Creating the perfect storm
Mental health starved of funds
United push for national action on climate and health
Your rights and entitlements at work Nurse Uncut – your stories What nurses and midwives said Nursing research online
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THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION VOLUME 74 NO. 7 | AUGUST 2017
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CONTENTS Contacts NSW Nurses and Midwives’ Association For all membership enquiries and assistance, including Lamp subscriptions and change of address, contact our Sydney office. Sydney Office 50 O’Dea Avenue, Waterloo NSW 2017 (all correspondence) T 8595 1234 (metro) 1300 367 962 (non-metro) F 9662 1414 E email@example.com W www.nswnma.asn.au Hunter Office 8-14 Telford Street, Newcastle East NSW 2300 NSWNMA Communications Manager Janaki Chellam-Rajendra T 1300 367 962 For all editorial enquiries letters and diary dates T 8595 1234 E firstname.lastname@example.org 50 O’Dea Avenue, Waterloo NSW 2017
VOLUME 74 NO. 7 | AUGUST 2017
People power stops privatisation T hree saved, two to go in our campaign to
prevent five regional public hospitals from being gifted to the private sector.
Produced by Hester Communications T 9568 3148 Press Releases Send your press releases to: F 9662 1414 E email@example.com Editorial Committee Brett Holmes, NSWNMA General Secretary Judith Kiejda, NSWNMA Assistant General Secretary Coral Levett, NSWNMA President Peg Hibbert, Hornsby Ku-ring-gai Hospital Michelle Cashman, Long Jetty Continuing Care Richard Noort, Justice Health
Information & Records Management Centre To find archived articles from The Lamp, or to borrow from the NSWNMA nursing and health collection, contact: Jeannette Bromfield, Coordinator. T 8595 2175 E firstname.lastname@example.org The Lamp ISSN: 0047-3936 General Disclaimer The Lamp is the official magazine of the NSWNMA. Views expressed in articles are contributors’ own and not necessarily those of the NSWNMA. Statements of fact are believed to be true, but no legal responsibility is accepted for them. All material appearing in The Lamp is covered by copyright and may not be reproduced without prior written permission. The NSWNMA takes no responsibility for the advertising appearing herein and it does not necessarily endorse any products advertised. Privacy Statement The NSWNMA collects personal information from members in order to perform our role of representing their industrial and professional interests. We place great emphasis on maintaining and enhancing the privacy and security of your personal information. Personal information is protected under law and can only be released to someone else where the law requires or where you give permission. If you have concerns about your personal information, please contact the NSWNMA office. If you are still not satisfied that your privacy is being maintained, you can contact the Privacy Commission. Subscriptions for 2017 Free to all Association members. Professional members can subscribe to the magazine at a reduced rate of $30. Individuals $82, Institutions $138, Overseas $148.
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COVER STORY Creating the perfect storm
Strong leadership from nurses, midwives and other health unions and overwhelming support from the community, effective backing from local ALP MPs and a lot of effort from committed activists saved Wyong’s public hospital from the profit-grabbing clutches of private corporations.
MENTAL HEALTH Mental health starved of funds
The NSW mental health system can reduce the use of seclusion and restraint only if it gets adequate support and resources.
CLIMATE CHANGE United push for national action
on climate and health Federal, state and territory governments have been urged to establish a Ministerial Health and Climate Change Forum to oversee coordinated national action to tackle the urgent health threats arising from climate change.
5 6 6 27 33 35 37 39 41 43 45 46
Editorial Competition Your letters News in brief Ask Judith Nurse Uncut Facebook Nursing Research Online Crossword Book reviews Movie reviews Diary dates
Creating the perfect storm
Mental health starved of funds
United push for national action on climate and health
Your rights and entitlements at work Nurse Uncut – your stories What nurses and midwives said Nursing research online
p.33 p.35 p.37 p.39
THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION VOLUME 74 NO. 7 | AUGUST 2017
ABORIGINAL HEALTH Third world diseases persist
in remote communities Australia’s Indigenous communities are suffering from shockingly high levels of blindness, hearing loss and early death from heart disease. In many cases, these diseases that have been virtually eliminated in most other developed countries are to blame.
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OUR COVER: Sue Moule, Glenn Hayes and Pam Illingworth Photographed by Sharon Hickey THE LAMP AUGUST 2017 | 3
4 | THE LAMP AUGUST 2017
Holmes GENERAL SECRETARY
A win for the ages Years of effort and campaigning by many people who care deeply about our public health system has paid dividends with the state government backing off on its plans to privatise Wyong, Bowral and Goulburn hospitals. The peerless Nelson Mandela once said: “It always seems impossible till it’s done”. This is certainly a sentiment we should hold onto when, as we often do, we go toe to toe with powerful vested interests in business, media and government who wish to sweep away public goods and services that have taken generations to build. For a good forty years now our world-class public service has been white-anted and eroded by privatisations and outsourcing. Last year we needed four pages of The Lamp to list the sell offs here in NSW that had happened or were in play. This mania to inject the profit motive into all public services seemed to reach its apogee with the Baird government decision to gift five regional hospitals to the private sector. It was an action we saw coming and we warned the community in a very high profile campaign before the last state election what the government had in mind. Of course we took a lot of heat and vitriol for our position. That has never blunted our determination to do the right thing for our patients. Over these many decades when governments have privatised whatever they could they have never been stopped. We have now drawn a line in the sand. We need to be clear. This is a very significant win. It could never have been achieved without the fullblooded commitment of nurses and
‘As great as the victory at Wyong and Bowral is, we now need to maintain our focus to reverse the privatisations at Shellharbour/Port Kembla and Maitland.’ midwives, the support of their local communities and the solidarity among health unions that created the intense pressure which forced the government to back down.
It will have the same contractual arrangement as in other publicprivate partnership proposals, such as the new Northern Beaches Hospital.
We remain resolute in our belief that a strong, properly resourced public health system is the foundation stone for the well being of Australians.
At Maitland, not-for-profit organisations have been offered the same contract as for-profit corporations, and the model will still be surplus driven.
MAITLAND AND SHELLHARBOUR/ PORT KEMBLA NEED OUR HELP
The same dangers and threats will exist for nurses and midwives at Maitland as at the Northern Beaches hospital. Staff will only be guaranteed employment with existing conditions for two years. This means, after this time, staff will be forced over to a new enterprise agreement that will be unlikely to include ratios.
As great as the victory at Wyong and Bowral is, we now need to maintain our focus to reverse the privatisations at Shellharbour/ Port Kembla and Maitland. There is still much work to be done and the nurses and midwives at these hospitals and the communities they serve need and deserve our support. The Berejiklian government has announced it will seek a not-forprofit organisation to build and run the new Maitland Hospital. Do not be fooled. This is more of the same. Contrary to what the government claims, this is not the same relationship NSW Health has with Newcastle’s Calvary Mater or Sydney’s St Vincent’s Hospital.
This union will never back down from defending the public health system. The Government’s intention to seek a “not for profit” tender for Maitland Hospital proves to us that every battle has its low points but we should never be deterred. If we stand up for what’s right, community and union power will prevail and the Wyong, Bowral and Goulburn communities have retained their public hospitals as a result of it. ■
THE LAMP AUGUST 2017 | 5
WIN A LUXURY ESCAPE TO
Annual leave lunacy Can the Association have a crack at changing regulations around annual leave? The mere fact that it is annual leave (which is over a year) and our entitlement must be used within 6 months past our anniversary date. So for any of us who have anniversaries before June, we don’t get to have Christmas off unless we opt to use pro rata leave. Total lunacy. My workplace is currently enforcing the 6 months entitlement usage, there is no negotiation – this to me is unfair. I am continually harassed about using annual leave and how it will build back up again. Despite this and after ringing the union, I do not and none of us under this award have any rights to our leave. Despite calling and fighting for my rights I know that come my anniversary next year in February I will have next to no entitled annual leave. Kirsty McCreadie RN, Dubbo EDITORIAL RESPONSE:
Picture a luxuriously appointed estate set amongst rolling vineyards and native bush land just two hours’ drive from Sydney. A place where great food and wine provide the perfect recipe for relaxation, Spa Anise adds to the feeling of rejuvenation and revitalization and where appreciating life comes as naturally as appreciating the latest vintage.
WIN! The Lamp is offering NSWNMA members the chance to win two nights luxury accommodation (Sunday to Thursday) in a King Spa Room with breakfast daily. Package valued at $918 To enter the competition, simply provide your name, address and membership number and email your entry with the subject: Spicers Vineyards Estate to firstname.lastname@example.org *Conditions apply. Rooms subject to availability. Prize must be redeemed by 1 August 2018 and is valid for stays Sunday to Thursday nights (not valid during long weekends, NSW School Holidays or Public Holidays). The voucher is non exchangeable, non transferable and not redeemable for cash. Voucher must be presented on arrival. Competition entries from NSWNMA members only and limited to one entry per member. Competition opens 1 August 2017 and closes 31 August 2017. The is drawn on 1AUGUST September 2017. If a redraw is required for an unclaimed prize it must be 6 prize | THE LAMP 2017 held up to 3 months from the original draw date. NSW Permit no: LTPM/17/01625
Most awards require annual leave to be taken within six months of it becoming due. This reflects the standard in the Annual Holidays Act. However, some flexibility exits. In public health, taking leave can be postponed for a further six months by mutual agreement. Or it can be taken before it is due by agreement. The impediment to having a flexible approach is a directive from the NSW Government to all government agencies to keep accrued annual leave entitlements below six weeks. Unfortunately many LHDs have adopted a draconian approach to this directive but it does not need to be this way – a sensible and reasonable approach to the scheduling of leave is still possible and preferable.
Proud of our union It is great to be a member of a union that you can be proud of. Thanks to Brett and the whole team for your representation of nurses and for the access to professional journals and resources. I look forward to every edition of The Lamp, which is full of news and views, locally and for nurses internationally. Ross Fear RN, Baulkham Hills
Advertise in The Lamp and reach more than 66,000 nurses and midwives. To advertise please contact Danielle Nicholson 02 8595 2139 / 0429 269 750 email@example.com
YOUR LETTERS SEND YOUR LETTERS TO: Editorial Enquiries EMAIL firstname.lastname@example.org fax 9662 1414 MAIL 50 O’Dea Avenue, Waterloo NSW 2017. Please include a high-resolution photo along with your name, address, phone and membership number. Letters may be edited for clarity and space. Anonymous letters will not be published.
If there’s something on your mind, send us a letter and have your say. The letter of the month will WIN a gift card. The case for the humble water jug
Letter of the month
I work in a large tertiary metropolitan hospital. Approximately four years ago, overnight, we went from a jug and cup for each of our patients to 600ml bottles of water. To make a 600ml bottle for water requires 1.8-4.2 litres of water and 600ml of oil. These are precious finite resources that are being turned into a product that is usually single use.
Wyong says thanks for the solidarity
To put this in context: Our hospital is approximately 600 beds. Eighty-five per cent capacity is approximately 510 beds. Two 600ml bottles are delivered to each patient per day. Therefore, at a minimum on any given day in only one hospital, 1020 bottles of water are given out, or 372, 000 bottles annually. Multiply this by the number of hospitals in one city, then the cities and towns in one state, by the states in one country, it is easily seen what an enormous waste problem this presents. There is a cost to all this plastic production at both a macro and micro level. Waste disposal is an expensive business. This money could be used for patient care, new equipment or even extra staff. The cost to the environment and our health of this plastic production is enormous. At the recent World Economic Forum, it was estimated that by 2050 there will be more plastic in the world’s oceans than fish! This is insanity. I believe, not only as health professionals but humans living on this amazing non-renewable planet, we have a duty to encourage and educate our employers and the wider community to tread lightly and respectfully. There has to be a better way to hydrate our patients. PLEASE can we bring back the water jug. Melinda Davis RN, Hornsby
Unacceptable ratios in aged care Aged Care now is for profit, pure and simple. Providers are doing everything to provide as few staff as possible. The NSW government won’t even stand up and demand RNs remain mandatory for night duty. Those facilities that do employ RNs on nights have a ratio of 1:100, on days it’s 1:35 or 40. Tell me that’s acceptable! AiNs are spending more time on computers than patient care (not their choice). Workload is increasing at an alarming rate, with no increase in staff numbers. Residents are sicker, more immobile and with more multiple co-morbidities than in the past. Relatives expect full treatment with transfer to hospital. Paramedics are refusing to transport to hospitals. Hospitals send sick residents right back because God forbid any old person should take up a bed. Relatives are dictating care to the point of refusing medications prescribed by LMOs or conversely insisting on medications that are unnecessary. It’s a no-win situation for staff and more importantly the residents.
What a wonderful outcome we have achieved through all the hard work everyone has put in to prevent the PPP from happening at Wyong Hospital. From very early on it was a concerted effort from the branch and its members, rallying the community to get them onside and it proved that people can make a difference. If it wasn’t for our illustrious leaders and organisers in the NSWNMA, all our branch members as well as members all over NSW, we wouldn’t have achieved our goal, so a big thank you. I’d also like to thank our local state members who fought with us and took the fight to parliament to give us a voice; what an invaluable asset they were. From the onset it seemed like a difficult fight; we could see the light and that’s what kept us going, but how could we make the government see sense? To make a hospital like Wyong private was just insane, what was going to happen to our community? To get an understanding of why they thought this was a viable option and exactly how it was going to work was never explained fully. Questions were asked but no reasonable answers were forthcoming. It didn’t inspire us to go along with it at all. So, the fight was on! And we won! A big thanks once again to everyone that played a part in this! Pam Illingworth CNE, Gwandalan
Letter of the month The letter judged the best each month will win a $50 Coles Group & Myer gift card! Union Shopper offers members BIG savings on a wide range of products!
Kathy Loy RN, Edensor Park
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23/02/15 THE LAMP AUGUST 201711:53 | 7AM
People power stops privatisation Three saved, two to go in our campaign to prevent five regional public hospitals from being gifted to the private sector.
he NSW government has backed off from privatising Wyong and Bowral hospitals after immense pressure from nurses, midwives, along with two other health unions and local communities. Three out of the original five hospitals targeted by former Health Minister Jillian Skinner will now be retained in public hands. The gover n ment had prev iou sly announced Goulburn Hospital would remain public. Shellharbour and Maitland hospitals are the two other hospitals that remain under threat. The decision of the Berejiklian government to walk away from plans to privatise Wyong and Bowral hospitals came after ten months of hard campaigning by nurses and midwives alongside community members, public health advocates and local health workers. NSWNMA General Secretary Brett Holmes says the government finally came to the only sensible decision. “Without a doubt, this is a welcome result and shows that commonsense can prevail when governments are prepared to listen to all stakeholders,” he said. “The previous health minister made a serious error of judgement when she announced last September that Wyong, Bowral, Goulburn, Shellharbour and Maitland would be redeveloped under private– public partnerships without consulting staff, community members or health unions. 8 | THE LAMP AUGUST 2017
‘If you stick together you can do great things. If we had sat back and done nothing we would have lost.’ — Pam Illingworth, delegate, Wyong Hospital. “There is overwhelming evidence showing public–private partnerships are an expensive, ill-fitting model when it comes to the health sector. “Handing over public hospitals to be built and run by private operators results in a loss of accountability, a lack of safe patient care and more taxpayers’ dollars being gifted to private shareholders. The residents of Wyong understood this and didn’t want to see it happen to their local hospital.”
A HOSPITAL THAT BELONGS TO THE COMMUNITY The fight to save Wyong Hospital began immediately after the announcement of its privatisation in October last year when over 2000 health staff and community members flocked to Morrie Breen Oval in Kanwal to voice their anger over the loss of their hospital to private interests. People at the rally were particularly incensed at the lack of respect paid by the government, with no consultation either with staff or the community before the announcement. This was made worse by the knowledge that the hospital had benefited greatly over the years from the generosity of local residents and businesses through donations to pay
for much-needed equipment. Over the last ten months, nurses, midwives and community supporters have been tireless in taking their message to the wider community through stalls, forums and rallies as well as leafleting at markets and railway stations and letterboxing. They have also lobbied local MPs and built local networks through social media. They collected more than 34,000 signatures on a petition that was presented to parliament. Strong support from their colleagues at Gosford hospital and throughout the Central Coast also helped. Pam Illingworth, a delegate at Wyong Hospital, says the government underestimated t he Wyong community. “People were never given a voice. I perceived people thought they were treated with contempt. It didn’t matter what the community wanted. We weren’t being listened to. We were just told this was going to happen. “I think it was people power that changed their minds. If you stick together you can do great things. If we had sat back and done nothing we would have lost.” ■
People power at Wyong
And now for Shellharbour and Maitland… Our campaign to defend our regional public hospitals from privatisation now focuses on Shellharbour and Maitland hospitals. Branch official Glen Hayes says nurses and midwives at Shellharbour Hospital take a lot of heart from the decision to abandon the privatisation of Wyong and Bowral hospitals. “I’m really pleased that they’ve done that. I don’t know what impact it will have on Shellharbour. It looks as if the government is still looking at going ahead with the privatisation here. Gareth Ward (the local Liberal MP) said as much last week. People are optimistic but nothing has changed from our perspective until we hear an announcement to the contrary. “People are really determined to carry on the fight. We are totally committed to it. We want services publicly provided. “You can’t run a health service on profit. They aren’t as effective in terms of care delivery. They don’t have the same standards. They’re not transparent.” Glen says support for the retention of Shellharbour Hospital in public hands is strong and growing. “We’ve only just had a community forum and we are reaching out to community organisations. “On 10 August, they’ll be debating the Shellharbour privatisation in parliament. We will be presenting the 14,000 signatures that we’ve collected. We are also getting local groups like the pensioners and the superannuants to come up with us to show a community response as well as a union one. “Until we find out what’s going to happen we’re going to continue the way we’ve been.”
‘People are really determined to carry on the fight. We are totally committed to it.’ — Glen Hayes
THE LAMP AUGUST 2017 | 9
Creating the perfect storm Strong leadership from nurses, midwives and other health unions and overwhelming support from the community, effective backing from local ALP MPs and a lot of effort from committed activists saved Wyong’s public hospital from the profit-grabbing clutches of private corporations.
uphoria and relief runs through Wyong Hospital after the NSW government announced the hospital would remain a publicly owned and operated facility says delegate Pam Illingworth. “We are elated about it, so over the moon,” she says.
seen something of that size before in Wyong. Three quarters of them were from the community. It gave us a sense we could do it, that everyone was behind it.”
“Everybody is glad that the government has made some common sense moves. And that’s all it is – common sense. Privatisation was never going to work. Everybody has this sigh of relief. We’re now confident we can go back and deliver health care without that underlying worry about what is going to happen in the future.”
“The ALP politicians were 110 per cent with us and they took it to parliament for us. I went to parliament to hear our local MP David Harris bring it up. There was no support from the Minister of Health (Jillian Skinner) and that was really disappointing. There were two members from the Liberal party who weren’t even from our area speak in favour of the privatisation. Even their facts were wrong.
While nurses and midwives took up the baton and led the fight to keep Wyong Hospital public, Pam says it could never have been won without the overwhelming support of the local community and the other health unions. “It was encouraging the community got behind us 100 per cent. Nurses and midwives stood up for the hospital but without community support it doesn’t have the same buyin. The community needs to send the letters and support the rallies and candlelight vigils. “From the rally we had in October I thought we had the community onside. It was awesome. Beforehand we thought we would get 300 or 400 people. That would have been fantastic. We were floored when we got over 2000 people. We’ve never 10 | THE LAMP AUGUST 2017
Pam says the support of local ALP politicians was also critical as was the economic evidence that supported keeping the hospital public.
“We had an independent economist at a forum we held. He said the numbers just didn’t add up. It was amazing to hear him saying stuff that we had been thinking but he put it into graphs and f ig ures that nurses just don’t k now how to do.” ■
‘We had the community onside. It gave us a sense we could do it, that everyone was behind it.’ Pam Illingworth, delegate, — Wyong Hospital
Keep wyong Hospital public! Sto
p the Am er of Pub icAnisAtion lic heA unionsn l t h! sw.org.a u/keepo #
The journey to victory Over ten months Wyong nurses and midwives engaged with their community, built alliances with other health unions and created the pressure that led to the Berejiklian government backing down on the privatisation of their hospital. 15 SEPTEMBER 2016 Minister for Health Jillian Skinner announces the privatisation of five regional hospitals including Wyong.
9 FEBRUARY 2017 Premier Gladys Berejiklian and Health Minister Brad Hazzard are confronted by Wyong Hospital staff and supporters at the regional cabinet meeting held at Mingara Recreation Club.
29 SEPTEMBER 2016 Community meeting held by the Central Coast Community Union Alliance.
16 OCTOBER 2016 2000 attend community rally in Kanwal.
9/10 FEBRUARY 2017 Wyong Public Hospital Blitz/Breakfast.
14 FEBRUARY 2017 Valentine’s Day Action.
25 MARCH 2017 March In March Central Coast at Gosford where nurses and midwives were joined by supporters and marched over the McGowan bridge.
16 APRIL 2017 Easter Fun Day at the Entrance.
10 NOVEMBER 2016 Parliamentary debate: ALP MP David Harris presents our case for Wyong hospital to remain public.
22 APRIL 2017 Candlelight Vigil outside Wyong Hospital.
18 NOVEMBER 2016 Protest against Privatisation outside the Wyong Public Hospital’s entrance with Greens MP Jeremy Buckingham.
14 DECEMBER 2016 Anti–privatisation campaign training with Wyong activists.
15 JUNE 2017 Community forum attended by over 300 people at Wyong Leagues Club.
6 JULY 2017 Celebration outside Wyong Hospital after ‘Wyong Public Hospital remains public’ announcement.
THE LAMP AUGUST 2017 | 11
Public health first! A local community group was a key driver behind the campaign to keep Bowral Hospital in public hands.
ue Moule, branch secretary of our Bowral branch, has no doubt that the energy and commitment of a local community group – Public Health First – was pivotal in retaining Bowral Hospital in public ownership. “In March, the association organised a rally at Bradman Oval near the Bradman museum. That really put the idea into people’s heads to form a community organisation. “We had done petitions before that and spoken on local radio. We had a night at the pub when Brett Holmes spoke. Edna Carmichael and her group picked up on that and got up and ran with it.” Edna, a retired teacher, says Public Health First came about when her friend, Gordon Markwart, suggested “why don’t we get together with other people and see what happens”. “So four of us decided we would take this on as an action and see what we could do. We became the four pairs of feet on the ground. Meanwhile there were other people in the background doing research, making donations, writing letters and making comments on various websites. Some were going to some of the forums with South West Sydney LHD, to find out what they were saying. Some were emailing other people: basically that’s how we put the campaign together. “One of the people involved in the group was involved in the promotion of more appropriate development for the highlands and she had an email list of almost 400. That was a very good resource for us to commence our community engagement.”
IT WAS ABOUT WHAT WAS RIGHT FOR THE COMMUNITY Edna says she and her cofounders were making “a statement against private partnerships and the government not taking responsibility for its own actions”. But they were also driven by a clear analysis of the impact of such a massive change for the community. “As a community group we couldn’t understand what the hospital was going to gain out of having a relationship with a private provider like Ramsay. Although Ramsay runs a very smooth, 12 | THE LAMP AUGUST 2017
‘This hospital started out with the community raising money for it back in the 1880s because the government wasn’t coming forward with plans for a hospital. Therefore there is quite a community spirit about the hospital here. — Edna Carmichael, Public Health First well-organised (private) hospital up here it does not really meet the definition of what we would understand to be a hospital, with much of it’s work being day surgery. We couldn’t see how they were going to offer extra services to the community,” she said. “The LHD said there would be $50 million more from the PPP. As we started going to their meet-and-greets we discovered we weren’t going to get much more than a brand new building.” Edna says there didn’t seem to be any thought put into assessing the needs of an ageing population or the impact on the less well off people in the community. “There are a lot of retirees who you might think are well off but it’s not true. There are a lot of people doing mining work or factory work that are on a low income around here. There is affluence here but there are also people who are not very well-off at all.”
STRONG PUBLIC SUPPORT Edna says the level of public support for the campaign was high from the beginning. “On 13 March, we held our public meeting with close to 300 people. There were 140 people who came to a SWS LHD meeting – after we forced them to call one. There wouldn’t be two weeks go by without something in the newspaper about the hospital – either written by the paper or through letters to the editor.
From left: Jai Rowell MP; Sue Moule, Bowral Hospital; Brad Hazzard, Minister of Health; Emma Small, Bowral Hospital; Edna Carmichael, Public Health First “We went to all of the local markets month after month. We did street meet-and-greets with handouts and continued that all the way. We were at the Bowral market – the largest market in this area – just to let people know what we doing and how they could help. There was plenty of public interest in what we were doing. “This hospital started out with the community raising money for it back in the 1880s because the government wasn’t coming forward with plans for a hospital. Therefore there is quite a community spirit about the hospital here.”
PUTTING PRIVATISATION UNDER THE MICROSCOPE The group not only put a lot of work into building support for the campaign. They also put the government’s plan under the microscope. “We tried to get a copy of the clinical services plan for Bowral Hospital but weren’t able to get it. We put a motion to the local council and they were able to get it. We went through that carefully. “There were people on our committee who had good skills. They had experience in health infrastructure, one was a demographer, and there was an engineer who had a long history of working with the development of health facilities, including setting up the medical faculty at the University of Wollongong. They were able to help us go over various statistics and information. We analysed the clinical services plan and came to a determination that the plan wasn’t even about Bowral. Out of 127 pages Bowral wasn’t mentioned very much.
‘We wanted the public to take on a public health issue. It was brilliant that this community group got up and ran with it.’ — Sue Moule, branch secretary, Bowral Hospital “Looking at the analysis and the graphs we could see quite clearly that they were not going to provide the types of services that this community were going to need.”
NEXT STEPS Edna says the group feels very excited about the government’s backdown on privatisation but “we’ve got other things to do now. We’re working on that – to try and get enough money for the hospital because it deserves it. “In 2009 the Treasury said it required $110 million for redevelopment. So if the Treasury said it needed $110 million then we are saying it now needs $160 million. That’s what we are working towards.” Sue Moule says the nurses and midwives at Bowral Hospital would like to give a big thank you to Public Health First for all the work they put in. “We wanted the public to take on a public health issue. It was brilliant that this community group got up and ran with it.” ■ THE LAMP AUGUST 2017 | 13
Mental health starved of funds The NSW mental health system can reduce the use of seclusion and restraint only if it gets adequate support and resources.
nderfunding of mental health services over many years has hindered the adoption of measures to ensure optimum safety of patients and staff, says the NSWNMA. A “tight fiscal strategy is now having an impact on clinical outcomes in mental health services,” says a union submission to the inquiry into the practice of seclusion, restraint and observations (see box). It says increased use of seclusion and restraint cannot be seen in isolation from underlying problems within the NSW mental health service. “A lack of leadership by government, along with budget constraints, has led to mental health services being poorly resourced. “With a developing employment profile of a non-specialised and inexperienced mental health workforce, the level of safety for clients and staff is now at a critical level.” Rather than addressing the issues, the government appears to have stepped back from its overall responsibilities and allowed local health districts to make decisions driven by strict budget constraints, the submission says. “This has forced LHDs to resort to stopgap, low-cost measures in order to remain in budget at the cost of evidenced-based best practice that ensures better safety of clients.”
14 | THE LAMP AUGUST 2017
NSWNMA SUPPORTS MINIMISING SECLUSION It says the union supports the work of many agencies to minimise the use of seclusion nationally in line with international trends and “best practice principles for patient centred care, trauma informed care and crisis prevention strategies”. “Patient and staff safety has always been a priority of the NSWNM A and our members, along with evidence-based clinical practice that provides best care for the individual. “Seclusion and restraint events hold many risks and appropriate measures to help reduce the number of seclusion and restraint episodes will also reduce the exposure of clients and staff to the associated risks.” The submission points to research showing a small number of high risk clients are involved in most seclusion episodes. “This research indicated that 84 per cent of episodes had harm to others as the reason for seclusion and with 20 per cent of patients accounting for 70 per cent of the hours for seclusion.” The submission argues that seclusion must remain an option and is a necessary last resort to ensure optimum safety. “The NSWNMA holds the view that the use of seclusion and restraint
can be reduced in NSW, but only with the right support and resources in place.”
LOSS OF EXPERIENCE The submission calls on the government to prioritise the recruitment and retention of suitably qualified mental health nurses. Budget constraints have had a detrimental effect on staffing levels and skill mix in mental health units and community mental health services, it says. The system has failed to acknowledge the competency, education and experience of specialist mental health nurses and ignored their calls for interventions that would improve service delivery. This has led to them moving to other areas of health care or leaving the profession altogether. It says managers of mental health services often have no mental health nursing background. A number of LHDs no longer require mental health experience and qualifications when advertising for staff. “With this acute decline in a qualified and highly experienced specialist mental health nursing workforce and an aging workforce retiring from the profession, we now have a generation of less experienced junior nurses that have inadequate mentorship and role modelling available for them to learn from.” ■
Report by December The NSW government has announced it will examine the state’s mental health system via a parliamentary inquiry and a review by an “independent” panel led by chief psychiatrist Murray Wright. The government says the parliamentary inquiry will look at “all aspects” of mental health care while Dr Wright’s panel will investigate the use of seclusion, restraint and observations. The review will “consider whether existing legislation, policy, clinical governance and practice standards are consistent with national standards, international best practice and the expectations of patients and the community”. The panel will visit NSW hospitals, acute mental health units, mental health intensive care units, and declared emergency departments and review past cases of seclusion and restraint. The public will be able to make submissions and there will be “the opportunity for face-to-face consultations through public workshops”. The review panel is to release its report by December. Other panel members are: • Kevin Huckshorn, CEO, Huckshorn and Associates • Karen Lenihan, NSW Principal Official Visitor • Julie Mooney, Executive Director of Nursing and Midwifery for Southern NSW LHD • Robyn Shields, Deputy Commissioner at the NSW Mental Health Commission • Jackie Crowe, Deputy Commissioner of the Australian Mental Health Commission.
‘The level of safety for clients and staff is now at a critical level.’
MORE INFORMATION The NSWNMA submission on seclusion and observation is available online: http://www.health.nsw.gov.au/patients/mentalhealth/Pages/ default.aspx
THE LAMP AUGUST 2017 | 15
Loss of experience must be reversed A shortage of experienced nurses has led to the overuse of seclusion in some mental health units, says nurse practitioner Joanne Seymour
oanne has been a mental health nurse for 23 years and a nurse practitioner (NP) for 14 years. Joanne believes the use of seclusion could be reduced if more NP positions were created for in-patient units.
medication and admit and discharge patients without them having to see a doctor.
NPs would role model best practice to junior nurses, helping them to avoid the need for seclusion. Victoria is already moving in this direction, she says.
“Young nurses have adequate theoretical training but in a practical sense they will learn what is role modelled to them. If you don’t have senior staff to learn from then you learn bad practices right from the start.
“Seclusion should only be used as a last resort in extreme circumstances, for the safety of other patients and staff,” says Joanne. “It should only be used when patients are highly agitated and aggressive and do not respond to medication. “Some inexperienced mental health nurses who don’t yet have the necessary skills tend to use it as a first option, because they are scared of patients or they don’t feel they can communicate with them. “The lack of experienced mental health nurses means seclusion is not always being used therapeutically or as a last resort as it should be.” As an NP Joanne not only assesses patients but can also order investigations for them, prescribe
A LACK OF CAREER OPPORTUNITIES She says there needs to be a focus on retaining experienced staff.
“If you had NPs assigned to in-patient units they would help junior nurses to identify when patients are becoming distressed or agitated, review the effectiveness of their medications and ensure that situations don’t escalate to a point where patients need seclusion.” Joanne says that in the absence of an NP, nurses have to rely on doctors, who are often not on duty on the wards. Nurses are left to manage difficult behaviour as best they can because no doctor is available to review a patient’s medication. Practical mental health training is also hampered by constraints on nurse educators.
Mental health nurse, Joanne Seymour 16 | THE LAMP AUGUST 2017
“Nurse educators are often tied
up in statewide rollouts of training programs or are required to work on wards to alleviate staff shortages. They don’t have enough time for clinically focused one-on-one education.”
Joanne says the use of restraint could be reduced by rostering more mental health nurses to EDs. “If you had a 24-hour mental health presence in the ED you would have someone capable of engaging with patients, which would significantly reduce the use of restraint.” Joanne says the government’s review into seclusion, restraint and observations follows a number of adverse incidents related to lack of compliance with observation procedures.
MENTAL HEALTH AND DRUG & ALCOHOL NURSES FORUM
C a l n a n n i a c id
MORE ED MENTAL HEALTH NURSES REDUCES RESTRAINT
DEBUNKING THE MYTHS
She suspects those procedures were introduced because of a growing reliance on junior nurses. “Before these observation policies were implemented, mental health nurses engaged with patients a lot more and knew if they were escalating or becoming distressed. “I think that those policies have given nurses permission to tick a checklist every so often to say they have seen someone. It doesn’t necessarily mean they are engaged with them. “There is sometimes more focus on completing paperwork than attending to the person in front of them.” Joanne urges mental health nurses to take any opportunity to contribute their ideas to the government review.■
FRIDAY 8 SEPTEMBER 9am to 4pm NSWNMA, 50 O’Dea Avenue, Waterloo COST: members $30 / non-members $60
‘Some inexperienced mental health nurses tend to use seclusion as a first option, either because they are scared of patients or they don’t feel they can communicate with them.’
SPEAKERS Lucy Haslam, United in Compassion Justin Sinclair, Research Fellow, NICM Office of Medicinal Cannabis NSW more speakers TBC There will also be a special screening of acclaimed journalist, Helen Kapalos’ documentary A life of its own: the truth about Medical Marijuana
bit.ly/ NSWNMAeducation For enquiries contact NSWNMA Metro: 8595 1234 Rural: 1300 367 962 THE LAMP AUGUST 2017 | 17
Identify barriers to best practice The statewide review of seclusion, observation and restraint is a response to serious public and professional concerns about standards and practices in NSW mental health facilities, says nursing academic Bethne Hart.
ethne Hart, Associate Professor in the School of Nursing at the University of Notre Dame, Sydney, says NSW Health policy is very specific about seclusion, restraint and observation standards and practices. Bethne, a mental health nurse and sociologist, says, “We have to ask, what gets in the way of policies being upheld and best nursing practice being followed? “It is important that we engage fully with the review and systematically identify the factors that support best practice mental health care, and the factors that contribute to weaknesses and failures in care provision.
“Are staffing and other resources sufficient? Are staff properly educated, skilled and up to date with policy developments? “Mental health nurses are providing care to people who are often seriously ill, with both physical and mental health needs. Standards of care and policies governing this care must be embedded into the everyday practices of nurses. 18 | THE LAMP AUGUST 2017
‘Nurses need to be able to speak up about their concerns regarding patient safety and the upholding of standards and policies, and their own well-being.’ “This requires continuing professional development and strong clinical leadership. “Clinical supervision and staff mentoring are very important to nurture and sustain best practice mental health nursing. “There is also a question of leadership and workplace culture. Are managers strongly leading the practices of nurses?
standards and policies, and their own well-being.”
TRUST NEEDED IN MENTAL HEALTH SERVICES Bethne says it is important to examine not only deficiencies but also those mental health services that “work hard to reduce seclusion and are very aware of upholding policy.”
“Safe workplace cultures have effective communication, teamwork, and core values of therapeutic care.
“Many mental health services and nurses are engaged in models of care and standards of practice that uphold safety, expertise and core therapeutic values. These must be recognised, and their knowledge and practices shared across the health professions and services.”
“Nurses need to be able to speak up about their concerns regarding patient safety and the upholding of
She says mental health services and nurses are challenged in caring for people who may be
“Is the culture of workplaces getting in the way of policies being observed and implemented and standards being upheld?
Nursing academic Bethne Hart acutely intoxicated, aggressive, distressed, and a threat to the safety of themselves, nursing staff and patients. “We must be certain that the environments in which we give care actually support safe care. “Close observation of people who are very unwell can be limited by environmental conditions, and distress and disturbed behaviours will increase in environments where people feel unsafe or unable to recover within their surroundings.” Bethne says the Australian College of Mental Health Nursing is providing leadership via a project that supports the reduced use of seclusion. “The college is promoting mental health nursing and workplace cultures that reduce the risks of physical and emotional harm for people with mental illness. “Fundamentally, we want people with mental illness and their carers, and broader communities to have confidence and trust in mental health services. “What we do as mental health nurses, and how we are educated and supported to do this, is central to this goal. “We must take every opportunity within the review to speak up about what we do well, and also about the factors that diminish care and what we need to do better.”■ THE LAMP AUGUST 2017 | 19
When seclusion is the only option Policies and procedures governing seclusion are “very stringent” and staff already do their best to avoid the practice, says delegate, Luke Muller.
uke Muller works in Cumberland Hospital’s acute mental health ward and on the admission desk where he triages presentations. He has 15 years’ experience in mental health nursing. “There are strict criteria – you can’t just throw a patient into seclusion for a minor reason, such as yelling at someone or threatening to harm someone,” he says. “Seclusion is almost always reserved for patients whose behaviour poses a real threat to the safety of other patients and staff. “Sometimes the only way you can safely manage certain patients is to isolate them from other people while they are at the height of their psychotic episode or whatever it is they are experiencing. “However, putting someone who is suicidal into a seclusion room might put them at even greater risk of self-harm. “In such cases it is far better to increase the level of observation, sit with them and engage with them and use other strategies to manage their behaviour.” Luke says the number of patients put in a seclusion room after admission is relatively low. “Most seclusions are for people taken directly from the street into a seclusion room. “Often they have been detained by police who are unable to use the strategies and techniques we have to calm people down and prevent them from harming others. “They come to us at crisis point. The medication they are using – if any – is not helping and seclusion is the safest place to be. “They are not yet in a state that allows us to have a cup of tea and a chat with them and get them talking about their problems.”
20 | THE LAMP AUGUST 2017
BANNING SECLUSION WOULD CREATE PROBLEMS Luke says a ban on the use of seclusion would result in worse outcomes for both patients and nurses. “Any open and broad review into how we can do things better is welcome so long as it’s not designed to reach a predetermined result such as closing seclusion down.” He says patients are not secluded in order to make life easier for staff. Strict monitoring requirements for secluded patients only add to nurse workloads, he points out. “The requirements for documentation mean that a lot of your clinical time is spent making notes and ticking charts, which means less time available to engage with patients. “We are always stretched for staff. If we had more staff on the wards we could spend more time building rapport with patients. “One positive result would be that patients would be less likely to escalate to the point where they had to be put into seclusion.” Insufficient staffing also cuts the time available to mentor new graduate nurses. “A lot of our staff are retiring after working at the hospital for decades. They have a lot of knowledge and have built a lot of rapport with our patients, many of whom are in and out due to the revolving door syndrome. “We are getting an influx of new staff, which is great to see but they get a short orientation package before being thrown in at the deep end.”■
Observation demands can be ‘unachievable’
‘Patients come to us at crisis point. The medication they are using – if any – is not helping and seclusion is the safest place to be.’
The NSWNMA wants the mental health review to consider how better staffing and use of new technology could improve restraint and observation of patients. Failure to accurately observe patients correctly has had fatal consequences, says the NSWNMA submission to the review into mental health services. “The Association strongly advocates that all staff comply with state and local policy at all times to ensure best possible client outcomes,” it says. “The Association acknowledges there have been situations where failure to accurately observe patients correctly has resulted in poor and on different occasions, fatal consequences.” It says nurses have warned that due to the number of patients requiring observation and the physical layout and design of some units, the required frequency of observations (every 10 or 15 minutes) is “unrealistic and in some cases unachievable”. On the issue of restraint, the submission says a sufficient number of restraint-trained nurses are required to be able to implement a restraint procedure safely. “Mental health units have minimum staffing overnight and need to rely on trained staff to come from other areas before a minimum complement for restraint is available. “This can impact on the feeling of vulnerability that staff feel when managing a high-risk client.” The submission says staff try not to wake clients due to the detrimental effects of poor sleep on clients’ mental state. They also are reluctant to disturb clients at night when nursing numbers are lowest, “due to the fear of aggression and violence that could result”. The Association suggests the review look at the use of technology to help monitor clients overnight. This could include instruments to measure breathing and movement and electronic wristbands that monitor pulse.
Luke Muller THE LAMP AUGUST 2017 | 21
United push for national action on climate and health Federal, state and territory governments have been urged to establish a Ministerial Health and Climate Change Forum to oversee coordinated national action to tackle the urgent health threats arising from climate change.
landmark new report recommends that the Forum include ministers from each jurisdiction whose portfolios cover health, energy, the environment, resources, emergency services, planning and infrastructure. The Framework for a National Strategy on Climate, Health and Well-being for Australia, launched with tripartite support at an event at Parliament House in June, was developed by the Climate and Health Alliance with wide consultation across the health sector. The NSWNMA is a member of CAHA. The strategy framework sets out a detailed road map for addressing the health risks of climate change, and is aimed at the health and other sectors that influence the determinants of health. It calls for a national education and training framework to support health professionals in recognising, preparing for and responding to the health impacts of climate change, and for a national sustainable healthcare unit to be established within the Commonwealth Department of Health. The framework also recommends that a new National Safety and Quality Health Service (NSQHS) Standard be developed, aimed at minimising the risks of climate change to patients and the delivery of safe, quality care. This new NSQHS Standard would incorporate organisation-wide risk assessments and planning for risks such as surges in service demand, destruction of infrastructure and equipment, and interruptions to workforce availability. 22 | THE LAMP AUGUST 2017
â€˜The health challenges are massive; the health sector needs to be prepared.â€™ â€” Dr Liz Hanna, president of CAHA
The framework calls for mandatory standards prioritising climate resilience for health facility design, construction and ongoing management, and says the NHMRC and Medical Research Future Fund should establish climate change and health funding streams. Speaking at the launch, Shadow Health Minister Catherine King pledged that a Labor government would draw on the framework in implementing a national strategy on climate, health and well-being. The framework calls for a national educational campaign to inform communities about the health risks of climate change, health-protective adaptation strategies and the health benefits of reducing emissions and transitioning to a low carbon future. It also recommends a national certification and labelling scheme for products to guide consumers towards low carbon choices, and an end to subsidies for fossil fuelbased energy industries.
AUSTRALIA LAGS BEHIND REST OF WORLD At a roundtable meeting hosted by the Australian Healthcare and Hospitals Association after the Parliament House launch, nursing organisations and leaders were among those groups urged to support action on the framework. Chief Nursing and Midwifery Officer Debra Thoms was among the attendees at the roundtable meeting. Fiona Armstrong, founder and executive director of CAHA, and a former nurse, said the health sector did not need to wait for Federal government leadership to start work on implementing the framework. “We don’t necessarily need commitments from government to act, though they are obviously very useful; there is a lot that can be done in terms of implementing strategies,” she said. The CAHA report notes that policies and frameworks to address climate change and health have been developed by the EU and in the US by the Centers for Disease Control and Prevention, while the UK has implemented a policy for the NHS that includes both mitigation and adaptation strategies. Armstrong warned that without such a national strategy or a mechanism to include health in climate policy decisions, Australia would fail its obligations under the Paris agreement. At the launch, the Minister for Indigenous Health and for Aged Care, Ken Wyatt, congratulated CAHA for providing “this important report”, and said he would discuss it further with Health Minister Greg Hunt. “The independent voice of this strategy framework adds value to policy discussions,” he told the launch. Senator Richard di Natale, leader of the Greens and a public health doctor, congratulated all who contributed to this “excellent” piece of work advocating for a national framework to support transformation across health systems.
“We are at a critical juncture right now; we know that we are facing catastrophic global warming,” he said. Di Natale stressed the co-benefits to health of reducing emissions. “When you transform your energy sector, when you transform your transport sector, when you make sure that you plan your cities in a way that encourages active transport and drives down emissions, you actually produce a range of other co-benefits,” he said. “It means reductions in things like heart disease, and obesity, reductions in things like diabetes, and of course road deaths, injuries – and improved air quality.
HUMAN SURVIVAL AT STAKE Dr Liz Hanna, president of CAHA and an academic at ANU, gave an alarming overview of the impacts of rising temperature upon health, now and into the future. “It’s a human survival issue that we are facing. The health challenges are massive; the health sector needs to be prepared. It’s not only political will but getting the urgency of the message out to the community so it’s part of every decision they make with their own emissions,” she said. CAHA is urging health professionals to engage with the campaign’s plan to create a climate health mentor for all MPs. “Everyone needs to take some responsibility. This is a very complex problem, none of us can solve it on our own,” said Fiona Armstrong. “The health sector can bring extraordinary expertise but we need to work together with policymakers and parliamentarians at all levels.” Meanwhile, the AHHA has backed the framework’s calls for a new national standard to ensure health services plan for and address the impacts of climate change upon healthcare. Alison Verhoeven, chief executive of the AHHA, said: “In terms of healthcare and hospitals, at AHHA we think climate change is a threat multiplier to a sector that is already under pressure.”
FOR MORE INFORMATION You can download the Framework for a National Strategy on Climate, Health and Well-being for Australia from the CAHA website: www.caha.org.au/nationalstrategy-climate-healthwellbeing You will also find an Advocacy Toolkit to provide you with everything you need to know for getting in touch with your local MP, plus other resources.
WHAT YOU CAN DO • Write to health, energy and environment ministers endorsing the framework and asking them to respond. • Seek a meeting with your local MP and ask them to advocate for a climate health strategy in parliament. • Talk to policy makers and health department representatives to ask what they will do to adopt the strategy. • Donate to CAHA’s work.
THE LAMP AUGUST 2017 | 23
Third world diseases persist in remote communities Australia’s Indigenous communities are suffering from shockingly high levels of blindness, hearing loss and early death from heart disease. In many cases, three diseases that have been virtually eliminated in most other developed countries are to blame.
ndigenous Australians are 122 times more likely to live with the life-threatening rheumatic heart disease than their non-Indigenous peers. An eye infection called trachoma is contributing to rates of blindness six times higher in Indigenous communities than among non-Indigenous adults. And in some remote communities, up to 90 per cent of Aboriginal children have some form of the ear infection otitis media, which can lead to hearing loss. “Trachoma disappeared from white Australia more than 100 years ago as living conditions improved, and Australia is the only developed country that still has the disease,” Professor Hugh Taylor, the Harold Mitchell Chair of Indigenous Eye Health at the University of Melbourne, told The Lamp. “The blinding trachoma requires repeated episodes of reinfection and the transmission of infection from one kid’s eye to another, so to stop trachoma we really need to stop these frequent episodes of infection.” Trachoma (see box on page 25) persists in some remote Aboriginal communities because of poor hygiene that is exacerbated by poor standards of housing and washing facilities. Preventing trachoma “comes 24 | THE LAMP AUGUST 2017
down to keeping every kids’ face clean, and to do that we need to make sure the kids know their faces are dirty, but also to make sure there have adequate washing facilities,” Professor Taylor said. Nurses in clinics play a role: “Every kid who walks into the clinic who has a dirty face, snotty hair and snotty eyes should be asked to wash their face and be reminded to keep it clean,” Professor Taylor said. “And you can’t wash your face without washing your hands, so by blowing your nose, washing your face and using clean towels you are going to dramatically reduce trachoma, otitis media, respiratory infections, diarrhoea and skin infections, including those that lead to rheumatic heart disease.”
A MASSIVE DROP IN TRACHOMA BUT HOTSPOTS REMAIN In 2009, the Australian government committed to eliminating trachoma by 2020. At that time, disease rates ranged between 15 per cent and 20 per cent. Data from 2015 show a massive drop, with the national average for children in endemic areas at 4.6 per cent. The results are encouraging says Professor Taylor, but there are many “hotspots” where the disease persists. The
that can cause hearing loss, otitis media, affects nearly every child in remote Indigenous communities from soon after birth, says Professor Amanda Leach, Leader of the Ear Health Research Program (EHRP) at the Menzies School of Health Research. “What is happening in remote communities is that it is progressing to the most severe form, to suppurative otitis media, or chronic running ears. The longer the infection is left untreated, the further risk it poses to hearing.” Professor Leach says that at twelve months, just 5 per cent of babies have normal eyes in three of the largest remote communities in the Top End and Western Australia. In some areas, 4 per cent of Indigenous children aged from five to nine years old have an active trachoma infection. In the Northern Territory, that rate is 5 per cent, which is considered an endemic level. “Much more needs to be done,” she says, starting with vaccines at an early age, antibiotics to address cases caused by bacteria, education about hygiene, and more effective programs to address the overcrowding and substandard housing that contributes to diseases spreading. ■
‘Otitis media affects nearly every child in remote Indigenous communities from soon after birth.’ — Professor Amanda Leach
The diseases plaguing remote communities OTITIS MEDIA*
ACUTE RHEUMATIC FEVER
Otitis media is a middle ear infection that causes hearing loss. It is sometimes called bulging eardrum (acute otitis media), glue ear (otitis media with effusion) and runny ear (chronic suppurative otitis media). It is caused by multiple strains of three bacteria common in the nasal passages of young children: Streptococcus pneumoniae, non-typeable Haemophilus influenzae and Moraxella catarrhalis. The longer the infection is left untreated, the greater risk it poses to hearing. One study found Indigenous children were five times more likely to be diagnosed with severe otitis media than their nonIndigenous counterparts. Early hearing loss is associated with lower rates of school attendance in Indigenous students, while later in life hearing loss is linked to problems securing and keeping employment. Depending on the diagnosis and the specifics of each situation, treatment can involve antibiotic (amoxycillin). Surgery, where devices known as tympanostomy tubes (grommets) are inserted into the ear drum to prevent accumulation of fluid, may be needed.
Acute rheumatic fever is an abnormal immune response to throat and skin infections from the bacteria group A streptococcus. Usually, the bacteria are harmless colonisers of the nose and mouth, but an active infection can cause a “strep throat”. This prompts the body’s immune system to respond. In most cases, the immune response is appropriately targeted to kill bacteria and the infection resolves. In some cases, the body mistakenly targets normal tissues in the body, including the heart, skin and joints. The fever and joint pains that typify acute rheumatic fever tend to resolve over a period of weeks, but damage to the heart valves generally persists. Each recurrence causes further heart damage. Eventually, the heart valves become scarred. This chronic phase of the disease is called rheumatic
*Information edited and adapted from a three-part series of articles on Indigenous Health published in The Conversation between 14–16 September 2016.
heart disease. Over time, it increases the risk of heart rhythm disturbances, stroke and heart valve infections, and culminates in heart failure.
TRACHOMA Trachoma (sometimes known as sandy blight because the eyes feel full of sand), is the world’s leading cause of infectious blindness. It’s caused by the bacterium Chlamydia trachomatis, which creates swelling under the inner eyelid leading to scarring. The scars cause the eyelashes to turn inward and scratch the eye, which is intensely painful and made worse by blinking. If left untreated, the scratching will result in the cornea going cloudy and irreversible blindness. Trachoma easily spreads from one child to another through infected eye and nose secretions.
‘Early hearing loss is associated with lower rates of school attendance in Indigenous students, while later in life hearing loss is linked to problems securing and keeping employment.’ THE LAMP AUGUST 2017 | 25
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Formerly State Super Visit stateplus.com.au or call us on 1800 841 677 today to make the most Financial Services of your deﬁned beneﬁt super scheme. Where horizontal space contraints apply, the StatePlus is the trading name for State Super Financial Services Australia Limited, holder of Australian Financial Services Licence 238430, ABN 86 003 742 756. This information is of a general legacy statement may appear in two lines. . nature only and is not speciﬁc to your objectives, ﬁnancial situation or needs. Before making any decisions you should consider its appropriateness to you Leading is set solid (the same as the point size). 26 | THE LAMP AUGUST 2017
NEWS IN BRIEF
A third of English aged care facilities “inadequate” 32 per cent of English nursing homes failed their official inspection. The Care Quality Commission (CQC) – the watchdog that oversees UK aged care – says that of 4,000 nursing homes they had inspected, 32 per cent have been rated inadequate or require improvement and 37 per cent have been told they must improve safety. Only 2 per cent managed the top rating of “outstanding”. Many facilities were downgraded after re-inspection. Of more than 1,800 inspected more than once since 2014, 26 per cent were subsequently relegated to “requires improvement” or even “inadequate” after initially gaining a rating of “good”. Age UK – the largest UK charity for older people – said the results leave elderly people and their families “playing Russian roulette” when they choose a nursing home or other care service. Andrea Sutcliffe, the CQC’s chief inspector of adult social care told The Guardian the results showed a fundamental lack of dignity and respect. “Many of these homes are struggling to recruit and retain well-qualified nursing staff and that means that this is having an impact on delivering good services to people who have got very complex needs,” she said. The CQC warned last year that care was approaching a “tipping point”. Since then the government has injected £2 billion in emergency funding into the sector. Despite this Sutcliffe said care remained “precarious”. Recently announced cuts by local authorities will lead to £6 billion less spent on social care than when the Conservative government’s austerity measures began in 2010.
‘Elderly people and their families were ‘playing Russian roulette’ when they choose a nursing home or other care service.’ — Age UK
Growing crisis in British nursing workforce The number of UK nurses and midwives leaving their professions has increased by 51 per cent in four years. 20 per cent more people left the Nursing and Midwifery Council (NMC) register than joined it in the last year. The overall number of leavers was 34,941, compared with 23,087 in 2012/13. While there has been a drop in European nurses working in the NHS since Brexit, the NMC figures show that it is the departure of UK nurses – who make up 85 per cent of the register – that is having the biggest impact. Over the last year, 29,434 UK nurses and midwives left the register, up from 19,818 in 2012/13, and 45 per cent more UK registrants left than joined last year. The average age of those leaving the register has fallen from 55 in 2013 to 51. Of those who left in the last 12 months, 2,901 were in the 21-30 age group, almost twice the 2013 number. Unions say there is a shortage of 40,000 nurses and 3,500 midwives in England and they blame the government’s pay cap (which limits pay rises to 1 per cent annually) and workplace pressures. Janet Davies, chief executive and general secretary of the Royal College of Nursing, told The Guardian patients were paying the price of government policy. “The average nurse is £3,000 worse off in real terms compared with 2010. The 1 per cent pay cap means nursing staff can no longer afford to stay in the profession and scrapping student funding means people can no longer afford to join it,” she said.
‘The average nurse is £3,000 worse off in real terms compared with 2010. The 1 per cent pay cap means nursing staff can no longer afford to stay in the profession and scrapping student funding means people can no longer afford to join it.’ — Royal College of Nursing THE LAMP AUGUST 2017 | 27
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NEWS IN BRIEF
Global warming even worse than previously thought
Landmark ruling on casual staff rights
The slow warming of the world’s oceans will amplify the heating of the planet according to new research.
Casual workers have won the right to demand a permanent full-time or parttime job after 12 months.
Any optimism that carbon emissions will not drive up temperatures to dangerous levels has been smashed by new research. The Earth’s ‘climate sensitivity’ – the amount by which global temperatures rise for a certain level of carbon emissions – was found to be greater than previously thought. The reason previous temperature measurements indicated a lower climate sensitivity is because the Earth has a fast and a slow response to increases in carbon emissions. Land heats up quickly. But there is also a slower response associated with the warming of oceans. The new study from Harvard University published in the journal Science Advances (advances.sciencemag.org/content/3/7/e1602821 – July 2017) used computer models and paleoclimate data from warming periods in the Earth’s past. It shows that previous temperature measurements do not reveal the slow heating of the planet’s oceans that take place for decades or centuries after CO2 has been added to the atmosphere. “(The oceans) are big and full of cold water, especially at depth, and take a long time to heat up,” said the lead researcher Christian Proistosescu. “The hope was that climate sensitivity was lower and the Earth is not going to warm as much. All the (new) models show there is an amplification of the amount of warming in the future,” he said.
‘Previous temperature measurements do not reveal the slow heating of the planet’s oceans that take place for decades or centuries after CO2 has been added to the atmosphere.’
The Fair Work Commission has ruled that casual workers who work on a long-term regular basis must be provided with the option to convert to permanent employment. The ruling provides a common standard for casual workers to apply for conversion and extends it to a larger number of workers. ACTU Secretary Sally McManus said the decision plugs one small hole “in an epidemic of insecure work that was wrecking the lives of families, individuals and communities”. “Too many employers have been abusing the term casual and use it as a business model to drive down wages,” she said. “Business too often organises its workforce and its capital to avoid the protections that were supposed to be there for working people. This decision deals with just one of the forms of casualisation that have prevented modern workplaces keeping pace with modern life.”
‘Too many employers have been abusing the term casual and use it as a business model to drive down wages.’ — ACTU Secretary Sally McManus
THE LAMP AUGUST 2017 | 29
NEWS IN BRIEF
First downturn in the HIV epidemic in gay men There has been a large drop in the number of gay men becoming infected with HIV in London thanks to a combination of frequent testing of people at high risk of infection and rapid treatment.
ALP vows to restore weekend penalty rates Bill Shorten has promised to legislate to restore Sunday penalty rates if Labor wins government after the next election. Cuts to penalty rates in four industries kicked in at the beginning of July but the opposition leader has pledged to reverse the decision of the Fair Work Commission if elected in the next federal election. The penalty rate cuts will impact up to 700,000 people in the retail, fast food, hospitality and pharmacy sectors and have been endorsed by Malcolm Turnbull and his government.
New data from Public Health England covering five of the biggest London sexual health clinics found that in the year beginning October 2015, HIV diagnoses fell by 32 per cent compared with October 2014 to September 2015 among men who have sex with men (MSM). The reasons for the fall are thought to be the big step up in testing. Gay men at high risk because their partner has HIV have been offered testing every three months with immediate antiretroviral drug treatment – which suppresses the virus – to those who test positive. At the same time, significant numbers of gay men in London have been taking pre-exposure prophylaxis (PrEP) – which can prevent them becoming infected with the virus. Some have been involved in trials to establish how effective PrEP is, while others have bought the drug online following successful trials in the US. “Basically we are witnessing a phenomenal experiment. What we are seeing is the first downturn of the HIV epidemic in gay men,” Valerie Delpech, head of HIV surveillance for Public Health England, told The Guardian. “There is absolutely no reason why we cannot scale that up to further reduce new infections in gay men – and also in all people who may be at risk of HIV in the UK, regardless of gender, ethnicity or sexuality.”
Labor has already tried to reverse the cuts with a private members’ bill that passed the senate with Greens and crossbench support but was voted down in the lower house by the government. One government MP, George Christensen, crossed the floor to support the Labor bill. Shorten told an ACTU gathering: “I promise you this: a new Labor government will restore the Sunday penalty rates of every single worker affected by this cut. And we will change the law to protect the take-home pay of working Australians into the future”. Shorten pointed out how the penalty rate cuts came into force on the same day high income earners received a tax cut. “In Malcolm Turnbull’s Australia someone who earns $1 million will get a tax cut worth $16,400. And a mum working a Sunday shift in retail will get her penalty rates cut. Not traded for a better base rate of pay, not negotiated for improved conditions – just a straight-up cut to wages.”
‘We will change the law to protect the take-home pay of working Australians into the future.’ — Bill Shorten 30 | THE LAMP AUGUST 2017
‘HIV diagnoses fell by 32 per cent.’
NEWS IN BRIEF
A step towards national family and domestic violence leave The ACTU says an important first step has been achieved to get access to paid family and domestic violence leave (FDV). A full bench of the Fair Work Commission – hearing a test case brought by the ACTU – said it accepted the ACTU argument that FDV is a significant community issue, that it disrupts workforce participation and that it disproportionately affects women and that it requires a workplace response. The Commission said it had taken the “preliminary view” that it is necessary to make provisions for family and domestic violence leave. It decided that unpaid leave should be available in awards as a basic standard for all workers. The commission stopped short of paid leave at this stage but left the door open for this in the future. ACTU President Ged Kearney said she was disappointed the Commission had not awarded paid leave at this time but recognized that the decision was “the first step in the fight to ensure working people trying to deal with or recover from family and domestic violence have both job and financial security”. “Australia will become the first country in the world to have a nationally enshrined right to family and domestic violence leave,” she said. “The FWC accepted that family and domestic violence is a social and workplace issue with widespread impacts, and that workplace rights must keep pace with community expectations.”
‘Australia will become the first country in the world to have a nationally enshrined right to family and domestic violence leave.’ — ACTU President Ged Kearney THE LAMP AUGUST 2017 | 31
what’s ON ARE YOU MEETING YOUR CPD REQUIREMENTS? – ½ Day n COFFS HARBOUR Tuesday 29 August n BALLINA Thursday 2 November An essential ½ day workshop for all nurses and midwives to learn about CPD requirements and what’s involved in the process. Members: $40 | non-members: $85 LEGAL AND PROFESSIONAL ISSUES FOR NURSES AND MIDWIVES – ½ Day
n COFFS HARBOUR Wednesday 30 August n BALLINA Friday 3 November Learn about potential liability, disciplinary tribunals, NMC and HCCC complaints, Coroners Court, and more. Members: $40 | non-members: $85
FINANCIAL WELLNESS SEMINAR This free half day seminar is designed to assist people in their decision making regarding their financial future. Subjects covered on the day are detailed below and cater for all ages.
PRACTICAL, POSITIVE WAYS IN MANAGING STRESS AND BURNOUT – 1 Day n LIVERPOOL Friday 11 August Members: $85 | non-members: $170
POLICY & GUIDELINE WRITING FOR NURSES & MIDWIVES – 1 Day
n WATERLOO Friday 1 September Members: $85 | non-members: $170
L L U F e s r u o c
MEDICATION SAFETY FOR NURSES & MIDWIVES – ½ Day n NEWCASTLE Wednesday 27 September Members: $40 | non-members: $85
TOOLS IN MANAGING CONFLICT AND DISAGREEMENT – 1 Day n WATERLOO Monday 9 October Members: $85 | non-members: $170
PRACTICAL SKILLS MANAGING DIFFICULT AND AGGRESSIVE CLIENTS – 1 Day n GYMEA Friday 20 October Members: $85 | non-members: $170
n WATERLOO Friday 20 October For RNs, ENs and AINs in residential, community and hospital aged care settings across private and public sectors. Members: $85 | non-members: $170
PRACTICAL SKILLS GETTING PEOPLE ON-SIDE – 1 Day
• Superannuation Guarantee • Government CoContributions Scheme • Contribution Limits • Salary Sacrifice • Consolidation of Multiple Accounts (Rolling Over) • Insurance (Income Protection / Death Cover / Total and Permanent Disability / Binding Nominations / Nominated Beneficiary) • Investments (Asset Classes / Volatility etc) • Transition to Retirement • Help Links (e.g. MyGov Website / Money Smart Website) • ASFA Retirement Standard (the difference between a modest and comfortable retirement) • Centrelink (General Information e.g. income asset tests) • Q&A •
Time: 9am to 2pm Lunch & refreshments provided
Nurses and midwives: this seminar will not attract CPD hours.
Tuesday 29 August Dubbo RSL
AGED CARE NURSES FORUM
n WATERLOO Wednesday 8 November Members: $85 | non-members: $170
Thursday 21 September The Shellharbour Club
Wednesday 1 November Ballina RSL Numbers are limited in some locations. Pre-registration is essential.
Click on the education tab. Scroll down to the education session you would like to register into and click Register Online. For enquiries contact NSWNMA • Metro: 8595 1234 • Rural: 1300 367 962
Judith Breaking News Concerns remain for Family and Community Services nursing staff moving to the non-government sector. The rollout of the NDIS gathers pace and will start to affect FACS nurses progressively from this month onwards, due to the NSW Government’s decision to ‘vacate’ the disability services field altogether. This decision continues to cause both concern and frustration to FACS staff. The Association and members continue to make representations in all available forums to discuss concerns with the current framework and processes being utilised and the exclusion of the public sector from being a much needed service provider. This included a meeting with the Minister for Disability Services earlier this year, along with continuing discussions and negotiations with FACS and NSW Public Sector IR (NSW Treasury) to resolve continuing concerns regarding the industrial arrangements and protections for transferring staff. Unfortunately, some of our concerns have not been satisfactorily resolved. In large part this is due to powers that have been vested in the Minister for Disability Services under the National Disability Insurance Scheme (NSW Enabling) Act 2013, which permits the forced transfer of current FACS employees to NGO providers. Accordingly, there is no need for the NSW Government to negotiate or provide better incentives or transfer arrangements. This is not good for FACS nurses nor those who they care for and support. However, despite the obstacles, the Association and members will continue to argue for better outcomes, and ensure that the guarantees provided are both real and enforceable.
When it comes to your rights and entitlements at work, NSWNMA Assistant General Secretary Judith Kiejda has the answers.
Options on taking long service leave I am a Registered Nurse in a public hospital. I have accrued long service leave (LSL) and was wondering if I have options as to how to take it? Clause 33(iii) of the Public Health System Nurses’ and Midwives’ (State) Award 2017 sets out the three options as to how to take LSL – at full pay; half pay; or double pay. However you should think through these options carefully. For example, if you take double pay LSL, twice the number of days taken will be deducted from your LSL balance. Conversely, if taking half pay LSL, only half the number of days taken will be deducted. If during your career you have worked differing contracted hours due to, for example, parental or carer responsibilities, you should seek advice from Health Share in the first instance as to the current monetary value of your LSL entitlement. An ‘averaging’ formula is utilised in these circumstances to determine what you receive when taking LSL.
Workload management in a Healthscope hospital I recently started working in a hospital operated by Healthscope after starting my career in the public health system. What is in place to assist with managing workloads in this hospital? Clause 40 of the Healthscope and NSWNMA/ANMF – NSW Nurses and Midwives’ – Enterprise Agreement 2015–2019 contains the process and framework that
should be adopted to ensure that staffing levels are appropriate and sufficient to deliver high quality patient care and a safe working environment for nurses and midwives. The framework is required to take a number of factors into account, including occupancy, patient acuity, skill mix and specialisation that may be required, along with the geography and layout of the facility. Workload matters can be included for discussion at ward/ unit meetings, although any nurse or midwife who believes that workloads are unreasonably heavy on a regular basis can raise such concerns with their manager and have a response provided within 48 hours if at all possible. The clause also sets out how matters may be escalated if they remain in dispute.
Underpayment in a public hospital I work as a Registered Nurse in a public hospital. When checking my pay I noticed that it was missing two days’ pay. When I followed this up I was told it would be sorted in my next pay. Is this right? No. Clause 27(v)(a) of the Public Health System Nurses’ and Midwives’ (State) Award 2015 sets out that an underpayment of equal to or greater than one day’s gross base pay will be rectified in three working days. Only underpayments of less than one day’s gross pay can be rectified in the next normal pay.
THE LAMP AUGUST 2017 | 33
JOURNEY ACCIDENT INSURANCE
Your journey injury safety net
DID YOU KNOW THAT
your membership fees cover you for travel to and from work? If you are involved in an accident while travelling to or from work, NSWNMA’s Journey Accident Insurance provides you with peace of mind. As a financial member of the NSWNMA you are automatically covered by this policy. Make sure your membership remains financial at all times, so you’re covered.
Unsure if you are financial?
It’s easy! Ring and check today on 8595 1234 (metro) or 1300 367 962 (rural). Change your payment information online at
It was nice to know that the Association was there to provide that assistance. I am so impressed and indebted to them for it. RN Alexis Devine
bit.ly/NSWNMA-alexis Watch Alexis talk about Journey Accident Insurance
The Association has been absolutely marvellous, helping me step by step throughout the whole process. They also organised and helped me go back to work on restricted duties. RN Shari Bugden
bit.ly/NSWNMA-shari Watch Shari talk about Journey Accident Insurance
34 | THE LAMP MARCH 2017
Do you have a story to tell? An opinion to share? Nurse Uncut is a blog written by everyday nurses and midwives. We welcome your ideas at email@example.com
New on our Support Nurses YouTube channel
Do we really need to use so many gloves? UNION DAY OF ACTION Protesting against attacks on our rights. bit.ly/DayofActionnswnma
Alice works in a surgical hospital as a theatre nurse, but has doubts about the extensive use of gloves, especially double gloving. http://www.nurseuncut.com. au/do-nurses-really-need-to-use-somany-gloves/
A midwife’s story: Light and shade Midwifery is a beautiful and privileged role – but one that shares in the most poignant griefs. http://www.nurseuncut.com. au/a-midwifes-story-light-and-shade/
Story from an aged care nurse: The invisible man Frank is such a quiet resident he is almost invisible – until he is told some bad news. http://www.nurseuncut.com.au/ story-from-an-aged-care-nurse-theinvisible-man/
AGED CARE NURSE ON PENALTIES RATES ‘A perfect storm’. bit.ly/Jocelynpenalties Connect with us on Facebook Nurse Uncut www.facebook. com/NurseUncutAustralia New South Wales Nurses and Midwives’ Association www.facebook.com/nswnma Ratios put patient safety first www.facebook.com/ safepatientcare Aged Care Nurses www.facebook.com/ agedcarenurses Look for your local branch on our Facebook page www.facebook.com/nswnma
Please bring back the water jug! Melinda is alarmed by the plastic bottle wastage she sees at work every day – why can’t they bring back the simple water jug? http://www.nurseuncut.com.au/anurses-plea-please-bring-back-thewater-jug-heres-why/
Tips for packing a healthy meal for work Tips that make it simple to take your own food to work – and a video demonstration! http://www.nurseuncut.com.au/ nurses-and-midwives-tips-forpacking-a-healthy-meal-foryour-shift/
Follow us on twitter @nswnma / @nurseuncut
Self care for nurses in an app
Share on Instagram by tagging @nswnma and don’t forget to use the hashtag #nswnma!
The Nursewell app offers health and wellbeing advice for nurses, including video guides to back strength. http://www. nurseuncut.com.au/nursewell-appsupports-self-care-for-nurses/
Listen to our podcast ICE – WHERE TO FROM HERE? bit.ly/Icewhere2 THE LAMP AUGUST 2017 | 35
Going to work shouldn’t be like this
Download the NSWNMA App and report your workplace violence incident. The NSWNMA has a tool as part of our NSWNMA Tool Kit App that allows you to quickly report an incident to the Association as soon as it happens. It’s an easy fillable form you can submit from your mobile device and an officer of the Association will be in touch with you. Nursing is considered one of the most dangerous professions. HELP STOP VIOLENCE AT WORK! NSWNMA Toolkit App is FREE and available to download from iTunes and Google Play store 36 | THE LAMP MARCH 2017
What nurses and midwives said and liked on Facebook www.facebook.com/nswnma
Nurses stronger on assisted dying
Workplace super foods: chocolate and tea!
The vast majority of nurses – unlike doctors – support assisted dying legislation, according to a survey in the run-up to a NSW euthanasia bill.
These wartime nurses were lining up for a simple cup of tea. We asked you what superfood you like at work.
Yes, a lot more nurses support euthanasia than doctors. Why? Because they can come and go, give orders and forget about it... Us? We actually have to care for these people and see their suffering. Also, nurses are a LOT more switched on about our patients’ wants and their actual life. Doctors are only concerned about their medical care most of the time. Nurses are a lot more empathetic. It is quality of life, not the number of years you have lived. We should all have the right to die with dignity before we are in intractable pain from a terminal disease or when our dementia is so advanced we are a wasted, unrecognisable caricature of our former selves. A living will should be a legal, binding document that cannot be changed by a guilty or selfish relative. I believe if you are brain dead or in shocking pain it should be legal. It is in Holland. If you’re brain dead you are already legally dead in Australia. I worked in ICU for about 8 years. In my experience, anyone who’s clinically brain dead is taken off life support pretty quickly.
Still happy to get a cup of tea. When I worked in the NHS in London in 1981 we could elect to have money taken out of our very low monthly wage which entitled us to 1 cup of tea a shift! We had a teacup sticker on our name badges to identify who had paid. All tea after the first cup had to be paid for. Dhal and rice. Porridge. Chocolate! Cheese sandwich toasted. Protein bars. Vegemite on toast. 2 minute noodles.
Three public hospitals saved – two to go! Wins against privatisation! 3 hospitals – Goulburn, Wyong and Bowral – have been saved for the public, but we’re still fighting for Shellharbour and Maitland.
Proud of you! Keep up the good work, we will do our best to support you. Keep fighting. We can fix it. Oh wow, you fought the good fight and won. Great outcomes – unity is strength. Big thank you to all my comrades that made this happen. Ecstatic! Now to save the other public hospitals threatened by the stupid ideology of this current government.
A lively debate on housing affordability
The price of housing is hurting nurses and midwives across the state. That’s why we’re fighting for more accessible housing options for essential services workers. Not everyone agrees. Seriously, since when has housing affordability been an issue for the NSWNMA to deal with? I would expect them to concentrate on ratios and weekend penalty rates. That would be more appropriate and let the bloody government worry about the housing issue. “Let the bloody government worry about the housing issue”? You mean THIS government?! You need the union to MAKE the ‘bloody government’ put it on their agenda. If the issue is not pushed or brought to the table then they are not going to ‘worry’ about it are they? I respect a holistic approach by the union - as a community this is a very big issue. Thanks for taking on this initiative, it’s going to need a big picture approach that’s for sure. They have a living in London allowance, how about a living in Sydney allowance?
/4 1/ E D nurse Angie from Murwillumbah delivers these NSWNMA-funded stethoscopes to nurses in Kiribati. 2/ I t was National TAFE Day and our cake for Hunter TAFE students says ‘Delivering future nurses’. 3/ D octors (and nurses) for the Environment gathered outside Commbank with a strong anti-coalmining message. 4/ Asking Commbank to rule out investing in the world’s biggest coalmine in Australia.
THE LAMP AUGUST 2017 | 37
n: Environmental Hea lth S ducatio E A emi M N nar NSW
9AM TO 3.30PM PRINCE OF WALES PRIVATE HOSPITAL
Conference Room, Level 7 Barker St, Randwick COST: Members $60 • Non-Members $85 • Associate Members $30* Lunch and Refreshments provided
NURSES & MIDWIVES:
Seizing Sustainable Health Care Opportunities FRIDAY, 15 SEPTEMBER 2017
GUEST SPEAKERS: Joanna Immig, CO-ORDINATOR, NTN NATIONAL TOXICS NETWORK Sharon Nulty & Louise Wight, MONASH HEALTH CARE, AWARD WINNING: NON-CHEMICAL CLEANING IN HOSPITALS
Libby Barnes, RN, LISMORE BASE HOSPITAL RECYCLING PROJECT Matt Power, CONSULTANT IN ENERGY AND SOLAR POWER, UPDATES ON ENERGY REDUCTION AND PLASTICS
Kate Kelly, ENVIRONMENTAL SUSTAINABILITY OFFICER, ST VINCENT’S HOSPITAL DARLINGHURST
POTENTIAL CPD HOURS
REGISTER NOW & SAVE THE DATE!
bit.ly/NSWNMAeducation ENQUIRIES: (02) 8595 1234 (metro) or 1300 367 962 (regional)
*Associate Members please contact the Association to register
Authorised by B.Holmes, General Secretary, NSWNMA
LIONS NURSES’ SCHOLARSHIP Looking for funding to further your studies in 2018? THE LIONS NURSES’ SCHOLARSHIPS OPEN ON 1 AUGUST AND CLOSE ON 31 OCTOBER EACH YEAR The trustees of the Lions Nurses’ Scholarship Foundation invite applications for scholarships. Nurses eligible for these scholarships must be resident and employed within the State of NSW or ACT. You must currently be registered with the Nursing and Midwifery Board of Australia
and working within the nursing profession in NSW or the ACT, and must have a minimum of three years’ experience in the nursing profession – the last twelve months of which must have been spent in NSW or the ACT. Details of eligibility and the scholarships available (which include study projects either within Australia or overseas), and
application forms are available from: www.nswnma.asn.au/education Administration Liaison Lions Nurses’ Scholarship Foundation 50 O’Dea Avenue Waterloo NSW 2017 or contact Matt West on 1300 367 962 or firstname.lastname@example.org
COMPLETED APPLICATIONS MUST BE IN THE HANDS OF THE SECRETARY NO LATER THAN 31 OCTOBER Nurses Scholarship.indd 38 Lion | THE LAMP AUGUST 20171
10/07/2017 10:37 AM
NURSING RESEARCH ONLINE
Improving safety in mental health Mental health care, particularly seclusion and restraint practices, has been brought into focus with an ongoing inquiry in NSW. Use of restrictive practices during admitted patient care In 2005, Health Ministers endorsed the national safety priorities in mental health: a national plan for reducing harm, Australia’s first national statement about safety improvement in mental health. This plan identified four priority areas for national action including “reducing use of, and where possible eliminating, restraint and seclusion”. The plan recognised that seclusion and restraint are a serious infringement of an individual’s rights, and can cause psychological trauma and physical injury to consumers and to healthcare staff. In response, there have been a number of initiatives aimed at reducing seclusion and restraint in public mental health facilities including a national seclusion data collection and reporting framework. Most seclusion and restraint occurs in acute specialised mental health hospital service setting, therefore quality improvement initiatives and data collection and reporting have focused on that setting. https://mhsa.aihw.gov.au/services/admitted-patient/ restrictive-practices/
Seclusion and Restraint Project Report National Mental Health Commission, August 2014 In 2012, one of ten key recommendations made by the National Mental Health Commission (NMHC) (2012, p.13) was to ‘reduce the use of involuntary practices and work to eliminate seclusion and restraint’. The NMHC stated (2012, p.14) that it would call for evidence of best practice in reducing and eliminating seclusion and restraint and help identify good practice treatment approaches. The NMHC commissioned the University of Melbourne research team to investigate and identify instances of ‘best practice’ in reducing and eliminating the practices of seclusion and restraint in relation to people with mental health issues. Serious concerns about the use of seclusion and restraint in mental health care have been raised at least since 1993 (Australian Human Rights and Equal Opportunities Commission, 1993). Academic literature has noted a number of adverse consequences for those subjected to seclusion and restraint (Frueh et al., 2005; Gerace et al., 2014) and raised concerns with human rights breaches (Kumble and McSherry, 2010). A national mental health seclusion and restraint project (known as the Beacon project) was established in 2007 and ran until 2009 (Australian Institute of Health and Welfare, 2012). The Beacon project targeted eleven key sites around Australia, all of which introduced strategies with the aim of reducing and, where possible, eliminating the use of seclusion and restraint in public mental health services. The project developed a set of key principles and guidelines for the use of seclusion and restraint by mental health
services, but did not recommend any specific legislative changes (Kumble and McSherry, 2010). http://socialequity.unimelb.edu.au/research/ seclusion-and-restraint
Seclusion and restraint: why are they still used in acute mental health care? Life Matters, ACB Radio National, May 2014 Seclusion rooms and physical restraint are both still used in some acute mental health facilities across Australia to manage people with volatile behaviours. Seclusion was once considered therapeutic, now it’s understood to cause profound distress. A national project is focused on documenting and ending its use, and promoting alternative approaches. http://www.abc.net.au/radionational/programs/ lifematters/seclusion-and-restraint3a-why-are-theystill-used-in-acute-men/5421568
Ending Seclusion and Restraint in Australian Mental Health Services National Mental Health Consumer & Carer Forum A Position Statement by the National Mental Health Consumer & Carer Forum, (NMHCCF) The frequent requirement to seclude and restrain people with an acute mental illness highlights the ongoing failure of the mental health system to provide high quality care. Seclusion and restraint are often used despite the lack of evidence that they offer positive health outcomes. Indeed, seclusion and restraint are commonly associated with further trauma, risk of violence and potential human rights abuse. Why do we find it necessary to engage in these practices on a daily basis? The answer is depressingly straightforward. The predominant foci of acute mental health care in Australia today are the emergency departments of our large public hospitals and their associated acute psychiatric wards. In these locations, there are few alternatives available for the safe management of dangerous behaviours. In these inappropriate and under-resourced contexts, seclusion and restraint are the accepted practices. Quality mental health care requires time, resources and space to allow health professionals to deliver health care to meet the unique needs of patients. In a nutshell, we do not have what we need to practice people-centric mental health care. The underlying issue here is the ongoing failure to invest in any alternative models of care, particularly communitybased services. The fact is that acute hospital care has become almost the only place where people with complex mental health problems can receive care. https://nmhccf.org.au/sites/default/files/docs/ seclusion_restraint.pdf THE LAMP AUGUST 2017 | 39
Recently changed your email? Classification changed?
online. nswnma. asn.au
Log on Update details Go into the draw*
iPad *The winner must be a financial member of the NSWNMA
online. nswnma. asn.au
40 | THE LAMP MARCH 2017
Log on and make sure all your details are up to date. You can easily update your address, workplace or credit card details as well as pay fees online, print a tax statement or request a reprint of your membership card – it’s simple! Everyone who uses our online portal from 1 July – 30 September 2017 to update their details will automatically be entered in the draw to win.
ACROSS 1. A chemical condensation leading to the formation of a polymer by the linking together of molecules of a monomer and the releasing of water or a similar simple substance (16) 9. One of the specialised parts of a protozoan or tissue cell (9) 11. Utilised (4) 12. Street names for heroin (4) 13. Umbilical artery catheter (1.1.1)
14. Most distant from the centre or inside (9) 16. To contaminate again (8) 18. Observation care unit (1.1.1) 19. Troublesome or oppressive; burdensome (7) 20. Limulus Amoebocyte Lysate (1.1.1) 22. Relating to the sense of touch; tactile (6) 24. Unintelligible or nonsensical talk or writing (9) 27. Storing up potential energy or heat (11)
28. Improving outcomes guidance (1.1.1) 30. The state of being familiar with or used to something (9) 31. Produced or caused by living organisms (6) 33. A syndrome associated with toxocariasis, in which the eye is invaded by migrating larvae (1.1.1) 34. Entering (7) 35. Notch (8) 36. Open Media Network (1.1.1) 37. Waste which cannot be broken down (3.13)
DOWN 1. Destruction of tissue by the heating effect of intense focused white light or by the use of a laser (16) 2. Incandescent lamp (5.4) 3. Tubular structures usually seen as paired organelles lying in the cytocentrum (9) 4. Nothing; zero (3) 5. Subjecting to movement of charged particles suspended in a liquid under the influence of an applied electric field (16) 6. Slow to perform or respond to stimulation (8) 7. A covering of fine hairs or scales (10) 8. The use of drugs to inhibit the effects of narcotic substances, as with naloxone (8.8) 10. Life support system (1.1.1) 15. Ate too much, binged, engorged (12) 17. Symbol for europium (2) 21. A unit of electrical charge (9) 23. Caused acetic fermentation; became vinegar (9) 25. Symbol for rhenium (2) 26. Standard deviation (1.1) 28. A polygon whose angles are equal (6) 29. The third sign of the zodiac (6) 32. The first digit on the radial side of the hand (5) THE LAMP AUGUST 2017 | 41
WARMERS 4 2
Winter is here. Keep warm in NSWNMA winter favourites which are not only stylish & comfortable,but also affordable & sold at cost to members. 1 CLEARANCE! Navy Bonded Polar Fleece Vests $15. Quantity:
2 Navy Hoodies $45. Quantity: Size:
3 Red Hoodies $45. Quantity: Size:
METHOD OF PAYMENT Cheque MasterCard
4 Active Soft Shell Navy Jacket $50. Quantity: Size:
5 Bonded Polar Fleece Zip Front Jacket $30. Quantity: Size: L XL XXL XXXL
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Postage and Handling $5 per item. Total cost of order $
TO ORDER » WWW.NSWNMA.ASN.AU 42 | THE LAMP MARCH 2017
FAX (02) 9662 1414 POST NSWNMA, 50 O’Dea Ave. Waterloo NSW 2017
REVIEWS DISCOUNT BOOKS FOR MEMBERS The Library is pleased to announce that McGraw Hill Publishers are now offering members a 25% discount off the RRP! The offer currently covers medical as well as a range of other professional series books. Please see the online Book Me reviews for a link to the promotion code and further instructions, or contact the Library directly for further information.
Part of the Understanding Public Health series, this book offers students and practitioners an accessible exploration of global health.
Edited by Johanna Hanefeld McGraw Hill Education http://www.mheducation.com.au/ RRP $82.95. ISBN 9780335264087
Globalisation and Health
All the latest Book Club reviews from The Lamp can be read online at www.nswnma.asn.au/libraryservices/book-reviews.
IN T E
Global health is a relatively new but rapidly expanding field as public health practitioners recognize the important challenges that global changes are posing for human health. Health issues are increasingly crossing national boundaries, and this book explores the actors that shape global health, including private companies, foundations, civil society and multilateral organisations, and explores some of the key issues in global health.
The Body Keeps The Score: Mind, Brain And Body In The Transformation Of Trauma Bessel A. van der Kolk
Penguin Books Ltd: https://www. bookdepository.com/ RRP $16.16 ISBN 9780141978611
What causes people to continually relive what they most want to forget, and what treatments could help restore them to a life with purpose and joy? Here, Dr Bessel van der Kolk offers a new paradigm for effectively treating traumatic stress. Neither talking nor drug therapies have proven entirely satisfactory. With stories of his own work and those of specialists around the globe, The Body Keeps the Score sheds new light on the routes away from trauma – which lie in the regulation and syncing of body and mind, using sport, drama, yoga, mindfulness, meditation and other routes to equilibrium.
The Evolving Project of Labour Law: Foundations, Development and Future Research Directions John Howe, Anna Chapman, Ingrid Landau Federation Press: http://www.booktopia.com.au/ RRP $88.25. ISBN 9781760021313
This collection draws together contributions from leading Australian
and international labour law scholars, based on papers delivered at a conference to mark the 21st birthday of the Centre for Employment and Labour Relations Law at the University of Melbourne. Collectively, the contributions provide an account and exploration of labour law scholarship’s evolution over the last two decades, and its future trajectory. They explore a number of enduring and emerging themes in labour law.
Physical Healthcare and Promotion in Mental Health Nursing Stan Mutsatsa McGraw–Hill Education: http:// www.footprint.com.au/ RRP $66.00. ISBN 9781446268186
It is essential for mental health nurses to understand the physical health needs of people with mental health disorders in order to provide holistic care. Yet these people often have their physical health needs unrecognised or poorly managed. This text is a practical and informative guide to the physical health care of people with mental health illnesses. It covers a range of health-promotion strategies, including exercise, diet and oral health, and assessment, intervention and skills for common physical disorders found in people with mental-health problems. It takes a recovery perspective and emphasises the importance of communication and collaborative care for adherence to healthy lifestyles.
Advanced Practice Psychiatric Nursing, Second Edition Joyce J. Fitzpatrick and Kathleen Tusaie Springer Publishing Company: http://www.angusrobertson. com.au/ RRP $149.05. ISBN 9780826132536
This text reinvigorates the emphasis on the therapeutic relationship that is the core of nursing practice. It also relies on our strong history as therapists and introduces a need for integration of all aspects of care, a true holistic approach that characterises the nursing perspective. This book should serve as a review for nurses who are studying for certification exams and is very useful for coursework in DNP programs as well as the masters programs in psychiatric mental health nursing.
All books can be ordered through the publisher or your local bookshop. NSWNMA members can borrow the books featured here via the Library’s Online Catalogue: visit http:// www.nswnma.asn.au/library-services. Call 8595 1234 or 1300 367 962, or email email@example.com for assistance with loans or research. Some books are reviewed using information supplied and have not been independently reviewed. THE LAMP AUGUST 2017 | 43
ASSOCIATION MEMBER TRAINING
Trade Union Training for NSWNMA Members BRANCH ESSENTIALS
WINNING AT WORK
6-7 September 22-23 November
13-14 September 8-9 November
19 September 21 November
8:30am registration for 9am start 5pm close
8:30am registration for 9am start 5pm close
NSWNMA Waterloo Office
NSWNMA Waterloo Office
10am â€“ 4pm (Followed by Committee of Delegates) NSWNMA Waterloo Office
The most effective unions are those that have active workplace representatives. This 2-day course aims to provide you with the skills and knowledge you need to understand how the NSWNMA can win improvements in your workplace, across the industry, and how you can be an effective branch member. This is a MUST DO for newly elected branch officials, those wanting to brush up, or any members keen to become more involved in the Association.
This course is aimed at members who are ready to take it up a notch. Perhaps thereâ€™s a long standing issue at work that needs a bigger campaign, perhaps your branch is involved in the state-wide issues or perhaps you want to develop skills to campaign in your community. This 2-day course explores how we achieve change and how we encourage decision makers to make the right choice for our communities.
For more information on any of the courses outlined:
The NSWNMA also offers the courses on assisting members during fact finding and disciplinary processes and a range of professional development subjects. For more information on any of these courses please give us a call on 1300 367 962 or email us at firstname.lastname@example.org
P 8595 1234 METRO
1300 367 962 NON-METRO E training@ nswnma.asn.au 44 | THE LAMP AUGUST 2017
This course looks at the role of delegates and how your role fits within the NSWNMA. It will help you build confidence around participating as a delegate in your Branch, at Committee of Delegates and Annual Conference
Registration forms and copies of the course outlines are available on our website:
at the movies
Chris Ladera, RN at CCU St Vincent’s Hospital is this month’s reviewer. If you would like to be a movie reviewer, email email@example.com
When the maid got invited to dinner We meet wealthy American couple, Anne (Toni Collette) and Bob (Harvey Keitel), riding bicycles around the romantic streets of Paris. Their marriage troubles are evident early on – one is increasingly frustrated and the other ready to give up. While preparing for a glamorous dinner in their luxurious Parisian manor, highly superstitious Anne is mortified to find out that the dining table is set for thirteen guests. She demands Maria (Rossy de Palma), her loyal maid, join them for dinner as her mysterious Spanish friend. Maria reluctantly agrees and joins the affluent and powerful group for dinner. Seemingly out of place, she is instructed by Anne to smile and to remain invisible. Wine and lively chatter puts Maria at ease and inadvertently captivates David (Michael Smiley), a British aristocrat and art broker. A delightful and unlikely love affair begins. A little romance proves to be a novel cure for the uninspired and mundane. Not everyone is happy with the socially incompatible romance, however. Anne, despite appearing
to have everything, finds herself unimpressed by the aberrant pairing, chasing her maid around the city of love. It may be easy to dismiss the film as a tale of a modern Cinderella, however contrary to typical romantic comedies the film explores how Maria and David’s romance fit into their separate worlds. Ultimately, the film challenges the seemingly dated themes of love and status in modern society. French novelist Amanda Sthers, the film’s writer and director charms audiences with this comedydrama. She describes the film as neither French nor American, a reflection of our increasingly global society. The film is as colourful and vibrant as its characters. Toni Collette impressively embodies the visibly distraught, Anne. Spanish actress and Pedro Almadovar’s muse, Rossy de Palma, enthralls as Maria. Harvey Keitel and Michael Smiley rounds up the stellar cast as Bob and David. Email The Lamp by the 12th of the month to be in the draw to win a double pass to Madame thanks to StudioCanal. Email your name, membership number, address and telephone number to lamp@nswnma. asn.au for a chance to win!
E GIV E
EM OM B
The Frozen Dead A horrific discovery in a small town nestled high in the French Pyrenees begins to unravel a dark mystery that has been hidden for years. On an unforgiving winter morning, a group of workers discover the headless body of a horse, hanging suspended from the edge of a frozen cliff. Commandant Martin Servaz starts investigating and soon discovers a dark story of madness and revenge. Email The Lamp by the 15th of the month to be in the draw to win a DVD of The Frozen Dead thanks to Acorn Media. Email your name, membership number, address and telephone number to lamp@ nswnma.asn.au for a chance to win! THE LAMP AUGUST 2017 | 45
make a date
Diary Dates for conferences, seminars, meetings, and reunions is a free service for members. firstname.lastname@example.org
EVENTS: NSW SESLHD Breastfeeding Education Day 2 August 2017 Research and Education Centre Auditorium, St George Public Hospital Kirstin.email@example.com National Health Innovation and Research Symposium 3-4 August 2017 Opal Cove Resort, Coffs Harbour http://www.mnclhdevents.com.au/ Psychosocial Dimensions of End Stage Kidney Disease Thursday 10th August, 2017 St George Hospital, Kogarah firstname.lastname@example.org Renal Supportive Care Symposium Friday 11th August, 2017 St George Hospital, Kogarah email@example.com Drug and Alcohol Nurses of Australasia Nursing Forum 11 August 2017 Sydney http://www.danaonline.org/ National Nursing Forum ‘Making Change Happen’ 21-23 August 2017 Event Centre, The Star www.acn.edu.au/nnf2017 4th International Collaboration of Perianaesthesia Nurses [ICPAN] Conference 1-4 November 2017 Luna Park, Sydney www.icpan2017.com.au Australian College of Critical Care Nurses NSW Branch Seminar 17 November 2017 Colombo House Theatres, UNSW, Randwick https://www.acccn.com.au/events/ event/nsw-critical-care-seminar-17november-2017 Westmead Hospital Critical Care Nursing Conference 3 November 2017 Jennifer Yanga: Jennifer.Yanga@health. nsw.gov.au EVENTS: INTERSTATE Nursing Informatics Australia Conference 6 August 2017, Southbank, Brisbane https://www.hisa.org.au/hic/nia/ Australian Palliative Care Conference 6-8 September 2017 Adelaide Convention Centre http://pca2017.org.au/ 4th National Eating Disorders and Obesity Conference 7-8 August 2017, Gold Coast http://eatingdisordersaustralia.org.au/ 46 | THE LAMP AUGUST 2017
Please send event details in the format used here: event name, date and location, contact details – by the 5th of each preceding month. Send your event details to: firstname.lastname@example.org Fax 02 9662 1414 Post 50 O’Dea Ave, Waterloo NSW 2017. All listings are edited for the purposes of style and space. Priority is given to non-profit professional events.
SMART STROKES 2017 Conference Marriott Resort, Surfers Paradise, QLD 10-11 August 2017 Website: http://www.smartstrokes.com. au/ 18th International Mental Health Conference 21-23 August 2017 Gold Coast http://anzmh.asn.au/conference/ Indigenous Drug and Alcohol Misuse Conference 21-23 August 2017 Stamford Plaza. Brisbane www.indigenousconferences.com The Art and Science of Spiritual Care October 2017 Adelaide www.ncfansw.org 20th ACM National Conference 2017 30 October – 2 November Adelaide http://www.acm2017.org/conference2017/ EVENTS: INTERNATIONAL 6th World Congress of Clinical Safety 6-8 September 2017 Rome, Italy www.iarmm.org/6WCCS 8th International Nursing and Midwifery Student Conference in Spiritual Care: Spiritual Care – A resource in nursing 21-22 September 2017 Copenhagen, Denmark http://diakonissestiftelsen.dk 3rd Shanghai International Nursing Conference 28-30 September 2017 Shanghai, China http://nursing.knwpartners.com IHF 41st World Hospital Congress 7 October – 9 November Taipei International Convention Centre, Taiwan https://ihfnews.files.wordpress. com/2017/01/ihf-tapei-call-for-abstracts11jan17.pdf 10th European Congress on Violence in Clinical Psychiatry 26-28 October 2017 Crown Plaza, Dublin, Ireland http://www.oudconsultancy.nl/dublin_10_ ECVCP/index.html 4th Commonwealth Nurses and Midwives Conference 12 March 2018 London UK http://www.commonwealthnurses.org/ conference2018 NCFI PACEA Conference ‘Christian nursing in a troubled world’ 7-11 June 2018 Taipei, Taiwan ncfi.org/conference/ ncfi-pacea-regional-conference
EVENTS: REUNIONS Sydney Hospital Graduate Nurses’ Reunion Lunch 4 October 2017 Parliament House, Macquarie Street Jeanette Fox: (02) 4751 4829 or email@example.com St George Hospital Graduate Nurses Association 70th Anniversary and Reunion 22 October 2017, 12 noon The Gardens on Forest, 764 Forest Rd, Peakhurst Joan Wagstaff: 02 9771 2508 Prince of Wales, Prince Henry Hospitals and Eastern Suburbs NSW of UNSW 1973 PTS class 17 February 2018, 6 pm Malabar (Randwick) Golf Club Roslyn Kerr: firstname.lastname@example.org Patricia Marshall (Purdy): email@example.com Tamworth Base Hospital February 1984 Intake 30–year Reunion 25 November 2017 Rachel Peake: Rachel.Peake@hnehealth. nsw.gov.au Vickie Croker: Vickie.Croker@hnehealth. nsw.gov.au Wendy Colley: Wendy.Colley@hnehealth. nsw.gov.au RNSH Hospital July 1977 Intake 40–year Reunion Ann Fincher (Wyllie-Olson): firstname.lastname@example.org Linda Tebbutt: email@example.com Tamworth Base Hospital February 1976 intake 40-year Reunion Sandra Cox: firstname.lastname@example.org Sean O’Connor: 0408 349 126 Gerard Jeffery: 0417 664 993 Camden District Hospital PTS February 1978 Reunion Gay Woodhouse 0438 422 069 Gay.email@example.com CROSSWORD SOLUTION
Do you want to escape to
i! l w a r a r e n d b d g o e i h n a t t o m e m B u, ew g n g n a a C n i t n i a w 5 night holiday to rui
The 2017–2018 NSWNMA Member Recruitment scheme prize The winner will experience their very own private oasis in two luxurious villas, with the following inclusions (for two): g 5 nights’ accommodation at two super luxe properties located in Canggu, Bali (3 nights at Sandhya Villa and 2 nights at Lalasa Villas) g Return airport transfers and transfers from Sandhya Villa to Lalasa Villas g Breakfast daily g One (1) dinner for two guests at Lalasa Villas g One (1) 60 minute massage for 2 guests at Unagi Spa g The NSWNMA will arrange return flights for two to Denpasar. You will experience a serene and peaceful holiday away from the hustle and bustle, with Seminyak’s fabulous restaurants and shopping just a stone’s throw away. Relax by your private pool, take a free shuttle service to Berawa Beach or explore the village of Canggu. Recruiters note: Join online at www.nswnma.asn.au. If you refer a member to join online, make sure you ask them to put your name and workplace on the online application form. You will then be entered in to the NSWNMA Member Recruitment scheme draw.
Every member you sign up over the year gives you an entry in the draw! Conditions apply. Prize must be redeemed by 30 June 2019 and is subject to room availability. Block out dates 1-30 August 2018 and 24 December 2018 – 5 January 2019. Competition opens on 1 August 2017 and closes 30 June 2018. The prize will be drawn on 30 June 2018. If a redraw is required for an unclaimed prize it must be held up to 3 months from the original draw date. NSW Permit no: LTPM/17/01625
Prize drawn 30 June 2018
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