The balance between being a government-funded service and a charity with a small army of dedicated volunteers has long been the precarious line trod by St John.
As a result, it is just under three-quarters funded by government via our taxes and slightly more than one-quarter via fundraising and endowments. This has allowed the order to provide emergency medical responses while also being the friendly face offering assistance at public events and rattling a donation tin.
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With the dwindling contributions from the public, amid a rising number of charities clamouring for a slice of the philanthropic pie, it's long been said ambulance services need to shift the ratio more to government-assured funding.
It's this conundrum which Health Minister David Clark has to manoeuvre. St John says the funding ratio now isn't enough so ambulance response times to non-urgent calls will have to get longer, staff cuts may be necessary and training may have to give way.
To be fair, emergency ambulance services did receive an extra fillip in May's wellbeing Budget. The one-off boost of $21 million over two years for St John and Wellington Free Ambulance was hoped to provide enough breathing space to continue through to the expiry of the ambulance provision contracts with the Ministry of Health and ACC in 2021.
This week, however, St John chief executive Peter Bradley told the Herald the top-up would not be enough to guarantee survival beyond this year.
The timing of Bradley's call coincides with Cabinet considering a report which reportedly shows St John's ambulance services are cost-effective and provide better value for money than similar overseas services.
There are well-publicised pressures which have been brought to bear on St John in recent times.
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St John is moving its 111 clinical control centre staff out of a leaky building and into a fit-for-purpose space. It means it can also recover the costs for extra frontline paramedics employed in Christchurch in February - which were much needed the following month when terror attacks occurred at city mosques.
The pressures can be readily seen with pleas plastered on ambulance windows to support ongoing action for better conditions and pay for ambulance professionals.
The funding model has long been considered antiquated but it has allowed St John to continue recruiting and deploying volunteers for programmes such as health shuttles, Caring Caller, Friends of the Emergency Department, ASB St John in Schools and the St John Youth programme. But for how much longer?
Bradley this week said efforts to engage with officials at the Ministry of Health and ACC had led to being told to wait until the current contract expired in 2021 and renegotiate then.
If that is the case, then NZ First leader Winston Peters is quite right to rattle a few cages and make the issue an election one. To suggest letting such a vital contract expire without an assurance of continuity of service, or announcing an equivalent alternative, would seem unconscionable.
It's time we heard about a sustainable model for our critical first responder.