Introductory remarks to evidence given at the NSW Inquiry into the Management of COVID by The Healthy Communities Foundation Australia (formerly Rural and Remote Medical Services) CEO, Mark Burdack.
I would like to acknowledge that I am talking to you from Orange in Wiradjuri country and pay respect to Wiradjuri Elders past, present and emerging of this country and to any other Aboriginal people present or listening.
RARMS is a charity that was established in 2001 and we manage community general practices in vulnerable communities such as Collarenebri, Warren and Gilgandra.
Prior to 1 March 2021 RARMS also operated community general practices in Bourke, Brewarrina and Walgett. However, we were regretfully forced to close our practices in these towns during COVID.
My focus will be on rural and remote communities as you would expect, but I think there are lessons that can be learned from the management of COVID for how we deliver health services in NSW more generally.
In terms of the management of COVID I would like to make a few opening observations:
There is no doubt that the scale and severity of COVID took the health system by surprise given the last global pandemic was the Spanish Flu in 1918. It was in some senses understandable that the early response was a little disorganised. But the ongoing problems with the response is more concerning. We had a national plan for managing pandemics which was shown to be, like so many of these documents, an expensive paper-weight rather than an actionable plan. We had led the world in response to the HIV epidemic and in dealing with SARS and MERS, yet the same integrated and coordinated “health” approach seemed to have been replaced by a “hospitalist” approach in dealing with COVID. Rural and remote people do not understand why, after the expenditure of so much money to prepare for the inevitability of a pandemic, that we appeared so unprepared for actually dealing with it.
There is no doubt that everyone was motivated by best intentions. But unlike other national crises, COVID did not bring us together as a nation in a common effort and this was felt heavily on the ground in rural and remote communities. While Ministers were rightly guiding the community about the risks of COVID and need for urgency, there was a sense of ‘business as usual’ in the early response of the health system. In March 2021 contracts for Visiting Medical Officer services in 7 rural and remote towns in NSW were taken away from the local rural general practices in the middle of COVID and awarded to Sydney-based medical provider which undermined the sustainability of general practice in these towns and led to the loss of permanent rural GPs just when we needed them the most. Rural and remote people were listening to our Ministers correctly saying that we were in the middle of a global “health” crisis, yet at the same the health system was engaged in activities that they were aware would disrupt local provision of health care on which we would rely to respond to COVID in vulnerable rural and remote towns.
There is no doubt that rural and remote people have suffered disproportionately during COVID due to dysfunction in our rural and remote health system that has been highlighted by rural and remote people in the NSW Inquiry into Rural Health that recently concluded its hearings. Our failure to anticipate, or plan for, how this pandemic would impact on rural and remote communities made a bad situation worse and reflect the problems in the way our health system supports rural and remote communities and how underfunding of rural and remote health has undermined our preparedness for dealing with natural disasters and other health emergencies.
What the COVID crisis and its management tells us is that more than ever, NSW runs a hospital system and not a ‘health’ system.
The focus of our response from the beginning was on the disease and its cure, not on people and patients. There was a sense that all we needed to do was find a cure and the job was done.
Little thought appears to have been given early on to the human dimensions of health care such as “how are we going to get these vaccines into people’s arms” and “how are we going to deal with the inevitable hesitancy around a rapidly developed treatment”.
Primary health care, that is GPs and nurses on the ground working with rural and remote communities, were not consulted and there was little to no coordination until the system realised that our ability to flatten the curve relied on engaging with people, and that GPs were the only ones that had the relationships in communities to address this critical aspect of the response.
Our ‘disease-focussed’ response resulted in numerous gaps:
the failure to positively engage with people around the new vaccines, and the sometimes contradictory statements by governments, created a void which was readily filled by individuals with conspiritorial ideation. The damage to public health of the emergence of a renewed ‘anti-vax’ movement will be felt for decades, leave aside the damage to the mental health of individuals for whom our approach to COVID validated misconceptions about the world in which they live.
we closed our borders but did not reflect on the impact this would have in a national health workforce market, or on the recruitment of overseas doctors on which rural and remote communities rely. Following the opening of borders to doctors, we have continued our failure by refusing to give priority to those doctors that have applied to work in rural and remote communities where they are needed.
rather than engaging with primary health care in rural and remote towns about how to secure reliable health services, our hospital system went to market in competition with primary health to secure the workforce. Locum costs have escalated as hospitals sought to address gaps in their workforce by offering more money, which has made practices in rural and remote towns unsustainable.
we did not consider the severity of impact on rural and remote people, and Aboriginal and/or Torre Strait Islander people, who are more likely to have pre-existing conditions that make them susceptible to poor health outcomes from COVID. This was not only in the priority given to cities in our vaccine roll-out, but the lack of priority given to supporting rural and remote general practice to ensure our patients continued to receive ongoing care for their chronic illnesses.
RARMS worked with the local community in Goodooga on a local pandemic plan to address local concerns about the risks to Elders and the unwell if COVID entered this small Aboriginal community. We had worked with Khan’s IGA and the Lightning Ridge Bowling Club to organise online food ordering and deliveries to isolated communities to reduce the need for sick people to come into town. We prepared a Guide for Local Government on COVID to provide advice on what local government could do with their community to make sure people who are isolating were being checked and had adequate supplies. We talked to Manildra who supplied 2000 litres of hand sanitiser for distribution to GPs, schools, community groups and others who had run out.
We must learn the lessons of COVID and recognise that a functioning health system requires all elements of government to work together including hospitals, primary health care and human/community services. We must return to a system that is focussed on the ‘health, people and patients’, rather than an focus on ‘institutions, diseases and cures’.