Back to Basics
Industrial Relations in the Hospital and Medical Services Industry (I)
Some four years ago, in a discussion with a member
of the Victorian State Industrial Relations Commission,
I was advised that it was inevitable that the health
industry would be in for a traumatic time until it
properly understood and accepted what he called the
reality of industrial relations. The extent of the
trauma to be gone through was compared to that which
had occurred in the metals industries.
The opinion which was expressed to me was a prophetic
one. The health industry, more particularly the hospital
industry, is suffering from excessive industrial stress.
The reality for the private health sector is that it
has to tag along with the agenda set in the public
Regrettably, I believe the term 'might is right' is
an apt interpretation of the term 'industrial reality'
as it is practised in the health industry in Victoria.
I shall endeavour to illustrate this point, more particularly
as it applies to the private health industry in Victoria.
I shall refer to certain key events which have occurred
during the past few years, to illustrate the influences
at work, the developments which are occurring, and
the direction in which I believe they are heading.
My comments are the views of someone who is deeply
involved in day-to-day operations. They are not an
esoteric exercise. I am a player.
4 Per Cent Second Tier---The Public Health Sector
Industrial relations negotiations are essentially a
highly centralised procedure in the public health sector
in Victoria. This is so despite recent attempts to
introduce industrial officers into public hospitals.
The excesses of the centralised procedures have meant
that the executive managements of the public hospitals
have played little part in the outcome of the industrial
negotiations. They 'cop' what is arranged for them
between the Department and the unions.
My perception is that an irreconcilable chasm of mistrust
exists between the executive management of public hospitals
and the central bureaucracy.
The experience of the 4 per cent Second Tier issue
illustrates this point.
Following the handing down of the decision of the
Australian Conciliation and Arbitration Commission
and State Industrial Relations Commission in March/April
1987 in regard to the 4 per cent Second Tier issue,
the public sector began assessing how to find a basis
for reaching agreement with the unions in order to
satisfy the requirements of the decision.
Invitations from the central bureaucracy of the Health
Department brought no response from the executive management
of the public hospitals on the issue of offsets. There
are 165 of them.
In order to find a basis for a solution, the central
bureaucracy chose a sample of 17 public hospitals.
The lack of co-operation was such that this was eventually
reduced to 8. These were used to carry out sampling
of pilot proposals.
The State Government through its Treasurer, Mr Jolly,
and Minister of Labour and Industry, Mr Crabb, announced
that the 4 per cent increases had to be 'cost neutral'.
After some four months of constant consultation, a
deal was struck on what I would describe as an 'ethereal
basis' and was manoeuvred through the State Industrial
Relations Commission. A 4 per cent increase was granted
to all employees in the public health sector, from
20 October 1987, at a cost of approximately $56m. The
decision was one of the first in productivity bargaining
on wages. An experienced advocate with whom I discussed
the decision suggested to me that the outcome must
be understood in the light of the Commission's moderate
expectations. Whilst representing CAI in the National
Wage Case, Mr Colin Polites expressed another view
when he referred to the 4 per cent agreement in these
'Examples of an agreement by an industrial tribunal
that causes even more concern, and that really amounts
to an agreement which may be agreed in the future,
is that in the Victorian public sector health industry
That agreement related to 9 health industry Awards
and was ratified by the Industrial Relations Commission
in Victoria in full session on the 20th of October
1987. Components of the agreement appeared to us to
be firstly increased throughout resulting from
changes in admissions and discharge procedures. Secondly
an application of what is known as the Royal Womens
Hospital model which is an establishment review
procedure agreed by the management of the Royal
Womens Hospital and the Hospital Employees Federation
No 1. Branch, and thirdly a proposal to review a
more effective approach to the management of sickness
and accidents injury absence in public hospitals.
The full bench decision states that the government
estimates that the cost of the increases will be at
least fully offset by productivity increases cost savings
which will be achieved progressively between now and
the financial year 1988/1989.
The Victorian Health Department has been prepared
to agree to a 4% increase based on illusory offsets
which may or may not materialise. It is for this reason
that the national wage bench itself in March inserted
the second condition, and also, we respectfully put,
inserted in the second tier principle (d) which provides
for no retrospectivity.
Surely to award 4% prior to any restructuring and
efficiency agreement being achieved and on the basis
of an agreement to agree, is in fact retrospectivity.
One other major concern in relation to this decision
is the consequences for the private health sector industry
I shall comment on this last point later.
In its October 1987 Report, the Victorian Hospitals
Association, which represents the public hospitals,
stated its views as follows:
'The negotiated trade-offs for the 4% Second Tier
wage increase are likely to be met with sarcasm and
derision by hospitals and community health centres
given the bitter experiences with the 38-hour week
and non-nursing duties negotiations and their outcome.
The real losers in the experiment may well be the
employers. Just how well the unions and employees will
adhere to the trade-off agreements once they receive
the salary increases remain a matter for conjecture.
The understandable fear of hospitals and community
health centres is that they will again end up the losers
with the employees receiving the 4% pay increase and
the Government requiring that the major proportion
of the 4% be found from savings resulting from changes
in work practice and revenue initiatives even if proven
Of some comfort is the fact acknowledged by Government
that hospitals are not currently in a position to withstand
further effective cuts in funding and that this would
only result in reduced services.
Of particular significance to those with direct responsibility
for hospital financial management is the recognition
by the Minister and Health Department that even
if the trade-offs are to be obtained, they will
take some time to achieve. The willingness to provide
interim funding indicates welcome increased willingness
to try to understand the problems that hospitals face.'
These comments reflect the attitudes of public hospitals
My understanding is that the 4 per cent increase
in the public sector costs approximately $56m in its
first year. The question for the State Government was
how to fund this cash flow. Whilst its policy was that
all 4 per cent payments had to come out of productivity
improvements, the 'industrial reality' would hardly
allow that to happen. The deal was that the Government
would fund the first few months, but thereafter public
hospitals would have to find the additional money.
The extra cash flow is to be obtained by increasing
the charge for the privately insured patients in the
public hospitals, thus extracting more cash from the
private health insurance funds. This mechanism is now
in operation and is expected to raise an additional
$19m in the first year.
You will recall from the Colin Polites quotation that
one of the components of the 4 per cent agreement was
increased throughput resulting from changes in admission
and discharge policies.
This reflects the control over throughput which the
health unions have in public hospitals. They are seeking
to extend this power into and over private hospitals.
Worker participation is one thing but union control
is quite another.
I emphasise in passing that there are 25,000 people
on the public hospital waiting-list. They are the indigent,
the pensioners and the non-levy-paying members of our
community. The waiting-list is a sensitive political
Having got the 4 per cent public health sector decision,
the unions then concentrated on the private health
In Victoria, the majority of private hospitals have
little union membership amongst their employees. However,
some of the larger private hospitals might have in
excess of 30 per cent of employees belonging to a union.
In certain key areas of some of these hospitals, such
as the kitchen and operating theatres, some very militant
union members are to be found. It is in these hospitals
that frequent threats of industrial action are made
and implemented. This is an industrial reality. Executive
management of private hospitals are in an invidious
situation because many are on the knife-edge of viability.
The pressure is on them to concede to excessive union
demands, which become intolerable for some. Their position
is made more difficult when they are responsible to
Boards, members of whom see their philosophical and
humanitarian responsibilities for caring for the sick
as being of higher priority than conceding to excessive
Inevitably the public health sector agreement has
flowed through to the private health sector, albeit
with some modifications.
I stated to the Joint Hearing of the Boards which
ratified the 4 per cent private health sector agreement
which became operative from 1 December 1987 that productivity
offsets to cover the 4 per cent increase could be achieved
by 1988-89 if the attitudes of the unions expressed
at the hearing were applied in practice. The smirk
on the faces of the union representatives was barely
Award Superannuation (3 Per Cent)
The Association I represent decided to create a superannuation
fund, the Private Hospital Employees Superannuation
Fund, and to make it available to its members. It has
since become a national Fund and has been adopted by
the Private Hospitals Associations in other States
and the Australian Private Hospitals Association. A
key feature is that employee members of the Fund elect
their representatives. They are not union appointed.
In Victoria, private hospitals commenced offering
this scheme to their employees last September/October
on the basis that they would pay 11Ú2 per cent with effect
from November 1987 and a further l1Ú2 per cent in November
1988. At about the same time, the Victorian Trades
Hall Council, on behalf of health unions in Victoria,
made a claim to the State Industrial Relations Commission
for an immediate payment of 3 per cent into two approved
Funds: the Hospital Employees Superannuation Trust
(a Fund organised by the ACTU and a number of health
unions, including the Federal RANF) and the RANF (Vic.
Branch) Scheme, which is named Future Care.
Conferences were held directly between the parties
and under the chairmanship of the Commissioner appointed
for the task. The unions are adamant that they will
not allow any Fund other than their own. We have argued
that each employee should have the right of choice
between the employer-sponsored Fund and the union Fund.
This is not acceptable to the unions, yet PHAV members
as a whole have less than 2 per cent of employees who
are union members. In the negotiations, the ACTU has
been strongly represented. The matter is heading for
an arbitration by the Commissioner concerned. We delayed
the commencement of the flow of funds into the Private
Hospitals Employees Superannuation Fund when we started
the negotiations before the State Industrial Relations
Commission because we were concerned that the Commission
might make an arbitration duplicating contributions
being made by employers to the Fund. The unions were
making loud noises in this regard.
One might speculate on the motives of the unions concerned
and particularly those of the ACTU as they endeavour
to influence the Commission before an arbitration is
My perception is that the establishment of a national
union-sponsored Superannuation Fund will act as a catalyst
for the creation of a national union of health workers,
which conveniently fits into the ACTU strategy of reducing
the number of unions. This would also be a helpful
prerequisite for launching the proposals outlined in
'Australia Reconstructed' and also be the mechanism
for unionising the entire health sector workforce.
One can therefore understand why the ACTU is paying
so much attention to this case.
One of the more incredible aspects of Award Superannuation
is what the Victorian State Government is doing, and
perhaps even more incredible is the lack of response
from Opposition politicians and employer groups.
In the public health sector, approximately 70,000
employees are to be taken into the Victorian State
Government Hospital Superannuation Fund. The Government
is offering this arrangement to take effect from the
beginning of 1988. Where an employee makes no personal
contribution, the Government will contribute 3 per
cent; where the employee contributes 6 per cent, the
employer will contribute 13 per cent, i.e. 10 per cent
above the 3 per cent.
The State Government is actively promoting and encouraging
every employee to contribute the 6 per cent. My experience
of the Victorian health unions is that they will ensure
that the additional 10 per cent contribution from the
Government is made. A 10 per cent increase in public
health sector labour costs is equivalent to employing
an additional 7,000 employees. Even on the basis of
average weekly earnings as at June 1987, a further
$220m will be added to the wages bill. My concern is
related to the effects such a trend in cost increases
will have on health policy and on flow-on into the
private health sector and into private industry.
One further incredible aspect of this is that the
State Government does not propose to fund the scheme.
At this stage the liability is to be met out of future
taxes. This is a part of the Government's strategy
of postponing liabilities incurred, leaving it for
our children to foot the bill in the future. Is this
not totally counter to the concept of Award Superannuation?
Employees working in the Victorian public sector,
which account for one-fifth of the State workforce,
are to receive an employer contribution 10 per cent
above that decreed by the Australian Conciliation and
Arbitration Commission. The funds to meet this contribution
must come mainly from the private sector, which cannot
afford to pay that same rate to its own employees.
I find it quite astonishing that having alerted a
wide cross-section of the political, business, media
and industrial worlds to this tactic, I have received
no acknowledgements, but, metaphorically speaking,
many blank stares. Yet the flow-on created by this
Victorian Government action must surely have significant
repercussions throughout all industry and for future
What does this lack of response mean? Why are we so
paralysed with inertia? Why are we not explaining the
position to the wider community?
The important role of the nurse in the delivery of
health care, particularly within a hospital, is self-evident.
This importance is reflected in the allocations of
hospital operating costs. Labour costs approximate
70 per cent of total operating costs, with nursing
labour costs accounting for some 60 per cent of labour
In Victoria, the long-running Nurses Career issue
was supposed to have been settled in the so called
Nurses Case No 1, which commenced in early October
1985 and concluded with a decision on 20 June 1986
awarding substantial pay increases except for student
and first-year nurses.
However, on 22 July 1986 a decision in New South Wales
by Mr Senior Conciliation Commission Wells resulted
in NSW nurses getting higher wage levels than their
Victorian counterparts. The result was industrial havoc
in Victoria, leading to the Nurses Case No 2 decision
handed down on 23 January 1987, which supposedly achieved
Nurses working in hospitals in Victoria and doing
the same job are earning between 20 and 40 per cent
above what they were receiving before 20 June 1986---even before the 4 per cent Second Tier is considered.
Later in 1987 in New South Wales, the RANF made an
application to an Anomalies Conference for a finding
as to 'agreeable case' with respect to professional
salary rates for nurses, this being prompted by the
imminent graduation of nurses from CAEs. Their training
contrasts with the pre-existing pattern of nurse training
which was largely hospital based.
The decision of the President of the NSW Commission
decision was handed down on 10 December 1987. The decision
indicated that the approach of Ms Staunton (RANF's
NSW Branch Secretary) was again based upon 'the major
upgrading of basic nurse education in the public hospital
system that has taken place over the last six years'.
The RANF's NSW claim was for parity for college and
hospital-trained nurses with other health professionals
(Occupational Therapists, Speech Pathologists, Medical
Technologists and Scientific Officers).
The President decided that 'the case cannot be run
again to produce a further round of larger increases
in salaries. The Nurses Association cannot have cake
in 1986 and eat it again in 1987'.
More specifically his decision was:
- to decline to refer the general matter of a new
salary scale involving increases in salaries in the
6-25 per cent range, as set out in para. 2 of the Schedule
to the Notice of Motion filed, to an Anomalies Bench,
on the basis that no arguable case could be found of
any limited or exceptional situation which might prove
to be anomalous;
- to refer to an Anomalies Bench the general question
as to salary rate and incremental scale of the CAE
graduate entrant registered nurses on the basis that
an arguable case did exist of a limited or exceptional
situation to the effect that the presently prescribed
rate of an incremental scale of salary might prove
to be anomalous.
The NSW Branch of RANF is appealing this decision.
The Branch made strong threats of industrial action
and in January 1988 the NSW Government issued a media
release which confirmed that it supports the principle
of professional rates of pay for registered nurses
and the same pay for doing the same job whether hospital-trained
or CAE trained.
This averted the threatened industrial action in New
South Wales, which may be thought of as convenient
given that an announcement of a State election is imminent.
In Victoria the RANF, with the support of the ACTU,
has built up a significant expectancy for elevating
the wage rates to what is termed 'professional rates'.
A case to review the RANF claim for professional rates
commenced before the full bench of the Victorian Industrial
Relations Commission in October 1987. It was adjourned
in November pending the outcome of the anomalies hearing
in the NSW Commission.
When the NSW Commission's determination became known,
the Health Department of Victoria in essence submitted
that the claim for professional rates should be rejected,
but conceded that it could be arguable that tertiary
trained nurses may have a case for some higher increment.
It should be noted that the number of tertiary-trained
nurses in hospitals in Victoria is probably less than
3 per cent. On the threat of industrial action
by the RANF (Vic. Branch), the State Industrial Relations
Commission agreed that the Victorian case should continue.
With the political opportunism of the NSW Labor Government
announcement, the Victorian Branch claim is now in
effect for all the hospital-trained and tertiary-trained
nurses to be elevated to wage levels comparable with
hospital scientists. I am advised that this is to be
granted; it will add a further $102m to the public
sector wage bill (i.e. about the equivalent of Nurses
Case No 1 and No 2 combined).
This case is currently adjourned in Victoria and is
to continue at a date to be determined. The situation
has been reached where neither hospitals nor the community
can afford these exorbitant wage increases. It reflects
back on the capacity of health insurance funds to pay
benefit levels which do not result in excessive out-of-pocket
costs for the patient and the capacity of consumers
to pay the contribution rates for health insurance.
The rapid escalation of wage costs has blown this system
totally out of balance over the past two years.
This situation, coupled with the effects of decisions
made by both the Federal and Victorian Governments,
has reached the stage where the future of the private
hospital sector is in jeopardy. All Australians, and
all medical practitioners in particular, should think
carefully about a health industry in which there are
only public hospitals. These same cost increases are
being incurred in public hospitals where cost controls
and work practices are determined by the unions with
the acquiescence of Government.
Anti-doctor paranoia dominates the thinking of unions.
Jim Simmonds of HEP has put his views as follows:
'On top of all this, there is also all this talk about
restraint with equity. From our side, our people see
a group of the most greedy people (doctors)---driving
around in flash cars and enjoying a great lifestyle.
It makes the call for restraint with equity a big
A direct consequence of the over-pricing of registered
nurses' labour is that SENs will seek to elevate their
qualifications and to take over the more traditional
bedside role of the Registered Nurse. SENs in general
are members of the Hospital Employees Federation in
Victoria rather than the RANF. A major demarcation
confrontation seems to be inevitable and both the HEF
and the RANF are endeavouring to organise themselves
in this struggle.
It also seems inevitable that hospitals and surgeons
will increasingly rely on Theatre Technicians for operating
theatre work rather than more costly Registered Nurses.
I believe that unionists will cause major divisions
within the nursing profession. They will probably be
assisted in their cause as the number of CAE-trained
nurses increases. Their course curriculum contains
a significant social/behavioural science component.
It might help if all social/behavioural science lecturers
were to spend a year trying to make an enterprise function
before undertaking their work. The unionists are preaching
that all other roles in health care are subservient
to theirs. I quote from a statement made by Ms L Grigg
(RANF's Victorian Branch Assistant Secretary):
'It is up to nurses---we have been the advocate for
patients; we have been the ones implementing the health
policy. It is time this was turned around. We know
what is necessary, and nurses should be working together
to ensure that we in fact determine health policy'.
The role and input of nurses is obviously crucial
but this blinkered view surely needs an injection of
maturity and balance.
Right of Access
Each of the key Awards has a right of access provision
for union representatives.
For example, the H & B H Award states:
'Employees of any establishment subject to this Award
may, with the consent of the person in charge of such
establishment (which consent shall not be reasonably
withheld) be interviewed by the Secretary or other
accredited representative of the Hospital Employees
Federation of Australia, or have their Union contributions
collected by the steward of the said organisation'.
Generally, access procedures work well. However, the
major unions are consistently and persistently trying
to expand their right of entry facility to enable them
to enter hospitals without warning at any time and
to enter any part of the hospital. The issue is not
that of gaining access but the purpose of seeking unrestricted
access. Experience shows that the unions want to be
the de facto controllers. There have been many unpleasant
incidents over the past few years resulting from these
union activities. The attitude we have taken in private
hospitals is to use the law of trespass to remove the
militant union officers.
I refer to some recent incidents which occurred at
the Diamond Valley Community Hospital.
In October last year, two RANF organisers attempted
to call a mass meeting of nurses within the hospital
at a crucial time of the day. They had refused to confer
with management on the issues they wished to address.
Management of the hospital called the police and the
two union organisers, who made a forced entry into
the hospital, were arrested and charged by the local
police after being duly warned. Police responded quickly
and effectively to the call by the hospital. An attempt
to disrupt the operation of the hospital was aborted.
Three days later the RANF (Vic. Branch) Secretary,
Ms Bolger, repeated the process, forced access into
the hospital and spoke to a number of nurses who had
heeded a call for a stop-work meeting. Surprisingly
on this occasion, police were delayed in attending
to their duties and turned up only when Ms Bolger had
completed her meeting. A senior officer from the Central
Office of the Victorian Police arrived and endeavoured
to explain away the situation. I believe that State
Government interference had occurred and the police
had been warned off to prevent making Bolger a martyr.
The effects on the hospital and the precedent it was
creating for private hospitals appeared to be of no
consequence to the State Government.
Some 31 nurses out of a total of 100 employed by Diamond
Valley Community Hospital went on strike, but the hospital
was able to continue to operate. In the course of the
conciliation processes, the following incident took
On Monday, 26 October 1987, the Executive Officer
of the hospital returned to the hospital from a business
meeting just prior to 3 pm to be told that the Registrar
of the State Industrial Relations Commission had telephoned,
requiring the Chairman of the Hospital Board, Director
of Nursing and himself to attend a compulsory conference
at 3 pm that day. This was not possible and the Commission
was advised. At 4.10 pm the same day, the Chairman
of the Hospital Board, Executive Officer and the DOW
were summoned under the State Industrial Act (Section
31(3)) to attend a compulsory conference at 6.30 pm
that evening. They complied with the order. No resolution
resulted from the compulsory conference which was adjourned
until 4.30 pm the following day.
The conference reconvened and the Commissioner's attitude
to the hearing was that the employers would need to
reach a resolution that night or he would arbitrate
that evening. The RANF were under no pressure. The
situation was that the representatives from the Diamond
Valley Community Hospital had to remain, under penalty
of $1,000 fine each.
Again no satisfactory solution was reached at this
meeting, as the RANF would not accept the proposals
of the hospital representatives and indicated that
they would consider their position overnight. The Commissioner
accepted this approach from the RANF and adjourned
the compulsory conference until 9.30 am on 29 October.
I mention this to illustrate the defensive position
of the employer which seems to be their constant lot
in the Victorian Industrial State System.
Industrial Relations System
With few exceptions, every decision made in the Victorian
Industrial Relations Commission in regard to private
hospitals over the past four years or so has given
some additional strength to the union side of industrial
I personally attended most of the hearing before the
full State Industrial Relations Commission of the Nurses
Case No 1 and No 2. In my view inordinate latitude
was granted to the RANF as opposed to the employer
group. While I understand that the applicant has the
carriage of the case, in my view the issues should
have been resolved within four to five months of their
commencement in October 1985.
Although the case started in October 1985, it was
not until March 1986, after approximately 30 days of
sitting, that the RANF finally presented a tangible
It is of interest that prior to and during this case,
we in the private sector formed a nursing committee
made up of 12 nurses representing a wide cross-section
of that profession within the private hospital industry.
The issues were presented to that committee over a
number of meetings and the case presented by my Association
was based on the advice we received from those nurses.
In the case of the public sector, the representations
made by the Health Department were predicated on results
of consultations between industrial relations advocates
and the unions, in conjunction with the Victorian Trades
Hall Council. The State Industrial Relations Commission,
it seems, totally ignored our arguments and evidence
on the subjectivity of their deals.
Given the amount of time that was granted to the RANF
in presenting its case, it was very frustrating for
the private health sector to be granted only an occasional
overnight adjournment in order to consider developments
which had occurred through deals being struck between
the union and the State Government.
The RANF undoubtedly wielded enormous influence over
the actions of the Commission through the threat of
further industrial action---and it continues to do
so. Whilst I acknowledge that the Commission has responsibility
for protecting the wider community, I submit that appeasement
is an excessive concession and not in the interests
of the wider community.
The Commission has the power of discretion. Prime
facie the outcome of a case is a question of advocacy
and the calibre of the Commissioners. The reality is
that the cumulative effect of all the myriad of decisions
which are made each and every day constitute opportunities
for increasing the subjugation of the enterprises by
The result is that unions are participating in more
and more consultative committees, more monitoring committees,
more reporting back to industrial tribunals. It is
becoming an industry in itself. These committees are
interposed in the decision-making processes between
the legally responsible management and the workers.
Those who sit on industrial tribunals appear to believe
that union representatives are blessed with abilities
and community spirit not available to those who run,
operate and work the enterprises.
Perhaps worst of all, this atrophying process is creating
a ballooning expectancy among an increasing number
of workers that additional benefits are an automatic
right. No regard is paid to balancing income and expenditure
and the influences which affect that balance.
I raised this with Ms Bolger in September 1986. She
indicated that the bankruptcy of private hospitals
was not her concern and the fewer private hospitals
there were the easier it would be for the union. However,
she is fully entitled to her view and I would defend
to the end her freedom to express it.
My comments are based on the experience of the past
few years. The position is deteriorating in my view.
For instance, do you realise that an individual overseas
nurse who seeks to migrate here and describes his/her
occupation as nurse has to get union approval to secure
Vying with this atrophying process is the awful feeling
of frustration of employers and managers apropos these
The concern about being picked off is a deeply entrenched
The method of keeping at arms' length through employer
group representation has obvious protective benefits
but is over-used.I believe.
It seems to me that the advocates of employer groups
are so enveloped in the system as it is that they become
absorbed by it. It is the only system---therefore it
must be right.
The system is cloying. It is creating a growing sameness.
In my view proprietors and managers must develop dialogue
with their workers to the point where the confidence
of the worker in the enterprise is stronger than the
influence of the unions.
To assist employers in this task, a countervailing
power is urgently needed to create a more positive
industrial environment. The will and wit to create
this must come from employers, with the understanding
of their employees.
Employers and employees do need to get back to basics
in developing the industrial environment which suits
their enterprise and its people.
Employer groups must be single-minded in supporting
Above all, there must be the laws and regulations
which allow this to happen.