budget analysis
What’s missing from the Budget? Budget 2020, while big on health spend, is short on some crucial details. By researcher/nursing policy adviser Sue Gasquoine
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he Minister of Finance Grant Robertson named the 2020 Budget Rebuilding together.1 Rebuilding from where? And how “together” can it be when its starting point is inequity? NZNO members work in and contribute skill and knowledge to the care economy. The care economy is part of our social infrastructure, defined by the Council of Trade Unions as” “the bedrock on which physical infrastructure and financial activity rests. Its focus is keeping us healthy, nurtured, and able to reach our potential as human beings”.2 This infrastructure is in need of rebuilding post-pandemic, along with the rest of the economy. The 2020 Budget promised unprecedented support for physical infrastructure, but was less forthcoming on how our social infrastructure would benefit. There are frequent references in the media to jobs in “shovel ready” infrastructure projects for good reason – they are tangible. Jobs in our social infrastructure are perhaps less tangible, because the product of work in the care economy is not as visible or as easily quantified. It is, however, no less important. There is no purpose for a physical infrastructure without a social infrastructure.
More detail needed
Significant investment into the health and disability sector, including $3.9 billion for district health boards, was announced before Budget day. But more detail about how that money will be targeted is necessary, lest important opportunities to address equity issues are missed. These opportunities include redevelopment of the infrastructure – physical and social – supporting primary and mental health, disability and aged care. Trades training and apprenticeships 24
have been singled out for special attention in this Budget – $1.6 billion worth. NZNO reminds the Government of the urgent need for a skilled, diverse health workforce, particularly in aged care, disability and mental health. Low staffing and shortages of the specialist skills needed in these sectors have been starkly revealed by the COVID-19 crisis. The opportunity for training and support to meet this growing need should not be missed. Part of realising this opportunity can be retaining those who signed up for the Ministry of Health’s “surge” workforce and recruiting into the health workforce those from the service industries badly affected by the COVID-19 downturn.
Release of review report
There is division among groups representing health professionals about the release of the Simpson Report, ie the comprehensive review of the health and disability sector. Some seek its immediate release so its findings can be considered alongside the recovery and rebuilding programmes the Budget seeks to resource. Others conclude this is not the time to further complicate an already complex set of circumstances with findings that are expected to recommend major changes to a health and social sector significantly affected by the pandemic response. However, implementing the report’s findings is likely to be another opportunity to address inequities entrenched in our social infrastructure. The metaphor of women as an economy’s “shock absorbers” was debated at a recent webinar hosted by the Public Policy Institute at The University of Auckland. This pointed out the impact of women being more likely to be under-employed for a variety of reasons, including the need to be flexible for References
non-paid caring responsibilities. It also revealed that women are more likely to: have periods of unemployment; work in the social infrastructure; be workers in the care economy; and earn less over their working lives, so pay less tax and retire poorer. It also showed their ability to contribute to a consumer economy was constrained, they lived longer with long-term conditions and their unpaid caring responsibilities continued well into their later years. All these factors need to be considered in any rebuild of the social infrastructure. NZNO’s 2020 general election manifesto, with feedback from members, is being finalised. It will propose a number of initiatives that are heavily budget dependent, These include: ulFunding the immediate expansion of primary health care services; ulFunding low-cost, age-friendly housing at the levels required to achieve housing affordability for families. ulResourcing the health sector sufficiently to achieve: • equitable access for Mâori to all services • an internationally bench-marked youth suicide reduction target • safe staffing and skill mix in aged care • capital expenditure to upgrade and maintain equipment stocks and buildings • settlement of all health pay equity claims including for nurses working for Mâori and iwi providers. While there is more to be done, particularly in aged care, NZNO welcomes aspects of the Budget. Acting industrial services manager Glenda Alexander said NZNO welcomed funding that targeted the social determinants of health, including massive increases to state housing and insulation; lunches for 200,000 schoolchildren; and trades training, “because good housing, nutrition and employment are central to good health”. •
1) New Zealand Government. (2020). Wellbeing Budget 2020 Rebuilding Together. Retrieved from: https://treasury,govt.nz/publications/ budget-speeches/budget-speech 2020 2) New Zealand Council of Trade Unions. (2020). Budget 2020 Rebuilding Together? Will we have an equitable post-Covid-19 future? Retrieved from www.union.org.nz/wp-content/uploads/2020/05/CTU-Report-on-Budget-2020-.pdf
Kai Tiaki Nursing New Zealand * vol 26 no 5 * June 2020