Patients spent 5,891 hours ramped in ambulances outside SA public hospitals in August, the highest figure ever recorded, as an independent review tabled in state parliament said South Australia's public health system had deteriorated under the current government.
Who Pays for the Breakdown
The people at the bottom of the system paid first. In August, patients sat in ambulances for 5,891 hours outside SA public hospitals, topping the previous record of 5,866 hours set in July 2025. The review of SA Health, released the same day, said that between 2022 and 2026 ramping was chronic and that the performance of the state's public health system had deteriorated in too many areas over recent years. That's the language of an apparatus stretched past the point it wants to admit, while ordinary people wait in metal boxes outside the doors.
The SA Health Performance Council conducted the review. It found that in 2024-25, less than half of metropolitan patients were transferred from paramedics to emergency department staff within 30 minutes of ambulance arrival. A decade earlier, in 2014-15, that figure was more than 92 per cent. The drop is brutal. Fast transfer became slow transfer, and slow transfer became a system that leaves people parked outside while the machinery inside keeps failing them.
What the Council Said
The council said it was unreasonable to think ambulance ramping could ever be fixed. It said it was more reasonable to recommend system targets that meet community expectations while being safe and sustainable, and said ramping would be, if not fixed, at least under control if it reduced to a pre-COVID level of under 2,000 total monthly hours. That’s a low bar dressed up as realism. The review doesn’t promise rescue. It describes management of collapse.
In a statement addressed to Health Minister Blair Boyer, the council's chair Professor Stephen Duckett said SA Health's culture needed to change from micromanaging and siloed, to strategic, connected and being held to account. He said the findings indicated a lack of system-wide planning, mis-alignment between priorities and performance measures, and local health networks missing their targets. He also wrote: "The buck stops with you, as Minister, for accountability to Parliament and the public for performance, governance, and the stewardship of public funds."
That line lands hard because it names the hierarchy plainly. The minister sits at the top, the public sits at the bottom, and the money flows through the same structure that leaves patients waiting in ambulances.
Pressure, Excuses, and the Same Old Bottleneck
The SA government said there was no doubt the public health system was under more pressure than ever. It said presentations at emergency departments had increased by more than 50 per cent over the past decade, with growth between 2022 and 2025 alone at almost 12 per cent. The government said this had added enormous pressure to public hospitals. It also said ambulance response times had significantly improved over the past four years and that it had recorded high levels of patient satisfaction. It said significant progress had already been made in expanding capacity, improving patient flow, strengthening workforce capability and enhancing access to care.
Blair Boyer said August had been a very tough month on the ramp. He said the state had seen the highest transfer of care, or ramping, hours it had seen. He linked the ramping figure with the number of patients stuck in hospital while waiting for residential aged care beds. In August, that number broke a new record and reached 483, up from 60 in October 2022, he said. He said those were beds in the public hospital system that were not available for acute patients. Boyer said he would push for more aged care beds when he meets the federal health minister, as well as state and territory counterparts, on Friday.
That’s the reform loop in miniature. More meetings. More ministers. More promises to push. Meanwhile, the bottleneck stays where it is, and the people needing care keep getting trapped in the gap between institutions.
What Workers and Critics Said
Ambulance Employees Association general secretary Paul Ekkelboom said ramping remained at crisis levels and said: "This is a government's problem to solve." He said: "We're hearing excuses as to what the barriers are. They need to address those barriers; they've made the promise to actually fix ramping. We're not getting anywhere close." He said: "[In] 2017 the ramping hours were 328 hours. For the month now of August, it's 5,891 hours, which is too excessive." He acknowledged the impact of a shortage of aged care beds but said it was up to the SA government to find solutions. He said: "It's a very convenient argument right now, but it is a real argument."
SA opposition spokesperson for health and wellbeing Jack Batty said the review tabled in parliament was damning and that the health system had gone backwards. He said: "This scathing report shows ambulance response times have deteriorated, ramping remains chronic, and emergency department delays are entrenched." He added: "After four-and-a-half years, billions of dollars and countless excuses, South Australians are now spending more time stuck in ambulances outside hospitals than ever before."
The numbers do the talking. The institutions answer with pressure, targets, and meetings. The people in ambulances keep waiting.