The latest Healthcare Quarterly report shows that between July and September, Hunter New England had a record number of emergency department (ED) presentations and the highest number of elective surgeries performed since BHI started collecting the data in 2010.

Just over 110,000 patients presented to Hunter New England public hospital EDs in the July to September quarter, up from more than 103,000 at the same time in 2018.

More than 22,000 people presented to John Hunter Hospital in that time.

The hospital had a "record" number of ED presentations, up 7.7 per cent from the same time last year.

About seven-in-10 patients (71.1 per cent) began treatment within clinically recommended time frames, down 2.1 percentage points from the year prior, and about 58 per cent of patients spent four hours or less in the ED.

More than 10,000 patients presented to the Calvary Mater ED in the July to September quarter, up 4.3 per cent from the same time in 2018.

It comes as new data shows patient demand for NSW public hospitals was higher in July to September, 2019, than any previous quarter recorded by BHI.

The quarter saw the highest numbers of ED presentations, elective surgical procedures performed, and admitted patient episodes in NSW since 2010.

There were more than 760,000 ED presentations across the state - an increase of 6.6 per cent compared with the same quarter last year, as well as more than 60,000 elective surgical procedures performed (up 3.6 per cent) and almost 500,000 admitted patient episodes (up 1.9 per cent).

BHI spokesperson, Hilary Rowell, said ED presentations in NSW had exceeded 750,000 every quarter since the beginning of the year.

"The key thing the report shows is that public hospitals right across the state were busier in July to September this year, of any quarter, since the Bureau of Health Information began reporting in 2010," she said.

"There is always a whole range of reasons... But when we look at emergency department presentations, July to September is typically the busiest quarter in any given year, and it tends to coincide with flu season.

"We know that this year's flu season started earlier and lasted longer than usual - so that's likely to be a factor, but by no means the only influence on this level of demand.

"The other thing we have noticed this year is that we haven't seen the usual seasonal dips in activity.

"Normally there would be a dip in ED activity between summer and winter, and that hasn't happened this year. So demand has simply remained very high each quarter."

Ms Rowell said there had been a general decline in the "timeliness of care" in NSW EDs.

"The John Hunter Hospital had a record quarter in terms of presentations since we started reporting in 2010," she said.

"We did see at John Hunter Hospital that timeliness slipped a little bit, but it really held up well - despite substantial increases in urgent and emergency cases.

"It is performing above its peer group on some of its key ED measures."

Brett Holmes, general secretary of the NSW Nurses and Midwives' Association, said the ongoing strain on EDs and the need for more nurses to keep up with unprecedented demand was "evident".

"It's clear our public hospital system is in desperate need of a new nurse-to-patient ratios system to manage demand more effectively, including a ratio of one nurse to three patients in our emergency departments," he said.

"Year after year, the pressure on emergency departments has continued to build and it's taking a toll on nurses. The BHI data shows presentations are rising, yet nurses and other hospital staff are simply asked to absorb the increased workloads.

"It's unsustainable and frankly, it's unsafe. The government is stubbornly relying on a staffing model that we all know can be manipulated to save hospital costs."

Mr Holmes said branch members in the Hunter have had a "long running dispute" concerning staff shortfalls in the ED at Maitland Hospital.

"We know there are also issues at Kurri Kurri, Singleton and Moree, primarily due to there being one registered nurse rostered in the emergency department after hours," he said.

NSW Health has thanked its frontline hospital staff for their extraordinary efforts over

the peak winter period, with data showing they cared for a record number of patients.

NSW Health deputy secretary, Susan Pearce, said the BHI report showed "unprecedented" patient numbers.

"Yet our teams have done us proud," Ms Pearce said.

"More than 70 per cent of patients presenting to our emergency departments had their treatment start on time and given the extraordinary numbers, it's a brilliant effort.

"We've just experienced the longest flu season in a decade - the longest since the 2009 pandemic and hospital presentations have been unrelenting since January."

The BHI report showed NSW Ambulance also had a busy quarter, with close to 320,177 ambulance responses, up by 7.6 per cent or an additional 22,543 responses on the same quarter in 2018.

The longest flu season in NSW since the 2009 pandemic was a significant contributor to record numbers of emergency department presentations across the state Hunter New England Local Health District chief executive Michael DiRienzo said.

Mr DiRienzo said the July to September quarter was a particularly busy quarter for the district, with a 6.5 per cent increase in emergency department (ED) presentations, up by almost 6,700 patients, to 110,140 when compared to the same period last year.

"It is pleasing to see some of our hospitals have improved their performance despite a large increase in presentations by patients needing the most urgent, life-saving treatment," Mr DiRienzo said.

The district experienced a 33.7 per cent increase in the number of the most urgent Triage 1 (Resuscitation) patients compared to this time last year, up by 118, to 468 patients.

"This quarter's results show just how hard our staff are working to improve patient experiences despite the ever-increasing demand on our services."

Manning Hospital's ED performance improved significantly, with an almost 16 per cent increase in the number of patients starting their treatment on time, compared with the same quarter last year. In addition, 93 per cent of patients within the Emergency triage category, the second most urgent group, started their treatment on time, a 19.3 per cent improvement when compared to the same quarter last year.

"This is a great result, considering the unit experienced a 6.5 per cent, overall increase in presentations, up 517 to 8,470, and more than double the number of Triage 1 (Resuscitation) patients than cared for during the same period last year."

Gunnedah Hospital also performed well with 87.3 per cent of patients leaving the ED within four hours. This was despite a significant 7.3 per cent increase in ED presentations compared to the same period last year, up by 160 to 2,361 presentations.

"Gunnedah Hospital's improvement is due to the additional training we're providing to staff and the streamlining of triage and assessment processes," Mr DiRienzo said.

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