We acknowledge the traditional custodians of the land on which we work and pay our respects to all Elders past and present, and to the children of today who are the Elders of the future.
Artist: Jasmine Sarin, a proud Kamilaroi and Jerrinja woman.
The NSW Ombudsman’s newly released Casebook January 2026: Investigations and complaint-handling case studies (Casebook) is providing a greater understanding of how independent oversight can address failures in public administration and deliver better outcomes for the people of NSW.
The Casebook shares learnings with public sector agencies while informing the Parliament of NSW and the public about the work of the NSW Ombudsman. It highlights a selection of the 8,492 actionable complaints received and 4 maladministration investigations finalised between 1 July and 31 December 2025.
Three of the 4 investigations outlined in Part 1 relate to the NSW healthcare system. One involves a doctor raising concerns about a backlog of 50,000 unreported radiology images at Concord Hospital. The resulting investigation recommended that the Sydney Local Health District (LHD) work together with the radiology department to develop and implement a forward-looking action plan to meet future radiology demand.
Another investigation into the Ministry of Health (the Ministry) found that doctors involved in an 8-month misconduct investigation were not informed of the specific allegations against them, and faced a delay that was unfair and unreasonable. Recommendations included that the Ministry should make a clear decision whether to progress the investigations, consider additional or other strategies to deal with any workplace issues, formally apologise to affected parties for procedural failures and delays and review internal policies.
Fourteen recommendations were made across the 4 investigations reported in this Casebook. NSW Ombudsman, Paul Miller, emphasised the importance of monitoring recommendations, stating that, “monitoring agency progress against our recommendations is a key step in holding agencies to account.”
“In 2024–2025, 98% of the recommendations responded to were accepted, illustrating how our work leads to tangible and positive change across the NSW public sector.”
The second part of Casebook details complaint-handling case studies, often showing how the resolution of an individual complaint can result in the identification and resolution of systemic issues, to the benefit of the wider community.
In one case, a system error had delayed the LHD insurance claim for over 6 months after a man paid his mother’s hospital discharge costs out-of-pocket. A $10,000 refund was secured from a LHD within 14 days and led to remedial action for others affected by the same process.
In another, an inmate with partial paraplegia was granted access to his electric wheelchair after delays by Corrective Services (CSNSW) in approving access, as he’d been using an older style manual wheelchair meant for short-term use. This case highlights the importance of clear communication across CSNSW and other agencies when it comes to the sharing and recording of information.
“A recurring theme in the Casebook is that our early intervention can resolve complaints, even where issues have been in dispute for a considerable period prior to it reaching our office,” said Mr Miller.
“Through early resolution powers, including conciliation, preliminary inquiries, direct referrals and liaison with agencies, we work to promote positive change and help ensure fair and effective decision-making across the public sector.”
Alongside complaints and investigations, the NSW Ombudsman provides guidance, resources and ongoing training to public sector agencies to strengthen complaint-handling practices. This work is guided by the 6 Principles for Effective Complaint Management — respectful treatment, information and accessibility, communication, taking ownership, timeliness and transparency — published last year as a practical framework for agencies to improve administrative practices and deliver better services to the community.
We acknowledge the traditional custodians of the land on which we work and pay our respects to all Elders past and present, and to the children of today who are the Elders of the future.
Artist: Jasmine Sarin, a proud Kamilaroi and Jerrinja woman.