The news this week that St John is set to trial a new system whereby ambulances will not be sent to minor 111 calls as part of changes to help curb a $15 million-a-year loss is the latest manifestation of a crisis in the pressured health sector struggling to balance increasing demand with limited - and sometimes reducing - funding.
St John's annual operating loss has nearly doubled in five years as paramedics struggle to cope with an annual increase in demand, which last year pushed the number of callouts to a reported 337,000 - an average annual 4.5% increase.
An increasing elderly population with chronic illnesses has contributed to the problem, which has also affected response times, particularly in urban areas. Concerns about heavy staff workloads and the safety of officers who are increasingly being required to man ambulances alone are also part of the equation. At a local level, in July, this newspaper reported concerns over staffing of the Wanaka St John service at night, with GP Dr Susie Meyer saying she had raised the issue of emergency services to rural communities at a conference for rural GPs almost two years ago and it remained a national issue.
Under the new system, which will be trialled in Christchurch next month with the intention of launching nationwide, non-urgent calls will be attended by a St John officer in a car, or redirected to a GP or other healthcare facility.
St John says 10% to 15% of all emergency calls are non-urgent and the changes mean officers will be able to respond to life-threatening calls faster. It also says it needs more staff and is unable to meet demand unless the service's finances are addressed. The charity receives 80% of its funding from the Ministry of Health and ACC - to the tune of $223 million in the 2010-11 financial year - but relies heavily on donations, fundraising, sponsorship and the work of volunteers.
As well as emergency response through its ambulance services, the organisation provides first-aid training, event medical services, medical alarms, and a range of youth and community programmes.
St John is not the only medical response service finding itself under pressure. The country's rescue helicopters face a constant struggle for survival as many do not receive direct government funding. Callouts are funded by the agency which initiated the call - ACC, hospitals or police - but the helicopter rescue trusts rely heavily on sponsorship from businesses, and funding from the likes of community trusts, councils and the public to pay the hundreds of thousands of dollars of additional costs involved, particularly for equipment.
It is not just frontline services feeling the push. New Zealand's ageing society is increasing the pressure on all aspects of our health sector, and costs are forecast to spiral. "There's a brick wall coming. But that's true of the health sector in general," St John operations manager Michael Brooke says. And we can add to the mix the background of the global financial crisis, which means governments are focused on managing debt and allocating spending.
While a National Ambulance Sector Office - a joint venture between ACC and the Ministry of Health - was set up in 2008, with one of its aims to co-ordinate funding from the main agencies that support the ambulance sector, a Ministry of Health spokesperson has said no significant funding increases are planned because St John "is making excellent progress with introducing new ways of working that will enable it to manage demand growth within existing resources".
However, St John says the changes will only buy the organisation time, possibly only a couple of years: "Response times will get worse unless more money goes into ambulances," Mr Brooke said.
So if the organisation, with its proud motto of "first to care", is not deemed first in the government funding line, it appears the public - and private enterprise - will need to continue to dig deeper into their own pockets to answer its call - in order that it can continue to respond to theirs.
