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Monthly Archives: October 2024


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(Un)Intended consequences

Anne Daniels, President
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

Unintended consequences are outcomes of a purposeful action that are not  planned or foreseen. The concept provides a useful tool for explaining complexities resulting from government policy and law. For the less serious matters, it can be laid alongside Murphy’s law as a way to view outcomes that perhaps should have been seen as self-evident. For more serious matters, it provides a perfect lens through which to view and analyse complex reactions and the impact of change. As a case in point, one could ask if there are any (un)intended consequences regarding the current Coalition Government’s position on the Dunedin hospital rebuild?

Unintended consequences can be seen as intended if they are driven by the need for an immediate solution, a need so urgent that the decision to ignore outcomes is deliberate such as the strong and repeated evidence that Dunedin must have a tertiary level care hospital to support not only the Otago region but the whole of the South Island. There are currently only two, the other being Christchurch Hospital.

There is also the concept of a “self-fulfilling prophecy” which describes a false definition of the situation evoking a new behaviour which makes the originally false conception come true such as misinformation through the use of specific language that negates and hides the truth. An example of this is the Government saying the Dunedin hospital rebuild will happen suggesting we will get the tertiary level care hospital that is needed for the whole South Island but offering a secondary level hospital instead.

Currently, Dunedin Hospital provides tertiary level care (see primary, secondary, tertiary, and quaternary care). It’s services support all primary and secondary health and regional hospital services within the Otago region which has increasing demand as it grows as a vibrant and growing tourist mecca. Dunedin Hospital also provides a myriad of high-level specialist care services to meet the patient need throughout the South Island. And, as identified in the original 2021 business case, one of the key drivers for change is  Otago’s high older population who are more likely to experience health challenges such as stroke (70% of strokes occur in patients 65 or older), heart attack (60% of MI occur in patients 65 or older), abdominal aortic aneurysm (triple A), or trauma (over 40% of people over the age 65 experience trauma and are more likely to die than younger people).

Why is this important?

If the Government gets its way and the level of tertiary care is reduced, what will this mean for patients? We all know TIME is brain/heart muscle and we have heard of the golden hour in trauma care. Acute care is usually time-sensitive and can result in death or long-term disability if the person does not quickly receive the care they need. Further, advanced trauma care can only be provided by Level III intensive care units and Emergency Departments, of which Dunedin Hospital is one of two in the South Island.

Reducing capability and capacity of the “new build” will also reduce the level of care and the ability of the Otago Medical School to provide the level of clinical placements it needs to continue to attract students. This in turn will impact the economic outcomes of the city and region. Fewer services mean fewer health care professionals and support staff, and poor if not tragic outcomes for the people who need tertiary care services. Lastly, the impact on demand for the Christchurch Hospital tertiary level care (if it is the last one standing) will be monumental.

On 23 October 2024, the Council of Trade Unions led a nationwide revolt against “the most anti-worker government in decades, who are attacking rights of workers and the right to publicly funded health care that meets the need of the people over their lifetimes”. Thousands of people stopped work, as was their right, and made it clear to the Coalition Government that when workers have their backs against the wall, they will fight back, and win. The Dunedin hospital rebuild is not a regional issue, it belongs to all of New Zealand. it will set a precedent for this Government, to continue to divide, rule, and dismantle. But together, we are fighting back, and we will win.

To be a part of the change you want to see, please sign and share the petition to build (Dunedin Hospital) it once, build it right..

You can sign the petition here


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There are benefits to sharing power with one million Māori

Kerri Nuku, Kaiwhakahaere
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

It’s not unusual in any political cycle that indigenous people are used as political fodder. Internationally, nationally and regionally, indigenous people are blamed for increasing violence, homelessness, poverty and draining state resources particularly in justice, welfare and health.

It becomes easy for ordinary people to believe this because the perpetrators of lawlessness and violence, relentlessly splashed all over the media, are disproportionately images of people of colour. At the heart of these political games are people, children and mokopuna who are already prejudged by parts of society because they look a certain way or are born into a particular class of people.

Shifting the burden of responsibility is easier to do because it is harder to admit that we have failed as a country and we have failed to support our indigenous people.

In Aotearoa, a year into the Coalition Government, attacks on workers, unemployed and Māori are clear to see. From the Treaty Principles Bill and the Māori Wards referenda to the scrapping of Fair Pay Agreements, benefit sanctions, and the war on health and safety legislation, this is a right-wing Government bent on stoking racism, eroding worker rights, and helping the rich get richer.

The assault on our rights is overwhelming, but it has also heightened the consciousness of those who want a more just world. Yet, though we say it all the time, we have to acknowledge that even though this coalition is absolutely terrifying and hateful, no Government of the past few decades has made truly transformative change that benefits the health of our people.

We can’t wait for more promises from politicians or experts to tell us what we already know. We know what it would take to be truly valued in the work we do, and we know what it would mean to live in a society that upholds equity, human rights and Te Tiriti o Waitangi.

We all know what Māori health inequities look like.

As nurses, we know Māori are unlikely to live as long as non-Māori. We also know that by the time many Māori reach the hospital, their illness is advanced and sadly, the clock already began ticking for them before we even triaged them.

There is one common question I’m often asked by non-Māori members and colleagues, who like me are sick of seeing so many tangata whenua die of things that could have been prevented or treated if caught earlier.

That question is: “what’s the best way to address Māori health inequities”?

In my view, the answer does not lie in the medical or the clinical.

The answer lies in sharing power (and responsibility) with Māori at all levels from the boardroom table to the frontline, backline and sidelines, inside and outside our union.

The Māori population is now at its highest – one million – and at the rate my whanau, hapu and iwi are going, it will only rise.

From the people of Ngai Tahu in the South Island to the people of Ngapuhi at the top of the North Island, Māori want the genuine partnership guaranteed to them in Te Tiriti o Waitangi. They want to be in control of their own destiny, they want mana motuhake.

Māori have proved they can fix themselves when power, and that includes resources and spaces, are shared with them and when they are not micromanaged.

In the 1980s, the Māori language had almost become extinct until Māori created the kōhanga reo movement. Forty years later, the language has been saved – tens of thousands of Māori are speaking it. And hundreds of thousands of non-Māori are benefiting too.

At NZNO, we are still on the journey of sharing power, resources and spaces with Māori. The position I hold is a clear example that we have started that journey. But it must not stop there.

We must let Māori fix themselves. Tangata Tiriti or non-Māori in Aotearoa can do that by sharing power, resources, spaces with Māori at every level of our mahi.

Sometimes that means tangata Tiriti stepping aside to let Māori talk rather than talk for them.

What’s good for Māori, can only be good for this nation because when the most disadvantaged in our society are empowered, everyone in that society benefits.