Former White House health policy adviser Zeke Emanuel has hit on a staggering comparison to illustrate the inefficiencies of the predominantly privatised American healthcare system compared with the publicly funded European health care systems.

‘The United States spends on health care alone what the 65 million people of France spend on everything: education, defence, the environment, scientific research, vacations, food, housing, cars, clothes and health care.

In other words, our health care spending is the fifth largest economy in the world.’ (France has the fifth largest economy in the world, with a gross domestic product of nearly $2.6 trillion. In 2010, the United States spent $2.6 trillion on health care.)

For more than 30 years, US health care costs have been growing 2 per cent faster than the country’s overall economy.

Emanuel says that if this rate of growth is maintained, health care will be roughly one-third of the entire economy by 2035 – one of every three dollars will go to health care – and nearly half by 2080.

‘The United States spends about a quarter more than countries with some of the best health care systems in the world, like Germany and France.’

Does this comparison surprise you? Why do you think this is?

Image credit: NSWNA

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Nurses and assistants in nursing working in aged care and public health in the Federal electorate of New England have joined together to seek Tony Windsor’s support.

By supporting aged care in Budget 2012, Tony Windsor can make a real difference to thousands of older Australians living in New England.

‘Please support us Mr Windsor’ ‘Please help us achieve aged care reform and an increase to aged care funding. This will deliver benefits to so many local people you represent, older Australians, their families and dedicated Nurses and AiNs throughout your electorate.’ – Irene Neyle, Enrolled Nurse, Werris Creek.

Aged Care is in crisis and quality of care for vulnerable older Australians must be a priority. By signing the petition, we are asking local MP, Tony Windsor to:

1. Make Budget 2012 the aged care budget;
2. Ensure quality of care by guaranteeing a minimum number of nurses to residents on every shift;
3. Ensure that Budget 2012 commits the funds to close the wages gap and guarantee nurses remain in aged care.

Community Meeting

Nurses in Tamworth will be holding a community meeting on Wednesday March 7th at 7.00pm in the Tamworth Community Centre to talk about the aged care crisis, and hand over the petition to Tony Windsor MP. Speakers include

• Tony Windsor, MP Member for New England,
• Yvonne Chaperon, Assistant Federal Secretary ANF,
• Jan Howard, Registered Nurse, aged care,
• Ros Norman, Enrolled Nurse, public hospital, and
• Maryann Krug, wife of a nursing home resident.

Nurse Jan Howard (pictured) who is speaking at the meeting will talk about the day to day reality of working in aged care.

Want to help?

1. Download a leaflet
2. Put up a poster
3. Come to the community meeting
4. Sign the petition to Tony Windsor MP and ask your friends and families to sign it.
5. Send a message to Tony Windsor MP that you support more aged care funding.

Image credit: ANF

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The continuing global shortage of more than 4 million health care workers is symptomatic of the crisis in health care as essential public health services are reduced, with both health care workers and users suffering its severe consequences.

A direct consequence of this crisis is the exodus of workers from health sector employment, which eventually leads to migration, with workers seeking better pay and working conditions in other countries.

The NSW Nurses’ Association in conjunction with Public Services International (PSI) are undertaking a comprehensive participatory research and mapping of migration in the health and social care sectors. The results will form part of a Global Report on Migration which will be presented at the 2012 PSI Congress.

Did you migrate to Australia to work as a nurse or midwife?

Why?

Was it to take advantage of better pay and working conditions in a different country?

Please leave your comments in the section below! 

Or, if you have 30 minutes to contribute to this very important research, we would love to hear from you. Please email lkremmer@nswnurses.asn.au for more information.

Image credit: PSI

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The Australian Nursing Federation (ANF) says the Nursing and Midwifery Board of Australia is deterring nurses and midwives from wanting to rejoin the workforce, with their $10,000 ‘refresher courses’.

ANF federal secretary, Lee Thomas, said the courses would mean “nurses and midwives who have been out of the profession for five to 10 years undertaking a three-month re-entry competency course, with fees of up to $10,000 being charged”.

“While re-entry courses are important this one size fits all solution does not consider individuals needs.”

The full article is published in the Australian Ageing Agenda, which you can read here.

According to the Nursing and Midwifery Board, new laws passed by all state and territory governments on 1 July 2010 had mandated standards that every health practitioner must meet.

The harmonised national standards, agreed upon by all state and territory health ministers, relate to criminal history checks, professional indemnity insurance, continuing professional development, English language skills and recency of practice.

“The whole scheme is about protecting the public … to provide for robust public protection, and the Board believes the standards are necessary for registered practitioners to provide safe care to Australians,” a spokesperson for the Nursing and Midwifery Board of Australia told AAA.

“The Board does not run the re-entry courses for nurses and midwives and does not set the fees for them. This is done by education providers and costs vary depending on whether there is any government subsidy.

“If a nurse has been out of the workforce and wants to return to practice, they need to apply to the Board for advice about what kind of program will bring their skills up to date. The Board gives advice tailored to the individual.

“They make the individual judgements about each nurse. The issue, I believe, is that in New South Wales there was no [previous] requirement that people had recency of practice before July last year; they could still be renewed even if they hadn’t worked for 20 years. The board felt that was not safe, and they were also required by the legislation to set those standards.”

“There is currently an oversupply of graduate nurses, resulting in more nurses than jobs,” the spokesperson added, in response to the union’s argument that Australia faced a “critical shortage” of nurses.

“We believe it’s ludicrous that experienced nursing and midwifery professionals are now being forced to pay significant amounts of money to be re-registered,” the ANF’s Lee Thomas said.

“The industry should be welcoming back nurses and midwives with open arms, instead, they’re making it financially unattractive, in some cases impossible, for them to get back to work.”

According to the ANF, research shows 15 per cent of nurses are retiring every five years with an exodus of 90,000 nurses expected to retire up by the year 2026.

”Quite simply, the number of new nursing graduates cannot keep pace with the exodus of nurses, resulting in a critical shortage of nursing and midwifery professionals,” Ms Thomas added.

“The aged care sector alone urgently needs 20,000 extra nurses to meet the challenges of Australia’s ageing population.”

There have been a lot of comments about the expensive fees in relation to this course – which you can read here.

But what do you think about the Nursing and Midwifery Board’s response?

Do you agree there is an over supply of graduate nurses? Or do you think there is a critical shortage?

Do you think the re-entry competency course is justified?

Image credit: NSWNA.

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In this two part blog series, Bronwen Griffiths, a Clinical Nurse Specialist in NSW, tells us about her recent trip with the MOSAIC programme (Medical Outreach and Social Aid in Communities) to Northern Thailand. She tells us about the programme and her experiences in the village of Ban Khunsuay.

You can read part 1 of the blog here.

Unsurprisingly, given the steep terrain and punishing working conditions, we see a lot of people with ‘back pain for twenty years’. Of more concern is the large number with nausea, headaches and dizzy spells in the last two years worse in the last two months.

Over this time an agrochemical company has been leasing out the steep hillsides for a corn crop. Anecdotally, we hear that – as the top soil washes away – people are using more and more chemicals to keep the crop going. We have started education about wearing masks while spraying, but the last two months have been harvest time, not spraying time, so we are working to get the water tested. The runoff from the corn goes straight into the creek that provides water for the village both for drinking and for rice growing.

On day 2 we go to the village school. Some of the volunteers take the older kids outside for some highly energetic English language games, while I look at the children the teachers have identified as most vulnerable in their health profile.

The teachers were wary of our presence at the school when we first went to see them earlier in the week. A religious group had come by three years ago then had never come back. They initially looked sceptical about what we could offer them.

In the end, however, the school trip becomes the highlight of our visit. The teachers prove both knowledgeable and concerned about the social conditions and the nutritional status of every child. They have a group of orphans and a bunch of other children who shift uneasily between extended families. They feed them all a hot meal every lunchtime, and are clearly concerned that for some of these kids, this is the only regular meal in their day.

The school clinic turns out to be one long parade of inflamed and/or suppurating ears. The children are uniformly uncomplaining but, when asked, quite a few admit that their ears hurt a lot. We discuss strategies for maximising learning in children with decreased hearing due to chronic glue ear. A few absolutely acute cases are given antibiotics, and we will work on strategies to address the chronic cases next time around.

The teachers cook us a spectacular lunch of local dishes as a thankyou for our visit. The potential for this relationship to develop and provide an early warning system for children at risk of trafficking will be a major practical focus of ongoing MOSAIC trips.

On the final morning we check out the rest of our community clinic, including a number of people from a neighbouring Lahu village. This requires every question going from English to Thai to Akha to Lahu and back again. It’s fair to say that my grip on the details of some of these problems gets a little hazy.

So why would you volunteer for this program? This is not ideal health care by any means; the language barriers are tortuous, and even when problems can be identified, the capacity to treat them is primitive at best. There are times when it feels that what we are able to offer is so scant that it is almost an insult to provide it at all. But nothing at all is, in fact the alternative. This is the first health clinic the village has ever seen.

These are communities of hard working, resilient and cheerful people who are disenfranchised by language, culture and geography. The most basic primary health care, like the most basic gravel road, is currently outside their list of options. The chance to take a part in developing community health in this wild, beautiful and neglected corner of Thailand is a privilege that will keep me returning as often as finances and my family will allow.

Have you heard of the MOSAIC project? Have you been on any medical outreach trips or would you like too?

Image credit: Bronwyn Griffiths.

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In this two part blog series, Bronwen Griffiths, a Clinical Nurse Specialist in NSW, tells us about her recent trip with the MOSAIC programme (Medical Outreach and Social Aid in Communities) to Northern Thailand. She tells us about the programme and her experiences in the village of Ban Khunsuay.

It’s only 12 kms off the district highway to the village of Ban Khunsuay, but it takes nearly an hour of grinding low gears over the precipitous, rutted track that passes for a road before we get there. Bad as the road is, however, it’s the least of what divides the subsistence farmers of the Doi Wawee area from the comforts of modern Thailand.

Separated by language, culture, and the lack of a legal Thai identity, the mostly Akha, Lahu and Yao people who work this steep hill country are 30 years behind their lowland Thai neighbours in terms of basic services. They are not allowed to own land, their children seldom progress beyond primary school, and there is no provision for even basic healthcare services in the local area.

The MOSAIC program is part of a wider engagement with the local communities to address the endemic trafficking of children in this area for labour and sex work.

Our brief is to identify the core health and social needs of the community and then see what can be done to provide some solutions, while working on a next to nothing budget and the goodwill of volunteers.

We have a good range of basic equipment, including a donated ex ambulance cardiac monitor. Unfortunately, however, we have a very limited capacity to purchase medication for ongoing treatment. Our team theoretically includes support from the Chiang Rai District Health Service, but they prove unable to make an appearance, so we are left with only one clinician (me) and an enthusiastic crew of COSA volunteers.

We spend the first evening doing health checks on a group of kids recently removed from a trafficking network who are now boarding with families in the village and attending school. Most of the girls were shuffled through the brothel system for up to a year before being passed through this area on their way down South, so we need to arrange sexual health follow up (a five hour round trip with significant logistic hurdles.)

The general community clinic is scheduled to run from the local meeting hall on our first full day in the village. We’ve given great thought to how we can create an area of privacy for assessment, but the community clearly feels this would rob them of excellent entertainment. As the first elderly Akha woman in traditional silver headdress cheerfully bears her entire breast for the stethoscope, I realise that our curtains will remain a purely decorative backdrop.

The atmosphere is festive – people have dressed up for the occasion and wait patiently for hours, sewing, catching up on local gossip and showing a keen collective interest in every single presentation.

On the first day we register 60 people and get through 35. We ask the others to come back for the catch-up clinic in 2 days when we have finished with the village school. The cardiac monitor (AKA ‘Keith’) is definitely the hit of the occasion, and as the day goes on a trend for adding some vague chest problem in the hope of being hooked up clearly emerges.

Keith earns his keep though – we have a case of rapid AF in the first half hour and later on a symptomatic 39 year old with marked ischaemic changes and left ventricular hypertrophy.

All I can do is put both men on daily aspirin and give them a printout of their rhythm strip to take to Mae Suai hospital, this ensures that regardless of the language barrier their need for urgent treatment will not go unnoticed.

Read part two of Bronwen’s blog tomorrow!

Have you heard of the MOSAIC project? Have you been on any medical outreach trips or would you like too?

Image credit: Bronwyn Griffiths.

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Workers, unions, community and other representative groups have just one week left to contribute their experiences to the Independent Inquiry into Insecure Work in Australia, with submissions to close next Friday.

ACTU President Ged Kearney said more than 360 workers, community organisations, unions and academics had already lodged their submissions as of this week.

“The submissions we have already received have provided valuable evidence for the inquiry panel to consider the impact insecure work has on people’s ability to plan for their future, to make ends meet and to spend time with family and friends,” Ms Kearney said.

“The Inquiry, chaired by former Deputy Prime Minister Brian Howe, is investigating all of these issues and it is important that we hear from as many in the community affected by insecure work as possible.

“We know that insecure work – casual, fixed or short-term contracts, labour hire, and contracting – has almost doubled in the last two decades to make up about 40% of the workforce now.

“We know from research we have conducted, that for workers, insecure work often means lower pay and fewer rights and entitlements at work. It makes it harder for them to manage their household finances, to spend time with their family and friends, and to plan for the future.

Ms Kearney said after the submissions closed, the Inquiry would conduct hearings around the country in February and March. It would then prepare a report detailing the issues and possible solutions to insecure work.

The ACTU recently prepared for the Inquiry an options paper, The future of work in Australia: dealing with insecurity and risk, which found half of all casual workers would prefer to have a standard, secure job.

“The paper acknowledges that solutions to the growth of job and income insecurity in Australia will be complex and diverse, but should aim at improving the rights and conditions of all work for all workers,” Ms Kearney said.

Submissions can be lodged on the campaign website, securejobs.org.au, by email to inquiry@securejobs.org.au, or by phoning a special hotline on 1300 362 223 (toll free).

Image credit: http://securejobs.org.au/

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The Australian Government must consider economic sanctions against Fiji’s military regime in the wake of new laws that place even greater restrictions on human rights in the island nation, say unions.

ACTU President Ged Kearney said a new decree quietly introduced by the Fiji Government was even more draconian than past laws, with anyone who campaigned for workplace rights able to be considered a terrorist and placed in jail indefinitely.

“Just two weeks ago Fiji’s Prime Minister Frank Bainimarama spruiked the removal of the draconian Public Emergency Regulations (PER), which banned public meetings and freedom of the press, as part of his desire to encourage free debate in the lead up to democratic elections in 2014.

“But Mr Bainimarama seemingly forgot to add that he had concurrently introduced another set of laws that give his illegal Government sweeping powers of arrest and detention without a warrant and for 16 days. Under the new laws, ‘terrorism’ is redefined to cover any act that is seen to be campaigning to influence the government towards change.

“This essentially means that a Fiji worker or union leader that asked the ACTU or Australian Government to pressure the Fiji Government to change its draconian ways would be guilty of an act of terrorism. That person may be imprisoned for life.

The new decree also includes:

• A ban on the manufacture, use, sale, display or possession of any flag, banner, emblem or picture if the Prime Minster deems it in the public interest to do so;
• An application to hold a public meeting must be submitted to the police seven days in advance, with a possible five years imprisonment and $10,000 fine if the meeting occurs without a permit;
• Control over freedom of movement, including where a person may travel or live in Fiji, at the discretion of the Government;
• Empowers a police officer to arrest a person without warrant and detain him or her without charge for up to 16 days by order of the Prime Minister and enables the military to perform police function, by the consent of the police;
• Further curtails freedom of speech, with any person who makes any statement, likely to undermine Fiji’s economy or financial integrity to face 10 years imprisonment and/or a $50,000 fine; and
• Quashes the role of the judiciary, with the courts unable to hear any claim by anyone challenging the validity, or legality of any decision made by the commissioner of police, any divisional police commander, the Prime Minister or any public official under this decree.

“This new decree is even more draconian and places even more restrictions on the rights of Fijians than past laws. The Australian Government cannot turn a blind eye. We renew our call to the Australian Government to reconsider its recent decision to renew a textile, clothing and footwear scheme with the Fijian Government under a regional trade agreement.

“The agreement which gives unfettered access to the Australian market – the largest market for Fijian textile products –merely legitimises an oppressive regime that has persistently flouted human rights in the face of international and local opposition.”

What do you think of the situation in Fiji? How would you like to see the Australian Government act?

Image credit: Melody Tan via Flickr

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The NSW Nurses Association has sought the urgent assistance of the NSW Industrial Relations Commission to stop planned cuts to facility space at the Alstonville Community Health Service.

NSWNA members at the Alstonville Community Health Service, and its parent service Lismore Community Health, were advised that Northern NSW Local Health District CEO, Chris Crawford, had directed the Alstonville service’s premises be downsized to half its current floor space. This was to take effect from 31 December 2011.

Agreement was reached through the NSW IRC, for any change to be delayed until February 28, to allow for greater consultation with staff and the community and more discussion about the service’s infrastructure needs.

NSWNA general secretary, Brett Holmes, said this was an appalling, penny-pinching decision for Mr Crawford to impose on nursing staff and the local community and is actually a negative move in such a growing and vibrant community.

“It also gave nursing staff only four working days to completely reconfigure the service to fit into the reduced space. The decision was also made without any consultation with the nurses or their union representatives. I am not aware of any community consultation either. So we welcome this breakthrough in the NSW IRC, which will help rectify these deficiencies in the Local Health District’s approach.

“Alstonville clinic provides generalist community health nursing and child and family health nursing services to the towns of Alstonville and Wollongbar, which have a growing number of families with children and also many retired and elderly people.

“The generalist community nurses provide wound management, at the Alstonville clinic and in people’s home, palliative care and hospital in the home. The child and family health nurses provide developmental assessments, support to families with young children and the universal home visiting service to all parents with newborns, which is a compulsory service required by the NSW Families department.

The nurses also work together to provide childhood immunisation services to the two communities.

“I am advised the proposed reduction in working space will cause services like onsite wound management to cease. It will also reduce waiting room space for families attending the clinic, with many, including babies and young children, being forced to wait on the footpath.

“With the proposed cuts now postponed the NSWNA will use the time to campaign to protect community nursing services in Alstonville and ensure the nurses have the necessary space to continue providing high-quality healthcare to their local communities. We will be asking the people of Alstonville and Wollongbar to join us in that campaign,” Mr Holmes said.

What do you think of the planned cuts to facility space? Why do community nursing services need to be protected?

Image credit: Lower Columbia College via Flickr

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Australian unions have launched the Speak Up campaign so that workers have a say in making sure their workplaces are safe and healthy.

ACTU Assistant Secretary Michael Borowick said it was important that workers understood they would have enhanced rights to elect their own health and safety representatives under the harmonised occupational health and safety (OHS) system.

“Workers need to know that when they are confronted by a health or safety issue in their workplace, they don’t have to deal with it alone,” Mr Borowick said.

“They have an iron-clad right, under law, to elect their own health and safety representatives. These reps act as watchdogs within the workplace, making employers comply with the law well before regulators have to become involved.

“They have rights to stop work and demand improvements when there are health or safety concerns.

“Employers who interfere with the work of health and safety reps, or refuse to allow them to properly represent their workmates, are breaking the law.

“Importantly, unions can offer a wealth of expertise, know-how and training to back up those reps, and make sure they can perform the roles they have been elected to, and to provide workers with assistance to make their own workplaces safer.

“Health and safety is a fundamental industrial issue and a major priority for unions, who have a long and proud history of delivering healthier and safer workplaces for Australians, frequently in the face of employer and business resistance. Over the last 160 years unions have campaigned tirelessly to reduce injury and illness within the workplace, and many of the current rights and conditions have been fought for and won by unions.

“It is no coincidence that workplaces with a union presence are far more likely to be safer than those without unions. Collectively, with the support of a union, workers are far more able to speak up about health and safety than they can individually.”

Alongside the distribution of Speak Up campaign materials in workplaces around Australia, a new website www.safeatwork.org.au has also been launched.

The website will be a hub of information for workers and OHS reps about common health and safety issues, rights and obligations, tips for safer workplaces, legislation, and news. Workers will also be able to post questions about health and safety and get advice from union experts.

What do you think of the Safe at Work campaign? What are some of the health and safety concerns you have at your workplace?

Image credit: NSWNA

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