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Give me the tools to do a good job

Female mechanic

A fast red car or nursing degree in my middle age? I decided on my long held dream of the nursing degree. So now, I’m part of a team of extraordinary professionals who remind me every day that flagging the fast car was the right decision. I love my job, I love and respect the people I work with and I care passionately about those I am charged to care for.

But, every day it’s getting harder. Harder to care the way I want to, the way I know I should and to care to the standard that my job description and Nursing Council expect of me.

This sounds emotive – it’s meant to be! Last time I looked I’d signed up for the ‘caring profession’, I’m paid to care – not to short change my patients. I didn’t for one moment, while studying, consider that I would have to factor ‘care rationing’ into my day. Care and rationing don’t even belong in the same sentence – It messes with a nurse’s head, it shouldn’t even be a concept!!

Most people have no idea how much these constant budget cuts impact on my ability to do my job. A few get a snapshot, when they are unwell and require medical help. If I’m lucky they are empathetic and understanding of the difficulties nurses face every day, they appreciate what we do and how hard we work.”

If the Minister of Health, Dr Coleman is going to name and shame hospitals who fail to meet the ‘ED Six Hour Target’, then he should be obliged to give the public the full story – the reasons why this is happening in the first place! Perhaps explaining that some EDs have increasing, unprecedented presentations – some patients very unwell, needing massive resource input, so others sit for hours waiting to be seen because there aren’t enough nurses or medical staff to keep the patient flow going. Or maybe that the hospital is in ‘bed lock’ – not a single bed, until hurried discharges are made – a short term solution, because some of those patients will be back in ED, sicker- requiring a higher level of care and  another admission. Or maybe that some days ED waiting rooms are full of patients who could have gone to their GP, but have left it too late, or couldn’t get an appointment, or didn’t have the money.

Nurses were voted the ‘most respected profession’ survey this year. I don’t feel respected by our government. If the government respected us and our work, they would make sure that nurses had the tools to do their job, and to do it well.  Our health service is being stripped so bare, many nurses are walking away or planning to. They’re done with the stress, the shifts that end in tears, not wanting to go back tomorrow.

I just want to be able to do my job properly, safely and go home knowing I’ve done a good job. Our health system should be given a realistic budget that allows it to function properly.

If we want things to change then it’s up to nurses to say so – nobody else is going to! So do we wait until the next pay round?  Do we wait for a nurse to make that error we all dread? Do we keep waiting… for what? It’s time to use the strength of our union to give the public the full story of what is happening to our health system and why that system is letting them down. To say nothing is negligent!

By NZNO member Ady Piesse

Photo credit under Creative Commons licence.


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The demise of democracy

RIP democracyNZNO industrial adviser for the DHB sector, Lesley Harry talks about democracy, privatisation and Southern district health board.

Last week the Minister of Health announced that Kathy Grant will stay on as commissioner of Southern district health board until 2019. Democracy is at a premium in the south these days.

Grant was appointed by the Minister in June and is paid more in a day than most nurses get in a week. Apparently her $1400 a day pay rate is due to the “personal risk to her reputation” of having to improve the DHBs finances in such a short period of time. To us, that’s a clear signal that Minister Coleman is aware that the cost-cutting and service-cutting that will ensue will be hugely unpopular.

Only time will tell as to the true cost of “savings initiatives” now that Grant and her team have an extra three years to deliver the required savings.

Grant has promised a “whole of system change with more care in the community, reducing waste and working in more efficient ways.”  Integration of primary and secondary services is on the agenda and this will likely lead to more hospital-based services being directed to primary services with PHO and other private providers having more say on the way health services are governed, managed and delivered.

We will have to wait and see what will be proposed, but I am concerned that this current Government will exploit the sacking of the Board and appointment of a commissioner to move towards more privatisation of public health services in the southern region as a model for the future.

The commissioner has delivered on her commitment for improved communication with DHB staff and stakeholders, with meetings and regular updates. Long may that continue.

Although, the commissioner’s goals appear laudable; it’s the how? and at what cost? we need to keep a careful watch on.

The citizens of Southland and Otago no longer have democratically elected representatives governing their health services. The Minister and his appointed commissioner have enormous power to implement change.  Whose interests will be served will remain unclear for longer, now that voters will have to wait until 2019 for democracy to be reinstated in the southern region.


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The Budget and the MECA

scalpel12This past week has been a busy one. Thursday 21 May was Budget Day. It’s a day we are always on the edge of our seats, hoping for a plan for health that delivers for our members and all New Zealanders.

And the day after that we held our final meetings about the offer from DHBs for our multi-employer collective agreement. The results of those meetings did not surprise us but what we didn’t expect was the extent to which NZNO members working in DHBs rejected the DHBs’ offer. Over 82 per cent voted no.

This years’ Budget does not provide enough funding to meet the health needs of New Zealanders. In order to meet the costs of rising prices, an increasing population, an ageing population, an ageing health workforce, long overdue decent wage increases, new services etc etc, we estimate the funding allocated is at least $260 million short.

District Health Boards (DHBs) are short-changed by at least $121 million. And we know almost all of them are already struggling to manage massive deficits, meaningless health targets and the continuing push from government to “centralise” services at any cost.

How are DHBs going to deal with the likely flow-on impacts on safe staffing, workplaces that are healthy for staff and patients and quality care?

Nurses, midwives, caregivers and other health care workers are telling us they are already stretched to the limit. Some are having to sacrifice tea and lunch breaks and are working unpaid overtime just to keep up with the care they need to give to ensure needs of patients are met. Support for training and development is decreasing. Stress levels are rising and morale is low.

And it’s not only DHBs that are bearing the brunt of reduced spending. Efforts to reduce poverty related illness are not being tackled in a “joined-up” way.

Health workforce planning is proceeding at a snail’s pace. New graduate nurses are still looking for jobs that aren’t there. Older nurses are still being pressured to work night shifts.

Health workers need a fair deal to cope with the increasing demands that are being placed on them.

And this means we need to stand together to make progress in our bargaining with the DHBs for our multi-employer collective agreement.

NZNO members working in DHBs don’t feel valued. They instructed the negotiating team to retain what’s already in the MECA, secure a decent pay increase, improve access and support for professional development and advance safe staffing and healthy workplaces.

The DHBs’ offer clearly didn’t cut it. They need to do better for their largest group of workers.

We’re heading back into bargaining on Thursday with a clear mandate: the offer must be improved. Nurses can no longer continue to take up the slack for a sick health system.

We can’t do all the work here! DHBs need to take some responsibility for advocating for the funding that provides appropriately for every member of staff and every patient. New Zealanders won’t settle for anything less.


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Southerners won’t back down

Nurses at Dunstan hospital celebrate International Nurses Day

Nurses at Dunstan hospital celebrate International Nurses Day

Southerners are gutted to hear of a five percent funding cut to their network of rural community hospitals in Oamaru, Ranfurly, Dunstan, Balclutha and Gore.

And if that’s not bad enough, there will be reviews of health services and no increases for changing costs or population. What that means is that if the population of your town increases, there won’t be any corresponding increase to health funding.

Hospitals are still working out what impact this will have on services and each hospital will be affected differently. What we do know is health services are under threat and so are many jobs.

At the same time, Southern District Health Board (SDHB) has announced plans to contract out and privatise its food service, with frozen meals being driven down from Auckland, in a further attempt to save money that threatens local jobs. We can see no sense in that whatsoever!

So why is all this happening? Southern DHB’s financial situation is pretty grim – they are $27 million in the red this financial year and are predicted to be at a $42 million financial deficit next year. When DHBs are squeezed this tight, something has to give. This time it’s the health of our rural communities, not to mention their nutritional needs!

While we don’t know all the reasons for their financial woes, or why they are so much worse off than other DHBs, we do know that a contributing factor is the year in, year out, underfunding of health services in New Zealand [pdf].

It’s this Government’s seventh budget this week, and they’ll be announcing funding for health for the next year. If they get it wrong, we’re looking at losing local jobs and local health services. Without more money coming in, it’s hard to see how Southern DHB will be able to preserve all the health services the population needs.

It’s not fair that valued local services, through no fault of their own, have to bear the brunt of Southern DHB’s deficit. NZNO will be working constructively with the affected rural hospitals to save services and protect member’s jobs. Not only will these cuts put patients’ health at risk, but removing skilled jobs from the regional economy impacts on the region’s long term financial health.

This ends up costing the Government more in the long run through health, social services, and other agencies. Southerners understand this, and we will be backing them all the way to find healthy and sustainable solutions to the District Health Board’s financial crisis.

Watch this space for NZNO’s response, and updates on the Southland and Otago rural hospital network plan for dealing with the cuts.

 


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The underfunding of DHBs

Bill Rosenberg is the Policy Director/Economist at the New Zealand Council of Trade Unions Te Kauae Kaimahi. He is widely published on globalisation, trade and e-learning. You can read Bill’s monthly economic bulletins here

For the past five years, the Council of Trade Unions has analysed how much was approved for Health spending in each year’s Budget. The theme is “Has Health been given enough to stand still?” We look at the costs, the population pressures including the ageing of the population, and the promises for new services, and compare them to what is actually provided. You can see the reports which give details and show the assumptions we used here.

Treasury estimates of real changes in health spending after costs and population growth.health expenses

In the 2014 Budget we estimated that the Health Vote was $232 million behind what is needed to cover announced new services, increasing costs, population growth and the effects of an ageing population.

The Health Vote increased by $307.9 million in operational funding overall between Budget 2013 and Budget 2014 (from $14,134.6 million to $14,442.5 million). This is $185.6 million short of the $493.5 million we estimated was required just to keep up with costs without providing for new and improved health services. However the Budget in addition introduced “new policy initiatives” costing $120.1 million in 2014/15 (putting aside the bulk of the “initiatives” which were actually funding towards increasing costs and population pressures), bringing the total needed to $613.5 million. This was offset by “savings” totalling $73.6 million including $56.7 million that are not explained, plus a reduction in the provision for risks such as epidemics or natural disasters of $17.0 million. If we take the savings at face value, the total shortfall is therefore $232.0 million.

District Health Boards (DHBs) were underfunded by an estimated $94 million just to cover increased costs and demographic changes. When the costs of new services which the DHBs are expected to provide are taken into account, the shortfall is likely to be well over $100 million.

Centrally managed national services such as National Disability Support Services, National Elective Services, National Emergency Services, National Mental Health Services, Primary Health Care and Public Health services received $134 million below needs.

We don’t look at capital funding in any detail, but it rose sharply: from $520 million in Budget 2013 to $1,114 million in Budget 2014. This follows a significant increase in capital expenditure last year. In the 2012 Budget, $289 million was budgeted for capital. The Ministry of Health had observed in its Four Year Plan that “Capital investment is needed nationally because a significant proportion of hospital buildings are in poor condition[1]. While the increase in capital funding is much needed, increased capital assets create additional costs for DHBs because they have to pay the government capital charges and must provide for depreciation. As Treasury noted in 2013 Budget papers, “new capital builds are more likely to result in large deficits for DHBs”[2].

We also had a look at the cost of the welcome policy initiative to enable children under 13 to have free access to GPs and free prescriptions from 1 July 2015. Our estimate was that it could cost closer to $40 million per year rather than the $30 million in the Budget estimates.

How good are our estimates, and what about the forecast funding for the four years to June 2018 which are part of the Budget? In past years, Ministry of Health estimates of the funding shortfall were released, but they were largely redacted from documents released following the 2013 Budget.

However, for the year to June 2015 (financial year 2014/15) Treasury is forecasting health to have a real growth of negative 2.3 percent according to its spreadsheet issued with the Budget. On their figures we calculate that represents a shortfall of $360 million. So our estimate is conservative.

Greater cuts are forecast for the following three years. In the event, Health could get some more from the ‘operating allowance’ for new spending in those years but not enough is being allocated for this to cover the shortfalls in all the areas of the forecast Budgets, most of which will be in a similar position to health. (See the May CTU Economic Bulletin for more detail.)

Treasury estimates of real falls in Health funding after costs and population growth(Fiscal Strategy Model, 2014 Budget)
Year to June 2014 2015 2016 2017 2018
Percent -0.6% -2.3% -3.7% -3.6% -3.1%
$million -$82m -$360m -$587m -$559m -$488m

Treasury warned in the preparation of the 2013 Budget that such cuts would require major changes to our health services. This could include “more targeted services and funding” which implies dropping services, making some available only to certain groups, or introducing user charges[3].

 

[1] Vote Health 4 Year Plan for 2013/14 to 2016/17, December 2012, p.14, available at http://www.treasury.govt.nz/downloads/pdfs/b13-info/b13-2659847.pdf.

[2] Treasury Aide Memoire to Ministers of Finance and State Services, 6 December 2012, p. 6, available at http://www.treasury.govt.nz/downloads/pdfs/b13-info/b13-2505130.pdf.

[3] “Four Year Plan – Assessment and recommendation on final four-year plans submitted by Ministers to MoF and MoSS”, p.4-5, available at http://www.treasury.govt.nz/downloads/pdfs/b13-info/b13-2564298.pdf.


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Sometimes it’s the little things that matter

dinoScrubsWe all know there is cost cutting going on everywhere in the health system at the moment. DHBs are being forced to cuts tens of millions of dollars from their budgets and cost cutting measures (called “savings”) are being implemented in every ward and unit.

We hear every week about community health initiatives whose contracts with the DHB have been slashed. Clinics for refugee and migrant and other high needs populations are disappearing, aged care contracts are being squeezed and every hospital in the country is facing cut after cut after cut.

We know how stretched the nursing team is. Not being able to take annual leave, being called back from annual due to short staffing, vacancies not being filled, care being rationed – we hear sad stories every day.

I think it’s hard for people to get their heads around what’s actually happening in our health system. It’s hard to believe because when they or a loved one are in hospital the care they receive from the nursing team is so professional and they feel well cared for.

Today I heard that one hospital is stopping paediatric nurses from wearing bright, cartoon character scrubs. It’s a cost cutting measure. From now on all staff will wear the same plain blue scrubs.

That might not seem like a big deal; might seem sensible, even. But it’s not. It’s the little things that matter.

Being in hospital is one of the scariest things a sick child can face, and it must be pretty traumatic for family and whānau as well. Part of good nursing practice is to make the experience as comfortable as possible under the circumstances, and wearing bright, cartoon character scrubs is one way a nurse can help an ill child feel safe.

Putting paediatric nurses into plain scrubs might save the DHB a few dollars but the affect it will have on patients and families is more important than saving a few pennies. The philosophy of patient-centred care that turned paediatric wards into bright, sunny and interesting places with brightly dressed nursing staff, designed to put children and families at ease, is being turned on its head. It won’t be long now till children’s wards will be back like they were in the bad old days – dismal institutionalised places, not kid friendly at all.

That’s not what I want for our health system.

 

The image is from http://www.mightynurse.com/the-5-ws-of-pediatric-nursing/


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Nelson ED nurses get together to create change

successNZNO members at Nelson Hospital have had their voices heard. They have successfully advocated for quality patient care and a safe environment for staff.

ED staff have been concerned for some time that their work is being compromised by a lack of staff, and all the flow on effects of that situation.

Reportable events about staffing levels had been logged but no action taken. NZNO College of Emergency Nurses guidelines for nurse/ patient ratios were not being met and nursing staff were concerned about the potential for breaches of the Health and Disability Commission code of patient rights.

The ED was experiencing an increased number of high acuity patients and Government targets were not being met. Staff vacancies were not being filled in a timely way and staff were worried that more vacancies were coming up. Annual leave requests were being turned down and staff were becoming more and more stressed and fatigued. They were overworked and overwhelmed.

It’s pretty hard on morale if you work in an emergency department and you don’t have the resources to deal with an emergency!

It’s often difficult to see the wood for the trees when you’re feeling like that, so it is a testament to the courage and wisdom of NZNO members that they made a decision to do something about it, and then followed through.

A meeting with the Director of Nursing and Midwifery and the Nelson Associate Director of Nursing was called and members told their stories one by one. It was a powerful and moving meeting. Staff were honest, passionate and resolute that the situation needed to change. That was 2 weeks ago.

Within 2 days the numbers had been crunched and ED staff were notified that an extra 2.14FTE had been approved and were being advertised. In the interim, casual staff are being used to ease the workload.

It’s a great outcome, and one that only happened because NZNO members worked collectively to address their concerns. When we stand together we are heard.

Ehara taku toa i te toa takitahi. Engari, he toa takitini.

Success is not the work of one, but the work of many.