We do not have a health system with collaboratively oriented values. A plan for reform of the health system must take into account differing stakeholders’ objectives and values and incorporate new values. This requires an agreement by stakeholders to embrace the common good. It will also need strong leadership and a willingness to embrace fundamental change.

Cost-shifting, blame-shifting and patient-shifting are an integral part of our health system, and the COAG health reforms are unlikely to signal their demise.

Having seen cardiac arrests in action - chest compressions, defibrillation, intubation - most friends and colleagues in acute health care would choose not to be resuscitated, unless the chances of coming out alive, cognitively and physically intact, far outweighed the discomfort and risk.

The final report of the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals was published on 27 November 2008. The report acknowledges the challenges facing the New South Wales health system, including increasing numbers of patients, rising treatment costs, workforce pressures, and the breakdown of working relations between clinicians and management.

In the short term, the only answer to emergency department overcrowding is to fund more staffed hospital beds. In the longer term, we need to think creatively about how to better manage patients with chronic and complex illness in non-hospital settings.

Staff continue to do more and more with less and less, resulting in risks to patient safety, rising workplace stress and dwindling morale. Many of our precious public hospital clinicians are voting with their feet, seeking employment in the private sector or outside the health sphere altogether.

Emergency departments are under pressure. Chronic staff shortages, access block and other problems are increasingly affecting the ability of medical and nursing staff to treat patients

Use of locum medical officers is increasing in the NSW hospital system. Locums are expensive, and have highly variable expertise and experience. Locum employment arrangements are ambiguous. Locum work may divert junior doctors from participation in specialist training. Attempts to regulate the locum workforce must be accompanied by measures that increase the appeal of public hospital work and vocational training positions.