The Draft New Zealand
Ambulance Service
Strategy
The first line of emergency intervention in
the continuum of health care
CONSULTATION DOCUMENT
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We want your input
The Government wants to know your views about all of the issues raised in this document, and you are
encouraged to make a submission to the National Ambulance Sector Office. A number of questions are
raised throughout the document to help focus your responses. Questions for you to consider as you
read this document include:

Whether you support the proposed vision for the future of the ambulance service in New Zealand?

Whether the Draft Strategy identifies the right goals for ambulance services?

What feedback you have regarding the proposed initiatives for change under each of the goals?

What are the three most important initiatives to progress and why?

Is there anything to add to this Draft Strategy?
The Government is especially interested in knowing what you think of the overall framework: Do you
agree with the vision and goals, or are there aspects you think should change? Similarly, do you agree
with the initiatives that are proposed?
How to have your say
You can post, email or fax your submission to the National Ambulance Sector Office.
Please forward one copy only of your submission to:
NZ Ambulance Strategy Consultation
National Ambulance Sector Office
133 Molesworth Street
WELLINGTON
or
e-mail: [email protected]
or
fax to 04 816 4484
The closing date for submissions is 12 December 2008.
If you are making a submission on behalf of an organisation, please describe the organisation and its
interest in ambulance services, identify your position within the organisation, and indicate the extent of
any consultation or discussion you have undertaken within your organisation in making your submission.
If you are making a submission as an individual, please indicate the reason for your interest in
ambulance services (eg, as a consumer, researcher or health practitioner).
Note that your submission and all correspondence you have with the National Ambulance Sector Office
may be the subject of requests under the Official Information Act 1982. If there is any part of your
submission or correspondence that you consider could properly be withheld under the Act, please
include comment to this effect along with reasons why you want the information withheld. The reasons
for withholding information under the Official Information Act 1982 are contained in Appendix 1.
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If you are making your contribution as an individual as opposed to an organisation, the National
Ambulance Sector Office will omit your personal details from the submission if you include the following
statement at the front of your submission and sign it:
‘I do not give my permission for my personal details to be released to persons requesting
my submission under the Official Information Act 1982.’
What happens next?
The release of The Draft New Zealand Ambulance Service Strategy - The first line of emergency
intervention in the continuum of health care is an important step toward better ambulance services to
New Zealanders. All the submissions we receive will be considered and analysed, and a summary of
will be prepared. Analysis of the submissions will then inform policy advice to the Government about
what a final Ambulance Service Strategy should contain and the initiatives that are a priority to get
underway.
Implementing the proposed initiatives may require additional financial resources. These will need to be
identified and considered by the government before implementation gets underway. This is a usual
process and includes government comparing initiatives to ensure that its resources are fairly and
sensibly used.
Contributions to date
This Draft Strategy was developed by a working group of Ministry of Health and ACC officials, with
representation from Ambulance New Zealand (a sector representative body). A Senior Officials Group
was established to oversee the Draft Strategy’s development.
The Draft Strategy was informed by presentations from a range of organisations including St John
Ambulance, Wellington Free Ambulance, Wairarapa and Taranaki District Health Boards, New Zealand
Police, New Zealand Fire Service and the Air Ambulance Reference Group. The Draft Strategy is also
underpinned by previous ambulance sector reports, international studies and planning documents.
The Draft New Zealand Ambulance Service Strategy (the Draft Strategy)
Ambulance services are trusted and respected for helping people in their moment of critical need.
People working in the service aim to provide a high standard of care to those living in urban and rural
communities throughout New Zealand. Their interventions have a positive impact on many peoples’
lives and on the communities they live in. However, there are a number of challenges for these services
in continuing and improving their ability to make a real difference to the health of New Zealanders. This
Draft Strategy builds on the positive elements that already exist in the New Zealand Ambulance Service
and sets an ambitious vision that would see the New Zealand Ambulance Service as the first line of
emergency intervention in the continuum of health care.
The Draft Strategy has three key goals to be achieved by 2013:

Strategic Leadership: ensure that the ambulance sector has clearly defined roles in the
emergency and health sectors

Community Resilience: deliver a long-term plan for meeting community emergency health
needs
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
Seamless Delivery: integrate ambulance services within the wider health sector.
QUESTIONS:
Question 1:
Do you support this vision for the future of the ambulance sector in New Zealand?
Question 2:
If not, what is missing? Or what is there that ought not be?
Question 3:
Does the Draft Strategy identify the right goals for the sector?
Ambulance Services
Ambulance services are part of the first line in the continuum of health care. They respond to medical
emergencies and accidents, and transport, ‘treat and transport’ or ‘treat and leave’ patients.
The primary role of all ambulance services is emergency pre-hospital care, including a telephone triage
through a sophisticated communications infrastructure. Patient transfer services are a complementary
use of ambulance skills and resources. The interface between ambulance care and other health
facilities needs to be seamless.
Beyond the emergency role, the service has the potential to provide an out-of-hospital clinical care
service in addition to the pre-hospital clinical care. This may enhance access to health services for rural
communities.
In New Zealand approximately 900 full time equivalent paid ambulance officers, supported by 2,600
volunteers, from 210 locations, respond to over 400,000 calls in any one year. These officers range from
fully trained advanced paramedics with many years experience, to volunteers who dedicate themselves
to the service, but who may have only very limited training. The three Emergency Ambulance
Communications Centres (EACCs) are staffed by approximately 140 call takers and dispatchers. The
ambulance sector providers have adapted over the years to new challenges and technologies, such as
the introduction of new communications centres.
New Zealand communities are committed to supporting their local services. They have a strong interest
in ensuring that ambulance services continue to be provided in their communities. Every day, about
1,100 people rely on this service to treat and/or safely deliver them to healthcare facilities around New
Zealand. The government also has an interest in ensuring that the needs of individuals and communities
for ambulance service are met.
Why does New Zealand need an Ambulance Service Strategy?
Although individuals, communities and providers have together made a considerable effort to provide
and grow a quality service, the delivery of ambulance services is variable and is significantly reliant on
community goodwill, and the sector’s ‘best endeavours’ to meet quality requirements.
The Crown agencies have not taken a cohesive national approach when purchasing ambulance
services, until recently, and issues arising within the sector have been dealt with in an ad hoc manner by
each agency independently. Funding streams and contract terms differ, and providers report that the
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different approaches inhibit longer term planning and investment by the sector, particularly the air
ambulance sector. A lack of guaranteed income may impact on provider sustainability in more remote
and rural areas.
The sector is now working collaboratively to address a number of issues associated with inconsistencies
in service delivery. The Draft Strategy aims to provide Crown leadership for the sector to ensure a
cohesive and consistent approach between emergency ambulance providers, with greater national
consistency in training, clinical guidelines and oversight and levels of practice.
There are a number of issues within the sector which need to be addressed from a strategic overarching
perspective, in collaboration with the sector. These include:

Fragmentation of the sector

Divergent approaches by the funding agencies (Ministry of Health and ACC) to purchasing
services

Increasing costs to the Crown, without the availability of the information necessary to monitor
the quality of services purchased

Lack of clarity regarding the role of ambulance in the health and emergency sectors

Impacts of changes in the rest of the Health sector on ambulance

Lack of recognition of paramedics as health professionals

Inconsistent clinical standards and crewing among providers

A high reliance on volunteers and increasing difficulty in recruiting and retention of those
volunteers

Lack of a single “ambulance” voice in emergency and disaster forums
In order for these issues to be addressed systematically, the ambulance sector needs strong cohesive
leadership and direction from the Crown. This Draft Strategy responds to this need and provides a clear
direction for the sector going forward.
Going into the future the government is seeking an ambulance sector where:

service expectations are aligned to patient outcomes using a sound funding rationale

there is community pride and confidence in the service

patient outcomes are improved as a result of more co-ordinated care
There are a number of ways of delivering the vision and its goals. Currently options for doing so are
limited because some of the essential building blocks need development. In particular, there is currently
poor information on what services should be being purchased, and the extent to which service
expectations are being met. Some far reaching options, such as nationalisation, devolution to District
Health Boards, integration with other emergency services, and other similar models adopted
internationally, may have some merit. However, this Draft Strategy recognises the uniqueness of the
New Zealand system which has served us well, in particular, the community participation and provider
leadership; therefore, at this stage, the Draft Strategy seeks to build on the strengths of the current
system.
To operate effectively, leadership is required to:

Collaborate to set a cohesive strategic direction

Agree on service expectations
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
Hold providers accountable for service delivery

Align community and government expectations

Assure capacity to respond to mass casualties

Sustain the workforce

Adopt an integrated health and emergency sector approach

Prioritise interventions

Evaluate the impacts on patient outcomes
There are opportunities to improve and better utilise ambulance services, for example:

Exploring ways to fully utilise ambulance capacity for health promotion, to enhance primary
care and to reduce demand on hospital emergency departments

Professionalise the workforce and increase the numbers of paid personnel including support for
greater numbers of higher skilled paramedics

Mandate ambulance standards
The draft New Zealand Ambulance Service Strategy has 10 initiatives for change. These are not listed in
any order of priority:

Initiative 1: Form an accountable ‘strategic management’ function to provide strategic
leadership to the sector.

Initiative 2: Develop transparent, sustainable funding model(s) that link external drivers to
agreed service expectations.

Initiative 3: Develop outcome performance indicators to monitor the contracted performance of
providers.

Initiative 4: Development of a framework to facilitate effective consultation with the community
on long-term planning.

Initiative 5: Improve the level and extent of clinical expertise and the sustainability of the paid
and volunteer workforce.

Initiative 6: Improve the integration of the ambulance sector into the New Zealand emergency
management planning system.

Initiative 7: Develop protocols for integrating national care pathways, and extending the role of
the paramedic.

Initiative 8: Introduce sector-wide information capability for evaluating health outcomes.

Initiative 9: Improve ambulance service configurations and deployment.

Initiative 10: Strengthen triaging to ensure interventions accurately reflect the patient’s
condition.
These initiatives are listed in the order that they appear on the Strategic map. Diagram 1 below shows
the Strategic Map which outlines key elements of the Strategic Plan for Ambulance Services to 2013.
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Diagram 1
Key
1
"Today"
"Tomorrow"
See corresponding number below
for related initiative for change
Initiatives for Change
Strategic Leadership: ensure that the ambulance sector has clearly
defined roles in the emergency and health sectors
Initiative 1:
Form an accountable
‘strategic management’
function to provide
strategic leadership to the
sector
Objective: To have a central function with the responsibility and
authority for leading the ambulance sector
Initiative 2:
Develop transparent,
sustainable funding
model(s) that link external
drivers to agreed service
expectations
Objective: A consistent agreed basis for funding providers
Action 1: Establish the accountable ‘strategic management’
function
 Confirm the responsibilities of the accountable ‘strategic
management’ function
 Determine the form of the accountable ‘strategic management’
function
 Secure funding and resources
 Establish the form – along with the people, systems and
infrastructure required
 Establish a work programme
Action 1: Model the total cost of providing ambulance services
 Identify cost drivers
 Develop transparent, sustainable funding model(s)
 Establish the role of sponsorship, donations and co-payments
and provider subsidisation. Review ambulance co-payments
 Establish the ongoing funding contributions from the Ministry of
Health and ACC
 Finalise model taking into account stakeholder feedback
 Secure funding
Action 2: Test the model with key stakeholders
 Consult with key stakeholders
 Implement new model
Initiative 3:
Develop outcome
performance indicators to
monitor the contracted
performance of providers
Objective: To ensure the objective measurement of the impact of
ambulance services on patient outcomes
Action 1: Develop outcome based performance indicators for the
ambulance service
 Determine the impact of other health strategies on outcome
performance
 Develop a framework for measurement of performance –
including routine reporting, evaluation, audit, complaints and
sentinel events
 Target performance indicators for rural and urban differences
 Ensure technology capability for reporting
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Action 2: Provide ambulance performance assurance to the
government and communities
 Mandate the Standard NZS 8156
 Ensure capability for measurement
 Audit and ensure quality assurance
 Publicly report performance outcomes
 Ensure the accountable ‘strategic management’ function has
the capability for responding to outcome performance failure
QUESTION
Question 4:
What is your feedback on the initiatives for change under the Strategic Leadership goal?
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Community Resilience: deliver a long-term plan for meeting community
emergency health needs
Initiative 4:
Develop a framework to
facilitate effective
consultation with the
community on long-term
planning.
Objective: To ensure communities’ contributions fit within the
context of agreed long-term plan
Initiative 5:
Improve the level and
extent of clinical expertise
and the sustainability of
the paid and volunteer
workforce
Objective: To have a framework for ensuring that the correct
clinical skills mix and workforce capability to deliver a consistent
standard of integrated care nationwide
Action 1: Develop a framework to facilitate effective consultation
with the community on long-term planning.
 Develop a draft prioritisation framework in consultation with key
stakeholders, including the community
 Release the framework for use within communities when
prioritising and evaluating initiatives such as the appropriate
siting of resources
Action 1: Determine the optimal workforce mix
 Review the current clinical skill mix nationally, including the
ratio of volunteers to paid staff
 Review international models to determine best practice for
crewing and skill levels
 Explore and implement options to move towards the optimal
state
Action 2: Increase the level of ambulance workforce skill
 Standardise clinical competency levels and education of
ambulance officers and paramedics to achieve national
consistency
 Enable the inclusion of paramedics under the Health
Practitioners Competence Assurance Act
 Explore fast-track immigration pathways for advanced
paramedics to address skill shortages
 Identify clear career pathways for paramedics to encourage
further study
 Encourage links between ambulance sector and Emergency
Departments to facilitate good decision making and transport
to nearest place of definitive care
Action 3: Develop a strategy for attracting and retaining
volunteers
 Develop a system to provide higher-level clinical expertise to
support volunteers
 Undertake international research and introduce incentives to
encourage the public to undertake voluntary ambulance work
and access training opportunities
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Initiative 6:
Improve the integration of
the ambulance sector into
the New Zealand
emergency management
planning system
Objective: Confirm the ambulance sector’s contribution to largescale incidents with other emergency providers
Action 1: Determine and move towards the preferred capacity and
capability for ambulance response to mass casualty and civil
defence events
 Determine the current resilience capacity and capability of
ambulance services to respond to mass casualty, infectious
disease or civil defence incidents (including ongoing evaluation
against civil defence exercises)
 Model essential and optimal resilience capacity and capability
 Explore options to close any gaps identified
 Regular public reporting on the resilience capability of the
sector
Action 2: Incentivise integration between emergency services
 Ensure ambulance sector representation at emergency
operations centres
 Examine the current level of interaction between emergency
services with a view to improve integration
 Improve engagement with whole-of-government initiatives that
impact on ambulance services
Action 3: Develop community resilience
 Examine and agree on the role of co-responders in the
community
 Supporting initiatives to develop capacity and capability
 Explore opportunities for developing an integrated national
database of volunteers
QUESTION
Question 5:
What is your feedback on the initiatives for change under the goal of Community
Resilience?
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Seamless Delivery: Integrate ambulance services within the wider
health sector
Initiative 7:
Develop protocols for
integrating national care
pathways, and extending
the role of the paramedic
Objective: To establish national protocols (and incentives) for
integration across care pathways, creating seamless services for
patients
Action 1: Establish formal links to the primary health care sector
 Establish an ambulance sector National Clinical Advisory
Group, with among others links to the Primary Response In
Medical Emergency programme
 Facilitate ambulance sector representation on the New
Zealand Primary Health Care Advisory Council
 Consider options to be involved with the Joint Ministry/DHB
Primary Health Care Work Programme, to integrate policy work
and sector representatives
Action 2: Improve clinical leadership within the ambulance sector
 Identify the gaps in clinical protocols across the pre-hospital
emergency care sector
 Engage clinical leaders (through the ambulance sector
National Clinical Advisory Group) to make improvements
Action 3: Extend the role of the paramedic
 Identify opportunities to utilise paramedics in primary health
care and health promotion
 Determine how opportunities might be realised in the context of
the government’s Primary Health Care Strategy
Initiative 8:
Introduce sector-wide
information capability for
evaluating health
outcomes
Objective: To establish the ongoing basis for sharing knowledge
across health and emergency providers
Initiative 9:
Improve ambulance
service configurations
and deployment.
Objective: Improve the ability to respond to and sustain service
cost effectiveness in the long term
Action 1: Improve IT capabilities for ambulance services across
the sector
 Determine whether ambulance sector information systems can
be linked to those of existing primary and secondary care
patient information systems
 Address identified gaps in information technology capabilities
 Reach agreement on minimum data sets
 Develop the necessary infrastructure to capture information
and provide quality assurance
Action 1: Review the configuration of ambulance services
 Consider acquiring configuration modelling software
 Determine the most effective future configuration for New
Zealand based on demographic changes
Action 2: Review the deployment of ambulance services
 Review the interaction of communications and ambulance
modalities
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
Initiative 10:
Strengthen triaging to
ensure interventions
accurately reflect the
patient’s condition
Consider innovative models of deployment, particularly for rural
areas
Objective: Improve the confidence of the Emergency Ambulance
Communications Centres to make the right clinical decisions on
the spot
Action 1: Establish a national clinical advisory group to ensure
consistency and innovation in clinical practice among ambulance
providers
 Enable the establishment of a National Clinical Advisory Group
 Establish international links for audit and accreditation
Action 2: Improve clinical decision-making support within
Emergency Ambulance Communications Centres
 Use technology and clinical expertise to increase capabilities
within the system
 Develop delivery protocols, in conjunction with the wider health
sector, to ensure the point of definitive care is accurately
identified
QUESTION
Question 6:
What is your feedback on the initiatives for change under the goal of Seamless Delivery?
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ADDITIONAL QUESTIONS
Question 7:
What do you think are the three most important initiatives to progress immediately and
why?
Question 8:
Is there anything to add to this Draft Strategy?
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Appendix 1: Relevant Provisions of the Official Information Act 1982
9.
Other reasons for withholding official information –
(1)
Where this section applies, good reason for withholding official information exists, for
the purpose of section 5 of this Act, unless, in the circumstances of the particular case,
the withholding of that information is outweighed by other considerations which render
it desirable, in the public interest, to make that information available.
(2)
Subject to sections 6, 7, 10, and 18 of this Act, this section applies if, and only if, the
withholding of the information is necessary to –
(a)
protect the privacy of natural persons, including that of deceased natural persons;
or
(b)
protect information where the making available of the information –
(i)
would disclose a trade secret; or
(ii)
would be likely unreasonably to prejudice the commercial position of the
person who supplied or who is the subject of the information; or
(ba) protect information which is subject to an obligation of confidence or which any
person has been or could be compelled to provide under the authority of any
enactment, where the making available of the information –
(i)
would be likely to prejudice the supply of similar information, or information
from the same source, and it is in the public interest that such information
should continue to be supplied; or
(ii)
would be likely otherwise to damage the public interest; or
(c)
avoid prejudice to measures protecting the health or safety of members of the
public; or
(d)
avoid prejudice to the substantial economic interests of New Zealand; or
(e)
avoid prejudice to measures that prevent or mitigate material loss to members of
the public; or
(f)
maintain the constitutional conventions for the time being which protect –
(g)
(i)
the confidentiality of communications by or with the Sovereign or her
representative;
(ii)
collective and individual ministerial responsibility;
(iii)
the political neutrality of officials;
(iv)
the confidentiality of advice tendered by Ministers of the Crown and
officials; or
maintain the effective conduct of public affairs through –
(i)
the free and frank expression of opinions by or between or to Ministers of
the Crown or members of an organisation or officers and employees of any
Department or organisation in the course of their duty; or
(ii)
the protection of such Ministers, members of organisations, officers, and
employees from improper pressure or harassment; or
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(h)
maintain legal professional privilege; or
(i)
enable a Minister of the Crown or any Department or organisation holding the
information to carry out, without prejudice or disadvantage, commercial activities;
or
(j)
enable a Minister of the Crown or any Department or organisation holding the
information to carry on, without prejudice or disadvantage, negotiations (including
commercial and industrial negotiations); or
(k)
prevent the disclosure or use of official information for improper gain or improper
advantage.
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