An audit has found that “ambiguity” in the governance structure of NSW local health districts and poor engagement with medical staff is hampering performance. 

The audit, released on April 18, found the responsibilities of local health districts (LHDs), which provide public hospitals and related health services to local communities, are in some cases unclear, potentially resulting in duplications and inefficiencies.

The audit also found that more collaboration is needed with medical staff in key decisions affecting the NSW health system.

While the responsibilities of LHDs and their relationship with other bodies are generally understood by board members, staff and stakeholders, there is ambiguity around more complex functions which needs addressing, the NSW Auditor said.

Some of the functions of LHDs, such as the implementation of innovation agendas, don’t sit within the formal guideline of responsibilities, creating risks of duplication, inefficiency and program failure, the audit said.

Areas of complexity in governance, such as individual responsibility between chairs, boards, executive staff and the ministry are likely to be subject to more ambiguity, the audit says, and uncertainties around the relationship between executives and board members creates risks of conflicted interests or obligations.

The audit also found that LHDs are unclear on the extent of their engagement with related agencies and the scope of delegation.

The relationship between LHDs and “pillar” agencies like the Agency for Clinical Innovation and the Clinical Excellence Commission, for instance, is unclear, the audit says, with 20 per cent of board members saying they didn’t have a clear understanding of the roles of these agencies.

Despite the lack of clarity around the ambit of certain responsibilities, there are no high-level rules to guide decision-making where responsibilities are blurred, the audit says.

A statement of principles clarifying procedures around the delegation of responsibilities is needed, the audit says, to prevent over-reach in areas that should be another organisation’s responsibility.

Medical staff left out of decision making 

The audit has also called for the Ministry of Health to work with LHDs to overcome barriers to engagement with medical staff and provide clarity around the relationship between the body and agencies.

The report says medical staff should be included in key decisions by LHDs.

Engagement with medical staff in LHD’s decision-making has been inconsistent, the audit says, despite a push in 2011 towards strengthening clinical engagement in the delivery of services.

The audit described the current level of engagement with medical staff as “deficient,” calling for more engagement with clinicians in the decision-making of LHDs.

NSW opposition health spokesman Walt Secord said the lack of engagement was “mind-boggling.”

“This report is damning and shows how the Berejiklian Government is ignoring the views of doctors, nurses and other health and hospital workers,” he said.

The auditor has called upon the state’s LHDs to address the findings of the audit by June 2020.

NSW Health has welcomed the findings of the report and accepted all of the NSW Auditor-General’s recommendations.

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