No apology from Rural Health Minister Bronnie Taylor for damning findings of rural health inquiry

The minister said she was "proud" of the system, which she said had performed to an "international standard" in the face of the COVID-19 pandemic.

"I understand that there are issues and they're always issues, but you know what? I'm looking at fixing those issues," she said.

But the NSW Parliament's rural health inquiry found that the system which "in some instances is in crisis", is rife with staff shortages, inequity, staff bullying, and even a "culture of fear" deterring staff from speaking out.

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In its first finding, the inquiry determined that rural residents endure "significantly poorer health outcomes, greater incidents of chronic disease and greater premature deaths" than their metropolitan counterparts.

But they also pay more, travel more, rely on services which are "significantly under resourced when compared with their metropolitan counterparts" and "have inferior access to health and hospital services, especially for those living in remote towns and locations and Indigenous communities".

After nearly two years of hearings and submissions, the 'health outcomes and access to health and hospital services in rural, regional and remote New South Wales' inquiry finally released its 294-page report on Thursday.

Patients and workers in the system told ACM they weren't surprised about its damning findings, condemning what one government MP called a "system in its death throes", but hoped that bringing a years-old problem to light would lead to change.

Gunnedah's "crisis" health care system is used as a case study by the inquiry.

Mayor Jamie Chaffey said the community of more than 12,000 has just 4.75 full-time equivalent doctors.

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Cr Chaffey said it was a "relief" that the recommendations had been finally released, after enormous effort by advocates and the community

"It's my hope now that once this report is completely understood and all organisations and individuals have had an opportunity to thoroughly look through the information that there is cohesion across political parties and organisations, both in the medical professions and local government and other organisations to be united in endorsing actions that will make a significant difference to the people who live in rural and regional areas, and provide the healthcare that they deserve," he said.

Northern Tablelands Nationals MP Adam Marshall, who spent years lobbying for hospital upgrades and stronger health staffing, has vowed to "fight tooth and nail" to see every finding from the damning report implemented.

He said the inquiry showed the state has "a health care system in its death throes."

There is a "critical shortage" of health professionals in rural areas, with doctors in rural areas working under "enormous pressure" and routine overwork, but with little reason to remain, the report finds.

The inquiry judges that the long-standing visiting medical officer model - which uses doctors in private practice to fill emergency departments in public hospitals - is crumbling.

Nurse, Jill Telfer, who serves as the Secretary of the local branch of the NSW Nurses and Midwives' Association, said local hospital emergency departments can be left without doctors altogether, all too often.

Without a GP, the buck stops with an RN, even in the face of a victim of a car accident, or a heart attack.

"I've spoken at length to nurses at Gunnedah and I'm aware of the situation they've had at Tenterfield," she said.

"You can't predict what's going to come through an emergency department.

"Basing staffing on previous activity doesn't matter when you have a multi-person motor-vehicle accident. You have to have the resources there on the ground."

The union is bitterly disappointed the inquiry did not recommend adopting nurse-patient ratios, a long-running objective of its industrial pressure.

Ms Telfer said ratios are a proven mechanism for improving health outcomes and eliminating staff shortages.

"We're so short-staffed up here because of COVID at the moment, it's crazy," she said.

"We're on skeleton [staffing] every day, if you take part of the skeleton away, you're in real trouble. We need to see change."

But even larger-scale rural hospitals - like Tamworth's rural referral hospital - can be left transferring patients for routine health complaints.

Doctors from the New England said sick cancer patients can be forced to drive to Newcastle for "something as simple as a PET scan", or to sign a consent form.

Tamworth Medical Staff Council chair Doctor David Scott told the inquiry the hospital was one of the biggest in regional NSW, but was still struggling to cope.

"We have the busiest emergency department outside the metropolitan areas," he said.

"We get a lot of referrals from Tenterfield out to Coonabarabran and Walcha and Murrurundi. All of these places, they come to us. We are struggling to have enough specialists and enough diversity of specialists to cater for them."

The inquiry found that NSW Health should conduct a review of "the working conditions, contracts and incentives of GPs working" in public hospitals, so the model remains viable.

It also recommends that the state government and federal government work together to "immediately" develop a 10-year workforce strategy to fill gaps.

Tamworth GP Ian Kamerman backed several of the recommendations of the inquiry, including the review of VMO models and a single employer model for trainee doctors.

One of the inquiry recommendations has already been implemented.

Nationals MLC Bronnie Taylor was appointed Minister for Regional Health last year, even before the inquiry recommended the ministry be created.

The closest Ms Taylor came to an apology for the health system on Thursday was to accept the inquiry findings.

"I accept the evidence and the finding that there have definitely been situations where we have seen, not our best care delivered, but what I also must stress to you is that every single day incredible things happen in our health system..." she said.

"And to those people that have been let down...my absolute empathy and my absolute respect to you for coming and talking about it and for showing us."

Ms Taylor told journalists on Thursday afternoon that she was "just focused on looking forward", and gave her "absolute commitment" to work with the federal government to solve doctor shortage problems.

Asked why the system had got so bad after 10 years of coalition Liberal and National government, she said they had done their best to find solutions to a complex problem.

"I think when you look at a lot of the issues that have come out in terms of workforce, we've known that there have been workforce issues for quite some time," she said.

"And to be fair, we've looked at a lot of different models and a lot of different ways of addressing that over the time. Not all of them have worked.

"Some of them have worked really well, but we have been trying to do that."

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The former rural nurse blamed COVID-19 for adding pressure to the system.

Northern Tablelands MP Adam Marshall said there was "no excuses" for not to take action.

"This report is an absolute indictment on the regional healthcare system and vindicates everything the community and I have been saying about the dire lack of health services and resourcing which is putting patients' lives at risk," he said.

"The sad part is none of the recommendations are rocket science - review funding models, increase staffing and overhaul the incentives and training structures to encourage more doctors to work in the bush."

The inquiry also heard from multiple nurses about the fear of speaking out about inadequate services or systemic failings, for fear of bullying or intimidation.

In Finding 19, the inquiry determined that "there is a lack of transparency and accountability of NSW Health and the rural and regional Local Health Districts in terms of governance."

Committee chair, Labor MLC Greg Donnelly, said the inquiry had heard repeated stories of individuals and families being let down by the health system.

"We heard stories of emergency departments with no doctors; of patients being looked after by cooks and cleaners; of excessive wait times for treatment; and of misdiagnoses and medical errors," he said.

But the inquiry stopped short of recommending mandated minimum staffing levels for rural communities, despite a recommendation from both Animal Justice and Greens Party committee members.

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Greens MLC Cate Faehrmann, who served on the committee, said the inquiry was "vital in shining a light on the inequities in health services that regional, rural and remote NSW communities experience" and urged the government and Labor opposition to "put politics aside and work together to implement" its recommendations.

"One of the more disturbing issues that surfaced during the inquiry, and indeed, through the pandemic more broadly, was that NSW Health employees risk their careers if they speak out about issues in the workplace," she said.

"I urge the NSW Government to act upon the recommendation to establish an independent office of a Health Administration Ombudsman because the number of complaints received by the committee shows it is urgently needed.

"The Ombudsman would receive and review concerns about the administrative conduct of management of Local Health Districts and NSW Health from staff, doctors, patients, carers and the public."

The inquiry also recommended considering holding an additional inquiry into mental health services in the future.

The government is due to respond to the inquiry in November.

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