AEAWA Correspondence

18th October 2024

Office of the Information Commissioner
Albert Facey House
469 Wellington Street
PERTH WA 6000

By Email: [email protected]

Dear Information Commissioner,
Subject: Application for External Review – FOI Request Regarding Emergency Ambulance Services Agreement with WA Health

In accordance with section 65(1) of the Freedom of Information Act 1992 (WA), I am writing to request an external review of the Notice of Decision issued by the Department of Health dated 14 October 2024. This upheld the initial Notice of Decision dated 20 September 2024.

Both Notice of Decisions determine the document as exempt from disclosure, citing Clause 10(4). We reject this part of the decision. The reasons are outlined below.

The decision-makers also considered the application of Clause 10(6) and determined the matter remains exempt under Subclause (4) as disclosure would not be in the public interest. We reject this determination and believe disclosure is in the public interest. The reasons are outlined below.
1. Commercial Affairs of an Agency – Schedule 1, Clause 10 (Subclause 4) FOI Act.

The Decision Maker has asserted that the contract in question involves matters of commercial sensitivity, referencing the potential competitive disadvantage to other providers. However, the FOI request submitted on 1 August 2024 was specifically limited to the Emergency Ambulance Services Agreement. It did not seek information related to non-emergency or patient transport services, which are managed under separate agreements. As SJWA is the sole provider of 000 emergency ambulance services in Western Australia, the reasoning that disclosure could negatively affect competition is, respectfully, irrelevant. There are no competing providers of emergency ambulance services in this context. The FOI request made on 1 August 2024 was for the Emergency Ambulance Services Agreement only. It did not request contracts relating to non-emergency ambulance or patient transport.

SJWA has exclusively provided emergency ambulance services since 1904, taking full responsibility in 1922. Since there is no competition for this service, the disclosure of the contract could not reasonably cause adverse effects to either party’s competitive position. Furthermore, the absence of a tender process for this service underscores the absence of any competitive marketplace relevant to this contract. Other ambulance providers serve only nonemergency transport needs, and the FOI request explicitly excludes such contracts.

Additionally, the 2015 Ambulance Services Agreement was publicly available. This document and its extensions governed the provision of emergency ambulance services until 2022. The original 2015 was tabled in Parliament by the then Minister for Health, Dr Kim Hames, on 8th September 2015, raising the question of why the new contract, fundamentally similar in scope, is now being treated as commercially sensitive.

The 2015 contract was initially signed on 29 June 2015 for a three-year term. On 25 September 2020, a deed of amendment, restatement, and release was signed. This deed amended the payment mechanism in the contract and extended the expiry date until 30 June 2022. This deed of amendment heralded the ‘commercial in confidence’ approach to this contract.

The decision also references West Australian Newspapers Ltd and Western Power Corporation [2005] WAICmr 10. In that case, while the Commissioner found some elements to be commercially sensitive, significant portions of the documents were ordered to be released in the public interest. The onus, as determined in that case, lies with the agency to establish the grounds for exemption under section 102(1) of the FOI Act. I respectfully submit that the Department has not adequately discharged this burden.

2. Public Interest – Clause 10 (subclause 6) FOI Act
The matter is not exempt under subclause 4 if disclosure is, on balance, in the public interest. I assert that there is a compelling public interest in the disclosure of this contract, particularly given its direct relationship to the operation of a critical emergency service. The Information Commissioner’s decision in West Australian Newspapers Ltd and Western Power Corporation [2005] WAICmr 10 found that the public interest in the accountability of public services, especially those involving significant public expenditure, outweighed the potential commercial sensitivity of certain contract details. In that decision, the Commissioner noted that the public has a right to know how their money is spent and whether they are receiving value for it.

The emergency ambulance service provided by SJWA is vital to the health and safety of all Western Australians. Moreover, a significant portion of its funding comes from public funds. It is therefore in the public interest for the terms of the contract to be transparent, particularly to assess whether service performance metrics are being met and whether the contract’s mechanisms are sufficient to hold the provider accountable.

The Decision Maker’s argument that public interest has already been served through the open disclosure of a parliamentary report is unsatisfactory. That report predated the finalisation of the new contract and did not provide any detailed scrutiny of its terms. Additionally, the inquiry had limited capacity to ensure the rectification of the issues it identified, and the public remains unaware of whether those issues were adequately addressed in the new agreement.

Public transparency over key performance indicators (KPIs) is of paramount importance. While the DoH’s 2022-2023 Annual Report provides data on only two KPIs, it is reasonable to assume that the contract includes more comprehensive performance measures. The media has reported that this new contract introduces enhanced KPIs and financial penalties for underperformance, but the details remain undisclosed. The public deserves to know whether these measures are adequate and if they are being enforced.

3. Lack of Transparency and Accountability – Findings from Parliamentary Inquiry
The lack of transparency in the delivery of ambulance services has been a recurring concern. The report from the Parliamentary Inquiry into the Delivery of Ambulance Services in Western Australia (2022) was critical of the opacity surrounding the use of a private organisation to deliver such a critical state service. Specifically, the report highlighted that, as a private organisation, SJWA is not directly subject to key governmental oversight mechanisms.

As stated on page 101 of the report: “As a private organisation, St John Ambulance WA is not directly subject to these oversight bodies.” Furthermore, SJWA’s contractual obligation to comply with FOI requests through its agreement with the Department of Health was acknowledged by SJWA’s then CEO, Michelle Fyfe, who stated that while SJWA is not directly subject to the Freedom of Information Act 1992, it is bound to provide information to the Department under the Emergency Ambulance Services Agreement. Fyfe confirmed:

“In other words, if the department receives an FOI [freedom of information] request from a member of the community regarding services provided by St John under the agreement, under that agreement, the department can seek that information from St John WA. We will, and in fact we do, provide it, and that information is made available to the member of the community under the FOI regime.”

This indicates a clear expectation of transparency in the contract’s operation and further supports the argument that the public has a right to scrutinise this agreement. Additionally, the Inquiry recommended legislative amendments to ensure greater transparency and oversight. On page 102, Recommendation 20 states: “The State Government investigate introducing legislation amending the Corruption, Crime and
Misconduct Act 2003 and the Freedom of Information Act 1992 so ambulance service providers can be:
• subject to Corruption and Crime Commission oversight
• required to comply with freedom of information requests.”

This underscores the recognition that ambulance services, as a critical public service, must be subject to adequate transparency and accountability measures. The current withholding of the Emergency Ambulance Services Agreement undermines this principle.

The 2022 DoH document, A New Century for Ambulance Services, highlighted ongoing concerns regarding SJWA’s performance, despite numerous reports and recommendations over the years: “It is concerning that despite St John Ambulance WA’s (SJWA) delivery of ambulance services being subject to 12 reports and 122 recommendations since 2009, the Committee’s findings indicate substantial issues persist with respect to its performance, staffing levels, governance, and workforce culture.” The government’s response clearly demonstrates that stronger public oversight of the ambulance service is essential. However, without full transparency of the contract terms, the public cannot assess whether the necessary oversight mechanisms are in place.

The media statement issued by Minister Amber-Jade Sanderson in December 2022 further underscores the importance of transparency. Minister Sanderson described the ambulance service as a “life and death service” and emphasised the significance of the new contract in terms of performance and accountability. However, without public access to the full terms of the agreement, there is no way to verify whether the mechanisms in place are appropriate for ensuring that performance targets are met and that the service remains accountable to the public.

Conclusion
For the reasons outlined above, I respectfully request an external review of the decision to deny access to the Emergency Ambulance Services Agreement. The public interest in transparency, accountability, and effective governance in the provision of this critical service must be weighed against any claims of commercial sensitivity, especially given the absence of competition and the historical availability of similar contracts.

I look forward to receiving your decision.
Yours sincerely,

On behalf of the Executive Committee
Ambulance Employees Association of WA

14th February 2024

Rudi Brits
Head of Patient Safety and Clinical Quality, St John WA

209 Great Eastern Highway
Belmont WA 6104

By email: [email protected] and [email protected]

Standing down increased scope back-up (all scopes)

Dear Rudi,

The AEAWA write to you today in regard to the recently announced ‘new process for standing down back-up of increased scope’, as per your email of 14 March 2024. This new process was surprising, insofar as there had been absolutely no prior education distributed to the wider workforce, in what may have been a sensible initial measure to pre-empt the need for an entirely new process. There was no ‘lessons learned’ regarding suggested best practice on standing down back-up crews, and no clinical update email from Clinical Services. More concerningly, there was not a single moment of the four days of Paramedic CEP 2023 devoted to this issue, which might have improved clinical outcomes without requiring the introduction of such a drastic, ‘blanket rule’ new process.

While undoubtedly well intentioned, the announced process change is disappointing for the following reasons:

Safety concerns
We are unsure if this new process went through a formal risk assessment. While it is commendable that Clinical Services seeks to reduce patient risk in these rare events whereupon a backup crew is incorrectly stood down, such risks need to be balanced against the risks associated with continued (often prolonged) Priority 1 driving, despite the clinicians on scene wishing to stand the crew down. Priority 1 driving poses risks to both the employees performing the drive and other road users, especially over longer distances. For many of these automated dispatch criteria, several vehicles may be dispatched simultaneously, all travelling at speed, and crossing intersections. In our view, it is irresponsible to continue one or more vehicles under priority conditions towards a call where a registered clinician has deemed it unnecessary. We are unsure how the automated criteria can continue to outweigh the perspective of a clinician on scene in such circumstances. A sensible compromise would have been to permit the crew to at least change the back-up to Priority 2 conditions, pending the full set of vital signs and NEWS2 / PARROT, whereupon the back-up could be stood down completely, or upgraded as required.

Resource unavailability
It is not uncommon during peak periods to have several Priority 1 or Priority 0 cases occurring simultaneously or within minutes of each other, across metro. Given the limited number of CCP units, CSP and PSO crews available and the considerable geographical distances involved in some responses, it would seem important to have these scare resources available, for as much time as possible. It is therefore counter-intuitive to have these resources assigned and effectively ‘dispatch locked’ (P1 or P0 ) to a case when a clinician on scene is attempting to stand them down. Were they able to be downgraded to a Priority 2 in the first instance, the Special Services Desk or automated criteria would still be able to utilise these resources, remembering that statistically they would be very unlikely to be needed at the original call, where the clinician has sighted the patient and is contemplating a stand down.

Poorly communicated
It is disappointing that Clinical Services have chosen this rather heavy-handed approach as their first strategy in managing isolated examples of questionable clinical decisions. Sadly, such a blanket rule approach seems to be embedded in the culture of Clinical Services. Rather than seek to understand why individual clinicians arrived at an early, perhaps incorrect decision to stand down back-up (and provide those individuals with appropriate support and training) the decision is made to implement a blanket rule. Rather than pass any learnings on to the wider workforce to develop all clinicians, the decision is made instead to remove any clinical decision making ability from the registered paramedic on scene, and have another registered paramedic based in Belmont make the decision, based on vital signs.

The way this change has been communicated has been incredibly damaging to relations between Clinical Services and on-road operational clinicians, and further hampers the cultural change sought by our senior leadership team. Intended or not, the implicit message in this communication is that all on-road paramedics cannot be trusted to make sound clinical decisions.

Lack of consultation
The communication issued states that ‘there has been significant cross departmental consultations over many months in developing the new process.’ Clearly this did not involve any employee representative groups, and while this may not have been required to implement such a business decision, consultation may have led to useful process feedback, or at the very least some feedback as to the likely reception, and therefore the likely impact on culture and morale.

What we have now is a process announcement which has led to many feeling that they simply ‘will not stand down any back-up’ at all, or that they will aim to ‘leave before the back-up arrives’. Anecdotally, we have heard from many officers in ‘higher scope’ roles who are frustrated by the damage done to relationships they have worked hard to build, through this process change and the way it was communicated. Obviously, such outcomes are contrary to what was intended, but could have been anticipated from the rather clumsily worded communication.

Kind regards
John Thomas
On behalf of the Executive Committee
Ambulance Employees Association of WA

1st February 2024

Ms Libby Mettam, MLA
Leader of the WA Liberal Party, Shadow Minister for Health; Mental Health; Prevention of Family & Domestic Violence

16 Prince Street
Busselton WA 6280

By email: [email protected] cc [email protected]

Requests for WA Police Assistance by SJA (St John Ambulance) in ‘Non-Police Related’ Incidents

Dear Ms Mettam,
I write to you on behalf of the Ambulance Employees Association WA (AEAWA) in relation to the recent changes to the way WA Police respond to requests for assistance from St John personnel. The AEAWA is an independent employee representative group which represents the majority of front-line operational employees within the ambulance industry in Western Australia, including Paramedics, Patient Transport Officers, State Operations Centre Communications Officers and Emergency Medical Dispatchers.

We write to you as Leader of the WA Liberal Party, and noting that on 12th September 2023 during the Legislative Assembly, you highlighted inadequate police resources, and called upon the WA Labor Government to ‘recognize its failure to keep West Australians safe’ and to adequately resource systems to prevent crime.

We are unsure if you are aware, but effective 1 st December 2023, all requests for WA Police assistance by St John Ambulance (SJA) personnel are now subject to assessment and management by the Police Assistance Centre (PAC) and Police Operations Centre (POC). The majority of requests are refused, and WA Police do not attend to support their fellow emergency service colleagues.

As part of this new strategy to reduce their workload, WA Police initiated the removal of nearly 800 location and person-based warnings from St John’s own internal safety systems; warnings which had been put in place internally due to documented incidences of violence and aggression, and which formed an integral part of our safety systems. This was done to reduce police attendance at high-risk locations.

These two ‘initiatives’ mean:

1. WA Police (POC) routinely refuse to send support to St John personnel when requested
2. St John ambulance personnel will now be entering high-risk locations without any advance CAD warning

It seems that WA Police senior leadership, presumably with the oversight of the Minister of Police, Hon Paul Papalia, have determined that it would be more cost effective for WA Police to abandon many of their core police functions, than to adequately resource systems to keep Western Australians safe. We have written to the Minister for Police also raising these same concerns over this new strategy. Since the introduction of this new initiative in the Perth region, the AEAWA are aware of numerous incidents being reported where our members have suffered an increase in exposure to high-risk situations, violence and aggression.

We fear it is only a matter of time before a front-line healthcare worker is hurt as a result of a removed ‘location warning’ or due to police refusal to assist. Of great concern, is that we have recently received information that WA Police plan to expand this initiative into the regions from 12th February 2024 with Albany, Australind, Broome, Bunbury, Busselton, Collie, Geraldton, Hedland, Kalgoorlie, Karratha, Kununurra, Northam, Norseman and Pinjarra earmarked for inclusion.

WA Police leadership appear to be ‘doubling down’ on this strategy to avoid adequately resourcing the police force indicating they are expanding this new approach to policing, and advising that:

• Police attendance in support of SJA for health only incidents where the request is submitted based only on an SJA alert (location warning) will most often not be supported.
• Police will not provide a “security” presence for SJA based only on alerts or concerns. There must be an actual imminent and present threat to safety.
• Requests for police attendance to assist force entry to a premises will most often not be supported. These requests should be directed to DFES (where available) as police are not equipped nor trained any more than SJA to force entry.
• Requests for police assistance with elderly, infirm patients within nursing homes will most often not be supported. Nursing Staff, Family and SJA Paramedics are most often equipped to manage elderly patients. Only in critical circumstances will police become involved with health incidents with nursing home patients.

We already have a situation where WA Police routinely ‘hand-ball’ to St John most calls received from the public regarding vagrancy, public drinking and ‘move on’ requests from business owners, under the guise of ‘health related’.

The AEAWA have heard further information that the police will soon decline to attend ‘welfare check’ requests from the public also, as these will also be deemed ‘non-core police business’. The AEAWA recognize that WA Police often face competing and simultaneous demands on their services. Ambulance services face a similar challenge, utilizing a structured triage process to aid in managing competing demand. Should WA Police be unable to attend to calls for urgent assistance from the public, as well as provide assistance and support to other emergency services, then perhaps the real issue is not co-response with ambulance but poor managerial decisions, inadequate growth in numbers of police officers and well publicised concerns around staff retention (noting a record 465 sworn officers resigned in 2022 alone).

In regards to the removal of our internal location warnings, the AEAWA consider it wholly inappropriate for WA Police management to interfere with legitimately created internal safety warnings belonging to another organisation, and to assess risks as being ‘acceptable’ for a workforce whom they do not employ, do not control and for whom they do not have legislated duty of care obligations in respect to the Work Health and Safety Act 2020 (WHS Act). Many of the St John location warnings were put in place as a direct result of a person at the address exhibiting threatening, aggressive or violent behaviors toward our frontline members. Often such behaviours may be due to either chronic substance abuse and/or severe anti-social behaviour traits or poorly controlled psychiatric conditions.

Our members, having no access to police data, relied solely upon our internally generated warnings, created in response to actual incidents involving our frontline healthcare members. It is therefore concerning that WA Police, based on their own criteria, have determined it appropriate to remove 50% of our location warnings. While we acknowledge it was reasonable to update and remove some warnings (where a person is no longer resident at an address, or who is now deceased etc.) many others have been removed where a high-risk individual still resides at a location.

WA Police management will undoubtedly have a different perspective on what constitutes an acceptable level of risk. This is because their officers are trained specifically to manage high-risk situations and have training in police personal protective techniques and empty hand tactics. They have access to up-to-date information on the residents at a location, their known associates and their criminal record history. Their officers also have protective clothing, body armour, a service pistol, pepper spray, a telescopic baton, handcuffs and ready access to reinforcements. Often, individuals who may be prone to acts of violence and aggression or sexual harassment towards ambulance officers, choose to moderate their behaviour in the presence of police and so may falsely appear to police to be ‘low risk’. In short, what constitutes acceptable risk to one emergency service may not translate well to another.

These process changes appear to be initiated to combat media scrutiny over WA Police response decisions, but they simply provide a ‘Band-Aid’ solution to conceal the real issue of chronic under-resourcing and under-funding of WA Police. Providing a co-response with fellow emergency services in managing high-risk persons should not be dismissed as ‘non-police related’ or ‘non-police core business’. The fact that such an initiative was deemed necessary to manage workload by senior figures within WA Police, should sound an alarm for the Minister. Emergency services should work together while striving to serve the community, and certainly one service should not take steps to sabotage the safety
systems of another emergency service, due to their own response time issues.

In addition to the issue of location warnings, is the issue of appropriate management of mental health crises in the community. The ambulance service and police are regularly called to acute psychiatric emergencies where a person is threatening suicide, or who is exhibiting acutely disturbed and abnormal behaviour, and who by their behaviour or statements make it known that they will refuse voluntary admission to hospital. Often, these situations are complicated and compounded by illicit substance use.

Frequently, callers to 000 will request the police in the first instance, given that erratic behaviour is the callers primary concern, but WA Police will re-direct such calls to St John claiming them to be a ‘health matter’. In such cases, it is critical to note that pre-hospital emergency care providers have no legal authority under the Mental Health Act 2014 (WA) to detain or apprehend such an individual for their own safety. It is also reasonable to assume, that such a person who is suffering an acute disturbance of thought may behave unpredictably should emergency services arrive at their home. Since 1st December 2023, WA Police have refused to attend many such instances, again putting our members in dangerous situations.

The Chief Psychiatrist (WA) practice document “Clinicians’ Practice Guide to the Mental Health Act 2014” is clear on which ‘prescribed persons’ have authority under the Act. The document states “The role of the police officer is significant for ensuring the safety of people experiencing mental illness in the community”. The MHA 2014 legislates at s. 156; “A police officer may apprehend a person they suspect is experiencing mental illness in order to protect the health and safety of that person, the safety of another person or prevent the person causing or continuing to cause serious damage to property (s. 156 Apprehension by police officer of person suspected of having mental illness)”.

The term ‘ambulance’, ‘ambulance officer’, ‘paramedic’ (or any equivalent) are not presentanywhere in the Mental Health Act (2014) or the associated Regulations.

The ambulance service and its employees have no authority to apprehend or restrain involuntary persons. Historically, such psychiatric emergencies were jointly responded with police and ambulance, however this new initiative by WA Police leadership has seen POC refusing to send a unit to many of these situations, believing them to be ‘non-police related’ or a ‘health only matter’. We are confident WA Police leadership understand the relevant legislation, but refusing to send a unit suggests a disregard for a core legislative function of the police and disregard for the safety of our members, and importantly, the safety of the at-risk person experiencing crisis.

This refusal to attend such instances not only puts the safety of front-line healthcare workers at risk, but also the safety of vulnerable members of the public who experience mental illness. The WA Police position is that they will attend only when there is “real-time evidence of current risk to ambulance crews”, or ‘actual imminent and present threat to safety” appearing very determined to reject anything which could be interpreted as a ‘non police related’ matter. What this means in practice is that WA Police will not attend until St John
personnel have entered a scene and made contact with the persons at the address. ‘Real time risk’ and ‘present threat’ imply actively under threat where ambulance employees are expected to be the ‘canary in the coal mine’.

Depending on the situation, this could clearly expose our members to unacceptable, high-risk of injury or abuse. It also completely fails to recognize that many situations involving the public do not fit neatly into clean categories such as ‘health related’ or ‘police related’. In relation to ‘non police related matters’ our members can assure you that in the majority of situations where a location warning was placed, there is a history of either illicit substance use and possession, threatening behaviour and violence, sexual harassment and intimidation, and often concealed weapons or prohibited weapons, all of which are undeniably ‘police related matters’.

We urge you as Leader of WA Liberal Party, Shadow Minister for Health and for Mental Health to investigate this latest initiative. Ambulance workers are health care professionals and should not be expected to face violence and aggression while performing their job. The AEAWA will not allow our members to be injured as a result of removed location warnings or WA Police refusal to attend high risk locations. By enacting this ‘initiative’ WA Police are admitting they cannot perform their traditional roles with the current level of resourcing.

Rather than choose to address the underlying issues of recruitment, staff retention and morale, WA Police leadership are choosing to re-define their traditional and legislated workload as ‘non-police business’ or ‘health related’. This ‘black and white’ thinking fails to understand the nuance and complexity in serving the community, fails to provide safety for people experiencing mental illness in the community, and fails to support and assist their fellow emergency services.

The result is that ambulance workers are being left to fend for themselves in managing violence and aggression and are being used to mop up issues created by the inefficient, ineffective and neglected mental health system in Western Australia.

Kind regards

John Thomas
AEAWA President
On behalf of the Executive Committee
Ambulance Employees Association of WA

31st January 2024

Hon. Paul Papalia CSC, MLA
Minister for Police; Corrective Services; Racing and Gaming; Defence Industry; Veterans Issues

10th Floor, Dumas House,
2 Havelock Street,
WEST PERTH WA 6005

By email: [email protected]

Requests for WA Police Assistance by SJA (St John Ambulance) in ‘Non-Police Related’ Incidents

Dear Minister,
I write to you on behalf of the Ambulance Employees Association WA (AEAWA) in relation to the recent changes to the way WA Police respond to requests for assistance from St John personnel.

The AEAWA represents the majority of front line operational employees within the ambulance industry in Western Australia, including Paramedics, Patient Transport Officers, State Operations Centre Communications Officers and Emergency Medical Dispatchers.

As Minister for Police you will be aware that effective 1st December 2023, all requests for WA Police assistance by St John Ambulance (SJA) are now subject to rigorous assessment and management by the Police Assistance Centre (PAC) and Police Operations Centre (POC). You will also be aware that WA Police initiated the removal of nearly 800 location and person based warnings from SJA’s own systems; warnings which had been put in place internally due to documented incidences of violence and aggression.

These two initiatives mean:

1. WA Police (POC) routinely refuse to send support St John personnel when requested
2. St John ambulance personnel will be entering high risk locations without any advance CAD warning

Many of the location warnings were put in place as a direct result of a person at the address exhibiting threatening, aggressive or violent behaviors toward our frontline members. Often such behaviours may be due to either chronic substance abuse and/or severe anti-social behaviour traits or poorly controlled psychiatric conditions. Our members, having no access to police data, relied solely on our internally generated warnings, created in response to actual incidences involving our frontline healthcare professionals. It is therefore concerning that WA Police, based on their own criteria, have determined it appropriate to remove 50% of our location warnings.

While we acknowledge it was completely reasonable to update and remove some warnings (where a person was no longer resident at an address, or who was now decease etc.) many, many others have been removed where a high risk individual still resides at a location.

The AEAWA consider it wholly inappropriate for WA Police management to interfere with legitimately created internal safety warnings belonging to another organisation, and to assess risks as being ‘acceptable’ for a workforce whom they do not control, do not employ and do not have duty of care obligations in respect of the Work Health and Safety Act 2020 (WHS Act).

WA Police management will undoubtedly have a different perspective on what constitutes an acceptable level of risk. This is because their officers are trained specifically to manage high-risk situations and have training in police personal protective techniques and empty hand tactics. They have access to up-to-date information on the residents at a location, their known associates and their criminal record history. Their officers also have protective clothing, body armour, a service pistol, pepper spray, a telescopic baton and handcuffs, and access to backup. Often, individuals who may be prone to acts of violence and aggression or sexual harassment towards ambulance officers, often choose to moderate their behaviour in the presence of police and so may falsely appear to police to be ‘low risk’. What constitutes acceptable risk to one emergency service may not translate well to another.

These process changes appear to be initiated to combat media scrutiny over WA Police response decisions, but simply provide a ‘Band-Aid’ solution to conceal the real issue of chronic under-resourcing and under-funding of WA Police. Providing a co-response with fellow emergency service in managing high risk persons should not be dismissed as ‘nonpolice related’ or ‘non-police core business’. The fact that such an action was deemed necessary to manage workload by senior figures within WA Police, should be sound an alarm for the Minister.

Emergency services should work together while striving to serve the community, and certainly one service should not take steps to sabotage the safety systems of another emergency service due to their own response time issues.

The AEAWA recognize that WA Police often face competing and simultaneous demands on their services. Ambulance services do also, utilizing a structured triage process to aid in managing competing demand. Should WA Police be unable to attend to calls for urgent assistance from the public, as well as provide assistance and support to other emergency services, then perhaps the real issue is not co-response with ambulance, but excessive administrative duties, inadequate growth in numbers of police officers and well publicised poor levels of staff retention (noting a record 465 sworn officers resigned in 2022 alone).

In addition to the issue of location warnings, is the issue of appropriate management of mental health conditions. The ambulance service and police are regularly called to acute psychiatric emergencies where a person is threatening suicide, or who is exhibiting acutely disturbed and abnormal behaviour, and who by their behaviour or statements make it known that they will refuse voluntary admission to hospital. Often, these situations are complicated and compounded by illicit substance use.

Frequently, callers to 000 will request the police in the first instance, given that erratic behaviour is the callers primary concern, but WA Police will re-direct such calls to St John claiming them to be a ‘health matter’. In such cases, it is critical to note that pre-hospital emergency care providers have no legal authority under the Mental Health Act 2014 (WA) to detain or apprehend such an individual for their own safety. It is reasonable to assume also, that such a person who is suffering an acute disturbance of thought may behave unpredictably should emergency services arrive at their home. Since 1st December 2023, WA Police have refused to attend many such instances, again putting out members in dangerous situations.

The Chief Psychiatrist (WA) practice document “Clinicians’ Practice Guide to the Mental Health Act 2014” is clear on which ‘prescribed persons’ have authority under the Act. The document states “The role of the police officer is significant for ensuring the safety of people experiencing mental illness in the community”. It notes at s. 156; “A police officer may apprehend a person they suspect is experiencing mental illness in order to protect the health and safety of that person, the safety of another person or prevent the person causing or continuing to cause serious damage to property (s. 156 Apprehension by police officer of person suspected of having mental illness)”. The term ‘ambulance’, ‘ambulance officer’, ‘paramedic’ (or any equivalent) are not present anywhere in the Mental Health Act (2014) or the associated Regulations.

The ambulance service and its employees have no authority to apprehend or restrain involuntary persons. Historically, such psychiatric emergencies were jointly responded with police and ambulance, however this new initiative by WA police leadership has seen POC refusing to send a unit to many of these situations, believing them to be a ‘non-police related’ or a ‘health related matter’. We believe there is an understanding of the relevant legislation, but it does appear to suggest a disregard for a core legislative function of the police, disregard for the safety of our members, and importantly, the safety of the at risk persons. This refusal to attend not only puts at risk the safety of front line healthcare workers, but also the safety of vulnerable members of the public who experience mental illness.

The WA Police position is that they will attend only when there is “real-time evidence of current risk to ambulance crews”, and they seem to actively avoid any ‘non police related’ matters. What this means in practice is that WA Police will not attend until St John personnel have entered a scene and made contact with the persons at the address. ‘Real time risk’ would imply actively under threat where ambulance employees are expected to be the canary in the coal mine. This, depending on the situation can clearly expose our members to unacceptable, high-risk of injury or abuse. In relation to ‘non police related matters’ our members can assure you that in the majority of situations where a warning was placed, there is a history of illicit substance use and possession, threatening behaviour and violence, sexual harassment and intimidation, and often concealed weapons or prohibited weapons, all of which should be considered ‘police related matters’.

We urge you as Minister for Police to re-evaluate the wisdom of this latest initiative. Ambulance workers are health care professionals and should not be expected to face violence and aggression while performing their job. The AEAWA will not allow our members to be injured as a result of removed location warnings or WA Police refusal to attend, and we will seek to highlight any and all such incidences at every possible opportunity so that the public are made aware of how under-resourced the WA Police force currently are, and how ambulance workers are being left to fend for themselves in managing violence and aggression, and used to mop up issues created by the inefficient, ineffective and
neglected mental health system in Western Australia.

Should you wish to discuss our concerns further, we welcome correspondence but remain open to meeting in person.

Kind regards
John Thomas
AEAWA President

13th January 2021

Rene Anderson
Head of People Services
St John Ambulance WA
109 Gt Eastern Highway
BELMONT WA 6109

By Email

Dear Rene,

Ongoing delays on processing leave requests and changes. We have been contacted by a large number of our members who have submitted requests to alter their leave blocks, and who have not had their requests processed within a reasonable timeframe.

For several months now the Leave department has not replied to officers, and lately have had an automatic ‘Out of Office’ reply, advising of delays in responding to leave requests. Some enquiries receive further correspondence which acknowledge the delay but go on to advise that ‘Due to the large increase of queries before and during the festive period, we have had to place highest priority on all queries and requests for the next roster commencing 10/01/21 and the roster commencing 7/03/21’.

While acknowledgements and updates are welcome, our members would prefer to hear if their request for leave changes have being granted. The processing of leave requests occurring only 2-3 month in advance is a very real and frustrating issue for our members, many of whom have important family or social obligations they need to be able to plan and commit to, in addition to wishing to organise strategies to manage their health and wellbeing.

The findings of both the Chief Psychiatrist Review and the Phoenix Report noted deficiencies in ‘operational management practices within St John were contributing to organisational and workplace stressors for employees. The Independent Oversight Panel: Ambulance Service Review 2016, stated ‘Annual leave conditions were reported as being overly restrictive
with little to no flexibility in when annual leave can be taken. This means that employees are not able to take a break when they recognise, they need to, contributing to their lack of ability to manage stressors, and generally recharge.’ Nearly 5 years on from this review and we still have issues with leave flexibility.

Further, the CEO’s communication on 11th May 2020 in which the rescheduling and cancellation of Leave was restricted until 2021, further hindered our members ability to proactively manage their stressors with the rescheduling, splitting and altering of leave allocations.

We hope that the organisation recognises the significant impact the current lack of ability to alter leave allocations has on the workforce. As you are aware, this is a workforce that is already under significant pressure, dealing with unprecedented ramping, minimal to no downtime, and the subsequent mismatch between resourcing and demand.

With this letter we seek a commitment from St John to invest sufficient resourcing within the Leave department, so that they are adequately staffed and supported in order to process the backlog of leave requests.

Kind regards
AEAWA Committee
Ambulance Employees Association WA

26th March 2021

Deon Brink
Executive Director Ambulance Operations
St John Ambulance WA

209 Gt Eastern Highway
BELMONT WA 6109

By Email:

Dear Deon,

Metropolitan Ambulance Management Model

The AEAWA write in response to your email communication dated 25th March 2021, announcing the approval and subsequent intended roll out of the ‘Metro Management Model’.

The AEAWA formally wish to express their profound disappointment with the level of consultation that has so far taken place, and feel that the concerns of our members have once again been largely ignored. Providing employees with just one avenue to give feedback, an email address with no possibility of anonymity, ensured an inbuilt filter for any negative feedback, with only positive feedback ever being received. Employees would quite rightly be reluctant to write anything which may jeopardise their career progression. It is clear that the organisation only wanted to hear good feedback.

This is evident not only from the December 2020 ‘Pilot KPI and Benefits Report’ produced by St John (which mostly included quotes and feedback from those undertaking a managerial role within the Pilot) but also from the February 2021 ‘Interim Report’, which again fails to detail any negatives, and portrays completely unrelated ‘clinical’ and other imaginary successes as stemming directly from the Pilot. St John have touted the ‘Metro Management Model’ as addressing a number of issues highlighted in the 2019 Culture Survey.

Indeed, St John senior leadership have commented on several occasions ‘you asked for this in the culture survey’. Further, the 2021 Interim Report states that ‘the reformed management model is in direct response to feedback received by the 2019 Culture Survey’. Frequently referenced was a specific finding that 66% of respondents of the 2019 Culture Survey respondents had no confidence in senior management and felt that senior managed did not listen to staff. The key words in this specific question were ‘senior management’ and ‘listened’. Unfortunately, St John WA senior management have once again failed to listen to their staff who have raised objections to this model, and proceeded to bulldoze the plan through, paying only lip service to consultation.

Let us be clear in our response to this premise; no staff member to whom we have spoken, imagined that the solution to being ignored by senior management was the zoning of the metropolitan ambulance service and the placement of Area Managers in depots. The results indicated a lack of confidence in senior management, but St John’s focus has entirely been on lower and middle management. The Pilot has completely failed to address these concerns.

Frustrated at the lack of opportunities for our members to provide anonymous feedback, the AEAWA conducted its own survey of our membership in November 2020. Our results provided damning feedback from real employees working in the pilot zone, who felt the model offered very little, and that they felt no more supported or heard than previously. These employees were also extremely skeptical about the true motivations of the model, which seem more focused on performance management, ‘reducing sick leave’ and ‘ensuring S8 check compliance’ than on improving the actual managerial culture within St John.

Despite dismissing the results of the AEAWA survey, St John have failed to gather their own anonymous feedback. The 2021 Interim Report asserts that ‘a staff survey is the most precise way to effectively measure the impact of the Pilot’, yet today St John propose to continue with the roll out, without conducting any satisfaction surveys and by ignoring the feedback provided thus far from employment representatives.

Therefore, before the roll out of this management plan continues, we request that St John show genuine interest in the views of operational staff, and be brave enough to seek genuine feedback in the form of their own anonymous survey. We also request that St John conduct another Culture Survey with the same questions from 2019, and collate the results separately between the South West Pilot Zone area and the wider metropolitan area.

This will accurately illustrate if the culture has improved within St John as a whole, and specifically within the South West Pilot zone. A failure to survey this feedback would simply cement the idea that our culture has moved backwards and not forwards, since the 2019 Culture Survey, and that senior management continue to ignore the views of their staff.

We thank you for considering our requests and look forward to hearing from you soon.

Kind regards
AEAWA Executive
Ambulance Employees Association WA

14 August 2020

The Honourable Mark McGowan MLA
Premier; Minister for Public Sector Management;
State Development, Jobs and Trade; Federal-State Relations

9th Floor, Dumas House
2 Havelock Street
WEST PERTH WA 6005
By Email: [email protected]

Dear Mark McGowan,

ACCESS TO COVID-19 LEAVE FOR WA AMBULANCE SERVICE EMPLOYEES

I write to you on behalf of the Ambulance Employees Association WA (AEAWA) in relation to the Public Sector Labour Relations circular dated 23rd March 2020 (revised 15th April 2020) regarding Leave Arrangements for the COVID-19 Pandemic.

The AEAWA represents front line operational employees within the ambulance industry in Western Australia, including Paramedics, Patient Transport Officers, State Operations Centre Communications Officers and Emergency Medical Dispatchers. As you have publicly acknowledged, our members, along with many other healthcare workers, play an essential role in the nation’s response to the COVID-19 pandemic.

Our members commend the excellent work of the McGowan government in containing and minimising the spread of COVID-19 in Western Australia. However, the known virulence of COVID-19 suggests it is likely to resurface within our community in the longer term, despite our best efforts. This fact has been illustrated recently by the current situation in Victoria. It is also central to our concerns, that healthcare workers have made up more than 15% of Victoria’s COVID-19 cases.

We note the WA Government’s Media Statement dated 16th March 2020 which reports that public sector employees will be granted 20 days of paid COVID-19 leave “to make sure those who are sick stay home, ensuring a safe work environment and helping to reduce the spread of the virus”. We note a further quote in the same media release, attributed to yourself, as highlighting the “responsibility to provide a safe work environment for the State’s hard-working public sector employees”. Our members are not public sector employees, but they are certainly hard working and they undertake work that is normally operated by the public sector in most jurisdictions in Australia. Indeed, the work undertaken by our members forms part of a contract with WA Health.

Another statement from the media release attributed to Industrial Relations Minister Bill Johnston asserts the “new COVID-19 leave arrangements give workers peace-of-mind in knowing there is paid leave available to them, should they need to self-isolate”. The Honourable Minister goes on to state “as we continue to manage the spread of COVID19, it’s vital that those displaying symptoms do not feel any pressure to continue to work, particularly due to financial concerns.”

Our members are entitled to just 10 days of personal leave per annum. Many of our members have minimal accrual hours and would be unable to self isolate for 14 days without suffering financial hardship. Our members form part of an essential workforce, with a high proportion of workers who are very mobile during the course of their normal working day.

Our members visit multiple locations each day including public and private hospitals, GP surgeries, public and private residences and other high risk environments such as residential aged care facilities. Our members should be supported and able to confidently access their leave balances when they feel unwell. We urge the WA Government to stand by our ambulance industry employees and ensure they are secure enough in their leave entitlements to stay at home when it is required of them, thereby offering additional protections to
the wider community.

Should community transmission resurface in WA, many of our members will undoubtedly come into contact with COVID-19 patients during the course of their normal work. They are therefore more likely to need to self-isolate, having come in to close contact with a patient who subsequently tests positive. And they are unfortunately at high risk themselves of becoming infected with COVID-19. Others may need to self-isolate to comply with other government advice, should family members develop symptoms or test positive.

We strongly request that the state government consider extending the 20 days of paid COVID-19 leave to our ambulance industry employees with the same entitlement conditions as public sector employees. We would argue that the additional burden to the State of such an arrangement would be negligible. The additional coverage of COVID-19 Leave provisions to ambulance industry employees would protect just over 1000 additional essential workers. When compared to the size of the current public sector employee base of some 140,000 employees, it would seem a worthwhile safeguard against transmission and a recognition of the important service our members provide.

An outbreak within our workforce could be devastating for the ambulance service’s ability to respond to our community, and potentially deadly to the most at risk and vulnerable patient groups to whom we attend on a daily basis. It is therefore essential that ambulance industry staff who are unwell or who are displaying symptoms ‘do not feel any pressure to continue to work, particularly due to financial concerns’.

Although transmission rates are currently low, there remains a significant likelihood that this disease will continue to circulate internationally and resurface more potently within Western Australia. The potential financial burden to our members should they contract COVID-19 in the course of their employment is therefore significant. In addition, our members are acutely aware of the difficulties they will undoubtedly face in establishing a causal link for WorkCover, should they contract COVID-19 while performing their duties at work.

The AEAWA are grateful for your consideration of this proposal and would of course be willing to meet with Government officials to help give effect to the proposal outlined in this, if required.

Should you wish to discuss this matter further, please feel free to contact me.

Sincerely,

John Thomas
President
Ambulance Employees Association WA