Former Moree hospital chair explains how Hunter New England Health Area was created

Roger Butler, a Moree businessman, whose advice was sought by the state government in the creation of the first-ever health districts, has said that the more centralised services were, the more it seemed to be "dictatorial rather than cooperative".

"Communities that are responsible for their own welfare are much more proactive and the closer you are to the ground, the better equipped you are to meet the needs of a community," Mr Butler said.

The sentiment comes after mayors from the New England Joint Organisation of councils unanimously voted to investigate the splitting of Hunter New England Local Health District.

The group wanted to break up what they described as a top heavy, "Newcastle-centric" service and look at the potential of establishing Tamworth as the centre of a New England health district.

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But Mr Butler said even that would be difficult to manage.

"Based on my experience, that is too big to be effectively community orientated," he said.

"There is too much travel required. People keep telling you that Zoom and teleconference et cetera works, but they don't work nearly as well as face to face. A Tamworth base would be better than Newcastle, there's no doubt about that. But if you are asking what would be the best, the (old) district model was the one that worked well."

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After a "shake-up" of the system in the early 1990s the Barwon District Health Board was established, of which Mr Butler was the first chairman.

The regional board included two directors from each hospital board of Moree, Narrabri, Wee Waa, Boggabri and Bingara.

Mr Butler explained that originally, every community built their own hospital and was responsible for maintaining it. He said subsequently legislation passed which gave governments responsibility but by and large, every community ran their hospital with a local board of directors responsible for the day-to-day running of the facility.

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"There was very real local input and the hospital was thus sensitive to the needs of a particular community," he said.

"As time went by, more specialised services were required and no single country hospital could afford all the expertise so they had shared services. Management of those shared services became a bit of a problem because they were all competing for more time," Mr Butler said.

"Moree got together with some other hospitals who they were sharing with and agreed to form a district health board which would have control of these and administer the services for the benefit of the hospitals.

"That experiment worked extremely well," Mr Butler said. "So much so that the minister invited me to a meeting of directors from hospital boards across the state to talk to them about it.

"The government then legislated to create districts. They were a combination of a series of hospitals around a centre that they all were happy to relate to and by in large were voluntary involved."

But, only a few years later as Labor came into power in the 1990s, a report, which according to Mr Butler was never published, was commissioned that claimed to have supported the abolition of the health districts. This is when the new health districts, as we know them, were created.

Then in July 2004 the state government reduced the number of area health services across the state from 17 to eight, cutting hundreds of administration jobs in the process.

New England Health was merged with the Hunter and parts of the Mid North Coast, creating the massive Hunter New England Health region, which included 25 local government areas at the time.

"There's always been a battle over control because all the bureaucrats thought they knew best, many with no actual hands-on experience in hospitals whatsoever," Mr Butler said.

Thousands of NSW nurses walked off the job earlier this year, as they felt their pleas were going unheard.

"I am not sure why we have a problem at the moment. We certainly didn't have that problem when the districts existed," Mr Butler said.

"I hear regular complaints from staff that they don't feel as though they are owned by the community. They feel they are remote centres taking direction from Newcastle and not sensitive to the local community. That may be a factor, but I don't know as a fact because I haven't been able to undertake any sort of study, that's anecdotal."

Mr Butler said with staff shortages across many fields, there was possibly a societal problem.

"What we need to do is create more job satisfaction and that generally comes with a better relationship between the service provider and the service receiver," he said.

"Remember the days where the public actually worshipped the nurses and nursing was a real, satisfying career path?

"Why that's not the case now, there may be a number of factors, but I certainly think completely remote management is one of the factors."

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