HUNTER New England Health has a budget this year of $2.665 billion, an increase of $126.2 million, or 4.9 per cent, on the 2021-22 figure of $2.539 billion.
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Back in 2018-19 the budget was $2.279 billion, and this figure rose by $80 million or 3.5 per cent in 2019-20, to reach $2.359 billion.
In four years, the service budget has risen by $386.1 million, or 16 per cent.
Hunter New England Local Health District confirmed that its budgets, along with all NSW local health districts, are developed using the "case management model" - also known as "activity based funding" - which was introduced in 2012.
This includes a "state efficient price" - the theoretical cost of treating a patient - which Hunter New England Health confirmed had been set this year at $5095.
In 2019, the NSW government adopted a new strategy called "outcome budgeting", which Hunter Health says "reflects the continuing shift in focus from incremental input measures to the delivery of outcomes and performance, where performance metrics are given as much importance as the financial results".
Hunter Health has been under increasing pressure in recent days with senior medical staff expressing a growing loss of confidence in the chief executive, Michael Di Rienzo.
While various budget documents for the budget figures are posted on the Hunter Health website, they do not seem to have been advertised to staff, or promoted to the public.
Urologist Sandy Grant, who spoke out about Hunter Health management this week, was one of a number of doctors in the public system who said they had not seen the figures previously.
"I'm not an accountant," Dr Grant said when asked his opinion of the budget material sent to him by the Newcastle Herald.
"But the important thing, as much as the money itself, is how far it has to go in terms of the size of the population, and the services we are expected to provide."
Hunter Health says this year's $2.665 billion figure does not include COVID-19 expenses. It says that since the start of the pandemic, it has received $254.4 million "over and above (the budget) to support our response" to COVID.
The biggest facility in the Hunter Health budget, the John Hunter Hospital, has a budget this year of $730.6 million, up $64.3 million, or 8.8 per cent, on the $660.2 million allocated in the year to June 30.
A review of the annual budgets since 2018-19 shows that on paper, the budgets for more than 45 institutions in the Hunter, New England and Taree areas have tended to grow year on year, although three Hunter services are shown as facing funding cuts this financial year.
They are John Hunter Children's Hospital, Wallsend Aged Care Facility and the Hunter's Community Health service.
Since 2018-19, the John Hunter Children's Hospital budget has gone from $88.8 million to $92.7 million in 2019-20 and $103.5 million last year, before a fall of $1.5 million or 1.5 per cent to $101.7 million dollars this financial year.
Services covered by "nursing and midwifery/population health" had budget allocations of $25.5 million, $25.8 million and $37.5 million, before a 21.9 per cent reduction this year to $30.7 million.
The Newcastle Herald found the budget figures online while investigating Wallsend MP Sonia Hornery's concerns about funding cuts to Wallsend Aged Care.
They show the aged care facility in the old Wallsend Hospital grounds receiving $9.7 million in 2018-19 and $10.8 million in 2019-20, an increase of 11.1 per cent.
But last financial year, its budget was trimmed to $10.53 million.
Its budget allocation for this financial year is $8.58 million, a reduction of almost $2 million, or more than 22 per cent. A footnote to the funding reduction says "one floor of nursing home has been closed".
The Herald has published a series of reports outlining funding concerns at the new Maitland Hospital at Metford.
Its most recent allocations have been $129.5 million, $132.4 million and $136.5 million, before a substantial $17.7 million increase - or 11.5 per cent - this financial year, to $153.9 million.
Waiting lists are one closely watched indicator, but Hunter Health has dozens of "key performance indicators" that must be measured and reported, with two volumes of KPI criteria on the website running to more than 500 pages.
Disaffected staff say pressure to meet key criteria is affecting the clinical treatment of patients.
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Ian Kirkwood
Reporting journalist at the Newcastle Herald since 1987. Editorial writer, general reporter, industrial relations, industry and coal.
Reporting journalist at the Newcastle Herald since 1987. Editorial writer, general reporter, industrial relations, industry and coal.
