Dr Arnold was giving evidence at the NSW parliamentary inquiry into Health Outcomes and Access to Health and Hospital Services in Rural, Regional and Remote New South Wales.

In her opening submission, Dr Arnold was critical of the Local Health District (LHD) board system, calling for the reinstatement of state-wide services planning.

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This was the first of 10 recommendations by the NSW Medical Staff Executive Council, which Dr Arnold summarised in her submission. Another recommendation was establishing avenues for early conflict resolution between clinicians and administrators which were independent of LHDs.

Responding to a question from inquiry panel member Walt Secord, Dr Arnold said she did hear reports of clinicians wanting to make recommendations or highlight problems but who were fearful of retribution.

"Absolutely the current system does not make this easy when people need to raise concerns," she responded.

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"The problems are that there is a tendency for staff to raise concerns, administrators to defend their position because they do not want to admit that they are wrong or that there is blame.

"That situation needs to be diffused so that the focus can be on patient care and on quality and on sifting through what are genuine concerns about how the systems are running, and getting away from the self-defending stance of some administrators."

Dr Arnold said NSW Health did not always have the jurisdiction or resources to fully investigate issues the way it should and relied on input from the LHD to explain a matter.

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"The LHD can tell NSW Health ... that everything is ok which is not always the case.

"The resources to independently step in and arbitrate are deficient and lacking."

Mr Secord asked if she felt there was more of an interest in defending a situation or refuting a doctor than trying to solve a problem to which Dr Arnold replied 'Absolutely'.

"There was a defensive stance from administrators and a cover-up mentality and a 'keep things out of the media at all costs' mindset,' she said

Also included in the NSWMSEC's 10 key areas needing an overhaul were reforming the independent oversight and governance structures, reviewing the role and performance of LHDs, fixing the poor engagement of LHD's with clinicians and the low level of inclusion of clinicians in decision-making, and stop the over-spending of public money on consultant reports.

Dr Arnold's appearance before the inquiry also discussed Telehealth and its implications for rural residents and the use of key performance indicators which were based on budget or time markers.

The inquiry into Health Outcomes and Access to Health and Hospital Services in Rural, Regional and Remote New South Wales Inquiry was established on September 16, 2020 to inquire into and report on health outcomes and access to health and hospital services in rural, regional and remote New South Wales.

A full transcript of Dr Arnold's testimony can be viewed at www.parliament.nsw.gov.au.

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