January 29, 2022

Editorial

Time to tell the truth: We aren’t coping

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I know the situation in hospitals and aged care facilities is incredibly tough and I’ve heard from members how frustrated and angry you’re feeling right now.

We are absolutely right to be furious with the NSW and Federal governments. Their actions and inactions have led us to this. Their persistence in saying the system is coping reveals a complete disregard for the truth. 

It is outrageous that NSW Premier Dominic Perrottet continues to spin the lie that our public healthcare system is ‘strong’. He repeats this lie while you are exhausted, working excessive overtime and still remain short-staffed. Patient care is suffering.

It is unforgivable that aged care nurses are struggling to have access to appropriate PPE with many not even fit tested. It is outrageous that the Morrison government asks people to rely on RATs, knowing ordinary working families can’t get access to them. Diabolical that RATs are not available in nursing homes while many aged care residents still await their booster.

The NSWNMA will never stop advocating strongly on your behalf and fighting for improved working conditions across the public, private and aged care systems. Officers, Organisers and Branch officials are continuing to provide support to members concerned about sick leave, COVID isolation requirements, NSW Health directives.

Within January 2022 alone the NSWNMA has been supporting

  • An average of 110 members per day with COVID-19 issues
  • 80% of all member inquries have been related to COVID-19

Key issues raised with the NSWNMA

  • Transmission in the workplace/workers compensation
  • Leave entitlements
  • Members being directed or pressured to return to work while symptomatic
  • PPE advice & Fit-testing and infection control
  • Workloads and Staffing levels
  • Isolation requirements
  • Redeployment
  • Advice on government support payments
  • Successful advocacy around workers’ compensation where a rapid antigen test is now sufficient to lodge a claim, instead of having to rely on a PCR test

I know you are angry, frustrated, fed up, and eager for change. We support the call that many are making for collective action. As your union we are continuing to fight for our members and provide support. I encourage all of you to get active, speak out, share your stories with us. Speak with your branch representatives or NSWNMA organisers to discuss the next steps.

While our health care systems may not be strong right now, nurses and midwives are strong. It is our goodwill holding these systems together and it will be our collective actions that can bring change.

More than ever before nurses and midwives are saying ‘Enough is Enough’ and they’re speaking out.

Since the start of the year, at least 40 members have spoken to media, either speaking on behalf of their branch or anonymously. This has led to hundreds and hundreds of stories on radio, online, TV and in newspapers making sure all our communities know what you are going through right now.

We will continue to ensure nurses and midwives can publicly speak the truth. But it is clear that stating the facts are not enough when we have state and federal governments continuing to deceive. The NSW government is the only one who can fix these problems. We will not forget this, and we will hold them to account.

Information is changing rapidly, and we are updating members through email and social media.

Please remember, if you need support your union is here for you. Do not hesitate to contact us.

In unity,
Shaye Candish
Acting General Secretary
NSW Nurses and Midwives’ Association

Congratulations for your amazing contribution

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Summer is always a time of optimism and positivity and as we slip into the holiday season the NSW community should, and I think does, appreciate the enormous contribution of the state’s health workforce in getting us through the biggest health emergency in 100 years.

People in NSW will be able to enjoy with their families the best this state has to offer more safely than we were looking at not so long ago. I truly hope as many of our members as possible are able to experience  some of the holiday experience.

The contribution of nurses and midwives in getting us to this enviable point has been spectacular and I couldn’t be more proud of you.

Of course this has come at some cost when nurses and midwives have barely had a break in two years. Everyone is tired.

While I’m sure the community appreciates your sacrifices, commitment and hard work I’m not sure I can say the same about our governments.

While they regularly sing the praises of nurses and midwives publicly their actions tell another, quite different story.

When it comes to talking about improving pay for nurses and midwives their petty meanness is apparent.

When it comes to talking about ratios and improved staffing, they wilfully refuse to acknowledge the reality of our under-resourced public health system.

In this issue of The Lamp we report on the Perrotet government’s attempt to strip nurses and midwives and other essential workers of their right to automatic cover for COVID-19 (see p. 18).

This would mean nurses and midwives would have to prove they were infected on the job and not in the community – a burden of proof that would be almost impossible to achieve.

This measure literally heaps insult upon injury. It is cruel and unwarranted.

These things together do raise important questions.

Is our state government capable of learning the lessons of COVID?

Do they have the vision and the will required to build a robust, well-resourced public health system that will be able to provide safety for the NSW community against the health threats that experts tell us are inevitable.

More pandemics, superbugs and the consequences of climate change can no longer be dismissed as something that will happen down the track.

These threats exist now.

Delayed demand for normal health services will also put immediate pressure on our system as COVID, hopefully, abates.

A pressing priority must be the resilience of the health workforce.

The Australian College of Critical Care Nurses say critical care nurses are “leaving in droves”. We continue to press the NSW Minister for Health to recognise the problem and to act to establish professional standard staffing levels.

There is a growing body of research that shows that the pandemic has exacted a heavy emotional toll on nurses and midwives. Levels of post-traumatic stress disorder (PTSD), burnout, depression and anxiety among the health workforce have ballooned during COVID.

The research shows, and we also know it from our own experiences, that much of that mental trauma comes from a heartfelt concern that our patients would not get the care they need and deserve because of a shortage of staff and resources and the vulnerability this engenders during a lethal pandemic.

The Association has been saying it for more than a decade but it is important to keep saying it: our public health system has been seriously under resourced and understaffed. COVID has just exposed that weakness and made it worse.

The state government with its responsibility for the public health system and the federal government with its responsibility for aged care just keep putting their heads in the sand and hope their political spin will make these problems go away.

That is at once laughable and irresponsible.

The Association takes the responsibility of improving the public health system seriously. We have tirelessly advocated for ratios as an important pillar of any robust public health system. That position has been backed by irrefutable research.

The problems aren’t going away and neither are we.

There’s no going back

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It can’t just be business as usual post-COVID-19, lessons need to be learnt and applied.

If there is one glaring lesson to be learnt from the pandemic it is that science needs to be restored to its proper place at the centre of our decision-making processes.

This is particularly true in respect to health.

The idea that health can be managed with a minimal workforce and a “just in time” system of procurement has been badly exposed by COVID-19.

The signs, evidence and warnings were always there that the public health system needed to be more robust and better resourced and there needed a to be a plan-in-waiting for the manufacture, procurement and distribution of vaccines.

The slavish belief in a global market protected by so called free trade agreements resulted in insufficient manufacturing capability in areas like essential personal protective equipment. This placed our members lives at risk.

COVID-19 didn’t come out of the blue. There have been several pandemics on our doorstep in Asia over the last few decades. Many Asian countries heeded the warnings from SARS and MERS and strengthened their public health systems and prepared their public health responses.

All these countries responded much more quickly, decisively and effectively to the outbreak. Our lack of preparedness and the extended fight needed to get agreement to even fit test for respirator masks was an indictment of a system focused elsewhere.

Australia’s response, like many countries in the western world, has been shaped by an immediate concern for the economy coming before life and the health of the community.

It is now clear that a lack of worldwide supply of respirator masks delayed the acceptance of the immediate need for communities to adopt face masks as an early defence to an airborne pathogen.

Our capacity as an island to close borders meant there was complacency in securing adequate early supplies of vaccines.

Deep into the pandemic, with a year to prepare and numerous vaccines on tap, vulnerable frontlines like quarantine and aged care were unconscionably neglected and left exposed.

Underpinning this neglect of public health is the misguided idea that health is somehow not a top economic priority. That it is an expense not an investment.

Solidarity is needed to get us through

At another level the pandemic has shown how important collective action and solidarity is to deal with a public health emergency.

At least some of the vaccine hesitancy that has proved an obstacle to resolving the crisis has its roots in a culture of individualism and a narrow interpretation of freedom.

I am deeply saddened by the loss of nurses and midwives who have made choices to end their employment rather than be vaccinated. They have a strong belief in their own individual choice which overrides the greater good of a vaccinated society where nurses and midwives do every reasonable thing to protect themselves and their patients from serious harm.

It has been jarring to hear some of our leaders harping on about individual responsibility when a sense of solidarity and civic mindedness, a caring for each other as well as for self is the only way out of this predicament.

Which brings us to the here and now.

For as long as I have been the General-Secretary of this union the Association has been warning successive NSW governments of the vulnerability of our public health system and the need for it to be strengthened and properly staffed and resourced.

In this month’s Lamp we look at how the public health system in rural and regional areas has been allowed to degrade to the point where it is leaving local communities dangerously vulnerable.

It is equally true of the city where the current outbreak of the Delta strain has put our ICUs and EDs on the brink.

Nurses everywhere are telling us that they are barely coping. And it is only because of their heroic sacrifices that the system itself is hanging on. But this state of affairs is totally unsustainable.

This month we also look at the latest ratios research from the United States. It documents how ill prepared US hospitals were for the pandemic. We know that there are parallels here in Australia.

It concluded that “a robust nursing workforce is essential for addressing the current and future outbreaks”.

This is something we have relentlessly fought for in our ratios campaigns and something we will relentlessly continue to fight for.

Stay the course and keep up the fight

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Our strike and rally actions for shift-by-shift ratios are on pause during the COVID-19 lockdown, but when it is safe we will step it up again.

We are eighteen months into the worst public health emergency the world has seen in a century and everyone from experts to politicians are learning new facts and dealing with the unknown.

Mistakes are being made at all levels. A major mistake has been the vaccination of the aged care workforce.

The Commonwealth Government has failed aged care again. As usual its response to its failures has been to blame the workers.  The leap to compulsory vaccination to fix their failure is unforgivable.

Our State Government and Ministry of Health have tried to step in and help by offering priority access in their vaccination hubs. This is welcome but clearly not enough.

I welcome that in a rare show of unity aged care employers and unions have jointly determined the necessary solutions and presented them to the Federal Health Minister with some success.  The challenge now is to address the access to all vaccines as well as the communication failures around the Astra Zeneca vaccine.

There is no current NSW Public Health Order that confirms the announcement that COVID-19 vaccination will be compulsory for aged care workers. We will inform our members when that occurs.  It will not be unprecedented as we already have compulsory vaccination for flu and other illnesses. It will cause much concern for those who are hesitant or those who intend to refuse.  I have warned the MOH of the consequences of such an order on the workforce.

My preference would be that our members are allowed to make an informed decision based on best evidence available and take into consideration their duties to the patients and residents in their care to do no harm.

We’re fighting for a safer public health system

In the NSW Public Health System it is only thanks to strong campaigning and advocacy by our members that there is adequate access to P2/N95 respirators and fit testing.

Of course, the critical issue to be addressed to ensure the safety of patients and staff in our public health system is shift-by-shift ratios.

In the month leading up to the lockdown our members made their feelings well known with a wave of strikes throughout the state.

Our pressure has forced the government to backtrack on their previous position on pay and they will pay a 2.04 per cent increase to Public Health System members.

This is not nearly enough to appease nurses and midwives operating under the most challenging circumstances in what is an increasingly dangerous situation.

We will not stop advocating for shift-by-shift ratios until they are law.

A pillar of our union retires

I am deeply saddened to say goodbye to our Assistant General Secretary Judith Kiejda. A formidable nurse, midwife and trailblazing unionist, Judith has brought courage, passion, persistence and enthusiasm to her senior leadership role for 19 years.

Judith’s achievements are too numerous to mention but here are some:

  • Her advocacy to create the NursePower fund gave us the resources to run large-scale advertising campaigns in tandem with well resourced workplace campaigns
  • NursePower was used to to fight off WorkChoices, to push for ratios, to defend Medicare, to stop privatisations of our public rural hospitals and to improve aged care
  • She has positioned the NSWNMA as a significant contributor to international nursing through her involvement in Public Services International and Global Nurses United

She was a long time member of the ACTU Executive, ACTU Junior Vice President from 2013 and President of Unions NSW.

Judith has played a critical role in helping to deliver outcomes for our members across all sectors. She has been a great union leader.

With Judith retiring I would like to welcome Shaye Candish to the leadership team as the new Assistant General Secretary.

I look forward to working with Shaye as we go forward to meet the formidable challenges in front of us.

Listen to the science on ratios 

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An evaluation of Queensland’s ratios has swept away the last tenuous excuses for not implementing them in NSW.

The evaluation, conducted by researchers from the United States and from Queensland, was a requirement built into the law that established ratios in 2016.

It found that ratios pay for themselves. In fact, the savings in Queensland were twice the cost of additional nurse staffing. The study also found the system delivered a “flexible design”.

The research found that more staff were attracted to work at hospitals where nurse-to-patient ratios were implemented. There were significant improvements in patient mortality, length of stay and re-admissions. There were substantial cost savings.

To paraphrase our Prime Minister’s favourite saying: How good are ratios?

The study, published in the prestigious medical journal The Lancet, builds on decades of previous research.

But it goes further and demolishes the last remaining arguments used to block their implementation. It provides unequivocal evidence that government intervention will yield better staffing and those extra staff will lead to better patient outcomes.

We need to make the government act

The evidence is now well and truly in and our immediate challenge is to get the NSW government to listen to the science and act.

It needs to hear that the system is in crisis and that nurses are holding a precarious public health system together.

Worryingly, we are receiving reports that many nurses and midwives can’t take it anymore 
and are walking away from the public health system.

We simply cannot let this happen.

The Association wrote to the Premier asking her to work with us to implement shift-by-shift ratios and to meet with a group of nurses and midwives to hear the challenges they face at the frontline. To date, she hasn’t even paid the courtesy of replying.

This isn’t good enough. The government has benefitted  greatly from the hard work and sacrifices made by nurses and midwives during the pandemic.

NSWNMA members throughout the state have been taking our message to their communities throughout May. We intend escalating those actions.

We are buoyed by the knowledge that the community is on our side and appreciate the sterling efforts of nurses during the pandemic.

We will continue to reach out to the community to join us in putting pressure on the government to meet their responsibilities and adequately resource the public health system with safe staffing.

Bold leadership required

Scott Morrison promised us a “once in a generation” reform of aged care in the federal budget but after raising such expectations the outcome was a damp squib.

At a time when bold leadership has been needed the prime minister has been found wanting.

The Royal Commission into Aged Care had done much to shine a harsh light on the sector and to provide a framework for fixing its myriad problems.

The royal commission concluded that inadequate staffing levels, skills mix and training were the principal causes of substandard care.

While there are positives in the budget but there is a sense of tinkering around the edges when it is so clear that fundamental change is required.

The time-honoured reflex of throwing taxpayers’ money from a helicopter at aged care providers has never worked and will never work when there is no accountability for delivering that money to the direct care of residents and consumers of home care.

Aged care needs to be reformed not only considering the royal commission’s findings but also in the broader context of lessons to be learned from the pandemic. The royal commission did not deliver on all of our claims, but the least Scott Morrison could do is implement those recommendations in full.

Expecting our public health system and our aged care sector to be able to provide safety and protection to our communities and our elderly when they are inadequately funded and where providers put profit before care will no longer wash.

Aged care has been left to wither over a long period of time and by governments of different stripes.

While we welcome the positives in the budget, the problems have not been sufficiently addressed and we will continue to campaign until they are.

A road map forward 

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The Royal Commission into Aged Care final report is not perfect but there are strong recommendations in key areas such as workforce and governance that can drive the sector to a much better place.

There is much to digest in the commission’s final report which runs to eight hard-copy volumes and has an executive summary of over 120 pages.

There are some in the sector who are disappointed by the report but a close analysis reveals a vision for the aged care workforce that is underpinned by values and policy recommendations that the ANMF and the NSWNMA have been advocating for more than a decade.

The commissioners, Tony Pagone and Lynelle Briggs, recognise that the 1997 Aged Care Act introduced by the Howard government, which is the foundation stone that has shaped the profit-driven sector we now have, has failed.

That legislation allowed providers to decide for themselves what staffing numbers were adequate and how taxpayers’ funding was used. It was from this moment that the replacement of nursing staff with unregulated care workers began.

The consequences of this have been dire and the commissioners have identified key issues that need to be addressed if the sector is to be salvaged.

They point out that there are not enough workers to provide high quality and safe, person-centred care and that the proportion of qualified staff, such as registered nurses and allied health workers is too low.

This is in circumstances where the acuity of people receiving care has increased.

The commissioners agree that the aged care workforce is poorly paid for difficult and important work. They also observe that some staff are untrained or insufficiently trained for the work they do.

Current staffing levels are unacceptable

They accept the evidence that there is a link between staffing levels and care outcomes and observe that currently, staffing levels within large parts of residential aged care, fall well short of acceptable practice standards.

To remedy these deficiencies in the workforce the report recommends that the sector needs:

  • the right number of staff with the right mix of staff and skills
  • a greater proportion of registered nurses, nurse practitioners, and allied health professionals
  • better education and training to achieve a more highly professional workforce
  • registered personal care workers/AiNs
  • minimum qualifications for personal care workers/AiNs
  • improved pay and conditions.

These recommendations match the key objectives of our long, hard-fought campaign for a better and viable aged care sector.

The commissioners recognise that the aged care workforce needs to be professionalised which will require improvements to education, wages and conditions.

They agree that there is a wages gap between aged care workers and workers performing equivalent functions in the public health sector. They are in no doubt that a registration scheme is needed for personal care workers/AiNs.

The commissioners see a clear link between more staff, safety of care, a safe work environment and attraction and retention of staff.

The federal government’s integrity is on the line

The responsibility for implementing the commission’s recommendations now falls to the federal government.

The ball is now in Scott Morrison’s court and it is not an understatement to say the integrity of his government is on the line.

The testimonies and revelations in the lead up and during the course of the commission’s inquiry about the way many aged care residents have been neglected in a sector whose reason-for-being is care of our elders have been heart-rending.

The commission’s report clearly shows that the problems of the sector are deeply structural. The commissioners leave no space for excuses by the federal government to abdicate its responsibility for the governance of the system.

There have been many commissions, inquiries, analyses and reports about aged care in the past that have resulted in absolutely zero change.

We cannot allow that to happen with this pivotal report. Despite its flaws it is a significant step in the right direction.

The NSWNMA and the ANMF will campaign hard to have the commission’s recommendations implemented including through a paid advertising campaign.