Reports
Actions for Managing demand for ambulance services 2017
Managing demand for ambulance services 2017
NSW Ambulance has introduced several initiatives over the past decade to better manage the number of unnecessary ambulance responses and transports to hospital emergency departments. However, there is no overall strategy to guide the development of these initiatives nor do NSW Ambulance's data systems properly monitor their impact. As a result, the Audit Office was unable to assess whether NSW Ambulance's approach to managing demand is improving the efficiency of ambulance services.
NSW Ambulance uses a telephone referral system to manage triple zero calls from people with medical issues that do not require an ambulance. This has the potential to achieve efficiency improvements but there are weaknesses in NSW Ambulance's use and monitoring of this system. Paramedics are now able to make decisions about whether patients need transport to a hospital emergency department. NSW Ambulance does not routinely measure or monitor the decisions paramedics make, so it does not know whether these decisions are improving efficiency. Extended Care Paramedics who have additional skills in diagnosing and treating patients with less urgent medical issues were introduced in 2007. NSW Ambulance analysis indicates that these paramedics have the potential to improve efficiency, but have not been used as effectively as possible.
Our 2013 audit of NSW Ambulance found that accurate monitoring of activity and performance was not being conducted. More than four years later, this remains the case.
NSW Ambulance has recognised the need to change the way it manages demand and has developed initiatives that have the potential to improve efficiency. However, there are significant weaknesses in the strategy for and implementation of its demand management initiatives.
NSW Ambulance has identified the goal of moving from an emergency transport provider to a mobile health service and developed several initiatives to support this. Its demand management initiatives have the potential to contribute to the broader policy directions for the health system in New South Wales. However, there is no clear overall strategy guiding these initiatives and their implementation has been poor.
NSW Ambulance's reasons for changing its approach to demand management have not been communicated proactively to the community. Demand management initiatives that have been operating for over a decade still do not have clear performance measures or targets. Project management of new initiatives has been inadequate, with insufficient organisational resources to oversee them and inadequate engagement with other healthcare providers.
NSW Ambulance uses an in-house Vocational Education and Training course to recruit some paramedics, as well as recruiting paramedics who have completed a university degree. No other Australian ambulance services continue to provide their own Vocational Education and Training qualifications. Paramedics will need more support in several key areas to be able to fulfil their expanded roles in providing a mobile health service. Performance and development systems for paramedics are not used effectively. Up to date technology would help paramedics make better decisions and improve NSW Ambulance's ability to monitor demand management activity.
There are gaps in NSW Ambulance's oversight of the risks of some of the initiatives it has introduced, particularly its lack of information on the outcomes for patients who are not transported to hospital. Weaknesses in the way NSW Ambulance uses its data limit its ability to properly assess the risks of the demand management initiatives it has introduced.
Parliamentary reference - Report number #295 - released 13 December 2017
Actions for Planning and evaluating palliative care services in NSW
Planning and evaluating palliative care services in NSW
NSW Health’s approach to planning and evaluating palliative care is not effectively coordinated. There is no overall policy framework for palliative and end-of-life care, nor is there comprehensive monitoring and reporting on services and outcomes.
Parliamentary reference - Report number #291 - released 17 August 2017
Actions for Sydney Road Maintenance Contracts
Sydney Road Maintenance Contracts
In November 2013, Roads and Maritime Services (RMS) outsourced the maintenance of State roads in the Sydney region south and west zones using an innovative contracting approach called the Stewardship Maintenance Contract (SMC). The SMC links risk to reward, and uses a performance framework where outcomes should drive improved performance over time.
WA | VIC | QLD | NSW | |
---|---|---|---|---|
Roads managed (lane kms) | 52,659 | 50,510 | 71,353 | 80,348 |
Estimated spend ($/lane km) | 5,000 | 4,500 | 6,000 | 7,000 |
Road quality measure (%) | 99 | 99 | 94 | 91 |
Parliamentary reference - Report number #288 - released 15 June 2017
Actions for NorthConnex
NorthConnex
The processes used to assess NorthConnex adequately considered value for money for taxpayers.This report also found that the impact of tolling concessions on road users and the motorway network was consistent with policy objectives described in the 2012 NSW Long Term Transport Master Plan.
Parliamentary reference - Report number #287 - released 8 June 2017
Actions for Passenger Rail Punctuality
Passenger Rail Punctuality
Rail agencies are well placed to manage the forecast increase in passengers up to 2019, including joining the Sydney Metro Northwest to the network at Chatswood. Their plans and strategies are evidence-based, and mechanisms to assure effective implementation are sound.
Appendix one - Response from the agencies
Appendix two - Response from Audit Office
Appendix three - About the audit
Appendix four - Accuracy of punctuality measurement
Appendix five - Train and customer punctuality
Parliamentary reference - Report number #281 - released 11 April 2017
Actions for Handback of the M4 Tollway
Handback of the M4 Tollway
This audit focuses on the M4 handback. It looks at whether the road will be in good condition when the State gets it back, and whether it will cope with the extra traffic after the toll is removed. These are critical issues for taxpayers and motorists. Taxpayers don’t want to be responsible for a large repair bill and motorists don’t want to be stuck in traffic jams.
To ensure that future private sector partnerships (PPP) deal adequately with handback, we recommend that the Roads and Traffic Authority (RTA):
- ensure deeds spell out an appropriate inspection and testing program to determine repairs required to bring roads up to a satisfactory condition at handback (p.11)
- ensure deeds link condition standards and maintenance approaches to changing industry standards and approaches over the life of the PPP (p.11)
- consider including in deeds a requirement that operators provide a performance bond or similar security over the cost of handback repairs (p.11)
- review the lessons learnt from the M4 tollway handback and determine whether it should seek to negotiate changes to existing tollway deeds to better deal with handback, by June 2010 (p.11)
Parliamentary reference - Report number #193 - released 27 October 2009
Actions for Tackling Cancer with Radiotherapy
Tackling Cancer with Radiotherapy
Overall radiotherapy services are managed in a reasonably efficient and effective manner. Much is being done to further improve efficiency and effectiveness, and more can be done. While New South Wales has a number of well-established radiotherapy treatment centres, the high capital cost limits their availability in all hospitals. Some patients need to travel long distances and be away from their homes for up to seven weeks. The projected growth in demand for radiotherapy services will further challenge NSW Health and it needs to more clearly demonstrate how it will have the right facilities in the right place at the right time.
Parliamentary reference - Report number #188 - released 23 June 2009
Actions for Ambulance Service of NSW: Readiness to respond
Ambulance Service of NSW: Readiness to respond
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
Actions for Hospital emergency departments: Delivery services to patients
Hospital emergency departments: Delivery services to patients
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