Senior NSW health department bureaucrats have apologised to patients and families who received substandard health care in rural and regional areas.
The officials conceded there had been evidence of "regrettable patient experiences and outcomes" at a long-running parliamentary inquiry into regional and rural health in the state.
"To these people and their families, we sincerely apologise for experiences that did not meet the high standards of health care that we expect in this state," NSW Health Deputy Secretary Nigel Lyons told the final hearing day of the inquiry on Wednesday.
The evidence had been "very difficult to listen to", Dr Lyons said.
The inquiry heard shocking tales across 15 hearings, including some in the regional towns of Dubbo, Lismore, Gunnedah and Cobar.
Witnesses spoke of hospitals without doctors, children delivered on the side of the road, a lack of basic supplies like antibiotics and years-long waits for treatment of ear conditions in kids.
In a submission to the inquiry, NSW Health said it has listened to all the evidence and reviewed more than 700 submissions to the inquiry.
The harrowing evidence prompted the department to engage independent experts at the Sax Institute to consider the issues raised.
Dr Lyons said NSW Health is committed to improving and ensuring all patients in the future receive the high quality of care they expect and deserve.
But he said the issues raised in the inquiry were complex and the government would need to explore different strategies and initiatives to address them.
The main struggle highlighted by Dr Lyons and fellow deputy secretary Phil Minns is a shortage of health workers outside the major cities.
Numbers of doctors entering GP training across Australia fell 14 per cent between 2016 and 2020, though they have since recovered slightly with the pandemic keeping doctors in the country.
Changes in the way healthcare has been regulated over the last few decades mean it is harder to provide a full suite of skills outside the cities, he said.
The Omicron wave of COVID-19 following on the heels of the Delta outbreak created even greater workforce challenges, Mr Minns said.
While the department had developed plans to cope with COVID-19, "when Omicron hit and the speed with which it hit ... it overwhelmed those strategies", he said.
Surge strategies were "exhausted, they were tapped out, they didn't have any more capacity", he said.
The inquiry heard on Tuesday that staff shortages brought on by COVID-19 have been so severe at some regional hospitals that paramedics had been helping deliver babies in some maternity wards.
The NSW government will work with the federal government to address the primary care issue, Dr Lyons said.
It will also engage communities in local health service development, such as by working more closely with local councils and having regular forums with stakeholders.
The government will also explore ways to strengthen the rural health workforce.
