Ambulance services are similar except one is free
It started, or so the story goes, with an injured man sprawled on the pavement in Lambton Quay and a mayor yelling for an ambulance.
Unfortunately the year was 1927 and Wellington had just one ambulance and few telephones. As a bystander rushed off to find medical help, Wellington Mayor Charles Norwood draped his coat over the victim and waited impatiently, stewing over the delay.
It's not clear whether the man survived his accident. In one version of the story, he was denied an ambulance because he couldn't pay his way, in another version he was eventually gratefully carted off.
Whatever the truth, soon afterwards Norwood started cajoling his wealthy friends and leaning on councillors into forming the country's first free ambulance service.
Nearly 87 year later, Wellington Free is the last regional ambulance service left. It has doggedly clung on and even expanded as St John devoured ambulance services everywhere north of the Te Horo and south of Cape Palliser.
But with both services struggling for funds, amid soaring demand and criticism of overlaps in some regions, does the capital still need an ambulance service to call its own?
Wellington Free has lost money four out of the last five years. To survive, it relies on a complicated mix of funding, some paid in bulk, some donated, and some paid only when it performs certain services, such as transferring patients. The Ministry of Health and ACC provides most of the cash, about $15m a year, with the local councils pitching in a fraction. But a big chunk of funding needed to keep the ambulances on the road, about $4m, relies on wealthy benefactors and a big public funding drive.
Asking for cash is typical for any charity but Wellington Free is an emergency service, like police or fire. Without ambulances, the region's health system would grind to a halt, with disastrous consequences.
Wellington Free chief executive Diana Crossan has been in the job less than two years and acknowledges the service has previously struggled to live within its means. But after a few years of losses she is confident Wellington Free will be back in the black this financial year - and stay that way.
"We are not falling over tomorrow."
Not that relying on charity is ideal. She is quick to point out that in Australia, Canada and Britain ambulances are fully funded by the state. It appears to be largely an accident of history, she says, that New Zealand relies on donations to run its ambulances.
"If you step right back and say, ‘how comes it's funded in this way?' it does seem a bit odd," she says.
"Imagine a sausage sizzle paying for the police."
Crossan would prefer Wellington Free and St John to be fully funded by the state but says she is not holding her breath.
"We rely on the community understanding that we will have to charge if they don't stump up and people do."
Wellington Free isn't unique in having to raise money to kept emergency services running and St John is in far bigger financial strife. Last year, its operating loss ballooned to more than $14m. Both services are dealing with a growing number of call-outs, an ageing population and a rise in chronic diseases.
The strain on the ambulance service is not new. In 2008, Parliament's health select committee inquiry found that ambulance coverage nationwide was inadequate, with undermanned crews and "complicated and confusing" funding. In some instances, this lead to "perverse incentives" to hospitalise patients to bump up government funding.
Capital & Coast District Health Board member Sue Kedgley chaired the health committee at the time. She says that while the Wellington region is better served by Wellington Free than the rest of the country, many of the underlying problems here and everywhere persist.
"I suspect the long-term solution might be to integrate ambulance services into health services as has happened in Australia and the UK rather than continue to have frontline health services being run by charities."
That would mean creating one ambulance service and ditching one or both of the existing ones. But a big state takeover is not something either the Government, or either of the two remaining ambulance services are remotely interested in backing.
Both St John and Wellington Free say they now have an excellent relationship - but it is also a complicated one. In Wellington, they jointly own the central emergency communication centre that fields emergency medical calls for about a million people in the lower North Island.
But they have also been competitors. Wellington Free lost out to St John in a bid to takeover Taranaki's ambulance service in 2010. In 2012, Wellington Free won the contract to takeover Wairarapa's ambulance service, the country's last DHB-run emergency service.
This piecemeal approach had led to some odd outcomes. In Martinborough, there is one St John branded ambulance left after a district takeover by Wellington Free, owned by a local community trust and manned by St John volunteers. Last month, both services copped criticism after a Martinborough woman suffering a suspected heart attack waited 40 minutes for Wellington Free to travel from Masterton - while a fully-equipped St John ambulance sat in a garage just 500 metres away. Locals complained that rules restricting the use of their ambulance since Wellington Free took over left them resorting to calling the Fire Service for medical emergencies instead.
Crossan says the criticism was unfair and inaccurate. A lack of trained volunteers to man the Martinborough ambulance, not a change in contract, were to blame for delays, she says.
But, as one Martinborough local involved in the ambulance trust says, it is easy to see why the public are "bamboozled" by the arrangement.
"As far as they are concerned an ambulance is an ambulance."
Even in Wellington itself there is some tension. Wellington Free has repeatedly complained about St John fundraising on their patch, claiming they were not telling capital-dwelling donors that the money would not be going to support their local ambulance service.
So would it be simpler if it was just St John, everywhere?
St John declined to comment on a possible takeover of Wellington Free, other than to say it was happy with the statusquo.
Steve Yanko is St John's operations manager for Manawatu.
He regularly interacts with Wellington Free about who will respond to what medical emergency.
He says the two services work together closely, sometimes responding to emergencies in each other's patches depending on demand or even side-by-side at serious accidents.
"We do work seamlessly, it's what our funders expect."
Crossan concedes it hasn't always been like that. In the past St John had been interested in swallowing up Wellington Free, like many other ambulance services, and some long-term Wellington Free volunteers are still suspicious of their counterpart to the north and south.
But Crossan says attitudes on both sides have changed, particularly with the appointment of St John chief executive Peter Bradley in 2012.
"As far as he's concerned this is our region and he's got plenty to do."
Joy Cooper heads the Ministry of Health's National Ambulance Service Office, which was set up in response to the 2008 select committee inquiry.
She says huge progress has been made to improve co-ordination between the two services since. While both are dealing with rising demand and limited resources, combining them is not the answer, she says.
"While there are these differences in services, their core ambulance functions are the same, as such there would be limited savings in only having one national service."
Having two services even has some benefits, with Wellington Free providing a benchmark for measuring St John's performance and a testing ground for new services.
But part of the reason that Wellington Free has held on for so long probably lies in what makes it vulnerable - a reliance on charity.
Shirley Martin has been supporting Wellington Free for more than half a century and remains its patron today.
Sitting in her fourth floor Oriental Parade apartment, the 84-year-old flicks through a scrapbook jammed full of yellowing newspaper clippings.
In one photograph, a much younger and elegantly dressed Martin grasps her late husband, Alan Martin, the founder of appliance retailer LV Martin & Son, and smiles into the camera at one of Wellington Free's last fundraising balls.
For more than a decade, she was president of the Ladies' Auxiliary, the now-defunct fundraising arm of Wellington Free populated by daughters and wives of many of the city's civic and business leaders.
Fundraising was always tough, she says, but it was the gentle prodding of the well to-do and tickets to exclusive events, such as balls, rather than the jiggling of street corner buckets that often made the difference.
"I remember even as a little girl my father saying Charles [Norwood] had got these gentlemen together and said, ‘Come on, we've got more support for the ambulances'."
Martin says even while president she often relied on her husband's business to help out when funding was short.
The tradition of wealthy patronage has continued, with Ann Selkirk, married to Oscar-winning film editor Jamie Selkirk, and Jo Morgan, wife of entrepreneur Gareth Morgan, stumping up $250,000 for Wellington Free's latest ambulance.
Crossan says Wellington Free's independence may be a quirk of history but there are now obvious advantages to hanging on to it.
Replacing Wellington Free would mean giving up a loyal cohort of donors developed over more than 80 years.
"If one or other of the ambulance services was hugely better than one another it would be different.
"But there are pretty similar, except this one is free."
AMBULANCE NOT ALWAYS THE BEST OPTION
Next time you call 111 for medical help don't assume it will require a trip to hospital.
The rising number of emergency medical calls are putting a growing strain on the health system, tying up ambulances and clogging emergency departments.
In an effort to reduce costs and free up resources, ambulance services are trying to treat people at home with specialised paramedics, rather than automatically carting them off to hospital.
Wellington Free has been running the service, called urgent community care, on the Kapiti Coast for three years and this month has expanded into Porirua. St John recently restarted a similar tweaked service in the Horowhenua, after it was dropped amid concerns about its effectiveness last year.
If all goes well, eventually a call to 111 anywhere in the country could be responded to by a paramedic in a car rather than a fully equipped and manned ambulance.
Wellington Free medical director Dr Andy Swain is one of a dozen trained community care paramedics for the Wellington region.
He says the public used to call 111 only in the most dire life- threatening emergencies. But today about 3 in 5 patients who call with a medical emergency can be treated at home.
"When people call 111 they don't necessarily need an ambulance," he says.
A typical injury that could be treated at home would be an elderly person who has fallen and cut their head.
A paramedic could stitch up the wound and refer them to their GP the next day.
For the elderly in particular it is usually better to avoid hospital altogether, where their health is more likely to deteriorate and they are at risk of infection.
"These people don't want to go to the emergency department for something less serious just to wait in a line."
Covers 90 per cent of the population, everywhere apart from Wellington 400,000 people treated and transported a year 330,000 emergency incidents attended a year 600 vehicles 205 stations 900 paid ambulance officers 2800 volunteers Charge: You will be charged $88 if you are treated or transported by St John for a medical emergency or for an accident that happened more than a day ago. ACC will pay for the ambulance if responding to an injury. Most overseas visitors are charged $800. All services are free for Support Scheme subscribers
Covers about 500,000 people in the Wellington region 50,000 emergency incidents attended a year 24 vehicles 10 stations 150 paid paramedics 30 volunteers Charge: Free service. Public donations welcomed --------------------
The Dominion Post