The New South Wales (NSW) government has announced that it will withdraw from the Collaborating Hospitals’ Audit of Surgical Mortality (CHASM) by December 31, 2025. This decision effectively ends the state’s longstanding participation in the Australian and New Zealand Audit of Surgical Mortality (ANZASM), which has been instrumental in overseeing surgical quality and patient safety in the region.
The NSW Health department has indicated plans to develop an internal mortality review process by mid-2026. However, no specific replacement model has been defined, consulted on, or implemented to ensure that the same level of oversight and accountability is maintained. This move is more than a simple administrative adjustment; it dismantles an independent, clinician-led safety system that has supported surgical quality and learning in Australia for decades.
CHASM was established as a ministerial committee under the authority of the NSW Minister for Health. It has provided structured, system-level oversight of surgical outcomes and quality improvement in the state. Any decision to dismantle or weaken CHASM falls under ministerial responsibility and signifies a conscious withdrawal from established patient safety standards.
The implications of this withdrawal could be severe. The lack of an independent, peer-reviewed mortality audit raises concerns about patient safety. The Royal Australasian College of Surgeons (RACS) has expressed its disapproval and urged the Minister for Health to reconsider the decision. RACS advocates for a pause in the withdrawal from ANZASM until a replacement framework, with equivalent or stronger independent oversight, is formally established and consulted upon.
ANZASM has consistently emphasized its purpose as a confidential, peer-reviewed audit that scrutinizes deaths occurring during surgical care. It identifies clinical management issues and provides valuable lessons back to surgeons, hospitals, and health departments. The strength of this model lies in its independent scrutiny, national benchmarking, and structured professional reflection, which have collectively improved patient care across Australia.
NSW’s decision to withdraw from CHASM does not enhance safety; rather, it isolates the state from national learning and best practices. Internal hospital mortality reviews, while crucial, vary in quality and lack consistent benchmarking. They are often influenced by local pressures and resource limitations. International experience indicates that systems relying solely on internal reviews are more likely to overlook recurring systemic risks.
NSW Health has reassured the public that mortality reporting will continue and that there will be “no interruption” to patient safety processes. Nevertheless, it is essential to distinguish between reporting deaths and conducting audits. Without independent, structured peer review, mortality data risks becoming a passive record rather than an active tool for prevention. Independent audits routinely identify delays in diagnosis, transfer, or intervention that may not be evident to teams reviewing their own cases.
The annual cost of NSW’s participation in ANZASM is approximately $100,000. This expense is minimal compared to the multi-billion-dollar budget of the health system. The clinical expertise involved in the audit, including peer review and assessment, is provided pro bono by senior surgeons. The downstream costs of missed learning, such as repeated adverse events, extended hospital stays, avoidable complications, litigation, and loss of public trust, far outweigh the modest investment required to maintain independent oversight.
As NSW embarks on this significant change, the focus must remain on safeguarding patient safety and maintaining high-quality surgical standards. The future of surgical care in the state depends on the establishment of a robust framework that ensures transparency, accountability, and continuous improvement in patient outcomes.
