A new report into the NSW health system's COVID-19 response shows already under-staffed rural and remote hospitals did not have capacity to "surge" the workforce at the peak of the pandemic.
The debrief by independent convenor Robyn Kruk made six recommendations with 29 priorities to improve the response to future pandemics, identifying staffing as a key challenge in rural areas.
Edward River councillor and health advocate Shirlee Burge said her small community of Deniliquin near the Victorian border felt the brunt of staff shortages during COVID.
In October 2021, COVID cases and the refusal of some local nurses to be vaccinated meant the Deniliquin hospital had to temporarily close beds.
"Quite frankly, for everyone concerned it was bedlam and our medical people need to be congratulated on how they adapted and managed," Ms Burge said.
"Instead of doing say, cardiovascular nursing for a day, they were then running the COVID testing clinic and we lost out in a number of areas where our nurses or general staff were re-directed into dealing with COVID."
The report found rural and regional local health districts were under-staffed and operating at capacity before COVID and had "little-to-no capacity to flex their workforce" to meet the needs of the pandemic.
"When COVID-19 cases first increased in metropolitan LHDs, health staff were redeployed from rural and regional LHDs to assist, which left those regions short-staffed from furloughing and without access to an adequate surge workforce when their own COVID-19 burden increased," the report said.
The report's authors recommended ensuring rural and remote Local Health Districts (LHD) were resourced in emergencies.
State-border restrictions exacerbated staff shortages
The report also found regional areas were significantly impacted by border closures given the heavy reliance on international and locum workforces and the number of health staff and their families that resided across state borders.
"Arrangements need to be agreed between states to facilitate movements of essential workers, minimise risks to patient care and provide greater flexibility on compassionate grounds," the authors said.
Ms Burge was encouraged to see cross-border restrictions acknowledged in the report but said the government needed to implement its recommendations.
"We can't blame anyone for how things were handled but we've got to look for the future that next time round, especially in these cross-border areas that people don't die because they can't cross the border," she said.
'Extraordinary' efforts of staff
The debrief was carried out with 75 consultations involving more than 350 people from across the department and other health providers, including primary health networks, Aboriginal medical services and aged care providers.
The report described the contributions of staff throughout the pandemic as "extraordinary".
"The flexibility, dedication, and preparedness of the workforce to go over and above the call of duty for extended periods of time saw the system through periods of intense pressure," the authors said.
The report also recommended developing approaches to managing staff wellbeing in high pressure situations to retain and attract new employees.
Despite reports of some healthcare workers leaving the system due to the vaccine mandate, the report's authors said it wasn't something raised in the consultation.
"We heard little opposition to the policy approach taken by NSW to mandate vaccination for its workforce, the way it was communicated or implemented," they said.
Ms Burge estimated up to 20 Deniliquin healthcare workers refused to be vaccinated and were no longer working in the sector.
The report also suggested expanding the number of Aboriginal health workers as an action item, saying they were "stretched beyond capacity".
"Often seen as the face of NSW Health in the Aboriginal community, we heard how Aboriginal health workers worked around the clock to find solutions and assist other staff in delivering culturally appropriate services," the authors said.
According to the NSW Health website, the report's six recommendations have been accepted and implementation planning is now underway.
NSW Health will report on progress by November 2023.
