Motions

Ambulance Ramping

The Hon. J.A.W. GARDNER (Morialta—Deputy Leader of the Opposition) (11:19): On behalf of the member for Schubert and on behalf of the opposition, I move:

That this house–

(a) condemns the Malinauskas government for delivering record ramping in South Australia, despite promising to fix it at the 2022 election;

(b) notes that state Labor has delivered more ramping in less than two years than the former Liberal government's entire four-year term;

(c) recognises that patients and paramedics have never spent more time stuck on the ambulance ramp; and

(d) expresses its significant concern at the impact record ramping has on our hardworking frontline health workers and South Australian patients.

I move this motion on behalf of the member for Schubert, and I know that all members of the parliament wish the member for Schubert and her family very well at this very important time in their lives.

The central promise of the then opposition leader, now Premier, at the March 2022 election was that Labor will fix the ramping crisis. This promise appeared on, by my count, about five million posters: on every Stobie pole, on every lamppost, in every town, suburb, principality and location in South Australia.

Mr Odenwalder: Principality?

The Hon. J.A.W. GARDNER: Yes. You could not move in this state anywhere there were people without seeing Peter Malinauskas's face on a poster that said 'Labor will fix the ramping crisis'. More than that, you may well recall that they had shaded the letters differently, so that 'the' and 'crisis' were in a very dull tone, but bold in white 'Labor will fix ramping' was front and centre. You could not move. You could not move near a television that was not featuring an advertisement with Ash the ambo telling people to vote Labor like your life depended on it.

It is a nonsense to suggest that Labor's promise to fix ramping was anything other than their central promise. More than that, it was not an endeavour, as was pointed out to us so incredibly passionately this week by a survivor of a traffic incident who had a long wait for an ambulance and then an even longer wait on a ramp. They did not say they would try: they said that they 'will' fix ramping. The Premier said that he will fix ramping. It was an absolute promise.

It was a suggestion to the people of South Australia that this was an issue of such concern that people should fear for their lives and should cast their vote accordingly, not just that they should punish the former government for not addressing it to a satisfactory conclusion but further that they had the plan to fix it. 'Labor will fix ramping': that was the clear promise, that was the clear message, with 'the' and 'crisis' much less clear, but 'Labor will fix the ramping crisis'—Labor 'will'.

I think the record has spoken for itself and made clear that there was no plan to fix ramping. Labor may have had a plan and made promises about inputs into the health system, investments in certain projects or certain workforce elements. Some of these were also commitments of the former government, but Labor said that they will fix ramping. It was not a promise on what they would invest or who would be working where: it was a promise of what the outcome would be.

What feeds into that is more than just the commitments in relation to beds, doctors or ambulances: it is the whole system. It is the disruption that Labor caused to many people who they let go in the early days. It was the active decisions Labor made in relation to dealing with the COVID pandemic. Indeed, we know a lot less about COVID and its management now than we used to, because Labor brought it all under the control of the cabinet committee. It means that the old days where the Chief Public Health Officer would update people regularly of her own volition are well and truly gone and replaced with a system where everything is kept within cabinet.

At any rate, the promise of the opposition leader was to fix the ramping crisis. South Australians were told to vote Labor like their life depended on it. How prophetic those words turned out to be, most unfortunately, because the truth is that what Labor has delivered since the election are the worst two years of ramping in the state's history. Month on month, there are record figures or terribly bad figures.

In February 2022, the Liberal government's last full month in office, 1,522 hours were lost outside our emergency departments on ramps. Fast forward to November 2023 and that number had nearly tripled to 4,285 hours lost on the ramp. The latest available transfer-of-care data from March 2024 shows 4,095 hours lost on the ramp. They are the most recent figures, and it is worse by a matter of degrees than any month during the Liberal government's four years in office. The March figure—that 4,095 hours lost on the ramp this March—includes 1,476 hours lost at the Royal Adelaide Hospital alone, its worst month of ramping in the state's history.

Under the Malinauskas government, South Australians have endured the 22 worst months of ramping in the state's history. Since Labor came to office in March 2022, 86,317 hours of paramedic and patient time have been lost on ramps outside our emergency departments. It is the equivalent, it was revealed recently, of $5.2 million in wages that have been spent for paramedics to be in ambulances on ramps outside our hospitals. It took the Malinauskas government less than two years to amass the same number of hours lost on the ramp as were amassed during four years of the former Liberal government. I can only imagine what that figure will be by the time we get to March 2026 and the conclusion of the term of this Labor government.

It is worth noting that when Labor promised through their advertisements, through their press conferences, through their posters on Stobie poles, that they would fix the ramping crisis, it was a very clear promise. It was a very clear expectation. There was no suggestion that such a promise was anything less than the most urgent task confronting any government given the honour of leading South Australia.

Yet, when challenged since the election on their failure to deliver on this promise, the Premier or the health minister will usually say a couple of things. Firstly, they will talk about ambulance response times as the most urgent figure, when that is not what the promise identified as the most urgent commitment. Secondly, they talk about the fact that they have another two years to go, that it is a four-year term and that Labor would fix the ramping crisis. One assumes the asterisk that was not on the poster would have said 'by 2026, no earlier'. The figures continue to get worse and worse—a record number in November last year and the worst March on record just passed. There is no sign that those figures are abating.

The profound policy failure that we are talking about has created enormous stress for ambulance officers and the medical staff of our struggling emergency departments. There have been serious allegations of pressure being placed on ED doctors and nurses to treat patients out of their clinical order in a bid to improve ramping numbers. These are very serious allegations indeed, and they have been made by credible people.

It has also been catastrophic for many patients. We have seen the absolute tragedy of Eddie from Hectorville, the 54-year-old man who died after waiting 10 times longer than he should have for an ambulance as a result of ramping. Eddie lived just six kilometres from the CBD. A year before Eddie's tragic death, Betty Dobson, who had recently been diagnosed with cancer, waited in extreme pain for an ambulance to come to her home. Betty and her family lived just two kilometres away from the Noarlunga ambulance station. No ambulance arrived, so her family had to drive her to hospital in immense pain. She passed away the next day. Lives do depend on fixing the ramping crisis.

Yesterday in question time we put questions to the Premier that were put to him by a constituent of the member for Hartley earlier this week, asking why he had failed on his promise to her, to South Australians around our state, to give them an outcome on ramping. The Premier was satisfied with what I think he described in his words as a 'good result', and that she suffered no serious injury, as he described. It remains to be seen whether she is satisfied with that answer. What all South Australians heard was her anxiety, her fear, her extreme discomfort and her suffering as a result of being forced to wait for an ambulance.

Now all South Australians, having voted for a government that had as its central election promise—its main tenet for its existence as a government—that they would fix ramping, are instead confronted with the knowledge that the government has not fixed ramping. Indeed, if an ambulance comes to pick them up, they are far more likely to spend far more time on a ramp now than when they were picked up in February 2022, or in any other month during the time of the former Marshall Liberal government.

This government has a clear mandate to fix ramping, but more than that a responsibility, so I do think this motion, originally moved by the member for Schubert, is appropriate, that the house should condemn the Malinauskas government for delivering record ramping despite their clear promise to fix it; that we note that the ramping of the last two years is worse than the former four; that we recognise patients and paramedics have never spent more time on the ramp; and that we express our significant concern at the impact record ramping has on our hardworking frontline health workers, for whom we are all very grateful for their constant dedication to our health and wellbeing, and to South Australian patients who deserve better.

Ms CLANCY (Elder) (11:31): I move the following amendments:

Delete paragraph (a) and insert new paragraph (a):

(a) welcomes the 1,432 additional doctors, nurses and ambos and allied health workers that have been recruited in the last two years;

Delete paragraph (b) and insert new paragraph (b):

(b) recognises that ambulance response times have improved significantly from only 47 per cent of priority 1 cases reached on time in January 2022 to 73.3 per cent in March 2024;

Delete paragraph (c) and insert new paragraph (c):

(c) notes the government's significant investment, including adding 550 more beds to the system;

Delete paragraph (d) and insert new paragraph (d):

(d) expresses its significant concern at the impact ramping has on our hardworking frontline health workers and South Australian patients.

The state government is committed to doing everything possible to address ramping at our hospitals, ensuring South Australians receive the urgent care they need when they need it. In two years, we have added $4.4 billion to the health budget over five years. Unlike the opposition, we are focused on solutions, rather than focusing on the problem, and it is interesting, though not entirely surprising, that those opposite only decided there was a problem once they were no longer in government.

We inherited a system from the former government that, following underinvestment and neglect, saw significant increases in ambulance ramping times from 750 hours in March 2018 to 2,712 hours in March 2022, a 262 per cent increase. Instead of addressing the issue, the former government made more than 100 nurses redundant, including during the pandemic, and launched a war on our ambos. Corporate liquidators were also appointed to make hundreds of millions of dollars of cuts to our hospitals.

We are not cutting beds, we are not cutting staff, and we are not bringing in corporate liquidators to run hospitals. We have comprehensive plans to address every aspect of the blockages that lead to patients waiting longer on the ramp, and in the community, for an ambulance, and to invest in new health initiatives to meet demand pressures, ease pressure on hospitals and address ramping.

We, on this side of the house, have been working tirelessly to reverse the cuts and neglect. We are pleased to share the new data that shows the government has bolstered our hospitals and health sites with 1,432 additional nurses, doctors, ambos and allied health workers in the two years since the election. These 1,432 additional staff are supporting the government's commitment to open 550 more beds right across the system, including 280 by the end of next year, to deliver better health care for South Australians.

We are delivering more resources to the SA Ambulance Service to improve wait times by recruiting 350 more ambos, with more than 170 already on the road; building four new ambulance stations in priority areas, including in my community at the Repat; delivering a new SAAS headquarters, which includes a new city ambulance station; upgrading and expanding 14 ambulance stations; and launching a life-saving smart phone app, GoodSAM, to help people in cardiac arrest access CPR support sooner, potentially sending aid within seconds of a 000 call.

The latest Report on Government Services 2022-23 released earlier this year also shows that South Australia has experienced the most significant improvements of any jurisdiction in ambulance response times in a year. It shows that average ambulance response times in metropolitan Adelaide improved 22 per cent in our first year in government, with SAAS responding to 90 per cent of all incidents within 55.6 minutes compared with 71.3 minutes the year before, more than 15 minutes faster.

The report also highlights the Malinauskas government's increased investment in SAAS, with $109.9 million in additional government funding in 2022-23—a $109.9 million increase. This compares with the previous government, which cut funding to SAAS by $13 million in its first two years.

The combination of all these measures is essential to ensure the longstanding problem of the ramping crisis can be fixed and ambulances can be released to respond to cases in the community. This continues to be our number one priority because it is so important for improving patient care.

I shudder to think what situation we would be in had Labor not won the last election: more cuts, more denial, no leadership, no investment. I am proud that we are getting on with the job and doing everything we can.

Ms PRATT (Frome) (11:36): I am delighted to rise to the original motion. I thank the member for Schubert in her absence for her tireless work and advocacy—high-profile advocacy, most importantly—on bringing to the state's attention the blight that is the ramping statistics. I completely reject the government's attempt to rewrite this motion and rewrite history.

Mr Teague: It's a whitewash.

Ms PRATT: It is a whitewash. For the benefit of the house and for those listening, I want to repeat the motion that we move from the opposition, and that is:

That this house—

(a) condemns the Malinauskas government for delivering record ramping in South Australia, despite promising to fix it at the 2022 election;

(b) notes that state Labor has delivered more ramping in less than two years than the former Liberal government’s entire four-year term;

(c) recognises that patients and paramedics have never spent more time stuck on the ambulance ramp; and

(d) expresses its significant concern at the impact record ramping has had on our hardworking frontline health workers and South Australian patients.

In supporting the original motion in full, we wholeheartedly condemn this Labor government for its breach of faith with the South Australian public. More often than not, when we are in our own communities talking about the beleaguered health system, South Australians feel betrayed and express that betrayal that in listening to a promise that the Labor party would fix ramping, sadly the South Australian public have discovered that that is not the case.

This Labor government has delivered record ramping after promising to do the complete opposite. I think, as has been remarked in previous years under a Labor government, that it takes a special type of incompetence to spend this amount of money and still get the worst results. This relates solely to the South Australian health system.

In last year's state budget, the Treasurer had to commit an extra $2 billion to the health system merely to prop up this beleaguered health system. But an additional $2 billion has not delivered the results that have been promised. So what are the results that the government speaks of? They talk about employing more doctors and nurses, but we do not see decreased pressure on the health system. They talk about more money being spent on paramedics and ambulance vehicles, but ramping has gone up. They pat themselves on the back for response times on a call-out, but the most shameful and honest statistic remains on the ramp when that transfer of care from patient in the ambulance to the emergency department takes hours and hours.

Mr Teague: Shame!

Ms PRATT: It is a shame, and it delays that precious resource that we highly value, namely the crew, from being back on the road. This is a government that promised to fix ramping, but over two years into that promise, we all know that March was the worst ever month of ramping, where in total we account for the month of March seeing over 4,000 hours lost to ramping.

As it was reported in the media, when we calculate what that means in a fiscal response, a fiscal calculation to the Treasurer and therefore to taxpayers, we know that that calculation is $5.2 million in ambulance wages lost to ramping. Imagine what we could do with $5.2 million in regional health, in mental health, in preventative health. This is worse off than the former Liberal government's complete term. To sadly have to remark on the statistic of a total of 86,000 hours being lost so far in this Labor government's two-year term is something they should be ashamed of.

We know that ambulance ramping at our public hospitals has reached the highest peak on record. It is important that this motion comes to the house to allow the opposition to honestly ventilate and hold to account the government's promise in opposition at the time, 'We will fix ramping,' only to find that they were empty and vacuous words.

We too often are reflecting on anecdotes from those who have lived to tell the tale, like Rita, and, sadly, poor, vulnerable men like Eddie, who have not been able to express the devastation and distress that a patient must feel stuck in an ambulance for hours and hours with no certainty about that transfer of care, no full diagnosis. They are in the wonderful care of our paramedics, but the anxiety is an unnecessary addition and symptom of a system that is not working.

When I reflect on the promise that the government made to the people of South Australia, 'We will fix ramping' was on every corflute on every Stobie pole. We had faith in our paramedics, and when people like Ash the ambo came into our social media and mainstream media consumption telling the South Australian public to vote Labor like its life depended on it, people did. But even that was a breach of promise. We have continued to see deaths reported in relation to ramping.

We have a breach of promise and a betrayal of the South Australian voting public. We have record statistics only two years in, at the halfway mark, as the member for Morialta said. Who knows what that statistic is going to be at the end of four years of this current Labor government. We know that calculating those hours lost is $5.2 million.

When we extrapolate that out to the false economy the government is running on health, then I repeat: what could we do with $5.2 million in regional health, and what does it mean for this government to be failing in its promise to deliver on improving ramping statistics? What is the ripple effect on the regions? I will tell you, Mr Speaker. We are seeing a retreat from country hospitals. We are seeing a retreat by this government from investment in country hospitals. There are reports of ambulances being ramped at some of our bigger hospitals.

The motion before us rightly asks us to express our concern and the impact on our hardworking frontline health workers. In the city that is a paid workforce but in country regions, throughout the electorate of Frome for example, what is paramount, what is clear to us, is that we are relying on a volunteer workforce. Our emergency responders through the CFS, SES and SAAS are volunteers, so what does it mean for this government to not deliver on its promise to fix ramping? What does it mean in regional South Australia?

This financial year's budget had a top-up of $2 billion. We are a month away from finding out what this government's next funding commitment is to health, but I predict that we are not going to see that money flowing appropriately into mental health and we are not going to see it flowing into country hospitals. This government talks about where that money has gone and it has been recruiting and training more doctors and nurses but there is no incentive to speak of, particularly in regional SA where clinic after clinic, doctor after doctor, is calling out for attention and support because they are the frontline of the standard of health in regional South Australia. They do not see support coming from this government.

There is the threat of an additional payroll tax, a GP tax, a patient tax, on our hardworking doctors and a ripple effect on nurses. Midwives are like hen's teeth. We do not have a strategy from this government to source them either—and of course the PATS accommodation rebate of $40 a night is nowhere near enough. So I am grateful to the member for Schubert for bringing the original motion. We condemn the amendment, and I support the original motion in full.

Mr TEAGUE (Heysen) (11:47): I am moved to rise in support of the original motion having heard the amendment that has just now been moved by the member for Elder on behalf of the government—and pity the poor member for Elder who has been brought in to move these amended words. There is no sign of the Minister for Health who cannot front up to what is a series of statements of straightforward fact—

Mr ODENWALDER: Point of order, Mr Speaker.

The SPEAKER: The member for Elizabeth on a point of order.

Mr ODENWALDER: I ask you to rule that it is unparliamentary to mention a member who may or may not be in the chamber.

The SPEAKER: I uphold the point of order.

Mr TEAGUE: On the point of order, it is no reflection on the presence or otherwise of the minister in the chamber.

Mr Odenwalder: You said he's not here.

Mr TEAGUE: No, it is not; it is not a reflection on the member's presence in the chamber—it is his participation or not in the debate.

The SPEAKER: Member for Heysen, there is no need to debate this. I have upheld the point of order.

Mr TEAGUE: Alright. Well, we have heard an amendment moved by the member for Elder, and I pity the poor member for Elder in having to come along and move an amendment in the terms that it has been done because it one after the other after the other walks away from the government fronting up to basic statements of fact.

What part of 'delivering record ramping in South Australia' is the government having issue with? What part of 'delivered more ramping in less than two years than the former Liberal Government's entire four-year term' does the government take issue with? What part of 'recognises that patients and paramedics have never spent more time stuck on the ambulance ramp' does the government take issue with? These are basic, straightforward statements of fact that all South Australians are concerned about.

As the member for Morialta—in moving this important motion in the absence of the shadow minister for health, the member for Schubert, who so appropriately has brought this motion to the house—has articulated, these are matters that the Malinauskas Labor government put front and centre before all South Australians on every pole, on every street corner and in every place that any South Australian would go in the lead-up to the election.

What have we seen? Exactly what is set out on the face of the original motion. And so well it is that we are here debating this matter in this place at this time. All members of this place should reflect upon the blatant nature of those election campaign promises, because it is not just us on this side of the house who are calling this out.

We are seeing now over and over and over again those ordinary South Australians who would not otherwise be moved to be remotely politicised in their day-to-day lives finding themselves standing in front of the cameras and explaining the invidious and dangerous and tragic circumstances that they and their families are experiencing, most recently in the course of this week.

What does the government do? It comes into this place and moves amendments that would walk away from those core promises. We will not have it. It is galling in the extreme. For the government to turn around and move amendments that highlight various indications as to engagements of health workers and the provision of funds and those matters that are inherent to the proper management of the health portfolio, again it should be obvious to all concerned in this place that health is a major priority of government in this state.

It is a major concern for South Australians. There is no monopoly on prioritising the proper funding and allocation of resources for health in the state. What is different is telling South Australians the truth and delivering good management and good outcomes. Those of us who are adult about going about the responsible management of these things will reflect on that, as well we should.

The record of the Marshall Liberal government in health is a record of proud achievement. It is a record of navigation through the worst global pandemic the country, let alone the world, has seen in a century. In the face of all of that to deliver in health in so many ways is a record that we on this side of the house remain proud of. We will not sit silently by while the government quietly looks to walk away from the most basic of its election commitments only two short years ago.

I wholeheartedly endorse the motion in its original form and take this opportunity to condemn those endeavours to amend it by striking out every single one of those basic propositions of fact that are contained in the original motion. I commend the original motion to the house. It should be passed with acclamation.

The Hon. J.A.W. GARDNER (Morialta—Deputy Leader of the Opposition) (11:52): I have listened to the debate. I have heard the Labor Party move an amendment to the original motion that strikes out, as the member for Heysen said, each of the propositions in (a), (b) and (c), those propositions being largely statements of fact that there has been more ramping in the last two years than there was in the four years that preceded them and that we recognise that patients and paramedics have never spent more time stuck on the ambulance ramp.

The government, by its motion and if people were to vote for this amendment, would seek to strike that from the parliamentary record, although they cannot strike out the fact that it is something that is happening in South Australia, the fact that it is advice provided by the health minister to the public. Why they are so ashamed of this record, I can understand. If they believe that the South Australian people will forget their promise and not judge them on their record, I pity them.

The alternative proposition that the member for Elder has put forward includes a noting effect of inputs into the system. Every government has inputs into the system. The Marshall Liberal government added significant investment in the hundreds of millions of dollars to the health system. We passed $7 billion in the budget for the first time.

The Marshall Liberal government had inputs into the system. Yet, despite those inputs, despite extra resourcing and despite investment of more than a billion dollars in improved infrastructure, emergency departments, country health and a range of other health services, Labor still went to an election not interested in inputs or effort, but instead focused on one set of figures and one set of outcomes, they being the transfer of care data, the ramping figures.

That was the one thing Labor said was important before the election. That was the one basis upon which Ash the ambo and the ambulance union and the Labor Party argued that South Australians should vote Labor like their lives depended on it—only that. Not inputs: they were not interested in inputs. Not increased effort: they were not interested in that. They were not interested even in the South Australian outcomes through the worst pandemic, as the member for Heysen said, in a hundred years.

I often ask people the question, on the basis that not many people in this world were moving very much from jurisdiction to jurisdiction between February 2020 and February or March 2022—during that two-year period, most people in the world stayed in one place and stayed in one jurisdiction—in terms of quality of life, in terms of health outcomes and in terms of life expectancy, I put to anyone: where in the world would you rather have been than South Australia, and what does that say about the performance of the former Marshall Liberal government when it came to health outcomes, when it came to effective response to the pandemic and when it came to enabling maximum freedom within reasonable health outcomes in our daily lives?

Who produced the economic foundation for figures that the Treasurer and the Premier are still happy to gloat about and brag about every day, as if they had somehow created that foundation themselves? They talk about advanced manufacturing, machine learning, space industries and defence industries as if somehow that was work that the Labor Party had done between 2018 and 2022, and it was not.

Partly, the fact that we are able to do that was because of the health response created by the former Marshall Liberal government. Instead, they are not interested in that. They are only interested in the inputs that they have put into ambulances, nurses and doctors, and money since the last election. Those inputs, those increased investments in health, we are certainly not critical of, but you are not investing it in a way and making choices that are succeeding in doing the thing that the Labor Party said it was going to do: fix the ramping crisis.

I submit to all members that we should not support this amendment; in fact, in section (d) the only change that is made is to remove the word 'record'. We are still noting the concern of the impact ramping has on our hardworking health workers, but the Labor Party just does not want to acknowledge that it is record ramping—and it is record ramping. It is twice as bad as it was before. It is more ramping in two years than the four years before. Just because the Labor Party might vote for this amendment, that is not going to make any South Australians forget. They would do better, as all members should, to vote against this amendment and support the original motion.

The house divided on the amendment:

Ayes 22

Noes 9

Majority 13

AYES

NOES

PAIRS

Amendment thus carried; motion as amended carried.