GENERAL SECRETARY S REPORT. New South Wales Nurses & Midwives Association. Council Meeting. 5 September Contents

GENERAL SECRETARY S REPORT New South Wales Nurses & Midwives Association Council Meeting 5 September 2017 Contents Key Direction 1: Grow our capacity to influence 3 Central Coast Local Health District 3 Central Coast Community Nurses - Hospital in the Home restructure 3 Hunter New England Local Health District 4 Belmont Hospital - Breaches of staffing arrangements 4 Belmont Hospital, STRAS Unit Reduction in staffing and attempt to vary 10-hour night shifts 5 John Hunter Hospital - Investigation of suspected breaches of staffing arrangements 6 Illawarra Shoalhaven Local Health District 6 Wollongong Hospital Maternity vacancies and consequent workload issues 6 Justice Health & Forensic Mental Health Network 7 Forensic Hospital - Unsafe workplace 7 Macquarie Correctional Centre, Wellington - Commissioning of new facility 8 Murrumbidgee Local Health District 8 Nolan House, Albury - Safe patient care and staff safety 8 Northern NSW Local Health District 10 Lismore Mental Health Unit - Restructure 10 South Eastern Sydney Local Health District 11 Prince of Wales Hospital - Changes to ECR service 11 Key Direction 2: Be innovative in our advocacy and bargaining 12 Family and Community Services 12 Dispute regarding aspects of the forced transition of FACS staff to the NGO sector 12 South Eastern Sydney Local Health District 13 St George Hospital - Partial privatisation of the Renal Dialysis Unit 13

Key Direction 3: Promote a world class, well-funded, integrated health system 15 Keep our Hospitals Public Campaign 15 Wyong and Bowral Hospitals remain public 15 Shellharbour/Port Kembla Hospital - Public Private Partnership 16 Keep NSW In A Healthy State campaign 17 Anti-privatisation campaign 17 Ministry of Health - Northern Sydney Local Health District 18 Northern Beaches redevelopment - dispute re consultation process 18 NSW Parliament 19 Government Sector Employment Amendment (Transfers to Non-Government Sector) Regulation 2016 19 NSWNMA Education Program 19 2017 Program 19 Mental Health Observations Education Session 20 Environmental Health Seminar 20 Reconciliation Plan (RAP) 20 Scholarships 21 Bob Fenwick Mentoring Grants Program 21 Submissions and Inquiries 21 Aged Care Quality Assessment and Accreditation Framework 21 Review of Seclusion, Restraint and Observation of Patients with Mental Illness 22 Work Health and Safety 22 Meetings with SafeWork NSW 22 NSW Ministry of Health Policy review 22 National Safe Work Month 23 SafeWork NSW Musculoskeletal Strategy 23 Work Health and Safety Policy Review and Advocacy 23 Key Direction 4: Promote the Association as a significant and professional advocate for the health system and our members 24 Environmental Issues 24 Climate Network Australia (CANA) 24 Climate and Health Alliance (CAHA) 25 Key Partnerships 25 Australian College of Midwives State Conference 25 Australian College of Nursing National Forum 25 Early Patient Mobility Focus Group 26 Quality Aged Care Group (QACAG) 26 General Secretary s Report to Council 5 September 2017 Page 2 of 26

KEY DIRECTION 1 Grow our capacity to influence In order to win better outcomes for our members, the Association* must grow our influence. Influence comes when Association members and member leaders have the ability to use their collective power to enforce rights and achieve new outcomes in their workplaces, their sector and within the health system. We define the health system as inclusive of everywhere our members work. STRATEGIES 1.1 Grow power and influence by increasing the number of Association members 1.2 Identify new member leaders who can build their workplace influence 1.3 Equip Association member leaders with the skills, knowledge and confidence to lead members to use their influence 1.4 Grow the number of Association members actively engaged across the health, disability and aged care systems 1.5 Ensure a focus on retaining as many members as possible (* Association should be read to mean the New South Wales Nurses and Midwives Association and the Australian Nursing and Midwifery Federation NSW Branch) Central Coast Local Health District Central Coast Community Nurses - Hospital in the Home restructure The Central Coast Hospital in the Home (HITH) nurses have been going through a restructure for the past 12 months, which is now finalised. The restructure applied to the HITH nurses being taken from their own Hub and placed into the general community nursing hubs. The positions affected are: three nursing unit managers level 2 (NUM2) to be regraded to level 3 (NUM) and the current two NUMs to be regraded to clinical nurse specialist (CNS2)/Clinical Co-Ordinator. There was also a loss of a GP Liaison nurse (two nurses affected). Key Direction 1 Strategy 1.1 Strategy 1.2 Grow power and influence by increasing the number of Association members Identify new member leaders who can build their workplace influence The NSWNMA has formed a branch around the issue and have undertaken the Union Staff Consultative Committee (USCC) process. The staff representatives pushed for the NUM1 positions to remain and to increase the role of the after-hours team-leader. The NUM1 position will still go ahead for re-grading to a CNS2. The NUM2 position will still go ahead for re-grading to a NUM3. General Secretary s Report to Council 5 September 2017 Page 3 of 26

The after-hours role has been increased to a Nurse Clinical Co-Ordinator. The branch meetings had consistent attendance throughout the entire process, with 15-20 nurses attending each time. The branch executive has demonstrated strong leadership and a branch meeting has already been scheduled for the six month review. All nursing staff have been encouraged to collect data over the next six months, particularly if they are asked to complete anything that would be deemed a managerial task. Hunter New England Local Health District Belmont Hospital - Breaches of staffing arrangements The Belmont Hospital Branch of the Association has raised issues around workloads in the hospital which has a 5.0 NHPPD arrangement in many units. HNELHD has seemingly utilised a range of policies and techniques to minimise staffing including: Replacing absent shifts only partially (for example an 8.5 hour shift replaced with a 6.5 hour shift); Remove the delegation of NUMs to replace staff and instead require higher approval (which inevitably creates delays); Indicated to NUMs that 5.0 NHPPD was the maximum budgetary position and they were not to exceed this. Key Direction 1 Strategy 1.2 Strategy 1.3 Strategy 1.4 Strategy 1.5 Identify new member leaders who can build their workplace influence Equip NSWNMA member leaders with the skills, knowledge and confidence to lead members to use their influence Grow the number of NSWNMA members actively engaged across the health, disability and aged care systems Ensure a focus on retaining as many members as possible Key Direction 2 Strategy 2.7 Strategically use legal and industrial tribunals to deliver outcomes for individual members or groups After seeking documents voluntarily, and HNELHD declining on 17 August 2017, the Association utilised section 298 Industrial Relations Act 1996 (Right of Entry provisions) to obtain rosters and documents regarding the suspected breaches. Preliminary findings indicate systemic non-compliance with the 5.0 NHPPD provisions (see below). The Association has commenced dispute proceedings in the IRC of NSW. General Secretary s Report to Council 5 September 2017 Page 4 of 26

Week Commencing South Ward GFNB SAU Surgical/1FNB January* ward closed 4.80 5.02 4.95 February* 4.96 5.15 4.80 4.96 March* 4.88 5.16 4.77 4.64 April * 5.22 5.04 4.97 5.19 1 May 2017 5.31 5.50 5.50 5.13 8 May 2017 4.62 5.45 5.04 5.01 15 May 2017 4.88 5.06 4.88 5.15 22 May 2017 4.90 5.10 4.91 4.97 29 May 2017 5.15 5.05 5.00 5.23 5 June 2017 4.53 5.08 5.23 5.03 12 June 2017 5.46 5.16 4.75 4.75 19 June 2017 4.63 5.12 4.84 5.23 26 June 2017 4.82 4.79 4.73 4.67 3 July 2017 no information 4.96 4.81 4.91 10 July 2017 no information 4.75 4.68 4.88 17 July 2017 4.57 4.80 4.70 4.98 24 July 2017 no information 4.68 4.72 4.9 31 July 2017 4.63 4.70 4.77 5.07 7 August 2017 4.93 5.18 4.75 4.95 Belmont Hospital, STRAS Unit Reduction in staffing and attempt to vary 10-hour night shifts HNELHD is seeking to reduce the Short Term Aged Care Service unit from 5.5 NHPPD to 5.0 NHPPD (note: in July 2015 it was 6.2 NHPPD). During July, HNELHD unilaterally abandoned the introduction of change provisions and imposed the reduced staffing on the unit. Key Direction 1 Strategy 1.2 Strategy 1.3 Strategy 1.5 Identify new member leaders who can build their workplace influence Equip NSWNMA member leaders with the skills, knowledge and confidence to lead members to use their influence Ensure a focus on retaining as many members as possible The Belmont Hospital Branch voted for bed closures in response. In turn, the HNELHD filed a dispute in the IRC of NSW seeking orders that members not commence industrial action. The Association was able to convince the IRC to restore the previous roster. The Association agreed not to take industrial action whilst the parties consult. However, despite extensive discussions, HNELHD has made no changes to their proposed plans. This includes the rostering of nurses on eight hour night shifts in contravention of clause 4(iv)(b): Where 10 hour night shifts are in operation in any health facility, at the commencement date of this award or subsequent thereto, the length of these shifts must not be altered without the consent of the Head Office of the Association. The Association will seek to have the matter brought back before the IRC. General Secretary s Report to Council 5 September 2017 Page 5 of 26

John Hunter Hospital - Investigation of suspected breaches of staffing arrangements The John Hunter Hospital Branch has indicated concerns regarding compliance with the NHPPD provisions in their hospital. Key Direction 1 Strategy 1.2 Strategy 1.3 Strategy 1.5 Identify new member leaders who can build their workplace influence Equip NSWNMA member leaders with the skills, knowledge and confidence to lead members to use their influence Ensure a focus on retaining as many members as possible Significant feedback has been received from the Branch regarding the hospital s compliance with staffing arrangements as set out in the award. Notice was given to HNELHD on 25 August 2017 that the Association would commence an investigation into suspected breaches of the NHPPD provisions at John Hunter Hospital. Illawarra Shoalhaven Local Health District Wollongong Hospital Maternity vacancies and consequent workload issues Wollongong Hospital has been experiencing significant vacancies (currently 19.05 FTE) in the maternity services for the past few years. This has been the result of multiple factors: Recent re-calculation of Birthrate Plus figures that required an additional 40 FTE at the time. AHPRA changes occurred for overseas trained midwives. These midwives are now required to be supervised for a period of time and therefore some LHDs have decided to cease overseas recruitment. Some LHDs have decreased the offer of postgraduate Midwifery courses and instead are offering support for Direct Entry Midwifery. The transition from one course to the other did not allow for the period of time that would see reduced numbers of midwives being qualified. Changes to university courses at Wollongong University have resulted in no further Midwifery Course being offered, and no other university relationships to rely on to engage newly registered midwives. The branch has been working with local management to address the vacancies were possible and several positions have been recruited to. However, many vacancies continue to exist and the prospect of filling all positions in the near future is unlikely. This is resulting is significant workloads issues and is impacting on the provision of safe care. Poor skill mix and short staffing is commonplace with examples such as these happening on a daily basis: The CNE is used to care for patients and can have an allocation of up to12 mothers. Casuals are used to cover the vacancies and therefore sick leave cannot be replaced with like-for-like; one midwife has been rostered on the post-natal ward for 28 beds. General Secretary s Report to Council 5 September 2017 Page 6 of 26

Rosters are published with up to 80 vacant shifts per 4 weeks. These are then filled with RNs, AiMs and AiNs. Despite many clinical employees on the roster, only the midwives have scope to provide breast feeding education. The number of midwives is simply not enough, and mothers are feeling unsupported and have started to blame the staff. There has also been an increase in re-admission of babies due to low birth weight/failure to thrive due to lack of breast feeding engagement. Despite the issues with vacancies, midwives continue to complete non midwifery tasks, such as bed cleaning, mopping floors, admission paperwork, scheduling appointments. Key Direction 1 Strategy 1.2 Strategy 1.3 Strategy 1.4 Strategy 1.5 Identify new member leaders who can build their workplace influence Equip NSWNMA member leaders with the skills, knowledge and confidence to lead members to use their influence Grow the number of Association members actively engaged across the health, disability and aged care systems Ensure a focus on retaining as many members as possible The members have met on several occasions, with a focus on building their attendance at meetings and bringing their colleagues to be more involved. They wrote an open letter to the Executive, with 176 signatures from midwives and supporters obtained over seven days. The open letter highlighted the workload issues in Maternity Services and requested the provision of non-clinical support. The Association has written on two occasions to the Minister for Health to highlight the issues and seek intervention. Wollongong Executive management refused to provide additional non-clinical support. Members have since endorsed a resolution advising they will commence campaigning across industrial, media, community and political settings, with the intention of influencing local and state decision makers. Members have advised they will not engage in routine domestic work and will be enforcing their breaks and claiming compensation when this is not possible. Seven new member leaders have been identified across each of the Maternity Services Units. Justice Health & Forensic Mental Health Network Forensic Hospital - Unsafe workplace On 26 July 2017 another assault occurred on a nurse involving the patient who has been at the centre of recent discussion with Justice Health following other assaults on nurses by this patient. The NSWNMA made contact with SafeWork NSW who subsequently inspected and have issued two provisional improvement notices directly to the Justice Health Chief Executive. The inspection by SafeWork NSW was reported by those who attended to be a combative process and relationships with the JH&FMHN remain strained, however dialogue continues. General Secretary s Report to Council 5 September 2017 Page 7 of 26

Key Direction 1 Strategy 1.1 Identify new member leaders who can build their workplace influence Strategy 1.3 Equip NSWNMA member leaders with the skills, knowledge and confidence to lead members to use their influence Health and Safety Representatives (HSRs) have escalated concerns about the behaviour of management regarding the WHS Committee, which is also now under scrutiny via the Justice Health Chief Executive. HSRs continue to be active in representation of the affected members and making the employer accountable. Collaboration between HSR groups and their influence is increasing as they are visibly engaging and united. Density continues to slowly grow and is now at 70%. Macquarie Correctional Centre, Wellington - Commissioning of new facility The NSWNMA branch at the Wellington Correctional Facility has advised that a new facility with 400 beds is scheduled to be opened in October 2017. The branch is concerned about staffing deficits and has consulted with the Association. Key Direction 1 Strategy 1.1 Strategy 1.2 Grow power and influence by increasing the number of NSWNMA members Identify new member leaders who can build their workplace influence The matter has been raised with the JH&FMHN Joint Consultative Committee (JCC) and the NSWNMA has requested a WHS pre-occupation inspection. JH&FMHN has agreed to a WHS inspection and consultation is now in a process. Murrumbidgee Local Health District Nolan House, Albury - Safe patient care and staff safety Nolan House is a 24-bed Acute Mental Health Unit situated on the Albury Health Campus, with three HDU beds and one seclusion room. The facility has 34 FTE multidisciplinary staff, of which 26 are NSWNMA members. Currently, the facility is under the dual jurisdiction of NSW Health and Health Victoria. Key Direction 1 Strategy 1.1 Strategy 1.2 Grow power and influence by increasing the number of Association members Identify new member leaders who can build their workplace influence General Secretary s Report to Council 5 September 2017 Page 8 of 26

Strategy 1.3 Strategy 1.4 Strategy 1.5 Equip Association member leaders with the skills, knowledge and confidence to lead members to use their influence Grow the number of Association members actively engaged across the health, disability and aged care systems Ensure a focus on retaining as many members as possible New member leaders identified that a change in practice in the HDU would compromise the safety of staff. Supervision of patients in the HDU, which operates under NSW Health policy, was directed by the Chief Psychiatrist of Victoria to change to Health Victoria s Draft policy. The members were being asked to sit inside the HDU which has major safety issues. The branch requested an immediate WHS inspection and until the outcome of the inspection the current arrangement would remain, that is: Placing swipe access to all doors of the HDU. Instigating a safe viewing area within the HDU lounge that can act as an air lock with double door / swipe card entry. Only minimal space allocation need be put in place with reference to the Health Facility Guidelines. Duress points should be placed within the air lock. Lock down procedures and protocols for Nolan House are suggested to be reviewed with designated points of activation put in place within the office environments. Such should be facilitated in consultation with staff. Reporting mechanisms are highly recommended to be reviewed between Albury Wodonga Health and NSW Health. Such reporting should include all incident data and seclusion and restraint data at minimum. The branch proposed the following conditions: Decommissioning of the HDU beds due to WHS concerns identified by both management and the NSWNMA. Reduce the bed number from 24 to 21. No seclusion patients to be admitted from Albury Hospital s ED. No admission of HDU patients to be admitted from Albury Hospital s ED; management to seek transfer of these patients to other facilities. Specials of paediatric patients to continue. The HDU in Nolan House will remain closed until the redevelopment is completed early in 2018. Two new member leaders have been identified. An engagement of 20 members at most meetings. The branch has met with the Minister of Mental Health and their local MP, Mr Greg Aplin. General Secretary s Report to Council 5 September 2017 Page 9 of 26

Northern NSW Local Health District Lismore Mental Health Unit - Restructure The first phase of a proposed change in the Nursing Model of Care (MoC) for the 16 bed Acute and eight Close Observation Mental Health Beds at Lismore saw the removal of NUM1 positions on the morning and afternoon shifts, seven days a week (112 hours per week), which commenced on 8 August 2017. The second phase of the MoC, which was to commence on 11 August, would have seen a further 21 clinical nursing hours removed from the total 24 beds, equating to 280 hours in total per week. Key Direction 1 Strategy 1.1 Strategy 1.2 Strategy 1.3 Grow power and influence by increasing the number of Association members Identify new member leaders who can build their workplace influence Equip Association member leaders with the skills, knowledge and confidence to lead members to use their influence The branch took action by voting to take collective industrial action of bed closures. The branch increased their membership from 57 to 73 in two weeks during the action. Three new member leaders have been identified. Members are more confident in using their collective power against their employer since taking this action. Key Direction 2 Strategy 2.1 Strategy 2.2 Strategy 2.3 Review and implement improved Association approaches and processes for collective bargaining and enforcement of rights Ensure that advocacy and bargaining aligns with our growing capacity to influence Actively use political and community lobbying campaigns to assist with advocacy and bargaining outcomes The members used collective power to close beds and apply pressure on the employer to influence their decision to hold back on nurse staffing cuts. Key members have been involved in the Industrial strategies around this issue. Two Close Observation beds and four Acute beds were closed at one point. Media was used to provide awareness to the Lismore community. The branch members collectively used their power to influence a decision maker to hold off on the entire staffing cuts and to properly consult. General Secretary s Report to Council 5 September 2017 Page 10 of 26

South Eastern Sydney Local Health District Prince of Wales Hospital - Changes to ECR service Excessive overtime was in use which came as a result of the implementation of a 24-hour, seven day a week Endovascular Clot Retrieval (ECR) Service that was implemented under pressure from Ministry of Health following unfavourable media attention. Members became fatigued and were working excessive overtime and on-call to cover the ECR service. The previous staffing model was an 8.00am to 8.00pm service. The Prince of Wales Hospital ECR service now provides a state wide service that is required 24/7. An ECR service has been provided at other sites previously. Key Direction 1 Strategy 1.1 Strategy 1.2 Strategy 1.3 Strategy 1.4 Strategy 1.5 Grow power and influence by increasing the number of Association members Identify new member leaders who can build their workplace influence Equip Association member leaders with the skills, knowledge and confidence to lead members to use their influence Grow the number of Association members actively engaged across the health, disability and aged care systems Ensure a focus on retaining as many members as possible The branch had endorsed numerous resolutions and acted to return the ECR service to the previously agreed 8.00am to 8.00pm, seven days a week on-call service for the Medical Imaging Department. This on-call service is outlined in the Clinical Business Rule for the Interventional Radiology Service. This ECR service continued until July 2017. In July 2017, NSW Health developed and presented a strategy that was acceptable to Association members. This collective action of the nurses within this Medical Imaging Department resulted in the extension of this service to other facilities throughout the wider Sydney and Hunter/New England areas. The branch has been able to use their collective power and knowledge to influence the decision makers to consider the best options for the patients of the Health Service and NSWNMA members through advocating for each other and their action has resulted in the ECR service now being conducted at multiple sites. The branch has remained flexible in their consideration of proposals from executive management but has become confident enough to use their collective action to influence decision makers. General Secretary s Report to Council 5 September 2017 Page 11 of 26

KEY DIRECTION 2 Be innovative in our advocacy and bargaining New challenges and environments require new thinking and continuous improvement of professional and industrial advocacy and bargaining. The Association will directly represent and organise members and their workplaces, as well as engage with the community and other key stakeholders, to achieve advancement in professional and industrial outcomes. STRATEGIES 2.1 Review and implement improved Association approaches and processes for collective bargaining and enforcement of rights 2.2 Ensure that advocacy and bargaining aligns with our growing capacity to influence 2.3 Ensure existing Ratios systems are implemented and enforced properly through member education and member leader vigilance 2.4 Actively use political and community lobbying campaigns to assist with advocacy and bargaining outcomes 2.5 Campaign to extend enforceable staffing arrangements for safe patient care into other sectors 2.6 Review Association approaches and processes for linking professional advocacy to organising and growth 2.7 Strategically use legal and industrial tribunals to deliver outcomes for individual members or groups Family and Community Services Dispute regarding aspects of the forced transition of FACS staff to the NGO sector The rollout of the NDIS continues amidst concerns of the complete withdrawal of the public sector as a provider of disability services and the current transfer arrangements for Family and Community Services ( FACS ) staff. The Association holds concerns regarding the Enabling Act being used to transfer current FACS employees and the guaranteed entitlements following them. In addition, the transfer payment amount being made available as a result of this compulsory transfer is manifestly inadequate. Key Direction 2 Strategy 2.7 Strategically use legal and industrial tribunals to deliver outcomes for individual members or groups Key Direction 1 Strategy 1.2 Identify new member leaders who can build their workplace influence Strategy 1.5 Ensure a focus on retaining as many members as possible General Secretary s Report to Council 5 September 2017 Page 12 of 26

Key Direction 3 Strategy 3.2 Identify the features of a world class, well-funded, integrated health system The Association (and a number of workplace delegates) have in good faith been trying to resolve concerns with the current framework/processes being utilised for the transition of employment and services from FACS to the NGO sector. This of course arises with the rollout of the NDIS and the decision of the NSW Government to vacate the disability field entirely. There has been no shortage of meetings and discussions over the years. These discussions included the meeting with the Minister for Disability Services, the Hon Raymond Williams MP, earlier this year. The following critical questions or issues remain outstanding or requiring greater clarity: (i) (ii) (iii) (iv) (v) (vi) enforceability of employment commitments made by the NSW Government; maintenance of staffing/clinical profile post transition; access to the transfer agreement containing the employment rights to be maintained by the NGOs; issues relating to the use of implementation companies; recognition of previous public sector service if returning to the government sector; and uncertainty for those FACS staff not being transferred. Mindful of the dissatisfaction expressed to us by members, and the inability so far to obtain the resolution/clarity sought, the Association felt it had no alternative but to notify the IRC of NSW of a dispute. Three conciliation conferences have now been held. These private conferences have been assisted by the presiding Commission member making observations and recommendations, primarily directed to the IR Secretary and FACS. Some progress has been made, but others now require the Association to contemplate its position and how it may (or may not) advance any outstanding issues further. South Eastern Sydney Local Health District St George Hospital - Partial privatisation of the Renal Dialysis Unit The SESLHD is proceeding with the partial privatisation of the St George Hospital Renal Dialysis Unit. The Association has been advised that the preferred provider is Fresenius Medical Care, although no contracts have yet been signed. Key Direction 2 Strategy 2.1 Strategy 2.2 Review and implement improved NSWNMA approaches and processes for collective bargaining and enforcement of rights Ensure that advocacy and bargaining aligns with our growing capacity to influence The Association has attended two consultative meetings regarding this matter; the second of which was attended Fresenius Medical Care representatives. The Association has also carefully reviewed the draft Satellite Renal Services Agreement and proposed a number of amendments designed to protect and improve the wages and conditions of transferring employees. Representations in this regard continue to be made. General Secretary s Report to Council 5 September 2017 Page 13 of 26

Undertakings have been given regarding a number of issues including the recognition of service and accrual of entitlements. Consultation and advocacy is ongoing. General Secretary s Report to Council 5 September 2017 Page 14 of 26

KEY DIRECTION 3 Promote a world class, wellfunded, integrated health system Increasingly, health is becoming a defining political issue in our country and budget decisions impact on the delivery of care. The Association will be an effective advocate for delivery of quality outcomes of care in an ever-changing health system and influence policy and decision-makers to invest in prevention and universality. STRATEGIES 3.1 Consult with Association members on their vision of an integrated health system 3.2 Identify the features of a world class, well-funded, integrated health system 3.3 Develop an education program for Association members and member leaders 3.4 Develop initiatives, affiliations and partnerships on issues that affect Association members 3.5 Advocate and influence decision makers on key issues that affect Association members and the delivery of care Keep our Hospitals Public Campaign Wyong and Bowral Hospitals remain public After months of intense campaigning in the community, common sense has prevailed as it was announced in July by the Minister for Health, the Hon Brad Hazzard, that both Bowral and Wyong Hospitals would remain in public hands. Key Direction 3 Strategy 3.4 Strategy 3.5 Develop initiatives, affiliations and partnerships on issues that affect Association members Advocate and influence decision makers on key issues that affect Association members and the delivery of care After ten months of intense campaigning which involved health unions, Unions NSW, health advocates and the local community included actions like: Local rallies that drew thousands of people. Community forums. Local events like handing out information at market stalls and train stations. Lobbying the government and local members of the State. Regular peak tactical stunts by all the health unions and the local member MP for Wyong David Harris, which kept the issue relevant in the local media. General Secretary s Report to Council 5 September 2017 Page 15 of 26

As a result of our campaigning efforts and the activism of members, pressure was placed on the government to retreat from this unpopular decision that was made by the previous Health Minister and Premier, Jillian Skinner and Mike Baird. However, the fight is far from over as the campaign continues at Shellharbour, Port Kembla and Maitland. Shellharbour/Port Kembla Hospital - Public Private Partnership The campaign to retain the Shellharbour and Port Kembla Hospitals as public hospitals continues, following the recent announcements by the NSW Government regarding Bowral and Wyong. Key Direction 3 Strategy 3.1 Strategy 3.2 Strategy 3.3 Strategy 3.4 Strategy 3.5 Key Direction 2 Strategy 2.4 Consult with NSWNMA members on their vision of an integrated health system Identify the features of a world class, well-funded, integrated health system Develop an education program for NSWNMA members and member leader Develop initiatives, affiliations and partnerships on issues that affect NSWNMA members Advocate and influence decision makers on key issues that affect NSWNMA members and the delivery of care Actively use political and community lobbying campaigns to assist with advocacy and bargaining outcomes NSWNMA members, in collaboration with the health unions HSU, ASMOF as well as Unions NSW, organised a Community forum in Shellharbour and NSWNMA member leaders organised and ran a community committee meeting in collaboration with their union colleagues. NSWNMA officers provided 1:1 contact agenda and table talk training to member leaders prior to the community committee meeting and identified a clear ask of forming a community organisation. The MP for Shellharbour, Anna Watson, also arranged a debate in the NSW parliament following the submission of petitions. The community forum held on 5 June 2017 was attended by over 300, most of whom were community members. This assisted in identifying community leaders and activists. The forum was by emceed by Kimberley Pratt from WIN news. Speakers were member leaders from the NSWNMA, ASMOF, HSU, Gareth Ward (MP for Kiama); Anna Watson; Michael Whaites (Public Services International sub regional secretary). Panel members included Gareth Ward; Anna Watson; Michael Whaites; Andrew Holland (Executive Director, ASMOF); Mark Kearin (Acting Assistant General Secretary, NSWNMA); Gerard Hayes (Secretary, HSU); Arthur Rorris (Secretary, South Coast Labour Council). General Secretary s Report to Council 5 September 2017 Page 16 of 26

Walt Secord (NSW Shadow Minister for Health) was asked by an NSWNMA member leader: If Labor won the next election would they overturn the PPP?. Mr Secord made no commitment. A community organisation group - Shellharbour & Port Kembla Community Group - was formed as a result of the community committee meeting. The petition debate in the NSW parliament was well attended by health staff and community members and the Shellharbour & Port Kembla Community Group. Leader of the NSW Opposition, Luke Foley, addressed the attendees and announced that if NSW Labor won at the next election they would act to restore public ownership and operation of Shellharbour Hospital. The NSWNMA has subsequently assisted an independent community group to establish itself. The group plans to focus on stopping the privatisation of their hospital. Keep NSW In A Healthy State campaign Anti-privatisation campaign The Association s anti privatisation campaign was rebranded in the lead up to NSW Labor State Conference held on 29 July 2017. The outcomes of our messaging research indicated that a more solutions focused message around growing our public health system would resonate more with the community than one solely focusing on maintaining the status quo. With this in mind a tender was put to several creative agencies and three were shortlisted for interviews by a panel comprising the Association, HSU, ASMOF and Unions NSW. Campaign Edge was the successful agency tender. Key Direction 3 Strategy 3.4 Advocate and influence decision makers on key issues that affect Association members and the delivery of care It was decided that the new logo and brand of the campaign would have a soft launch at the NSW Labor State Conference. Given that one of the strategies of the campaign was to ensure that NSW Labor would be committed to reversing the privatisation when in government, the presence of health unions with the new branding would help in our lobbying efforts. The policy motion put forward by Labor affiliated union, HSU, that NSW Labor when in government would reverse any health privatisations that occur was unanimously supported by the conference. There was also positive support for the key messages of our campaign to grow the public health system. However, we must continue to lobby all parties in the lead up to the 2019 State election to ensure that privatisation of public hospitals and services is not an acceptable model for Unions, the members they represent and the communities they serve. General Secretary s Report to Council 5 September 2017 Page 17 of 26

Ministry of Health - Northern Sydney Local Health District Northern Beaches redevelopment - dispute re consultation process The NSW Government has contracted Healthscope to build and operate (and be the employing entity of staff) at a new Northern Beaches Hospital located at Frenchs Forest. This new hospital would be in lieu of public health services currently provided at Manly and Mona Vale Hospitals, with Manly Hospital closing entirely, and residual services remaining at Mona Vale Hospital. Unions NSW and public health unions had been unsuccessfully seeking definitive answers on a number of longstanding (global) issues related to this redevelopment. Key Direction 3 Strategy 3.4 Develop initiatives, affiliations and partnerships on issues that affect NSWNMA members Key Direction 1 Strategy 1.5 Ensure a focus on retaining as many members as possible Key Direction 2 Strategy 2.7 Strategically use legal and industrial tribunals to deliver outcomes for individual members or groups The Association, other public sector unions and Unions NSW, along with a delegation of workplace representatives across both hospitals, met with the Minister for Health on 2 June 2017 to discuss the concerns of members with the current framework and processes being utilised for the transfer of services and employment to the Northern Beaches Hospital. The conduct of the meeting was free flowing and permitted workplace representatives to provide the Minister with information and observations based on their experience, along with questions that needed to be answered. These included: (i) enforceability of commitments related to transferring employment; (ii) application of Government Sector Employment Regulation; (iii) recognition of previous NSW Health Service and that with Healthscope subsequently; (iv) job matching (or lack thereof to date); (v) remaining services/jobs at Manly and Mona Vale Hospitals; (vi) adequate time to consider any offer; and (vii) inadequacy of the proposed transfer payment. The Minister requested that the unions articulate the concerns discussed at the meeting in formal correspondence, with a commitment to investigate/consider further. A response has now been received from the Minister, which largely mimics (unfortunately) the previous position of the Ministry of Health on the issues raised. Unions and NSLHD have undertaken further work to revise the current terms of reference for the Northern Beaches Hospital Site (NBH) Specific Consultation Committee (SSCC) meetings (as recommended by the IRC of NSW), with the view of improving its effectiveness. Unfortunately, despite most suggestions of the unions being accepted, the Ministry continues to resist all requests/demands to participate in this consultation framework/process as a standing member. Joint unions meetings are scheduled at Manly and Mona Vale Hospitals on 31 August to report back to members and identify next campaigning steps. General Secretary s Report to Council 5 September 2017 Page 18 of 26

NSW Parliament Government Sector Employment Amendment (Transfers to Non-Government Sector) Regulation 2016 Disallowance motion to be debated in the NSW Parliament. Key Direction 3 Strategy 3.4 Develop initiatives, affiliations and partnerships on issues that affect NSWNMA members Councillors will recall from previous updates that the Baird NSW Government (without any prior warning or consideration to consult) had the Government Sector Employment Amendment (Transfers to Non-Government Sector) Regulation 2016 ( Regulation ) gazetted. The Regulation further eroded the rights of government sector workers whose role may be subject to privatisation. Unions NSW and affiliates have agitated with cross bench members of the NSW Legislative Council to support a disallowance motion on the Regulation (i.e. have it set aside) tabled by the NSW Opposition. After numerous adjournments, this debate has again recently been postponed till 13 September 2017. It remains unknown if this Regulation will be applied to members at Manly and Mona Vale Hospitals who decline to transfer to the new Northern Beaches Hospital (i.e. if no job subsequently found within the LHD - NO redundancy). In its current form, and if left standing, the Regulation would apply. Some indication of the NSW Government s determination to ensure that staff choice is illusionary in such processes and privatisations can be gleaned from information released to members working at Maitland Hospital, which make clear that: if you do not apply for or accept employment with the Hospital Operator and you cannot be redeployed within NSW Health, policies and laws that apply across all of the NSW Government mean that you will not be entitled to a redundancy or severance payment from NSW Health. [Emphasis added] NSWNMA Education Program Key Direction 3 Strategy 3.3 2017 Program Develop an education program for Association members and member leaders A half-day seminar on preparing for interview was held on 28 July to prepare nurses, midwives and undergraduates for interviews by providing them with the knowledge and skills to prepare for, apply for, and conduct themselves in interviews for nursing and midwifery positions, as well as new graduate programs. General Secretary s Report to Council 5 September 2017 Page 19 of 26

The Seminar proved very beneficial and relevant in assisting and providing resources to nurses, midwives and undergraduates in preparation for interview. The seminar received positive comments, with requests for a further seminar. Mental Health Observations Education Session Two education sessions for inpatient nursing staff were provided at the Nepean Hospital Mental Health Service. The first session was held at 2.30pm for morning and afternoon staff, with a second session held at 11.00pm for night staff. Both sessions were well received with very positive feedback with 11 staff attending the first session and seven staff attending night session. The sessions were on mental health observations, including professional obligations, accountability and delegation. Of interest to staff was management s responsibilities to nursing staff and how to help ensure they met their obligations. More sessions of this nature would be a positive support for nursing staff working in mental health inpatient units. Environmental Health Seminar The Association is partnering with the Prince of Wales Private Hospital (POWP) to run the yearly Environmental Health Seminar on 15 September 2017 at the POWP Hospital. The forum this year is titled: Nurses and Midwives: Seizing Sustainable Health Care Opportunities. Registrations to attend the seminar have nearly reached capacity. The program has been finalised and all guest speakers confirmed. Reconciliation Plan (RAP) Key Direction 3 Strategy 3.4 Develop initiatives, affiliations and partnerships on issues that affect Association members The Association marked NAIDOC week with a special Indigenous supplement in The Lamp covering a range of issues related to Aboriginal and Torres Strait Islander health outcomes and employment. The Association continues to work on development of our RAP. General Secretary s Report to Council 5 September 2017 Page 20 of 26

The Association observed the UN International Day of Indigenous People s day through our social media channels. Unfortunately, there have been staffing changes at Reconciliation Australia and the role of NSW RAP Coordinator is currently vacant. This may result in a delay in feedback for the first version of our RAP. Scholarships Bob Fenwick Mentoring Grants Program Key Direction 3 Strategy 3.4 Develop initiatives, affiliations and partnerships on issues that affect Association members All mentees have now completed their placements with very positive comments. An outline of our recommended requirements to be included in the next performance agreement for future rounds has been sent to the Mental Health Branch at the NSW Ministry of Health for their consideration. Planning for the Ceremony is well under way, with a response awaited from the Minister for Mental Health as to her availability to attend. Submissions and Inquiries Aged Care Quality Assessment and Accreditation Framework Key Direction 3 Strategy 3.5 Advocate and influence decision makers on key issues that affect Association members and the delivery of care Effectiveness of the Aged Care Quality Assessment and Accreditation Framework for protecting residents from abuse and poor practices, and ensuring proper clinical and medical care standards are maintained and practised. On 13 June 2017, the Senate referred this matter to the Senate Community Affairs References Committee for inquiry and report. The reporting date is 18 February 2018. This inquiry was referred to the committee in response to the reported incidents in the Makk and McLeay Aged Mental Health Care Service at Oakden in South Australia, and will examine the current aged care quality assessment and accreditation framework in the context of these incidents. The submission focused on failure of the Government to act on the recommendations of previous inquiries, safe staffing and greater accountability in aged care regulation. General Secretary s Report to Council 5 September 2017 Page 21 of 26

Review of Seclusion, Restraint and Observation of Patients with Mental Illness The Association provided a submission for the Review of Seclusion, Restraint and Observation of Patients with Mental Illness in NSW Health Facilities. Submission to this inquiry are not made public. A panel of five mental health experts and the NSW Chief Psychiatrist will review the practice of seclusion, restraint and observations across the NSW mental health system. The submission was also provided to the NSW Legislative Assembly, Inquiry into the Management of Health Care Delivery in NSW (July 2017) as part of their review of health care delivery. The submission can be viewed at the Legislative Assembly website (submission No. 26). The Association is supportive of the review into the practice of seclusion, restraint and observation of clients with mental illness in NSW mental health facilities. Our submission outlined that we believe seclusion episodes can be reduced if the right resources are put into place, but hold the opinion that seclusion must remain as a last resort for the safe management of a small number of clients. Work Health and Safety Key Direction 3 Strategy 3.5 Meetings with SafeWork NSW Advocate and influence decision makers on key issues that affect Association members and the delivery of care SafeWork NSW meetings which have been held at Unions NSW have provided an opportunity to meet with Peter Dunphy, Executive Director of SafeWork NSW to inform him of the level of violence being experienced by members. In particular, information has also been provided about experiences at the Forensic Hospital and Bloomfield Hospital that included discussion of the content of improvement notices issued that may focus on policy issues. It appears that some of the increased action by SafeWork NSW and the NSW Ministry of Health may be as a result of actions undertaken. NSW Ministry of Health Policy review The NSW Ministry of Health is undertaking policy review that appears to be linked to workplace violence, SafeWork NSW presentations and Union Right of Entry. Consultation and comment has been provided on two key documents, being the Protecting People and Property Manual and the Work Health Safety Better Practice Guide. Elements of the revision of the Australian Standard and references to the Work Health and Safety Act 2011 and Regulations are being incorporated to these policies. General Secretary s Report to Council 5 September 2017 Page 22 of 26

National Safe Work Month National Safe Work Month, held annually in October, aims to improve awareness of work health and safety, encourage discussion about safety at work and share positive workplace stories from across Australia. The first week of Safe Work Month will have a focus on musculoskeletal workplace injuries. In 2017, SafeWork NSW is encouraging Health and Safety Representatives (HSR), HSR training providers, employers and workers in a small to medium business and other interested parties to attend SafeWork NSW s free Consultation at Work Conference being held on 25 October 2017 at the Sydney Cricket Ground. Author and TV personality, Adam Spencer, will lead delegates through day focusing on workplace consultation and understanding of your obligations. All workplaces are encouraged to participate and promote a safe workplace. Safe Work Australia will be supporting National Safe Work Month by developing resources for businesses, hosting the workplace participation reward program and sharing stories and statistics about work health and safety. Information on how each workplace can be involved can be found on the websites of Safe Work Australia (https://www.safeworkaustralia.gov.au/) and/or SafeWork NSW (http://www.safework.nsw.gov.au/). SafeWork NSW Musculoskeletal Strategy The Association was invited to attend the inaugural meeting of the SafeWork NSW Musculoskeletal Strategy. Health care was seen as one of the focus areas for management of musculoskeletal injuries. Reference was made to AUSBIG and bariatric management in general. It was however noted that risk assessment tools, training, and guidance that was to be provided by SafeWork NSW would be generic in order to ensure it may be applied across all sectors of industry. Work Health and Safety Policy Review and Advocacy WHS Professional Officers have contributed to broader strategic WHS policy review and advocacy. SafeWork NSW Workplace Health Consultative Forum and Musculoskeletal Forum; SafeWork NSW feedback on consultation information on website; SafeWork Australia draft Model Code of Practice: WHS Consultation, Cooperation and Coordination; SafeWork Australia Terms of Reference for WHS Act review; SafeWork Australia feedback on Code of Practice Safety Data Sheets, Code of Practice Managing Risks of Hazardous Chemicals and Code of Practice Managing the Work Environment and Facilities; International Labour Organisation, Violence in the World of Work. General Secretary s Report to Council 5 September 2017 Page 23 of 26