The nurses are not to blame - Three Hospital Drs.

29 January 2002 Media Release

From: Three Christchurch Hospital Doctors

Headline: The nurses are not to blame

The nurses in Christchurch have been underpaid and undervalued for over a decade. This has been acknowledged by the Minister of Health and the Chief Executive Officer of Canterbury DHB. Traditionally, doctors and nurses as members of caring professions have not gone on strike because their commitment and duty is to their patients. Since this work ethic precludes serious prolonged industrial action, employees are therefore vulnerable and employers need to strive to be fair. Over the last 12 years in Christchurch remuneration of nursing and medical staff has not been fair in relation to other centres and even between individuals within the organisation.

The “health reforms” of 1992 largely excluded doctors from participation in their local CHE Boards and effective nursing professional input ceased. Staff were allowed to perform only what the Health Funding Authority would purchase, services were suspended at times and the tradition of compassion and care was displaced. The Crown Company Monitoring Advisory Unit of Treasury (CCMAU) had a strong influence on local decisions. In Christchurch it pushed for a restructuring of nurses and this was carried out by the Board with advice from a consultant. Some of the best qualified nurses lost their jobs. The idea was to “dumb-down” the work-force to reduce salaries and replace knowledge and experience with written “protocols”. It led to great distress for many nurses, loss of the Professional Nursing Unit, a long period where nursing did not develop, and undoubtedly adverse consequences for patients.

General standards of safety in the hospital fell to such a point that the Christchurch Hospital’s Staff Association (CHMSA) sought help from the City Council in 1995. Unfortunately, the Council felt unable to intervene. The Director General of Health, Karen Poutasi, stated that her review by Chief Medical Advisor, Colin Feek, and the Chief Nursing Advisor found no evidence that safety at Canterbury Health Ltd was compromised. Jenny Shipley, as Minister of Health, met with CHMSA and threatened them with the full force of disciplinary procedures. It took publication of the document “Patients are dying” by CHMSA, under Chairman, Stuart Gowland, for the investigation by Robyn Stent, Health and Disability Commissioner to confirm the problems. Unfortunately the spirit of her recommendations was not adopted.

The then CEO, Richard Webb, resisted and delayed the setting up of a Policy and Planning Committee of Staff. With the CHE Board’s approval huge amounts of money and three years of planning were wasted on an unsuccessful scheme to transfer the Women's Hospital into an unsuitable building. The Christchurch Health Services had been split into two CHEs, against medical protest, and then a few years later were recombined. The cost of this was enormous. Investments in expensive, incompatible computer systems were made. Administration costs are said to have increased from about 10% to 30% of total budget. An expensive good-news machine was introduced. Shouldn’t a good health service speak for itself? A multitude of external consultants have consumed vast sums. So it is no wonder that the Board now has financial difficulties.

Christchurch Hospital needs to regain its once excellent reputation. Treasury and CCMAU should cease interference in local management issues. The Department of Health should provide support for the needs of health professional staff and the maintenance of standards for patient care. The DHB and management need to change from their command and control approach and again trust in and support the endeavours of their professional staff. Whether the new CEO can achieve this, with a Board and management that have become habituated to autocratic control, looks doubtful. She accepts an internationally competitive salary while suggesting the DHB cannot afford even nationally competitive salaries for the nurses. Management needs to work with elected (not selected) health professionals in its own institutions. Safeguards need to be put in place to ensure that management cannot continue to act in an autocratic way and medical and nursing staff no longer feel disenfranchised.

A fundamental change in focus is needed to ensure the long-term health care of the people of Canterbury.

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