On the back of a positive 2022 with action to start improving conditions in our health, aged care and welfare sectors, the ANMF is determined to work on a list of priorities over 2023 that will support the professions and the health systems they work in. Robert Fedele and Natalie Dragon report.

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GENDER EQUITY

Australia is one of the few developed nations that does not actively set targets for gender equality. Yet, Australian women experience inequality in many areas of their working and social lives, including disparate wages, poverty, discrimination and gender-based violence.

Recent statistics show that the Australian gender pay gap is currently at 17.2%, which means females only earn 83 cents for every dollar earned by males.

Post-COVID, Australia has further slid down the rankings in the World Economic Forum’s Global Gender Gap Index to 50^th, down from 44^th in 2020 and 15^th when the index first launched. Australia is lagging in ‘economic participation and opportunity’ in women’s labour force participation rate, wage equality and earned income.

The Government’s plan for boosting wages in female-dominated industries will go some way to improving gender equity. The recent landmark Aged Care Work Value case has seen the Fair Work Commission grant a 15% wage increase for nurses and care workers in the sector as a “first step” towards securing better wages. Prime Minister Anthony Albanese has indicated that more stages would follow, including closing the gender pay gap.

The Secure Jobs, Better Pay Bill is critical in giving nurses and aged care workers access to a collective bargaining system that allows for wage growth increasing gender equity across workplaces. The introduction of a statutory equal remuneration principle is also aimed to reduce barriers to pay equity claims.

The ANMF is advocating for greater flexibility in the workplace for nurses, midwives, and personal care workers, many of whom are women juggling multiple work and caring responsibilities.

“We want to see genuine access to flexible work arrangements. The threshold for employers to refuse a flexible working arrangement and the factors on which this is based, should be reviewed and recalibrated to a modern workforce. Our members report reducing their hours, moving to casual positions, or even resigning due to being denied flexible work arrangements,” said ANMF Federal Secretary Annie Butler.

“We want to see better opportunities to balance work with personal responsibilities – our working hours and workplace conditions were set in a very different domestic context to what we have today.”

This includes a reduction of ordinary working hours from 38 to 32 on the negotiating table.

There is a lack of national policy to redress the reduced earning capacity during a woman’s lifetime. Women continue to earn less than men do and are more likely to be engaged in casual and part-time work, which are also contributing factors to the gender gap in retirement savings. Many women are currently living their final years in poverty – with the next generation of women also at risk. Superannuation reforms have been welcomed including the removal of the $450 per month superannuation guarantee (SG) eligibility threshold. The SG rate will also increase from 10.5% to 12% by 2025.

The ANMF will advocate for further super reform, including mandatory superannuation requirements on all periods of parental leave, the introduction of a benchmark on retirement adequacy that doesn’t disadvantage women, and a fair share of super tax concessions for women.

Promisingly, supporting women’s workforce participation and advancing gender equality were highlighted in the Albanese Government’s first Budget. Several provisions were made for better-paid parental leave entitlements, access to childcare, paid family domestic violence leave, all which contribute to closing gender inequity.

Federal Labor has also committed to implement in full the recommendations of the Respect@Work report into sexual harassment in Australian workplaces. After years of tireless advocacy and campaigning by the ANMF, the ACTU and the broader union welcomed the introduction of 10-days paid FDV leave.

The ANMF in 2023 will continue to call for a national plan on gender equality.

IMPROVING EQUITY IN ACCESS TO HEALTHCARE

Every Australian deserves access to quality and affordable healthcare, no matter who they are, or where they live. Yet, that’s not always the case.

The ANMF is calling for a range of measures to achieve health equity, including the review of health funding models, greater use of nurse-run clinics and nurse-led models of care, improving the capacity of the health system in rural and remote areas to meet community needs, and exploring digital telehealth opportunities, especially in rural and remote, and within nurse-led clinics.

According to ANMF Federal Secretary Annie Butler, a member of the Strengthening Medicare Taskforce, funding models should be reviewed so that they reflect the provision of healthcare, rather than activity, by providing incentives for outcomes such as improved health.

“The Taskforce is principally about improving primary healthcare,” Ms Butler explained.

“What we need to do in that space to ensure equal access for everybody and better outcomes for everybody.”

A key area of opportunity lies in giving nurse practitioners, and eligible midwives, expanded access to the Medicare Benefits Schedule (MBS) and removing barriers that prevent them from working to, and extending and developing, their full scope of practice.

To achieve better integration between primary care, acute care, and aged care, Ms Butler says the ANMF is advocating for the expansion of models such as nurse-led clinics in primary healthcare, Queensland’s successful Nurse Navigators, and Canberra’s community-based nurse-led Walk-in Centres. Further, the ANMF would also like to see Urgent Care Centres, announced by the Labor Party, expanded beyond the first 50, and a commitment given to include nurse-led and multi-disciplinary options.

“The evidence consistently demonstrates that nurse-led models of care improve access to care, increase patient satisfaction and deliver better health outcomes,” Ms Butler said.

Advanced Practice Nurse Rachel Backhouse, who works across Canberra’s nurse-led Walk-in Centres, believes the community-based model could be expanded nationally to improve access to healthcare.

Many patients access the centres because they are unable to see a GP, with one centre last year seeing 306 patients in a day, many who would have otherwise presented to an Emergency Department and clogged up the hospital system.

Nurses deliver care including ordering blood tests and X-Rays, and suturing. Nurse practitioners working in the clinics can also prescribe.

“We suture, we put casts on, we do a lot of things and we work with a lot of GPs as well. There’s a lot of work out there but we need to look at how we’re addressing primary healthcare in Australia because the emergency departments are just getting inundated with patients,” said Rachel, as part of a delegation of ANMF members who converged on Parliament House in Canberra last year to lobby politicians.

Extending and developing scope of practice for NPs will form one of the ANMF’s priorities in 2023.

Palliative Care Nurse Practitioner Juliane Samara, who works across 29 aged care facilities throughout the ACT, believes NPs can make a bigger difference in residential aged care and across the wider health system.

“We’re not a replacement workforce. We don’t replace doctors; we never want to replace doctors. We want to work as multidisciplinary teams. Nurses do that inherently and we do it well,” she said.

“The best models that I see are where everybody in the team is an equal member of that team. There’s no hierarchy but everybody knows what their role is and everybody knows that they can talk to each other, refer to each other and work together when there’s a need.”

AGED CARE REFORM

After years of declining quality in care and neglect for elderly Australians, the Albanese Government acted on its election promises by commencing long-overdue aged care reform.

Landmark legislation, spearheaded by the Aged Care Amendment (Implementing Care Reform) Bill 2022, passed into law on 27 October 2022, will require aged care providers to have a registered nurse on site, and on duty, 24/7, from 1 July 2023. Aged care providers will also need to be more transparent and accountable regarding their use of taxpayer funding, including regularly publishing financial information on what they spend on care, nursing, food, maintenance, cleaning, and profits.

In its 2022-23 Budget last October, the Albanese Government, which labelled workforce its biggest priority, unveiled a $3.9 billion package of aged care reforms.

They included a commitment to mandate the number of care minutes residents receive – beginning with 200 care minutes, including 40 from registered nurses, from 1 October 2023, and 215 care minutes, including 44 from RNs, from 1 October 2024.

ANMF Federal Secretary Annie Butler said the start of aged care reform offered renewed hope for members working in the sector.

“While implementation of these crucial reforms will take some time, ANMF members and aged care workers across the country will finally see the first real steps towards actually fixing the aged care sector,” Ms Butler said.

“The implementation of a 24 hour RN presence and mandated minimum staffing laws will help address the chronic understaffing in the aged care sector.”

Other legislative improvements introduced last year included a Star Rating System to help older Australians compare residential aged care services; an enforceable Code of Conduct for aged care providers and workers; strengthening governance by placing new reporting requirements on providers; and extension of the Serious Incident Response Scheme (SIRS).

At Parliament House to witness passing of landmark RN 24/7 legislation, Palliative Care Nurse Practitioner Juliane Samara said having nurses around the clock in aged care was vital.

“People don’t stop dying and getting sick just because the roster finishes at 10 o’clock at night. They [residents] deserve and need registered nurses to be there to assess, treat and manage whatever symptoms they’ve got, around-the-clock,” she said.

“RN 24/7 will allow a range of facilities that function through a loophole in the system at the moment to deliver a higher, safer, quality of care,” added NSW aged care RN Glen O’Driscoll.

Meanwhile, other budget measures included a new national registration scheme for personal care workers, costing $3.6 billion, home care administration and management fees capped and exit fees abolished, and a dedicated Aged Care Complaints Commissioner.

In 2023, another key priority for the ANMF will involve reducing public hospital admissions from aged care by increasing and embedding Residential In Reach (RIR) teams, including dementia specialists and nurses with psych-geriatric expertise, in public health services to meet local demand. The union also wants to expand the role of NPs in aged care, via a national plan.

More broadly, the ANMF is advocating for better career pathways into, and within, aged care. This includes funding transition programs that give early career nurses an opportunity to undertake post-graduate studies in gerontology, and supporting better skill mix and retention in the sector.

In a historic win, the ANMF’s aged care case for improved wages in the sector made inroads, with aged care workers securing an interim 15% pay rise after the Fair Work Commission (FWC) handed down its decision on the Work Value Case last November.

In summarising its decision, the FWC said the increase was “plainly justified by work value reasons”, supporting the ANMF’s claims that the work of aged care workers had never been properly valued and is in fact significantly undervalued.

INDUSTRIAL RELATIONS REFORM

In late October, the Albanese Government took action to finally get wages moving, improve working conditions and achieve gender-equality across workplaces, with the introduction of its industrial relations legislation, the Secure Jobs, Better Pay Bill passed into law in December.

The Bill modernises Australia’s bargaining system, including better options for multi-employer bargaining rather than only enterprise bargaining. For example, unions could negotiate one pay deal across multiple employers in sectors such as aged care, with the more uniformed agreement shifting the power back to workers and increasing the ability to win fair pay rises.

“Our existing bargaining system is outdated and unfair and severely disadvantages workers in smaller, care industries – nurses and carers working in aged care simply have no power,” ANMF Federal Secretary Annie Butler said.

“Many of our members have been ‘locked-out’ under the existing bargaining system and haven’t had a proper wage rise in years, with their conditions deteriorating to the point where more and more workers have abandoned their profession, leaving nursing homes dangerously understaffed.”

In Canberra to watch the Bill being introduced, NSW aged care registered nurse Glen O’Driscoll said it would help assist in recruiting and retaining staff.

“A casualised workforce has very little clout, very little security to tenure and very little benefits that a full-time employee gets. If this bargaining agreement can address those issues, that’s a plus, because it will assist retention in the industry and stop the exodus of skilled workers from our floor.”

Key focus areas the ANMF will lobby for industrial relations reform include creating less burdensome threshold requirements for taking protected industrial action; advocating for permanent employment and only limited use of fixed term contracts; and keeping pressure on employers to comply with flexible working arrangement obligations rather than relying on casual work arrangements.

Importantly, the Secure Jobs, Better Pay Bill also introduced significant reforms to address the gender pay gap and discrimination.

The Fair Work Act will include an explicit prohibition on the sexual harassment of workers, prospective workers or a person conducting a business in connection with work. Meanwhile, the Fair Work Commission will be bolstered with two new expert panels, on pay equity, and the care and community sector, to help determine equal remuneration cases and certain award cases.

“This Bill is a step towards ending the wage crisis that working people have been battling through for a decade,” ACTU Secretary Sally McManus said.

“This Bill will continue the work of making workplaces safer for women and making it easier for women to access and re-enter the workforce.”

NURSING, MIDWIFERY and CARE WORKER WORKFORCE

Globally there is a shortage of nurses and midwives. The pandemic has exacerbated health workforce shortages worldwide with many countries ill equipped and struggling to maintain adequate health service provision.

The Australian Department of Health forecast a national nursing shortage of about 85,000 nurses by 2025, growing to 123,000 nurses by 2030, in a detailed report on Australia’s future health workforce published back in 2014.

A broad range of factors influence the supply including the number of new graduates; the number of overseas nurses entering the Australian workforce; retention and workplace issues; and recruitment, along with the image of nursing.

For the past three years, nurses and midwives had been called to action like never before, ANMF Federal Secretary Annie Butler said.

“Many have reported feeling overwhelmed, anxious and exhausted. Anecdotally while many have left the profession altogether others have chosen to stay but have reduced their hours to cope.

“Lack of effective recruitment and retention of nurses and qualified care workers will only put further strain on a system at breaking point.”

A raft of recent measures including the Aged Care Bill, IR reforms, and flexible working arrangements may help to mitigate the exodus of those leaving the professions with better pay and improved conditions in sectors such as aged care. In addition, the government’s cost of living measures include for greater flexibility around paid parental leave and increased financial support for early childcare and education to support families.

The ANMF is working with government, alongside the Council of Deans of Nursing and Midwifery (Australia and New Zealand), the Nursing and Midwifery Board of Australia (NMBA), the Australian and Nursing Midwifery Accreditation Council (ANMAC) and other peak nursing bodies on strategies to grow our nursing, midwifery and care worker workforce and ensure a sustainable pipeline for the future.

Proposed strategies include fully funded or subsidised undergraduate and postgraduate education and scholarships, reintroduction of HECS exemption, and an increase in the number of undergraduate places for both nursing and midwifery along with increased funding and support for re-entry and return to practice programs.

“We need solutions to retain our current skilled workforce while we plan for how to recruit the next generation of nurses and midwives,” Ms Butler said.

Nurses and midwives have identified safe workloads, minimum staff ratios and skills mix, being paid overtime, wage increases and safe working conditions as key retention issues. Along with improved work satisfaction and being able to work to full scope of practice, in innovative models of care, and the ability to deliver high quality care.

The ANMF will continue to advocate for national ratios with federal health funding linked to minimum staffing requirements in all state and territory public health programs.

Mental health resources, adequate staff support and support programs for new nurses and midwives have also been highlighted as priority areas by members. The ANMF has welcomed the Albanese Government’s commitment to establish the National Nurse and Midwife Health Service which will provide health and wellbeing support for nurses and midwives across the country.

Supporting the development for a sustainable and experienced rural and remote workforce and greater efforts in our First Nations health workforce are also priorities for the ANMF in 2023.