Provincial-Municipal Services Realignment Social and Community Health Services Implementation Project

Transcription

1 Consolidation of Municipal Services Management Consolidation Planning Framework: Southern Ontario January 1998 Provincial-Municipal Services Realignment Social and Community Health Services Implementation Project

2 Queen's Printer for Ontario, 1998 ISBN M/01/98 (98-001) Ce document est disponible en français

3 TABLE OF CONTENTS I. INTRODUCTION...1 II. OVERVIEW Consolidated Municipal Service Management Principles Policy for Consolidation of Municipal Service Management Consolidation Arrangements Division of Costs Provincial Funding for Consolidation Costs Legislative Authority for Consolidation...5 III. STEPS IN THE CONSOLIDATION PROCESS Approving Consolidated Municipal Service Managers Implementation Planning Designation and Transfer of Authority...6 IV. CONSOLIDATION PLANNING REQUIREMENTS FOR MARCH 31, Provincial Review and Approval Information Required Where Municipal Agreement Is Not Reached...8 V. ONTARIO WORKS Impact of Consolidation on Ontario Works Implementation Consolidation and the Transfer of Sole Support and Foster Parent Caseloads Technology Implementation and Consolidation...10 VI. CHILD CARE Prior to January 1, Services Improvement Act Cost-Sharing Consolidation Transfer of Responsibility for Managing the Delivery of Child Care Services to Consolidated Municipal Service Manager Transition January 1, 1998 until Transfer of Responsibility for Managing the Delivery of Child Care Services Child Care Technology...13

4 VII. SOCIAL HOUSING Implementation Timetable Potential Municipal Roles Implications for Consolidation...16 VIII. LAND AMBULANCE SERVICES Municipal Roles and Responsibilities Consolidation Opportunities for Ambulance Services Designation of Areas and Delivery Agents Status of Implementation...18 IX. PUBLIC HEALTH Changes in Municipal Role Governance Structure for Public Health Opportunities for Changes Implications for Consolidation...19 X. NEXT STEPS...20 APPENDIX 1 CONSOLIDATION STATUS OF MUNICIPALITIES...21 APPENDIX 2 LEGISLATIVE AUTHORITY...24

5 I. INTRODUCTION The realignment of provincial and municipal responsibilities announced in January, 1997 creates the opportunity to build more effective local systems of social and community health services. Municipalities will be assuming responsibility for Ontario Works, child care, social housing, land ambulance and public health. There will be many opportunities across these programs to simplify access to services and serve clients better, while at the same time improving cost-effectiveness through clearer accountability, better co-ordination, innovation, sharing of resources, and economies of scale. Part of the realignment of responsibilities involves creating a system of approximately 50 consolidated municipal service managers with accountability to the province and local taxpayers for these services. The approach to be followed in determining which municipalities and municipal service boards will be the consolidated service managers was communicated to municipalities by a letter from Janet Ecker, Minister of Community and Social Services, on September 2, Ministers Ecker and Leach sent a subsequent letter on December 18, 1997 confirming that the policies will apply to the municipal management of Ontario Works, child care and social housing. This Consolidation Framework provides municipalities with the information they require to develop consolidation arrangements for Ontario Works, child care and social housing and to consider the inclusion of land ambulance and public health. The framework includes the following information: < Context and legislative authority for consolidation; < Policy for consolidation in Southern Ontario; < Outline of the steps in consolidation; < Consolidation planning requirements for March 31, 1998; < An overview of program transfer and consolidation considerations for each of Ontario Works, child care, social housing, land ambulance and public health. II. OVERVIEW 1. Consolidated Municipal Service Management The fundamental role that will be assumed by the municipalities and municipal service boards as a result of consolidation will be management of the system of services within their area. These consolidated municipal service managers will be accountable to the province and local taxpayers for management of these programs within the policies and standards established by the province. January

6 The municipal services managers will administer cost-sharing arrangements with the province for Ontario Works, the Ontario Disability Support Program, and child care. They will also administer cost sharing arrangements between the federal government and the province for social housing. The provincial-municipal arrangements for social housing will be based on a framework of legislation and regulations. The municipal services managers will be responsible for determining, within provincial policies, the most effective approaches to delivering services to clients in their area. Some delivery functions will be carried out directly by the service system manager (e.g., income support components of Ontario Works) while others may be carried out by the service system manager and/or by non-government providers (e.g., land ambulance operation). In some cases, lower-tier municipalities may continue to provide delivery even though they are not the consolidated municipal service managers (e.g., municipally operated child care centres). The decision to consolidate municipal service management does not dictate what the service delivery model will be. Each program differs in the delivery options available. It is expected that consolidated municipal service managers will, however, take advantage of opportunities to rationalize delivery across programs where it is cost-effective and consistent with provincial policies to do so. (For example, there may be opportunities for administrative rationalization of eligibility determination and income verification for Ontario Works, child care and social housing.) 2. Principles In developing the policy for consolidation of municipal service management, the following principles were taken into account: < Consolidated municipal service managers will have clear responsibility to meet provincial policies and standards and to be accountable to local taxpayers for the effective management of Ontario Works, child care and social housing within their service areas. < Services will be readily accessible to the public, with service delivery boundaries that are easily understood, take language and culture into account, and make sense in terms of existing transportation and communication patterns. < Service delivery boundaries will be defined so as to allow for effective strategic planning, and should be compatible where feasible with the boundaries used for planning and delivery of other social and health services. January

7 3. Policy for Consolidation of Municipal Service Management Ministers Ecker and Leach, in their letter of December 18, 1997, confirmed that the following policies will apply to the municipal management of Ontario Works, child care and social housing: a. In regional municipalities in Southern Ontario, and in those counties where there are no separated municipalities, the upper-tier municipality will manage services. Regional municipalities in Southern Ontario currently manage social assistance and child care within their jurisdiction. These arrangements will continue and will include social housing. The new City of Toronto, the Municipality of Chatham-Kent, the District Municipality of Muskoka and the restructured County of Oxford will also manage services. Counties which do not have separated municipalities will be the consolidated municipal service manager for Ontario Works, child care and social housing, unless they are required by the minimum population criterion outlined below to consolidate with another county or regional municipality, or choose voluntarily to do so. b. In counties where there is one or more separated municipality, no more than one municipality (either the county or one of the separated municipalities) will manage services. In counties where there are separated cities, towns or a township, arrangements must be in place for either the county or one of the separated municipalities to manage services on behalf of the other municipalities. The same municipality will be the consolidated municipal service manager for Ontario Works, child care and social housing. The choice as to whether the county or one of the separated municipalities manages the services, and the accountability arrangements among them, are to be decided locally. c. Counties with a population of less than 50,000 (including any separated municipalities) will make arrangements to consolidate service management with another county or regional municipality. There are three counties in Southern Ontario where the population is expected to remain below 50,000 over the next five years. These counties must make arrangements for another county or regional municipality to manage services on their behalf, or for themselves to manage services for other municipalities such that the resulting service area has a population of at least 50,000. The choice of partners is the responsibility of the municipalities involved, but the criterion of no more than one service manager within the geographic boundaries of a county must also be met. January

8 Appendix 1 identifies municipalities in the following two categories: < Municipalities in Southern Ontario which meet the consolidation criteria as of January 1, 1998 (Table 1). Note: In this table there are three counties with separated cities that have agreements for Ontario Works and child care. These agreements will need to be reviewed in light of the addition of social housing. < Municipalities in Southern Ontario which do not meet the criteria and should prepare consolidation plans (Table 2). 4. Consolidation Arrangements Upper- and single-tier municipalities that are required to consolidate will make arrangements among themselves as to which one will be the consolidated municipal service manager, what the accountability arrangements among them will be, and how municipal costs will be divided. A major objective of the policy is to provide flexibility for local development of consolidation arrangements, within the framework defined by the criteria above. It is the responsibility of the municipalities that are required to consolidate to negotiate a mutually acceptable arrangement. The province will approve the arrangement if it is consistent with the criteria outlined above and has the agreement of the municipal partners. The consolidation arrangements must include Ontario Works, child care and social housing. The inclusion of a public health board will be a matter for possible consideration where it is currently not a part of municipal government. Municipalities may also include planning for the management of land ambulance services as part of consolidation of social and community health services. Cost-sharing and accountability arrangements among the municipalities may be different for each of these programs. Upper- and single-tier municipalities in the geographic boundaries of the service area are the parties to a consolidation arrangement. Lower-tier municipalities within an upper-tier are not direct parties to consolidation. A locally developed consolidation arrangement must have the consent of all of the upper and single-tier municipalities involved. The consent of lower-tier municipalities is not required. In the absence of full agreement of the municipal partners, the province will decide which of the upper- and single-tier municipalities in the service area will be the consolidated municipal service manager and what the accountability arrangements will be. January

9 5. Division of Costs Division of municipal program costs between a county and separated municipality in a service delivery area is to be determined by mutual agreement. Agreement of all of the partners is required. The method of dividing costs may be different for any or all of the five social and community health services, as appropriate to local circumstances. If agreement is not reached on division of costs, there will be provisions for arbitration to resolve the differences of opinion. Regulations will be prepared for the Ontario Works Act, Day Nurseries Act, and Social Housing Funding Act detailing the arbitration provisions. Lower-tier municipalities will not be party to these agreements. They will continue to share in municipal costs for these programs as they do for other upper-tier services and in accordance with the Municipal Act. 6. Provincial Funding for Consolidation Costs Consolidation should be implemented in as cost-effective a way as possible, using existing assets and taking advantage of opportunities posed by restructuring and local government realignment. Municipalities may apply for funding of essential one-time requirements. Costs will be reviewed for approval on the same basis as ongoing expenditures to be cost shared in the administrative budgets for Ontario Works and program budgets for child care. One-time costs associated with consolidation and transfer of service system management responsibilities should be addressed in the implementation plans that will be prepared following approval of consolidation arrangements. 7. Legislative Authority for Consolidation The authority for the Province to require consolidation of municipal service management for social and community health services is provided by the Social Assistance Reform Act and the Services Improvement Act. January

10 III. STEPS IN THE CONSOLIDATION PROCESS 1. Approving Consolidated Municipal Service Managers The first step in the consolidation of management of Ontario Works, child care and social housing is the approval of an arrangement which specifies the consolidated municipal service manager for a geographic area. Consolidated municipal service managers will be assigned responsibility for cost-sharing for prescribed services and for integrated planning and management of Ontario Works, child care and social housing within a defined geographic area. Municipalities with consolidation requirements must submit a plan for review by the province. More detailed information on the development of consolidation plans and the approval process is provided in Section IV of this document. The deadline for submission of plans is March 31, Provincial approvals for consolidation plans and decisions as to consolidated municipal service managers will be made by May 31, Regional municipalities and counties that meet the requirements of the consolidation policy for Ontario Works, child care and social housing are not required to submit information. The province will confirm approval to those municipalities by letter. Municipalities who wish to incorporate land ambulance and/or public health into their consolidation arrangements may submit their plans any time either before or after the March 31, 1998 deadline. 2. Implementation Planning Following approval of a municipality as the consolidated municipal service manager, that municipality will develop an implementation plan addressing transfer of service responsibilities. The timetable and provincial requirements for implementation plans will vary for each of the five social and community health programs. For example, implementation planning will proceed more quickly for Ontario Works and child care than for social housing. An overview of the steps involved is outlined for each program in the Sections V to IX of this document. 3. Designation and Transfer of Authority Authority to act as service manager, and to carry out delivery where appropriate, will be formally transferred by designation as a delivery agent under individual program legislation. Details will vary by program. For example, designation will be by regulation for Ontario Works and child care, but by order of the Minister for land ambulance services. During the interim period, while social housing reform and devolution requirements are completed, the only changes resulting from consolidation will be in responsibility for cost-sharing. January

11 Designation and transfer of authority will be completed after implementation plans have been approved by the province and implementation has advanced to the point where the service manager is prepared to take legal responsibility for the program. Again, details will vary by program and are summarized in the program specific sections. IV. CONSOLIDATION PLANNING REQUIREMENTS FOR MARCH 31, Provincial Review and Approval Municipalities must submit proposed consolidation arrangements for Ontario Works, child care and social housing to the province by no later than March 31, The consolidation arrangements may be submitted jointly by the municipalities that are party to the consolidation, or by one of the municipalities with the consent of the others. Agreement of all parties to the consolidation arrangements is required. Consolidation arrangements will be approved by the province if they have the agreement of all parties and are consistent with the policies described in Section II above. Proposed arrangements will be reviewed for consistency with the policies by the Ministry of Community and Social Services (MCSS) and the Ministry of Municipal Affairs and Housing (MMAH). If there are no issues, the municipalities submitting the consolidation arrangement will be advised of approval of the arrangements by letter. Where consolidation arrangements submitted by municipalities include land ambulance and/or public health, the Ministry of Health will also review the proposal. Approval for consolidation arrangements will not have to wait until after the March 31, 1998 submission deadline. Proposed arrangements will be reviewed and approved as soon as possible after they are submitted. If further information is needed or the arrangements do not appear to be consistent with the consolidation policy, the municipalities involved will be contacted by the Provincial-Municipal Services Realignment, Social and Community Health Services Implementation Project. 2. Information Required The consolidation arrangements submitted for provincial approval should include the following information and documentation: < Name and phone number of a contact person. < Identification of the municipalities that are consolidating and which municipality will be the consolidated municipal service manager for Ontario Works, child care and social housing. < A description of how costs will be divided among the municipalities for each of Ontario Works, child care and social housing. January

12 < Whether the consolidation arrangement is proposed to include land ambulance or not. < Whether the consolidation arrangement is proposed to include public health or not. < A description of accountability arrangements among the municipal partners including: 6 nature of the agreements (e.g., purchase of service or joint board) 6 how decisions will be made 6 how costs will be monitored 6 how disputes will be resolved < Copies of resolutions of each of the municipal councils which are party to the consolidation arrangements, or signed agreements between the municipalities, outlining the arrangements described above. Municipalities are not required to provide detailed plans for the management and delivery of any of the programs as part of the consolidation plan. This information will be required as part of the program implementation plans to be developed later by the consolidated municipal service manager. 3. Where Municipal Agreement Is Not Reached It is expected that municipalities will successfully negotiate consolidation arrangements that meet the consolidation policy. However, where this does not occur, the Social Assistance Reform Act and Services Improvement Act provide the legislative authority for the province to designate service delivery areas and delivery agents for Ontario Works and child care, and to specify cost-sharing arrangements for social housing. If municipalities that are required to consolidate are unable to agree on who is to be the consolidated municipal service manager for Ontario Works, child care and social housing the following steps will be followed after March 31, 1998: < MCSS and MMAH will determine which municipality is best suited for service system management and will notify the municipalities in the service area by letter which municipality has been approved. < Provincial decisions will be made as soon as possible after March 31, 1998, but in all cases by May 31, < The municipality approved as consolidated municipal service manager will be asked to work with the other municipalities in the service management area in order to develop arrangements for: 6 accountability among the municipal partners, and, 6 division of costs among the municipal partners. January

13 < Details of accountability arrangements will be required to be submitted by the municipality that will be the consolidated municipal service manager by no later than June 30, < Where division of costs cannot be agreed upon locally, an arbitration process will be used. < The municipality approved as the consolidated municipal service manager will proceed with developing an implementation plan. V. ONTARIO WORKS 1. Impact of Consolidation on Ontario Works Implementation By early 1998, Ontario Works will be implemented in municipalities across the province. Newly consolidated municipal service managers will not take on service management responsibilities for Ontario Works until they are designated by regulation under the Ontario Works Act and the Ministry of Community and Social Services formally transfers authority. Even though the Ontario Works business planning process has resulted in a reduced number of municipalities delivering Ontario Works, consolidation to approximately 50 consolidated municipal service managers will be required. For example, Ontario Works is currently being delivered by a number of separated cities located in counties which are also delivering the program. These municipalities will participate in the larger service consolidation process to meet the requirements of the consolidation policy. In addition, consolidated municipal service managers will need to plan for the full integration of financial and employment assistance and for the transfer of sole support and foster parent cases to the Ontario Works program. Guidelines will be provided by MCSS early in 1998 to assist municipalities in the revision of a service contract as a result of consolidation. 2. Consolidation and the Transfer of Sole Support and Foster Parent Caseloads Planning for the proposed transfer of sole support and foster parent cases from the provincial Family Benefits program to the municipally delivered Ontario Works program is under way. Early in 1998 MCSS will provide a comprehensive tool kit to support an effective planning process and to help ensure that the transfer is managed smoothly and without disruption in services. January

14 The timing for the transfer of cases from the provincial system to Ontario Works will depend upon: < Approval as the consolidated municipal service manager < Joint local planning efforts which includes a human resources plan < An approved implementation plan < Municipal readiness to assume legal responsibility < Designation and transfer of authority under the legislation The goal is that full implementation of the initiative and a complete transfer of cases to municipalities approved as the consolidated municipal service managers for Ontario Works will occur by Technology Implementation and Consolidation In most of the areas with consolidation requirements, there exists at least one delivery site that is a current CIMS/CWT site. This hardware will be relocated, if necessary, to the designated consolidated municipal service manager to provide the technical infrastructure for the delivery of Ontario Works. Hardware installation and connectivity will be assessed as part of the implementation process. The ministry will ensure that implementation is consistent with existing ASAP implementation guidelines, and Ontario Works staff are trained to use the technology. Implementation to accommodate consolidation will also include sole support and foster parent case requirements for automation to ensure that there is only one retrofit and installation process. As part of the objectives of developing a common technology infrastructure to support the delivery of social assistance, the ministry will negotiate CIMS/CWT implementation in those areas where there are no existing CIMS/CWT sites. It is the ministry s goal to have the technology foundation for the future in place by the end of Technology guidelines for the delivery of Ontario Works will be available in January The guidelines will include information regarding the technology, cost-sharing and ministry implementation requirements. January

15 VI. CHILD CARE 1. Prior to January 1, 1998 Prior to January 1, 1998, municipal involvement in child care has been discretionary. Where municipalities chose to participate, they cost shared fee subsidies only (province paid 80% of cost and municipalities paid 20%). Ninety-four municipalities currently cost share fee subsidies with the province. Where there were gaps in service, MCSS entered into agreements with approved corporations to deliver fee subsidies (the province pays 80% and the approved corporations pay 20% through parent fees, fundraising, etc.). There are currently 92 approved corporations delivering fee subsidies in Ontario. MCSS has entered into agreements with service providers to deliver all other child care services throughout the province (resource centres, special needs resourcing, wage subsidy). Prior to January 1, 1998, these services were funded 100% by the province. 2. Services Improvement Act Child care is an important support for working parents to maintain employment as well as a critical support to the success of Ontario Works. In order to make the services more efficient, responsive to local needs, and accountable to taxpayers, the province made a series of decisions for local government realignment. Schedule C of the Services Improvement Act amends the Day Nurseries Act (DNA) in order to implement the child care portion of these decisions (see Appendix 2). Responsibility for licensing will not be transferred to municipalities at this time. The current child care standards specified in the Day Nurseries Act will be maintained. 3. Cost-Sharing Under the Services Improvement Act, municipal cost-sharing of prescribed child care services (i.e., fee subsidies, wage subsidies, special needs resourcing, resource centres) are mandatory. All prescribed child care services are cost shared on an 80/20 basis between the province and municipalities. This improves accessibility to child care across the province and improves the stability of the system, since municipal participation in child care has been discretionary and mainly limited to cost-sharing and delivery of fee subsidies. January

16 4. Consolidation The Services Improvement Act provides authority for the Minister to designate municipalities to manage the delivery of prescribed child care services. The process for becoming an approved consolidated municipal service manager is described earlier in this document. 5. Transfer of Responsibility for Managing the Delivery of Child Care Services to Consolidated municipal service managers Before consolidated municipal service managers can be designated, and authority for managing the delivery of child care services can be transferred, approved consolidated municipal service managers must complete a Plan for the Transfer of Responsibility for Managing the Delivery of Child Care Services. The plan, which will be developed jointly between the consolidated municipal service managers and MCSS Area Offices, will describe how the transfer of responsibility for the delivery of child care services from the province and existing municipal service delivery agents will occur. In areas with consolidation requirements, the plan will also describe how the consolidation of authority to manage and deliver child care will occur. The transfer plan must be submitted to MCSS Area Offices no later than August 31, 1998; however, some consolidated municipal service managers, particularly those without consolidation requirements will be in the position to submit plans earlier than that date. Early submissions are encouraged. MCSS will be releasing guidelines for the child care transfer plan in early Input on these guidelines has been received from a child care provincial/municipal implementation group which met in the fall of 1997, and will continue to meet in 1998 to discuss service planning. Upon approval of the transfer plan, consolidated municipal service managers will be designated, and MCSS will enter into a service contract with the designated consolidated municipal service manager. Once the delivery agent is designated and the service contract is signed, the transfer of authority will take place. The transfer of authority for Ontario Works and child care may occur at different times, depending on the readiness of the municipality to assume responsibility for each program. This would be specified in the service contract. 6. Transition January 1, 1998 Until Transfer of Responsibility for Managing the Delivery of Child Care Services The transfer of child care responsibilities will occur at different times across the province depending on municipal readiness and consolidation requirements. January

17 Between January 1, 1998 and the time that authority is transferred, child care will be managed in the same way that it is managed now. The most significant change will be that provincial/municipal cost-sharing will be broadened: < The 94 participating municipalities will continue to manage their fee subsidy systems. Existing contracts for fee subsidies between MCSS and the 94 participating municipalities will be maintained. < MCSS will maintain agreements with 92 approved corporations to manage and deliver fee subsidies. < MCSS will maintain agreements with existing service providers throughout the province for all other child care services (resource centres, special needs resourcing and wage subsidy). < There will be 80/20 cost-sharing on all child care services with the exception of approved corporations where those agencies will maintain their 20% contributions. < Municipalities and the province will maintain existing service levels. < The child care system will be managed within provincial and local child care policies and standards. 7. Child Care Technology In the context of realignment of municipal and provincial responsibilities, MCSS is in the process of examining management information needs. A steering committee worked with MCSS staff to produce a strategic plan for the development of a child care management information system. Work included discussions with some municipalities regarding their existing municipal information systems. The recommendations of the report have provided MCSS with a number of options to consider in deciding on the scope of a future child care management information system. For example: < The possibility of automating municipal functions such as managing contracts with service providers and eligibility testing (as well as licensing at a future date). < The possibility of modifying existing municipal systems to include a standard set of data elements. < Software to extract standard data from municipal systems to a provincial database. < Linkages to the social assistance Business Transformation Project. < The possibility of automating functions where they are not already automated (e.g., smaller municipalities). January

18 There is a significant amount of work to be completed before any new system would be ready. In the interim, existing information systems will continue to be used. VII. SOCIAL HOUSING 1. Implementation Timetable The devolution of social housing will be phased in three stages. First stage: < A billing process is introduced to charge municipalities for provincial costs of social housing commencing January 1, < Except for the change in cost-sharing, the roles and responsibilities of the province, municipalities and housing providers will remain substantially the same. Second stage: < Social housing programs will be reformed to simplify administration before they are transferred to municipalities. This will require legislation. < On October 20, 1997, the Minister of Municipal Affairs and Housing announced that he accepted in principle the report of the Advisory Council on Social Housing Reform, which proposed reforms to the financing, administration and regulation of social housing in the province. < The Ministry of Municipal Affairs and Housing has established a Social Housing Committee and three Working Groups to involve municipalities, housing providers and other stakeholders in the design of program delivery and reform initiatives. < A separate consultation process on supportive housing will be undertaken. Third stage: < Administrative responsibility will be devolved to municipalities following passage of proposed legislation, program reform and development of municipal capacity. This is anticipated to take place from late 1998 to January

19 2. Potential Municipal Roles Local delivery models for social housing will follow the current reform process. As a follow-up to the recommendations of the Social Housing Advisory Council, the Social Housing Committee and Working Groups set up by the Ministry of Municipal Affairs and Housing will explore strategies for the administration of social housing by municipalities. Potential municipal roles that will be considered include: < Designing the administrative system for social housing, including client access. < Dealing with housing providers for budgets, operations, and reporting. < Ensuring that income verification processes, rent calculations, eligibility determination and access systems meet provincial requirements. < Monitoring providers and reporting to the province on compliance with federal principles and provincial standards. < Participating in mortgage default management, and bench-marking processes. Municipalities may have discretionary authority for: < Creating the organizational structure to oversee housing operations. < Achieving administrative efficiencies, possibly through greater integration of administrative functions with other income support programs, i.e., Ontario Works, child care and through use of benchmarked costs. < Managing the rent supplement contracts with housing providers. < Taking remedial action to help housing providers meet provincial requirements and local agreements. Prior to devolution, the province will establish provincial standards to: - specify roles and responsibilities, - determine levels of service, access requirements, eligibility, benefit levels, etc., - set the accountability framework for monitoring and reporting. The province will also, prior to devolution, make initial determination of market rents and bench-marking of operation costs, in consultation with municipalities. January

20 After devolution, the province will primarily be responsible for: - provincial standards, - transfer of federal monies and reporting to CMHC, - monitoring compliance with federal and provincial standards, - managing the contingent liability. 3. Implications for Consolidation Service system management responsibilities will be carried out by the same consolidated municipal service managers that will be responsible for Ontario Works and child care. How this consolidation will be implemented, and the extent of integration with these other programs, will be examined by the province and municipalities as service delivery models for social housing are developed. The Advisory Council on Social Housing Reform recommended that municipalities have flexibility, within certain parameters to be established by the province, to determine the most effective way to structure the social housing system in order to respond to local needs and priorities. There are approximately 70,000 social assistance recipients who live in RGI (rent geared to income) social housing units and they comprise one-third of the RGI households in social housing. For reasons of service coordination and administrative efficiency, municipalities may choose to rationalize delivery of the income support functions of social housing with Ontario Works and child care delivery at the local level. VIII. LAND AMBULANCE SERVICES 1. Municipal Roles and Responsibilities January 1, 1998: < Upper-tier municipalities, including regional municipalities, counties, the City of Toronto, the Municipality of Chatham-Kent, the restructured County of Oxford and the District Municipality of Muskoka, will become responsible for the funding of land ambulance services. < A two-year transition period will allow current service providers and municipalities to prepare for the full transfer of responsibility from the province to municipalities. < During this period, the delivery of services may continue to be a responsibility of the province in many areas. January

21 < Subject to Ministry of Health approval, municipalities listed above may assume responsibility for contracting with existing operators at any time prior to January 1, < Where the Ministry of Health is providing program management, service contracts with current operators will be managed by the Ministry (i.e., payment of operators, provision of vehicles and equipment) the province in turn will recover the cost of the services from municipalities. < Where an upper-tier municipality assumes early responsibility for the delivery of land ambulance service this also includes provision of funding as well as vehicles and equipment. September 30, 1999: < Municipalities must declare to the Ministry of Health their choice of service operator in preparation for the assumption of full service responsibility. < The upper-tier municipality has the option to become the service provider, continue with the existing provider, or conduct a highest quality best price proposal call. January 1, 2000: < Municipalities become responsible for all aspects of the funding and ensuring the delivery of the service including the provision of vehicles and equipment. 2. Consolidation Opportunities for Ambulance Services Ambulance services share some common attributes with both health care and emergency services. There will continue to be a natural relationship with health care facilities and professionals and with police and fire agencies. Land ambulance shares some common, and some operational features with each: Emergency services: Health facilities: Need to be available around the clock; quick response to an emergency is predicated upon a rapid response network and a high quality, wide area communication system. People oriented, focused on illness and injury, related to services of health care facilities and staff; require integration with medical control framework. Most operational functions in the delivery of land ambulance services are distinct from the operations of other emergency and health services. January

22 Some administrative functions such as human resources, purchasing services, maintenance of vehicles and equipment may be consolidated, simplified or shared with other emergency services or other health and social services. 3. Designation of Areas and Delivery Agents In Southern Ontario upper-tier municipalities will be responsible for the delivery of land ambulance services. Where there are separated municipalities within the geographic boundaries of a county, the county and the separated municipalities will need to determine among them which one will manage land ambulance services. 4. Status of Implementation A Land Ambulance Transition Team is currently reviewing proposed new regulations and transfer issues. The Ministry of Health is currently developing transfer criteria for land ambulance services and related information. IX. PUBLIC HEALTH 1. Changes in Municipal Role Public health is 100% funded by municipalities as of January 1, 1998 (with the exception of the Healthy Babies, Healthy Children program and vaccines, which will continue to be 100% provincially funded). Boards of health, which are now funded by municipalities, will be required to continue to meet province-wide public health standards. The existing guidelines have been revised and are being made available to municipalities. Municipalities have discretion to provide programs or levels of service above the provincial standards. 2. Governance Structure for Public Health Public health is governed by boards of health, with the majority of members being municipal appointees. Within regional municipalities, Regional Council acts as the board of health. January

23 3. Opportunities for Changes The Services Improvement Act allows: < With approval of the Minister of Health, additional entities (such as county councils) to become boards of health through regulation changes. Municipalities would be required to make a proposal to the ministry demonstrating how the proposed board would maintain public health standards. < The executive officer function to be assumed by someone other than the Medical Officer of Health and for the administration and business affairs of the board to not be under the direction of the medical officer. This allows opportunity for consolidation to achieve administrative efficiencies. However, staff delivering public health programs under the Health Protection and Promotion Act, or other Acts, must be under the direction of the medical officer, and the medical officer maintains responsibility for the management of public health programs and services. 4. Implications for Consolidation With the City of Toronto amalgamation, there will be 37 boards of health delivering public health programs throughout Ontario. Unlike other programs being transferred to municipalities, public health is already consolidated into fewer organizations than the approximately 50 consolidated municipal service managers required by the consolidation policy. In fact, even further consolidation of some smaller boards would create more efficient public health organizations. Due to the nature of public health service delivery and its focus on population-based strategies, economies of scale are best achieved with populations of approximately 250,000 in Southern Ontario. Some Ontario health units already include two or more counties to approach these economies. The province will consider suggestions on the best organizational models to suit local service delivery. It is possible that different structures would be more cost-effective if a range of social and health services are to be combined at the municipal level. Considerations in developing consolidation arrangements with regard to public health are: < The first step in implementation of consolidated municipal services management focuses on Ontario Works, child care and social housing to reduce the number of delivery organizations for these programs. This consolidation will provide a basis for exploring further integration of services, including public health. January

24 < If public health is to be included in a consolidation, consideration would have to be given to the impact of breaking up a public health unit into smaller units. Consolidation arrangements would need to demonstrate that programs would be delivered more efficiently and effectively than under current arrangements. X. NEXT STEPS This consolidation framework has provided municipalities with the information they require to develop consolidation arrangements for Ontario Works, child care, and social housing. Information to assist municipalities to consider further consolidation of land ambulance and public health has also been provided. Municipalities seeking further clarification of the consolidation policy or process, are invited to contact Katherine Willson of the Provincial-Municipal Services Realignment, Social and Community Health Services Implementation Project: Telephone: (416) Fax: (416) willsoka@epo.gov.on.ca Proposed consolidation arrangements should be submitted to: Mr. Barry Whalen Assistant Deputy Minister Provincial-Municipal Services Realignment Social and Community Health Services Implementation Project Ministry of Community & Social Services 56 Wellesley Street West, 12th Floor Toronto, Ontario M7A 1E9 Fax: (416) Phone: (416) January

25 Appendix 1 Consolidation Requirements and Municipalities Table 1 Southern Ontario Municipalities Management of Ontario Works and Child Care Consolidated as of January 1, 1998 Brant CO - Brantford C Bruce CO Chatham-Kent M Dufferin CO Durham RM Grey CO - Owen Sound C Haldimand-Norfolk RM Halton RM Hamilton-Wentworth RM Lambton CO Muskoka DM Niagara RM Northumberland CO Ottawa-Carleton RM Oxford CO Peel RM Toronto C Victoria CO Waterloo RM Wellington CO - Guelph C York RM Abbreviations: C City M Municipality CO County RM Regional Municipality Note: There are three counties with separated cities that have agreements for Ontario Works and Child Care (Brant, Grey and Wellington). These agreements will need to be reviewed in the light of the addition of Social Housing. January

26 Table 2 Southern Ontario Municipalities Management of Ontario Works and Child Care Consolidation Needed County Elgin Essex Frontenac Ontario Works Delivery (as of January 1, 1998) St. Thomas C Elgin CO Windsor C Essex CO Kingston C Frontenac CO Child Care Delivery (as of January 1, 1998) St. Thomas C Elgin CO Windsor C Essex CO Kingston C Haliburton Haliburton CO Haliburton CO Hastings Hastings CO Hastings CO Sidney TWP Huron Huron CO Goderich T Wingham T Tuckersmith TWP Lanark Lanark CO Lanark CO Almonte, Pakenham & Ramsay T Carleton Place T Smiths Falls T Leeds & Grenville Lennox & Addington Middlesex Perth Brockville C Gananoque T Leeds & Grenville CO Lennox & Addington CO London C Middlesex CO Stratford C Perth CO Brockville C Gananoque T Sheffield TWP London C Middlesex CO Strathroy T Wardsville V Stratford C St. Mary s T Perth CO January

27 County Peterborough Ontario Works Delivery (as of January 1, 1998) Peterborough CO Peterborough C Child Care Delivery (as of January 1, 1998) Peterborough C Prescott & Russell Prescott & Russell CO Prescott & Russell CO Rockland T Vankleek Hill T Prince Edward Prince Edward CO Prince Edward CO Renfrew Renfrew CO Renfrew CO Arnprior T Deep River T Braeside V McNab TWP Rolph, Buchanan, Wylie & McKay TWP Simcoe Stormont, Dundas & Glengarry Barrie C Simcoe CO Cornwall C Stormont, Dundas & Glengarry CO Barrie C Orillia C Simcoe CO Cornwall C Stormont, Dundas & Glengarry CO Abbreviations: C City M Municipality CO County TWP Township DM District Municipality T Town DWAB District Welfare Administration Board V Village January

28 Appendix 2 LEGISLATIVE AUTHORITY The authority for the province to require consolidation of municipal service management for social and community health services is provided by the Social Assistance Reform Act and the Services Improvement Act. 1. Social Assistance Reform Act Schedule A of the Social Assistance Reform Act is the Ontario Works Act. When proclaimed, Part III of the Ontario Works Act will: < Require the Minister of Community and Social Services to designate geographic areas by regulation for the purposes of administering Ontario Works (Section 37). < Allow the Minister to designate by regulation a municipality, band or prescribed board as a delivery agent for a designated geographic area (Section 38). < Require that, where geographic areas include more than one municipality, the municipal share of costs will be divided among the municipalities in accordance with regulations (Section 53 (1)). < Allow the Lieutenant Governor in Council to make regulations respecting the division of costs among municipalities in a designated geographic area (Section 74 (1) 38). < Allow the Minister to make regulations designating geographic areas and delivery agents (Section 74 (2) 2). < Regulations for division of costs may do one or more of the following: - authorize the municipalities in a geographic area to reach agreement on dividing costs; - provide for an arbitration process to determine division of costs; - set out a method for dividing costs (Section 74 (7)). < Regulations may also provide for an interim method of dividing costs, permit an agreement or arbitration decision to apply retroactively, and provide for reconciliation of amounts paid on an interim basis (Section 74 (8)). February

29 2. Services Improvement Act The Services Improvement Act is amending legislation that allows for changes in a number of programs affected by the realignment of provincial-municipal services. Provisions that are relevant to consolidation are included for child care, social housing, land ambulances and public health. Schedule A amends the Ambulance Act to specify the responsibilities of municipalities for land ambulance services: < Part III, Section 6 (1), provides that upper-tier municipalities will be responsible for costs of land ambulance services, and for ensuring provision of land ambulance services on January 1, 2000 (or earlier if provided for by regulation). < Part III, Section 6 (3), allows upper-tier and separated municipalities to enter into agreements regarding costs associated with ambulance services provided across their boundaries. < Part IV, Section 6.7, addresses areas that do not form part of an upper-tier municipality, and allows the Minister of Health to designate by order a municipality or an agency, board or commission established by the province as a delivery agent, and to designate the geographic area for which the delivery agent is responsible. < Part IV, Section 6.9 (2) provides that costs within a designated service delivery area will be divided among the single-tier municipalities included in accordance with the regulations. < Part VI, Section provides the Minister with powers to make regulations governing the division of costs among municipalities in different circumstances. < Regulations for division of costs may do one or more of the following: - authorize the municipalities in a geographic area to reach agreement on dividing costs; - provide for an arbitration process to determine division of costs; - set out a method for dividing costs (Section 22 (2.1)). < Regulations may also provide for an interim method of dividing costs, permit an agreement or arbitration decision to apply retroactively, and provide for reconciliation of amounts paid on an interim basis (Section 22 (2.4)). Schedule C addresses child care through amendments to the Day Nurseries Act. The amendments will: < Require the Minister of Community and Social Services to designate geographic areas by regulation for the purposes of administering child care (Section 2.1). February