In a media release claiming to ‘welcome’ the findings and recommendations of the newly released parliamentary Inquiry into Health outcomes and access to health and hospital services in rural, regional and remote New South Wales the NSW Government thanked those who participated in the process, including doctors who had accused public health officials of covering up avoidable deaths in regional NSW hospitals.
The Minister for Regional Health, Bronnie Taylor said the Inquiry ‘shone a light where it needed to, hearing directly from rural and regional communities, patients, their families and healthcare workers… The NSW Government has listened and accepts that there is a need to do more to improve patient care in regional and rural locations.’
However, the Perrottet-led government – which includes Nationals’ MPs representing areas where the performance of health facilities was strongly criticised – immediately ruled out accepting the inquiry’s recommendations for a Rural and Remote Health Commissioner, minimum required staffing levels at regional hospitals and improved nurse-to-patient ratios.
“The committee has found that there is a culture of fear in relation to employees speaking out and raising concerns and issues about patient safety, staff welfare and inadequate resources.”
In the final report’s introduction the inquiry chair Greg Donnelly, a Labor MLC, said, ‘On the issue of nurses and midwives, the evidence has shown a disconnect between the reality of the daily challenges faced by them working in rural, regional and remote areas, and NSW Health’s perception of the situation.’
While noting the inquiry had raised ‘serious concerns about the governance of the health bureaucracy in this state,’ he and his co-ALP Member joined forces with their three political opponents (two Liberals, one Nationals) to reject these recommendations. The Members from the minor parties (Greens and Animal Justice) disagreed.
Also rejected was a classification scheme for rural and remote health facilities that would establish minimum required staffing levels at each level of facility based on population catchment size.
Emma Hurst MLC (Animals) offered a dissenting statement: ‘Overall, this report falls short on its commitment to the health of people in rural, remote and regional NSW… [it] is largely comprised of weaker recommendations which I am concerned will not lead to any substantial change. The people of rural, remote and regional NSW deserve better.’
The Greens’ Cate Faehrmann MLC noted her generally ‘strong support’ and ‘sincerely hoped’ the government would use the findings and recommendations to reform the system.
However, she was deeply concerned about nursing and midwives’ staffing numbers and the refusal to appoint a Rural and Remote Health Commissioner to report to the Minister through a board comprised of representatives of rural and remote communities including residents, general practices, local government, community and First Nations organisations.
NSW Health Minister Brad Hazzard would not be drawn into commenting, leaving government responses in the hands of Mrs Taylor: ‘To those who shared their deeply personal experiences, thank you. The NSW Government has listened and accepts that there is a need to do more to improve patient care in regional and rural locations.’
The 293-page final report, released on 5 May, made 22 findings and 44 recommendations for improvement, including a review of regional maternity services, a palliative care taskforce, improvements in patient transport services (IPTAAS), and treatment for First Nations people and cancer patients.
“On the issue of First Nations people’s experiences with health services, the evidence was that factors such as discrimination, racism, poor experiences with healthcare professionals, lack of transport, and the lack of affordable and culturally appropriate healthcare services contribute to a reluctance by some First Nations people to seek medical assistance.”
Specifics included –
• That NSW Health and the rural and regional Local Health Districts actively engage with local community groups and charities to understand the services and resources they provide, and to ensure that where possible and appropriate, service gaps are filled by government.
• That NSW Health work with the Australian Government and the Primary Health Networks to expedite the implementation of a single employer model for GP trainees across rural, regional and remote New South Wales.
• That NSW Health work with the Australian Government, the Primary Health Networks, the university sector and the specialist medical colleges to increase rural GP and specialist training positions…
• That NSW Health work with the Australian Government collaboratively to immediately invest in the development and implementation of a 10-Year Rural and Remote Medical and Health Workforce Recruitment and Retention Strategy.
• That NSW Health acknowledge the significant cultural barriers that telehealth poses for First Nations communities and work to ensure face-to-face consultations are prioritised.
• That NSW Health, in conjunction with The Australian and New Zealand Society of Palliative Medicine, the Royal Australian College of General Practitioners, the Royal Australasian College of Physicians and the Aboriginal Health and Medical Research Council of NSW urgently establish a palliative care taskforce…
• That Portfolio Committee No. 2 – Health consider undertaking an inquiry into mental health, including into mental health services in rural, regional and remote New South Wales in the future.
• That the rural and regional Local Health Districts, and those metropolitan Local Health Districts that take in regional areas of the state, review their maternity services in order to develop plans for midwifery, GP Obstetrics, specialist Obstetrics and newborn services.
The inquiry urged the government to publish its evaluation of the 2021 rural health plan, and recommended another inquiry into regional health in two years’ time to monitor progress.
Regardless of the notable exclusions, it is clear that after two years’ work, and considerable pressure from health insiders, patients and families/friends, and the media, notably The Sydney Morning Herald, the tiger has at last roared. It remains to be seen whether it will have bite or be as toothless as many an inquiry before it, and perhaps the one to follow in two years’ time.
