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

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

The NSW model of rural fire fighting is complex, and requires an extensive amount of coordination and cooperation to function properly. This has inherent risks. In general, the model has been made to work quite well and much improvement in rural fire fighting has been achieved over the past decade. The efforts of all concerned should be recognised and applauded especially since any change must be developed cooperatively between a number of agencies and groups.

Nevertheless, past tensions and difficulties have left pockets of disagreement and resistance. The rural fire fighting culture which was developed over the course of a century has always been highly dedicated, as it is today. However, changed organisational, technical, legal, financial and environmental factors have necessitated major and continuing changes.

Parliamentary reference - Report number #57 - released 2 December 1998

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

Improving immunisation levels has been a policy priority for NSW and Commonwealth governments since the early 1990s. Along with other States they are pursuing a range of initiatives aimed at reaching immunisation target levels above 95% by the year 2000. At such levels, the occurrence of vaccine preventable diseases is minimised and their spread prevented.

There is considerable support for this policy from the public, the medical profession and all levels of government. However, like much in public health, it depends for its success on effective cooperation between many participants, both nationally and locally, with competing demands on their time and resources.

Parliamentary reference - Report number #38 - released 12 June 1997