Since 1885, St John has been the mainstay of this country's ambulance service, as well as the familiar face of first aid at public events. Over that period, New Zealanders have become accustomed to the efficiency of its operations.
Just recently, however, there have been signs of fraying. St John seems no longer to be providing the utterly reliable service that we have so long taken for granted.
Several recent incidents confirm as much. Today, this newspaper reports the case of a wheelchair-bound man stuck on the side of a road in an ambulance while the sole paramedic worked on him after a heart attack. A taxi driver had to be flagged down to drive the ambulance to hospital.
Recently, we told of 83-year-old stroke victim Thea Hallie, who had to wait half an hour for an ambulance that never arrived. Eventually, her son was forced to drive her to hospital. Also this week, two swimmers on Auckland's North Shore were rushed to hospital in a police car, a reaction that suggested the officers had little faith in an ambulance arriving in good time.
The problems do not end there. About a quarter of callouts in rural areas are responded to by single-crewed ambulances, not the far more suitable double-crewed vehicles. One of the perils of this was highlighted when a woman paramedic was hijacked in her ambulance by two drug-addled teenagers. So it's dangerous, as well as sometimes forcing them to decide between treating a patient or getting to the hospital as quickly as possible.
St John acknowledges increasing demand in areas reliant on volunteers is a concern. In fact, the surge in callouts is at the root of most of its problems. People are living longer and chronic health problems are more common. Emergency calls average more than 1000 a day. This has meant some of the time targets agreed with the Ministry of Health and the ACC were not met last year. It has also meant St John has had to establish priorities. Ambulances are now being assigned so that the quickest response is to immediately life-threatening incidents.
That, of course, places a greater burden on St John's call-takers. They must make key judgments. In the case of Thea Hallie, a mistake was made. St John has apologised, saying she was coded as a sick person, rather than a stroke victim and, therefore, accorded a lower priority than she should have had.
There was no error, however, with the two swimmers who got into difficulty at Cheltenham Beach. Quite simply, St John was too busy with other emergencies to rush to their aid.
Organisations that have provided a very high standard of service over a long period have a particular problem. Any mistakes they make stand out, and public confidence can quickly ebb.
St John is clearly aware that the increasing demands on its ambulance service present a major challenge.
After a review in 2007, it received an extra $48 million from the Government to pay for 100 new paramedics. A further review now would surely result in a further funding boost.
Full crewing everywhere may be a financial step too far. New Zealanders, however, should be able to continue to rely on a high standard of service from St John. And that should not simply come down to whether or not you live in a big city.