Public Hospital Report Card 2023

New South Wales

AMA NSW President’s Introduction

Dr Michael Bonning

AMA NSW President

During COVID, the NSW Government dedicated the necessary funding and resources to ensure the health system was adequately equipped to deal with the evolving challenges associated with the pandemic. The response was demonstrative of the State’s capacity to respond to the crisis at hand.

Whilst the COVID threat has waned, the State faces new challenges – ambulance ramping, hospital log jams, and long planned surgery waitlists. The pressure from a growing and ageing population with complex, chronic health conditions is pushing the system to its limits.

The statistics in this report reveal a clear trend – our public hospitals are falling behind on the Government’s performance measurements. Quarter on quarter our ability to meet patients’ health care needs is worsening – it is a crisis in slow motion.

The NSW Government needs to apply the same political will to finding solutions to these current challenges as it did to the COVID pandemic.

The NSW Government has dedicated significant funding to building new infrastructure, but there hasn’t been the same resourcing dedicated to bolstering workforce numbers. Operating theatres sit empty while wait lists grow longer because we do not have enough doctors, nurses, and other health workforce staff.

The current health workforce is exhausted due to chronic understaffing.

AMA (NSW) is calling on the NSW Government to create 1750 new, permanent positions for doctors, as well as modernise contractual and employment arrangements to reflect modern service delivery, contemporary models of care, and more efficient ways of working.

NSW doctors are among the lowest paid in the country with conditions dating back to the 1980s. The Government’s failure to address Award conditions is demoralising. Award and contract conditions must be updated to attract and retain the best and brightest in our public hospital system. It is frustrating to see NSW hospitals train experts in clinical care and then witness the best of these trainees leave – attracted by better remuneration packages and administrative support by interstate hospitals where their skills and training are highly valued.

We’re also calling on the State Government to apply comprehensive and sustained funding to improve planned surgery wait times. The health system should set a goal of 15% increase in planned surgery over the next two years, and a plan to reduce the wait list to be under 25,000 by 2028, with a 10-year plan to achieve ‘back to zero’ on planned surgery waitlists.

If we are to build a world-class health system, then we need a government that is willing to invest in health staff.


Emergency department

New South Wales - COVID-19 impact on public hospital emergency department patient volumes

During 2021-22 reporting period, NSW emergency department public hospital performance declined compared to the year before. Percentage of Triage Category 3 Emergency department patients seen within recommended time (< 30 minutes) dropped by three per cent compared to the year before. However, NSW continues to be the best performer nationally on this important indicator, and 14 per cent above the national average of 58 per cent. Note that the 2021-22 reporting period was heavily influenced by COVID-19 after Australia removed many Covid-19 public health measures in late 2021.

Waiting times

Percentage of Triage Category 3 emergency department patients seen within recommended time (< 30 minutes) – New South Wales

Source: The State of our Public Hospitals (DOHA 2004-2010). Australian Institute of Health and Welfare (AIHW). Emergency department care 2010-2021-22

Percentage of emergency department visits completed in four hours or less – New South Wales

Source: Australian Institute of Health and Welfare (AIHW). Emergency department care (2011-12 to 2020-21): Australian hospital statistics.
Note: National emergency access targets were abolished with effect from 1 July 2015

Planned surgery

Although in 2020-21 reporting period NSW recorded significant increases in planned surgeries compared to the same period the year before,49 most of this was offset in 2021-22, with the State recording a significant drop in the numbers of planned surgeries performed, on average around 30 per cent per quarter compared to the year before.50

Waiting times

New South Wales – COVID-19 impact on public hospital planned surgery volumes

After the increase in the median wait time for planned surgery in NSW from 53 days in 2019-20 to 68 days in 2020-21,51,52 in 2021-22, the median wait time improved to 55 days. Still, in NSW median wait time was 30 days longer than the best performing State (Victoria).53

Median waiting time for planned surgery (days) – New South Wales

Source: Australian Institute of Health and Welfare (AIHW). Planned surgery data cubes (2001-02 to 2006-07): Australian hospital statistics. Australian Institute of Health and Welfare (AIHW). Planned surgery waiting times (2007-08 to 2021-22): Australian hospital statistics

Category 2 patients

Percentage of Category 2 planned surgery patients admitted within the recommended time (90 days) New South Wales

In 2020-21 79 per cent of category 2 planned surgery patients were admitted within the recommended period in NSW. Although NSW is still the best performer on this indicator, 2021-22 marks a significant drop from 87.4 per cent in 2020-21.54

Source: The State of Our Public Hospitals (DoHA 2004-2010) FOI request reference 253-1001 lodged June 2011. 2011-12 estimate based on State and Territory Government published data; State and Territory data for 2012 calendar year published by Australian Institute of Health and Welfare (AIHW) National emergency access and planned surgery targets 2012: Australian hospital statistics. Australian Institute of Health and Welfare (AIHW) Planned surgery waiting times 2013-14 to 2021-22: Australian hospital statistics 2010-12 data not available

Public hospital funding

The most recent public hospital funding data is 2020-21, so it is affected by COVID19 response.

Commonwealth and New South Wales government per person funding for public hospitals (constant prices)

Source: Australian Institute of Health and Welfare (AIHW) 2022, Health Expenditure Australia: 2008-09 to 2019-20 viewed 10 February 2022 https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure-australia-2019-20/contents/main-visualisations/overview

Per person average annual per cent increase in public hospital funding by government source (constant prices)

2008-09 to 2012-13 2013-14 to 2017-18 2018-19-to 2020-21 2008-09 to 2020-21
NSW Govt 4.1% -1.0% 8.1% 2.82%
Commonwealth -1.3% 3.0% -0.1% 0.96%

49 AMA Public Hospital Report Card 2022

50' NSW Bureau of Health Information 2023. Data portal – Healthcare Quarterly Results-Planned surgeries performed-Overall results https://www.bhi.nsw.gov.au/data-portal

51 Australian Institute of Health and Welfare (2021). Australian Hospital Statistics: Planned surgery waiting times 2018-19 Table 4.11 https://www.aihw.gov.au/getmedia/5042f8a8-4711-455a-9c6d-60650f954fbe/Planned-surgery-waiting-times-2018-19.xlsx.aspx

52 Australian Institute of Health and Welfare (2023). Australian Hospital Statistics: Planned surgery waiting times 2021-22 data tables Table 4.11 https://www.aihw.gov.au/getmedia/9d847d52-b1d3-4366-9900-1a0d4db1055d/Planned-surgery-waiting-times-2020-21.xlsx.aspx

53 Ibid.

54 Australian Institute of Health and Welfare (2023). Australian Hospital Statistics: Planned surgery waiting times 2021-22 data tables Table