No reform without nurses

Federal health minister Tanya Plibersek
Federal health minister Tanya Plibersek

Federal health minister Tanya Plibersek says nurses are critical to the success of health care reform.

From Medicare Locals to Disability and Aged Care services, nurses will be instrumental in delivering some of the biggest changes to the Australian health system since the Whitlam Government introduced Medicare in 1975.

These changes are focused on preventive care at community level, backed by better resourced acute care hospitals. But they will also require a major effort to train and retain nurses.

“I see the role of nursing as critical for a few reasons,” Ms Plibersek told The Lamp in an exclusive interview. “We have workforce shortages in Australia and will continue to have them in some locations if we don’t continue to train more nurses and more doctors. But we also need to keep people already in the area engaged and interested and able to change their career according to different preferences in their lives and different life circumstances.”

She says expanding and developing the roles of nurses is an important part of keeping them in the health workforce.

“It’s also an important part of providing great services to the community. We know a lot of patients prefer to deal with a nurse, particularly if you’re talking about chronic disease management or mental health.”

Describing the introduction of the National Disability Insurance Scheme, due to be introduced by May 2013, Ms Plibersek said: “It’s as big a deal as Medicare, so there will be a need for an expanding disability services workforce.

“Having said that, I don’t want to underestimate how important the shortage of people to work in disability and ageing is right now because of the disparities we see there. The cuts the New South Wales government is making in a whole range of different areas are hugely concerning for patient care. You can’t cut $3.5billion out of the state’s health without compromising patient care.

“The New South Wales government says it will redirect some of that but that’s still a substantial cut. That $3.5billion has to come from somewhere and in part it’s coming from wages and conditions, in part from fewer services. Anyway you look at it, it’s a problem.”

First hand experience

Ms Plibersek’s first hand experiences with nurses reflect her own health needs. Her third child Louis was born at the Royal Hospital for Women in Randwick on October 1, 2010.

With 75 Labor MPs to the Coalition’s 74, opposition leader Tony Abbott granted her a “pair” – meaning an absent MP’s vote in parliament is neutralised by sidelining an MP from the other side – for just four weeks.

This placed young Louis very much at the centre of power, with his mother breastfeeding and back at work full time within three months of his birth. Some of the less usual trappings of the ministerial office – playpens, bassinets and nursing bras – were very much in line with her portfolio duties at the time as Minister for Human Services and Social Inclusion.

Ms Plibersek acknowledges that having a nanny, plus the introduction of childcare facilities in Federal Parliament as more women of child bearing age have been elected, made her more fortunate than many working mums. Though with such a fragile majority, it must have been tough to stick with her philosophy of breast is best for mother and child for the first year.

Hardly surprising then, that she counts time with lactation consultants among her best personal experiences with nurses.

“Like most people I’ve had experiences both being in hospital and having family members in hospital and I see the extraordinary dedication of nurses who look after patients,” she said.

“I’d say that the particularly good experiences I’ve had have been in two areas. The first with midwives and lactation consultants and with nurses who’ve gone on to specialise in looking after women before, during and immediately after the birth of their babies. I’ve had almost universally terrific experiences with them.

“And the second area is with palliative care. Anyone who has been with someone as they’ve gone through the last stages of their lives, in and out of hospital and in and out of palliative care, would see the comfort and support from a nurse that goes beyond medical care. The emotional support nursing staff in palliative care give to patients and their families is irreplaceable, absolutely irreplaceable. You can’t put a dollar value on it.”

Policy of prevention

The federal government’s health policy emphasis on prevention is not necessarily an easy option in the complex field of powerful special interest groups that all administrations must confront when big changes are under consideration. And there are few more powerful lobby groups than big tobacco.

Ms Plibersek says the government’s plain packaging measures have removed the last advertising opportunity from tobacco companies.

“The fronts of cigarette packs were like little mobile billboards,” she said. “The big tobacco companies see this as the last gasp of their dying industry and they’re pulling out all the stops to oppose our measures.

“They took us all the way to the High Court, and while we were pleased that we were successful, we still have international action against us, where cigarette companies are working hand-in-hand with some tobacco exporting countries to take us to the World Trade Organisation or use bilateral trade agreements against us.

“So it’s been a tough fight and it’s still on. I don’t know that we can comfortably celebrate the victory yet.”

The stakes are high on both sides, with the treatment of smoking-related death and disability costing Australian taxpayers around $31.5billion a year, and lung cancer the largest cancer killer across the population.

Medicare local

A less internationally significant, but equally ground breaking, change in the delivery of medical care has been the focus on Medicare Locals.

“This is where we are really making primary health care decisions at a local level, working beyond the traditional GP practice, including nurses and allied health professionals in order to provide integrated and comprehensive primary health care services,” Ms Plibersek said.

“We know that countries that spend a similar proportion of their overall budgets on health do better if more of that spending is at the primary health care end, keeping people healthy and out of hospital.

“It doesn’t mean that we don’t invest in acute hospital services. We do. We’ve massively increased the funding to the hospital sector and will continue to do so.

“But if we can keep people healthy and out of hospital that will be a great achievement and the emphasis on Medicare Locals and GP super clinics is part of that.”

Last year Ms Plibersek announced a $4billion dental health scheme that included $2.7billion for the treatment of children and $1.3billion to states and territories to expand existing services.

“I’m incredibly proud of the investment we’re making in dental. Essentially it will be as easy for 3.4 million kids to see a dentist as it is now for them to see a GP. We’ve also got a massive boost for the public dental systems in the states to treat more needy patients.

“I’m also proud of the expansion of the bowel cancer screening program and Gardasil for boys is another favourite of mine. It means we will have better protection for girls and boys from cancers related to the human papilloma virus.”