home are provided by staff who have only minimal clinical training (First Responder) as this is the need dictated by their duties. It was recommended that the Ambulance qualifications offered through NAOTS be recognised by the Authority for Advanced Vocational Awards (AAVA). With the Bolger led National Government reforms of the 1990s; the New Zealand Qualifications Authority was established to replace the AAVA and by 1996 the NAOTS certifications were shifted onto the newly established Nationals Qualifications Framework thus became formal vocational qualifications of higher learning. Proficiency Ambulance Aid was replaced by the National Certificate in Ambulance (Patient Care and Transport) while the National Diploma in Ambulance (Paramedic) replaced both Post-Proficiency Modules (Intermediate Aid) as well as Advanced Aid however in practice the Intermediate Aid qualification was still offered as two Unit Standards from the Diploma. The National Training School closed in 1999 as it had "become dysfunctional" and the recently introduced Ambulance Education Council considered that a drive towards regional service-led training was best thus began a decade of inconsistency within clinical education, although not as great as to return to the pre-NAOTS era of splintification. Post NAOTS (1999–2008) Following closure of the National Training School and disbanding of the New Zealand Ambulance Board which had previously published the National Authorised Patient Care Procedures each service took on responsibility for its own clinical education and standing orders (patient care procedures) which would further aggravate regional differences and ultimately, help lead a return to nationalised clinical education. In 1999 a program of "Intermediate Care Upskilling" was introduced by St John (initially in the Auckland District ) to equip selected ICOs with adrenaline, morphine, naloxone and (at the time) metoclopramide. This distinct training package was not part of any formal qualification. St John also merged the two Post-Proficiency modules back into one education program at some point during this time so that an officer became qualified in both portions of Intermediate Aid concurrently. Wellington Free Ambulance chose to adhere to the original Post-Proficiency module design thus retaining two distinct practice levels (cardiac and IV/cardiac). They also developed their own upskilling program known as "advanced life support" consisting of two modules, A and B; module A contained cardiac arrest drugs (at the time adrenaline, atropine and lignocaine) while Module B provided intravenous pain relief along with naloxone and metoclopramide. To coincide with introduction of the various upskilling packages in the early 2000s