The key goals of the NSW public sector health system are to help people stay healthy and to provide access to timely, high quality, patient centred health care.

Achieving these goals requires clear priorities, supportive leadership and staff working together, underpinned by the CORE values:

  • Collaboration - Improving and sustaining performance depends on everyone in the system working as a team
  • Openness - Transparent performance improvement processes are essential to make sure the facts are known and acknowledged, even if at times this may be uncomfortable
  • Respect - The role of everyone engaged in improving performance is valued
  • Empowerment - There must be trust on all sides and at all levels with responsible delegation of authority and accountability 

NSW Health Performance Framework

The Framework includes the performance expected of affected organisations to achieve the required levels of health improvement, service delivery and financial performance.  The Framework and associated key performance indicators listed in Service Agreements apply at both whole-of-health-service and facility or service levels, promoting and supporting a high performance culture.

The Framework sets out the performance improvement approaches, responses to performance concerns and management processes that support the achievement of these outcomes in accordance with government policy.

The NSW Health Performance Framework applies to:

  • the 15 geographical NSW local health districts and other NSW health services: NSW Ambulance; Sydney Children’s Hospitals Network; St Vincent’s Health Network; Justice Health and Forensic Mental Health Network; Affiliated Health Organisations ​
  • ​NSW Health support organisations: Agency for Clinical Innovation, Bureau of Health Information, Cancer Institute NSW, Clinical Excellence Commission, Health Education and Training Institute, HealthShare NSW and NSW Health Pathology

In relation to Affiliated Health Organisations (AHOs), the role of the Framework is to provide the context for the Service Agreements between local health districts and individual AHOs, while recognising the different legal status and governance of AHOs. Regarding support organisations, the Framework’s principles and processes apply to the extent appropriate to each organisation’s roles and functions.

Service Agreements

Service Agreements are a central component of the Performance Framework.  By setting out service and performance expectations and funding, they support the devolution of decision making, responsibility and accountability for safe, high quality, patient centred care to local health districts, other health services and support organisations.

Principal purpose

To clearly set out the service delivery and performance expectations for the funding and other support provided to districts, other health services and support organisations.


  • to enable local health districts, other health services and support organisations to deliver a coordinated, high quality health service to the communities it serves and to support its teaching, training and research roles
  • to promote accountability to government and the community
  • to ensure NSW Government and national health priorities, services, outputs and outcomes are achieved
  • to establish with each organisation a performance management and accountability system that assists in achievement of effective and efficient management and performance
  • to provide the framework for Chief Executives to establish service and performance agreements within each organisation
  • to outline each organisation’s roles and responsibilities as a key member of a wider NSW public health network of services and support organisations
  • to facilitate the progressive implementation of a purchasing framework incorporating activity based funded services
  • to develop effective and working partnerships with Aboriginal Community Controlled Health Services and ensure the health needs of Aboriginal people are considered in all health plans and programs developed by the organisation
  • to provide a framework from which to progress the development of partnerships and collaboration with Medicare Locals
  • to address the requirements of the National Health Reform Agreement in relation to Service Agreements, noting that the various requirements will commence at different stages over a number of years
Current as at: Tuesday 9 August 2022
Contact page owner: System Purchasing