From 31 December 2025, NSW will withdraw from the Collaborating Hospitals’ Audit of Surgical Mortality (CHASM), ending its long-standing participation in the Australian and New Zealand Audit of Surgical Mortality (ANZASM). NSW Health has indicated that an internal mortality review process may be developed by mid-2026. No replacement model has yet been defined, consulted on, or implemented.
This is not an administrative change. It is the removal of an independent, clinician-led safety system that has underpinned surgical quality and learning in Australia for decades. It represents a serious step backwards for patients.
Ministerial responsibility and patient risk
CHASM was established as a ministerial committee under the authority of the NSW Minister for Health to provide structured, system-level oversight of surgical outcomes and quality improvement in NSW. As a ministerial body operating within government, any decision to dismantle, suspend or materially weaken CHASM is a matter of ministerial responsibility and cannot be characterised as an administrative or operational adjustment.
Proceeding with the removal of an independent, clinician-led mortality audit in the absence of a replacement that preserves independent peer review, national benchmarking and legal protections represents a conscious withdrawal of established patient safety safeguards. This creates a foreseeable and avoidable risk to surgical patients in NSW and is inconsistent with the standards of transparency and accountability expected of a modern health system.
RACS is not opposed to change; it urges the Minister again to intervene, pause the withdrawal from ANZASM, and retain CHASM until an equivalent or stronger independent audit framework is formally established and consulted on, ensuring a risk-managed transition to an improved state.
Why surgical audits matter
ANZASM is not about blame. It is a confidential, peer-reviewed audit that examines deaths occurring under surgical care, identifies clinical management issues, and feeds lessons back to surgeons, hospitals and health departments. Its strength lies in independent scrutiny, national benchmarking and structured professional reflection.
This model has demonstrably improved patient care across Australia and is widely regarded as a key contributor to Australia’s strong surgical outcomes by international comparison. NSW’s withdrawal does not enhance safety; it isolates the state from national learning.
Internal hospital mortality reviews, while important, are not a substitute. They vary in quality, lack consistent benchmarking, and are inevitably influenced by local pressures and resource constraints. International experience shows that systems relying solely on internal review are more likely to miss recurring systemic risks.
A false reassurance
NSW Health has stated that mortality reporting will continue and that there will be “no interruption” to patient safety processes. Reporting deaths, however, is not the same as auditing them.
Without independent, structured peer review, 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 apparent to teams reviewing their own cases.
Cost-cutting masquerading as reform
The annual cost of NSW’s participation in ANZASM is approximately $100,000. The clinical expertise that underpins the audit — including peer review and assessment — is provided entirely pro bono by senior surgeons.
In the context of a multi-billion-dollar health system, this is a negligible investment for a high-impact safety function. By contrast, the downstream costs of missed learning — repeated adverse events, prolonged hospital stays, avoidable complications, litigation and loss of public trust — far exceed the modest cost of maintaining independent oversight.
A step backwards on transparency
ANZASM operates under federal Qualified Privilege protections, enabling sensitive clinical information to be shared for quality improvement without fear of legal exposure. Other states use this framework to escalate preventable deaths or serious clinical management issues for further review and action.
NSW has chosen not to align with this national approach. Withdrawing from the audit weakens transparency for clinicians and for patients who rightly expect governments to learn from mistakes, particularly when lives are lost.
Patients deserve better
Surgical mortality audits are foundational to a safe, learning health system. NSW patients deserve the same level of independent oversight as patients elsewhere in Australia.
RACS urges NSW Health to pause this transition and recommit to an independent mortality audit aligned with national standards. Any future model must preserve independence, robust peer review, national benchmarking and strong legal protections for clinicians.
Patient safety should never be the casualty of administrative convenience.