The unhealthy state of health

Lately we have done a lot of inquiring into the state of our health system. In the last 12 months the Queensland Health system, especially the public health system, has been in the spotlight like never before.

The Davies-Morris Inquiries into events at Bundaberg and other public hospitals and the Queensland Health Systems Review by Peter Forster highlighted many serious systemic issues of concern. The recent national Health Workforce Review conducted by the Productivity Commission also highlighted key areas of reform. Other national inquiries into health related areas have been numerous and include: a Senate Inquiry into Nursing, a national review into nursing education, a Senate Inquiry into public hospitals and another into Medicare.

The problems and potential solutions have largely been identified in these reviews - what has been missing has been a co-ordinated political will, at the state and federal government levels, to take action to address these concerns.

While looking at the problems of our health system it is essential to maintain a balanced perspective - to remember that despite the many and varied problems that exist the system continues to function and good work is done every day. In large part this is due to the hard work and dedication of nurses, allied health professionals, doctors and other clinical and non-clinical health workers.

Nurses, working 24 hours a day, 7 days a week, particularly play a vital role as stewards of safety and continuity of care in the health system. As the most numerous of the frontline health workers, nurses also bear the brunt of community anxiety and fear about the state of our health system. Continual undermining of community confidence in the system can have the effect of severely damaging morale and can lead to wastage of staff from a system that cannot sustain such losses. It is a “Catch 22” situation.

Good sense and balance must be maintained in this important debate about the future of our health system. All contributors must be aware of the likely impact of their actions and inactions and the community must develop their skills of critical thinking. The motivations and interests of all players in the debate must be in the forefront of all our minds.

I will declare the interests of the Queensland Nurses’ Union (QNU) upfront. As the largest health union in Queensland (with over 33,500 members) covering all levels of nurses (Registered Nurses, Midwives, Enrolled Nurses and Assistants in Nursing) working across all sectors of health and aged care our interests are many and varied. The objectives of our union place a particular emphasis on both industrial and professional matters - our mission is to “Promote and defend the industrial, professional, political, social and democratic interests of our members”.

Our brief is therefore quite broad and complex and there is often considerable overlap between objectives and at times there may be competing interests. For example, increasingly we are finding that industrial and professional boundaries are being blurred. The issue of ensuring safe workloads for nurses and their patients is both an industrial and professional matter. It also is a social interest of our members, as nurses are not only providers but “consumers” of health services, and therefore have a dual interest in ensuring that safe, patient centred quality care is delivered to the community.

A central role of every union is to improve the wages and working lives of their members. Nurses don’t want to receive the pay of merchant bankers - they want fair and consistent pay outcomes. No matter where they work (hospital, community, aged care, doctors surgery, school, factory, prison or elsewhere) or what sector (public or private) or what geographic location (within Queensland or interstate) nurses want pay parity. Nationally consistent rates of pay were achieved for nurses for a brief period in the early 1990s. Then with the advent of enterprise bargaining and nurses’ pay and conditions now differ across each distinct health “enterprise”.

We maintained from the outset that a system such as enterprise bargaining (one predicated on conflict and disputation) is not well suited in a sector such as health and that another approach is required. Unfortunately, the Howard Government’s extreme WorkChoices legislation will see industrial relations in this country further de-regulated and as a result hard fought for conditions will be under threat. Although this is a topic for another On-line Opinion piece it is a significant contextual factor to keep in mind when we consider the state and future of our health system.

The interests of our members often coincide with the interests of the community. For example, the QNU’s legal costs associated with the Davies-Morris Inquiries last year were in excess of $500,000. The QNU had to maintain a strong presence throughout these inquiries in order to represent the interests our “whistleblower” members, who felt duty bound to protect the community by “going public” with their concerns. The QNU and its members take seriously our responsibility for working in partnership with the community to improve nursing and health services in Queensland. This is evidenced by our co-sponsorship (with the Queensland Nursing Council) of the Social Charter for Nursing in Queensland. We see the need for a significant shift in the health paradigm and power relationships and we see the social charter as being one starting point for such change.

There are two interests the QNU must be declaring. The QNU is a strong believer in and defender of our universal health system. Equity of access to health services and equality of health outcomes must be principles that underpin our health system. Access to care must be determined by clinical need and not ability to pay. We also believe it is more efficient, effective, equitable and sustainable to fund health services through our taxation system rather than through a “user pays” approach.