The final report by the Inspector-General for Emergency Management, Tony Pearce, into Victoria’s ailing triple-zero system makes for sobering reading. When the investigative and health teams at The Age started uncovering the problems in Victoria’s ambulance system last year, it was clear that the appalling delays in answering emergency calls were contributing to people dying.
But Pearce’s report is still shocking. He has revealed 40 serious potential adverse events between December 1, 2020 and May 31 this year “associated with call answer delays, agency command and control decisions, and/or ambulance resourcing issues”, and that “tragically, 33 of these patients did not survive their emergencies”.
ESTA was so unable to keep up the cost of providing a workable service to a growing population that it was almost inevitable it would fail when the pandemic struck and call numbers shot through the roof.Credit:Wayne Taylor
Pearce is at pains to point out that the phone operators were not to blame. Instead, he points to funding problems entrenched as far back as 2004 that left the operator – the Emergency Services Telecommunications Authority or ESTA – so unable to keep up with inflation and a growing population that it was almost inevitable it would fail under pressure. Then the pandemic struck and call numbers shot through the roof.
Call takers who then fell ill or had to isolate compounded the problem, and archaic industrial and bureaucratic practices made it difficult to respond to staff shortages. The crisis meant staff mental health had to be identified as “non-essential” and, in any event, the report noted the “most important mental health reform would have been to increase staff sufficiently to meet the overwhelming demand”.
For the families of those Victorians who died waiting for a potentially lifesaving intervention, Pearce’s report will confirm their fears and stoke their anger at a system that was left deplorably unable to meet their reasonable expectations. Pearce has apologised for not being able to provide information about specific cases because of the limited scope of his inquiry, but has laid bare the failings of a system we are entitled to rely on.
This is a system funded by the state government. It has nobody else to blame. And these failings were only compounded by the government’s decision to not only sit on the report for a month but then to make it publicly available on a Saturday – the first of the AFL finals series – when it clearly calculated that public and media attention would be directed elsewhere.
All governments employ the strategy of releasing damaging information on an otherwise busy day – it’s known cynically in the trade as “taking out the trash”. But this was particularly disgraceful. When bureaucratic failures are so comprehensively linked to the loss of life, the government owes us all an apology, a full and frank admission of liability and a commitment to rectify the issues. In this case, the premier has not been seen publicly since the report’s release.
The government should have fixed these funding issues as far back as 2015, when the auditor-general first made it aware of them. It should have done more to act in the early days of COVID-19 to bolster an already struggling system – the nine lives lost in the thunderstorm asthma event of 2016 offered a taste of how emergency services might struggle to cope with a sudden surge in demand.
A similar excoriating review by former Victoria Police chief commissioner Graham Ashton earlier this year has already led to some changes, and the government put $333 million extra into the system at the last budget. But Pearce told The Age yesterday that this was a “short-term fix” that did not deliver a sustainable funding model. “If you don’t finish the work on that model, you will be back in the same place you are now,” he said.
The government has promised that Pearce’s recommendations will be implemented in full. But whatever good news there was in this report has been buried along with the bad, which speaks volumes for this government’s lack of commitment to accountability and transparency on a politically contentious issue just months before an election.
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