A former chairman of the New England Health Service says he predicted the problems now facing the region, as he throws his support behind the de-amalgamation of the local health cluster.
Armidale's Dr Jim Maher earned world recognition after completing a PhD thesis through the University of Calgary in Canada entitled "Regional Health Authorities and Federalism: Australia and Canada".
He spoke against the merger of the Hunter and New England health service areas two decades ago at a rally in Tamworth.
"Interestingly, the three speakers including myself, member for New England Tony Windsor and the National Party's Jenny Gardner all spoke against it," Dr Maher said.
"The rally was well attended but the merger went ahead anyway and we predicted a lot of the things that you're currently experiencing," he said.
Years of health work
Dr Maher was chair of the former Armidale and New England Hospital Board from 1985 until 1990.
With a change of government in 1995, Dr Maher was called-up to chair the newly created New England Area Health Service alongside CEO David Briggs who had been in the same position at Tamworth Base Hospital.
"When the NEHS was established, the government of the day dismissed all the hospital boards, about 23 across this region," Dr Maher said.
"They were all gone overnight," he said.
"The three districts (New England, Tamworth/North West and Barwon), they all went as well and were replaced by the NEHS.
"There was a lot of angst in the community. They'd lost their boards, and they felt like they'd lost their input."
But Dr Maher said a lot was acheived when the three districts combined.
"We could provide services for a population," he said.
"We did a study that found Bingara had the oldest population in the area, but when matched-up with what services were there, it wasn't good, so we set about improving care for their aged.
"When we looked at the population for Moree and Armidale we found they were the two youngest in the area, yet the services being provided weren't suited to the population's needs - so we addressed those things. Maternity was one at Moree and mental health services as well.
"So I'm in favour of that ... if you ask which I prefer, it's the old New England health service border.
It had 23 hospitals, 28 community health centres, and serviced 20 local government areas. There was about 3400 full-time employees across an area of about 98,000 square-kilometres - which is about 1.5 times the state of Tasmania.
"That was a big enough challenge," he said. "Having chaired both, I felt we achieved more for our region by having the area health concept."
Dr Maher said they used to rotate board meetings every month at a different centre and held public meeting where they would listen tor questions and comments from the community.
He said this link with the community needed to be re-implemented.
"I believe that way you can keep your ear to the ground, and keep in touch with your community," he said.
"There is no opportunity for locals - the people actually living and working in this region - to have real, genuine input."
Not a new problem
Dr Maher said he was shocked to hear Inverell hospital was without a doctor, especially with new facilities, and saddened by the stories he had heard across the district.
However, he said this wasn't a new issue.
"We were talking about these things when I was there back in the 90s. I can remember the federal minister for health coming to the region and this was on the agenda.
"It's always been a struggle trying to populate doctors across regional areas; it's not like this is coming left field. We should've been doing something this whole time.
"That's why they built the medical facility at UNE with Newcastle, to train people from the regions in the regions, so they stay and work in the region.
"Maybe those who do come are being worked too hard and are getting burnt out?
"But I've also had doctors tell me in the past that they have appreciated coming to a regional area because they've been thrown in the deep end, and dealt with a lot of issues they may not have dealt with at a teaching hospital.
"They gain far wider experience, so there are a lot of positives but it is certainly something that needs a thorough investigation."
Bureaucracy and sheer size the problem
Dr Maher said Hunter New England Health now has more than 11,000 staff and he said the big decision makers in Newcastle did not have the same appreciation of what the needs and limitations are in the New England region.
"I've met a lot of good people in health," Dr Maher said.
"I'm not bagging the people who work in the system," he said.
"There are a lot of good people and they are not all confined to patient care areas. There are good administrators with caring hearts as well.
"But we have a very bureaucratic system... a hospital manager has to report to Newcastle. Your first priority is to your superiors within the system."
With that in mind, he said a smaller health service, based in New England would benefit the local area.
"Look at the map of the old New England area. There's cultural connections between the communities: sporting, government, education, agriculture... we have similar interests but Newcastle is different and then you've got the coast as well which has a different culture again," Dr Maher said.
"We can cooperate, liaise and build relationships but I think the problem with the health service area is that the Hunter is just too big. There's one million people in the catchment and these are huge distances of 134,000 square-kilometres.
"How can you expect someone from John Hunter Hospital to understand the needs of someone in Toomelah or Tenterfield?
"A lot wouldn't even know where it is," he said.
Make sure you are signed up for our breaking news and regular newsletters