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 Managing IT Services Contracts
Managing IT Services Contracts
Neither agency (NSW Ministry of Health and NSW Police Force) demonstrated that they continued to get value for money over the life of these long term contracts or that they had effectively managed all critical elements of the three contracts we reviewed post award. This is because both agencies treated contract extensions or renewals as simply continuing previous contractual arrangements, rather than as establishing a new contract and financial commitment. Consequently, there was not a robust analysis of the continuing need for the mix and quantity of services being provided or an assessment of value for money in terms of the prices being paid.
Parliamentary reference - Report number #220 - released 1 February 2012
Actions for Readiness to respond: Follow-up audit
Readiness to respond: Follow-up audit
The Ambulance Service of New South Wales has substantially implemented the 28 recommendations of the 2001 audit report that it accepted. It has also introduced significant new initiatives to improve performance that were not part of the 2001 recommendations. It has made substantial changes to its organisation and operations to implement these changes. Many of the changes are still proceeding. The Service has addressed a key finding of the 2001 audit report - that it did not have adequate, relevant or credible management data for decision making. The Service now has five years of operational data from the Computer Aided Dispatch (CAD) system.
Parliamentary reference - Report number #167 - released 6 June 2007
Actions for Responding to homelessness
Responding to homelessness
Many projects, both Partnership Against Homelessness and by individual agencies, have shown good results or led to improvements. One example is helping mental health patients maintain stable housing. Another is providing street outreach services to homeless people in inner Sydney. Despite these efforts, we were unable to determine how well the government is responding to homelessness statewide. This is because there are no statewide performance measures or targets on homelessness. Also there is limited benchmarking, and no formal means of spreading information on homelessness initiatives and projects.
Parliamentary reference - Report number #165 - released 2 May 2007