Frontline ambulance officers at ‘breaking point’ are stepping up strike action, but their employer says everything’s fine. So how is our national ambulance provider funded, what are the workers’ concerns, and whose job is it to fix them?

This week, First Union ambulance officers are intensifying strike action around the country, as their industrial dispute with Hato Hone St John over wage and hiring freezes stretches into its seventh month, with no new date set for bargaining and no resolution in sight. 

The escalating strike action comes after months of conflicting messages. Ambulance officers say wage and hiring freezes are leading to dangerous waiting times and are putting lives at risk. St John is denying allegations of understaffing, saying “Hato Hone St John has the highest number of paid staff ever.” 

Faye McCann, First Union national ambulance organiser, is accusing both “St John and government ministers of hiding from the spotlight and hoping this will all blow over soon and be forgotten”.

What the hell is going on, and what, exactly, are we supposed to be forgetting? 

First of all, who is St John?

You remember St John, AKA John the Baptist. Famous before Jesus. Didn’t cut his hair. Head served on a platter. There’s a long and complicated history about the origins of the Order of St John, involving Benedictine monks, the Crusades and Henry VIII, that I won’t go into. But with the exception of the Wellington and Wairarapa regions, which are serviced by the Wellington Free Ambulance, Te Hato Hone St John has been the primary national ambulance provider for almost 140 years. In addition to the ambulance service, the organisation runs first-aid training courses, sells health merch and operates a medical alarm service. 

Currently, around 82.4% of the funding for St John’s operational costs is covered by funding from Te Whatu Ora and ACC, with the remaining 17.6% coming from charitable donations and commercial activities. The ambulance service is currently on a four-year contract with said agencies, and the contract is up for renegotiation in 2026. 

Our national ambulance service is a charity?

Yes. Although New Zealand has a government-funded fire and police service, our ambulances have never been fully nationalised. So why doesn’t the government just suck it up and take the whole thing on? 

This is a politically complicated question with ambiguous answers. Better funding for ambulance services was part of a coalition pledge between NZ First and National, with now health minister Shane Reti catching heat in the lead-up to the 2023 election campaign for tagging along on ambulance night shifts – not the kind of hands-on governmental support one wants in the middle of a potentially life-threatening emergency. First Union organisers are accusing the coalition of breaking that pledge. But in a 2024 pre-budget interview, Luxon claimed St John “actually don’t want to be 100% funded”. 

Previous comments from St John seem to support this. In a 2018 Stuff article Jennifer Eder reported that “St John chief executive Peter Bradley CBE said the non-governmental organisation model worked well for St John, aligning with its values and origins.” This message, however, seems to be at odds with what St John has communicated to their staff and union members. 

In a press release from First Union in May 2024, McCann is quoted as saying “It was really shocking to hear the prime minister claim that St John don’t actually want any more money from government when we’ve been sitting at the bargaining table with them since December last year and have been repeatedly told that a wage freeze is in place because government funding isn’t sufficient.”

Reading between the lines, it seems that St John wants increased government funding, but also to retain its charitable status and have some degree of operational autonomy. 

What’s the problem?

Ambulance officers are in a similar position to many other healthcare professionals in New Zealand, who are raising alarms about our crumbling health sector, with stagnant wages and dangerously overworked staff, many of whom are heading overseas in search of better pay and working conditions. 

According to First Union, frontline ambulance officers are at “breaking point”. 

“There’s something darkly ironic about workers being told the service is in the best shape it’s been for years, that they don’t need extra staff or better pay, while they are simultaneously being asked to cover understaffed shifts every day despite being on strike over this very issue,” said McCann in a press release. “We desperately need to recruit more skilled ambulance officers and emergency communication staff to meet current demands, but St John will lose experienced staff overseas and miss out on new trainees if wages continue to stagnate.”

What does St John say about the whole thing?

St John has responded to union criticism by saying that “the St John’s vacancy rate is the lowest it has been in a long time”, and denying there is any hiring freeze in place. However, earlier this year, One News reported St John told a paramedic student “there is a recruitment freeze for the entire country.”

This week, as part of their strike action, frontline ambulance officers have shared screenshots of text correspondence from St John with urgent staffing requests for vacant shifts. 

Stu Cockburn, the general manager for Te Hato Hone ambulance operations, responded by saying, “This is not a result of an overall resourcing or vacancy rate within the service, but because of high staff-related illness or additional leave requests during this time.” 

“If that’s what a fully-staffed and adequately funded service looks like, we should all be very concerned,” said Ms McCann.

What is the strike action?

So far, the industrial action is intended to have as little effect on New Zealanders seeking emergency care as possible.

Actions undertaken have included striking members breaking the “no-comms” clause, ceasing non-urgent patient transfer services, and chalking St John ambulances with slogans such as “We are not St John’s Charity.” 

But until St John agrees to return to the bargaining table, strike action will likely intensify. Yesterday, in an interview with RNZ’s Charlotte Cook, McCann said “We are very close to getting to a stage where we’ll have to put a strike action in to stop responding to some level of (low acuity) jobs.” 

Why should I care?

Do you have a corporeal form? Do you like your bones? Do you like them where they are? 

The consequences of underfunding our ambulance system are obvious. The stakes are literally life and death. Several towns and regions such as Te Kūiti and Hokianga have recently expressed concerns about reduced ambulance services. 

“If Ministers Reti and Costello [Casey Costello, associate minister of health] can’t step up and provide any certainty that the government will urgently intervene to increase St John funding, we’ll be waiting for the next White Island or Christchurch earthquake before the massive gap between funding levels and actual public need become tragically obvious to all of us and it’s far too late to do anything about it.”