Patients are being harmed by the deteriorating finances of ambulance services, a paramedics' group says.
"New Zealand's two ambulance services are facing a funding crisis," said Sean Thompson, the chairman of the New Zealand chapter of Paramedics Australasia and an intensive-care paramedic at Wellington Free Ambulance.
He told the Herald it was particularly older patients who were at risk.
"The elderly, who should be calling us because of chest pain, they don't call because they don't want to be a bother. We find we are getting called really late after there has been significant heart damage.
"We say, 'You should have called as soon as you got chest pain'. They say, 'We didn't want to be a bother, we know how busy you are'."
"Our concern and the concern of St John and Wellington Free Ambulance is that the baseline level of Government funding has been eroded from 80 per cent a few years ago to 70 per cent today."
The 30 per cent of funding generated by the services themselves came from commercial activities and public donations. St John passes on a part-charge of $98 to emergency patients.
He said the St John ambulance service posted a $7.5 million deficit in the past financial year and Wellington Free was $600,000 short. Both organisations were still facing big budget shortfalls following their main annual fundraising drives.
Associate Health Minister Peter Dunne said the government is well aware of the funding issues around ambulance services but does not accept that New Zealand does not have a first world ambulance service.
"New Zealanders receive a very high standard of ambulance service, from providers who are committed to very high professional standards. For example, St John has an annual cardiac arrest report, which finds New Zealand ambulance services perform very well against the international services it compares itself to."
The Budget in May provided an extra $15 million over four years for air and road ambulance services.
Thompson said this was not enough to keep up with growing costs. Ambulances were being called more, per capita, and there were a growing number of calls to the kinds of medical problems that could be dealt with by GPs, despite moves to divert these 111 calls to a nurse who could refer to Healthline or a GP if it was considered safe to do so.
"It is extraordinary that in many areas of New Zealand critical medical decisions are made by volunteers, many of whom work alone."
"This is not the First World ambulance service New Zealanders deserve. Police are fully-funded as an emergency service . . . However ambulance services operate as an emergency service and, more importantly, as a core health service, yet they are made to operate as charities and rely on the goodness of New Zealanders to stay afloat."
It is extraordinary that in many areas of New Zealand critical medical decisions are made by volunteers, many of whom work alone.
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Thompson has chosen now to highlight the problem because the Government is considering its response to a review of ambulance services funding by former Treasury chief Murray Horn.
St John chief executive Peter Bradley and Wellington Free said they had concerns about funding.
Bradley said St John faced similar pressures to much of the health sector: increasing demand, rising costs and an ageing population.
"This means that even though we've made significant advances in increasing income, reducing costs and modernising our service delivery methods, we require additional funding to simply stand still. In addition we need to find a way to bring single-crewing to an end."
Wellington Free said: "We are lucky to receive tremendous support from our community in terms of fundraising, however more Government support would mean a more reliable and sustainable funding model.
"Along with St John we are working with the Government on a new baseline and future funding model for the ambulance service."
First Union, which represents paramedics, said services could deteriorate if the Government didn't step in and cover the ambulance funding shortfalls.
New Zealand First health spokeswoman Barbara Stewart said: "The Government's cost-cutting measures have pushed ambulance services to breaking point, leaving staff and patients at risk."