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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.

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.

Respect nurses and midwives

A way forward for aged care