Civil servants and the minister of health tried this week, sometimes in vain, to soothe local politicians' concerns about public health unit mergers.
"I want to reinforce: this is a voluntary merger opportunity to explore and consider for your communities," Health Minister Sylvia Jones said at the Rural Ontario Municipalities Association (ROMA) conference on Monday.
But one high-ranking bureaucrat admitted she doesn't know what will happen if the Tories don't see enough mergers for their liking.
"I will be very transparent. We have been asked, 'So what if?' And we have not had that conversation with government yet," said Elizabeth Walker, the executive lead of the Office of Chief Medical Officer of Health (CMOH). "To this point, it is voluntary. We're certainly encouraging, for sure."
Jones' office wouldn't commit to mergers never becoming mandatory.
Spokesperson Hannah Jensen said in a statement that “decisions to merge will be voluntary, done at the local level, where each region will make their decision based on the needs of their local community and their ability, through a merger, to connect people to more consistent and convenient care."
The Ford government wants mergers, particularly in small communities, to avoid duplication and to give rural units more "critical mass" in delivering programs — not to save money or cut services or front-line jobs, civil servants said in a Q&A session with municipal delegates at ROMA.
If there are savings, the new health units can reinvest them into programs, said Brent Feeney, also with the CMOH.
“This is not a provincial savings exercise," he said.
The province will cover the costs of the transition until March 31, 2027, and increase base public health unit (PHU) funding by one per cent per year over those three years. he said.
Delegates had concerns about what happens after.
"You've been starving us from a public health standpoint for decades," Cavan Monaghan Mayor Matthew Graham said. Mandatory programs that used to have four or five staff can now only afford one, he said.
"If you actually want the program to be mandatory, you're actually going to have to add four or five staff to a number of these departments to provide the service," he said to applause.
Graham said 87 per cent of his unit's funding goes to staffing.
“There’s not a lot of efficiencies that are gonna be generated from that other 13 per cent," he said.
Combining different health units means the "boat floats up" for whichever set of workers is paid less, added Frontenac Islands Mayor Judy Greenwood-Speers.
Some councillors worried that larger distances could mean more gaps in services for Indigenous and northern remote communities — and higher taxes if a unit absorbs unincorporated territories that don't contribute to the levy.
"That is exactly what we're trying to avoid. That's not what this is," Walker said, stressing that the ministry understands the importance of local service delivery.
Bigger health units mean bigger travel costs, Sudbury councillor René Lapierre said. His unit is in talks with Algoma's.
The trip from one end of Sudbury's unit to the tip of Algoma's is 887km one-way, he said.
"So it would take our staff ... a day to just travel to go provide service when it's required," he said. "So as we think of funding in the rural and large remote, we also have to think of travel expenses as being triple and quadruple the costs."
Health units can raise these pressures during the Ministry's upcoming funding review, Feeney said. The goal will be to stabilize funding since some PHUs get half their cash from the province and others get 80 per cent, he said.
That review will also consider whether the province can deliver more programs, Walker said.
Concerns were also raised about the timeline. Health units can submit their business proposals in April, with approvals in August. The province is aiming for mergers to happen on Jan. 1, 2025.
Even if a merger is viable — which he doesn't think it is — that's not enough time, Sioux Lookout Mayor Doug Lawrance said.
Mergers don't need to be complete by then, just "underway," said Colleen Kiel, the director of Public Health Ontario's policy, planning and communications branch.
Port Hope Mayor Olena Hankivsky got applause from the room when she asked if the province would provide funding for burnt-out health workers who will have to deal with the mergers.
The provincial funding that covers transition costs is "exactly for that," Walker said.
