Why WA may have to shift its focus to making ambulance ramping safer

Australia Broadcast Center

3 days ago

Across Western Australia, ambulances spent more than 7,000 hours parked outside the state's hospitals last month.
That figure breaks all previous records — even those set during the height of COVID.
It goes without saying, that's a big problem.
Those ambulance crews aren't on the road answering other calls, and patients are receiving less-than-ideal care.
In the grand scheme of the behemoth that is Western Australia's health system, it is also a symptom of much deeper problems, according to experts.
The first problem is the state does not have enough hospital beds to meet demand.
On the most recent data (up to mid-2023) Western Australia had the second-lowest rate of hospital beds based on population out of all states and territories.
For comparison, if WA had the same ratio of beds per person as the highest state – Tasmania – it would have had an extra 1,500 or so places.
'We've delivered over 900 beds to the hospital system since 2021, we've increased staff by 30 per cent and we're looking at innovative ways that we can deliver care,' Health Minister Meredith Hammat said on Friday.
But the state still needed 'at least 1,000 more beds', according to the Australian Medical Association.
'At the end of the day, we need more beds. We need more capacity in our health system. It really can't get any simpler than that,' WA President Kyle Hoath said.
Those beds can take a long time to build and bring online – not the solution you want in the middle of an immediate crisis.
There's also the problem, the government says, of too many beds being taken up by people who could be in aged care.
But solving the problems in that sector is not quick or straightforward, either.
Dr Hoath's solution was to look to private hospitals and medi-hotels, where he said there was spare capacity.
'There are beds there that could be used as hospital beds and we need to take advantage of that,' he said.
Ms Hammat wasn't giving away whether she thought that was a good idea though.
It was a similar answer she gave to almost every question – repeating that phrase 17 times in about 14 minutes while offering no new ideas on how to tackle the problem.
The second problem ramping reveals, according to Dr Hoath, is that the hospital system does not have the capacity to handle the increased load of serious illness presenting to emergency departments.
In responding to the grim total, Ms Hammat pointed to the government's efforts to divert people away from hospitals as a success.
The minister singled out the Virtual Emergency Department program, which connects patients with doctors before they reach hospital.
She said a trial of the program enabled 74 per cent of people who called for an ambulance to receive care without going to an emergency department.
That could help explain why the number of semi-urgent and non-urgent cases in WA's emergency departments reduced by about 10 per cent between 2020-21 and 2023-24.
But it was not enough to offset a 15 per cent increase in the two most serious categories – resuscitation and emergency – over that same period.
'Where people may have presented with severe diabetes in the past, they're now presenting in renal failure and needing a transplant,' Dr Hoath said.
'People are more unwell because they're not getting the care they need at the right time.'
That's a tricky problem to solve but would likely be helped in the long run by increased bulk billing rates – which the federal government could face an uphill battle to do – and more care in the community, rather than in hospitals.
But that's also much easier said than done.
The opposition was squeezing the terrible report card on WA's health system for every political point it could on Friday.
'Don't build race tracks, don't build movie studios, don't do those other things,' leader Basil Zempilas said.
'My strongest advice for the premier would be: make it your number-one focus.
'That means every day when you get up, and you drive up from Kwinana, don't think about other projects.
'Think about health. Make that your job, your responsibility, until the people of Western Australia know that ambulance ramping is on the way down.'
It's an idea many would challenge. Governments can, and do, handle doing many things at the same time, while prioritising some issues over others.
But shadow health spokesperson Libby Mettam made a point many would agree with.
'How is it in a state as wealthy as Western Australia that we have such a crumbling health system?' she asked.
The answer is there's no simple answer.
Building a health system which can meet the growing demands of a rapidly aging population is one of the most wicked problems governments across Australia face.
Add in a worse-than-usual flu season with low vaccination rates and there's little surprise hospitals are so full.
Earlier last week, having investigated the deaths of three people who passed away while ramped, a South Australian Coroner called on that state's government to acknowledge ramping is 'a reality that all modern healthcare systems encounter'.
'While efforts to reduce the levels of ramping remain extremely important, efforts must also be made to make the process of ramping safer for those patients who will inevitably experience it,' Acting Deputy State Coroner Ian White concluded.
That might be an unpalatable answer for many.
But if growing demand for healthcare continues to massively outstrip government's ability to meet it, that focus might make the best of a bad situation until the effects of wider reforms start to be felt.