Analysis: Can this country’s ambulance services continue operating on the smell of an oily bandage? That’s a question inadvertently brought to the fore by a pre-Budget announcement from Health Minister Simeon Brown.
The $35 million over four years, to bail out road ambulance services and improve services for patients and frontline staff, will be rightly welcomed. It will help fund two ambulance hubs in Auckland, a patient record system, additional training for comms centre staff, and clinical welfare checks for patients.
“When New Zealanders call an ambulance, they need confidence that they will get the help they need quickly and that frontline crews have the support and resources they need to respond,” Brown says. “Demand for ambulance services continues to grow across the country.”
But this also underscores how one of our most fundamental health services has come to depend on an unreliable and fragmented scattershot of funding.
In a recent editorial, the NZ Medical Journal argued ambulance services need to be transformed. “Ambulance services have moved far beyond patient transport to deliver advanced emergency, urgent and primary care,” it said.
“Paramedics now perform complex procedures, such as rapid sequence intubation, under robust clinical governance. Yet, unlike the police and fire services they have never been recognised in statute as an emergency service.”
Yes, you heard it right. NZ Police is a fully-funded Crown department. Fire and Emergency NZ is a Crown agency. The National Emergency Management Agency … well, it’s in the name.
But not ambulances.
‘The underlying funding model has not been fit for purpose for many years… What’s needed now is a reset – not a short-term Band-Aid.’
Peter Bradley, Hato Hone St John
Hato Hone St John is a registered charity that relies heavily on $66 million in public donations, bequests, ambulance memberships, corporate sponsorships and commercial services, as well as its Ministry of Health and ACC contracts. So too, Wellington Free Ambulance ($12m).
The rescue helicopter trusts around the country are also charities, dependent on Westpac and other donors for about $20m of their annual operating costs.
The Govt has no interest in changing this. And why would it? While it may be paying roughly 80 percent of the operating costs through contracts, there’s another $100m that’s being contributed by corporates and the public. And that’s before we even start talking about the capex for fully-kitted new ambulances ($325,000 apiece) and choppers ($20m each).
Critical public services are outsourced, not to the private sector, but to the voluntary sector. According to the latest Hato Hone St John annual report, the service relies on 3353 paid staff and 8057 volunteers.
Hato Hone St John has spent the past year negotiating a new Emergency Ambulance Service Contract which will come into effect in July this year.
In commentary this month, ahead of the pre-Budget announcement, chief executive Peter Bradley says the funding model is at a crossroads – and I suspect he speaks for the leadership of all the ambulance and rescue helicopter trusts in warning of the existential threat to the service’s very sustainability.
“Health will be one of the defining issues in the lead-up to Budget 2026. The choices made in the coming weeks will signal not just fiscal priorities, but whether New Zealand is prepared to invest in the foundations of its health system – including the emergency response people rely on when most vulnerable.”
He observes that many people are under financial strain and other pressure, and the health sector is stretched. The population is ageing, demand is rising.
At the same time, ambulance services are increasingly exposed to global and economic pressures. Fuel supply concerns have shown how quickly external risks can affect essential services and add significant costs.
Rising construction costs, supply chain disruption, workforce shortages and more frequent severe weather events all add to the challenge of sustaining nationwide coverage.
Now, he says, St John is at a crossroads as the next four-year emergency ambulance service funding contract is developed.
“The underlying funding model has not been fit for purpose for many years. It has not kept pace with demand growth and cost pressures, and it has consistently not recognised the full cost of delivering a modern national ambulance service, including the infrastructure and enabling assets that make frontline care possible.”
“What’s needed now is a reset – not a short-term Band-Aid. Budget 2026 is an opportunity to take a longer-term view and ensure New Zealand’s national emergency ambulance service remains dependable for every community.”
