The President comments: ‘Powered by unity and determination’

JULY 12, 2018, is a day that will go down in New Zealand nursing history.

For just the second time, nurses in our public health system took nationwide industrial action, alongside midwives and health-care assistants (HCAs) covered by the district health board (DHB) multi-employer collective agreement (MECA). 

For me, the hours I spent picketing and marching with my fellow NZNO members that day are the proudest moments of my nursing career. 

NZNO members stood together. “Yes” voters, “no” voters and non-voters stood side by side, outside on the picket line, or inside, providing life-preserving services. 

Auckland march - Newshub frame 1 (crop)
‘An historic day: Time spent picketing and marching with my fellow NZNO members on July 12 are the proudest moments of my nursing career.’

And now, three weeks later, DHB members are being asked to vote once again. They’re deciding whether to accept DHB offer number five – the third to be recommended by the NZNO negotiating team. As I write, the outcome of the vote is unknown. But what is clear is just how far we’ve come. 

Back in November 2017, most members were being offered three pay increases of two per cent, over 33 months, and a lump sum of $350 (pro rata). 

The DHBs had agreed in principle to support a pay-equity process, but there was no definite date for completion. They said, once again, they would implement care capacity demand management (CCDM) – this time, by June 30, 2021. 

In February, after rejecting the first offer, we were told DHBs could not provide wage increases above two per cent, unless they were to resolve an anomaly like the identified senior nurse issue, or were achieved through a pay equity process. 

But in this second offer, the lump sum was increased to $1050 and a deadline of July 1, 2019, was set for a pay-equity settlement. 

Prime Minister intervenes 

When that offer was also rejected, Jacinda Ardern was moved to speak up – the first time a New Zealand prime minister had intervened publicly in our bargaining – and proposed an independent panel. Our submission to the panel set benchmarks for appropriate pay ranges – $44,500 to $56,300 for an HCA, $57,500 to $61,500 for an enrolled nurse and $64,300 to $80,000 for a registered nurse or a midwife. 

We rallied because #HealthNeedsNursing, and we marched so New Zealand would #HearOurVoices. When the third offer came in June, it was almost twice as big. The lump sum was bumped up to $2000. Pay rises ranged from 9.3 per cent to 15.9 per cent over 26 months. 

Members were allowed to vote online for the first time, which led to the highest participation ever seen in a MECA ratification ballot. 

An extra $38 million was pledged by the Government to employ 500 more nurses, and $10 million allocated for additional expert nursing staff to support implementation of CCDM. Recruitment of the extra nurses has already begun. 

And now, at the end of July, after two further “reject” votes, Health Minister David Clark has put his signature to a new accord on safe staffing. The accord acknowledges that making sure there are enough nurses and midwives in our public hospitals to guarantee safety for staff and patients requires support from the Government. It strengthens commitments to deliver this by June 2021. 

The journey so far has not been easy. But every one of these advances has been powered by the unity and determination of thousands of NZNO members, who should be enormously proud of themselves. • 


Kai Tiaki cover, 7.18
First published in Kai Tiaki Nursing New Zealand, August 2018. Reposted with permission.


‘Striking for a better health system’ – Speech to Auckland NZNO rally

On 12 July 2018 nurses, midwives and health care assistants walked off the job at DHBs nationwide for the first time in almost thirty years. In Auckland, thousands NZNO members and supporters of the strike marched up Queen Street to rally in Aotea Square and listen to delegates from the city’s three DHBs – Gui Restall, Sela Ikavuka, Alys Moriarty and Joel Peeperkorn. The Chair of NZNO’s Greater Auckland Regional Council, Esther Linklater, CTU Māori Vice-President Syd Keepa and NZNO Lead Organiser Carol Beaumont also spoke. It was my honour and privilege to make this short announcement first. 



Kia ora. What a wonderful sight you all are! 

I have two brief messages to deliver. The first one is for you, the NZNO members gathered here. 

I want you to know that the whole of NZNO is behind you today. I would like to read a statement from the Board of Directors, the elected governing body of your organisation:

“We offer our solidarity and support to all our members who are on strike and picketing. We also acknowledge those who are on rosters for life preserving services taking care of the public at this time. And we thank all members for their support.”

The second message, before I hand over to our wonderful member speakers, is for the public and the government.

Today we are striking today for a better a health system for us all. This is a message from all of us to the government and the employers. And I think it’s one that they can share. I believe the government and the DHBs also want a better health system for us all. 

The government say they can’t make up for nine years of underfunding in a single Budget, and that it’s going to take time. And I think we understand, deep down, that there is some truth to that. 

But we also want the government to understand something in return. They need to move faster, and they need to start with a bigger step right now! 

The last thing is for any members of the public who are here, or watching on live streams. Today’s action, this is for you. So please show your support for our nurses today. 

Thank you. 

Walking together in solidarity and friendship

BEING IN Suva for three days attending the FNA symposium and AGM highlighted for me and kaiwhakahaere Kerri Nuku the strong ties between nurses in the two countries. The visit also enabled shared learning.

NZ team at FNA
“Team New Zealand”: Symposium participants from Aotearoa pictured with FNA President Dr Adi Alisi Vudiniabola (second from right).

Auckland-based Pacific nursing leader Fuimaono Karl Pulotu-Enderman opened the symposium as the first keynote speaker. The closing speaker was Abel Smith, a former member of the FNA executive who now holds many nursing leadership roles in New Zealand. He is treasurer of NZNO’s Pacific nursing section.

In between, there were presentations from Auckland University researcher Ofa Dewes, from Waitematâ District Health Board’s health science academies programme coordinator Malcolm Andrews, and from two other New Zealand-based nurses, Simione Tagicakbau and Vunirewa Uluilakeba.

It was the first time that elected NZNO leaders had been invited to open the AGM. Participation as FNA’s chief guests was a great honour. The experience showed me the many similarities between our two countries, but also some differences.

Fiji – Grant & Kerri
NZNO co-leaders at the FNA AGM.

NZNO can only aspire to the kind of relationship with the Ministry of Health that exists between the FNA and the Fijian Ministry of Health and Medical Services. The chief nursing and midwifery officer, Silina Waqa-Ledua, responded on behalf of the ministry to many questions and comments from delegates.

“There are many commonalities,” Nuku said. “Fijian nurses are also grappling with health underfunding, the growing burden of non-communicable diseases, poverty, climate change and the dangers of privatisation.

“But only more recently have they begun to seriously consider cultural safety, in the context of increasing numbers of internationally qualified nurses being employed in foreign-owned private hospitals,” she said.

Around 300 nurses attended the events, over the three days. My opening address to the AGM, ‘Walking together in solidarity and Pacific friendship’, is available online: 

Report by NZNO president Grant Brookes

Related coverage:

Pay push for Fiji nurses




Pay push for Fiji nurses

With the backing of NZNO and an Australian nursing and midwifery union, Fiji nurses have achieved significant pay increases.

By NZNO president Grant Brookes

In April, kaiwhakahaere Kerri Nuku and I were invited as honoured guests to open the Fiji Nursing Association (FNA) annual general meeting (AGM). The invitation for the NZNO co- leaders to attend came after joint work last year between FNA, NZNO and the New South Wales Nurses and Midwives Association on a pay push for Fijian nurses.

It was the latest in a long series of collaborations between the Pacific nursing unions. In 2005, after New Zealand’s “fair pay” multi-employer collective agreement was successfully concluded, NZNO campaign leaders travelled to Fiji to support the FNA’s own fair pay campaign. In return, FNA leaders shared their victory and inspired delegates at the following NZNO AGM.

More recently, Fiji’s nurses had seen their pay fall behind the rising costs of living. But in 2017, backed by Australasian research and policy analysis, the successful FNA submission on a new civil service salary structure has resulted in pay increases of up to 75 per cent.

For the first time, the new pay grades recognise advanced nursing practice and specialty roles. However, they also impose five-year fixed term contracts in place of previous permanent employment.

The first roles to be graded under the new salary structure include nurse practitioners (NPs) and midwives. NP Vilisi Uluinaceva told me that the FNA’s evidence-based submission made a big difference.

Vikatoria & Vilisi IMG_6922
Nurse practitioners Vikitoria Makrava (left) and Vilisi Uluinaceva enjoy a break during the AGM.

Previously, she said, Fiji’s 40 NPs earned between FJ$26,000-28,000 (NZ$19,000-20,400) a year. “We’d been working for so long on that pay, we didn’t know how to bring this up.”

Now, she said, they’re on FJ$43,000.

Fellow NP Vikatoria Makrava explained: “When we talk about pay, we look at what we do. Many of us work in remote areas. There are no doctors. We prescribe – we do everything – and we might see more than 60 patients in a shift. The pay was not appropriate before.”

Aliote Galuvakadua is a midwife and maternity unit manager who first registered as a nurse in 1976. She said she was excited when she read the FNA submission. It has seen midwife pay go from FJ$18,000 to FJ$28,000.

Fiji Times photo (with Aliote Galuvakadua)
Midwife Aliote Galuvakadua explains what the new civil service salary structure means for her profession at the AGM (Photo/Fiji Times).

“The paper was really good”, she said. “It’s good we have been recognised as specialists after all these years. Talk of balloting for a strike is now gone.”

Other nursing specialties have either undergone, or are about to undergo job evaluations in order to be placed on the new salary scale. So far, the average pay increase for the nation’s 3360 nurses has been 14 per cent.

Meanwhile the Fiji Trades Union congress has lodged a dispute with the Ministry of Labour over the decision to place all civil servants on individual fixed-term contracts and says it plans to take the matter to the International Labour Organisation. •

First published in Kai Tiaki Nursing New Zealand, June 2018

Related coverage:

The President comments: ‘To strike, or not to strike? Is that the question?’

MECA meeting Kenepuru 2, 12.12.17


To strike, or not to strike? Is that the question?

Or as NZNO members in DHBs prepare to vote on their employer’s latest offer, is the question now vexing the troubled soul of nursing something deeper? 

There’s no doubt we’re living in a time when unrest is driving change, for our profession and for NZNO. As I said in last month’s issue of Kai Tiaki, members are rising up and making history.

“Never before have NZNO members in our public hospitals voted to reject an offer recommended by the national negotiating team, as they did in December”, I observed. 

“And the turnout at the March meetings saw a majority of members vote in a ratification ballot for the first time.”

To that, we can now add that more members took part in the online strike ballot last month than in any other vote in NZNO’s 109-year history. 

The past as we knew it – one of “doing more with less”, of increasing workloads and stress, and of NZNO membership as just “an insurance policy” and a person at the end of the phone – this is being swept away. Yet in the words of Joe Strummer, “the future is unwritten”. 

But as we write the future, we must attend to the soul of nursing. Fundamentally, it’s now a question of being true to who we are, as professionals and as trade unionists. 

As nurses, we have a unique language of kindness, understanding, perception and logic. Every day we bring that to the patients we care and advocate for. It is that language we now need to use for our own advocacy. 

The foundations of our profession are built on ethical integrity. We are evidence-based in thought and compassionate in deeds. 

We must now interact with each other and engage with our employers and the wider public ethically, using evidence and compassion. 

When the DHBs chose to talk to the media rather than give us time to digest their offer, we were angry. But we kept our integrity. We cannot let fear or anger undermine who we are or decide our vote for us. 

We are advocates. Effective advocates combine passion with good analysis, and carefully crafted communication. We must be that kind of advocate for ourselves and our profession. 

And we are carers. Each of us was drawn to the work of helping others because of this. 

Another name for care is solidarity. Our foremothers and forefathers who founded the union movement understood the meaning of this word. 

They were animated by the socialist spirit of looking out for others and standing together behind the collective decision, whatever it may be. As we seek change, let us also hold fast to that spirit. 

Whether we strike or not, the next steps for us may be difficult. But with care towards each other, they can be made easier. 

Struggle and adversity can bring out the worst, or the best in people. How we struggle and advocate for our profession defines who we are as a profession. 

My call to each and every one of you is this: be yourself, it is who we need most right now to win. •

(Written for Kai Tiaki Nursing New Zealand. Posted here in advance of publication in the June issue, with permission)

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.

‘Walking together in solidarity & Pacific friendship’ – Speech to Fijian Nursing Association AGM

NZNO Kaiwhakahaere Kerri Nuku and I were honoured and deeply humbled to be the Chief Guests at the 61st AGM of the Fiji Nursing Association (FNA), held in Suva on 28 April 2018. It was the first time that elected NZNO leaders had been formally invited to Fiji. Our invitation reflected decades of work with the FNA by many people in our organisation. I spoke second, after the Kaiwhakahaere, and delivered this speech.

FNA speech

Ni sa bula vinaka, kia ora koutou, warm Pacific greetings to you all. 

It is customary in our country, when beginning a formal speech at a meeting, to start by acknowledging the Creator, and those who have gone before as well as those present. This custom has been adopted from the indigenous culture of Aotearoa New Zealand. Over the last two days I have been learning of the many similarities between this Māori culture and the cultures of Fiji. 

Nō reira, Ko te kupu tuatahi, ki to tātou kaihanga, nāna nei te kākano i ruia mai i Rangiātea. 

E ngā mate, haere, haere, haere. Rātou te hunga mate ki a rātou. Tātou te hunga ora e huihui mai nei, tēnā tātou. 

To translate: my first word was to the Creator, who sowed the seed from the realm of beginnings, and endings. I greet those who have passed on, and the living assembled here.

To introduce oneself, we speak of the place and the people we belong to. We refer to our connection to the natural and spiritual world of our birthplace, to a shared experience of migration and to a collective identity based on ancestry – as Kerri also did, a few moments ago. 

Ko wai ahau? 

Ko Kapukataumahaka tōku maunga

Ko Owheo tōku awa

Ko Cornwall tōku waka

Ko te Tāngata Tiriti tōku iwi

Ko Grant Brookes taku ingoa, ā, ko te perehitene ahau ō te Tōpūtanga Tapuhi Kaitaiki ō Aotearoa. 

Who am I? The sacred mountain overlooking my birthplace is Kapukataumahaka, and the sacred river is Ōwheo. My ancestors arrived on board the ship, Cornwall. My tribe is known as the People of the Treaty, which means I am not indigenous. I reside on the land by right of Te Tiriti o Waitangi, the 177-year old treaty between the Māori peoples and the British Crown. My name is Grant Brookes and I am the Co-President of the New Zealand Nurses Organisation Tōpūtanga Tapuhi Kaitaiki ō Aotearoa. 

Our bicultural leadership model, reflecting Te Tiriti, consists of indigenous and non-indigenous Co-Presidents. Kerri, who has just spoken, is the other Co-President of NZNO. Her Māori title is Kaiwhakahaere. 

In a formal speech it is then customary to pay respects to the land on which we are meeting and to its traditional guardians. So, as a vulagi, I acknowledge the vanua, the people of the Burebasaga confederacy and the ancestor Ro Melasiga, or Ro Koratu. 

Vakaturaga i Kubuna, Burebasaga, Tovata. 

I acknowledge also ngā rau rangatira mā, the many great nursing leaders from Fiji and around the Pacific I see before me, and I thank Dr Adi Alisi Vudiniabola and the Fiji Nursing Association for the invitation to speak today. 

I am here with you at an historic time for nurses, midwives and health care assistants in Aotearoa New Zealand. 

Six days ago, on Monday, the 28,000 members of NZNO who work in the public health system, for our District Health Boards (DHBs), began voting to strike. 

It is just the fifth time in the 109-year history of our organisation that such a vote has been held. 

The last time that NZNO members in the public health system voted to strike was part of a famous episode in our history – an episode which also marked the beginning of stronger bonds between our organisation and yours. 

The year was 2004, and our claim was for a single, multi-employer collective agreement (MECA) to unite all of our members in the DHBs, for safe staffing levels, and for pay equity with teachers and police. This would mean pay increases of between 20 and 47 percent – the biggest ever seen in New Zealand’s public health system until that time. 

We called it our “Fair Pay campaign”, and it was successful. 

In February 2005, as our celebrations were about to get under way, we were privileged to receive a two-week long visit from Pacific nursing unionists, including Miriama Vakaloloma and your current Vice-President, Miliakere Nasorovakawalu. The story is told in the pages of our NZNO journal, Kai Tiaki Nursing New Zealand.

2018-04-28 Speech to FNA AGM – slides 

Afterwards, the leaders of our NZNO Fair Pay campaign, Laila Harré and Lyndy McIntyre, came to Fiji to meet with FNA members.

2018-04-28 Speech to FNA AGM – slides2 

When on International Women’s Day, 8 March 2005, the FNA launched your own Fair Pay campaign, it was a great honour for us. We were pleased to be able to share the fruits of our work, sending Fair Pay stickers and t-shirts, and to see how you were able to improve on our campaign tactics. To win support for your campaign, you produced postcards for people to send to the politicians – like ours, but with the addition of a prayer on the back.

2018-04-28 Speech to FNA AGM – slides4

Laila Harré also gave evidence at the arbitration hearing here in Fiji against performance pay for nurses. After your successful five-day strike in August, your general secretary Kuini Kutua and Nurse of the Year Mereani Yaranamua were guests of honour at our 2005 NZNO AGM and Conference. The inspiration they brought to New Zealand was immeasurable. 

2018-04-28 Speech to FNA AGM – slides5

Two years later, our NZNO chief executive Geoff Annals was able to reciprocate, attending your 2007 FNA AGM. 

Later in 2007, we watched avidly as nurses and midwives in Fiji again took industrial action – this time, for 17 days – to stop a five percent pay cut. The NZNO Board of Directors was able to return Kuini’s and Mereani’s gift and make a small contribution to support FNA members facing hardship. When you won, we also celebrated your victory for nurses and patients. 

In 2008 we were again here with you in Fiji, when the FNA hosted the 14th South Pacific Nurses Forum.

2018-04-28 Speech to FNA AGM – slides6 

Kuini and 30 FNA members came to Auckland for the next Forum in to 2010.

2018-04-28 Speech to FNA AGM – slides7 

More recently, NZNO members volunteered to join the New Zealand Medical Assistance Team which was deployed to Fiji in the aftermath of Cyclone Winston.

2018-04-28 Speech to FNA AGM – slides8 

My friend and colleague from Wellington Hospital, Emma Brooks (second from right in the photo), sent back amazing stories of extraordinary and outstanding service by Fijian nurses to their communities, some of which had been almost devastated by the cyclone. Seeing the humanitarian need, the NZNO Board had to respond with support for the FNA.  

And last year, we welcomed the chance to work with our sister union, the New South Wales Nurses and Midwives Association, on your FNA submission about the new pay structure for nurses and midwives. 

Our stories, as Fijian and New Zealand nurses and midwives, as Pacific trade unionists, are intertwined. Our bonds of friendship and solidarity are many and strong. 

And so it continues, as we now embark on fresh campaigns for health as a human right. 

“Nurses: a voice to lead – health is a human right” is the theme for this FNA Symposium and AGM. It is also the theme set by the International Council of Nurses for International Nurses’ Day (IND) this year. As Dr Adi Alisi has just mentioned, the idea of health as a human right is not a new one. It is an idea which guides our work as NZNO – including the ballot on strike action in the DHBs which started last Monday. 

In her introduction to the IND information kit, ICN President Annette Kennedy says individuals and communities all over the world are suffering from illness due to a lack of accessible and affordable health care. But nurses also need to remember that the right to health applies to us as well.

“We know that improved quality and safety for patients depends on positive working environments for staff”, she says. “That means the right to a safe working environment, adequate remuneration, and access to resources, and education. We must add to this the right to be heard and have a voice in decision-making and policy development implementation.”

The right to health is underpinned by national and international legal instruments and conventions, such as Section 38 of the Fiji Constitution or the third of the United Nations Sustainable Development Goals (SDGs). SDG3 sets the target of achieving Universal Health Coverage by the year 2030. 

And what is Universal Health Coverage? According to the World Health Organisation, “UHC means that all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.”

At the pre-AGM Symposium held on Thursday and Friday, there was a focus on how far there is to go for Fiji to reach this goal. My country, on the other hand, is generally thought to have achieved this target long ago, as far back as the end of the 1930s. But is this really so? Do we have Universal Health Coverage in New Zealand today? 

Surprisingly perhaps, the New Zealand government does not collect and publish comprehensive data showing whether individuals and communities receive the full spectrum of health services they need without suffering financial hardship. Without this data, you might ask, how can we report on our achievement of Universal Health Coverage? How can we identify priority areas for attention? 

But a few measures of access and barriers to health services are contained in the New Zealand Health Survey, conducted annually by the Ministry of Health. The results for the 2016/17 year, published in December, include some disturbing findings, such as:

  • 28 percent of New Zealand adults reported trouble getting seen in primary care 
  • 1 in 7 adults (14 percent) reported not visiting a GP due to cost in the past year. 
  • Less than half of adults with natural teeth (47 percent) visited a dental health care worker in the past year
  • 268,000 adults (seven percent) reported not collecting a prescription due to cost in the past year.

The International Health Policy Survey, conducted by the US-based Commonwealth Fund, is another source containing some measures of access to health services for individuals and communities. 

In the latest survey, New Zealand ranks poorly against similar countries for access-related performance measures, in particular access to diagnostic tests, long waits for treatment after diagnosis, long waits to see a specialist and long waits for elective surgery. 

Of the New Zealand doctors surveyed, 59 percent reported difficulty in gaining access to diagnostic tests for their patients, and 34 percent said patients “often experience long waits to receive treatment after diagnosis”. Twenty-one percent of New Zealanders surveyed reported cost-related barriers to accessing health care. 

The lack of comprehensive New Zealand government data on unmet health need last year led a group of medical researchers to conduct a pilot study. Their research, published in the New Zealand Medical Journal, found at least 25 percent of adults were unable to get the primary health care they required while 9 percent of people had unmet secondary health care needs.

Christchurch surgeon Dr Phil Bagshaw, one of the lead authors, said, “There are probably hundreds of thousands of people who have an unmet need that are not recorded”. 

Bagshaw said the 9 percent of people with an unmet secondary health care need in the survey had been told by a specialist they needed treatment but had not received it, generally because they didn’t meet the criteria to go on the waiting list.

The major reason for this emerging picture that human rights to health and Universal Health Coverage are under serious threat in New Zealand is nine years of cumulative health underfunding. Government spending on health has failed to keep pace with population and cost increases each year since 2009/10. It has also fallen as a percentage of GDP. Each year, health spending has slipped further and further behind. In the current financial year, the shortfall compared to 2010 reached $1.4 billion. 

The impact is being felt not only by the individuals and communities who are unable to receive the full spectrum of health services they need without suffering financial hardship. It is also being felt by nurses, midwives and health care assistants working in the public health system. 

Over the last decade, the underfunding of our public health services has meant that NZNO members have reported ever-increasing workloads, increasing patient acuity (patients are sicker coming into hospital), stress, fatigue, and lack of job satisfaction. This is contributing to high staff turnover and to lower morale. Our members are also impacted by inadequate levels of staffing, unhealthy shift rostering, the undervaluation of nurses work and a lack of appropriate access to continuing professional development and study leave.

Which brings us back to my starting point. I am here with you at an historic time for nurses, midwives and health care assistants in Aotearoa New Zealand. For the first time since 2004, the 28,000 members of NZNO who work in the public health system, for our DHBs, are voting on strike action. 

The vote is the latest step in our new campaign. This one is called #HealthNeedsNursing. 

Health Needs Nursing has a dual message. On the one hand, it is an affirmation that the nursing team is the essential core of the health system. We are dedicated, caring and always there. 

Health Needs Nursing also says that the health system itself is sick. It too needs to be nursed back to health. 

The goal of our campaign is to rebuild our public health system back to good health. The immediate staffing crisis has to be addressed. Full employment of new graduate nurses and employment of additional nurses to achieve the right skill mix matched to the needs of patients is required for New Zealand to truly claim Universal Health Coverage. Our goal is to enable nurses to maintain a standard of care that equates to our professional standards – a standard patients deserve. 

Equally, our members salary structure does not adequately recognise experienced staff nor does it incentivise nurses to remain in the profession. Inadequate pay is contributing to a vicious cycle of high nursing staff turnover. Investment in fair pay for our DHB MECA nursing and midwifery teams is urgently required.

Over the last three weeks, thousands and thousands of NZNO members and supporters have taken action, from one end of the country to the other, in the big cities and in the small towns, too.

2018-04-28 Speech to FNA AGM – slides9 

There have been at least 34 rallies for good health held so far – the latest one at Burwood Hospital in Christchurch just yesterday.

2018-04-28 Speech to FNA AGM – slides10

You may recognise some of these faces. In the photo on the top right is Christchurch nurse Simione Tagicakibau, who presented at the FNA Symposium yesterday on Pacific health models in New Zealand. 

We’ve been front page news.

2018-04-28 Speech to FNA AGM – slides11 

We’ve been on TV, too. 

We are not just protesting, though. We are also engaging with members of the public at markets and public transport hubs, talking with them about the need to rebuild our health system. These photos were taken at Wellington Railway Station.

2018-04-28 Speech to FNA AGM – slides13 

We are sending thousands of electronic postcards to government ministers. We are collecting stories from our members to submit to an independent panel which is considering ideas for resolving the dispute. 

And we are winning. On Tuesday, Prime Minister Jacinda Ardern said that the government is factoring our claims into the way it is working up its Budget, due to be released on 17 May. 

We are hopeful that our goals can be achieved without resorting to industrial action. If strikes do go ahead, they are scheduled for early July.  

But to ensure health as a human right in Aotearoa New Zealand, it will take more than a win for our #healthneedsnursing campaign. 

Discussion at the FNA Symposium over the last two days has highlighted the lack of health equity between countries, such as Fiji on the one hand and Australia and New Zealand on the other. Achieving the UN Sustainable Development Goals means reducing this health inequity. NZNO is committed to multilateral cooperation in advancing global health equity and addressing global health crises and risks. 

At the same time, it is important to address health disparities within countries, including within New Zealand, which undermine any claims of Universal Health Coverage. 

Earlier this year, New Zealand reported on progress against another UN framework, the International Covenant on Economic, Social and Cultural Rights. The UN committee responsible for overseeing the convention looked at outcomes in a range of areas such as health, housing, education and employment. According to Janet Anderson-Bidois, chief legal adviser/tumuaki kaitohu ture at the New ZeaLand Human Rights Commission/Te Kahui Tika Tangata, the committee expressed surprise and concern about the information it received from the government, and in separate reports provided by the Human Rights Commission (HRC), NGOs and community groups.

“The reports revealed significant disparities in key health areas for groups such as Māori, Pacific people, disabled people and the LGBTI community”, said Janet Anderson-Bidois. “Māori and Pasifika are more likely to be affected by preventable conditions, and to die prematurely. They have a greater chance of experiencing mental illness, dying at work or committing suicide.”

In order to reduce these disparities and ensure health as a human right for all, it is necessary to strengthen culturally appropriate services and workforce. For this reason, alongside our #HealthNeedsNursing campaign in the DHBs, NZNO is also campaigning for equitable funding for Māori and Iwi (or tribal) health providers, for a pay parity for nurses working in these providers with their DHB colleagues and for a doubling of the proportion of Māori nurses, to match the population. This NZNO campaign is being led by Kerri Nuku and our Māori governance group, Te Poari o Te Rūnanga o Aotearoa NZNO. 

Following in the footsteps of Whina Cooper who we have just heard about, Kerri led a Hīkoi (or peaceful march) in 2016 from the Te Puea Memorial Marae in Auckland to the Indigenous Nurses Aotearoa Conference.

2018-04-28 Speech to FNA AGM – slides14

The hīkoi was a show of collectivism, solidarity, enabling members of Te Rūnanga to kōrero, to waiata, to celebrate and to advocate for pay parity for Māori and Iwi Provider nurses. 

In conclusion, I hope that these stories from NZNO stimulate your discussions today, and in times to come. I believe they show how FNA and NZNO have worked together over the years, in bonds of solidarity and Pacific friendship, and how we can continue to walk our paths together in future. 

Finally, to conclude a formal speech in the custom of the indigenous people of Aotearoa, we greet three times the people gathered at the meeting. 

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

Vinaka vakalevu