The ambulance services chapter of Australia's national Report on Government Services, 2026 edition released 2026-02-05, carries no measure of how long ambulance patients wait at hospital to be handed over to emergency department staff

What is happening?

When an ambulance reaches a public hospital in Australia, the patient is not finished with the ambulance. The crew stays with the patient until emergency department staff take over care, and while that lasts the vehicle cannot answer another call. The interval goes by several names — transfer of care, off-stretcher time, ramping — and the ambulance chapter of the national report that compares how governments perform does not report it.

The Report on Government Services 2026, published by the Productivity Commission on 2026-02-05, has an ambulance services chapter. That chapter reports response times, measured from the moment an emergency call is received to the moment the first ambulance resource arrives at the scene. It carries no indicator for the time between the ambulance arriving at hospital and the patient being handed over. The same chapter states that patient safety indicators are still under development and cannot yet be reported, and that expenditure data are mostly not comparable or incomplete.

Where the interval is counted in the sources opened here, it is counted by a state. Two definitions on record start the clock at different points. In a report tabled in Parliament on 2019-07-31, the Western Australian Auditor General described ramping as the time from 20 minutes after arrival at hospital until the ambulance is released to respond to another call, and noted that hospitals separately track off-stretcher time up to the point they accept care of the patient. A 2026 preprint analysing Victorian data, not peer reviewed, defines ramping as the minutes from arrival at the destination hospital until the patient is moved off the ambulance stretcher — a clock that starts at arrival, not 20 minutes later. South Australia speaks in total ramping hours per month: 5,891 hours in August 2026, according to a 2026-09-03 news report citing the state.

Whose problem is this?

The bodies that run the two services at the hospital door are state bodies. No source opened here shows a national body that owns a definition of the handover interval.

Where does this problem end?

Value questions excluded by name. Which state threshold is right — 30 minutes, 40 minutes or any other — is not judged here. Whether long handover times caused any particular death or clinical outcome is not claimed here; no individual case was examined. How much money hospitals or ambulance services should receive is outside this frame.

The boundary is drawn at the door of the emergency department because that is where one service stops counting and the next one has not yet started.

What is the state now, and what should it be?

Now

Needs a new measurementthe target state: no source opened here records a national body setting a target for a common handover measure, or a commitment to report one in ROGS. The only call for a nationally standardised ramping indicator comes from a health management professional body writing as an advocate on 2025-10-06, and that is an opinion, not a target set by any government. A South Australian benchmark of fewer than 2,000 ramping hours a month, described in the press as the pre-pandemic level the state Health Performance Council treats as under control, is a single state reference, not a national one.

How big is it?

A national size cannot be stated, because the national number is the thing that is missing. What exists are state counts in different units, and the two definitions on record do not start the clock at the same point.

In Victoria, a preprint that is not peer reviewed analysed 2,026,569 ambulance transfers to emergency departments between 2020-01 and 2024-03 and estimated 1,491,127 cumulative lost ambulance hours over that period. In Western Australia, the Auditor General recorded 592,079 ambulance calls and 335,609 dispatched cases for 2017-18. In South Australia, monthly ramping totals reported in 2026 ran from 3,616 hours in February and 3,750 hours in March to 5,891 hours in August.

These numbers cannot be added together and they cannot be set against each other. One is a count of transfers, one a count of calls, and one a count of hours on a clock whose starting point may differ from the others.

Under what conditions does it arise?

1. Two services meet at one door and each owns half of the interval. The ambulance service owns the crew and the vehicle, the hospital owns the bed and the staff who accept the patient. The 2019 Western Australian audit recorded that the two sides looked at ramping differently: the contracted ambulance provider through ambulance availability, the Department of Health through patient flow in the emergency department.

2. The clock is defined where the service is run. Ambulance services and public hospitals are run by states and territories. The two definitions opened here, Western Australia as audited in 2019 and Victoria in a preprint that is not peer reviewed, start the clock at different points. A clock that starts at arrival and a clock that starts 20 minutes after arrival will give different totals for the same night at the same hospital.

3. The national chapter flags its own comparability limits. The ROGS ambulance chapter records that its patient safety indicators are not yet reportable and that expenditure data are largely not comparable. No source opened here says why handover time is not among its indicators.

4. States report the interval in different units. South Australia publishes monthly hour totals, other material cited here uses the share of patients handed over within a set number of minutes. A total and a share answer different questions even when the clock is the same.

What has been tried?

The attempts on record work inside one state. None of the sources opened here describes an attempt to agree one national definition or to add the interval to ROGS.

What was found?

Why is it still unsolved?

Measurement absent — the interval exists on every ambulance arrival, and the ambulance chapter of the national report that compares governments carries no figure for it.

No source opened here says why the chapter leaves the interval out. What the chapter does say is that its safety indicators are not yet reportable and that its spending figures are mostly not comparable, so the gap at the hospital door sits inside a chapter that already records its own limits.

The interval also belongs to two services at once. The ambulance service sees lost vehicle hours and the hospital sees an emergency department that is full, and the 2019 Western Australian audit recorded that the two sides held different views of the same problem with no agreed plan between them. No source opened here names a single body responsible for the interval as a whole.

What the states do publish is not built to be compared. A monthly total of hours and a share of patients handed over in 30 minutes are both honest numbers, but they cannot be lined up against each other, and a clock that starts at arrival cannot be lined up against one that starts 20 minutes later. As long as each figure is reported only in its own state, the absence of a national figure produces no visible event.

What observation would mean it is solved?

Candidates — (a) ROGS adds an ambulance handover indicator, on one definition, reported for every jurisdiction (b) a national data specification defines a single start and end point for the interval and the states adopt it (c) state handover times, measured on that common clock, fall over several consecutive years.

(a) alone can hide a split. An indicator can be added with footnotes saying each state uses its own definition, which would put the problem in the table without removing it.

(b) alone is paper. A common definition that is published but not collected gives no number, and nothing opened here says whether the national emergency department dataset already holds the handover time.

(c) alone cannot be read without (b). A fall in one state on its own clock cannot be compared with a rise in another on a different clock. The three have to be read together, and (c) only counts once (b) exists.

What is it connected to?

Fills with researchinpatient bed shortage and emergency department crowding, ambulance response time performance, aged care beds and hospital discharge, and the Commonwealth and state division of health funding. Relation type and evidence grade were not confirmed in this round.

What these sources do not say

• That Australia has no single national definition, in a government voice. No government source opened here — not the Productivity Commission, the national health data agency or health ministers — states that a national ramping definition is missing. What the sources show is that the ROGS ambulance chapter does not carry the interval, and that the Western Australian and Victorian definitions are written differently. The general claim that definitions differ across jurisdictions rests only on an advocacy opinion and a preprint citing earlier research.
• Whether the national emergency department dataset records handover time. The sources opened here do not say whether the national non-admitted patient emergency department care data specification includes a handover timestamp, so this document cannot say either way.
• The state thresholds. State handover targets appear only in material that could not be opened, so none is used here. The only threshold in the sources opened is the 30-minute share South Australia cites.
• Whether other ROGS chapters carry handover time. The ambulance chapter opened here does not say whether another chapter of the report, including the public hospitals material on emergency departments, records the interval.
• The current Western Australian clock. The 20-minute starting point is the definition as audited in 2019. No source opened here says whether it still applies.
• The position of the Productivity Commission or the Commonwealth on this gap. No published statement about why the ROGS ambulance chapter does not carry the interval was found. The South Australian Government has said that emergency department presentations rose about 50 percent over ten years and that 483 people were waiting in hospital for aged care beds in August 2026, and that it has made significant progress. The Western Australian Department of Health, responding to the 2019 audit, pointed to its mental health transfer pilot.
• Why South Australian monthly totals moved. Monthly hours ran from about 3,600 to about 5,900 within 2026. No source opened here explains the movement, and the state government and opposition read the same figures differently.
• How much of the delay comes from bed shortage inside the hospital. No source opened here puts a number on that share.
• The ROGS edition label. The chapter describes itself as the 2026 edition released 2026-02-05, while its web address carries 2025 in the path.

See the evidence

One national report and one state audit were read directly. The ROGS ambulance chapter and two pages of the Western Australian Auditor General report carry the strongest claims here: the absence of a handover indicator in the national report, and the 2019 Western Australian clock. The Victorian definition and counts come from a preprint that has not been peer reviewed. The South Australian figures come from two news reports citing the state. The claim that definitions differ across all jurisdictions is carried only by an advocacy opinion and by the preprint, and is graded low. Seven sources that would have tested state thresholds and the national dataset could not be opened and are left blank with the reason. This is a Path A output (research-based definition), so observation_refs is empty and provenance_mode: press-derived.

People affected

Estimated range Not derivable

The reason and what is missing are listed under “What is missing” below