Mr. Stephen Mulvany:

The Chair is correct. The delay in the handover of ambulances outside EDs is a problem. It means those ambulances cannot pick people up from the side of the road who might need to be picked up. That is a significant issue. While the target time for a handover is 30 minutes, the actual average time in the country now is approximately one hour. That is a problem.

In some jurisdictions internationally, including across the water, the handover time is multiples of that but that is not a reason to be complacent. The problem is largely a symptom of the pressure in the ED. The ambulance service is seeking to mitigate the problem. They have a number of protocols. Some patients are well enough to be handed over to the triage part of the ED and are able to sit in the waiting area. I acknowledge the awful stories the Chair relayed.

In some cases, an ambulance crew that is already at the hospital waiting for handover can co-operate and look after another patient to free up an ambulance to go back on the road and be able to pick up callers. We allocate ambulances dynamically, so we try to mitigate the impact of having ambulances backed up outside the ED. Again it is a system problem. The staff of the ED want to get the patients in and through as soon as possible. That is not always practical and we need to encourage insofar as possible a whole-hospital, whole-health service approach, because if we cannot get people into the community, it is hard to move them through the hospital and hard to admit them. The very back of the back door is the ambulance, which can in some cases, unfortunately, become almost part of the emergency department. While those patients are safe and being cared for by paramedics and advanced paramedics, as the Chair stated, they need to be on the road picking up the next patient. It is about seeing it as an entire risk system, so the rapid handover team tries to assist with that. Do colleagues want to make any other comments on that?