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Speech to the National Nurses Forum

The Minister for Health, Greg Hunt's speech to the National Nurses Forum on the Gold Coast on 29 August 2018.

The Hon Greg Hunt MP
Former Minister for Health and Aged Care

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And thanks very much to Ronnie, to previous speaker Del and I have to say what you were discussing in relation to men’s health and also what we do on women’s health is a national priority. We are working now on putting into place a long term plan out to 2030 for women’s health and a long term plan for men’s health, also out to 2030.

So Del, I think you were right on the mark in terms of being able to highlight the need to discuss, to diagnose and to treat. To Professor Christine Duffield, to Professor Kylie Ward, I bring apologies from the Chief Nursing Officer Deb Thoms and she’s sorry she can’t be here, particularly because when I was speaking with her this morning she said it was minus-five degrees in Canberra and so when she says she wants to be at the National Nursing Forum, she really, really means it.

And of course to all of our amazing nurses from around Australia, wherever you are within this extraordinary profession. For me, it’s deeply personal. My mother was a nurse. In fact, my parents met at Frankston Hospital. So she was working at Frankston Hospital. My father met at Frankston Hospital. I was born in Frankston Hospital. I’m assuming I wasn’t conceived in Frankston Hospital.

And then of course my wife Paula is a nurse. She’s not practicing at the moment because we’ve got two young children. It’s a story that many of you wrestle with in terms of your own lives and your own careers and your own professions. So nursing has been literally a fundamental and central part of my life. Paula, my wife, is a nurse - a theatre nurse. And she in particular has had responsibility for infection control, so she’s always saying every time you go to a medical or health environment I want you to be washing your hands. And so she’s driving me on that and so I now have the cleanest hands in the country.

But on that front, I want to say a special thank you. We released some figures today. We know that last year was a horror flu season. As of yesterday, in comparing 2017 to 2018, the national figures are: last year, there were 143,000 people who had reportable cases of flu and obviously the actual numbers were much higher. As of 28 August this year, it’s 25,000.

At this point last year, we had 610 people who were reported as having lost their lives to flu. On this day, it’s 38. And that’s an extraordinary achievement which it’s in part to the nature of this year’s virus, in part due to the strength and the targeted nature of the vaccines that are available.

But in particular due to the dramatically higher level of vaccination and the work of yourselves and your colleagues in infection control. And so when you think of what you do, you can look at that example of flu where vaccines, vaccination rates, infection control, the role of the nursing community, all come together and you can literally measure the lives that you have helped save. So I think that’s a great place to start.

Now as I look out at this group and Kylie and Christine were saying, it’s nurses from all walks of the profession, whether it’s primary and community, whether it’s acute, whether it’s aged care, whether it’s some of the different specialist disciplines within nursing. You’re all represented here today.

And so I want to take the point that Ronnie was making about a long term national health plan and to apply to nursing and we’re in conjunction with the Australian College of Nursing, we’re intending on heading as a country and of course working with the states and territories who are the principle employers of nurses. But it’s a long term vision that I want to set out today, and then to work on conjointly with all of you.

There are really three spaces that I’d like to discuss. Firstly, is in relation to the roles of nurses within our society. Secondly, it’s in relation to the conference themes. And thirdly, it’s about the future vision for nursing. So when we come to the first of those and the roles of nurses within our society, and of course there is on virtually every survey about the respect of which professions are held, nursing is at the top or near the top of virtually everyone and I think that’s an immense tribute to who you are and what you do and it’s an appropriate reflection of the contribution you make at the community level and right across the health and medical system within Australia.

Now if you think through, we know that there are about 315,000 nurses that are registered in different ways within Australia. And in that, if we start with primary and community care, we have about 43,000 nurses in that field, a mixture of community, a mixture of general practice, a mixture of other forms of health services and in particular I’ve been able to witness some extraordinary Aboriginal community controlled health organisations in remote and regional Australia and that work on the front line is immensely important. At the moment we’re supporting that with about $8 million for developing those pathways.

But much more importantly than that, right now, as I said at the AMA conference, we’re working with the AMA and the College of GPs and we’re including the College of Nursing in this process, looking at new models of general practice. Option models that individual doctors or practices may choose to be a part of where there is a greater emphasis on the practice as a whole and therefore the role of the nurse being able to deliver additional services and be engaged in the long term ongoing care of the patient. So it becomes a whole of practice rather than just a doctor to patient relationship. And this is something that the leaders of the medical profession are very excited about. And so I think that’s an extraordinary bright moment in terms of opportunity.

With regards to hospital and acute care, this of course is where the largest number of nurses are in Australia, depending on where you cut it, about 193,000 are involved in that space. That’s the traditional conception of nursing, but of course our task is to broaden out the opportunities and to broaden out the conception of nursing within Australia. But for that fundamental core area, one of the things that I think has been lacking and it’s been partly because the vast number of nurses are employed at the state and territory level, is an overarching national nursing strategy.

We’re working on an education program and looking at the education pathways but I’ve had a lot of discussions, I mentioned earlier with Debra Thoms, the Chief Nursing Officer and also this morning with Christine and Kylie, and I’m delighted to announce today that we will broadened out the National Education Strategy to develop a Nursing 2030 National Nursing Strategy. And we’ll do that with the states, with the territories, and most significantly with all of you, with the profession.

The Chief Nursing Officer at the federal level will work with all of her state and territory counterparts and we’ll have a process going forward to develop this and to aim to achieve a National Nursing Strategy for Nursing 2030. And that’s about pathways for recruitment, for education, for professional development, for, in particular, mental health and physical health of nurses, their quality of life and quality of work all brought together. And it should happen but it’s not something that’s happened in the past.

And this is your moment, so I’m really thrilled that together we’ll be able to do that over the coming months. The next thing of course is that we have our aged care nurses and I know my father spent his final months in an aged care facility and I know one of the great challenges is that people are living longer at home, which is a good thing, which is why we’ve actually had to increase and very happily increase the number of homecare packages. But at the same time, when they come into an aged care facility, they come in at a higher level of need and that brings all sorts of challenges. So we have to work with the aged care sector and yourselves on the needs of the nursing community.

As part of that, we’ve just announced $100 million for mental health for senior Australians, $8 million of which will go towards supporting mental health in aged care facilities, and $20 million of which will go towards supporting mental health for seniors through mental health nurses within the community. And I think that’s an extremely important recognition of the great challenges. Whether it’s isolation, loneliness, whether it’s the mental health challenges or the fear which comes with age and the loss of physical capacity. All of these things come together and that support, I think, is absolutely critical.

And the last of the roles that I want to mention is in relation to specialised nursing. Of course, this comes in many different forms across the three areas that I’ve already mentioned. But whether it’s also in breast care, prostate care, whether it’s the roles of our advanced practitioners or our nurse practitioners and I think there are about 1340 nurse practitioners around the country. What we want to do is to be able to give you more options and opportunities to head down that path if you want to do that.

And that’s good for your careers, it’s good for the quality of health and medical care in Australia and it’s also, if I’m honest as somebody who has to oversee the whole of the health system, a way of providing career development that is more likely to attract people at times other than in their early 20s and to keep you in this career for a much longer period of time than may otherwise have been the case. And I think both of those benefit the healthcare system and benefit all of our magnificent nurses as well as all of our patients. And so, when we put all of that together, that brings me to the themes of this conference and of course diversity and difference is the overarching theme.

There are really two points on that first theme that I wanted to address. I think nursing does a great job, a great job of pulling people in from all of the different strands of our society. But I know talking to Kylie that there’s more that we can do to bring in people from non-English speaking backgrounds, to bring in people and to give them language training to provide those opportunities. But also, of course, to bring in more men.

In most of my other areas of work, it’s about providing opportunities for women to have greater roles, to have greater leadership, to have greater participation. Nursing is the reverse where it’s a 90 per cent female field and that means that we’re missing out, and so we want to add to that diversity then in terms of the full breadth of the Australia cultural and linguistic background, but also trying to bridge the gender divide to increase the workforce.

And I’m very open and inviting suggestions as to what are the things that we can do to ensure that the traditional and really the old paradigm of nursing being perceived as an overwhelmingly female career, which that shouldn’t be case, isn’t appropriate and is the sort of barrier that we’ve broken down in the rest of the country is something we can now break down here. So your assistance and your suggestions and your guidance on that front, I think you’re extremely important.

A second area that is one of your themes is IT and the nursing-informatics community has played a tremendous role as so many doctors have pointed out to me. They’re absolutely embarrassed that they rely so much on the nurses for the running and the maintenance of the information systems, which allow for much better patient records. You’ve been very involved, deeply involved with the digital health agency and the development of the My Heath Record and we’re obviously moving to add even stronger privacy protection, but at a clinical level, you know that if a patient is cognitively impaired in an emergency department, if a patient simply doesn’t have that part of their history or doesn’t know exactly which drug it is or where there are incompatibilities, that these can be extraordinarily difficult moments.

And to have access to that record saves time but above all else, has the potential to save adverse outcomes and, in some cases, as the head of the AMA have said, save lives. And so it is I think an extremely important development and in three, in five years’ time many people will say, how did we ever do without a national voluntary patient system where anybody can opt out at any time but that record I think would be really important. And I want to engage you to continuously provide your feedback on improvements.

That then brings me to the third of the areas for this conference, which is policy. Now, you have a huge role to play. Already your leadership is engaged with myself and with the national government and all of the state governments when policy questions relate to nursing. But I’ve spoken with the Chief Nursing Officer and as part of the development of the National Nursing Strategy, what we want to do is to have roundtables and a process for input from everybody as we design that. Design that around themes such as recruitment, retention, development and then the clinical outcomes in health, in particular physical and the mental health of our nursing community around the country.

And I think it’s very, very important that we deal the question of mandatory recording for mental health and that the presumption is that just as in every other, in virtually every other profession, if a nurse has a mental health challenge, and we know that four million Australians in any one year will have a mental health challenge, they will be able to seek help without risk or fear that will impact on their career because the earlier you seek help, as you say, with all of your patients in this situation, the far better. It can literally be lifesaving and it can absolutely be life changing. So, that is a deep, strong personal commitment from me to you.

The last of your things is trailblazers and this is about innovative nursing, about new ways of doing things. And because you work with the patients and you see things which will be successful, you see things which can be better, we want to support and encourage that. We will be announcing today, we will be introducing a National Nursing Innovation award, so Health Minister’s Innovation Award for Nursing, it’s something that we’ll do through the College.

The College will lead that program and it will be a way to encourage the trailblazing, the pioneering, the innovation within your own profession. You’ll do it in any event but this is a way of recognising that innovation in nursing and in clinical practice starts with the people who are engaged with the patients every single day.

All of this brings me then to the third big thing which is the future and within the future, I particularly want to look at the transformation of the health system in nursing over the coming years as well as education, as well as rural Australia. In terms of the transformation, the big thing that we are facing is a move right away from acute care as a sort of an immediate step in so many cases, to try and to turn what is often called an avoidable hospital admission into a genuinely avoidable hospital admission.

And what we’re working on with the medical profession is providing options for general practice to be much more engaged in stewardship and I mentioned this earlier, and patient stewardship is all about ensuring that the whole of the practice, the doctors, the nurses, others are engaged in constant work with patients. And what that means is that we want practices to have an option, they can continue on exactly as they wish if they so choose. But to have an option to have greater engagement, whether it’s online, telephone, and in other ways with our nurses working directly with patients on a consistent basis.

The goal of that is to keep more people out of hospital. We know when we look at Sweden for example, they have had real and dramatic success on that front. There are other models around the world and in particular, for us to be able to equip our nurses in that space and to have you help design and be involved in that transformation, where there would be greater engagement at primary and community level, I think is an immensely important step forward.

That then naturally leads to the question of education and the College has done an amazing job. I think about 74,000 nurses trained through the College since 2004. And it will become, I believe, an increasingly important part of our system. Going forwards, I’m delighted to announce today that to assist the College with its work, we’d be providing $1.125 million. It’s not the money, it’s the recognition of the role of the College in helping to (inaudible).

And then of course, as we go forwards, one of the great challenges in what believe can and should be the world’s best health system is this. It’s the fact that the Commonwealth Fund recognises us, in Australia, as the number two health system in the World, number one for clinical outcomes and for our researches, our nurse, our doctors, that’s an amazing testament and tribute. But lower down, which brings us down to number two for issues of access and that primarily relates to rural, remote and Indigenous Australia. And so one of our great tasks over the medium-term is to boost the number of nurses and the number doctors in rural Australia by 3000 each.

So the Health Strategy, the Rural Health Strategy, which we announced in the budget includes a $180 million package of additional assistance for what’s called a Workforce Incentive Program - $125,000, up to $125,000 is based for practice nurse employment with higher weightings for those in Modified Monash three and above areas.

But most significantly, we need to help educate to help provide the opportunities to help assist with the transition as we boost those numbers by extra 3,000. Immediately, we have the challenge of the drought and the drought means that for the nurses, they can themselves have significant issues of distress and they are dealing with very significant issues of distress.

So I’m also delighted to announce today that we’ll be supporting CRANAplus with $158,000 for working, very specifically, on training of our nursing staff and our medical staff within drought affected areas in recognition of psychological trauma, in dealing with psychological trauma and in understanding the pathways for treatment and for referral. All of those things represent what you do.

My task is to provide the best possible framework and pathways so that you can provide the best possible care for your patients and for yourselves and ultimately, lead Australia today in what can, should, and will be the best health system in the world. There’s a little bit more to do to get there, but we’re almost there. And my belief is, if we can resolve those equity issues in terms of rural access and we can support our nursing profession, we can have an extraordinary situation. To speak on behalf of my wife and my mother and to be here today is a real honour.

There’s been a couple of challenges in the last week. And the one thing I was absolutely determined to do was to come to this conference and to speak with you because I get what you do, I understand what you do, in every way, shape and form. Feel a responsibility and being with you and on your side because you are an extraordinary group of people, not just those here, but everyone you represent. With that, I want to thank you, and honour you, and wish you all of the best.

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