What happens to a politician’s promise after it wins them an election?

Does anyone remember it? Does anyone care?

What about this pledge?

A Labor corflute from the 2022 SA state election promising to fix ramping.(ABC News)

It won SA Labor the 2022 state election — toppling the Marshall Liberal government after just one term.

The campaign was made all the stronger with the backing of health unions and their members — like “Ash the Ambo”, who implored South Australians to “vote Labor like your life depends on it”.

The problem for Labor now though, is that the ambulance ramping crisis has got significantly worse.

Halfway through Peter Malinauskas’s first term as premier, ramping has risen from about 2,700 hours per month to more than 4,000 per month.

That figure dropped to about 3,400 hours in April.

In total, ambulances have spent more time on the ramp during Labor’s two years in office than under four years of Liberal government.

Labor has said it is “throwing the kitchen sink” at the problem, spending hundreds of millions of dollars on new ambulance stations, extra crews, more hospital beds, and increased staffing.

So, what’s going wrong?

The fine print

When pushed on what “fixing the crisis” looked like, Labor said it wouldn’t actually end ramping.

Rather, it said it would get ambulances rolling up on time more often — specifically in line with 2018 rates.

Not quite as snappy for an election slogan.

Applying that metric, the South Australian government is confident Labor will be able to keep its promise, even though ramping itself has worsened.

Ambulances ramped outside Royal Adelaide Hospital.(Facebook: Ambulance Employees Association)

The government has so far hired 219 of the extra 350 paramedics it promised, and response times have indeed improved.

Priority 1 calls — the most urgent of cases — are back to 2017 levels, above the government’s targets.

There has been an improvement to priority 2 response times, but they remain well below the government’s target times.

“We are continuing to make every possible investment that we can [and] we are using a significant amount of state government resources,” Health Minister Chris Picton said.

The Liberal opposition would have voters interpret the soaring statistics to be a “catastrophic breach of faith with the South Australian people”.

“The South Australian people didn’t vote for the fine print,” opposition leader David Speirs said.

Will voters care about ramping in 2026?

The opposition believes ramping will be a “battering ram against Labor’s credibility” come the next election.

But it might not be a very effective one, according to at least one South Australian political analyst.

University of Adelaide emeritus professor of politics Clem Macintyre said Labor was expected to retain office, whether it fixes the ramping crisis or not.

Emeritus professor of politics, Clem Macintyre.(ABC News: Lincoln Rothall)

He said the Liberals were unlikely to convert any voter discontent into an election win.

“The perception is that the government is doing reasonably well even if it’s not succeeded in that one critical promise that it’s made and that will leave Labor in good standing at the next election,” he said.

“Labor will lose some skin from that, but on the other hand is travelling very well in other regards and certainly will go into the next election as a very strong favourite.”

In other words, voters might mark Labor down if the crisis persists, but not write them off.

The union that was so pivotal to the cut-through of Labor’s campaign – the Ambulance Employees Association — remains on side, for now.

Leah Watkins says paramedics are frustrated ramping is still happening.(ABC News: Eric Tlozek)

It believes the government is going to “extraordinary lengths” to resolve the issue, but state secretary Leah Watkins said members were “incredibly frustrated” by the hours they’re still spending stuck in parked vehicles, unable to offload patients and attend other calls.

“Despite … all of the efforts made thus far, there has been no improvement in ramping from their perspective, and in some pockets, it’s felt to be worse than it has [been] before,” she said.

“There’s so much riding on the next few years for the government to turn this around.”

The Health Minister has repeatedly acknowledged there’s still plenty of work to do over the remainder of this term.

What else is the government doing to ‘fix’ ramping?

Labor made a suite of promises to increase health resources and alleviate ramping in the lead up to the 2022 election.

Among them were pledges to add 300 extra beds in the hospital system, recruit an extra 400 doctors and nurses combined, and introduce better systems for patient transfers, offload, and discharge.

Election commitment












Hospital beds



Since taking office, the government has hired 1,432 extra clinical staff above attrition – including an extra 691 nurses and 329 doctors – and implemented a range of new programs to improve efficiency within public hospitals.

It’s seen success at the Lyell McEwin Hospital, where the government said ramping had decreased by 62 per cent since October 2023.

But those additional resources alone can’t comprehensively “fix” ramping.

That’s because the issue is just one symptom in a complex set of problems in public heath, many of which the state government is not responsible for.

The primary cause of ramping is “bed block”, also known as “access” or “exit” block.

Delays in discharging patients mean there is a lack of beds for new patients in hospital wards, leading to congestion in emergency departments and on the ambulance ramp.

A shortage of aged care and NDIS places is a major factor in “bed block” – both federal government responsibilities.

Chris Picton acknowledges there is still a lot to do on the health system.(ABC News: Che Chorley)

Health Minister Chris Picton told the ABC there were about 150 people in SA hospitals on any given day waiting for aged care places.

Patients are also arriving at hospitals with more severe and more complex health problems, that take more time to treat.

Some of this may be caused by declines in the primary care system – think general practice, community, and allied health — much of which is also a federal government responsibility.

But only the state government is responsible for its own promises.

Whether it’s over-promised will be for voters to decide in 2026.