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Actions for Supporting the District Criminal Court

Supporting the District Criminal Court

Justice
Community Services
Information technology
Internal controls and governance
Project management

The Auditor-General for New South Wales, Margaret Crawford, released a report today on whether the Department of Communities and Justice (the department) effectively supports the efficient operation of the District Criminal Court system.

The audit found that in the provision of data and technology services, the department is not effectively supporting the efficient operation of the District Criminal Court system. The department has insufficient controls in place to ensure that data in the system is always accurate.

The department is also using outdated technology and could improve its delivery of technical support to courts.

The audit also assessed the implementation of the Early Appropriate Guilty Pleas reform. This reform aims to improve court efficiency by having more cases resolved earlier with a guilty plea in the Local Court. The audit found that the department effectively governed the implementation of the reform but is not measuring achievement of expected benefits, placing the objectives of the reform at risk.

The Auditor-General made seven recommendations to the department, aimed at improving the controls around courts data, reporting on key performance indicators, improving regional technical support and measuring the success of the Early Appropriate Guilty Pleas reform. 

The District Court is the intermediate court in the New South Wales court system. It hears most serious criminal matters, except murder, treason and piracy. The Department of Communities and Justice (the Department) provides support to the District Court in a variety of ways. For example, it provides security services, library services and front-desk services. This audit examined three forms of support that the Department provides to the District Court:

  • data collection, reporting and analysis - the Department collects data from cases in its case management system, JusticeLink, based on the orders Judges make in court and court papers
  • technology - the Department provides technology to courts across New South Wales, as well as technical support for this technology
  • policy - the Department is responsible for proposing and implementing policy reforms.

Recent years have seen a worsening of District Court efficiency, as measured in the Productivity Commission's Report on Government Services (RoGS). Efficiency in the court system is typically measured through timeliness of case completion. There is evidence that timeliness has worsened. For example, the median time from arrest to finalisation of a case in the District Court increased from 420 days in 2012–13 to 541 days in 2017–18.

As a result, the government has announced a range of measures to improve court performance, particularly in the District Court. These measures included the Early Appropriate Guilty Pleas (EAGP) reform. One of the objectives of EAGP is to improve court efficiency, which would be achieved by having more cases resolve with a guilty plea in the Local Court.

This audit assessed whether the Department of Communities and Justice effectively supports the efficient operation of the District Criminal Court system. We assessed this with the following lines of inquiry:

  • Does the Department effectively collect, analyse and report performance information relevant to court efficiency?
  • Does the Department effectively provide technology to support the efficient working of the courts?
  • Does the Department have effective plans, governance and monitoring for the Early Appropriate Guilty Pleas reform?

The audit did not consider other support functions provided by the Department. Further information on the audit, including detailed audit criteria, may be found in Appendix two.

Conclusion
In the provision of data and technology services, the Department is not effectively supporting the efficient operation of the District Criminal Court system. The Department has insufficient controls in place to ensure accurate data in the District Criminal Court system. The Department is also using outdated technology in significant numbers and could improve its delivery of technical support to meet agreed targets.
The Department effectively governed the implementation of the Early Appropriate Guilty Pleas reform. However, it is not ensuring that the benefits stated in the business case are being achieved, placing its objectives at risk.
The impact of inaccurate court data can be severe, and the Department does not have sufficient controls in place to ensure that its court data is accurate. Recent Bureau of Crime Statistics and Research reviews have identified data inaccuracies, and this demonstrates the Department needs strong controls in place to ensure that its court data is accurate.
The Department does not have a policy for data quality and has not formally assigned responsibility for data quality to any individual or branch. The Department also does not have a data dictionary outlining all the fields in its case management system. While the Department validates the highest risk items, such as warrants, to ensure that they are accurate, most data is not validated. The Department has recently commenced setting up a data unit for the Courts, Tribunals and Service Delivery branch. It is proposed that this unit will address most of the identified shortcomings.
The Department did not provide timely technical support to the court system in 2017 and is using outdated technology in significant numbers. The Digital and Technology Services branch of the Department had agreed a Service Level Agreement with the rest of the Department, outlining the expected speed of technical support responses. The branch did not meet response times in 2017. Performance improved in 2018, though DTS fell short of its targets for critical and moderate priority incidents. Critical incidents are particularly important to deal with in a timely manner as they include incidents which may delay a court sitting.
Requests for technical support rose significantly in 2018 compared to 2017, which may be related to the number of outdated pieces of technology. As at April 2019, the whole court system had 2,389 laptops or desktop computers outside their warranty period. The Department was also using other outdated technology. Outdated technology is more prone to failure and continuing to use it poses a risk of court delays.
The Department is not measuring all the expected benefits from the Early Appropriate Guilty Pleas reform, placing the objectives of the program at risk. The Early Appropriate Guilty Pleas business case outlined nine expected benefits from the reform. The Department is not measuring one of these benefits and is not measuring the economic benefits of a further five business case benefits. Not measuring the impact of the reform means that the Department does not know if it is achieving its objectives and if the reform had the desired impact.

The Department is responsible for providing technology to the courts, which can improve the efficiency of court operations by making them faster and cheaper. The Department is also responsible for providing technical support to courtrooms and registries. It is important that technical support is provided in a timely manner because some technical incidents can delay court sittings and thus impact on court efficiency. A 2013 Organisation for Economic Co‑operation and Development report emphasised the importance of technology and digitisation for reducing trial length.

While the Department may provide technology to the courts, they are not responsible for deciding when, how or if the technology is used in the courtroom.

The Department is using a significant amount of outdated technology, risking court delays

As of April 2019, the whole court system had 2,389 laptops or desktop computers out of warranty, 56.0 per cent of the court system's fleet. The court system also had 786 printing devices out of their normal warranty period, 75.1 per cent of all printers in use. The Department also advised that many of its court audio transcription machines are out of date. These machines must be running for the court to sit and thus it is critical that they are maintained to a high degree. The then Department of Justice estimated the cost of aligning its hardware across the whole Department with desired levels at $14.0 million per year for three years. Figures for the court system were not calculated but they are likely to be a significant portion of this figure.

Using outdated technology poses a risk to the court system as older equipment may be more likely to break down, potentially delaying courts or slowing down court services. In the court system throughout 2018, hardware made up 30.8 per cent of all critical incidents reported to technical support and 41.9 per cent of all high priority incidents. In addition, 16.2 per cent of all reported issues related to printing devices or printing.

From 2017 to 2018, technical support incidents from courts or court services increased. There were 4,379 technical support incidents in 2017, which increased significantly to 9,186 in 2018. The Department advised that some outside factors may have contributed to this increase. The Department was rolling out its new incident recording system throughout 2017, meaning that there would be an under‑reporting of incidents in that year. The Department also advised that throughout 2018 there was a greater focus on ensuring that every issue was logged, which had not previously been the case. Despite these factors, the use of outdated technology has likely increased the risk of technology breakages and may have contributed to the increase in requests for technical support.

Refreshing technology on a regular basis would reduce the risk of hardware failures and ensure that equipment is covered by warranty.

The Department did not meet all court technical support targets in 2017 and 2018

The Digital and Technology Services branch (DTS) was responsible for providing technical support to the courts and the Courts and Tribunal Services branch prior to July 2019. DTS provided technical support in line with a Service Level Agreement (SLA) with the Department. In 2017, DTS did not provide this support in a timely manner. Performance improved in 2018, though DTS fell short of its targets for critical and moderate priority incidents. Exhibit 7 outlines DTS' targets under the SLA.

Exhibit 7: Digital and Technology Services' Service Level Agreement
Priority Target resolution time Target percentage in time (%)
1. Critical 4 hours 80
2. High 1 day 80
3. Moderate 3 days 85
4. Low 5 days 85
Source: Department of Communities and Justice, 2019.

Critical incidents are particularly important for the Department to deal with in a timely manner because these include incidents which may delay a court sitting until resolved or incidents which impact on large numbers of staff. Some of the critical incidents raised with DTS specifically stated that they were delaying a court sitting, often due to transcription machines not working. High priority incidents include those where there is some impact on the functions of the business, which may in turn affect the efficiency of the court system. High priority incidents also include those directly impacting on members of the Judiciary. 

This audit examined DTS' performance against its SLA in the 2017 and 2018 calendar years across the whole court system, not just the District Court. The total number of incidents, as well as critical and high priority incidents, can be seen in Exhibit 8.

Exhibit 8: Number of incidents in 2017 and 2018
Priority 2017 2018
All 4,379 9,186
1. Critical 48 91
2. High 128 315
Source: Audit Office of NSW analysis of Department of Communities and Justice data, 2019.

The Department's results against its SLA in 2017 and 2018 are shown in Exhibit 9.

The Early Appropriate Guilty Pleas (EAGP) reform consists of five main elements:

  • early disclosure of evidence from NSW Police Force to the prosecution and defence
  • early certification of what the accused is going to be charged with to minimise changes
  • mandatory criminal case conferencing between the prosecutor and accused's representation
  • changes to Local Court case management
  • more structured sentence discounts.

More detailed descriptions of each of these changes can be found in the Introduction. These reform elements are anticipated to have three key effects:

  • accelerate the timing of guilty pleas
  • increase the overall proportion of guilty pleas
  • decrease the average length of contested trials.

Improving District Court efficiency is one of the stated aims of EAGP, which would be achieved by having more cases resolve in the Local Court and having fewer defendants plead guilty on the day of their trial in the District Court. The reform commenced in April 2018 and it is too early to state the impact of this reform on District Court efficiency.

The Department is responsible for delivering EAGP in conjunction with other justice sector agencies. They participated in the Steering Committee and the Working Groups, as well as providing the Project Management Office (PMO).

The Department is not measuring the economic benefits stated in the EAGP business case

The business case for EAGP listed nine quantifiable benefits which were expected to be derived from the achievement of the three key effects listed above. The Department is not measuring one of these benefits and is not measuring the economic benefits for five more, as shown in Exhibit 12.

Benefit Economic benefit (over ten years) Being measured?
Accelerated timing of guilty pleas $54.6m yellow circle with minus in the center
Increased guilty plea rate $90.7m yellow circle with minus in the center
Decreased average trial length $27.5m yellow circle with minus in the center
A reduction in the delay of indictable matters proceeding to trial N/A check circle mauve
Increase the number of finalised matters per annum N/A check circle mauve
Reduction of the current backlog of criminal trials in the District Court N/A check circle mauve
Reduction in bed pressure on the correction system due to reduced
average time in custody
$13.7m Exclamation circle red
Productivity improvements due to reduction in wasted effort $53.3m yellow circle with minus in the center
Bankable cost savings due to jury empanelment avoided $2.5m yellow circle with minus in the center

 

Exhibit 12: The Department's measurement of quantifiable benefits
Key check circle mauve Measuring yellow circle with minus in the center Not measuring economic benefit Exclamation circle red Not measuring
Source: Audit Office of NSW analysis.

While it is too early to comment on the overall impact of EAGP, better practice in benefits realisation involves an ongoing effort to monitor benefits to ensure that the reform is on target and determine whether any corrective action is needed.

The Department is measuring the number of finalised matters per annum and while the Department is not measuring the reduction in the backlog as part of this program, this measure is reported as part of the Department's internal reporting framework. The Department is not monitoring the reduction in delay of indictable matters proceeding to trial directly as part of this reform, but this does form part of the monthly Operational Performance Report which the Department sends to the EAGP Steering Committee.

The Department is not monitoring any of the economic benefits stated in the business case. These economic benefits are a mixture of bankable savings and productivity improvements. This amounts to a total of $242.3 million over ten years which was listed in the business case as potential economic benefits from the implementation of this reform against the total cost of $206.9 million over ten years. The Department is collecting proxy indicators which would assist in these calculations for several indicators, but it is not actively monitoring these savings. For example, the Department is monitoring average trial length, but is not using this information to calculate economic benefits derived from changes in trial length.

The Department is also not collecting information related to the average length of custody as part of this program. This means that it is unable to determine if EAGP is putting less pressure on the correctives system and it is not possible for the Department to calculate the savings from this particular benefit.

While stakeholders are optimistic about the impact of EAGP, not measuring the expected benefits stated in the business case means that the Department does not know if the reform is achieving what it was designed to achieve. Further, the Department does not know if it must take corrective action to ensure that the program achieves the stated benefits. These two things put the overall program benefits at risk.

The Department has not assigned responsibility for the realisation of each benefit, potentially risking the success of the program

The Department has not assigned responsibility for the realisation of each benefit stated in the business case. The Department holds the Steering Committee responsible for the realisation of all benefits. Benefits realisation is the process which ensures that the agency reaches benefits as stated in the business case. Assigning responsibility for benefits realisation to the Steering Committee rather than individuals is not in line with good practice.

Good practice benefits realisation involves assigning responsibility for the realisation of each benefit to an individual at the business unit level. This ensures there is a single point of accountability for each part of the program with knowledge of the benefit and the ability to take corrective action if it looks like that benefit will not be realised. This responsibility should sit at the operational level where detailed action can most easily be undertaken. The role of a Steering Committee in benefits realisation is to ensure that responsible parties are monitoring their benefits and taking appropriate corrective action.

The Department advised that it believes the Steering Committee should have responsibility for the realisation of benefits due to the difficulty of attributing the achievement of each benefit to one part of the reform alone. Given the Steering Committee meets only quarterly, it is not well placed to take action in response to variances in performance.

A BOCSAR evaluation is planned, however data errors make some of the information unreliable

BOCSAR are planning to undertake an overall evaluation of EAGP which is planned for release in 2021. Undertaking this evaluation will require high quality data to gain an understanding of the drivers of the reform. However, data captured throughout the first year of EAGP has proven unreliable, which may reduce the usefulness of BOCSAR's evaluation. These data issues were discussed in Exhibit 5 in Chapter 2, above. Access to accurate data is vital for conducting any program evaluation and inaccurate data raises the risk that the BOCSAR evaluation will not be able to provide an accurate evaluation of the impact of EAGP.

In addition to the BOCSAR evaluation, the Department had plans for a series of 'snapshot' evaluations for some of the key elements of the reform to ensure that they were operating effectively. These were initially delayed due to an efficiency dividend which affected EAGP. In August 2019, the Department commissioned a review of the implementation of several key success factors for EAGP.

There was clear governance throughout the implementation of EAGP

The implementation stage of EAGP had clear governance, lines of authority and communication. The Steering Committee, each Working Group and each agency had clear roles and responsibilities, and these were organised through a Project Management Office (PMO) provided by the former Department of Justice. The governance structure throughout the implementation phase can be seen at Exhibit 13.

The Steering Committee was established in December 2016 and met regularly from March 2017. It comprised senior members of key government agencies, as well as the Chief Judge and the Chief Magistrate for most of the duration of the implementation period. The Steering Committee met at least monthly throughout the life of the program. The Steering Committee was responsible for overseeing the delivery of EAGP and making key decisions relating to implementation, including spending decisions. The Chief Judge and the Chief Magistrate abstained from financial decisions. The Steering Committee updated the governance and membership of the Steering Committee as appropriate throughout the life of the reform.

Appendix one – Response from agency
 
Appendix two – About the audit 

Appendix three – Performance auditing 

 

Copyright Notice

© Copyright reserved by the Audit Office of New South Wales. All rights reserved. No part of this publication may be reproduced without prior consent of the Audit Office of New South Wales. The Audit Office does not accept responsibility for loss or damage suffered by any person acting on or refraining from action as a result of any of this material.

Parliamentary Reference: Report number #329 - released 18 December 2019

Published

Actions for Ensuring contract management capability in government - HealthShare NSW

Ensuring contract management capability in government - HealthShare NSW

Health
Management and administration
Procurement
Project management

This report examined whether HealthShare NSW, a part of NSW Health, has the required contract management capability to effectively manage goods and services contracts valued over $250,000. 

The report found that HealthShare has a procurement framework that should support effective contract management, but it is not applying it consistently. In particular, the audit found that HealthShare was not applying key contract management elements to over 80 per cent of the high-value contracts it manages. The audit also found that HealthShare’s contract management practices were limited by inadequate performance monitoring.

'Effective contract management is essential to ensure the contracts HealthShare enters into are delivering as expected and ensuring value for money,' said the Auditor-General. 'Without this, the value for money or savings HealthShare achieves when it negotiates these contracts is at risk of being eroded over the life of the contract.'

The report recommends that NSW Health develop a performance improvement plan to ensure HealthShare is fully compliant with procurement policies and that NSW Health meets its obligations under the Government's Accreditation Program for Goods and Services Procurement.

HealthShare is a NSW Health entity responsible for providing shared services, including procurement, to support the delivery of patient care within the NSW health system. In 2018, HealthShare procured high value goods and services contracts with an annual estimated total spend of around $1.8 billion, with most of the contracts of long duration.

NSW Government agencies are increasingly delivering services and projects through contracts with third parties. These contracts can be complex and governments face challenges in negotiating and implementing them effectively. A robust contract management framework helps ensure all parties meet their obligations, contractual relationships are well managed, agencies achieve value for money, and deliverables meet the required standards and agreed timeframes.

Contract management capability is a broad term, which can include aspects of individual staff capability (such as staff knowledge, skills and experience) as well as organisational capability (such as policies, frameworks and processes).

The NSW Procurement Board is responsible for overseeing the Government's procurement system, setting policy and ensuring compliance. It has accredited the Health Administration Corporation (HAC) to procure goods and services with no upper financial limit. Under the terms of this accreditation, the Secretary, NSW Health (as head of HAC) has delegated the procurement of high-value (over $250,000) goods and services contracts within NSW Health to only the Ministry of Health and HealthShare NSW (HealthShare).

HealthShare NSW (HealthShare) is a NSW Health entity responsible for providing shared services, including procurement, to support the delivery of patient care within the NSW health system. In 2018, HealthShare procured high-value goods and services contracts with an annual estimated total spend of around $1.8 billion, with most of the contracts of long duration.

HealthShare’s Contract Management Guide states that, without rigorous contract management, 75 per cent of projected sourcing savings can disappear within 18 months of the contract starting.

This audit examined whether HealthShare has the required capability to effectively manage high-value goods and services contracts. Contracts we examined included critical items such as food services in hospitals, patient transport services, intravenous equipment and kidney dialysis services, where risks include patient safety as well as value for money. We did not examine infrastructure, construction or information communication and technology contracts. We also did not examine HealthShare’s sourcing processes, including identifying business needs, tendering and contract award.

We assessed HealthShare against the following criteria:

  1. HealthShare's systems, policies and procedures support effective contract management and are consistent with relevant frameworks, policies and guidelines.
  2. HealthShare has capable personnel to effectively conduct the monitoring activities throughout the life of the contract.

We included the NSW Public Service Commission and NSW Treasury, through NSW Procurement, as auditees because they administer policies which directly affect contract management capability. These include:

  • NSW Procurement Board Directions and policies
  • NSW Government Procurement Policy Framework
  • Accreditation Program for Goods and Services Procurement
  • the NSW Public Sector Capability Framework.

NSW Procurement was transferred to NSW Treasury from the former Department of Finance, Services and Innovation on 1 July 2019 as part of changes to government administrative arrangements.

Conclusion
HealthShare is not applying the capability needed to effectively manage high-value (over $250,000) goods and services contracts. HealthShare's procurement framework includes elements that should support effective contract management, and it has a systematic approach to managing staff contract management capability. That said, HealthShare is not implementing key contract management elements of its own framework. As such, the value for money or savings it achieves when it negotiates contracts is at risk of being eroded over the life of these contracts.
Effective contract management is essential for HealthShare to ensure contracts it enters into are delivering the goods and services expected and achieving value for money, safety and quality. The Ministry of Health and HealthShare have invested in developing and implementing systems and tools to support effective contract management. In line with its obligations under the Agency Accreditation Program for Goods and Services Procurement (accreditation program), the Ministry of Health mandates the use of contract management plans for high-value contracts. The Ministry of Health also requires that all health entities use the PROcure contract management system for ongoing management of contracts with a value over $150,000. HealthShare is not complying with these directions for over 80 per cent of the contracts it manages.
In the absence of HealthShare following its framework, and the Ministry of Health’s directions, we looked for other evidence that HealthShare was effectively managing high-value contracts. We found that HealthShare’s contract management practices were limited by inadequate performance monitoring.
When Local Health Districts (LHDs) need to procure high-value goods and services, the Ministry of Health’s procurement policy requires that they use HealthShare to source and manage the procurement. This is to manage risk and provide oversight of procurement and contracts across the NSW health system. Despite this policy, HealthShare was only managing the sourcing stage of the procurement and transferring responsibility for contract management to the relevant LHD.

Appendix one – Response from agencies

Appendix two – Contract performance management summary

Appendix three – About the audit

Appendix four – Performance auditing

 

© Copyright reserved by the Audit Office of New South Wales. All rights reserved. No part of this publication may be reproduced without prior consent of the Audit Office of New South Wales. The Audit Office does not accept responsibility for loss or damage suffered by any person acting on or refraining from action as a result of any of this material.

Parliamentary Reference: Report number #328 - released 31 October 2019

Published

Actions for Mental health service planning for Aboriginal people in New South Wales

Mental health service planning for Aboriginal people in New South Wales

Health
Management and administration
Project management
Service delivery
Workforce and capability

A report released by the Auditor-General for New South Wales, Margaret Crawford, has found that NSW Health is not forming effective partnerships with Aboriginal communities to plan, design and deliver appropriate mental health services. There is limited evidence that NSW Health is using the knowledge and expertise of Aboriginal communities to guide how mental health care is structured and delivered.

Mental illness (including substance use disorders) is the main contributor to lower life expectancy and increased mortality in the Aboriginal population of New South Wales. It contributes to a higher burden of disease and premature death at rates that are 40 per cent higher than the next highest chronic disease group, cardiovascular disease.1 

Aboriginal people have significantly higher rates of mental illness than non Aboriginal people in New South Wales. They are more likely to present at emergency departments in crisis or acute phases of mental illness than the rest of the population and are more likely to be admitted to hospital for mental health treatments.2 

In acknowledgement of the significant health disparities between Aboriginal and non Aboriginal people, NSW Health implemented the NSW Aboriginal Health Plan 2013 2023 (the Aboriginal Health Plan). The overarching message of the Aboriginal Health Plan is ‘to build respectful, trusting and effective partnerships with Aboriginal communities’ and to implement ‘integrated planning and service delivery’ with sector partners. Through the Plan, NSW Health commits to providing culturally appropriate and ‘holistic approaches to the health of Aboriginal people'.

The mental health sector is complex, involving Commonwealth, state and non government service providers. In broad terms, NSW Health has responsibility to support patients requiring higher levels of clinical support for mental illnesses, while the Commonwealth and non government organisations offer non acute care such as assessments, referrals and early intervention treatments.

The NSW Health network includes 15 Local Health Districts and the Justice Health and Forensic Mental Health Network that provide care to patients during acute and severe phases of mental illness in hospitals, prisons and community service environments. This includes care to Aboriginal patients in the community at rates that are more than four times higher than the non Aboriginal population. Community services are usually provided as follow up after acute admissions or interactions with hospital services. The environments where NSW Health delivers mental health care include:

  • hospital emergency departments, for short term assessment and referral
  • inpatient hospital care for patients in acute and sub acute phases of mental illness
  • mental health outpatient services in the community, such as support with medications
  • custodial mental health services in adult prisons and juvenile justice centres.

The NSW Government is reforming its mental health funding model to incrementally shift the balance from hospital care to enhanced community care. In 2018–19, the NSW Government committed $400 million over four years into early intervention and specialist community mental health teams.

This audit assessed the effectiveness of NSW Health’s planning and coordination of mental health services and service pathways for Aboriginal people in New South Wales. We addressed the audit objective by answering three questions: 

  1. Is NSW Health using evidence to plan and inform the availability of mental health services for Aboriginal people in New South Wales?
  2. Is NSW Health collaborating with partners to create accessible mental health service pathways for Aboriginal people?
  3. Is NSW Health collaborating with partners to ensure the appropriateness and quality of mental health services for Aboriginal people?
Conclusion

NSW Health is not meeting the objectives of the NSW Aboriginal Health Plan, to form effective partnerships with Aboriginal Community Controlled Health Services and Aboriginal communities to plan, design and deliver mental health services.

There is limited evidence that existing partnerships between NSW Health and Aboriginal communities meet its own commitment to use the ‘knowledge and expertise of the Aboriginal community (to) guide the health system at every level, including (for) the identification of key issues, the development of policy solutions, the structuring and delivery of services' 3 and the development of culturally appropriate models of mental health care.

NSW Health is planning and coordinating its resources to support Aboriginal people in acute phases of mental illness in hospital environments. However, it is not effectively planning for the supply and delivery of sufficient mental health services to assist Aboriginal patients to manage mental illness in community environments. Existing planning approaches, data and systems are insufficient to guide the $400 million investment into community mental health services announced in the 2018–19 Budget.

NSW Health is not consistently forming partnerships to ensure coordinated care for patients as they move between mental health services. There is no policy to guide this process and practices are not systematised or widespread.

In this report, the term ‘Aboriginal people’ is used to describe both Aboriginal and Torres Strait Islander peoples. The Audit Office of NSW acknowledges the diversity of traditional countries and Aboriginal language groups across the state of New South Wales.


1 Australian Burden of Disease Study: Impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011 (unaudited).
2 Australian Institute of Health and Welfare data 2016–17 (unaudited).
3 NSW Health, The Aboriginal Health Plan 2013-2023.

In May 2019, the Audit Office of New South Wales invited Aboriginal mental health clinicians and policy experts from government and non-government organisations to attend a one-day workshop. Workshop attendees advised on factors that improve the quality and appropriateness of mental health care for Aboriginal people in New South Wales. They described appropriate mental health care as:

  • culturally safe, allowing Aboriginal people to draw strength in their identity, culture and community
  • person centred and focussed on individual needs
  • delivered by culturally competent staff with no bias
  • holistic, trauma-informed and focussed on early intervention where possible
  • delivered in places that are appropriate including outreach to homes and communities
  • welcoming of the involvement of local Aboriginal community and connected to local knowledge and expertise including totems and kinship structures. 

The definition of 'appropriate' mental health care for Aboriginal people throughout this report is based on this advice.

Aboriginal people access emergency services at much higher rates than non-Aboriginal people

The choices that people make in relation to health service options provide some insight into the suitability and appropriateness of the service to their needs.

Aboriginal people have different mental health service use patterns than non-Aboriginal people. Aboriginal people are much more likely to be in a crisis situation before receiving mental health services, usually in an emergency department of a hospital.

Aboriginal people make up three per cent of the total New South Wales population, but they constitute 11 per cent of emergency department presentations for mental health treatments. In regional areas, Aboriginal people make up 20.5 per cent of presentations at emergency departments for mental health reasons. 

A number of factors help to explain Aboriginal mental health service usage patterns. According to government and non-government mental health organisations:

  • emergency department services are better known to Aboriginal people than other mental health services
  • community-based models of care are not appropriate for Aboriginal people
  • Aboriginal people are reluctant to access community-based mental health services to prevent crisis situations
  • community mental health services are not available for Aboriginal people after hours and during the weekend, so emergency services are the only option.

The statewide proportions of Aboriginal people presenting at emergency departments for mental health treatments has been increasing over time (Exhibit 6).

Appendix one – Response from agency

Appendix two – The NSW Aboriginal Health Plan

Appendix three – About the audit

Appendix four – Performance auditing

 

Parliamentary Reference: Report number #326 - released 29 August 2019

Copyright reserved by the Audit Office of New South Wales. All rights reserved. No part of this publication may be reproduced without prior consent of the Audit Office of New South Wales. The Audit Office does not accept responsibility for loss or damage suffered by any person acting on or refraining from action as a result of any of this material.

Published

Actions for Managing growth in the NSW prison population

Managing growth in the NSW prison population

Justice
Infrastructure
Management and administration
Project management
Service delivery
Workforce and capability

The Department of Justice has relied heavily on temporary responses to accommodate growing prisoner numbers according to a report released today by the Acting Auditor-General for New South Wales, Ian Goodwin.

At the time of this audit, the NSW Department of Justice (DOJ) was responsible for delivering custodial corrections services in New South Wales through its Corrective Services NSW division (Corrective Services NSW). From 1 July 2019, the Department of Family and Community Services and Justice will be responsible for these functions. 

Within DOJ, Corrective Services NSW is responsible for administering sentences and legal orders through custodial and community-based management of adult offenders. Its key priorities are:

  • providing safe, secure and humane management of prisoners
  • reducing reoffending
  • improving community safety and confidence in the justice system. 

The prison population in New South Wales grew by around 40 per cent between 2012 to 2018, from 9,602 to 13,630 inmates. This rate of growth was higher than experienced prior to 2012. DOJ forecasts growth to continue over the short and longer-term. 

DOJ has responded to inmate population growth by doubling-up and tripling-up the number of prison beds in cells, reactivating previously closed prisons, and a $3.8 billion program of new prison capacity. DOJ has also developed a long-term prison infrastructure strategy that projects long-term needs and recommended investments to meet these needs. 

This audit assessed how efficiently and effectively DOJ is responding to growth in the NSW prison population. In this report, we have not analysed the sources of demand or recommended ways that custody may be avoided. These are largely government policy issues. 

Conclusion
The DOJ has relied heavily on temporary responses to accommodate growth in the NSW prison population. Sustained reliance on these responses is inefficient and creates risks to safety, and timely access to prisoner support services.
DOJ has experienced significant growth in the prison population since 2012. To meet demand, it has relied on temporary responses that are not designed to be sustained, including doubling-up or tripling-up the number of beds in cells, reopening previously closed facilities and using obsolete facilities. DOJ has also regularly moved inmates between its facilities to accommodate the increasing need for beds in metropolitan Sydney. 
Relying on temporary approaches over a long period contributes to prison crowding and has affected DOJ's ability to manage inmates in line with its correctional principles. It has increased risks to staff and prisoner safety, and timely inmate access to prisoner support services and programs. In addition, the cost per prisoner per day increased over the past two years.
DOJ is progressively delivering new capacity to address the growing prison population.
In response to continuing and projected growth in the prison population, the NSW Government announced a one-off $3.8 billion program to deliver around 6,100 beds by May 2021. Under the program, DOJ developed and delivered two rapid build dormitory style prisons within 18 months. DOJ’s capability to deliver the program, including implementation of new beds and new prisons, governance, project management, risk assessment and commissioning has improved over time. Most new capacity will be delivered on existing DOJ sites, mainly in regional New South Wales. 
DOJ has developed a strategy to respond to long-term projected growth in the prison population, but it has yet to be funded. 
The Corrective Services NSW Infrastructure Strategy (CSIS) sets out challenges, strategic priorities, and planned actions to respond to projected growth over the next 20 years and improve overall system efficiency and effectiveness. But, proposed actions are subject to individual business cases and funding decisions. Three versions of the CSIS have been provided to, and endorsed by, the NSW Government. The key challenge identified in the CSIS is to overcome demand for prison beds in the Sydney metropolitan region. DOJ advised that it is developing a final business case to address metropolitan capacity needs, but this is subject to government approval and funding. DOJ should continue to highlight the urgency of this issue until it is addressed, as it prevents planned actions to improve system efficiency and effectiveness.
 

The Productivity Commission’s Report on Government Services outlines the performance indicator framework for corrective services in Australia (Appendix three). We have used measures from this framework to assess the efficiency and effectiveness of DOJ’s responses to prison bed capacity needs. 

In this section, we analyse system-wide indicators as DOJ has not consistently published or reported data for individual correctional centres over the period of review.
 

Published

Actions for Governance of Local Health Districts

Governance of Local Health Districts

Health
Internal controls and governance
Management and administration

The main roles, responsibilities and relationships between Local Health Districts (LHDs), their Boards and the Ministry of Health are clear and understood, according to a report released today by the Auditor-General for New South Wales, Margaret Crawford. However, there are opportunities to achieve further maturity in the system of governance and the audit report recommended a series of actions to further strengthen governance arrangements.

Fifteen Local Health Districts (LHDs) are responsible for providing public hospital and related health services in NSW. LHDs are:

  • established as statutory corporations under the Health Services Act 1997 to manage public hospitals and provide health services within defined geographical areas
  • governed by boards of between six and 13 people appointed by the Minister for Health
  • managed by a chief executive who is appointed by the board with the concurrence of the Secretary of NSW Health
  • accountable for meeting commitments made in annual service agreements with the NSW Ministry of Health.

The NSW Ministry of Health (the Ministry) is the policy agency for the NSW public health system, providing regulatory functions, public health policy, as well as managing the health system, including monitoring the performance of hospitals and health services.

The current roles and responsibilities of LHDs and the Ministry, along with other agencies in NSW Health, were established in 2011 following a series of reforms to the structure and governance of the system. These reforms began with the report of the 'Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals' ('the Garling Inquiry'), which was released in 2008, and were followed by reforms announced by the incoming coalition government in 2011.

These reforms were intended to deliver greater local decision making, including better engagement with clinicians, consumers, local communities, and other stakeholders in the primary care (such as general practitioners) and non-government sectors.

The reforms empowered LHDs by devolving some management and accountability from the Ministry for the delivery of health services in their area. LHDs were made accountable for meeting annual obligations under service agreements.

This audit assessed the efficiency and effectiveness of the governance arrangements for LHDs. We answered two questions:

  • Are there clear roles, responsibilities and relationships between the Ministry of Health and LHDs and within LHDs?
  • Does the NSW Health Performance Framework establish and maintain accountability, oversight and strategic guidance for LHDs?
Conclusion
Main roles, responsibilities and relationships between LHDs, their boards, and the Ministry of Health are clear and understood, though there is opportunity to achieve further maturity in the system of governance for LHDs.
Main roles and responsibilities are clear and understood by local health district (LHD) board members and staff, Ministry of Health executive staff, and key stakeholders. However, there is some ambiguity for more complex and nuanced functions. A statement of principles to support decision making in a devolved system would help to ensuring that neither LHDs or the Ministry 'over-reach' into areas that are more appropriately the other's responsibility.
Better clinician engagement in LHD decision making was a key driver for devolution. This engagement has not met the expectations of devolution and requires attention as a priority.
Relationships between system participants are collaborative, though the opportunity should be taken to further embed this in the system structures and processes and complement existing interpersonal relationships and leadership styles.
Accountability and oversight mechanisms, including the Health Performance Framework and Service Agreements, have been effective in establishing accountability, oversight and strategic guidance for LHDs.
The Health Performance Framework and Service Agreements have underpinned a cultural shift toward greater accountability and oversight. However, as NSW Health is a large, complex and dynamic system, it is important that these accountability and oversight mechanisms continue to evolve to ensure that they are sufficiently robust to support good governance.
There are areas where accountability and oversight can be improved including:
  • continued progress in moving toward patient experience, outcome, and quality and safety measures
  • improving the Health Performance Framework document to ensure it is comprehensive, clear and specifies decision makers
  • greater clarity in the nexus between underperformance and escalation decisions
  • including governance-related performance measures
  • more rigour in accountability for non-service activity functions, including consumer and community engagement
  • ensuring that performance monitoring and intervention is consistent with the intent of devolution. 
There is clear understanding of the main roles and responsibilities of LHDs and the Ministry of Health under the structural and governance reforms introduced in 2011. Strongly collaborative relationships provide a good foundation on which governance arrangements can continue to mature, though there is a need to better ensure that clinicians are involved in LHD decision making.

NSW Health is large and complex system, operating in a dynamic environment. The governance reforms introduced in 2011 were significant and it is reasonable that they take time to mature.

The main roles of LHDs and the Ministry are clear and well-understood, and there is good collaboration between different parts of the system. This provides a sound foundation on which to further mature the governance arrangements of LHDs.

While the broad roles of LHDs, their boards, and the Ministry are well understood by stakeholders in the system, there are matters of detail and complexity that create ambiguity and uncertainty, including:

  • the roles and relationships between the LHDs and the Pillars
  • to what extent LHDs have discretion to pursue innovation
  • individual responsibility and obligations between chairs, boards, executive staff, and the Ministry.

These should be addressed collaboratively between boards, their executives, and the Ministry, and should be informed by a statement of principles that guides how devolved decision making should be implemented.

Better clinician engagement in health service decision making was a key policy driver for devolution. Priority should be given by LHDs and the Ministry to ensuring that clinicians are adequately engaged in LHD decision making. It appears that in many cases they are not, and this needs to be addressed.

The quality of board decision making depends on the information they are provided and their capacity to absorb and analyse that information. More can be done to promote good decision making by improving the papers that go to boards, and by ensuring that board members are well positioned to absorb the information provided. This includes ensuring that the right type and volume of information are provided to boards, and that members and executive managers have adequate data literacy skills to understand the information.

Recommendations

  1. By December 2019, the Ministry of Health should:
     
    1. work with LHDs to identify and overcome barriers that are limiting the appropriate engagement of clinicians in decision making in LHDs
    2. develop a statement of principles to guide decision making in a devolved system
    3. provide clarity on the relationship of the Agency for Clinical Innovation and the Clinical Excellence Commission to the roles and responsibilities of LHDs.
       
  2. By June 2020, LHDs boards, supported where appropriate by the Ministry of Health, should address the findings of this performance audit to ensure that local practices and processes support good governance, including:
     
    1. providing timely and consistent induction; training; and reviews of boards, members and charters
    2. ensuring that each board's governance and oversight of service agreements is consistent with their legislative functions
    3. improving the use of performance information to support decision making by boards and executive managers.
Accountability and oversight mechanisms, including the Health Performance Framework and service agreements, have been effective in establishing accountability, oversight and strategic guidance for LHDs. They have done this by driving a cultural shift that supports LHDs being accountable for meeting their obligations. These accountablity and oversight mechanisms must continue to evolve and be improved.

This cultural shift has achieved greater recognition of the importance of transparency in how well LHDs perform. However, as NSW Health is a large, complex and dynamic system, it is important that these accountability and oversight mechanisms continue to evolve to ensure that they are sufficiently robust to support good governance.

There are areas where accountability and oversight can be improved including:

  • continued progress in moving toward patient experience, outcome and value-based measures
  • improving the Health Performance Framework document to ensure it is comprehensive, clear and specifies decision makers
  • greater clarity in the nexus between underperformance and escalation decisions
  • by adding governance-related performance measures to service agreements
  • more rigour in accountability for non-service activity functions, such as consumer and community engagement
  • ensuring that performance monitoring and intervention is consistent with the intent of devolution.

Recommendations

3.    By June 2020, the Ministry of Health should improve accountability and oversight mechanisms by:

a)    revising the Health Performance Framework so that it is a cohesive and comprehensive document
b)    clarifying processes and decision making for managing performance concerns
c)    developing a mechanism to adequately hold LHDs accountable for non-service activity functions
d)    reconciling performance monitoring and intervention with the policy intent of devolution.

Published

Actions for Implementation of the NSW Government’s program evaluation initiative

Implementation of the NSW Government’s program evaluation initiative

Industry
Justice
Planning
Premier and Cabinet
Treasury
Environment
Financial reporting
Internal controls and governance
Management and administration
Risk
Service delivery
Shared services and collaboration
Workforce and capability

The NSW Government’s ‘program evaluation initiative’, introduced to assess whether service delivery programs achieve expected outcomes and value for money, is largely ineffective according to a report released today by NSW Auditor-General, Margaret Crawford.

Government services, in areas such as public order and safety, health and education, are delivered by agencies through a variety of programs. In 2016–17, the NSW Government estimates that it will spend over $73 billion on programs to deliver services.

 

Parliamentary reference - Report number #277 - released 3 November 2016

Published

Actions for Preventing and managing worker injuries

Preventing and managing worker injuries

Justice
Management and administration
Risk
Workforce and capability

Police officers and firefighters in NSW are benefiting from an improved focus on preventing and managing injuries, according to a report released today by the NSW Auditor-General. However, the audit found these gains may not be enough to offset risks associated with increasing common law claims, and death and disability scheme costs.

‘Emergency service workers face dangerous situations and traumatic scenes’ said the Auditor-General ‘and are at a significant risk of injury and illness. While the NSW Police Force and Fire & Rescue NSW have made positive shifts towards more proactive injury prevention and better return to work programs and practices, both face significant cost issues.’

 

Parliamentary reference - Report number #275 - released 13 October 2016

Published

Actions for Monitoring food safety practices in retail food businesses

Monitoring food safety practices in retail food businesses

Health
Local Government
Compliance
Internal controls and governance
Management and administration
Risk
Shared services and collaboration

New South Wales has a lower rate of foodborne illness than the national average. This reflects some good practices in the NSW Food Authority’s approach to monitoring food safety standards. It also is a factor of the long-standing commitment by local councils’ to ensuring retail food businesses meet these standards.

To ensure foodborne illness remains low, the Authority needs to better monitor its arrangements with councils which inspect retail food businesses on its behalf, and receive additional and more timely information from councils on compliance with food safety standards.

 

Parliamentary reference - Report number #274 - released 15 September 2016

Published

Actions for Reintegrating young offenders into the community after detention

Reintegrating young offenders into the community after detention

Justice
Management and administration
Shared services and collaboration
Workforce and capability

Juvenile Justice prepares and assists young people to reintegrate into the community reasonably well, given the complex needs of young people in detention, according to a report released today by the NSW Auditor-General, Margaret Crawford.

Juvenile Justice has many processes and programs to identify and address young people’s needs while in detention and links them to relevant support services in the community. It still faces some significant barriers which make reintegration difficult. Some are within its control to fix, such as improving training and recreational activities available to young people in detention. Others relate to external factors, such as the capacity of other organisations to address their reintegration needs like housing, education and employment, and a young person’s period of detention.

 

Parliamentary reference - Report number #269 - released 28 April 2016

Published

Actions for Performance frameworks in custodial centre operations

Performance frameworks in custodial centre operations

Justice
Management and administration
Risk
Service delivery

The effectiveness of Corrective Services NSW’s performance framework is limited because organisational key performance indicators (KPIs) do not cascade to public correctional centres, according to a report released today by the Acting New South Wales Auditor-General, Tony Whitfield.

'As a result, individual public correctional centres could not be assessed on how well they are contributing to overall Corrective Service objectives, and it is difficult to vary performance expectations in response to changing operating environments', said Mr Whitfield. 'Its commissioning and contestability project is designed to address these issues', he added.

 

Parliamentary reference - Report number #267 - released 3 March 2016