Opinion piece
Health will be one of the defining issues in the lead-up to Budget 2026. The choices made in the coming weeks will signal not just fiscal priorities, but whether New Zealand is prepared to invest in the foundations of its health system - including the emergency response people rely on when most vulnerable.
This conversation is happening at a time when many New Zealanders are under pressure. Many are under financial strain, and the health sector is stretched. That’s why emergency ambulance services must remain sustainable - so help is there when it’s needed, where it’s needed.
Hato Hone St John’s ambulance service is a front door into urgent care. Each year, the ambulance service and related community health initiatives connect with more than a million New Zealanders. The work is not just transport to hospital; it is about getting the right care, at the right time, in the right place. That might mean treating someone at home, connecting them with primary care, or providing clinical advice over the phone, helping ensure emergency departments and hospital teams can focus on those who need them most.
The operating environment is changing quickly. New Zealand’s population is ageing, and demand is rising. Around half of ambulance responses already involve patients aged 65 and over. An ageing population brings higher rates of falls, frailty and co-morbidities, requiring more complex assessment and care. At the same time, inequities persist and communities are becoming more diverse, with different health needs and barriers to access. That makes an equity lens in service design and resourcing more important than ever.
Ambulance services are also increasingly exposed to global and economic pressures. Fuel supply concerns have shown how quickly external risks can affect essential services and add significant costs. Rising construction costs, supply chain disruption, workforce shortages and more frequent severe weather events all add to the challenge of sustaining nationwide coverage.
Despite these pressures, New Zealand continues to get strong value from its ambulance system. On a per-person basis, government spend on ambulance services here is less than half of what is spent in Australia. Ambulance care also reduces pressure elsewhere. For example, enhanced secondary triage programmes such as “Hear and Advise” provide over-the-phone clinical assessment and referral to another provider where appropriate. In the past six months alone, almost 30,000 calls have been resolved without dispatching an ambulance - keeping ambulances available for life-threatening emergencies and reducing pressure on emergency departments.
But we are now at a crossroads as the next four-year emergency ambulance service funding contract is developed.
We are grateful for the additional funding uplifts in recent years which have helped maintain service continuity. However, the underlying funding model has not been fit for purpose for many years. It has not kept pace with demand growth and cost pressures, and it has consistently not recognised the full cost of delivering a modern national ambulance service, including the infrastructure and enabling assets that make frontline care possible.
Ambulances, stations, high-value clinical equipment and critical ICT are not “nice to have.” They are core to safe, reliable care and a resilient response. When funding settings don’t reflect that reality, the result is predictable: growing strain on a service expected to meet rising demand while renewing essential assets and maintaining performance.
What’s needed now is a reset - not a short-term Band-Aid. Budget 2026 is an opportunity to take a longer-term view and ensure New Zealand’s national emergency ambulance service remains dependable for every community. At a time when people are doing it tough, it is even more important that emergency care is sustainable and ready to respond when it matters most.
An investment in the resilience of emergency ambulance services is an investment in health system resilience - and in the wellbeing of communities across Aotearoa.
ENDS
About Hato Hone St John:
- Hato Hone St John provides emergency ambulance services to 90 percent of people in New Zealand across 97 percent of the country.
- Hato Hone St John is made up of a mix of full-time paid staff and volunteers.
- Along with the emergency ambulance service, Hato Hone St John operates a significant number of community health programmes and other activities which help build community resilience. They include Waka Ora Health Shuttles, ASB Caring Caller, St John Youth, and St John in Schools.
- Hato Hone St John also delivers event health services, medical alarm services, first aid training, and operates retail stores across the country.
For further information please contact:
Hato Hone St John media team
PH: 0800 756 334 | E: media@stjohn.org.nz
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