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Motion: Ambulance Ramping

15 May 2024

The Hon. R.A. SIMMS (16:56): I move:

That this council—

  1. Notes with concern that the number of hours patients spent ramped in ambulances, awaiting transfer to hospital emergency departments, has risen from 328 per month in July 2017 to 4,095 per month in March 2024.
  2. Notes with concern that South Australians are struggling to access a GP, with only 11 per cent of GP clinics offering bulk-billing in regular business hours.
  3. Calls on the Malinauskas government to tackle the ramping crisis by:

(a) fully subsidising 200 new free GPs for people with a health care card;

(b) establishing special 'transit wards' at major Adelaide hospitals to expedite ambulance patient transfers;

(c) establishing a statewide bed manager to oversee all patient transfers and ensure prearranged bed availability for admitted patients and avoiding ramping of interhospital transfers going to an ED; and

(d) establishing rapid off-load procedures for transferring patient care within 30 minutes of arrival at emergency departments.

This motion notes with concern the number of hours that patients are spending ramping in ambulances waiting for transfer to hospital emergency departments. It also notes the concerns of South Australians in terms of being able to access a GP—at the moment in our state only 11 per cent of GP clinics offer bulk-billing in regular business hours—and it calls on the Malinauskas government to tackle the ramping crisis by implementing the recommendations of the Ambulance Employees Association but also fully subsidising 200 new free GPs for people who have a health care card.

The ramping crisis continues in our state. We have heard both sides of politics battle it out for years now. What people want are solutions that can actually be implemented. We know, of course, that the Malinauskas government, as part of their election pledge, made a commitment to fix the ramping crisis. We know that there are no easy solutions, but I would have thought the best starting point is to listen to the recommendations of the Ambulance Employees Association.

The number of hours patients have spent ramped in ambulances awaiting transfer to our hospital emergency departments has risen from 328 hours per month in 2017 to a colossal 4,095 hours per month in March. That is a slight decrease from the record high of 4,285 lost hours in November of last year, so it is nothing to celebrate. It is out of control.

What this tells us is that there are system wide issues that go beyond politics and who is in charge, because the reality is that neither Labor nor the Liberal Party have been able to get this under control. The crisis has reached a critical tipping point, and we need to look at all options. We need to look at what we can do to improve our healthcare system—that is, reduce the need for people to seek emergency support but also to improve the processes that are undertaken when dealing with emergency situations.

The ramping crisis in South Australia is compounded by the reality that people in our state are continuing to struggle to access even the most basic primary care services. According to the Cleanbill 2024 Blue Report, only 11 per cent of South Australian GP clinics are bulk-billing for standard consultations during regular weekly business hours. The same report shows that the average out-of-pocket cost has increased by 7.2 per cent in South Australia over the last 12 months. I am concerned that that is going to increase further as a result of the end of the amnesty period for payroll tax and that is why the Greens were pleased to work with the Hon. Connie Bonaros to pass a motion calling on the government to remedy that.

This could be addressed also by subsidising 200 new GP positions specifically designated for people who have a health care card. This investment will ensure equal access to quality primary care and will provide the first line of defence against further strain on our emergency departments.

No South Australian should be forced to forgo seeing a doctor due to their financial circumstances. It is a right of every citizen in our community to be able to access the health care that they need. In the middle of a cost-of-living crisis, we need to ensure people can access the fundamental human right of affordable health care. This is not the United States where people are priced out of going to see a doctor. It is not how we do things here in Australia. It is not how we do things here in South Australia.

In April last year, the Ambulance Employees' Association issued a media release that outlined some key solutions to the ramping crisis. These are not new ideas. The AEA has stated that these proposals were sent to all political parties ahead of the 2022 election. Two years on, we still have not seen these recommendations being implemented.

The first suggestion is to establish transit wards at our major hospitals across the Adelaide metropolitan area. These dedicated wards would serve the crucial function of expediting the transfer of patients who need to be moved from an ambulance or discharged. According to the AEA, currently in most metropolitan hospitals in Adelaide when a patient is ready to be discharged and requires ambulance transport, e.g. to a RACF or to a disability facility, they remain in their ward awaiting a transfer ambulance to arrive. As this is not an urgent ambulance attendance, these transfers can be significantly delayed for many hours. During this time, the bed is unable to be utilised by a patient awaiting admission from the ED.

Further delays occur when an ambulance arrives and the patient is not ready to be discharged, despite being booked in by the hospital in advance. Delays of medication dispensation by pharmacy or discharge paperwork yet to be completed could all contribute to delays in the patient's discharge, leading to the ward bed remaining occupied and not being able to receive the next patient. That is the advice of the AEA. It is not me saying it. These are the experts who work in this field. Transit wards could alleviate the current strain on beds, ambulances and emergency departments by ensuring that there is a more efficient system in place.

Secondly, a statewide bed manager could be established to oversee all patient transfers and guarantee that hospital beds are available and ready at the time of transfer. A centralised and coordinated approach is required to address the occurrence where transfers arrive at hospitals without a bed being available on the ward. A statewide bed manager could coordinate the available beds to ensure that people can be transferred directly to the relevant ward or unit rather than clogging up emergency departments and potentially duplicating diagnostics.

Lastly, we need to implement rapid off-load procedures to transfer patient care from ambulance to hospital staff within a maximum of 30 minutes of arrival at the emergency department. The Australasian College for Emergency Medicine position statement on ambulance ramping has stated that:

Within 30 minutes of arriving at an ED, 100 per cent of patients should have their handover completed.

The AEA have stated that:

Current policies and procedures within SA Health are demonstrably inadequate at mitigating this practice.

They advocate that rapid off-load procedures could free up ambulance availability and would also improve patient safety.

We have clear guidance from people on the frontline of this crisis. These are reforms that are proposed by the AEA. They are supported by the Greens. They are the ones who are witnessing the impacts of this ramping crisis firsthand. They know the solutions. This really calls on the Malinauskas government to listen to the experts and to take the steps necessary to get this crisis under control.

I know people will ask, 'How could the government fund this?' Well, budgets—and we will have a state budget handed down very soon—are about priorities. This Labor government gives over $100 million of subsidies to the fossil fuel industry, an industry which we know promotes adverse health outcomes for our community. They could cut those subsidies and put that money into our health system. Indeed, the Greens have done the math, and we have worked out that cutting those subsidies would be more than enough to fund what is being advocated for by the AEA, as well as hiring these 200 GPs to provide support for South Australians who are doing it tough.

The Malinauskas government has been in power for two years now. They need to step up and get this health crisis under control, and listen to the experts in this field. I will say, it is not just the fault of the Malinauskas government, albeit the Labor Party has been in power for 18 of the last 30 years in this state. They must shoulder a lion's share of the blame, but neither side of politics has been able to get this crisis under control. I think the community is sick of the bickering, and they actually want to see some real solutions here.