''Given his preference for hiring spin doctors rather than real doctors, what does he say to people needing ear, nose and throat surgery now that many hospitals have shut their books because waiting lists are so long, including Prince of Wales Hospital where 283 patients are on the list and 63 have been waiting for more than a year?''

Seven years on, and now Health Minister, Skinner could be forgiven for regretting just how much she knew about the problems in the health system while she was in opposition.

Her devastating attacks - seeing health minister after health minister out the door - are coming back to haunt her.

Figures released this week by the Bureau of Health Information show the median wait for non-urgent surgery at Prince of Wales is 334 days. Stories abound of specialist clinics, such as the ear, nose and throat clinic at Westmead Hospital, refusing to take on new patients.

When Fairfax Media this week revealed waiting lists of two years just to get on a waiting list for eye surgery, Skinner may have wished she hadn't promised to end hidden waiting lists as the Coalition surged to power.

Pre-June 30 is a dangerous time of year. Local health district bosses are frantically looking for savings to help them meet strained budgets, at the same time as trying to meet surgery and emergency targets. Surgeries have been moved or cancelled in hospitals around the state.

Skinner came into office knowing where the holes in the system were - but she would have needed an army to plug them.

She has been able to drive some improvements: the proportion of hospitals providing elective surgery within clinically recommended time-frames is increasing. And when people do get their surgery, their time in hospital is going down - a sign hospitals may be treating people more efficiently.

''As well as delivering a record health budget, we are treating more patients in faster times, we have employed more staff - 4000 extra nurses and 900 extra doctors - and we are spending billions of dollars rebuilding rundown hospitals,'' Skinner says.

But when the ''hidden waiting list'' was again revealed this week, the old rhetoric was gone. Instead, both she and Westmead Hospital described outpatient clinics as ''a safety net'' for patients who couldn't see Medicare-funded specialists or who didn't have private health cover.

Stephen Leeder, professor of public health at the University of Sydney, bristles when asked if outpatient services should be described as a safety net. ''I don't agree, frankly, that they should be described that way, any more than Medicare should,'' he says.

Yet the gradual disintegration of outpatient services has happened slowly - with waiting lists for specialist treatment building up, and growth areas, such as those in western Sydney, never adequately resourced to provide them.

''We have to be honest about the fact that outpatient clinics are just not able to cope with the demand that is out there,'' says the NSW head of the Australian Medical Association, Brian Owler.

Still, he says, ''it would be news to most people if outpatient treatment was just a safety net … And it's not really much of a safety net if you can't get an appointment''.

Outpatient clinics, which can do everything from assessing people for surgery to testing them for allergies or providing rehabilitation, developed in a piecemeal way, and some are more or less integrated into hospital care. Hospitals have been gradually shifting them into doctor's private rooms, meaning the cost is borne by Medicare payments instead.

But it also generally involves doctors charging extra to cover their costs - meaning patients go from getting free care in the outpatient clinic to substantial out-of-pocket fees.

Owler says doctors want to work in public hospitals, but feel pushed out. ''[Doctors] tend to spend more time in their rooms seeing patients and less time in outpatient departments, and I think it's a reflection of the way doctors have become disengaged from the hospital system,'' he says. ''With the gradual restrictions on the way [doctors] can treat patients in hospitals, [doctors] spend less time in them than they used to.''

Skinner promised to give local control back to local doctors, but many still feel alienated from the public system.

A survey commissioned by the AMA this week before the state budget found most don't believe there are adequate mechanisms to include them in hospital decision-making.

One in four said they intended to leave the public system in the next five years.

And the doctors' feelings seem to reflect public sentiment.

A Nielsen report card commissioned for the government's midterm in March found voters were more disappointed with health than any other area.

More than 50 per cent said the government was doing a poor job, which is a far better assessment than that given to the Keneally government (72 per cent), but the same as the Iemma government and a little lower than Bob Carr scored.

Christine Bennett has probably heard more complaints about the health system than any other person in the country.

The professor and dean of medicine at Notre Dame University in Sydney was also the chairwoman of Kevin Rudd's National Health and Hospitals Reform Commission.

''Frankly, having travelled around Australia twice and spoken to tens of thousands of people, hospital beds aren't the issue,'' she says. ''The main concern is how to get better out-of-hospital care.''

She says the experience of Andrew Sporle (see above) is typical. ''I think we need to talk about empowering the patient to have an informed financial decision, not just an informed health care decision,'' she says.

Bennett says it's people such as Sporle, who have an initial health problem that means they need to see multiple specialists, often flicking between Medicare and hospital-funded care, who have the most difficult time.

But she suspects that a lot of the anger directed at the state government is misplaced.

''People's most common complaint is 'I can't get in to see my GP'. That isn't a state responsibility frankly, but it's a complicated system and people don't understand''.

Medicare Locals - brought in to connect often disparate services - and national funding agreements (due to expire soon), to fund things such as rehabilitation care, are the two things Bennett credits as being most likely to fix the problem.

She says in Kevin Rudd's initial plan for health reform he had agreed the Commonwealth would take on full responsibility for outpatient services, but in the agreement Julia Gillard eventually negotiated with the states this was removed.

''One of 'the emperor has no clothes' moments of the reform journey was the public confirmation that projected growth in state revenues are not adequate and cannot support the rising costs of the most expensive part of our health system - hospitals,'' she wrote recently.

To fix these problems, a combined state and federal approach is needed - and hard questions are going to have to be answered about who provides what care, and at what cost.

When questioned Skinner about her comments on Monday describing outpatient eye clinics as a ''safety net'', she denied that the clinics were anything less than a ''fundamental part of the health system''.

''We have a fully funded outpatients system that provides free, highly specialised services and will continue to do so,'' she said.

But Bennett argues urgent and systematic reform needs to continue to stop the piecemeal process of disintegration of these services.

''There's a lot, lot, lot more work to be done,'' she says.