| Apr 17, 2019

Ontario to cut the number of paramedic service operators, Public Health Units, to 10.

“In 45 years working in Paramedic Services, I’ve never seen such a well-kept secret” said Frontenac County Chief of Paramedic Services, Paul Charbonneau, on Tuesday.

Charbonneau was commenting on an email he, along with all the other Paramedic Chiefs and Chief Administrators in Ontario, received early on Monday from Paul Vanni, President of the Association of Municipalities of Ontario (AMO). The email was titled “URGENT – Municipal Land Ambulance Services to be Restructured”.

Vanni’s email message starts as follows: Today, we were told that it was MOHLTC’s [Ministry of Health and Long-Term Care] intent to move 52 ambulance services to 10 through restructuring.  This is apparently what the phrase ‘by integrating emergency health services into Ontario’s health care system’ means in the budget document.

It goes on to say the AMO “is shocked with today’s news and deeply concerned.  There is no ready information on the government’s plan to do this restructuring, how it was determined, let alone what happens to cost sharing and say for pay among other governance and funding matters.  Municipal governments contribute about $720 million and the province about $580 million to what is a cost-shared service, although not a true 50-50 one.”

Vanni then said that AMO will pursue the matter with the ministry, and advises those Chiefs to remain patient in the interim.

Aside from saying he had no idea that this move was being contemplated, Charbonneau did not want to comment further. His concern lies mainly with staff who work for Frontenac Paramedic Service, both unionised and non-unionised. He sent an email to the paramedics on Tuesday morning, confirming the news, which he shared with the News.

Here it is, in part:

“Just as much as AMO is shocked and deeply concerned, so are we. We had absolutely no idea this was happening. At the moment, we don't have any idea on how this is going to unfold, and we all have many questions, but we wanted to share this with you right away. I am committed to working with your union leadership moving forward and I am always available to speak with you directly.  For now, it's business as usual. Nothing has changed because of this announcement yet. Let's keep up the excellent patient care we are known for and we will keep you posted as soon as we have further information.”

Frontenac Paramedic Services is a core function of Frontenac County, serving the county and the City of Kingston as well. Losing it would cut the Frontenac County budget from its current $43 million annual operating budget to under about $25 million. There is no word on how this would impact other county services.

To illustrate how unexpected the change was, Frontenac County recently completed a rebranding exercise, tweaking the name of the service to Frontenac Paramedics, in order to focus on the role of Paramedics as leading-edge health care providers.

But late on Tuesday Premier Ford seemed to be stepping back from the definitive message that the Ministry of Health delivered to AMO earlier.

When asked about the reports that government will be cutting the number of paramedic service providers to 10, he said, according to a CBC report, “We're just reviewing that right now. Nothing is carved in stone, but we're going to look at everything."

The abrupt announcement about restructuring of Paramedic Services is similar to another announcement that has left municipalities in Frontenac County, and across Ontario, on edge.

In the back pages of that provincial budget document that was released last Thursday (April11) it was announced that somewhere between 2020 and 2022 the government intends to reduce the number of Public Health Units in Ontario. There are now 32, and there will be 10, once restructuring is complete.

Frontenac Islands Mayor, Dennis Doyle, chairs Kingston Frontenac Lennox and Addington (KFL&A) Public Health. The announcement last Thursday took him by surprise as well.

“We thought the amalgamation of health units had been put to rest. The former government had been looking at it, but after we made the case for the local integration that made our operations pretty effective, they agreed with us. But this is much more drastic than what they were looking at. That was only tweaking in comparison,” Doyle said, in a phone interview on Monday (April 15).

Doyle pointed out that there is already one large Public Health Unit serving the City of Toronto’s population of 3 million people, a service that is integrated into the City’s own operations.

“In order to serve the rest of Ontario residents with only 9 more Public Health entities, each of them would have to serve over 1 million people,” he said.

“That would mean all of Eastern Ontario, from Peterborough to Cornwall, all the way up to Renfrew County and Algonquin Park, except for the City of Ottawa, which operates like Toronto.”

Public Health, like Paramedic Services, is financed through shared funding agreements between the province and local municipalities.

“When they were set up, they were supposed to be 75% funded by the province, said Doyle, “but as time has gone on, the municipal share has increased. We [KFL&A] receive about 60% of our funding in provincial grants, currently.”

KFL&A Public Health is overseen by a 9-member board, which includes 5 municipal appointees and four provincial appointees.

“The municipal input will go out the window if they follow through with this,” Doyle said, “and I don’t see where they are going to realise the savings they are after except by cutting services.”

The provincial contribution to Public Health is $900 million annually, and the province expects to save $200 million each year through restructuring.

“Most of our spending goes to front line workers, not administration, said Doyle. “They may save $5 or $6 million by cutting out 22 Medical Officers of Health, who earn about $300,000, but that is nothing like $200 million. You need to cut service to get there.”

Doyle also said that services such as septic inspections and restaurant inspections, currently done by KFL&A Public Health, will likely be downloaded to the local municipalities in order to realise those savings.

“Local municipalities will pay more in order for the province to pay less,” he said, “it’s downloading by stealth.”

KFL&A Public Health has taken a lead role in ensuring vaccination rates in its catchment area are well above the provincial average. It has also been working on the problem of radon gas emissions, which is a more pervasive problem in Frontenac and Lennox and Addington than in other parts of the Province.

In addition to its headquarters on Portsmouth Avenue in Kingston, it operates satellite offices in Napanee, Sharbot Lake and Cloyne.

Aside from septic inspections, water testing is a key service offered out of its rural satellite locations.

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