Small hospitals in the health district are under the spotlight  in a staffing review as part of a rationalisation to rein in costs in the region.

NSW Nurses and Midwives Association regional representative Darius Altman said one of the union’s greatest concerns was the amount of care that would be able to be delivered in smaller hospitals and multipurpose facilities with existing staffing levels or any planned staff cuts.

“What we have to remember is that it is the most vulnerable people who will suffer,” he said.

“These places are home to many of the elderly people in small communities who need to be cared for and have nowhere else to go.”

Mr Altman said nurses had been told they would be allocated three hours in every 24 for the care of each patient, and the statistics don’t stack up to ensure adequate patient care.

“Take the example of an elderly person who has to be fed, then showered and toileted - very often using two people, that is counted as double time so there will be many hours patients are left alone - it is a major concern for us,” he said.

“We don’t want the WLHD to be relying on the goodwill of nurses because that happens already - they work through their breaks and work unpaid overtime.”

 WLHD chief executive officer Scott McLachlan said the new model being devised would allow greater flexibility for the WLHD to increase or decrease staffing levels depending on patient numbers in smaller hospitals, while maintaining an appropriate level of care.

He said after a review of Molong hospital up to four extra  nurses would be appointed to match the additional workload of sending sub-acute and palliative care patients from Orange to the smaller hospital - a model introduced several months ago.

However, Mr Altman said the Molong positions were not new.

“They are simply unfilled positions,” he said.

Mr McLachlan said no decisions on staffing at any of the 33 smaller hospitals or multipurpose facilities would be made by management until each site had been carefully assessed.

“What we do have now is the recognition that these staff numbers at various facilities fluctuate wildly,” he said.

“We are still in the process of talking to staff and unions and so no positions have been locked down yet.”

Mr McLachlan said each site had its own set of challenges, with Molong well placed for doctors who work in the hospital, while Blayney still struggles to attract doctors.

“We are still trying to find solutions,” he said.