It is estimated that one in five people will be affected at some stage by a mental health problem or illness. The increasing prevalence of mental illness means that at some point in time most of us will either be affected or we will know of someone who is.

Although most people with mental illness can be treated in the community, at times some may require emergency treatment or admission to hospital for shortterm intensive therapy.

Not only are more mental health patients presenting to an emergency department for treatment than ever before, they are reportedly sicker and a greater number require admission to a hospital bed for further treatment. And, because of its very nature, those suffering from acute mental illness may not understand what is wrong or be able to communicate their problems clearly.

This makes access to emergency mental health services a significant issue for government that requires continuing attention.

The focus of this report is on the provision of 24-hour crisis services to adults. Emergency mental health services play a vital role in providing timely and appropriate care. Without proper treatment the severity of the illness may escalate, increasing the risk of self-harm or harm to others.

There have been many changes to mental health services over the last decade to deal with increasing demand. Much has been done to improve access to, and the quality of emergency services through significant increases in funding, the opening of new beds and the employment of more mental health staff.

Yet recent reviews have highlighted problems with accessing mental health beds and inadequate levels of psychiatric support in rural areas.

I believe that our report will provide valuable assistance to area health services on alternative models of emergency mental health care that better manage patient risk and further improve service quality.

Parliamentary reference - Report number #136 - released 26 May 2005

This audit follows our earlier studies on ambulance response times, on waiting times for elective (i.e. non-urgent) surgery and on the ‘Code Red’ status of hospital emergency departments. Those audits indicated that matching resources to the ever-increasing numbers of people seeking emergency treatment was certainly an issue, but not the only issue. We found that problems were also occurring at the ‘interface’ between different parts of the health system – when patients arrive in ambulances at emergency departments or when they need to be admitted from emergency departments to hospital wards.

Parliamentary reference - Report number #125 - released 28 July 2004

All three hospitals followed the Department of Health’s guidelines for judging capacity and had systems in place to notify hospital staff and ambulance crews of changes in status. We found discrepancies in the records kept by all three hospitals when compared to the records maintained by the Department of Health. Our view however, is that these records do not need to be a perfect match for the intended purpose, which is to guide ambulance crews to the shortest queue.

Parliamentary reference - Report number #121 - released 15 December 2003

In our opinion there are inadequacies in the current arrangements for detecting unauthorised driving. For example better information is needed on the extent of unlicensed driving. This may require giving the NSW Police power to conduct random licence and registration checks. In addition, there are technological and legal constraints to the efficient and effective detection of unauthorised driving.

Parliamentary reference - Report number #115 - released 4 September 2003

Some form of teacher performance assessment has been in place in NSW public schools for the past 40 years and the scheme has been significantly enhanced through its inclusion in the 2000 Award. We welcome these changes. However, we are of the opinion that further changes are required to improve its effectiveness. We have two issues of concern. Firstly, that the scheme may not provide for fair and consistent assessments across all schools. Secondly, that the annual performance review does not allow a teacher who is not a probationer or on a formal improvement program to be rated as anything other than ‘efficient’.

Parliamentary reference - Report number #109 - released 14 May 2003

The NSW Police and Department of Corrective Services (DCS) have committed to improve performance and productivity in their organisations. Both agencies have introduced several initiatives to promote the health, safety and welfare of their personnel. In addition the DCS policy provides for acknowledgements and sanctions based on the amount of medically uncertified leave taken by the employee. There are additional steps that could be taken to improve the management of sick leave.

Parliamentary reference - Report number #100 - released 23 July 2002

This performance audit indicates that the Service has considerable work to do to reach its aspirations of being recognised amongst leading examples of best practice services. The commitment of the Service to serving the community and the professionalism of the Service's officers is not in question. It is, however, apparent that a number of barriers to performance will need to be overcome for the Service to perform as well as it would wish.

Parliamentary reference - Report number #80 - released 7 March 2001

Realisation of the Government’s objectives for integrating computers into the school environment is a major change that will take some time to achieve. The logistics of equipping schools with computers and making them operational have been approached energetically by the Department. Four years into the Computers in Schools Program, student and teacher access to computer hardware, software and the Internet is now substantially greater and teachers are now better placed to integrate computers into teaching and learning. But while much has been achieved there are significant challenges that still remain.

Parliamentary reference - Report number #73 - released 7 June 2000

There have been notable changes in the provision of emergency department services over the last decade, principally by increasing the number, seniority and training of staff and upgrading facilities. More recently, programs have focussed on achieving improvements in emergency department waiting times (the time taken to see a doctor) and access block (delay in accessing a hospital bed). However, these programs have had limited effect. Although waiting times for seriously ill patients have decreased, waiting times for around 95% of emergency department patients have increased or remain unchanged and performance against benchmarks for access block has declined each year.

Although The Audit Office identified opportunities to improve patient flow in the emergency department, benefits will be limited by access block and the congestion caused by being unable to move patients to a ward. Only a better balance of resources between inpatient access programs (that is booked and emergency department patients) will bring about improvements in access block.

Parliamentary reference - Report number #72 - released 15 March 2000

The Police Service is in the process of undertaking a wide range of information technology and systems developments that are expected to improve the Service’s capabilities to apply intelligence information to the deployment of staff at Local Area Commands (LACs). Implementation of the current phase is to take place over the next eighteen months. The Audit Office considers that the developments are timely and when fully implemented should significantly contribute to the Police Service’s ability to be more proactive and provide for better staff deployment.

The Audit Office is of the view that the impact of these developments on the efficiency and effectiveness of rostering and tasking at LACs would be further enhanced by attention to gaps in systems and to restrictive staff allocation practices.

Parliamentary reference - Report number #70 - released 31 January 2000