Nurses are working overtime, expectant mothers are travelling long distances to have their babies and local councils are being forced to lure doctors to their towns - that's the health diagnosis for the bush.
As political parties promise thousands of additional health jobs in the lead up to the election, there are already hundreds sitting vacant across the state - some unfilled for 14 months.
An audit of health jobs on the website iworkfor.nsw.gov.au, show there are 404 unfilled health jobs outside of Sydney, Newcastle and Illawarra.
Labor want to introduce nurse-to-patient ratios to bring regional hospital staffing levels to the level of city hospitals, in a policy which will add 5,500 more nurses.
The Coalition Government has promised, in what they describe as 'the largest workforce boost in the history of Australian healthcare', that patients will gain an extra 5000 nurses and midwives under its government over four years.
Of the jobs available in the audit, more than half are for nurses and midwifery positions. There are 50 allied health jobs, 29 medical doctor/specialist positions and 31 patient support. The most heath vacancies are in the Murrumbidgee Local Health District with 115, followed by western NSW with 72.
The job board shows there are two nursing and midwifery positions in the Orange (Central West Local Health District), which have been left unfilled for 14 months - longer than any health jobs in Sydney.
Leeton needs doctors
At Leeton, the Shire Council is working with Murrumbidgee Local Health District to lure doctors to work as Visiting Medical Officers (VMO) in the hospital. The hospital currently has four VMOs, which are rotating general practice doctors. But the community say it is not adequate to service the town
Nurses are using the remote medical consultation process, Critical Operations Standard Operating Procedures (COSOP), as a stop-gap to assess patients.
"The council has stepped in as we are the voice of the people and there is a community concern that there are a lack of VMOs at the hospital," Leeton mayor Paul Maytom said.
In addition, he said there was no GP obstetrician in town and the operating theatre, opened a few years ago, had not been used for well over 12 months.
Danielle McMullen, vice president of the Australian Medical Association NSW (AMA), said there was not one quick solution to solve the issues faced in the bush. But she said workforce one of the biggest challenges.
"Rural health, where do you start? It's very complex," Dr McMullen said.
"There are horror stories where people are being sent miles away because the nearest hospital says no."
The AMA has released an election document, Our Vision for a Healthier NSW, which recommends a number of ways to improve the health system.
Dr McMullen said there were programs in place with student and junior doctors working in rural and regional areas, which was an effective mechanism. But she said health care professionals also needed services to support them and their families moving to the bush.
NSW Nurses and Midwives' Association general secretary Brett Holmes said nurses and midwives had been pushed to the brink with rural and regional public hospitals no exception.
Mr Holmes said due to increased overtime, working short-staffed or with skill-mix difficulties, many nurses were opting to work part-time or casual because they hold their professional obligations in high regard and feared they were being put in high-risk situations too often.
He said having mandated minimum nurse-to-patient ratios would make a huge difference in the state's hospitals. "Nurses and midwives would feel more supported, confident and be happy to stay in nursing," he said.
What Labor says
Shadow Minister for Health Walt Secord has slammed the Coalition Government’s failure to fill vacancies in rural and regional health positions saying the vacancies affected patient care and put an extra burden on existing hard working staff.
“This is unfair on so many levels – it is unfair to patients and it is unfair to hardworking hospital staff, who have to carry the extra patient workload," Mr Secord said.
“This has created a two-tiered health system where patients in the regions miss out on quality treatment and patient care.”
He said "sadly, and once again", the Murrumbidgee Local Health District had the largest number of unfilled health jobs.
“These vacancies aren’t just numbers, they impact local hospitals and can affect patient care," he said.
“Leaving nursing and midwifery jobs vacant for 14 months in regional NSW is unacceptable and it wouldn’t be tolerated in Sydney.”
A spokeswoman for NSW Health Minister Brad Hazzard said NSW had one of the biggest workforces in the country, with 117000 employees and a relatively low vacancy rate.
"Like other states, it can at times be challenging to quickly fill positions in rural and regional areas," the spokeswoman said.
"However, the NSW Liberals and Nationals has found when you invest in hospitals - we have completed upgrades at Dubbo, Bega, Orange, Tamworth, Port Macquarie, Kempsey, Bryon, Bathurst, to name a few - it boosts local communities and makes it easier to attract trained staff."
The spokeswoman said the State Government was committing $2.8 billion to recruit an extra 8,300 frontline staff in the next term, with 45 per cent for the regions.
AMA president, Dr Kean-Seng Lim, said, building hospitals alone would not be effective in safeguarding the health system.
“Candidates of all stripes like announcing infrastructure, pilot programs, and funding for projects – but not always in the most helpful of ways," Dr Lim said. “This can sometimes be ad hoc or done without a great deal of thought on how it may benefit the health system as a whole."