Key findings on WA Health’s response to the Inquiry

WA Health increased its funding of SJA, from $42 million in 2008-09 to an expected $100 million this year and has monitored SJA’s expenditure to ensure that the funding has been used to implement the Inquiry’s recommendations.

WA Health has progressed the regulation of ambulance services and paramedics but progression with State legislation was not supported by the Department of Treasury and the registration of paramedics depends on the implementation of a national registration scheme. The Inquiry considered legislation and registration to be important to better control the operations of emergency ambulance services and the conduct of paramedics.

It is not clear that SJA is stationing WA Health funded paramedics in the country sub-centres where they are most needed. SJA has activity criteria for allocating paramedics to country locations. Since these were introduced in the last contract (2010) they have not been consistently followed. Compared to the criteria, 10 of the 13 career sub-centres are over resourced and three (Broome, Geraldton and Albany) are under-resourced.

WA Health has been slow to make changes to IHPT arrangements and does not formally contract for these services so there are no specified standards for patient care. WA Health also does not centrally control and monitor the costs, estimated to be over $12 million in 2011-12. SJA informed us that since the audit a fee arrangement has been agreed for these services.

Key findings on SJA’s response to the Inquiry

People who need an emergency ambulance are now more likely to get one. SJA introduced a structured call taking system, as used in other states. The system is risk averse and the proportion of calls prioritised as emergencies has increased by 31 per cent. Another consequence has been an increase in over-prioritisation of calls as emergencies – from 46 000 cases under the old system to 69 000 now. However, SJA does review and adjust the system for allocating priorities, based on clinical evidence.

SJA has improved its metropolitan Priority 1 response times. It is on track to meet its 2012-13 target and came very close to meeting its contractual target in 2011-12. It did not meet its contractual target in the previous year. The improvement has occurred despite a 48 per cent increase in demand for ambulances over the last three years and higher levels of ramping. Increased staff numbers and changes to staff rostering have been key factors in improving response times. The changed rostering means that SJA is more efficient and has helped SJA improve response times with a standby rate of 42 per cent rather than the 52.5 per cent funded by WA Health.

SJA and WA Health’s efforts to address ramping have so far been unsuccessful. Despite some improvement in 2011, ramping times increased by 35 per cent between 2009-10 and 2011-12, from 4 936 to 6 641 hours in the metropolitan area. In the 10 months to 30 April 2013 ramping totalled 12 446 hours – a 144 per cent increase on the same period in the previous year. In early May SJA, in partnership with WA Health and Hollywood Private Hospital, started a temporary trial to help reduce the impact of ramping during the 2013 winter months.

Response times for country career sub-centres have worsened. There has been a decline in the emergency calls responded to within 15 minutes from 83.4 per cent in 2009-10 to 76 per cent in year to date 2012-13 (30 April). Although SJA increased the number of paramedics it was insufficient to offset the growth in demand as well as the increase in emergency calls resulting from the use of the new call taking system. Response times for volunteer sub-centres, however, have improved significantly between 2009-10 and year to date 2012-13 despite an increase in demand and Priority 1 calls.

SJA’s regionalisation initiative has significantly improved the model for country services. It increased numbers of transport officers, ambulance and community paramedics by 54 per cent, and located corporate staff in country regions.

SJA has done much to improve its clinical governance framework in a short time, but improvements are not yet fully embedded. Greater clinical governance of country volunteer services is needed, specifically extending clinical audits into these services.

SJA now reports serious clinical incidents resulting in patient death or risk of death and its investigations of these to WA Health. Recently WA Health’s policy changed to require reporting of more kinds of clinical incidents by contracted health services. This is not reflected in SJA’s Contract but should be included in any future contracts.

SJA’s complaints management system has improved significantly. There is now a clearly identified process for making complaints on the SJA website. In spite of this, we found that some WA Health ED staff are not clear about how to raise concerns with SJA.

Key findings on WA Health’s contract for ambulance services

WA Health’s contract management has been effective but the Contract has limitations and does not assist WA Health to demonstrate whether the State is receiving value for money. The Contract is largely input rather than output based and does not include incentives or penalties. It lacks mechanisms for WA Health to monitor the quality of the service provided, such as standards of patient care, staff training or conduct, and equipment.

SJA reports its performance on national indicators in the Report on Government Services (ROGS). These include: cost per capita; cost to government per capita; patient numbers; and patient satisfaction. ROGS data shows that SJA’s performance is on par or better than ambulance services in other jurisdictions. The majority of these indicators are not reported to WA Health as part of the Contract.

The current Contract expires in 2013 but is likely to be extended for another year. There is a gap in senior level engagement between WA Health and SJA in addressing key issues such as a new funding model. A committee set up to enable WA Health and SJA to discuss and resolve strategic and complex issues such as a new contract has not met for over a year.

For more detailed information supporting the Key Findings, please refer to the report content.