"We know that the rural area health system is stretched, we know that we have work force deficits and we know that our staff work really hard all of the time, let alone if you have a pandemic," Susan Heyman, Hunter New England Health (HNEH) executive director of rural and regional health services told Australian Community Media on Wednesday.

"So it will put the system to the test if we have large COVID case numbers - there is no question about that."

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In April 2020, Ms Heyman said that Armidale Hospital, like other HNEH facilities, had done pandemic planning, and this week she confirmed those plans had been updated as required.

"We have 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, we 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."

The increase in staffing could occur at Armidale Hospital but only if the need was localised at one point in time because, Ms Heyman said, there are not enough trained medical staff available in the Northern Tablelands.

"It's all very well to pretend there is surge staff we can just move in but it is not that simple," Ms Heyman said.

"When it's contained you can bring in staff but when it is widespread you really have to look at consolidating people into regional centres to provide the right care and ensure you have the workforce.

"If the pandemic was widespread across the Northern Tablelands then our workforce right across that region would be stretched, but if it is only in one local government area then we would be able to bring staff in from another hospital."

HNEH had done a 'detailed level of planning' in regards to cases numbers across the spectrum of clinical conditions Ms Heyman stressed. 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, such as Tamworth Base or the John Hunter Hospital in Newcastle, as is the case with non-COVID-19 patients.

"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," Ms Heyman said.

"The condition and circumstances of the patient would determine whether or not they require local hospital care, receive care in the home, or require transfer for a higher level of care. However, some may be well and may not require ongoing medical support."

Increased demand for services to transfer patients to other hospitals has also been factored into HNEH's 2020 pandemic planning.

"If the numbers escalate, the retrieval service's resources are finite as well and there are only so many transfers they can cope with," Ms Heyman said.

"So we had to look at what our hospitals and staff can deal with realistically and what is the balance between transferring out and managing locally.

"We've looked across the whole HNEH area to ensure that we have equity and that people living in our rural areas are not going to be disadvantaged by living here and being serviced by Tamworth Base Hospital - including their access to John Hunter Hospital if required."

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Ms Heyman confirmed both COVID-19 and non-COVID-19 retrievals will continue throughout the pandemic.

"We've worked with the state-based retrieval services to look at what enhanced capacity will be necessary for retrievals so that these can continue because we can't expect people in smaller sites to be able to deal with trauma that they don't have the workforce or resources to manage," she said.

The rapid transmission of the COVID-19 Delta variant has also been factored into current plans.

"And we've taken into account the higher level of vaccination rates across the district because last year we were looking at overseas data but 12 months on we've built up that knowledge base locally," Ms Heyman said.

The fatigue of frontline medical staff was also a concern and Ms Heyman said additional resources could be called upon from across the state and the Australian Defence Force.

"If we need additional resources we will certainly call on those," Ms Heyman said.

"You can only ask staff to do so much in terms of reassignment and overtime so you still need to supplement with surge staff, and that is fundamental to the plan.

"We have cases in our district and are already actually responding to COVID-19 really well.

"We don't know what the numbers will be when things open up, but our staff have done the planning and they are well positioned. HNEH staff are trained in the management of COVID-19, and I am very proud of the way our staff have handled this evolving situation."

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