New England's mayors unanimously voted this week to investigate how to break up what they described as a top heavy, "Newcastle-centric" Hunter New England Local Health District.
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The enormous health authority administrates hospitals across a vast area stretching from Newcastle's enormous John Hunter Hospital, to the tiny Tenterfield Hospital near the Queensland border.
All eight mayors of the New England Joint Organisation of councils (NEJO) voted on Monday to investigate splitting it and resurrecting the old Hunter and New England Health Districts.
If successful, the move would establish Tamworth as the centre of the New England health district.
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Inverell Mayor Paul Harmon, who was re-elected chair of the NEJO at the meeting, raised the idea on Monday.
He said the health services had worked more efficiently and listened to the community, before the amalgamation.
"Our communities feel that Hunter New England Health is just so large that every resource just gets poured into the Hunter Region," he said.
"Our communities feel that the top end of the state, where we are, whilst we have brand new hospitals - Inverell has a $60m new hospital; Glen Innes is slated to get a new hospital; Moree is on the list for a new hospital - it's great to have infrastructure, but we actually need the staffing and the resources to make that work."
HNEH is the only health authority in NSW to serve both a metropolitan area, Newcastle, plus a large rural area.
It also administers the largest number and most diverse range of health facilities in the state - though it isn't the largest in terms of population, or area.
Cr Harmon said the organisation isn't working, and accused it of being "Newcastle-centric" and employing "management practices" that limited the range of services offered in small communities, instead relying on transfer to bigger hospitals.
"We need to change that philosophy," he said.
"We need to be looking to see how we can actually improve health services in our region. This is a starting point. "
The NEJO is now set to consult with Namoi Unlimited, the joint organisation representing the councils in the North West region, including Tamworth.
Gunnedah Mayor and Namoi Unlimited chair Jamie Chaffey said it was great for the two joint organisations to be working together.
"Where our priorities align we should be advocating on behalf of the entire region, the New England North West, together," he said.
"As the chair, I look forward to the approach. We'll be taking it to the board of the Namoi and we'll be closely looking at the detail."
The NEJO consists of the Armidale, Glen Innes Severn, Inverell, Uralla, Tenterfield, Moree Plains and Narrabri councils, plus the Gwydir Shire Council as an associate member.
A spokesperson for the Minister for Regional Health and Mental Health, Bronnie Taylor said she had no plans to change the existing LHD structure.
Cr Harmon said the NEJO executive officer would begin by consulting with the general managers of local councils.
One question that would need to be answered before any bureaucratic change: where to draw the line on the map to separate the two.
Hunter New England Health was contacted for comment.
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