Health

1.1. "Ramping" is not a word New South Wales measures — this is

New South Wales does not publish an indicator called ramping. What it publishes, and what every local health district is held to in its service agreement with the Secretary of Health, is transfer of care: the percentage of patients arriving by ambulance whose care is handed over to an emergency department clinician within 30 minutes of arrival. The target is 90 per cent, and NSW Health's own framework classes a service between 80 and 90 per cent as "under performing" and anything below 80 per cent as "not performing"[i].

· In the January to March 2026 quarter the statewide figure was 80.5 per cent — half a percentage point above the line at which NSW Health's own framework would call the state's ambulance transfers "not performing"[ii]

· A year earlier the comparable statewide figure was about 83 per cent, so the trend is backwards, not forwards[iii]

· Ambulance responses across the state rose 18 per cent between the December quarter of 2018 and the December quarter of 2023, and the Auditor-General records that New South Wales carries the highest volume of emergency and urgent incidents of any state[iv]

· It has been far worse — a Legislative Council committee found transfer of care fell to 72.5 per cent in the June quarter of 2022, the lowest since the Bureau of Health Information began reporting the measure in 2013[v]

A paramedic parked in a corridor is not treating the next patient. Ramping is not an ambulance problem. It is the whole hospital, backing up to the front door.

1.2. The emergency department is where every other failure eventually arrives

Emergency departments are the only part of the health system that cannot say no, so every gap somewhere else turns up there. The scale is now enormous, and the exit is blocked.

· There were 791,987 attendances at New South Wales public hospital emergency departments in the January to March 2026 quarter alone[vi]

· In that quarter 68.4 per cent of patients started treatment on time, and 64.4 per cent of those treated and discharged were out within four hours[ii]

· The October to December 2025 quarter set two records the Bureau has not seen since it began reporting in 2010 — 820,009 attendances, and 79,004 patients who left an emergency department without, or before completing, treatment, up 15.9 per cent in a single year[vii]

· The benchmarks are not arbitrary. NSW Health's service agreements require Triage 2 patients to have clinical care commenced within 10 minutes and Triage 3 within 30 minutes, with "performing" set at 80 per cent and 75 per cent respectively[viii]

Nationally, the Productivity Commission found that only 67 per cent of emergency patients were seen within the clinically recommended time for their triage category in 2024–25, down from 74 per cent in 2015–16 — a national figure, not a New South Wales one, but the direction is unmistakable[ix]. And the consequence is not merely inconvenience: the foundational Australian study, now two decades old and drawn from Western Australian hospitals, associated overcrowding with a 30 per cent higher hazard of death by day seven and roughly 2.3 excess deaths per 1,000 emergency admissions[x].

The reason patients cannot move out of the emergency department is that the beds beyond it are full of people who no longer need them. The number of New South Wales hospital patients medically ready for discharge but unable to leave for aged care rose from about 300 in December 2023 to 776 in 2025, consuming 44,487 bed-days against 11,943 — which the Health Minister described as the equivalent of an entire hospital taken offline every day — while the Bureau recorded record-high bed occupancy in 2024–25[xi]. A Legislative Council committee had already named the fix in 2022: fund enough staffed beds to bring occupancy down to 90 per cent, and then to 85 per cent[v].

You cannot unblock the front door of a hospital by shouting at it. You unblock it by opening the back door.

1.3. Planned surgery: the target is zero, and almost nobody meets it

NSW Health's service agreements do not set a tolerance for overdue surgery. The target is zero patients waiting beyond the clinically indicated timeframe in every urgency category — Category 1 within 30 days, Category 2 within 90 days, Category 3 within 365 days — with "not performing" defined as one patient or more[xii].

· The Auditor-General found in May 2026 that New South Wales has largely cleared its COVID backlog, from almost 19,000 overdue patients in April 2022 to about 3,900 in December 2025 — real progress, and it should be said plainly[xiii]

· But in 2024–25 only four of seventeen local health districts and specialty health networks actually met the zero target[xiii]

· The same audit found that surgery hubs and pooled waiting lists were trialled successfully and then not rolled out across the state, and recommended efficiency targets benchmarked internationally[xiii]

· In the January to March 2026 quarter 56,410 planned surgeries were performed and the number waiting longer than clinically recommended fell to 3,955, from 8,588 a year earlier[vi]

· Over the same quarter, AMA (NSW), citing the Bureau's figures, reports that 2,532 procedures were contracted out to private hospitals, against 926 in the same quarter the year before — a near-tripling that sits directly alongside the improvement[xiv]

Outsourcing is not automatically wrong. Buying capacity to clear a backlog is a legitimate use of public money. What is wrong is reporting the improvement without reporting what it cost and who performed it.

A waiting list that shortens because the state rented someone else's operating theatre is a different achievement from one that shortens because our own theatres run better. Both are worth doing. Only one is worth pretending.

1.4. Country New South Wales is issued a different health system

This is the most thoroughly documented failure in New South Wales public administration, and it has been documented repeatedly, by different committees, in different chambers, over four years.

· The Legislative Council's 2022 inquiry — 21 months, 15 hearings, 220 witnesses, more than 700 submissions — found that rural, regional and remote residents have significantly poorer health outcomes and "inferior access to health and hospital services… which has led to instances of patients receiving substandard levels of care", and made 44 recommendations[xv]

· NSW Health's own evidence to that inquiry recorded that people in regional and rural local health districts live on average 2.2 years less than people in metropolitan districts — 81.4 years against 83.6 — on data running to about 2018[xvi]

· A Legislative Assembly select committee, established to check whether those 44 recommendations were actually being delivered, reported in August 2024 that "regional healthcare in NSW is the worst it's been for many years"[xvii]

· In March 2025 the same committee found that hospital birthing services continue to close "with no evident plan to re-establish these services", and that paediatric waits in regional public hospitals run from 18 months to six years[xviii]

· In May 2025 it found that "rural and remote primary care is in crisis, despite the reported completion of actions by NSW Health", and that "the intent of many… recommendations has not been fulfilled, despite NSW Health reporting that the implementation of these recommendations has been completed"[xix]

· The substitution shows up in the accounts: spending on medical locums across the system nearly doubled from about $142 million in 2020–21 to $270 million in 2023–24, and in Southern NSW Local Health District locums made up 67.56 per cent of the medical workforce[xix]

Ambulance is the one area where the country result is genuinely mixed. The Auditor-General concluded in 2024 that NSW Health is "maintaining the effectiveness of ambulance services in regional New South Wales, despite increasing demand", and several regional districts beat the state average on transfer of care. But at the 85th percentile — the slowest incidents, which is where people die — regional Priority 1A response times were 17.88 minutes against 13.58 minutes in the city[iv].

When a health department reports a recommendation as complete and the town it was written for cannot find a doctor, the reporting is the problem.

1.5. A workforce held together by overtime, locums and goodwill

The Special Commission of Inquiry into Healthcare Funding — the most comprehensive review of NSW Health in over a decade — was blunt about how the state plans its workforce, finding that the approach is not built from a bottom-up understanding of population health need and that New South Wales "has not done a very good job of predicting ahead of time how many doctors [it will] need, [and] how many nurses". It found most NSW Health awards outdated and no longer fit for purpose, with the notable exception of the nurses' and midwives' award, and that Visiting Medical Officer determinations had not been updated since 2014[xx].

· New South Wales has not legislated nurse-to-patient ratios. It has negotiated Safe Staffing Levels through a memorandum of understanding and the nurses' and midwives' award, with phase one in Level 5 and 6 emergency departments and recruitment running to July 2027. Victoria legislated ratios in 2015 and Queensland in 2016[xxi]

· The strongest evidence for ratios is Queensland's, not ours: a prospective study of 27 hospitals subject to the 2016 minimum ratios against 28 that were not found that each one fewer patient per nurse was associated with 7 per cent lower odds of death and of readmission, and that the avoided costs were more than twice the cost of the additional nursing[xxii]

· The Auditor-General found in May 2026 that NSW Health spent $1.32 billion on Visiting Medical Officers in 2024–25, up more than $123 million in a year, with no coordinated statewide governance and without effective internal controls over those payments — including no validation against Medicare item codes and no monitoring for excessive hours[xxiii]

· A separate audit found NSW Ambulance spent $116.4 million in a single year on overtime and missed meal breaks, and that it "is unable to demonstrate efficient management of unplanned leave and overtime due to work design and rostering practices that contribute to a sustained reliance on overtime"[xxiv]

The 2026–27 Budget answers with scale: the Government announces $10.3 billion in additional recurrent health funding over four years for 9,000 additional health workers, and $11.9 billion over four years for infrastructure delivering 2,500 more beds and treatment spaces[xxv]. That is a serious commitment and we say so. It is also announced in media releases rather than reconciled line by line in the Budget Papers, and money for 9,000 workers is not the same thing as 9,000 workers in the wards that need them.

Recruiting nine thousand people into a system that loses them to burnout, agency work and interstate pay is filling a bath with the plug out.

1.6. Mental health care that only starts when it becomes an emergency

In June 2024 a Legislative Council committee concluded, after around 1,200 submissions, that "mental health care in NSW has become reactive and crisis-driven… mental health care is chronically and severely underfunded and fragmented", and made 39 recommendations[xxvi].

· The same committee found that emergency departments "are not an appropriate setting to provide mental health care in the majority of presentations", and that police attendance at mental health emergencies "has been harmful in a significant number of cases"[xxvi]

· It recorded that 49 per cent of mental health related emergency department presentations in New South Wales public hospitals in 2021–22 arrived by ambulance, against 6 per cent by police — the health system is already doing this work, just at the most expensive possible moment[xxvi]

· It found that in an under-resourced community system, community treatment orders "have the capacity to be overused or misused"[xxvi]

· The AIHW reports that New South Wales spends less per person on state specialised mental health services than any other jurisdiction — $295 per capita in 2023–24, against a high of $423 in the Northern Territory — and the AMA records New South Wales at 32.1 specialised mental health beds per 100,000 people in 2021–22, down from 35.2 in 2016–17[xxvii]

NSW Health does have a service agreement indicator for exactly the failure people describe — emergency department stays of no more than 12 hours for mental health and self-harm presentations, with a 95 per cent target, the same standard as for everyone else[xxviii]. Performance against it is not routinely published.

A mental health system that can only be entered through an emergency department is not a mental health system. It is a queue with a triage nurse at the front of it.

1.7. The two cheapest things in health, and New South Wales underfunds both

The Special Commission was careful and fair. It found the New South Wales health system "is a good one", well managed, and that "the money allocated to NSW Health… is not wasted" — anyone quoting only the criticism is misrepresenting the report. Its criticism was nonetheless severe: "if universal healthcare is the aim of the NSW public health system, at least parts of that system are underfunded", and "one significant failure is that adequate and timely primary care is not available to parts of the NSW population", with outright market failure in some rural and remote areas[xxx].

The Commission also demolished the convenient state defence — that primary care is Canberra's problem and acute care is ours. Urgent Care Clinics, it said, siphon off lower-acuity patients and "nobody should pretend that they are any substitute for effective primary care. They are not." Prioritising acute care over primary care, it found, "fails to grapple in any meaningful way with the fact that the absence of adequate primary care will likely only increase the demand" for emergency and acute services, "at vastly higher cost and with inferior long term clinical outcomes"[xxx].

· The Bureau's own patient survey found that 28 per cent of New South Wales emergency department patients said their condition could have been treated by a GP but they had no other option — most often because the service was closed (50 per cent) or no appointment was available in a reasonable time (35 per cent)[xxxi]

· Nationally, the Grattan Institute estimates around half a million Australians live in "GP deserts" where people receive 40 per cent fewer GP services and are nearly twice as likely to be admitted to hospital for preventable conditions — New South Wales is not the worst-affected state, and we will not pretend otherwise[xxxii]

· The Commonwealth's tripled and expanded bulk-billing incentive now costs the equivalent of about $2.8 billion a year, yet Grattan found the areas in the bottom 5 per cent for GP services per person saw the smallest bulk-billing increases and declining service levels[xxxiii]

On prevention, the Commission could not even establish the number. NSW Health claims 10 per cent of its expenditure goes to "prevention and promotion", but the Commission found that other data indicates actual prevention spending is "no more than 2 per cent of the health budget", against a national target of 5 per cent by 2030 — and that "what is used by NSW Health for the 10 per cent funding claim is not clear. It should be."[xxxiv] Nationally, the AIHW puts government spending on public health activities at 2.9 per cent of total government health expenditure in 2023–24, with New South Wales at $198 per person against a national average of $201[xxxv].

The Government's answer to the Commission, in December 2025, supported 18 of the 41 recommendations, supported 11 in principle, noted 10 and did not support 2. The recommendation that NSW Health assess unmet primary care need and, in many cases, deliver that care itself was merely noted — the response pointing to the Commonwealth's responsibility under the National Health Reform Agreement, and to the fact that Medicare section 19(2) exemptions reach only the most remote communities and "do[] not adequately cover all costs"[xxxvi].

All of that is true, and none of it treats a single patient. The person who cannot get a GP appointment in Dubbo does not care which government is to blame — and they arrive in a state-funded emergency department either way.

2.1. Open the exit door before touching the front door

Ramping, access block and record numbers of people walking out of emergency departments untreated are one problem with one cause: there is nowhere for admitted patients to go. We would make bed capacity, not front-door throughput, the primary planning target.

· Adopt the 2022 committee's structural recommendation as a stated goal — fund enough staffed beds to bring public hospital occupancy to 90 per cent, and then 85 per cent, so that hospitals have the surge capacity to move admitted patients out of emergency[v]

· Treat aged-care discharge delay as a health-system emergency, not an accounting dispute with Canberra: 44,487 bed-days lost in a year is capacity New South Wales is already paying for and not using[xi]

· Publish, hospital by hospital and quarterly, how much of the Budget's promised 2,500 additional beds and treatment spaces has actually opened, and where[xxv]

A bed is not infrastructure until someone is rostered to staff it.

2.2. Measure ambulance performance honestly, and give paramedics tools that work

The Auditor-General found that the response-time indicator New South Wales uses "only reflects the performance of the fastest 50 per cent of incidents", that a statewide metric obscures the difference between city and country, and that only one of the 15 indicators in the NSW Ambulance service agreement is specific to regional New South Wales[iv]. We support fixing the measurement before arguing about the result.

· Publish response times at the 85th and 95th percentiles alongside the median, separately for metropolitan and regional New South Wales[iv]

· Fund and deliver a replacement NSW Ambulance electronic medical record, and bring NSW Ambulance into the Single Digital Patient Record — paramedics should not be printing hard copies of patient records in order to complete a transfer of care[iv]

· Support the outstanding recommendations of the 2022 ramping inquiry that remain undelivered, including a Chief Paramedic Officer, system-wide oversight of patient flow, and expansion of the Extended Care Paramedic program into rural and remote New South Wales[v]

· Remove the location restrictions that a parliamentary committee found are effectively de-skilling the paramedic workforce by confining Intensive Care Paramedics to large stations[xviii]

2.3. Planned surgery: run the theatres better before renting someone else's

The zero target is the right target, and four of seventeen districts meeting it is not good enough[xii][xiii]. We would take the Auditor-General's own remedy seriously rather than treating outsourcing as the default.

· Roll out surgery hubs and pooled waiting lists statewide — they were trialled successfully in New South Wales and then left on the shelf[xiii]

· Adopt efficiency and theatre-utilisation targets benchmarked internationally, as the audit recommends, and report against them publicly[xiii]

· Publish, every quarter, the number and cost of procedures contracted to private hospitals alongside the waiting-list figures, so improvement can be read for what it is[xiv]

Transparency is not an attack on the system. It is the only way anyone can tell whether it is getting better.

2.4. Safe staffing that can actually be enforced

New South Wales has staffing commitments; Victoria and Queensland have staffing law[xxi]. The difference matters when budgets tighten, because an award can be varied and a statute has to be repealed in Parliament.

· We support completing the Safe Staffing Levels rollout in full and on schedule, and then testing — publicly, on published data — whether an agreement-based model delivers what legislated minimums deliver[xxi]

· We support legislated minimum nurse-to-patient ratios where the clinical evidence supports them, and we are honest that the strongest evidence is Queensland's medical–surgical ward data, not New South Wales emergency department data: one fewer patient per nurse, 7 per cent lower odds of death and readmission, and avoided costs more than twice the cost of the extra nurses[xxii]

· We support the Special Commission's call for a genuine award reform process, including modernising Visiting Medical Officer determinations untouched since 2014[xx]

· We would implement the Auditor-General's Visiting Medical Officer recommendations in full — statewide oversight, segregation of claims checking from claims payment, and validation of claims. This is about payment controls over $1.32 billion, not about the clinicians doing the work[xxiii]

· We would treat NSW Ambulance's $116.4 million overtime and missed-meal-break bill as a rostering and work-design failure to be fixed, not a line item to be budgeted for indefinitely[xxiv]

2.5. A country health commissioner with statutory teeth

Three separate inquiries in four years have found the same things, and NSW Health has reported recommendations complete while the communities they were written for say nothing changed[xv][xix]. That is a governance failure, and it needs a governance answer.

· We support the select committee's Recommendation 18 — legislating an independent statutory office of the NSW Remote, Rural and Regional Health Commissioner, able to evaluate rural health programs, report directly to Parliament, and oblige the Government to respond[xix]

· We support its Recommendation 17 — that the Auditor-General be asked, and separately funded, to audit rural maternity services, rural health workforce planning and the Rural Health Workforce Incentive Scheme[xix]

· We support publishing a statewide maternity services plan with ten years of service-level change and a published measure of births delivered in rural public hospitals against catchment birth rates, as the committee recommended, because "no evident plan" is not an acceptable answer for a town that has lost its birthing service[xviii]

· We support expanding the rural generalist single employer pathway, which lets junior doctors keep NSW Health pay and entitlements while training across hospitals and general practice. It began in Murrumbidgee and has employed 74 trainees since 2024 across eight regional districts — a good program at a fraction of the scale of the shortage, and one that requires Commonwealth cooperation to grow[xxxvii]

Country New South Wales does not need another inquiry. It needs someone with statutory power to make the last three stick.

2.6. Move mental health care upstream of the emergency department

We support the substance of the 2024 committee's 39 recommendations, and in particular the ones that shift care out of crisis settings[xxvi].

· Increase and sustain funding across the mental health system with priority investment in community-based services, as Recommendation 19 asks — New South Wales spending less per person than any other jurisdiction is a choice, not a constraint[xxvi][xxvii]

· Expand Safe Havens towards 24/7 operation where feasible, including in high-need rural, regional and remote communities[xxvi]

· Build out a health-led crisis response so that ambulance and health clinicians, not police, are the default responders to a mental health emergency[xxvi]

· Lift pay for public mental health clinicians to at least parity with other states, because a service with no staff is not a service[xxvi]

· Publish performance against the existing 12-hour emergency department target for mental health presentations, district by district. The indicator already exists; the reporting does not[xxviii]

On funding, the committee asked the Government to explore new revenue streams and recorded that Victoria's mental health payroll surcharge raised $912 million in 2023–24[xxvi]. That is a Victorian figure and not a costing for New South Wales. We would put a dedicated, hypothecated mental health revenue stream on the table for public debate rather than pretend the gap can be closed from within the existing envelope.

2.7. Aboriginal health, led by Aboriginal organisations

On the latest available estimates, from 2020–2022, Aboriginal and Torres Strait Islander life expectancy in New South Wales is 6.8 years lower for men and 5.9 years lower for women than for other people in this state — the smallest gap of the four jurisdictions for which the ABS publishes these estimates, and still close to seven years[xxxviii]. Nationally, the Productivity Commission assesses only four of 19 Closing the Gap targets as on track; life expectancy is improving but not on track, and the social and emotional wellbeing target is going backwards[xxxix].

· We support the Special Commission's recommendations on Aboriginal Community Controlled Health Organisations — joint clinical service planning with NSW Health, an end to yearly and short-term funding cycles for core ongoing services, pooled Commonwealth and State resourcing, and rationalised reporting requirements[xl]

· We support extending state-level rural recruitment and retention incentives to ACCHO staff, who a parliamentary committee found are currently excluded from them, and amending the Health Services Act 1997 to require at least one Aboriginal community representative on every local health district board[xviii]

· We support genuine collaboration being a measured obligation rather than a stated aspiration, given the same committees found in 2025 that it "is still not occurring across remote, rural and regional NSW"[xix]

· We would ask the Auditor-General to revisit its 2019 finding that NSW Health was not meeting the objectives of the NSW Aboriginal Health Plan in mental health — a report that found Aboriginal people, about 3 per cent of the population, accounted for 11 per cent of emergency mental health presentations statewide and 21 per cent in regional areas[xxix]

Self-determination in health is not a courtesy. It is the delivery model with the best evidence behind it.

2.8. Prevention and primary care — and honesty about what a state can do

We will not pretend a New South Wales government can fix Medicare. Primary care funding, GP training numbers and bulk-billing incentives are Commonwealth responsibilities, and the national evidence is that the current settings are not reaching the communities with the least care[xxxii][xxxiii]. But the Special Commission was right that this cannot be used as a reason to do nothing, because the consequences land in state-funded emergency departments at vastly higher cost[xxx].

· Make preventive health a standing whole-of-government priority, as the Commission's first recommendation asks and the Government has said it supports[xxxiv][xxxvi]

· Publish an auditable definition of what NSW Health counts as prevention spending, and the actual figure. A department that cannot say whether it spends 10 per cent or 2 per cent cannot manage the number, and the Commission said so[xxxiv]

· Set a published trajectory towards the 5 per cent of health expenditure envisaged by the National Preventive Health Strategy, stated in dollars and years rather than as an aspiration[xxxiv][xxxv]

· Where primary care is absent and a community is going without, support local health districts to assess the unmet need and commission or deliver care — using Medicare billing to offset the cost where the rules allow — rather than waiting for intergovernmental negotiations to conclude. The Government only "noted" this recommendation; we would act on it[xxxvi]

· Use the renegotiation of the National Health Reform Agreement to argue New South Wales' case hard, including for section 19(2) arrangements that reach beyond the most remote classifications and actually cover costs[xxxvi]

· Keep Urgent Care Clinics, and stop describing them as primary care reform. The Commission was explicit that they are no substitute for effective general practice[xxx]

Every dollar this state refuses to spend on prevention and primary care, it spends four times over on an ambulance, a bed and a bad outcome. The Australian Democrats would rather pay once, early, and say what it cost.

Every figure and finding on this page is drawn from published NSW Government, parliamentary, audit and peer-reviewed material, cited below so you can check our work — the same standard we ask of government. Where a figure is national rather than New South Wales specific, or has been superseded by a later release, we say so in the text.

[i] NSW Ministry of Health: 2025–26 KPI and Other Measures Data Supplement, NSW Health Service Agreements — indicator KSA101, Transfer of Care (2025); the measure and its 90 per cent target are quoted in the same terms in Audit Office of New South Wales, Ambulance services in regional New South Wales — performance audit report (2024)

[ii] Bureau of Health Information: Healthcare Quarterly, January to March 2026 — statewide averages as reported in NSW Government local health district media releases and corroborated by AMA (NSW) (2026)

[iii] Mid North Coast Local Health District: media release quoting Bureau of Health Information, Healthcare Quarterly, January to March 2025 — statewide transfer of care figure, rounded to whole per cent (2025)

[iv] Audit Office of New South Wales: Ambulance services in regional New South Wales — performance audit report of the Auditor-General (2024)

[v] NSW Parliament, Legislative Council, Portfolio Committee No. 2 – Health: Impact of ambulance ramping and access block on the operation of hospital emergency departments in New South Wales — Report 60, including Recommendations 2, 4, 5 and 6 (2022)

[vi] Bureau of Health Information: media release, "New reports provide insights into NSW health system performance", accompanying Healthcare Quarterly, January to March 2026 and Healthcare in Focus 2026 (2026)

[vii] Bureau of Health Information: Healthcare Quarterly, October to December 2025 — released 11 March 2026, subsequently superseded as the latest quarter (2026)

[viii] NSW Ministry of Health: 2025–26 KPI and Other Measures Data Supplement — indicators SSA105b and SSA105c, Emergency Department Presentations Treated within Benchmark Times, Triage 2 and 3 (2025)

[ix] Productivity Commission: Report on Government Services 2026, Part E Health, Chapter 12 Public hospitals — national aggregate figures (2026)

[x] Medical Journal of Australia: Sprivulis PC, Da Silva J-A, Jacobs IG, Jelinek GA, Frazer ARL, "The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments" — 2006;184(5):208–212; relied on in Australasian College for Emergency Medicine, Submission 16 to the NSW inquiry into ambulance ramping and access block (2006)

[xi] NSW Government: ministerial release announcing a NSW Productivity and Equality Commission inquiry into patients unable to be discharged from hospital into aged care (6 May 2026); and Bureau of Health Information, Healthcare in Focus — New South Wales health system performance 2026 (2026)

[xii] NSW Ministry of Health: 2025–26 KPI and Other Measures Data Supplement — indicators SSA108, SSA109 and SSA110, Overdue Planned (Elective) Surgery Patients; and NSW Health PD2022_001 Planned (elective) Surgery Access Policy (2025)

[xiii] Audit Office of New South Wales: Planned surgery access — performance audit report of the Auditor-General, tabled 14 May 2026 (2026)

[xiv] Australian Medical Association (NSW): response to the Bureau of Health Information quarterly report, January to March 2026, published 10 June 2026 — stakeholder commentary citing BHI data (2026)

[xv] NSW Parliament, Legislative Council, Portfolio Committee No. 2 – Health: Health outcomes and access to health and hospital services in rural, regional and remote New South Wales — Report 57, tabled 5 May 2022, Findings 1–5 and 44 recommendations (2022)

[xvi] NSW Parliament, Legislative Council, Portfolio Committee No. 2 – Health: Report 57, paragraph 1.44, citing NSW Government Submission 630 — life expectancy by local health district, underlying data to approximately 2018 (2022)

[xvii] NSW Parliament, Legislative Assembly Select Committee on Remote, Rural and Regional Health: media release, "Committee publishes first report into healthcare in remote, rural and regional NSW", 14 August 2024 (2024)

[xviii] NSW Parliament, Legislative Assembly Select Committee on Remote, Rural and Regional Health: Report 2/58, The implementation of recommendations relating to the delivery of specific health services and specialist care in remote, rural and regional NSW — Findings 1, 5, 13, 16, 17 and 23, Recommendations 1, 20 and 22 (2025)

[xix] NSW Parliament, Legislative Assembly Select Committee on Remote, Rural and Regional Health: Report 3/58, Final report — The implementation of recommendations relating to cross-jurisdictional health reform and government consultation with remote, rural and regional communities, including Findings 1, 3, 4 and 11, Recommendations 2, 16, 17 and 18, and locum expenditure data at paragraphs 3.49–3.50 drawn from evidence to the Special Commission of Inquiry into Healthcare Funding (2025)

[xx] Special Commission of Inquiry into Healthcare Funding (Commissioner: the Hon. Justice Richard Beasley SC): Final Report, Volume 1, Chapter 2 Key findings (workforce and planning, clauses 2.103–2.137) and Volume 3, Chapter 18 The health workforce, with Recommendation 28 (2025)

[xxi] NSW Government: media release "Safe staffing to deliver more nurses for NSW hospitals" and NSW Health Safe Staffing Levels material (2024–2025); Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015 (Vic); Queensland minimum nurse-to-patient ratios in prescribed public hospital wards from 1 July 2016

[xxii] The Lancet: McHugh MD, Aiken LH, Sloane DM, Windsor C, Douglas C, Yates P, "Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals" — 2021;397(10288):1905–1913, Queensland medical–surgical wards (2021)

[xxiii] Audit Office of New South Wales: Oversight of Visiting Medical Officers — performance audit report of the Auditor-General, tabled 7 May 2026 (2026)

[xxiv] Audit Office of New South Wales: Managing unplanned leave and overtime — performance audit report of the Auditor-General, tabled 30 April 2026, covering Corrective Services NSW, Fire and Rescue NSW and NSW Ambulance (2026)

[xxv] NSW Government: ministerial releases "Record health investment for more staff and services" (14 June 2026) and "Building a better NSW" (23 June 2026), NSW Budget 2026-27 — media releases rather than Budget Papers (2026)

[xxvi] NSW Parliament, Legislative Council, Portfolio Committee No. 2 – Health: Equity, accessibility and appropriate delivery of outpatient and community mental health care in New South Wales — Report 64, tabled 4 June 2024, Findings 2, 11, 12, 14, 15 and 16, Recommendations 10, 19, 21 and 27, and paragraph 3.66 on the Victorian mental health payroll surcharge (2024)

[xxvii] Australian Institute of Health and Welfare: Expenditure on mental health-related services — state and territory specialised mental health services, recurrent expenditure per capita, 2023–24; and Australian Medical Association, Public Hospital Report Card — Mental Health Edition, NSW specialised mental health beds per 100,000 population, 2021–22 (2024)

[xxviii] NSW Ministry of Health: 2025–26 KPI and Other Measures Data Supplement — indicators KPI2404 and KPI2407, ED extended stay of no greater than 12 hours, all patients and mental health or self-harm related presentations (2025)

[xxix] Audit Office of New South Wales: Mental health service planning for Aboriginal people in New South Wales — performance audit report of the Auditor-General, tabled 29 August 2019 (2019)

[xxx] Special Commission of Inquiry into Healthcare Funding: Final Report, Volume 1, Chapter 1 Overview and Chapter 2 Key findings — clauses 1.12–1.14, 1.42, 2.4, 2.5, 2.22 and 2.31–2.35 on system funding, primary care and Urgent Care Clinics (2025)

[xxxi] Bureau of Health Information: Patients' experiences in emergency departments, 2023–24 — as reported by the NSW Government; patient self-assessment, not clinical audit (2024)

[xxxii] Grattan Institute: How to eliminate "GP deserts" — Peter Breadon and Wendy Hu, national analysis (2025)

[xxxiii] Grattan Institute: A better Medicare — How to reform GP funding, Peter Breadon and Molly Chapman, national analysis of a Commonwealth program (2026)

[xxxiv] Special Commission of Inquiry into Healthcare Funding: Final Report, Volume 1, Chapter 1 Overview, paragraphs 1.31–1.34, and Chapter 3 Schedule of Recommendations, Recommendation 1 — with the National Preventive Health Strategy 2021–2030 target of 5 per cent by 2030 (2025)

[xxxv] Australian Institute of Health and Welfare: Government expenditure on public health activities in Australia 2023–24 — released November 2025; "public health activities" is a defined category narrower than prevention in ordinary usage (2025)

[xxxvi] NSW Government: Response to the Special Commission of Inquiry into Healthcare Funding, 4 December 2025 — including the treatment of Recommendations 1 and 4 and reference to section 13 of the Addendum to the National Health Reform Agreement (2025)

[xxxvii] NSW Government: ministerial release "More doctors join rural generalist program in 2026"; NSW Health progress report on Select Committee recommendations, May 2026; and Australian Government Department of Health, Disability and Ageing, Evaluation of the Single Employer Model — Early Report (2026)

[xxxviii] Australian Bureau of Statistics: Aboriginal and Torres Strait Islander life expectancy, 2020–2022 — released 29 November 2023; estimates published for NSW, Qld, WA and NT only (2023)

[xxxix] Productivity Commission: Closing the Gap Annual Data Compilation Report July 2025 — national assessments against the National Agreement targets (2025)

[xl] Special Commission of Inquiry into Healthcare Funding: Final Report, Volume 1, Chapter 3 Schedule of Recommendations — Recommendations 7, 8 and 9 on planning, funding cycles and reporting for Aboriginal Community Controlled Health Organisations and Aboriginal Medical Services (2025)