Breaking up the Hunter New England Local Health District should be "on the table" rural advocate Fiona Simson said, speaking after the National Farmers' Federation President diagnosed the state's health system as "sick".
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Hers was one of 149 submissions by health professionals and residents released by an upper house parliamentary inquiry this week.
Most were anonymous.
But the rural advocate and Liverpool Plains farmer made her own on-the-record submission to the inquiry, telling the committee there was a need for urgent change to what she said is a "broken system".
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"If it was just a one-off situation then it wouldn't be such a concern," she said.
"This is a problem that is being repeated in local health service, after local health service, after local health service. It's widespread and it's chronic. The NSW rural and regional health system is sick. And it needs some urgent attention. And then it needs some preventative maintenance and ongoing treatment."
But the issue is particularly intense in the Hunter New England (HNE) region, Mrs Simson said.
Outside Newcastle the region "doesn't seem to have access to the number of specialists that a town like Orange does," she said.
"I don't think we should beat each other up about it. I think we should look to Orange and find why they've been successful.
"Yes, it's got a great vibe, Orange, but it's bloody cold there in winter and it's a long way from the beach, and a long way from the city. The council's trying really hard in Tamworth with its new specialist centre. But why aren't we having as much luck in some of these areas?"
She said "everything needs to be on the table" - including adopting Queensland's model of directly hiring doctors in the public system or fundamental reform of the local health district system by breaking up the districts.
"HNE for example is enormous. It runs from Newcastle to the border. If you break a bone in Armidale, you're just as likely to be sent to Maitland and then have to make your own way home. That is just not acceptable," she said.
"We really almost need to go back to the drawing board. Are the local health districts as they're set up at the moment, are they appropriate going forward? They're trialing a cluster model out west. Are we better looking at a cluster model where like-minded, closely-related hospitals could work together for staff?"
Mrs Simson spoke as an advocate for the bush and Liverpool Plains farmer, not in her role as head of the NFF.
But her high-profile advocacy should speak louder than most.
The health outcomes and access to health and hospital services in rural, regional and remote New South Wales inquiry was told a nurse went two years without a formal meal break, in a system dangerously over-reliant on overworked local nursing staff.
Locals told it the Manilla hospital lacked security despite the threat ice addict patients pose to staff, that Tamworth hospital has not had an ear nose and throat surgeon in seven years,
"One of the things they have been told is that we have coped with out it this long so we don't need [an ENT surgeon]," one anonymous submission said.
"This is absolute rubbish.
"There have not been any staffing increases since we moved into the new [Tamworth] hospital and already we have out grown it."