If anyone knows how NSW's rural, regional and remote health system ticks it's former paramedic turned Health Services Union State Secretary Gerard Hayes.
Mr Hayes holds grave concerns for the well-being of hospitals, allied health services, general practice and health workers post lockdown and believes the pressure that will be placed on an already embattled health system is yet to be fully realised.
He said this, coupled with unprecedented growth in regional centres, does not augur well.
"I'm not saying this to be obtuse, but what we have seen over the past decade has been a system tightening its belt constantly and working to be as lean as possible.
"Now, as many can work from home, city people are moving to rural locations compounding the pressure already lumped on the health system in these areas as it struggles to cope with a growing population," Mr Hayes said.
"Are we prepared for what's to come? No, I don't think so.
"I've seen over the past decade health has been tightening it's belt consistently and working towards being lean as possible," Mr Hayes said.
"Health has a lot of competing interests it tries to address and we've seen, in relation to cleaning services etc, a position where some have been contracted out. It's been all about how we can we save a buck.
"Look at paramedics, they're understaffed by about 1500 across the state. Then look at centres like Newcastle which is an expanding region. Look at the fight we had to save the new Maitland Hospital from privatisation.
"Governments of any persuasion are looking at efficiencies and productivity but health is where the investment needs to be made," Mr Hayes said.
And the pain doesn't stop there.
"There are a lot of GPs closing their books or not bulk billing and that's placing more pressure on the hospitals and that goes right up and down the coast and inland.
"It's such a challenge for regional NSW."
In terms of COVID? Mr Hayes said health services do not know what sort of spike there will be.
"There will be a percentage of people who will not get vaccinated and that percentage is playing out in aged care. Last Thursday there were between 5000 and 8000 people across Australia who no longer work in aged care because they are not vaccinated.
"This is in an area where there are not enough workers at the best of times let alone losing another two per cent of the work force," Mr Hayes said.
"By the end of September there may be a percentage of the health workforce who can't go to work because they are not vaccinated.
"Staffing is consistently under invested and the investment has not been there for a long time and this involves government of all persuasions."
If there is a spike of COVID in regional centres Mr Hayes said there are no teaching hospitals like there are in Sydney to pick up the slack.
"Rural and regional centres don't have the range of teaching hospitals like they do in the city with ICU and specialist care beds they can fall back on. So the real factor is that we need to make sure people avoid going into the health system - it will become even more overwhelmed."
And he said there is no short term fix.
"Last year we had to bring manufacturing back to Australia as we struggled to find PPE. Now we should be looking at the reality of staffing and the potential of people moving out of the city and into regional areas. We must have plans in place to start investing in health.
"We have to make sure if someone needs an ICU bed or more intense therapy beds that they are available. We have to make sure that people who have had a stroke, been injured in a car accident or have suffered a heart attack for example have beds available.
"And as a community we have to take responsibility for ourselves and take the pressure off the system by preventing presentations at hospitals.
"We must get vaccinated," Mr Hayes said.
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