Periodically we review the extent to which agencies have changed their practices as a result of our audits. This gives Parliament and the public an update on the extent of progress made.

In this follow-up audit, we examine changes following our September 2002 report, to assess whether NSW Health has improved its buying of hospital supplies using electronic systems.

NSW Health spends over $1.3 billion on hospital supplies. It is the largest expenditure area after employee costs. Reform of this area has the potential to make significant savings that could be redirected to frontline services.

As part of our series of audits in the area of e-government, our previous audit looked closely at the extent to which technology was being used to deliver potentially major savings in purchasing hospital supplies. This is a key area of so-called “process re-engineering” in the “e” field, and NSW Health provided an ideal case study.

Whilst implementing large-scale e-procurement has many technical aspects, it is not chiefly a technical issue. The key requirements for success reside in effective change management, in particular being clear as to who has the authority to make change decisions and be held accountable.

This audit looks at NSW Health’s successes to date, and its frustrations and challenges in making further progress in this field. Many of the issues raised in this report may provide lessons for any agency that is seeking to drive a significant change program.

Parliamentary reference - Report number #145 - released 23 November 2005

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

The audit identified that overall the agencies had carried out the redundancy process satisfactorily and the process, with some exceptions, complied with Government and internal policies. Government policy states that performance problems should be dealt with by managing the performance of the employee rather than restructuring/redundancy processes. In a limited number of instances certain employees, whose performance had been questioned, had been offered and accepted voluntary redundancy.

The audit also indicates that the process of redundancies has resulted in lower salary costs, in real dollar terms, without undue increase in either overtime or consultancy costs nor any detrimental effect on service quality. However, it is noted that the decrease in staffing levels occurred exclusively in the non-budget sector. Budget sector staffing levels increased by 1.4 per cent during 1989-95. There are also signs that the need for and the benefits arising out of redundancies are not well planned or measured. The need for redundancies often arises from a desire to reduce staff related costs while there is no comparison of the costs of redundancy compared to benefits.

Parliamentary reference - Report number #37 - released 17 April 1997

Following a request from the NSW Legislative Council in September 1996, a performance audit into various matters affecting the operation of the New South Wales Department of Agriculture was undertaken by The Audit Office.

Among the recommendations from this report, the Audit Office found that:

• An economic appraisal should be undertaken before all major developments, including rationalisation plans, are implemented. It should include details of anticipated benefits from the changes planned, so that their achievement can be evaluated after implementation.

• Government policies should be made explicit or else established by directives in writing. Planning Infrastructure and human resources should be planned to maximise efficiency and effectiveness. If Government chooses alternatives that have higher costs or lower benefits for the Department, then these should be explicitly funded.

• The Department should strengthen its system of internal control by strengthening the role of the Board of Management as a means of management control, directing an overhaul of the Charter of the Internal Audit Committee and using it to drive the Department’s internal audit function and ensuring implementation of an effective financial management information system.

Parliamentary reference - Report number #36 - released 27 March 1997