Quality of financial reporting continues to improve

Unqualified audit opinions were issued on the 30 June 2017 financial statements for all entities in the health cluster.

Health cluster entities continue to improve the quality of financial reporting. The number of misstatements identified fell again in 2016–17.

Financial statements were submitted on time

In 2016–17, all cluster entities met the deadlines for completing early close procedures and submitting financial statements. Health entities controlled by the Ministry of Health continued to submit the financial statements well ahead of the statutory deadlines.

NSW Health recorded an operating surplus of $407 million in 2016-17

Overall, NSW Health recorded an operating surplus of $407 million in 2016–17. The statewide operating surplus was $84 million higher than 2015–16. Net surpluses contribute to NSW Health’s ability to invest in new facilities, upgrades and redevelopments.

More health entities reported operating deficits in 2016-17

Eleven local health districts/specialty networks recorded operating deficits in 2016–17, four more than 2015–16. The financial results were once again impacted by reduced NSW Government funding as part of the initiative to improve cash management across the sector.

NSW Health's expense growth rate decreased

In 2016–17, expenses across NSW Health increased by 4.4 per cent (6.0 per cent in 2015–16). The growth rate was 1.6 percentage points lower than the expected long term annual expense growth rate for NSW Health outlined in the 2016 NSW Intergenerational Report.

Five health entities received cash assistance

In 2016–17, the Ministry needed to provide $135.6 million in cash assistance to five health entities, nearly double the amount provided in 2015–16. The Ministry gives cash assistance to health entities when needed to pay debts as they become due.

Health entities' capital replacement ratios ranged from 0.5 to 5.7 in 2016-17

The overall capital replacement ratio for NSW Health increased from 1.7 in 2015–16 to 1.8 in 2016–17. This indicates NSW Health is investing in hospitals and other assets faster than it is depreciating its existing assets.

Managing excess annual leave is a continual challenge for health entities

Thirty-five per cent of NSW Health’s workforce have excess annual leave balances.

Recommendation (repeat issue)

Health entities should further review the approach to managing excess annual leave in 2017–18. They should:

• monitor current and projected leave balances to the end of the financial year on a monthly basis
• agree formal leave plans with employees to reduce leave balances over an acceptable timeframe.

Sick leave taken by NSW Ambulance employees is above the health sector average

NSW Ambulance continues to face significant challenges in managing sick leave. It had the highest average sick leave rate in NSW Health of 85.2 hours per FTE in 2016–17 (78.7 hours in 2015–16). This was higher than the statewide average of 62.1 hours (62.0 hours in 2015–16).

Recommendation (repeat issue)
NSW Ambulance should further implement and monitor targeted human resource strategies to address high rates of sick leave taken.

NSW Ambulance’s overtime payments remain significant

NSW Ambulance’s overtime payments in 2016–17 totalled $74.6 million; $2.8 million more than 2015–16 and significantly higher than other health entities.

Recommendation (repeat issue)
NSW Ambulance should further review the effectiveness of its rostering practices to identify strategies to reduce excessive overtime payments.

Unapproved employee timesheets continue to be a problem for health entities

Weak timesheet approval controls increase the risk of staff claiming and being paid for hours they have not worked. Stronger controls would reduce the volume of roster adjustments, manual pays, salary overpayments and leave not recorded accurately in the system.

Recommendation
Health entities should conduct a risk-based review of time and leave recording practices to ensure control weaknesses are identified and fixed.

Service agreements were signed earlier than prior years

Thirteen local health districts/specialty networks signed their service agreements with the Secretary of NSW Health by the 31 July 2017 due date. This is a significant improvement with only seven local health districts/specialty networks meeting the date in 2015–16.

Five NSW Health entities are not meeting performance expectations

The Ministry assessed five NSW Health entities as not meeting the expectations set out in service agreements with the Secretary of NSW Health at 30 June 2017. The Ministry is managing these entities in accordance with its performance review process.

NSW Health again, on average, met targets across all triage categories

Data provided by the Ministry shows NSW Health, on average, met the targets across all five triage categories for the fourth consecutive year. This indicates NSW Health, on average, continues to provide people with clinically appropriate access to services in emergency departments.

The rate of patients leaving emergency departments within four hours did not improve

One of the State priorities is to ensure 81 per cent of patients leave emergency departments within four hours. Data provided by the Ministry shows only four local health districts achieved the target in 2016–17 compared to five in 2015–16.

NSW Ambulance met the Ministry’s target response time for imminently life‑threatening incidents

Data provided by the Ministry shows the median ambulance response time for imminently life‑threatening incidents (Priority 1A) in New South Wales was 7.5 minutes in 2016–17. The data shows NSW Ambulance met the Ministry’s median response time target of 10.0 minutes.

NSW Ambulance response times for potentially life‑threatening incidents did not improve in 2016–17

Data provided by the Ministry shows the median ambulance response time for potentially life‑threatening incidents (Priority 1) in New South Wales increased slightly from 11.0 minutes in 2015–16 to 11.1 minutes in 2016–17. This is despite the number of Priority 1 responses reducing by 4.3 per cent.

Patient transfers from ambulances to emergency departments were faster in 2016–17

Data provided by the Ministry shows the percentage of patients transferred into the care of hospital emergency departments within 30 minutes increased to 91.7 per cent (87.6 per cent in 2015–16). This is exceeding the Ministry’s 90 per cent target.

NSW Health, on average, improved on-time admission of patients for elective surgery

One of the State priorities is to increase on‑time admissions for elective surgery, in accordance with medical advice. Data provided by the Ministry shows NSW Health improved on‑time admission of patients for elective surgery in 2016–17 despite a 1.8 per cent increase in admissions. While the result improved, the data shows only one of the three targets for elective surgery waiting times was met in 2016–17.

NSW Health, on average, did not reduce the rate of unplanned hospital re‑admissions in 2016–17

Data provided by the Ministry shows the rate of unplanned hospital re‑admissions increased slightly in 2016–17. The data shows eight local health districts met the target to reduce the rate of re‑admissions compared to the previous financial year. The Ministry changed the target in 2016–17. The previous target was for re‑admission rates to be less than or equal to five per cent. Based on the data, only one local health district would have achieved the previous target in 2016–17.

A snapshot of NSW Health is shown below.

The Ministry of Health (the Ministry) is the lead agency in the Health cluster. The cluster is responsible for:

• providing health care services to patients and the community

• promoting wellness and illness prevention

• developing health care policy and planning

• managing, monitoring and reporting on health system performance

• building healthy communities by working with other parts of the NSW Government.

The commentary in this report covers the following cluster entities

Unqualified audit opinions were issued for all agencies’ financial statements

Unqualified audit opinions were issued on the 30 June 2017 financial statements for all entities in the cluster.

Quality of financial reporting continues to improve

Health cluster entities continue to improve the quality of financial reporting. The number of misstatements identified in financial statements has fallen from 109 in 2013–14 to 24 in 2016–17. The table below shows the number and dollar value of misstatements in the cluster over the past four years.

Financial statements were submitted on time

In 2016–17, all cluster entities met the statutory deadlines for completing early close procedures and submitting financial statements. Health entities controlled by the Ministry of Health continued to submit the financial statements well ahead of the statutory deadlines.

Timely financial reporting is essential for sound financial management, effective decision making and improving public accountability.

Early close procedures were substantially completed, but some health entities could do more

Health cluster entities demonstrated high levels of maturity in completing early close procedures. They were substantially completed across all health cluster entities, but some could do more to enhance the procedures performed, such as:

• resolving significant accounting issues during the early close process or documenting a clear path towards timely resolution
• ensuring sufficient documentation supports management’s proposed accounting treatments, judgements and assumptions
• ensuring management sufficiently engages with its valuer and interrogates the findings
• compiling adequate working papers to support revaluations of property, plant and equipment to allow for an efficient and effective audit before year‑end
• stronger communication and collaboration between the entity and its shared service providers to close out issues.

Early close procedures bring forward the resolution of issues that can impact the quality and timeliness of financial reporting.

Appendix three of this report provides information on the timeliness of health cluster entities’ financial and audit reporting.

NSW Health recorded an overall net surplus of $407 million in 2016–17, $84 million higher than the $323 million surplus recorded in 2015–16. The large net surplus was primarily due to significant additional State and Commonwealth Government funding. Net surpluses contribute to NSW Health’s ability to invest in new facilities, upgrades and redevelopments.

The value of assets held by NSW Health increased from $17.6 billion at 30 June 2016 to $18.6 billion at 30 June 2017. This was mainly due to significant capital expenditure on new facilities, upgrades and redevelopments across NSW Health. Eight health entities revalued land, buildings and infrastructure assets in 2016–17 adding to the recorded value of the assets. Total liabilities increased from $4.5 billion to $4.9 billion at 30 June 2017.

Appendix six of this report summarises key financial results for health cluster entities.

The following table summarises the health entities performance against some key financial indicators as at and for the year ended 30 June 2017.

Health entities' original expense budgets were increased by $798 million

Budgeted expenses at the start of 2016–17 for all local health districts/specialty networks totalled $16.7 billion. The expense budgets were revised to $17.4 billion progressively during the year. Some of the largest statewide expense budget increases were for:

• highly specialised drug allocations ($263.7 million)
• increases to legal claim provisions ($80.8 million)
• voluntary redundancy reimbursements ($17.4 million)
• supplementation for emergency department services ($20.0 million)
• funding for various programs and projects, such as the National Partnership Agreement on Adult Public Dental Services, Integrated Care Demonstrator Program, and The Bright Alliance projects ($118.4 million).

Most statewide expense budget increases are due to non‑cash adjustments offset by revenue budget increases, or the allocation of available funding within NSW Health.

The table below shows:

• original budgeted expenses, excluding losses, at the beginning of the financial year
• final budgeted expenses after budget revisions during the year
• actual expenses reported by each local health district/specialty network
• variances between the actual reported expenses and the original and final budgets.

At 30 June 2017, NSW Health had property, plant and equipment valued at $15.2 billion ($14.5 billion at 30 June 2016). NSW Health is managing a $1.7 billion capital program in 2017–18 ($1.5 billion in 2016–17).

Capital projects

Major projects completed in 2016-17

Major capital projects were completed on time and within budget

Health Infrastructure completed four major capital works projects, each with an estimated cost of $50.0 million or more, in 2016–17. As shown in the table below, these projects were completed on time and within approved budgets.

At 30 June 2017, NSW Health employed around 116,100 full time equivalent employees (112,500 at 30 June 2016), 72.5 per cent (72.3 per cent) of whom were clinical staff. The statewide percentage of employee related expenses compared to total expenses was 59.6 per cent in 2016–17 (61.1 per cent in 2015–16).

Managing excess annual leave

Managing excess annual leave is a continual challenge for health entities

The number of NSW Health employees with annual leave balances above target has decreased from 45,541 at 30 June 2016 to 44,985 at 30 June 2017 due to efforts to monitor and reduce annual leave balances. Some employees accrue four weeks annual leave each year, while those working a seven day roster can accrue up to seven weeks per year.

The health and wellbeing of staff can be adversely affected if staff do not take sufficient leave. Excess leave entitlements also negatively impact the cash flow of an organisation as leave liabilities generally increase over time in line with salary increases. Further, fraud is more likely to be detected when staff are on leave, particularly if they perform key control functions.

Thirty–five per cent of NSW Health’s workforce have excess annual leave balances

The table below shows the number of employees in NSW Health with excess leave.

One in four internal control issues reported were repeat issues

The 2016–17 financial audits of health cluster entities reported 123 internal control issues to management. By comparison, 126 were identified in 2015–16 and 164 in 2014–15. Around 24 per cent of issues reported in 2016–17 were unresolved from previous years’ audits.

Breakdowns and weaknesses in internal controls increase the risk of fraud and error. We report deficiencies in internal controls, matters of governance interest and unresolved issues identified to management and those charged with governance. We do this through our Management Letters, which include our observations, related implications, recommendations and risk ratings.

Appendix three of this report provides information on Management Letter findings for health cluster entities.

The table below summarises Management Letter issues across health cluster entities by risk rating.

Use of internal audit

Internal audit resourcing varies across NSW Health

Health entities spent $12.4 million on internal audit activities in 2016–17 ($11.6 million in 2015–16). A common measure of the sufficiency of investment in internal audit is to compare total internal audit costs to total expenses. On average, local health districts and specialty networks spent $59 for every $100,000 of expenses in 2016–17 ($56 in 2015–16).

Four local health districts/specialty networks spent substantially more on internal audit per $100,000 of expenses in 2016–17 compared to the average: Southern NSW ($161), Far West ($147), Murrumbidgee ($93) and Justice Health and Forensic Mental Health Network ($89).

Three local health districts spent substantially less on internal audit per $100,000 of expenses in 2016–17 compared to the average: Western NSW ($28), Northern NSW ($30) and Hunter New England ($33).

An appropriately resourced internal audit function allows a systematic, disciplined approach to evaluate and improve the effectiveness of risk management, control, and governance processes.

Most internal audit reporting related to the evaluation of internal controls

The graph below shows the focus of internal audit reviews in 2016–17 across NSW Health.

The Secretary of NSW Health has service agreements with local health districts/specialty networks and NSW Ambulance which outline performance requirements for safety and quality, service access and patient flow, finance and activity, population health, people and culture. Similarly, the Secretary of NSW Health has performance agreements with Pillar agencies and statements of service with shared statewide service agencies which detail service responsibilities and accountabilities.

The Secretary agrees to provide funding and other support to health entities and they agree to meet the service obligations and performance requirements in the agreements. The NSW Health Performance Framework outlines how the Ministry monitors performance and holds health entities to account.

Most local health districts/specialty networks’ service agreements were signed earlier

The 2017–18 service agreements were sent to the seventeen local health districts/specialty networks and NSW Ambulance on 20 June 2017 and were due to be signed by 31 July 2017. Thirteen local health districts/specialty networks met this date. This is a significant improvement with only seven local health districts/specialty networks meeting the date in 2015–16.

Of the seventeen local health districts/specialty networks and NSW Ambulance, thirteen signed the service agreements in July 2017 and five in August 2017. By comparison, seven signed their 2016–17 service agreements in July 2016, eight in August 2016, one in September 2016, one in October 2016, and one in November 2016.

Local health districts/specialty networks and NSW Ambulance should sign service agreements with the Secretary of NSW Health as close as possible to the start of each year as they clarify roles, responsibilities, performance measures, budgets, and service volumes and levels.

Agreements for other health entities were signed earlier than prior years

Three of the five performance agreements between the Secretary of NSW Health and other health entities were signed by the due date. The remaining performance agreements were signed in August 2017. While not meeting the due date, this is an improvement compared to last year where agreements were not signed until September 2016.

Five NSW Health entities are not meeting the Ministry’s performance expectations

At 30 June 2017, five NSW Health entities (three at 30 June 2016) were not meeting the performance expectations in the service agreements with the Secretary of NSW Health.

The Ministry rates health entities as performing, under review, underperforming, serious underperformance risk or challenged and failing. The Ministry's performance framework and service agreements clearly set out performance expectations to ensure NSW Government and national health priorities, services, outputs and outcomes are achieved.

The Ministry of Health’s most recent performance assessments of the fifteen local health districts, two specialty networks and NSW Ambulance are shown below.

The NSW Government released its new State priorities ‘NSW: Making it Happen’ in September 2015. It outlines two key priorities to improve health services in New South Wales including one priority of the Premier.

The two priorities are to:

• improve service levels in hospitals – 81 per cent of patients through emergency departments within four hours
• cut waiting times for planned surgeries – increase on‑time admissions for planned surgery.

The performance of NSW Health against these priorities, and a range of other targets and measures, is discussed in this chapter.

Data provided by the Ministry indicates NSW Health, as a whole, is performing well against key service delivery measures

NSW Health is a large and complex health system. Measuring and managing service delivery performance across NSW Health ensures resources can be appropriately deployed to meet the demands placed on the health system.

The chart below shows statewide performance against target in 2016–17 for a range of key service delivery measures.

Emergency department attendances are increasing across most New South Wales hospitals

In 2016–17, there were 2,784,700 emergency department attendances at New South Wales hospitals compared to 2,733,900 in 2015–16, an increase of 1.9 per cent. Emergency department attendances have increased 9.7 per cent over the past five years.

In 2016–17, the largest increases were at: Murrumbidgee (4.8 per cent); Hunter New England (3.6 per cent); and Northern Sydney (3.1 per cent) local health districts. The three largest decreases in emergency department attendances were: Western NSW (2.5 per cent) and South Eastern Sydney (1.6 per cent) local health districts and the Sydney Children’s Hospitals Network (1.3 per cent).

NSW Health again, on average, met targets across all triage categories

Data provided by the Ministry shows NSW Health, on average, met the targets across all five triage categories for the fourth consecutive year. This indicates NSW Health, on average, continues to provide clinically appropriate access to services in emergency departments.

The table below shows statewide emergency department triage performance over the last four years

The rate of patients leaving emergency departments within four hours did not improve

One of the Premier's priorities is to ensure 81 per cent of patients leave emergency departments within four hours. 2016–17 data provided by the Ministry shows NSW Health did not meet the target. The statewide average for 2016–17 was 74.2 per cent (74.2 per cent in 2015–16). The ability to achieve the target is challenging the sector when faced with increasing emergency department attendances.

While the Ministry’s data indicates NSW Health’s emergency treatment performance did not improve, data reported by the Productivity Commission shows its performance in 2015–16 was above the national average of 73.2 per cent.

NSW Health aims to increase the number of patients who stay less than four hours in the emergency department to improve access to public hospital services and patient satisfaction.

Seven health entities did not meet emergency treatment performance expectations

2016–17 data provided by the Ministry shows only Far West (90.6 per cent), Murrumbidgee (86.9 per cent), Southern NSW (83.8 per cent) and Western NSW (82.8 per cent) local health districts met the Premier and NSW Health's priority target of 81 per cent. Five local health districts achieved the target in 2015–16.

The Ministry considers local health districts and specialty networks are not meeting expectations when less than 71 per cent of patients leave emergency departments within four hours. Seven health entities did not meet the Ministry's emergency treatment performance expectations in 2016–17 (six health entities in 2015–16). The Ministry is working with these health entities to improve performance in this area and provide more timely access to care in emergency departments.

The chart below shows the percentage of patients that left emergency departments within four hours for each local health district and the Sydney Children’s Hospitals Network.

NSW Ambulance response times for potentially life-threatening incidents did not improve in 2016–17

Data provided by the Ministry shows the median ambulance response time for potentially life‑threatening incidents (Priority 1) in New South Wales increased slightly from 11.0 minutes in 2015–16 to 11.1 minutes in 2016–17. This was despite the number of Priority 1 responses reducing by 4.3 per cent, from 519,550 in 2015–16 to 497,380 in 2016–17.

NSW Ambulance implemented strategies to improve ambulance response times, including changes to how it prioritises triple zero calls. This resulted in a decrease in the overall proportion of Priority 1 responses from 46.6 per cent in 2015–16 to 44.3 per cent in 2016–17.

The graph below shows NSW Ambulance response times for Priority 1 incidents.

Patient transfers from ambulances to emergency departments were faster in 2016–17

In 2016–17, there were 547,850 ambulance arrivals at NSW hospitals compared to 586,030 in 2015–16, a 6.5 per cent decrease. 2016–17 data provided by the Ministry shows the number of patients transferred into the care of hospital emergency departments within 30 minutes increased to 91.7 per cent (87.6 per cent in 2015–16).

The timely transfer of patients from ambulances to emergency departments, known as ‘transfer of care’, is an important measure. Timely treatment is critical to emergency care, and improves health outcomes and patient satisfaction. Effective coordination between ambulance services and emergency departments allows patients to be treated quickly.

The chart below shows arrivals with 'transfer of care' within 30 minutes for each local health district and the Sydney Children’s Hospitals Network.

The average length of stay for patients in NSW hospitals was 3.0 days in 2016–17

2016–17 data provided by the Ministry shows the average length of stay for patients with acute episodes was 3.0 days (3.1 days in 2015–16). The Ministry advises there are no set targets or benchmarks for this measure because it is dependent on clinical variations in the types of episodes, the procedures undertaken and the patients’ condition.

The average length of stay is a key driver of hospital costs and affects the capacity of the health system in terms of bed availability. NSW Health seeks to minimise the time patients spend in hospital, without compromising health outcomes.

Variations exist between the lengths of stay at local health districts/specialty networks

The variation in the average length of stay for patients with acute episodes between local health districts/specialty networks decreased from 1.5 days in 2015–16 to 1.1 days in 2016–17. The variation may be greater when considered at an individual hospital level.

The Ministry’s 2016–17 data shows Northern Sydney and Sydney local health districts shared the highest average length of stay at 3.3 days. Southern NSW Local Health District had the lowest at 2.2 days. This means, on average, patients spent 1.1 days longer in Northern Sydney and Sydney hospitals compared to Southern NSW.

The Ministry’s 2015–16 data shows Northern Sydney Local Health District had the highest average length of stay at 3.8 days. Southern NSW Local Health District had the lowest at 2.3 days.

Local health districts/specialty networks in metropolitan areas may have a slightly higher average length of stay than rural areas, because they deal with more complex patient conditions requiring longer periods in hospital.

The chart below shows the average length of episode stay in days for each local health district and the Sydney Children’s Hospitals Network.

On average, NSW Health improved on-time admission of patients for elective surgery

One of the State priorities is to increase on‑time admissions for elective surgery, in accordance with medical advice. In 2016–17, there were 222,893 admissions (218,944 in 2015–16) for elective surgery in NSW public hospitals, representing a 1.8 per cent increase. 2016–17 data provided by the Ministry shows NSW Health met one of the three targets for elective surgery waiting times.

NSW Health is attempting to reduce waiting times for elective surgery in public hospitals. Cutting waiting times is important to reduce the burden of disease and injury on patients and their carers.

The table below shows the statewide average percentage of elective surgery patients treated on time over the last four years.

NSW Health, on average, did not reduce the rate of unplanned hospital re‑admissions in 2016–17

2016–17 data provided by the Ministry shows the statewide average unplanned hospital re‑admissions rate was 6.4 per cent (6.3 per cent in 2015–16). The Ministry’s target is to reduce the rate of re‑admissions compared to the previous financial year. The Ministry changed the target in 2016–17. The previous target was for re‑admission rates to be less than or equal to five per cent. Based on the data, only one local health district would have achieved the previous target in
2016–17.

The data shows that, once again, Central Coast Local Health District recorded the highest rate at 8.2 per cent (8.3 per cent), while Western NSW Local Health District recorded the lowest at 4.9 per cent (Sydney Local Health District at 5.2 per cent in 2015–16).

The chart below shows unplanned hospital re-admissions for each local health district and the Sydney Children’s Hospitals Network .

On average, NSW Health improved the post discharge follow-up of acute mental health patients

Most people with chronic and recurring mental illnesses are cared for in the community. Continuity of care (including follow up and support by professionals and peers) in the community for mental health patients after they have been discharged can lead to reduced symptom severity, lower re‑admission rates, and improved quality of life.

2016–17 data provided by the Ministry shows the statewide average for post discharge follow-up of acute mental health patients within seven days was 70.0 per cent (66.0 per cent in 2015–16). The statewide average improved in 2016–17 and met the NSW Health target of 70 per cent.

The Ministry’s 2016–17 data shows the Sydney Children's Hospitals Network had the greatest improvement from prior year with an increase of 19.8 percentage points. The data shows Southern NSW Local Health District had the largest reduction in performance, dropping 55.5 percentage points to 11.4 per cent of post discharge follow-up within seven days. The Ministry attributes the reduction to data quality issues because of problems extracting data from a new system.

The chart below shows the post discharge follow-up of acute mental health patients within seven days for each local health district and the Sydney Children’s Hospitals Network.

Most health entities did not achieve NSW Health's mental health acute re-admissions target

2016–17 data provided by the Ministry shows the statewide average mental health acute re‑admissions rate was 14.4 per cent (14.6 per cent in 2015–16). Sydney Children’s Hospitals Network recorded the highest mental health acute re-admissions rate at 20.0 per cent (Sydney Local Health District at 18.6 per cent in 2015–16), while Murrumbidgee Local Health District recorded the lowest at 9.7 per cent (Far West Local Health District at 6.2 per cent in 2015–16).

The data shows the Sydney Children’s Hospitals Network and Far West Local Health District experienced large changes in their performance compared to 2015–16. The Ministry attributes the movement to low volumes of acute mental health patients creating greater volatility in the results. The Ministry also advise of potential data quality issues impacting the Sydney Children’s Hospitals Network result.

The Ministry’s data shows twelve local health districts did not achieve the NSW Health target of 13 per cent in 2016–17 (11 local health districts in 2015–16). High re-admission rates may indicate deficiencies in inpatient treatment and follow up care.

The chart below shows mental health acute re-admissions within 28 days of being discharged for each local health district and the Sydney Children’s Hospitals Network.

Most health entities reduced unplanned and emergency re‑presentations in 2016–17

2016–17 data provided by the Ministry shows the statewide average unplanned and emergency re‑presentations rate fell to 4.9 per cent from 5.0 per cent in 2015–16. The data shows Far West Local Health District recorded the highest unplanned rate of re‑presentations at 7.0 per cent (7.7 per cent in 2015–16). The data shows South Western Sydney Local Health District and the Sydney Children’s Hospitals Network had the lowest rate of 3.9 per cent (3.9 per cent in 2015–16 respectively together with Western Sydney Local Health District).

The Ministry’s 2016–17 data shows ten local health districts reduced the number of unplanned and emergency re‑presentations to the same emergency department within 48 hours of being discharged.

NSW Health’s target is to reduce the number of unplanned and emergency re‑presentations to emergency departments.

The chart below shows New South Wales hospitals unplanned and emergency re‑presentations to emergency departments within 48 hours of being discharged.

'Golden staph' infection rates remain well below national standards

Staphylococcus aureus bloodstream infection (SA‑BSI), also called 'golden staph', is a common cause of healthcare associated infections. The incidence of healthcare associated SA‑BSI is used as a measure for the hygiene compliance of healthcare workers.

Data provided by the Ministry shows SA‑BSI rates across NSW Health were below the national benchmark of less than two cases per 10,000 bed days. In 2016–17, the average SA‑BSI was 0.72 cases per 10,000 bed days (0.75 in 2015–16). NSW Health’s 2015–16 result is consistent with the national average SA-BSI rate.

NSW Health minimises the risk of unnecessary injury and mortality from healthcare associated infections in healthcare facilities through infection control practices.

Details on each local health district's and specialty network's average SA‑BSI rate are included in appendix seven.

Data provided by the Ministry indicates thirty-four events led to patient deaths or serious harm in New South Wales hospitals in 2015–16

Sentinel events are those which result in death or very serious harm to patients. Even a small number of isolated sentinel events have the potential to seriously undermine public confidence in the healthcare system.

In 2015–16, there were 34 sentinel events in New South Wales hospitals compared to 50 in 2014–15 and 53 in 2013–14. Details on sentinel events for the previous financial year are not available at the time of writing this report.

In 2015–16, on average, one sentinel event occurred for every 85,893 patients admitted to a New South Wales hospital.

The table below summarises the number of sentinel events over the three years to 2015–16 for the eight nationally agreed sentinel events.

NSW Health monitors patient experiences through surveys

NSW Health has a patient survey program which collects feedback on various aspects on the patient experience. This includes the physical environment of the hospital, safety and hygiene, accessibility and timeliness and communication and information. Patients are asked if they were treated with respect and dignity during their admission.

The Bureau of Health Information reports on the overall NSW Health system. Local health districts and specialty networks can compare their performance against others.

Survey results provide valuable insights into how well the healthcare system in New South Wales is functioning and where there are opportunities to improve and help healthcare professionals and policy makers deliver safe, quality care.

The Bureau of Health Information reports most NSW patients rate the care they received as ‘very good’ or 'good'

In 2015, the Bureau of Health Information surveyed over 27,000 adult admitted patients in NSW. The survey collected information about the care patients received while admitted in hospital. Overall, 65 per cent of patients rated the care as ‘very good’ and 29 per cent rated it as ‘good’. The results were consistent with the 2014 results when 63 per cent rated their care as ‘very good’ and 30 per cent as ‘good’.

During April 2014 to March 2015, the Bureau of Health Information surveyed around 18,000 emergency department patients. Overall, 58 per cent of patients rated the care while in the emergency department as ‘very good’ and 38 per cent as ‘good’. In comparison, 52 per cent surveyed during April 2013 to March 2014 rated their overall care as ‘very good’ and 30 per cent care as ‘good’.

The service agreements between the Secretary of NSW Health and local health districts/specialty networks include a target to increase the percentage of patients rating care as ‘very good’ or ‘good’. On average, NSW Health achieved the target for emergency department patients and adult admitted patients based on the latest published data.

The table below shows the overall results for NSW Health.

Reforms are being implemented to NGO funding processes to increase accountability

In 2016–17, NSW Health allocated around $155 million ($153 million in 2015–16) in Ministerial grant funding to over 310 Non‑Government Organisations (NGOs) across the State. Ministerial grant funding is provided for programs addressing women’s health, aged care, palliative care, chronic care and aged disability, community transport, population health, drug and alcohol, mental health, kids and families, aboriginal health, and other state-wide issues.

NSW Health is implementing reforms to existing frameworks and systems that manage NGO funding to:

• strengthen partnerships and service outcomes through longer term agreements that promote greater sustainability of services
• better align NGO services funded by NSW Health with NSW Government priorities
• reflect enhanced performance frameworks
• demonstrate effectiveness and value for money.

The reforms have progressed in a staged approach. During 2014–15 and 2015–16 (Phase One), NSW Health:

• completed service evaluations and introduced streamlined funding and reporting arrangements for NGOs
• delivered a training and education program to build skills and capabilities of NGOs, which reached over 250 participants across the State.

In 2016–17 (Phase Two), NSW Health:

• assessed existing arrangements with NGOs to identify those suitable to be transferred to longer term funding agreements with enhanced performance indicators from 1 July 2017
• will continue to fund and review the remaining agreements with NGOs until 30 June 2018 which may, in the future, be more appropriately funded under other arrangements, such as the National Disability Insurance Scheme.