Staff at the District Municipality of Muskoka is recommending that ambulance service delivery across the region be taken in-house rather than contracting it out. They argue it would be cheaper, primarily because municipal staff would forgo the administration fee paid to a private contractor to run the service, but that recommendation isn’t sitting well with everyone.
Huntsville Mayor Scott Aitchison says he’s not convinced.
Aitchison cited a similar experience in London, Ontario which did not go as well as anticipated. He said staff there, too, predicted a savings by taking the service in-house, but six months into the experiment they were back before council asking for just as much money as they thought they’d save.
According to the District report by staff, there could be a savings of anywhere from an estimated $400,000 to $500,000, depending on the service option considered, which would translate to a savings on the tax levy of anywhere from 0.6 to 0.7 per cent. However, the calculation does not include other cost components such as future capital purchases, District support staff to run the program in-house, as well as the cost of ambulance building and grounds maintenance, utilities, taxes and GIS service costs.
“It stands to reason that if you’re not paying a private contractor a profit margin around a service, that you should be able to save money if you’re doing it in-house, but governments are not particularly cheap at doing anything and the District particularly so,” said Aitchison, adding, “It’s a much larger bureaucracy, it’s entirely unionized…”
Lake of Bays Mayor Bob Young echoed Aitchison’s sentiment.
Governments have a history of being rotten at running businesses, so that every time they take them over or continue to operate them they are not necessarily the most efficient. Lake of Bays Mayor Bob Young
Lines a little blurred
Medavie has been the private contractor providing the service for the District since 2009, but the upper-tier municipality has retained responsibility for defining the level of service by choosing the location of the ambulance stations, approving the number of hours paramedics can work annually as well as their qualifications, ambulance coverage plans tied to response times, ensuring quality of service and clinical performance and vehicle procurement. Yet, according to Aitchison, there’s a discomforting overlap between the administrative role of the District and the contractor.
“The District of Muskoka owns the bases, we own the ambulances and we’re supposed to take care of all those things so we have somebody that does that, apparently, and yet Medavie does it too. Medavie deals with the ambulances and sends them in to get whatever repair they need. We have an employee… I don’t know exactly what they do because that employee’s job description looks remarkably the same as one of the Medavie supervisor’s job descriptions. So the hybrid system that we have right now is ridiculous,” said Aitchison who also had some harsh words for staff.
He said a recommendation was made to spend $200,000 for software to upgrade the defibrillators paramedics use, yet paramedics are not trained to use the upgraded version. He said the defibrillators’ value might have increased on trade-in, but the net return would not have justified the expenditure.
“It’s already more of a machine than our staff are capable of using and she wanted to do the software upgrade for $200,000 and couldn’t explain why it was so important to be done. So we found out that, in fact, it did very little,” said Aitchison.
The whole file stinks to me. It’s always pissed me off and now that I’m the chair of Corporate and Emergency Services at the District level, I’ve dug into it an awful lot more. At the end of the day, if in fact District council does decide to bring it in-house, we’re going to need to do a significant overhaul of exactly how it works and who runs it because right now it’s not working very well. Huntsville Mayor Scott Aitchison
Would there be job loss?
Aitchison said area paramedics would still have a job and if District takes the service in-house, it would still require supervisory staff.
“I heard rumours that some of the folks at the District have said none of the supervisory staff that currently work for Medavie will be considered and of course that’s simply not true,” said Aitchison, who predicted that at the end of the day “we’re going to have a much more effective and efficient service.”
Timing isn’t the greatest
Whatever its decision, the District will have to count on the goodwill and cooperation of Medavie, as the current contract for ambulance service with the contractor expired on December 31, 2015.
Instead of having this discussion last year, we’re having it now with a gun held to our headsAitchison
The Huntsville mayor said that fortunately Medavie has indicated that it is willing to work with council to help it through the process.
Would ambulance services be impacted?
Aitchison said residents should not be worried about the provision of ambulance service.
“All the paramedics who currently work through Medavie, all that cost is borne by the District and if somehow Medavie leaves all of a sudden and says ‘do it on your own,’ we still have all those paramedics that will continue to operate. We would certainly make sure that the ambulances still run because they’re all here and we pay for them.”
Aitchison assured that Muskoka residents “won’t see a blip.”
More staff at the District?
Young, who is also concerned about establishing ambulance presence in his municipality, did say adding to the existing bureaucracy at the District is a bit concerning.
“It really was difficult to fight the numbers the District put forward but it worries me that we’re basically taking the management staff that was part of the current organization (Medavie) or hiring them or new people to do the same functions, which just expands our staff count.”
Young said he is also perplexed about the timing. “Why didn’t we see this a year ago? Because (District staff is) saying it’ll take a year or a good part of next year to get the thing set up. So they’re proposing to negotiate with a company that’s losing the business to sort of carry on in a staged fashion until they take it over.”
The report by staff was presented to the mayors’ committee on December 14, 2015. To view it click here.
I find this debate very interesting! I certainly do not know all the details about this topic so I decided to do some research on different EMS models, who Medavie EMS is, and what are important factors in operating an EMS operation. After doing such, it then raised some questions that i do not know the answers to.
The information I read shared some common themes. It doesn’t really matter what model you use, the important thing that is stressed is how you assess your quality of performance. It reads that quality assurance is very important. So the obvious question I have as a tax payer, is there qualified personnel within the District Administration that know how to do this? Is the District properly set-up to perform such a task? My initial gut feeling is that they do not. The District has not operated the EMS system for quite some time. I certainly hope they would not go and cost the tax payers any more money to hire personnel of this caliber when we already have a provider who has the expertise and qualities to perform the tasks.
I looked at the Report that was presented to Committee in Dec and some of it made me very confused. A part of it spoke to Community Paramedicine and that if the District did direct delivery then it could run such a program. To me this advantage sounds like a really great thing for our communities. I assumed by reading this report that Medavie EMS couldn’t run such a program so I wanted to check it out. I did a google search using “Medavie EMS” and “Community Paramedicine”. To my complete surprise, my screen blew up with all kinds of information that Medavie EMS has done a lot with Community Paramedicine. In fact, Medavie EMS in Chatham-Kent, here in Ontario are running a program that has gained a lot of media attention. After reading this, my next question is why is this an advantage for the District if they ran the service and not Medavie EMS? One article I read spoke to there being $6 million dollar given to various EMS service throughout Ontario in 2015. Did Muskoka apply for any of this money?
From what I read above, the system is not broken and it sounds like Public Sectors do not do well at running services such as EMS. As a tax payer, I think there needs to be a proper analysis of the current system and set-up we have. It appears that there is some duplication of jobs? Why are we as citizens paying for someone in the District to do something we pay a provider to do? It is disappointing that it takes a process like this to identify these issues. Someone needs to be accountable for this and fix it.
Hello I have been a Paramedic in Muskoka for over 32 years now, have been a member of the Ambulance Service Review Team, a former Supervisor to the previous private operator and at this time have only one suggestion for local Councillor’s and that is seek out your local Paramedic’s and ask them directly for their input. I may also be reached at [email protected].
Regards,
Steve Mahon
My name is Pauline Meunier and I am the General Manager of the ambulance service in Muskoka. I started working in Muskoka in 1993 as a paramedic and have worked for Medavie EMS Ontario (MEMSO) Muskoka since 2009 when the transition took place from the previous private operator.
I want to thank those who have commented above. I am proud of the paramedics and the service MEMSO provides the Muskoka community and therefore, feel it is appropriate and important to address some of the concerns outlined by those posting, including a comment that has now been removed.
Muskoka is a vibrant community in the midst of an important decision requiring careful consideration. Although disappointed in the recommendation presented to the Corporate and Emergency Services (CES) committee, MEMSO Muskoka respects the DOM’s right to be diligent and will continue support them as we move forward.
Addressing some of the previous points:
We are responsible for the operational budget provided by the DOM that includes wages and benefits for professional EMS staff.
The DOM pays for fuel, vehicle and equipment purchases, maintenance and uniforms directly.
The DOM requested a cost savings (budget reduction) plan which we provided and implemented, this plan provided the least possible impact on patient care services.
We provide monthly detailed financial reports to the DOM.
Any profits (management fee) after operating costs go to our only shareholder; Medavie Health Foundation grant program. http://medaviehealthfoundation.ca/
The paramedics in Muskoka are professionals and I commend them for refraining from public media forums and remaining focused on patient care. Information has been shared openly with them through communication from me, to help ensure they are up to date and have an opportunity to ask questions. As the paramedics are directly impacted by the DOM’s decision, it was great to see many of them engaged and at the last CES meeting.
We have an excellent relationship with the DOM and have worked to identify and act on a cost savings plan. MEMSO Muskoka is not administratively heavy in staff, with only four managers, one administrative assistant and myself, all wearing many hats to support the 85 professional paramedics providing patient care. Our management team has over 150 years combined EMS industry experience. This was positively noted in our Ministry of Health Service Review report that we received on August 31, 2015; outlining the MEMSO Muskoka teams’ hard work and excellent review results. We all have worked and raised our children here, because we want to be in Muskoka.
As the General Manager of MEMSO Muskoka, I am responsible and committed to being accessible for our team and to the communities we serve. As such, I am available to address concerns and answer questions at any time. To reach me, please email [email protected]. I look forward to hearing from you.
Why the District would want to jettison an arrangement that works so well as the private sector Ambulance service we now have is beyond me.
Council should recognize that the costs will only escalate if District takes over the operation. Surely we can see this .
Atchison has already identified several.costs not yet taken into consideration in the report presented by staff. We can be sure thee will be others.
If ambulance employees become employees of the District, instantly there will be benifits and pensions and other employee related liabilities which I doubt have been fully costed.
Wake up council before you walk into a horrible mistake !
My suggestion is for District to get out of the present meddling in the management of the system and negotiate a new agreement with the present provider giving them at least 5 year contract. Have we learned nothing about public sector inefficiency over the past 20 years? Apparently not much.