The Ford decimal system

Jeff Green | Apr 17, 2019

Those who said that the Ford government in Ontario would bring in the kind of tumultuous era that came about when the Mike Harris government ruled the roost in the late 1990’s, might be saying I told you so about now.

Under Harris, the delivery of health, education, social and municipal services in Ontario all saw radical changes. Under Ford, the same thing is happening.

The 14 Local Health Integration Networks LHINS, which fund hospitals, homecare and other health services, are being folded into a single agency. That was not a huge shock to anyone. The LHIN’s, a Liberal government innovation, were never very popular and the Conservative Party said they would eliminate them while on the campaign trail last spring.

The subsequent plan to eliminate dozens of health care and community support agencies in order to set up single service providers for populations of 300,000 or so residents signaled the direction the government intends to take, across the spectrum of provincially delivered services.

This week, the true breadth of change is coming even more clear with the announcements that Public Health Units will be restructured. Thirty-two health units will be reduced to 10, each serving a million or so people.

Then, another shoe fell, when it was announced on Monday that 52 Paramedic Service Providers in the province will be restructured down to 10 as well.

As taxpayers, we should be able to hear from our politicians how these changes, with all the up-front costs they will bring, will improve service delivery and/or save money. Before disrupting operations that have been working to create efficiencies and trying to build effective corporate cultures around delivering public services, we all need to know that there is a coherent plan to actually make things work better.

But we have none of that. All we have is this suspiciously round number, 10. There are 14.8 million people living in Ontario, spread in a very uneven fashion over a 1.07 million square kilometre land mass. Somehow, it makes sense to have 10 (not 9, not 14, not 8) but exactly 10 Public Health organisations and the exact same number of Paramedic Service operators.

It might be a coincidence but it suggests that instead of a thoughtful consultative process aimed at determining the best way to deliver essential paramedic services, and promote and defend public health, a small group of political operatives sat around a table and thought 10 was a nice round number.

The Minister of Health, Christine Elliott, put out a statement on twitter on Tuesday, after the story came out, about the changes to Paramedic Services.

“As we modernize our health care system, we will empower paramedics to improve the already great emergency care they provide. We are working with frontline paramedics and our municipal partners to ensure emergency health services can better meet the needs of Ontario’s communities,” she said

The way this has been announced and the fact that no one involved in paramedic services had any idea this was coming, suggests that Elliott’s claim that “we are working with frontline paramedics and municipal partners” is false. If that claim is false, then why should Ontarians believe that the new emergency system will indeed “better meet the needs of Ontario’s communities”.

Later in the day, Premier Ford seemed to step back from what had been a definitive statement of the governments intent to make these changes, by saying “nothing is written in stone” and “we are looking at all options”. This only serves to indicate that this government is willing to make announcements first, and develop concrete policy later.

I might be proved wrong, but I expect that services to more remote regions of our area, such as Denbigh and Robertsville in Frontenac and Lennox and Addington, will face closure when a single service provider, with no local oversight, is responsible for all of Eastern Ontario, from Cobourg to Cornwall in the South and Pembroke to Huntsville in the North.

The implications of this will hit Frontenac County more than just about any other jurisdiction, since losing the Paramedic Services will cut out over 40% of its operating budget.

What this does, as well, is leave municipal politicians to wonder what comes next. The changes to Paramedic Services and Public Health reveal that the provincial government is more than willing to radically change services, that are financed with both provincial and municipal dollars, and operated by municipalities. And in doing so, they will effectively be taking over the services.

There is an example of how this works, the operation of the OPP. Municipal ratepayers pay for the service through property taxes, but municipal councils have no say in either the operation of the service or how much it costs their ratepayers. All of the control rests with the Province.

It is becoming more and more evident, that the next change that is coming will involve a restructuring of Ontario municipalities themselves.

Should we be getting prepared for the 10 municipalities solution in Ontario?