On the afternoon of 3 April 2021, a seven-year-old girl named Aishwarya Aswath was carried into the emergency department at Perth Children's Hospital by her parents, feverish and in pain. She waited roughly two hours in a crowded waiting room before a doctor properly assessed her. By then the infection overwhelming her body, a Group A streptococcal infection that had progressed to fulminant sepsis, had gone too far, and she died that day. The Deputy State Coroner later found there was a small possibility that earlier, urgent treatment might have saved her life, and identified a series of missed opportunities inside a department under sustained pressure (Coroner's Court of WA, Inquest into the Death of Aishwarya Aswath Chavittupara, findings delivered 24-Feb-2023).
Her death became the case West Australians attach to a wider statistic: the number of hours ambulances spend queued outside hospital doors because there is no bed to hand their patient into, known as ramping. It is not an abstract measure. It is the time between an ambulance arriving and a patient actually beginning treatment, and in Western Australia that time has been setting records almost every year of an unbroken run of Labor government since 2017, through a mining boom that has made this the best-funded state budget in the country.
What the government did
Labor has governed Western Australia continuously since March 2017, when Mark McGowan won a landslide, through to today under Roger Cook, who became Premier in June 2023 after McGowan's resignation and then led Labor to a third consecutive term at the 8 March 2025 election, winning 46 of the 59 lower-house seats, the first party to manage a third term in WA since 1989 (Parliament of Western Australia; 2025 WA state election results). For almost all of that period, the government has also enjoyed the largest fiscal windfall of any state in modern Australian history. WA's 2018 GST floor deal and a decade-long iron ore boom have delivered an unbroken run of budget surpluses: the Commonwealth Grants Commission has estimated the GST arrangement was worth around $6.6 billion to WA in a recent assessment year, relative to the standard fiscal-equalisation formula, and iron ore royalty income alone was budgeted at about $7.7 billion in 2024-25 (approx.; WA Budget Paper No. 3, 2024-25 and 2025-26, citing CGC estimates). The government has forecast a further operating surplus of $2.5 billion for 2025-26 and $2.9 billion for 2026-27 (approx.; WA Budget Paper No. 3, 2025-26).
Almost every budget since 2021 has been presented, at least in part, as the answer to ambulance ramping. The 2021-22 Budget carried a $1.9 billion health and mental health package (WA Government media statement, 8-Aug-2021). The 2022-23 Budget added a further $2.5 billion, including a dedicated $252 million, 17-initiative Emergency Department Reform Package aimed specifically at ramping (WA Government media statement, 12-May-2022). The 2023-24 Budget, McGowan's last before he resigned, was described by the government itself as a "record $2.7 billion" health and mental health injection (WA Government media statement, 11-May-2023). Under Cook, the 2024-25 Budget added a further $3.2 billion for health, including more than $1.2 billion for core hospital services (approx.; WA Budget Paper No. 2, 2024-25). The 2025-26 Budget, the first delivered after Labor's third-term win, included $1.4 billion in new health and mental health spending, $829 million of it for hospital services, and a specific $110 million package for emergency departments and "emergency access reforms," on top of a $3.2 billion four-year health infrastructure pipeline (WA Government media statement, 19-Jun-2025; WA Budget Paper No. 2, 2025-26, Part 5). Each announcement has used similar language: record investment, more beds, shorter waits. Each has been followed, within a year or two, by a new ramping record.
The strongest case
An unprecedented population boom meeting a national workforce shortage
Put the government's defence at its strongest, because parts of it are real. Western Australia is the fastest-growing state in the country: its population grew 3.1 per cent in the year to March 2024 and remained the nation's fastest-growing at 2.2 per cent in the year to December 2025, driven by record net overseas migration (around 65,000 people) and net interstate migration (around 10,000), on top of the state's own natural increase (ABS, National, State and Territory Population, releases to Mar-2024 and Dec-2025). No health system builds beds and trains nurses and paramedics as fast as a resources-driven migration surge can add residents. WA also shares with every other state a national shortage of nurses, paramedics and GPs that no single government fully controls, and much of the "bed block" behind ramping, patients well enough to leave hospital but with nowhere safe to discharge to, sits in the Commonwealth-funded aged-care and disability systems rather than in a state hospital budget line. Emergency departments nationwide had a difficult run through the flu seasons and COVID aftermath of 2022 to 2025. Against that backdrop, a $3.2 billion four-year health infrastructure pipeline and a specific $110 million 2025-26 package aimed at emergency department flow is a genuine and substantial response, not a token gesture. A government cannot be blamed for demand growth this fast; it can only fairly be judged on whether its response kept pace with it.
The evidence
None of this is a matter of dispute. It is recorded in St John WA's own ramping data, WA Health's emergency department activity releases, and the Productivity Commission's Report on Government Services (RoGS). Between 2017, McGowan's first year in office, and 2022, the annual hours ambulances spent ramped outside metropolitan hospitals rose from 9,819 to 66,307, a roughly 6.8-fold increase in five years (approx.; St John WA, Ambulance Activity and Response Times data, as reported). The trend did not reverse once the worst of the pandemic passed. Ramping exceeded 7,000 hours in a single month for the first time in mid-2025, a level St John WA data show as higher than any month recorded during the COVID period; September 2025 then set a fresh record of 7,257 hours, the third consecutive monthly record; and February 2026 was the worst February on record, at 4,892 hours (St John WA/WA Health ramping data, as reported in WA parliamentary and media commentary, Oct-2025 and Mar-2026).
The Productivity Commission's Report on Government Services 2025 found Western Australia had the lowest proportion of any state of Category 3, or urgent, emergency patients seen within the clinically recommended 30 minutes: just 32 per cent, around 29 percentage points below the national figure, based on 2023-24 data (Productivity Commission, Report on Government Services 2025, Health, Public Hospitals). Independent analysts have flagged a bed shortfall behind that number for years: the AMA (WA), citing Australian Institute of Health and Welfare hospital resource benchmarking, calculated in 2021 that WA needed around 612 more public hospital beds simply to reach the national average bed-to-population ratio (approx.; AMA (WA), Action Agenda, 2021, citing AIHW Hospital Resources data), a gap that predates, and helps explain, the ramping records that followed. The state's own auditor reached a related conclusion years earlier again: the Auditor General's 2019 follow-up audit of WA's ambulance services found ramping had increased significantly since mid-2017 and that the Department of Health had no agreed plan to reduce it (WA Auditor General, Delivering Western Australia's Ambulance Services, Follow-up Audit, 2019).
The critique
Money, in other words, has not been the constraining resource. Western Australia entered this period as the best-funded state government in the country, running an unbroken sequence of budget surpluses built on iron ore royalties and a uniquely generous GST floor, and it has poured billions of new dollars into health in almost every budget since 2021. And still, on the Productivity Commission's own figures, it has the worst emergency department performance of any state against the recommended-time benchmark, and it keeps breaking its own ramping record. That combination, the richest state budget and the worst results, is the core of the case against this government's management of its hospitals.
Accountability for that record does not sit only with the current Premier, and fairness requires naming who held the portfolio when. Roger Cook was Deputy Premier and Minister for Health from March 2017 until a December 2021 reshuffle moved him to the tourism portfolio, the period in which annual ramping hours climbed from 9,819 to roughly 52,435, more than fivefold (approx.; St John WA data). Amber-Jade Sanderson has held the health portfolio since December 2021, through the year ramping hit its then-record 66,307 hours in 2022, and through the monthly records of 2024, 2025 and 2026. Cook, as Premier since June 2023, carries ultimate responsibility for a government that has now presided, across two health ministers and eight years, over ramping figures that have never sustainably come back down, only risen, then risen again from a higher base.
The government's own reform packages illustrate the pattern. The $252 million, 17-initiative Emergency Department Reform Package landed in the 2022-23 Budget with the explicit aim of reducing ramping; the worst calendar year on record followed within months. The 2025-26 Budget's $110 million package for emergency access reforms was announced within months of the state recording its worst July, then its worst September, on record. Each package has been real money, targeted on paper at genuine bottlenecks, more short-stay units, more hospital-in-the-home care, more paramedic and nursing positions, and each has been followed by the same headline. That is not proof the money was wasted; some of it clearly bought beds and staff that would not otherwise exist, and demand has grown faster than any single package could offset. But eight years and several billion dollars into "reform," a health system that keeps setting new ramping records is no longer being tested by an unforeseen shock. It is failing a test it has had years of warning, and a mining boom's worth of money, to prepare for.
Western Australia has the money to fix this. What it has produced instead is a new record almost every year.
The accountability gap
Aishwarya Aswath's death is the case most West Australians remember, but it was not the only one, and not the first warning. Ashleigh Hunter, a Perth woman, died at Royal Perth Hospital on 27 December 2019 from a meningococcal infection after waiting roughly an hour outside the emergency department, first on the ambulance ramp, then in an overflow bay, before being properly assessed. The State Coroner found the quality of care she received fell below the standard expected of a public hospital, and that the delay most likely brought forward the time of her death, even though it could not be shown to have caused it (Coroner's Court of WA, Inquest into the Death of Ashleigh Rebecca Hunter). Both inquests describe the same underlying mechanism: a department too full to assess a deteriorating patient quickly enough, at a time when ramping was already a matter of public record.
Measuring the scale of the problem has itself been contested. A November 2024 Auditor General report on the quality of WA's emergency department data did not examine ramping or ED performance directly, and its narrow scope was itself telling: eight years into a widely reported crisis, the state's independent auditor had not been tasked with a fresh, dedicated audit of ramping and ED performance since 2019 (WA Auditor General, Quality and Utilisation of Emergency Department Data, Nov-2024). Voters, for their part, re-elected the Cook government in a landslide on 8 March 2025, Labor's third consecutive term, the first for any WA party since 1989, with cost-of-living pressures, not hospitals, dominating that campaign (Parliament of Western Australia; 2025 WA state election results). A government can win an election comfortably while a specific portfolio keeps missing its own targets. The two are not the same test, and this masthead applies the second one.
The risk to the future
A boom-time budget that has not bought boom-time capacity
Western Australia's fiscal position will not stay this favourable forever. The surpluses funding each new health package rest on iron ore prices and a GST floor arrangement that a future Commonwealth government could revisit; if royalty income falls from its current elevated levels, the flow of billion-dollar "record investment" announcements will be harder to sustain, even as the state's population, still forecast to keep growing faster than any other state or territory, keeps adding people to a system that already has the country's lowest rate of on-time emergency care. Capacity built for the top of a resources cycle, rather than for the underlying long-run demand curve, is the wrong kind of investment for a state whose commodity revenue has always moved in cycles.
There is a second, quieter risk in the pattern itself. A government that announces a new record health budget nearly every year, against a hospital system that sets a new ramping record nearly every year, teaches the public to discount both kinds of announcement, the reassurance and, eventually, the warning. If the next Aishwarya Aswath or Ashleigh Hunter is a headline still to be written, the risk is not only clinical. It is that a state with the resources to have fixed this by now instead normalises it, one record-breaking month at a time.