When Jill Robards’s 79-year-old husband had a stroke, the gaps in the health system were stark, she says.
Flagged for discharge from Dubbo hospital without her knowledge, her husband was sent in a taxi to their local hospital which had no doctor at the time. He was sent home three days later by a doctor who saw him via Telehealth, back into 80-year-old Jill’s care, without having received physiotherapy.
“It seemed like there was a breakdown in how things should’ve worked,” she says, sitting in the kitchen of her central west New South Wales cattle farm. Robards is at pains to state she is not upset with the hospital or the staff, but the system.
“The doctors and nurses are doing their best, but they’ve got to get rid of the patients to make room,” she says.
“And that’s where the system falls down.”
Healthcare staff across the NSW central and far west regions say the strain of under-resourcing is causing patients to be palmed from hospital to hospital, jeopardising the communities’ health.
“We’re getting people just bouncing back,” says Tina Robinson, who was a nurse at Warren multi-purpose health service at the time of speaking to Guardian Australia.
“[Health problems] that should be dealt with properly aren’t getting done the way they should,” she says.
A scathing report handed to the NSW government on Thursday, after the state inquiry into healthcare in regional, rural and remote regions, found the health system is “failing” rural communities, contributing to poorer health outcomes and “inferior access to hospital services” compared to people living in metro areas.
From 2020 to 2021, the western NSW local health district had the highest number of emergency department presentations in the state. Potentially avoidable deaths, which measures deaths among the community rather than in the hospital system, were also 43% higher than the rest of the state from 2011-2016, according to the latest data.
Dr Aniello Iannuzzi, a doctor at Coonabarabran hospital, said the lack of healthcare workers and under-resourcing of rural health services in the region is increasing transfers of patients to Dubbo hospital.
“We’re sending more and more patients to Dubbo because our staffing and resources are so bad that we don’t feel it’s safe to keep them in our hospital,” he says.
Sacha, a nurse at a hospital in the region who spoke on condition of anonymity, said Dubbo hospital – which helps service communities as far as five hours away – hasn’t been resourced to deal with this influx, discharging patients “not because it’s the best time for them to leave, but because they have significant pressures on their beds”.
“And then that reverberates out on to the multi-purpose health services, and other procedural hospitals.”
Robinson and Sacha say they frequently warn Dubbo hospital when they don’t have the staff or resources to adequately care for a patient being discharged to their health facilities, but this is often ignored.
This pressure of under-resourcing in rural areas has reverberated to Orange medical health service, another regional hospital in the area. It wrote in its submission to the inquiry that the demand on its hospital – as a result of smaller hospitals not retaining suitably qualified GPs – was not accurately predicted or modelled.
A spokesperson for the western NSW local health district said it was developing a plan to consider how three communities in the central west – Wellington, Dubbo, and Narromine – can have their health needs met by future funding, taking into account population demand.
They said since 2016, the NSW and federal governments had invested more than $305m in the redevelopment of Dubbo hospital, increasing its capacity to care for patients.
The number of transfers to Dubbo hospital has remained steady across recent years, and the facility safely managed increased pressure from the Covid-19 pandemic, according to the spokesperson.
“In some rural areas, it is difficult to sustain 24/7 coverage of the local hospital as there are not enough GPs or doctors willing to undertake work as a visiting medical officers to provide a safe roster with no gaps,” the spokesperson said. They added the federal government is responsible for ensuring patients have access to primary care and GPs.
“When GP visiting medical officers are unavailable, an alternative is for a locum doctor to provide services for the hospital. Locums and visiting medical officers can be difficult to source, even with generous remuneration arrangements in place,” they said.
‘Pressure on the nurses’
Healthcare workers say the reliance on Telehealth and nurses as the mainstay of care in some rural health services in the region is adding to the stress on the system.
“It’s putting a lot of pressure on the nurses,” says Robinson, who had just finished an 18-hour shift at the time of speaking to Guardian Australia.
“If we don’t have a doctor on call and we get a triage one … we’re doing everything under a camera. So we’re doing like the whole resuscitation without a doctor, we’re even shocking people,” she says.
If the patient needs to see a doctor face-to-face, Robinson says they’re sent to Dubbo hospital.
Mark Burdack, CEO of the Rural and Remote Medical Service – a charity providing medical services in the central and far west – is critical of the way Telehealth is being used “to replace local GPs in rural hospitals” rather than as a tool to support existing doctors with low acuity healthcare.
A spokesperson for the western NSW local health district said the use of Telehealth has increased during the Covid pandemic, “However, virtual care is not a replacement for local doctors.”
They added that virtual care plays an important role in health facilities to support local clinicians care for patients around the clock as close to home as possible, reducing the need for patients and carers to travel.
Since the start of this year, Robinson says four nurses, and now herself, have left due to exhaustion and disenfranchisement with how the system is run.
As the only nurse in child and family health at Warren multi-purpose service at the time of speaking to Guardian Australia, she worries what this will mean for the health of mothers and their children in her community.
This story is part of a special series on rural health conditions co-published with The Guardian Australia. Travel and research was supported by a Melbourne Press Club Michael Gordon Fellowship, awarded to former The Citizen cadet Jordyn Beazley. Part 1 of the series is here.