Anne Daniels, President
NZNO Tōpūtanga Tapuhi Kaitiaki o Aotearoa

Curiosity (from Latin cūriōsitās, from cūriōsus “careful, diligent, curious”, akin to cura “care”) is a quality related to inquisitive thinking, such as exploration, investigation, and learning, But there is also a saying that ‘curiosity killed the cat’. This suggests that asking too many questions might get you into ‘hot water’. Curiosity has not always been encouraged. In fact, censorship has always been evident in our political and societal history. Censorship is used to control and restrict the choices of individuals and groups and is a hallmark of far-right politics.

Challenging such ideologies start with challenging conversations. Censorship is the antithesis of being open to having challenging or difficult conversations within our society and in our workplaces. But challenging conversations are necessary to become aware and informed of potentially conflicting opinions. When the option to have challenging conversations is taken from us, many of us, rightly, push back.

Very recently Sir Colin Tukuitonga (Professor of Public Health, Auckland University and President of the New Zealand College of Public Health Medicine) described the current Coalition governments decision to demand that Medical Officers of Health must get their employers permission to speak out about health issues, as censorship. Professor Micheal Baker (Otago University Public Health Specialist) stated that this policy would ultimately reduce the ability of our system to respond to public health issues and safety. Further it has been noted that complying with such a policy would breach collective employment agreements and if extended to other health professionals, their ability to practice to the standard required by the Health Practitioners Competency Assurance Act and consequent regulations and competency standards.

This is just part of the attack on the regulations that support patient safety. It started with the austerity policy of ‘freezing’ nurse, doctor, and support staff recruitment. It continues with the proposed deregulation of regulated health staff, which once again does not put patient safety first. In a recently published review paper by the Minister of Health entitled “Putting Patients First: Modernising health workforce regulation, patient safety is mentioned once over 13 pages, whereas cost, bloated bureaucracy, red tape and various types of ‘assistants’ were mentioned frequently. Current regulations not only put patients first, but they put patient safety as the priority. Yet this government is trying to change this priority amid a workforce and patient safety crisis.

Recently Te Whatu Ora published a Clinical quality and safety review that analysed the results of care provided over the last ten years. It found that overall access to care at both primary and hospital level has deteriorated, particularly since 2020. Death rates in patients who left an emergency department without being seen increased. The number of complaints involving Te Whatu Ora, received by the Health and Disability Commissioner, has doubled from 330 to 653.

But reading between the lines and looking at what is not there is even more important. The actual rate of adverse events is unknown. With the exception of severe harm events, this information is not collected. Nor is there any mention of the relationship between workforce decimation and patient harm. However, quality and safety indicators that require nurse resource and time to prevent patient harm have deteriorated significantly, particularly since 2020 when Covid arrived on our shores and workforce pressures exacerbated. These include healthcare-associated Staphylocccus aureus bacteraemia, pressure area injuries, and DVT/PE injuries.

The relationship between high nursing workloads, lack of experienced, knowledgeable and skilled staff and deteriorating patient outcomes is well researched. Te Whatu Ora chose not to include workforce resourcing as part of its review. The question is why not? Censorship is not just about restricting free speech, it is also about restricting information, changing the messaging, and ‘putting the muppets back in their box.’

These sentiments are growing in Aotearoa and leading to a fractured cohesions where younger disaffected New Zealand men, under the age of 48, believe that having a strong leader in charge of the country, without the checks and balances of a democratic government is preferrable, another hallmark of far-right politics. We need to ask why and where this is heading. We need to have more challenging conversations not less and use facts not fiction in our kõrero. As a nation, we need, more than ever, to all be politically aware so we can stand up together and fight to keep our rights to freedom, democracy and a safe quality public health system. Only then will we be able to turn the tide of the deteriorating health and wellbeing of our nation.

Maranga Mai!