State-funded, charitable non-profit, or privatised - ambulance services come in all shapes and forms.

As St John Ambulance staffers continue their partial strike across New Zealand, some are wondering why the critical service relies on donations to survive.

In some countries, ambulances are fully funded by their governments, but in New Zealand they depend on donations, volunteers and payment for commercial services and products.

The Government allocated $59 million to double-crew ambulances across the country by 2021, but the Ministry of Health and ACC only cover 72 per cent of the service's operating costs.

First Union transport, logistics and manufacturing secretary Jared Abbott said many ambulance workers felt it was time the Government fully funded the national ambulance service.

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"A lot of the public think that too. When you look at ambulances being the front line of DHB (district health board) services, it doesn't make sense," Abbott said.

JEFF MCEWAN/CAPTURE STUDIOS Some ambulance staff say New Zealand's ambulance services are too important to rely on donations.

New Zealand had some of the lowest-paid ambulance staff in the developed world, Abbott said.

"Looking at the qualifications and hours they have to work, they're paid well below other developed countries," Abbott said.

"The starting rate is below $20 dollars an hour. If recognition payments for night and weekend work are factored into this, many ambulance professionals would have to be on or below the minimum wage."

Crew members often ended up working overtime as unpaid "volunteers" to cope with being understaffed, Abbott said.

SUPPLIED First Union transport, logistics and manufacturing secretary Jared Abbott said ambulance staff want services to be fully Government-funded to improve their work conditions and the service quality.

But full public funding was only a solution to long hours and low pay if the Government was willing to fund enough staff to meet the demand, Abbott said.

"We want two qualified ambulance staff in every ambulance, which is standard practice everywhere else."

Former Wellington Free Ambulance chief executive Diana Crossan said last year it was "strange" New Zealand's ambulance services depended on donations.

PIERS FULLER/STUFF Wellington Free Ambulance chief executive Mike Grant hopes to increase the Government's funding of the free service.

The charity's current chief executive Mike Grant said the model worked well enough, but they were drafting a new model with St John that would improve both services.

"We make up the difference, around $4m per annum, through fundraising. On one hand this is good in the way it keeps us so closely involved with our community. We feel very lucky to have such amazing support from the people who live here, councils, businesses, trusts, and of course we have our annual Onesie Day fundraiser every September.

"On the other hand, we could do so much more with increased funding from Government. We have had some positive discussions and are working with St John on drafting a case for a model that would step the whole sector closer to a position of full funding."

STACY SQUIRES/STUFF St John chief executive Peter Bradley CBE says the organisation's current funding model is not sustainable long-term.

St John chief executive Peter Bradley CBE said the non-governmental organisation model worked well for St John, aligning with its values and origins.

"St John provides a high quality emergency ambulance service, achieving the response time targets set by our Government funders. We currently have the highest levels of patient satisfaction we have ever recorded, and we have one of the highest out-of-hospital cardiac arrest survival rates in the world," Bradley said.

But he hoped the Government would review its level of funding before the current funding contract ended, Bradley said.

ROBERT KITCHIN/STUFF The Wellington Free Ambulance is only partly funded by the Government, councils and ACC, but they do not charge patients for the service.

"The increasing requirement to be asking the public for money to run a national emergency service is coming to an end. The current funding model needs to be addressed by the time our existing contract comes to an end," Bradley said.

"We know that this level of funding isn't sustainable in the medium term and, with this in mind, we are preparing a case to Government to increase our funding level to 95 per cent."

WHAT HAPPENS ELSEWHERE

St John operated in 22 countries, including Western Australia and the Northern Territory. The rest of Australia used state-funded services, though some still charged patients fees.

Both St John Australia and New Zealand ran at a loss last year, despite being partly funded by their governments.

The United Kingdom, Croatia, Latvia and the Czech Republic had completely free, publicly-funded services.

STUFF A member of the public is moved into an ambulance by emergency services after a police officer was stabbed near Parliament in London, 2017.

Several European countries had both public and private ambulance services, a Dutch study found in 2015.

Ireland had public, private and voluntary ambulance services, while people in Lithuania and Norway could choose from several private services. Ambulance services in Belgium and Germany were part of the fire brigade.

The Dutch study stopped short of endorsing a particular funding model, but said the more funding a service had, the more staff they got, and the quality of service improved.

United Hatzalah of Israel was funded purely by donations, and staffed with more than 4500 volunteer medics, using a GPS dispatch system and a fleet of rapid response "ambucycles". It opened a Ukrainian branch in February to cater to the country's Jewish community.

In Thailand, ambulances were contracted to larger hospitals which were government-funded, but they were rarely sent out due to traffic congestion.

KATE GERAGHTY/FAIRFAX AUSTRALIA An ambulance carries the sixth person rescued from Tham Luang cave in Thailand.

Nearly 1000 St John Ambulance officers across New Zealand were campaigning for better recognition of night and weekend work with a "partial strike" from November 14.

Union members refused to go to non-emergency commercial events, a source of income for the charity.

The New Zealand Professional Firefighters Union backed the action, with members refusing to go to events in place of ambulance workers.

Abbott said union members were sick of long shifts with no breaks, and overtime without pay.

"Imagine working a rotating shift pattern of 14-hour days with no breaks, speeding on the roads, dealing with emergency situations, running red lights ... Single-crewed ambulances also see a lot of assaults. They're often sent to situations with a lot of intoxicated people around."

A fully-funded service could fix the funding and staffing shortfalls, Abbott said.

The strike would continue until an agreement was reached, he said.

BRADEN FASTIER/STUFF St John Ambulance district operations manager James McMeekin, left, and station manager Rebecca Lee, are pleased Marlborough will finally get double-crewed ambulances.

MARLBOROUGH STAFF BOOSTED

Two paid and qualified crew members will staff St John Ambulances in Blenheim and Picton from now on, after extra government funding.

Previously, staff shortages meant crews were sometimes volunteers, or sometimes just one person, which made it difficult to treat people while driving.

The changes come as part of a national four-year project to end single-person ambulance crews across the country, with 400 extra paid staff funded with $100m from the Government in May 2017.

Tasman district operations manager James McMeekin said while previous crews still delivered a good standard of service, double crewing meant safer conditions for crew members and an increased quality of service.

"There was a huge reliance on volunteers to support services in Marlborough, but with additional funding we're able to give some assurance there will be a paid crew in ambulances."

Five of the region's volunteers took paid positions as emergency medical assistants or technicians, and gained the qualifications necessary. The region also gained a new paid crew member from Christchurch.

Blenheim would have a double crew ambulance available 24/7, and a second ambulance with a volunteer crew 12 hours a day.

Picton would have a double crew from 7am to 11pm, which was when most callouts came through, supported by a new first response vehicle.

BRADEN FASTIER/STUFF Most of St John Ambulance's funding comes from the Government, but it still depends on donations, and funds from commercial activities.

Acting station manager Rebecca Lee said the region had long struggled to find enough staff, so they often ran on single-crewed vehicles before the double-crew project.

"Now we'll have the same two people working every shift, and you can get to know each other's practices very well. To me, that's very good practice."

McMeekin said St John Marlborough still needed volunteers. There were about 40 in Marlborough, spread between Blenheim, Picton, Havelock and Okiwi Bay.

"They provide a great support to the higher qualified paramedics, and the EMPs (paramedics) to support the ICP (intensive care paramedic) on the front line."

An increasing and ageing population in Marlborough meant an increasing demand on the service, as callouts increased by 7 per cent on average, compared to the national average of 5 per cent, McMeekin said.

"I think the timing of this has been well received, with summer workload increases over the holidays ... especially with State Highway 1 reopened."