NSW budget 2016: Where will the money go?

More money for existing projects – that was Tuesday's NSW budget in a nutshell, when it comes to Illawarra spending, writes Andrew Pearson.  

Most of the 2016-17 state budget cash splash went to the region's major road upgrades, with $196 million to be spent on eight planned Princes Highway improvements between Cataract and Dignams Creek. Read on 

Money for Wagga justice system and freight infrastructure: The state government has invested in Wagga’s justice system to relieve the crippling caseload squeezing visiting circuit judges.

Tuesday’s announcement included funding for the city’s first full-time District Court judge, as well as $700,000 to round out the $19.5 million upgrade to the Wagga Courthouse. Read on

Commencement of Port Macquarie Base Hospital’s Mental Health Unit upgrade funded: Funding of $3.2 million has been included for the new inpatient mental health unit which will double the number of mental health beds to 24, and enhance the care provided to all patients including the capacity to provide care to the elderly and younger people. Read on

$10m announced for Manning Hospital in 2016-17 State budget: The funding windfall, announced in the 2016-17 NSW budget on Tuesday June 21, will continue stage one of the redevelopment of the hospital and represents half of the total amount promised by Member for Myall Lakes Stephen Bromhead before last year’s State election. Read on

Long-awaited Hexham rail by-pass under way: An end to the long delays at the Adamstown and Islington rail gates is in sight, with the Hexham to Fassifern rail by-pass receiving initial funding in this year's state budget.

Although the $14 million allocated for the coming financial year is a modest amount compared to the overall cost of the project, it is a sign the state government is closer than ever to committing to the project. Read on

Record infrastructure spend fails to reach Hunter:  There's big surpluses and barely any debt, but aside from a $14 million commitment to begin planning for a much-needed freight rail bypass from Hexham to Fassifern, the state budget doesn't offer much new spending to excite the Hunter, writes Michael McGowan.

In her second budget, Treasurer Gladys Berejiklian has delivered a $3.4 billion surplus that she says has NSW "leading the nation". Read on

Modest hospital spending in the Hunter: An allocation of $10.3 million to the second and third stages of the John Hunter Hospital's neonatal unit tops the Hunter Region's list of health spending promises in this year's budget, writes Ian Kirkwood.

All up, the expansion is set to cost $18 million and to be finished in 2018. Read on

Token funding for Maitland hospital: Despite record spending on health and infrastructure in the 2016/17 state budget announced in Tuesday, just $6.2 million has been allocated to advance the new Maitland Hospital. Read on

Current projections of the growing burden on NSW public hospitals may be underestimated, the Australian Medical Association has warned before Tuesday's state budget announcement.

Hospital emergency departments have had a record increase in presentations, with 672,000 visits between January and March 2016, the Bureau of Health Information reported.

The data also shows a 10 per cent increase in triage category 1 (immediately life-threatening) cases from the previous quarter.

The jump was cause for concern, as Triage 1 cases usually increase like clockwork by just 1 or 2 per cent quarter on quarter,  Australian Medical Association NSW branch president Brad Frankum said.

"It is alarming and surprising. Certainly if this is a sustained rise it will place a lot of extra pressure on emergency departments. Time will tell," Professor Frankum said.

Though triage 1 and triage 2 (imminently life-threatening) cases make up just 13 per cent on all emergency presentations, Prof Frankum said the sudden increase could be a warning sign that current projections of rising demand on hospital services are underestimated.

"The numbers look small but these patients require an enormous amount of resources," he said.

"If this trend continues, not only will we have more presentations, but more presentations of sicker patients, which will inevitably put pressure on the whole hospital.

"Sicker patients require more services, more high-end, intensive care, emergency surgeries that could potentially divert resources that could make dealing with other patients harder as well," he said.

Funding uncertainty from the federal government in the coming decades will put further strain on state government coffers to meet the rising demand on the health system.

A three-year interim measure separates the hospital system from an impending funding black hole of more than $50 billion nationally during the next decade, after both major federal parties failed to deliver a plan to help ease the burden of rising hospital bills beyond the next term of government.

A rise in one category of emergency department admissions is "alarming and surprising".

Elective-surgery wait lists had ballooned to a record 74,351 patients, the BHI report found, and ABS figures released in 2015 showed the number of available beds in NSW public hospitals was decreasing compared with the size of the population.

Health funding has floated near 27-28 per cent of the total state budget during the past decade, with every treasurer increasing funding just over 5 per cent every year.

But the 2014-15 budget paper cited the growth in health costs was about 6 per cent, suggesting the current level of funding growth won't keep up with the rise in health costs.

Health economists have suggested anything less than an increase of 7 per cent would be a cut in real terms, taking into account the growing population, the so-called grey tide of ageing Australians, wage increases and the cost of new medical technologies.

Health economist Stephen Duckett at the Grattan Institute said the budget would need to meet growth during the next five years and outline strategies to try to reduce the demand on hospital services.

Allocating funding for hospital redevelopment, such as Westmead hospital's planned $100 million allocation in the next budget, will be accompanied by appropriate funding for staffing and other resources, Dr Duckett said.

"[Treasury] have to be guaranteeing with the money they are putting into capital they are budgeting for the recurrent expenditure of operating the facilities," he said.

"They also need to make sure they are meeting the demands of new medical technologies and IT and so on."

Beyond hospital funding, the budget needs to allocate funding to support primary care, treating chronic illness in the community, and dental services to keep people out of hospitals, he said.

NSW Health said performance in the state's public hospitals remained stable despite the increasing numbers of people attending emergency departments every year.

The time-to-treatment performance was better than the national average in all triage categories, and NSW was the only state to meet the target for all triage categories, a spokesperson said.

The NSW government will invest $1.8 billion in mental health funding in the 2016-17 budget, an increase of $106 million on last year.

The budget will support the government's decade-long mental health reform to better shift the balance from hospital to community-based care, so that people with a mental illness can live well.

Minister for Mental Health Pru Goward said NSW is reforming mental health to build a world-class, community-based mental healthcare system.

"The new investment in this year's budget continues to support the delivery of inpatient services and includes a focus on community mental health, supporting young people and suicide prevention," Ms Goward said