The NSW public would be in better health if nurses had a greater role in primary health care, health promotion and disease prevention, the NSWNMA has told a state government inquiry.
The NSWNMA has argued for greater investment in nurse and midwife- led preventative and community health services in a submission to the Special Commission of Inquiry into Healthcare Funding.
Led by Commissioner Richard Beasley SC, the inquiry is reviewing the funding of health services in NSW, including:
- the existing governance and accountability structure of NSW Health
- the way NSW Health funds health services delivered in public hospitals and community settings
- strategies available to address escalating costs, limit wastage and identify areas of improvement in financial management.
The NSWNMA submission cites the Ministry of Health’s Future Health: Guiding the next decade of care in NSW 2022–2032 Report, which reveals that more than one-third of the current disease burden is preventable and also due to modifiable risk factors.
The Future Health report further shows that two-thirds of the disease burden in NSW is caused by conditions that could be managed outside of an acute care setting.
However, 85 per cent of NSW Health spending is concentrated in hospitals. Activities related to prevention and promotion currently only receive 10 per cent of NSW Health expenditure, and a mere 5 per cent is invested in community or other care settings.
Therefore, a renewed focus on, and investment in, prevention and promotion at the primary healthcare level is crucial, the union submission says.
It points out that nurses form the largest occupational group in the primary healthcare sector.
Nurses “are best placed to provide broad support at a population level to increase health literacy, provide education to improve self-care, and to enable people to age in place longer by living in their own homes”.
“Nurses and midwives, employed and utilised effectively within primary healthcare settings, have the potential to transform the delivery of care to people in NSW and have a major role to play in hospital avoidance.”
The submission calls for increased funding of primary health care, and health promotion, with nurses and midwives central to this workforce, to improve health outcomes of the population and thereby lower the cost of health care in the acute care sector.
NEW COMMUNITY CARE MODELS
It says NSW Health should investigate and trial new nurse-led models of community-based care, such as the Buurtzorg model, to reduce the costs to the health budget while keeping more people in their own homes and communities.
It points out that existing models of care and lack of recognition of nurses’ full scope of practice restricts their contributions.
“Nurses and midwives are already leading care and undertaking evidence-based practice and person-centred care in their local communities.
“Still, they are constrained by medical funding models that promote supervision by GPs, stifling their ability to work autonomously.
“Additionally, they may be subject to further restrictions as a result of jurisdictional or organisational policies that constrain their practice, despite their education and experience.”
The submission recommends that NSW Health lobby for legislative funding reform, as well as jurisdictional and organisational policy reforms to enable nurses and midwives to work to their full scope of practice and expand the delivery of nurse and midwife-led primary healthcare services.
WALK-IN CENTRES
The submission says NSW Health should consider establishing Canberra-style walk-in centres, which “demonstrate significant progress in the delivery of nurse- led primary health care, enabling nurses to work to an expanded scope of practice”.
It advocates greater use of the Midwifery Group Practice (MGP) model, the “gold standard of care”, which allows midwives to work autonomously and to their full scope.
MGP, the submission argues, demonstrates cost savings for health departments due to reduced intervention rates and hospital stays, and results in better rates of normal birth compared to standard hospital care and private obstetric care.
In mental health, the submission calls on NSW Health to develop a caseload management system for community mental health workers.
This is needed so “caseloads are maintained at levels that allow good support for consumers while also managing the psychosocial hazards associated with role overload for nurses to prevent psychological injury and burn out”.
RATIOS ARE A GOOD INVESTMENT
Public hospital staffing ratios are “the single most effective measure” to improve efficiency and reduce unnecessary cost in NSW Health, the NSWNMA submission says.
It adds there is “substantial research” that shows ratios lead to improved health outcomes for patients, and higher rates of recruitment and retention of nurses and midwives. “Improved retention results in efficiencies, because the cost of advertising for, employing, and training new staff is significantly diminished.”
It says ratios have been shown to reduce unplanned readmissions to hospital (estimated to cost $1.5 billion per year Australia wide), length of stay and avoidable deaths.
“Ratios also were associated with a reduction in hospital-acquired health conditions such as pneumonia, pressure areas (commonly known as bed sores), urinary tract infections and falls, all of which add considerable (and avoidable) cost to the health system.”
The submission notes that the current NSW Government has committed to implement a ratios system in five key areas of public hospitals.
“While we strongly welcome this and continue to work closely with MoH on its implementation, we believe ratios or equivalent safe minimum staffing systems should be implemented in all clinical areas of the health system.
“It has been clearly demonstrated that the widespread implementation of ratios is not a ‘cost’ to the system; it’s an investment in patient care and the well-being of workers that will more than fund itself.”