Proposed cuts in the west leave patients vulnerable

Some of the most vulnerable communities in the state are threatened as the local health district takes the axe to staff numbers.

Nursing hours could be cut at up to 21 rural health services in Western New South Wales under a plan to reduce the Local Health District’s (LHD) budget deficit.

Nurses across the LHD have condemned the cuts, which follow the LHD’s announcement of a $19.5 million deficit for the previous financial year.

LHD management is trying to sell the cuts as a necessary step to “equalise staffing levels” and promote primary care over hospital care (see story page 12).

However, Acting General Secretary of the NSWNMA Judith Kiejda described the cuts as a money grab that would make it even harder for nurses to safely care for vulnerable people in remote parts of the state.

“Cuts at some of these facilities will grossly compromise the delivery of safe patient care and will place people at risk,” she said.

The LHD put 21 multi purpose sites and small hospitals on notice late in 2013. It said it would implement a new staffing formula at six of these facilities as a first step: Canowindra, Coonamble, Condobolin, Nyngan, Oberon and Rylstone.

NSWNMA organisers Darius Altman and Margaret Burgess visited 24 western NSW hospitals late last year to brief nurses on the planned cuts and seek their opinions.

In a 5000-kilometre, four-week trip, Darius and Margaret visited the 21 facilities marked for cuts plus three spared the knife because they were already badly understaffed due to unfilled vacancies.

Darius said members were angry the LHD did not consult them or the NSWNMA to determine what nursing hours are required to care for their patients and residents.

He said nurses at every site they visited unanimously opposed the cuts.

He said LHD managers at all meetings he attended said “if nothing is done to reduce costs within NSW Health, the NSW health budget will consume the entire state budget within 10 years”.

The 21 affected services cover five state electorates stretching from Rylstone north to Lightning Ridge, west to Burke and south to Grenfell.

Lightning Ridge and Walgett hospitals will each lose 16 hours per day of direct nursing care under management’s proposed staffing formula. Other losses include Nyngan 14 hours per day and Brewarrina MPS 12 hours per day, while Coonamble, Narromine, Gilgandra and Bourke will each lose eight hours per day.

The NSWNMA is campaigning to extend safer nurse-to-patient ratios from big city hospitals to facilities not yet subject to mandatory ratios, such as small country hospitals and multi-purpose services.

The new staffing formula being pushed by Western NSW LHD would, on average, guarantee just over half the nursing hours per patient day (NHPPD) being sought by the NSWNMA.

For example, staffing for acute patients is 4.5 NHPPD compared to 6 NHPPD under the union’s claim.

The LHD formula for renal patients is 3.8 NHPPD. High care residents will get only three care hours (not necessarily nursing hours) and low care residents just two.

Judith Kiejda said casual, permanent part-time and agency nurses would bear the brunt of the reduced hours.

Judith says the facilities targeted for cuts are home to elderly people in small communities who need to be cared for and have nowhere else to go.

“Take the example of an elderly person who has to be fed, then showered and toileted, very often by two staff members. Under this proposed staffing formula there will be many hours when patients are left alone.

“Does the Western NSW LHD intend to rely on the goodwill of nurses who already work through their breaks and work unpaid overtime to fill the gaps?”

Judith said the staffing formula failed to take into account the geographical isolation of many of these facilities in some of the poorest parts of the state.

“People in these small towns with only one or two GPs tend to go to ED because it can be hard to get a doctor’s appointment.

“And when hospitals in small communities are short staffed it’s difficult to get replacement nurses at short notice.

“The situation is made worse by the LHD’s refusal to put anyone on call and to have a proper escalation plan for when things turn bad.”

Multiple excuses for cuts

Western NSW Local Health District chief executive Scott McLachlan has put forward various explanations for why the LHD is enforcing district-wide cuts to nursing hours.

These include the need to achieve “equitable staffing” and a desire to shift resources into community health care. He has also mentioned the need to reduce the LHD’s $19.5 million budget deficit.

Minister for Western NSW and Barwon MP, Kevin Humphries, has blamed the “alarming and continuing trend of increased and unfunded staffing levels” for helping to create the LHD’s $19.5 million deficit in 2012-13.

Mr McLachlan told the Central Western Daily the new staffing formula was aimed at achieving “equitable staffing” across 34 health services.

In the Dubbo Daily Liberal Mr McLachlan said the proposed reduction of nurse hours would “see money eventually redirected to community-based care to reduce hospitalisation rates …”.

In “the future” the health district would call for expressions of interest from nurses keen to develop skills needed for working in the community, he said.

Acting General Secretary of the NSWNMA Judith Kiejda said cutting acute services staff to promote a so-called primary care health model was “putting the cart before the horse”.

“There is no attempt to boost community awareness and primary health services first, to see what impact that has on demand for hospital services.

“If this is about providing alternatives to hospital admission and treatment, why is the LHD also cutting staff from high and low-care residences?”

She said the “equitable staffing” argument was flawed because the affected health facilities cover such a wide geographical area and serve very different communities.

“Some of these facilities serve big Aboriginal communities and also farmers who have been battling drought for 10 years. They must deal with severe physical and mental problems associated with high levels of drug and alcohol abuse and violence.”