No blame games! Rural hospital inquiry must focus on increasing quality care

Dr John Hall.

Dr John Hall.

The Rural Doctors Association of Australia (RDAA) and Rural Doctors Association of NSW (RDANSW) have welcomed an inquiry into the NSW rural hospital system, but cautioned that it must focus on providing robust support for rural hospitals and closely involve experienced rural clinicians in its deliberations.

RDAA President, Dr John Hall, said the inquiry needs to focus on strategies for improving the level of service available on the ground in rural areas.

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"This inquiry is a great opportunity to highlight the significant additional investment that is needed in the NSW hospital system, both in terms of infrastructure and medical workforce.

"After decades of funding erosion by successive state governments we need to halt and reverse this alarming trend, which is not keeping pace with community needs.

"The rural population continues to grow, and this should be accompanied by increased local medical capacity, with less centralisation in Base hospitals," Dr Hall said.

The associations have urged the inquiry to focus on:

  • continuing poor investment in NSW's rural hospital infrastructure
  • the continuing need to recruit more Rural Generalist doctors who can work both as GPs in NSW rural communities and as Visiting Medical Officers (VMOs) at their local hospital
  • the need for the same standard of robust clinical governance to be put in place at all NSW hospitals - public or private, city or country.

"We need to be absolutely clear - this inquiry needs to listen closely to advice from rural clinicians who have long-term experience of working in the NSW rural hospital system" Dr Hall said.

"We are deeply concerned that the inquiry will rely on advice from city-based sub-specialists who may never have worked in rural settings, and have no practical knowledge about the challenge of providing rural health care.

"It must be led by clinicians who have extensive experience in delivering services in to rural and remote communities, as they are the only ones who have a real understanding of the needs and limitations of rural hospitals.

"Relying on city-based sub-specialists or their professional associations for advice will only result in an inquiry that makes erroneous findings.

"The worst outcomes for rural communities will be that much-needed local hospital services, that are currently providing quality health outcomes to rural NSW patients, are shut down.

"While the inquiry has been triggered by some adverse patient outcomes, these are not the norm in the rural health system," Dr Hall said.

"These outcomes are deeply distressing to families and to the health professionals involved, but they are rare - and they also occur at major city hospitals.

"Multiple studies have shown that rural hospitals are some of the safest settings to receive care, and while adverse outcomes should be an important part of the inquiry, they must not be the only element.

"Good clinical governance at all hospitals - and better investment in rural hospital infrastructure and the rural health workforce - are the big ticket items that will drive the best possible outcomes for rural NSW patients.

Dr Hall said there is also a strong need for the inquiry to recommend that all NSW rural hospitals should be required to genuinely support true medical leadership.

"Doctors working in NSW rural hospitals must be supported to have genuine influence over health service management decisions, including the range of clinical services offered at the hospitals, clinical processes and systems, and the recruitment and retention of clinical staff.

"At the moment, this is rarely, if ever, the case."