This report includes comments on financial audits of government agencies in the Health sector. In 2010-11, Ambulance Officers spent an extra 77,200 hours waiting at emergency departments for patients to transfer to hospital care. In 2010-11, only 66 per cent of patients were moved from the emergency department to an inpatient bed within eight hours of their arrival. This is significantly down on last year’s 73 per cent and well below the 80 per cent target.

We found that hospitals are generally able to deploy their VMOs and staff specialists to be at the place and time required. However, a hospital’s ability to manage supply and demand at a local level is limited. This limitation will become more critical with the current national health reforms when public hospital funding will depend on their ability to set and meet activity targets and priorities. NSW Health cannot be sure that all payments made to VMOs are for agreed and delivered services. Across the hospitals visited we found limited checking of VMO claims for payment, limited quality information on staff specialist activities and limited hospital-level analysis of trends or inconsistencies in activities and treatments.

Parliamentary reference - Report number #219 - released 14 December 2011

Organisations generally work together to improve the safety of victims when there is an overt and serious crisis, particularly where children are involved. There are no standard ways for victims and perpetrators to access help that might prevent ongoing violence and address underlying issues. This is particularly problematic where there are repeat victims and perpetrators, many of whom have complex mental health, drug and alcohol problems and are difficult to work with. New South Wales has trialled a number of projects to improve the way that organisations work together to support vulnerable people in particular communities.

Parliamentary reference - Report number #218 - released 8 November 2011

Over the last ten years the NSW Police Force (Police) has used cautioning to divert over 39,000 minor cannabis offenders from the courts, saving at least $20 million in court costs. People cautioned for minor cannabis offences are also less likely to reoffend than those dealt with by the courts. Adults are more likely to be cautioned for minor cannabis offences today than when cautioning was introduced ten years ago. However this is not the case for young offenders who are more likely to be charged today. Cautioning may help people think about the consequences of their cannabis use. However few people seek help to reduce it with only 1.6 per cent of offenders contacting the drug helpline under the adult cautioning scheme. And there have been no evaluations yet on whether cautioning reduces drug use in NSW.

Parliamentary reference - Report number #211 - released 7 April 2011

We found many aspects of good grants management, particularly in the Trust. All of the programs we looked at are clearly aligned to the Government’s objective to improve environmental outcomes. The Trust also has good practices for allocating grants. Performance in respect of results was mixed although many grants delivered tangible benefits - homes were protected from floods, degraded waterways restored and endangered habitats protected.

Generally we found that while both Department of Environment, Climate Change and Water and the NSW Environmental Trust had a range of strategies to monitor grants these were not always applied consistently or effectively. Grant programs need to be regularly evaluated to see what is working and what can be done better.

Parliamentary reference - Report number #190 - released 26 August 2009

The Magistrates Early Referral into Treatment program (MERIT) diverts adult defendants with drug problems from the local court into a drug treatment program. Recent studies of MERIT outcomes indicate that MERIT is a highly appropriate intervention program for Aboriginal defendants. It has improved the health of participants, including significant reduction in drug use and significant improvement in mental health. Better justice outcomes include lower rates of imprisonment and reduced rates of reoffending.

Overall, the ability to identify MERIT clients, the eligibility criteria, the location and the ability of MERIT teams to engage with Aboriginal defendants are key factors that limit MERIT’s capacity to treat Aboriginal defendants. MERIT needs to overcome these barriers. If MERIT is to be a truly mainstream program, it must adapt to meet the needs of all who should participate.

Parliamentary reference - Report number #189 - released 5 August 2009

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

We found no significant difference in the funding of government and opposition electorates. However, more money was given to electorates that were safely held by the major parties. These seats received $1.29 for every dollar given to marginal and independent seats with government marginals getting the least. Electorates also receive different levels of funding according to which region they are in. Such variations may reflect valid agency objectives such as meeting State Plan targets or addressing socio-economic disadvantage.

But while agencies publish who gets what, they do not adequately evaluate or explain what grant programs have achieved. As a result, there is a risk that New South Wales may not get the best value for its spending. We recommend that agencies regularly evaluate their grant programs and publish the results.

Parliamentary reference - Report number #186 - released 6 May 2009

In 1998 NSW Health developed Waste Management Guidelines to promote continuous improvement in waste management across the public health sector. Systematic implementation of the Guidelines was impeded in 1999- 2000 by resistance from the waste industry and transport workers. Since then, NSW Health has not actively promoted waste management in public hospitals. As a consequence Area Health Services (AHSs) and hospitals have developed separate and individual responses to waste management. This has resulted in inconsistent management of waste by public hospitals, inappropriate segregation of waste and additional costs of waste disposal.

Parliamentary reference - Report number #105 - released 10 December 2002

Reform of procurement in the NSW public health system is a huge, complex and difficult task. Much thought has been given to this reform. An immense amount of planning and preparatory work is required, and is apparent. In our opinion, at this time, the NSW public health system is making only limited progress towards achieving the economies in purchasing that its size and market dominance could deliver. While millions of dollars in savings are potentially available, much needs to be done to realise this. It is critical that all those involved, at all levels, ensure that reform is given priority, and driven through to fruition.

Parliamentary reference - Report number #102 - released 25 September 2002