The review of Victoria’s emergency ambulance call answer performance by the state’s inspector-general for emergency management was released on Saturday morning by the Andrews government. Damon Johnson at The Australian was entirely right to call the timing of the release cowardly, gutless and disgraceful. The “trash” being taken out in a sneaky weekend release involved 33 lives.
The review found that from October 2021 to March 2022, the performance of Victoria’s Emergency Services Telecommunications Authority (ESTA) materially degraded: most 000 calls were not answered within five seconds — its standard benchmark — and often took 10 minutes. In one case, it took 76 minutes. The result: “There were 40 events involving seriously ill and injured patients, many of which were subject to call answer delays. Tragically, 33 people did not survive these emergencies.”
Some of those may have died regardless of the delay. Others would have survived. The final number of deaths will be a matter for the coroner.
The reasons aren’t complex: after lockdowns ended, COVID surged and the number of 000 calls also surged, to 2800 a day, or 400 more than the 2020-21 daily average, and ESTA had to deal with that surge with a workforce also affected by COVID — and by burnout from the high demands placed on remaining staff. Strain on ambulances services and emergency departments were a contributing factor.
But as the review describes, these relatively simple reasons hide much more systemic issues.
ESTA was aware of the coming surge and had modelled it while still in lockdown, and kept updating its modelling. In fact ESTA was consistently accurate with its modelling of the call volumes it expected to receive. But it couldn’t get the staff because it didn’t have the funding.
The lack of funding was despite the Victorian government knowing for years that its funding model was deeply flawed.
The funding model was a classic piece of neoliberal public administration policy: user pays. ESTA was funded by revenue from its “clients”, the Victorian emergency services. Every time an ambulance was despatched, Ambulances Victoria paid a fee to ESTA. Every time the police were despatched, or the SES called out, ESTA got a fee from the police and the SES.
The intention was to encourage organisations like the police and the ambos “to prioritise their needs effectively to help contain costs by imposing discipline on the sector”.
If the idea of the 000 operator getting a fee every time someone called up for an emergency wasn’t strange enough, the “fee” charged was set in 2004 and not been indexed since, without recognition of the rising real cost of emergency calls. By 2014 ESTA was incurring a deficit, one that the Victorian government simply plugged every year with a top-up. The top-up started at $10 million and is now $33 million.
In 2015, the Victorian auditor-general warned that there were problems with the model. But Treasury and Finance in Victoria preferred simply to top up ESTA’s budget every year post-fact, rather than move it to a sustainable footing.
The Andrews government has, since March, announced hundreds of millions of dollars in extra funding for ESTA. But it’s too late. ESTA needed the money in 2020 and 2021, when it needed to be recruiting for the expected post-lockdown surge. Other health bodies, the report shows, were properly resourced to do this. But ESTA, with its jerry-rigged funding model that provided inadequate funds and no certainty, couldn’t.
There were other problems, too, such as the lack of coordination in COVID plans between agencies, and inflexible rostering arrangements. But at times the COVID surge in January was so massive that even if ETSA was staffed to full capacity it couldn’t have met demand.
Internal public sector user-pays models are very common. They’re a holdover from the 1980s-90s’ fad for “letting the managers manage” and imposing private sector discipline on government, like the now-abandoned “capital use charge” that use to feature in budget papers. In practice they do little to “impose discipline” because managers don’t manage; managers do what ministers tell them, and work to ensure they minimise public embarrassment for the politicians they serve. The concept is even more ridiculous when applied to an area like emergency services.
In this case, their application has had deadly consequences.
