In the past week the Baillieu government and public hospital CEO’s (particularly those in regional areas) have announced funding cuts, though exactly where the problem lies is unclear – the State government’s position is that Federal funding’s been cut, but

Federal Health Minister Tanya Plibersek said the Federal Government’s investment in Victoria’s health system continued to grow.
She said the 2012-13 Budget update released by the Commonwealth confirmed that funding for health in Victoria would increase by 26 per cent over the next four years, from $3.6 billion in 2012-13 to $4.5 billion in 2015-16.
Ms Plibersek said the state Health Minister, David Davis, had failed to take $100 million in federal funding on offer. [source]

Ms Plibersek’s also said

I understand that that is frustrating for the Victorian Government but having a 26 per cent funding growth over the next four years, in contrast to $616 million of actual cuts from them, that a very big contrast indeed and I don’t think that he should be blaming anyone but himself for the stress in the system [source]

Is it a coincidence that Victoria’s public sector’s been told we have to save $106.75 million this financial year, and the government’s Cabinet-in-confidence document from last May targeted a saving of $104 million? A sum curiously close to the $100 million the Federal Health Minister, Tanya Plibersek, says wasn’t taken by Vic. Health Minister Davis?

Addit: for a comprehensive overview of the funding picture, please see the ANF (Vic. branch) letter, released this afternoon.

Wherever the blame for the reduced funding lies, right now I’m less interested in the reason and more focused on the impact of the cuts.

According to Maria Mondini, a colleague at Bendigo hospital, staff there were today asked by their CEO to enlist their unions in a fight against the cuts – the listed consequences of the reduced funding included “longer waiting list, nurses redundancies, a reduction in elective surgery, closure of beds , forced leave for staff, cessation of all new appointments…” I won’t dwell on the irony of this coming from a man who was not only anti-union during our campaign but currently suing both an individual nurse and the ANF (Vic. branch).

Here’s my concern : tucked away at the end of their discussions about the impact of funding cuts on elective surgery etc is the warning that “jobs may be shed”. I’ve written before about the illusion that somehow it’s possible to cut non-front line staff and reduce costs without affecting the provision of services.

We’ve seen in Queensland that when state Liberal Premiers cut hospital jobs that includes front line nursing staff, with regional areas at particular risk.

We’ve seen in NSW that having an EBA that includes ratios doesn’t mean ratios are safe; at Coff’s Harbour earlier this year sick leave wasn’t replaced until wards were already one down.

Nurses and midwives don’t work alone – the doctors, occupational therapists, physiotherapists, speech pathologists, dieticians, pharmacists, orthotists, radiographers, pathologists, psychologists, theatre techs, support staff and others are also essential components in the provision of safe, effective, quality care.

Move away from the acute sector and that extends to preventative health care, community clinics, drug and alcohol services, counselling services, lactation specialists, post-natal follow-up, homeless health clinics, and scores of areas I’ve missed or am unaware of. Cuts hit all of us.

However – the nursing/midwifery staffing component is the largest part of any health care budget; as I’ve said before, one can see why it’s so tempting an area to cut. The reason, though, that nurses and midwives cost so much is because patients who don’t need nursing and midwifery care aren’t in hospital – they’re in the community (being cared for by District nurses, community health nurses, maternal and child health nurses), they’re in rehab (being cared for by rehab nurses) or they’re in placement (their care performed by health assistants and overseen by nurses).

And, when finances are tight, nursing and midwifery places go.

There are innumerable examples of how  far unsafe staffing can go – for me the most striking is an NHS hospital’ whose high-risk maternity ward employs three midwives for forty women and their newborns, while also supervising health assistants.

When nurses and midwives are overwhelmed they experience compassion fatigue, one of the first signs of burnout – more often than not, even from those who should know better, this is perceived as the fault of nurses, or an indictment of their training, rather than a warning sign of a system at breaking point.

That’s in addition to the recognised effects of inadequate nursing numbers – increased rates of pneumonia, IV-site infections, wound infections, pressure ulcers, falls, drug errors, increased length of stay, failure to rescue, cardiorespiratory arrest, ICU admissions, and deaths.
Perhaps I’m seeing conspiracies were there are none. Yet I can’t help but worry that, under the guise of budget constraints, the Baillieu government , known for their broken promises – where are those extra 800 beds promised to be delivered by June 30th? – will once again attack nurse/midwife: patient ratios, either directly or by stealth. The introduction of patient care attendants (or health aides) would reduce short-term costs, a technique this government appears much enamoured of regardless of the long-term consequences.

Nurses, midwives, our colleagues, and anyone who may need public health care should be concerned – and that means we should all be concerned. Watch this space… and keep counting.But know that, though the election’s now only a year, eleven months, three weeks and one day away, that’s more than enough time to wreak significant, catastrophic destruction to one of the strongest, least expensive, most successful health care systems in the world.