Workers First Union and CICTAR* are today launching “Emergency! Saving New Zealand's Ambulance Services” – a major new report arguing that New Zealand's partly charity-funded ambulance system is no longer fit for purpose, and that Budget 2026 must mark the beginning of its transformation into a fully publicly-funded service.
The report identifies five compounding pressures that together threaten to permanently overwhelm the current model, and the union is calling on the Government to fully fund ambulance operations and close the Trans-Tasman wage gap as a first step toward eventual public ownership.
Below, the union outlines the key headlines in the report and reacts to the Government’s announcement of a $35 million funding increase this morning.
FIVE PRESSURES
An ageing population. The over-65 population will double by 2065, pushing ambulance callouts up 61% – growing at nearly twice the rate of the overall population. Older patients cost 30% more per callout, take 20% longer on scene, and are 30% more likely to require hospitalisation. The total annual cost to serve is projected to rise from $508 million today to $1.93 billion by 2065, crossing $1 billion for the first time by 2045.
“New Zealand has an ageing population that will double in the next 40 years,” said Anita Rosentreter, Workers First Deputy Secretary. “The cost to serve the over-65 population alone will increase 368% by 2065.
“The ambulance service will cost nearly four times as much within a generation, and the current model has no answer for that.”
A Trans-Tasman wage gap bleeding the workforce. NZ ambulance officers earn 17-33% less after tax than their Australian counterparts – a gap of $13,000 to $35,000 per year depending on role. Australian superannuation contributions are nearly four times higher than NZ KiwiSaver. Training a registered paramedic costs the public nearly $150,000 before they can work without supervision.
“Our ambulance officers are being paid to leave New Zealand,” said Ms Rosentreter. “The moment any of them cross the Tasman, they are substantially better off. We’re effectively subsidising the Australian health system with $150,000 of public investment every time a trained paramedic walks out the door, and every 1% increase in attrition costs this country roughly $5 million a year.”
The collapse of charitable giving. Donations to St John fell 25% in 2022 and have barely recovered, while costs rose $154 million between 2021 and 2024. The average NZ donor is now 71 years old, with no pipeline of younger donors to replace them. Charitable donations are on track to become a negligible fraction of ambulance funding costs within two decades.
“The charitable model is collapsing just when we need it most,” said Ms Rosentreter. “And rather than fixing that, the system is shifting costs onto patients at their most vulnerable – St John raised its callout charge 28% last year to $125 and further rises could be ahead.”
A fuel crisis that has turned a long-term problem urgent. The national ambulance fleet runs entirely on diesel. Electrifying the national fleet would save an estimated $37 per vehicle per day at current fuel prices and $20.1 million per year in social costs from diesel pollution – but the $259-300 million upfront cost is out of reach for charities operating on tight margins. Only Crown financing makes it viable.
Coordination failures across the health system. Because ambulance services sit outside the public health system, workforce planning, recruitment and clinical pathways are managed in isolation from the rest of the sector. Public ownership would allow shared protocols, integrated data and aligned incentives, which would reduce system-wide costs and improving patient outcomes across the board.
AMBULANCE OFFICER REACTS
“The Australian pay packet can be very attractive to ambulance officers at all levels,” said Hannah Kennedy, a Critical Care Paramedic and Workers First delegate. “It’s the reason I moved to Australia after graduating, and after coming back for family reasons, you notice the difference.”
“The cost of living is already putting pressure on many of us, especially those who travel long distances to work with the price of fuel. Banks don’t consider your overtime rates as a base income, so even if you work them every week, getting a mortgage can be tough for people.”
She said the winter flu season was now beginning and older patients required more ambulance callouts as a result. “Care for our patients is not something we would ever compromise on, but it’s ambulance officers who bear the burden in missed breaks, late shifts and psychological pressure.”
“I just want to see the ambulance system fully funded and protected for the future so we can keep helping the patients who need us and keep paramedics working in New Zealand.”
BUDGET 2026
A new ambulance funding cycle begins in July 2026 – the first since the previous Labour Government's 2022 agreement. Workers First is calling on the Government to use Budget 2026 to fully fund ambulance operations and take meaningful steps toward closing the Trans-Tasman wage gap.
The “hurriedly announced” $35 million increase announced this morning was welcome, but another one-off funding top-up would not be sufficient to fully fund ambulance services and left the model reliant on charity, Ms Rosentreter said.
“More one-off funding for our ambulance service is welcome, but we need long-term solutions, not more band-aids and quick decisions made in an election-year. We’re talking about a ticking time-bomb here.”
“The injection of $8.75 million new funding per year does not fully fund the service by any stretch of the imagination, and continues the reliance on donations to fund life-saving emergency medical care.”
Workers First estimates that halving the wage gap in Budget 2026 would require $69.1 million in new remuneration funding – made up of $34.7 million to cover projected attendance growth and a 5% wage increase, and a further $34.5 million to close half of the current 18% average after-tax gap across all roles.
The union is also calling for a single, consolidated reporting system covering the entire emergency ambulance service. Ambulance funding is currently spread across multiple providers, government agencies and budget documents with inconsistent reporting standards, making meaningful public scrutiny almost impossible.
“Transparency is a prerequisite for a system designed to deliver for patients and workers,” said Ms Rosentreter.
“The Government is already the effective economic employer – it sets the funding envelope and that dictates everything operators can and cannot do. Budget 2026 must reflect that reality. Full funding now, and public ownership as the goal.”
Background information
- New Zealand's emergency ambulance services are currently provided by two partially charity-funded operators: Hato Hone St John, operating nationally, and Wellington Free Ambulance, covering the Wellington and Wairarapa regions. New Zealand is an international outlier among comparable OECD nations in funding ambulance services partly through charitable giving rather than as core public health infrastructure.
- St John was established in New Zealand in 1885. Wellington Free Ambulance was founded in 1927 after Wellington mayor Charles Norwood witnessed an injured man lying beside the road with no ambulance available. Government contracts were eventually added to these charitable structures, but the underlying model was never redesigned. The Crown is already the dominant funder – covering 87% of Hato Hone St John's annual costs in 2024-25 – but ambulance services remain outside the public health system.
- The “Emergency!” report was authored by Edward Miller of CICTAR, with contributions from Anita Rosentreter (Deputy Secretary) and Faye McCann (National Organiser) from Workers First Union.
- *CICTAR – Centre for International Corporate Tax Accountability and Research
