Some rural doctors and nurses say problems with St John Ambulance services are putting patients' lives at risk.
One of those who expressed concern at the Rural General Practitioners Network conference in Wellington over the weekend was Dr Carol Horgan, chief executive of Dunstan Hospital near Clyde in Central Otago.
Dr Horgan says patients with acute conditions often need to be transferred to Dunedin but staff are regularly told there is no ambulance available.
She says no-one has died because of a lack of ambulance services, but she does not know whether that is due to management or luck.
Dr Horgan says St John provides transport only when patients are moved meaning nurses are forced to spend hours away from their ward duties to travel with patients.
St John Ambulance says it has staff and volunteer shortages across the country, faces a $10 million funding shortfall every year, and can only offer services as far as funding allows.
Operations director Tony Blaber says most of the 15 contracts it has with district health boards only cover transport.
However, a review of the issue began several weeks ago, he says.
Health Minister Tony Ryall told Morning Report the Government is working on a strategy to improve ambulance services which will look at rural access, double crewing, training of volunteers and the need for highly trained paramedics on ambulances.
Mr Ryall expects to roll out the strategy in the next two months. He says the Government has set aside money in the budget to improve ambulance services.