How ANMF members
saved ratios
(again)
Victoria’s healthcare system, and its exhausted workers, have been battered by the pandemic.
Three years in, it can be difficult to remember that the state’s public health services began the COVID crisis among the best in the world.
In October 2019, the Victorian Agency for Health Information (VAHI) released a report that compared the state’s public healthcare system to those elsewhere in Australia, as well as in other nations including Canada, France, Germany, New Zealand, Norway, the Netherlands, Sweden, Switzerland, the United Kingdom and the United States.
The report shows that Victoria ranks highly against other top-performing OECD countries when it comes to healthcare.
Although Victoria’s globally praised nurse-to-patient and midwife-to-patient ratios were not specifically compared – as one of the few jurisdictions in the world to have legislated ratios, comparisons are not easy – for the state’s nurses, midwives and carers, they are key.
On 23 December 2015, the Safe Patient Care Act was proclaimed law.
On 23 December 2015, the Safe Patient Care Act was proclaimed law.
Following an election commitment from Daniel Andrews ahead of the 2014 election, ratios became law in 2015. Too often, election commitments can seem to vanish or languish when a government is up and running, so it’s worth remembering this world-beating achievement and how it happened.
Ratios gained
Following the devastation of the health system during the Kennett years, in 2000 Victoria became the first state in Australia to introduce nurse-to-patient ratios, and the first place in the world to have mandated ratios.
Bumper sticker protesting Victorian Liberal government's widespread privatisation of the public health service (and other public services) in the 1990s, led by Jeff Kennett. Victorian Collections. Accessed 7 November 2022.
Bumper sticker protesting Victorian Liberal government's widespread privatisation of the public health service (and other public services) in the 1990s, led by Jeff Kennett. Victorian Collections. Accessed 7 November 2022.
The then Australian Nursing Federation (ANF) successfully convinced Fair Work Australia (FWA) that ratios were necessary to bring back nurses, who had left the profession in droves under Kennett.
But, having gained ratios, the union and the state’s nurses and midwives spent the next decade campaigning to keep them.
‘Every government, no matter what persuasion, Liberal and Labor from 1999 through to 2011/12, opposed ratios,’ says Branch Assistant Secretary Paul Gilbert.
The government always tried to corner us so that we’d end up in a situation where ratios were under dire threat.
This is exactly what happened in 2011/12. But with the leak of cabinet-in-confidence papers that revealed the Baillieu Liberal Government’s tactics to the public, this was no ordinary campaign.
Ratios lost
(almost)
‘What was incredible about the 2011/12 [EBA] campaign was the leak of a cabinet document showing the government’s tactics as they attempted to water down nurse-to-patient ratios, and introduce a whole lot of what they called efficiencies [to] save money on nurses’ wages,’ says journalist Michael Bachelard, who broke the leak on the front page of The Sunday Age on 6 November 2011.
It was for cabinet. It wasn’t meant for public distribution. It was really a naked political and financial document, which didn’t take any account of the level of care that people had come to expect in Victorian hospitals.
The document, signed by then health minister David Davis on 5 May 2011, revealed the Baillieu Liberal government’s ‘aggressive’ secret plan to cut the number of nurses and midwives ‘and replace them at hospital bedsides with low-skilled “health assistants”,’ Bachelard wrote.
When Michael Bachelard came to me with that document, it reinforced for me the absolute lack of respect for nurses and midwives and the work that they do, that I thought that the government had at that time.
Just seven months earlier Davis had written to the ANF, outlining the Coalition’s healthcare commitments should it win the 2010 state election. He pledged, among other things, to: maintain nurse patient rations in their current form and as supported in current agreements; and work constructively with the ANF in negotiating the next EBA.
Far from working constructively with nurses, the Coalition Government’s plan was duplicitous, with a ‘sham approach’1 to bargaining, Ms Fitzpatrick says, referring to the revelation that the government planned to achieve its aims by deliberately frustrating pay negotiations so it could force the state’s nurses into arbitration, where they would lose ratios. (A previous case involving the education union had created a precedent for this, and hence the Baillieu Government knew its best chance to get rid of mandated ratios was in arbitration.)
Lockout
The revelation of the Baillieu Government’s plans came two months into the 2011/12 EBA negotiations that would ultimately become the longest in Victorian nursing and midwifery history.
Following the revelation, on Tuesday 8 November ANF members voted to take industrial action. The next day, Ben Schneiders reported in The Age that Victorian public hospitals had received advice on how to conduct a ‘lockout’ of nurses during industrial action. Such a lockout had been used by Qantas only days earlier, grounding its entire fleet of aircraft in response to industrial action by engineers, pilots and baggage handlers.
The Qantas lockout was seen to embolden employers in other sectors. For the Victorian Hospitals Industrial Association (VHIA) to consider a similar ploy was an ‘amazing’ overreaction, Ms Fitzpatrick said at the time. Even ‘Jeff Kennett didn’t treat nurses like this.’2
David Davis, meanwhile, ‘vowed the state government would do everything it could’ to help Victorian hospitals end the industrial action3.
This meant arbitration – aka their original plan. Ultimately, the Branch avoided arbitration thanks to a decision by FWA to ‘suspend’ for 90 days rather than ‘terminate’ members’ protected industrial action. But the government still wouldn’t budge.
Over the next few months, members held community rallies and ultimately rolling walkouts; they doorknocked the marginal electorate of Bentleigh, held by the Liberal member Elizabeth Miller by 19 votes; they signed mass resignation letters. Until in March 2012 an agreement was finally reached.
2014 election and the Safe Patient Care Act
The bad taste left by the 2011/12 campaign made the Branch and its members even more determined to see ratios enshrined in law. When the state election was called in 2014, members swung into action again.
Their campaigning in 2011/12 convinced Daniel Andrews to make the historic commitment to legislate nurse- and midwife-to-patient ratios should he win office at the 2014 state election. On 23 December 2015, the Safe Patient Care Act was proclaimed law.
These promises, these commitments would not have come if it wasn’t for ANMF delegates, members and those who work for the union convincing us that these matters needed to be beyond doubt.
That ratios needed to be off the table, not part of the negotiating process.
ANMF delegates and members, and the union’s leadership, convinced us of this and these changes would not have happened without them.
Ratios today
While nurse-to-patient and midwife-to-patient ratios were legislated in the Safe Patient Care Act in 2015, they were never meant to be set and forget.
Two amendments to the Act – one in 2019 and the second in late 2020 – are ensuring ratios are improved over five years and will ultimately see more than 1100 extra nurses and midwives in the system.
The amendments, many of which originated in resolutions passed by delegates at our annual delegates conferences, are being implemented in a phased rollout. Implementation of the 2019 amendments, known as ‘phase one’, began in 2019.
A five-stage phase, it has seen improvements introduced annually in March with the final stage due in March 2023.
Phase one: stage 5 from 1 March 2023
(Safe Patient Care Amendment Act 2019)
50% rule removal (must round up)
Afternoon shift in:
• special care nurseries
• neo-natal intensive care units
• antenatal and postnatal wards
• birthing suites.
The 2020 amendments, known as ‘phase two’, have been introduced each July with the final stage due in July 2023.
Phase two: stage 5 from 1 July 2023
(Safe Patient Care Amendment Act 2020)
50% rule removal (must round up)
Morning shift in aged high care residential wards
Improved ratios
• Level 3 hospital general surgical and medical wards (night shift) + in charge currently no plus in charge (Part 2 s.17 of the Act)
• Birthing suites (afternoon shift) + in charge if six or more nominated birthing suites currently no in charge (Part 2 s.31 of the Act)
• Geriatric evaluation management beds (night shift) + in charge currently no plus in charge (Part 2 s.24 of the Act).
References
1. Michael Bachelard, ‘Revealed: Secret plan to cut nurse numbers’, The Age, 6 November 2011, p4
2. Ben Schneiders, ‘Nurses lockout plans exposed: Victorian public hospital managers get secret advice on strike-breaking’, The Age, 09 November 2011
3. Josh Gordon and Julia Medew, ‘Bid to stop nurses’ action’, The Age, 14 November 2011
Note
At the time of publishing, COVID-19 hospitalisations were continuing to decline and most of the wards that had implemented extended team models were returning to the requirements of the Safe Patient Care Act. We are working to ensure that all are compliant with the Act.
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