space to do what is required.
Even if takes – however long it takes?
Again, I don’t entertain emotive questions, because that is one.
Raising Doctors’ On-Call Claims
Do you support doctors’ ask to raise their on-call rates to RM25 an hour? (On-call claims are allowances that are not dependent on one’s salary grade, but only differ between medical officers and specialist doctors — for an active call on weekends or public holidays, specialists only get paid RM30 more than medical officers, i.e. RM250 vs RM220. RM220 is equivalent to RM9 per hour for a 24-hour on-call).
The doctors have every right to ask for whatever they feel is necessary, and they did, and the minister heard.
Do you support?
But the question is, you’re making something that is actually a lot more complex, which is understood by the doctors, in a way that makes you sound like you don’t understand the issue.
Because it’s not just about their wage; it’s about their prospect of development, their prospect of climbing the ladder and the scale of grading, which then translates to wage.
And it’s also potential and opportunity for training if and when they get to the next grade.
So I think, number one, it shouldn’t be so simplified and over-simplified as them asking for higher wages because actually, no, most of them are not just asking for a higher wage; they’re just asking for a more decent process in them getting to the next stage.
Number two, for them to claim what is already theirs, but denied because of certain bullying incidents that happened.
And I’m not the person to talk about that; it should be the doctors. We should respect the rights of the doctors to talk about what they want to talk about and what they don’t want to talk about.
They have, with CodeBlue.
So therefore you know, which is why you know exactly what the story is.
After the town hall, they issued a press statement; MMA (Malaysian Medical Association) issued a press statement, saying that they want to follow up with the minister for solutions. They want solutions, Howard.
I welcome what they’ve said, and I agree with them.
Frustration Among Doctors
Do you acknowledge that there is frustration among doctors for not hearing or getting anything all this while?
Of course. I was in the room. I’ve been talking to them. I’ve been talking to doctors for at least the last six months on a one-to-one basis and a group basis. I’ve seen tears rolling off their faces. I’ve been there to help them solve their problems.
So don’t assume that I don’t know; I do know, I do know, I do know.
The fact is, I’m acknowledging their anger, I’m acknowledging their frustration, and I know the problem is much larger. It is a legacy issue that needs and requires time, and not just rhetoric by some politician in front of a camera telling you, ‘I have the solution; I’m giving you the solution’, because it’s not as simple as that.
Because lives are at stake, futures are at stake, our entire health system is at stake.
I think the doctors want to see – nobody is expecting instant solutions, but they do want timelines. But I’m not asking you for timelines because you’re not the minister.
Exactly.
Whether you would put pressure as the lawmaker, or whether you would put pressure to produce timelines for solutions?
Oh I’m putting pressure, I can assure you that.
Like I said, some solutions don’t require funding; some do.
For me, the most important timeline is the source, the mother document that would inform the decisions and policies moving forward.
The Health White Paper.
The Health White Paper has been committed to be published by and if not before June, by the minister herself. That’s number one.
Number two, I have openly, in the state assembly, pushed to bring forward certain segments of the Health White Paper. I haven’t seen a commitment or heard a commitment to what I’m requesting. For me, that is at least one bit of evidence in the open House, the august open House, of me asking for an expedition of the workforce part of the White Paper.
Now, it’s not in my power to press unnecessarily for something to be expedited because I do understand there are still other stakeholders that need to have their contributions to be put into the White Paper. That’s number one.
Number two, you’re also potentially looking at, you know, Public Service Department’s contribution and looking into the new budgetary implications that have literally just been announced on Friday.
So for me, I’m not gonna say, I’m not gonna ask for patience; I’m just gonna say that there needs to be time. I’m just as impatient as any other individual in the room and outside the room because there’s my constituents.
And I can tell you that my cousin last weekend had a hypo spell and she had to wait at least six hours before she was even seen. And by the time she was seen, she was already ready to leave the ED (emergency department).
I feel it. When you’re talking about HRPB (Raja Permaisuri Bainun Hospital), when you’re talking about the rights of the doctors there, we all have had experiences. We know that, but I’m also here as a policymaker, as a bridge between those who make policy and those who will benefit or are lacking in benefit of the system.
So I’m seeing the challenges and the difficulties, but I’m also feeling the pain.
I’m here, as someone who literally just last weekend felt deep, you know, in my heart, on my arm, the pains of how the system is failing, but I’m also seeing the efforts behind the scenes of what is being tried and what is being worked on.
The Health White Paper contains proposals.
How do you know what the White Paper contains?
Well, the minister has talked about it.
Exactly, you know what could be in it.
I’m not talking about specific solutions here. I’m just saying that in general, in principle, the Health White Paper will contain many proposals, but these proposals still need political will behind them. And some of the proposals may have already been proposed before, but have never been done because the government just doesn’t wanna do it.
Yeah, the previous government.
What this current government has already done, which is an unprecedented large allocation to the Ministry of Health, an increase of four plus billion [ringgit] to the entire ministry’s allocation. We’re talking about inter-ministerial cooperation to make health care and the care system more robust.
You’re talking about an unprecedented will and openness by the minister to engage different stakeholders, and you’re talking about an unprecedented White Paper.
We have had more than a dozen White Papers and policy documents over the past two decades.
What I’m telling you right now is there has been an unprecedented amount of openness and admission that there is a problem that I’ve never seen before.
Could you elaborate on that? Who is admitting there is a problem?
I think if you look at what’s been said by the health minister.
I have.
Well, if you can’t see it, that’s my apologies. I’ve seen it. The doctors seem to think they’ve seen it. Go and interview the doctors, go and interview those who were in the town hall.
You’re telling CodeBlue to interview doctors?
Huh?
Never mind.
Public Health Service in Crisis?
Do you accept that the public health service is in crisis?
I didn’t say it’s not in crisis.
So do you acknowledge that it’s in crisis?
Again, I don’t entertain emotive questions.
Oh it’s not emotive at all. That is from the doctors themselves.
It depends on what you mean by crisis. I think we’re in a situation where we absolutely need a complete rethink of the entire structure. And if I was to say there’s no crisis, I’d be stupid.
But what kind of crisis? Yes we’re in an NCD (non-communicable disease) crisis, yes we’re in an ED overspilling crisis, yes we’re in a health care workforce crisis. But if I was to say that we have an overarching infrastructure crisis, no, I won’t say that because there are really good hospitals out there with state-of-the-art equipment, but they’re not manned.
Which part of the crisis are you looking at?
So I’m not going to entertain the extraction of an emotive blanket sweeping statement that we have a health care crisis, because it’s not as simple as that.
The service is in crisis, at least that’s what the doctors say; that’s what 95% of doctors said in CodeBlue’s survey.
If you’re talking about a health care workforce crisis, yes, but that wasn’t your question.
