"We have been reflecting in this Committee a bit about the various promises for a fantastic health service over the last 10 or more years. There is the New South Wales Government's State health plan "Towards 2021"—of course, it is now 2021.
"At the time this was written, the foreword from the then Minister Jillian Skinner says:
… the NSW Government began a process of change in 2011 to build a 21st century healthcare system to really deliver on our promise of 'Right Care, Right Place, Right Time' …
It is now 2021. I might get your opinions on whether the New South Wales Government has actually achieved that "right care, right place, right time" promise."
CLICK on the link above for the full transcript.
MICHAEL HOLLAND, Co-founder, ONE - One New Eurobodalla Hospital, affirmed and examined
CATHERINE HURST, Private Individual, affirmed and examined
PATRICIA DAVID, Secretary, Unions Shoalhaven, affirmed and examined
The CHAIR: We thank you all for making yourselves available today. I acknowledge the submissions
made to the inquiry. The first one is submission No. 17, standing in the name of One New Eurobodalla Hospital, or ONE. Thank you for that. It has been received, processed and stands as a submission to the inquiry, and it has been uploaded to the inquiry's webpage. Equally, I acknowledge the submission from Unions Shoalhaven. It has been received as submission No. 274, processed and uploaded onto the inquiry's webpage. Both of those stand as submissions and, accordingly, evidence to this inquiry. That has been very helpful for us.
You can take those two submissions as read by Committee members; they have all had the opportunity to read and study those submissions. So there is no need in your opening statements to go into the content of the submissions in detail per se but rather perhaps scope out some broad issues that you would like to put on the table—of course, pointing to points in the submission if you wish—and that will then lead to an ability for the Committee members to ask you a range of questions that you would particularly like addressed to you. We will perhaps start with One New Eurobodalla Hospital. I am just wondering, Dr Holland, did you want to share an opening statement with Ms Hurst or were you going to do one on her behalf? How were you going to proceed?
What would you prefer?
Dr HOLLAND: I have given Cathy Hurst a copy of the opening statement, which she has endorsed, and she has her own prepared statement. So I can start representing both of us.
The CHAIR: Please do.
Dr HOLLAND: I thank the Committee for the opportunity to provide evidence in the inquiry. I represent a rural advocacy group who for the past three years have petitioned, and continue to petition, State and Federal governments for improvement in local health services. Our group is also represented today by Cathy Hurst, who has personal experience of the deficiencies of rural health care access for local cancer patients. The submission was received by the New South Wales Parliament 12 months ago. I will not reiterate its content as there has been no objective improvement in regard to the issues submitted. If anything, there has been a deterioration in the provision of safe maternity and neonatal care, which, in an untimely manner, has reached a crisis point in the month of this inquiry. Also, since the original submission, our community has been disappointed by the rejection of funding for local radiation oncology services specifically designated for our region by pre-election promises from the Federal Liberal, Labor and National parties.
The Eurobodalla has clinical and social needs that exceed our neighbouring regions with level 4 hospitals.
This includes the largest number of vulnerable older population and Indigenous residents. Emergency presentations are 65 per cent greater and admissions are 25 per cent greater than our neighbouring hospitals, and our maternity service has the largest number of births for a rural maternity service in the LHD. Despite this, our community remains disadvantaged and will remain disadvantaged on the opening of the new regional hospital.
The capital funding for the new regional hospital is inadequate and will result in reduced bed numbers— specifically in maternity, neonatal and paediatrics. The department of health maintains a policy of drip-feeding rural health services and prevaricates on the critical issue of opening the proposed Eurobodalla hospital with level 4 services. The current clinical services plan equivocates by the promise of delivery of certain services by 2031—some 10 years away. Our community expects immediate improvement in health services and equity of services in the new Eurobodalla hospital.
The CHAIR: Thank you very much, Dr Holland. I pass now to Ms Hurst. Would you like to add to or
lend to the comments of Dr Holland?
Ms HURST: No, Chair. I won't at this point. I think Dr Holland has addressed everything.
The CHAIR: Thank you very much. I am sure there will be some questions, so thank you for that. We will move now to Mrs David. Do you have an opening statement that you would like to make?
Mrs DAVID: I do, thank you. Good morning to the portfolio committee and thank you for giving us the opportunity to speak to this inquiry. The availability of health services is an important issue to many people.
Unions Shoalhaven engaged its community to test their views on the subject of the proposed redevelopment of the Shoalhaven district community hospital. The majority thought that the current Shoalhaven hospital has outgrown its size and capacity.
Responses for a greenfield site were: (1) the location and the impact this has on response times to get patients from their residence to hospital in an emergency situation—this impacts hugely on residents living in outlying villages and further south of Nowra, and at the moment compliance to best practice fails; (2) a need for separation of general emergency admissions from mental health emergency and Justice Health divisions is a must for best practice outcomes; (3) a better pathway is based on best practice outcomes and acute mental health; (4) detox and rehab services—no detox centre in Shoalhaven; (5) inadequate stroke services; (6) MRI and lack of neurology services in the public hospital; (7) a need for public orthopaedic ward at the hospital; (8) requires a specialised, updated cardiology department and update some stress test services; (9) shortages of medical and surgical beds—only 26 surgical beds at the hospital; (10) the highest waiting list for public surgery because recovery beds are not available, resulting in bed block; (11) a lack of GPs in the Shoalhaven is putting extra stress on our emergency department as well as a lack of bulk billing practices; (12) believe that a separation of the Illawarra and Shoalhaven into their own health districts is needed; (13) a need for closer links to the university;
(14) traffic issues, including timely access; and (15) the public did not want the park land adjacent to be resumed— they wanted that to be left to the community.
The main problem that concerned people who saw that the redevelopment of the hospital was [inaudible] was basically the need to get this done now. They thought that a greenfield site might impact on the time and delay it unjustifiably. The Shoalhaven LGA is a large area that spreads over 125 kilometres. The population forecast for 2021 is 106,000 more, which trebles in holiday season. It is estimated to grow to 137,000 and more by 2051. Currently our hospital number of beds is believed to be averaged out to 175, of which 12 are only ICU.
The intensive care unit is outdated and requires an upgrade. We are acutely aware of the need for a bigger hospital asap. On the current site is a multistorey car park run by Wilson car park. There is a cancer clinic and a GP clinic.
The commencement date is not known, although it has been reported as commencing in March 2023 or sooner.
If this redevelopment is not due to be completed for seven to eight years, it seems ridiculous to not even consider a greenfield site further south, especially when Shoalhaven southern areas are placed at a distinctive disadvantage and places like the basin area, Sussex and Milton Ulladulla need to be included when planning service delivery infrastructure into the future. Milton Ulladulla Hospital is aging and poorly resourced, and the ED cannot cope with demand during [inaudible] season. The maternity services only provide ongoing antenatal leading up to birth, where they have to travel to Shoalhaven, and postnatal care after—definitely poor practice.
Shoalhaven hospital could continue to run uninterrupted while a new hospital is being built. Once completed, the old hospital site would remain fully functional, with specialist care, an extension on mental health care, drug and alcohol centres and more.
The CHAIR: Thank you very much, Mrs David. That was a very detailed and frank assessment of
matters in the Shoalhaven. We will proceed now to questions from Committee members. We will commence with the Opposition.
The Hon. WALT SECORD: Thank you, Dr Holland, Ms Hurst and Mrs David, for your submissions.
They present a picture that shows that the South Coast and far South Coast have been neglected by the State Government involving health. I thank you for your frank assessments. Dr Holland, what is it like to be the only obstetrician in Eurobodalla shire?
Dr HOLLAND: It is a position that I have held for 19 years. This virtual contact is probably unique; you are actually speaking to a dinosaur that will soon be extinct. Health care will not be provided by single practising specialists in any region without adequate backup from credentialed and well-trained GP proceduralists.
It has made my job sustainable. However, many of you would not understand or believe the hours that are put in on a routine week, being 96 hours on call continuously and, every one to two months, being on call for 264 hours continuously.
The Hon. WALT SECORD: That is extraordinary. What happens if there are complications or difficulties involving small babies and you are not around or you have worked 264 hours?
Dr HOLLAND: There is a team of GP obstetricians who are first on call. I provide second on call. Any complicated maternity case, I will attend. That includes every caesarean or instrumental vaginal birth and, also, if there are any maternal complications. For many years—it is a perennial problem that we have fought to get neonatal resuscitation services that are provided by a single practitioner in a situation where you do not ring one person and be referred to another person or referred to the other. This is where the crisis has arisen recently that, over a period of time, well-trained GP VMOs are no longer present on a VMO roster to cover these issues. These positions are regularly held by locum VMOs who may be general practitioners with varying degrees of skill in neonatal care, or they may be a physician who is a practising geriatrician or endocrinologist filling time in in the area.
The Hon. WALT SECORD: Dr Holland, let's cut to the chase here. Is this unsafe?
Dr HOLLAND: Yes, it is unsafe. In the past two weeks there has been over 20 births. Five babies have needed resuscitation or neonatal support during that time, and two of those babies have needed to be transferred outside our area.
The Hon. WALT SECORD: What does neonatal resuscitation mean?
Dr HOLLAND: Neonatal resuscitation may be a baby that is born unexpectedly with a very low heart rate or not breathing. It is the equivalent, in many situations, of CPR as you would do in an adult. That is a critical and life-threatening situation. Basically, all people who are involved in dealing with childbirth could be trained to deal with it—that includes the obstetricians and the midwives present. However, a midwife, doctor or obstetrician who is involved in the care of the mother cannot then be expected to take over the care of a critically ill newborn.
It extends further to babies who deteriorate some hours after birth, where you need, again, someone experienced in newborn or paediatric care to continue to care for those babies who may be sick for other reasons.
The Hon. WALT SECORD: You have similar concerns about oncology cancer treatment in the region too, don't you?
Dr HOLLAND: I do not want to pre-empt Ms Hurst on this issue, who has her personal experience of this. The problems that we share in oncology services in the Eurobodalla are shared by most rural and regional areas when you consider that probably 50 per cent of oncology or cancer cases could benefit from radiation oncology but only a third of people take up radiation oncology services. In rural areas, that primarily occurs because of the inability to access services locally. The situation in the Eurobodalla is either to travel three hours to Canberra, three hours to Nowra or 4½ hours to Sydney.
The Hon. WALT SECORD: That is extraordinary. Would you mind if I asked, Ms Hurst, could you please give us a personal perspective on your cancer and your radiation journey?
Ms HURST: I would like to thank the Committee for this opportunity because you have probably heard lots of personal experiences from other people who have suffered with terrible things as well. I got diagnosed in March this year with having anal cancer. I was given the opportunity to choose between Canberra or Sydney. That was a bit of a dilemma. Whilst Canberra is closer, where was I going to stay and who was I going to burden with my staying there for up to six weeks? Sydney, I was told, had a very good multidisciplinary team, which is the new way of working with cancer and has better outcomes, so I am led to believe. In the end I chose to go to Sydney. I thought that was better for me because I could stay with my children and still do things. There is a sense of helplessness if you are just sitting around full of self-pity. So I went to Sydney and I had the choice of private or public. I ended up going with GenesisCare because they were able to facilitate times when I could go and things that worked best for me, which, obviously, in a public health system you cannot necessarily do because of the burden that is placed on them with all of the other patients.
I found out through friends, not through the medical fraternity, that there was actually a thing called the patients travel and accommodation assistance scheme. That allowed me to actually stay in Sydney on the weekdays and come home on weekends, which was marvellous and should be publicised more. It does not cover all of the costs but it covers some of them. I was also fortunate that my husband is self-sufficient and could look after our animals and our small business, which is Airbnb. And so the process began. Whilst I did not have as many side effects as a lot of other people have, towards the end of the treatment it became really difficult doing this travel.
Travelling meant that I had to be prepared for whether I was going to vomit on a plane, have diarrhoea attacks or anything, which is highly embarrassing and concerning. You get shaky just thinking about can you get on that bus for that long or the train or whatever it was you were taking. The difference between that and actually having a hospital or a facility in your region where you can drive yourself, have your 15-minute radiation treatment and come home—it would make all the difference to people. As I said, I was fortunate, but if you are a young, single person who had no support and had young children, what would you do? How would you survive? How do you get money if you are not working? There are all these other problems for a whole lot of people in regional areas that are not necessarily an issue in the cities.
The Hon. WALT SECORD: Thank you, Ms Hurst. Dr Holland, what excuses or reasons is the State
Government giving for not providing radiation oncology services in Eurobodalla?
Dr HOLLAND: A tender was put in by private radiation oncology providers to provide bulk-billed
services for radiation oncology using the proposed money promised by the Federal Government in 2019. The response was that the population base was inadequate to support radiation oncology services, with an estimate of a need of population of 400,000 to provide these services. This is in contradiction to the providers who do provide services to equivalent or smaller populations across Australia, including Mount Gambier, Geraldton and Gladstone in other States.
The CHAIR: Walt, I will need to move on. You can ask a question quickly, but I will need to move on.
The Hon. WALT SECORD: I will be very quick. Are you saying that there was a private provider willing to provide bulk-billing services but it was not followed up by the State Government?
Dr HOLLAND: That is correct.
The Hon. WALT SECORD: Thank you, Dr Holland.
The CHAIR: We may return to that, but we will move over to the Deputy Chair, the Hon. Emma Hurst.
The Hon. EMMA HURST: Thank you, Chair. I want to thank Ms Hurst for sharing her story. I know it is difficult to come here amongst a group of people who you do not know and share those details, so thank you very much. It is really useful for us as a Committee to actually understand what happens to people on the ground. I want to ask a question to Mrs David. My understanding, having read through your submission, was that there is a really strong community support for moving the Shoalhaven hospital to another location. Can you give us a better understanding about this, whether there was pushback about moving that location and if that has been accepted? And if not, why not?
Mrs DAVID: We started campaigning on this issue when it was first raised. We went out in the community and we spoke to a lot of people who attended the forums and everything like that and listened to what the concerns were. I would say close to 85 to 90 per cent of the people that we spoke to agreed that a greenfield site would be a better option for the Shoalhaven based on the proximity of the hospital, which they are saying is only going to be redeveloped. We understand that the location of the current hospital has got the cancer clinic plus a GP clinic. But we think that this hospital can be built better as a new hospital in a bigger location a little bit further down south to give it better access for people in the outlying southern villages and towns of the Shoalhaven, going all the way down to Milton Ulladulla. This gives them a better response time to get to hospital in emergency
situations.
People have identified a greenfield site near the Falls Creek area because of access to the main highway and everything like that. We understand people's concerns, also, that if the redevelopment does not go ahead and there is a greenfield site, that they feel that this is going to impact on the timeline to get an upgrade of this hospital that is very much needed. While we support their fears and concerns, we also support the majority of people who want the greenfield site. We can see it working two ways. If the new greenfield site goes ahead, you have got the ability for no disruption at the old site while this is being developed. If it is going to take seven-odd years or something to the final completion of this project, then why this insistence on just the redevelopment other than we need it now? If it is not going to be finished in seven or eight years, then people are concerned that it is not the right viable option. For a community that is largely expanding, access in the southern suburbs needs to be considered, most definitely. That is our main concern.
The Hon. EMMA HURST: You mentioned the amount of time to actually get to the hospital with the current location compared to the proposed location. What are the time differences that some people are looking at?
Mrs DAVID: If you live in, let's say, the Milton Ulladulla area of the South Coast, that is an hour's drive to Shoalhaven hospital depending on traffic. If you are delayed for any reason, it can be a lot longer. If it is during peak holiday season, you could be stuck for up to two hours or more. Yes, you have the ambulances that are responding from those areas, but they still have that hour to get up there—and that is in a good flow of traffic and everything like that. And then you have got the outlying villages that do not have an ambulance or anything like that. They are relying on them to come from Vincentia or St Georges Basin or something like that. That impact can be quite huge. If you are having a heart attack or a stroke or something like that, we all know how important it is for the reaction time to get people to their emergency care in a best practice time. Those figures are not created willy-nilly. They are best practice figures and they need to be adhered to, most definitely. One of the main concerns that people have when you are living in such a vast LGA like the Shoalhaven is the response times for emergency situations.
The Hon. EMMA HURST: Thanks for that. Dr Holland, we have heard a lot in this inquiry about the difficulty of attracting staff to regional, rural and remote areas. Do you have concerns going forward about making sure that any new hospital, when it is eventually built, will be fully staffed and will be staffed when it is open and ready to go?
Dr HOLLAND: Yes, I do. In my personal experience—my contract with the LHD ends in 21 months.
Every time my contract has been renewed, I have reminded them of the need of succession planning and recruitment. Specialists do not grow or fall out of trees. They need a succession plan to attract them to new hospitals. With most professions, most professionals are not attracted by money. You would not come to the country if you wanted to make money. They are attracted by the overall terms and conditions and the professional satisfaction of the work that you do. I must say, and you probably heard before, that most rural and regional doctors find more satisfaction in their care than metropolitan doctors, but you cannot attract people with inadequate bed numbers and inadequate staffing from specialised nurses, midwives and allied health. If you build a hospital that is 50 per cent smaller than it should be and you don't start recruiting people years before the doors open at that hospital, you will open it as a dysfunctional hospital.
The Hon. EMMA HURST: In your submission you also talk about innovative contractual arrangements
necessary to attract general practitioners and specialist VMOs. What are you envisaging in regard to an innovative contractual arrangement? What does that involve?
Dr HOLLAND: Traditionally, doctors would be employed as visiting medical officers, either on a sessional or fee-for-service basis, or they may be employed as staff specialists. I think in many areas you need to have different contractual arrangements where people are paid not by how much work they do but by how often they are on call. Their work needs to be—my own position, particularly, is made sustainable by the support of GP proceduralists. In rural areas, you can have one or two specialists who can be on call every one or two nights, as long as they have adequate GP proceduralist backup. That applies for obstetrics, it applies for paediatrics, it applies for mental health and it applies for general medicine.
Ms CATE FAEHRMANN: Thank you all for appearing today. I will start with you, Dr Holland. Your submission makes the point that the Government has said, and I think you mentioned it in your opening statement, that the Eurobodalla Health Service Clinical Services Plan will not be ready, if you like, in terms of its development until 2031. That is what the Government or the LHD has said. Is that correct? Where has that come from?
Dr HOLLAND: There are various manifestations of the clinical services plan. I was the VMO representative on the design of the clinical services plan. The clinical services plan 2019 does not reflect the clinical services plan 2020, which was signed off by our chief executive. In fact, there has been a progressive reduction in the number of general beds and emergency beds. Maternity beds have been reduced from seven beds to three beds and paediatric and neonatal beds have been reduced. The Minister for Health has equivocally said that work on this new hospital will start within the term of the present Government. That could be sometime before March 2023 and he would still be telling the truth.
The clinical services plan describes a long-term plan to provide services up to 2031. In other words, you could open that hospital, which the community expects to have level 4 services—level 4 services imply that you have an intensive care service. According to role delineations of clinical services, no other service comes up to level 4 or level 3 without a level 4 intensive care service. So you may open the doors, but they are not committed to fulfilling the full level 4 service until the end of 2031. We may be lucky; it may happen before. But I am sure it won't without community pressure on them.
Ms CATE FAEHRMANN: We have been reflecting in this Committee a bit about the various promises for a fantastic health service over the last 10 or more years. There is the New South Wales Government's State health plan "Towards 2021"—of course, it is now 2021. At the time this was written, the foreword from the then Minister Jillian Skinner says:
… the NSW Government began a process of change in 2011 to build a 21st century healthcare system to really deliver on our promise of 'Right Care, Right Place, Right Time' …
It is now 2021. I might get your opinions on whether the New South Wales Government has actually achieved that "right care, right place, right time" promise.
Dr HOLLAND: From my perspective, if you look at the population size of the Eurobodalla, the number of older residents, the size of our Indigenous community—of which a large proportion are in the younger age group and make up 10 per cent of our maternity service—and if you look at the fact that the number of births in the Eurobodalla is the largest in the rural segment of the LHD, why are we waiting in 2021 to get a level 4 service
that includes adequate maternity services and adequate neonatal services? We have children waiting 12 to 18 months for a routine paediatric consultation and we have no paediatricians. I think this is a problem that is shared across the whole South Coast. It is not a Eurobodalla versus Bega issue. Medicare should provide medical services in an equitable and accessible manner, and these services should be provided across the whole far South Coast of New South Wales for equity. That includes the need for paediatric services and it includes the need for radiation oncology services, which will benefit people from the Victorian border up to Milton Ulladulla.
Ms CATE FAEHRMANN: I will go to the other two witnesses in a second to answer that, but considering we have had this health plan that said back in 2011 that we would have the "right care, right place, right time" by 2021 and now you are faced with another plan with promises for something in another 10 years' time, I can understand it would be quite difficult for you to believe in this promise. Why is it not done now? They have had so long to do it.
Dr HOLLAND: There is some frustration on the process of delivery of health care on the South Coast.
Without making it sound like Bega envy, the building of that health service was not in the right place at the right time when you simply look at the fact that our emergency presentations are over 60 per cent higher than Bega and our admission rates are 25 per cent higher. Without being cynical, there was a win-win situation for both sides of politics on a Federal and State level with the decision to build South East Regional Hospital. That was partly compounded by the divisions in our community about trying to build a single, uniform hospital. To be fair, I have been here 19 years, nine years of which have been under a Labor State Government and 10 years have been under a Liberal State Government. I believe there should have been action well before now.
Ms CATE FAEHRMANN: Thank you. Ms Hurst, would you care to comment about the "right care, right place, right time" promise. Was that the situation for you?
Ms HURST: Five years ago, I returned from Papua New Guinea and came back to Canberra. It was too cold and I moved down the coast. I had not given any thought to things like health care; I just knew I did not want to be cold anymore. But coming down here, I realised, with my situation, how lacking the services are down here.
Things like having a PET scan diagnosis, I had to go to Nowra. I always seemed to have to go somewhere for the treatment. From my perspective, we have not got the services at the right place at the right time. I cannot talk about the history because I was not here at the time.
Mrs DAVID: I think if we look at it in respect of what has occurred within the Shoalhaven hospital in that 10-year period, they got a bloody good multistorey car park, there was an upgrade to the ED, I believe, and there was a cancer clinic built for it. But the overall expansion in regards to surgical beds and all that type of thing—the clinical services and that have been woefully left behind. In fact, people have to travel to Wollongong to get any broken limbs set, and it has only just been recently that they have started to open up a ward that will deal with that type of thing. I have not actually seen how it is running as yet or anything.
I have just noticed they have made an announcement in the last week or so about stroke services coming on line, but whether that is actually occurring at this moment in the current hospital, I am not too sure. When you read all of the submissions that have come through on this inquiry, the whole regional, rural and remote areas are woefully lacking in support and the care that they need to be provided to the communities. It should not be happening. The other thing is, with the lack in some of our regional areas of GPs and everything like that, the
stress that this is putting on our emergency departments to take the excess load because some of these GPs do not work weekends and public holidays and all that type of thing—in peak holiday periods, this is just a huge impact.
It is something that needs to really be looked at in regards to all regional, remote and rural areas. We are just not coping with the community stress all the time, not just for the population but for the nursing staff and doctors and everything within our hospital. It should not be [inaudible].
The CHAIR: Thank you for that. We will move now to the Government's questions. The Hon. Wes Fang, were you going to kick off? Or was the Hon. Natasha Maclaren-Jones going to?
The Hon. WES FANG: Thank you, Chair. I am happy to kick off. Obviously, if the Hon. Natasha Maclaren-Jones returns, we can see if she has got some questions as well. My apologies, I was not here when you started giving your evidence. Please let me know if some of what I am about to ask has been covered already.
I wanted to start with the hospital situation itself. Obviously, we have spoken about the Bega situation with their hospital. With the provision of services into the future, has there been coordination between the LHD and the areas with regard to duplications, provisions and how the services are going to be integrated with the community?
I will start with Dr Holland.
Dr HOLLAND: Thank you, Mr Fang. The design of the clinical services plan is to basically provide the proposed services across all clinical streams going into the new hospital. Every hospital should basically have the provision for care for the older population; for women having babies; for women's health generally, which is restricted on the South Coast with the number of options that are available; and for children, our most vulnerable.
Medicine and surgery, that is what we get our degree in, so that is a no-brainer. Our concern is rationalisation of medical services where a hub and spoke model is developed to say it is good enough for a rural population to travel 1½ or two hours to have your hip replacement done, even though there might be more hips and knees in the population that you live in. We are awaiting a coastal network plan to be developed by the Southern NSW Local Health District. Our group is concerned that it will follow the same pattern as adult mental health services, where our residents with mental health issues will simply be transferred to industrial-size inpatient services rather than having their care closer to home.
The Hon. WES FANG: But at this stage there has been no engagement or confirmation that there will be division of services between the hospitals? Do you have any indication that is what is being discussed?
Dr HOLLAND: I can tell you on the basis of women's health services, there has been no discussion of how women's health services will be provided following the end of my contract in 21 months' time. There is no design for hospital-based outpatient services for women. A model of care needs to be developed to provide these services which are currently provided from Milton Ulladulla down to Eden. The number of theatre spaces has been reduced. As far as I am aware, there is no plan for recruitment of orthopaedic surgeons to do major orthopaedic surgery in the region, which they cannot do without level 4 intensive care services because of the need for postoperative care. These deficiencies go across all clinical streams. You cannot recruit a paediatrician if the clinical services plan says you are only going to have two paediatric beds. What paediatrician would come under those conditions?
The Hon. WES FANG: I could imagine that you would potentially have a private paediatrician who services the town doing private paediatrics and then would operate in a VMO arrangement. Would that not be something that would be suitable? Even with two paediatric beds, potentially with two paediatricians, a one-in-two roster would be, I would think, something that would be an attractive position and lifestyle for somebody, particularly in the beautiful part of the world that you live in.
Dr HOLLAND: It is a beautiful part of the world that we live in, but you can feel like you are living in a beautiful jail if you are on call 24 hours a day, seven days a week and cannot go anywhere. Those things do not attract people in terms of the quality of life. If you are on call, you cannot have a surf and you cannot go up to Canberra and watch the Brumbies or the Waratahs play. You are restricted to a 20 minute circle around your area.
Currently, there is no private or public paediatrician in the Eurobodalla. Our children have to go for admission to Bega, Canberra, Nowra or Sydney. They are waiting 12 to 18 months for an appointment.
The Hon. WES FANG: I was just going to say that I have experience with people in paediatrics in particular and the difficulties of on call rosters, which is why I actually said if you had two of them and you had a one-in-two roster, it would potentially allow you to have the paediatricians in the town. With two beds, you would still be able to provide that service. Is that the sort of thing which is being discussed around making the provision of services within the town for day-to-day paediatrics but then having those people potentially on a one-in-two on call roster for the hospital? Has that been discussed and looked at through engagement with the clinicians?
Dr HOLLAND: There is a director of clinical services in paediatrics who is linked with the South East Regional Hospital paediatrics service. That director agrees that two paediatric beds will not sustain a paediatric service. You will not attract clinical nurse specialists in paediatrics to staff two beds, you will not have the professional satisfaction for any specialist to cover two beds, and the issue of having two people is that two people on call becomes one person on call when one person gets sick or goes on holidays. The minimum sustainable, and what should be the minimum sustainable of on call in any specialty safely, is no more than one in three on call.
You can achieve that with two specialist paediatricians or obstetricians and backup with GP proceduralists with special skills in either paediatrics or obstetrics.
The Hon. WES FANG: But haven't you really hit the nail on the head with the issues that arise for professionals such as specialists in medical fields, where they may move somewhere and provide not only a private service by day but also be on call, whether it be a one in two or one in three. They are not able to actually sustain the skills which they have, whether it be through their training through one of the children's hospitals where they might get ICU time and duty and they are not able to actually sustain that level of skill. Given the patient load and the lack of variety, they are unable to maintain those skills. Can you see that that is potentially part of the problem when you have a one-in-three or one-in-four roster in a smaller community? There is a dilution of the number of patients that you see in [disorder].
Dr HOLLAND: Let me speak to private practice in the first place. Private practice in rural areas is a false economy. I am sitting in my room—
The Hon. WES FANG: [Disorder]
Dr HOLLAND: Yes?
The Hon. WES FANG: Sorry. My screens are frozen. Am I on—
The CHAIR: Please proceed, Dr Holland.
Dr HOLLAND: Private practices in rural areas are a false economy. I am providing a service here in my own funded private practice, which patients have to pay for. It simply is the fact that these services are not provided through outpatient clinics in rural and regional hospitals. It is a diversion of the cost to the patient. Often the argument is, "Well, you charge the patients as much as you like because they would have to spend a day travelling somewhere else to see another specialist." Most specialists in rural areas have some moral and ethical objection to that principle. You do not come to these areas to make lots of money. You can come to regional areas to have very rewarding and broad clinical experience, as long as you have adequate training before you come here. The other alternative is to see every tumour or gynaecological condition and then, once again, say, "Well, this needs to be treated in a metropolitan area." My own college has not really taken up the baton on this issue of well-trained procedural obstetricians and gynaecologists that can basically perform most forms of surgery and services in rural areas. You would need an adequate hospital with adequate beds and adequate service capability definitions to provide those.
The Hon. WES FANG: I am just going to ask if any of my colleagues want to jump in with any questions.
The Hon. NATASHA MACLAREN-JONES: I am okay. Like Wes, I am having connection problems. I am missing quite a bit of this.
The CHAIR: I do apologise for this. Wes, did you want to ask a final question to round things out?
The Hon. WES FANG: How much time do I have left? I was not sure if I was cutting people off.
The CHAIR: You have pretty much had all of your time, but there has been a little bit of disruption so
I am happy to give you another question.
The Hon. WES FANG: I will put any other questions I have got on notice, but thank you. Apologies for the technological issues. My screens keep freezing.
The CHAIR: That has been acknowledged. We do not hold you responsible for that. I will conclude now by thanking our witnesses. Dr Holland, thank you for some deep and rich insights into matters of health. You obviously bring much experience and insight, which has been very helpful to the Committee and we appreciate that. Thank you, Ms Hurst. It is not easy bearing one's soul, so to speak, in public like this. It has provided us with a very specific case study around which there is detail, which I am sure will help inform our deliberations over the preparation of the report and its recommendations. To Mrs David, for the work you do down there with your constituents, thank you very much. That survey work which has produced those comments that informed your opening statement and your submission will be very helpful. Once again, thank you to the three of you. We appreciate the contributions you have made. That brings us to the conclusion of the session this morning.
(The witnesses withdrew.)
(Luncheon adjournment)
