Otago Daily Times

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.