The NSW Liverpool Plains farmer lives on the border of the NSW Hunter New England and Western Local Health Districts.

In her experience, it's a hard border - and ambulances never cross.

"We've seen the problems that have resulted from the states imposing hard borders between the states. My personal experience is that that's what happens on a daily basis between the health districts," she said.

"So for people who live on a border of it like me, it's diabolically bad. I think it's resulting in sub-optimal outcomes for some of the people and some of the hospitals and some of the health services in those areas."

The rural advocate was one of 149 patients and staff who used her submission to an upper house parliamentary inquiry into rural health to condemn NSW's rural health system as understaffed, underfunded and getting worse.

Mrs Simson has a recurring problem with a dislocated hip that leaves her in excruciating pain and prevents her from walking.

Clinical best practice suggests her hip needs to be x-rayed then repositioned under general anaesthetic and within six hours.

Instead, she's been taken to Coolah, which has no doctor on-call, and wouldn't have the services to be able to re-set her hip if there was one.

The rural advocate lives just 130 kilometres from Tamworth Regional Referral Hospital - but no ambulance will take her across the border. Their policy is to transport patients to the nearest LHD hospital, whether or not it has proper services available.

After a three-day wait for hospital transfer in Coolah she's often sent to Dubbo Base Hospital, which is 70 kilometres further than Tamworth.

For the rural advocate, that has meant nights being driven to hospital in the back of a truck while downing painkillers.

In one case, an ambulance turned up, helped her into a family vehicle, then left.

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Today's hospitals can't and don't provide emergency care, she said. That might not be good enough - but at the moment it is true.

She said government needs to urgently invest in additional rural ambulance services in order to allow drivers to take patients to the most clinically appropriate hospital - not necessarily the closest, and not necessarily in the same district.

"We need to deal with the fact that people are still being taken to [small regional understaffed hospitals] who need emergency care," she said.

"Ambulance services, because they need to cover their community, unless it's life and death and there are very strict conditions around that, then they're required to take the patient to their nearest local health service, irrespective of whether there's a doctor there."

Mrs Simson spoke as an advocate for the bush and Liverpool Plains farmer, not in her role as head of the NFF. But her high-profile advocacy should speak louder than most.

The upper house health outcomes and access to health and hospital services in rural, regional and remote New South Wales inquiry will hold its first hearing in March.