The promotion of decentralised collective bargaining and the right to strike were central elements of federal legislative reforms operative from early 1994. The reforms also enabled compulsory arbitration, at tribunal discretion, in essential services. This examination of five public health services disputes reveals decentralised bargaining to be impracticable where significant labour costs are involved. A distinction between nominal and operational bargaining structure is developed and legislative recognition of the reality of centralised, multi-employer bargaining is advocated. The essential services dispute settlement provisions are found to continue the Australian tradition of the co-existence of collective bargaining and compulsory arbitration but in circumstances of greater Commission power. The provisions have proved controversial, with challenges to principal party motives, and the exercise of Commission discretion has involved diverse responses and outcomes. Initially the approach was conservative, favouring arbitration, and coincidentally providing an apparent windfall for unions. Subsequently, the Commission position became less predictable and by the end of 1995 a preference for bargaining over arbitration had emerged. The inherent weaknesses in the provisions are identified and weighed against the benefits of enabling pro-active tribunal intervention directed to protection of the community within a collective bargaining regime legitimising coercive power.