Details of St John WA boss Michelle Fyfe’s emergency meeting with Amber-Jade Sanderson revealed

St John WA chief executive Michelle Fyfe was hauled into a meeting with Health Minister Amber-Jade Sanderson just a week before announcing her resignation, which came following a breakdown of the relationship between government and the ambulance provider. Ms Fyfe’s departure follows a series of controversies and weeks of thinly veiled barbs between the CEO — who remains in her role until July 12 — and both Ms Sanderson and Premier Mark McGowan. And it comes at a critical juncture for St John, which is yet to finalise a new contract with WA Health after months of negotiation, with the current deal — due to expire on Thursday — extended until the end of the year as work continues on modernising the agreement. Some of that modernisation will be informed by the work of a parliamentary inquiry that last month recommended sweeping changes to St John’s operations and a potential government takeover of the ambulance service — an existential crisis Ms Fyfe’s replacement will be forced to weather. Against that backdrop, The West understands Ms Fyfe was summoned to a meeting with Ms Sanderson last week for a frank discussion about her concerns. The St John board then met with Ms Fyfe on Tuesday, where the decision to part ways with the CEO was formalised. Ms Fyfe did not front media on Wednesday but in a message to staff wrote she was leaving with a “sombre but satisfied heart” and that it was time for “fresh energy to take the organisation forward”. Escalating levels of ambulance ramping under the McGowan Government’s watch has placed increasing pressure on St John’s resourcing and response times but the arrival of COVID into WA exposed deficiencies on the part of the not-for-profit itself. St John was thrust into spotlight for the first time in April following the death of Geraldton grandmother Joan Hope, who died outside her son’s home waiting more than 30 minutes for paramedics to arrive. Less than three weeks later, on May 9, St John issued the first of a series of public alerts warning of “extremely high demand” in the Perth metropolitan area that might mean ambulances were delayed in responding to emergency calls. Then, on May 15, two more West Australians — 80-year-old Georgina Wild and a man in his 80s — died after dialling triple-0 and waiting more than two hours for paramedics to arrive, sending shockwaves around the State. Three days later — and after weeks of calling on St John to fully activate critical worker protocols designed to allow asymptomatic paramedics exposed to COVID to keep working — the McGowan Government launched an unprecedented intervention. Mr McGowan and Ms Sanderson announced senior police and WA Health officials would be embedded in St John’s operations centre and 48 firefighters would be trained to drive ambulances. Critical worker protocols were also enacted in full. It signalled the beginning of the end for Ms Fyfe, with Mr McGowan repeatedly making clear his displeasure that both measures — first planned in 2020 in the early days of the pandemic — had not been activated sooner. The next blow came the very next day in the form of a long-awaited report from a parliamentary inquiry into ambulance services in WA, which made 48 recommendations proposing major overhauls to St John’s operations designed to improve emergency response times, transparency and minimum service levels in the bush. The inquiry, chaired by United Workers Union-backed Labor MP Pierre Yang, suggested St John be given five years to clean up its act before the Government appoint a new provider or bring the ambulance service in-house. The next weekend brought yet another controversy, with a senior St John staffer mistakenly emailing at least one public hospital notifying them “business continuity plan level 3 measures” were immediately coming into effect and St John ambulances would cease ramping besides in exceptional circumstances. Ms Fyfe was forced to issue a late-night clarification, walking back the notification and advising the measures would not be activated without advanced notice. In the midst of the ongoing ambulance crisis Ms Fyfe failed to deny reports she had applied for the role of WA Police Commissioner, a bad look when publicly insisting she had no plans to resign and remained the best person to lead St John. On June 11, after St John had again issued a public alert warning of high demand, Mr McGowan was asked if Ms Fyfe retained his confidence as CEO — but refused to back her in. “We don’t control St John, it’s an outsourced model... we just want to make sure that they improve their services and make sure that they use all the resources available to them to ensure that happens,” he said. The next week, St John chair Shayne Leslie issued a statement throwing his support behind Ms Fyfe. It was short lived. On Tuesday — just over a fortnight later — second statement confirmed she was departing. Shadow health minister Libby Mettam accused the McGowan Government of using St John and Ms Fyfe as a “scapegoat” for the failures of the hospital system. “St John have been operating with a hand behind their back when it comes to being able to respond to priority calls across the community because they are waiting record hours outside emergency departments because the McGowan Government have failed to properly resource our hospital system,” she said. Ms Mettam added Ms Fyfe’s resignation created an opening for unions to apply “untold pressure” to the “union-backed Labor Health Minister“ to bring the ambulance service within the public sector. Mr McGowan has previously ruled out a takeover of the ambulance service during the current term of government, which expires in 2025. A spokeswoman for Ms Sanderson did not directly address a series of questions from The West, including whether that commitment stood. “The State Government continues to work closely with St John to ensure West Australians have access to a timely and effective ambulance service,” the spokeswoman said. Ms Fyfe’s four-year tenure stands in stark contrast to her two immediate predecessors — Tony Ahern and Ian Kaye-Eddie — who between them held the reins for 38 years dating back to 1978. Both men were also appointed to the St John board after standing down from the CEO role, with Mr Ahern still serving in that capacity, an example of what St John insiders described as the insular nature of the organisation. Mr Ahern’s board appointment came despite a spate of five paramedic suicides in 16 months under his watch, with a trio of reports commissioned in the wake of the tragedies detailing a “culture of bullying” and “toxic” workplace culture. Those findings were borne out by St John’s 2016 Culture Survey, which found only half of respondents believed bullying and abusive behaviours were prevented and discouraged and that 61 per cent of staff believed senior management did not listen to them. A follow-up survey in July 2019 — less than a year after Ms Fyfe replaced Mr Ahern as CEO in late 2018 — found the same issues persisted, with staff again indicating concerns over bullying and a disconnect between managers and frontline responders. St John’s 2022 Culture Survey was recently completed but the results have not yet been released — and possibly contributed to the board’s decision to move on from Ms Fyfe. Multiple St John staffers who spoke with The West described discontent over the swelling ranks of middle management under Ms Fyfe’s watch, with the career paramedics pulled off the road to fill many of the positions contributing to rostering shortfalls and an increased reliance on volunteers. There was also shock at St John securing a $28 million commitment from the Coalition Government ahead of the 2019 election to establish four new urgent care medical centres in Perth — expanding its network to seven — which paramedics told The West was emblematic of a culture that did not place enough focus on the core function of emergency ambulance response. United Workers Union national ambulance coordinator Fiona Scalon said St John had repeatedly been warned it was not employing enough career paramedics during the COVID pandemic — and especially in the lead up to the hard border falling — but had failed to act. “Our leaders went to St John, prior to the borders opening, saying you’re going to need to bolster your resources in the lead up to Omicron hitting Perth and the rest of WA and they chose not to,” Ms Scalon said. Instead as COVID hit and paramedics were forced into furlough, St John increased its reliance on volunteers, introducing “mixed crewing” that paired qualified medicos with “rapid ambulance support officers” with limited intervention capability and who were not permitted to drive under lights and sirens. “It is important for (ambulance paramedics) to note that the RASO training only involves basic familiarisation with the ambulance and equipment to enable the RASO to assist the paramedic,” an internal memo sent to St John staff read. The West understands some career paramedics baulked at this solution, booking off shifts that paired them with a RASO which further exacerbated shortages. Ms Scalon said she welcomed Ms Fyfe’s resignation but that the issues at St John were “not one person”. “Perhaps some more independence (on the board) would make for different decisions in that regard,” she said. “If people are indoctrinated into a particular way of ‘we’ve always done things this way, we need to keep doing it this way’, it doesn’t leave room for new ideas and moving with the times.”