'Dire need': kids waiting years for paediatric appointments

Dr Niro Wickramasinghe says she has run out of options when referring children for specialist paediatric appointments.

The GP at Narromine Shire Family Health Centre near Dubbo in NSW said the situation had become serious 18 months ago when paediatricians left Dubbo Hospital and weren't replaced.

Now, there just aren't enough specialists to see the children who need help.

This means some children aren't being diagnosed with behavioural issues and developmental delays until they are adults.

Dr Wickramasinghe told ACM the remaining behavioural paediatritians' books are closed at the hospital because they are full.

"Other clinicians like psychologists, there's long waiting times like six to 12 months for a proper assessment," she said.

"Some of the private clinicians are able to help us, but the cost becomes a huge factor there, if the [families] have to travel to Sydney or somewhere to see them."

The issue is part of a significant gap in paediatrics services across regional NSW.

Children with significant developmental challenges cannot access a public paediatric clinic in any rural area in the state under 18 months with most wait times between two and six years.

Private paediatric assessments cost a minimum $3000.

Allied health services, including speech, occupational therapy and clinical psychology also have long wait times and specialists are long distances away or cannot see clients regularly enough to have an impact.

This is according to Jacqueline Emery, the CEO of Manly-based children's health charity Royal Far West, who said the lack of services could lead to serious issues for children who are left undiagnosed.

But with up to 60 per cent of patients being referred to Royal Far West from regional NSW, the Sydney clinic is overloaded as well and has closed some of its books.

Twelve months ago, Ms Emery told ACM the increased complexities faced by families had led to a surge in the demand for paediatric services, which had put additional strain on an already "dire" situation.

The issue is still relevant today.

"We are hearing of and witnessing in our own services huge increases in complexity in children - ballooning behavioural concerns, violence, mental health concerns, child protection concerns, disengagement from learning in the last three to four years," Ms Emery told ACM.

There are also rising reports of youth crime in Dubbo.

The existing Manly clinic has been co-funded by NSW Health for more than two decades. Now, Royal Far West is calling on the NSW government to provide $2 million per annum between 2025 and 2027 for two new rural paediatric assessment clinics, in Dubbo and Wagga Wagga.

Dr Wickramasinghe, who refers about one patient a month to Royal Far West at Manly, said she thought all rural GPs would support the two new clinics.

"It's amazing if we can have those outreach clinics ... Families would not have to travel as far as they have to do now, and [there would be] more opportunities to see the multidisciplinary team they offer," Dr Wickramasinghe said.

The Dubbo and Wagga Wagga rural assessment clinics would have on-the-ground staff and visiting clinicians, supported by telehealth services to ensure efficient and regular services for children with developmental challenges.

The new service model would allow Royal Far West to see more families where they live and grow their service capacity.

The Dubbo clinic, dubbed Royal Far West Western, would provide a paediatric developmental assessment service delivered by a full multi-disciplinary team, made up of a combination of local staff, telehealth and outreach.

The team would work with local services and clinicians throughout the assessment process, including case conferencing, and roles would include a clinical nurse coordinator or other care navigator role, as well as an Indigenous health officer.

Children would be discharged to local services for treatment where possible. Where there are gaps and no local services are available, children may be offered treatment and care from Royal Far West, including through NDIS.

Dubbo MP and leader of the NSW Nationals Dugald Saunders said people in rural and regional NSW deserved access to healthcare closer to home.

"I know from talking to people in my own electorate just how important the Royal Far West is, and I absolutely support this organisation expanding its services, particularly for our state's youngest and most vulnerable," he told ACM.

Parkes MP Mark Coulton said it was "vital" that children with developmental delay and behavioural challenges have access to paediatric services.

"I am very supportive of the proposal being put forward by Royal Far West and am hopeful that a collaboration between Western Health and Royal Far West will help fill the gap in paediatric services in our region," he told ACM.

Tanya Forster, Macquarie Health Collective CEO and psychologist, said access to psychiatry, paediatrics and psychology for kids across our region is a "big problem".

Her own books are closed and she hears there are minimum six-month wait-lists for other child psychologists, occupational therapists and speech pathologists. Psychiatrist wait-times are "considerable".

Ms Forster supported improved access to healthcare services for the region, but said workforce retention needed to be front and centre of the debate, as there was a serious lack of specialists moving to and staying in the regions.

"I would love to see an investment in local on-the-ground services," Ms Forster told ACM.

"And I think realistically, if we would like to see considerable change, then the investment needs to be focused on workforce solutions beyond any other measures because without an increased workforce for our community, very little will change."

A Western NSW Local Health District spokesperson said staff vacancies at its Paediatric Outpatient Clinic at Dubbo Health Service were "hard to fill" and were advertised with incentives.

"Attracting and retaining the required workforce in regional areas, particularly specialist clinicians, remains an ongoing challenge across Australia," the spokesperson said.

"To ensure impact to services is minimised as much as possible agency and temporary staff, including locum clinicians, are engaged where required."

The spokesperson told ACM the clinic remained open to "new and existing patients" and new referrals were "triaged and prioritised based on urgency and acute clinical need".