‘The role for migrant nurses in NZNO’ – Presentation to NZNO Migrant & Internationally Qualified Health Workers Conference

(Following some unscripted remarks on the events in Christchurch the previous day, these were the speaking notes for my presentation.)

Photo courtesy of Kai Tiaki Nursing New Zealand.

Āta mārie, tēnei te mihi ki a koutou. 

Good morning, greetings to you. 

Ko wai ahau? Ko Kapukataumahaka tōku maunga, ko Ōwheo tōku awa, ko Cornwall tōku waka. 

Ko te Tāngata Tiriti tōku iwi, ko Don rāua ko Helen ōku mātua. Ko Grant Brookes ahau. Nō reira, tēnā koutou katoa. 

Who am I? The place I come from looks up at a mountain called Kapukataumahaka, or Mount Cargill, and sits beside a river called Ōwheo, the Water of Leith. My ancestors arrived there, in Dunedin, aboard a waka, or ship called The Cornwall. I belong to the People of the Treaty, the people who reside here under the agreement first signed at Waitangi in 1840. My parents are Don and Helen, and I am Grant Brookes. 

The topic I have been given to speak about is, “Where to from here? Into the future, the path forward, what is the role for migrant nurses in NZNO?”. 

Let’s begin with definitions. What is this group, the migrant nurses in NZNO? Who are they? 

The answer may surprise you. We don’t entirely know. 

The NZNO membership database contains a field recording a member’s “country of first qualification”. In theory, therefore, the migrant nurses in NZNO should be clearly identifiable. They would be the members who ticked a box other than “New Zealand” in their membership application, in response to this question. 

However, in speaking with the NZNO Membership Department in preparation for this talk, I learnt that it’s not so simple. 

Firstly, this field was added to the database only around four years ago. For members who joined prior to that, there is no record of where they first qualified. And I was told that anecdotally, the data is not reliable, as many members who have joined since 2015 left this field blank on their membership form, or filled it out incorrectly. 

But when we speak of migrant nurses (and of internationally qualified health workers who may not be working as nurses, the other group covered by this conference), what we’re often thinking of are people who share particular cultural backgrounds – backgrounds other than New Zealand European or New Zealand Māori. Research suggests that the experiences of NZNO members in these minority groups (including experiences of racism) are similar, regardless of whether the person first qualified as a nurse in New Zealand or overseas.

In other words, what we’re talking about is ethnicity. And with your permission, I would like to focus on this concept, which thankfully is captured by NZNO in a time-series data set which is more robust. 

Do you like data? I do, as you may have guessed. So if you’re not a fan, please indulge me for a couple of minutes as I present some charts showing the changing ethnic makeup of our membership over the last ten years.

Just one final word about data quality – up until 2015, ethnicity categories in the NZNO membership database were less specific. So, for example, members belonging to one of the many Asian ethnic groups were described as either Chinese, Indian or “Other Asian”. The NZNO Board requested refinements to the reporting categories in 2016, to make the growing diversity of our membership more visible. You will see this in the later charts. Ethnicity data captured in the NZNO database is now aligned with the fields recorded by the Nursing Council, although it’s still not perfect and anecdotal reports suggest a member’s ethnicity sometimes defaults incorrectly to NZ European.

So based on what we have, this was the picture at 31 December 2008.

Our membership was largely made up of people identifying as New Zealand European, with a significant Māori group. There was also a visible group of “Other Europeans”, reflecting the traditional trickle of migrant nurses from places like the UK and Australia. 

Click to play the video below and watch how it changes, year by year. 

In 2010, the “Other Asian” group started to overtake “Other European”, as the primary source countries for IQNs started to change. The trend then accelerated. 

And this is where we are now. 

If current trends continue, New Zealand Europeans like me will be a minority of NZNO members by 2025. 

It is worth mentioning in passing that there hasn’t been any similar transformation of the NZNO staff. There are almost 130 people employed by NZNO, in a variety of roles. But aside from our Chief Executive, there are still no IQNs of non-European ethnicity among them. 

So that’s the picture from the last ten years. But if you go back further, the demographic transformation of the NZNO membership appears starker still. I became a member of NZNO in 2002. Back then, the organisation looked like this. 

As you can see, the NZNO which I joined was largely monocultural, at least as far as our membership base was concerned. 

You might also note that the opening up of this monoculturalism has come through the declining proportion of members identifying as New Zealand European. Māori membership has not declined. The proportion of members who are tāngata whenua, or people of the land, and the proportion who are tauiwi, or more recent arrivals residing here by virtue of Te Tiriti o Waitangi, is virtually unchanged through this period. 

The relationship between these two groups underpins the bicultural foundation of our organisation – in accordance with the bicultural foundation of our nursing profession, and indeed of our nation. Kerri Nuku will speak more about this next. 

If this is the story so far, what is the role for IQNs and migrant health workers in NZNO, into the future? 

Let me first flip that question. What is my role, as Co-chair of the NZNO Board, for IQNs and migrant health workers in NZNO? 

I know that as a New Zealand European, citizen and NZRN, I automatically benefit from a system of privilege, whether I like it or not. My role for IQNs and migrant health workers in NZNO is to use that privilege to make space at the top table for people without it, like you. 

Your role is quite simply to take your place in the leadership of NZNO – as increasing numbers of you are already doing. 

I would like to briefly showcase just a few of the leading roles being filled by migrant nurses today. Some of these people, you will probably recognise. 

Victoria Santos is an IQN from the Philippines. She also holds a senior leadership position in the governance of NZNO. Victoria sits on the Membership Committee, the national body which advises the NZNO Board of Directors on the views and needs of the diverse membership. The Membership Committee also helps to carry out delegated work such as drafting the constitutional changes which will this year see voting on NZNO policies and rules opened up to everyone, though an online “one member, one vote” system

Jed Montayre is also from the Philippines. Within NZNO, Jed is an elected member of the National Committees of Gerontology Section and also the Nursing Research Section. He has served on the abstracts committee which selected the papers for presentation at the NZNO Annual Conference. Here, he is pictured receiving the award as joint winner of the NZNO Young Nurse of the Year in 2016. 

One of the three abstracts chosen for last year’s NZNO Annual Conference was on “The Experience of Migrant Health Workers in New Zealand”. It was jointly presented by three Filipinos – Joey Domdom, Judith Salamat and Mayie Pagalilauan – in conjunction with Toga Katyamaenza, an IQN from Zimbabwe. Here they are pictured with IQN and former NZNO Board member Monina Hernandez, who will speak to us later this morning. 

Shamim Chagani is an IQN from Pakistan, and an elected member of the National Committee for NZNO Nurse Managers New Zealand. She is also the editor of the Nurse Managers’ newsletter, Te Wheke, a Māori title which means, “The Octopus”. 

But IQNs are not just demonstrating professional leadership within NZNO. 

This poster features Ebson Abraham, an IQN from India. The poster was produced by the NZNO Tai Tokerau Regional Council for International Nurses Day last year, to celebrate local NZNO leadership in Northland. The writing is probably too small for you to read, but it says Ebson was a workplace delegate at Cairnfield House Rest Home in Whangarei, where “he took responsibility for NZNO services, promoting the union movement from scratch and then constructed a movement that is measurable by the increase of NZNO membership density up to 80% that eventually built a strong force for change. This wave became a pillar… for NZNO bargaining in 2016/17 with an effective settlement of a collective agreement in 2017”. 

As an aside, there is a widespread assumption among New Zealanders that union membership and activism are somehow foreign to the cultural values in the primary source countries for IQNs today.

The diversity clearly displayed on marches and rallies by DHB nurses last year should help to dispel that stereotype. But so would greater knowledge of overseas nursing unions, which are growing under very difficult conditions and waging struggles on a scale and intensity which make our DHB strike look timid. 

A case in point is the United Nurses Association of India. It was formed in the southern state of Kerala in 2011, in response to the suicide of a nurse who had been bullied by her managers. It now numbers over half a million members. Months of protests and strikes in 2017 and 2018 won agreements on pay rises for around 80,000 nurses in private hospitals. At one hospital in Kerala, nurses remained on strike and picketed outside the facility daily, for over a year

The spectacular rise of the United Nurses Association is an amazing story. I hope to meet leaders of that union for the first time in July at the annual meeting of our international union federation, Global Nurses United. But it’s by no means an isolated case. Nurses in the Philippines have been organising for decades – again under very difficult conditions – through unions including the Alliance of Health Workers and more recently through Filipino Nurses United. Last year, Kerri Nuku and I attended 61st annual general meeting of the Fijian Nursing Association. FNA has been active as a Pacific nursing union since 1977, including campaigning for workers’ rights under military rule, and so on. 

Returning to the slides, the last two IQN leaders in NZNO I wish to showcase highlight the need to avoid assumptions when it comes to migrant nurses. 


Current Board member Eseta Finau occupies the highest leadership role in NZNO of any IQN. She will talk to us shortly about that role. Despite also being the most Tongan person I know, however, she actually qualified as a nurse in Australia. Gidday cobber! 

And then there are NZNO leaders who you might not pick as IQNs from their appearance.

Debbie O’Donoghue is a former NZNO Board member who now serves on the national committee of NZNO Nurse Managers New Zealand. She is also an IQN, from the UK. 

But leadership for IQNs within NZNO does not depend on holding a title, like these people. The NZNO Strategy for Nursing 2018-2023 recognises that, “Many nurses demonstrate excellent… leadership, though they may not recognise this, associating leadership only with formal roles.”

In many ways, leadership exercised by people without a formal title is the most important kind. As Bernie Sanders likes to say, “Real change does not happen from the top down. It happens from the bottom up.”

One of the ways that any member can influence NZNO’s direction from the bottom up is by responding to consultation requests. This is where staff from the NZNO policy and research team seek member input, in order to determine NZNO’s position on a wide range of issues. They do this by emailing all member groups, including Regional Councils, to ask for feedback. 

They also post the requests on the NZNO website, under the menu “Get Involved > Consultation”. If migrant nurses are not getting the consultation requests by email, from a member group, you can sign up on the website to be notified each time a new one comes out. 

Here is a recent request, asking for input to shape NZNO’s view about the changes to temporary work visas for migrants currently being proposed by the government. Unfortunately, the deadline has passed for people to respond to this request, although if anyone is interested in making an individual submission to the government, you can do it via the MBIE website until Monday, at the address on screen. 

So these are some of the ways that migrant nurses can take up your role as leaders of NZNO and use your power to make a difference.

But as the title of Monina Hernandez’s presentation on today’s programme reminds us, the role for migrant nurses in NZNO is not just about “making a difference”. It’s also about “being yourself”. I will end on this point. 

Coming up before morning tea is Abel Smith’s presentation, “An introduction to the Pacific Nursing Section”. The PNS is one of NZNO’s 20 colleges and sections. I am really looking forward to it because for me, this group epitomises what it means for ethnic minority members to be themselves while also making a difference. 

NZNO sections and colleges are groups of members with a focus on a specific field of nursing. The colleges are groups relating to a specific clinical specialty, while the sections are groups representing a role or membership classification, such as those sharing a specific culture or cultures. Formed in 2008, the Pacific Nursing Section was the last NZNO section to be established before a moratorium was placed on the formation of new sections in 2011. 

The NZNO Constitution was amended last year, through a remit submitted to the NZNO AGM by the Greater Auckland Regional Council, to lift the moratorium and allow the creation of new colleges and sections. 

The rationale provided in support of the remit noted that: “NZNO structures need to be flexible enough to respond to the changing reality”. And we’ve seen in the pie charts the changing reality of NZNO membership. The remit rationale added: “Various membership and role classification groups exist without a corresponding NZNO structure to date. Examples include… internationally qualified nurses”. 

I will now hand over to Kerri Nuku. Because we will be back as part of the discussion panel after lunch, and because I have used up all of my available time, I would ask that you save any questions until then. 

Thank you. 

The President comments: ‘A new strategic direction for NZNO?’

Titiro ki muri kia whakatika ā mua. Look to the past to proceed with the future.

I CAME across this proverb last month at Te Matatini, the national kapa haka championships in Wellington. It summed up for me our task as we prepare to update and replace NZNO’s five-year strategic plan, which expires next year. The process approved by the board will involve input from external stakeholders, NZNO staff and members.

Looking back, and thinking about the future, gives us all a chance to re-focus on the big questions for NZNO. Who are we here for? What are we hoping to achieve? How will we get there? What’s going on in our environment – political, economic, social/cultural, technological, legal and environmental – that we will need to respond to?

Much has changed since delegates at the 2015 NZNO annual general meeting voted to approve the current strategic plan. Back then, as chief executive Memo Musa reminded us, union membership was declining. Law changes had made it harder for unions to operate, and union influence was dwindling. An NZNO strategy stressing nursing professionalism fitted with the times.

Fast forward to 2019 – anti-union laws have been reversed, and the trend of declining union membership has also turned around. Union engagement with employers and government is stronger. Health funding is no longer falling. There’s also much to learn from last year’s unprecedented DHB MECA campaign.

The board has also agreed in principle on a review of our operational structures, to make sure they’re suitable for implementing the new strategy. And while no decision has been made, we have discussed whether the NZNO constitution – which spells out who has the power to do what in NZNO, and members’ rights and responsibilities – might need to be reviewed, as well.

Who are we here for?

In my view, the answer to the first big question, “Who are we here for?”, is that NZNO is here, above all, for the members, and we must keep members at the centre of our planning. If we focus on supporting and empowering members, then our strategic goals and the ways to achieve them will become clear.

Members see the impacts of health and social policies, and belong to communities who experience impacts, too. Supporting members means our strategic goals should include political changes.

All of us are unionised workers and health professionals. Focusing on members solves the conundrum of whether to stress “industrial or professional” strategies. At all times, we are both.

And nurses and midwives are required to practise in a culturally safe manner, under the Treaty of Waitangi/Te Tiriti o Waitangi. Supporting members means strengthening biculturalism.

Such a member-centric strategic plan might suit an NZNO structure where more authority and resources are devolved to our volunteer member-leaders.

It could drive full implementation of NZNO’s organising model, an approach which empowers members in the workplace to act as a team in their own interest, rather than just looking to an NZNO staff member to “fix” things for them. •

First published in Kai Tiaki Nursing New Zealand, March 2019

The President comments: ‘Here Comes The Sun’

HERE COMES The Sun – the classic Beatles track off the 1969 Abbey Road album – was one of the first songs that our son, aged two and a half, learned to sing. Memories of walking to feed the ducks in the summer of 2007/8, accompanied by strains of, “Sun, sun, sun, here it comes!” still warm my heart.

This George Harrison composition could have been a glib, throwaway ditty. I think its longevity and power stem partly from its invocation of a “long, cold, lonely winter” which has lasted for what “feels like years”.

Shortly after its release at the end of the 1960s – that decade of struggle – brilliant cover versions appeared, by feminist civil-rights singer Nina Simone and rebel reggae artist Peter Tosh.

Ice is melting

They enriched the meaning of lines like, “I feel that ice is slowly melting”. Patterns of injustice long frozen were starting to shift.

And so, as summer 2018/19 arrives in Aotearoa, there are signs the long, cold winter – for nursing and for the people we care for – is also coming to an end. The ice has been cracked by passion, courage and the collective action of NZNO members.

Nine years of underfunding ended in May with this year’s Budget. It was our campaigning, together with others, which made health the number one issue for voters and a top priority for the incoming government.

Our escalating protests and strikes this year were unprecedented. Our demand to bring back the warmth into health has been game-changing.

We didn’t win everything we need to rebuild our health system, but I can see rays of sunlight. Over the last couple of months, I’ve helped assess and approve each DHB’s plans for their share of the 500 new nursing positions created by our campaign. And I’ve felt the warmth returning to our profession.

Meanwhile, the health minister will be looking at options for providing employment and training for all nursing and midwifery graduates – delivered under the new Safe Staffing Accord.

I see new buildings, new services, new initiatives for our peoples, and I have hope.

It will take more struggle to clear away all the dark clouds over our public health system – and the deeper chill still lying across the rest of the sector. But as our courage and passion spreads, so, too, do the cracks in the ice.

In November, the first-ever collective action by NZNO members at Ngāti Porou Hauora confronted historic injustices facing Māori and iwi health providers. Trying to survive on meagre government funding, these providers pay nurses around 25 per cent less than those working for DHBs; some are also having to cut services to survive. 

And December saw members at Family Planning vote to strike for the first time.

But before we take up the struggle again, it’s time to celebrate. Summer is here. Let’s make it a good one.

Whether you’re working through, or have leave approved, I hope you are all able to enjoy some time in the sun with your loved ones. I will be.

Our son is older now, and has a younger sister. From our whānau to yours, I wish you a happy festive season. •

(First published in the December/January issue of Kai Tiaki Nursing New Zealand. Reposted with permission).

The President comments: ‘NZNO’s bold new experiment in democracy’

NZNO HAS embarked on a bold new experiment in democracy. That, for me, was the big news to come out of our annual general meeting (AGM) and conference, held in Wellington last month.

The two-day event, which was preceded by colleges and sections day and the National Student Unit AGM, attracted around 230 members, staff and guests (see coverage, p11-19).

IMG_1729
Around 230 people attended the NZNO AGM and conference last month

We celebrated the outstanding achievement and service of members at our NZNO awards dinner. And presentations by an amazing group of cross-sector leaders on the second day helped us all raise our sights and embrace the conference theme, Health is a human right – optimising nursing to make it happen.

But it was on day one that the major decisions were made. As I noted in my opening address, we had come together on Suffrage Day, and at the end of a turbulent year for our union and our profession.

Overshadowing all else in the last 12 months has been the bargaining in the district health board sector. The effects of nine years of underfunding, which we highlighted and campaigned against in 2017, finally compelled us to take unprecedented industrial action.

The MECA bargaining sparked a campaign of extraordinary drive and determination, on the part of NZNO members and staff alike. Together, we achieved momentous things.

But there were also problems. As we faced difficult decisions, differences emerged between members, and between members and their representatives. Some felt the voice of members was not being heard.

Unity out of division

These differences were seen again in the debates on the conference floor. But the democracy that the Suffragists fought for, back in 1893, has the power to forge unity out of division. A democratic vote can resolve many individual differences into one collective union decision.

So the decision by AGM delegates to deepen and strengthen democracy within NZNO could be the most important thing to happen to our organisation in a long time.

Up until now, voting on proposed changes to NZNO policies and our constitution has been done at the AGM. Only those who attended got to vote.

From next year, however, all members will be able to vote online on these matters, with the results announced at AGM. Agreement to move to the “one member, one vote” system means the voice of members will be heard more clearly.

IMG_1946
Jennie Rae, a mental health nurse from Taranaki, introduces the proposal to move to the “one member, one vote” system.

For me, as your president, the 2018 AGM and conference marked the start of my second term in office. I pledged to delegates that over the next three years I will work for NZNO’s renewal, in partnership with the kaiwhakahaere and in conjunction with the board and chief executive.

In every organisation, there are always a few who want to keep things as they are. But I never underestimate our collective power as NZNO members to deliver renewal.

AGM delegates have placed their trust in their fellow members. Now the obligation is on us to live up to this trust, to participate wisely in the new democratic process to make sure NZNO is the open and responsive organisation we need. •

First published in the October 2018 issue of Kai Tiaki Nursing New Zealand. Reposted with permission.

’Your Place in the NZNO World’ – Speech to NZNO Colleges & Sections Day 2018

Grant - Colleges & Sections DayKia ora, koutou. Thank you for inviting Kaiwhakahaere Kerri Nuku and I to present at your Colleges and Sections Day. With only ten minutes allocated for both of us, please forgive me if I skip the introductions and get straight down to the topic at hand: “Colleges and Sections – Your Place in the NZNO World”. 

As I was preparing for this talk, I thought I’d better check what it says about the topic in your own documentation. In the Colleges and Sections Handbook, I found this statement: “Colleges and sections are part of NZNO: they do not have a separate legal status.”

So it seemed to me that the topic is essentially about the relationship of this part – your part – to NZNO as a whole. And much like the relationship of an organ to a biological system, we can describe the relationship of part to whole in terms of structure, or function. 

In other words, your place in the NZNO world can be described in terms of the “anatomy” of NZNO, or in terms of our “physiology”. 

In terms of physiology or function, the purpose of NZNO activity is to pursue the goals in our Strategic Plan 2015-20.

Draft NZNO Strategic Plan 2015-20 Part A for AGM

These are:

• Improved health outcomes – by promoting excellence in patient care 

• Skilled nurses – by contributing to, and advocating for the development of nursing education programmes and the ongoing professional development of members 

• Strong workforce – by strengthening nursing workforce planning, sustainability and leadership 

• Effective organisation – by ensuring NZNO is a healthy and sustainable organisation 

You will all be very familiar with the Strategic Plan above. This year, as Acting Manager of Nursing and Professional Services Hilary Graham-Smith has just mentioned, the Strategic Plan 2015-20 has been supplemented by the NZNO Strategy for Nursing 2018-2023, which you will discuss in more detail after lunch.

Your role in this functioning of NZNO is vital. The Colleges and Sections Handbook says, “Colleges/sections are integral in realising the goals of the NZNO Strategic Plan 2015-20 and its professional vision for nurses.”

You do this by performing functions such as: 

• Hosting educational conferences and publishing journals or newsletters. These contribute to the ongoing professional development of members and achievement of skilled nurses. 

• Making formal submissions or providing input into NZNO’s national submissions, sometimes through responding to NZNO Consultation Requests. These can promote the excellence in patient care needed to achieve improved health outcomes. 

• Representing NZNO on external committees or in the media (including specialty media such as Kai Tiaki, Nursing Review, NZ Doctor etc.). 

• Building strategic relationships, scanning the environment and communicating emerging strategic issues to NZNO leadership. This helps achieve NZNO’s goal of being an effective organisation. 

Your capacity to perform all these functions, as volunteers, has been the focus of the Board’s Volunteer Sustainability Project.

Switching now to the “anatomical” view, your place in the structure of NZNO is shown in the Structural Diagram: “Our Waka, Our Way”. 

I will race through this presentation, which was given at last year’s AGM and at this year’s Regional Conventions, highlighting just a few points. The full powerpoint will be on the Membership Committee page of the NZNO website. 

In the side view, the hull or riu of the waka is the membership. 

Riu

In the top view, the staff are seated towards the stern and the various membership groups sit towards the bow. Your place is marked number six. Those sitting nearest to you indicate your direct relationships: these are Te Rūnanga (number seven), Regional Councils (number eight), and the Membership Committee (at number nine). 

top

“The college and section link with the Board of Directors is through their representation on the membership committee”, says the Colleges and Sections Handbook. 

Your next speaker is Victoria Santos, the current Colleges and Sections rep on the Membership Committee. 

And then at the front of the waka are the National Hui and the AGM (at number 17), which takes place tomorrow. 

Because Colleges and Sections do not have a separate legal status, you must comply with NZNO rules and policies. These are set and amended through remits to the NZNO AGM. 

Colleges and Sections can have input into these rules and policies, and often do. A recent example is the 2017 remit from NZNO Nurse Managers New Zealand: “That the NZNO membership has the option to belong to up to three colleges or sections”, up from two. This remit was passed, and as at 31 March 2018 there were 109 members who had joined three Colleges or Sections. 

It followed an earlier attempt in 2016, by the Cancer Nurses College, to allow members to join as many colleges or sections as they needed, to allow them to be professionally supported in their chosen fields or interests. This earlier attempt was unsuccessful, as the voting system is not based on “one member, one vote”, and multiple College or Section memberships would increasingly distort representation at AGM. 

A number of other remits from Colleges and Sections have been unsuccessful in recent years, including another one from the Cancer Nurses College in 2016, that “Clinical Supervision be provided for nurses as per NZNO guidelines and that this should be included in the MECA”. DHB MECA negotiations are now complete, and an entitlement to clinical supervision has not been included. 

I understand that further discussion of these topics is planned today. As time is short, I won’t take questions now, but I will be available throughout the day to assist. 

Statement on my remuneration as NZNO President

Money

Statement on my remuneration as NZNO President

In standing for election in 2015, as many NZNO members know, I pledged publicly that, “As your next President, I will accept only my current Staff Nurse pay rate”.

As I approach the end of my first three-year term in office, I make this brief statement on my remuneration to verify that the pledge has been fulfilled.

The mechanism for delivering on my campaign commitment was reported in the September 2015 issue of Kai Tiaki Nursing New Zealand:

“[Brookes] says he will be standing by his pledge to only accept a staff nurse pay rate by donating the difference back to NZNO. 

‘My preference, so I don’t give any suggestion the role is worth less than the previous president has received, would be to accept the full salary and donate back the difference between my current staff nurse pay rate and the presidential pay rate’.

And since 2015, with the support of my family who were directly affected, this is what I have done.

Keeping my take-home pay the same as it was before I became President, and adjusting it only in line with changes in the DHB MECA, meant that I started on a net (after tax) annual salary of $60,246.94. This went to $61,451.88 on 4 July 2016, when base rates in the MECA rose by two percent. There it remained, up until the ratification of the new MECA last month.

Over the course of the last three years, I have reported in regular letters to the NZNO Board of Directors, through its Governance Committee, on the amounts donated back to NZNO. I now publish these letters, in the interests of full transparency.

Although it wasn’t part of my pledge, I also wanted to save money on work-related expenses. This was achieved by doing things like staying with local NZNO members while away on work trips, rather than in hotels, and by choosing the cheapest fares.

For the two full financial years I’ve been in the role so far (1 April 2016 to 31 March 2018), spending on travel and accommodation averaged just 53% of the money budgeted per annum in the NZNO President cost centre.

For their part, the Board wanted to make it clear that they did not endorse my decision to accept only Staff Nurse pay and to donate the rest back to NZNO – a position they expressed, for example, at the Board meeting held on 18 October 2017 (see page 5 of the minutes, available at this link).

My last letter to the Board and Governance Committee, dated 10 September 2018, notes that when I stood for re-election this year, my candidate profile statement did not repeat the 2015 pledge to accept only the pay of a Staff Nurse. This decision was made after consultation with my family.

Therefore, while I will continue to decline the full salary during my second term as NZNO President starting on 19 September 2018, this statement constitutes my final public comment on my remuneration for the role.

Grant Brookes, NZNO President

If health is a winner on Budget Day, we’re all better off

Kerri & Grant TPPA

by NZNO President Grant Brookes and Kaiwhakahaere Kerri Nuku

It’s Budget week. All eyes are on Finance Minister Grant Robertson, and what the government’s first budget has shaped up like. Our eyes of course are primarily on what it means for health.

Kiwis see the need: A third of people think that health should be the top priority on Thursday, according to the last 1 News Colmar Brunton poll. The reasons aren’t hard to find. DHB deficits, crumbling hospital infrastructure and the mental health crisis and health workforce dissatisfaction have made the headlines for months.

A decade of severe underfunding of our public health services has meant our health system has failed to keep pace with our growing community need, the demands of an ageing population and ageing workforce, and increased costs of providing services.

The health system itself is now sick, and needs to be nursed back to health. This is the number one message to the Government from the New Zealand Nurses Organisation on Budget Day. It’s why we’re rallying around the country.

But “health needs nursing” in more ways than one. The nursing team is the largest workforce in health. We are the dedicated, skilled professionals who are with you from the moment you’re born until your last breath.

It is concerning however that this year the rhetoric has been about the “competing demands” on the government, and about expectations that are not likely to be met in a year of spending.

Prime Minister Jacinda Ardern has said: “It is as important for us to make sure we meet the competing needs that we have around strong services for health and education as it is to also make sure that we keep the books in good shape, that we are ready for any economic shocks”

While the threat of another earthquake or two is making the government cautious, is it really a case of balancing health against the economy?

World Health Organisation Director General Dr Tedros Adhanom stated recently that, “Governments see health as a cost to be contained…This is wrong. Health is an investment to be nurtured.”

In 2016, we took part in a meeting in Geneva to advise the United Nations High-Level Commission on Health, Employment and Economic Growth and here is an extract from its statement:

“The returns on investment in health are estimated to be 9 to 1. One extra year of life expectancy has been shown to raise GDP per capita by about 4 percent.

“Investments in the health system also have multiplier effects that enhance inclusive economic growth, including via the creation of decent jobs. Targeted investment in health systems, including in the health workforce, promotes economic growth.”

Evidently investing in health makes us all better off.

Rebuilding a quality public health system includes investment in the health workforce. To enhance the health and wellbeing of all peoples in Aotearoa/New Zealand and to lift our economy, adequate and safe staffing levels in our health services, healthy shift rostering, access to study leave for professional development and full employment of new graduate nurses are vital ingredients.

This will attract students to the profession and retain those already in it. It also leads to a happier, healthier workplace that will also relieve some of the bullying that can occur.

Fair pay, which appropriately recognises our skills and qualifications, naturally also attracts and retains nurses, midwives and healthcare assistants.

The health and wellbeing of New Zealanders also depends on other factors surrounding the healthcare system, like having liveable incomes, warm and affordable housing, equitable access to education, nutritious food, and a healthy environment. Therefore NZNO is also assessing Budget 2018 for policies in the social sector and environment that support health and wellbeing.

Tomorrow we will see whether the government has decided to make a sufficient investment in health. We hope for the sake of the health and wellbeing of the population and the nursing workforce especially that it does, if not in one go then we want to see a clear roadmap to recovery of the public health system and workforce itself. As shown in the placards at rallies around the country: The healthcare team needs to be well to keep others well.

Finance Minister Grant Robertson has hinted that come Thursday, “Health and Education will get long overdue boosts to their capital and operating funding to deal with cost pressures.”

For all our sakes, the boost must be big enough, and soon.