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NSW spends around $80 billion on health each year, almost 30 per cent of Australia’s total health expenditure. Yet much of that investment is still organised around institutions, funding streams, and episodes of care rather than the journeys people take through the system. The result is plenty of innovation but too little permanence: successful models are piloted, evaluated, and then left to struggle for ongoing funding.
What would it take to move from promising local innovation to integrated care at scale? That question framed a roundtable hosted by CEDA, Nous Group, and Streamliners. The answers were practical: we need to change how we think about integration, how we organise care around people, what we hold ourselves accountable for, and what we fund.
Integrate the pathway, not the organisation
For decades, one of the truisms of integrated care has been that integration is local, built on relationships between the people who deliver care. That remains true. But local integration works far better when system-level infrastructure makes it easy for organisations to connect: common clinical pathways, referral systems, shared information, virtual front doors, and interoperable digital systems.
That means starting with a real need and designing the journey around the person. Technology belongs inside that journey, not beside it. AI solutions should be embedded into core systems rather than being standalone products. The task is to build one connected digital layer and stop funding disconnected projects.
Fund the care trajectory before the crisis
The system is still better at responding to illness than preventing it, especially for older Australians and people with chronic disease or mental illness. Investment in primary care, community support, or early intervention may prevent a hospital admission, but the organisation that pays rarely captures the benefit. Participants noted that barriers have a tendency to arise when responsibilities sit with one part of government and benefits accrue elsewhere.
The practical response is flexible or pooled funding around defined populations and pathways, coupled with shared outcomes. Much of the money is already there. Australian researchers estimate that about 60 per cent of care is high value, 30 per cent is low value or waste, and 10 per cent causes harm. Even a small shift in that ratio would be worth billions.
Put people at the centre, with choice and control
Health reform can quickly become a conversation about structures, budgets, and organisations. Consumer voices brought the discussion back to its purpose. The question to ask is always: What are we buying and who is it for?
Answering that question means giving consumers a meaningful role in the design of pathways and governance, particularly people who face the greatest barriers to navigating the system. Patients should not have to understand which government funds which service or which organisation owns which part of their pathway. They should not be made project manager.
Build trust, governance, and incentives around the pathway
Organisations are expected to work together while being funded, measured, and held accountable separately. Governance should follow the problem being solved, not simply inherit existing organisational boundaries. To put it another way, governance should be chosen rather than assigned, and patients should have a say in who coordinates their care.
Pooled funding, so often proposed as the technical fix, has worked in Australia before. Participants who had seen it work said the active ingredient was relationships, and relationships are thin. The pandemic pushed organisations into bunkers, moved meetings online, and weakened the working relationships that carried the integration agenda.
Yet NSW has advantages. Primary health networks and local health districts share roughly aligned boundaries, an advantage much of the country lacks. Rebuilding trust takes sustained intention: chairs and chief executives of districts and networks meeting in person, shared priorities on paper, and joint board meetings that end in commitments.
Community providers should also be part of those conversations, given the significant role they play in delivering care in people’s homes and communities. Private hospitals and insurers also need a seat at the table, particularly where information and care pathways cross organisational boundaries.
Stop piloting and start scaling
Pilots are valuable when they test something genuinely uncertain, but they are not an alternative to systems reform. Once a model has demonstrated that it works, the question should shift from Does this work? to What would it take to make this routine?
Scaling does not mean copying a model wholesale. It means identifying what must be standard, what must stay local, and what infrastructure is required to connect the two. That gives NSW a practical path: pick a defined population and a real problem; design the ideal pathway with consumers; invest earlier; give local organisations authority to adapt; provide shared digital infrastructure; align funding and accountability around outcomes; then learn from implementation and scale what works.
For decades, we have said that integration is local. The next step is recognising that even local integration needs a system around it. The challenge is moving from principles to operational change. The roundtable closed with a question for every leader: What will you do differently next week, and the week after, and the week after that?
Integrated care will not arrive through restructure, announcement, or accident. It will be built through the choices leaders make about pathways, funding, technology, governance and accountability, Leaders build it conversation by conversation, decision by decision, starting now.
Continue the conversation at CEDA’s Health Delivery NSW Conference in Sydney on 5 November, where leaders from across the health system will examine the next steps for improving health service delivery.
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