The New South Wales government will consider all options to improve regional healthcare after a scathing report found doctors had been operating in a “culture of fear” that was leading to poor outcomes for patients.
Speaking after the 322-page report was tabled on Thursday, the state’s regional health minister, Bronnie Taylor, thanked those who gave evidence during the inquiry and said she would spend the next six months going through its recommendations “with a fine-tooth comb”.
“The NSW government has listened and accepts that there is a need to do more to improve patient care in regional and rural locations,” she said.
“Everything is on the table when it comes to improving health outcomes in rural and regional NSW.”
The report made 22 findings and 44 recommendations after hearing from dozens of witnesses and receiving more than 700 submissions about the state of regional, rural and remote medical care in NSW.
Chris Minns, the state’s opposition leader, implored the government to “act immediately” on the recommendations, including improvements to healthcare workforce retention plans, palliative care and Indigenous health outcomes and access.
“The findings are concerning for those that live outside metropolitan Sydney,” Minns said.
Key among the recommendations was greater communication between the state and commonwealth – at a ministerial level – to address issues around funding and responsibilities, with a 10-year plan recommended to ensure an ongoing supply of doctors.
Taylor said she was up for the challenge and would work with “whatever government we have” after the upcoming federal election.
“People in our community, they don’t care if it’s a state or federal issue, they just want us to sort it out,” she said.
She pointed to the recent establishment of the regional health division at NSW Health as part of the government’s efforts to improve outcomes and processes.
The premier, Dominic Perrottet, said spending on rural health was at an all-time high but “we could always do better”.
But implementing the recommendations and improving health outcomes and access in NSW would only be possible if the state and federal governments increased spending, according to the Australian Medical Association (AMA).
The body is calling for an increase, from 45% to 50%, of the commonwealth’s share of funding and for the state to then reinvest the funds freed up.
“Without change to the current funding arrangements and a significant commitment between the state and commonwealth governments to work cooperatively to improve rural health, it will be difficult to achieve many of the recommendations outlined by the committee,” said the AMA’s NSW president, Dr Danielle McMullen.
The AMA also called on governments to address the need for better workforce planning to deal with understaffing and burnout, and proposed a consideration of incentives and contract flexibility for regional doctors.
“The inquiry caused considerable distress to those working in rural and regional NSW, and the focus now needs to be on ensuring that some positives come from this process,” McMullen said.
While the inquiry did recommend NSW Health expedite its review of the nursing and midwifery workforce, it did not recommend the introduction of nurse-to-patient ratios, which the NSW Nurses and Midwives’ Association (NSWNMA) had argued for.
“The urgent implementation of safe staffing ratios is paramount and would help to address these issues,” the NSWNMA’s general secretary Brett Holmes said.
One of the recommendations was to establish an independent office of the Health Administration Ombudsman to probe concerns over the conduct of NSW Health and local health district management.
This is supported by the Australian Lawyers Alliance, a national group dedicated to justice, freedom and the rights of the individual.
“It is essential that there is increased transparency in the system and public access to meaningful data, particularly regarding adverse patient outcomes,” the ALA’s spokesperson and regional health advocate Catherine Henry said.
Henry also supported the recommendation that a second inquiry be held in two years to check on the state’s progress, noting it was important the report did not sit in a drawer at Macquarie Street and “gather dust”.
The state government has six months to deliver its response.
