*The contents in this blog relates to legislation in New South Wales.
The NSW Parliamentary Inquiry into health outcomes and access to health and hospital services in rural, regional and remote New South Wales (‘the Inquiry’) was established on 16 September 2020. Since then, the Inquiry has received over 700 written submissions. It has held public hearings in regional towns and heard shocking evidence about the state of our healthcare system.
In this series, we will follow the Inquiry and look into the evidence heard at each public hearing.
Recently, the Inquiry travelled to Cobar, Wellington and Dubbo where it heard from a number of key figures regarding healthcare in Dubbo and in the wider Western NSW Local Health District. This is an area that covers a population of around 277,000 residents, of which 11% are Aboriginal & Torres Strait Islander people. It encompasses three major base hospitals at Orange, Dubbo and Bathurst, as well as a number of smaller hospitals and multi-purpose services including in towns like Bourke, Walgett, Warren and Parkes.
The Inquiry heard that there were a number of key issues that affect the Western NSW Local Health District:
Centralisation of health services
The Inquiry heard that there has been a reduction of funding and services over the years, which has led to the centralisation of health services to the detriment of the local communities. Councillor Ken Keith, Mayor of Parkes Shire Council, expressed concern that the allocation of resources to the larger ‘base’ hospitals had been done at the expense of the smaller regional hospitals. This means that services which were previously offered in smaller towns were no longer available.
In relation to Coonabarabran Hospital, evidence was given that the Western NSW Local Health District had deliberately stripped away medical items such as surgical instruments, obstetric labour beds, a CTG machine, cardiac stress test treadmill, neonatal crib and paediatric beds. This means that the hospital is unable to provide those services, even if they have medical practitioners who can provide them.
The centralisation of health services to bigger towns has lead to patients having to travel greater distances for healthcare and a substantially increased workload for the local general practitioners.
Many examples of patients needing to travel significant distances to bigger hospitals were provided, including someone from Parkes who suffered a dislocated shoulder and who was forced to travel to Orange to receive anaesthetic to have their shoulder put back in as there was no anaesthetist available in Parkes.
There was a woman from Bourke who presented to the hospital in labour. She was taken to the Bourke airport to be transferred to Dubbo via the flying doctor service as there were no maternity services available at Bourke. She ended up giving birth at Bourke airport.
Later in the Inquiry, Scott McLachlan, the CEO of the Western NSW Local Health District, gave evidence that of the 38 hospitals within the district, only 9 carry blood products due to the short lifespan on the product.
Lack of general practitioners
Mr McLachlan conceded that most of the issues faced across the Western NSW Local Health District came back to the lack of general practitioners within the region.
Dr Kerrie Stewart, a general practitioner in Parkes, told the Inquiry that the huge shortage of general practitioners had resulted in the inability of current general practitioners to have capacity to provide essential care to members of the community.
Dr Stewart told the Inquiry that patients had to wait one month for an appointment with a general practitioner in her practice. Dr Amy-Lea Perrin, a general practitioner at the Aboriginal Medical Service in Dubbo, indicated that patients were waiting up to six weeks for an appointment with her service. Because of the shortfall, there were zero on the day or emergency appointments available to patients. For urgent issues, patients were forced to present to the local hospital.
Dr Stewart said general practitioners were placed in an incredibly difficult scenario because it meant that they were unable to offer good, safe medicine if they could not follow patients up.
A similar situation was expressed in Warren, where Mayor Milton Quigley said they had about half the amount of general practitioners required to service the town.
Lack of forward planning for retirement
The Inquiry heard that many medical practitioners provided advanced warning of their retirement. Despite this, there has been a lack of forward planning to replace those practitioners before they retire. For Parkes, Mayor Keith said that it meant the maternity ward closed in June 2019 due to the retirement of three general practitioner-obstetricians.
Over-reliance on telehealth
Telehealth and virtual assessments are being used across the district as a way of combatting the shortfall in medical practitioners.
Ms Tanya Forster, a psychologist from Dubbo, talked about how covid-19 had increased the use of telehealth services for mental health, which had had a profound impact on provision of mental health services. Prior to covid-19, patients would have to drive four hours to attend a one hour psychology appointment, and four hours home. Clearly there was a benefit to the use of telehealth in this area of medicine which is so lacking in rural areas.
The Inquiry heard from Ms Kearines who gave evidence about her father’s death in Narromine Hospital. He was 92 years old when he was diagnosed with blood cancer. He experienced a decline in his condition quite quickly and was admitted to Narromine Hospital on Boxing Day. He sadly passed away on 4 January. During the time that he was admitted, Ms Kearines’ father was physically seen by a doctor once. On all other occasions, he was seen via a virtual doctor – this meant a doctor in another city, or perhaps another country, who consulted by video. This was problematic as her father had hearing issues and the doctor missed diagnosing aspects of his condition that they would have picked up on if they were in the same room. She said that at times Ms Kearines’ dad waited hours for pain medication due to nursing staff being over capacity. Ms Kearines felt her father’s last days were plagued with pain and confusion as to his condition.
She said, “My sister is an ex-vet nurse. She made the comment that if that was her dog, she would be having police charges laid against her for letting it be in as much pain as what our father was in at times.”
A number of witnesses told the Inquiry that telehealth performs a helpful role because it is not realistic to expect there to be specialists in each town or even each major centre. However, it should be used as adjunct to support the clinicians on the ground rather than relying on it as a first port of call.
Increasing burden on local government
Mayor Quigley noted that increasingly the burden for provision of health services is being placed on local government. He indicated that Warren Shire Council had purpose-built a medical facility able to accommodate three general practitioners as well as allied health professionals. In an effort to attract people to the area, he Council had subsidised rent for doctors to stay in Warren.
In Parkes, Mayor Keith told the enquiry that the local Council has held community fundraising days to raise money to fund additional general practitioners. He said the community had raised over $200,000 to go towards the recruitment of general practitioners.
Both mayors expressed that the Council was putting these funds into healthcare because they were now hitting a crisis point and accessing funds from state or federal governments took too long or never came.
The Inquiry was told it was difficult to attract people to the regions, leading to a shortage of healthcare workers. Often, people would come for a short period to complete a portion of training but not stay in the region once their training was complete. This has led to staff shortages across the board, but especially in the hospitals.
Pen McLachlan told the Inquiry there were many horror stories she had seen in 22 years as a nurse in Condobolin. She said that earlier in 2021, the cook from Condobolin Hospital was forced to sit with a patient in a car park outside who had had a stroke because the two nurses who were on duty were too busy in the emergency department and in the ward to attend to the patient.
Lack of specialist services
Dr Perrin told the Inquiry that access to specialist services was lacking Dubbo. The issue was two-fold: access generally, but also access to affordable specialist services. She said waiting times were up to 12 months long for some specialists and so she had taken to referring patients to Orange, Bathurst, Sydney and Newcastle. In the meantime, general practitioners were required to monitor patients and keep them well while they were waiting to see a specialist. This meant they were seeing the patient a lot more frequently, which only further increased general practitioner backlogs. As a result of the lack of specialists, waiting times in the public hospital for surgeries were extended and she said quite often patients would be waiting the maximum 365 day waiting period for a non-urgent surgery.
In addition to medical services, the Inquiry heard that there is a severe lack of mental health services available across the Western NSW Local Health District. Councillor Keith noted that youth suicide had increased dramatically over the last few years. Dr Perrin said that while some services were available, her referrals were often rejected. She indicated there was an average of about an eight week wait for a private psychologist. In addition, she said that a number of her patients lived below the poverty line and could not afford the out of pocket costs to see a private psychologist.
Dr Perrin told the Inquiry that having extra services in the community that general practitioners could refer to and knowing that their patients were getting the care that they would if they lived in the middle of Sydney would take a lot of pressure off.
The lack of specialist services meant the local hospitals are being underutilised. As an example, in any given week, the operating theatres in Parkes would be vacant for three days.
Lack of culturally appropriate services
Dr Perrin gave evidence that some patients would travel up to three hours to the Dubbo Aboriginal Medical Health Service in order to access medical care.
Ms Ann-Maree Chandler, the owner of Indidg Connect, gave evidence that the feedback from community members was that patients felt that when they went to the doctor they were not being listened to.
Ms Chandler identified that there was a need for advocates to be with indigenous people when they visit the doctor to ensure that they are understood and respected. Dr Perrin and Ms Keed provided a number of examples of poor treatment of indigenous people including a patient having heart attack that was missed at a local hospital because she was placed in a waiting room having been labelled a malingerer.
Those who gave evidence made a number of key recommendations, including:
- The creation of a statement government Minister for Regional Health.
- Creating more generous packages for doctors to recognise their training in Regional NSW and creating packages that actually remunerate them at an appropriate level for the risk that they have to take and the knowledge they have to acquire to be able to practice in Rural and Regional NSW.
- Implementation of rural medical schools so that students were able to do their undergraduate studies in rural and regional locations.
- Availability of more senior doctors to supervise junior doctors in the community.
- A more proactive, rather than reactive approach to funding and manning in hospitals.
- Liaison officers should be employed to assist people who are taken to hospitals via ambulances, noting the huge distances between towns and larger hospitals.
- Building of short-term accommodation specifically to cater for the people transported to Dubbo from remote and regional areas and that this accommodation be provided at no cost to patients.
The themes of the submissions made were that there is a difficulty in attracting and keeping staff in rural areas, that there is an ageing population that needs to be planned for, staff are burnt out and because of all these reasons, the community are not receiving the standard of healthcare that they expect and deserve.
As one witness said, “Our problem is getting doctors—bottom line. I cannot add any more than that. There is a shortage of doctors. This has gone on in the past decade. It has gradually gotten worse and worse.”
Get in touch
At Turner Freeman, our medical negligence team has fielded many enquiries in relation to poor healthcare from many rural hospitals and facilities, including in the Western NSW Local Health District. We know the issues faced by rural and regional patients are different to those faced by patients in the city.
If you are concerned about your treatment in a rural or regional hospital, get in touch with us on 13 43 63. We have specialist medical negligence lawyers throughout NSW who will assess your case and provide personalised advice regarding your legal entitlements. Our medical negligence lawyers are located across NSW including in our offices in Parramatta, Sydney, Wollongong, Newcastle and Toronto.