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Scathing report into NSW regional health released

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The New South Wales (NSW) Parliamentary Inquiry into the state’s rural and regional healthcare has been released, with the NSW Government reaffirming its commitment to strengthen healthcare in the state.

The report titled Health outcomes and access to health and hospital services in rural, regional, and remote New South Wales was released on 5 May 2022, outlining 44 recommendations for strengthening NSW health.

The recommendations come after 22 damning findings including:

  • the prevalence of significantly poorer health outcomes for patients in rural, regional, and remote locations
  • inferior access to health and hospital services, especially for those in remote towns and Indigenous communities
  • significant under-resourced medical staff in rural, regional, and remote locations
  • enormous pressure placed on GPs/visiting medical officers under the current model
  • perceptions of frontline workers that the extent of exhaustion and depth of concerns felt by many nurses and allied health workers are not appreciated
  • critical shortage of health professionals and staffing deficiencies in hospital and health services across rural, regional, and remote locations
  • Some First Nations patients still experience discrimination when attempting to access healthcare
  • A culture of fear that operates across NSW Health in relation to employees speaking out and raising patient safety concerns, staff welfare, and inadequate resources
  • Lack of communication and genuine consultation between boards, management, and communities when changes are proposed or made.

In making its recommendations, the committee members heard from residents in rural, regional, and remote locations who described a broad range of issues. Common issues raised included:

  • Emergency departments with no doctors
  • Severe shortages of nurses and midwives
  • care delivered by non-healthcare professionals
  • excessive wait times
  • misdiagnosis and medical misadventure
  • and lack of culturally safe and sensitive services.

Harrowing examples were provided such as the very recent case of a ‘cook from the hospital forced to sit with a patient who had had a stroke in a car park outside the facility because the two nurses on duty were too busy, there was no ambulance in town to provide backup.’ The patient waited for 15 to 20 minutes for the fire brigade to assist.

This was not an isolated incident. During consultation, another participant stated:

We have got this situation now where we have cleaners in the emergency department…who are sitting with patients who may be confused or demented…They have also been asked on the wards to actually sit and monitor the dementia patients because we no longer have a 16-bed dementia ward.

Two daughters described in gut-wrenching detail the treatment their fathers received at three different rural hospitals. The first described how her father, Mr Bryan Ryan was admitted to the hospital with pneumonia but was given higher doses of medication three times, one leading to Mr Ryan’s heart rate slowing. Mr Ryan was then transferred to a private hospital where the errors continued. The daughter explained her father was on prescribed blood thinners to help prevent stroke. Despite doctors being given a full list of his medications, not one doctor or nurse, during the eight days of Mr Ryan’s treatment, picked up on the error. Mr Ryan suffered a catastrophic stroke. Adding to the family’s pain, was the fact that the 79-bed hospital only had a single doctor rostered.

The second experience involved Mr Wells, who had undergone multiple operations at Dubbo Base Hospital within five days of each other. Despite his age and health condition, Mr Wells daughter had to fight for her father to remain in hospital. Hours later, Mr Wells went into cardiac arrest. Despite having a full resuscitation plan in place, the staff suggested Mr Wells not be resuscitated.

Fortunately, Mr Wells survived the cardiac arrest but was then forced to beg for food and water over the long weekend because the hospital apparently could not afford to roster someone on to assess Mr Wells ability to eat and drink safely. The ward then ran out of pain killers, with staff stretched beyond limits. Mr Wells was recorded as having ‘dementia’ despite not having ever been diagnosed and passing the hospital mental acuity tests 100 percent. He was then transferred to another hospital by road ambulance in 40-degree heat, with ‘not to be returned’ written on his discharge papers. Mr Wells daughter explained:

I can still see my father’s frightened face. He was in pain and still unable to walk. He knew Cobar Hospital staff did not want to look after him. Dad was taken to the nursing home on Melbourne Cup Day thinking he was not worthy of a hospital bed. He grabbed my arm and cried as he said, “They’re giving up on me.” Mr Wells died five days later.

In what was described as a cruel indifference to human suffering and to the elderly, Mr Wells daughter described how months later, she saw a photo of NSW Health Minister Brad Hazzard launching a $30 million hospital carpark at Dubbo Base Hospital.

Following consultation, the committee made 44 recommendations, including a recommendation that health undertakes an inquiry and report on the progress of developments two years from the date of the report’s release.

Recommendations from the report cover key issues of the health system, with a specific focus on rural, regional, and remote locations.

Recommendations include reviewing current funding models for all rural and regional Local Health Districts to identify service delivery gaps, improving assistance to isolated patients, and developing collaborations between NSW Health and NSW Transport to make it easier for people living in rural, regional, and remote NSW to access the healthcare they need. Government must also engage with local charities and community groups to better understand the services and resources currently available, with the government to fill the gaps.

The report also recommends strengthening training, accreditation, and support for GPs as well as conditions, contracts, and incentives for GPs working as visiting Medical Officers in rural, regional, and remote locations.

 Additional recommendations call for the establishment of clear governance at the state and national level, as well as a strategic plan to deliver on health reforms recommended throughout the report. An immediate investment in a 10- year rural and remote medical and health workforce recruitment strategy, in consultation with key community stakeholders, is also recommended.

Recommendations also called for review and strengthening of end-of-life and midwifery continuity of care in rural, regional, and remote locations.

An inquiry into mental health, including mental health services in rural, regional, and remote NSW has been recommended, along with a review on the use of ambulances for patient transport.

The report has recommended a thorough and independent review of workplace culture across NSW health and establishing an independent office of the Health Administration Ombudsman to review concerns around the management of health employees, alleged coverups of medical errors or deaths, false or misleading data and inaccurate communications to name a few.

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