Kia ora,

My name is Grant Brookes. I'm standing for election to Capital & Coast District Health Board.

The most trusted profession have put their trust in me, electing me President of the New Zealand Nurses Organisation. Now I'm asking you to put me at the top of your list of DHB candidates this October.

I am committed to:

  • Fences at the top of the cliff, not ambulances below
  • Reversing the decline in our health funding
  • Money for health improvement, not CEO pay rises
  • Putting the "care" back into Aged Care
  • Whānau Ora – family well-being for all

  • Having stood for the Board in 2013 and narrowly missed out, I now aim to become part of a fresh, like-minded team with the energy to meet today's health challenges.

    You can find out more About me and My priorities by clicking on the links, or by contacting me on 021 053 2973, or emailing grant_brookes at paradise dot net dot nz.


    What do you think are the issues for older people?
     Like my fellow candidate David Choat, I think that older people want to lead a rewarding and engaged life with their family and friends, the same as anyone else.
     This means being valued for themselves and being enabled to make meaningful contributions, through strong connections to other people.
     But I also think that older people value security - which means personal safety, financial security, and a certainty that help is on hand if ill-health strikes.
     It's not for nothing that the Act of Parliament which underpinned New Zealand's welfare state was called the Social Security Act.
     I want to strengthen the security provided by our health system.

     What are your positions on these issues?
     I promote an "ambulance at the top of the cliff" approach to healthcare, focused on keeping people well so that they need as few of the invasive and costly treatments as possible.
     This means universal access to a GP or practice nurse when you need it. This is far from the case at the moment. A third of the people in the Capital & Coast District experienced "unmet need for primary health care" in the last year. The most common form of unmet need was being unable to get an appointment with your GP or other health professional at your usual medical centre within 24 hours. I want to help fix this problem.
     In the case of our older generation, keeping people well also means supporting them to remain in their own homes for as long as possible. Again, recent decisions by Capital & Coast DHB - such as the June 2010 decision to reduce household management support - has hindered this goal. Help with cleaning, cooking and shopping are now much more restricted. I think this decision was a mistake.
     Finally, keeping people well means tackling causes of avoidable illness such as cold and damp housing, poor diet, inactivity and social isolation. Underlying all of these social determinants of health is poverty. I think that Regional Public Health Services should be beefed up and allowed to go after these root causes of illness, to create a healthier population of younger and older people alike.

     Do you have any policy ideas you would like older people to care more about?
     The world is constantly changing. New Zealand today is very different from the country that older people grew up in.
     The migration of Māori people from the country to Greater Wellington happened within their lifetime. The Māori cultural renaissance and the arrival of new migrants have changed the face of our district.
     So I am not surprised if an older person does not immediately support these "new arrivals" in our district when they speak out about their needs.
     But I believe that non-European cultures have a lot to offer in many areas of life - including health policy. The Whānau Ora philosophy is one such contribution.
     Sadly, it has become a political football. Some of those who would like to discredit the idea have misrepresented it so that it becomes hard to understand.
     But at its core, the Whānau Ora philosophy expresses health values shared by most people. Firstly, we should help people to help themselves. And secondly, a person is not just a patient to be medicated or operated on, but a member of a family and a community, whose wellbeing underpins their own. The Whānau Ora philosophy goes hand in glove with the "ambulance at the top of the cliff" approach to keeping people well.
     I'd like people to maybe take another look at Whānau Ora. After that, I would hope that all older people cared more about this policy idea.

     How do you balance inter-generational equity in your policy thinking?
     "Inter-generational equity" is a fairly recent idea in social policy. It arose historically after the emergence of the so-called "generation gap". And I think it's a product of the "me generation".
     When New Zealand led the world in welfare for older people and children alike, a century or more ago, our system was based on a very different understanding of equity. Those in need were supported by a welfare safety net. This was funded by progressive taxation, which took more from the people who were more fortunate. This was generally accepted as fair and equitable.
     Dismantling this system involved privatisation of many parts of the social fabric - including the privatisation of retirement savings and elder care. No longer could struggling older people rely on support from the more fortunate. In the reign of the "me generation", each individual was expected to save for their own retirement, and purchase their own care.
     In this brave new world where people are expected to fend for themselves, along came the idea of "inter-generational equity". At its heart, the idea is based on the view that the older generation are a "burden" on the young.
     I reject this premise. Instead, I think we need to bring back the original understanding of equity into our policy thinking. From each according to their ability, to each according to their needs.
     Some people vote on who you are as much as what you stand for. What is it about you that you think is important for older people to know?
     I am a nurse. I have worked at the bedside and in the community to care for people for the last 17 years. Before entering nursing, I worked as a volunteer in a hospice. So I know the realities of caring for older people.
     I also bring experience of health sector governance and in-depth knowledge of the health system. I have represented Greater Wellington on the New Zealand Nurses Organisation Board of Directors and I also chair NZNO's DHB Sector Committee.
     "Putting the care back into aged care" is number one in my "top five" list of priorities, as listed on all my election campaign material.

     More broadly, what is the one policy you would like to see implemented across the health system?
     If I had to choose just one policy to be implemented across the health system, it would be for DHBs to become Living Wage employers for all their staff.
     The minimum wage in New Zealand is currently $13.75. The Living Wage campaign aims to establish a minimum pay rate which is enough for people to live and participate in society, not merely survive. The New Zealand Family Centre Social Policy Research Unit calculated this year that it would require an hourly rate of $18.40.
     This would particularly benefit the aged care sector, where a majority of care workers are on, or just above the minimum wage. Their poverty pay blights many services with high staff turnover, poor morale - in fact, in more ways than I care to mention. And what message does it send about the value of older people in our society when their carers are treated so badly?
     But the benefits of implementing the Living Wage in DHBs would flow far wider. The evidence published by British epidemiologists Richard Wilkinson and Kate Pickett, in their book The Spirit Level: Why More Equal Societies Almost Always Do Better, is very clear. Greater inequality is linked to greater health problems. And New Zealand has the fastest-growing gap between rich and poor in the Western world.
     Making DHBs Living Wage employers could could help the movement to lift low pay across the economy and create a healthier New Zealand.
     Is there anything I should have asked you about that I haven't that you think it is important for older people to know.
     No, that's all. Thank you for your thoughtful questions. If anyone wants to ask me other questions, or make suggestions, they are welcome to email me at g_brookes (at) paradise (dot) net (dot) nz.


    After years of cuts, the cracks in the health system are starting to show.

    The crisis in aged care was clear at least as far back as 2010, when opposition MPs Sue Kedgley and Winnie Laban led an inquiry into our country’s rest homes and home support services. Their "Report into Aged Care: What does the future hold for older New Zealanders?" clearly showed the emerging crisis.

    But none of the recommendations were implemented, leading to the shocking stories of neglect – such as the rest home resident who was repeatedly left lying in her own faeces – on the front page of the papers today.

    The DHB administers the contracts with these rest homes. I am standing as the Health First candidate for Capital & Coast DHB to put the care back into aged care.

    In the public hospitals, meanwhile, we are now seeing stories of "care rationing" by overstretched nurses. This is the result of years of underfunding. The Ministry of Health acknowledges that the overall funding shortfall for the four years ending 2015/16 will be $1.5 billion.

    To make things worse, the continuing cuts are driving short-term thinking at Capital & Coast. An example was the decision last year to axe funding for primary health services designed to keep people out of hospital.

    I promote an "ambulance at the top of the cliff" approach to healthcare, focused on keeping people well so they don't need invasive and costly hospital treatments.

    This also means tackling causes of ill-health such as cold, damp and overcrowded housing. We may not be able to eradicate poverty, but we must at least rid the DHB of responsibility for the problem by ensuring all directly employed and contracted staff are paid a Living Wage.

    Underfunding is also driving further privatisation, such as the move to contract out laundry services at CCDHB. I am opposed to cuts and privatisation.

    Like my fellow candidate David Choat, writing in WCC Watch Soapbox a few days ago, I believe that highlighting and resisting underfunding is a vital role for the elected governors at our DHB.

    And like him, I am committed to openness in decision-making, not secret discussions behind closed doors. I stand for local democracy, not remote bureaucracy.

    The good news, however, is that the current election for Capital & Coast DHB is likely to deliver a Board more willing to take this path. I want to contribute to this new direction.

    I am a Wellington Hospital nurse, so I understand the realities of care at the bedside and in the community. I also have experience in health sector governance, having just completed a term on the Board of Directors of the New Zealand Nurses Organisation.

    Although independent, I am standing with NZNO endorsement. If elected, my connection into the health workforce will enable me to promote action for health outside the boardroom, as well as inside.

    I am also committed to partnerships with Māori. I am honoured by endorsement from the MANA Movement.

    My appeal to voters in this election is simple. When you fill out your ballot paper for Capital & Coast DHB, remember to put Health First.

    Putting the care into aged care

    Aged care is in crisis. It’s headline news. In August, pay cuts of up to $100 a week for staff at Ranfurly Rest Home and Hospital in Auckland were the lead story on Campbell Live (When your employer proposes a pay cut). In early September, an inquiry into shocking neglect of elderly residents at Wellington’s Malvina Major Home was on the front page of the Dominion Post (Rest Home failed all its residents, Ministry says)
    Although the mainstream media reported these as isolated issues, in reality they are the tip of an iceberg.
    The systemic crisis has been clear for at least the last three years. In 2010, opposition MPs Sue Kedgley and Winnie Laban led an alternative inquiry into aged care, after National Party members of the health select committee blocked a formal parliamentary inquiry.
    And it was confirmed last December by the Caring Counts report, published by the Human Rights Commission. This found that the predominantly female workforce in aged care – many of whom are new migrants – and the elderly people they look after are undervalued and discriminated against. 
    The situation for support workers, often working alone to help elderly people in their homes, is largely invisible. But it’s probably even worse.
    Aged care in New Zealand is suffering the ravages of neoliberal capitalism. Today’s crisis flows from the privatisation and deregulation of the sector over the last 25 years.
    Up until the 1980s, rest homes were mainly run by charities. But by 2010, over two thirds of residential facilities were privately owned and run for profit.
    The industry is dominated by multinational corporations, banks and private equity firms. A third of the beds nationwide are provided by six large chains.
    One of them is Ryman Healthcare. Ryman owns the Malvina Major Home, of Dominion Post fame, where a confused elderly woman was repeatedly left lying in her own faeces.
    In the 1980s and 1990s, there were legal minimum staffing levels for homes like this. But in 2002, deregulation removed minimum staffing requirements.
    Ryman Healthcare receives $800 million a year from the taxpayer. How much of this goes straight into the pockets of investors is unknown, as the company is not obliged to account for this public money.
    It is known, however, that on night shifts they employ just one or two nurses to look after the 200 residents at Malvina Major. Is it any wonder that residents are sometimes neglected?
    The aged care crisis has been the focus of a decade of campaigning by the three unions representing in the sector – the Nurses Organisation, the Service & Food Workers Union Nga Ringa Tota and the PSA.
    But the proportion of workers who belong to a union, while higher than the private sector average, is much lower than in the public health system.
    In 2006, union density across aged care averaged 20 percent. This has weakened the ability of workers use industrial action to press for change.
    Despite this, aged care has featured prominently in strike statistics in recent years, winning modest improvements (or limiting the deterioration) for workers and residents in some places.
    Grant Brookes picketing with aged care workers in Upper Hutt in 2012

    But given the relative industrial weakness, the unions have also turned to political campaigning. Because District Health Boards administer the funding contracts with aged care providers, elected members of the DHBs do have some influence.
    The PSA is lobbying DHB candidates to commit to pay justice for contracted out home support workers, including equal pay with those directly employed by the DHBs.
    The SFWU is calling on DHB candidates to support its Living Wage campaign, and its minimum hourly rate of $18.40.
    And the Nurses Organisation is asking candidates to sign a pledge, including commitments to the Living Wage and equal pay for nurses and caregivers in aged care compared with their DHB counterparts.
    Standing as a candidate for Capital & Coast District Health Board, I am proud to continue my years of involvement in the battle for aged care by supporting these union campaigns.

    Guest editorial in Tobacco Control Update

    (Thanks to The Smokefree Coalition, for allowing me to contribute a guest editorial to the latest issue of Tobacco Control Update).


    Staff at Te Whare O Matairangi recently celebrated a birthday. On 2 July, Wellington's refurbished Mental Health Recovery Unit, where I work, turned one.
    The $7.8 million, state-of-the-art facility at Capital & Coast DHB has enabled the development of a new model of care – less restrictive, more collaborative and more home-like.
    Importantly, 2 July was also the first anniversary of our Unit going smokefree.
    The journey to smokefree status was not all plain sailing. When planning for the new unit began in 2009, a majority of staff were opposed to the idea. Some nurses believed that doing away with designated smoking areas in the ward would lead to increased incidence of violence, restraint and seclusion.
    Others felt it was paternalistic to enforce abstinence on service users who were detained under the Mental Health Act, and unable to go off the premises to smoke.
    One nurse wrote to the Human Rights Commissioner, seeking an opinion on whether a ban would breach patients' statutory rights.
    However with the support of management, staff and consumer advocates examined the research and worked through the difficulties. Over a three year period, we came up with a set of policies and procedures for a successful transition.
    Issues do remain, such as the relative unpopularity of patches compared with e-cigarettes as a mechanism for NRT among our client group, and the need for more organised activities to replace smoking.
    The incidence of tobacco use, among staff as well as service users, is falling. Admission to the psych ward is no longer synonymous with days spent puffing and clouds of second-hand smoke.
    The smokefree journey also confirmed to me the ability of staff to successfully drive positive change in the DHB.
    Sadly, the expertise and practical knowledge of clinicians is too often lacking in health sector governance. A desire to bring this expertise to the board table has impelled me to stand for election to Capital & Coast DHB this October.
    As a nurse, I think decision-makers need to know the realities of care at the bedside and in the community. From this perspective, smoking cessation makes perfect sense as part of an "ambulance at the top of the cliff" approach to healthcare, which aims to keep people well and prevent avoidable illnesses.
    It's equally clear, from where I sit, that we need to put the care back into aged care and strengthen local democracy, not remote health bureaucracy. Nurses also know that health is based on whānau ora – family well-being.
    Contracting out and privatisation might make sense to the accountants, but clinical experience frequently tells otherwise.
    I hope to be successful in the local elections this year, for the well-being of our district. And in so doing, I hope to set an example for other nurses to follow.

    Video: Grant Brookes speaks as Health First candidate for Capital & Coast DHB

    Candidates for Capital & Coast District Health Board were invited to speak at Newtown Community Centre, Wellington, on 14 September 2013. Grant Brookes is the Health First candidate.

    Candidates want nursing's voice heard

    Two long-time NZNO activists and board members, Grant Brookes and Heather Symes, have decided to run in the October local body elections for the Capital and Coast and Canterbury District Health Boards (DHBs) respectively.

    Both are mental health nurses. Both are motivated by a desire to advocate for low income, migrant, Pasifica and Maori communities, and to ensure a nursing voice is heard at the board table.

    Brookes said over the last 11 years working for CCDHB he had seen the impact of board decisions on the staff and the public. "I am motivated to stand by the values of health equality, to lift up the health and well-being of the disadvantaged majority," he said.
    He’s concerned about underfunding of health which is driving integration, privatisation and erosion of services.

    Symes, who will be running on a People’s Choice ticket in Christchurch, said health was a political arena and she wanted to speak for those who didn’t have a voice – “those who use specialist mental health services, the elderly, youth who are disengaged, tangata whenua and those who belong to the 140 different nationalities living in Christchurch and who are not using health services.”

    Both say their experience as NZNO board members stands them in good stead for governance of the wider health sector. “I have experience in health sector governance as a current NZNO board member. I have extensive knowledge of the DHB sector as the convenor of the DHB national delegates’ committee. But, above all, I’m a long-serving staff nurse at Wellington Hospital and I’m in touch with the realities of care at the bedside, in the clinics and the community. I will bring these realities to the board table,” Brookes said.

    Symes says as a staff nurse at the regional semi-secure forensic unit at Hillmorton Hospital, Te Whare Manaaki, she works with some of “society’s most vulnerable and most despised and, as a nurse, I have to be political.” She says many “professional directors” have little knowledge and less understanding of the realities of the health sector, while nurses, the sector’s largest workforce, knew where the stresses and strains were within the system. 

    Symes believes national health targets are a good idea for those targeted “but what about those who are not included in the six targets? The targets are at the expense of many other people’s health needs.”

    Brookes, whose campaign slogan is “Health First”, said while DHB members were responsible to the Minister of Health, they also had a “moral responsibility” to their constituency. “I will put my policies to voters. If elected, I will be morally bound to pursue them. I will also work to empower staff and community groups.”

    Given the growing contractual links between DHBs and other healthcare agencies, he believes DHBs should also be looking at imposing some kind of contractual obligations on aged-care providers to improve pay and staffing in the sector.

    Both Symes and Brookes are looking forward to the election campaign and will continue in their clinical roles if elected.

    If elected, they will join a small band of nurses already on DHBs and who are running again. These nurses include Pauline Alan-Downs will be running for a third term on the Northland DHB. Primary health care nurse Yvonne Boyes is hoping for a fourth term on the Bay of Plenty DHB, a board which has boasted three nurses over its last few terms: Boyes, NZNO president Marion Guy and board chair, Sally Webb. 

    Guy is not yet decided whether she will run again. NZNO board member Karen Naylor, who works in women’s health, will be running for her second term on MidCentral DHB. “I sit on the DHB with the same aspirations as I sit on the NZNO board – how can this be better for patients and better for staff?”

    NZNO’s advocacy and empowerment project team wants members to engage in the election process and to care about who is running for their local DHB. 

    “We really want members, regardless of where in the health sector they work, to think about the influence the DHB has one their work and the people they care for,” NZNO’s campaigns adviser Huia Welton said.