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Health Services Amendment (Nurse-to-Patient and Midwife-to-Patient Ratios) Bill speech

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Cate Faehrmann
NSW Greens MP
16 November 2022

Mr President, I proudly rise to introduce the Health Services Amendment (Nurse-to-Patient and Midwife-to-Patient Ratios) Bill 2022. 

The Greens fully support the NSWNMA and its demands and this bill gives effect to the majority of the NSW Nurses and Midwives 2022 award claim. 

Most importantly, it would introduce a minimum staffing level and nurse to patient ratios into our public hospitals to ensure there are enough nurses and midwives, on every shift, every time, to provide safe levels of care for patients. 

Nurse to patient ratios acknowledge that patients require a minimum level of care to achieve good health outcomes and that nurses can only provide particular levels of care to a certain number of patients. 

This bill will ensure that the number of nurses on a shift is enough to provide a level of care that provides for the health and wellbeing of patients in our state’s public hospitals. 

The people of NSW expect and deserve nothing less.

The pandemic revealed the deep fissures in our state’s public health system and despite the claims of this Government things have not bounced back. 

We have all heard the stories of public hospitals that are chronically understaffed and of nurses and midwives who are being forced to constantly work overtime or double shifts. 

Speaking at one of the hearings into Ambulance Ramping in NSW, Dr Clare Skinner described Covid-19 as the “straw that broke the camel’s back.”

We also heard that patients were forced to wait up to 36 hours sometimes to secure an emergency department bed. 

The most recent Bureau of Health Information (BHI) data revealed that 76,117 patients walked out of public hospital emergency departments during April to June this year, the highest of any quarter since 2010. 

Almost one in five of those patients who left re-presented for care within three days.

This is because there aren’t enough beds and there aren’t enough nurses and midwives to staff those beds.

Nurses are walking off the job that they’ve dedicated their lives to because they can no longer cope with the conditions that this Government has allowed to fester in our public hospitals. 

We know that poor staffing leads to poorer health outcomes and increased rates of readmission, increasing the burden on a shrinking pool of nurses. 

That is why the NSW Nurses and Midwives' Association is demanding mandated safe nurse-to-patient ratios, which would ensure that the right numbers of nurses and midwives were present on each shift to ensure optimal patient care and safety. 

In response to deteriorating conditions in our public health system, nurses and midwives have walked off the job multiple times this year in large and small protests across the state. 

Nurses and midwives went on strike twice in six weeks in February and March with thousands of nurses and midwives marching up Macquarie Street and standing outside parliament calling on the Government and the Labor party to support their demand for nurse to patient ratios. 

In June, nurses walked off the job in Western Sydney where between 50 and 100 unfunded beds were opened at Blacktown and Westmead hospitals with not enough nurses to care for the extra patients. 

In August I visited Westmead hospital to speak to nurses who spoke to me of their frustration with the way they have been consistently dismissed or gaslit by NSW Health and this Government. 

I was told that the emergency department is dysfunctional, with up to 100 people to 22 nurses at times with another 50 in the waiting room. 

They expressed the same concerns we’ve heard over and over - that their colleagues were burning out and resigning, losing skilled and often senior members of their teams and leaving those who remained under even more pressure. 

In October it was reported that Griffith hospital was short by 43 staff, with local paediatric nurse Stephanie Bell describing the impact to the ABC;

“The extra stuff is what’s not being done…If you are a dependent patient, you rely on someone to help you eat your breakfast in the morning, ‘sorry, there’s no one to help you eat your breakfast’.... the more you rush, the more likely you are to make a mistake and that’s just a fact,”

Nurses and midwives have been crying out for help for years and ringing the alarm on a failing health system yet this Government has ignore them. 

This is why this bill to legislate minimum nurse to patient ratios is so important.

My office has worked closely with the NSW Nurses and Midwives Association in the drafting of this bill. 

I’d like to thank them for their tireless advocacy for nurse to patient ratios and their efforts in assisting my office to draft this complex piece of legislation. 

The bill establishes minimum staffing levels and nurse to patient ratios for a ward, unit, department or entire hospital. 

The bill ensures that a ward is properly staffed not just with the appropriate amount of nurses or midwives to treat patients but that additional staff are made available to provide support, manage the ward, triage patients and other necessary tasks. 

The bill makes it clear that these and other supplementary roles do not count towards, and are in addition to, the nurse required to fulfil a ratio. 

The bill also makes it clear that a nurse providing clinical care to a patient assessed as requiring 1 on 1 care, except in a ward with a 1:1 ratio, does not count towards a ratio. 

This would apply for example in an emergency ward with a 1:3 ratio that has a patient that requires an additional level of care, acknowledging that this nurse is unable to provide both that additional care and attend to their typical duties on the ward. 

The bill outlines that any staffing requirement in the bill does not prevent the operator of a hospital from staffing a ward with additional nurses or midwives and that a ratio may be applied flexibly to evenly distribute the workload with regard to the level of care the patients in a ward require. 

The bill allows for the variation of staffing ratios under an agreement entered into by the Health Secretary and the NSW Nurses and Midwives Association if both are satisfied that a variation would not have a significant adverse impact on the quality of patient care and the operator of the hospital and the union can come to an agreement as to the variation. 

The bill ensures that there are at least 3 nurses in a regional hospital, including at least 2 registered nurses. 

The rural health inquiry revealed the all too common situation where nurses found themselves in. In some cases, a single nurse would be responsible for an entire ward. 

The bill also introduces a requirement for at least 90% of nurses in the emergency department to be registered nurses, and at least 85% in general medical or surgical, in-patient mental health, neonatal intensive care, palliative care or rehabilitation wards. 

I now turn to division 2 of the bill which introduces compliance and reporting requirements. 

A public hospital operator will be required to report monthly on their compliance with the ratios and staffing requirements including identifying instances of non-compliance. 

This data will be required to be reported by the Health Secretary on a quarterly basis and be made publicly available.

Division 3 of the bill introduces enforcement provision and dispute resolution provisions including allowing for a public hospital operator to be referred to a local court by a nurse or midwife or the union if the dispute is not resolved. 

If successful the public hospital will be liable for up to $10,000 for each instance that they have breached the act. 

Due to time and resource limitations this legislation does not implement the NSWNMA’s claims regarding birthrate plus or other minimum care requirements for maternity, outpatient care or implementing the Australian College of Critical Care Nurses (ACCCN) Workforce Standards for Intensive Care Nursing  or Australian College of Perioperative Nurses (ACORN) Standards for Perioperative Nursing in Australia standards. 

However, Part 5 of the bill requires the Health Secretary in conjunction with the union, to review birth rate plus and determine if and how that methodology might need to be augmented, including setting minimum maternity care levels in public hospitals that do not use birthrate plus. 

A review of birthrate plus will be required every 3 years following that initial review. 

Part 5 introduces a similar requirement for the Health Secretary to review minimum care levels in outpatient wards and report on how they could be augmented. 

Part 5 also requires that within 2 years the Health Secretary investigate, in conjunction with the union, how the ACCCN and ACORN standards could be implemented within the public health system.

If this bill is passed NSW will join Victoria, Queensland and the ACT in having legislated nurse to patient ratios. 

Victoria legislated ratios in 2015, followed by Queensland the following year. 

Queensland's law established minimum nurse-to-patient ratios in medical surgical wards in 27 public hospitals, which care for 83%of patients hospitalised across the State. 

It was just the fourth jurisdiction in the world to implement ratios. 

The Queensland ratios legislation included a requirement for an independent analysis of the impact of ratios to be conducted. 

Published in The Lancet in May last year, it showed that ratios had direct cost benefits to the health system of about $70 million between 2016 and 2018. 

The analysis also  found that in each hospital with ratios, there were 145 fewer deaths, 255 fewer readmissions and 29,222 fewer hospital days than if they had not implemented the policy.

Prior to the 2019 election, the Parliamentary Budget Office estimated it would cost just $1.3 billion over seven years and $590 million per year after that to implement the nurse to patient ratios in NSW public hospitals. 

This is a small price to pay to save our public health system, to save lives, to lower readmissions, to stem the mass exodus of nurses and midwives from our health system. 

Nurses and midwives and their union have been demanding safer conditions, for themselves and most importantly for their patients, for years.

And this government has ignored them.

This bill legislates what this government should have years ago.

Minimum nurse and midwife to patient ratios across NSW public hospitals.

The union has been calling for:

1 to 4 on the floor

1 to 3 in ED

1 to 1 in ICU

This is what this bill does and more.

I commend the bill to the house.

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Cate Faehrmann
NSW Greens MP
16 November 2022
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