St John's

The southern ambulance sector has welcomed MPs' calls for ambulance services to be restructured but is disappointed changes - if adopted - will not come sooner.

A report from a health select committee inquiry in to ambulance services released yesterday raised concerns about crewing levels, service funding and patient costs and training and regulation of ambulance officers. The committee recommended all ambulances be double-crewed within four years (three years for cities and four for towns with more than 15,000 residents), ambulance officers become registered health professionals, national training standards be established for paramedics, and a single governing body for the sector be set up. It also suggested the Government review funding of the service in favour of longer contracts and a single funding stream; promote co-location of ambulance and fire services, where possible, and the Fire Service be funded for attending medical callouts.

The report made 14 recommendations to the Government.

Health Minister David Cunliffe said the report seemed to be well reasoned and would be given "very serious consideration".

The Order of St John, the largest ambulance service provider, covering 86% of the population, including Otago and Southland, welcomed the report. St John chief executiveJaimes Wood said many of the report's recommendations reflected St John's submission. "The St John position has always been that emergency ambulances should be fully crewed wherever possible."

Eighty-two percent of St John ambulance responses were double-crewed and he warned that increasing this would have significant funding implications. St John has previously estimated it would require $53 million more a year to double-crew all its callouts. About $40 million would be needed to increase its frontline staff from 800 to 1200.

Calvin Fisher, of the Amalgamated Workers Union (Southern), which represents ambulance workers in the South Island, where St John operates ambulance services, said the report's recommendations were encouraging, but its timeframe with regard to double-crewing was disappointing for staff in certain areas.

Of particular concern was central Christchurch, the busiest ambulance station in the country, where ambulance officers were often sent to calls on their own because of a lack of staff.

By comparison, Dunedin had a relatively low rate of single-crewing because it was not as busy as other stations, had stability among ambulance officer ranks and more highly qualified staff than in other cities. However, single-crewing could not be avoided, especially while St John's funding was under pressure. Until changes were implemented, patients would be at risk, Mr Fisher said.

St John southern regional manager Gary Williams welcomed the report and its recommendations. He did not think the recommendation to promote the co-location of ambulance and fire services would, if adopted, make a difference in the South. More than 10 ambulances and emergency response vehicles available to St John-trained volunteers or ambulance officers were already housed at fire stations across the region, including Invercargill, Omarama, Clinton and Omakau, and the situation was regularly reviewed.

Ambulance, fire and police services were all housed in the same building in Lumsden. St John also provided extra training for volunteer firefighters by arrangement with specific brigades.

The decision to co-locate services or vehicles was mainly an economic one in towns and a logistical one in remote rural areas, where volunteers were trained to cope with a situation until an ambulance arrived from further afield.

Main recommendations

• Double crewing within four years
• Ambulance officers to become registered health professionals
• National training standards for paramedics to be set up
• Single governing body for sector to be set up
• Review of funding in favour of single funding stream

The ambulance sector has welcomed a parliamentary inquiry into the service it provides but says patients will be at risk until changes are implemented.

An inquiry into ambulance services by the health select committee says cities should have ambulances with two crew on board within three years and all large towns over 15,000 people within four years. The MPs said single crew callouts should stop, but it would take time for more staff to be put in place.

The Order of St John, which is the largest ambulance service provider covering 86 percent of the population, estimated it would require $53 million more a year to double-crew all its callouts.

Health Minister David Cunliffe said the report seemed to be well reasoned and would be given "very serious consideration" by the Government. It had a policy of moving towards double crewing ambulances as priorities allowed. "It's not an inexpensive step ... it is definitely an additional resource and the health budget is pretty stretched," Mr Cunliffe said.

In a press release later, Mr Cunliffe said to implement the recommendations would mean a "rethink of health spending authorities". More money had been put into ambulance services and further work was being done on a national ambulance strategy.

St John chief executive Jaimes Wood said he was delighted with the report. "The St John position has always been that emergency ambulances should be fully crewed wherever possible," Mr Wood said. Eighty-two per cent of St John ambulance responses were double crewed and to increase this would have significant funding implications.

National Distribution Union ambulance co-ordinator Craig Page said the Government had been warned about the dangers posed by the current level of service. "The best way to deliver effective and consistent ambulance services is through one well resourced national ambulance service provider," Mr Page said. "Professionals told the committee of our concerns with a lack of regulation, multiple service providers, under-funding, poor quality assurance, inadequate network coverage and single crewing in rural centres. As long as these issues are glossed over patients remain at risk."

The inquiry followed calls by the Ambulance Association that coverage was inadequate, ad hoc and a large number of single crew callouts was putting people at risk.

There have been reports of families of people suffering from heart attacks or witnesses at scenes of accidents being asked to drive ambulances to hospital while a paramedic helps the patient.

MPs recommended the three and four-year targets be taken up by the Government. "We realise that the nature of the workforce will mean that there is a mixture of paid and volunteer officers achieving this goals."

The report called for clinical standards to be applied to ambulance services and paramedics to become registered medical practitioners under health laws. MPs said funding to ambulance services through the Ministry of Health and ACC was complicated and confusing. For instance, all callouts created costs, but ambulance services were only paid if a live person was transported to hospital for treatment after a traffic accident.

Some have called for a single national ambulance service, but the MPs stopped short of recommending that, saying there should be greater co-operation and collaboration. MPs said streamlining funding and setting up a national standards body would go some way to achieving this.

Paramedic cut is a fight this region can’t really afford to lose
by Iain Gillies
Friday, 11 May, 2007

It is disturbing to learn that our emergency services could be compromised by the loss of a permanent advanced paramedic in Gisborne, while ambulance stations at Ruatoria and Te Puia will be managed from Tauranga.

And this at a time when St John Ambulance here has been two paramedics down since the end of last year.

Sometimes it is necessary for governments to come to the rescue and spend money they were saving for something else.

It all boils down to priorities. And in the build-up to Budget week everyone and every organisation, every arm of government services can come up with a "priority".

But health must always be right up there at the top of the list. And the Government is already pouring multi-millions of dollars into health services every year.

Even so, providing isolated areas such as the Gisborne-East Coast with the paramedic services we feel are necessary won’t start a new bout of inflation or empty the Government’s coffers.

New Zealanders, through the state, spend big on health. They rightly feel entitled to at least a satisfactory standard of health service in return.

But, whatever the causes, many no longer feel confident that services will be available to them when they need them.

They worry whether they are receiving a fair return for their outlay. They suspect unreasonable waste. And it hurts when they see an organisation as valuable as St John having to ration its resources.

National Distribution Union branch organiser Neil Chapman says there is "serious concern" about the staff shortage and further planned restructuring.

"We have argued for many years to get advanced paramedic positions in this area and we don’t want to see a dilution of that in any way. Gisborne has gone from having three advanced paramedics to two, and that is our concern."

Our view? The only area of health services that needs cutting is the bureaucracy. And there will be a lot of appreciation if steps are taken to ensure emergency services are kept at full strength.

St John sets record straight
by Staff Reporters
Friday, 11 May, 2007

The Gisborne Herald would like to correct inaccuracies in a report in Wednesday’s paper on St John ambulance resource levels in Gisborne, and to apologise to St John and spokesman Brent Nielsen.

We accept that information provided to us by St John Midland regional operations manager Brent Nielsen was provided in good faith and is correct — that is, that Gisborne’s rate of single-crewing in ambulances is in line with the national average.

We regret repeating unchallenged an allegation from National Distribution Union spokesman Neil Chapman that a significantly higher percentage of ambulance callouts in Gisborne are attended by a single crew member.

St John’s position on single-crewing — stated publicly on several occasions — is that all emergency ambulance calls should be responded to by a vehicle with two ambulance officers, and that to achieve this St John needs increased resources, including increased full-time paid staff and volunteers.

"Where St John responds to an emergency with an ambulance with a single crew member, it is not a matter of choice — it is a matter of available resources," says St John external communications manager Ali Tocker.

"St John believes it is appropriate in these situations to respond with a single-crewed vehicle rather than responding with no vehicle at all or waiting for one to come from a greater distance."

• St John also wants to correct a statement in last night’s paper by Mayor Meng Foon, reported from the Waerenga-o-kuri long-term community plan meeting.

Mr Foon said St John planned to "downgrade" staffing by having ambulances staffed by "just the driver" instead of by a paramedic and driver.

"We want to reassure the public that all staff crewing St John ambulances have medical skills," Ali Tocker said.

A senior St John ambulance officer has been accused of giving deliberately misleading information about single- crewing of ambulances, which is said to be putting lives at risk.

National Distribution Union branch manager Neil Chapman says up to 70 percent of ambulance callouts in Gisborne are attended by a single crew member.

This is in response to claims made by Midland regional operations manager Brent Neilsen that Gisborne’s rate of single-crewing in ambulances matches that of the national average, at less than 20 percent.

"That is an absolute urban myth," Mr Chapman says.

"Those results are skewed due to the high volume of double-crewing in large centres like the Auckland metro area. In regional areas like Gisborne, it is much more than that."

In Gisborne, most callouts occurring during business hours are double-crewed, but night-time callouts are predominantly single-crewed, Mr Chapman says.

"This is definitely a concern that needs to be addressed," he says.

The situation is about to get worse, with permanent staffing levels dropping from 10 staff to nine before the end of the month, Mr Chapman says.

St John Gisborne area manager Shane Clapperton says he is not at all happy with single-crewing in any situation.

"We never want vehicles leaving single-crewed for a job, due to staff safety and patient care.

St John chief operations officer Kevin Tate acknowledges regional variations to the national statistic and says single-crewing always occurs due to a shortage of available staff.

"On the occasions that we single-crew, we have only one ambulance officer available in that area at that time. There can be several reasons for this and it is never a matter of choice," Mr Tate says.

"We rely on a combination of paid staff and volunteers to crew our ambulances within available funding.

"The most common reason for single-crewing is that, in a number of locations, we rely on a volunteer to be the second crew member.

Mr Clapperton says it is an ongoing process to recruit volunteer ambulance staff to fill shifts on the Gisborne roster.

"However, voluntary staff are exactly that — voluntary — and it is always difficult to recruit and retain a full complement of voluntary staff."

A new report from the New Zealand Ambulance Association says many patients have suffered as a result of single-crewing, and ambulance officers are also far more vulnerable in dangerous situations, Green Health spokeswoman Sue Kedgley says.

"Many aspects of an ambulance officer’s job cannot be handled alone, from performing CPR to lifting an immobile patient on
to a stretcher and into the ambulance, and it is putting
people’s lives at risk to send single-crewed ambulances to emergencies.

"Officers are turning up to car crashes and heart attack victims on their own, and staff are being forced to choose between tending a patient or driving.

"Ambulance officers tell of repeatedly stopping
en route to hospital, losing valuable time in the process, to monitor patients and administer treatments," Ms Kedgley says.

However Mr Tate says in circumstances where single-crewed responses do occur, most take place without incident, with the patient treated or stabilised by the ambulance officer before being transported to hospital.

"The St John position is clear — all emergency ambulance calls should be responded to by a vehicle with two ambulance officers," he says.

"Full-time ambulance officers are allocated throughout the country, based on available funding, an assessment of comparative workloads and local factors."

Emergency services in this region could be further compromised by the loss of a permanent advanced paramedic in Gisborne, while ambulance stations at Ruatoria and Te Puia will be managed from Tauranga.

St John Ambulance has been short of two paramedics in Gisborne since the end of last year, when an advanced paramedic and a paramedic relocated elsewhere.

The staff shortage and further planned restructuring for this region is a serious concern, says National Distribution Union branch organiser Neil Chapman.

"We have argued for many years to get advanced paramedic positions into this area and we don’t want to see a dilution of that in any way.

"Gisborne has gone from having three advanced paramedics to two, and that is our concern. It puts a huge amount of pressure on the remaining two advanced paramedics."

Advanced paramedics are able to administer medicines and carry out life support procedures that other staff are not qualified to do. They are also called on to attend emergencies that require the attendance of the Lion Foundation Rescue Helicopter, and often attend other incidents to support other paramedics.

"We are absolutely concerned that the number of paramedics able to carry out this role has been limited," Mr Chapman said.

"Gisborne is some way away from other centres — staff who are out there on their own with a seriously ill patient need to know with confidence the advanced paramedic is available to support them.

"There are times when ambulance staff know a patient will have a better chance of recovery with access to an advanced paramedic."

Proposed restructuring by St John Ambulance in the midland region means that Gisborne’s area manager position will be disestablished and replaced by a duty-based team manager.

Effectively, the Gisborne station loses a staff member, leaving it with just two advanced paramedics on staff.

The car-based area manager position has meant an extra vehicle with a full supply of medical equipment has been on the road at busy times, as well as providing a quick response by an advanced paramedic at trauma situations.

While it has been proposed the car will still be available for use in Gisborne without a car-based manager, it is likely to remain on-station, meaning delays in responding to emergency situations.

While the Gisborne station will still be managed by the team manager, this position will now be ambulance-based, with the manager working shifts as part of the station roster.

This means reduced availability to support other staff or attend as back-up to major incidents, Mr Chapman believes.

St John Gisborne area manager Shane Clapperton was unable to comment on the situation.

The proposed restructuring will be implemented by the end of May.

The decision to have Ruatoria and Te Puia managed from Tauranga rather than Gisborne meant local relationships and knowledge would be lost, Mr Chapman said.

"I am astounded these changes are happening and not one iota of consultation has taken place.

"They’ve just gone ahead and made decisions that have a big impact on our communities.

"The ambulance service is a public service, publicly-funded and therefore should consult the public.

"It has got to the stage where we at the union are considering going to the Government and asking the health select committee to carry out an investigation into the ambulance service provided by St John in this country."

• St John Midland regional ambulance service manager Brent Nielsen said the changes were being made as a result of months of consultation and extensive input from staff and management.

"The changes are part of a wider change programme designed to improve our management framework and help us better deliver services to the community.

"The changes are not about cutting costs, but about providing a better service for patients and customers.

"In fact, there will be more staff overall after the changes."

The Herald understands that while this might be true in other regions, Gisborne’s staffing level will drop from 10 to nine.

The ambulance service in Gisborne is also staffed with 15 volunteers and is always looking to recruit more.

"The service relies on a combination of volunteer and paid staff.

"Volunteers form an essential part of St John in New Zealand," Mr Neilsen said.

Gisborne staffing change seems ‘crazy’ after Wairoa’s experience
by Staff Reporters
Wednesday, 9 May, 2007

While the proposed Gisborne staff cuts are news to some people, to others it is a case of déjà vu, after Wairoa spent months last year and earlier this year battling similar staff cuts.

Just last month, the town won its long-fought battle to re-instate a fourth full-time ambulance officer after going without since 2000.

After fighting a staffing battle in her town, Wairoa paramedic Adrienne Andresen said proposed changes to Gisborne staffing was going to be a big problem for the whole East Coast region.

"It seems absolutely crazy. Gisborne definitely needs that third advanced paramedic — not just
to cover Gisborne, but also for the rescue helicopter and as back-up across the whole region.

"Having Ruatoria and Te Puia under Tauranga’s control is a crazy idea too. All their patients come down to Gisborne — they have absolutely no connection to Tauranga."

"From my experience in the battle we fought here, we did not win because of what we put forward, but from putting the battle to the community. It was only then St John management sat up and took notice," she said.

While rostered overtime had covered the shifts for six years, St John management proposed changing to a three-person roster with a part-time patient transfer officer staffing the second ambulance on weekdays.

St John’s initial assessment of Wairoa’s workload and demand had indicated two emergency ambulances were not required 24 hours a day.

That thinking was turned on its head on April 3 after the community and National Distribution Union rallied together, telling St John executives loud and clear they wanted nothing less than the return of a fourth full-time paramedic officer.

"We have looked at the circumstances again. Wairoa is quite a unique case with rural isolation features," St John Midland Region chief executive officer Eddie Jackson said at the time.

One in six ambulance officers has been hurt on the job in the past three years in the upper South Island.

The injuries – to officers in the South Canterbury, Canterbury, West Coast, Marlborough and Nelson regions – included assaults, falls, strains and being accidentally jabbed with needles.

Federation of Ambulance Officer Unions of New Zealand (FAOUNZ) secretary Karl Anderson said he was concerned about violence and abuse towards officers.

"I don't think there is an epidemic, but there have been some serious ones and there is a lot of abuse. There's a certain amount of disrespect for them," he said.

Since 2004, 138 of the 800 officers in the South Island northern region reported injuries that affected their ability to work.

There were no assaults on ambulance officers in the 2004-05 year, but there had been four reported incidents since in which officers were injured.

The St John operations manager for the region, Chris Haines, said the assaults were concerning, but it "did not cause as much grief here as in the North Island".

Last month, Waikato ambulance services faced two incidents in less than a week when they had to "back off" from a job because of safety concerns.

In one case, a man died from stab wounds at Kawhia as ambulance officers could not safely work on him owing to partygoers throwing missiles.

Haines said every care was taken to ensure the safety of ambulance officers.

"If there is any indication that there is a violent situation, our staff are sent to a safe arrival point and police go in first," he said.

Anderson felt the most pressing issue for the ambulance service was ensuring all vehicles were crewed with two people.