Speech to New Zealand Nurses Organisation Toputanga Tapuhi Kaitiaki o Aotearoa Conference

Tēnā tātou katoa

Ki te reo pōwhiri, kei te mihi

Ki a koutou ngā pou o te whare hauora o Aotearoa, kei te mihi

He taura tangata, he taura kaupapa e hono ana i a tātou katoa i tēnei rā,

Arā, ko te New Zealand Nurses Organisation Toputanga Tapuhi Kaitiaki o Aotearoa annual conference.

Mauri ora ki a tātou katoa

Before I go any further, I'd like to just take a moment to acknowledge the passing of former New Zealand union leader Ken Douglas yesterday, who I know was a big influence on me, on many of us here, I'm sure on many of you. E te rangatira Ken, moe mai rā.

It is an honour for me to be here today to open this year’s New Zealand Nurses Organisation | Tōpūtanga Tapuhi Kaitiaki o Aotearoa conference.

It is especially pleasing to be able to talk with you in person, rather than through a Zoom link, which is the way we all met last year.

I would like to acknowledge some of your people:

• Kaumātua Keelan Ransfield
• Kaiwhakahaere Kerri Nuku
• President Anne Daniels
• and chief executive Paul Goulter.

I also acknowledge the Ministry of Health chief nurse, Lorraine Hetaraka.

Our health system has been through some of the most challenging circumstances in a generation, and when this happens, the pressure is no less felt by health sector leaders, such as Kerri, Anne and Paul.

Your work increases, too, and I acknowledge the leadership you have brought to bear during this time. E nga rangatira, nga mihi ki a koutou.

And for kaumatua who act as a spiritual pou, amongst other things, it is also challenging. Nga mihi ki a koe.

And I acknowledge all of you, too - the delegates to the conference.

You represent your members and workplace delegates throughout our health system.

You are part of that essential union task of bringing the members' voices to bear upon the policies and direction of the New Zealand Nurses Organisation, a union I regard as one of the most important in the New Zealand health system.

This morning, I want to talk about:

• The health reforms, the reason for them, and my expectations of them.
• The workforce and workplace challenges we have, and the important role health unions need to play in addressing those challenges.
• And what the future could look like and why reaching a better future tomorrow depends on our ability to collaborate today.

Before I talk about these points, I want to address two concerns confronting us right now.

The first is to, once again, acknowledge the extraordinary pressure our response to the COVID-19 pandemic has put on nurses and other health workers.

I thank you as delegates - and your members throughout the health system - for the incredible effort that has been put in over the past couple of years.

Nurses have been critical - in our hospitals, in GP and community practices, in aged-residential facilities, in our testing centres, in our vaccination centres and on the end of the phone in our telehealth services - as we’ve responded to the needs of our communities.

COVID-19 has stretched and tested our health system (which means the people in it), to a degree not seen in generations.

And in the winter just gone, we not only had continuing COVID-19 infections to deal with, but also a record flu season too.

We’ve had record presentations to emergency departments and general practices around the country.

Many long-serving health professionals have told me they simply don’t recall seeing a flu season like the one we’ve had this winter.

Let me say again: thank you to your members for their professionalism, dedication and commitment to patients, and to keeping the system operating in the incredible circumstances that have prevailed.

The problem is not just the number of patients presenting and the conditions they’ve got.

Nor is it just the short-staffing caused by vacancies and staff sickness.

Those things create workload pressure. But there’s another sort of pressure – the feeling that, under these circumstances, you can’t do your best.

A fear something has been, or will be, missed. That the patients you and your colleagues care for, are not getting the best care.

I hear that from you. In July, I was presented with a report on a survey the NZNO carried out of its members. It was a lengthy and comprehensive report, and I have carefully read much of it.

It was sobering reading. The message was clear to me.

And I commit to doing everything I can to make sure we don’t have a repeat of these circumstances.

This means making every effort to step up recruitment and training, and supporting nurses during times of major stress on the system, which I know Te Whatu Ora - Health New Zealand is addressing.

I know you will be hearing from Fepuali’i Margie Apa during your conference. I cannot speak for her, but I am confident Te Whatu Ora - Health New Zealand is thinking right now about making sure we don’t see a repeat of the pressures we saw this winter.

The second point I want to touch on before I talk about reforms and the future, is to acknowledge that the New Zealand Nurses Organisation and the Government are in the middle of a significant disagreement over the pay-equity claim.

Last December, after a lengthy period of engagement, an agreement-in-principle was reached, but this has now been challenged on a number of grounds and is the subject of litigation.

Because of this, it is not appropriate for me to express any further views.

I don’t know how long it will take to resolve the matter through the Employment Court and the Employment Relations Authority.

Both are considering different aspects of the claim, and the issues are complex and technical.

One thing is clear, however: the dispute won’t be resolved quickly, and I expect that decisions from the Court and the Authority are likely to be more than a year away.

I will just say this: I hope that, as the respective legal teams continue with their preparation and become better acquainted with the details of the dispute, any opportunity that might arise to discuss the issues and resolve them by mutual agreement is taken.

Now, let me turn to the health reforms.

The structural change that underpins the reforms took effect from 1 July this year.

We now have a single organisation, Te Whatu Ora – Health New Zealand, responsible for running the public hospital system.

It will also commission, and co-commission along with Te Aka Whai Ora – the Māori Health Authority, primary care and fund aged-residential care.

Te Aka Whai Ora takes on a significant leadership role in the health system.

It is the expression of “By Māori, For Māori” in health.

It will have commissioning and co-commissioning responsibilities and will work closely with Te Whatu Ora to ensure all parts of the system are responsive to Māori.

Te Aka Whai Ora will also monitor the system for its performance on Māori health, and work with Manatū Hauora Ministry of Health on better data collection and analysis.

The Ministry remains the policy leader on health, and is the Government’s principal health adviser.

Its job is to make sure the system as-a-whole delivers for New Zealanders.

The new Public Health Agency will bring renewed emphasis to developing public and population health measures, so we get a more dedicated focus on actions that prevent poor health.

Frontline nurses won’t necessarily have noticed much change yet. The intention was never to cause unnecessary disruption to functions and services, at the outset.

But there will be change, because there has to be.

That brings me to one of the most important challenges our health system faces, and that is workforce issues. And there are many of them.

First, we have to have a sustainable plan to fill the gaps in the workforce.

We have long relied on immigration to assist with this. Overseas- qualified nurses will continue to play a vital role in our health system, but this cannot be the only response.

We have to create our own pipeline of future nurses. That’s why this Government has invested in actions to do this.

We are expanding the Return to Nursing support fund that provides up to $5000 per person to help nurses get their practising certificates renewed and back to work.

A successful pilot this year has helped 225 nurses so far return to the front line, many of them working in aged-residential care.

I have already made sure, after hearing from nurses, that this fund is available for those wanting to work part-time as well as fulltime.

Another change that is coming in the next round is that New Zealand-trained nurses won’t need to have a job offer in order to be eligible to apply.

We also have record numbers of student nurses in nursing schools, and this year the system has employed a record number of graduating students – 1732 on the funded Nurse Entry to Practice programme.

We are also doubling the number of funded Nurse Practitioner training positions, from 50 now to 100 by June 2024.

We’ve increased the Nurse Entry to Specialist Practice places for mental health nurses, and made more primary care nursing placements.

We have 46 new bursaries for Māori students, and 30 scholarships for Pacific students.

And we are doing more to assist overseas qualified nurses to work here.

With around 3300 vacancies right now just in the hospital system alone, we need to take immediate steps to fill them. And we are.

We are providing financial support to enable overseas-qualified nurses to complete the Competence Assessment Programme required for many of them to work in New Zealand.

We have changed the immigration rules so it is easier for nurses to come here and get residency.

Let me say that again: the facts are, we’ve made it much easier for nurses to come to New Zealand.

But many of these are short-term measures and, on their own, aren’t enough.

That’s why the nationwide nursing pipeline project is so important.

This project is led by Te Whatu Ora – Health New Zealand district directors of nursing.

They are working with the Ministry of Health chief nurse, Te Aka Whai Ora - Māori Health Authority, the Nurses Organisation, the Nursing Council, education providers, the aged-care sector and nursing leaders.

The programme focuses on a series of initiatives:

• Reducing undergraduate nursing attrition rates, and supporting Māori and Pacific nursing students to complete their studies and thrive in the early years of their nursing careers. We know that one of the greatest points of attrition for nursing students is at the point they do their final placement and we need to address that.
• Developing a nationally consistent process for career progression, with recognition of prior learning and support. For example, from healthcare assistant, to enrolled nurse, to registered nurse, to nurse practitioner.
• Helping new graduates develop a career framework to get them into advanced-practice roles.
• And improving access to clinical placement, co-ordination and experience for all nursing students.

In addition to all these measures, we also need to harness the input of the health workforce to make sure all ideas are considered about what we do to address these gaps.

The Ministry of Health is presently considering how we can get that input from organisations like yours, and the many other health organisations that are advocates for the sector.

But it is one thing to grow the workforce to fill the gaps we’ve got, and to take measures to ensure a pipeline of future health talent.

It is another to make sure the working environment is supportive and positive.

I have made clear my expectation that promoting a workplace culture in which you, and your members, are engaged in developing processes and systems, is of high importance.

I frequently get the message that nurses don’t feel they have a say on issues at work.

It is important that you and all other health workers feel that you do.

Te Whatu Ora and Te Aka Whai Ora are committed to positive engagement culture across the workforce.

That is why the union’s role is - and will continue to be - so important.

A benefit of a single employer in the hospital system working with unions should be that over time, we see consistency in approaches on workplace issues.

We shouldn't have a repeat of the Holidays Act situation that we've got at the moment that I know is very frustrating for everybody and we hope to get some sort of resolution soon.

But that just simply should not arise in a workforce that has the same skills doing the same work across the hospital network across the country.

And the importance of the union’s role brings me to my final point this morning: change will continue.

And that change will also involve how nursing is practised in the future.

One of the biggest questions facing our health system - and health systems around the world - is how to satisfy demand for health services in light of what we understand is likely to happen.

Our population is ageing, which will place more demand on health care in the future.

At the same time, we are seeing more complex health issues in younger people, which is also adding pressure to the system.

Demand for mental health services and support has been growing for some years.

We have to expect that Covid, which saw the lives of young people, especially, disrupted at a crucial developmental age for them, will have consequences for mental health services in the future.

Knowing these factors, we need to think about the best way to use the nursing workforce – and the best way to use  every person working in the health system.

What does the future of nursing look like? You, and other unions, need to be central to that discussion and those decisions.

This debate is important, because healthcare is a big chunk of the Government’s budget – a fifth of it, in fact.

Since coming into Government in 2017, we have increased the health budget by around 43 per cent.

It’s not just operational funding but infrastructure too.

We have so far committed $7 billion into buildings, hundreds of millions of dollars into data and digital infrastructure, and are making a significant investment in mental health.

We have increased Pharmac’s funding.

But there are limits. We cannot do everything everyone would like, in all circumstances.

Government funding will always have limits - that’s why we do Budgets every year.

And that means public funding of health will always come up against those limits.

There will always be a debate about priorities – priorities within total Government spending, and priorities within health spending.

This Government has made health spending a priority. Labour Governments always will.

That explains why we’ve increased health spending to the degree we have.

Good-quality public health care is part of the social wage. It’s about accepting health care is vital, and must be accessible and equitable.

So how we organise health in the future, to get the best out of what we spend, is essential.

Making sure people get to see the right health professional, at the right time, in order to get the right care means spending our health dollar to achieve that.

It means continually asking “who is the right health professional to be carrying out this task, at this time?”

Doing more of the same won’t be good enough. Your voice needs to be there - not to resist change, but to shape it.

That’s why I regard this relationship as so important. It’s why I will always be here, talking to you and listening to you, even when we face challenging issues in our relationship.

Thank you again for the opportunity to address your conference.

I offer you my very best wishes for a great conference.

No reira, tena koutou, tena koutou, tena koutou katoa.