Locums, agency staff and volunteers are the face of public hospital health care in the NSW Northern Rivers region in 2023-2024

 

Clarence Valley independent, 13 December 2023:

Staff shortages amongst doctors, nurses, and specialists on the north coast has seen the Northern NSW Local Health District spend $148 million in the 2022-2023 financial year on agency staff.....

In July 2023, The Sydney Morning Herald revealed that NSW Health was spending about $1 billion annually on temporary health workers, with $148 million spent on locum doctors who are paid up to $4000 a day, while working in under resourced regional hospitals.

Northern NSW Local Health District NNSWLHD Chief Executive, Tracey Maisey said the past few years have been challenging, navigating the COVID-19 pandemic, floods and bushfire emergencies.

“Despite these challenges our staff have succeeded in delivering high quality and positive outcomes of care,” she said.

“When vacancies exist, NNSWLHD engages agency medical and nursing staff to supplement the permanent workforce across the District.

“The 2022 floods had a significant impact on local communities and our local workforce, and agency staff played an important role in supporting our services throughout this period.

“In the 2022-23 financial year, the costs associated with our agency workforce totalled $148 million.”

The $148 million spent in the 2022-23 financial year on locum staff equates to about 13 per-cent of the Northern NSW Local Health District NNSWLHD annual budget, with more than $68 million paid in wages and $16 million spent on accommodation for these staff.....

Recruitment of staff is ongoing.

“An overseas nursing recruitment program conducted earlier in 2023 is bolstering local nurse numbers, with the first of 60 new nurses already settling into their roles at hospitals across the District,” Ms Maisey said.

“In partnership with our staff and expert external support we have developed a comprehensive recruitment campaign, and there are recruitment and retention incentives for critical roles.

“We are supporting the retention of existing staff by assisting eligible staff on temporary contracts to transition to permanent employment and are working with our facilities to support them to improve internal recruitment processes and timeframes.

“We have also increased our new graduate nursing numbers, as well as offering permanent positions rather than traditional fixed term contracts.”

The Northern NSW Local Health District board has also looked at the issue of creating a volunteer arm in its service provision and in November 2023 issued a media release which stated in part:

Northern NSW Local Health District (NNSWLHD) is calling for community members to join the Healthcare Helpers volunteer program, with a range of roles available in health facilities for 2024.

Applications are now open for volunteer roles supporting patients, visitors and healthcare staff in facilities in Tweed, Nimbin, Ballina, Lismore, Maclean, Grafton, Bonalbo, Urbenville and Kyogle.

NNSWLHD Volunteering and Fundraising Manager, Claire Quince said the volunteers support health staff and improve the experiences of patients and visitors.

“After welcoming 30 new Healthcare Helpers to Lismore, Grafton and Maclean Hospitals in June this year, we are now expanding the program to the District’s other health facilities,” Ms Quince said.

“In addition to meet and greet roles in hospital public areas, we are introducing companion volunteers to provide social support to patients undergoing surgical procedures, cancer treatment and dialysis rehabilitation, as well as new mothers in the maternity ward.

“Our residential aged care facilities at our Multi-Purpose Services are also recruiting companion volunteers to provide social support and assist with outings for aged care residents.”

NSW Nurses and Midwives Association, June 2023: between Grafton and Maclean Hospitals another 40 nurses are needed to provide adequate staffing levels

 

Grafton Base Hospital is a Level 3/4 rural community hospital with an est. 68 bed inpatient capacity which provides acute medical, surgical, orthopaedic, paediatric, anaesthetic, geriatric, obstetric and maternity, intensive and critical care, renal, oncology, palliative care, emergency, some specialist outpatient services and day surgery facilities. Maclean District Hospital is a Level 3 rural community hospital with an est. <43 inpatient bed capacity, an inpatient Rehabilitation Unit and a Day Surgery Unit.

Clarence Valley Independent, 14 June 2023:

Between Grafton and Maclean Hospitals another 40 nurses are needed to provide adequate staffing levels say the NSW Nurses and Midwives Association as the Local Health District tries to fill 180 nursing vacancies across the region.

NSW Nurses and Midwives Association Clarence Valley branch secretary Thea Koval said without agency nursing staff being called in, who are paid significantly more than NSW Health nurses, Maclean and Grafton hospitals would struggle to operate.

“Without agency nursing staff our hospitals would not be able to be run with the nurses employed only by NSW Health,” she said.

“Without that external agency support we would be completely drowning, there just would not be enough staff.”

Ms Koval said both Grafton and Maclean hospitals are continuing to experience increasing numbers of patients presenting to the emergency department ED, which leads to increasing wait times until they are treated.

This combined with the lack of nursing staff, Ms Koval said is leading to a decline in patient care.

“We are constantly and have been for the last 10 years saying that the amount of staff we have is not enough to provide the care we are expected to our patients,” she said.

“That can range anywhere from not being able to provide a shower, so there’s patients going without showers on the wards, to people waiting excessive amounts of time in ED to be seen by a nurse, or once they’re seen by a nurse waiting for pain relief, waiting to be helped to the toilet or delays in getting antibiotics.”

Ms Koval said the frustrating lack of staff led to nurses striking four times last year.

“We raise the issue through to our managers, we try and raise it with the Ministry of Health and so far, nothing has changed,” she said.

“This new government has promised to introduce the ratio system, which they termed ‘safe staffing’ but that hasn’t happened yet.”

Ms Koval said the planned ratios are one nurse to three patients in ED, with a dedicated resuscitation nurse, a dedicated triage nurse and a dedicated team leader on all shifts.

“That would make a massive difference to Grafton and Maclean Hospitals, particularly on our night shifts when our staffing drops from seven nurses to three nurses, and more often than not these days the ED is full of patients,” she said.

As Queensland Health have implemented nurse to patient ratios, where nurses experience better conditions and earn $10 an hour more than in NSW, Ms Koval said a number of local nurses have left to work over the border.

As a result, the Northern NSW Local Health District has confirmed there are 180 full time equivalent nursing vacancies across the region.

“Grafton and Maclean hospitals have approximately 40 of those vacancies,” Ms Koval said.

“That is just to make it back up to what the government currently considers as reasonable staffing levels…and when this new ‘safe staffing’ comes in as promised, that level of vacancies will increase.”

Ms Koval said staff shortages extend to the number of local doctors, as two surgeons have recently left Grafton hospital without being replaced and locums are regularly called in to fill positions in Grafton and Maclean hospitals.

“It’s a very large expense (for locums) but it’s what you have to do otherwise you don’t have medical coverage,” she said……

Read the full article here.

Frontline medical staff not happy with Morrison Government's lack of thought or preparation behind the national plan to re-open Australia

 

Nurses union the ANMF calls on Australian Prime Minister Morrison to address critical concerns before triggering national plan to re-open Australia

ANMF Australian Nursing and Midwifery Federation Journal, 1 September 2021:

The Australian Nursing and Midwifery Federation (ANMF) has written to Prime Minister Scott Morrison to outline its significant concerns regarding the government’s national plan to re-open Australia and transition the country’s pandemic response based on the Doherty Institute’s COVID-19 modelling and the Commonwealth Department of Treasury’s economic analysis.

In the letter, the union requests that more detailed modelling and analysis be undertaken and considered by National Cabinet before it takes any further steps to re-open the country.

“As you are aware, the nursing and midwifery workforces, as the largest and best distributed components of the health workforce, are fundamental to ensuring that the Australian community remains safe and healthy both during COVID outbreaks and as we seek to gradually move the nation beyond the current ‘suppression phase’ of the COVID-19 response,” ANMF Federal Secretary Annie Butler wrote.

“This means that the impacts of re-opening and transitioning the country’s national COVID-19 response prematurely without adequate planning or sufficient resourcing will disproportionately affect nurses and midwives and their capacity for ongoing delivery of quality care.”

Ms Butler argued the Doherty modelling, which currently underpins the government’s proposed re-opening plan, fails to take into account all the factors affecting this capacity.

Specifically, the ANMF has called on the government to consider the following factors before re-opening:

1. Current health system demand capacity, including expansion capacity, both critical care and general, and management of non COVID health demand

2. Assessment of safe vaccination targets, which include the entire population, not just those currently eligible

3. Vaccination rates needed for vulnerable populations, including those aged over 70 and other high-risk groups

4. Management of anticipated vaccination rollout channels for boosters, once recommended

5. The impact of the Delta and future variants, including on children, particularly in the context of uncontrolled community transmission, as is currently occurring in NSW

6. How the test-trace-isolate-quarantine TTIQ workforce will be fully resourced and maintained without impacting the nursing and midwifery workforces

7. How to ensure all communities across Australia will have equal access to safe healthcare as we progress through the pandemic

Like all Australians, Ms Butler said the ANMF was keen to transition the country’s COVID-19 response from one of strict virus suppression to more relaxed restrictions. However, it cannot happen without first addressing critical concerns, she warned.

“We cannot overstate the importance of ensuring that we do not make this transition until we can guarantee that vaccination rates and appropriate public health measures are sufficient to allow the health and aged care systems and their workforces to be able to continue to deliver best practice care to all those requiring it.”

AMA calls for stronger quarantine model – a need to move away from temporary measures and introduce permanent quarantine solutions

Australian Medical Association, 2 September 2021:

The AMA has called for an urgent stocktake of potential quarantine sites around Australia in a submission to the Chair of National Review of Hotel Quarantine, Ms Jane Halton AO PSM. Ms Halton invited the AMA to provide this submission as part of her further review into Australia’s quarantine arrangements.

Australia’s current hotel quarantine has resulted in over 30 breaches, one of which has led to the third wave of infections. Australia needs to move away from this temporary measure and introduce permanent quarantine solutions.

The AMA has welcomed the announcement of the three quarantine facilities announced in recent weeks, however the facilities will take months to complete. The AMA is also concerned about the lack of engagement with the local medical communities in the vicinity of these facilities.

The submission also calls for further examination of the options for expanding home quarantine for fully vaccinated people arriving from lower risk locations. This would alleviate some of the burden on quarantine facilities.

AMA President Dr Omar Khorshid will meet with Ms Halton in the coming weeks to further detail the AMA’s priorities in ensuring Australia has a robust quarantine regime. Underpinning the AMA’s position are two goals: To prevent COVID-19 originating overseas from spreading through Australia, and to ensure that Australians can continue to return here from overseas, ideally in increased numbers.

National Cabinet needs to look at the whole Australian hospital system, not just ICU beds

Doorstop interview, 2 September 2021:

DR OMAR KHORSHID: The AMA is today calling on National Cabinet to look at the capacity of our hospital system, not just ICU beds, but our whole hospital system, to make sure that once we open up, we don’t see a disastrous reduction in the care available to Australians who are sick simply as a result of increase in the risk of COVID in the community from opening up. And of the hospitals having to pivot towards treating COVID without treating all those other conditions that people currently present with.

The reality in public hospitals in Australia right now is that they are full, they are always full, and there are ambulances parked outside, too many of them as we speak, simply because the hospitals don't have the capacity to look after the healthcare needs of Australians. That's before COVID. And we know that as soon as COVID comes into the community, hospitals will have to stop doing elective surgery. They will have to turn their ICUs into COVID ICUs. And that means people not being able to access lifesaving cancer surgery, lifesaving heart surgery, because the ICUs will have very sick COVID patients to look after, patients who stay in the ICUs for weeks and weeks.

Now, we are not worried that our system will fail to look after COVID patients. We think the planning has been done, but we are worried about Australians who get heart attacks, who need surgery, who have a sore hip, who are going to miss out on care if we don't get the planning right. Our hospitals are starting from a position of being completely overloaded, and adding more to that load is only going to make things worse. So we're asking National Cabinet to take that into account with their planning. Is it right to open up at 70 or 80 percent if the hospitals are going to predictably fail within weeks? Which will, of course, send us straight back into lockdowns, which would be extremely disappointing for all Australians or is there a better way to plan to use our system, to make sure that the resources that we do have, limited as they are, can be best pointed towards the most efficient care possible?

Now, we're asking for planning not just around ICU beds, but around all the processes, the staffing, how we deal with COVID in hospitals, how we run our primary healthcare sector, so that we've got the best chance that when Australia does open up to the rest of the world, when we do open up our interstate borders, that we have a healthcare system available to everybody who needs it. It’s a pretty simple ask, but it's a complex task. And we believe that we must use the available weeks and months that we have, to get that planning done so that the healthcare system doesn't become the handbrake on Australia's economy and our ability to open up…...

North East NSW tells it like it is to the Legislative Council Inquiry Into Health Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South Wales in Lismore on 17 June 2021

 

Ryan Park MLC

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.....