January 25, 2021

Editorial

Safety is the number one priority

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In a difficult and dangerous year, the safety of nurses, midwives and patients has been our overriding concern.

At the end of this strange year, full of uncertainty, light is appearing at the end of the tunnel.

Evidence that several vaccines are showing signs of strong effectiveness against COVID gives us reason for hope that the threat of coronavirus will be reducing in 2021. The massive task of immunizing the world lies ahead but at least the prospect of having vaccines to do it with is uplifting.

While it seems like it has been a very long year, truth be told, the vaccines have been developed in a breathtakingly short time.

It is a powerful reminder, thrilling really, of the potential of science and medicine to solve enormous problems confronting humanity when they are backed by political will and appropriate resources.

COVID has also laid bare the effectiveness of global health systems in a crisis – for better and for worse.

In the United States we have seen the worst. In the richest country on the planet more than a quarter of a million people have died from the coronavirus with more than 12 million infected.

For the US health system, and the nurses working within it, COVID is an unmitigated disaster. A fragmented and unevenly resourced system combined with political ineptitude has put patients and health staff at a risk that is unconscionable.

A recent survey by National Nurses United, revealed more than 70 per cent of US hospital nurses said they were afraid of contracting Covid-19 and 80 per cent feared they might infect a family member.

More than half said they struggled to sleep and 62 per cent reported feeling stressed and anxious. Nearly 80 per cent said they were forced to re-use single-use, PPE, like N95 respirators. Nearly 1400 US health staff have died from the virus.

Australia is up there among the countries who have dealt best with the pandemic thanks to a world class health system, a skilled and dedicated health workforce and an effective, evidence-based strategy.

Even Victoria, the state hit hardest, is one of the few places in the world to have overcome a substantive second wave.

In NSW, nurses and midwives should be proud of their achievements during this testing year. You have been “the safe pair of hands” throughout.

NSWNMA members have not only contributed to the safe environment for patients and the community through their daily work but also through effective campaigning they have brought about enduring safety improvements to the health system with better PPE and the use of fit-testing as a norm.

It was pleasing to see these achievements recognised in the SafeWork awards.

Despite Australia’s success in dealing with COVID, there is no room for complacency and lessons still need to be learnt.

Governments need to realise this success did not come through luck. They need to fully grasp the reality that COVID has brutally exposed globally: that underinvestment in health and the health workforce poses mortal threats to the community and to the economy.

Yet, unfortunately, there are signs that some politicians have not learnt these lessons.

The insulting pay cap imposed by the NSW government on nurses and midwives as a “reward” for their valiant efforts at the frontline of COVID is one such sign.

The policy paralysis in aged care and failure to invest in improved nursing care in that troubled sector is another.

It was instructive to see that the counsel assisting the Royal Commission into Age Care point out in their final report how nursing unions have been sidelined by the federal government, even though they have been advocating for the obvious improvements to care needed to provide a safer environment for elderly Australians, and have been doing so for a long time.

It is high time politicians listened to what nurses and midwives, and their representatives, have to say about safety in our health and aged care sectors. They are at the frontline and know what they are talking about.

Aged care’s moment of truth

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Scott Morrison’s Australia is not going to be a good place to grow old if the crisis in aged care and the threats to superannuation continue.

For more than two decades the NSWNMA and the ANMF have been forthright in highlighting how dangerous understaffing in the sector had become.

We warned politicians and the community what the tragic consequences would be for many older Australians and their families.

Despite numerous inquiries and commissions, reports and research, discussions, conversations, media campaigns and desperate testimonies from our members, nothing has ever been done to make the necessary changes to prevent the suffering and neglect of elderly Australians in our nursing homes.

The pandemic has blown up all the weak, dishonest and self-serving excuses for inaction. It has put front and centre the stark reality that the first priority of the sector must be the safety and care of residents.

It should not have taken a deadly virus to tell society this obvious fact.

For too many politicians and too many providers the priority has been money and profit which has led to cost cutting at the expense of care and safety.

The distorted priorities of the sector have been eloquently described by the thinktank Per Capita: “The need to ensure high quality care is fundamentally at odds with the imperative to make a profit from a privatised system of care for vulnerable people.”

The COVID crisis is aged care’s moment of truth. It is also a moment of opportunity to reinvent the sector and reset the priorities around safety and care instead of pretending that aged care facilities are merely a lifestyle choice.

The NSWNMA and the ANMF have worked tirelessly to create an alternative vision for the sector.

The ACTU and other unions working in aged care – the HSU and United Workers Union – have now  joined us to launch a comprehensive plan to fix our broken aged care system.

The unions are united in calling for the following changes:

  • Mandated minimum staffing levels and required mix of skills and qualifications in every residential facility, over every shift
  • Transparency and accountability for government funding
  • Mandated training requirements (including infection control and ongoing professional development) accessible to all staff and paid for by the employer
  • Government funding is required to be increased, linked to the provision of care and the direct employment of permanent staff with decent pay and enough hours to live on.

The Morrison government can no longer just look away. It must accept and meet its responsibilities to residents, families and staff.

Our members on the frontline in aged care know that having appropriate levels of registered nurses and care workers in the right skills mix is the key to safe care for residents.

Mandated minimum staffing levels must be the government’s urgent priority.

We have to repel the attacks on super

We cannot allow the Morrison government to use the cover of the coronavirus to ruin workers’ retirements.

Moves are well afoot by the government to renege on its election promise to raise the super guarantee from 9.5 per cent to 12 per cent by 2025 starting with an initial increase to 10 per cent next year.

The increase to workers’ super is already enshrined in law and failing to implement it would be a major betrayal.

Even before the COVID crisis the superannuation guarantee rate was not enough to deliver dignity in retirement for all workers.

This was particularly true for many women who retire into poverty with just over half the superannuation of men.

The government says the increase is unaffordable and that an increase in super would impact negatively on future wages. An army of experts has rubbished this argument.

The union movement is proud of its role in the creation of industry super and we will defend our world-class system that gives some dignity to workers in retirement.

Investing in your future

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Superannuation is again in the news, as a push is on to stop the super increases occurring next year. This would mean that rather than employer contributions going to 10 per cent from 1 July 2021, it will stagnate on the current 9.5 per cent. Union members fought for superannuation to be paid on top of wages because all workers should retire with dignity. It was part of a compact made decades ago with the Hawke/Keating governments. It was to provide not only a retirement income for all workers, but also reduce the reliance on sustaining retirement solely on a pension 
(and in turn reduce the drag on the public purse).

In addition, your superannuation funds amount to billions of dollars invested in Australian infrastructure projects that create jobs here. That’s an important contribution to helping Australian families and communities.

Super is not perfect. Women now retire on average with 47 per cent of the superannuation of men. Women over 50 are the fastest growing group of homeless people in Australia. There are real and growing barriers that women face in getting a good retirement. Freezing employer super contributions under the guise of COVID-19 is misconceived and will only worsen this divide. It robs from your future to supposedly address a problem of today (setting aside it just doesn’t end up as additional profits). This is simply not good enough when wage increases are scarce or resisted. Your future, and that of our country, is too important to become prey to short-termism.

P.S. For those approaching retirement, make sure you do not have any super accounts sitting idle from earlier periods of employment. For example, if you resigned and were lost to SASS, and when resuming employment became part of First State, your previous monies may not have been automatically rolled over.

Essential but not valued

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The Berejiklian government plays a sly hand when it effusively praises nurses for their role in containing COVID-19 while effectively reducing their real wages.

Politicians have a habit of treating health as a sideshow somehow subservient to the main game of economics and the power that flows from that discipline.

This year has exposed the hubris of that worldview. The COVID-19 contagion has devastated economies around the world, including Australia’s, just as we were coming to grips with the consequences of climate change after a summer of apocalyptic bushfires.

The natural world has delivered a massive reality check in 2020 and posited with crystal clarity the centrality of health – of the human population and of the planet.

For nurses and midwives this year started with significant recognition as the World Health Organization declared 2020 the Year of the Nurse and Midwife.

This is a year in which we should be celebrating the nurses and midwives who dedicate their lives to the health of others.

Instead, it has turned into a time of mourning for the hundreds of nurses and other health workers who have fallen victim to the coronavirus across the world.

AsThe Lamp goes to print, the pandemic shows no signs of abating as infections accelerate worldwide, and with nearly 15,000,000 confirmed cases and more than 600,000 deaths.

Every day of this pandemic nurses have fronted up despite the risks and at great personal sacrifice. Each nurse that has caught COVID-19 is one too many and highlights the danger they face keeping the public safe.

In NSW it is easy to understand then their sadness and anger as their state government targets them to carry, not just the responsibility of saving people’s lives in the world’s worst pandemic since 1913, but also the economic burden in the aftermath of the epidemic.

It is morally disgraceful, callous, and it makes no economic sense.

Economists raise the alarm

Numerous economists have raised the alarm over the government’s public sector wage freeze. Even the Treasury has proffered advice that “reducing public sector wage growth in the short-run would deepen the recession”.

Dr Andrew Charlton, who was a key economic adviser for the Rudd government when it crafted its stimulus package in response to the Global Financial Crisis says the pay freeze is “precisely the opposite direction economic policy needs to be headed to achieve the government’s goal of supporting economic recovery.

This is damning criticism from a widely respected economist with a strong track record in charting recovery from an epic-level financial crisis.

The wage freeze also sits uneasily with the public. Since the freeze was announced our members have engaged tirelessly with their communities. Their message that the wage freeze will adversely impact local businesses and jobs has resonated especially strongly in rural and regional areas still recovering from the hammer blows of drought and fires.

The policy finds few friends in parliament outside of the Liberal Party. A regulation to impose the freeze was disallowed in the NSW Parliament. A majority of the NSW Upper House did not agree with a freeze to public sector wages.

The NSW government also finds itself alone in the Commonwealth with this financial folly.

Victoria, South Australia and Tasmania have all committed to wage increases for their nurses and midwives this year and for the following years. Queensland is to delay payment for this year but has promised two increases next year.

The truth is, in NSW, the wage freeze is not a one-off as a consequence of the coronavirus. It sits on a continuum of policy that has been implemented since 2011.

The Liberal government since its election 9 years ago, under several different leaders, has unilaterally capped the wages of nurses and midwives and obstructed improvements to ratios.

It loves to sing the praises of nurses and midwives when it suits it and has done so regularly during the COVID-19 outbreak. But what is clear is the government doesn’t really value their essential work.

A blind belief in the market will no longer do

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An evidence-based approach is just as important for economic recovery after COVID-19 as it was in the health response to the pandemic.

This year, nurses have been confronted with the monumental challenge of two back-to-back crises of epic proportions – both with daunting health consequences.

Bush fires of unprecedented size and ferocity, and the biggest global pandemic since 1913, have put our public health system under enormous pressure in a way that could barely have been imagined six months ago.

Nurses have risen to these challenges magnificently. These crises came out of the blue and our level of preparedness was underwhelming, yet Australia has coped relatively well, in no small part because of our robust, universal public health system underpinned by highly professional and dedicated nursing and midwifery workforces.

The sacrifice of nurses has been inspiring. COVID-19 has shown that if you need a steady hand in a crisis, nurses always deliver.

You would think the government’s response to such a stellar performance would be one of appreciation and a commitment to strengthen our public health system and to lift the morale and wellbeing of its nursing workforce.

Not so. The Berejiklian government’s decision to freeze public sector wages, including those of nurses and midwives, is not only disappointing, it’s exasperating. As one commentator has said, it is “morally questionable and a major economic mistake”.

Austerity policies such as the cost cutting of public services and the freezing of wages – the classic neo-liberal strategy – were a disaster as a response to the last great economic shock – the Global Financial Crisis.

The bushfires and now COVID-19 show the false economies of the neo-liberal model that has been imposed on us for decades.

It is an economic model of penny pinching, neglect, a failure to invest in vital services, of insufficient planning and a lack of preparedness – all driven by a narrow, sectarian vision which serves corporate interests above the interests of society.

It is an economic model which has seen domestic manufacturing wither and has left us vulnerable to overseas production and supply of PPE and vaccines and in an unedifying competition for these resources in a global market.

The economic hit from this failed vision – which places blind faith in the market at the heart of all governance – is incalculable. It will no longer do.

Invest in people

Spending public money on vital services like health, including the workforce that sustains these services, needs to be seen as an investment not a cost. The cost, as we are now painfully aware, comes from not doing it.

Cheerleaders for the corporate sector are advocating something completely different.

“The COVID-19 shock opens the political door for a policy reset that the Morrison government must now commit to fully walking through,” the Australian Financial Review recently editorialised.

That reset, it continued, included tackling “state-wide, rigid, union-negotiated industrial award agreements for public hospital doctors, nurses and other operational staff”.

This is not a reset. It is more of the same, failed economic policies of recent decades. Make no mistake a freeze is a real cut to wages and it will flow to all our members in the private and aged care sectors let alone the rest of the workforce by sheer market forces.

There is another way, which has even been advocated by heavyweight institutions like the IMF and the Reserve Bank of Australia. Their policy prescriptions for higher wages to bolster sluggish economic growth have been based on empirical analyses of the austerity measures imposed in the wake of the GFC. These measures  were implemented as soon as the Liberal–Nationals won government from the ALP.

Both the federal government and the NSW government are to be applauded for listening to and following the advice of health experts in handling the coronavirus pandemic. It is a welcome change to the denial of science when it comes to climate change.

It’s now time for them to be brave in the economic realm and to abandon the discredited policies of the past and to listen to the economic evidence that has been growing since the GFC erupted a decade ago.

They could start by abandoning their ill-considered wage freeze.

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.