Author: Dr Rhonda Kerr - Co-Chair AAHP
Australia’s largest health system, New South Wales, has just undergone one of the most comprehensive reviews in its history. Over 18 months, a team led by highly qualified legal professionals undertook a rigorous examination of healthcare funding in NSW. This involved extensive submissions, hours of testimony, and careful interrogation of the issues facing health service delivery.
Many challenges were well described. Clinicians, managers, researchers and non-government organisations gave compelling accounts of the obstacles to delivering equitable, timely and quality healthcare across the state. Insightful evidence was gathered and made publicly available. https://healthcarefunding.specialcommission.nsw.gov.au/documents/
At a cost of between $15.7(1) million and $25.5 million, the Special Commission’s report (2) identified major funding gaps in areas largely under Commonwealth responsibility: general practice, Medicare, aged care, primary health care, mental health, dental services and First Nations health. It also highlighted weaknesses in shared funding arrangements between the state and the Commonwealth.
Many of the report’s recommendations such as a sugar tax and a whole-of- government approach to prevention have been heard before. The importance of preventing chronic disease, particularly among socioeconomically disadvantaged populations, was once again reinforced.
The report acknowledges funding constraints across Local Health Districts (LHDs) and proposes a familiar solution: better planning. It calls for improved systems, workforce, and service planning grounded in a robust understanding of local and specialty needs.
(1) NSW Parliamentary Budget Office Report 20 March 2023
/NSW%20Parliamentary%20Budget%20Office%20Report%2020%20March2023https://www.parliament.nsw.gov.au/pbo/Documents/2023OppositionCostingsandRequests/C1411%20-%20Costing%20-%20Special%20Commission%20of%20Inquiry%20into%20the%20funding%20of%20healthcare%20in%20NSW.PDF
(2) NSW Special Commission Inquiry into Healthcare Funding - 16 May 2025
special-commission-inquiry-funding.pdf
And yet, strikingly, nowhere in the 1,000+ page report is there any substantive recommendation to invest in health systems or health service planning. The foundational work of Health Needs Assessment, strategic planning, and service model design at the local level, often delivered through partnerships with health planners, remains unfunded and unrecognised.
If “form follows finance,” as the adage goes, how can this level of planning occur without dedicated investment?
The report also critiques current infrastructure-led planning approaches, stating: “Because LHDs and SHNs have traditionally delivered facility- based services, planning processes have had a tendency to be driven by capital needs... The ‘real planning need’ or the needs of [a] community [have] nothing to do with a facility.”
It recommends shifting focus from "bricks and mortar" to service models delivered through general practice, nurse-led care, or allied health. While this shift is well-intentioned, the idea that diverting capital funding from acute care infrastructure to preventative and primary services will resolve current and future demand is, frankly, naïve.
Anyone working in healthcare understands the long lead times required for prevention initiatives to take effect. Even the most successful anti-smoking campaigns (arguably the gold standard in preventive health) have not eliminated the burden of lung cancer. In 2024, 66 per 100,000 men are still diagnosed annually. The need for acute treatment services remains and will for the foreseeable future.
Obesity prevention was identified in the report as a priority, yet no funding was recommended for targeted campaigns. This disconnect between analysis and investment is concerning.
The report’s Finding 2.107 rightly notes that decisions about acute services are driven by funding, workforce constraints, political realities, and legacy commitments. It calls for system wide service planning responsive to local community needs and local decision-making. But again, the resourcing remains centralised, and the LHDs remain constrained.
How, then, can localised, strategic, community-informed planning occur without funding, support or recognition for the health planning profession?
It is deeply disappointing to see the work of NSW Health Infrastructure Planners and Health Service Planners so lightly dismissed. AAHP members engaged in this work are committed professionals dedicated to improving community health outcomes through evidence-informed planning.
Equally concerning is the report’s lack of attention to future demand. There is little meaningful exploration of service projections or demographic trends. The very elements the report calls for - population health analysis, demand forecasting, socio-economic profiling - are core competencies of professional health planners.
Too often, those without a health planning background overemphasise population size and overlook the importance of epidemiology, age and gender profiles, socio-economic determinants, fertility trends, and local patterns of morbidity and mortality.
Despite the high quality of the submissions and testimonies, the report fails to grapple with the true complexity of the health landscape, and the growing demands on acute services.
The solution lies in health systems planning. But planning to the standard required (the standard AAHP members deliver) needs appropriate recognition and resourcing.