Call her Maureen. She is 81, lives alone in the Adelaide Hills, and one Tuesday afternoon in 2024 a fall in her kitchen fractured her hip. Paramedics reached her within minutes and had her stabilised, but when the ambulance pulled in at the Royal Adelaide Hospital there was no bed to wheel her into. She stayed on the ambulance trolley, in a hospital corridor, under the care of the crew that brought her, for close to two hours before an emergency department nurse could formally take charge of her case. That wait is "ramping" — the queue of ambulances stuck outside emergency departments because the hospital behind the doors is already full — and while she waited, her crew could not answer the next triple-zero call in the Hills.
Maureen is a composite, not a named patient, but her wait sits close to the pattern SA Health's own monthly figures describe. Ramping put Peter Malinauskas into the Premier's office in March 2022 on the strength of one blunt promise: fix it. Four years on, the record shows a government that spent more and hired more than it pledged, on a problem that kept getting worse before it began, only recently, to ease.
What the government did
Labor went into the 19 March 2022 state election with ramping as its defining pitch, campaigning under the banner of "fixing the ramping crisis" against a one-term Liberal government led by Steven Marshall. The problem was real and visible: in the weeks before the vote, statewide ramping had jumped sharply, and only 47.1% of the most urgent (Priority 1) ambulance calls were reaching patients within the eight-minute benchmark that January (SA Health ambulance performance data, Jan-2022). Labor's costed policy promised $1.15 billion over four years for 350 extra ambulance officers and paramedics, 300 extra nurses, 100 extra doctors and 300 additional hospital beds. On election night Labor won a landslide, taking 27 of 47 lower-house seats.
In office, the government moved on several fronts at once. It launched an Ambulance Ramping Action Plan and reported hundreds of new frontline staff within its first year. By March 2025, SA Health had recruited 2,091 additional nurses above normal attrition — more than six times its 300-nurse pledge — and grown the ambulance workforce by roughly 26% (approx.), opening nine new or upgraded ambulance stations (Premier of South Australia, media releases, 2023–2025). It added beds too: more than 330 were committed to open by the end of 2025 in the 2024-25 Budget alone, on top of earlier openings, taking the government's own tally to more than 600 new beds online since 2022 (approx.). It also opened five Priority Care Centres — GP-led clinics for urgent but non-life-threatening cases — and expanded My Home Hospital, a hospital-in-the-home program, to keep lower-acuity patients out of emergency departments altogether. Across its first three budgets to 2024-25, the government put a cumulative $7.1 billion in additional funding into the health system, including a further $2.5 billion over five years and a dedicated $58 million ambulance package announced in the 2024-25 Budget (SA Budget Papers, 2024-25). And when a doctor publicly alleged that ramped patients were being deprioritised behind emergency department waiting-room patients, the government commissioned an independent safety review, led by Dr Bill Griggs and Professor Keith McNeil, which reported in January 2024, found no evidence of unsafe deprioritisation or resulting deaths, flagged an unexplained trend worth further study, and had its five recommendations accepted in full.
The strongest case
A genuine demand surge, and a government that targeted the right lever
No government controls how fast a population ages or how many people get sick in a given year. South Australia's ramping problem predates Labor: statewide ramping hours had already climbed from around 15,000 a year in 2019-20 to roughly 28,000 in 2021 (approx.), the last full year under the Marshall Liberal government, as COVID-era workforce shortages and rising demand from an ageing population collided with a system that had not expanded inpatient beds to match. An earlier independent review of the former government's own $86 million ramping strategy at Flinders Medical Centre found that expanding the emergency department alone was never going to solve ramping "in the absence of inpatient reform," because the real bottleneck is how quickly admitted patients can be moved into a ward bed, not how big the ED is. That is precisely the lever the Malinauskas government pulled — inpatient beds and the staff to run them, on top of ambulance and ED capacity — rather than repeating its predecessor's narrower approach, and it did not create the demand curve it inherited.
The evidence
SA Health publishes ramping hours monthly, and the trend since 2022 is stark. Statewide ramping rose in almost every year of Labor's first term: from roughly 28,000 hours in 2021 to 40,474 hours in 2023, 47,380 hours in 2024 — a record at the time — and more than 52,000 hours across the 2025 calendar year, a new high (SA Health monthly ramping data, as compiled in AMA SA's Ambulance Ramping Report Cards, 2023–2026). July 2024 alone produced a then-record single month of 5,539 hours, more than 230 days of cumulative ambulance waiting time inside 31 days. By July 2026, the opposition's health spokesman, Jack Batty, was describing "50 consecutive months of the worst ramping on record" — a political framing, but one consistent with the monthly totals SA Health itself publishes.
Response times tell a more mixed story. The share of Priority 1 calls reaching patients within eight minutes rose from 47.1% in January 2022 to 70.8% by December 2024, and to 76.9% by March 2026 (SA Health ambulance performance data) — genuine, sustained improvement even as total ramping hours kept climbing, because rising emergency demand and rising ambulance efficiency can move at the same time. The Auditor-General's Report 9 of 2025 on State Finances found the 2024-25 budget surplus was revised down by $230 million, driven in part by SA Health spending beyond its original allocation to meet higher-than-planned activity levels — independent confirmation that demand, not simple inertia, was outrunning the budgeted response (Auditor-General for South Australia, Report 9 of 2025, Nov-2025).
There are recent signs of a turn, and the government has been quick to claim them. Statewide ramping fell in the first months of 2026 — 3,616 hours in February and 3,750 in March, below the same months in 2025 — and May 2026 volumes ran roughly 17% below May 2025 (approx.). At the Queen Elizabeth Hospital, where new beds and a hospital-avoidance hub opened, ramping fell 39% between January and May 2026 against the same period in 2025, even as emergency presentations there rose 9.2%; the Royal Adelaide recorded a 26% fall over the same window (SA Health data, reported by InDaily, 3-Jul-2026). Health Minister Blair Boyer credited "a coordinated, system-wide approach." AMA SA's president, Associate Professor Peter Subramaniam, welcomed the improvement but added the caveat that matters most for this record: "we're still seeing thousands of hours on the ramp."
A government can recruit more than six times the nurses it promised and still watch the ramp set a new record five years running.
The critique
Measured against Labor's own 2022 language, the promise has not been kept. "Fix" implied resolution — ramping hours falling back toward pre-crisis levels — not a slower rate of increase. On that test, the record between 2022 and 2025 is unambiguous: ramping rose in almost every calendar year of the government's first term, from roughly 28,000 hours in 2021 to more than 52,000 in 2025, very nearly doubling despite $7.1 billion in extra funding and a workforce expansion that beat every headline pledge. The single worst month on record, July 2024, arrived more than two years into the government's term, not at its start.
The government's own explanation — that demand outpaced even record investment — is corroborated by the Auditor-General's finding of a mid-year budget blowout tied to SA Health activity levels, and it is a fair partial defence. But it is only partial. New hospital beds take years to plan, fund and build; a large share of the "600 new beds since 2022" and the 330 committed in the 2024-25 Budget landed only in 2025 and 2026, meaning the bulk of the extra capacity arrived near the end, not the start, of the term in which ramping was supposedly being fixed. A promise costed and delivered against a four-year electoral cycle collided with an infrastructure and workforce pipeline that runs on a longer clock — a mismatch the government could have flagged more plainly in 2022 rather than promising a "fix."
There is also a harder structural point in the government's own evidence base. Independent reviewers have repeatedly located the cause of ramping upstream of the emergency department, in how quickly patients already admitted can be discharged into aged care, mental health or disability support once they no longer need a hospital bed. Much of that discharge pipeline depends on Commonwealth-funded aged care placements and NDIS packages that South Australia does not control — a state government can build the ward, but not always empty it on schedule. The government built more beds and hired more staff on its own side of the ledger; it could not, unilaterally, fix the exit side.
None of that changes the political fact. Voters were asked in March 2022 to judge a Premier on a specific, plain-English promise, and by the government's own published data, the thing promised — fewer hours on the ramp — had not materialised over a full term. What materialised instead was a system handling more emergencies, more successfully, per call, while the cumulative queue outside hospital doors kept growing until, only in the opening months of 2026, it began to shrink.
What they got right
Credit belongs where the evidence supports it. The workforce numbers are real and independently reportable, not just announced: 2,091 extra nurses is a verifiable payroll fact, not a press release line. Commissioning the Griggs-McNeil review, rather than dismissing the ramped-patient-safety allegations that prompted it, was scrutiny most governments would rather avoid. Publishing ramping hours every month, unlike jurisdictions that report only quarterly, gives voters and journalists the tools to hold the government to its own promise — the same data this analysis relies on. And the early-2026 falls at the Queen Elizabeth and Royal Adelaide hospitals, arriving alongside new beds and a hospital-avoidance hub, suggest the investment is now, finally, showing up in the numbers that matter, four years after it was promised.
The risk to the future
A landslide re-election that could remove the pressure to finish the job
On 21 March 2026, South Australians re-elected the Malinauskas government in an even larger landslide than 2022 — Labor's best result in the state's history — despite ramping having set a new annual record in most years of the government's first term (Electoral Commission of South Australia, 21-Mar-2026). Health and ramping were still central to that campaign, and voters plainly judged the government's overall record, including genuine investment, as worth rewarding even though its signature 2022 promise remained unmet on its own terms. That is a legitimate democratic verdict. But it also removes the sharpest form of accountability — an election loss — as a spur to finish the job, at precisely the moment South Australia's population is ageing and demand for emergency and inpatient care is set to keep rising. If the early-2026 improvement stalls once the scrutiny of a re-election campaign passes, the government now has four more years before voters can render another verdict, and every one of those years will be measured, fairly, against a promise it has now made twice.