The Beagle Editor along with our Local State and Federal politicians and those charged with the delivery of Health Services in the South East, First some facts:
The Eurobodalla Shire has the second largest population in the Southern NSW Local Health District, the largest aged population, with a significant estimated growth over the next ten years, and the largest indigenous population.
The population triples during holiday periods further straining services.
Our services exceed those of South East Regional Hospital, Bega and Goulburn Base Hospital, hospitals which have been, or are being developed, at the cost of $187 million and $120 million respectively. Shoalhaven Hospital has received $430 million of funding towards redevelopment.
One hundred patients per month are transferred outside the region by ambulance or retrieved by aeromedical services per month. A large number of residents need to leave the area for elective services unavailable locally.
This has arisen due to the expensive, inefficient and unsustainable division of services between two hospital sites.
The separation of hospital sites results in each hospital receiving role delineation of clinical services at the same level of smaller rural hospitals such as Moree, Narrabri and Milton-Ulladulla which have already suffered loss of services including maternity. A significant number of women now drive one hour from the Milton-Ulladulla region to Moruya for birthing services.
Combined, the services of Moruya District Hospital and Batemans Bay District Hospital would result in a role delineation equivalent to South East Regional Hospital & Goulburn Base Hospital.
Our region is disadvantaged, as a consequence, with the loss of surgical services in the Eurobodalla, the lack of a central Accident & Emergency service with specialist cover, the lack of Critical Care and Intensive Care service, the lack of a local Mental Health Unit, as well as the lack of specialist physician, paediatric, anaesthetic, breast cancer and colorectal surgery services.
There is no Regional or Base Hospital in the 300 kilometres between Nowra and Bega.
The current divided role delineation does not allow for accreditation for intern and registrar training, positions which would sustain the local health service by retaining medical officers living in the region for the future.
The NSW Ministry of Health commissioned a review of Surgical and Critical Care Services by the Agency for Clinical Innovation in March 2017. This review was presented on 14th November 2018 indicating the need for development of Accident & Emergency Services and the establishment of a Close Observation Unit with a view to transition to Intensive Care level.
The Southern NSW Local Health District conducted a Eurobodalla Clinical Services Plan Community Consultation process in March 2018. Community, medical, nursing and allied health members were consulted over a period of five days in Moruya, Batemans Bay and Narooma.
The significant findings of this review were the need for access to specialist services close to home, the need for local orthopaedic services, the integration of local services, the local availability of Intensive Care Services, inclusive services and a single central service.
The Eurobodalla health services provide only 56% of public and private inpatient services. Even worse, it is self sufficient for only 25% of acute mental health services. Where to next?
In response to what is perceived to be a potential crisis in local health services, a social media movement (ONE – One New Eurobodalla hospital on Facebook) was initiated calling for immediate improvement in clinical services in the Eurobodalla and development of a single new Regional or Base Hospital. I encourage you to visit the Facebook group HERE and gain some insight into the sentiment in the Eurobodalla.
This group has attracted over 2,900 members and an online petition received 937 signatures in one week petitioning the NSW Minister of Health for these services.
A formal petition to the NSW Legislative Assembly of approximately 3000 signatures was received by Mr Brad Hazzard, NSW Minister for Health on 15th November, 2018. The Minister responded to the Clerk of the NSW Legislative Assembly on 18th December, 2018
On the 31st October, 2018, the Premier of NSW, Ms Gladys Berejiklian, and Mr Andrew Constance, the Member for Bega, announced the allocation of $150 million towards the the development of a single Regional hospital for the Eurobodalla.
The commitment to the development of a single new Regional hospital has been gratefully received by the community with anticipation of improvement of services and reduced outflow of patients. However the expectation is for services equal to those of the Regional and Base hospitals within SNSWLHD.
The Eurobodalla shire straddles the Federal electorates of Gilmore and Eden-Monaro.
The population perceives a discrepancy in provision of services to Bega and Nowra with that provided locally. Specifically, the development of the South East Regional Hospital in Bega attracted over $160 million in funding with the assistance of Dr Mike Kelly.
As the Eurobodalla Health Service Clinical Services Plan towards the development of the new Regional hospital is not scheduled for tabling to NSW Ministry for Health until June, 2019, the response has been that no commitment will be made to additional funding until after the Plan is tabled.
There is a NSW State election in March and a Federal election in May. There is the opportunity for both levels of government and opposition parties to commit to funding for additional services before June.
Federally, under Section 96 of the Constitution, Special Purpose Payments may be made to State governments as a grant for capital works.
There is a discrepancy between the Federal funding for the South East Regional Hospital which was developed at a cost of $187 million by primarily Federal funding and the $150 million promised by the NSW government towards the single new Regional Eurobodalla hospital.
There are several options for potential Federal government capital contribution.
Firstly, the acute mental health services are currently only 25% self sufficient in the Eurobodalla. There is no plan as yet within the Clinical Services Plan for an inpatient mental health service and therefore cannot fulfil the proposed role of supporting the remaining clinical streams.
Currently (2016/17) the total separations for acute psychiatry, non acute psychiatry and psychogeriatric care were 517. There is a 75% outflow of patients to Bega, Goulburn, ACT and Sydney.
Between October 2016 and September 2017, there were 1,761 Triage and Emergency Care Support (TECS) referrals to Eurobodalla CMH, the majority (62%) referred through the Mental Health Helpline, another 32% were referred via emergency departments (20% at Batemans Bay, 10% at Moruya) and 6% via hospital wards.
Community Mental Health services consisted of 68% adult & general, 15% child & adolescent, 10% older people and 7% dementia & acute behavioural disturbances.
The Eurobodalla Drug and Alcohol service had 274 client episodes in 2016/17, with 52% at Moruya/Narooma and 48% at Batemans Bay. The service saw more males (64%) than females, and 16% of clients were Aboriginal. Six per cent were aged between 14-24 years.
Federal funding could allow a purpose built adult acute psychiatric inpatient service with subsequent State operational funding. The issue of mental health services and paediatric services are the two issues with the most local community engagement and sentiment.
Despite having a relatively low proportion of infants and young people (4.3% aged 0-4 years, 15.3% aged 5-19 years), the Eurobodalla Shire has similar numbers to Goulburn-Mulwaree and Bega Valley LGAs (7,450 people aged 0-19 years in 2016).
It has the largest indigenous population (5.6%, with 46% of these being aged 0-19 years)
Of psychiatric services there was a higher proportion of female clients represented in the 12 - 25 year age group. The Aboriginal community represented 19% of adolescent services.
Headspace, the National Youth Mental Health Foundation funded by the Australian Government Department of Health has services in Nowra, Bega and Queanbeyan but there is no service within the Eurobodalla. It is 300 kilometres from Nowra to Bega. Young people, particularly those with young children, are disadvantaged by distance and limited transport opportunities.
Despite the Federal Government announcing extra funding for the national youth mental health foundation aimed at allowing it to employ more staff and provide 14,000 extra services at its 107 centres across the country, despite mental health services receiving a $52 million boost in an attempt to cut waiting times for desperate teenagers struggling with anxiety or depression, and despite $12.8 million being allocated to offering online support to youngsters in rural and remote areas, there is no local headspace service in the Eurobodalla region.
Recently, the Hon Mr Greg Hunt, Federal Minister for Health, has announced over $200 million of funding for headspace services and over $1.4 billion towards mental health services via Primary Health Networks such as the local provider, Coordinare.
The youth population of the Eurobodalla deserve the same level of mental health services as those of the surrounding towns.
On the final mental health issue, I have lobbied Federal and State parliamentary representatives on the lack of perinatal and early childhood support via Tresillian and the Gidget Foundation.
Maternity services are provided by an innovative and sustainable model of care incorporating midwifery based antenatal, intrapartum and postnatal care in collaboration with a single specialist Obstetrician & Gynaecologist, GP Obstetricians and locum specialists. Private midwifery services offer antenatal and postnatal care and there is an excellent Aboriginal Maternal & Infant Health Service. There is an increasing number of women travelling to the Eurobodalla for birthing services due to the closure of the Milton-Ulladulla District Hospital.
Perinatally, of the 300 women per annum booking for antenatal care in the Eurobodalla, 157 women are identified through Safe Start multidisciplinary meetings of the Eurobodalla Maternity service as having psychosocial issues. Of these 24 stand as having intensive needs. A significant proportion of these women are aged under 25 years. Similarly we have a higher rate of Indigenous women having care locally. Care for these women, children and families is provided by a single Perinatal and Infant Mental Health Coordinator based outside the region as 0.5FTE and covering the entire SNSWLHD.
I have recently received in principle support from Mr Robert Mills, CEO of Tresillian, Australia’s largest child and family health organisation, towards the establishment of a early childhood and parenting service in the Eurobodalla. There is also interest from the Gidget Foundation, a not for profit organisation that provides program around perinatal anxiety and depression to support the emotional wellbeing of expectant and new parents, to incorporate with the Tresillian services locally.
There is the potential for Federal capital funding towards a site for this combined Tresillian/Gidget Foundation service.
In a timely manner, the Senate’s Community Affairs Reference Committee Inquiry into Accessibility and Quality of Mental Health Services in Rural and Remote Australia has identified that although rural Australians are less likely to seek mental health services and are twice as likely to die from suicide than metropolitan residents, there is alienation of rural Australians from mental health service design and delivery. Equally there remains a lack of cultural competency in mental health services for Indigenous Australians.
The Eurobodalla has strong health education links the Australian National University, the University of Wollongong and the University of Canberra. Medical, nursing and allied health students are trained locally and will ultimately be retained locally when the new Regional hospital is developed. NSW Health has a well supported and functional Health Education and Training Institute (HETI) providing services across the state. With the establishment of a new hospital, accreditation is anticipated from specialist Colleges towards postgraduate specialist training positions for registrars in medical, surgical, anaesthetic, obstetrics & gynaecology and general practice proceduralists.
The Eurobodalla has the potential to become an educational hub for the South Coast with the development of a clinical training facility covering undergraduate and postgraduate medical, nursing and allied health training. Federal government capital funding could contribute to the building and development of a campus on the site of the new hospital with continued functional support from the NSW government via HETI.
There is also the need for continuing professional development of qualified medical and nursing practitioners which is difficult to access in rural regions. These issues have a flow on effect towards the recruitment and retention of health professionals and the sustainability of the health service. Current clinical training is increasingly performed in simulation environments which have been established in many hospitals and are shown to be highly effective learning experiences.
A purpose built educational facility incorporating a multipurpose interdisciplinary simulation laboratory with lecture theatre, office space for learning and library resources would make the new Eurobodalla hospital a hub for health learning on the Far South Coast.
Finally, the South East Regional Hospital, Bega, has established Booraja House, SERH Carer's accommodation with the assistance of Federal government funding. Relatives and carers require accommodation close to the hospital in rural regions due to the distances and time involved in accessing services. Similarly, on call staff face long after hours journeys which are a risk after call backs. Locum providers could be accommodated on site providing more immediate availability for the hospital and reducing the expense of providing private rental accommodation. The Eurobodalla community expects a similar service to be provided with the development of a single new Eurobodalla hospital.
Currently, I am conducting a survey with over 400 responses in two weeks.
Ninety six percent of respondents want a new hospital. More significantly 98% expect a level of services equal to the other regional and base hospitals in the SNSWLHD. The increased range and level of services as well as medical and nursing staffing levels are the most important issues to the respondents. Seventy eight percent expect an inpatient mental health service and eighty eight percent support the development of educational facilities for medical, nursing and allied health professionals on the site.
The petition to the Minister for Health requested;
1 – Provision of immediate improvement to the Accident & Emergency, Critical Care and Perioperative services of the Eurobodalla Shire by funding and upgrading the existing infrastructure and workforce.
This needs to be addressed by implementing safe nursing ratios, adequate medical staffing and the development of a new Emergency department and Close Observation Unit in Moruya District Hospital as recommended by the review into Critical Care and Perioperative Services performed by the Agency for Clinical Information of NSW Health
2 - Commitment to the funding, planning and building of one new regional hospital for the Eurobodalla Shire, located at a site providing equitable accessibility for the people of the Eurobodalla, which will provide medical services equal to those of the Regional and Base Hospitals within the Southern NSW Local Health District.
This requires adequate capital investment from NSW and Federal governments to provide a level of all streams of clinical service – Aged Persons’ Care, Critical Care, Surgical Care, Medical Care, Child & Family Care, Subacute Care and Mental Health, Drug & Alcohol Care – equal to that provided in SERH, Bega and Goulburn Base Hospital. Michael Holland