Ratios in the Public Health System
Stay up to date on the rollout of ratios
Following four historic statewide strikes in 2022, which convinced the incoming Labor government to pursue the introduction of ratios in public health, we saw the establishment of the Safe Staffing Levels Taskforce in April 2023.
This initiative has seen representatives from the NSW Nurses and Midwives’ Association hold regular meetings with NSW Health. Together, the parties have been working to chart the delivery of ratios in five key areas of public hospitals.
In September 2023, the NSW government shared the details of its first budget. While it went some way towards easing the decade-long neglect of the public health system, the reality is that more needs to be done to achieve the reforms we have been asking for.
Almost $1 billion was allocated for nursing and midwifery positions to help deliver ratios in public health. However, the current funding allocation is not enough to roll out ratios in every hospital, ward, and unit within the five designated specialties over the next four years.
Prior to the state election, Labor made a commitment to the people of NSW to deliver Safe Staffing in emergency departments, intensive care units, postnatal maternity, Multi-Purpose Services, and pledged to convert current nursing hours wards to shift by shift ratios. We must ensure future funding is committed to see these changes implemented across our state. Our message to the government is clear: Serious health reform is not negotiable.
The NSW government must expand the spread of ratios and deliver further improvements to your pay and conditions. This is a fight we will take right up to the next state budget in June. We will soon share more details on our campaign to secure ratios across every public hospital. Nurses and midwives deserve full certainty around the resourcing of ratios, and ongoing improvements to pay and conditions.
Where are we up to?
1 November, 2023
The Association continues to hold talks with the Ministry of Health regarding the implementation of minimum and enforceable ratios in five key areas across a schedule of workplaces.
Earlier this year, the Safe Staffing Levels Taskforce began this work with the ambition of firming up this rollout schedule by the end of October.
However, as flagged in the past few weeks, the Association recently sought the intervention of the Health Minister after talks with his ministry reached an impasse.
We now believe all parties are achieving progress in good faith, but what is clear is that more work is needed to clearly define the implementation of our ratios claim, and therefore the scope of the schedule.
NSW Health cannot prepare a schedule for the rollout of this reform until we have agreed on the implementation of our ratios claim within the safe staffing levels. Whilst we need the rollout to start as soon as possible, the Association is acting to ensure we achieve as much reform as possible within this round of funding.
We’re committed to ensuring the new staffing system is transparent, accountable, and enforceable – and we continue to stress this in these negotiations.
27 October, 2023
The Association has held productive talks with the Ministry of Health and all parties, including the Health Minister, believe progress has been made in good faith as to how ratios shall apply.
Attention has now shifted to finalising the implementation detail coming out of the Safe Staffing Levels Taskforce. This will allow us to bring comprehensive information to members for your consideration.
We have been determined to ensure this new ratios system is transparent, effective and enforceable, and although we have experienced delays in this process, we maintain these requirements are essential to delivering real and systemic change in the long term, and that we cannot proceed without them.
13 October, 2023
The Association held further discussions with the Ministry after analysing data shared with the Safe Staffing Levels Taskforce. Despite our efforts to negotiate to ensure this rollout is successfully delivered, there were still a number of matters that the parties were unable to reach agreement on.
As a result, the Association sought intervention from Health Minister Ryan Park to work with both the union and his Ministry, in an effort to find a path forward.
Talks with the Minister and the Ministry are set to continue and further updates will be provided once available.
After more than a decade of neglect and decline under the former government, it is Labor’s duty to do what is right and ensure this policy is implemented as it was intended.
21 September, 2023
On 19 September, the state government shared the details of its first budget. While the budget went some way towards easing the decade-long neglect of the public health system, the reality is that more still needs to be done to achieve the reforms we have been asking for.
Almost $1 billion was allocated for nursing and midwifery positions to help deliver ratios in public health. However, the current funding allocation is not enough to roll out ratios in every hospital, ward, and unit within the five designated specialties over the next four years.
Click below to hear our assessment of the budget.
7 September, 2023
The Association signed a Memorandum of Understanding with NSW Health. This binds both parties into ensuring ratios go into your Award and will then be implemented via a scheduled rollout.
In the most recent round of talks, the Association continued to examine the scope of FTE that is available, how the schedule will firm up, and what the rollout will look like into the future.
Please click below for more.
25 August, 2023
The Association continued meeting with the Ministry of Health as part of the government’s Safe Staffing Levels Taskforce.
The most recent round of talks centred on how this ratios claim will apply. Specifically, the Association assessed the Ministry’s data around the full-time equivalent (FTE) level required to convert all workplaces within the five areas to a ratios model, vs. the amount of FTE in the current budget.
Please click below to hear where things stood.
Frequently asked questions
The NSWNMA has held regular meetings with the Ministry of Health as part of the state government’s Safe Staffing Levels Taskforce, which was established back in April 2023.
Throughout this process, we’ve ensured the voice of members has been heard, and we’ve been firm in conveying our expectations to the premier, treasurer, health minister, and health officials. This includes the delivery of minimum and enforceable Safe Staffing ratios in five key areas across a schedule of workplaces:
- Conversion of current NHPPD units/wards to 1:4 shift by shift ratios
- 1:3 in EDs
- 1:3 in postnatal maternity & review of Birthrate Plus®
- ICU staffed to the latest Workforce Standard outlined by ACCCN
- Three nurses on shift in MPSs where the ED is open 24/7
Recent talks with the Ministry indicated that the government’s funding simply does not meet the financial requirements to see ratios rolled out in these five key areas right across the state. This concern was confirmed when the delayed state budget was finally announced on 19 September 2023.
The budget papers have shown that almost $1 billion has been allocated for nursing and midwifery positions to help deliver ratios in public health.
However, the current funding allocation is not enough to roll out ratios in every hospital, ward, and unit within the five designated specialties over the next four years.
Our campaign has shifted to ensuring that the state government increases its funding as part of the next budget. This is essential to ensure ratios are delivered as intended – in the five key areas right across NSW.
We know ratios save lives, that’s why ratios are essential in all public hospitals. This is something we’ve championed since the establishment of the government’s Safe Staffing Levels Taskforce in April 2023.
Through our talks with the state government and the Ministry of Health, we’ve made it clear that comprehensive funding is needed to deliver the ratios rollout this state deserves. Despite initial hurdles and differences in approach between the Ministry and the Association, we believe all parties, including the Health Minister, are working in good faith to see ratios delivered in a sensible and sustainable way.
Given the complexity of the state’s health system, there has been a large volume of Ministry data to analyse, but we have been committed to making informed decisions throughout this process.
The state government’s commitment of almost $1 billion for nursing and midwifery positions to help deliver ratios in public health is a start, but there is more to do.
We’re asking the NSW government to allocate increased funding towards the rollout of ratios, to ensure they are applied in the five agreed areas across the entire state, in every ward and unit, in every public hospital.
With the next state budget due in June 2024, we’re asking the government to immediately start work to increase the funding for ratios.
With the proper funding to deliver a ratios system safely, we can reform our hospital system ensuring that every patient in NSW gets the quality care they deserve and voted for.
The key focus at this time is getting ratios into the Award.
Work is ongoing as we negotiate the details of what this rollout will look like – including the schedule. Our aim is to have this done, and the implementation phased in, as soon as possible.
What the most recent state budget confirmed is that the full-time equivalent (FTE) level required to convert all workplaces within the five key areas is not met by the FTE allowance committed by the government.
Once ratios are in the Award, our focus shifts to fighting for more sites, and more specialties to have ratios implemented.
The Premier, Treasurer, and Health Minister must allocate increased funding towards the rollout of ratios, to ensure they are applied in the agreed areas across the entire state, in every ward and unit, in every public hospital.
Victoria, Queensland, South Australia and the ACT have made nurse/midwife-to-patient ratios law. Western Australia has begun rolling out ratios in public health, and Tasmania has a commitment to progress a ratio rollout.
Thanks to the collective activism of members, and strong negotiations by NSWNMA leaders, NSW received a commitment to introduce nurse/midwife-to-patient ratios following the March 2023 state election. However, the Labor government must go further to ensure these ratios are implemented safely and sustainably across the five agreed areas.
