Friday, 10 June 2022

NSW Upper House report on health & hospital services in regional, rural and remote areas of the state documents instances of lack of access to specialist services, understaffing, poor treatment outcomes, inadequate ambulance presence, long wait times, high out-of-pocket expenses and discrimination


It is hardly a secret that the NSW public health & hospital system has been under stress for much of the last two years and remains under stress in 2022.

Nor is it a secret that the ongoing global Covid-19 pandemic and seasonal respiratory disease have played a big part in this organizational stress.

However, they are not the only contributing factors and in rural, regional and remote areas health services stress has been building for decades.

There is a reported absence of a GP or chronic shortage of health professionals in: Bonalbo, Eurobodalla, Gunnedah, Deniliquin, Edward River, Manning Valley, Port Stephens, Temora, Glen Innes, Gulgong, Wee Waa, Wollondilly, Mid-Western Regional Council, Coleambally, Warren Shire Council, Broken Hill, Wentworth, Merriwa, Tenterfield, Parkes, Coonamble, Gwydir, Bourke, Hay and Leeton, with another 41 Western and Far West NSW towns identified as being at risk of not having a practicing General Practitioner within the next 10 years.

Often there is only one doctor on duty at smaller regional, rural or remote hospitals and 27 per cent of all adverse events (clinical incidents or mishaps) occurred in rural and remote health services.

In addition, the NSW Ambulance service is frequently overwhelmed by a combination of low staff numbers on a given day, vehicles tied up by being 'ramped' at over stretched hospitals and increased travel times.

A NSW Upper House inquiry was established on 16 September 2020 to inquire into and report on health outcomes and access to health and hospital services in rural, regional and remote New South Wales.

It received 720 submissions.

The following are extracts from the Inquiry report tabled in the NSW Parliament on 5 May 2022.

NSW LEGISLATIVE COUNCIL, PORTFOLIO COMMITTEE NO. 2, REPORT 57, May 2022, “Health outcomes and access to health and hospital services in rural, regional and remote New South Wales”

Committee comment

3.126 As already outlined in this report, the inquiry has heard evidence from a number of witnesses providing first-hand examples of inadequate health services and care in rural, regional and remote New South Wales. There is no doubt that doctor and clinician workforce issues are a key, if not the key to explaining many of these experiences. The committee acknowledges and appreciates the many doctors and clinicians who gave up their time and shared their expertise and personal experiences to inform the inquiry of the issues they face in rural and remote settings, including their ideas about ways to improve the current situation. These accounts provided detailed and thoughtful evidence as to both the challenges and opportunities to address them.

3.127 It is clear to the committee that the availability of doctors and clinicians in rural and remote locations is short, in some cases critically short of where it needs to be. While Chapter 2 detailed the impact this shortage is having on members of the community, the committee has also heard doctors and clinicians describe the unsustainable working conditions, particularly with respect to hours of work arising from insufficient supply of doctors and clinicians to cover the available work demands. The committee is concerned about doctor and clinician shortages and maldistribution in rural and remote settings, and the risks it poses to the health of community members, doctors and clinicians alike.

3.128 Consequently, the committee finds that rural, regional and remote medical staff are significantly under resourced when compared with their metropolitan counterparts, exacerbating health inequities…..

3.130 Indeed, there can be little doubt that the doctor workforce challenge is complicated and compounded by the division of responsibilities between Commonwealth and State. In fact, both levels of government acknowledged the Commonwealth/State divide as one of the most challenging aspects of health care delivery. But the existence of these challenges is not new. The committee is of the view that efforts to overcome them have been inadequate to date, ultimately failing to achieve the necessary structural reform. Consequently, the committee finds that the Commonwealth/State divide in terms of the provision of health funding has led to both duplication and gaps in service delivery.

3.131 The committee therefore recommends that the NSW Government urgently engage with the Australian Government to establish clear governance arrangements and a strategic plan to deliver on the reforms recommended below to improve doctor workforce issues. This should occur at the ministerial level to ensure the necessary political and policy momentum is maintained. We also believe that with a renewed commitment to work together to break down barriers and achieve health reform, progress can be made on those initiatives that both levels of government have identified as meritorious, but where progress has been slow or non-existent.

3.132 Despite the role played by the Australian Government, the committee also believes that, given the interdependency between primary health and hospital care, there is a need for the NSW Government to investigate ways to support the growth and development primary health sector in rural, regional and remote areas and support the sector’s critical role in addressing the social determinants of health and reducing avoidable hospitalisations for the citizens of New South Wales. [my yellow highlighting]

The report made 44 specific recommendations which are outlined on pages xv to xxii of the report found at:

Formal response from the Perrottet Government in not due until November 2022.

No comments: