Doctors blame $70m shortfall for hospital woes
He nominated the funding shortfall this week as an inquiry into the delivery of acute care services in NSW public hospitals heads to Lismore.
"It's a significant amount of money; it's the difference between having a well-resourced service and a poorly-run service," he said.
Dr Ingall will be one of many people making submissions to the head of the inquiry, Peter Garland at the Lismore Workers Club on Monday.
"I'll be asking him to look at the structure of the area health advisory council and the occupancy rate of Lismore Base Hospital, and how that impacts on the delivery of acute care services," Dr Ingall said.
"They're the two areas I'll be focusing on."
Dr Sue Page is a former national and state president of the Rural Doctors Association and is the current director of education at the Northern Rivers University Department of Rural Health.
She believes the whole system of health care funding for hospitals needs to be overhauled.
"For too long health funding has been for buildings rather than people," she said.
"It's easy to focus on what happens in a building rather than on where services can be delivered. We need to find new models that look at how services can be delivered."
Dr Page said a lot of health funding is tied to hospital buildings or the number of doctors working in an area, whereas she believes it should be allocated according to population.
This approach would allow more community-based nurses and other out-of-hospital services to be provided in regional areas, which would be a much more efficient use of the money.
The Northern Star spoke to several doctors who have left the public system because of frustration at the way financial cutbacks affected the way they could work.
One of them was Dr Ray Randle, an orthopaedic surgeon who worked at the Lismore Base Hospital (LBH) from 1985 to 2000.
Dr Randle is recognised as a leader in the field of joint replacements and has been developing new tools and implants for orthopaedic surgery most of his working life.
The reason he left LBH was the quota that was placed on the amount of elective surgery he could do.
"Joint replacements were cut down to nine for the year. Before that I was doing up to 15 a week - that's a big reduction. It was purely financial and I found I couldn't practice."
Dr Randle now works exclusively in the private system at the Gold Coast, saying the public sector in Queensland was no better.
"In early the 1990s, if a patient was in severe pain and I wanted to get them in for a joint replacement, there was always a way of finding the extra surgery time somewhere," Dr Randle said.
"But after the mid 1990s it tightened up, bureaucratic barriers went up and I couldn't get patients in anymore. It became a faceless bureaucracy. There was no-one to talk to anymore, which just increased the frustration.
Dr Martin Hartman has been working in casualty at LBH for 17 years. What is delivered in a rural setting is 'outstanding' and 'staff commitment is equal to none', he said.
What was inefficient was the way resources are allocated, particularly to psychiatric services.
Fifteen years ago if someone came in and they were 95 with a broken hip they just died, Dr Hartman said.
These days each patient is much more complex and costs so much more money. There is a much higher expectation in the community of what we treat and what we don't.