TAMRMS#: B06
10.3
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Alberta Health Services - Provision of EMS Services
Presented by: Everett Cooke, Director (Fire Chief), Emergency Services
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RECOMMENDED MOTION(S)
recommendation
That the CAO be authorized to execute an agreement between the City of St. Albert and Alberta Health Services for the continued provision of EMS ground ambulance services for a term of up to 5 years, including renewals, on terms and conditions acceptable to the CAO.
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PURPOSE OF REPORT
To provide Council information related to recent contract negotiations with Alberta Health Services and to authorize the CAO to execute the agreement proposed by Alberta Health Servies.
BACKGROUND AND DISCUSSION
History
The City of St. Albert has provided pre-hospital care for residents since 1977. On April 1st, 2009, Alberta Health Services (AHS) assumed this responsibility throughout the Province of Alberta. This responsibility led to the consolidation of 12 separate health entities into one authority. As a part of this endeavor, AHS acquired the necessary staff and equipment to deliver services, creating three centralized dispatch centers providing stand alone medical dispatch, while contracting several fire services to continue delivering EMS services within their respective communities.
The City of St. Albert is one of seven municipal fire services still under contract to deliver these services.
Since 2009, the City of St. Albert has entered two service contracts with AHS. The first was signed in 2009 and the second in 2014. As required, St. Albert has agreed to multiple contract extensions addressing lapses in contractual timelines, while ensuring local service delivery to residents.
Negotiations
In mid 2022, AHS announced their desire to enter negotiations on what would be St. Albert’s third service contract. Negotiations commenced nearly a year later with the delay resulting in further contract extensions.
Although there was a gap between AHS’s announcement and the commencement of negotiations, dialogue continued between the seven fire services and AHS, resulting in all parties committing to partner on the delivery of pre-hospital care in our areas.
St. Albert and AHS met in Q2 of 2023 to formally begin contract negotiations. Department representatives from the City of St. Albert included Fire Services, Human Resources, Legal, and Finance.
Prior to meeting with AHS, Fire Administration identified four priorities which have remained the focus of discussions throughout the entire process:
• Staff wellbeing
• Local service delivery
• Long term contract
• Remuneration
Representatives from both St. Albert and AHS met on multiple occasions; however, it was clear by September 2023 that negotiations were ineffective as little to no advancement on a new agreement had been made. On September 11, 2023, a letter outlining conditions of a new long-term agreement was received by St. Albert from AHS, with a request to return a written response of our acceptance, by September 15th. No response was provided.
Shortly after receiving AHS’s letter, several Chief Administrative Officers representing the integrated services met with Andy Ridge, Assistant Deputy Minister and Chris Nickerson, then Executive Director, Health System Planning, with Alberta Health, to discuss current negotiations and the need for a more partnership-based, collaborative approach. All participants were in agreeance and soon after, the Government of Alberta (GOA) announced changes to the structure of Alberta Health Services and the creation of the new Acute Care Division. Negotiations began again in November 2023 with a representative from Alberta Health now at the table.
During this second round of negotiations, which started in late November, movement did occur with regards to the term of the contract, seven years with a three-year extension option. Also, discussions on how new Interfacility Transfer (IFT) contracts, being signed with other third-party providers, would assist in reducing St. Albert resources being utilized outside of our City as often.
On February 28, 2024, the City of St. Albert was notified that the due to circumstances relating to the reorganization of Alberta Health Services and the creation of the new Acute Care Division, the term of the new contract would only be two and half years expiring September 2026; no extension would be included in this new contract. Since this time, much lobbying has occurred and although the contract term will remain, an extension of two and a half years has now been included, although there is no guarantee of this option being exercised by AHS.
Proposed Contract
The current version of the contract includes the following terms:
• 2.5 year term (April 1, 2024 - September 30, 2026) with an option for AHS to extend another 2.5 years
• Creation of a Governance Committee to meet and discuss matters related to response, resourcing, and service delivery
• Language relating to AHS having the first right of refusal to purchase St. Albert assets at the end of the term
• Increase to per ambulance funding
As presented, this agreement lacks the improvements sought which would focus on the well-being of staff. Further, this agreement will result in the full integration of City resources into the System Status Management (SSM) system developed by AHS. While this borderless system focuses on delivering exceptional patient care, participating agencies that fail to achieve required staffing levels will increase the demand placed on other providers, leading to resources being drawn out of their communities.
The provision of providing pre-hospital care is identified in St. Albert’s Service Level Inventory guide. In efforts to provide this level of service, the City maintains a fleet of four ambulances with the necessary equipment, while over 80 firefighters are registered Paramedics with the Alberta College of Paramedics (ACP). When a paramedic is not assigned to an ambulance, their medical skills are utilized on Medical First Response (MFR) responses.
STAKEHOLDER COMMUNICATIONS OR ENGAGEMENT
N/A
IMPACTS OF RECOMMENDATION(S)
Financial:
After completing an all-in cost analysis of the City of St. Albert’s ambulance service, the proposed contract of $3.4 million results in an estimated net increase of $600 thousand in additional contract revenue as compared to the prior contract of $2.8 million. This agreement will reduce the annual short fall to approximately $616 thousand however this deficit is projected to increase with the addition of new capital assets and the ratification of the collective bargaining with IAFF. Further, the contract provided by AHS caps the Annual Consumer Price Index (CPI) at a maximum of 3%, which in the future may contribute to an expanded deficit.
Compliance & Legal:
Council Policy C-CAO-01 (CAO Delegations) permits the CAO to enter into revenue contracts provided the anticipated annual revenue to the City does not exceed $100,000. The expected annual revenue in the AHS agreement would exceed $100,000; therefore, Council approval is required to enter into a new agreement.
Approval to proceed with this contract ensures that the City of St. Albert will continue to provide services until September 2026 or, such time as the 2.5 year extension is exercised or a new longer-term contract can be negotiated and executed.
Program or Service:
None at this time.
Organizational:
The proposed contract provides only short-term certainty to the City of St. Albert. By not delivering the confidence of a long-range contract, considerations must be given to the procurement of replacement ambulances and equipment as well as the hiring of any
additional staff for the City’s forthcoming new fire hall. As the City is currently over-hired in preparation for Station 4, care must be given to balance operational needs to reduce the impacts to current staff while meeting intended future staffing levels.
In efforts to provide this level of service, the City maintains a fleet of four ambulances with the necessary equipment, while over 80 firefighters are registered Paramedics with the Alberta College of Paramedics (ACP). When a paramedic is not assigned to an ambulance, their medical skills are utilized on Medical First Response (MFR) responses.
Risks
Should the City of St. Albert no longer be required to provide pre-hospital care, that responsibility will reside solely with AHS and be delivered in a manner determined by that organization. This may result in service delays, an increased demand on the City’s MFR program and a loss of situational awareness for the City.
ALIGNMENT TO PRIORITIES IN COUNCIL’S STRATEGIC PLAN
N/A
ALIGNMENT TO LEVELS OF SERVICE DELIVERY
The provision of providing pre-hospital care is identified in Section 5.3.1 Emergency Medical Services, of St. Alberts Service Level Inventory guide.
ALIGNMENT TO COUNCIL DIRECTION OR MANDATORY STATUTORY PROVISION
On April 2, 2024, Council passed the following motion:
AR-24-150
That the CAO be authorized to execute a bridging agreement for up to 45 days between the City of St. Albert and Alberta Health Services for the provision of EMS ground ambulance services, on terms and conditions acceptable to the CAO.
IMPACTS OF ALTERNATIVES CONSIDERED
Council may consider the following alternatives:
1. That Council move in camera to discuss a matter pursuant to sections 24(1)(a), 25(1)(c)(iii), and 27(1)(a) of the Freedom of Information and Protection of Privacy Act.
The above noted motion may be used by Council to move in camera to discuss matters related to the contractual negotiations between the City and AHS, labour matters, as well to receive legal advice related to the terms of the new contract.
2. That the City of St. Albert does not enter into a new agreement with AHS for the provision of ground ambulance services and proceed to transition away from providing the services in accordance with the terms of the expired agreement.
The above noted motion may be used if the City of St. Albert elects not to enter into the proposed agreement. In this case, the City would be in a contractually mandated transitional period for 180 days allowing AHS to put in place a service model deemed appropriate to deliver services within St. Albert.
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Report Date: May 7, 2024
Author(s): Everett Cooke
Department: Emergency Services
Department Director: Everett Cooke
Managing Director: Diane McMordie
Chief Administrative Officer: Bill Fletcher