Health inquiry hears of chronic staff shortages across MLHD

The state government’s rural health inquiry kicked off its regional hearings last week, visiting Deniliquin on Thursday and Cobar on Friday.

The inquiry – which is examining the health outcomes and access to health and hospital services in regional, rural and remote New South Wales – received over 700 submissions from individuals, organisations and politicians across the state in the lead up to in-person hearings.

A number of the submissions make direct reference to the Snowy Valleys region and healthcare services on offer locally.

Shan Elliott, a nurse in Tumbarumba, wrote that the MPS doesn’t have “enough nurses for a safe roster.”

She said that staff at the MPS overwork themselves to treat patients the best they can without a permanent doctor on site, but often a doctor on the phone.

“We have a high resignation rate and a zero replacement rate,” she wrote. 

“Mental illness is now prevalent [among] our staff. Both they [and] their patients are at genuine risk. Please help us close the gap.”

Snowy Valleys Councillor Geoff Pritchard, who is a retired specialist surgeon, also made a submission. He wrote that when he was working in Tumut, urgent diagnoses, immediate surgery and resuscitation was readily available at mostly no cost to the patient.

“Now Tumut is getting a new hospital but is only slated to undertake ‘Day Surgery’. This means that there would not be enough work to attract procedural GPs, let alone a surgeon, to the area and keep their skills up,” he wrote.

“Medical practice has changed in recent years and it is hard to get emergency [coverage] at the hospital and locums are too expensive.”

Cr Pritchard said the region seems to have enough GPs, suggesting that it is doctors that need to be brought to the area.

“There are plenty of Australian trained doctors overseas who, if offered residency conditional on specific regional service for a period, would come,” he suggested.

In his ten-page submission, Wagga Wagga MP Dr Joe McGirr outlined a number of issues facing regional and rural hospitals and staff.

He argued that rural communities require an on-the-ground, on-site medical workforce that can become “part of the social structure of the town, part of the economic vibrancy of the community and an important part of the provision of health services.”

In recent years, however, this has been replaced with fly-in, fly-out services and telehealth options, Dr McGirr stated.

“These issues have been highlighted in relation to Tumut hospital in my electorate that has struggled to maintain a full medical roster,” he wrote. 

“The LHD employs a remote health service and video technology to support nursing staff. However, the community rightly expect a full complement of on-the-ground medical staff to support what is a major district hospital. 

“Smaller communities around Tumut have also struggled to find on the ground medical services with local on-call services after hours.”

Speaking of paramedic services, Dr McGirr said they often “bear the brunt” of the lack of hospital services when there are no medical staff.

“While there has been investment in physically upgrading stations, there are ambulance stations that have missed out – including the Tumut station which requires significant upgrading and should be relocated to the soon-to-be completed new Tumut hospital,” Dr McGirr argued.

A submission made anonymously calls for all rural and remote hospitals to have one or two doctors on-site 24 hours a day, after this person had to travel from their local hospital to Wagga Wagga 100 kilometres away after falling ill. They then waited two hours in the emergency waiting room, and a further ten in triage.

“I find this unacceptable in this day and age. Just because we are not in the city doesn’t mean we should be treated like we live in a third world country,” they wrote.

One RN who works at an unnamed hospital in the Murrumbidgee Local Health District (MLHD) said that nursing staff have been requesting management for extra staffing for the past two years, “which has constantly been rejected.”

“Staff are constantly working overtime, called in to work on days off, mentally fatigued, and constantly being called to fill open shifts where staff are unavailable,” the RN wrote.

“How does this impact on the well being of our patients that we are supposed to be delivering holistic care to? 

“The MH of both staff and patients have been increasingly at risk of deterioration.”

Another anonymous RN working within the MLHD said that the workload for all nursing staff “has become unmanageable.”

“Staff are working 12hr-18hr shifts to cover sick leave in all areas of the hospital– they are exhausted,” the RN wrote, also describing recruitment as an ongoing issue.

“In the long term, this is paramount, but receiving new staff, even post-graduate placement nurses, only compounds the workload for the RN managing the dept,” they wrote.

“Having to train them, as they graduate poorly skilled, check their competencies and documentation, and constantly picking up the extra missed workload for them. 

“Agency nursing staff have been employed in our facility short term, and have expressed their shock at the workload we are submitted to. Few want to return.”

Liam Minogue, who is currently doing Covid testing within the MLHD, believes that rural areas need ratios implemented, using the example of an afternoon shift with a patient load of nine or more.

“You have acutely sick patients and a palliative and due to no ratios you don’t get to spend any time with the palliative care patient and are lucky to get a dinner break,” he wrote.

“This can’t go on, nurses and patients deserve better.

“Having ratios would also provide a much safer environment for both staff and patients.”

Dr Claire Cupitt describes working a locum position in Gundagai where a ward round and outpatient assessment that should have taken two hours took six, “due to multiple computer glitches and no nursing staff allocated to assist me or orient me or even give me the computer passwords.”

“I was quite psychologically distressed by the time I made it back to the private general practice to see the patients that were booked in,” she added.

Dr Cupitt was also offered locum work in Lake Cargelligo and Temora, and when seeing the list of requirements, felt she could “not risk further severe stress before I even started”.

She described the paperwork necessary for the locum work as “onerous”, having to obtain approval from NSW Health despite working for them for almost 40 years.

“As it turns out, the media apparently heard of the situation and made an enquiring phone call to [MLHD] re Lake Cargelligo,” Dr Cupitt wrote.

“The following day … I was phoned and advised that I could get a contract to work at Lake Cargelligo without the paperwork after all.

“It seems wrong that it took a media phone call, rather than the community need, to create a solution.”

An anonymous doctor in Cooma, working in general practice and at the Cooma hospital, wrote a long submission outlining a number of issues they have identified.

This includes: no taxi service at night, with patients brought in having to be admitted overnight; limited access to GPs; people being discharged without medication as the pharmacist is not at hospital every day; reduction in elective surgery; lack of specialist services; outdated IT systems for radiology; and the difficulty of getting trainee doctors.

One anonymous writer believed there was inadequate ambulance and hospital services for Jindabyne and the Snowy Mountains area, especially during the winter ski season and summer school holidays “with accidents to tourists leaving the local community without adequate service.”