The new Federal Labor Government has promised, in conjunction with the Council of Australian Governments (COAG), to establish a National Health and Hospitals Reform Commission. Its stated aim will be to develop stringent performance benchmarks in areas such as rural health, workforce and the next Australian Health Care Agreements. If the states and territories have not begun implementing the resultant national health reform plan by the middle of 2009, the Labor Government has undertaken to seek a mandate from the Australian people for the Commonwealth to assume full direct funding (but not management) responsibility for the nation's public hospitals. $600million has already been pledged as a sweetener to reform waiting lists.

!It is critical that nurses and their status and retention in the health workforce not be forgotten in the new commission's discussions about performance benchmarks. Nursing is essential to all bed-based health care services and many community-based preventive services. As our population ages, there will be a greater need for nurses in palliative care, community prevention, mental health, diabetes, rehabilitation, wound management and cardiac rehabilitation.

There have been supply shortage signs in the nursing labour market since the year 2000. Most of the supply shortage is due to not training sufficient numbers of young nurses. Working conditions in public hospitals are the other important factor. When compared with other female professionals, nurses have been found to have less overall job satisfaction. Particularly young nurses are less satisfied with the opportunities, pay and recognition in hospital nursing. The profession continues to age and nurses rarely work beyond age 60. With training output insufficient to meet demand, the retention of nurses in public hospitals is imperative in an environment of competition for nursing skills.

!Efforts to address nurses' working conditions need to come both from federal and state governments. Patient falls, medication errors and pressure sores are adverse events which occur if nursing numbers, qualifications and/or experience don't match patient care demands.

The next Australian Health Care Agreement should include a specific initiative for the introduction of outcome measurements which are sensitive to nursing. This would allow for, firstly, a matching over time of ward nursing supply to patient care demand in an evidence-based way. Secondly, hospitals could be paid for the quality of nursing care delivered and so mobilise additional funds for nursing to address clinical nurses' poor career structure and limited education opportunities.

!State health services can be encouraged by performance benchmarks to address the problem of an increasing indirect nursing care workload caused by inefficient hospital processes. For example, reduced hospital bed numbers ties up nurses' time in locating accommodation for patients.

Addressing process inefficiencies which take nurses away from the bedside will make a difference to patients and nurses. Additionally, hospital investment in labour-saving devices for nurses enables them to be more efficient with their care. Fully funded re-entry courses would assist nurses to offset the expense of retraining. The purchase and continued maintenance schedule for care equipment can prevent many injuries. !Further, nurses are a mainly female workforce and public hospitals have been largely unresponsive to their specific concerns. Why not co-locate private child-care centres with public hospitals? After all, private hospitals are commonly co-located this way. !In relation to hospitals policy, it will be important that any performance indicators created for public hospitals are simultaneously used to measure the performance of private hospitals. Performance indicators should also be investigated for application to the private health insurance rebate, particularly in the light of regular premium increases not related to inflation and to access to private health facilities (particularly in rural Australia). Any referral to the people for federal hospital funding should include consideration of constitutional protection of citizen's rights to tax-funded emergency medical treatment. !The Rudd Government's new "transparency in government" policy should apply to the Medicines Working Group established under the Australia-US Free Trade Agreement. All its past and present minutes should be made available to the public. The Access to Medicines Working Group established under the recent PBS legislative changes should include a broader range of stakeholders than the patented pharmaceutical industry.

Marlene Eggert is a registered nurse and a NH&MRC-funded PhD scholar at the ANU, where Thomas Faunce is an Associate Professor in the Medical School.