I recently watched ACT MP Todd Stephenson delivering a speech in Parliament outlining his concerns that health professionals are required to practise in a culturally safe manner and that this requirement is embedded in measurable competencies.
Clearly the concern of Stephenson and his colleagues in the ACT party underpins the current coalition drive to “modernise health workforce regulation”.
Submissions on this proposal are currently open (closing on April 30), aimed at the public and presented as a set of very disingenuous questions which work to capture the very answer they wish to hear.
Working on the same assumptions which underpinned the proposed Treaty Principles Bill, they suggest, innocently, that everyone should be treated the same. On the face of it this is a seemingly compelling argument designed to capture the support of those who have not thought deeply about this, nor been closely involved in providing health services.
I describe the questions as disingenuous because while it is described as seeking patient-centred regulation, it is really Government-centred, asking regulatory agencies to act in accord with Government direction rather than evidence, which is horribly reminiscent of the current chaos in the United States.
Listening to Stephenson took me back to the early 1990s when there was a similar uproar.
Importantly, there is a fundamental tenet that any changes in regulation should be addressed to solving an identified problem. In this instance, there is no identified problem. Changes to regulation will not increase the number of health professionals available and will certainly not make them safer to practise.
Such concerns on the part of the ACT Party and many of their coalition counterparts demonstrate a spectacular level of ignorance.
Listening to Stephenson took me back to the early 1990s when there was a similar uproar. MPs (of similar right-wing persuasion) became exercised about the requirement for nurses to have awareness of the impact of colonisation and the cultural needs of Māori patients, and to understand biculturalism as an appropriate foundation for also acknowledging the multi-cultural needs of New Zealand’s diverse population.
Why culture matters in health
During the 1990s we fought a tedious battle to protect the right for nurses to be educated according to the overwhelming evidence. Such evidence shows that unless health care is regardful of people’s context and culture, it is likely to be less effective.
I am not referring to surgical processes and medical procedures, which of course are shaped by anatomy and evidence, not culture. But I am talking about how we relate to people, what we know to be important for that person and what the context is that shapes their health literacy and their options and choices. Without this knowledge and awareness, our efforts are often cruel and often wasted.
Ironically, Stephenson noted that in his view nurses just really need skill and a big heart. And of course he drew on the concerns of the inevitable few nurses who have expressed their outrage at needing to be culturally competent. Nursing is a very large professional group and it is of course sadly true that there are those among us who choose not to understand.
Without this knowledge and awareness, our efforts are often cruel and often wasted.
Having a big heart in nursing means delivering a high level of knowledge-based expertise, but with deep compassion and consideration for those for whom we care. If we act in a way that is oblivious to ethnicity, sexuality, power differentials and difference of any sort, then our hearts are closed and our care will be less than that person needs.
It is hugely annoying to watch MPs pontificating on something about which they have a very superficial understanding. It is also frustrating that when we are currently struggling to continue to deliver care in very difficult circumstances, we must yet again defend the safe regulation of health professionals.
It is beyond foolish to endanger that process through an ideological drive to remove our commitment to te Tiriti.
The only reason for regulating health professionals is public safety. The regulatory process is how we ensure that their education is fit for purpose, that the incoming internationally qualified workforce meet our standards, and it is how we ensure that the few unsafe practitioners are managed out of patient care.
It is beyond foolish to endanger that process through an ideological drive to remove our commitment to te Tiriti.
For Māori as tangata whenua of Aotearoa, our drive to provide culturally safe care is a matter of our obligation to te Tiriti and simple respect rather than practising with arrogance and ignorance. It is a matter of being effective rather than failing. It is based on compassion rather than disregard.
And above all it is based on evidence that culturally competent care produces better results which is obviously cost effective and this, if nothing else, should interest the coalition.
Jenny Carryer, RN, PhD, CNZM, is a professor in the school of nursing at Massey University, and an honorary professor in Auckland University’s school of nursing.
- This viewpoint was originally published in The Post. It is reprinted here with permission.