NSW Health has progressed in identifying and addressing key R&D issues in a complex and difficult environment. The Infrastructure Grants Program (IGP) is an innovative program and reflects a commitment by Government to support research infrastructure. The IGP has as its aims the provision of significant funding accompanied by clear research objectives and criteria for accountability and introduces a rational basis for the allocation of infrastructure grants.

While NSW Health has progressed, there is an opportunity to make the IGP more efficient and effective. These opportunities are in the areas of addressing longer term planning issues in health, streamlining and clarifying eligibility and selection criteria, improving decision-making structures and processes and improving accountability.

Parliamentary reference - Report number #56 - released 25 November 1998

The Audit Office is of the view that:

• there is no system wide plan for the location of emergency departments. This function is undertaken by each Area Health Service

• coordination between the Department and the NSW Ambulance Service could be improved in aspects such as the collocation of facilities and direct communications between ambulances and emergency departments

• there is no policy framework that recognises the increasing role and impact of private providers

• the Department’s guidelines do not take into account demographic factors, the number of patients treated or the acuity of presentations as criteria for determining the size of an emergency department or the level and scope of emergency services that should be available at that location.

• the Department has introduced a range of initiatives over a period of time to improve the performance of emergency departments such as the establishment of the Integrated Bed Management Committee. Some have been quite effective, whilst others have had mixed success. There has been an overall improvement in emergency department waiting times for urgent cases. However, there has been little improvement in waiting times for less urgent cases and a decline in performance for access block (the time taken to be admitted to a hospital ward from the emergency department after a decision has been made that this is required).

Parliamentary reference - Report number #54 - released 21 October 1998

In most organisations with a board or committee, there was confusion about the respective roles, powers, responsibilities and accountabilities of the Minister/s, the board and the Chief Executive Officer (CEO). There are a wide variety of governance arrangements in operation across the spectrum of boards and committees. This is partly due to differing arrangements set out in relevant legislation and gaps in legislative detail which have been addressed in a variety of ways.

Under current arrangements, governing boards of SOCs have accountabilities to Shareholding Ministers and Portfolio Ministers, as well as to Ministers who are responsible for industry-wide regulation. Non-corporatised Government businesses have different accountability and control arrangements. The large number of statutory and nonstatutory bodies and authorities have a wide array of governance arrangements. As a result of uncertainty and confusion on governance aspects, The Audit Office observed that many governing boards operate as high level advisory management committees. The audit also found that board and committee practices fell short of standards expected in a professional boardroom culture.

Parliamentary reference - Report number #49 - released 7 April 1998

Fraud control in the NSW public sector needs to be better. Some agencies have approached the issue with vigour and initiative, and improvement since 1993 is evident in the major audit clients of The Audit Office. However, the overall achievement of NSW agencies in implementing fraud control strategies leaves much room for improvement.

There is a need for stricter requirements, better monitoring and improved central support to ensure that fraud control is properly addressed. This Report makes some suggestions in this regard, and highlights some issues for further research and guidance. There is a need to change management perceptions on the issue of fraud control. To this end, The Audit Office fully supports recent initiatives by the Chief Executives Committee (in constituting an Ethics Working Party) and NSW Treasury (in seeking to introduce a risk management approach to the public sector). These initiatives place fraud control into a broader context of effective ethical management, which is where it belongs.

Parliamentary reference - Report number #48 - released 25 March 1998