How do we address developing financial pressures and an ongoing workable plan for Emergency Medical Services in New Zealand?
Ambulance services constitute a pivotal element in the continuum of healthcare provision, responding to medical exigencies and accidents through either a 'treat and transport' or 'treat and leave' approach. In NZ, we currently have 2,500 full-time equivalent staff in our ambulance service (1,922 being frontline emergency ambulance FTE) and 2,700 ambulance operations volunteers. This cadre spans from highly experienced advanced paramedics to volunteers committed to service with minimal training. The infrastructure supporting this service includes three Emergency Ambulance Communications Centres (EACCs), manned by roughly 140 call handlers and dispatchers. Over time, ambulance service providers have evolved to meet emerging challenges and embrace new technologies, including the establishment of advanced communications centres.
The genesis of modern ambulance services in New Zealand dates to the 1880s, with the recognition of the necessity for swift medical intervention often linked to military advancements. The inception of formal first aid training in NZ also occurred in the 1880s, with the establishment of the first St John division in Dunedin in 1892. By 1907, the number of such divisions had expanded to 41, and in 1927, the Wellington Free Ambulance was inaugurated. Currently, Hato Hone St John provides emergency ambulance services to 90% of the population, covering 97% of the nation's geographical expanse. St John has initiated several key projects in recent years, including the Electronic Patient Report Form, 111 Clinical Hub, and the implementation of double crewing for ambulances.
Recent analyses of St John's operations have not identified significant cost inefficiencies, suggesting that St John operates with a degree of cost-effectiveness comparable to international peers, benefiting from its community-based volunteer model. However, in the 2018/19 fiscal period, St John's operational expenses escalated by 6.7% from the previous year, culminating in an $11 million deficit against total revenues.
The existing funding model is unsustainable, necessitating a reevaluation to ensure the service's stability. Unlike St John, Wellington Free Ambulance, a charity serving the greater Wellington area, does not face continual funding challenges.
New Zealand's challenging topography, extended travel distances, and the relatively small, dispersed population significantly impede access to hospital-level care, affecting the timely and equitable delivery of pre-hospital Emergency Medical Services.
As demand for ambulance services escalates, St John has advocated for full government funding. Unlike in nations such as the UK and Canada, where ambulance services are government-funded, St John partially relies on donations and volunteer support.
Postponing these necessary financial reforms could have grave implications for health outcomes, underscoring the urgency for a comprehensive funding review.