Provincial downloading has resulted in Toronto Ambulance having to request a budget increase as part of the City of Toronto=s 1998 Operating Budget Process. This has been necessary to cover the budget shortfall created by downloading, and to allow the Department to maintain its service delivery standards.

The unification of the Metro Toronto and the six area municipal governments into one municipal government structure - and the absorption of the >Toronto Ambulance= service into it - came at the same time that the Ministry of Health was starting the process of divesting itself from the funding and operation of ambulance services throughout the province.

With Provincial downloading, all Upper Tier Municipalities (UTMs, of which Toronto is one) are now responsible for 100% of the funding of the ambulance service delivery within their regions. For Toronto, this would normally have amounted to the elimination of the annual provincial grant for ambulance service. In 1997, (Metro) Toronto=s Ambulance Service budget was $61.9 million. Of this, the Provincial grant portion was $34.892 million. Therefore, for 1998, the cost of downloading of ambulance services for the City of Toronto should have been a straight $34.892 million (there were discussions between the Province and the four regions surrounding Toronto with respect to the recovery of some of these funds through a GTA >pooling= formula, but those discussions have been put in abeyance indefinitely).

It must be noted, however, that for 1997 - and for many years preceding - the funds the Province provided Toronto=s ambulance service through formal grants did not cover the full cost of providing the service. Two main areas where Toronto Ambulance has received additional >subsidy= have been in the areas of (1) ambulance vehicles, and (2) emergency supplies and equipment. For Toronto Ambulance, these are the two major additional impact areas of Provincial downloading

Prior to 1992, funds for the yearly purchase of ambulance vehicles were drawn from the Department=s operating budget. In 1992, in response to increasing budgetary and staffing pressure which preceded and which were expected to include the government of the day=s >Social Contract=, the Ministry of Health began supplying the Department with all its ambulance vehicles. The understanding held by both parties initially was that the vehicles would be on >loan= to Metro Toronto. Therefore, it was not captured as part of Metro=s portion of our operating budget, nor as part of the Ministry=s portion of its grant funding.

The >loan= became extended from one year to the next, with the Ministry indicating each year that the arrangement was not intended to be a permanent one, and that they reserved the right to recall the vehicles at any time, with suitable notice.

The equivalent annual purchase price of the provided vehicles, based on a replacement cycle of 24 vehicles per year, is estimated at $2.500 million. This represents an amount that Toronto has, in fact then, been Asupplemented@ with for the last six years (the need for 24 replacement ambulances a year is based on a six year, repeating fleet replacement cycle).

In addition to this, the Department will also have to purchase equipment and supplies which have also been supplied to our Department, at no cost to (Metro) Toronto, over the last six years. These represent specialized types of Ministry-introduced mandatory and disposable items which are required in an ambulance, based on the Ministry=s specifications. They are equal to an amount of approximately $500 thousand per year.

There have been no formal written agreements between the Ministry and our Department regarding these vehicles and equipment. Late last year, the Ministry did advise us that, technically, they still owned the vehicles and that they might >bill= Toronto for the equivalent outstanding residual value of them. However, they have since determined that they will transfer all the vehicles to Toronto at no charge (there may be some provincial tax costs associated with the transfer, but this is still being negotiated). The equivalent value of these assets is approximately $4.5 million, a cost that the City of Toronto will not have to incur.

Below is an itemized list of the financial impacts of the province=s down-loading of ambulance services to the City of Toronto, as reproduced from our 1998 Operating Budget submission. The total additional cost for 1998 is anticipated to be about $2.5 million.

The Ministry of Health has indicated that, from 1998 and on, it will be assuming the cost of operating Toronto Ambulance=s Communications Centre. The Ministry had traditionally provided direct funding for all the Central Ambulance Communications Centres (CACCs) in the Province, except for Toronto=s. However, it had also suggested that, historically, CACC funding was built in to it=s previous grant co-funding.

Under Bill 152, the Province will retain operational control and funding of all ambulance communications centres. In Toronto=s case, it will permit Toronto Ambulance to continue the day to day operation of the centre.

The amount of funding which the Province will make available has been set at $8.0 million. Discussions between Toronto Ambulance and the Ministry of Health aimed at confirming the amount are presently taking place. This has been presented to the Budget Committee, and will form part of the Department=s final budget outcome.

The first of these is the matter of >cross border= service delivery. Under the previous >seamless= system of ambulance service delivery, ambulances in Toronto would move freely across the political borders of the surrounding GTA regions. If a Toronto ambulance was the closest resource to an emergency call in Mississauga, for example, then that ambulance would be dispatched to service the call. Cost recovery was not an issue, since the Province funded all services, either partially or wholly.

As of January 1, 1998, this is no longer the case. Since Upper Tier Municipalities are now responsible for the funding of ambulance services in their regions, any >cross border= movements are potentially billable. Bill 152, the Services Improvement Act, allows for cross border and mutual aid agreements between adjacent municipalities. This is particularly important as the Communication Centres controlling ambulance services will remain under Provincial control. Ambulances will be selected and dispatched to emergency calls based on their geographic proximity to the calls, and not on their municipal home base.

Similarly, non-Toronto ambulances also crossed into Toronto=s borders, but on a much smaller comparative scale. These calls represent a potential source of >cost recovery= revenue for Toronto, but will require the appropriate Toronto and regional officials to strike suitable cross border fee structure agreements.

Officials of Toronto Ambulance will be meeting with representatives of the four regions to discuss this issue further, with a view to establishing some form of mutually agreeable cross border billing arrangement. From there the Ministry of Health and then City of Toronto corporate representatives (e.g the CAO=s office) will need to become involved.

A second indirect impact of downloading is related to health services restructuring, and to hospital closures. This is an external >downloading= pressure on Toronto, but one which its ambulance service is expected to absorb without any increase in its resources. A significant rise in the amount of time hospitals are becoming overextended and therefore unavailable to ambulance patients is resulting in a rise in the call transport and call completion times of our service. Citizen frustration levels are also running high as patients are being diverted from >unavailable= neighbourhood hospitals to hospitals farther away.

This posed a difficulty in timing: the Department was still required to satisfy its operating needs (through the purchase of vehicles) but the formal municipal approval mechanisms were in transition. As well, the downloading liability and the necessity for a budget increase to offset it was, at the time, a good distance away from being dealt with through the new City budget procedures. In a very real sense, Toronto Ambulance got >caught= in inauspicious timing.

Downloading also had an indirect effect on Toronto Ambulance in as much as the timing of the financial impacts did not coincide favourably with formalization of new City=s governance and administrative structure. As well, indirect impacts of downloading include the need to address the matter of cross border service delivery, and the demands being placed on ambulance service by the increasing incidence of hospital closures.