The ‘Final Report of the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals’ (the ‘Garling Report’) was released in 2008 and presented various recommendations to the New South Wales Government.
As hospitals were understaffed at the time, and training was deemed insufficient, the recommendations aimed at improving patient care and treatment by focusing on hospital staff and implementation of new training and best practice guidelines. However, there is still concern, particularly with respect to smaller regional hospitals, that these recommendations have not led to any significant improvement in the level of care and treatment which is being provided.
Despite the subsequent implementation of various policy frameworks and training platforms across NSW – such as the 2012 ‘Between the Flags’ system [which included the Clinical Emergency Response System (CERS)] – big question marks remain over the numbers of staff, and the level of staff training and experience, in smaller regional hospitals with emergency departments.
Garling Report findings for rural hospitals
Chapter Six, Volume One of the Garling Report includes numerous findings in relation to rural hospitals. These include the following:
- A major lack of staffing across all levels, including GPs, specialists, anaesthetists, nurses and midwives. Exacerbating factors include very slow replacement of staff and an ageing workforce.
- Recruitment and retention of staff are both low.
- Inability to retain permanent specialist staff has led to a reliance on fly-in/fly-out specialists, at great cost.
- There is a flow-on effect from the lack of clinical nurse educators, making it harder to recruit and train nurses. Second/third year RNs are often the most senior nurse on a shift.
- There is a lack of staff in training programs, and little support from government and colleges for increasing training.
- The lack of staff/facilities is especially pronounced for mental health services in rural areas.
- There are significant issues with transport, both with regards to rural patients getting to metropolitan/regional hospitals for specialist treatment, and with the trip home, which seemingly has no consistent system in place.
Recommendations proposed to improve services provided by rural hospitals (2008)
The Garling Report put forth several recommendations including:
- Recommendation 12: NSW Health should take immediate steps to enhance the supply of a skilled workforce of clinicians to rural areas by ways which include, at least:
(a) Giving consideration to whether there is an available process by which there ought be made compulsory a rural training term for employed junior medical officers in their second and third year of employment with NSW Health, including reviewing which hospitals have the capacity to accept such trainees and what other steps are necessary to ensure the adequacy of the training of such junior medical officers undertaking a rural term.
(b) Reviewing the existence of and developing, as required, employment packages with features which would attract and retain skilled staff to work in rural communities. This may include developing formalised partnership structures between metropolitan hospitals and rural hospitals which facilitate the transition of clinicians between the hospitals.
(c) Developing education facilities and programs which ensure that clinicians working in the rural and remote areas of NSW are provided with adequate education and training.
- Recommendation 13: NSW Health should seek an amendment to the Mental Health Act 2007 to permit suitable remote facilities, specified in regulations to the Act, to operate safe assessment rooms for mental health patients on the basis that three hourly review of the patient may be undertaken by a senior nurse or psychiatrist over a video link.
- Recommendation 14: NSW Health should address the transport problems associated with providing care for rural patients including:
(a) Abolishing the personal contribution and administration charge for all qualifying IPTAAS claims;
(b) that there is a need to create a non-urgent transport service to be responsible for the return transport of patients from metropolitan or rural hospitals to either their hospital of origin or alternatively to their homes, depending upon their clinical condition.
Current state of rural hospitals and conclusions
Although numerous recommendations were made in the Garling Report, it is uncertain whether they have had any real impact on the quality of care provided by smaller regional hospitals.
Many local healthcare employees have commented on the current issues in their industry.
Brett Holmes, general secretary of the NSW Nurses and Midwives’ Association, comments that almost all these nurses and midwives cited ‘workloads’ and ‘inadequate staffing levels’ as the cause.
At Catherine Henry Lawyers, we have represented many clients who have claimed damages for personal injury and death as the result of inadequate care and treatment received at regional hospitals. The root causes of these failures were that these hospitals were under-staffed, under-resourced and/or the staff did not have the requisite training and experience to provide necessary acute care and treatment.
For example, we were recently involved in a case where our client’s mother tragically passed away as a result of a serious medical condition which went undiagnosed and untreated until it was too late.
It is imperative that the Australian and NSW governments make the necessary legislative and funding reforms in relation to our acute care hospitals. Urgent action is required to ensure that the acute care and treatment provided by regional hospitals is both timely and competent, ultimately avoiding preventable injuries and deaths.