February 28, 2023

New South Wales Regional Health Strategic Plan 2022

– 2032 Regional Health

The last New South Wales (NSW) regional health strategic plan, NSW Rural Health Plan – Towards 2021, expired in 2021, two years ago now and COVID-19 and the Rural Health Inquiry have given good cover to the current Government as to why we don't already have a new strategic health document to allow scrutiny on our health services.

In discussions with the Health Minister, and in questions on the matter in Parliament, as Parliamentary Members for Orange and Barwon we continually raise the issue that there are no metrics relating to the availability of treatment, or the time taken for treatment to be offered and delivere

The reason this focus is avoided is because it will simply immediately identify a massive under resourcing for regional and rural health, hiding from scrutiny of under resourcing is not a good enough reason to avoid placing that style of metric in a strategic regional health plan.

Aside from old-fashioned honesty, there are structural reasons that metrics on availability of treatment, time taken for treatment to be offered and assessment of the final outcome of treatment are crucial to improvement.  These metrics, measurables, offer two significant outcomes:

The Commonwealth drives directly, and indirectly, virtually all state health funding. Identifying under resourcing and transparency by individual health sites, allows a proper discussion with the Commonwealth on bed allocation, resourcing for beds, and training and support for regional health workforces.  At previous times, the Commonwealth contract for funding with NSW has included detail by health area and actual health facility, we need to return to this.

There is no doubt that the quality of life of regional people has declined over the last few decades because of the declining regional health service.

It's important in any debate regarding rural/regional health that the performance of the health workforce is not questioned.  The current workforce is not the problem, it's the high-level management who are placed in the position of continually explaining away declining health outcomes which are driven by lack of resourcing- as not due to lack of resourcing.

The Regional Health Ministerial Advisory Panel appointed to put together the next 10 years of regional health planning are certainly a competent dedicated group of people

The question is, why would you, as a government of 12 years, attempt to roll out the next decade of strategic planning without widespread consultation on the details of that plan prior to deciding on the final plan, weeks before an election?

Reading through the details such as are available, the key strategy missing from the last health plan that ended in 2021 are hard and fast metrics, it’s now 2023 and again that looks lacking.

We cannot continue to ask health professionals to comment on the periphery, on matters such as the patient experience when the elephant in the room is massive under resourcing, and from a government perspective, lack of care over a sustained period for rural and regional people.

• The release of the strategic plan should be delayed until after the election, the current government may be returned or we may have a new government, the polls say it is that close.
• The plan shouldn’t be signed off in a hurry in the next few weeks by the current government, it should be road-tested and available for comment by rural people and rural leaders across regional NSW.
• The plan must have hard and fast metrics on the availability of treatment, treatment times and the strength of workforce on a site-by-site basis. E.g., XXX Multi-Purpose Facility – 10 in-patient beds, XX treatment available as in-patient, XX treatment available as out-patient, XX Emergency/critical care staff, XX Registered Nurses, XX Maternity staff
• The CEOs of each health district must by legislation be required to report against those metrics on a site-by-site basis annually. This report will include both the shortfall in meeting the metrics, and a proper estimate of the resourcing and measures required to end the gap between the agreed standard and the delivered standard.
• These reports will for the near future be a litany of explaining, that the metrics cannot be delivered because of resourcing issues. That will be a huge change, the CEOs will be charged with the responsibility of revealing and discussing under resourcing. Currently, the CEO is effectively tasked with avoiding all discussion of under resourcing and they have no individual responsibility to actually detail under resourcing and the lack of availability of treatment on a site-by-site basis.
• The annual report of the health CEOs must, by legislation, be tabled annually in the NSW Parliament with the Regional Health Minister being required to explain why the metrics aren't being met.
• The annual report for each health district needs to be discussed on an ongoing basis with newly appointed local health committees to allow each community to be fully aware of the shortfall in the availability and delivery of treatments as well as resourcing required to stop the gap.
• These committees need to be Ministerial appointments vetted by a non-political selection process, it's time to end the blockages to good outcomes caused by party faithful obscuring problems through key roles.
• The Commonwealth should be requested to also comment on the shortfalls and be an active participant in ensuring their funding drives an improvement to the lifespan and general health of regional people.

The recent Parliamentary Inquiry into health outcomes and access for rural, regional, and remote NSW found the NSW Rural health system is in crisis and is failing its’ residents. 44 recommendations were made. Two are most relevant when considering the timing of the release of the NSW Regional Health Strategic Plan 2022-2023 (these have been summarised):

1. Recommendation 11: That NSW Health work with the Australian Government collaboratively to immediately invest in the development and implementation of a 10-year Rural and remote Medical and Health Workforce Recruitment and Retention Strategy. This should be done in consultation with rural, regional, and remote local government, schools, community services, human services, unions, professional organisations, general practice, pharmacists, and community organisations. It must also address hospital and general practice workforce shortages.

The new NSW Health Workforce Plan 2022-2032 has already been published. It contains no clear data on projections or sourcing. Where was the consultation in our communities?

1. Recommendation 38: That the NSW Government ensure that the development of the next Rural Health Plan:

• Includes genuine consultation with rural and remote communities
• Contains realistic, measurable, and quantifiable goals in terms of tangible health outcomes
• Provides the funding and support required to deliver against those goals

What a start! a ten year plan released with no general consultation. There are no clear measurable and quantifiable goals in the new report. This is what I am asking for. How are we to improve without acknowledging failings and working towards a clear purpose? A satisfaction survey from a local rural hospital is not enough.

Discussion over a Regional Health Minister is just political distraction without that Minister having Legislative responsibly and accountability for actual change and improvement.

Relevant Links

NSW Regional Health Strategic Plan 2022-2023

NSW Regional Health Strategic Plan 2022-2032 Priority Framework

NSW Rural Health Plan: Towards 2021

NSW Rural Health Plan: Towards 2021 Final Progress Review

Health outcomes and access to health and hospital services in rural, regional and remote New South Wales

Media contact Troy Lennon 0447 381 148