Activism on all fronts ensures victory: community health services in Wellington, Kenepuru and Kapiti are to stay with the district health board, thanks to a multi-faceted campaign.

Capital and Coast District Health Board (CCDHB) district nurses (DN) and community support workers have won their battle to keep their services in public ownership. Key factors in the victory were unflinching NZNO support, delegate and community activism, political lobbying and professional nursing input.

After several years of reviews, DHB chief executive Ken Whelan announced last month that community health services would remain with the DHB. The announcement was a vindication of the We Care campaign, the activism in affected communities and the tireless efforts of NZNO delegates and members and organiser Barbara Crozier. The services are provided from three sites, Wellington, Kenepuru and Kapiti, by a staff of 100 DNs and community support workers.

The most recent review of the service began in December 2006. At that time, staff morale was very Low because of the endless reviews and the DHB's historic lack of genuine community consultation. "Members never thought we could win the fight," Crozier said. "One of the key reasons we did was because the community took a stand, formed the We Care group to fight the DHB's plans and presented a 6000-strong petition opposing the privatisation to Otaki MP Darren Hughes at Parliament in July last year."

NZNO delegates were very active in the community campaign, lobbying Labour MPs Hughes and Winne Laban, chair of the Health Select Committee, Green MP Sue Kedgley, and DHB members. "Winnie Laban was instrumental in making the DHB management consult with the community," Crozier said.

Crozier and NZNO delegates also talked about the proposed options at community gatherings and encouraged grassroots community involvement--writing to politicians, attending public meetings, signing petitions.

Kapiti Coast District councillor and member of We Care, Lyndy McIntyre, said people power was a huge factor in the win. Fifteen hundred Kapiti people participated in the formal DHB consultation. "What was significant was the intensity of the community campaign, which continued until the issue was won," she said.

The We Care group travelled to Wellington to lobby DHB members and placed advertisements in local papers calling on the community to take a stand. The role of Paraparaumu man Philip Segedin, who has multiple sclerosis and depends on the service daily, was crucial in mobilising community support. He launched the campaign with the petition and sent hundreds of letters to MPs.

When the DHB announced there would be no privatisation, the community applauded the decision. However, the DHB subsequently announced it was considering a partnership with another provider. "The campaign cranked up again. The relentless campaigning paid off," McIntyre said.

While community campaigning was crucial, NZNO's comprehensive submission, the result of extensive consultation with charge nurse managers, DNs and community support workers, detailed the professional practice concerns with privatisation. "The key to the success of this submission was the hard work of members on the working party formed to develop the submission, the information and research it contained, and the knowledge and expertise of NZNO professional nursing adviser Charlotte Thompson," Crozier said.

Seeking Government's views

Crozier took any opportunity to ask government representatives their views on the privatisation of the service. At the Council of Trade Unions' forum in Wellington in April, both the Prime Minister Helen Clark and Minister of Health David Cunliffe reassured Crozier they did not support privatisation. "This was a very empowering experience, as I took this information back to DHB management," she said.

Media interest in the story was also important in bringing the issues to a wider audience and keeping the pressure on the DHB.

Kenepuru DN Kim Poole said the DHB's announcement was a welcome surprise. "The uncertainty of the lengthy review affected staff morale. This negativity also had an influence on recruitment and retention," she said. But retaining the service was a vote of confidence in DNs, who were a critical element in community health care and whose role had evolved to encompass palliative care, chronic disease management, infection management, as well as more traditional services such as wound care.

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District nurses wanted all those involved in the campaign to know just how crucial their contributions were. "We want to thank the local communities, Kapiti in particular, for their tireless campaign to retain the service and all those who supported us," Poole said.

Wellington DN Anne Leslie said nurses were "delighted and relieved" at the decision, which meant they could now get on with "developing rather than defending the service"

The widespread community support also showed appreciation for the value of the service throughout the region, she said.

Reflecting on the campaign, Crozier believes engaging the community, political lobbying, extensive communication, remaining positive--"even through the tough times"--staying in close contact with members to ensure their issues were heard, supporting delegates to be leaders, liaising with NZNO's DN section and professional staff, and developing a thick skin to deal with DHB management, were crucial success factors.

The campaign is not over yet. The next stage is for a small working group to meet with management and scope out some of the ideas presented in NZNO's submission. These will go to the board in October. "I feel really proud of NZNO's submission and that it is going to be used to improve the service to the community. After all, that's what we are about at the end of the day," Crozier said.

What this campaign proves beyond doubt is that NZNO's industrial and professional expertise, combined with member and community activism and political lobbying, are powerful forces against privatisation. That's an important lesson to remember whenever public health services are under review.