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

In our view, the agencies we studied cannot be sure that the grants they allocate align with their corporate objectives, and that program outcomes are achieved. This is mainly due to problems with grant selection and the evaluation of results. It was good to see that most of the grants programs had funding objectives which were fairly clear. But we found problems across most programs which could affect the fair and equitable selection of grants, such as, often no procedures for assessing applications, no assessment guidelines for advisory committees, often no clear rationale for assessments and poor documentation of the reasons for decisions.

Parliamentary reference - Report number #104 - released 4 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

The regulatory framework introduced under the Protection of the Environment Operations Act 1997, along with other initiatives progressively being implemented by the Environment Protection Authority (EPA), should enhance the overall effectiveness of environment protection in NSW. The Audit Office is of the opinion that the framework is consistent with best practice and once fully implemented, should contribute to the achievement of further improvements in the environmental performance of industry.

However while the legislative framework supports best practice in regulation and enforcement, there are a number of issues which limit the effectiveness of the reforms. Some of the problems, such as the quality of licences and the effectiveness of compliance activities, have been identified by the EPA and may be addressed through recent initiatives.

Parliamentary reference - Report number #82 - released 18 April 2001

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

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