The New South Wales health system has repeatedly been recognised as one of the most effective systems in Australia. It is built upon the day-to-day heroism of doctors and other healthcare workers. Despite its strengths, the NSW public hospital system risks losing its status if it is not possible to attract and retain doctors to work in it.
The workforce pressures that have been apparent for some time were exacerbated by the COVID-19 pandemic, and by the growing differential between the terms and conditions available under VMO, Staff Specialist and doctor-in-training arrangements, compared to those offered by other states and territories and the private system.
As a result, patients wait for treatment, for surgery, appointments and basic care because of under-resourcing and an attitude that our system is “good enough”. The current workforce is exhausted due to chronic understaffing.
In addition, NSW doctors are amongst the lowest paid in Australia, as the government continues to fail to address the need for reform of terms and conditions. Award conditions must be updated to attract and retain staff in the NSW public hospital system.
In September, the state’s health system was dealt a further blow by the newly elected Minns government’s first budget. It included a mere 0.87 per cent increase in health spending, an amount which, after health indexation, amounts to a dire funding cut.
According to the 2024 Public Hospital Report Card, the NSW health system’s performance fell across the board. Despite being the best performing state overall, in 2023 the state reclaimed the unwanted title of longest median wait time for planned surgery.
Patient outcomes worsened for the percentage of emergency department Category 3 patients seen within 30 minutes, the proportion of patients leaving the emergency department within four hours or less, median waiting time for planned surgery and the percentage of Category 2 patients seen on time (90 days).
These figures should be a wakeup call for the NSW government. The health system is crumbling under unprecedented demand, while staff try to manage with fewer health dollars.
There is a view that health is a cost to be managed, as opposed to an investment to be made, which has resulted in a healthcare system that responds to poor health outcomes rather than actively preventing them. It is time to reframe our thinking and expand our focus.
Key takeaways
While NSW remains the best performing state in key metrics, 2022-23 saw the state experience the
longest median wait time for planned surgery.
People from NSW are now waiting over twice as long for planned surgery as they were twenty years ago. It is also one of the two states to fall in performance across
all four key metrics.
Table 1: New South Wales performance 2022-23 compared to the previous year
| Cat 3 ED on time |
4 Hour Rule |
Median Surgery wait |
Cat 2 Surgery wait |
| ❌ |
❌ |
❌ |
❌ |
Table 2: New South Wales performance 2022-23 compared to national average (below or above)
| Cat 3 ED on time |
4 Hour Rule |
Median Surgery wait |
Cat 2 Surgery wait |
| ▲ |
▲ |
▼ |
▲ |
Emergency department performance - New South Wales
New South Wales’ emergency department performance declined in comparison to the previous reporting period.
Despite remaining a national leader in the percentage of emergency patients seen within the recommended time and above average performance the “four-hour rule”, NSW public hospitals are failing to keep up with demand.
The fall from 75 per cent of emergency patients seen within four hours or less in 2016-17 to 59 per cent of patients seen within four hours in the last reporting period is indicative of a public hospital system which has failed to bounce back from the effects of COVID-19.
Figure 3: Percentage of Category 3 (urgent) ED patients seen within the recommended time of under 30 minutes - NSW
Figure 4: Percentage of ED visits completed in four hours or less - NSW
Planned surgery performance - New South Wales
The greatest weakness of New South Wales’ public hospital performance remains the state’s historically long waiting time for planned surgery. Despite leading the field in other areas, the median patient living in NSW must now wait more than twice as long as they did for planned surgery twenty years ago,
making NSW the worst performing state in this regard in 2022‒23. NSW leads the nation in the proportion of Category 2 planned surgery patients admitted within the recommended timeframe, however
their performance in this category has seen a major fall off since pre-COVID levels, from over 95 per cent to under 75 per cent in 2022‒23.
Figure 5: Median waiting time for planned surgery (days) - NSW
Figure 6: Percentage of Category 2 planned surgery patients admitted within the recommended (90 days) - NSW
Public hospital expenditure - New South Wales
Figure 7: Per person average annual percentage increase in public hospital funding by government source (constant prices)
|
2011-12 to 2021-22 |
2011-12 to 2016-17 |
2016-17 to 2021-22 |
| Commonwealth |
1.62% |
1.69% |
1.27% |
| NSW Government |
1.76% |
-0.51% |
3.79% |
Figure 8: Public Hospital Funding, per person, by government source (constant prices)
The most recent public hospital funding data are from 2021-22. In New South Wales, the majority of public hospital funding (58 per cent) comes from the state government.
This is largely in line with the national average of 59 per cent, as most state and territory governments continue to take on a majority of the funding burden for our public hospital system.
