Short-staffed and ‘a culture of fear’ in rural health
It’s official – health services outside the state’s biggest cities are chronically underfunded and critically short of staff who are ruled by “a culture of fear”.
A NSW parliamentary inquiry has delivered a damning indictment of regional, rural and remote health services and NSW Health.The inquiry 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.
After 15 public hearings and more than 700 submissions, the inquiry’s final report called for a review of funding needs and gaps in services.
“There has been a historic failure by various NSW and Australian governments to attract, support and retain health professionals, especially doctors and nurses in rural, regional and remote areas,” it said.
The inquiry 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.”
It said NSW Health and rural and regional Local Health Districts (LHDs) “lack transparency and accountability” while LHD boards and management show “a lack of communication and genuine consultation” with the communities they supposedly serve.
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”.
“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,” Donnelly added.
“In order to expand and develop the workforce, the committee has 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 Opposition pledged to act on the inquiry’s recommendations “from day one” if elected in 2023.
However, both Liberal and Labor MPs – accounting for five of the seven committee members – refused to back Greens and Animal Justice Party MPs in calling for mandated nurse-to-patient ratios in regional and rural hospitals.
A spokesman for Labor leader Chris Minns told the Sydney Morning Herald the Opposition would not allow other parties to dictate its election policies and there were no up-to-date costings for increased staffing.
NSW Health Minister Brad Hazzard declined to comment on the report to the Herald.
However, the new Minister for Regional Health Bronnie Taylor said: “We need to be able to look at (workforce issues) in a courageous way and a different way. I certainly don’t want to keep doing the same thing because then you can only expect the same outcomes.”
The NSWNMA called on the government to immediately adopt the committee’s recommendations.
Acting General Secretary Shaye Candish said that while the union welcomed the committee’s recom-mendation for a workforce review, “the urgent implementation of safe staffing ratios is paramount and would help to address these issues.”
Shaye said services would remain at risk until the government adopted safe staffing ratios.
“The NSWNMA will continue to fight for safe shift-by-shift ratios regard-less of which party is in government,” she said.
“The goodwill of nurses and midwives to continue working under-staffed and keep the doors of their rural and regional hospitals open must stop being exploited. It’s not safe for our members; it’s not safe for our communities.
“Nursing and midwifery under-staffing in rural and regional health must change. The poor skills mix issues must change. The lack of enough clinical nurse and midwifery educators to provide supervision and mentoring must change.”
‘On the issue of nurses and midwives, the evidence has shown a disconnect between the reality of the daily challenges faced by them and NSW Health’s perception of the situation.’ – Committee Chairman Greg Donnelly MP
What the RRR inquiry recommended
The parliamentary inquiry made a number of recommendations specific to nursing and midwifery in rural, regional and remote parts of the state. It called on NSW Health to:
Work with the federal government to establish a 10-year plan, to improve health outcomes and address staff shortages including GPs, nurses and midwives, nurse practitioners, mental health nurses, psychologists, psychiatrists, counsellors, social workers, paramedics, allied health practitioners and rural generalists.
Expedite its review of the nursing and midwifery workforce with a view to urgently increasing staffing numbers based on local need.
“Widely implement” the nurse practitioner model of care by funding the recruitment and training of additional NPs, particularly in facilities without 24/7 doctor coverage, or that use virtual medical coverage.
Employ a geriatric nurse in all peer group C hospitals in addition to peer group B hospitals. Where a geriatric nurse is not employed, NSW Health should give staff members annual training in geriatric care.
“Formalise and remunerate” on-call arrangements for nurses and midwives across all rural and regional public health facilities “in accordance with industrial awards”.
Implement professional, financial and career enhancement incentives for nurses and midwives who work in rural and remote locations.
Commit to a model of care “under which virtual care technology is used to supplement, rather than replace, face-to-face services.”