March 2, 2021

Editorial

Respect nurses and midwives

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The state government has responded to our public health system log of claims and on the big staffing issues they have nothing to say.

We are often told we are living in a dynamic world of constant change which requires adaptability and nimbleness to meet contemporary challenges.

These are qualities that the NSW government seems to lack – at least when it comes to health.

As The Lamp goes to print we have just received an offer from the government in response to our log of claims for the NSW public health system.

As they have done over the last six years the government has ignored a carefully crafted document, put together after months of consultation with the many members we have in the public health system who, every day and night and weekend, hold together our public hospitals and health services the length and breadth of the state.

These hardworking, dedicated nurses and midwives have an instinctive feel for the issues, challenges and shortcomings of public health from their daily experiences at the frontline of the system.

Our log of claims is a distillation of their collective analysis of what needs to be done to improve the system so that the people of NSW can continue to get the world-class care they deserve.

The government’s disappointing response is to ignore the informed voices of nurses and midwives and to offer a 2.5 per cent pay increase without any consideration of the critical issues facing health that we have put before them.

Heading the list of those issues is ratios. Effectively there has been no significant improvement to ratios since 2011 when we achieved ratios after a hard-fought campaign. The government tells us there are more nurses but our members are constantly telling us they are run off their feet – all over the state.

There is overwhelming evidence that ratios work. Over the years we have documented in The Lamp, and we have presented to the government, the mountain of international evidence that shows lives are saved when hospitals employ more nurses.

Ratios, specialling and rosters need to be addressed

Of course, there are many other issues besides ratios that need to be resolved. In this issue of The Lamp we highlight two that our members tell us are of critical importance – specialling (see pp 12-13) and rosters.

A survey conducted by the NSWNMA showed the heavy burden specials put on our wards. Almost half the nurses surveyed said no extra staff were provided to look after these patients who require one-on-one care. And when staff were provided they tended to be AiNs.

A second survey showed widespread dissatisfaction with rosters and the lack of advance notice makes it very difficult for nurses and midwives to have normal lives.

An International Labour Organisation conference attended by our Assistant General Secretary Judith Kiejda showcased a different way that governments, unions and employers can work together to improve health systems than what we have become accustomed to in New South Wales.

At this important United Nations meeting unions were recognised for their role in representing the global health workforce and their concerns listened to and acted upon.

All the parties – unions, govern-ments and employers agreed to two important positions:

• Public spending on the health workforce should be seen as an investment and not a cost and

• Mandated staffing is the only way to guarantee decent working conditions in health services.

This government is not listening to nurses and midwives and they need to listen to the people who measure the pulse of our public health system every day.

They should show some respect to those who understand what needs to be done to improve its health. 

Be alert, be aware and join the fight to defend penalty rates

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When it comes to workers’ rights and living standards the Turnbull government loves to play the politics of the empty gesture. What is needed is meaningful action to protect our standards of living.

Prime Minister Malcolm Turnbull said he was ‘putting Australians first’ by giving them priority for jobs currently open to overseas workers when he announced the government was abolishing the 457 temporary work visa.

Immediately the ACTU refuted the claim that this was a significant change in policy. ACTU President Ged Kearney, in a comprehensive analysis, pointed out that less than one in ten jobs had been eliminated from the scheme and the requirement to market test for Australian workers’ availability was still left up to the employer.

There is no doubt, nurses and midwives brought to Australia have filled shortages where Australian-educated nurses have either not been encouraged sufficiently to move to or where skill levels have not matched jobs.

It is, however, alarming that the sudden concern for Australian jobs and changes to citizenship requirements are seemingly in response to a political agenda beyond these policies.

This is not the first time the government has shed crocodile tears for Australian workers.

The Fair Work Commission’s decision to cut Sunday penalty rates for thousands of low paid workers came the day after the Bureau of Statistics found that wages growth had been the lowest since records began in the 1990s.

Responding to the ABS figures Treasurer Scott Morrison claimed that low wage growth was the “biggest challenge” facing the Australian government.

“The biggest challenge we have is to ensure what Australians are earning every week is increasing,” he said.

Within days he, the Prime Minister and the rest of the government were endorsing a pay cut for the lowest paid in the country.

Nurses and midwives are not immune from cuts to penalty rates

Malcolm Turnbull said it was “absurd” and “ridiculous” to claim that the Commission’s decision to cut penalty rates could affect nurses.

Not long after the Prime Minister voiced his support for the Commission’s decision and claimed that nurses were immune to a roll back of penalty rates a major health care company Sonic Health Plus were proposing exactly that (see pp10-11). Sonic, which employs hundreds of nurses across Australia tried to cut Sunday penalty rates from 75 per cent to 50 per cent in EBA talks.

Sonic was not alone. In aged care we have seen the same thing. As my colleague Lee Thomas said: “Sonic Health proves that employers are now lining up to start stripping away penalty rates from nurses and other employees”.

What has always underpinned decent living standards for Australian workers are well paid, unionised jobs, protected penalty rates, a strong safety net, a universal health system, educational opportunities for all our children and livable retirement incomes.

All these rights have been under attack by the Coalition. The government always hides behind the language of neoliberalism and trickle down economics to justify these attacks. Cutting penalty rates and cutting corporate taxes will create more jobs, they say.

This is a stale policy of privatisation, fiscal austerity, deregulation, free trade, and reductions in government spending in order to increase the role of the private sector in the economy and society and Australians deserve better.

Recently our new ACTU Secretary Sally McManus copped an enormous amount of flak when she said “neoliberalism had run its course”. It was interesting that Paul Keating, the architect of the open Australian economy, immediately supported her position.

The government is clinging to tired ideas that have only delivered inequality for working people.Trusting the market or the benevolence of employers to maintain living standards is a demonstrable failure.

It’s time for a new course and Malcolm Turnbull could make a start by stepping up to the plate and protecting penalty rates in law.

NSW can afford improved ratios

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brett-holmes2

Strong economic growth means the NSW government can afford to improve safe patient care through improved ratios and the federal government has no excuse for not protecting the penalty rates of the lowest paid.

Figures released by the Australian Bureau of Statistics in March show that the Australian economy is buoyant. The national economy grew by 3 per cent in the December quarter – the third best quarterly growth in 28 years.

In NSW, economic growth is outpacing the rest of Australia with healthy budget surpluses forecast for the next four years.

Yet, the benefits of this strong economic growth are not being shared by all. Those same ABS figures showed that the amount of money going to wages fell by 0.5 per cent.

One economic commentator, Greg Jericho, points out that “the total amount of wages has been falling at the same time that profits rose faster in one quarter than they have for 40 years”.

These results are consistent with the latest OECD report on Australia which showed that in the decade of the mining boom from 2004 to 2014 the wealth of the lowest fifth of the population grew by 5 per cent while for the richest it surged by nearly 40 per cent.

Inequality has been growing rapidly in Australia and continues to do so.

It’s time to improve ratios

This is the economic backdrop to our claim for improved ratios in the public health system (see pp 8-13).

Seven years ago, chronic understaffing of nurses and midwives placed enormous pressure on our public health system and was the catalyst for our first nurse to patient ratios campaign.

NSW nurses and midwives won ratios in 2011 after strike action and bed closures convinced the ALP Governernment to act. Over 1800 FTE nurses were added to the NSW public health system with a funding injection of over $500 million.

However, all our subsequent Award claims to improve and expand ratios have been refused. Ratios in regional and rural hospitals were only part-won in 2011. These hospitals are still struggling to deliver high level patient safety through adequate nursing care. Specialties such as emergency departments, paediatrics and intensive care units are yet to receive nurse to patient ratios.

Year on year, the NSWNMA has lobbied the NSW Coalition government for improved and expanded minimum, mandated nurse to patient ratios as part of our public health system Award talks.

The Victorian and Queensland Governments have been convinced that ratios are so important for patient safety that they have enshrined them in legislation. It is time the NSW Government stopped denying their importance and instead expand and improve them to deliver safe patient care in this State.

Penalty rates must be protected

The decision by Fair Work Australia (FWA) to reduce penalty rates for workers in retail and hospitality is unconscionable and will only worsen the gaping divide between the haves and the have-nots. Women and young workers will take the brunt of this poor decision (see pp 16-19).

Workers in accommodation, food services and retail are already the very ones that have been left behind as inequality has widened.

It is natural and reasonable for workers in other low paid sectors like aged care to now fear for their penalty rates.

ACTU polling shows over two thirds of Australians disapprove of the FWA’s decision to cut penalty rates. Two thirds also want the government to change the laws to protect penalty rates.

FWA’s decision is typical of the economic policy – with its focus on reducing labour costs – that has driven inequality in Australia.

The latest economic figures show that greater economic growth does not necessarily translate into improved incomes for many working people.

Prime Minister Turnbull has an opportunity and a responsibility to respond to this attack on people’s incomes and should legislate to protect penalty rates.

A cautionary tale for metro members

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By Judith Kiejda, Acting General Secretary

Late last year the state government unveiled plans to privatise five regional NSW hospitals. Now, with the announced privatisation of the St George Hospital renal dialysis services, we know they are targeting our metropolitan public health services as well.

The renal dialysis service at St George Hospital is to be gifted to a private operator under a business plan drawn up without any consultation with nurses.

“Up to 11.85 full time registered and or enrolled nurses” are to be handed over to a private operator according to correspondence sent to NSWNMA by the hospital.

The privatisation is the result of a South Eastern Sydney Local Health District feasibility study carried out in secret during 2016.

The study says growing demand for renal services has “placed significant pressure” on the current number of haemodialysis chairs at the hospital.

However there is no provision for additional renal dialysis capacity in the current major redevelopment of the hospital.

In this modus operandi we see the outlines of the government’s strategy to privatise metro services by stealth. Any new service or hospital where there is a need for capital works development – like St George – gives the government an opportunity to privatise public health services.

If the government is only stumping up sufficient funds for building works and not for the operational requirements of health services the LHDs are placed between a rock and a hard place and forced down the route of giving those services to the private sector to operate.

Services like renal dialysis, rehab and maternity services are highly lucrative targets for private corporations. There are already lots of private maternity and rehab services. Now, as we see at St George, renal dialysis is ripe for privatisation.

Metro hospitals face privatisation by stealth

It would be very difficult politically for the government to openly privatise major Sydney tertiary hospitals in the same way that they have with regional hospitals. 

But tertiary hospitals like St George, Prince of Wales and Sutherland all have large capital works programs in play and this gives the government the opportunity to accelerate their agenda of privatising public health.

This political tactic is a variation on the great money trick played by the federal government with the state governments. If you cut their funding for health – as they have on a massive scale – then you are forcing them to slash their health budgets. This trickles down to the level occupied by nurses and midwives: with less services, less staff, less resources, more privatisations and more outsourcing. 

If you join all the dots: the cuts to funding, the cuts to Medicare, the privatisation of regional hospitals and the outsourcing of metro health services it is not hard to work out there is a very comprehensive agenda by state and federal Coalition governments to move people from a public health system for everybody to one where user pays.

This is an agenda that everyone should stand up and fight against. Which comes to the next element of this strategy – the crushing of resistance to it. The Association has been made aware of several instances where nurses that have stood up and spoken out against privatisation have been put under immense pressure by their management.

This is unacceptable. Nurses and midwives have a democratic right to express their opinion on any issue they like. And they have an obligation under their registration to advocate for their patients in their care.

Management has no right to put them in a difficult situation if they speak out against privatisation. It is imperative that we all stand up for a health system that is accessible to all and free at the point of service. This union will back any nurse or midwife to the hilt if they do so. 

A way forward for aged care

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Judith Kiejda, Acting General Secretary

If we want to have an aged care sector that has the capacity to care for older Australians to the standards the community expects then a good place to start is with an understanding of what the staffing requirements are to deliver that care.   

Over the last two decades, numerous Productivity Commission reports and Senate Inquiries have consistently highlighted the need for a method of determining safe staffing levels and skills mix in the aged care sector.

Incredibly, despite the interminable debate about aged care staffing there has been no empirically-based research to determine how to establish those staffing levels.

As my colleague Lee Thomas, Secretary of the ANMF, has said: “There has been a monumental failure of successive governments to establish and legislate evidence-based staffing levels and skills mix that provide a minimum safe standard of quality care to vulnerable
older Australians” (see p.8).

The Productivity Commission recognised the difficulty in attracting and retaining a workforce in the sector for a myriad of reasons including a lack of competitive wages, poor management of facilities and lack of career opportunities.

Its timid response was limited to addressing education and training opportunities.

This crisis in the aged care workforce will undoubtedly be exacerbated by recent budget cuts by the Federal government that will reduce funding to the sector.

It is obvious that much bolder initiatives are needed especially a methodology for aged care that considers both staffing levels (the right number) and skills mix (the right qualification).

The ANMF Federal Executive recognised this critical gap and commissioned and funded the National Aged Care Staffing and Skills Mix Research. The evidence-based tools that have been established by this research will inform staffing and skills mix in aged care.

Now, thanks to the ANMF (with the support of all its state branches including the NSWNMA), and in collaboration with researchers at Flinders University and the University of South Australia, we finally have a national aged care staffing and skills mix model which can provide a platform to take the sector forward.

IMPORTANT QUESTIONS ANSWERED

The project is a first for Australia and provides important answers to questions about what needs to be done to provide appropriate,
safe care for older Australians.

The research was comprehensive and involved focus groups across the country with aged
care nurses, a “Misscare” survey with over 3,200 participants and the imput of 102
invited experts.

Key recommendations coming from the research include:

  • an average four hours and eighteen minutes of care per day,
  • a skills mix requirement of RN 30 per cent, EN 20 per cent and AiN 50 per cent.

This is the minimum care requirement and skills mix to ensure safe residential and restorative care.

The Misscare survey threw up some alarming results – only 8 per cent of aged care nurses thought staffing was always adequate. The survey identified inadequate staff numbers
as the most common reason for missed care.

76.8 per cent indicated they could not request additional staff. Only 10 per cent indicated that extra staff were provided when requested.

The status quo is clearly failing older Australians. Successive governments and aged care providers have prioritised budgets and profits over standards of care.

The ANMF and the NSWNMA will not stand by and allow this to happen. The point of departure in any discussion about how aged care should go forward should be: What are
the care needs of older Australians?

We now have a clear idea of what the staffing requirements of the sector are and the next step of our campaign will be to fight for their implementation.