Dr Peter Hughes is the president of the Regional Medical Specialists Association (RMSA), a group of non-metropolitan medical specialists who are concerned about the 'deteriorating standard of hospital facilities in rural areas'.

The group meets regularly to discuss problems with non-metropolitan medical services.

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"NSW Health is running them down, and Armidale Hospital is an example of this," Dr Hughes said.

"I've been hearing about this example for years and how it is getting worse.

"One of the problems is that as you reduce the service, this also restricts what a hospital is allowed to do, so some surgery that in other base hospitals would be done routinely is not allowed at Armidale. So there is a lot of dissatisfaction in the area."

Dr Hughes claims the predominant culture in medical administration means that 'anyone who opens his mouth is liable to get severely damaged'.

"But since I have come out publicly with my opinion on Armidale Hospital, I have had a few people from the town's medical profession contact me to say I was spot on," Dr Hughes said.

"The standard of service at other base hospital type towns around the country is very variable - it is high in some and disappointing in others."

Armidale deputy mayor Debra O'Brien said she had also been told by those working in the Armidale health industry that Armidale Hospital does not have an effective Intensive Care Unit.

"I've had local medical people say to me that we do not have intensive care capacity at all," Cr O'Brien said.

"And we are not the only ones. If we have any kind of outbreak of COVID-19 a huge number of rural towns will not have the capacity to deal with serious cases."

Dr Peter Hughes agreed that parts of rural NSW are ill-equipped to deal with any severe cases of COVID disease - including Armidale.

"Most Base Hospitals, such as Tamworth, Dubbo, and Wagga Wagga have well equipped and staffed Intensive Care Units, but Armidale does not," he said.

"The NSW Health Department has allowed the so-called Intensive Care Unit in Armidale to deteriorate to the extent that it would now barely qualify as a Close Observation Unit, with resultant significant restriction of the range of surgery that may be performed in the hospital."

Dr Hughes went on to say that it is fortunate that Armidale has not so far had any severe cases of COVID-19 requiring long-term ventilation, as this requires the supervision of intensive care specialists.

"They have gradually reduced the staffing and equipment, and there are now only one or two specialist anesthetists in the town, so it means that if someone requires ventilation while a transfer is arranged, an anesthetist would have to babysit that case and do nothing else," Dr Hughes said.

"A well-staffed ICU can keep a patient on ventilation for a few days if they have to, whereas it would cause a crisis in Armidale Hospital. A ventilator is just a machine but what matters is having someone competent to run it."

In April 2020 Susan Heyman, Hunter New England health (HNEH) executive director of rural and regional health services, told The Armidale Express that Armidale Public Hospital, like other HNEH facilities, had done pandemic planning and this week she confirmed those plans still stood.

"If a patient, including a COVID-19 positive patient, requires a higher level of care they can be transferred to a larger, more specialised hospital that provides more comprehensive ICU services," Ms Heyman said.

"Hunter New England staff are trained in the management of COVID-19 and I am very proud of the way our staff have handled this evolving situation."

Responding to Dr Hughes allegations re the capability of Armidale's intensive care facility and its ability to cope with COVID patients, Ms Heyman said Armidale Hospital has an ICU which provides 'a range of critical care services applicable for a rural referral hospital'.

"Hunter New England Local Health District has a pandemic plan in place for all our hospitals to respond to COVID-19, including workforce surge and demand management plans," Ms Heyman said.

"We are also supported by our networked hospital system which ensures patients can be transferred or redirected to other hospitals where necessary.

"During 2020, HNEH sourced additional equipment , including ventilators to address the surge in intensive care patients, should the pandemic spread across the region.

"We also have plans in place to surge staffing and intensive care capacity if and when it is required."

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Each hospital has a plan to provide ongoing care to a patient with COVID-19 or transfer that patient to a suitable hospital within the district, Ms Heyman said.

"Our facilities also have suitable clinical spaces to appropriately care for patients with COVID-19, and our larger hospitals have identified surge capacity to accommodate larger patient numbers in wards, ICU, the emergency department and those being cared for at home," she said.

"Our ICUs are networked with others across the state and are available to provide care as required."

But Dr Hughes said beyond the COVID response, a standard level of staffing is required to maintain an intensive care unit continuously.

"Armidale should have an ICU, and the health department should agree to set up and staff the department so there is one, just as there is in Tamworth," he said.

"The ICU sign on the door at Armidale Hospital is currently misleading, and I wouldn't be surprised if that sign disappears very quickly."

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