Ambulance funding background information

Ambulance funding background information 2017-05-18T10:22:40+00:00

New staffing numbers

  • On Sunday 14 May, the Government announced 430 new ambulance staff at St John Ambulances over the next four years.
  • This includes 375 for areas currently single-crewed, 45 to cover historical population growth and 10 communication staff.
  • The exact number of different level roles will be confirmed over the next month.
  • It will include around 300 clinically-unqualified roles called Emergency Medical Assistants (EMAs).
  • An EMA is essentially a driver with advanced first aid training who can’t act clinically and requires supervision.

The proposal won’t end single-crewing

  • The Government and St John are saying the proposal will end single-crewing, provide double-crewing and give rural areas the same level of care as most cities already have.
  • This goes against earlier comments by St John that it needed more than 545 extra staff to end single crewing.

The proposal is for assisted-single-crewing, not double-crewing

  • The 2008 Select Committee Inquiry in Ambulance Services defines “double-crewing” as two qualified ambulance officers.
  • Today’s proposal is “assisted-single crewing” where one unqualified assistant works with one qualified officer.
  • Assisted single-crewing is a welcomed late step in the right direction.
  • The move comes nine years after the inquiry and after years of underfunding at St John.
  • St John will still need to fundraise 25% of its cost.
  • The extra money won’t assist those who have suffered where they were supported by a single or assisted-single crewed ambulances.

Assisted single-crewing does not provide the same level of care as most big cities which already have two qualified officers.

  • Medically-unqualified assistants won’t be able to provide the care Kiwis need, when they most need it.
  • Critical life saving interventions or where there are two or more patients, such as a high speed vehicle accidents or a complicated pregnancy need two qualified officers.

The new proposal will not cover future workload pressures.

  • St John previously said 45 FTE were required for historical population growth.
  • It also estimated 9.5 FTE were required every year to maintain staffing levels with population growth.
  • In four years St John will be down 38 FTE in real terms.
  • Rural and provincial Kiwis still won’t be getting the quality care as most cities get.

The lowest qualified ambulance role only costs $15,000 more per year than an EMAs.

  • It will only cost an extra $4.5m to upgrade the 300 roles to the minimum level qualified role (Emergency Medical Technicians or EMTs).
  • The Council of Trade Unions estimates the Government has underfunded the health system by more than $1.85 billion. This is because funding hasn’t kept up with an ageing and growing population with increased mental health needs and other costs.

It will take an EMA 10 years to earn the current living wage.

Appendix

Roles and training

Qualification Title Authority to practice Qualification shorthand
Qualified Ambulance Officer Intensive Care Paramedic (ICP) (Advanced Life Support / ALS) Yes 4 year Post-graduate
Paramedic (Intermediate Life Support / ILS) 3 year Degree
Emergency Medical Technician (EMT) (Basic Life Support / BLS) 12 month Diploma
Unqualified assistant Emergency Medical Assistant (EMA) No 76 hours (Certificate with module) + on the job training. [1]
First Responder (FR) 60 hours Certificate

[1] Note the Government said today the training would be five months.

Pay rates

  • The minimum qualified ambulance officer role is $15,000 more than the new unqualified assistant role.
  • It will take 10 years for the new unqualified role to earn above the current living wage, and will still only earn $528 a year above it.

Start rate

Position Salary Total cost (approx)[1] Total cost difference to EMA (approx)
Intensive Care Paramedic $77,444 $90,377 $41,685
Paramedic $69,853 $81,518 $32,827
Emergency Medical Technician $54,241 $63,299 $14,607
Living wage [2] $44,117 $51,485 $2,793
Emergency Medical Assistant $41,724 $48,692

1 – 3 years

Position Salary Total cost [1] Total cost difference to EMA
Intensive Care Paramedic $78,413 $91,508 $42,207
Paramedic $70,726 $82,537 $33,236
Emergency Medical Technician $54,919 $64,090 $14,789
Living wage [2] $44,117 $51,485 $2,183
Emergency Medical Assistant $42,246 $49,301

10 years +

Position Salary Total cost [1] Total cost difference to EMA
Intensive Care Paramedic $83,006 $96,868 $44,767
Paramedic $74,865 $87,367 $35,267
Emergency Medical Technician $58,149 $67,860 $15,759
Emergency Medical Assistant $44,645 $52,101
Living wage [2] $44,117 $51,485 -$616

[1] The total cost of an employee is greater than the salary. KiwiSaver, Annual Leave and other non-wage costs all add to the cost of an employee. The total wage cost has been approximated at 116.7% of salary.

[2] Livingwage.org.nz has set the living wage rate as of 1 July 2010 set at $20.20. The salary has been calculated by the St John salary divisor for 4 on 4 off shift pattern at 2184 .

It will only cost $4.5m extra for the new roles to be qualified

Option Unqualified roles (EMAs) Minimum qualified roles

(EMTs)

Cost difference
300 EMAs $14.6m $19 $4.5m
Total cost (430 new roles) $59.2m $63.6 $4.5m

Key quotes from the 2008 Select Committee Inquiry into Ambulance Services

The 2008 Inquiry into the provision of ambulance services in New Zealand can be found here: (https://www.parliament.nz/resource/en-NZ/48DBSCH_SCR4100_1/512079c402e3c0cd3386de9bc8182a9ef5bbeda8

Key quotes:

  • “We are concerned at crewing levels in the ambulance sector, and the fact that for some areas of New Zealand 70 percent of emergency call-outs are responded to by single-crewed ambulances. This may result in sub-optimal care for the patient and safety concerns for the ambulance officer.” (Page 3)
  • “We accept that for patient safety and optimal patient care call-outs should be double- crewed.” (Page 4)
  • “We recognise that ideally all emergency call-outs should be attended by a double-crewed Ambulance.” (Page 4)
  • “Double crewing means that on an emergency call-out, there are two qualified ambulance officers on board.”  (Page 12)
  • “We were informed by providers that current funding is insufficient to provide the contracted level of service. St John informed us that it considers that public funding meets no more than half of the cost of delivering current services.” (Page 16)