The Lawler Government has announced a second review into the troubled St John Ambulance NT service at the same time giving it a 16.9 per cent funding increase, with the review examining either the government operating the service or awarding the contract to another operator, and comes while St John is already under investigation by the government for its treatment of patients.

NT Health is already conducting an “external” review of how St John Ambulance NT operates, a review that was only made public last month when the NT Independent was leaked the terms of reference, a document which stated the review followed recent cases where the organisation’s dealings with patients needed to be investigated by NT Health.

Chief Minister Eva Lawler and Health Minister Selena Uibo announced the second review on Wednesday, but said only that it was to ensure a “quality service”, however the terms of reference show the latest review will look at the “service model design”, while suggesting the government would look at possibly taking over the ambulance service or establishing a hybrid model and specifically stating it would consider options for giving the contract to another operator.

However, Ms Lawler also announced on Wednesday that St John will be given an additional $7.8 million funding increase on top of its annual $45.9 million – or a 16.9 per cent increase – due to “demand pressures”, including an increase in patients. The additional funding will trigger an independent audit of St John’s finances and follows the paramedics union’s concern the service was run as a business and not a health service.

“This review will examine whether our ambulance service provides a contemporary, efficient and effective service that meets the needs and expectations of Territorians, and keeps communities safe,” the terms of reference state.

“It is also an opportunity to consider the impact an expanded pre-hospital service can have on the current health services, and how a future service can enable the Northern Territory to meet its commitments under the national agreement on closing the gap.”

The terms of reference state the focus of the review will assess the current model, including communications, emergency response and patient transport services, as well as dispatch coordination, including integration and interactions with other patient transport services, and assess ambulance/patient transport models in other jurisdictions for their relevance to the NT geography and context.

Under a heading titled “service delivery and demand management”, the terms state the review will assess gaps or issues in ambulance and patient travel services, assess the factors impacting ambulance availability (including ramping), review the quality and effectiveness of the service and performance metrics, and explore opportunities to transfer services to other providers, including options to bundle with broader patient travel services, and to change the model.

The terms of reference also state the review will look at how much the government is spending on the ambulance service and benchmark that against other jurisdictions, look at linking funding and performance to better accountability measures, and undertake a cost benefit analysis of the service.

The person overseeing the external review, which will begin on July 1 and be handed to government on October 31, has not been named, but the review will be overseen by a steering committee chaired by “executive director of the NT Health chief executive officer’s office”, and will be made up of senior government officials and senior health practitioners from NT Health, the Treasury and Finance Department and the Department of Chief Minister and Cabinet.

“No matter if you live in the city or the bush – the Territory Labor Government will always invest in quality health infrastructure,” Ms Uibo said.

“The review will examine whether our ambulance service provides contemporary best practice in the delivery of care, meets the needs and expectations of Territorians, and keeps communities safe.”

United Workers Union NT secretary Erina Early said while the union welcomed the review, St John Ambulance provided no accountability to the government and operated as business not a health service.

“We have seen many reviews into ambulance over the years however nothing really is achieved, just more money thrown at an inadequate ambulance provider who has no accountability at all to the government and the health of Territorians,” she said.

“Just because this has been the way of doing business for over 50 years is not an excuse anymore. The community and our paramedics deserve better.

“Our members have high hopes for this review as this is the first review into the ambulance service which dives deep into the service model and opens up for the big question – bringing back our ambulance service to government.

“Every Territorian deserves the same pre-hospital and emergency care as anyone interstate, but this does not occur in the NT. This is because it is run as a business not a health service model as it would be by government.

“It is time that a government finally steps up, listens and delivers to our NT paramedicine health professionals.”

Investigating St John Ambulance’s treatment of patients

In the terms of reference for the first, clinical review, NT Health chief executive officer Dr Marco Briceno said the external clinical governance review was intended to improve the processes for reporting concerns about treatment and would establish a fit-for-purpose “clinical governance framework”.

“Following on from recent clinical cases where there has been concerns raised and investigations undertaken on these cases, and to improve the safety culture and processes for reporting of clinical concerns between NT Health facilities and St John NT, the commitment to review the clinical governance systems and reporting processes between NT Health and St John NT has been established,” he said.

It was unclear when the findings of the first review will be finalised and is unlikely to be made public.

However, while the government refers to it as an “external” review, it is being undertaken by Dr Craig Ellis who, apart from being an emergency and pre-hospital medicine specialist from New Zealand, is also a deputy medical director of St John Ambulance NZ.

Neither Dr Briceno or St John Ambulance would explain why it could be considered external.

You can read the latest review terms of reference at the NT Health website.

The current St John Ambulance contract expires in January 2026.