BYO bandages: The case for regional and rural health reform
22nd Apr 2021
There is a current Upper House parliamentary inquiry into health outcomes and access to health and hospital services in rural, regional and remote NSW. ALA member, Kasarne Burgan, and I wrote a submission to this inquiry on behalf of the ALA.
The problems being revealed in the inquiry – the impact of inequitable health resourcing to the bush – are far from unique to NSW. Although these problems are often talked about, there has been little or no action. The NSW inquiry is the first of its kind in Australia. There have been previous inquiries in NSW around quality and safety in our health services but these have focused on public hospitals in general, and not specifically on hospitals in regional areas. And hospitals are just one part of the problem.
Plaintiff lawyers – particularly those who undertake medical negligence litigation – see first-hand the impact that inequitable health resourcing and services has on those living in rural, regional and remote areas. The result is avoidable serious injury and death.
Australian Institute of Health and Welfare data shows that the median age of death decreases substantially with distance from major cities. For men, the difference is up to 11 years and for women, the gap is up to 15 years.
Those in rural, regional and remote NSW also experience higher rates of potentially preventable hospitalisations than those in metropolitan areas.
People living in rural and remote areas face stressors unique to living outside of large cities. Suicide rates for areas outside capital cities are over 50% higher than in capital cities. For example, suicide rates of men in the 15–29-year-old age bracket are twice as high as for those living in major cities due to limited access to mental health care in rural areas.
Media pressure sparks inquiry
Pressure for an inquiry intensified following a September 2019 ABC Four Corners program, as well as a September 2020 60 Minutes program featuring the tragic and avoidable deaths of the fathers of Liz Hayes and ABC journalist Janelle Wells.
The ALA submission commented on those terms of reference of the inquiry which focused on the comparison of, and the role played by: staffing challenges; provision of ambulance and oncology services; and health and hospital services for Aboriginal and Torres Strait Islander communities. We used legal case studies to demonstrate each of our points.
Insufficient public data
It is difficult to make accurate assessments as very little detailed data on adverse incidents is publicly available.
Unlike other OECD countries, no state or territory government nor the Federal Government publishes death and serious injury data in Australia. Such data would make it easier to detect the poor performance of disgraced medical practitioners, such as that of former surgeon Dr Jayant Patel who was permanently deregistered in Queensland in May 2015.
Data would enable prospective patients to examine a hospital’s record, including any data recording death certificates, where the death was caused by adverse events or unexpected outcomes.
Barriers to access and workforce issues
The key issues that prevent rural, regional and remote people from accessing proper care are related to cost and shortages of practitioners, particularly specialists.
The NSW Bureau of Health Information estimates that 12% of rural Australians forgo healthcare because of cost and access issues.
Training hospitals, universities, and specialist accreditations are also much more prevalent in major cities and graduates often don’t move far from where they studied.
In general, there is an over-reliance on locums and a lack of community care. Some hospitals are staffed purely by nurses. Staffing shortages lead to increased pressure on those staff who are working, which contributes to high staff turnover and increased errors.
In response to these issues, the ALA submission recommended:
- Priority development of a rural health workforce.
- Continuing programs to attract and retain senior nurses.
- Introduction of a compulsory rural training term for junior medical officers.
- Improving the General Practice Rural Incentive Program and the Practice Nurse Incentive Program.
- Formal recognition of the rural generalist program.
- Establishment of training hospitals and programs in regional areas.
Community paramedicine (registered paramedics who recruit, train and supervise or mentor volunteers) is a model to be explored, as is using volunteer ambulance officers for patient transportation.
One-third of cancer patients live in rural areas and they have poorer survival rates in comparison to Australians in major metropolitan centres. The additional transport problems for rural and remote patients when receiving treatment is also an issue.
There has been some commitment from Government to regional cancer centres however the success of these centres depends on the availability of properly trained medical and allied health personnel. In addition, stronger networks linking regional and metropolitan cancer services would be beneficial.
First Nations health
The gap in the health outcomes of Aboriginal and Torres Strait Islander communities is unacceptably wide – it is a UN human rights issue. As such, we recommended support for the National Justice Project, a not-for-profit legal service for the vulnerable and we encourage ALA members to support it too.
What can lawyers do to affect change?
- Use your position and voice to advocate for change. We expect the inquiry to publish our submission soon.
- Use social media and news media, and lobby parliamentarians to affect change.
- Encourage your rural clients impacted by poor health care to attend upcoming inquiry hearings and to share their story where appropriate.
This is an edited extract from ALA member and Newcastle health and aged care lawyer Catherine Henry’s presentation to the ALA NSW Personal Injury and National Medical Law Conference 2021. View the Conference presentation slides here.
Catherine Henry is the principal of Newcastle-based health and relationship law firm, Catherine Henry Lawyers. Catherine was the recipient of the 2020 ALA Civil Justice Award and is the national spokesperson on aged care for the ALA.
The views and opinions expressed in these articles are the authors' and do not necessarily represent the views and opinions of the Australian Lawyers Alliance (ALA).
 Dr Patel’s New York State licence was withdrawn in 2001, whereupon he moved to Oregon, where he was also sanctioned for unprofessional conduct. Despite having no formal surgical qualifications, Dr Patel took up a post as Director of Surgery at the Bundaberg (Qld) Base Hospital in 2003. Over the next two years, 97 deaths were linked to Dr Patel, 30 of whom were directly under his care. Having returned to Oregon in 2005, Dr Patel was extradited to Australia in 2008. He was convicted and jailed in Queensland in 2010 on three counts of manslaughter – subsequently quashed on appeal in the High Court in 2012. One manslaughter retrial resulted in acquittal; remaining charges were dropped in exchange for a guilty plea to two charges of fraud. Dr Patel was sentenced to two years in jail, wholly suspended, after which Dr Patel returned to the USA.