Paramedics should be allowed to "say no" to people who have dialled triple zero over a grazed knee, according to the NSW auditor-general.
In a statewide review released on Wednesday, Peter Achterstraat found that the time ambulances wait at hospital emergency departments has risen over the last seven years, from an average 30.5 minutes to 42.1 minutes.
The median response time to emergency calls has risen from 9.5 minutes to 10.9 minutes.
Mr Achterstraat said "bed block" was partly to blame, and that in some cases beds were not being freed up fast enough because hospital staff were spending too long on paperwork before discharging patients who were otherwise ready to leave.
"If we want new patients to get in faster, we have to get existing patients out faster," Mr Achterstraat said.
He said improvements at some hospitals, like Nepean Hospital, which used new procedures to halve its triage time, proved more could be done within existing budget constraints.
"There are pockets of good practice, but two pockets don't make a surgical gown," he said.
Health Minister Jillian Skinner said the auditor-general's 11 recommendations for faster turnaround times were already being addressed in three major reform initiatives underway in NSW.
But the NSW opposition says reversing the ambulance turnaround trend will only be possible with increased funding.
Labor's health spokesman Andrew McDonald said the ambulance system was in crisis.
"With figures like this, one thing is quite clear: a measly two per cent increase in the ambulance budget is not going to fix this problem," he told reporters.
"Every ambulance crew off the road is an accident waiting to happen."
NSW Greens MP John Kaye said strategies like holding patients in waiting rooms would only work short-term.
"Better discharge planning will help solve some of the ambulance waiting time problems but there is a real risk that cash-strapped hospitals will be forced to push patients out the door before they are ready to cope on their own," Dr Kaye said in a statement.
"Trolley block cannot be solved in isolation nor will it get better without a substantial increase in hospital funding."
But Mr Achterstraat said flippant members of the public were also straining the system by calling ambulances for minor ailments like splinters or bee stings.
In one case paramedics rushed to help a woman who had gotten mascara in her eye, while on another occasion a caller scraped her knee, called an ambulance and insisted she be taken to a nearby hospital.
"If the paramedic gets out there and sees that the person only has a grazed knee, the paramedic should be able to say to that person `Listen my friend, I think I'll just put a bandaid on that rather than taking you to hospital'," Mr Achterstraat said.
He wants paramedics to be able to refuse transport to patients who don't need it by December next year.
The Health Services Union blamed government budget cuts for the increased ambulance response times.
"It's time to stop gilding the lily. Our ambulances are simply not getting to jobs as fast as they should," HSU NSW secretary Gerard Hayes said.
"Clogged emergency departments are slowing down paramedics and preventing our crews getting back onto the road as fast as possible.
"There's no way to sugar coat this. Patient outcomes are clearly deteriorating.
"Our concern is that this will only get worse as budget cuts take full effect."
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