Witness from the Rural Doctors’ Association of NSW tells the Inquiry how some cancer patients in the Northern Rivers are going home after having chemotherapy to a tent. In the rain.
— Cate Faehrmann 🌏🐨 (@greencate) October 5, 2022
They’re still homeless 7 months after the floods.
This is our national shame.#nswpol #auspol
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.
Office of the NSW Labor MLA for Lismore Janelle Saffin, media release, 2 September 2021:
CO-PATRONS: Lismore Parkinson’s Support Group Convenor Di Lymbury, right, with the group’s co-patrons Jenny Dowell OAM and Lismore MP Janelle Saffin.
LISMORE MP Janelle Saffin has welcomed confirmation that the Northern NSW Local Health District is considering establishing a specialist Parkinson’s nurse in Lismore to provide services to the Lismore and Clarence Valley communities.
Ms Saffin, who is co-patron of the Lismore Parkinson’s Support Group, from day one has strongly lobbied the Government and NSW Health to base a specialist nurse locally to meet growing demand from support group members and for other residents newly diagnosed with Parkinson’s disease.
“I have been working closely with Lismore Parkinson’s Support Group Convenor Di Lymbury and others to provide this extra level of care and support to improve the quality of life for local residents living with Parkinson’s,” Ms Saffin said.
“I lobbied NSW Health Minister Brad Hazzard and Northern NSW LHD Chief Executive Wayne Jones, and welcomed Treasurer Dominic Perrottet’s $8.6 million Budget package over four years, which includes funding to boost the number of specialist nurses statewide.”
Ms Saffin said she was encouraged by advice provided by NSW Parliamentary Secretary for Health James Griffin to Di Lymbury that Northern NSW LHD Acting Chief Executive Lynne Weir will consider using the new funding to establish a specialist Parkinson’s nurse in Lismore.
Mr Griffin told the support group that the LHD recognised the clinical benefits and improved outcomes for people with Parkinson’s disease that the existing specialist nurse position at Tweed Heads had provided.
“Ms Weir acknowledges it is difficult to access medical specialist neurology services in rural areas due to limited number of these specialists working outside the metropolitan area,” Mr Griffin wrote.
“The LHD is focused on developing support and clinical care for people with Parkinson’s through specialist clinics with geriatricians.
“The LHD also provides services, such as allied health, through the brain injury and spinal cord service, which supports people with Parkinson’s to maintain their function and independence,” Mr Griffin wrote.
Ms Saffin said she very much looked forward to the formal appointment of a specialist nurse based out of Lismore and viewed it as a major win for the Lismore Parkinson’s Support Group and the wider community.
“The sooner this happens, the better,” Ms Saffin.
Gender bias takes many forms and the media perhaps more frequently reports on gendered income bias. Such as the longstanding pay gap between the average weekly full-time earnings of males and females, which predominately favours men. Currently Australia's national gender pay gap stands at 13.4 per cent. Or the end of working life disparity between the superannuation outcomes of men and women.
However, it has been apparent for many years now that the health professions, hospitals and governments carry a general societal bias against women into the healthcare sector and that bias barely rates a mention when governments establish terms of reference for parliamentary inquiries into aspects of health service delivery and outcomes.
The NSW Legislative Council Portfolio Committee No.2 - Health’s Terms of Reference for its current Inquiry Into Health Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South Wales Health Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South Wales is no exception to this lack of consideration of gender bias.
A bias which has the potential to disproportionally affect the health outcomes for females from low income families, those women who identify as Aboriginal or Torres Strait Islander and women living in regional, rural and remote areas.
So these articles below are a timely reminder that the existence of gender bias is indicated in Australia and also of the global scale of such bias.
Australian Institute of Health and Welfare, “Cardiovascular disease in women”, report excerpt, July 2019:
1.1 A focus on women
Much of our knowledge of heart disease is based on research conducted primarily among men (McDonnell et al. 2018), which shapes our view of how cardiovascular disease impacts the Australian population. However, it is known that there are important differences between women and men in risk factors for CVD, in symptoms, and in treatment and outcomes.
Need for greater awareness
Many women are unaware of the risk that CVD presents to their health. Their knowledge about heart attack symptoms and CVD as a cause of death is less than optimal—in 2018, for example, only one-fifth (21%) of Australian women correctly perceived heart-related causes to be the leading cause of death (Bairey Merz et al. 2017; Flink et al. 2013; Heart Foundation 2018; Hoare et al. 2017).
2 Cardiovascular disease in women
Women presenting with CVD often have different symptoms than men. These symptoms may not be recognised as CVD, thus increasing the likelihood of a missed diagnosis.
Although men with heart attack typically describe chest pain or discomfort, women are more likely to have non-chest pain symptoms such as shortness of breath, weakness, fatigue and indigestion (Mehta et al. 2016; Wenger 2013), and frequently with worse consequences (Maas et al. 2011; McDonnell et al. 2018; Pagidipati & Peterson 2016).
Women generally present with CVD later in life than do men. Older women are also more likely to have other health conditions, making their CVD more complex to diagnose and treat, which in turn can lead to worse health outcomes (Bennett et al. 2017; Saeed et al. 2017).
Physicians are more likely to underestimate CVD risk in women, and this can influence their diagnosis and treatment (Wenger 2013). Research finds that younger women aged under 55 with acute coronary syndrome are more likely to be misdiagnosed and discharged from emergency departments than men (Bairey Merz et al. 2017; Saw et al. 2014).
Differences in treatment
A number of studies have identified disparities between women and men in CVD treatment and in outcomes. Women with acute coronary syndrome tend to receive fewer medications, are less likely to have their condition treated aggressively and have fewer invasive interventions (Kuhn et al. 2014, 2015, 2017; Pagidipati & Peterson 2016; Saeed et al. 2017).
Similarly, women with ST segment elevation myocardial infarction (STEMI: a type of heart attack) are less likely to receive invasive management, revascularisation or preventive medication at discharge (Khan et al. 2018). Women with stroke are more likely to have a delay in care than men, and are less likely to receive aspirin, statins or thrombolytics (Raeisi-Giglou et al. 2017).
Healthier women
An increased recognition of gender differences in risk factors, presentation, treatment and outcomes will contribute to improving women’s cardiovascular health in Australia.
The Australian Government, the Heart Foundation, the Stroke Foundation and other key stakeholders contribute by building awareness among the public and health-care providers about the risks of CVD to women’s health.
Chronic conditions, including CVD, and preventative health are a priority for action in the National Women’s Health Strategy 2020–2030 (Department of Health 2018). The development and delivery of a national campaign to promote awareness of the different risks for and symptoms of CVD in women is a key action in the current strategy. The ongoing monitoring of the impact of CVD is an important component of policy and programme initiatives that focus on women’s health.
Australian Institute of Health and Welfare, Cardiovascular disease in Australian women — a snapshot of national statistics, June 2019:
”Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes affecting women and their health have gained momentum. Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated. This Commission summarises existing evidence and identifies knowledge gaps in research, prevention, treatment, and access to care for women. Recommendations from an international team of experts and leaders in the field have been generated with a clear focus to reduce the global burden of cardiovascular disease in women by 2030. This Commission represents the first effort of its kind to connect stakeholders, to ignite global awareness of sex-related and gender-related disparities in cardiovascular disease, and to provide a springboard for future research.” [THE LANCET COMMISSIONS, The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030, 16 May 2021]
The Lancet, 19 June 2021:
Ana Olga Mocumbi (May 2021) “Women's cardiovascular health: shifting towards equity and justice”
Cardiovascular disease in women is understudied, under-recognised, underdiagnosed, and undertreated globally, despite being the leading cause of death in women worldwide, as highlighted by a new Lancet Commission.1 Several misperceptions contribute to this neglect, notably, the persistent view that cardiovascular disease primarily affects men or only women in high-income countries and results from poor lifestyle choices. The Lancet women and cardiovascular disease Commission1 identifies disparities in prevalence and outcomes of cardiovascular disease in women worldwide, delineates the substantial impact of socioeconomic deprivation in determining these differences, and proposes strategies to address these inequities, increase sex-related research, and support integration of care and strengthening of health systems.1
From 1990 to 2019 there have been large declines in cardiovascular disease age-standardised rates of death, disability-adjusted life-years, and years of life lost.2 There have been declines in age-standardised prevalence of coronary heart disease and stroke mortality rates in men and women in most parts of the world, with greater age-specific reductions in coronary heart disease in men than in women.3
Between 2010 and 2019, the age-standardised cardiovascular disease death rate increased or stagnated in many other parts of the world, including eastern Europe and countries in central, south, and east Asia.2 In a Canadian setting, the 30-day acute myocardial infarction mortality rates declined similarly for women and men from 2000 to 2009, but women younger than 55 years had an excess mortality risk compared with men of the same age.4 Under-representation of young people in clinical studies on cardiovascular disease, as well as worse risk profile due to comorbidities, might contribute to these slow improvements. Importantly, because of women's longer life expectancy, overall deaths from cardiovascular disease are higher in women than in men, and this excess number of cardiovascular disease deaths in women is likely to increase with population ageing. Moreover, the success in declining age-standardised cardiovascular disease mortality over the past decades has been limited to countries with a high Socio-demographic Index (SDI); some countries with a low SDI had the highest cardiovascular disease mortality rate shift from men to women.2
• View related content for this article
Poverty continues to affect a considerable proportion of the world's population, determining unique patterns of non-communicable diseases, including cardiovascular disease in young women.5 In countries with a low SDI, where premature cardiovascular disease mortality is largely driven by poverty, poor access to care, and underuse of interventions of proven efficacy, women face the coexistence of an increased prevalence of cardiovascular disease, a rise in metabolic risk factors, and endemic infectious diseases such as tuberculosis, HIV/AIDS, and schistosomiasis. Furthermore, specific risk factors and conditions affect women in countries with a low SDI. Chronic exposure to biomass fuel is common in rural Africa and Asia and contributes to the burden of acute coronary events and stroke,6 affecting predominantly women; this exposure could partly explain the high occurrence of and sex differences in isolated right heart failure in non-smokers in these places.6, 7 Similarly, in poor countries women younger than 40 years are increasingly affected by neglected or poverty-related conditions, such as rheumatic heart disease and endomyocardial fibrosis.8,9 Moreover, maternal mortality remains unacceptably high. About 295 000 women died during and after pregnancy and childbirth in 2017.10 94% of these deaths occurred in low-resource settings, where the maternal mortality ratio was 462 per 100 000 livebirths versus 11 per 100 000 livebirths in high-income countries.10 Since cardiovascular disease is the leading non-obstetric cause of maternal mortality worldwide,11 one should consider the role of disparity in fertility rates, incidence of peripartum cardiomyopathy, and pre-existing uncontrolled arterial hypertension8 as potential determinants of maternal mortality. Indeed, there are a considerable number of maternal deaths due to cardiovascular disease in low-income and middle-income countries.12 Unfortunately, even in the USA, where the maternal mortality ratio was 17·4 maternal deaths per 100 000 livebirths in 2018, the maternal mortality ratio was more than double among non-Hispanic Black women (37·1 per 100 000 livebirths), with more than half of these deaths and near deaths being preventable, and cardiovascular disease being the leading cause.13 Inadequate access to quality and affordable health care along with long-standing health disparities plays a role in this disparity; additionally, social determinants of health can increase the risk of gestational diabetes, peripartum cardiomyopathy, caesarean deliveries, and future cardiovascular disease in neglected communities.
To address the gaps highlighted by this Commission, current knowledge must be used to achieve health equity so that no one is disadvantaged from attaining their full health potential because of their social position or other socially determined circumstance. Reduction of disparities in clinical outcomes requires the prioritisation of high-impact solutions in under-resourced areas, involving tailored strategies for decentralised and integrated care, and support from global and regional partners to improve the availability of interventions for cardiovascular disease prevention and management. Front-line health workers with shared competences for cardio–obstetric care, digital health, and portable ultrasound should be used to deliver decentralised care, improve referral systems, and support surveillance of sex-related outcomes. Digital health provides opportunities to enhance the quality, efficiency, and safety of primary health care, as well as help address racial and ethnic disparities,14 but insufficient digital health competencies among front-line health workers are among the factors that hamper the adoption of digital tools and technologies.15 Finally, as emphasised in the Commission, peer-to-peer supporters and educators in local communities should be used to empower women in improving their ability to access, understand, appraise, and apply health information to promote good cardiovascular health.
In the midst of the COVID-19 pandemic, values of human dignity, solidarity, altruism, and social justice should guide our communities to ensure equitable share of wealth and leveraging of efforts towards the reduction of cardiovascular disease burden in women worldwide. The Commission's recommendations on additional funding for women's cardiovascular health programmes, prioritisation of integrated care programmes, including combined cardiac and obstetric care, and strengthening of the health systems accords with efforts to bridge the gap for the world's worst off.5 Such a shift in women's cardiovascular care would be a major step towards equity, social justice, and sustainable development.
I declare no competing interests.
References
1.Vogel B Acevedo M Appelman Y et al.
The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030.
Lancet. 2021; (published online May 16.)
https://doi.org/10.1016/S0140-6736(21)00684-X
2.Roth GA Johnson C Abajobir A et al.
Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015.
J Am Coll Cardiol. 2017; 70: 1-25
3.Bots SH Peters SAE Woodward M
Sex differences in coronary heart disease and stroke mortality: a global assessment of the effect of ageing between 1980 and 2010.
BMJ Global Health. 2017; 2e000298
4.Izadnegahdar M Singer J Lee MK et al.
Do younger women fare worse? Sex differences in acute myocardial infarction hospitalization and early mortality rates over ten years.
J Womens Health. 2014; 23: 10-17
5.Bukhman G Mocumbi AO Atun R et al.
The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion.
Lancet. 2020; 396: 991-1044
6.Bassig BA Dean Hosgood H Shu XO et al.
Ischaemic heart disease and stroke mortality by specific coal type among non-smoking women with substantial indoor air pollution exposure in China.
Int J Epidemiol. 2020; 49: 56-68
7.Stewart S Mocumbi AO Carrington MJ Pretorius S Burton R Sliwa K
A not-so-rare form of heart failure in urban black Africans: pathways to right heart failure in the Heart of Soweto Study cohort.
Eur J Heart Fail. 2011; 13: 1070-1077
8.Mocumbi AO Sliwa K
Women's cardiovascular health in Africa.
Heart. 2012; 98: 450-455
9.Zühlke L Engel ME Karthikeyan G et al.
Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study).
Eur Heart J. 2015; 36 (122a): 1115
10.WHO
Maternal mortality, key facts.
https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
Date: 2019
11.Kassebaum NJ Barber RM Bhutta ZA et al.
Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.
Lancet. 2016; 388: 1775-1812
12.Heemelaar S Petrus A Knight M van den Akker T
Maternal mortality due to cardiac disease in low- and middle-income countries.
Trop Med Int Health. 2020; 25: 673-686
13.Bond RM Gaither K Nasser SA et al.
Working agenda for Black mothers: a position paper from the Association of Black Cardiologists on solutions to Improving Black maternal health.
Circ Cardiovasc Qual Outcomes. 2021; 14e007643
14.López L Green AR Tan-McGrory A et al.
Bridging the digital divide in health care: the role of health information technology in addressing racial and ethnic disparities.
Jt Comm J Qual Patient Saf. 2011; 37: 437-445
15.Jimenez G Spinazze P Matchar D et al.
Digital health competencies for primary healthcare professionals: a scoping review.
Int J Med Inform. 2020; 143104260
https://doi.org/10.1016/S0140-6736(21)01017-5
Copyright
© 2021 Elsevier Ltd. All rights reserved.
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| Ryan Park MLC |
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| Janelle Saffin MLC |
NSW Shadow Minister For Health Ryan Park and Labor Member For Lismore Janelle Saffin deserve the region's thanks for both their efforts to spread the word that the state’s north-east would have a chance to speak directly to the NSW Legislative Council Inquiry Into Health Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South WalesHealth Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South Wales in Lismore on 17 June 2021, for lobbying to have a webcast of this public hearing and for their attendance on the day.
ABC North Coast, 17 June 2021:
A state parliamentary inquiry has heard some rural residents in northern New South Wales are being left "stranded" outside hospitals late at night with no way of getting home.
The NSW Upper House inquiry is examining the challenges people face in seeking medical care in remote, rural and regional areas.
Bonalbo pharmacist Sharon Bird told the inquiry some residents with chronic and complex illnesses are travelling more than 100 kilometres to access health services with virtually no public transport.
She said many residents "give up" on seeing a doctor because "it all gets too difficult".
"Many of my customers have had negative experiences when accessing healthcare in the referral centres," Mrs Bird said.
"Like being abandoned in Lismore in their pyjamas after an emergency ambulance trip with no way to get home again.
"[Many] are reluctant to seek help or call an ambulance again."
Northern NSW Local Health District chief executive Wayne Jones said steps had been taken to ensure such incidents did not happen again.
"Unfortunately we have failed in several of those occasions, but I can tell you it is not the standard of what we have tried to achieve," he told the inquiry.
"We have put memos out to staff reminding them we've increased our own patient transport vehicles locally, we have community transport contracts and we have a clear position that particularly after 8:00pm if people can't find a way home we need to find accommodation for them."
Residents need to 'schedule their accidents'
The inquiry heard the towns of Bonalbo and Coraki had struggled to attract general practitioners, often leaving residents with limited or no access to doctors.
Mrs Bird said Bonalbo had an X-ray machine but no staff to operate it and only one radiographer for two hours a fortnight, so residents would need to "schedule their accidents for that day".
The chair of the Ballina Cancer Advocacy Network Maureen Fletcher also gave evidence, talking about the dire need for increased funding for cancer care coordinators in the region.
She said many patients had "suffered needlessly" because they did not know what services were available before, during and after cancer treatment.
Ms Fletcher said there was one man who lost half his nose after melanoma surgery and felt socially isolated.
"He only found out that a prosthetic nose was available when a fellow patient in hospital asked why he didn't have it," she said.
Flow-on effects
The inquiry also heard from residents who spoke about the difficulties that arose from the region's reliance on south-east Queensland for specialist care.
Andre Othenin-Girard said he suffered on and off from atrial fibrillations and had been waiting almost three years to see a cardiologist on the Gold Coast, which was complicated by the Queensland border closure.
He said he had been hospitalised five times at Lismore Base Hospital while he waited.
The committee has been warned that the access to and availability of medical services could deter highly skilled people and businesses from moving to regional NSW.
Veterinarian Florian Roeber told the hearing he had to make at least 15 trips to the Gold Coast after being diagnosed with a neurological condition.
He said he moved to the state's north from Melbourne and believed he would have had better access to care if he had stayed in the city.
"I kind of regretted my decision to move to regional NSW because it led to a potentially worse outcome for me," Dr Roeber said…...
Problems are not confined to just the Northern NSW Local Health District. At Taree on the Mid-North Coast on 16 June the Inquiry heard the following.....
The Sydney Morning Herald, 17 June 2021:
A NSW hospital serving nearly 100,000 people has been relying on cleaners to look after dementia patients due to severe staffing shortages, a parliamentary inquiry heard.
Doctors, nurses and patients lined up to vent their frustration and despair as the inquiry into regional health travelled to Taree and Lismore for public hearings on Wednesday.
The inquiry heard that at Tamworth, "ghost" operating theatres are being used for storage and for staff to make quiet phone calls because the hospital is struggling to find specialists to use them.
Tamworth has the busiest non-metropolitan emergency department in NSW.
Three senior doctors delivered a scathing assessment of the state of affairs in Taree on the state's mid-north coast, which is serviced by Manning Base Hospital.
"Houston we have got a problem and the problem I'd like to talk to you about is workforce," said Dr Simon Holliday, a rural GP with three decades' experience and a staff specialist at Manning Base Hospital.
He said less than 5 per cent of Australian-trained doctors were choosing to practise in rural areas which was a "disaster" for people living outside capital cities.
Dr Holliday said overseas-trained doctors from developing countries were stepping in to fill the void which was tantamount to "reverse foreign aid".
He said there was an epidemic of burnout among the foreign-trained doctors, who were having a "horrific time" as they were used as "cannon fodder" in understaffed facilities.
Dr Holliday was critical of the Australian Medical Association for refusing to endorse medical conscription, where doctors are made to serve in regional and rural areas.
"Australia needs to start providing Australian-trained workforce for rural areas," he told the upper house committee.
"Today you've heard about the pain and anguish in our community, as in many other regions' communities, and you have the weight of our expectations on your shoulders."
Dr Seshasayee Narasimhan said chronic underfunding had rendered Manning Base an “exhausted and severely downgraded hospital” that was “not appealing for new recruits”.
“No one wants to come here,” he said.
The Taree region has only one cardiologist serving a population of nearly 100,000 people and the worst cardiovascular outcomes of anywhere in regional Australia.....
President of the Manning Great Lakes Community Health Action Group Eddie Wood said the hospital's dementia ward had been shuttered without any consultation with the community.
"The cleaners on the ward have been asked to monitor and sit with the dementia patients," he said. "Dementia patients deserve the same level of care as anyone else ... it's horrendous."
Marion Hosking OAM later told the inquiry her son had been present at the hospital when the gardener was brought in to sit beside a troubled dementia patient.
But Mr Wood said assurances from the hospital administrators and local health district that there was no staffing problem further incensed the community.
“You say that to the ... first year graduate nurse who is put in charge of a ward,” Mr Wood said.
Mr Wood said only half of the 18 beds in the emergency department were funded and staffed......
“When you see your hospital and your staff demoralised and leaving, it’s atrocious,” he said.....
Office of NSW Labor MLA for Lismore, Janelle Saffin, media release, 17 May 2021:
Rural Health Inquiry’s Lismore hearing to be webcast
NSW Labor has ensured that the NSW Parliamentary Inquiry into health and hospital services in rural, regional and remote NSW’s Lismore hearing on Thursday June 17 will be webcast, according to State Member for Lismore Janelle Saffin.
“This is a good win because all locals, together with all residents of rural and regional NSW need to have access to their Parliament and its processes,” Ms Saffin said yesterday.
“I lobbied for this Inquiry to sit in our Electorate of Lismore and it is important that as many people as possible get to hear testimony from individuals and organisations who made submissions about their experience of the health system.
“The Inquiry has already held hearings in Deniliquin and Cobar, both of which were not webcast. I understand that the transcripts then took over a week to be released publicly.
“This was unacceptable to many country people and media outlets, so my colleague, NSW Shadow Minister for Health Ryan Park raised these concerns directly with the Chief Executive of the Department of Parliamentary Services.
“In light of the high level of public interest in the Inquiry’s work, the Committee, chaired by Labor MLC Greg Donnelly, now will be trialling the live webcasting of its hearings in Wellington tomorrow (Tuesday, 18 May) and in Dubbo on Wednesday (19 May).”
The 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 has received more than 700 submissions from people across NSW.
Live stream details:
https://www.parliament.nsw.gov.au/Pages/webcasts.aspx
The Saturday Paper, 3 April 2021:
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| The minister formerly in charge of the National Disability Insurance Scheme, Stuart Robert. CREDIT: AAP / MICK TSIKAS |
Last Saturday, shortly after lunchtime, it all exploded. The WhatsApp group – set up between state and territory disability ministers and the then Commonwealth minister, Stuart Robert – had been seething with anger for a while. Then suddenly it was too much.
“I may actually self-combust with incendiary rage before this thing is over,” the ACT minister for Disability, Emma Davidson, messaged her colleagues.
It had been more than 24 hours since a leaked proposal for changes to the National Disability Insurance Scheme was reported in Nine newspapers. But state and territory ministers, who share half the oversight of the $25 billion scheme, had still not been given a copy of the legislation. None of them had seen even a briefing note.
At no point since has the federal government – or Stuart Robert, who was moved from the NDIS portfolio earlier this week in a cabinet reshuffle – made the document available to the states and territories.
The Saturday Paper has spoken with several members of the WhatsApp group and the Disability Reform Council, both of which include Robert.
“He thinks it is okay to have state ministers begging to see a copy of the draft legislation,” one minister for Disability says.
“Robert says he is up to draft 80 on this and no one outside of the federal government has seen it. Not state ministers and certainly not people with disability.”
“Stuart Robert is taking all of the King Henry VIII powers,” one legal source said. “You cannot get a more pure power grab. That is a God power.”
After Davidson’s message, New South Wales Liberal minister Gareth Ward offered her a thumbs-up. Within moments, he phoned to express his support.
In the Northern Territory and Western Australia, ministers called for Robert to release the official draft. Until that happens, state and territory ministers are working from a leaked document that outlines an alarming future for the NDIS, including a “God power” for the federal minister to remake the scheme at will.
Robert offered no reply to his fellow ministers at the weekend. It was only after Scott Morrison’s Monday cabinet reshuffle – which saw Robert transferred to the Employment, Workforce, Skills, Small and Family Business portfolio – that the Queensland MP popped back up in the chat.
Robert told the other ministers he was removing himself from the group and adding in the new minister for the NDIS, Linda Reynolds.
Reynolds, who remains on paid medical leave following revelations about her handling of former Liberal staffer Brittany Higgins’ rape allegation, politely said hello to the ministers with whom she soon would be working.
Sensing an opportunity, they again requested the draft NDIS legislation. Reynolds did not reply, and has not been in the chat since.
The Saturday Paper has obtained a leaked copy of the proposed changes to the NDIS Act, dated December 2020.
The documents signal plans for a broad, sweeping and potentially irrevocable consolidation of power within the scheme to a single person: the federal NDIS minister.
In its 323 pages, bureaucrats have taken the current NDIS Act and tracked changes throughout. They have added entirely new sections to the legislation and deleted key clauses that have underpinned the very nature of the scheme.
Central to the seismic shift is a new ability of the Commonwealth minister to make so-called “rules” at any time, which the chief executive of the National Disability Insurance Agency must follow when interpreting the legislation…...
The Commonwealth minister would be given unilateral power to rule on general supports that will be provided under the scheme, and to dictate the criteria for “determining the total amount of funding allocated for the purposes of a plan”.
This change will strip the states or territories of the veto power they now hold.
But this is not the only significant proposal. The draft legislation includes an expanded debt recovery power, which would allow the NDIA to claw back money from participants who breach the new rules, sparking concern about its similarity to the controversial robo-debt scheme.
In effect, the agency could raise a debt on an individual if they spent their NDIS funding on “ordinary living expenses” or on a service or support the Commonwealth minister decides should have been funded by a state or territory government. These decisions could be entirely arbitrary.
Moreover, as one sector source pointed out, the government is “building a capability to surveil” NDIS participants in order to watch what they spend and where, in close to real time. Using technology solutions such as blockchain – already trialled in the scheme – the government wants to see what people are spending and will launch a new NDIS app in coming months to consolidate these features.
A new section of the act, 46C, would hand the Commonwealth minister the extraordinary power to ban any kind of support and to force states and territories to potentially fund others.
“A participant who receives an NDIS amount, or a person who receives an NDIS amount on behalf of a participant, must not spend the money to acquire goods or services prescribed by the National Disability Insurance Scheme rules for the purposes of this subsection as goods or services acquired as part of ordinary living expenses,” the documents read.
These banned “goods or services” – note, the scheme’s common language of “supports” is not used here – may be things the minister decides ought to be funded by “other general systems of service delivery or support services, whether or not they are currently being so funded or provided”.
The states and territories are concerned this will shift responsibility back to them – as, prior to the introduction of the NDIS, they were the major providers of disability services.
This particular clause, 46C, appears designed in response to a number of Administrative Appeals Tribunal (AAT) findings made against the NDIA…...
Legal experts who spoke with The Saturday Paper were astonished at the breadth of this section in the proposed changes.
“He [Stuart Robert] is taking all of the King Henry VIII powers,” one legal source said. “You cannot get a more pure power grab. That is a God power.”
In law, Henry VIII clauses are often described as subordinate pieces of a primary legislation – in this case NDIS rules under the NDIS Act – that subvert or amend the legislation itself, typically through executive power.
This consolidation of power continues throughout the document.
Proposed changes to section 27 of the act would give the Commonwealth minister unfettered ability to decide, for example, whether people are mentally ill to the degree required for NDIS support. It could allow the minister to deny early intervention funding if they believed the evidence about its “benefit” in the future was unclear.
Most strikingly among the draft changes, though, is the removal of the entirety of section 34, which currently declares that participants will be given “reasonable and necessary” support funding “to pursue [their] goals, objectives and aspirations”.
Contrary to other media reports, there has been no suggestion from the Commonwealth that this is a mistake in the drafting or that it will be unwound.
On March 26, Stuart Robert tweeted, “We are introducing reforms to the NDIS because we believe access to the scheme and a participant’s plan should not be determined by your postcode or how much someone can pay for a report.
“This does not extend to removing the term ‘reasonable and necessary’ from NDIS legislation.”
Robert’s wording is deliberate. The term will likely remain in the legislation but not as a descriptor for what participants should receive in terms of support. Now, the term “reasonable and necessary” will describe a participant budget. The difference is subtle, but the latter places more emphasis on the financial metrics of the NDIS and, according to legal sources, would allow rationing of support without an avenue for legal challenge.
Where the draft discusses what is currently written as “reasonable and necessary supports” for individuals with disability, the reference is struck through and replaced only with “funding for supports”.
No less alarming to disability advocates, but more discreet, is a slew of language changes throughout the new document.
Under this proposal, for example, people with disabilities will no longer be entitled to “reviews” of their own funded support package but will instead be submitted to a “reassessment”. This language is changed throughout, and the word “request” has been changed to “requirement” for assessment information. Privately, NDIA staff and Stuart Robert’s office believe they do not need legislative force to introduce controversial independent assessments (IAs) – by government contractors who will examine disabled people to determine their functional needs, breaking the often years-long relationship between people and their treating health professionals – but these are included in draft proposals.
“A requirement … may specify that the assessment or examination is to be conducted by a person included in a class of persons made known to the prospective participant,” the draft clause says.
Public Interest Advocacy Centre senior solicitor Chadwick Wong, who leads the organisation’s project to institute a fairer NDIS, says the combined effect of independent assessments and the leaked legislative changes create new “transparency, accountability and governance issues”.
“The government’s cost-cutting overhaul of the NDIS includes a number of disturbing changes that will erode the ‘choice and control’ promised by the scheme to people with disability,” Wong says.
“The removal of the word ‘co-design’, as seen in documents leaked to the media … also points to a concerning step away from meaningful engagement with the disability sector.
“We urge the government to stop the implementation of these changes immediately, and to properly consult with the community so that improvements to the NDIS may be co-designed with people with disability.”
Taking all of the proposed and planned changes together, the impact on people with a disability is significant. Here’s how independent assessments will work with the government’s desired legislative overhaul.
The eight-year-long experience of people turning up to a planning meeting, expressing their goals and ambitions to live life in the community and having each of those goals funded through a “reasonable and necessary” support to achieve them are over.
Instead, a person’s first experience of the NDIS will be a functional assessment carried out by a team of strangers for a few hours. This assessment will automatically generate a “draft budget” based on software that splits them into categories. These categories will be informed by the functional need score, their age and, according to the agency itself in a submission to a parliamentary inquiry, “the impact of their environment, such as the informal supports available to the participant and other contextual factors such as locality or circumstance”.
Rather than building a support package from scratch, participants will arrive at their first planning meeting with a generic draft budget and then have limited opportunity to argue for individual changes.
Advocates are calling it “robo-planning”. If the NDIS was the greatest policy achievement in a generation, these changes represent the greatest disfiguring of its original intention. They lay the groundwork for an NDIS that is less generous, less fair and less accessible – all under the caprice of a single minister. And he just left the chat.
