Assistant Secretary Sam Casey
One of the most common questions we get asked by mental health nurse members is when will we get nurse-to-consumer ratios in public mental health?
ANMF (Vic Branch) has consistently advocated and campaigned for ratios to be universal, across public and private, general healthcare, mental healthcare and aged care.
The Victorian government – as the employer of the state’s 60,000+ public sector nurses, midwives and carers – fought us for many years on the matter of ratios before finally securing them in legislation them in 2015.
ANMF and members continue to campaign in the private sector for safe staffing requirements in enterprise agreements.
To understand the challenge, it’s necessary to understand the history.
The road to ratios
Victoria was only the second place in the world, after California in the US, to secure mandated ratios – on 31 August 2000 – and was the first to implement (general) ratios, in 2001, via the public sector general agreement.
But, having gained nurse/midwife-to-patient ratios, ANMF and our members spent the next 12 years campaigning to keep them.
‘Every government, no matter what persuasion, Liberal and Labor from 1999 through to 2011/12, opposed ratios,’ says former ANMF (Vic Branch) Assistant Secretary Paul Gilbert. ‘The government always tried to corner us so that we’d end up in a situation where ratios were under dire threat.’
In 2011/12, a leaked cabinet in-confidence document revealed the Napthine/Baillieu Government’s secret plan to replace nurses and midwives with cheaper ‘health assistants’. It led to the longest EBA campaign in Victorian nursing and midwifery history.
It also directly contributed to the most significant achievement in ratios since their implementation: enshrining them in law: members’ campaigning in 2011/12 convinced then Opposition leader Daniel Andrews to make the historic commitment to legislate nurse- and midwife-to-patient ratios should he win office at the 2014 state election.
‘These promises, these commitments would not have come if it wasn’t for ANMF delegates, members and those who work for the union convincing us that these matters needed to be beyond doubt,’ he said at the time.
‘That ratios needed to be off the table, not part of the [EBA] negotiating process. ANMF delegates and members, and the union’s leadership, convinced us of this and these changes would not have happened without them.’
The Safe Patient Care Act – the state legislation that mandates ratios in the general public sector – was proclaimed law on 23 December 2015.
Why not mental health?
The ratios gained via the general public sector EBA did not cover nurses working in mental health because Victoria has separate EBAs for nurses in general public health services and public mental health services. We have previously written about the history that led to this situation.
This also meant that legislated ratios, which replaced EBA ratios, also explicitly excluded ‘any ward that is being predominantly utilised for the care of persons being treated for a mental illness within the meaning of the Mental Health and Wellbeing Act 2022’.
Achieving staffing profiles in the mental health EBA has also been complicated by the fact that the public mental health agreement also covers all other employees in these services – including allied health professionals, support staff and admin – and until recently, HACSU, the union representing these staff, has also opposed ratios for nurses in mental health.
Throughout this time, ANMF has continued to advocate for ratios in public mental health. We have achieved additional EFT for mental health nurses in each EBA since 2016, including:
- 125 mental health nursing EFT in 2016
- Additional mental health nursing EFT for high dependency units, SECUs, and older adult mental health in 2020, as well as additional EFT for parent infant units, and grad support nurses in 2026.
- minimum staffing levels in bed-based services embedded in the 2024–2028 EBA, which are the next step towards ratios.
These staffing profiles in bed-based services provide transparency and safeguards for minimum nurses in bed-based services and provide protections to operationalise the management of changes through consultation.
While we chip away at progress via the EBA, we also continue to advocate for amendments to the Safe Patient Care Act to include mental health.
We welcome HACSU in joining ANMF’s longstanding calls for mental health nurse ratios in public mental health, and we have sought a commitment from the Carroll Government for legislated nurse ratios in public sector mental health.
What about the private sector?
Each private sector employer is covered by its own EBA, or by the national Nurses Award. ANMF has consistently advocated for ratios in the private sector EBAs we negotiate but most employers oppose the idea.
We have been making headway, however, with several recent agreements including safe staffing provisions and workload escalation clauses that are a stepping stone towards ratios.
We have also called on the state government to update the Health Services Regulations that cover private hospitals and day procedure centres to establish minimum nurse-to-patient and midwife-to-patient ratios these are identical to or align closely with the Safe Patient Care Act.
