Our public hospitals need proper funding and creative solutions – November 2007

There’s no doubt inherent problems exist in the public hospital system but the media attack on RNSH reveals the work of nurses is misunderstood and undervalued.

The recent media frenzy at Royal North Shore Hospital (RNSH) showed there is an elevated level of ignorance in the media and in the community about the lot of nurses.

This sad affair revealed that the work of nurses is misunderstood and undervalued particularly by people who do not have direct experience of hospital care.

For some time our members have been telling us – and this was borne out by the furore at North Shore – that the public and the media do not have a realistic idea of nursing skills, the range of activities undertaken or the level of responsibilities carried by nurses.

Workloads are often unrealistic and the workplaces can be chaotic, particularly in EDs – especially in winter.

The circumstances that led to the train of events that unfolded at RNSH are to be found to some degree or another in many other public hospitals.

The shortage of nurses and the skills mix on some shifts can lead to conditions that are sometimes less than ideal for some patients and this can be an unbearable burden for nurses. The fear of litigation or complaint from something going wrong is high.

Aggression is now a normal part of nurses’ work environment. It would not be unreasonable to describe the reaction of the media and politicians as another form of aggression.

We need less blame

Unfortunately, it is easy to use health and hospitals as a political football when a fiercely contested election is imminent. It is easier to look at the consequences and play the blame game than it is to identify the causes and fix the problem.

What has happened at RNSH is a prelude to what is sure to be a bitter election campaign where health will be a prominent issue, as will industrial relations.

While there is little difference between the two main parties on many issues, health and IR are two areas where there is a distinct choice. This issue of The Lamp contains an election pullout that looks at these issues in depth but I would like to touch on one thing.

The Howard government’s announcement that it will force state governments to reestablish local hospital boards is a step backwards and does nothing to develop or fund the new models of care necessary to reduce pressure on the hospital system (see page 14).

Simply having another level of government meddling in the administration of hospitals does nothing to deal with pressure situations like that experienced at RNSH.

We need to find and fund creative solutions such as a maternity-based system when pregnant women are experiencing difficulties, not the accident and medical emergency system. Developing and properly funding such an approach will take pressure off the general hospital system and provide a more focused service for pregnant women and their families.

A back-to-the-future approach won’t work

These are the types of creative solutions we need. Not a back-to-the-future approach such as reinstating local boards, with all the local politicking, narrow-mindedness and parochialism that goes with them. There needs to be genuine community input into health decision making at all levels. These boards, with all the local patronage and politics they entail, will not achieve that.

Disconnecting individual hospitals from the broader health system in this way would also be a disaster for the quality of care and range of safe services in many regions. The fact is, for a variety of reasons, not every hospital can provide every service. It is not in the interests of stronger health care to have individual hospital administrators deluding themselves and their local communities that they can.

The NSWNA is also very concerned about the prospect of the Howard government, if it is re-elected, using these boards to meddle in the employment conditions of nurses and other hospital staff. This is code for forcing WorkChoices and AWAs on public hospital nurses, just as they have used funding negotiations to force them on other sectors such as higher education.

Our public hospitals do have various problems that need addressing. But they need funding for positive and creative solutions, not a step backwards into parochialism and lower nurse wages.