President’s Message: clarity and determination

We are now less than 200 days from the NSW election, and August has given us a month’s worth of announcements to weigh up. Taken together, they tell us a good deal about what the NSW Government is prepared to promise, and rather less about what it is prepared to deliver.

For the first time in a long while, preventative health is genuinely on the political agenda. This week the NSW Government confirmed the NSW Preventative Health Summit will be held in Parramatta over two days, on October 7 and 9, informed by a new report on the health of the people of NSW. I welcome that, and I will be there on behalf of AMA (NSW).

But a summit is not a strategy. Doctors have watched governments convene experts, publish communiques and move on. What matters is funding, delivering and measuring results.

The evidence has already been gathered. The NSW Government’s own report, the Special Commission of Inquiry into Healthcare Funding, recommended that preventative health become a whole-of-government priority embedded in every health decision. Justice Richard Beasley asked that the recommendations be implemented within 12 months. That deadline expired four months ago.

The scale of the gap is not in dispute either. In 2023-24, just 2.9 per cent of total government health expenditure went to public health and preventative activities. The National Preventive Health Strategy sets a target of five per cent by 2030. One in five people in NSW is now aged 65 or over, and that figure is projected to grow by more than a third over the next fifteen years. About 70 per cent of our total disease burden comes from chronic conditions, and at least 36 per cent of it is linked to risk factors we already know how to modify.

This is why AMA (NSW) is asking that all sides of politics commit to dedicated, prevention funding, so that prevention stops competing with acute care every budget cycle and every local health district has the resources to run programs suited to its own community.

Prevention works when governments commit to it. Mandatory seatbelts, tobacco control, vaccination and cancer screening all began as decisions that were argued over and are now taken for granted. Every one of them has saved more lives than any hospital expansion of the same era.

None of that, however, changes what our doctors are facing this week.

At the start of August, the NSW Government told the public our hospitals were prepared for winter. They were not. A command centre coordinating demand in real time is a sensible operational tool, but redirecting ambulances between hospitals during a regular winter surge is a symptom of a system without enough capacity, not evidence of one that is working.

Later in the month, the NSW Government announced an expansion of high-volume short stay surgery beyond Northern Beaches and Hawkesbury District hospitals. Getting patients to theatre sooner matters, particularly for regional communities.

An estimated 2,300 additional procedures by July 2027 is welcome, but it sits against a waiting list of tens of thousands. Its delivery depends entirely on having the doctors, anaesthetists and theatre teams to do the work safely, with proper post-operative follow-up close to home.

We also heard this month from senior doctors raising concerns about governance, workplace culture and whether it is safe to speak up when something is wrong. I take those concerns seriously and so should the NSW Government. A health system that cannot hear from its own doctors cannot identify its own problems, let alone fix them.

That same question sits behind the submission AMA (NSW) lodged this month on the Ministry of Health’s draft Secondary Employment Policy. NSW Health has legitimate interests in managing conflicts of interest, fatigue and the proper use of public resources, but those interests are already covered by the National Law, the Medical Board’s code of conduct and existing industrial instruments. What the draft adds is another layer of bureaucracy for an over-burdened workforce, a definition of secondary employment that reaches into doctors’ private and personal interests, and no explanation of how any of it would be funded or administered. If it proceeds in its current form, some doctors will reconsider their roles in the public system altogether. That is not a risk worth taking.

Every one of these issues comes back to the same missing piece. The NSW Government has promised 9,000 additional health workers – but how many are doctors, where they will work, and will how they will staff the wards, clinics and theatres that keep being announced? Prevention needs a workforce too. Doctor-led public outpatient and rapid access clinics, early intervention and strong general practice all depend on doctors who are trained, retained and supported to stay in the NSW public system.

So, our asks going into March are unchanged, and they are practical. Fund prevention properly and protect that funding. Implement every recommendation of the Special Commission of Inquiry, with a published timetable and transparent reporting. Publish a comprehensive medical workforce strategy with real numbers attached. Expand doctor-led public outpatient and rapid access clinics. Fund public hospitals sustainably. Work with the Federal Government to strengthen general practice, and free up hospital beds by fixing the aged care and disability bottleneck.

AMA (NSW) will judge every commitment made between now and polling day against those tests. Our advocacy remains independent, evidence-based and focused on patients. We will support good policy wherever it comes from and we will say so plainly when an announcement is not what it claims to be.

And in closing, it was fantastic to see former AMA (NSW) president Dr Michael Bonning elected as the next federal AMA president at the weekend’s national conference. We are looking forward t working with him, and his incoming vice president Dr Sarah Whitelaw, to improve the health system for all.