<< back to archive index Adjournment Speech Date: 21st September, 2006 Subject: Nursing Faculty Student Places:This speech was given was given in response to a motion put forward by a Labour party backbencher, the Hon. Jan Burnswoods, condemning the closure of the Faculty of Nursing at the University of Sydney. The Hon. Dr ARTHUR CHESTERFIELD-EVANS: " I am always a little reluctant to speak at length on motions that involve Federal and State, and Labor and Liberal bickering. This House should not be involved in that sort of bickering. We now have, effectively, three motions to choose from-we have a smorgasbord of choice. The motion moved by the Hon. Jan Burnswoods condemns the closing of the Faculty of Nursing at the University of Sydney and notes that since 1996 18,000 nursing applicants have been turned away from the university because there are not enough places; confirms that New South Wales needs more nurses, not less; and calls on the Federal Government to co-operate with the New South Wales Government to address the shortage of nursing places in New South Wales universities. The changing of nursing to a university faculty was in response to the desire to professionalise and raise the status of nurses, but it took away the apprenticeship-type system where nurses spent a lot of time at hospital bedsides as they trained. Of course, that was a very important resource for the staffing of hospitals with well-motivated and enthusiastic people. The shortage of nursing, in part, came from the fact that instead of working in hospitals as they trained student nurses worked in universities. While the status of nurses was higher and their pay, in consequence, was higher, I believe it led to better-trained nurses but fewer of them, and of the ones that were trained fewer of them were at hospital bedsides because they were more expensive. The nurses who trained in hospitals, and are very well trained, are often discriminated against in regard to promotion because they have a nursing certificate rather than a degree. There has been a quite significant downside-although I believe nurses are probably better trained, at least at a theoretical level. The Howard Government treated universities as just another industry, and if they make money from selling their courses the courses prosper and if they do not sell their courses they do not. That very narrow view of education has ignored the previous way of arranging university education, which was to attempt to project work force needs for the future and fund universities to do that. However imprecise that science may have been, I think it was better than simply relying on what makes money today. That strategy assumed that all the people who knew how much science would be needed in 20 years enrolled in science or took an interest in science, and so on. Of course, we have ended up with-God help us-a glut of lawyers and a shortage of scientists, dentists and nurses, as one might have expected, looking at how cheap it is to train lawyers and the difficulty of training scientists, dentists and nurses. The Howard Government has been very stupid and short-term in its attitude to the university sector in general and the nursing sector in particular. While these nurses were being turned away, everyone was crying from the hilltops that there was a shortage of nurses. It is just another example of the Howard Government's stupidity and venality in the higher education sector. There is no doubt that New South Wales needs more nurses. The Federal Government has to work more co-operatively on this issue. The amendment moved by the Hon. Jennifer Gardiner notes that the Faculty of Nursing at the University of Sydney did not result in a reduction of undergraduate nursing places_some were transferred to the University of Technology and the Australian Catholic University. In a sense, it means that the University of Sydney said, "We do not want to have nurses", and some of the other universities took up the slack. There is an idea to have them trained by Catholic universities: presumably there is secular education in nursing-we can only hope there is. The amendment states that the Federal Government should be commended for funding an extra 1,000 higher education nursing places at a national level-having cut far, far more than that from the system. This is just one of those overblown sops to a cheap headline when the Federal Government has systematically done a hell of a lot of damage. The fact that the Liberals can come in here with this sort of nonsense-a fig leaf to cover a horrendous policy-shows the triumph of politics over reality in a most unfortunate fashion. The same might be said for mental health nursing. While we have far more than 420 new places in gaols for our mental health patients, 420 new places in mental health nursing is a tiny bit and very late. The Federal Government's approach to mental health has been very tokenistic and, frankly, impractical. To say that only 36 per cent of registered enrolled nurses in New South Wales work in the public health system shows there is some sort of a fiddle in numbers, because that figure is for full-time nurses. There are quite a lot of nurses who are either on maternity leave or who are working part-time, so the figure is higher than that. While the Howard Government supports the private hospital sector to the extent it does, it is trading nurses out of the public hospital sector. It is a bit disingenuous then to say that only a few of the registered enrolled nurses work in the public health system when in fact the Howard Government is subsidising the private health insurance system to hell with money that should be going into the public health system. To condemn the State Government over the critical shortage of nurses when the Federal Government is so involved in the closure of nursing is, again, disingenuous. I refer to the closure of 3,000 hospital beds. While there is a shortage of hospital beds, it must be said that Australia does not do too badly in the general hospital sector. The decline in hospital beds to a large extent results from shortened hospital stays in the acute sector, and that should be noted. The problem of hospital beds should, to some extent, be addressed with more sensible public health measures-how much support there is for people to continue to live in their own homes and health measures that stop people getting sick and lessen the incidence of chronic illness that makes people bedridden. So to simply look at the number of beds and extrapolate that across is also somewhat disingenuous. The amendment of the Hon. Jennifer Gardiner is stitched together as fine politics, but it does not cut the mustard in the real world. The Greens' amendment expands the issue beyond nursing to look at the broader problems in the provision of health care and the training of medical and nursing practitioners. It is true that there has not been a good look at the delivery of health services. It is also true that the cost shifting and blaming between Federal and State governments is a depressing feature, and I will not broaden it further by saying that the Democrats solution to this problem is to abolish State governments. I have a plan for doing that, which I have enunciated to this House on a number of occasions. Be that as it may, I also have a 10-point plan to save the health system, one of which is to have a single administration, away from the Federal and the State systems. The key object of health policy now is not how to build the best health system but how to shift the costs to the other tier of government, the patient or the insurance systems. The key objective of health policy is to shift costs. The concern is not about total cost but the component of cost for which that person is responsible. John Menadue, who had a distinguished career in the public service, and who looked into the public health system, said the problem is that nobody is in charge. He said that it is a, "strife of interests", to use the phrase of Sydney Sacks, who talked about the politics of health care in his seminal book some years ago. My 10-point plan involves rationalisation of the single system of Federal-State problems in health, which was to support the public system because competition in health care is nonsense. The main competition between different systems simply results in duplication and a need for excessive record collecting. This means that the overheads of different health funds are far greater than the overheads of Medicare because of its universal coverage of the whole country. Also, competition does not really exist because patients are not able to make informed decisions about something being cheaper because they are not in a position to know prices and, therefore, cannot make valid comparisons on technologies or expertise. The market model simply does not work. A privatised system also seeks the most lucrative procedures and does nothing towards prevention, which must be done at the national level or by targeting relevant groups. Prevention is ignored in the market system. Medical indemnity reform is needed because a huge percentage of pathology and radiology services are carried out so that doctors cannot be sued for not being diligent. That may appear worthwhile but it wastes huge resources on tests when the answers are already known. It seeks also to strengthen the Pharmaceutical Benefits Scheme [PBS], which has been systematically weakened by the Howard Government after the lobbying of Pfizer so that drugs are now in the upper price range. It might be noted that pharmaceuticals have risen dramatically as a percentage of the health budget but cost effectiveness has been reduced. The PBS system before Howard reformed it was the envy of the world in that it not only looked at the drugs but the cost effectiveness of the drugs, which is the key aspect. Honourable members who would like to read the rest of my 10-point plan can visit my web site at www.chesterfieldevans.com. The Greens amendment further states: Calls on the Government to initiate a national constitutional conference to develop options for a new model for delivery of health services and the training of nurses and other health professionals that provides an effective, efficient and responsive health service for the Australian people. The Labor Party has criticised that. It suggests it is doing its best to get national co-operation through the mechanisms of the Council of Australian Governments and, as such, that is not a justifiable call. However, the more effort put into national co-operation the better chance we have. It is a radical point that there may be other methods of delivering health care. We need closer scrutiny of the current mix of doctors and their roles, and nurses and their roles. We need to consider the exclusion of psychologists from the public system in significant numbers and whether they could make a huge difference in mental health. Closer scrutiny should be given to the importance of podiatrists in lessening pathology from foot problems in diabetics and elderly people, physiotherapy and rehabilitation and which groups are funded. It is inefficient to have people who are overly qualified and it is dangerous to have people who are unqualified. It is a question of determining the mix of people and optimising the mix. It is time that someone examined the issue. Primary prevention is stopping the disease, secondary prevention is stopping it from getting worse and tertiary prevention is the speed of rehabilitation. The use of skills other than doctors in terms of Medicare and the way it is funded and optimising the skills mix of people delivering health care needs attention. The Greens amendment is a little distant from the motion but it is worth supporting. The motion is reasonable in that it highlights the lack of attention given to the training of nurses in the environment of a nurse shortage and the Howard Government's neglect of the higher education sector. As such the motion deserves support. The Liberal Party's amendment is a piece of political nonsense and does not deserve my support. The Greens amendment is correct, although it is broader, and I will support it.

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