Amid record ambulance ramping and bed block across the hospital system this week, the Premier said today that the Royal Adelaide Hospital (RAH) “will have to be expanded” to meet the state’s future health needs.

The RAH has been under significant pressure this week as the state’s health system copes with a surge in demand. At one point on Tuesday, there were 122 patients in the RAH emergency department – well over its 69 treatment areas capacity – with nine patients waiting more than a day for a bed.

The former Rann and Weatherill Labor government delivered the new RAH between 2007 and 2017, although there were warnings from doctors during construction that it would be too small.

Asked on ABC Radio Adelaide today whether those warnings had come to fruition, Malinauskas said: “I think that depends who you speak to is the honest answer.

“The new hospital is a lot bigger than the old one, but at some point in the future it will have to be expanded.”

The RAH emergency department has been under significant pressure this week. Photo: Tony Lewis/InDaily

The Premier said the government’s decision to build the new $3.2 billion Women’s and Children’s on the Thebarton barracks site rather than the railyards adjacent the RAH was done with future RAH expansion in mind.

“Since I’ve been at the decision-making table, the inflection point or the critical decision that we had to make was do we build the Women’s and Children’s Hospital next to the RAH that would prevent it from being expanded in the future… or do we find a new location,” he said.

“So we made the tough and the controversial decision as a state government to say no we’re not going to do that – we are going to build a new Women’s and Children’s Hospital in the precinct but we’re going to do it on the other side of the railway line.

“Two reasons for that: it means we can build a bigger Women’s and Children’s from the start so we don’t make mistakes of the past, and the second thing is I didn’t want to stop the RAH from being expanded in the future.”

The new Women’s and Children’s Hospital site on the Thebarton barracks will allow the RAH to expand, Premier Peter Malinauskas says. Image: SA Govt/supplied

Malinauskas, whose central plank for the 2022 election was to “fix the ramping crisis”, conceded today that the record ramping figures released this week were “desperately disappointing”.

The November figures showed that ambulances spent 4285 hours outside hospital entrances waiting to admit patients, eclipsing the previous record of 3968 hours in March this year.

The number of hours ambulances spent on the ramp was equivalent to nearly half a year. They were also up 963 hours from October.

Health Minister Chris Picton yesterday attributed the figures to increased COVID presentations and outages affecting SA Health’s electronic patient management system, Sunrise EMR, which is now under review.

Malinauskas said the November result “feels like two steps forward, one step back”.

“There’s no two ways about it… I was incredibly disappointed with the numbers that we saw come out yesterday,” the Premier said.

“We’ve had six months… of month-on-month improvement on last year.

“Six consecutive months we were really starting to get somewhere in terms of improvement.

“And then the numbers released yesterday in respect to the last month were exceptionally disappointing – it feels like two steps forward, one step back.

“It just demonstrates that we’ve got a lot of work to do. There is no lack of effort on behalf of the government, we’re investing unimaginable sums in terms of into the system over and above what was the case previously.”

It comes after South Australian Salaried Medical Officers president Dr David Pope posted on social media that emergency department clinicians were being “intimidated to off load ambulance pts (patients) when there are sicker and more urgent pts in the waiting room”.

Pope posted on Twitter that he sees ambulance patients being prioritised over sicker waiting room patients “every shift I work”.

“The repeated calls from hospital managers demanding ambulance off-load counter to other patient’s urgent clinical needs are so distressing,” he said.

“We back up our nurses but they still receive call after call. No clinician should be subject to this.”

But Malinauskas said it was “patently false” to suggest hospital executives were prioritising getting patients off ambulances so ramping statistics improve. He said that patients on ambulances were sometimes prioritised to ensure ambulance could respond to other urgent emergency callouts.

“It is true… that where we have our ambulance service overwhelmed… one thing that we have got senior executives in the hospital system doing – as has always been the case – is they do have to… make a system wide decision… around ambulance being dispatched to priority one callouts in the community,” he said.

If two patients are equally unwell – one in an ED waiting room and one on the ramp – then a decision “is made to prioritise getting the patient out of the ambulance and into being treated because that allows the ambulance to be dispatched to attend a priority one callout.”

“There has never been an instance where politicians are making decisions in emergency departments.”