But Professor Debora Picone AO isn’t qualified to say, the Ministry of Health’s senior counsel asserts.
Professor Debora Picone, appearing as an expert witness for the NSW Nurses and Midwives Association, has a list of qualifications and decades of experience, including CEO of the Australian Commission of Safety and Quality in Health Care and Director-General of NSW Health, but the NSW government’s counsel says she doesn’t have the expertise on this topic.
On day two of Secretary of the Ministry of Health v New South Wales Nurses and Midwives’ Association, senior counsel Simon Meehan tried to get the bench to dismiss the testimony of Professor Picone, because while eminently qualified on many aspects of health and nursing, gender-based undervaluation of work wasn’t one of them, he said.
But the union’s barrister, Leo Saunders, pointed out it wasn’t as an economics expert that Professor Picone was asked to appear, and the bench ruled that it was valid, saying “the mere statement of opinion by someone with Professor Picone’s background, without evidence, is not without weight”.
Mr Meehan also objected to the court considering evidence from Professor Meg Smith, deputy dean of the School of Business at Western Sydney University, and Dr Michael Lyons, a senior lecturer in the school, provided in a supplementary report.
But the commissioner said it was actually really important evidence.
The evidence referred to the undervaluing of the skills possessed by nurses in dealing with violence – “invisible skills”, like being able to de-escalate situations, the undervaluing of which is a key part of the union’s case.
“To play devil’s advocate, there would be other professions which are not female dominated, which have to deal with violence and need to learn skills to de-escalate. And the police force would be a prime example of this. So the mere fact that that’s a skill doesn’t mean it’s a skill that is being valued or undervalued based on gender,” the bench said.
“Yes,” Mr Saunders replied.
“But when you have two cohorts of worker who are exposed to dangerous work – frontline nurses, frontline police – the risk is different, the pay is different, the skill is the same. The question is, has it not been recognised in one aspect of the work because of a lack of recognition of the risks and dangers associated with nursing, because of culturally based perceptions of the nature of caring work?”
Professor Picone finally took the stand after morning tea, and Mr Meehan began by going through the many eminent positions held by Professor Picone, the contributions she has made to healthcare and the recognitions she has received, concluding with her lifetime membership of the NSWMNA.
“Do you hold yourself out today as an independent expert?” Mr Meehan asked.
Ms Picone said her opinion was independent of her membership.
Related
“But… I have to be frank with you, I’ll never be independent from the health system, and particularly from the nursing profession, because I started with that when I was 17. And so while most of my time at the end, I spent more time out of nursing than in, I’ve always felt like a nurse. When people ask me now, what do you do? I say I’m a nurse…,” said Professor Picone.
Within nursing itself, there was a gender pay gap, said Professor Picone. And even when nurses were raised to professional status in the 1990s, that did not remove it, just as doctors, who had had professional status for a long time, still had a gender pay gap.
Mr Meehan argued that the pay and wage disparities between men and women were historical, but were not reflected in today’s awards. Professor Picone disagreed.
“Men are more likely to enter specialties like ICU, emergency or mental health, and they sometimes come with allowances or higher classifications. Males are also over represented amongst them as managers and educators and roles that have higher pay scales,” said Professor Picone.
“A male nurse might get more quickly to, say, to a clinical nurse consultant position or a clinical nurse specialist position. It’s not quite understood what the dynamic of that is, but one part of it is the interruptions in the females working career, mainly associated with family commitments and other things … whereas the male tends not to have an interrupted career progression.
“A CNC or a clinical nurse specialist or a nursing unit manager has a pay scale and a rate associated with it, so it is very much a part of their award.”
Mr Meehan asked Professor Picone about the impact of budgetary constraints on the ability to pay nurses more.
“I think you said, when you were director general, maybe in your experience, earlier, you gave some evidence on a similar subject about, in effect, the capacity to pay being a limiting factor in being able to address what you say in your evidence is an undervaluation,” he said.
“Money is always an issue… But the argument that I put is that there is always someone making a decision… When they say they don’t have enough money, that doesn’t cover the actual dynamics of the decision making at all,” Professor Picone replied.
It was “quite correct” to consider budgetary constraints, said Professor Picone.
“But it’s often not considered in the appropriate way,” she said
She said there were other ways to save large amounts of money. Improving patient safety was one of them.
“There’s a 30% error rate… If we concentrated on that and, say, got that down to 15%, that raises, nationally, in the vicinity, I think, of $4-5 billion,” she said.
“So often these decisions are made in isolation of where you can actually really do something.”
That’s what had been so frustrating about this case, she said. “A few other steps could have raised maybe even half the money that they needed to make these adjustments, let alone the longer-term impact on staff morale and all the rest of it.”
Mr Meehan went on to say that changes, such as the electronic medical record, meant less work for nurses now.
He also challenged Professor Picone’s assertion in her evidence that nurses were leaving the profession because of wages and conditions, suggesting she was just parroting the union’s information about this.
“I’m an expert because of my background and experience… And I hope that that won’t be discarded simply because I chose to quote the nurses and midwifery association’s article, and not somebody else’s… I think it’s an expert opinion. I’m quite comfortable to give it,” she said.
Professor Picone said that when nurses were recognised as having professional status in the 1990s, their pay had started at a lower base, and so they were still not receiving a wage that was on par with others in the health profession.
“In the past, when I used to compare professions, I used to think, well, who’s closest to whom here? And probably back then, you know, say maybe 15, 20, years ago, I would have said something like occupational therapy, physiotherapy; you know, we were similar,” she said.
“But because of the changes in the technology, particularly, I’d say that [experienced] nurses have become more and more like junior doctors. And I’d probably take that up to their prevocational training.
“No one’s ever asked me that equivalence question before. It’s a bloody good question, because you really do have to think.”
After Professor Picone left the stand, the next witness, Professor Meg Smith, was sworn in.
The court case is expected to continue over the next six weeks.