The key themes of the hearing, held in Taree on Wednesday, included "chronic, inadequate underfunding", downgrading of facilities and services, and challenges attracting and retaining suitable qualified staff to the region.

Manning Great Lakes Community Health Action Group president Eddie Wood told the NSW inquiry into regional hospital and health services that prior to Manning Hospital becoming part of the Hunter New England Health network about 15 years ago, it was a "leader" in education and initiatives.

Read more: Call for "total rethink" on health system as inquiry heads to Taree

"Other hospitals used our systems," he said.

"Once we joined Hunter New England, we started losing our services... and it was done suddenly.

"When you see your hospital and your staff demoralised, and leaving, it is atrocious."

He added that the emergency department was "short staffed" by 7.1 full time positions, saying staffing levels were in "dire straits".

"We have a situation where we have cleaners in the emergency department ... they have also been asked on the wards to actually sit and monitor the dementia patients because we no longer have a 16-bed dementia ward," he said.

Hunter New England Health chief Michael DiRienzo appeared at the hearing later in the evening.

When questioned, he said he did not believe cleaners at Manning Base Hospital were looking after dementia patients.

The inquiry heard children could wait as long as three-to-five years for public ear, nose and throat (ENT) services in the Manning area, and that there was a lack of appropriate palliative care.

It heard that an imbalance and over-reliance on visiting medical officers in the region contributed to a "lack of governance" and oversight to ensure the correct and necessary procedures were performed on patients in the area.

Witness Dr Nigel Roberts said this had led to at least one case where a visiting medical officer, since de-registered, had operated "unfettered" in the hospital system for about 16 years, despite multiple "horrific" complications. More than 200 women had come forward to express concerns about their care under this one particular doctor, he said.

"Because regional hospitals are largely staffed by VMOs... regional residents in NSW are forced to pay for the same care that their city cousins enjoy for free.. or worst of all, they go without the care altogether," he said.

Acute care physician Seshasayee Naramsimhan explained to the upper house committee his "extraordinarily large workload" as the only cardiologist living and working in the region, despite the area's poor cardiovascular health.

"I constantly work 80 works a week at the bare minimum," Dr Naramsimhan said. "I'm lucky that I only sleep four hours a day ... it doesn't affect my ability to give care but it incredibly frustrates me that I can't provide the contemporary, current and expected care.

"I have been asking for five years for an additional cardiologist."

Dr Naramsimhan said he believed the key problems stemmed from a disconnect from decision-makers and local stakeholders providing services.

"Nobody wants to come here. It's not an appealing hospital for new recruits," he said. "We are haemorrhaging qualified and experienced allied health professionals."

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