A case of ambulance ambiguity

Hey there, time traveller!
This article was published 04/12/2017 (2875 days ago), so information in it may no longer be current.

As clear as mud.

That is fast becoming the only definitive description of the most recent funding dispute between the City of Winnipeg and the province.

This time, the fight is over ambulance services. In short, the city has accused the province of unilaterally freezing funding for ambulance services, leaving the city holding the bag for a $2.5-million shortfall this year and another $4.6 million next year.

The province rejected the allegation outright, and said the city is getting more than enough money to provide ambulance services.

Neither side has been able to provide enough unambiguous fact to support their argument.

First, some background:

For many years, the city and province have shared the cost of ambulance services. They do this with a funding formula where the province, through the Winnipeg Regional Health Authority (WRHA), and city each pay 25 per cent of total costs; the remaining 50 per cent comes from fees charged to the people who use the service.

This formula starts with a baseline funding commitment from the province at the beginning of each calendar year. Then, based on volume and other unanticipated events throughout the year, the province makes an additional “year-end adjustment” payment to the city.

That combined amount establishes the new baseline funding number for the following calendar year.

It’s a system that has worked reasonably well. In recent years, however, there have been significant increases in the annual costs of city ambulance services, a trend that has run head-on into the current Tory government’s efforts to reduce expenditures to help balance its budget.

On Nov. 22, Helen Clark, the WRHA’s chief operating officer, wrote a letter to Doug McNeil, the city’s chief administrative officer, with an update on ambulance funding. In it, she strongly suggested that funding to the city in 2017 would be frozen.

“For the city’s fiscal year ended Dec. 31, 2017, our base funding will be equivalent to that provided in 2016,” Clark wrote. She went on to say that after talking with the Winnipeg Fire and Paramedic Service (WFPS), “we anticipate the year-end settlement request for 2017 will not exceed this amount in any material way.”

Clark’s letter hit the mayor’s office like a hand grenade. Already reeling from a provincial decision earlier this year to unilaterally freeze funding to a “basket” of cost-sharing agreements, including transit, Clark’s letter seemed to be more of the same.

In particular, city officials were having a tough time with Clark’s assertion that no additional funding would be needed to make ends meet in 2017.

According to a senior civic official, the WFPS has identified $2.5 million in additional provincial funding to unbudgeted costs in 2017. Bowman immediately went public, accusing the province of a unilateral decision to freeze funding that was going to leave city taxpayers holding the bag for increases in the cost of providing ambulance service due to inflation, wage settlements and increased demand for service.

Health Minister Kelvin Goertzen returned fire, suggesting the city’s allegations were off-base. Although he said there was a need to control the growth in costs for ambulance services, he flatly denied there was any plan to freeze funding.

The entire dialogue between the city and province over ambulance funding is a triumph of ambiguity. A big part of the problem here is the letter from the WRHA. Although it does raise the possibility of a funding freeze, it is not explicit. In fact, the letter also suggests that a final decision will only be made after the WFPS accumulates and submits final numbers on costs.

Goertzen also contributed to the confusion. Although he has been steadfast in denying there is a funding freeze, he also created the impression the province is preparing to slow, if not halt, future increases in funding.

Goertzen said last week that the province would not continue to pay year-over-year increases of the magnitude of those experienced in 2016, but even he is no doubt aware those costs were largely driven by an increase in demand for ambulances, medical decisions that resulted in inter-hospital transfers and an expansion of on-site paramedic services provided at the Main Street Project, an initiative approved by the WRHA to divert fewer urgent patients to emergency departments.

Bowman must also share some of the blame. With so much ambiguity, the mayor should have spent more time trying to sort out what the WRHA was saying in its letter before going public.

This could turn out to be just another unilateral effort by the province to solve its fiscal woes by cutting financial support to the city.

But this could also be a massive, intergovernmental failure to communicate. If that’s true, then the leaders of both levels of government owe it to themselves, and the citizens they serve, to resolve it as soon as possible.

dan.lett@freepress.mb.ca