While NSW health minister Ryan Park blames overworked workers, the Australian Medical Association (AMA) says the NSW Health budget is “failing to meet patient demand” and that underpaid nursing staff are being forced to strike for a fair pay deal.
NSW AMA President Dr Kathryn Austin said too many services remained desperately underfunded, following the Bureau of Health Information’s first-quarter data release in May.
“Our health system is held together by the goodwill of treating professionals,” Austin said. “But with demand continuing to rise to record levels and a lack of funding … it is becoming increasingly impossible for the doctors and health workers of NSW to deliver the care that the citizens of this state deserve.”
In the subsequent June 2024–25 budget, NSW Health was allocated “a record” $35.1 billion. But critics say the cheque is not nearly as big as it looks.
NSW AMA Vice President Dr Fred Betros said the budget was another blow to the already ailing health system. “This year’s (2024–25) health budget of $31,873 billion is a 2.97% increase on last year’s budget of $30,951 billion,” Betros said. “It falls below actual health CPI,” he said, “meaning that after health inflation this is an effective loss”.
While what looks like more money for hospitals always passes the pub test, the reality is that the provision of health services in rural areas repeatedly fails the delivery and accessibility test.
The reasons for this discord and why the NSW government is regularly accused of city-centric health planning are found not on a budget spreadsheet. They are found on a map of where impacted people live, relative to the way state-based funding is split up into local health district health plans.
Entrenching access inequity
Inequity of access, by default, is already an issue for rural and remote patients, particularly low-income households, disabled people and pregnant women.
NSW has 15 local health districts, six of which are in the greater Sydney region. The rest are spread out across NSW in a convoluted system of base and district hospitals, emergency departments, ambulance services, community health and nursing services, clinics and medical centres.
There is no margin for overflow from other facilities.
Nonetheless, for health ministers desperate to cough up the state-wide political fur ball that is ambulance ramping, and accident and emergency department congestion, local district health plans are a golden opportunity to reshuffle established, localised medical services with an eye on improving statewide, aggregated performance data.
There are no prizes for guessing who loses.
Labor’s current draft plan for the Murrumbidgee Local Health District (MLHD), which includes Cootamundra Health Service, is a case in point.
Cootamundra is located roughly halfway between Canberra and Wagga Wagga, with a population of about 7000, plus numerous satellite towns and villages of varying remoteness.
The community learned in May that the pathology, surgical and birthing units at Cootamundra Hospital would be discontinued under the MLHD draft Health Services Plan, to make more space for the emergency department.
The announcement blindsided local MPs, triggered a stop-work meeting and caused community outrage.
The now-closed public consultations were extended after the melee — the draft plan and consultative feedback are now back with the government for finalisation before an as-yet-undated release.
Michael McCormack, federal National MP for the Riverina, raised the problem of associated cuts to maternity services in parliament, alongside projections showing a significant expected increase in population, due to the expansion of the local meat works. Steph Cooke, NSW Nationals MP for Cootamundra, said the region is playing catch up after chronic, long-term underfunding.
Relocation of critical services
Labor’s draft plan outlines the “relocation” of pathology, surgical and maternity services from Cootamundra to other hospitals at Temora, Young and Wagga Wagga.
It said those services are “better” and “more likely” to be chosen by patients, and that it reflects the projections for an increase in demand for medical beds and a decrease in surgery and birthing needs. This is at odds with McCormack’s projections and makes no sense to locals.
What the plan does not show is the relativity of where Cootamundra lies on the map.
Losing maternity services there means patients face a potential two-hour journey on country roads to give birth, particularly if they are directed to Wagga Wagga and live in an outlying village.
If patients are forced to call an ambulance, it defeats the entire premise on which the cuts are being made.
Temora District Hospital is closer to Cootamundra than Wagga Wagga, at under an hour. But if you live in any of the outlying villages on the other side of Cootamundra, the route to Temora is an hour in the opposite direction.
That leaves Young Hospital, the closest for most residents if they cannot use Cootamundra. However, the draft plan does not guarantee it additional resources. This is further complicated by the fact is one of the services is co-managed with Far West Health Service.
Disabled residents disadvantaged
Relocating surgical services from Cootamundra, which includes day-only dental surgery, will leave some patients unable to access services at all.
Disabled resident Kerry (*pseudonym) told Green Left she was furious at the planned cuts, which she said would seriously impact the many disabled people who live in the area.
“The government just doesn’t get it,” she fumed. “There is no public transport here.
“Every time I go out I have to pre-book community transport, hire expensive care workers and arrange back-up care at home for my partner. Then there are the arguments between my NDIS and his Aged Care Package over who funds what.”
“If I have to go further away, necessitating an overnight stay, it’s immediately both financially and logistically out of reach.”
Kerry said shafting services to farther away hospitals “is a stupid idea because it’s completely unnecessary. My own dentist could easily do the day-only surgery I need at nearby Cootamundra, where he and other trusted local clinicians have operated for many years.”
Kerry said it’s just as well she is not a maternity case, “or I’d be having the baby on the bathroom floor or in an ambulance, if I was lucky”.
With the imminent release of the final MLHD Health Services Plan, residents will find out if the service cuts stand and about NSW Labor’s health priorities.
[Suzanne James is a compliance, policy and risk framework consultant and a former assistant to the Director of Clinical, Mid-North Coast Area Health Service.]