Government responds to Garling

The NSW Government has taken on most of the recommendations of the Garling Special Inquiry into public hospitals. Now we need political and bureaucratic willingness to see these reforms through.

The NSW Government has accepted 134 of 139 recommendations, made by the Garling Special Inquiry into public hospitals, accepting the challenge to deliver the most comprehensive reform of the state’s health system to date.

At the centre of the reforms is a plan to return senior nurses to their clinical leadership roles within the health system by radically overhauling the role of the Nurse/Midwife Unit Manager.

The 41-page response entitled Caring Together: The Health Action Plan for NSW cites ‘reduced bureaucracy’ and a ‘refocus on patients’ as key to successfully implementing the changes recommended by Commissioner Peter Garling.

The Government will spend $485 million over four years on a ‘suite of measures’ it plans to implement in three stages.

To get senior nurses back on the wards, the Government has announced it will spend $176 million on 500 ward-based clinical support officers to assist with administrative duties.

The plan aims to ensure that NUMs spend at least 70% of their time attending to clinical duties, and no more than 30% on administration, management and transactional duties.

Commissioner Garling’s  recommendation of a new clinical designation for RNs with over 10 years’ experience was supported ‘with modification’ by the Government. However, the Government continues to oppose the NSWNA’s claim for a new designation for RNs with more than eight years’ experience in the Industrial Relations Commission.

The Government also supported Commissioner Garling’s recommendation to increase nurse practitioner and advanced practice positions, introduce better benchmarks for the delivery of postgraduate clinical education, and instigate a new badge system to identify all staff by name and designation.

The NSW Minister for Health, John Della Bosca, will also establish a Community and Clinician Advisory Council to support the implementation of the recommendations, and an independent body to audit and monitor progress.

NSWNA General Secretary Brett Holmes said it was absolutely essential that the clinical expertise of N/MUMs was properly recognised and utilised.

‘It is a point we made very strongly in our own submissions to the Garling Inquiry and we are pleased the idea was picked up by the State Government,’ he said.

‘By outlining the areas of clinical leadership N/MUMs are expected to provide, the Government’s action plan should help ensure their role stays clinically focused. However, it is vital we provide the extra administrative support.’

Other key reforms include a clinician-led, state-wide hospital review to assess how to best match resources with community needs.

‘The review will involve some hard decisions that will have to be made for the good of the system,’ said Brett.

‘The rational, evidence-based findings of the Garling Inquiry demonstrated that, with our limited health budget, some rationalisation of services will have to occur in order to continue to offer those services safely,’ he said.

‘We hope the Government adheres to Commissioner Garling’s key point that any future assessment and reallocation of resources be a truly clinician-led process as opposed to the micro-management decisions of bureaucrats that clinicians and health workers have been subjected to in recent years.’

The Government has also set aside $12 million to re-introduce gender-specific wards – a seemingly small but important contribution to patient dignity – and allocated $50 million for a ‘culture change’ program, Caring Culture, aimed at improving respect and dignity for patients and staff. It will include a grievance advisory service with front-line advisors working in each Area Health Service.

‘The objectives of the new Caring Culture program have the NSWNA’s full support,’ Brett said. ‘Mr Garling rightly identified workplace bullying as a problem in the health system and it is important that employers continually strive to reduce and even eradicate it.’

‘The NSWNA also welcomes the establishment of an independent council to provide advice directly to the Minister for Health and the Director-General on the implementation of this action plan and the work of the implementation teams being established at each local facility.

‘It is also encouraging to see that an independent

audit of the progressive implementation of Caring Together will be commissioned by the NSW Government and analysed by an independent panel. On many occasions new plans have been announced and little effective monitoring has taken place. Hopefully, these measures will prevent that happening this time.

Garling supports NSWNA recommendations

  • Re-design of the NUMs role. NSW Health has agreed that the clinical leadership aspect of the N/MUM’s role must be restored in the interests of quality patient care. Changes will be implemented to ensure that the N/MUM is recognised as the manager of the unit.
  • Restoration of clerical and other ancillary supports to allow nurses to nurse. The Government has allocated $176m over four years for 500 ward-based clinical support officers to relieve N/MUMs and nursing staff of non-clinical tasks and administrative burdens to allow them to focus on patient care.
  • More nurse practitioner positions. NSW Health has already introduced 82 Nurse Practitioners to provide advanced care, with another 64 currently in transition. The Government said more positions would be created but no new numbers were provided.
  • More clinical initiative nurses in EDs. The Minister has announced 30 new Clinical Initiative Nurse positions in busier ED waiting rooms to initiate treatment (under protocol), improve communication on waiting times and help with admission paperwork.
  • A new emphasis on respect in the workplace and more resources to address grievances. NSW Health will initiate a cultural change process including a training program and support for staff with improved procedures for managing bullying.
  • Renewed emphasis on hand washing across the workforce. NSW Health is developing a new Hand Hygiene Policy Directive to reduce infection and plans to support improved compliance with the current enforcement regime.
  • Rostering designed to ensure adequate senior nursing and medical support is available out of hours. NSW Health will implement a program to redesign rostering systems to ensure junior staff are adequately supported.