Ambulance ramping and the health system

It is a Tuesday evening at a regional Victorian hospital, and a paramedic crew is backed into the ambulance bay with a patient on the stretcher — and staying there. Every cubicle inside is occupied, so the crew waits, monitoring the patient themselves, unable to clear and take the next call. Multiply that scene by dozens of bays across the state on a bad night and you have "ramping": ambulances queued outside emergency departments (EDs) because the department inside has nowhere to put the patient. It is not a rare event. It is now a routine, measured feature of Victoria's health system, tracked quarter by quarter by Ambulance Victoria and audited year by year by the state's own watchdog — and in October 2025 a parliamentary inquiry concluded that reform at Ambulance Victoria "is not optional — it is urgent and badly needed."

What the government did

Ambulance Victoria is a statutory authority funded and governed by the Department of Health; Victoria's 68-odd public health services are funded mainly through activity-based payments set in the annual Budget. Two decisions by the Allan government (and its Andrews-era predecessor) sit at the centre of this topic. First, in April 2022 the government committed $1.5 billion to a COVID Catch-up Plan, aiming to lift planned-surgery capacity to 125 per cent of pre-pandemic levels and add roughly 40,000 extra surgeries to work through the backlog left by pandemic-era postponements. Second, at the end of 2023, as health-service deficits widened, the Department of Health directed public hospitals to revise their budgets and find savings — chiefly from non-clinical staff and services — with a stated goal of returning individual health services to financial breakeven by July 2025 and no further government "top-ups" to cover shortfalls. The 2025–26 Victorian Budget then allocated $11.1 billion to the public health system, including a $9.3 billion boost for hospitals and $634.3 million to open nine new or upgraded hospitals and community facilities. Those are the two poles of the government's approach: a large, targeted catch-up investment in surgery, sitting alongside a general instruction to the health system to run leaner. Ambulance Victoria's own governance has separately been under scrutiny: the Legislative Council inquiry examined not only ramping and response times but call-taking and dispatch practices, procurement, and allegations of fraud and embezzlement inside the organisation — a reminder that funding decisions sit alongside management and cultural questions inside the agency itself, not just budget lines set by government.

The evidence

Set against that steelman, Victoria's own record-keepers tell a harder story once the time frame extends beyond a single quarter. The Victorian Auditor-General's Office (VAGO), in Access to Emergency Healthcare (tabled 25 June 2024), examined a decade of ED performance and found the health system met only one of its five key emergency-care targets across that period — failing the other four every single year. The share of ambulance patients transferred into ED care within the clinically recommended 40 minutes fell from around 86 per cent in 2014–17 (against a 90 per cent target) to 62 per cent in 2023; Ambulance Victoria's own more recent figures put the 2023–24 transfer rate at 65 per cent, a 6.6-percentage-point improvement on the prior year but still well short of target. The number of patients left in an ED for more than 24 hours — against a government target of zero — rose roughly twentyfold over the decade to 11,363 patients in 2023 (approx.), with the problem roughly twice as severe in regional health services, VAGO named Ballarat, Bendigo, Geelong, Warrnambool and Mildura specifically. A related but distinct measure — the share of ED patients treated within the timeframe clinically recommended for their triage category — followed a similar arc: 75 per cent in 2013, falling to a low of 63 per cent in 2022, before edging up to 65 per cent in 2023, a level VAGO said it was too early to call a sustained recovery rather than a one-year blip. On the ambulance side, the Legislative Council's Legal and Social Issues Committee tabled its final report into Ambulance Victoria on 14 October 2025, delivering 52 findings and 21 recommendations after hearing evidence of chronic over-triage, ramping and paramedic burnout.

The critique

The problem is not that Victoria lacks a plan for surging demand — it is that the funding approach layered onto that plan has been "efficiency" rather than capacity. The late-2023 directive told health services already missing four of five emergency-care targets to find savings, at a moment when the Department of Health's own figures showed the sector running a statewide operating deficit of roughly $1.46 billion in just the six months to December 2023 (approx.), with every regional health service reporting a shortfall. Asking a system already failing its own benchmarks to also reach financial breakeven, primarily by trimming non-clinical staff and services, treats an accumulated capacity gap as a budgeting problem rather than what the evidence shows it to be: a structural mismatch between demand growth and bed, staff and workforce supply. That squeeze is also occurring alongside a wider budget story: the 2025–26 Budget projects net debt rising to $185.2 billion by June 2028, with interest costs on that debt already running at about $10.6 billion a year — a fast-growing claim on the same budget that funds hospital operating grants, and one plausible reason new money has gone disproportionately toward capital works such as new hospital buildings, which are announced and ribbon-cut, rather than toward the recurrent operating funding that pays for beds to be staffed and open. A further, harder-to-see pressure sits underneath the headline $11.1 billion figure: it is a nominal increase, not one explicitly adjusted for wage growth under paramedics' and nurses' enterprise agreements or for health-cost inflation, which typically runs above the general consumer price index. A record dollar figure does not automatically translate into more beds or shorter queues once ordinary cost growth is subtracted from it.

A budget line can move into balance while the ambulance queue outside the emergency department does not.

The Catch-up Plan is a genuine partial success, but VAGO's Planned Surgery in Victoria (tabled 13 August 2025) shows it fell short of its own targets on almost every measure that matters to a patient waiting at home: 209,925 planned surgeries were delivered in 2023–24 against a target of 240,000 (13 per cent short), and the share of patients treated within clinically recommended timeframes improved from 72 per cent to 83 per cent — well short of the 95 per cent goal. Of the 42,478 patients who were already waiting beyond recommended timeframes as of March 2022, only 75 per cent had been treated by the government's own March 2023 deadline. The plan also underspent its budget by $356.4 million, largely because fewer public-private partnership arrangements went ahead than planned — money not spent is not automatically money saved when the unmet target is measured in people still waiting for surgery.

The government's public communications lean on genuinely improving headline metrics — a "lowest on record" median ED wait, a record 2025–26 health investment, national leadership on Category 1 surgery — while VAGO's decade-long view and the ambulance inquiry's findings describe a system that has been missing its own published targets for years and now says it needs paramedics and nurses to absorb rising workload inside a budget the government has told health services to shrink. Both pictures are true simultaneously; the second is the one the "efficiency" framing tends to leave out of the press release.