Coalition offers little solution to regional woes

The year 2022 was notable for a parliamentary inquiry’s damning indictment of regional health services – and the Coalition government’s weak response.

The dire condition of NSW regional health services was laid bare by a parliamentary inquiry in 2022. It found that people outside Sydney, Newcastle and Wollongong face “significantly poorer health outcomes, greater incidence of chronic disease and greater premature deaths” as a result of chronic underfunding and critical staff shortages.

It decried a “historical failure by various NSW and Australian governments to attract, support and retain health professionals, especially doctors and nurses in rural, regional and remote areas”.

Inquiry chairman Greg Donnelly, a Labor MP, said staff were “pushed to breaking point” by “unsustainable working hours, poorly coordinated recruitment and retention strategies, inadequate remuneration, lack of resources, threats to physical safety and a culture of fear”.

The inquiry held 15 public hearings and received more than 700 submissions, including from NSWNMA members who gave evidence at the hearings.

The NSWNMA submission pointed out that residents in regional, rural and remote parts of NSW have higher rates of coronary heart disease, stroke, chronic kidney disease, mental ill-health and diabetes, but less access to health services.

Our submission said regional health services are characterised by poor staffing and skill mix, with nurses and midwives routinely working in isolation.

They have limited access to continuing education; rely on colleagues to provide unpaid, on-call support; suffer from inadequate security; and bear the burden of a doctor shortage.

The doctor shortage puts “a huge burden of responsibility” on NSWNMA members, who experience widespread problems with accessing on-call and telehealth doctors, the submission said. After considering submissions, the inquiry recommended that NSW Health “expedite its review of the nursing and midwifery workforce with a view to urgently increasing nurse and midwifery staffing numbers based on local need across rural, regional and remote NSW”.

The NSW Coalition government responded by agreeing to fund extra nurses and midwives for regional areas, and a recruitment and retention incentives package. However, this response was inadequate because it “ignored evidence-based workplace solutions, such as safe nursing and midwifery staffing ratios”, said NSWNMA general secretary, Shaye Candish. She said services would remain inadequate and unsafe until the government adopted shift-by-shift ratios.

“Unless the government addresses the shocking working conditions staff are enduring, patients will continue to be at risk,” Shaye added.

Government ignores ‘culture of fear’ warning

The parliamentary inquiry into regional healthcare reserved its harshest language for NSW Health’s treatment of staff. It found there is “a culture of fear operating within NSW Health in relation to employees speaking out, and raising concerns and issues about patient safety, staff welfare and inadequate resources.”

The inquiry recommended the government establish a new independent ombudsman to tackle serious governance issues across regional hospitals. However, the government rejected this recommendation, claiming the job was already being done by the NSW Ombudsman and Health Care Complaints Commission.

WHERE THE PARTIES STAND ON REGIONAL HEALTHCARE Coalition

Announced an incentive scheme to attract and retain staff in rural and remote areas in 2022. The scheme included incentive packages ranging from $5000 to $10,000 per worker per year of service.

Established a 15-member panel to help NSW Health to implement recommendations of the Rural Health Inquiry, including the development of a new Regional Health Plan.

Rejected the NSWNMA’s claim for an allowance for FLECC/ENECqualified regional and rural nurses and an additional RN to be rostered on-call for sites without 24/7 access to medical officers.

Labor

Promised minimum nurse-to-patient ratios in multi-purpose services (MPS): 3/3/3 (am:pm:nd) nurses as a minimum in MPS where there is a 24/7 ED. At least two nurses will be RNs and staff must be FLECC/ENEC-trained.

Like other safer staffing measures promised by Labor, the MPS ratios will be “phased in over time”.

Promised to implement recommendations of the Rural Health Inquiry “in full”.

Committed to an additional 500 paramedics in regional and rural NSW.

The Greens

Called for mandated nurse-to-patient ratios in regional and rural hospitals following last year’s Rural Health Inquiry report but received no support from the Coalition or Labor.

Called for an independent Rural and Remote Health Commissioner to monitor and report on the performance of NSW Health in meeting rural health workforce and health outcome targets, and to advise the state government on health policy and reform.

Advocates telehealth in rural and regional EDs “where this service supports and does not replace on-site staffing”.