Unfit Health System by Nina Digiglio.

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I wouldn’t say politics opened my eyes to the problems in the health system. I knew very well they were there. Everybody knows there are problems within the health system, especially those who work there.

Politics gave me a lens to see the solutions, to see how easy our vast problems would be to fix, how best practice and best patient outcomes make the fullest sense to implement. Not to mention the cost savings, and the positive flow on effects of having a quality health system that works.

As a long-term nurse of over 30 years working in Emergency, ICU, Burns, Cardiology Theatres and Community Health, opportunity found me as I was head hunted to work at Shoalhaven Hospital over 17 years ago. I was secured to undertake project work developing “Pathways” for best practice care for stroke and heart attack patients. After this project nursing work took me on to the closing the gap program on Indigenous health and in managing Parkinson’s care in the region. Working in the area of best practice definitely made me more aware of the problems hospitals and health service providers face every day due to a lack of funding.

The Shoalhaven faces similar problems to other regional hospitals in the state. Inadequate staff numbers, low staff to patient ratios, and budgets so inadequate that fundamental resources are lacking. Our support staff are stressed, our nurses and doctors are stressed, our patients – well largely they are sympathetic, but they lose out too. So, they become stressed.

The Shoalhaven is not unique; however, it is severely disadvantaged. Nowra’s unemployment level is more than double the national average. We have a large Indigenous population who have endured historical disadvantage, an aging population and high number of people with physical and mental health issues.

Investing in multi-dimensional health care and importantly Primary Health care is crucial to building a thriving community where people can contribute to society in work, play and innovation. A multi-pronged approach would minimise ill health, reduce health care costs and provide the best outcomes to meet the diverse needs of our vulnerable community. We need to resource these health care dimensions appropriately and attract quality health professionals from all disciplines to ensure we are not always dealing with health in crises.

Avoiding a medical crisis is key in dealing with the multiple causes of illness early is more compassionate and cheaper. This requires better support services for the homeless, youth in distress, people with addictions, the aged and those with emerging mental health problems. We also need more local specialist doctors and nurses to ensure timely treatment and manage avoidable health complications so elderly patients and those with chronic disease or a disability don’t have to travel long distances to receive specialist advice.

Currently those experiencing an acute mental health event are left to wait in the emergency department for up to 15 hours, sometimes longer. This occurs because there is no best practice pathway model and structure for those presenting with mental health issues. The solution would be to fund a separate Mental Health Emergency department fully staffed to commence the pathway from Acute mental distress, Alcohol or Drug withdrawal through a system which has structures, policy and pathways to meet their needs in the first instance. This model proves to reduce multiple admissions saving tax payers thousands of precious dollars, not to mention the benefits to the patients and their families.

Regional areas like the Shoalhaven deserve state of the art hospitals with best practice pathway models of care, not the band-aid fix up that has been thus far pledged for the Shoalhaven.

We must demand a fully serviced hospital that will attract the full spectrum of specialists to our areas so we can service patients in their own communities, where they have support available to aid their recovery.

Hospitals and health services in regional services will be swamped as our aging population matures, with instances of stroke, Parkinson’s dementia, mental health and other conditions are expected to double within just 20 years.

We need to be ready. We need to look to the future; we need to prioritise public health, so quality care is there in the communities for those who need it.

The Shoalhaven is ranked in the top 5 Nationally for Stroke according to the Stroke Foundation study paper in 2017. As a community we must raise our voices and advocate for resources such as an MRI machine in the hospital, purpose fitted with a new Nuclear medicine department and a stroke unit with a minimum of 8 beds. Ideally a visiting neurologist to oversee thrombolytic therapy for acute strokes caused by clots would be best practice with best outcomes. This will reduce deficits caused by a Stroke and allow our Shoalhaven residents with a stroke to be treated and recover in the Shoalhaven locale, not in Wollongong or Sydney. Making it easier for loved ones to visit without having to travel great distances to visit their loved ones during stroke recovery.

We must reject existing plans for the Shoalhaven District Hospital upgrade and instead invest in a new Grade 5 Teaching hospital for the Shoalhaven with the essential services that will serve the growing needs of the Shoalhaven into the 21st century and beyond.

Let’s get serious and act. The opportunity and time is right now.

Nina Digiglio

Neurological Nurse Specialist & Shoalhaven City Councillor.


  1. Absolutely, well said Nina. Holistic health will place less burden on staff and will provide excellent service with sustainable and equitable balance to the system.
    You have a lot of support on this issue. Great work.

  2. I did not realise the health care system was so inadequate. Making people with mental illness wait more than 10 minutes is not acceptable. Crisis is crisis for heavens sake! Thanks for your reflections Nina, cheers John K

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