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.
It is not as simple as Bernard describes. As was reported by a 000 call operator on ABC radio this morning the operators had to take repeated calls from people in distress because the call operators were not able to despatch ambulances held up in choke points ramped at hospital emergency departments. Meanwhile many calls remained unanswered with tragic consequences as we have heard. Therefore the modelling needs to reflect the cascading effect of slow response and the many repeated calls that further tie up the operators leading so many calls unanswered or delayed answering. Thanks though for giving a description of the system as it stands and it clearly needs improvement. No argument there. Incidentally the thing that brought most relief to the crisis in both Victoria and NSW was the big vaccination push as BA4 and BA5 hit both states. This has made an enormous difference in reduction of the numbers hospitalised though more so in Victoria than NSW which has had up to four times as many people hospitalised (obviously putting a great deal of pressure on the emergency services).
One also has to consider the ideological pressure i.e. a generation of libertarian economics enforced on public sector and the blow back from media for any government that does not support; backgrounded of late by Covid which is viewed as a base ‘freedom & liberty’ issue not a health issue?
Looks like another bullseye hit on one of the fundamental errors at the heart of conventional market economics. The notion of structural efficiency was no invented by neoliberal wonks, but neoliberalism certainly over exploited the theory.
The pandemic has exposed the theory of economic ‘efficiency’ in many ways, some tragic, some costly and some funny. Inbuilt redundancy is an anathema to conventional economists, so deeply ingrained that they cannot or will no see the error even when spectacularly demonstrated by the pandemic in respect of emergency services, supply chains, prudent stockpiles ie what have now been proven to be crucial buffers against the shock that the mythical steady state on which economics has built its house of cards is nothing of the sort. The ‘steady state’ is actually a series of catastrophes that overlap and intersect and that we need a system with built in shock absorbers, not one that has to scramble ineptly to deal with the catastrophes post hoc.
The efficiency dividend is more deaths!
A quick message of total and absolute support for your article Bernard. You provided quite a bit of detail that I was not aware of in this report. Thank you for bringing this disgraceful information to our attention. You are doing an absolutely magnificent job of exposing the criminality of this neo-liberalism and the idiots who subscribe to it.
I have a ‘bit on my plate’ at the moment but in all honesty, I could not let this article go without a comment.
Thanks again.
There is an economics literature about how to design pricing of regulated industries, and the original model (apparently abandoned in 2014) is not what theory would recommend.