It’s about nurses, Tony – March 2010

Tony Abbotts backward-looking policy on health boards is inappropriate for a modern, complex, health-care system. Its also a diversion from the real issues of funding, staffing and skill mix.

Federal Opposition leader Tony Abbott has announced that a coalition government would abolish regional or area health authorities in NSW and Queensland and replace them with community management boards at each major public hospital.

This hospital board idea is a return to the system we had 20 years ago. This model did not provide solutions to the problems confronting an increasingly complex health system. In fact, local parochialism created a whole raft of extra pressures, which diverted scarce resources from where they could do the most good in an integrated health-care system.

The real issues that the Liberal Party at both the NSW State and Federal levels should prioritise are better funding and adequate staff with the right skills properly distributed across an integrated and networked health system. What we need is a health system that is properly balanced between treatment and preventative care for the whole community.

A hospital board, by its very nature, focuses on its own local interests. In the past such boards were unrealistic and naïve. They tried to provide the full range of services for their local community, no matter what its size. The cold, hard reality is there is neither the staff nor funding to do this and it is not always safe to do so.

Systemic problems need systemic solutions
Tony Abbott’s flight of fancy is a diversion from the intractable issues of funding, staffing and skill mix. He should take heed of the clear warnings coming from nurses at the coalface of our public hospitals.

In last month’s Lamp we reported on research conducted by the NSWNA that showed the unrelenting pressure on our nurses and their deep concerns for patient safety.
If the major political parties are serious about fixing the widespread systemic problems in public health, they cannot ignore this. We need more nurses in employment – and fast – because while things are bad now, there is also a demographic time bomb ticking away with our ageing nurse workforce.

In this month’s Lamp we look with a fresh eye at the issues of staffing numbers and skill mix. Professor Christine Duffield from the Faculty of Nursing, Midwifery & Health at UTS talks about the evolution of her thinking away from a model of measuring workloads by acuity to a blunter instrument like mandated minimum staffing ratios (see page 18).

Christine explains how her change of heart has come from a sense of disillusionment and despair at the worsening workloads three years after her landmark study Glueing It Together outlined the seriousness of the problem. These are feelings that I share.

The Victorian alternative
We also look at the implementation of ratios in Victoria (see page 21). The circumstances in which ratios were achieved in Victoria were clearly different to what we now face in NSW. There were many favourable factors – a sympathetic Commissioner and a new Labor Government that committed to funding extra nurse places.

There was also the terrible legacy of the Kennett Government, which had slashed and burnt its way through the Victorian health system, priming the public and the media for a radically different approach.

The implementation of ratios has not been a panacea for the Victorian system but they have made things considerably better. Victorian nurses have more control over their working days.

As a union and a profession we need to develop a transparent, enforceable mechanism for safe staffing and safe patient care. After more than seven years of looking for alternatives I believe we have no choice left but to seek mandated nurse-to-patient ratios that take into account skill mix acuity and throughput of patients.

Members in our public health system will have the opportunity to tell us what they think through their branches when they vote on the next Award Log of Claims (see page 24) in the coming weeks.
It will not be easy to achieve and it may be a long fight, but we are listening to what our members are saying about the intensity of their work and how they want things to improve.
Tony Abbott and his State colleagues, and Kevin Rudd and his State colleagues should be doing the same thing.