Despite persistent reports of medical errors and mistreatment of whistleblowers in rural hospitals, the NSW government insists there is no need for an independent health watchdog.
An inquiry into the rural health system identified a "culture of fear" and recommended a new Health Administration Ombudsman to investigate bullying, harassment and preventable deaths.
In its response to the report's findings released last week, the NSW government did not support the recommendation saying the Health Care Complaints Commission and the NSW Ombudsman already had that authority.
During a budget estimates hearing on Tuesday, several MPs raised concerns about cover-ups, fatal medical errors and the sacking of whistleblowers at rural hospitals.
Regional Health Minister Bronnie Taylor reiterated the two independent bodies had investigative powers, and that the health department would ensure health workers understood their avenues for complaint.
"I want to make sure we can work within that existing framework rather than inventing another one," Ms Taylor told the hearing on Tuesday.
The department had implemented all recommendations from an internal review at Dubbo hospital, where several cancer cases were missed and a child died after serious injuries went unchecked.
"That death was an absolute tragedy and my heart goes out to the family," Ms Taylor said, adding there had been no further incidents.
The case of Alex Braes, a Broken Hill teenager who died of sepsis after a plan to transfer him to a South Australian tertiary facility fell through, had also led to change, the hearing was told.
NSW Health secretary Susan Pearce said there were now 300 emergency transfers from Broken Hill to Adelaide a year under an agreement with SA Health.
Another senior health bureaucrat, Phil Minns, said in recent months staff shortages had been at their worst since the pandemic began in early 2020.
Some 6184 staff were furloughed due to illness in early January, followed by 4669 in April and 2906 in July.
An open letter from workers at Yass Hospital was read to the hearing, detailing shortages that left one nurse to cover the entire facility on July 6.
Ms Taylor said all health workers were doing their best and nurses were capable of operating emergency departments.
"Often in our rural and regional hospitals, we will call doctors in when that's required," she said.
"On those occasions that are mentioned, there were no adverse events and the hospital was staffed to the best ability."
The NSW Nurses and Midwives' Association said the government's response to the inquiry was "lacklustre" and ignored calls for safe staffing ratios, including a minimum of three nurses in every rural facility on every shift.
"If the NSW government ignores this and the evidence that safe staffing ratios save lives and money, many health services will remain at risk," assistant general secretary Michael Whaites said.