Amalgamation Of Local Health Units Inevitable, But Not Necessarily Wise

Jeff Green | Jan 17, 2024

The Ontario Conservative government is not the first one that thought it would be a good idea for some of the small public health units, such as Kingston Frontenac Public Health (KFLAPH) to amalgamate with other smaller health units.

Public health delivers services, such as dental screening of children and water testing, that are mandated by the province. They also address general health concerns, such as opioid addiction, flu and even the odd pandemic. And they have the authority to order compliance with provincial regulations. They can fine and shut down restaurants, enforce tobacco regulations, and more.

Since many of these mandates are identical throughout a vast territory with 15 million people, why fund the infrastructure for dozens of public health units, some serving only 50,000 to 200,000 people?

The Liberal government under Kathleen Wynne decided to address this. In Eastern Ontario, they approached Prince Edward Hastings Public Health, Kingston Frontenac Lennox and Addington Public Health, and Lanark, Leeds and Grenville Public Health, and asked them to consider amalgamating into a larger body.

In late 2017, all three got back to the government, and said 'thank but no thanks, we're good here'.

They argued that as things stood, they were better able to address local needs, as well as deliver provincial mandates. While almost all of the funding for public health comes from the province, the organisations are overseen by boards made up of municipal politicians and municipal appointees. Frontenac County has 1 representative on the 8 member KFLAPH board, and Frontenac County residents represent 15% of the people served by KFLAPH. Some of the public health initiatives that have been undertaken locally, and regionally, in recent years, such as messaging over public health risks such as tick borne diseases and radon gas emissions, came about at least partially from concerns that were first raised by Frontenac County residents, healthcare workers and politicians.

When Doug Ford took over as premier in 2018, there was an immediate push for change in a lot of areas, healthcare being a major one. The government said that in place of the 43 public health units in the province, there would be 10. Eastern Ontario would be served, in its entirety, by City of Ottawa Public Health. Unlike public health elsewhere in Eastern Ontario, in Ottawa, public health is a municipal department, overseen directly by Ottawa City Council.

In reacting to this provincial direction, the City of Ottawa indicated it was not that interested in taking on responsibility for public health outside of its boundaries, and local councils, public health boards, and public health staff across Eastern Ontario were not exactly looking forward to the new arrangement either.

In the wake of this, KFLAPH, and its two neighbouring health units, proposed that the amalgamation they had rejected under Kathleen Wynne was a good idea after all, and brought that idea forward as an alternative to the government's plan.

Not only did the Ford government's early bombast fade as the political, and geographic reality of the province hit home, after a disastrous first year in office, but COVID hit as well, and the profile of public health, and the local medical officers of health, became much higher for a couple of years.

Dr. Kieran Moore, the Executive Director of KFLAPH and the medical officer of health for the region, demonstrated how nimble a smaller Public Health Unit can be, by diverting inspectors from restaurants to long term care facilities before the pandemic was declared, imposing a mask mandate early, as a precaution, among other measures.

When seeking re-election in 2022, there was little talk by Doug Ford or his government, about healthcare amalgamation, but the idea did not go away completely.

The province is still encouraging local units to look at amalgamation, and are offering transitional funding to those who step forward.

Facing the fact that some day this is going to happen because the government still wants it, the boards of the three health units have decided to take the plunge themselves. They announced that they will look at the idea over the next few months, and will decide whether to pursue it by March of this year.

It's not likely that anything has changed since 2017.

For a smaller county like Frontenac, instead of having 15% of the population within KFL&A, we will be reduced to 6% of the population in Eastern Ontario Public Health. Last year saw the closing of the satellite Public Health Office in Sharbot Lake, while the Cloyne office was maintained, but that could easily change under the new model. And our representation on the board will likely be diminished as well, unless it becomes a much larger board.

Ross Sutherland, a former council member in South Frontenac, and chair of both the Kingston Health Coalition, and the Ontario Health Coalition, has come out against the change, saying that local decision making has served residents of both Kingston and South Frontenac well, and that the change will likely create a weaker service and larger bureaucracy.

Members of Frontenac County Council expressed similar concerns when they were informed about the plan at their meeting in December, particularly over the role of the municipality in the governance of the new entity that will be formed.

The details will emerge in the coming months, but as with all things in Ontario, eventually the provincial government ends up getting its way, in the end.

The result will not likely save any money. It might make public health services more consistent across the region, but that could also mean less service in some areas.