South Australia's public health system has "deteriorated" under the current government, according to an independent review released on the same day that ambulance ramping was revealed to have hit a record high.
The review of SA Health found that ramping was "chronic" between 2022 and 2026 — a period overlapping with the first term of the Malinauskas government, which had promised to "fix the ramping crisis".
The tabling of the review in parliament came hours after the latest ramping stats revealed patients were stuck outside public hospitals for a record 5,891 hours in August.
Conducted by the SA Health Performance Council, the review found that in 2024-25, less than half of metropolitan patients were transferred from the care of paramedics to emergency department staff within 30 minutes of ambulance arrival, down from more than 92 per cent in 2014-15.
"It is unreasonable to think that ambulance ramping is something that can ever be 'fixed'," the council stated in its report.
"Rather, we believe it is more reasonable to recommend system targets that meet community expectations, while being safe and sustainable.
"We believe that ambulance ramping would be, if not 'fixed', at least 'under control' if it reduced to a pre-COVID level of under 2,000 total monthly hours."
The council said that, "in too many areas … the performance of South Australia's public health system has deteriorated over recent years".
In a statement addressed to Health Minister Blair Boyer, the council's chair Professor Stephen Duckett wrote that SA Health's culture needed to change from "micromanaging and siloed, to strategic, connected and being held to account".
"Our findings indicate a lack of system-wide planning, mis-alignment between priorities and performance measures, and local health networks missing their targets," he wrote.
"The buck stops with you, as Minister, for accountability to Parliament and the public for performance, governance, and the stewardship of public funds."
In its response to the review, also tabled in state parliament this afternoon, the SA government wrote there was "no doubt the public health system is under more pressure than ever".
"Presentations at emergency departments have increased by more than 50 per cent over the past decade, with the growth between 2022 and 2025 alone at almost 12 per cent," the government wrote.
"This has added enormous pressure to our public hospitals."
The government stated that "while there is still much more to do", ambulance response times had "significantly improved" over the past four years and it had recorded "high levels of patient satisfaction".
"Significant progress has already been made in expanding capacity, improving patient flow, strengthening workforce capability and enhancing access to care," it stated.
'Not getting anywhere close'
The latest ramping figure surpasses the previous high of 5,866 hours from July 2025.
The government has repeatedly blamed ramping on a shortage of federal aged care beds, but the ambulance union today said "excuses" did not amount to solutions, and said SA was not "anywhere close" to fixing the problem.
Mr Boyer conceded that August had been a "very tough month on the ramp".
"We had the highest transfer of care, or ramping, hours the state has seen," he said.
The minister linked the ramping figure with the number of patients stuck in hospital while waiting for residential aged care beds.
"In August, that number broke a new record and got to 483 — 483 up from 60 [in October 2022]. They are beds in the public hospital system that we don't have available for acute patients," he said.
Mr Boyer said he would be pushing for more aged care beds when he meets with the federal health minister, as well as state and territory counterparts, on Friday.
Ambulance Employees Association general secretary Paul Ekkelboom said ramping remained at crisis levels, adding: "This is a government's problem to solve".
"We're hearing excuses as to what the barriers are. They need to address those barriers; they've made the promise to actually fix ramping. We're not getting anywhere close," he said.
"[In] 2017 the ramping hours were 328 hours. For the month now of August, it's 5,891 hours, which is too excessive."
Mr Ekkelboom acknowledged the impact of a shortage of aged care beds but said it was up to the SA government to find solutions.
"It's a very convenient argument right now, but it is a real argument," he said.
SA opposition spokesperson for health and wellbeing, Jack Batty, said the review tabled in parliament today was "damning", and that the health system had "gone backwards".
"This scathing report shows ambulance response times have deteriorated, ramping remains chronic, and emergency department delays are entrenched," he said in a statement.
"After four-and-a-half years, billions of dollars and countless excuses, South Australians are now spending more time stuck in ambulances outside hospitals than ever before."
