‘Safe staffing for all’ – Parliamentary submission on behalf of the DHB Sector Committee of the PSA

Kia ora, my name is Grant Brookes. I work as a Registered Nurse in a District Health Board. I am speaking to you in the Pae Ora Legislation Committee on behalf of the DHB Sector Committee of the PSA, about safe staffing and workplace health and safety.

Our committee represents people who interact with patients every day based on skill, knowledge and experience. I am here today in my lunch break, from the hospital where I’m currently on duty. Your submissions won’t come much more “frontline” than this. 

This week, the Association of Salaried Medical Specialists stated, “We have an undeclared health workforce emergency.” New Zealand needs an 1,500 more hospital specialists, they said, and an extra 1,400 GPs and 12,000 nurses. 

“These”, observed ASMS, “are serious numbers.”

I’m here to add that the number of extra DHB administrators required, and the additional numbers of Allied, Public Health, Scientific and Technical staff needed by New Zealand are equally serious. 

Our daily reality in DHBs now involves covering roster gaps and unfilled vacancies. We are trying – I’m trying – to do the jobs of one and half people, or more. We’re pulling double shifts, day after day. We’re working from early morning until long after dark. 

DHB staffing levels are unsafe, and it’s no secret that industrial peace and patient care are suffering as a result. All of this is before the Omicron wave even hits. 

Unsafe staffing is not a temporary problem. It is a long-term, structural feature of our health system. 

The main mechanism for addressing unsafe staffing, DHB by DHB, is Care Capacity Demand Management (CCDM). 

My DHB has completed implementation of CCDM for its inpatient nursing workforce. It began reporting results in 2017. By its own measure of “shifts below target”, nurse understaffing has grown successively worse each year since 2017. Last year, 55 percent of all day shifts across the DHB were understaffed. For my ward, the figure was 87 percent. 

As a former member of the governance group monitoring the nationwide roll-out of this system from 2015-2020, I saw the same trend in other DHBs. In my expert opinion, CCDM on its own cannot ensure safe staffing for inpatient nurses – to say nothing of the many other DHB services and occupational groups not even covered by this programme. 

In a sad reflection of CCDM’s weaknesses, WorkSafe NZ has been called upon repeatedly over the last year to investigate unsafe staffing levels in hospital wards and departments. 

I submit that it makes little sense to address our health workforce emergency like this in a reactive way, ward by ward – nor to address it piecemeal, one DHB and one occupation at a time. 

As reflected in our written submission, the creation of a national health service will finally enable nationally consistent, effective staffing models.

The specifications for publicly funded services, to be set under Section 14 of the Pae Ora (Healthy Futures) Bill, should include mandatory minimum staffing levels for all. 

Thank you again for your kind attention. I believe we have left a minute or two for questions.