Health was high on the agenda at Tuesday night’s leaders’ debate in Victoria, ahead of this weekend’s state election.
“We had the very best ambulance response times in the history of our state … just weeks before COVID hit,” Premier Daniel Andrews claimed.
He repeated the claim minutes later, as he praised paramedics for delivering “the very best ambulance response times in the history of our state,” and then again, saying paramedics were “absolutely determined to replicate … what they did just weeks before COVID arrived: deliver the best response times in the history of our state”.
These echo a claim he made at a press conference on October 19, where he told journalists:
The day we were sworn in, ambulance services were in a terrible state. We then worked hard, in partnership with our paramedics, to deliver the very best ambulance response times on record, ever. That was before the pandemic. Just weeks before the pandemic, in fact.
So, were Victoria’s ambulance response times the very best in the history of the state just prior to the pandemic?
RMIT ABC Fact Check investigates.
Mr Andrews’s claim is spin.
While ambulances have been in operation in Victoria, in some form, for almost 140 years, less than two decades of comparable data is available to assess his claim.
Even some of this data may not be comparable, according to the Productivity Commission.
This would mean that as little as 15 years of data is available.
At most, there is 18 years of data available. This data shows ambulance response times were at their best under the Bracks Labor government, but that era is not directly comparable.
Nevertheless, response times had improved significantly under the Andrews government prior to the pandemic, although they were at their best a year before the pandemic, not weeks.
They have crashed since.
What are ‘ambulance response times’?
Ambulance Victoria says response times “are measured from the receipt of the triple zero (000) call until paramedics arrive on scene“.
Each call “is assessed on clinical need”. Code 1 patients are designated as requiring urgent paramedic and hospital care — in other words, a “lights and sirens” response.
These are time critical, and Ambulance Victoria has “two official response time targets” they aim to meet:
Respond to Code 1 incidents within 15 minutes for 85% of incidents state-wide, and
Respond to Code 1 incidents within 15 minutes for 90% of incidents in centres with populations greater than 7,500.
Code 2 cases are “acute, but not time critical” and do not require a lights and sirens approach.
Malcolm Boyle, an associate professor and academic lead in paramedic education at Griffith University, told Fact Check “timely response” rates are the key performance indicator which the organisation reports to the government.
What data is available?
As Fact Check has previously explained, Victoria has had ambulances since 1883, and began using radio dispatchers to allocate jobs to them in 1954.
Ambulance Victoria began operating at the start of the 2008-09 financial year, following the amalgamation of metropolitan and rural services that had previously been in operation.
Data prior to this is not uniform and is therefore not comparable, as a previous fact check on this topic found.
In addition to the percentage of responses achieved within 15 minutes, Ambulance Victoria’s quarterly reports also include average response times in minutes and seconds for Code 1 and Code 2 calls. It began publishing this data in 2014-15.
Data is also available from the federal government’s Productivity Commission, which has included information on ambulance response times for each state and territory in its annual Report on Government Services series since 1998.
Its data is for the 50th and 90th percentile of Code 1 responses — “the time (in minutes) within which 50 per cent and 90 per cent of the first responding ambulance resources arrive at the scene”.
A small amount of data is also available in a 2010 report by Victoria’s auditor-general, Des Pearson, which looked at the declining performance of ambulances over the previous six years.
What are the issues with the earlier data?
Ambulance Victoria’s annual reports note that a different system for recording data has been in use from 2007-08 onwards.
This was when the Computer Aided Dispatch (CAD) system for recording response times was introduced in metropolitan areas, an Ambulance Victoria spokesperson said. Metropolitan paramedics had previously completed patient care records (PCRs) manually.
“What this means is PCRs are rounded minutes and recorded by ‘hand’, whereas the CAD is a computerised system comprising minutes and seconds,” an Ambulance Victoria spokesperson said.
Ambulance Victoria also notes that pre-merger data is aggregated from figures collected by the services it replaced, with some of this estimated due to discrepancies in the previous reporting systems.
Unlike Ambulance Victoria, the Productivity Commission says that results from prior to 2007-08 “are not directly comparable with previous years”, due to this change in reporting methods.
Victoria’s auditor-general also noted the issue of data comparability in his report — and nonetheless made a series of strong claims about declining response times.
“The overall picture is clear,” he said, with a “trend of deteriorating ambulance response times” being “evident prior to amalgamation” and continuing under Ambulance Victoria.
“Ambulances are taking longer to respond to Code 1 emergencies, with the worst performance since 2004–05 recorded in 2009–10,” he also said.
When contacted by Fact Check, Ambulance Victoria’s data insights team said that “you can compare the data”, even though “technically it’s not ‘directly comparable'”, while the Productivity Commission reiterated that data from earlier years is “not directly comparable”.
Fact Check previously concluded that “based on the available data, there is no way to fairly compare ambulance response times over the 60 years that Victoria has operated ambulances connected by radio dispatchers.
“There is no data for the early years, and since the 1980s, response times have been measured in different ways, making a direct comparison impossible.”
The source of the claim
Mr Andrews’ office said his claim was based on an Ambulance Victoria press release issued in February 2019 that said the service had “again recorded its best ever response time performance”.
If simply referring to Ambulance Victoria’s short history, then this press release was correct at the time.
What does the Ambulance Victoria data say?
Ambulance Victoria’s statewide Code 1 target data shows that response times peaked in the first year of the series, with 87.7 per cent of all Code 1 responses being under 15 minutes in 2004-05.
It fell from there, including after Mr Andrews became health minister under the previous Brumby Labor government.
It continued to fall after Labor lost the 2010 state election, and bottomed out at 71.8 per cent towards the end of the Coalition’s single term in office.
After Mr Andrews became premier, the rate improved significantly to reach 84.2 per cent in early 2019 — the highest figure recorded since the Ambulance Victoria merger.
Before the pandemic was declared a year later – on March 11, 2020 – the rate had slipped marginally.
It has subsequently fallen to the mid 60s, recording the lowest figure (64.0 per cent) in the final quarter of 2021-22.
Data related to Ambulance Victoria’s 90 per cent target (which excludes calls to less populated areas) does not include figures for these earlier years, but follows a similar trend where the data is available, and reaches a high point in early 2019.
The quickest result for average Code 1 response times in the Ambulance Victoria data was also recorded in early 2019. However, this time — 11 minutes 03 seconds — is behind the best figure from the auditor general’s report — 10 minutes 36 seconds in 2004-05.
For Code 2 calls, the quickest average response time in the Ambulance Victoria quarterly reports was recorded in early 2019 (23 minutes 36 seconds), a year before the pandemic.
Ambulance Victoria’s recent annual reports have also included response times data for “priority zero” cases, which involve the “most critically ill” patients, such as those who are not breathing or are not conscious.
Ambulance Victoria beat its priority zero target in both 2018-19 and 2019-20, though Dr Boyle noted that firefighters — who are only equipped to carry out some of the tasks of a paramedic — also attend these cases, which may influence the figure.
What does the Productivity Commission data say?
Excluding data prior to 2007-08, the best result in the Productivity Commission’s 50th percentile series was recorded in 2018-19, the last full financial year prior to the pandemic.
This time, of 9.5 minutes, was not as quick as the 9.0 minutes recorded in each of 2004-05, 2005-04 and 2006-07 — but the commission does not consider this data comparable.
For the 90th percentile data, 18.0 minutes was recorded in 2018-19. This is easily the best time from the years which the commission considers to have comparable data, but behind earlier years.
What do the experts say?
“Andrews’s statement that the best response times on record were delivered just before the pandemic cannot be considered factually correct,” said Simon Sawyer, the director of education at the Australian Paramedical College and a registered paramedic.
The limited dataset means “it’s not possible” to make a claim about when the best times occurred, Dr Sawyer said.
Given that some of this data may also show better periods of performance, he said Mr Andrews’s claim was “not accurate”.
Dr Boyle said that when it came to the reliability of data, he was “more inclined to go with the Productivity Commission view”.
“How can we be sure that the definition for response time has remained the same over the reported timeframes … and can it be guaranteed that the response time was accurately measured the same way each time?”
How important are targets?
Dr Sawyer said it “is reasonable” for the premier “to tout” Victoria’s pre-pandemic response time improvements, even if those improvements did not meet the service’s 85 per cent target.
He also said that he “wouldn’t read much into” the slight declines in response times during 2019 as “there is always going to be fluctuations” and “it probably had zero impact on outcomes that actually matter, such as patient healthcare outcomes”.
He describes the 85 per cent target as “arbitrary” and says it “puts patient healthcare outcomes second to speed” and is “not predictive of favourable healthcare outcomes for the vast majority of patients”.
“This performance metric is used as it’s simple to report and understand, but it is probably not the best data to determine the performance of state ambulance services.
“Ambulance Victoria has, in my opinion, many good programs aimed at improving patient healthcare outcomes, such as their responses to cardiac arrest, stroke and recently mental health patients.
“I’d like to see the focus moved from arbitrary performance metrics to the impact of the ambulance service on patient healthcare outcomes, which is where the real value of our world class ambulance services and paramedic workforce lies.”
Principal researcher: Jack Kerr
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