Local services and families say children are being left in limbo waiting to be assessed, diagnosed and treated for certain types of problems as access to paediatric specialists evaporates.

Children up to the age of 16 now have even fewer options with workforce shortages forcing the Paediatric Outpatient Unit at Dubbo Base Hospital to restrict their intake of “non-urgent” and “non-medical” patients.

In Coonamble, at least one child has been waiting for three years to see a paediatrician and all involved say the situation is getting worse.

A number of local services referring children have received letters from the Western NSW Local Health District’s paediatric outpatient unit stating “Unfortunately at this time we will not be accepting any non-medical referrals (eg. Behavioural concerns).”

“We suggest you redirect this referral to another service or private paediatrician.

"Please also consider what interventions you can offer in the interim. We return this patient back to your care.”

A set of ‘referral guidelines’ is also provided which includes a list of possible alternate sources of support.

However, the local service providers say that access to many of the suggested alternatives is also seriously limited and, in some cases, there is no alternative to a paediatrician.

CEO of Coonamble Aboriginal health Service Phil Naden says his organisation has received no official notice of any changes.

“This is of concern, as there is already a long waiting list for children to see a Paediatrician and this appears to be a redirection of care for clients that may need to see a paediatrician,” Mr Naden said.

“I think it’s great if there is alternate providers and if the advice clients receive is qualified it may fast track a diagnosis, but at the end of the day, if a child needs to see a paediatrician, they should be referred to a paediatrician.”

The list of ‘non-medical/behavioural’ concerns includes Autism Spectrum Disorder, ADHA, Anxiety or Depression, Anger Management/Aggression, Obsessive Compulsive Disorder/Oppositional Defiant Disorder, Speech Delay/Regression, and Self Harm/Suicidal Ideation, and more.

Responsibility for this type of care is shared among a complex network of public, private and funded non-government providers.

However local stakeholders say the increasing limits and delays mean the system is now failing many of the region’s most vulnerable children.

A spokesperson for Ochre Health Clinic in Coonamble said their GPs have confirmed that they were advised of restrictions to paediatric services six to eight months ago. 

“We received a letter giving some options but they’re not great options,” the spokesperson said. “Critically, the major concern is for the children.

“Our doctors are trying to connect with as many paediatricians as possible but have found it very difficult to refer outside the local health district because those specialists have a full load from their own areas.

“Doctors have tried different avenues, even referring to Sydney if they have to. They have to fossick around to see if they can find someone but there is a terrible shortage of practitioners, even in Sydney.”

“This area is chronically under-serviced.

“It’s a pretty dire situation and there is no miracle silver bullet.”

Private clinical psychologist Stephanie Ryan says the system is in crisis.

“Anywhere like Orange have closed their books. I was trying to find something, anything, for a child in Gular, and everywhere is closing their books to ‘non-medical’ cases,” she said.

“Clinical psychologists do a lot of assessments and get children ready to see a paediatrician, especially if they need medication for physical symptoms - all these are part of each disorder, they don’t just have a mental disorder or a physical disorder.”

She says separating children on the basis of brain-related (non-medical) issues as opposed to body-related (medical) issues is not a model that works.

“I know the driving reason is resources but it’s not the answer to ignore that fact that it’s all connected.

“It’s like stepping back a hundred years. What has happened to holistic health care?”

A spokesperson says that the Western NSW LHD’s Paediatric Outpatients Unit remains open to children with all types of problems but that “new referrals are triaged and prioritised based on urgency and acute clinical need.”

Letters sent to local doctors, therapists and families would indicate that ‘acute clinical’ need trumps other conditions that can also have devastating and far-reaching effects on children’s overall health and wellbeing.

Gilgandra-based occupational therapist Melinda Beveridge says it is almost impossible for children with emerging problems to access a paediatrician, unless there is an urgent medical aspect.

She says nothing can replace a specialist paediatrician.

“You access a paediatrician for diagnostic purposes and ongoing co-ordination of care when a child is using multiple allied health or medical services,” she said.

“Paediatricians are a really integral part of the care of children in the western area.

“It’s really devastating for families wanting to explore issues with a paediatrician, which is the right pathway - and the only pathway in a lot of cases.”

Children with a wide range of problems - from anger and anxiety to autism and ADHD - are being left on hold across the west.

The LHD currently has three permanent vacancies for specialist paediatricians.

“All vacant roles are identified as hard-to-fill, critical positions and advertised with incentives applied under the NSW Government’s Rural Workforce Incentive Scheme,” the spokesperson said.

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

Despite using locum clinicians wherever possible and running an ongoing recruitment campaign around Australia and internationally, those long-running vacancies mean that their service is under immense pressure.

Some primary-aged children have already been waiting years to see a paediatrician.

Local families, school staff and health workers say the situation is unacceptable and getting worse.

“A paediatrician is the gateway to other support services,” Mrs Beveridge said. “It’s an absolute crisis for families out here.

“It can have such significant impacts on learning, relationships, and disrupt classrooms and families.

“Often there is no alternative.

“There needs to be more paediatricians available.”