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Amanda said:

(1) That this House notes:

(a) NSW Health faces significant challenges in retaining permanent staff, exemplified by the loss of 12.6 per cent of its nursing workforce in 2021-22;

(b) consequently, a considerable amount of public funds are expended annually on overheads associated with the recruitment and allocation of temporary, locum and agency health workers through private recruitment and locum agencies;

(c) in 2008 the final report of the Special Commission of Inquiry into Acute Care Services in New South Wales Public Hospitals, prepared by the office of the Australian commissioner Peter Garling, SC, recommended that NSW Health should institute and maintain a centralised register of all doctors available and willing to fill casual shifts or act as locums for specified periods;

(d) the current Government has promoted the benefits of public ownership and management of essential assets and services, and committed to improving and optimising health spending through the special commission of inquiry; and

(e) health workers who undertake temporary or locum placement for NSW Health are required to complete repetitive and time-consuming credentialing and onboarding processes for each local health district.

(2) That this House calls on the Government to:

(a) discontinue the use of private recruitment and locum agencies for the recruitment and allocation of temporary, locum and agency health workers, with this instead to be undertaken directly by NSW Health; and

(b) harmonise credentialing and onboarding requirements for health workers between local health districts.

NSW Health faces serious challenges in retaining permanent staff and attracting them to areas of need, particularly rural and regional areas and cross-border communities. NSW Health lost 12.6 per cent of its nursing workforce in 2021-22. Doctors are catastrophically mal-distributed across the State. To fill that gap, NSW Health relies on a large number of medical locum and agency nursing staff, who are recruited through private agencies. While the broader recruitment and retention of permanent health workers requires multiple solutions, there is a simple step that the Government can immediately take to both improve continuity of care for patients and save tens to hundreds of millions of dollars that could be reinvested in our health system.

The New South Wales Government must discontinue the use of inefficient and expensive for-profit recruitment agencies, and instead bring the management of temporary contracts for health workers in-house to NSW Health. I am far from the first person to suggest this. As far back as 2008, the final report of the Special Commission of Inquiry into Acute Care Services in New South Wales Public Hospitals, prepared by the office of the Australian commissioner Peter Garling, SC, made that recommendation.

Allow me to explain how private agencies are so inefficient. I have worked as a locum doctor in communities as diverse as West Wyalong, Cowra, Leeton, Casino and Broken Hill. Different hospitals hire staff through different agencies, so no doctor can see every vacancy and no hospital can see every available doctor. That means that doctor A who lives in region A can be flown to region B, while doctor B who lives in region B is flown to region A. I have worked at hospitals where two doctors have accidentally been booked to work the same role for the same week and there is no doctor on the following week. Private recruitment agents, some of whom are paid commission, are incentivised to pricegouge our hospitals. Those agents have discouraged me from accepting placements before the hospital was offering crisis rates. That inefficient duplication impedes the mobilisation of healthcare workers in urgent situations.

Temporary health workers will always be needed, including to support and stabilise a health service following a disaster. That is why recruitment and allocation must be undertaken directly by NSW Health. Very quickly it can streamline and standardise processes as well as reduce overheads, like commission fees and travel costs. The inefficiency is not just costly; it impacts patient care. Even if a locum doctor or agency nurse fell in love with a rural community and wanted to stay longer than their placement, it goes against business sense for a private agency to allow that person to stay, let alone work with them to find them a position. Many agencies actually put in the terms of their contracts with doctors that they are not allowed to directly accept any offer to stay on or return to the same hospital without going back through the agency. That means many rural hospitals have new locum doctors starting every week with no followup of patient care and little knowledge of local referral pathways or cultural sensitivities.

Local health districts [LHDs] rarely receive the feedback that they need to improve working conditions to be able to attract and retain permanent staff. It is better for business for the private agencies for rates to be increased sky-high rather than addressing any of the reasons health workers do not want to work at a particular service. This worsens morale for remaining permanent staff, who watch locums and agency staff come and go, often earning more than double the local staff for less responsibility. I witnessed and experienced that firsthand working at Western, Far West and Murrumbidgee local health districts, and the locum problem is only getting worse. At Murrumbidgee, for example, the annual locum spend has ballooned from $30,000 to $1.8 million in the past decade. We must harmonise the onboarding and credentialing process between local health districts so that already exhausted health workers are not burdened with repetitive and unnecessary administration to work in a different region.

In my experience working between different LHDs I was asked to complete more than 15 hours of unpaid online modules for recredentialing in workplace basics such as infection control, how to document a patient's allergies, workplace privacy policies and how electronic medical records work. Regional New South Wales is absolutely beautiful in its diversity, but I can assure members that the most important differences between regions are not captured by the online handwashing module. The New South Wales Government has actively promoted the benefits of public ownership and management of essential assets and services. It has expressed its dedication to improving and optimising health spending through the special commission of inquiry. We will always need health workers for temporary placements, but ending the use of private agencies will improve continuity of care for patients and save money.


Amanda's motion received unanimous cross-party support, with the Labor Government moving amendments.


Courtney Houssos, the Minister for Finance, and Minister for Natural Resources said: 

I move: That the question be amended by omitting paragraph (2) (a) and inserting instead: "(a) examine the use of private recruitment and locum agencies for the recruitment and allocation of temporary locum and agency health workers, including considering whether NSW Health can undertake this work; (b) support the ongoing work of the National Health Workforce Taskforce of which New South Wales is a member, in considering the issue of supply and demand issues of medical locums"

I indicate that if Dr Cohn will support the amendment then the Government is happy to support the motion. We acknowledge that NSW Health faces significant challenges in recruiting health professionals and retaining permanent staff. This is being experienced not just locally but internationally. But we also acknowledge that if we immediately ceased using locums, some health facilities across New South Wales will essentially be unable to provide health care, leaving remote and rural communities in a vulnerable situation.

As someone who grew up in regional New South Wales, I understand the importance of having local health professionals who are deeply engaged in local communities. The Government will examine that. I have had several conversations with the honourable member around the growing reliance on medical locums. Whilst overseas health professionals are an important supplement to our locally trained workforce, we want to ensure that we are finding local health professionals who can live in local communities, understand those communities and service them. That is incredibly important. The New South Wales Rural Health Workforce Incentive Scheme has been established to attract and retain key health workers in rural and regional health services. The scheme has already distributed more than $40 million. This is an important issue and one we will be looking at closely. There is a great amount of work for the New South Wales Government to do going forward.


After some debate, Amanda spoke in reply. 

Amanda said:

I am buoyed to have support on the motion across party lines. I am delighted to hear that the new Government is willing to examine this issue. I am very confident that it will reach the same conclusion that I did and that the Garling report did in 2008. I reemphasise that the motion is not about ending the use of locum doctors or agency nurses; it is about ending the use of private agencies for their recruitment and management, which is much more efficient for NSW Health. I also hope for cooperation from other States. A Federal response would be wonderful. But the situation facing healthcare in New South Wales, particularly in rural and regional areas, is so dire that we cannot afford to wait for action from the Federal Government or other States before this Government takes the action that is needed now.


The amendment of the Labor Government passed, and then Amanda's motion (as amended) was passed successfully. 


Read the full transcript in Hansard here.



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