As pressure mounted on St John Ambulance boss Michelle Fyfe, the spotlight shone on WA’s struggling hospital system

Sharks had surrounded Michelle Fyfe for months.

Among the most prominent was the state government, which had made no secret of its frustration with St. John Ambulance and, by extension, Fyfe’s leadership as chief executive.

Even still, the veteran cop-turned-CEO maintained that she was the right person to weather the storm, right the ship, and sail into a post-COVID sunset.

That was until Monday when the relentless pressure got too much and she announced an early end to her stay at St John, leaving three months before the end of her contract.

His departure leaves a gaping hole at the top of an organization grappling with several significant issues simultaneously.

But the government got what critics call a “scapegoat”, and potentially a way to wield more power over the private ambulance operator.

Ms Fyfe is leaving the service amid a record ambulance ramp-up and a COVID-induced staffing crisis. (ABC News: Rick Rifici)

Publicly, tensions between Fyfe and the government had long been simmering.

One of the first public signs of this tension was expressed by Health Minister Amber-Jade Sanderson, who in April criticized the service for not activating “critical worker” protocols that would have handed over more paramedics paramedics in COVID isolation on the road.

Amber-Jade Sanderson, Washington State Health Minister
Amber-Jade Sanderson said St John could have allowed close contacts to return to work if they were asymptomatic and took a daily RAT.(ABC News: James Carmody)

Those pressures came to a head in May when, following the deaths of a number of ambulance patients, the government sent in firefighters, police and government officials to help the struggling service.

Premier Mark McGowan went out of his way to say that some of those staff, particularly firefighters to drive ambulances, could have been brought in sooner, if St John had asked.

He also explained that the aim of the police and bureaucrats, who were sent to the command center in St John, was to keep an eye on the service, to ensure that they used all the support possible, and then to report to the government.

The move left little doubt about the extent to which confidence had diminished in St John and his ability to cope with the extraordinary pressures he found himself under.

Government criticism deflected from ailing health system

And when the government increased the pressure on St John, it helped divert attention from a struggling health system struggling with staff pushed to the brink and growing waiting lists.

According to government critics and Fyfe defenders, there was little, if anything, the ambulance boss could have done to solve the main problem.

Two paramedics standing at the back of a row of ramped ambulances outside a hospital.
Ambulances are regularly deployed outside hospitals due to overcrowded and understaffed emergency departments.(ABC News: Keane Bourke)

While St John has a range of issues to deal with internally, including falling morale and the composition of its workforce, the state of WA’s hospitals was perhaps the most important.

A service already strained by increased demand and furloughed staff could certainly have done without crews spending an average of 170 hours a day parked outside the emergency services.

Unable to transfer patients, these paramedics cannot get back on the road and help more people, increasing ambulance wait times and risking worse patient outcomes.

And the condition of the hospitals is a factor entirely beyond the control of St John’s.

But finding more funding to better supply hospitals, as well as hiring more doctors and nurses, may not be the only options the government is considering.

Union multiplies calls for public takeover

As WA was going through its peak of COVID, a parliamentary inquiry released a 219-page report into St John’s performance.

After finding that it was unable to meet target response times in the 2020-2021 fiscal year, the report suggested the service be brought back to government, or outsourced to another provider, if there was no improvement in five years.

This was not a surprising result, given that the chairman of the committee, Labor MP Pierre Yang, is backed by the United Workers Union.

The UWU represents around half of St John’s staff and is keen to see the ambulance service no longer privately owned.

Following Ms Fyfe’s resignation, the union’s national ambulance coordinator Fiona Scalon suggested the process could start now.

“Now is the time when the government needs to get involved and make sure that some of the things that need to happen happen,” she said.

A full takeover has already been ruled out in this term of government, but it is not the only option that could give politicians and bureaucrats greater control of the ambulance system.

The interim chief has his work cut out for him

The service’s chief operating officer, Antony Smithson, has a big job ahead of him once he temporarily steps into the top job from July 12.

Michelle Fyfe and Antony Smithson wear professional attire as they stand outside an urgent care facility
Antony Smithson will have a huge job to do when he steps into the shoes of Michelle Fyfe in just 10 days.(St. John WA)

This includes continuing to lead the organization through the challenges of high demand and furloughs.

On top of that, the service is also engaged in protracted negotiations over its contract with the government, which expired on Thursday and has now been extended.

All this without a permanent CEO.

But there is little a new St John’s boss – acting or permanent – can do to get ambulances to the sick sooner, until the huge pressure on the emergency services is over. again under control.

Lillian L. Pena