Voting in the three-yearly election for the three Council members elected by the profession closed on September 1, but the timing of the election and change of government has meant the results remain in limbo.
The Council can’t announce the elected council members until the Minister of Health has approved the nominated candidates. This was initially expected to happen before Christmas but the Nursing Council says it now understand the nominations are due to go before the Appointments Committee at the end of January.
Just over 10 per cent of eligible nurses voted in the election – the same turnout as the elections held in 2011 and 2014. There were 16 candidates for the three positions, including the current chair, deputy chair and a council member.
]]>Yesterday English confirmed former Health Minister Jonathan Coleman as opposition health spokesman and announced Waimakariri MP and former Canterbury District Health Board manager Matt Doocey as mental health spokesman.
Cantabrian Doocey has an MA in health care management from London’s Kingston University and worked in mental health and healthcare management in the United Kingdom before returning to Christchurch after the Canterbury earthquakes. He was elected to parliament in 2014.
Other health-related spokespeople announced included Whangarei MP Shane Reti as associate health spokesperson and list MP Jo (Joanne) Hayes as Whānau Ora and associate children’s spokesperson.
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Incoming Prime Minister Jacinda Ahern announced today that Manukau East MP Jenny Salesa will become the associate minister of health as well as the country’s first Tongan-born and Tongan-speaking Cabinet minister Also announced as an associate minister of health, but outside of cabinet, is US-born Green Party health spokeswoman Julie Anne Genter. (See Salesa’s and Genter’s full portfolio lists below).
Salesa, who has degrees in education and law from the University of Auckland, first came to New Zealand when she was 16 to further her education. Her commitment to warm, dry affordable housing springs from her family’s early experiences of homeless during their first 2-3 years in New Zealand which were spent moving from family to family in South Auckland and living in overcrowded conditions. She entered parliament in 2014 after more than 20 years’ experience worked as a health and education policy specialist in New Zealand and the US.
“I am immensely proud, as an immigrant and as a Pacific woman, to show that anyone who comes here can dream big and can be successful, through perseverance and hard work, at whatever they set out to do,” said Salesa. “New Zealand was a land of opportunity for me and as a Cabinet Minister I can play a part in ensuring it remains so for everyone who chooses to live here”, she said.
Salesa said she was honoured by her appointment in “this ambitious Labour-led Government, which has the mandate to tackle New Zealand’s housing crisis, the recent years of funding cuts and neglect in health and education and to ensure that economic growth delivers for all Kiwis.” Salesa, who entered parliament in 2014, said she was looking forward to briefings and then knuckling down to work.
Julie Anne Genter grew up in Los Angeles – where her father was a doctor and her mother a dietitian – and has been the Green’s health spokeperson for just over a year. Speaking to Nursing Review prior to the election about the Green’s health policy – that specifically mentioned free visits for under-18s to nurses as well as doctors – Genter said: “Of course we see nurses as vitally important contributors to health care and they need to be part of our policy solutions.”
She also said pre-election that the Greens wanted a sufficient funding increase to the Health Budget to allow for wage increases to keep pace with the cost of living. Other priorities were a mental health inquiry looking at not only investing more money but also effective early prevention and ensuring staff in acute wards were not overworked and struggling to cope with demand. “A lot of our health initiatives are outside the health portfolio like our transport and housing policies which would go a long way to creating healthier and happier towns, cities and environments.”
The UC Berkeley graduate studied in Paris before coming to New Zealand in 2006 where she gained a Masters of Planning Practice at the University of Auckland and worked as a transport consultant. She worked as a political and media advisor at Parliament before becoming an MP in 2011.
In June this year Genter’s Misuse of Drugs (Medicinal Cannabis and Other Matters) member’s bill, which would make it legal for the terminally ill and those suffering a debilitating condition to use cannabis with the support of a doctor, was drawn from the ballot.
MINISTERS of HEALTH
David Clark
Minister of Health
(Also Associate Minister of Finance)
Jenny Salesa
Associate Minister of Health
(Also Minister for Building and Construction, Minister for Ethnic Communities, Associate Minister for Education and Associate Minister of Housing and Urban Development)
Julie Anne Genter (Green Party)
Associate Minister of Health
(Also Minister for Women and Associate Minister of Transport)
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“I feel sorry for David Clark,” said Professor Jenny Carryer, executive director of the College of Nurses. “I think he’s inheriting a terrible mess…a slowly imploding health system.”
Incoming Prime Minister Jacinda Ahern today announced Dunedin North MP and former Treasury analyst and Presbyterian minister Dr David Clark as the new Minister of Health. Joining him as associate ministers of health will be the country’s first Tongan-born minister, Jenny Salesa and Green party health spokesperson Julie Anne Genter. Both Clark and Salesa are in cabinet (numbers 10 and 15 respectively) while Genter holds portfolios outside of cabinet.
Carryer said she was absolutely delighted at Clark’s appointment. “He has a strong background through Treasury of using evidence to inform policy and he is clearly a thinker and is background gives me great confidence that we will see some much more effective decision-making.”
She also noted incoming deputy Prime Minister Winston Peters’ comments last week and agreed that “we have been hell bent on a neoliberal/capitalist direction and it’s long overdue for a rapid reversal of how and why we do things…and where we get advice”.
Jane MacGeorge, acting chief executive of the New Zealand Nurses Organisation (NZNO), said the new minister showed a good understanding of the social determinants of health such as poverty and the quality of housing. (See also earlier related story: Nursing unions welcome new government)
She said NZNO planned to meet with the Minister soon to discuss building a more sustainable nursing workforce and the need for nurses to be consulted on policy impacting on nursing and health. MacGeorge said the ‘health spend freeze’ of the last few years had had a negative impact on nursing, particularly staff shortages impacting on the care nurses can provide patients and nurses’ ability to get coverage for professional development leave.
Dalton Kelly, chief executive of the New Zealand Rural General Practice Network, also welcomed the new minster and looked forward to working with him to “resolve the long-running health challenges facing rural communities.”
“It is encouraging to see that both Labour and New Zealand First have common ground in terms of primary care health policy, such as the recruitment and training of more GPs and health professionals, a review of the number and funding of DHBs and PHOs and a need to review and improve mental health services,” said Kelly.
Ian Powell, executive director of the Association of Salaried Medical Specialists said Clark had already shown a good grasp of the portfolio and the association had “high hopes that he will be willing to tackle the challenges facing public health. “These include years of significant under-resourcing of public hospitals, longstanding shortages of senior medical specialists, a high level of unmet need in our communities, and disruptive privatisation moves.”
He said members looked forward to working with the new minister to rebuild the public health system and ensure equitable, quality access to health care for all.
David Clark was born in Auckland and graduated from the University of Otago in 1996 with a BA and a Bachelor of Theology. He was a Presbyterian minister for three years before returning to the University of Otago to gain his PhD after which he was a Treasury analyst for three years then an advisor to then Labour cabinet minister David Parker in 2006-07 (under the Helen Clark Government). He returned to Dunedin in 2008 to become warden of Selwyn College until elected as MP for Dunedin North in 2011. On the resignation of longstanding health spokesperson Annette King he became Labour’s health spokesperson. The new Minister of Health has twice completed the New Zealand Ironman course at Taupo.
MacGeorge said it was pleased to see the new Government’s emphasis on ending child poverty and commended the incoming Prime Minister’s stance by becoming the Minister for Child Poverty Reduction. She said it also wanted to see more Māori nurses attracted into nursing and more nurses going into mental health. Plus it wanted the sector’s more senior experienced nurses to stay in nursing and for employers to accommodate these nurses’ needs to keep them in the profession.
David Clark
Jenny Salesa
Julie Anne Genter (Green Party)
Jacinda Ahern
Carmel Sepuloni
Phil Twyford
Nanaia Manuta
Peeni Henare
Aupitu William Siu
Tracy Martin (New Zealand First)
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Labour and New Zealand First have signed an agreement to work together as a coalition including setting out a number of coalition priorities (see health details below) alongside Labour’s own policy priorities.
Labour and Greens have signed a confidence and supply agreement which allows the Greens to determine its own position on policy matters outside the shared policy goals the two parties signed up to (see health-related goals below). A Green Party member will also hold an associate minister of health portfolio.
“In this parliamentary term, New Zealand First policy has a number of priorities to progress which Labour will support alongside its policy programme.” These include the following goals:
“In this parliamentary term, the Green Party has a number of priorities to progress the implementation of the Sustainable Development Goals. The Labour-led Government shares and will support these priorities.” They include the following goals:
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Jane MacGeorge, acting chief executive of the New Zealand Nurses Organisation (NZNO) said nurses are looking forward to a reversal of the 2017 ‘scrooge health budget’ and $2 billion going back into health. (Labour’s election policy was to allocate an extra $846 million for Vote Health in the 2018-19 Budget – $293 million to “pay back National’s underfunding” and $554 million for “delivering a modern health system” – and it then planned to nearly double that amount to $1.5 billion extra for health in the 2019-20 Budget.)
Glenn Barclay and Erin Polaczuk, the national secretaries of the Public Service Association whose members include mental health and public health nurses, congratulated Labour, New Zealand First and the Greens on forming a new government. “We’re looking at an exciting new progressive partnership between three parties that have campaigned on commitments to deal with the biggest issues affecting New Zealanders,” said Barclay.
MacGeorge said health was the number one election issue and it was looking forward to a ‘funding correction’ in health funding when the new government announces its first Budget in six months time.
“The underfunding of our health services has led several DHBs to cut costs, resulting in fewer nurses being available to ensure safe staffing levels and practice and cut backs in expenditure on basic healthcare tools,” said MacGeorge.“Many nurses we have surveyed said they believe this cost-cutting is affecting the pace of recovery of their patients.
The PSA said it hoped for significant action from the new Government on issues key to its 64,000 members including: “slow wage rises and underfunding in the public sector, housing shortages and affordability issues, growing unmet need in the health system, and equal pay for women and those working in historically female-dominated industries”.
Polaczuk said the country could chose to see the “very real structural problems” in society as daunting but she was confident that the next Prime Minister had “the experience and skill to see the task ahead as an opportunity to build a better country that benefits the many, not just the few.”
MacGeorge said health underfunding “rippled across the system” impacting on the time nurses had to support new graduates, on the ability to attract and retain senior staff and to take up training opportunities. It also had a negative impact on job satisfaction and workplace relations.
“Many DHBs now report no more savings are to be found. There is no more room to cut nurse staffing numbers to save more costs. As state sector employers DHBs know they can’t continue to run their staff ragged, and not take care of their staff well-being,” MacGeorge said.
She said NZNO would present its briefing to the incoming Minister of Health in due course and also hand over the 6000 signed Shout Out for Health letters from members and the public calling for greater public investment in health care.
]]>With the speculation now over, the country waits for the announcement of the new cabinet, including the new health minister and their associates, and what policies have been agreed to or compromised on during the coalition talks.
What is known is that Labour, New Zealand First and the Greens all committed prior to the election to a mental health inquiry, with Labour stating that initiating a review of mental health and addictions services to identify gaps in service was one of its priorities for its first 100 days in office.
Also on Labour’s “100-day” priorities was passing the Healthy Homes Guarantee Bill to ensure rental properties are warm and dry. Paid parental leave is also likely to be extended, with both Labour and New Zealand First policies including increasing paid parental leave to 26 weeks.
On the nursing front, both Labour and the Greens had policies to increase nurse-led school-based health services. Labour also had on its policy books to fund and additional 100 Plunket and Tamariki Ora nurses.
On the funding front Labour’s fiscal policy included an extra $21 million for health to “pay back National’s underfunding” in the 2017-18 year and $293 million for the following four financial years.
Labour also committed to increasing health funding generally starting with an extra $554 million in 2018-19 and increasing progressively to an extra $2.8 billion in 2021-22 to make an overall $8 billion extra committed to health over four years.
The Greens wanted health funding to match increased needs and New Zealand First’s policy called for a “public health compact stipulating guaranteed minimum services”. New Zealand First also wants to review the number of district health boards.
In the palliative care area, the Greens had policies to improve palliative care training for medical, nursing and allied health, and New Zealand First wanted palliative care services fully funded.
Green Party Leader James Shaw has also said that a public referendum on legalising cannabis for personal use would be held by the 2020 election as part of the agreement between the Green and Labour parties.
Pay equity is likely to be under scrutiny under the new government with Labour pledging to scrap the Pay Equity legislation currently before parliament and to make mental health workers a priority in pay equity negotiations. The Labour and Greens inquiry into Aged Care noted that the pay equity settlement had created funding concerns for the sector, including the loss of pay relativity for registered nurses.
In the area of aged care, New Zealand First policy called for a review of aged care sector funding, particularly rest home funding after pay equity. Migration policies may also have impacts on the aged care sector.
The New Zealand Herald reported last night on what is known to date about the new government’s likely policy line following the New Zealand First announcement.
While the three leaders said they couldn’t go into detail about policy agreements until these were signed off and released early last week, some details were confirmed in media conferences.
These are:
• Immigration: Ardern said she will stick with Labour’s policy, which the party estimates will reduce net immigration by 20,000 to 30,000 a year.
• Housing: Ardern committed to implement Labour’s KiwiBuild policy, which would build 100,000 affordable homes over 10 years, with half in Auckland.
• Foreign ownership: Labour and New Zealand First have agreed to restrict sales of residential land and farmland to New Zealand citizens, permanent residents who live in New Zealand, and companies that are majority New Zealand-owned. A register of foreign ownership of land will be set up.
• Water tax: Indications are Labour’s proposed water royalty on agriculture won’t be introduced. While Ardern and Peters wouldn’t give a direct answer, Peters said farmers and people in the rural sector “should be happy”.
• Pike River: Peters said his commitment to clear the way for a re-entry of the mine will be kept.
• The Trans-Pacific Partnership: Parties agree to push to renegotiate so the trade deal allows for the Government to ban foreigners from buying New Zealand land.
• Māori seats: Will remain, despite New Zealand First’s policy to hold a binding referendum on whether to abolish them. Peters said his party had not been delivered enough support to demand such a measure.
• Reserve Bank: Peters indicated he didn’t get his wish to implement a drastically different model based on the Singaporean model, but there will likely be changes to the Reserve Bank Act to add greater weight to full employment when it sets interest rates.
• Moving the Ports of Auckland: Ardern indicated Labour is open to the New Zealand First policy of moving container operations to Northport, near Whāngārei.
• Education: Was not raised in press conferences, but major changes are very likely. All three parties want charter or partnership schools abolished, and National Standards scrapped.
• Kermadec sanctuary: Progress on the stalled 620,000-square-kilometre ocean sanctuary around the Kermadec Islands has been considered as part of the Greens’ deal with Labour. Greens leader James Shaw would not comment on the detail.
This is what the Government intends to do:
• Make the first year of tertiary education or training fees free from January 1, 2018
• Increase student allowances and living cost loans by $50 a week from January 1, 2018
• Pass the Healthy Homes Guarantee Bill, requiring all rentals to be warm and dry
• Ban overseas speculators from buying existing houses
• Issue an instruction to Housing New Zealand to stop the state housing sell-off
• Begin work to establish the Affordable Housing Authority and begin the KiwiBuild programme
• Legislate to pass the Families Package, including the Winter Fuel Payment, to take effect from July 1, 2018
• Set up a ministerial inquiry into mental health services
• Introduce legislation to make medicinal cannabis available for people with terminal illnesses or in chronic pain
• Resume contributions to the New Zealand Superannuation Fund
• Introduce legislation to set a child poverty reduction target
• Increase the minimum wage to $16.50 an hour, to take effect from 1 April 2018
• Establish the Tax Working Group
• Establish the Pike River Recovery Agency and assign a responsible minister
• Set up an inquiry into the abuse of children in state care
• Hold a Clean Waters Summit on cleaning up our rivers and lakes
• Set the zero carbon emissions goal and begin setting up the independent Climate Commission.
]]>The conference follows a week of ongoing media headlines over concerns about district health board deficits, understaffing and delayed surgery, alongside speculation on which way Winston Peters will swing when coalition talks get underway.
During that week the New Zealand Medical Association also released its Health as an investment position statement that calls for a public debate regarding the level of health funding needed to fulfill the original aims of universal access to comprehensive public health care.
“Nearly 80 years ago New Zealand led the world when we established a public health care system that made health a universal and fundamental right – it’s time our political leaders invest in that promise,” said NZMA chair Dr Kate Baddock.
She said health spending must not be seen as a drain on the economy but as a boost to the economy that improves the lives of New Zealanders. Also required was a commitment to address the social determinants of health such as education, housing and poverty.
Last week NZNO associate professional services manager Hilary Graham-Smith endorsed that by calling for the new government to “get people out of living in cars and damp garages and ensure tamariki are physically and sexually safe”.
“This is not a 100-day aim, this is now, immediately,” Graham-Smith said.
Lindbergh said the PHA endorsed the NZME statement. “As long as government fails to address the underlying causes of illness – poverty, inadequate housing, uncertain work, and educational failure, the health system only will continue to require greater investment,” he said.
He added that cost saving – as the population grew, aged and became more diverse – simply resulted on greater pressure on health services which were now “way beyond reducing costs through so-called ‘efficiences'”.
The senior doctors union, the Association of Salaried Medical Specialists (ASMS), also welcomed the NZMA statement, saying the next government should ensure that spending on our public health service should be seen as an economic and social investment.
“This statement draws attention to international research that indicates other countries are achieving a return on investment of nearly $5 for every $1 of government spending on health,” said Ian Powell, executive director of ASMS.
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But unlike National and Labour, the focus of New Zealand First’s policy is the over-65s, with a pledge to offer three annual GP visits for SuperGold cardholders.
The party has a 33 bullet point health policy (see below) that is broad but short on fine detail and also – unlike National and Labour – short on fiscal costings of how much the policies will cost or how it plans to pay for them.
This includes establishing a public health compact “stipulating guaranteed minimum services” that puts no dollar value on what that increased investment might require. Along with National, New Zealand First shares puts a high priority on elective surgery and calls for adequate resourcing of elective surgery and establishing guaranteed maximum waiting times for surgical/specialist treatment.
In the area of child health, it is calling for nationwide health screening for all children under one year old and supporting increasing paid maternity leave to 26 weeks.
New Zealand First wants the number of district health boards to be reviewed, establish a ratio of practitioners to administrators and review the funding of primary health organisations and the aged care sector (particularly rest home funding after pay equity). In addition, the party wants equality of funding for all family home carers
New Zealand First, like Labour, supports an inquiry or review of mental health services. It is committed to a suicide reduction target, re-establishing the Mental Health Commission and increasing mental health service options and beds (especially youth and mental health services).
Its social support policies include raising the minimum wage to $20 an hour over the next three years, removing secondary tax and introducing flexible state support for grandparents raising grandchildren.
Below are the full health policies from the New Zealand First website.
BETTER COMMUNITY HEALTH
AGED CARE
GPs AND HOSPITALS
THE HEALTH SYSTEM
TAKING HEALTH FORWARD
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Jean Ross was a keynote speaker at yesterday’s New Zealand Nurses Organisation annual conference in Wellington. She told New Zealand nurses that it didn’t seem to matter which country nurses were in as they were all battling the same issues, including understaffing and harassment and violence in the workplace.
Ross is co-president of the National Nurses United (NNU), which was formed in 2009 by bringing together the Californian Nurses Association (which successfully lobbied for safe staffing ratios to be introduced in California in 2004), the Massachusetts Nurses Association and United American Nurses to form the largest union and professional association of registered nurses in the US, with 150,000 members. NNU also helped to initiate Global Nurses United, an organisation of around 25 nursing unions from around the world, including NZNO, that work together to fight healthcare service cuts, bring in safe nurse staffing ratios and improve patient care.
“We [the nursing unions] want safe staffing, respect for nurses and safety for nurses,” Ross told Nursing Review. “We work outside the walls of our hospitals and outside of our union contracts for social justice and a system that lets us have the kind of health care that we know patients deserve. And it doesn’t matter what country you are in – the issues are all the same. Even in a country where you do have a good nationalised health system.”
Ross said safe staffing ratios was one of the tenets of Global Nurses United, but it was up to each member country to decide what that safe staffing ratio should be.
California is still the only state in the US to have a safe patient ratio law where it has had set RN-to-patient ratios since 2004, including 1:2 in intensive care units, 1:5 in medical/surgical wards, 1:4 in emergency departments and 1:6 in mental health. These are the maximum number of patients are nurse can be assigned and the Californian law also requires additional RNs to be assigned based on patient acuity.
There are currently two bills in front of the Senate and Congress calling for federal RN-to-patient ratios across the whole of the US and at a state-by-state level nurses are also campaigning for legislated safe staffing ratios.
“They [ratios] have been very successful in California,” said Ross. “Hospitals continue to fight them tooth and nail but they have worked very well.” She said arguments put up against introducing ratios included nurses being in short supply, but “surprise, surprise – nurses that had left the profession because the conditions were so bad came back into the fold and began working again”.
“Nurses are happy again,” said Ross. “They can do what they like at the bedside.” She said nurses used to worry about taking a break as it would foist all their patients onto a colleague’s patient load but now wards had circulating nurses so ratios stayed in place even when nurses were on a break.
She claimed at least one hospital system in California actually made more money after ratios were introduced, as they didn’t have to employ so many agency relief staff or pay overtime.
Ross said one area in which nursing in New Zealand did differ from the US was in having a universal or ‘single payer’ healthcare system. She said nurses in the US had been fighting to have something similar to the New Zealand or UK health system “for years and years and years” because they believed health care was a basic human right.
“The US doesn’t really have a healthcare system – it’s a medical industrial complex – the only way to make money in the [US] healthcare system is to deny patient care.”
The NNU and Ross were active supporters of Senator Bernie Sanders for the Democrat’s presidential nomination and are also backing his ‘Medicare for All Act that was introduced to the Senate on September 13 with the backing of 16 Democrat senators. (At the same time this year, Republican politicians have been trying, unsuccessfully to date, to repeal and replace the Affordable Care Act i.e. Obamacare, the controversial bill expanding health insurance to millions more Americans that was passed during President Barack Obama’s presidency.)
Ross said that Obamacare saw more people than ever before gain access to health insurance, but what the NNU wanted was a system that assured all people had access to healthcare. “And the only way to do that is through a national healthcare programme,” said Ross. She said the aim of Sanders’ bill was to extend the current Medicare healthcare programme to cover more than just the current over-65-year-olds.
While the current political climate under President Donald Trump was not supportive of increasing government involvement in healthcare, NNU believed the ‘void’ created by the Republican’s failure to repeal Obamacare made it a good time to put forward an alternative model.
When asked for her view of the current president, Ross replied, “Oh my word, that man-child!” and chuckled. “You know, the nurse in me says, ‘Be kind, the man is ill’… no, none of us are fond of Donald Trump. Although, sad to say, we must admit some of our nurses must have voted for him.”
But nonetheless, Ross said, Trump’s campaign had given people something to fight and hope for – much like the mushrooming of support she experienced first-hand during the Bernie Sanders’ campaign, which the NNU had actively supported by travelling alongside Sanders on the “Bernie Bus”.
“Honestly, when we first started [on the Bernie Bus] we did not know Sanders’ campaign would take off the way it did – we [nursing unionists] were hungry for a person like this – with the kind of values we shared. And we believed the people across the country felt the same way, but it wasn’t until we actively travelled with our ‘Bernie Bus’ and talked to people along the way that we found out we were right, and look how well he did [almost winning the Democrat nomination off Hilary Clinton].”
Ross believes the absence of a positive candidate like Sanders led to Trump’s success.
“People need a hopeful campaign – and what nurses stand for is what people want … and we found that out.”
She pointed out that year after year nurses come up tops in the US, and in many other countries around the world, as the most trusted profession. “There is a reason that people trust us – and we need to use that and talk to people. And they will very often listen because they trust us.”
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