In response to Plunket nurses’ concerns that Auckland’s draft plan might see nursing services curtailed, Plunket says its core services will remain unchanged.

A draft discussion plan for  Plunket’s Tamariki Ora/Well Child services in Auckland talks about reshuffling existing nurses to increase staffing in higher need areas and more evenly distribute staff between clinical leaders. It also says some clients, based on assessed needs, may travel further for clinic appointments and have fewer home visits – while high-needs clients would receive more visits and increased support.

Danielle Davies, the NZNO organiser for Plunket, said its Auckland members say they are understaffed and more staff were needed – not a staff reshuffle. In a submission, NZNO Auckland Plunket members said they were very concerned that the understaffing meant that it was almost the ‘new norm’ that babies were often not seen by Plunket until they were 12-13 weeks old. Staff were also concerned that Plunket may be shifting towards deciding whether a client was ‘low needs’ or ‘high needs’ based on the community they lived in rather than their assessed needs.

Davies said some members reported being told that 10-minute ‘drop-in’ clinics being piloted in West Auckland could be used for ‘low-needs’ clients as substitutes for the much longer home visits and clinic appointment currently offered. Also that nurses could save time by not following-up ‘no-shows’ to drop-in clinic appointments by low-needs families.

But Plunket Chief Nurse Dr Jane O’Malley said it remained committed to offering its universal service to all families and whether a client was ‘low needs’ or ‘high needs’ was still decided by a nurses’ clinical judgement and not where they lived. She also said drop-in clinics were being offered as an additional service, not a replacement for the seven core contacts between Plunket nurses and families offered by Plunket under its Tamariki Ora/ Well Child contract.

O’Malley understood the Auckland draft document was intended to stimulate discussion about how the region could do things differently to meet client needs and was not suggesting that the current universal core service to all families would be taken away.

She said Plunket was working within its budget to manage huge growth in babies being born in some regions with influxes of young families and new babies – including areas like Hobsonville in Auckland, Central Otago and post-quake growth in the western edge of Christchurch. “Naturally it’s our core business and we have to move our staff to where the need is – and that is done on a regional and local basis.”

Just over three-quarters of Plunket’s budget comes from Government funding. It received its last increase in Government funding in 2014 and ended the 2016-17 year with a multi-million operating deficit. A Plunket spokesperson said Plunket had budgeted for a further deficit for the 2017-18 year and was tracking to that budget.

O’Malley said Plunket was in discussions with the Government over funding, meanwhile its staffing numbers were stable and it made the best use of the resources it had available.

She said it worked hard to ensure that nurse caseloads were manageable and Plunket’s electronic record system indicate that Plunket nurse caseloads were roughly the same around the country (with differences mostly attributable to travel time, experience of staff and client need).

O’Malley said each core contact required Plunket nurses to assess and gather information on everything from the babies weight, height and developmental milestones to the domestic violence and the mother’s maternal health. The nurse then used their clinical judgment to assess whether the family needed additional support beyond the seven core contacts – like possibly being offered a brief drop-in clinic visit to check the weight of their baby.

O’Malley and Plunket CEO Amanda Malu were both in Auckland next week and would be talking to staff about the issues raised.

NZNO has about 300 members in the Auckland region, including Plunket nurses, clinical leaders, karitane and kaiāwhina health workers and administration staff. The NZNO Plunket collective agreement has about 1000 members and expires in February next year.

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