NZNO Constitutional Review – Speak up now for rules to empower union members

The revolt over broken promises to back-date Pay Equity for DHB nurses to 31 December 2019 is showing, once again, that union members are powerful when we organise and speak up. 

For many DHB nurses, the broken back pay promises briefly brought back bad memories of 2018, when our MECA negotiators told us to accept substandard offers, refused to let us vote unless we sat through hour-long meetings, cancelled a strike that we had voted for and then, when we did strike, they let DHBs make a mockery of the Life Preserving Services agreements.

On 11 April, three days after releasing the proposed Pay Equity settlement, NZNO backtracked and announced a full legal review of the settlement agreement and the process leading up to it. The review validated what members had been saying. This was fantastic. It really was!

But why does it have to be so hard to get NZNO to act on our behalf, when We Are The Union? 

We Are the Union. The Union is US.

This kind of thing mustn’t happen again. We need to rewrite the rules, so that NZNO is driven by its members. And between now and 30 April, with the Constitutional Review, we have a golden opportunity to do just that.

What is the Constitution, and why does it matter?

Weighing in at a hefty 49 pages and written in dense legalese, the NZNO Constitution is a document that most people have never read. Who can blame them? 

And yet the Constitution is a matter of importance for every fee-paying member of NZNO. This is because it: 

  • Defines the purpose and objectives of NZNO (what it’s for, and what it will do)
  • Sets out the rights of union members (along with our responsibilities)
  • Determines who has the power to do what, inside NZNO 

Since NZNO is an incorporated society and a union, its Constitution is a legally binding document. Any member is actually able to go to court or to the Employment Relations Authority if they believe the Constitution has been breached. And now this document is up for review. 

All NZNO members were emailed a link on 1 April to a Member Survey about the Constitution, open until 30 April. The survey is 40 pages long! I know, because I printed it to PDF using A4 paper size. Who’s got time for a 40-page survey? 

The good news, as explained at on page one, is that, “You do not need to answer all questions in order to provide valuable feedback. There may be specific issues of concern to you that you would like to focus on.” 

So if you read no further in this article, please at least click on that link in your email and go to Section 4 of the survey, to speak up for the “Objects of the NZNO” that you want to see prioritised. 

Along with the Board election later this year (more on that below), the survey is our biggest chance to exercise our rights as as members and speak up for a membership-driven union. If you’d like to see how I answered all the survey questions, click here. If you want to understand my perspective on problems in the Constitution and the rule changes needed to empower members, please read on. I am proposing ideas which you might like to put in your survey responses, in the following areas: 

Openness and honesty  

When Board members Anne Daniels, Katrina Hopkinson and Sela Ikavuka resigned in April 2020, just eight months after being elected, many NZNO members were shocked to learn that they were bound by a “gagging order”. “Right from the start”, the trio wrote, “we were required to sign a confidentiality agreement before our first meeting.” 

That’s right – the elected leaders NZNO are barred, under threat of legal action, from sharing information with the membership who vote them into office. It hasn’t always been this way. Up until a decade ago, all NZNO Board members used to produce regular reports for the members they represented. 

But NZNO today has a problem with openness and honesty, and the problem starts at the top. Last year, the Board refused to release an external review of its performance. Hundreds of members signed a petition calling for its release. “As a transparent, member-led organisation”, said petition organiser and NZNO delegate Al Dietschin, “we believe every member who wants to see this review, which was paid for by NZNO members’ fees, should be able to access it on the website.” The Board dismissed their call. 

Agendas and minutes of Board meetings are supposed to be made available to the membership and staff, after a binding motion was passed in 2016 by NZNO delegates unhappy at the Board’s lack of accountability and transparency. But last year, the Board simply ignored that vote and went back to operating in secrecy. Their secrecy has included a serious lack of detail about how all our member fees are spent. 

Perhaps the most significant report for NZNO in recent years, the Independent Review of the 2017/18 DHB MECA campaign which led to major changes in NZNO’s approach to bargaining, was also initially withheld. NZNO chief executive Memo Musa said the report would “remain confidential and not be shared with others without the express permission of the chief executive and industrial services manager.” It was only published, in a redacted form, thanks to the organising efforts of hundreds of members who forced its release. 

This culture of secrecy filters down from the top and affects other parts of NZNO, in ways big and small. The secretaries and chairs of NZNO Colleges and Sections, for instance, aren’t even allowed to know the names of the people on their own membership list. Delegates in the same workplace are prevented from talking with each other (and they members they represent) because they can’t get names or contact details. 

The withholding of information is a way of actively disempowering NZNO members. In place of open and honest communication, we have even been fed self-serving misinformation. In 2019, a very strange email to all member groups from the Board said, “The Board wishes to clearly state that it is united. Contrary to some suggestions that have been made, the Board is neither dysfunctional nor divided.” Meanwhile the external review, which later leaked despite the Board’s attempts to suppress it, said that during this time the Board was in “a governance crisis”, crippled by internal conflicts and unethical conduct, to the point where it couldn’t say what value (if any) it was adding to the organisation. 

“I want to see improved transparency”, said NZNO Vice President Nano Tunnicliff in her election profile statement last year. The Constitutional Review provides an opportunity to achieve this. The Constitution should set out clearly the rights of NZNO members to information about our own union. NZNO’s culture of secrecy is out of step with other similar organisations, current understanding about good governance and recent law changes.

This month, the Incorporated Societies Act 2022 came into force. This Act updates the legislation governing entities like NZNO, and expresses the expectations of New Zealanders around open and transparent governance. Section 80 of the Act sets out for the first time a legal right to information held by incorporated societies (including unions) for members of that society. If the officers of a union refuse an information request, members can now get a court order for its release. There are only a few limited grounds for refusing a request to release information to a member. One of them is if it says that information can be withheld in an organisation’s constitution. 

After learning from the Independent Review of the 2017/18 DHB MECA campaign, last year’s MECA bargaining was refreshingly different. DHB Sector members were given frequent updates, containing all the information they needed to make informed decisions for themselves. Information previously marked “confidential”, such as the detailed results of member votes, was now made available. NZNO negotiators were accessible for the first time on social media, and answered questions. 

It’s time to make this the norm, for all of NZNO. We can do that by speaking up for rules to empower NZNO members in section 7 of the survey. I suggest that the Constitution should explicitly state, under “Rights and Responsibilities of Membership”, that union members have a right to information held by NZNO, subject only to the grounds for refusing information requests provided in the Incorporated Societies Act 2022. 

Genuine democracy

NZNO today is stuck, part way through a transformation into a genuinely democratic organisation. The Constitution currently says that all members have the right to vote on some matters, but decision-making on other matters remains secretive and undemocratic. Section 6 of the Member Survey is our chance to speak up for changes to strengthen our union democracy and member voice. 

Enabling all members to vote is a relatively recent development for NZNO. It was not until 2018 that the system of “One Member, One Vote” was introduced, finally empowering every member to vote online for NZNO policy and rule changes. That same year, online voting was introduced in MECA bargaining. When online voting was first raised, it met with strong opposition from NZNO leaders. Now we have to wonder what all the fuss was about. It seems strange to think that prior to 2018, the only members allowed to vote on these things were those able to attend long meetings, in person. 

But for other decisions which affect NZNO members, voting by people able to attend long meetings is still in place. This is the case for Annual General Meetings and for two Special General Meetings of the union held in 2019. Whether I like it or not, this part Constitutional Review is bound up with my own story as NZNO President, as these SGMs were both about me. But as someone who has campaigned long and hard against undemocratic features of the Constitution for over a decade – in print, on line and at meetings, even drafting a remit for a constitutional review (later superseded) in December 2019 – my ideas now are not simply a reaction to my own recent experiences. 

The problems with the current system of voting at meetings “on a representational basis” are that: 

  • Under Section 30 of the Constitution, just 33 people (out of the 55,000 members in NZNO) are allowed to vote. They are the representatives of the 11 Regional Councils, 20 Colleges and Sections, the National Student Unit and Te Rūnanga 
  • These 33 representatives (generally the Chairpersons) get the number of votes equal to the number of members in the group they’re representing. This means you can have one rep casting the vote for up to 15,000 members 
  • The largest five membership groups comprise over half of the membership, meaning just five representatives could make a “majority” decision for all of NZNO
  • Yet, there is no requirement for the “representatives” to consult the membership they’re voting on behalf of – and many have been quite open about the fact they don’t consult – or to vote in accordance with the wishes of their members, if these are known 
  • There’s no way for members to know how their representatives even voted, because it’s “secret”
  • And the kicker? The eleven Regional Council Chairs, who wield two thirds of the total vote at AGMs and SGMs, aren’t even elected by the membership of their Region 

Members can see that an unelected handful casting thousands of secret votes is an open invitation to corruption, and this has contributed to a breakdown of trust in NZNO. It’s also a pretty rotten system that so few can make a decision that’s paraded around as a democratic decision of the membership. 

If this wasn’t reason enough, the system of voting “on a representational basis” is now broken completely in a time when meetings are being held virtually by Zoom. The NZNO Annual Report 2020/21 and the audited financial statements, for instance, were accepted through an AGM ballot where only a minority of the eligible reps voted on behalf of their members at all. 

Given this, I have two strong suggestions for responses in Section 6 of the survey. Firstly, people should clearly state that we must keep the “One Member, One Vote” system. Because believe it or not, there is a push at the top of NZNO to remove this from the Constitution and go back to making decisions about remits on a “representational basis” at meetings. Those driving the move backwards say that democracy is inherently “racist”, against Māori. 

Their argument rests on the assumption that all Māori think and vote the same way, and that Pākehā and other tauiwi always vote against them. Because Māori are a minority, the argument goes, they will always be outvoted and always lose out. 

This argument, however, stereotypes Māori and is not supported by the evidence. Voting for NZNO Board members, for instance, is an area where the “One Member, One Vote” system has applied since 2011. At the last election in 2019, democracy produced wins for Māori candidates. The following year, in an all-member ballot using the “One Member, One Vote” system, a remit giving Māori NZNO members the power to veto anything in future which affects Te Rūnanga or is inconsistent with their rules (Ngā Ture) attracted overwhelming democratic support. This remit to empower Māori NZNO members, which I wrote before stepping down as NZNO President, passed with 73 percent of the vote. 

It can sometimes happen that democratic, majority rule systems fail to adequately respect minority rights. This is why protections underpinned by Te Tiriti o Waitangi – like giving Māori members veto power over things which affect them – are needed. 

But democracy is not inherently racist. Dressing up opposition to democracy in the garb of anti-racism is just disingenuous. As the world looks on in horror at attempts to suppress democracy in Ukraine, we need to be very clear that democracy is the best system of governance we have. Since the introduction of online democratic voting in 2018, it has strengthened our union, massively increased participation, delivered better outcomes and improved member satisfaction. It is certainly superior to the secretive, unaccountable decision-making that goes on at meetings. 

The Kaitiaki headline testifies to the multifaceted success of the “One Member, One Vote” system of online democracy introduced in 2018. Full story: https://kaitiaki.org.nz/article/record-turnout-as-dhb-members-accept-offer/

So in addition to stating clearly in Section 6 of the survey that we must keep the current “One Member, One Vote” system, members should also tick “yes” to support “One Member, One Vote” on AGM matters and also tick the box to say that “Voting at a special general meeting should be… By one member, one vote to be carried out electronically or by post.”

Kaitiakitanga & servant leadership

The dissatisfaction over the Board’s lack of transparency and the damning assessment of its ethics in the recent external review has fuelled a widespread suspicion that in recent years, the NZNO Board has been driven by personal agendas – not by the needs of the membership. In my experience, this suspicion is well founded. Spending a quarter of a million dollars of members’ money on the Board’s own legal battles in 2018-19 must rank as a scandal, all on its own. We need a board who hold fast instead to values like kaitiakitanga, acting as custodians serving on behalf the membership for a time, rather than as owners of the organisation who would use its resources for their own ends. 

The culture and values of a Board, whether that’s a culture of service or an inflated sense of superiority and entitlement, is shaped by many factors. But in the case of the NZNO Board, they include aspects of the Constitution. 

Section 5 of the Member Survey focuses on the Board. The second question in this section begins, “The current term for board members, with the exception of the Kaiwhakahaere and the Tumu whakarae is three years, with a right of re-election for a further consecutive three years in any one position. A director may serve up to two terms in any one position. The maximum consecutive terms on the board in any combination of positions is four. Following two terms in any one position or four terms in a combination of positions, a director may be eligible to stand for office again after a break of two years.”

So as the survey explains, the Constitution currently limits how long the President, Vice-President and the non-officer directors can remain in their positions. 

What the survey does not mention is the very next clause in the Constitution: “… The term of the Kaiwhakahaere and Tumu whakarae Directors shall be three years, with a right of re-election for a further consecutive three years, and may be eligible to stand for office again every three years thereafter.” In other words, there are no limits on how long the Kaiwhakahaere and Tumu Whakarae can hold hold office. Nor does the survey mention the six figure salaries paid to the elected officers.

And the survey does not mention how the Kaiwhakahaere and Tumu Whakarae are elected, either. As stated in Schedule Three of the Constitution, these positions are elected at the Hui ā-Tau – which is run each year under the rules of Te Rūnanga (Ngā Ture). In accordance with the principle of tino rangatiratanga, Ngā Ture are determined by solely by Māori members of NZNO. They are not up for wider input as part of the Constitutional Review. However, Ngā Ture are referenced in the NZNO Constitution and need to be read alongside it, as these rules of Te Rūnanga provide relevant additional context. 

Ngā Ture state that to be eligible to stand in elections for the position of Kaiwhakahaere or Tumu Whakarae, candidates must have held a position at Te Poari within two years of applying. In other words, while a call for nominations for these positions goes out every three years to all 4,000 members of Te Rūnanga, the only people eligible to stand (apart from the two incumbents) are two nursing students from Te Rūnanga Tauira, or (realistically) the eleven regional representatives who make up the rest of Te Poari. 

This tiny pool of potential candidates (numbering just eleven, or perhaps a couple more given turnover in these positions in a two year period) are all people who have served loyally under the incumbent office-holders – who also happen to control the budget for travel and accommodation for the delegates to Hui ā-Tau, and control who may speak at Hui-ā-Tau, where the couple of hundred voters who’ve been funded to attend elect the Kaiwhakahaere and Tumu Whakarae. 

These rules go some way to explaining why, in the last 13 years, the position of Kaiwhakahaere has never been the subject of a contested democratic election – and probably won’t be in the future, either. 

The term limits which specified how long the Kaiwhakahaere and Tumu Whakarae can hold hold office were removed from the Constitution in 2017. The rationale for this was something I went along with at the time, and I lent my support to the change. But with the benefit of hindsight, the key argument – that the pool of Māori RN members with the level of skill and knowledge required is so small, that two individuals must be allowed to hold office indefinitely – does a gross disservice to the amazing strength and leadership abilities of Māori nurses as a whole. 

In combination with the strict limitations on eligibility for office in Ngā Ture and the introduction of six figure salaries for NZNO officers, the consequence of this Constitutional change – perhaps unintended – has been to effectively turn what should be kaitiaki roles into careers and “jobs for life”. This is having a negative impact on the development and emergence of new Māori nursing leaders, and creating psychological and cultural shifts on the Board which divert its focus away from serving the membership. 

Servant leadership is a leadership philosophy in which the goal of the leader is to serve. A servant leader shares power, puts the needs of members and staff first and helps people develop and perform as highly as possible. Instead of the people working to serve the leader, the leader exists to serve the people. This culture is what we need to restore to the NZNO Board, and Constitutional change can be a part of that. 

The last question in Section 5 of the Member Survey asks, “If I could propose one process involving the Board that would benefit me as a member, that process would be…”. I suggest that an answer could be, “To apply equal term limits for all Board members so they each understand their stewardship role, as custodians serving on behalf the membership for a limited time only.”

Engagement and Belonging 

Section 3 of the Member Survey will strike virtually all NZNO members as odd. Under a heading of “Connection to the NZNO”, it begins by asking whether you belong to a Regional Council. Faced with this question, most NZNO members will wonder, “What’s a Regional Council?”. 

In this way, the survey unintentionally highlights what is a fundamental disconnect between NZNO members and the structures of our union. This disconnect is based on flaws in the Constitution. We now have the opportunity to fix these flaws and build other member structures which support engagement and belonging. 

The eleven NZNO Regional Councils were created in 1989. They replaced the 54 “branches” in the old New Zealand Nurses Association (NZNA), shortly before it transformed into the NZNO we have today. Under the NZNO Constitution, Regional Councils have a lot of power. Not only do the Council Chairs wield thousands of votes each in NZNO meetings (see above), they also control the submission of remits for the “One Member, One Vote” process and approve candidates wishing to stand for the NZNO Board. 

The flaws in the system have been well understood for many years. Back in 1998, the NZNO Conference requested that the effectiveness of Regional Councils be reviewed. The review concluded that Regional Councils were not effective, but the resulting changes were minor. 

In 2003, delegates to the NZNO AGM went further. They debated a paper proposing significant change to the structure of NZNO. The discussion paper said:

  • “Regional Councils have not been effective in representing members and have been reviewed in the past. 
  • At present there are 11 Regional Councils. The Committee reviewed the attendance over the past 12 months of six of those Regional Councils; Central, Bay of Plenty, Auckland, Midlands, Wellington and Southern. All met two- monthly. The lowest attendance was three persons, the maximum attendance was 23 (Southern). No other Regional Council meeting had an attendance of 20 or more persons. The average attendance of the Regional Councils over the 12 month period ranged between under 10 to a little over 14 (Auckland). These are extremely low numbers and cannot give any confidence that decision making structures based around Regional Council are inclusive, democratic and participatory.” 

The problem has only gotten worse since 2003. In 2010 the official centennial history of NZNO, Freed to Care, Proud to Nurse, described the replacement of union branches by Regional Councils: 

“This restructuring was seen by NZNA leadership as better representing the majority of members, who now worked across multiple workplaces. It was perceived by the membership, however, as the destruction of the organic channels that they had created. In fact, the imposed structure was never to function in the comfortable, rhythmic way that the old branches had.”

Today, although NZNO membership has grown to the point that the Regional Councils are supposed to represent thousands or even tens of thousands of members each, most still struggle to get meeting participation numbering in double digits. 

I need to stress that the fault in this system does not lie with the member volunteers who keep the Regional Councils running. Regional Council members are among the most dedicated NZNO members, who work incredibly hard to try and make them work. The problem is, they’re working in a structure that’s never worked since it was first created, 33 years ago, and is now broken beyond repair. 

“The main drivers behind our present structure were legislative requirements in the Labour Relations Act 1987 and the Employment Contracts Act 1991”, observed the 2003 NZNO AGM discussion paper. These laws were repealed decades ago. NZNO Regional Councils are relics of a bygone age. Divorced from the conditions which led to their creation, they no longer made sense in 2003, and they make even less sense now. 

Other problems with NZNO structures flow on from this. The Membership Committee, which is first mentioned in Section 2 of the Member Survey, was created in 2012 “to advise the board”, due to member concerns that the Board would become remote and unaccountable. 

It hasn’t worked. The Board did become remote and unaccountable. The Membership Committee was never to fulfil the key functions in its original Charter of:

  • “Providing further insight into the views and needs of the diverse membership of NZNO and provide a link to the local level
  • Ensuring the NZNO is responsive to the needs and issues of members
  • Receiving and considering the summary of Board meetings and providing feedback”

There are two reasons for this. Firstly, because the Board would simply refuse requests to meet, or to provide a summary of their meetings. But also because the Membership Committee is based largely upon the unrepresentative, disconnected Regional Councils. 

Despite my best efforts during six years on the Membership Committee, in various roles, I watched it get captured by the agendas of the Board, succumb to the culture of secrecy at the top and finally adopt a new Charter in 2020 which deleted its original purpose. Today almost half the positions on the Membership Committee sit vacant, partly as a result of its irrelevance. Even with the added inducement of fully funded travel, meals and accommodation, paid leave and reimbursement of meeting expenses, the vacancies cannot be filled. 

Under “General Understanding of Constitution”, Section 2 of the survey asks about “the most important functions of the Membership Committee”. I suggest that an answer could be: “Representing the views and needs of the diverse membership of NZNO and providing a link to the local level, and ensuring the NZNO is responsive to the needs and issues of members, which it cannot possibly do under current Constitutional arrangements.” 

But outside of the Regional Councils and Membership Committee, there are functioning structures where NZNO members do engage and feel a sense of belonging, such as the Colleges and Sections. The functioning structures also include the Worksite Organising Committees (aka WOCs, or the “monthly delegates meeting”), led by an elected Convenor (aka “Lead Delegate”), and the National Delegates Committees (NDCs). The WOCs and NDCs provide crucial input into on NZNO’s industrial strategies at all levels and guide our negotiating teams. You may be surprised to learn that this democratic structure, where members are highly engaged doing vital NZNO work, is described in the NZNO Delegates Handbook but has no formal powers under the Constitution. 

The Colleges and Sections are a place where members feel a sense of belonging and engage in the work of NZNO.

The delegates to the NZNO AGM back in 2003 decided to commission a full structural review. The 2004 Report of the Structural Review Committee proposed solutions which still make sense today. It said: 

“The Issue

  • The Committee recognises that much of the activity and work of NZNO carried out by members occurs at workplaces, Colleges and Sections and it seems appropriate to locate decision making where membership activity occurs…”

“Proposed Changes

  • It is proposed that as far as possible NZNO should devolve its decision making and relate to, consult with, and organise its membership through Workplaces, Colleges and Sections.
  • The Committee proposes that Workplace Committees be formalised in the governance structure of NZNO. Under the proposed model general membership participation and decision making would be devolved to Workplaces, Colleges and Sections. The primary flow of communication would be directly from workplaces and Colleges and Sections to national structures and vice versa.
  • It is proposed that existing Regional Councils… be retained for a period of two years and then reviewed.”

Section 3 of the Member Survey asks, “The benefits that I obtain from a Regional Council are as follows”. Be honest. If the answer is nothing, say “nothing”. Then in Section 7 of the survey, which asks you to, “Indicate below if you have any comment in respect of a specific structure”. You might like to write something along these lines under “Regional Councils”: 

“Back in 2004, at the time of the last NZNO structural review, Regional Councils selected the members of the NZNO Board and did all the voting on remits. Both of these democratic functions have now been transferred to the “One Member, One Vote” system. As mentioned in responses under Section 6 of this survey, voting at AGMs and SGMs also needs to be done according to “One Member, One Vote”. The Regional Councils did have a (relatively small) role in organising Regional Conventions, but these have now been cancelled.

The functions remaining – which largely consist of proposing remits, endorsing candidates wishing to stand for Board, assisting with implementation of NZNO policies and strategies, electing Membership Committee reps and working in partnership with Te Rūnanga – should be devolved to Colleges, Sections and constitutionally defined Worksite Organising Committees, in accordance with the recommendations of the 2004 Structural Review Committee. Regional Councils can then be wound up.” 

What’s next? 

This article has suggested a few ideas for members to include in their responses to the current Member Survey on the NZNO Constitution. But it’s far from an exhaustive list. For anyone interested, my complete Member Survey responses are available (for a cheeky copy/paste) here.

Section 8 of the Member Survey asks if there are, “any other comments you would like to make in respect of the Constitution of the Organisation.” You might like to comment that NZNO is the only professional association and registered union in Australasia (and possibly the world, apart from the Royal College of Nursing in the UK) which has a Chief Executive Officer. There appears to be no valid reason for this, although it does lead to a much higher salary for NZNO’s most senior manager, funded of course by our membership fees. In fact, it looks like a bit like a colonial hangover. The CEO role prescribed in Section 20 of the Constitution should be re-scoped, possibly as National Secretary, which was the title held by our current CEO as head of his previous registered union and professional association from 2008-2022. 

Some of the things mentioned in the Member Survey – like the questions about Partnership under Te Tiriti o Waitangi in Section 6 – relate largely to personalities and practices, however, which won’t be fixed by changing the Constitution. And any Constitution is only as good as the people who operationalise it. The people who have been dominating the NZNO Board for years have trampled on our union’s system of rules and the values which underpin it – much like what President Donald Trump did with the US Constitution (even to the point of seeking to overturn a democratically-elected NZNO President). 

So as well as participating in the current Member Survey before 30 April, and considering the suggestions for survey responses in this article, I hope that union members will also participate in the upcoming election for the NZNO Board. Come August, seven of the eleven Board seats will be up for grabs. For the reasons already stated, this year we need to elect people who support the ongoing transformation of NZNO. We need bicultural servant leaders committed to openness and honesty, genuine democracy and engagement and belonging for NZNO members. 

NZNO Mental Health Nurses Section Newsletter – March 2022

Message from the MHNS Committee

Two years of world-leading public health responses kept Aotearoa safe from the worst effects of the global Covid-19 pandemic. Now the Omicron wave is here. MHNS members are in our thoughts at this time, whether managing suspected or confirmed Covid cases among our tāngata whai ora or isolating at home yourselves.

A newly-published open-access paper in the NZ Medical Journal [Every-Palmer et al., 2022] highlights how the wellbeing of New Zealanders with mental health and addiction issues has been disproportionately affected by Covid-19. Structural discrimination experienced by our client group in the vaccine roll-out has worsened this inequity, with just 80 percent of mental health consumers and 78 percent of AOD service users being fully vaccinated as at 14 February 2022. For tāngata whai ora Māori, the data on vaccinations are even more concerning, being 74 percent and 72 percent respectively.

In brighter news, however, anecdotal evidence suggests that infection prevention and control measures in workplaces are proving effective. A message sent on 2 March 2022 to all staff at Capital and Coast DHB and Hutt Valley DHB from CEO Fionnagh Dougan, for instance, said that despite the rising number of staff isolating at home, “There has been no spread that we are aware of in our clinical areas where staff have been excellent at wearing the appropriate PPE and following infection control processes.”

As we wish our members a safe and healthy emergence from the Omicron wave, we also look forward to the longer-term restructuring of the mental health, addictions and intellectual disability sector. Although the last issue of the MHNS Newsletter promised that we would showcase the International Journal of Mental Health Nursing, the Committee has chosen to include in this issue a pay-walled feature article which the NZ Medical Journal has kindly allowed us to re-publish, ‘New Zealand’s mental health crisis, He Ara Oranga and the future’. We found this article particularly thought-provoking. We hope that you do, too.

Committee news

The MHNS Committee met by Zoom for an additional unscheduled meeting on 1 February. The main item on the agenda was the 2022 Mental Health Nurses Forum. After postponing the Forum until March 2022 due to the Delta outbreak last year, we were forced to cancel the in-person event altogether on account of the Omicron outbreak. The Committee is working with our presenters on rescheduling Forum sessions, to be held by Zoom later in the year.

We also reviewed our process for producing the MHNS submission on Transforming Our Mental Health Law. The submission closing date of 28 January made it difficult to consult with members over the holiday season. The Wellington Anniversary Day closure of the NZNO National Office, along with the half-day closure on the preceding Friday, also shortened our consultation period by four days, while NZNO staffing issues prevented us from obtaining support from the NZNO policy team. We apologise to members for the curtailed consultation, we commit to giving greater opportunity to input in future submissions and we thank those who managed to get their thoughts to us in time. The final version of the MHNS submission is available here.

Lastly we discussed the review of the NZNO Constitution. As one of the movers of the 2020 remit for a full and independent review, the MHNS Committee is represented on the Constitutional Review Advisory Group. We are committed to a democratic, membership- driven Constitution for NZNO in accordance with the NZNO Strategic Plan 2021-25.

Committee vacancies – call for nominations

The MHNS Committee – currently made up of Helen Garrick (Chairperson), Margaret Daniela (Minute Secretary), Jennie Rae (Treasurer), Brent Doncliff (Committee member/Facebook group administrator) and Grant Brookes (Committee member/Newsletter editor) – is still looking to co-opt two additional members. This is an opportunity to get a taste of Section leadership, for a shortened term up until the Biennial General Meeting in August 2022. We invite any new, emerging leaders to join us. To express you interest, please click here for the nomination form.

References

Structural discrimination in the COVID-19 vaccination programme for people with mental health and addiction issues: now is the time to be equally well
Susanna Every-Palmer, Ashley Koning, Linda Smith, Ruth Cunningham, Cameron Lacey, Deborah Peterson, Angela Jury, Kate M Scott, Tony Dowell, Alison Masters, Helen Lockett NZMJ135(1550), pages 133-139. 25 February 2022

IJMHN, Vol. 31 No. 2, April 2022 

Issue Information. Pages: 241-242 First Published: 01 March 2022

Editorial
Free Access
Combating loneliness and isolation and promoting good mental health – One ukulele at a time
Philip Darbyshire RNMH RSCN DipN(Lond) RNT MN PHD, Cheryl Green RN, RMN, BSc, MPH, Grad Cert Health Services Management. Pages: 243-246 First Published: 24 November 2021

Review Articles
Vicarious trauma and nursing: An integrative review
Sophie Isobel PhD, RN(BN), grad cert CFHN, CAMH, Res Meth, Margaret Thomas RN(BN), MMHN, BSc
Pages: 247-259 First Published: 19 November 2021

Open Access
What evidence supports the use of Body Worn Cameras in mental health inpatient wards? A systematic review and narrative synthesis of the effects of Body Worn Cameras in public sector services
Keiran Wilson MSc, Jessica Eaton MSc, Una Foye PhD, Madeleine Ellis MA, Ellen Thomas, Alan Simpson PhD
Pages: 260-277 First Published: 08 December 2021

Suicide by hanging: A scoping review
Rachael Sabrinskas BAppSci, Psych, BN, M.Mental Health Nursing, PhD Candidate, Bridget Hamilton BPsychN, BN(Hons), PhD, Catherine Daniel BPsychNurs, PGDipN(MtlHlth) MN, PhD, John Oliffe PhD, MEd, RN
Pages: 278-294 First Published: 25 November 2021

Original Articles
Concept analysis of shame in nursing
Michael A. Jaeb BSN, RN
Pages: 295-304 First Published: 09 November 2021

The influence of a self-determination theory grounded clinical placement on nursing student’s therapeutic relationship skills: A pre-test/post-test study
Dana Perlman PhD, M.S. (Educational Leadership), Bachelor of Education (Physical Education), Lorna Moxham RN, MHN, PhD, MEd, BHSc, DASc, Cert OH&S, Cert Qual Mngmt, Cert IV Training & Assessment, FACMHN, FACN, MAICD, Christopher Patterson PhD, M.Nurs (Mental Health) and BN (Hons), Amy Tapsell Master of Public Health and Bachelor if Arts (Psychology), Emily Keough Bachelor of Psychology (Honours), PhD candidate (Psychology). Pages: 305-312 First Published: 24 November 2021

Factors associated with Health of the Nation Outcomes Scales (HoNOS) in an acute young adult psychiatric unit
Grace Branjerdporn Cert III(TESOL), BOccThy(Hons I), CHIA, PhD, Julia Robertson BPsychSc, Alex Dymond BSocWork, BPsych, Grad.Cert.Trauma, Grad.Cert.AcadHP, MForMH. Pages: 313-325 First Published: 24 November 2021

A qualitative study exploring adolescents’ perspective about Mental Health First Aid Training Programmes promoted by nurses in upper secondary schools
Tiago Filipe Oliveira Costa RMN, MSc, Francisco Miguel Correia Sampaio RMN, MSc, PhD, Carlos Alberto da Cruz Sequeira RMN, MSc, PhD, María Teresa Lluch Canut RMN, MSc, PhD, Antonio Rafael Moreno Poyato RN, MHN, MSc, PhD. Pages: 326-338 First Published: 25 November 2021

Relationship between nurses’ use of verbal de-escalation and mechanical restraint in acute inpatient mental health care: a retrospective study
Alonso Pérez-Toribio RN, MSc, Antonio R. Moreno-Poyato RN, MSc, MHN, PhD, Teresa Lluch-Canut RN, MHN, PhD, Laura Molina-Martínez RN, MHN, Anna Bastidas-Salvadó RN, MHN, Montserrat Puig-Llobet RN, MHN, PhD, Juan F. Roldán-Merino RN, MSc, MHN, PhD
Pages: 339-347 First Published: 26 November 2021

‘Are they really allowed to treat me like that?’ – A qualitative study to explore the nature of formal patient complaints about mental healthcare services in Sweden
Annelie J. Sundler PhD, RN, Anna Råberus MScN, RN, Gunilla Carlsson PhD, RN, Christina Nilsson PhD, RN, RM, Laura Darcy PhD, RN. Pages: 348-357 First Published: 11 December 2021

Exploration of the utility of the Nursing Process and the Clinical Reasoning Cycle as a framework for forensic mental health nurses: A qualitative study
Tessa Maguire RN, GD FBS, GD FMHN, MMentHlthSc, PhD, Loretta Garvey RN, PhD, Jo Ryan RN, Bed, GC VRAM, Georgina Willetts RN, BN, PhD, Michael Olasoji RN, PhD Pages: 358-368 First Published: 17 December 2021

Learning your limits: Nurses’ experiences of caring for young unaccompanied refugees in acute psychiatric care
Sebastian Gabrielsson RN, PhD, Hannan Karim RN, MSc, Git-Marie Ejneborn Looi RN, PhD. Pages: 369-378 First Published: 15 December 2021

Women’s experiences of restrictive interventions within inpatient mental health services: A qualitative investigation
Amy Scholes ClinPsyD, MSc, BSc, Owen Price PhD, MSc, BSc, Katherine Berry PhD, ClinPsyD, MSc, BSc. Pages: 379-389 First Published: 24 December 2021

Psychological experiences of caregivers of adolescents diagnosed with substance use disorder attending a youth centre in a low-resource setting
Lydia Nyaga Njoki RN, BScN, MSc, Irene G. Mageto RN, BScN, MSc, PhD, Lucy W. Kivuti-Bitok RN, BScN, Msc, PhD. Pages: 390-399 First Published: 21 December 2021

Review Articles
What are the experiences and the perceptions of service users attending Emergency Department for a mental health crisis? A systematic review
Maya Sacre RGN, RMN, MSc, Rikke Albert RMN, MSc, Juanita Hoe RMN, PhD Pages: 400-423 First Published: 23 December 2021

Open Access
Valued attributes of professional support for people who repeatedly self-harm: A systematic review and meta-synthesis of first-hand accounts
Cara Sass PhD, Cathy Brennan PhD, Kate Farley PhD, Helen Crosby PhD, Rocio Rodriguez Lopez MPH, Daniel Romeu MB BChir MA (Cantab) PGCert, Elizabeth Mitchell BSc, Allan House BSc, MBBS, MRCPsych(UK), MRCPsych DM, Else Guthrie MB, ChB, MSc, MD, FRCPsych
Pages: 424-441 First Published: 15 January 2022

Letter to the Editor
There must be a better way: The implementation of a nurse-led mental health service to support people living with a mental health condition
Lesley J. Douglas PhD, CMHN, MFMH, Grad. Dip. Midwifery, BH (MH), Eilish P. O’Shea Pages: 442-444 First Published: 01 February 2022

Feature article

New Zealand’s mental health crisis, He Ara Oranga and the future Roger T Mulder, Tarun Bastiampillai, Anthony Jorm, Stephen Allison. NZMJ135(1548) 21 January 2022, pages 89-95.

Click on the image below to read the article.

• This newsletter is re-posted from https://www.nzno.org.nz/groups/colleges_sections/sections/mental_health_nurses/newsletter

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

Presenting to the Pae Ora Legislation Committee, 28 January 2022

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.

Welcome to the re-launched Mental Health Nurses Section Newsletter

There’s always a bit of excitement around Issue 1 of a new periodical – and so it is, for us. 

Born of necessity after the demise of the Stop4th Nursing Information Provision Service (SNIPS), which provided our content up until July, the MHNS Newsletter will now showcase the International Journal of Mental Health Nursing. Each issue will feature a local article from the journal and the contents list. Full access to the journal is a benefit of MHNS membership. To obtain an article, please email library@nzno.org.nz with the citation of the full text article you would like. The MHNS Newsletter now be coming to you bimonthly, matching the IJMHN publication schedule. 

Committee news

The MHNS Committee met over two days on 18-19 November. Due to the Covid Alert Level in Auckland, the meeting was a blend of Zoom and face to face participation. 

Our full agenda included discussions with the MOH Deputy Director of Mental Health, Toni Dal Din, and MOH Principal Advisor Anne Brebner. Toni spoke to us briefly about reviewing guidelines for statutory officers, for the transport of special patients and for seclusion. 

But the bulk of his kōrero was about the repeal and replacement of the Mental Health (Compulsory Assessment and Treatment) Act 1992. The first phase of consultation on transforming our mental health law closes on 28 January, with further consultations to follow. Drafting of the new legislation is due to take place in 2023. The MHNS Committee will ensure that members’ voices are heard in this process.

Anne Brebner spoke about the role of the Specialist Services Team and the other parts of the Ministry which it interfaces with. A major piece of work for her team is the forthcoming Mental Health and Addiction System and Services Framework. This will guide the first major reconfiguration of the sector since the Blueprint for Mental Health Services in 1998. 

We also discussed the review of the NZNO Constitution. As one of the movers of the 2020 remit for a full and independent review, the MHNS Committee is represented on the Constitutional Review Advisory Group. The independent consultants who are assisting with the review zoomed in for this agenda item. 

The November meeting farewelled Philip Ferris-Day and James Mather, who are both stepping down to pursue new opportunities. We are appreciative of Phillip’s long service and many contributions on the Committee over the last four and a half years, and we are very grateful that James and former Committee member Cecil Williams will continue their “on the ground” assistance in preparing for the 2022 Mental Health Nurses Forum. The Committee is now: 

  • Helen Garrick (Chairperson)
  • Margaret Daniela (Minute Secretary)
  • Jennie Rae (Treasurer)
  • Brent Doncliff (Committee member/Facebook group administrator)
  • Grant Brookes (Committee member/Newsletter editor)

Committee vacancies – call for nominations

The departures of Philip Ferris-Day and James Mather mean that the MHNS Committee is now looking to co-opt two additional members. This is an opportunity to get a taste of Section leadership, for a shortened term up until the Biennial General Meeting in August 2022. We invite any new, emerging leaders to join us. Please click here for the nomination form. Nominations close 17th January 2022. 

2022 Mental Health Nurses Forum – Registrations now open

As announced by email on 1 December, the rescheduled Mental Health Nurses Forum is back on for 2022. Presented in collaboration with Southern District Health Board, this MHNS Forum is an excellent professional development opportunity for any Mental Health Nurse.

  • Date: Friday, 18 March 2022
  • Venue: Hutton Theatre, Otago Museum, Dunedin
  • Theme: “Capacity and Duty of Care”

REGISTER HERE
Click here for the forum flyer.

All details can be found on the Mental Health Nurses Section webpage. We look forward to seeing you there.

NZNO Mental Health Nurses Section Committee 

IJMHN, Vol. 30 No. 6, December 2021

Issue Information
Pages: 1471-1472 

Mental health, climate change, and bushfires: What’s colonization got to do with it?
Kisani Upward RN, BN, MPhiL Candidate, Vicki Saunders BPsych, MPH, PhD, Myfanwy Maple PhD BSW (Hons) GCTE GCAdolHlthWlf GAICD, Kim Usher AM, RN, PhD, FACMHN
Pages: 1473-1475

Understanding the factors that affect retention within the mental health nursing workforce: a systematic review and thematic synthesis 
Rosie Adams MSc, RMN, Tony Ryan PhD, Emily Wood PhD, RN
Pages: 1476-1497 

Improving the physical health of young people with early psychosis with lifestyle interventions: Scoping review
Ting Ting Hui RN, BC, MNP, PGDipMHN, MMHN, PhD Candidate, Loretta Garvey RN, BN (Hons), GCHPE, PhD, Michael Olasoji RN, BN (Hons), PGDipMHN, PhD.
Pages: 1498-1524 

An integrated review of the barriers and facilitators for accessing and engaging with mental health in a rural setting
Philip Ferris-Day RN, MMH, Karen Hoare PhD NP MSc, Rhonda L. Wilson RN, CMHN, BNSc, MN (Hons), PhD, Claire Minton RN, PhD, Andrea Donaldson PhD, MSc, BSc, BN, CATE, RCN
Pages: 1525-1538 

‘Acknowledge me as a capable person’: How people with mental ill health describe their experiences with general emergency care staff – A qualitative interview study
Katharina Derblom RN MSc, Jenny Molin RN PhD, Sebastian Gabrielsson RN PhD, Britt-Marie Lindgren RN PhD
Pages: 1539-1549 

Prevalence and severity of verbal, physical, and sexual inpatient violence against nurses in Swiss psychiatric hospitals and associated nurse-related characteristics: Cross-sectional multicentre study
Nanja Schlup MScN, Beatrice Gehri MScN, Michael Simon PhD RN
Pages: 1550-1563 

Nursing students’ attitudes towards alcohol use disorders and related issues: A comparative study in four American countries
Luz Patricia Diaz Heredia PhD, MSN, BSN, Divane de Vargas PhD, MSN, BSN, Erika Gisseth León Ramírez PhD, MSN, BSN, Madeline Naegle PhD, CNS-PMH, BC, FAAN
Pages: 1564-1574 

“Modifying” or “Retreating”– Self-management of physical health among a group of people with schizophrenia. An ethnographic study from Denmark
Birgitte Lerbæk, Rikke Jørgensen, Niels Buus, Marlene Briciet Lauritsen, Jørgen Aagaard, Julie Nordgaard, Andrea McCloughen
Pages: 1575-1587 

Towards epistemic justice doing: Examining the experiences and shifts in knowledge of lived experience researchers over the course of a mental health research training programme
Brett Bellingham, Holly Kemp BA, Katherine Boydell PhD, Sophie Isobel PhD, Katherine Gill PhD, Jo River PhD
Pages: 1588-1598 

Digital risks and adolescents: The relationships between digital game addiction, emotional eating, and aggression
Nuray Caner PhD, RN, Derya Evgin PhD, RN
Pages: 1599-1609 

Cultural issues on accessing mental health services in Nepali and Iranian migrants communities in the UK
Bibha Simkhada PhD, BA, BSc, RGN, Mariam Vahdaninia PhD, MSc, Edwin van Teijlingen PhD, MA (Hon), MEd, Hannah Blunt BSc (Hon), RMN
Pages: 1610-1619 

Exploring the experience of acute inpatient mental health care from the perspective of family and carers of people experiencing psychosis: A qualitative thematic analysis study conducted during the COVID- 19 pandemic
Lisa Wood BSc, MRes, DClinPsy, PhD, Callam Constant BSc, Alison Byrne BSc Msc
Pages: 1620-1629 

‘First tonight, the contentious new code telling nurses to say, ‘sorry for being white’: Mental health nurses’ beliefs about their Code of Conduct and cultural safety for Aboriginal and Torres Strait Islander Peoples
Luke Molloy PhD, RPN, Paul Beckett MMHN, RN, Sherphard Chidarikire PhD, RN, Matthew P. Scott BSc (Nursing), RN, Monica D. Guha MMHN, RN, Tammy Tran Merrick MPH, RN, Declan Patton PhD, RPN
Pages: 1630-1639 

Predictors of community mental health nursing services use in Switzerland: Results from a representative national survey
Christian Burr MScN, RN, Dirk Richter PhD, RN
Pages: 1640-1648 

Deliberate self-harm among adolescents: A structural equation modelling analysis
Arunothai Singtakaew RN, PhD, Nujjaree Chaimongkol RN, PhD
Pages: 1649-1663 

The role and activities of the Traveller mental health liaison nurse: Findings from a multi-stakeholder evaluation
Karin O’Sullivan BA, MA, PhD, Anne Marie Brady PhD, MSc, BSc, RGN, Carmel Downes MSc, Agnes Higgins PhD, MSc, BNS, RPN, RGN, Louise Doyle PhD, MSc, BNS, RPN, Thomas McCann McCann, BSc, MA, Brian Keogh PhD, MSc, BNS, RPN
Pages: 1664-1673 

Perceived COVID-19-associated discrimination, mental health and professional-turnover intention among frontline clinical nurses: The mediating role of resilience
Leodoro J. Labrague PhD, CHSE, CHE, Janet Alexis A. De los Santos PhD, RN, Dennis C. Fronda MAN, RN
Pages: 1674-1683

Nurses’ experiences of providing care during the COVID-19 pandemic in Taiwan: A qualitative study
Hwey-Fang Liang PhD, RN, Yi-Chen Wu MSc, PT, Chien-Yu Wu BSN, RN
Pages: 1684-1692 

A !rst-hand experience of co-design in mental health service design: Opportunities, challenges, and lessons
Rachel Marie Tindall BN, MANP (mental health), PhD, Melissa Ferris BBus, GradCertPubAdv, MAICD, Meredith Townsend, Gayle Boschert BSc (Biochem), GradDipNutr&Diet, MAICD, Steven Moylan BSc, BMBS (Hons), MPH, MPM, MBA, PhD, FRANZCP
Pages: 1693-1702 

‘You get this conflict between you as a person and you in your role…that changes you’: A thematic analysis of how inpatient psychiatric healthcare staff in the UK experience restraint, seclusion, and other restrictive practices
Michelle Mooney BSc, Ava Kanyeredzi PhD
Pages: 1703-1712 

Nursing handover involving consumers on inpatient mental healthcare units: A qualitative exploration of the consumers’ perspective
Ellen Van de Velde MSc, Ann Van Hecke MSc, PhD, Naomi Van Cleemput MSc, Kristof Eeckloo LLM, PhD, Simon Malfait RN, MSc, PhD
Pages: 1713-1725

Feature article

An integrated review of the barriers and facilitators for accessing and engaging with mental health in a rural setting
Philip Ferris-Day RN, MMH, Karen Hoare PhD NP MSc, Rhonda L. Wilson RN, CMHN, BNSc, MN (Hons), PhD, Claire Minton RN, PhD, Andrea Donaldson PhD, MSc, BSc, BN, CATE, RCN. December 2021. 
IJMHN 30(6), pages 1525-1538

This newsletter is re-posted from https://www.nzno.org.nz/groups/colleges_sections/sections/mental_health_nurses/newsletter

Newtown Union Health Service – Chairperson’s report to the 2021 AGM

Newtown Union Health Service is a not-for-profit community service providing healthcare for community service card holders, low income earners, union members and their families. NUHS is community owned and has provided affordable, accessible, appropriate, quality, not-for-profit and community based primary health care in Wellington since May 1987. Established with the support of local trade unions, two seats on the NUHS Board are reserved for representatives endorsed by the New Zealand Council of Trade Unions Te Kauae Kaimahi. Since 2013, I have filled one of these positions – serving for the last five years as the Board Chairperson. Here is the report I gave to the 2021 AGM, held earlier this month.

We were fortunate to have two fabulous guest speakers from the community at our AGM – self-described “D-Grade celebrity” Karen O’Leary, and Labour MP Ibrahim Omer

He waka eke noa”. “We are all in this together”. One year ago, in the 2019/20 Annual Report, I observed that the arrival of Covid-19 in Aotearoa had strongly shaped the year for NUHS, just as it had for the country as a whole. As we continue to play our part in the “Team of Five Million”, the pandemic has influenced our Service for another year. This influence has been felt in many ways – from driving practice innovations like a shift to virtual consultations, to opening up new funding streams or reducing international student numbers and patient enrolments at our Massey University clinic.

Patient enrolments at Massey at the end of 2020/21 were 1,524, down from 2,074 when NUHS took over the Massey clinic in May 2018. Income meanwhile was up, due to dedicated funding for Covid-related activity. This increase is the primary reason for the end of year surplus of $240,508. Excluding Covid-related activity, the end of year result would have been a deficit of $38,455. As some of these dedicated funding streams come to an end, the Board is planning for a deficit budget in 2021/22, but the Service remains in a strong financial position thanks to surpluses in each of the past five years. 

The other major environmental influence occupying the minds of the NUHS Board this year has been the Health and Disability System Review. In April, the Government released its long awaited response to the Review report. While some information about the new health system has been published by the Transition Unit, particularly about the replacement of District Health Boards by Health NZ and about the creation of the Māori Health Authority, less is known about the future of Primary and Community Care. The Board has been working with other union health services and with Tū Ora PHO to gather intelligence and strategise around how best to meet the needs of our community in the new environment. 

For our physical fixed assets, the Board was pleased this year to be able to secure the future of the premises at 14 Hall Avenue. The lease for the site has been renegotiated for another 20 years, with a right of renewal for five more years beyond that. This certainty enabled the Board to move ahead with a capital works programme. At the close of 2020/21, $328,752 had been spent on a new roof and other external remediation for the ageing NUHS building. This remediation work is expected to be completed in 2021/22, within the budget of $725,000, and should extend the life of the building until at least the end of the lease. Thinking will now turn to the future of the Broadway Clinic. 

Last year, the Board reviewed and adopted the new NUHS Strategic Plan 2020-25 and completed the update of the NUHS Constitution. This year, the focus at the governance level has been on implementing the new Constitution and revising the organisation’s governance policies.

A major change to membership criteria means that membership of the NUHS incorporated society is no longer automatic for, or limited to, enrolled patients. Under the new Constitution, membership is entirely voluntary and membership applications will be considered from supporters of the service who are not enrolled patients. This year, the Board created a membership register and an application process to manage membership applications. Under a sunset clause, current enrolled patients who have not applied to join the NUHS incorporated society will cease to be members on 28 August 2022.

At the close of the 2020/21 year, the Board was half way through revising the organisation’s governance policies. This includes development of a new process for electing the clinical staff members on the Board, in response to questions raised at the 2020 AGM. The intention is to complete the update of the remaining governance policies, and the finance policies, in the 2021/22 year. 

Collaboration with stakeholders continues to bear fruit. Joint work with Whitireia tertiary institute last year resulted in a set of four online learning packages in refugee health. This year, Nurse Practitioner Serena Moran co-presented on these packages at the Flexible Learning Association of NZ Conference. 

One of our union stakeholders, E tū, made a request for financial support for union members affected by industrial action at Lifewise. NUHS has a strong association and history with the union movement and was established with funding from trade unions. The interest from this legacy is the basis of an Industrial Action Support Fund. A $2,500 donation was made from this fund to the E Tū members. It is recorded here in the Annual Report, as required by NUHS governance policies. 

We have continued our excellent relationship with University of Otago, Wellington, contributing to medical student teaching and research. The Board acknowledges especially Dr Ben Gray, who retired in November after 27 years as a GP at NUHS but continues as an Associate Professor in the university’s Primary Health Care and General Practice Department. There he teaches alongside NUHS GP Dr Jonathan Kennedy and Nurse Practitioner Serena Moran.

2020/21 has also been another year of achievements for NUHS and our staff. Our service was a finalist for GENPRO General Practice of the Year at the 2021 Primary Health Care Awards He Tohu Mauri Ora. NUHS staff continue to be sought out for their expertise and advice, particularly around working with refugee background communities in Primary Care. 

On the Board itself, composition continues to evolve. Most notably this year, we farewelled community representative Ibrahim Omer after his election as a Member of Parliament in 2020. We congratulate Ibrahim on becoming New Zealand’s first African MP. We know he is committed to the health and wellbeing of communities like ours and we wish him all the best in his political career. 

At the 2020 AGM, Tim Rochford was elected to fill the community representative vacancy. Then in May 2021, union representative Sam Gribben stepped down, for family reasons. The Council of Trade Unions is nominating Sam’s successor. 

I acknowledge too the remaining Board members who have worked with us this year – Tāngata Whenua rep Fiona Da Vanzo, community reps Barbara Lambourn and Roger Shaw and Treasurer Julie Lamb. I am also grateful to Board Minute Taker Vanessa Gray and Finance Leader Giordano Rigutto, whose support has underpinned our collective achievements. 

Lastly, this will be my final NUHS Chairperson’s Report. I have informed the Board that after five years in the role, I will be handing over to a new NUHS Chairperson before the 2022 AGM. The strengths I see in the governance, management and staff of NUHS fill me with confidence in its future. 

Nō reira, tēnā koutou, tēnā koutou, tēnā tātou katoa. 

Grant Brookes, Chairperson NUHS Board