Victoria’s emergency departments were missing performance targets before COVID. Its operating theatres were underused. Its population was growing, and hospital planners were warning that existing facilities could not keep pace.
These were not problems discovered after the health system came under extraordinary pressure in 2020. They were documented years earlier.
By 2017, the Victorian Auditor-General had identified inefficiencies in public hospital operating theatres, weaknesses in statewide planning and opportunities to treat more patients with existing resources. By 2019, ambulance handover performance was deteriorating. By 2022, Victoria’s planned-surgery waiting list had climbed to approximately 86,000 patients.
In 2024, another Auditor-General investigation confirmed that Victorian hospitals had failed to meet several key emergency-care targets throughout the preceding decade.
Successive Labor governments under Daniel Andrews, Jacinta Allan and now Ben Carroll have committed substantial funding to hospitals, ambulance services, infrastructure and healthcare reform. Some interventions have delivered measurable improvements.
But if the problems were repeatedly identified, why did so many persist?
2014–2016: A GROWING POPULATION, AN ALREADY STRAINED SYSTEM
When the Andrews Government took office in December 2014, Victoria’s health system was already experiencing capacity pressures. The state’s population was growing, demand for healthcare was increasing and an ageing population was placing additional pressure on hospital services.
The Government inherited these challenges. It did not create all of them. But from that point forward, responsibility for planning, funding and responding to changing demands rested with the new administration.
The Victorian Auditor-General’s later examination of emergency healthcare provides a baseline. In 2013–14, approximately 84% of patients arriving by ambulance were transferred into emergency departments within 40 minutes, against a 90% target. In 2014–15, performance improved to approximately 86%, but remained below target.
In 2016, Werribee Mercy Hospital’s service plan recommended ongoing strategies to accommodate increasing demand associated with population growth in its catchment. Yet the hospital’s new emergency department would not be announced until 2022.
Six years passed between the documented planning warning and the announcement of a new emergency department. Other capacity improvements were undertaken in the intervening period, but whether their scale and timing matched forecast growth remains a legitimate question.
2017: THE AUDITOR-GENERAL EXPOSES UNUSED HOSPITAL CAPACITY
On 18 October 2017, the Victorian Auditor-General tabled Victorian Public Hospital Operating Theatre Efficiency. Demand for elective surgery had increased by 12% over the five years to 2015–16, yet the audit found operating theatres were not being used as efficiently as they could be.
55% of elective surgical sessions started more than 20 minutes late. Ten per cent finished more than 90 minutes early. Operating theatres were unused on 9.5% of available theatre business days during the measured period.
Some unused capacity reflected legitimate constraints, including staffing, maintenance, patient needs and funding. But the audit also identified preventable inefficiencies, inadequate statewide information on theatre utilisation and insufficient benchmarking between hospitals.
The report made 11 recommendations. It concluded that better use of existing resources could increase the number of patients treated and reduce waiting times.
This was not simply a warning that hospitals needed more money. It was a warning that existing public resources were not being managed as effectively as they could be. What changes followed, and were the identified inefficiencies reduced?
2018–2019: AMBULANCE PERFORMANCE DETERIORATES BEFORE COVID
By 2017–18, the proportion of ambulance patients transferred to emergency departments within 40 minutes had fallen to approximately 84%. In 2018–19 it fell to 82%; by 2019–20 it was 78%. The target remained 90%.
The deterioration began before COVID. Ambulance handover delays matter because paramedics waiting to transfer patients are unavailable to respond to other emergencies.
The problem is connected to emergency department congestion, inpatient bed availability, discharge processes and overall patient flow. A problem inside a hospital can become a problem for someone waiting for an ambulance kilometres away.
The deterioration was measurable. So was the growing demand. Was government planning keeping pace?
2020–2022: COVID EXPOSES THE SYSTEM — AND GOVERNMENT DECISIONS ADD NEW PRESSURES
COVID placed extraordinary demands on health services across Australia. Victoria faced infection-control challenges, hospital admissions, staff illness, isolation requirements and workforce shortages.
But the Government’s response also involved policy choices affecting healthcare access. Restrictions on planned surgery were introduced to preserve capacity; healthcare workers faced vaccination and workplace requirements; hospitals operated under changing infection-control arrangements.
The consequences of those choices warrant examination independently of the effects of COVID itself. In September 2020 the Government acknowledged a backlog created by suspending non-urgent elective surgery. Further restrictions followed in 2021 and 2022.
In January 2022 the Government suspended categories of planned surgery and declared a Code Brown emergency across Victoria’s hospitals.
Department of Health figures showed the planned-surgery waiting list rising from 55,806 patients in June 2020 to 66,320 in June 2021 and 85,999 in June 2022: more than 30,000 additional patients in two years.
The Government argued restrictions were necessary to preserve urgent-care resources. The question is whether those decisions were proportionate, what alternatives were assessed, and whether sufficient measures prevented avoidable deterioration for patients awaiting treatment.
2022–2023: THE EMERGENCY DEPARTMENT BOTTLENECK
By 2022–23, ambulance handover performance had fallen to approximately 62%. Barely six in ten ambulance patients were transferred within the required 40 minutes, against a target of nine in ten.
The Auditor-General also documented an extraordinary increase in patients remaining more than 24 hours in emergency departments. The rate rose from 518 per 100,000 population in 2013–14 to 11,363 in 2022–23 — an increase of 2,094%.
This measure concerns patients remaining in emergency departments for over 24 hours, not all presentations. The official target was zero.
The audit identified hospital bed availability and patient-flow difficulties as possible contributors, without independently establishing the precise contribution of each. Workforce shortages, patient complexity and difficulties accessing other forms of care also mattered.
These were interconnected pressures requiring coordinated planning, not simply more ambulances or another funding announcement.
2023: WERRIBEE MERCY — THE WARNING BECOMES A CASE STUDY
Werribee Mercy’s 2016 service plan had identified population-driven demand. In May 2023 an internal briefing recorded that demand was outstripping emergency department capacity.
The hospital also identified approximately 8,500 patients annually from its catchment who attended the Royal Children’s Hospital rather than Werribee Mercy between 2017–18 and 2021–22. Some families may have had legitimate reasons for seeking care elsewhere, but the pattern raised questions about local capacity.
The new emergency department had been announced in 2022, with completion then planned for late 2025.
The hospital had identified population-driven demand years earlier. By 2023 its own briefing confirmed that emergency department capacity was being exceeded. This is the same planning question raised by Victoria’s housing and population growth: essential services must keep pace with development.
2024: A DECADE OF MISSED TARGETS
On 25 June 2024 the Victorian Auditor-General tabled Access to Emergency Healthcare, examining 2013–14 through 2022–23.
The audit found that Victoria had consistently failed to meet key targets for ambulance handovers, timely emergency treatment and emergency department length of stay.
There was an important exception: hospitals consistently met the target for immediately assessing patients with the most life-threatening conditions, triage category one. That achievement matters, but it did not erase wider performance problems.
The Auditor-General found that the department, Ambulance Victoria and examined hospitals understood principal demand drivers and barriers to timely care. Various initiatives had been introduced, some meeting their individual objectives. Yet the audit could not establish significant improvements in overall emergency-care timeliness across the decade.
It also identified shortcomings in long-term public reporting and recommended investigating underlying causes, addressing access disparities and improving reporting.
After a decade of missed targets, the independent auditor was still recommending investigation of the underlying causes of performance failures.
2024: ANOTHER WARNING — WORKFORCE DATA WAS INADEQUATE
The 2024 emergency healthcare audit highlighted the Department of Health’s 2023–24 budget submission, which acknowledged a lack of sufficiently timely, detailed and reliable public health workforce information.
That limited the department’s ability to understand current and emerging needs. In February 2024 the Government launched a ten-year health workforce strategy.
Workforce shortages are not unique to Victoria, and national training pipelines, registration, migration and working conditions all matter. But the state remains responsible for understanding and planning for its own needs.
Why did Victoria lack sufficiently detailed workforce information after years of documented capacity pressures? A strategy is a commitment; its value depends on measurable improvements in recruitment, retention and patient access.
2025: SURGERY RECOVERY IMPROVES — BUT MISSES TARGETS
In 2025 the Auditor-General examined the Government’s planned-surgery recovery program. The waiting list fell from 88,434 patients in March 2022 to 57,476 in June 2024, a reduction of approximately 35%. That was substantial progress.
But the target was 55,400. The Government also aimed to deliver 240,000 planned surgeries in 2023–24 and delivered 209,925, a shortfall of 30,075.
The share of patients receiving surgery within clinically recommended timeframes improved from 72% in March 2022 to 83% by June 2024, below the 95% target.
The program finished $356.4 million under budget, primarily because fewer private hospital surgeries were delivered than planned. Some unused funding was redirected to assist health services with recovery.
The Government reduced the backlog. But it did not deliver the full volume of surgery promised, and thousands of patients remained on waiting lists. Both facts belong in an accurate assessment.
2025–2026: AMBULANCE REFORMS SHOW PROGRESS, BUT THE GAP REMAINS
Victoria introduced new standards in 2025 to improve ambulance handovers, hospital escalation procedures and ambulance availability.
Ambulance Victoria reported that 65.1% of Code 1 emergencies received a response within 15 minutes between October and December 2025; the figure increased to 66.4% between January and March 2026. The statewide average Code 1 response time improved to 15 minutes and 28 seconds.
These are meaningful improvements, but the proportion receiving a response within 15 minutes remained below the statewide 85% target. Ambulance response time and hospital handover time are separate measures and must not be conflated.
The evidence shows improvement. It does not yet establish that underlying performance problems have been resolved.
REGIONAL VICTORIA: THE PRESSURES EXTEND BEYOND MELBOURNE
Regional services face particular difficulties with workforce availability, specialist access, population ageing and transfers between hospitals.
Bendigo Health identified population growth, limited access to general practitioners, increased patient complexity, bed capacity and delays discharging patients into aged care or disability accommodation as factors affecting emergency performance.
A patient medically ready for discharge may remain in hospital because suitable accommodation or support is unavailable. That bed cannot be used for another patient, and congestion can extend back through emergency departments to ambulance handovers.
The Auditor-General identified statistically significant differences between patient groups, including metropolitan and non-metropolitan populations, while cautioning that further investigation was needed to establish causes.
Statewide averages can conceal very different experiences depending on where someone lives.
THE COST IS NOT JUST FINANCIAL
Ambulance delays can prolong the time before care. Emergency congestion increases distress. Delayed surgery can affect mobility, employment, independence and quality of life. Workforce shortages place further pressure on clinicians and support staff.
These consequences are difficult to capture in a single budget figure. They nevertheless form part of the public cost of inadequate planning and service delivery.
TWELVE YEARS OF WARNINGS. WHO WAS RESPONSIBLE?
Victoria’s health system did not stand still. Successive governments funded facilities, expanded services, introduced reforms and supported recovery programs. Some measures demonstrably improved outcomes.
But the chronology reveals repeated warnings: the 2017 theatre-efficiency audit; declining ambulance handovers before COVID; Werribee Mercy’s 2016 demand warning; the 2022 planned-surgery backlog; the 2024 emergency-care audit and workforce-data gaps; and the 2025 recovery audit documenting progress alongside missed targets.
These are findings from government records, official performance reports and independent audits. They do not establish that every failure was avoidable, or that funding alone could have resolved them.
They do establish that governments were repeatedly informed of weaknesses in planning, efficiency and service delivery.
The Andrews Government inherited a system under pressure. The Allan Government inherited the consequences of years of growth, COVID disruption and accumulated service demands. The Carroll Government inherits unresolved problems and responsibility for sustained improvement.
What did ministers and departments know? What corrective measures followed? How were they evaluated? Why did so many performance failures continue?
The warnings were there. The targets were missed. The consequences were measurable. The remaining question is whether successive Victorian governments responded with the urgency, planning and accountability the evidence demanded.
PRIMARY SOURCES
Victorian Auditor-General — Victorian Public Hospital Operating Theatre Efficiency (18 October 2017): https://www.audit.vic.gov.au/report/victorian-public-hospital-operating-theatre-efficiency
Victorian Auditor-General — Access to Emergency Healthcare (25 June 2024): https://www.audit.vic.gov.au/report/access-emergency-healthcare
Victorian Auditor-General — Planned Surgery in Victoria (2025): https://www.audit.vic.gov.au/report/planned-surgery-victoria
Victorian Parliament — Department of Health 2021–22 and 2022–23 financial and performance outcomes: https://www.parliament.vic.gov.au/4af556/contentassets/e644ed5bfce24b7c9e925478437b2c08/dh-paec-2021-22-and-2022-23-fpo-questionnaire.pdf
Victorian Parliament — Department of Health 2024–25 financial and performance outcomes: https://www.parliament.vic.gov.au/495a4e/contentassets/4a359ac6bb6e495ebe529d2bfb90ea34/department-of-health-response-2024-25-fpo-questionnaire.pdf
Victorian Parliament — Inquiry into the Victorian Government’s Response to COVID-19: https://www.parliament.vic.gov.au/get-involved/inquiries/inquiry-into-the-victorian-governments-response-to-the-covid-19-pandemic/reports/
Department of Health — Standards for Safe and Timely Ambulance and Emergency Care (2025): https://www.health.vic.gov.au/sites/default/files/2025-02/standards-for-safe-and-timely-ambulance-and-emegency-care-for-all-victorians.pdf
Ambulance Victoria — Paramedics Back on the Road Faster Across the State (2026): https://www.ambulance.vic.gov.au/paramedics-back-road-faster-across-state
Ambulance Victoria — Victorian Paramedics Clearing Hospital Faster to Save Lives (2026): https://www.ambulance.vic.gov.au/victorian-paramedics-clearing-hospital-faster-save-lives