Two steps forward, one step back

"Rewriting the regulations: how the World Trade Organisation
could accelerate privatisation in health-care systems"

by Allyson M. Pollock & David Price, The Lancet

09 December 2000

"The World Trade Organisation (WTO) is drawing up regulatory proposals which
could force governments to open up their public services to foreign investors
and markets." "The legal tests under consideration would outlaw the use of
non-market mechanisms such as cross-subsidisation, universal risk pooling,
solidarity and public accountability in the design, funding, and delivery of
public services as being anti-competitive and restrictive to trade."

"Most European health-care systems guarantee access to health care as a
universal right. Because of this, health care is funded either through
general taxation or social insurance with the role of for-profit firms
severely limited or banned altogether. To extend rights of access for private
firms, the WTO, with the backing of powerful trading blocs, multinational
corporations, and US and European governments, is attempting to use
regulatory reform to challenge limitations of private-sector involvement.
But this amounts to a challenge to the principles that lie at the heart of
social welfare systems in Europe. The new criteria proposed at the WTO
threaten some of the key mechanisms that allow governments to guarantee
health care for their populations by requiring governments to demonstrate
that their pursuit of social policy goals are least restrictive and least
costly to trade."

And, in and accompanying editorial:

"US health-maintenance organisations, whose profits have plummeted through
market saturation and efforts by government and employers to limit
health-care costs, hope to restore profitability by expanding abroad."

The other side:

WTO NEWS
Brussels 27 November 2000
"WTO Secretariat hits false attacks against GATS"

David Hartridge, Director of Trade in Services Division, WTO Secretariat:

"We also have to be clear that public sector services, in health and
education for example, can and almost invariable do coexist in the same
jurisdiction with private suppliers without being in competition with them
and therefore without losing the status of governmental services. Police
services don't 'compete' with private security firms working alongside them."

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Cosatu threatens general strike over labour law changes

December 22, 2000

Johannesburg (Reuters) - The Congress of SA Trade Unions (Cosatu) warned on
Thursday that it will call a general three-day strike in March if the
government does not back down from proposed changes to labour laws which
threaten job losses.

Zwelinzima Vavi, head of the 1.8 million strong labour federation, told the
SA Press Association that if no resolution is reached, the federation will
embark on protests every three months.

"They've [government and business] got all the time to reach an acceptable
compromise with us. If they don't it's because they are not willing to do
so," he told Sapa. The first general strike would take place between March 28
and 30.

Cosatu, the main political ally of the ANC, has repeatedly threatened strikes
over the proposed labour law changes, which have yet to be passed by
parliament. They include stripping workers of the right to strike over
retrenchments and removing extra pay for working on Sunday.

Labour Minister Membathisi Mdladlana maintains that the government will not
ditch the amendments, which business groups say are vital to woo foreign
investors and create more jobs. South Africa's unemployment rate is estimated
at a crippling 30 percent, although evidence shows that informal jobs are
increasing.

On Wednesday, Cosatu demanded that state-run telecoms body Telkom reinstate 2
374 employees which it plans to lay off, saying that it may suspend its
agreement with the government on the restructuring of state-owned enterprises
as a result.

Analysts say that the latest objections from Cosatu may point to further
labour instability in the year ahead, and rising tension between the trade
federation and the ANC over the government's privatisation programme. The
labour amendments are expected to be made law by February 2001.

"It's a threat that's running through the privatisation initiative ... that's
why it's taking so long, but I think the government is highly committed," ABN
Amro's Colen Garrow said. "There's been speculation that if there is a
breakdown in the alliance it could be because of privatisation."

The government aims to raise R40 billion from the restructuring of state
assets over the next four years, starting with an Initial Public Offering of
up to 30 percent of Telkom late in 2001.

Senior Cosatu workers and the Communication Workers' Union staged a two-day
sit-in at the Telkom offices to protest against the job losses. It ended on
Thursday, when Telkom issued a statement saying that it had invested more
than R400 million in a social plan to minimise the impact of retrenchments on
employees.

"The company reconfirmed its willingness to consult with organised labour on
any future severance packages, be it voluntary or involuntary. It has since
November 2, 2000 invited CWU for consultations around these matters," Telkom
said.

Copyright 2000 Reuters Ltd.

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This press release highlights MNA's legislative priorities for 2001. A bill
to mandate safe staffing levels in all health care settings tops the list.
For more information on all the bills filed by MNA, including fact sheets,
and the text of the bills themselves, visit the MNA web site at
<http://www.massnurses.org> www.massnurses.org and click the world
"Legislation" on the left-hand navigation bar; then click on the link for the
2000-2001 legislative agenda.

Also, nurses and supporters of this legislation are invited to attend the
MNA's annual Nurse Lobby Day at the State House, Thursday, March 8, 2001 from
8:30 AM until noon. Continuing education credits are provided, and this
event provides an opportunity for nurses and nursing students to learn about
this legislation, meet with legislators and help lobby for its passage.

Please feel free to share this message with your email lists.

P R E S S R E L E A S E
FOR IMMEDIATE RELEASE
January 4, 2001
Contact: David Schildmeier 781-821-4625 x717 or 781-249-0430

Safe Staffing Bill Tops List on MNA State House Agenda

CANTON, Mass. -- The nursing shortage, an increase in medical errors,
mandatory overtime, decreased satisfaction of nurses with their practice, a
dramatic rise in injuries among nurses; What do these hot-button issues in
nursing have in common? They are all related to the underlying and core
issue of inadequate nurse staffing.

The State of California responded to this crisis by becoming the first state
in the nation to pass legislation in 1999 that mandates safe staffing levels
in all health care settings. Here in Massachusetts, the MNA has proposed
similar legislation for four years running, and in December, it did so again.


Passage of legislation to mandate and monitor safe staffing levels in all
health care facilities is priority one for the MNA in 2001. In December, the
MNA filed an impressive package of bills to provide unprecedented protection
for nurses and patients in Massachusetts. The centerpiece of that package is
"An Act Relative to Sufficient Nurse Staffing to Ensure Safe Care," which is
a safe staffing bill sponsored by State Representative Christine Canavan, RN
(D-Brockton) and State Senator Robert Creedon (R-Brockton) who both served as
co-chairs of the Nursing Commission, a legislative committee that spent the
last year investigating the current nursing crisis.

Recent nursing research, as well as a number of media exposes, have made a
clear link between decreasing nursing staffing levels and unsafe
nurse-to-patient ratios and the problems of medical errors, unsafe patient
care conditions and the nursing shortage. It is not uncommon for
medical/surgical nurses at a Massachusetts hospital to be assigned between 9
- 12 patients on a shift, or nurses working in long term care to be assigned
30 - 40 patients. Home care nurses, who a few years ago were seeing 5-6
patients in a day, are now being asked to see between 7-9 patients. And in
all of these settings, patients are more acutely ill and in need of more
nursing care.

"This bill is of paramount importance to the future of the nursing profession
in our state, providing the /most important step we can take to protecting
patients and protecting the integrity of our nursing practice," said Denise
Garlick, President of MNA.

What the Bill Does

Current DPH regulations only require hospitals to provide "sufficient"
nursing care, without defining what is sufficient. The legislation would
solve the problem by mandating the creation, posting and monitoring of nurse
staffing levels in all health care settings that are sufficient to care for
the planned and unplanned needs of patients. The major provisions of the
legislation include:

* The creation of a nurse staffing commission that must work
collaboratively with the Department of Public Health (DPH) in relation to the
development of a nurse staffing plan;

* The promulgation of staffing rules and regulations within one year of the
passage of the act;

* Each facility would be required to anticipate, design and adhere to a
daily written staffing plan specific to each unit or specialty area of
practice as required by patients or residents to maintain safety and to
support nursing staff compliance with applicable professionally recognized
standards of nursing practice;

* That the regulations shall be enforced by DPH and that they be based upon
accepted standards of nursing practice, patient or resident classification
system(s), patients' or residents' acuity level and functional capacity for
self-care;

* The creation of specialty registered nurse positions which increase the
quality of patient care including: Nurse Executive, Occupational Health and
Safety Nurse, and Quality Assurance Nurse;

* Clear language related to the role of the licensed nurse and the
inability for institutions to delegate to unlicensed personnel duties which
demand nursing expertise;

* The utilization of research by the designated quality assurance
registered nurse to evaluate nursing services and nurse staffing in relation
to medical errors and patient outcomes;

* Strong consumer protections for "sufficient nurse staffing" including a
prominent posting of the daily written nurse staffing plan on each unit to
reflect the nurse to patient ratio per each shift as a means of consumer
information and protection; and

* Each facility will provide each patient and/or family member with a
toll-free hotline number for the Division of Health Care Quality at DPH,
which may be used to report inadequate nurse staffing. Such complaint shall
cause investigation by DPH to determine whether any violation of law or
regulation by the facility has occurred and fines for such substantiated
violations.

In addition to the safe staffing bill, the MNA has proposed additional
legislative initiatives to address the growing crisis in nursing. Entitled,
"Nursing's Agenda for Quality Care", the MNA's 2001 legislative package was
developed by its Congress on Health Policy and Legislation, with guidance
provided by a Blue Ribbon Commission of nurses from all areas of nursing
practice convened last year to assist in developing a nursing agenda that
solved the problems of nurses in practice today.

Below is a summary of key components of the MNA legislative package:

An Act Relative to Patient's Report Card of Nursing, which is sponsored by
Rep. Cory Atkins, (D-Concord) and Sen. Guy Glodis, (D-Worcester) would
mandate that all hospitals, clinics, long term care facilities and HMOs track
and report to the public annual data regarding staffing levels and skill mix
ratios; as well as nurse-sensitive patient outcomes, such as patient falls,
nosocomio (hospital-acquired) infections, bedsores, medical errors, patient
satisfaction, readmission rates and length of stay.

An Act To Ensure Safe Medication Administration, which is sponsored by Rep.
Brian Cresta, (R-Wakefield) and Sen. Marc Pacheco, (D-Taunton) would reverse
regulatory changes which teach and mandate unlicensed direct care personnel
to administer all schedules of medications in group home settings, after only
a 16-hour course and state certification. DPH, along with other state ag
encies, have expressed an interest in expanding this dangerous program to
other settings, including home care.

An Act Relative to Improvements in Private Duty Nursing Care for
Developmentally Disabled Children, sponsored by Rep. Christine Canavan, RN,
(D-Brockton) and Sen. Steven Tolman, (D-Brighton). This bill would improve
the care to the nearly 500 severely disabled children in the Commonwealth,
most of whom are ventilator dependent. These children require 24-hour
private duty nursing care in order to avoid being institutionalized. The
current system, implemented through state contracts with private sector
agencies, fails to provide the skilled nurses needed to deliver this care,
nor does it compensate nurses enough to meet the needs of these children and
families. The legislation would create a training program for the care of
these children and a stable pool of qualified nurses. Further, the nurses
would be employed by the state and would also be granted benefits and
commensurate salaries in an attempt to decrease the rapid turnover of
providers experienced by these families.

In addition, the MNA has proposed legislation to recognized the essential
role and distinct role of nursing in the safe delivery of health care in the
Commonwealth by raising the profile and influence of nurses in key
policymaking bodies impacting health care.

An Act Relative to a Director of Nursing in the Department of Public Health,
sponsored by Sen. Mark Montigny, (D-New Bedford) and Rep. Mary Jane Simmons,
LPN, (D-Leominster) would create a Director of Nursing position in the
Department of Public Health. This person would be responsible for working
with the DPH Commissioner to ensure that nursing-related issues are
adequately monitored and considered as the department carries out its mandate
to protect the public health and regulate the health care industry.


Finally, the MNA has proposed groundbreaking legislation that would provide
for essential preventative measures to decreases incidents of workplace
violence suffered by health care workers. Working as an employee in a health
care facility is considered to be the third most dangerous job in the United
States. In fact, according to the Centers for Disease Control and NIOSH,
nursing is one of the most dangerous occupations. For example, 73% of
psychiatric nurses have been assaulted at least once. Colonial Insurance
Company, the disability insurance carrier for the commonwealth reports
actuarial data suggesting that the nurses employed by the state have the
highest incidence of traumatic injury in the workplace of all occupational
groups covered.

An Act Related to a Comprehensive Workplace Violence Prevention Programs in
Health Care, sponsored by Sen. James Jajuga, (D-Methuen) and Rep. David
Donnelly, (D-West Roxbury) would mandate a comprehensive workplace violence
prevention program in any facility employing at least five health care
workers, along with a counseling program for victims of workplace violence
who work in the delivery of health care.

In addition to these bills, the MNA has worked with Senate Health Care
Committee Chair Richard Moore on a comprehensive package of bills he has
filed to address the nursing shortage and medical error prevention. Included
in his package is the Clara Barton Nursing Excellence Program, which would
provide nursing scholarships for students entering the profession, establish
student loan repayment programs, and a signing bonus for those who have
demonstrated an excellence in nursing.