New Budget spending for health is welcomed but the nursing sector is still bracing itse
lf for service cuts and restructuring.
Gary Lees, chair of directors of nursing group NENZ said the new money showed health’s priority but was still less than needed to stand still. “This will put a lot of pressure on district health boards,” he said. “Many of which are already struggling to manage deficits.”
NZNO chief executive Geoff Annals said the Budget was tighter than hoped for but the real challenge would be whether it fed the existing rush by DHBs to cost-cut, or encouraged innovation.
“There are lots of service re-organisations and reviews going on – many will be driven by needs to cut costs.”
Annals said it would be a test of nerve for DHBs and providers whether the tight financial constraints “spurred” them into innovation or “tipped” them over to even more cost-cutting to come in on budget.
Jenny Carryer, executive director of the College of Nurses, believed health did well to get as much as it had. “I’m not suggesting that it will solve all the problems but there was quite a generous allocation of funding to health.”
She also did not deny the financial pressure that the health sector was under but believed “embarking on another major round of restructuring” was “immensely foolish”.
Carryer said international evidence showed that restructuring did not achieve the goals of greater efficiency and the health service was long overdue for a “radical rethink” including careful thinking about the fact that a third of the health budget was spent on the last year of life. “As a medicalised system we find it almost impossible to stop pulling out all the stops for people in the last year of life.”
Lees said money could probably be saved through efficiency improvements but this was unlikely to be sufficient without some very “radical service redesign”.
“The outcome then is that there may well be service cuts around the country as efforts are made to control cost increases.”
Annals said there was a huge potential for registered nurses, nurse practitioners and enrolled nurses to do much more then they were at present to improve services.
The recently settled national terms of settlement not only provided a two per cent wage increase but also provisions for innovations in service development and productivity.
“It’s a Budget that we are going to have to work with and one that we can work with.”
College of Mental Health Nurses president Heather Casey said the new funding of $174 million over four years for mental health was positive but it was unclear how it was to be spent. She said nurses were reporting concerns about cuts to frontline workers and the services they work within, as DHBs reprioritise service delivery.
After 12 years of building capacity she said the college would be working to ensure any additional funds were directed towards patient care.
Alex Craig, head of the national directors of mental health nursing said directors were already facing a challenging time trying to meet DHB cost-saving targets and the Budget would not make it any easier.
She said directors had developed a “hunker-down mentality” to meet the challenges of saving money at the same time as trying to introduce staff-intensive innovations like reducing restraint and seclusion use and introducing smoke-free inpatient units. “So it’s not just business as usual, as we’re making innovative changes which in the short-term could cost more.”
