The NSW health system continues to be recognised as one of the nation’s strongest performing. Its strength lies in the daily commitment and efforts of doctors and healthcare workers.
However, it is rapidly losing its status with further damaging deteriorations evident since this report was collated.
In addition to critical budget cuts, NSW Health is facing a current and potential workforce crisis. Workforce pressures have been apparent for some time but are being exacerbated 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.
NSW doctors are among the lowest paid in the country, and as the government continues to fail to address the need for reform of terms and conditions, our health system loses the ability to retain and attract essential medical staff. Our state is the country’s largest in terms of population, and one of the most expensive to live in. The NSW Government needs to come to the table on this issue.
Additionally, the state’s health budget has copped tremendous cuts over consecutive years. Last year, the health budget was another effective loss after accounting for health inflation. While the NSW Government has announced areas of investment, it has failed to deliver resources which will fix the most significant holes in the NSW health system. We know that many hospitals have grown significantly with new infrastructure, but without the workforce to match, our state won’t meet increased bed and activity levels.
As a result, the 2025 Public Hospital Report Card shows NSW patients waiting longer in emergency departments, and for planned surgery. This cannot continue. Patients deserve better and as do our hard-working health staff.
Key takeaways
New South Wales remains a particularly strong performer, leading the nation in the percentage of Category 3 ED patients seen on time and the percentage of Category 2 planned surgery patients seen on time. Despite a small improvement, NSW also retains the unwanted title of the longest median surgery wait time in the country, demonstrating the urgent need to clear the state’s planned surgery backlog
Figure 1: New South Wales performance 2023‒24 compared to the previous year
| Cat 3 ED on time |
4-hour rule |
Median surgery wait |
Cat 2 surgery wait |
| = |
❌ |
✔️ |
✔️ |
Figure 2: New South Wales performance 2023‒24 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
Despite remaining a leading performance relative to the rest of the nation, the key indicators of New South Wales’ emergency departments have declined over the past five years. Being Australia’s largest state in terms of population, the NSW public hospital system is clearly struggling to keep up with demand, with longstanding (although now abolished) public service salary caps having detrimental impact on retention of the state’s essential medical workforce.
In 2023–24, 69 per cent of patients presenting to ED triaged as urgent were seen on time, down from 76 per cent five years prior. For all patients presenting to ED, only 57 per cent of visits were completed in four hours of less, two per cent down from the year prior, and 14 per cent down from pre-COVID levels.
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 lengthy median waiting time for planned surgery. Despite leading the field in other areas, the median patient living in NSW must now wait almost twice as long as they did for planned surgery 20 years ago. Despite a minor improvement, NSW remains 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, with a major improvement from 73 per cent in 2022–23 to 82 per cent in 2023–24. The 18 per cent of Category 2 patients who are overdue for surgery are waiting on average 142.8 days in total.
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)
|
2012‒13 to 2022‒23 |
2012‒13 to 2017‒18 |
2017‒18 to 2022‒23 |
| Federal |
2.45% |
3.68% |
1.24% |
| NSW Government |
2.56% |
-0.16% |
5.27% |
Figure 8: Public hospital funding, per person, by government source (constant prices)
The most recent public hospital funding data are from 2022–23. 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 61 per cent, as most state and territory governments continue to take on a majority of the funding burden for our public hospital system.
