Ambulance ramping

On a wet night in Devonport, an ambulance crew loads a man in his sixties with crushing chest pain and turns south-east for the Launceston General Hospital, the nearest hospital equipped to run a full cardiac work-up. Forty minutes later they are still parked in the ambulance bay, monitors attached, because every cubicle in the emergency department is occupied and there is nowhere to hand him over. The crew cannot leave; the patient cannot be formally admitted. Somewhere else on the island, the next triple-zero call — a fall, a stroke, a crash on the Bass Highway — is waiting for a vehicle that has already reached a hospital but cannot get back on the road. This is ramping: not a queue for treatment so much as a queue for the queue, and in Tasmania it has become the clearest single measure of whether the health system is coping.

A statewide "ramping ban" becomes the government's central health promise

Jeremy Rockliff held the health portfolio from 2014, first as Deputy Premier and Health Minister under Will Hodgman, then as Premier and Health Minister at once after he was sworn in as Premier in April 2022. He handed the portfolio on in mid-2023; since then it has passed through Guy Barnett, then Jacquie Petrusma from October 2024, and — after Rockliff's minority government survived a no-confidence vote and a snap election in July 2025 — Bridget Archer, sworn in as Minister for Health, Mental Health and Wellbeing on 11 August 2025.

In April 2024 the government announced a "transfer of care" policy, badged informally as a "ramping ban": public hospitals would be required to take formal responsibility for an ambulance patient, freeing the crew and vehicle, within 60 minutes of arrival. In December 2025 that window was tightened to 45 minutes. Alongside it, the government has funded the final $91 million of a $130 million Royal Hobart Hospital emergency department expansion (construction running to early 2028), released the design for a $53.5 million near-doubling of the Launceston General Hospital ED (construction not due to start before 2028), and opened or committed to new ambulance stations at Glenorchy, King Island, Legana, Snug, Cygnet, Bicheno and Longford. The 2026-27 Budget added $776.6 million for ambulance services over the forward estimates, inside a four-year, $14.5 billion health package. From 27 February 2026 the Department of Health began publishing hospital-by-hospital transfer-of-care performance daily.

What the primary record shows

The ramping-ban numbers sit on top of a much longer and worse baseline. The Tasmanian Audit Office's 2019 performance audit of the four major hospital emergency departments — covering July 2009 to June 2018 — found that ambulance ramping across the state had grown by around 149 per cent between 2012-13 and 2017-18, more than seven times faster than the 20 per cent growth in ED presentations over the same period. By the audit's final measurement window, the Royal Hobart Hospital was "bed-blocked" — unable to move ED patients into a ward bed — for close to 93 per cent of the time between June 2018 and January 2019, and the Auditor-General found patient safety was being "severely and routinely" compromised, with a serious adverse event occurring roughly once every four days. Much of that deterioration happened while Mr Rockliff himself was Health Minister; it is a problem this government inherited from itself as much as from its predecessors.

The mechanism behind both the 2019 findings and today's figures is the same, and it runs wider than ambulances. Ramping happens when an emergency department cannot move its own patients into a ward bed — "access block," in the Auditor-General's term — so paramedics queue in the corridor holding patients the ED itself has nowhere to put. Access block, in turn, is downstream of whole-of-hospital flow: older patients medically ready for discharge but waiting on an aged-care placement, and patients waiting on a National Disability Insurance Scheme package or a step-down bed, both occupy ward beds that would otherwise take ED patients out of the department and free the ambulance bay. Tasmania's ambulance-ramping figures are therefore a leading indicator of a hospital-capacity and aged-care-interface problem, not a stand-alone operational glitch that a transfer-of-care policy alone can fix.

Against that baseline, the current improvement is real but partial, and it is being measured against a moving target. The original clinical benchmark — the share of patients formally handed from ambulance to ED clinicians within 30 minutes, with a 100 per cent KPI — sat at just 70.9 per cent in 2023-24, the year before the transfer-of-care policy began. The policy that followed did not tighten that benchmark; it replaced it with a longer 60-minute, then 45-minute, target, which makes the pre- and post-policy figures difficult to compare on a like-for-like basis. The daily dashboard published since February 2026 reports performance against the new target rather than the original 30-minute one.

The workforce underneath the numbers

Ramping is ultimately a beds-and-rostering problem, and on paramedic numbers the record is harder to reconcile with the ramping-ban narrative. Right-to-information documents obtained by the Opposition, and reported by The Examiner, show that in 2025-26 only around 46,500 of 52,229 rostered paramedic shifts were filled — about one in nine going unfilled — with unfilled shifts in the North and West regions up more than 60 per cent in September 2025 compared with September 2024. Ambulance Tasmania's headcount fell from around 800 employees in June 2025 to 785 by 30 September 2025, and Ambulance Award full-time-equivalent positions dropped from 587.58 to 568.59 over the same three months. The government has partly offset that with claims, as of March 2026, of "around 50 more" staff in place since, against an election promise of 78 additional full-time paramedics under its "2030 Strong Plan."

The paramedics' union has disputed the improvement narrative directly, with members describing individual ramping delays of three hours or more even after the policy took effect, and warning the workforce is at breaking point. An earlier, Greens-sourced figure for 2023-24 put shift vacancies at 13.5 per cent, up from 10 per cent the year before, with 1,053 priority emergency calls waiting more than an hour for an ambulance to arrive. The exact percentages differ by year and by who is counting, but the direction is consistent across several years: a workforce that has been short-staffed while demand and population both grow.

The strain is not evenly spread across the island. Ramping statistics are dominated by the two major EDs, but a chronically short roster hits hardest in the North-West and on the West Coast, where some stations rely on single-officer crewing or volunteer ambulance officers and the nearest hospital can be well over an hour away by road. A Tasmanian with chest pain in Queenstown or on King Island is already waiting longer for a paramedic to arrive than a Hobart resident, before the question of whether that paramedic can then hand the patient over quickly even arises. A workforce shortfall concentrated in the regions compounds a ramping problem concentrated in the two big-city EDs; they are the same statewide capacity gap, seen from opposite ends of the ambulance run.

Why the numbers and the waiting room don't match

Two things can be true at once: the transfer-of-care policy has probably taken some pressure off ambulance ramps, and Tasmanians are still experiencing exactly the kind of waits the policy was meant to end. In June 2026, ambulance patients at the Launceston General Hospital were reported to have waited close to 349 minutes — nearly six hours — before being handed over, and the Department of Health separately warned people away from LGH's emergency department during a period when the hospital had as few as three available beds for weeks at a stretch. Those are not isolated statistical outliers; they are the tail of a distribution the daily dashboard's averages do not show.

A government can shorten the clock it measures without shortening the corridor patients actually wait in.

The deeper problem is that the fixes with the power to change the underlying arithmetic — more ED beds, more paramedics on the road, faster patient flow out of hospital into aged and community care — are still years from delivery. The Royal Hobart Hospital's ED expansion will not be complete before early 2028; the Launceston General Hospital's, on the current timeline, not before 2029. Meanwhile Ambulance Tasmania's own staffing numbers moved in the wrong direction through the second half of 2025, and the ministerial merry-go-round — three health ministers since Mr Rockliff left the role in 2023, spanning two elections in eighteen months — has made it harder for any one minister to own a multi-year capacity build. None of this makes the transfer-of-care policy a sham; it means it is a demand-management measure layered over a supply problem that neither the current nor previous governments have funded to the scale the 2019 Auditor-General's report said was required.

It also means the ramping figures cannot be fixed by Ambulance Tasmania or the Department of Health's emergency divisions alone. As long as older Tasmanians who are medically ready for discharge remain stuck in acute beds for want of an aged-care placement, and as long as the North-West and West Coast run thin on both paramedics and ward capacity, better handover protocols can only redistribute the queue, not shorten it. The government's own capital pipeline treats the emergency department as the point of failure; the evidence points further upstream, into aged care, disability-support transitions and regional bed numbers that sit largely outside the ambulance and ED budget lines this article has tracked.