Safe Staffing

Safe Staffing and Care Capacity Demand Management: Effective Implementation Accord

Parties to the Accord

New Zealand Nurses' Organisation (NZNO)
District Health Boards (DHBs, now Te Whatu Ora)
Director-General of Health

Download the Safe Staffing and Care Capacity Demand Management: Effective Implementation Accord (PDF, 179KB)


The purpose of this Accord is to record the commitment and assurance of the Parties to ensuring that staffing levels for nurses and midwives employed by DHBs are safe and to describe the actions that will be taken.


All Parties acknowledge and accept that:

  • The workload of the DHB nursing and midwifery workforce and how it is managed is a fundamental issue that must be addressed;
  • Commitment is required by all Parties to the Accord to address the issues;
  • These issues of safe staffing and workload have developed over a significant period of time and will take time to rectify;
  • Both the NZNO (the NZNO Strategy for Nursing 2018-2023) and the DHBs (the DHB Nursing Workforce Strategy 2018) have developed strategies that inform the management of this issue;
  • In addition ot the successful conclusion of the MECA, the effective implementation and monitoring of Care Capacity Demand Management (CCDM) is required to address workforce issues.

Further, the Parties note:

  • The comments by the Independent Panel that "the Panel noted the lack of an effective mechanism to ensure commitments made under the MECA are implemented, particularly related to the implementation of the CCDM programme. This has contributed to the reluctance to ratify the current agreement".
  • The recommendation of the Independent Panel "that a high level of commitment needs to be made to improving the nurse workforce planning strategy and to ensuring compliance with commitments agreed in the MECA. It is for the parties to agree to the effectiveness of the existing compliance and accountability procedures".


The Parties acknowledge and accept that implementation of CCDM is primarily the responsibility of the DHBs, in partnership with the workforce and NZNO. However, the Parties agree that support is required from Government to ensure effective and timely implementation. Therefore, in addition to the commitments in the MECA between the DHBs and NZNO, and in order to give effect to the existing commitment to implement CCDM by June 2021 the parties agree to:

  • Explore options for providing employment and training for all New Zealand nursing and midwifery graduates, taking into account the current model for doctors, and report to the Minister of Health by the end of November 2018;
  • Develop any accountability mechanisms that the Parties believe are necessary (over and above those already agreed) to ensure DHBs implement the additional staffing needs identified by CCDM within the agreed timeframe and report to the Minister of Health by the end of February 2019;
  • Develop a strategy for retention of the existing nursing and midwifery workforce and the re-employment of those who have left the workforce, and report to the Minister of Health by the end of May 2019.

The Parties agree that the development and negotiation of these commitments will be overseen by the Health Sector Relationship Agreement Group which contains representation from the Parties.

The provisions of the Accord came into effect on the date of signature (30 July 2018).