Healthcare workers in regional and rural New South Wales are operating in a “culture of fear” with many at “breaking point” due to widespread issues of resourcing, pay and safety, according to a scathing report handed to the state government on Thursday.
The report presented 44 recommendations to fix the healthcare system in rural, regional and remote areas, which it found to be “in crisis”, leading to “significantly poorer health outcomes” when compared to the city.
Its tabling in parliament follows a year-long inquiry that received more than 700 submissions and held 15 hearings, where doctors, patients, nurses and administrators outlined the extreme challenges they faced.
Among the 22 findings of the inquiry were the significant financial challenges for regional patients compared with people in cities, with some cancer patients “choosing to skip” life-saving treatments as a result.
The committee concluded there had been a “historic failure” by both levels of government to support and retain health professionals, especially doctors and nurses, in rural, regional and remote areas.
“The shortages in these workforces are, in some locations, at critical levels,” the report read.
“Unsustainable working hours, poorly coordinated recruitment and retention strategies, inadequate remuneration, lack of resources, threats to physical safety and a culture of fear are pushing some to breaking point, to the detriment of both the individual and the communities they serve.”
Many frontline healthcare workers feel that the department “does not appear to appreciate the extent of the exhaustion and depth of concerns felt by many nurses and allied health workers” across the state, the report said.
Among key recommendations was for the state government to urgently engage the commonwealth at a ministerial level to create a 10-year plan to address doctor shortages and for both levels of government to review their responsibilities and funding.
The inquiry found there were issues of significant under-resourcing in some areas, while the funding divide between the state and commonwealth governments had “led to both duplication and gaps in service delivery”.
Other recommendations included ways to address inferior access to services and disadvantage in Indigenous communities.
“It is unacceptable that some First Nations people still experience discrimination when seeking medical assistance in some rural, regional and remote hospitals in NSW,” the report said.
“Telehealth has created another barrier for First Nations people in terms of accessing culturally appropriate health services.”
To improve systems and catch issues earlier, the inquiry recommended an independent office of the Health Administration Ombudsman be established to probe concerns over the conduct of NSW Health and Local Health District management.
If established, the ombudsman would be able to investigate staff, doctors, patients, carers and public complaints including alleged cover-ups of errors, deaths, bullying or harassment.
The inquiry also recommended a review of the culture within NSW Health and regional Local Health Districts where it found staff were working within a “culture of fear” that was making it harder for people to raise concerns.
It suggested a second inquiry be held in two years to check on the state’s progress.
The inquiry heard stories of people travelling long distances to receive care, hospitals operating without doctors and the difficulty of recruiting GPs into regional areas.
Nurses recounted horror stories including patients dying on bathroom floors, families with loved ones in palliative care being forced to administer intravenous painkillers themselves, and cleaners and cooks performing nursing duties.
In February, NSW Health officials apologised to people who had been let down by medical services in regional and remote parts of the state.
“We acknowledge there has been evidence to the inquiry of regrettable patient experiences and outcomes,” department deputy secretary, Nigel Lyons, told a hearing of the inquiry.
“To these people and their families, we sincerely apologise for experiences that did not meet the highest standards of healthcare that we expect in this state.
“We reiterate our commitment to continual improvement and to ensure that all patients in the future receive the high-quality care expected and deserved.”
The NSW government has six months to respond to the report