Report snapshot: Planned surgery access

Objective

This audit assessed whether NSW Health efficiently and effectively provides access to planned surgery (also known as elective surgery) to public patients.

Key findings

NSW Health has mostly cleared the backlog of patients caused by pauses to planned surgery during COVID-19

Non-urgent planned surgery was paused several times during the COVID-19 pandemic between March 2020 and January 2022. This resulted in a backlog of overdue planned surgery patients, reaching a peak of almost 19,000 patients overdue for planned surgery in April 2022. At the end of the audit period in December 2025, this has dropped to approximately 3,900 overdue patients.

NSW Health is not completing planned surgery for all patients within clinically recommended timeframes

In 2024–25, only 4 of the 17 local health districts and specialty health networks met the goal of zero patients waiting longer than clinically recommended for surgery. There are also considerable variations in performance across districts.

NSW Health has not fully rolled out more efficient models for planned surgery

NSW Health has successfully trialled initiatives like surgery hubs and pooled waitlists to boost planned surgery efficiency but these are yet to be implemented across the state. NSW Health is focused on eliminating low-value surgical procedures that are not supported by strong clinical and patient outcome evidence.

NSW Health’s planned surgery access policy supports effective waitlist management

The planned surgery access policy provides clear directives on waitlist management and scheduling surgery in line with the ‘treat in turn’ principle and clinical urgency categories. Recent updates to the policy strengthen clinical governance review requirements and provide guidance that aligns with NSW Health’s efforts to increase planned surgery efficiency.

Despite local control weaknesses, NSW Health waitlist data can be relied upon

The administration of local planned surgery waitlists is reliant on manual data entry without automatic system checks. However, a system of structured clerical reviews mostly compensates for the control weaknesses. Waitlist data collected by NSW Health is suitable as a record of planned surgery access performance to inform decision-making.

Recommendations

The audit makes 3 recommendations to NSW Health.

• Define additional efficiency performance targets for inclusion in service agreements with local health districts.
• Identify and determine the planned surgery service delivery models that achieve greater efficiencies and surgical throughput, and target policy and investment accordingly.
• Develop additional risk-based guidance for local health districts to conduct regular reviews of waitlist management and compliance.

Further information

Please contact Renee O'Kane, Chief of Staff, on 9275 7347 or by email.