The Australian Nursing and Midwifery Federation (ANMF) has welcomed the opportunity to provide input into next week’s 2023-24 Federal Budget.

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In its pre-Budget submission to the Australian Government, the ANMF highlights its top priorities for significant policy reforms to maximise the contributions of nurses, midwives, and carer workers to Australia’s health and aged care sectors.

The ANMF’s four priorities for workforce and system support and reform include:

1. Nursing, midwifery and carer worker workforce reform
2. Aged care reform
3. Improved equity in access to healthcare
4. Gender equity

They detail the actions required to achieve improved contribution and utilisation of the workforce to enhance the overall health of diverse communities.

Here’s a snapshot of the key asks:

Nursing, midwifery and care worker workforce reform

Without doubt, the most urgent issue for the workforce currently is the need to retain suitably qualified and experienced nurses, midwives and care-workers.

In order to retain the existing nursing, midwifery, and care-worker workforce and grow the workforce of the future, The ANMF believes we must arrest the numbers of nurses and midwives either leaving the professions prematurely, reducing their hours, or turning to casual employment to achieve shifts that suit their non-work life.

The ANMF has outlined a range of immediate actions needed from the Federal Government to achieve workforce reform, including:

FLEXIBLE WORK ARRANGEMENTS AND ROSTERING

Nurses and midwives typically work in areas that operate 24 hours a day, 7 days a week. The prevailing employer mindset often requires nurses and midwife employees to be available 24/7, rather than recognising that offering employees the shifts they want across that spectrum may be an incentive to work in the system rather than a barrier.

To improve the issue, the ANMF recommends the Federal Government provide funding to allow states and territories to undertake dedicated projects to develop employee centred rostering principles, which will bring nurses and midwives back to the bedside.

POST-GRADUATE EDUCATION AND SUPPORT

The ANMF believes there is an urgent need to increase the number of nurses in specialty areas such as critical care, emergency, aged care and primary care, as well as an urgent need to increase the numbers of midwives, particularly in rural areas.

It has recommended the Federal Government adopt the following measures:

• Increased funding of Commonwealth Supported Places (CSP) to support nurses to undertake post graduate studies in targeted clinical areas.
• Increased access to undertake studies in midwifery both through a paid employment model and the undergraduate degree.
• Fund additional scholarships for postgraduate (certificate and diploma) education in nursing and midwifery.
• Provides HECS debt relief to all nurses and midwives

RETENTION OF OLDER NURSES AND MIDWIVES

Preventing, reducing or replacing the loss of skills and expertise of older nurses and midwives is one of the main workforce challenges facing many countries, including Australia.

The ANMF has called on the Federal Government to work with states and territories to provide flexible working opportunities that meet older nurses’ and midwives’ needs, ensure older nurses and midwives have equal access to relevant learning and career opportunities, and support job re-design to reduce heavy workload and stress and enhance job enrichment and the contribution of older nurses and midwives.

CLINICAL PLACEMENT FUNDING

Nursing and midwifery students must complete mandatory clinical placement hours in order to fulfil the requirements of their courses. According to the ANMF, while these placements are critical components of nursing and midwifery education, students are frequently unable to work in paid employment while completing the placements, with the negative cost impact acting as a disincentive to completing nursing and midwifery studies.

The ANMF is calling on the Federal Government to:

1. Funds meals, travel and accommodation allowances for students of nursing and midwifery while on clinical placement.
2. Provides funds for clinical facilitator positions in public hospitals, which would assist in increasing the number of clinical placements.

Aged care reform

The ANMF has welcomed the Albanese Government’s commitment to critical and urgent aged care reform, including legislated requirements for 24/7 registered nurse presence at every Australian nursing home, mandated minimum care hours in nursing homes, capping home care charges, and increasing requirements for transparency in the aged care sector.

The union also applauds the Government’s commitment to improving wages and conditions for workers in the aged care sector, in particular, funding the outcomes of the Aged Care Work Value Case, which awarded a 15% wage increase to all aged care workers, from 30 June this year.

Nevertheless, the sector remains in crisis mode in regards to workforce recruitment and retention.

Among a range of priorities, the ANMF has recommended the Federal Government:

• Specify, within the mandated minimum care minute target, the minimum portion that must be provided by ENs, i.e. 40 minutes.
• Implement a national registration scheme via Ahpra for personal care workers/ assistants in nursing, which includes a standardised national minimum qualification for entry to practice, at little or no cost these workers.
• Fund aged care transition programs that give early career nurses an opportunity to undertake post graduate studies in Gerontology. Support better skill mix and retention of nurses in aged care, and recognise the complexity associated with working with the older person.
• Enhance articulation between PCW/AIN, EN, RN, and NP roles and fund pathway from PCW/AIN – EN – RN and support RN to NP in aged care with guaranteed employment opportunities.
• Focus on audits and prosecution of breaches of obligations by aged care employers including breaches concerning payment of wages and minimum care minutes.
• Organisational change that may have an effect on an employee (not limited to major change that may have a significant effect (like dismissal) on employees) must be notified to relevant unions and central regulator.

Improved equity in access to healthcare

To support and sustain equitable access to healthcare for all, healthcare funding reforms are necessary, says the ANMF. By re-focussing funding models on facilitating and incentivising better healthcare experiences and outcomes, including illness prevention, reablement, and improved health and wellbeing, healthcare can become both more person-centred and cost-effective.

Key asks:

1. Implement a permanent 50/50 public hospital funding agreement between the Commonwealth and State/Territory Governments.
2. Establish a healthcare funding ‘innovation fund’ to trial and evaluate new models of funding to complement activity-based funding models and help transition from old to new, evidence-based models.
3. Discontinue fee-for-service arrangements in general practice.
4. Amend Commonwealth Health Insurance legislation and National Health Agreements to ensure all babies are counted in funding methodology for funding purposes.

MORE EFFECTIVE MODELS OF CARE

With greater Federal Government support, the ANMF says barriers to nurses and midwives working to their full scope of practice, including referral pathways, ordering diagnostics, prescribing and access to the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS), can be removed.

Nurse practitioners, for example, offer a promising and evidence-based solution to many issues with access and inequity. With stronger government support, nurse practitioners will be pivotal in addressing contemporary and future health challenges throughout Australia. Midwives, too, must be better supported through effective policy, legislation, and funding to contribute to better outcomes for mothers and babies and the wider community, particularly in regional and remote areas.

The ANMF has recommended the Federal Government adopt the following measures:

• Provide sustainable, ring-fenced funding to trial, evaluate, and scale up innovative and multi-disciplinary integrated models of care including nurse-/midwife-led approaches (eg. Midwifery Group Practice, the Mental Health Nurse Incentive Program, community-based extended hours mental health services, ‘Buurtzorg’ community nursing, urgent care centres, primary healthcare multidisciplinary and nurse-led clinics, Nurse Navigator models, primary healthcare located palliative care programs).
• Implement the recommendations made by the Nurse Practitioner Reference Group to the MBS Taskforce related to nurse practitioner services.
• Provide sustainable funding to develop a national policy on home birth, promote midwife-led models of care, and remove barriers (eg. collaborative arrangement requirements, difficulties regarding access to indemnity insurance)

DIGITAL HEALTH

The ANMF believes digital health and technology is central to ensuring optimal equity in healthcare access and outcomes.

It has called on the Federal Government to:

1. Address digital inclusion for all community members, particularly for those who live in rural and remote locations, culturally and linguistically diverse people, and First Nations people.
2. Explore opportunities in use of digital telehealth, especially in rural and remote and nurse-/midwife-led clinics.
3. Work with State and Territory Governments to trial, evaluate, and implement effective Hospital in the Home services and Virtual Wards.

Gender equity

The nursing, midwifery and care-worker workforce is overwhelmingly comprised of women.

The ANMF recognises that achieving gender equity requires legislative, policy and structural intervention on the part of governments, state/territory and Federal. It has set out broad measures that should be adopted to overcome differences in opportunity, access, and treatment experienced by women at work. They include:

• Expand parental leave entitlements, increasing to 26 weeks paid leave for each caregiver.
• Superannuation be payable on all periods of parental leave and paid/unpaid carers leave.
• Initiate early childcare reform that includes full-fee relief funded by government and/or employers.
• Expand childcare services for shift workers providing essential services, working outside standard working hours.
• Introduction of a positive duty to accommodate flexible working arrangements with the ability to refuse requests only where it would cause ‘unjustifiable hardship’.
• Expansion of grounds upon which flexible working arrangements can be made to include reproductive health concerns eg. Menopause, Polycystic Ovary Syndrome, Endometriosis, IVF.

Read the ANMF’s full pre-Budget submission here