Learning from a kind of defeat: Impact of the “Health Reforms” on Nursing at Christchurch Hospital (1995-1996)
- May 3
- 9 min read
Both of my elderly parents were patients at Christchurch Hospital during 1996. As I sat
by their bedsides during these days, the nurses seemed so busy, rushing, harried and
tired. I stayed longer and longer at my father’s side. He was su ering from a then-
undiagnosed post-op delirium and I tried to alert junior staff to these signs.
What I later learnt was that 1996 was a year of crisis at Christchurch Hospital. In 1995 senior nurses had tried to warn managers of the risks and dangers if they proceeded
with their plans to disestablish 39 Unit Nurse Manager positions. What happened is
documented in what became known as the “Stent Report” and is not discussed here.
But those days stayed with me, and as the years went by, I felt the story of nurses’
experiences at Christchurch Hospital in the mid-1990s needed to be told.
The prelude to this started with the “Health Reforms”.
Crown Health Enterprises (CHEs) were established in New Zealand in 1993 as
part of a radical restructuring of the public health system, which replaced 14
Area Health Boards with 23 distinct state-owned, limited-liability companies
tasked with operating on a commercial, "for-profit" basis.
The Canterbury Area Health Board was divided into two CHEs, against
significant “pushback” from medical sta . Christchurch Hospital fell under
the jurisdiction of the newly formed Canterbury Health CHE.
By mid-1995, it was clear that change was on its way for Christchurch Hospital. This
radical restructuring of nursing management and clinical leadership was to have grim
consequences for some patients and took a huge toll on the a ected nurses.
Courageous senior nurses worked cohesively to challenge the flawed plan to
restructure nursing. Jane O’Malley and Susanne Trim have kindly shared their
experiences of how senior nurses banded together as they tried to warn managers of
how this plan would have a catastrophic e ect on the provision of nursing services. But
it was not to be. The restructuring took place.
In January 1996, Jane said “In the past six months, we have felt powerless in the face of
intransigent arrogance and yet paradoxically we have enjoyed a precious and unfailing
solidarity.”
This is their story.
Nanette Ainge, 2026
Impact of the “Health Reforms” on Nursing at Christchurch Hospital (1995- 1996)
Recollections written by Jane O’Malley and Susanne Trim in 2024.
Proposals for change released
On the 31 August 1995, the draft of a restricting document, Proposals for change was
circulated. Within was A Proposal for Nursing, prepared by a management team.
It proposed to replace existing nursing structures at Christchurch and Burwood
Hospitals, at the newly formed CHE, Canterbury Health Ltd (CHL).
Nurses were shattered by the scope of the proposals for change of nursing practice
design and nursing structures presented. Management team members were considered
to be “disciples of economic fundamentalism” (Kelsey, Jane (1997) The New Zealand experiment: a world model for structural adjustment? Auckland
University Press.). We recall the formulation of a united response of nurses at Christchurch
Hospital, with the support of the New Zealand Nurses Organisation (NZNO), to the
proposals.
The proposed disestablishment of the core roles of 39 Unit Nurse Managers shocked
the nurses.
Initial Analysis and Research
There was initial horror at the radical proposals to remove Unit Nurse Managers (UNM)
and have a patient care manager over several wards and departments.
Concerns were expressed about the intent to
implement a singular case management model across every clinical area and develop critical pathways for every diagnosis related group (DRG)
do away with the primary nursing model of practice that had evolved over a number of years to meet the specialty needs
reduce the opportunity for inhouse professional development
It was identified by key nurses that the response to the proposals would need to be
highly strategic and reasoned. Natural leaders emerged and Jane O’Malley, Nurse Clinician in the Professional Nursing Unit (PNU) was selected to take a lead in the
analysis process. Susanne Trim, Professional Nursing Adviser - Southern, NZNO, and
part-time staff nurse at Christchurch Hospital, undertook an initial analysis of the
proposal’s strengths and weaknesses.
Initial analysis of the proposal document identified a number of key issues including
failure to specify problems which were to be addressed by the proposed change;
lack of understanding of the pivotal role of a UNM and the span of control;
removal of key change agents (UNMs) to drive the changes proposed;
poor knowledge of the clinical environment of acute secondary and tertiary hospitals;
the impossibility of maintaining quality care standards, managing up to 90 direct staff reports under the expanded scope of control of a reduced number of managers; and
the time required to develop critical pathways for 450 DRGs.
The authors of the proposals were approached a number of times with requests for
further information which was not forthcoming. Meticulous research of the proposed
models and analysis of the documents continued throughout the consultation period as
responses were prepared.
Uniting and Planning the Strategy
NZNO called a meeting of all senior nurses to discuss the proposals and to develop a
plan of approach. The meeting was held on the Christchurch Hospital site in the
nursing Professional Development Unit2 (PDU), a place of belonging. Nearly 100% of
UNMs, Duty Managers and PDU sta attended. The meeting was facilitated by Susanne
Trim and Jane O’Malley. The white board was used to develop the strategy.
Concern, fear and distress was expressed. Questions and issues with the proposal
were raised and noted. There was over 150 years of wise, nursing leadership and
management experience in that room. Although those nursing leaders were facing the
prospect of the ending of their careers, they supported each other and worked together
on the question “how do we challenge this proposal?”. This signified their deep
commitment to the patients that they served and the sta with whom they worked.
A strategy was developed, and roles assigned. The strategy involved
a) The nursing response
further research was to be undertaken. Lower Hutt, Lakeland Health and Northland Hospitals nurses were to be contacted about changes that had been made to nursing structures there which were referenced in the proposals;
The Kingston Hospital, UK, referenced in the proposal, was to be contacted to discuss their experience of similar changes;
management site meetings to inform sta of the changes were to be attended by as many nurses as possible with them raising questions, concerns and challenging assumptions;
meetings to inform nursing sta throughout the organisation of the proposal and its implications were organised over both hospital sites and they were encouraged to make submissions;
senior nurses were encouraged to write as many writing submissions as possible;
copies of submissions were to be sent to NZNO so that the breadth of issues could be addressed in the overarching NZNO submission;
NZNO was to demand that the NZNO submission was to be presented in person to the full management team and with representatives of nursing present;
A petition of no confidence in the Professional Adviser, Nursing and Midwifery, Canterbury Health, who was a key author of the proposal, was begun;
The Chief Executive of NZNO (previously Chief Nurse of the North Canterbury Hospital Board) to be invited to the formal presentation of NZNO’s submission and to present the petition of no confidence.
b) Informing, explaining and gaining wider support
Allied health professional leaders and ward clerks were to be informed of the
changes and implications for their services at clinical level;
The Christchurch Hospitals’ Medical Sta Association (CHSMA) was identified as a key group to inform and ask for their support. If they were to decline to provide that support to nursing’s response, then they were to be asked to remain silent and not act against our response;
The Christchurch School of Nursing Association were to be informed. These had been the nursing leaders and mentors of the current UNMs;
The Chief Nurse and the Chief Medical O icer in the Ministry of Health were to be informed of the concerns for patient safety and nursing practice;
NZNO was to consult with its industrial and medico-legal lawyers about the legality of the proposals;
NZNO’s industrial processes were to be used in line with the contractual agreements and protocols and Organisers would support all those a ected;
The co-editors of Kai Tiaki Nursing New Zealand, NZNO’s journal distributed to its 45,000 members, were to be contacted and articles and interviews prepared to inform all members of the radical changes that were being proposed;
The local health reporter for The Press was to be informed of the enormity of the proposals and nursing’s concerns for patient safety;
The editor of the magazine North and South was to be contacted with the story;
The need to inform Board members and the wider management team of concerns as an ongoing action was seen as important.
The plan was shaped on the whiteboard. Timeframes were included. The plan was put
to the vote with wholehearted support. Individuals were allocated particular roles and
responsibilities. Leaders were identified and agreed to the roles they were being asked
to perform. All were encouraged to support each other throughout this stressful
process and to seek additional emotional support if they felt they needed it. Further
meetings were planned to keep the information flow and exchange of ideas going and to
gather as a group for support.
The plan in action
A review of the proposed case management model revealed the literature supporting
the change was sparse and anecdotal, with no supporting literature focused on
outcome assessments of care quality or economic benefits supplied. The unit specific
4Case Management Model seemed to be based on a Booz Allen model of Patient
Focused Care touted around New Zealand early in 1995 by management consultants
associated with the Kingston Hospital in the UK. A discussion with nursing sta from
Kingston Hospital at the time revealed that at that stage the model had not been fully
evaluated, it had not been introduced across the board but only trialled in one medical
ward and fundamental issues at ward level around blurred accountability for overall
coordination and accountability had not been resolved. Furthermore, unlike
Canterbury, Kingston Hospital still had a fully intact nursing administration responsible
for nursing.
The Chief Nurse and Chief Advisor, Medical from the Ministry of Health visited
Christchurch. They received a full and frank briefing on behalf of concerned nurse
leaders, they also spoke with senior managers. Their response was perceived as an
attempt to bring nurse and medical leaders under control, rather than take the
concerns seriously.
The plan was successfully accomplished although the ultimate outcome was not what
was sought-after; the changes were to go ahead with some unremarkable concessions.
Medical colleagues became major players in challenging the proposals. Retired nurses
rallied around and provided immense support for the nurses that they had nurtured and
taught. Senior nursing leaders around the country provided advice and support (For a good example, see Joan Porteous’ Letter to Editor (Appendix)). Media
picked up on the story and wide coverage locally and nationally was published – this
was the most radical change proposed to nursing and patient care to date during the
Health Reforms. Submissions were shaped and shared. The Petition of no confidence
in the Nursing and Midwifery Adviser (The Petition) gathered 749 nursing signatures in 10
days.
The NZNO submission and The Petition was presented to the full management team at
Canterbury Health. Susanne Trim read every word and then the Chief Executive of
NZNO Brenda Wilson spoke to The Petition as it was presented.
It became apparent that the instigators of the proposal were intransigent in their views.
Facing the Future with Dignity
A service for nursing was organised at the Christchurch Nurses’ Memorial Chapel on 24
January 1996 (Called “Honouring Our Predecessors. Ourselves and Our Futures.” After the service, a now-historical photograph was taken of the senior nurses). This was a time of thanksgiving for nursing and for the nurses who had given so much to their profession and to quality patient care. Jane O’Malley spoke on behalf of the senior nurses. She said “In the past six months, we have felt powerless in the face of intransigent arrogance and yet paradoxically we have enjoyed a precious and unfailing solidarity.”
Nurses knew that they had put everything into challenging these proposals. The changes were made and in February 1996 the Unit Nurse Manager role was disestablished. With the disbanding of their roles, many suffered. Some died, thousands of hours of nursing experience were lost within a 3-month period and careers were lost or changed.
What happened next
Within 18 months, the Christchurch Hospitals’ Medical Sta Association had written
the report Patients are Dying: A record of system failure and unsafe practice at
Christchurch Hospital. It was presented to CHL on 24 December 1996.
This resulted in the Health and Disability Commissioner’s Report, The Stent Report into
Canterbury Health Ltd, 1998(Stent, R. Canterbury Health Ltd. A Report by the New Zealand Health and Disability Commissioner April 1998. Auckland, N.Z. page 120. Downloaded from https://www.hdc.org.nz/media/e3cdo5hr/canterbury-health-report.pdf).
As Robyn Stent later observed “The winter of 1996 was particularly severe in
Christchurch. Patient numbers were high and many of the managers were new to their
role and managing the winter pressure for the first time. Sta sickness was also high. ”
For us, there was no satisfaction in having our predictions come true.
The rebuilding period began with using the 112 recommendations that Commissioner
Robyn Stent made. This report and her recommendations provide a positive and
authoritative platform for nursing when faced with challenges in the future. The report
clearly demonstrates the pivotal role of nursing leadership, development and support
and what happens when it is decimated. It is a Report that should be dusted o
whenever nursing faces challenges because it provides the answers for going forward.
Jane O’Malley and Susanne Trim, 2024.
APPENDIX - Letter to the Editor, Press, 14 October 1995
Letter to the Editor, Press, 14 October 1995, page 23
The Cotter Medical History Trust has archival material pertaining to this period. https://cottermuseum.co.nz/contact-us/
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