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 Mental Health Workforce
Mental Health Workforce
Compared to the mental health workforce in most other Australian states and territories, the NSW workforce is more concentrated in acute hospitals for adult patients and is marginally smaller for its population. NSW Health increased its mental health workforce between 2006 and 2009. It has improved the geographical distribution of clinicians across the state to more closely match need. It has also increased the number of staff working with younger and older mental health patients. These are positive achievements in a time of financial stringency.
Parliamentary reference - Report number #210 - released 16 December 2010
Actions for Managing Forensic Analysis: Fingerprints and DNA
Managing Forensic Analysis: Fingerprints and DNA
Fingerprints and DNA play a critical role in solving crime and serving justice, but DNA evidence can result in more arrests, more prosecutions and more convictions. We found that while police effectively prioritise fingerprint evidence, it could better manage the screening and analysis of both fingerprint and DNA evidence to reduce delays.
Parliamentary reference - Report number #195 - released 10 February 2010
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
Actions for NSW Police Service: Staff rostering, tasking and allocation
NSW Police Service: Staff rostering, tasking and allocation
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