REGIONAL and rural communities are now at "breaking point", with "significantly poorer health outcomes" compared to their city counterparts, including higher chronic disease and premature death rates, a parliamentary inquiry has found.
The stories told by community members, health care professionals and others paint a picture of a rural health system that is experiencing 'significant difficulties and challenges' and in some instances is in crisis.
Committee Chair Greg Donnelly said the situation "can and should not be seen as acceptable'.
Many of the factors which have led to inferior access to health and hospital services in rural, regional and remote communities were linked to "significant and longstanding workforce challenges", the report says.
However, efforts to address the issue were "sluggish" and "patchy", and "stymied by complex layers of responsibility with little coordination across the multiple sectors".
The Commonwealth-state health funding divide had also led to both duplication and gaps in service delivery.
"Health and hospital staff are strongly committed to improving health outcomes for their patients, but they are constrained by a lack of resourcing from the NSW and Australian governments," the report says.
The 44 recommendations made by the committee include the need to address a "culture of fear" operating within NSW Health preventing employees from speaking out and raising concerns and issues about patient safety, staff welfare, and inadequate resources, calling on NSW Health to review and enhance whistle blower protections to ensure staff feel comfortable in speaking up.
It calls for 10-Year Rural and Remote Medical and Health Workforce Recruitment and Retention Strategy, and recommends that the state government maintain a regional health minister in cabinet.
It also calls for the urgent establishment of a palliative care taskforce and urges NSW Health to consider undertaking an inquiry into mental health,
The working conditions, contracts and incentives of GPs working as Visiting Medical Officers should be reviewed, and local health districts should engage with the emergency departments in their area to develop agreed plans to address security issues.
The report highlights a lack of transparency and accountability of NSW Health and the rural and regional Local Health Districts in terms of governance, and has recommended the establishment of a Health Administration Ombudsman.
Throughout the inquiry, the committee heard repeatedly about individuals and families let down by the health system, Mr Donnelly said.
"The committee heard stories of emergency departments with no doctors; of patients being looked after by cooks and cleaners; of excessive wait times for treatment; and of misdiagnoses and medical errors," he said. "There is much work to be done across so many areas."
The evidence included reference to the absence of a GP or chronic shortage of health professionals in 25 areas across the state, including Port Stephens, and wait times of up to three years in the Hunter New England Central Coast district for access to public ENT (ear, nose and throat) services - interventions and surgeries which all must take place at the John Hunter Hospital, at Maitland, or in Gosford.
Other concerns raised included a "critical" lack of staffing and specialists, missed diagnoses, long wait times, and a lack of accessible services in Hunter New England, and the lack of an on-site doctor - and occasionally the absence of an on-call doctor - at Dungog Hospital.
One mother told the inquiry it took six hours for her vomiting three-month-old baby to be seen at Maitland Hospital.
An elderly man "in agony" with chest pains also waited "many hours" at Maitland Hospital to be seen, another submission said.
Doctors from the New England region also said a lack of services in their region had forced sick cancer patients to drive more than 3.5 hours to Newcastle for "something as simple as a PET scan", or to sign a consent form.
NSW Minister for Regional Health Bronnie Taylor said at a press conference on Thursday that she would consider the recommendations and "go through them with a fine tooth comb".
Ms Taylor acknowledged that many harrowing stories had been told but every day, "really good things happen" and great health outcomes are achieved.
"I understand there are challenges ... and I am up for addressing these issues," she said.
One of the first issues she would address included workforce shortage, she said.
"If there was an easy solution, we would have done that ... we need to be able to look at it in a courageous way and a different way ... and I will listen to the workforce about what they need and what they want."
The grim picture of the state's rural and regional health care services which emerged during the inquiry, which included 15 hearings involving 220 individual witnesses and attracted more than 700 submissions, has already prompted a response from NSW Health.
Senior NSW Health official, Dr Nigel Lyons, apologised to rural patients during the inquiry, saying the department is committed to ensuring equitable healthcare.
The state government has six months to respond officially, but Ms Taylor indicated that she hoped to have a response together sooner.
Both major political parties have promised to inject $146 million in new funding into rural health, a move described by the Australian Medical Association (AMA) as a 'welcome shift' in the federal election campaign.
AMA President Dr Omar Khorshid said the Coalition had released of a suite of practical policies to bolster the rural health workforce, which the Labor Party has said it will match.
The $146 million spend offered by both parties would build on earlier Budget commitments, and support strategies to get more doctors into locations where they were most needed, Dr Khorshid said.
"We welcome the focus on bolstering the rural health workforce, with shortages remaining the number one issue facing many rural communities around the country," he said.
"Extra funding for workforce incentives and additional training places are badly needed to ensure rural patients have access to services."
Dr Khorshid said the inequity in health areas outside metropolitan Australia were unacceptable.
"According to the Australian Institute of Health and Welfare, Australians living in rural and remote areas 'have higher rates of hospitalisations, deaths, injury and also have poorer access to, and use of, primary health care services, than people living in major cities'."
