Showing posts with label parliamentary inquiry. Show all posts
Showing posts with label parliamentary inquiry. Show all posts

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:

https://www.parliament.nsw.gov.au/lcdocs/inquiries/2615/Report%20no%2057%20-%20PC%202%20-%20Health%20outcomes%20and%20access%20to%20services.pdf


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


Tuesday 18 May 2021

Labor MLA for Lismore: Rural Health Inquiry’s Lismore hearing to be live webcast on Thursday 17 June 2021

 

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


Thursday 11 March 2021

NSW Parliamentary Inquiry Into Health Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South Wales public hearings begin on 19 March in Sydney, with one hearing scheduled for the NSW North Coast at Lismore on 16 June 2021

 

A NSW Parliamentary Inquiry Into Health Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South Wales was established in September 2020.



Public hearings begin on 19 March in Sydney, with one hearing scheduled for the NSW North Coast at Lismore on 16 June 2021.



Submission excerpts as examples of what the Inquiry has heard thus far



Increase in work load adding pressure to perform unreasonable duties on your shift, resulting in working past your finishing time to complete patient notes and not getting paid to stay back, missed morning teas and lunch breaks due to patient work loads, overtime due to staff calling in sick and staff leaving the service due to burn out and not getting replaced, bullying from senior management is rife, medication errors due to over worked and high stress levels all caused by management, staff are being put on performance management programs due to, not being able to perform duties on shift, due to patient work loads, morale is at its lowest, nurses victimised for complaining or putting in an imms, lack of recruitment and the process being very complex and sometimes taking over 3 months to recruit a single nurse, our patients deserve much better from the health system which is broken and putting nurses registration at risk, with no support from management” [Name Suppressed, Submission No.2 out of 703 submissions received by Inquiry Into Health Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South Wales]



In November 2016 my mum had a fall and broke her pelvis. She was taken to Maitland Public hospital . She had suffered brain surgery and radiation treatment earlier in the year. She was 84. On the first day of her admission to hospital a resident doctor shocked both my father and myself telling us she would probably die not from the broken pelvis but from being in hospital. My dad and myself visited her every day for the next 8 weeks. She was sent to a neighbouring hospital at Kurri Kurri 3 times and returned twice with infections and delirious and we were never actually told why she was deteriorating so much. She would be very agitated saying she was not attended to when she wanted to go to the toilet. Then she was told she needed to try to walk and was using a walker, then all of a sudden that was taken away and a nurse said she was never supposed to start rehab yet. So much confusion and no one still explained to us exactly what would happen to her. No communications or accurate ones anyway.



And then it was Christmas we were going to try to get her home just for a couple of hours but on Christmas Eve she apparently had a stroke and was transferred close to a nurses station for observation her confusion level was beyond belief. On the day after Boxing Day I got a call from my dad very upset saying they were transferring mum back to Kurri hospital for rehab. I was very angry with this decision and went straight to Maitland hospital mum was screaming pleading not to be taken back there as she had already been there twice and sent back very sick both times. I argued with the nurse that it should not happen but she said there was no choice as it was about numbers. we were allowed to go in the ambulance with mum and she was crying all the way, even the ambulance drivers seemed upset. When we arrived at Kurri hospital we were met by a nurse who made a comment that surely someone else could have been transferred today.



Mum died two days later she was broken by this stage and made a comment to me that when you get to a certain age they don’t care about you any more. I said it wasn’t true at the time but ponder that question every day. Mum was a wonderful Wife, Mother, grandmother , great grandmother, sister and friend to many I miss her every day. My daughter sent a letter to Maitland Hospital and we did receive an apology for her treatment after an investigation.



Too late.”

[Name Supplied, Submission No.7 out of 703 submissions received by Inquiry Into Health Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South Wales]



The Tweed Hospital is a Peer Group B hospital that currently has 255 beds and Level 5 emergency department.



Currently at Tweed Hospital, Nursing Hours Per Patient Day wards (Medical and Surgical) are funded at 5.5 hrs instead of the 6.0 hrs that Peer Group A hospitals receive.



At Tweed the Surgical and Medical Wards are no different to any other wards of a city hospitals. The same type of patients with the same level of acuity, but at Tweed Heads every patient receives 0.5 hrs less care due to their postcode.



Our Hospital routinely has between 95%-104% occupancy and 5.5 NHPPD has a huge impact on delivering safe patient care and nursing workload.



Staffing retention is also an issue here at Tweed Heads due to our proximity to the Queensland Border, nurses no longer must put up with the horrendous workload, risks to their registration or their ability to deliver safe patient care. Many nurses have left the NSW system preferring to work in Queensland at the University Hospital 20 minutes up the highway:



They have Ratios 1:4

Education Allowance of $1800 per year

100% Salary Sacrifice

Higher pay rate by $3,000 per year

Higher penalty rates on Night Duty”

[Name Supplied, Submission No. 178 out of 703 submissions received by Inquiry Into Health Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South Wales]



In March 2012 the LHD announced it would develop a Clinical Services Plan for Coraki and surrounds to assess the health needs of the area and make recommendations on how those needs could best be met. That Plan was completed, with community input, in August 2012. It recommended the adoption of a 'HealthOne Model of Care' - bringing together Commonwealth- funded general practice and state-funded primary and community health services in the one facility. After considerable lobbying by the Reference Group the NSW Government allocated $4 million for the construction of the HealthOne in 2016 and the facility was opened in May 2017.



According to various publications by NSW Health the key features of the HealthOne model that distinguishes it from other primary and community health services are integrated care provided by co-located general practice and community health services; organised multidisciplinary team care; care across a spectrum of needs from prevention to continuing care; and client and community involvement. In Coraki we now have an impressive new HealthOne which has consulting rooms for two GPs and houses a variety of community health practitioners. Regrettably, since its opening it has not been possible to attract a single GP to the purpose-built facilities. We feel we have a HealthOne without a heart.



We are aware the lack of a GP is not unique to Coraki and that it is shared by many rural and regional communities across NSW. We are hoping this inquiry will shine a light on this problem and spur governments, both State and Commonwealth, to come up with solutions.



In Coraki's case a possible solution might be to expand the HealthOne into a Multi-Purpose Service. There is a 49-bed aged care facility adjacent to the HealthOne (operated by Baptist Care) and the future expansion of the HealthOne was allowed for in its planning and design. The Reference Group notes that a recent Commonwealth Government Report (Review of the Multi-Purpose Services Program - 2019), which was done in consultation with state and territory governments, found that the MPS is a sound model for delivering integrated health and aged care services in rural and remote communities and made recommendations, which have in large part been accepted by the Commonwealth Government, to strengthen and expand the MPS program. An MPS in Coraki, with its expanded range of health services and clients, would enhance the attractiveness of Coraki for prospective GPs.



Finally, we wish to draw the Committee's attention to the lack of an ambulance in Coraki. While ambulances are available from Casino, Evans Head and Lismore, the extra half hour they take to reach Coraki can be critical….” [Name Supplied, Submission No. 179 out of 703 submissions received by Inquiry Into Health Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South Wales]


 

To support our submission we would like to highlight anecdotal evidence of an issue that is raised time and time again – The need for increased funding for public health professionals working across the cancer care coordination/ social work areas to be more available to patients.



We have heard of many case studies from patients across the Northern Rivers and Far North Coast, ranging from private and public treatment centres about such barriers to better health outcomes.



One case study – a gentleman with Basal Cell Carcinoma of the outer nose, lost most of the features of his nose after surgery. This patient continued about his daily life with social anxiety, unable to go back to a normal daily life. Until one day, quite simply he was asked by a fellow patient to the reasons why he had not considered a prosthetic nose free of charge through a charitable support scheme. His heartbreaking response “I never had knowledge of such option, or service available to someone like me with limited financial means”. Please conceive, if only this patient had been linked to an appropriate cancer care coordinator or social worker, his burden could have been lifted much sooner and thus contributing to better outcomes. How many more patients are currently in the same position?



Another case study we would like to highlight is of a female who had undergone lumpectomy just over the border in Queensland. A breast cancer nurse who happened to be on shift advised - as this patient was living in New South Wales and not Queensland, she was not eligible to any support services. Therefore she was advised to go home to Byron Hospital and request community social work support. Once at Byron Bay Hospital, she was told that the hospital was only issued with two community social worker services per week, and that as it was now Thursday, they had already been handed out for the week. This patient was left alone at home, without support and in pain, not even able to slice a tomato for a salad. She was not even given a phone number to contact. With so many questions and with no one to turn to, she was left overwhelmed, scared and unsupported.



Had there been a dedicated cancer care coordinator available to both patients as highlighted in our case studies, they would have received the appropriate care deserved and thus better health outcomes.



We passionately could continue highlighting similar case studies as of the two above, however we hope these testimonies clearly demonstrate the priority need for increased funding for socio/emotional support during and after treatment.” [Name Supplied, Submission No. 184 out of 703 submissions received by Inquiry Into Health Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South Wales]


All written submission made to the Inquiry can be found at 

https://www.parliament.nsw.gov.au/committees/inquiries/Pages/inquiry-details.aspx?pk=2615#tab-submissions