June 3, 2020

Editorial

A well-resourced, robust health system is essential to combat pandemics.  

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If the COVID-19 outbreak tells us anything it is the critical importance of public health preparedness.

Three months ago it was a completely unknown virus, now it has spread globally, there is no known vaccine and many of the world’s health systems are ill equipped to deal with the clinical consequences.

From a biological point of view outbreaks of new pathogens are inevitable. Over the last fifteen to twenty years there have been similar outbreaks: SARS, H1N1, Ebola, MERS and Zika.

We should be much better prepared for these epidemics. Although some lessons have been learnt from previous outbreaks, many haven’t.

Both China and the World Health Organization learnt from the SARS outbreak. China enforced drastic measures to contain COVID-19 near its epicenter in Wuhan for as long as possible. This gave WHO valuable time to bolster the weak health systems of the most vulnerable countries in Africa and Latin America (see pp 12-13).

COVID-19 has exposed deeper deficiencies in the preparedness and funding of global health systems.

As one expert has said: “Fewer than one in three countries are close to being prepared to confront an epidemic which leaves the vast majority of the world’s population vulnerable. That in turn leaves us all vulnerable because we are only as safe as the least safe place.”

Even before the COVID-19 outbreak the World Health Organization (WHO) had made the spread of universal health systems its key priority. Tellingly, it identified nurses and midwives as the key to their spread and effectiveness. It is a major reason why it declared 2020 the Year of the Nurse and Midwife (see pp 14-15).

WHO has a very clear message for governments and policy makers everywhere: more nurses are critical for global health and governments need to invest more in the nursing and midwifery workforce.

WHO estimates that there is a global shortage of 18 million health workers including 9 million nurses.

While Australia has an excellent health system we are not immune to this problem.  The NSWNMA and the ANMF have campaigned relentlessly over a long period of time to alert governments and the public about the vulnerability of our own health services (and aged care).

Even though it is the early days of the epidemic our health system is already under stress with nurses facing drastic increases in demand, shortages of equipment and a climate of fear and uncertainty among the public.

I applaud you all for your calm, measured and professional response to these unprecedented challenges.

I want to assure you, we’re doing everything we can to support all of our members. Whether that’s negotiating special leave with your employer, enforcing Work Health and Safety, especially around Personal Protective Equipment (PPE), answering your questions, or providing updates with the latest information.

Your union is here for you and we’re working hard to keep you safe.

As frontline workers during this health crisis, there’s no doubt nurses and midwives are going to experience unprecedented demand. This is why the NSWNMA is urging the New South Wales Government to expedite its planned five thousand health ‘workforce boost’ promised at the last election and allocate extra nursing staff immediately.

We’re making headway. Our ongoing negotiations alongside other unions we have won New South Wales Health employees access to 20 days of special paid leave for COVID-19. We’re also in discussions with multiple private sector and aged care employers around special leave; isolation strategies and frameworks similar to the public sector.

The Federal Government has implemented restrictions on visitors to aged care facilities and many LHDs are also limiting non-essential meetings. In light of this, and to ensure NSWNMA staff do not place unnecessary pressure on the health system, we will not be visiting hospitals or facilities unless the visit relates to a WHS matter and is urgent. We’ve increased the number of officers available to answer your questions and we are changing our systems to do that in light of the new circumstances we face. We’re also sending regular updates regarding your rights and entitlements.

Given the increase in demand for advice and the need for members to contact us outside business hours, we’re working on improved methods to speed up our response times. We are making changes internally to ensure we can continue to provide members the essential assistance you all need from your union in unprecedented times.

It’s time to listen to the science and the experts

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Despite the warnings of experts backed by overwhelming scientific evidence, politicians left us unprepared and vulnerable to the fires that have ravaged our country. There are parallels of this modus operandi to be found in health and aged care.

What can I say about the calamity that has devastated our country?

The human, ecological and material costs of this spring and summer’s bushfires are staggering.

Twenty-eight people dead. Ten million hectares of our natural heritage incinerated. The homes of 2000 families obliterated. Over a billion animals burned to death.

The sheer scale and intensity of this carnage is barely believable.

But through it all there is also the uplifting, inspiring human response.

What stood out for me was the courage, commitment and selflessness of our emergency workers – firefighters, nurses, volunteers and others.

And one can only admire the resilience and solidarity of the communities who have been devastated by these unprecedented infernos.

The immediate dangers of some fires may now have passed with the onset of rain but the health consequences will persist for a long, long time.

Studies from previous bushfires, in Australia and elsewhere, show that the physical and mental health consequences endure for years.

There are many lessons to be learned, and it is imperative that they are learned, out of this catastrophe.

A positive lesson is that Australia still has a sense of community, solidarity and altruism that can get us through the worst of times.

But we can’t skate over the glaring deficiencies that the bushfires have exposed in the way Australia is governed.

We deserve better from our governments

As a country we were unprepared for the scale of these fires despite the alarm that had been raised by any number of experts: scientists, climatologists, firefighters and health clinicians over many, many years.

It is unconscionable that their advice was not just ignored but often ridiculed by a significant and powerful faction of our political class and media.

The lies, distortions and obfuscations that have been peddled about our changing climate have now been exposed as grossly irresponsible and a gigantic folly.

The natural logic of this denial or scepticism, in the face of overwhelming empirical evidence, is the lack of preparedness that we have seen and the exposure of the Australian people to nature’s wrath.

It is unacceptable that we have a government that only appears capable of acting after the fact and even then, only with reluctance and only when pushed.

As nurses and midwives, maybe this should not surprise us. In health we know first hand how expertise, experience and insight from those who actually know what they are talking about can be ignored, sidelined or contested by politicians or vested interests with their own agenda or by bean counters who fail to factor in the costs of inaction.

Which brings us to aged care.

In the fields of climate change and the environment we are used to the political art of doubling down in the face of a growing cataclysm.

The privatisation of Aged Care Assessment Teams by the Morrison government is another example of this way of operating.

Late last year, the Royal Commission into Aged Care delivered an interim report, which described the aged care sector as “a shocking tale of neglect”.

The commission heard countless, heart-rending tales of neglect and abject systemic failure and a lack of transparency and accountability by commercially driven facilities.

Yet even before the royal commission has delivered its final report, the federal government is handing over these public sector assessment teams to a private sector with a rank record of failure.

What point do we have to reach before there is a reckoning on this form of governance that ignores the advice and analyses of experts, and doubles down on failed policies when catastrophes are staring us in the face?

 

Bushfire information for nurses and midwives

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Judith Kiejda, Acting General Secretary of the NSWNMA, extends the Association’s support to all those affected by bushfires and outlines all nurses and midwives need to know if they’re impacted.

On behalf of the Association, I would like to pass on our thoughts and support to nurses, midwives and their communities who have been affected by the bushfires.

These unprecedented and devastating fires have ravaged through many of our communities, uprooting the lives of so many. Even for those of us not directly affected, many of us have family, friends or colleagues who have lost homes or been forced to evacuate from their properties. Many in our profession are also caring for patients who have been physically or psychologically impacted by these tragic events.

For those members who have been impacted, we wish to offer our heartfelt support.

FEE ASSISTANCE

For members of the NSWNMA who have lost homes, property or livestock in these fires, or have been injured in the course of this catastrophe, the Association is offering fee assistance. To access this support, please email gensec@nswnma.asn.au, or call us on 1300 367 962.

Please note that, due to the enormity of this event, each request for assistance will be determined on a case-by-case basis.

INDUSTRIAL SUPPORT

Members in affected areas may be experiencing issues with work, including being unable to attend work due to the fires, having to take time off work to support family and protect property or volunteer to fight the fires. In the first instance, where possible, please ensure you contact your employer to notify them of your circumstances. If you need industrial advice or support, please do not hesitate to contact us on gensec@nswnma.asn.au.

Please note that industrial rights and leave arrangements available in the current situation will vary between awards, agreements and employers. Your rights will also be in part determined based on your individual circumstances. Include as much information as possible about your situation in any contact with us.

MENTAL HEALTH

We also urge you to look after yourself, family, neighbours and friends during this crisis, and to access mental health services if you need it. You can contact any of the following services to access this support, or you can contact your employer to access their Employee Assistance Program.

Disaster Welfare Assistance Line: 1800 018 444
NSW Mental Health Line: 1800 011 511
Nurse Midwife Support: 1800 667 877

OFFERS OF HELP

For those who are not directly impacted by the bushfires, but wish to assist the efforts, we urge you to make a donation to one of the many charities doing great work on the ground, including the Rural Fire Service: www.rfs.nsw.gov.au/volunteer/support-your-local-brigade

At this stage, regional health facilities have not sought volunteer medical assistance from us. However, we will advise members of any request from NSW Health if such a request does arise.

We are keeping a close eye on this devastating crisis, and will continue to support our members and their communities.

Please take care, and continue to look after each other. Know that we do – and always will – stand with you.

Judith Kiejda
Acting General Secretary, NSWNMA

Defending our right to speak and be heard

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NSW nurses and midwives are respected and trusted by the community and should not be silenced for standing up for patients and our precious health system.

Our democratic right to campaign on behalf of our patients is under threat.

On two occasions over the last two years the Berejiklian government has attempted to muzzle our voice through legislation or regulation. The first time it was stymied by a High Court decision that deemed its law restricting our right to campaign as unconstitutional.

A Joint Standing Committee of the NSW parliament is now conducting an inquiry into the 2019 NSW state election. While such an inquiry is routine following an election, we feel compelled to challenge important restrictions on campaigning by third parties that the NSW government introduced by regulation prior to the election.

In May 2018 the state government brought in an electoral law that severely limited our capacity to campaign by:

  • Reducing the expenditure cap to $500,000 for third party campaigners (read unions)
  • broadening the definition of electoral expenditure so it even captured our everyday staff and travel costs as part of the cap and
  • making it unlawful to act in concert to campaign on member issues with other unions and or civil society organisations to exceed the cap.

The NSWNMA with other unions challenged the constitutional validity of this legislation in the High Court.

In an important decision, the High Court agreed with us that the law was invalid because it burdened “the implied freedom of communication on governmental and political matters, contrary to the Commonwealth Constitution”.

The High Court also agreed with us that “it was clear what this law is doing but one does not know why it is doing that other than to shut down … protected speech”.

Its decision confirmed our right to keep the people of NSW informed about issues around patient safety in our public health system.

The NSW government subsequently circumvented this ruling by introducing a regulation just prior to the March state election that introduced an electoral funding cap of $1,288,500 and a stringent definition of election expenditure.

The regulation remains valid until 31 December this year.

A dangerous erosion of our democratic rights

These draconian measures are damaging for our democracy.

In a submission to the parliamentary inquiry we have argued that “as part of our democracy it is essential that in the lead up to elections our voices and those of other campaigners be heard in amongst those of political parties and powerful media organisations. The expenditure cap must be fair to enable us this opportunity to be heard and to participate in the public debate”.

This is all the more so because the state government has previously rolled back our industrial right of access to the NSW Industrial Relations Commission and restricted our bargaining rights through its wages policy.

The right to a voice in the public domain on issues that impact on our members and the community is now of critical importance.

The NSWNMA has been left with no option but to campaign on issues like ratios and patient safety during elections when political parties are more likely to listen to the voices of their constituents.

Our reasonable recommendations

In our submission to the parliamentary inquiry we have recommended an electoral expenditure cap of $2 million with annual indexation for third party campaigners. This would allow us to adequately campaign on our issues using television advertising.

We have opposed the restrictions that make it unlawful for us to campaign with other unions or civil society organisations and we have argued that electoral expenditure should not include expenses that are part of the day to day running of the union.

All we seek is a fair and democratic electoral system where our voices will be heard on the issues affecting healthcare in NSW.

If we are unable to have our voices heard then we may have no choice but to form a political party ourselves – a motion that was democratically endorsed by the 2019 Annual Conference.

Safer work, safer care

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October has been nominated as Australian Safework Month.

In this month’s Lamp, as in many previous ones, we highlight the tremendous work and the resolute action taken by many nurses and midwives throughout the state to make their health environments safer for their patients.

At Blacktown and Concord, Gosford and Wilcannia and in many other hospitals and health services throughout the state our members have taken strong action to ensure that adequate resources are being deployed to provide safe and high quality care.

Having the right number of qualified staff remains the bane of our public health system. It is an issue the state government has very publicly promised to address with an increase in nursing and midwifery staff.

These extra staff are needed now and our members should be commended for their actions which keep local managements honest and have led to the recruitment of extra nurses and midwives.

The safety of patients, which is 
the driving force of these actions, is paramount but so too is the safety of staff.

Australian Safework Month provides us with a focal point to highlight the issues which impact on workplace safety in healthcare.

SafeWork Australia has published a safety plan for the healthcare sector which provides a refreshingly broad analysis of the issues that contribute to the risk of injuries and illness and that undermine the safety of healthcare environments.

It recognises muscular stress, falls, harassment and bullying and work pressure as the top causes of injury among healthcare workers.

Commendably, it acknowledges the importance of psychosocial risk factors such as high job demands, low job control, poor support, poor environmental conditions and violent or traumatic events.

It nominates work-related violence as a key priority area for improving workplace health and safety.

Staffing is at the heart of safety

These are themes which nurses and midwives are intimately aware of. They are recurring themes which, unfortunately but by necessity, often dominate the pages of The Lamp.

The causes and context of these issues is obviously complex. But in the health setting the common denominator is inevitably safe staffing. Unsafe staffing leads to safety risks for both staff and patients.

Psychosocial hazards – or the risk of work-related stress which arises from the design or management of work – is obviously exacerbated by understaffing. Likewise, understaffing is a risk factor for work-related violence.

Australian Worksafe Month is an opportunity for nurses and midwives to highlight the safety issues that blight our professions and to put forward our solutions to improve safety in healthcare.

On October 30 there will be a day of action which I would urge all members to participate in.

There are numerous ways you will be able to show your support: you can wear a badge or armband, hold or attend a branch meeting, organize a lunchtime rally, take a selfie and post it on social media using hastag #keepmesafe or email it here to us at the Association.

There is a dedicated area on the NSWNMA website where you will find resources to help you organise 
for the day as well as updates on activities.

NSWNMA members have always been brave, determined and effective in standing up for these safety issues, in the interests of our patients and our colleagues.

Every month we report on individual branches fighting resolutely for safer staffing, for 
safe patient care and against workplace violence.

This month let’s take this stand together and educate the community about the safety issues in healthcare and present the public with our remedies to make things better.

Our kids’ strike for climate deserves our support

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When school kids are brave enough to “tell it like it is” and their claims on climate change are overwhelmingly backed by science, maybe its time for their elders to listen and to offer their support.

In the feverish and dysfunctional debate over climate change that has taken place in Australia over the last decade it is easy to lose sight of what should be the decisive factor: the overwhelming scientific evidence that shows climate change poses an existential threat to humanity.

That evidence has steadily accumulated as more and more resources have been put into research and the tone of the scientific message has turned to alarm as the sheer magnitude of the emergency becomes clearer and clearer.

Without urgent and substantive change, calamity awaits.

The power and influence of highly-placed climate sceptics in the Morrison government and the media, particularly the Murdoch press, means this message has been effectively obfuscated in Australia.

But while these apologists for inaction on climate change can grandstand with their lumps of coal in parliament, or abuse their power on the airwaves to demonise children fighting for their future, the inconvenient truth remains: the planet continues to warm dangerously and that change is accelerating. 

This is important for nurses and midwives because climate change ultimately manifests itself in deteriorating health. It is a core issue for health practitioners.

The director-general of the World Health Organization, Tedros Adhanom Ghebreyesus has put this clearly: “We cannot delay on climate change. We cannot sleepwalk through this health emergency any longer.”

Before the last federal election there were clear signs that the sands were shifting and that a clear majority of Australians were supportive of significant action on climate change.

The election result dampened this optimism with the status quo maintained at the government  level.

But this is no reason to give up the fight. Elections are not the only pressure point for change.

Remarkably, leadership on this issue has come from an unlikely source – our kids.

On 20 September, school children around the world will again strike to save our planet from environmental catastrophe. They have asked older generations to join them.

The Australian union movement, including the NSWNMA, has committed its support.

In striking for substantive action on climate change our kids are also striking for health and I would urge all nurses and midwives to support  them by attending in person or taking some action during your breaks at work via social media in supporting their inspirational stand.

Concerns about staffing aren’t being addressed

Over the last month, throughout the state, our members have been telling us of severe shortages of nurses and midwives in our public hospitals.

At Campbelltown, Concord and Maitland the frustration of nurses and midwives led to well-attended rallies where our members alerted their local communities to the risk of errors or incidents from inadequate staffing.

While winter is always a time when the capacity of our public hospitals is tested with a pronounced spike in demand it would be disingenuous to attribute the problems solely to this.

Our members have spent months raising their concerns about staffing levels in reasonable workloads committees. These concerns have not been adequately addressed.

They are feeling fatigued, are experiencing burnout and feel unsupported by management. They are losing confidence in the current processes for addressing staffing shortages and genuinely fear for patients’ safety.

These problems have been obvious for a long time. The state government recognised this when it made an election promise to bring more nurses and midwives into the public health system. It feels like a promise to give with one hand and take with another.

The government and local managements should heed what nurses and midwives are now telling them: these resources are needed now.