The Committee heard from Heather Swail representing the Work and Family Network of Ottawa-Carleton. Ms. Swail indicated she and her co-presenter, Ms. Susan Howe, are

program consultants in Work and Family Partnerships, through the Andrew Fleck Child Care Services. For the past 10 years, they have worked with public and private organizations in Ottawa-Carleton to develop family-friendly programs and services and advance the issue of work and family. Ms. Swail provided background information on the network, established in 1992, which counts among its founding members the Regional Health Department.

Ms. Howe described the National Capital Region Emergency Child Care Consortium, a community-led initiative established in 1995 and the first of its kind in Canada. The Consortium has a diverse, representative group of public and private partners, including the Nortel Networks, the Ottawa-Carleton District School Board, the Canadian Union of Postal Workers, Nepean Hydro, Canada Mortgage and Housing, the County of Carleton Law Association, and the non-profit Short-term Child Care Program. Consortium partners contract with the latter to provide quality back-up bilingual child care whenever arrangements break down for employees and members. Ms. Howe said these progressive companies/organizations recognize that a breakdown in child care arrangements is a stressful work and family issue for working parents. By providing access to the program, the organization also benefits through increased productivity, improved morale, employee commitment and a reduction in absenteeism and its attendant costs.

Ms. Swail pointed out that the majority of parents are now in the workforce, the largest participants being women with young children. The aging population also means the workforce is carrying on increasing responsibility for its elders and this trend is projected to continue and grow. This is coupled with steadily declining government support for those carrying on these responsibilities. Increased stress due to work and family conflict leads to absenteeism, sickness, higher use of short and long term disability, and lower morale within organizations. In order to cope, families need supportive services at work. Research has shown that even access to back-up child care reduces stress and absenteeism; it improves relationships between spouses, their children and their colleagues at work. Ms. Swail said many employees want flexibility to help them handle their work and family responsibilities and tangible supports such as child and elder care. This must be accompanied by a supportive culture and an environment that goes beyond the family and into the community.

Ms. Swail posited that work and family-friendly communities attract investment, sustain development and support the healthy communities model implemented in Ottawa-Carleton. She spoke about the issue being pervasive and persistent, and being in all sectors, saying what is needed is a central, unifying body to take leadership, be a champion, initiate action and encourage others to take action. She suggested there were four major roles the Region could play, namely:

Ms. Howe said the Work and Family Network has met with regional staff from the Health and Human Resources Departments and is continuing its existing relationship with the Health Department. She asked that the Region:

Councillor W. Byrne asked how much work these requests would generate for regional staff. Ms. Swail suggested the Region take the lead in the proposed working group. If this happens, many other organizations will come forward. Responding to a further question from the Councillor, Ms. Swail indicated that promotional activities related to the Family and Work Life Day could include advertising, and promoting initiatives a workplace could undertake to advance family and work life.

Councillor Byrne put forward a Motion calling for a number of initiatives to be approved. She said that the issue of access to available, quality emergency child care is gaining prominence, as was illustrated in the presentation to Committee. Councillor Byrne expressed the view that the brunt of responsibility for both child and elderly care still falls predominantly on women. If more women are to move into the workplace and be as productive as they can be, this initiative must go forward. The Councillor intimated this has always been a factor to her advancement.

Network representatives have illustrated that the benefits are immense, not only to employees and their children but also to employers. The programs stand up to cost-benefit analysis and this is why they are recognized by companies such the ones already participating. Councillor Byrne felt the Region should take a leadership role along with the others and endorse the program.

- Special Advisor on Social Housing Report dated 4 Feb 99

The Special Advisor on Social Housing, Ms. Joyce Potter, presented the report. She noted the following events have transpired since her 4 Feb 99 report:

Responding to questions from Councillor D. Holmes, Ms. Potter provided the rationale for the contention there may be significant cost increases associated with the transfer of federal stock to the Region:

Councillor Holmes asked about the rationale for AMO’s position and about the composition of its Housing Task Force. The Task Force Chair, Councillor P. Hume, described it as a broadly-based entity, with representation from the City of Toronto, the Regions of Halton, Peel, Kitchener/Waterloo, Sudbury, and the Mayor of Oakville. It is regionally based, and heavily favours staff with a good grounding in administration and housing providers. As for AMO’s rationale, Councillor Hume said the first concern is that a lobbying effort such as the one proposed by the Social Housing Working Group will delay the federal/provincial agreement. He said the large urban mayors’ lobby asking Members of Parliament (MP) not to get involved caused a delay of approximately one year and a similar effort by co-operative housing providers had a similar effect. Both the provincial and federal governments have indicated that taking this approach will add another year to the Region’s costs.

Councillor Hume said there are also concerns about the negative impact on municipalities’ ability to turn negotiations from bilateral to tripartite. It is known that the federal government is more receptive to this idea than the Province is and this could be negatively impacted as well.

Another area of concern is the effect the lobby could have on membership in any municipal reference group advising the Province: AMO wants to ensure there is strong representation from the Regions in these reference groups.

Councillor Hume went on to say the most important aspect will be guaranteeing the complete "flow through" of federal dollars to municipalities. The Province has said the money would flow through it to municipalities and funds would be kept in housing. Councillor Hume posited that letting the funds flow through the Province may result in some trimming here and there.

Councillor Hume spoke about AMO wanting to present a strategic approach and bring recommendations forward as a package. He pointed out that the Regional Chairs of Ontario have written to the Minister of Municipal Affairs and Housing, stating their first priority is the conclusion of a federal/provincial agreement. Significant lobby efforts will be needed in the future to protect municipalities in the larger context. In response to a question from Councillor Holmes, Councillor Hume confirmed that the City of Toronto is not in agreement with AMO’s position.

Councillor W. Byrne asked whether letting the federal government maintain a role in social housing wouldn’t be accomplished by letting it retain the administration of unilateral units. Councillor Hume replied the consensus was that this should be done in a more comprehensive way and be part of a federal/provincial agreement on social housing. Councillor Byrne asked when would be the right time, if now is not the right time. Councillor Hume said the time will be right when there are indications the federal and provincial governments have begun negotiating and municipalities have a role to play. When this happens, AMO will come forward with a comprehensive package listing what municipalities need to protect themselves. The federal flow-through has a significant financial impact on municipalities, and if they have no part to play in the negotiations, municipalities will have to stand up as a sector and lobby all Members of Parliament to ensure their concerns are taken into account.

Councillor Byrne inquired whether AMO has determined that the SHWG’s position will be part of its package. Councillor Hume reiterated AMO’s position will be that the federal government should maintain a policy and funding role in social housing. There are uncertainties about the kind of arrangements the federal government will put on the table for municipalities to administer. If there are no administration dollars, AMO will not be advocating municipalities take on the responsibility.

The Committee heard from Ms. Catherine Boucher, Centretown Citizens Ottawa Corporation, a member of the Social Housing Working Group and a Board Member, Ontario Non-Profit Housing Association. She began by asking that the Region give the same treatment it gave to federal unilateral co-operatives when it endorsed their request to be retained at the federal level. Ms. Boucher posited that any discussion about agreements being delayed because of the status of federal unilateral non-profit units is moot. There are indications the Province has no interest in whether or not the units come to municipalities. She advanced the view that, if anything, the reform process may be lengthened by Canada Mortgage and Housing’s edict that there will be no opening of agreements between itself and providers without the consent of both parties.

Ms. Boucher continued by saying federal unilaterals are the oldest units of social housing that are not public housing units. Generally, they are nearing the first expiry of agreements and have negative replacement reserves. She cautioned that the stock will come with significant demand for replacement reserve funding. She posited the best way to keep the federal government in social housing is to keep them in the game and as long as they have an administration system. She cited the Residential Rehabilitation Assistance Program (RRAP) as an example of what happens when there is no delivery mechanism for the federal government to come back to the table when there is no infrastructure to flow money through. She urged the Committee to support the SHWG’s position.

Councillor C. Doucet asked for Ms. Boucher’s reaction to Councillor Hume’s exposition of AMO’s position. She responded by saying that the CCOA’s provincial and national associations have written to federal minister Gagliano, congratulating him on his decision to retain federal co-ops and asking him to extend the privilege to similar non-profit housing providers. Ms. Boucher said it is not a question of attacking but of supporting the federal decisions about co-ops.

At this point, Chair Munter read a Motion from Councillor Holmes which seeks to harmonize the diverging opinions expressed by the Committee.

Councillor Hume reiterated AMO’s position, and he expressed the view that lobbying on a one-off basis is not the best way to reach its ends. An effective lobby will ensure that the comprehensive package put forward achieves all the goals and eliminates having to keep going back for other changes.

Chair Munter said the Motion attempts to reconcile both AMO’s position and that of the SHWG. He spoke about participating in a conference call between the Federation of Canadian Municipalities (FCM) and Councillor Layton from Toronto, in an attempt to link municipalities and develop a national effort to get the federal government back into the housing "business".

The common theme is that the federal government must be a player and as many avenues as possible must be kept open for it to make an allocation to housing as part of a future federal budget.

Councillor Holmes posited there will be ongoing advocacy and lobbying on this issue for some time to come. Having as many entities as possible lobbying to get the federal government back as a significant player in national housing is desirable, not only as a provider of funds but also as a producer of housing stock. Councillor Holmes added that getting the responsibility for federal unilaterals without the appropriate administrative costs, and having to maintain subsidies at existing levels would be ludicrous. She felt it would take many years of sustained effort on the part of AMO and all municipalities to finally get both senior levels of government back into strong housing programs for the country.

Moved by D. Holmes

CARRIED, as amended

The Committee Chair, A. Munter, reminded participants of the original intent of today’s meeting, to consider how the system would evolve, i.e., would tenders be called or would there be a recommendation to establish a regional ambulance service. He indicated that because of the non-answer from the Ministry of Health on the issue of dispatch, it is difficult to make any decision at this point.

The Medical Officer of Health, Dr. R. Cushman, expressed his disappointment with the fact that, after one year, no decision has been reached. He reiterated that the RMOC wants to establish a high quality, performance-based land ambulance system, but its hands are tied. Dr. Cushman said all parties must continue to be patient and he expressed cautious optimism that the paramount issue of dispatch will be resolved. He pointed out that even if the Region were to get a decision in the next month, it will be difficult to offer a quality service early in year 2000. The alternative is that the RMOC will be forced to choose the least worse solution from a list of costly, ineffective options. Dr. Cushman said he suspected there will be a final decision or no decision from the Ministry by the next meeting, and staff will make recommendations on the Region’s options at that time.

Ms. Lalonde began by saying the failure of the current system is largely attributable to the dispatch centre and this illustrates the importance of the Region gaining control of this function. Injecting more money and working to improve the system, then handing it over to someone who cannot be controlled would be like buying a Porsche and handing it over to a neighbour’s sixteen year old, hoping for the best.

Ms. Lalonde said that, in January 2000, the Region will inherit much more than a fleet of trucks and stretchers: It will inherit the potential of what the service can become. She posited there is a lot more to pre-hospital care than cardiac arrests and bad car accidents. Ambulance workers are currently doing more and more social calls across the Region and deal with people who "fall through the cracks". If ambulance service is contracted out, it will remain a service where trucks move sick people from the street to the hospital. The Region’s Paramedics are specialists of street health, and the only ones who have access to street people and persons out of nursing homes. Because hospital emergency rooms are filled, ambulances may end up being the safety net for emergency pre-hospital service.

Ms. Lalonde spoke about transfer services, saying that some clients currently wait up to 12 hours or longer to be transported back to their homes. She said that ,while this is not as dramatic as dying, it is definitely unacceptable. She made reference to the fact that, should a private operator get the contract, any proposed change would have to be re-negotiated. If the Region were the operator, changes could be made as needs are identified. Ms. Lalonde asked that the Committee try to control how the system will grow and occupy a large part of the life of the community in Ottawa-Carleton.

Mr. Berthiaume began by commending the Region for its hard work to resolve important matters such as the control of dispatch, the timing of the change-over, and the budget needed for ambulance service. He expressed his support in trying to get control of dispatch, as this is the right way to deliver a performance-based service.

The following are salient points from Mr. Berthiaume’s presentation:

Mr. Berthiaume expressed confidence in the fact that, as a local, long-time provider, Rural/Metro Ontario has the experience, the technology, the community commitment, the training programs and the skills to deliver what the RMOC needs. This is why it has submitted an Expression of Interest in response to the recent call.

Mr. Berthiaume spoke about Rural/Metro Ontario’s 250 employees working in many municipalities across Ontario. In the RMOC, the company has 22 paramedics on staff, 18 of whom are Level 2, the highest ratio of expert ambulance attendants in the area. He refuted suggestions that, as a private interest, the company would demand patients prove they can pay before providing service: this has never been done and will not be done in the future. He assured Committee members that Rural/Metro Ontario would neither propose nor support the Americanization of health care, as it believes in a universal public health system. He spoke about comparisons made with the Metro Toronto Ambulance Service, reminding those present that Metro Toronto has paid for its higher level of service through a direct tax levy for more than 30 years and continues to do so.

Mr. Berthiaume said the issue of jobs is very important. For this reason, Rural/Metro Ontario has provided the Union with written confirmation that, if it is contracted to provide service to the Region, no one will lose his or her job. He tabled a copy of the letter with the Committee. He encouraged the paramedics and others to embrace the coming changes, saying that, with a performance-based system and new technology, operators will be better able to meet the needs of the community. He indicated that Rural/Metro can and will have operating systems in place to meet any deadline, including January 1, 2000.

Mr. Berthiaume made reference to the fact that Bill 152 directs that control is assumed on January 1, 2000, regardless of whether issues such as budgeting and dispatch are resolved. In this atmosphere of uncertainty, the Region should keep all options open. He urged the Committee to continue the process it has initiated with the call for Expressions of Interest and to recommend to Council it proceed with a Request for Proposals (RFP) for ambulance service.

Chair Munter pointed out that the commitment made by Rural/Metro Ontario to OPSEU is a re-statement of the decision taken by the Region and is required by the Expression of Interest document. Mr. Berthiaume agreed this was so, but he felt it was important to meet with Union representatives to assure them the company is open and would guarantee no loss of employment. Chair Munter spoke about the fact that half the population in Ontario is served by a private system which has not been performing well because of the lack of dispatch and other factors. Mr. Berthiaume indicated that the Ambulance Operators Association of Ontario has been advocating for years for the Province to move towards a performance-based service. The Province had capped at a maximum the level of service companies were able to provide. With the changes, operators are limited to a minimum level and this will allow the RMOC to improve services to the desired levels.

Mr. Randy Caverley read from a letter to the Minister of Health, asking the Minister to correct erroneous information released to the Toronto Star about private ambulance operators in Ontario and stating that one-third of ambulance service in Ontario is privately run. Mr. Caverley said the statement is wrong in fact and misleading in the impression it leaves with readers. The courts have ruled that these services "are crown agents, with no control of the means of production, no opportunity for profit, no chance of loss and no ownership of the tools of production". Downloading of ambulance service to municipalities is an experiment and municipal contracting of ambulance services to private, for profit companies, is totally untested. Private operators often make reference to their track record in the Province and most of them are legitimate, competent, productive members of the industry. Mr. Caverley questioned the statistics the Region has produced, advancing the view it is not reasonable to break them down in the current system and claim ownership to one set as opposed to another.

Mr. Caverley said Rural/Metro Ontario’s letter to OPSEU is relevant, and the Union appreciates the company’s concern about its members. However, this should not be interpreted as an endorsement of the private model of service, as OPSEU’s first choice is still public sector delivery. Speaking to the continuing concern about job displacement, Mr. Caverley focused on office and maintenance staff who were not necessarily included in discussions with paramedics about the delivery of health services. Some job displacements might be necessary to meet the requirements of the RFP. Certain workers might have to be brought in to meet established levels, with remaining workers staffing remaining positions and there being not enough positions for them. Mr. Caverley said these are ongoing issues and it is premature at this point to try to assure employment.

Mr. Moloughney began by saying that other Upper Tier Municipalities (UTMs) in the Province have moved beyond the point the RMOC is at presently. He made reference to a report prepared by IBI Consultants for the Regions of Durham, York and Halton, which supplies a cost analysis of public models of service delivery versus private, for profit, and concludes that the public model costs less than the private. For example:

The IBI report states that the Regions should enter into negotiations with the Ministry of Health to guarantee dispatch accountability and that the Ministry is agreeable to such discussions. It goes on to say the January 1 2000 deadline is too close to make the necessary changes to dispatch to ensure a performance-based system. It recommends taking over the land ambulance side and making the changes which, coupled with a dispatch accountability agreement, would move the system towards a performance-based model. The dispatch issue would then be approached as a long term objective for take-over. Mr. Moloughney indicated that Durham Council, on February 24, 1999, voted 25 to 2 in favour of establishing a regional ambulance department under the auspices of the Medical Officer of Health.

Speaking to the local situation, Mr. Moloughney said many presentations have been made to this Committee based on the premise that a public model of ambulance delivery is the best choice for Ottawa-Carleton. In OPSEU’s view, the public is better and more cost-effective. The dispatch problem can be addressed as stated earlier. Mr. Moloughney said he was confident the RMOC will reach the same conclusions that Durham, Halton, York, Windsor/Essex and the Greater Toronto area have reached, and will instruct regional staff to set up a regional ambulance department, under the responsibility of the Medical Officer of Health.

The Harris Government’s commitment that the downloading of ambulance costs to municipalities will be revenue neutral will enable the RMOC to move forward and bring the transfer of ambulance services to closure.

Chair Munter pointed out that downloading costs have generally not been revenue neutral. He said that, as a result of his involvement with the land ambulance group, he agrees the RMOC should be at the decision-making point, but regrettably it is not, and the process is temporarily on-hold. He reiterated his belief that the Region can locally operate a better quality ambulance service than currently exists. The notion of transferring land ambulance services from the provincial to the regional level makes sense in principle if the Region is given the tools and the funding to make it work. Chair Munter said what is so frustrating is that the Region is trying to implement a decision of the provincial government, on its timetable, only to be sabotaged by that same government. The Province’s non-answer on dispatch is at the root of the problem, and is akin to being asked to run an airport without getting an air traffic control tower.

Councillor H. Kreling said it was his understanding, from Chair Munter’s comments, that the Committee will make a decision at the next meeting about either establishing a regional ambulance department or going with a private contractor to provide service. He asked whether or not either of these scenarios have been costed and why, at the same time, are RFPs being received from contractors. Chair Munter said the Committee will have to decide whether to proceed with an RFP or whether to set up a regional department.

Councillor Kreling said he was concerned that UTMs and other municipalities are giving in on the issue of dispatch. He posited that, if the RMOC is the only one left standing, the Province will simply make the decision, there will be no co-operation and no partnerships. He proposed that Recommendation 2 become Recommendation 1, saying in effect that, unless the Region gets control of dispatch, it will stop the process. Councillor Kreling said the system is working, albeit not as well as it should. He asked why the Region should continue to discuss the matter if the Province won’t provide the cornerstone for the service. The Region will not be able to make the kinds of changes it wants without dispatch and bring on-line a performance-based system.

In response to Councillor Kreling’s comments, Chair Munter pointed out there are many outstanding issues, beginning with the legislation that puts the Region in the driver’s seat on January 1, 2000. He said he agreed with the Councillor’s comments, but he wanted staff’s advice on what this would mean. The Motion proposed by Councillor Holmes is simply meant to replace Recommendation 4 in the staff report. If there is still no answer about dispatch by the time of the next meeting, the Committee will discuss its options.

Chair Munter said the worse possible scenario is that the Ministry of Health continues to make decisions about the service while the Region pays for it. If this is the case, the Region should contemplate legal action. Both Councillors Kreling and Byrne asked that the Medical Officer of Health be directed to include items discussed, including information on possible legal courses of action, in the next report to Committee.

Moved by D. Holmes

Councillor D. Holmes provided information on the upcoming Canadian Housing and Renewal Conference, requesting this document be forwarded to all Members of Council.

NEXT MEETING

1 April 1999