Russ Ford's Blog

Will Anyone Stand Up to Toronto Public Health's Power Grab?

This week Toronto Public Health (TPH)  announced that its attempt to take control away from community agencies for speech and language services will be before the Board of Health at its July meeting.

Taking it before the Board of Health is a request LAMP  has made for more than two years. We see it as the only opportunity parents will be given to comment on the services that directly affect their children.  This is an opportunity to get this arrangement out of the back rooms and into the public domain.

Putting it on the  agenda  on  a mid summer`s afternoon  ensures that not only will it be difficult for many parents to attend, it is unlikely that all members of the Board of Health will be there too.  In making  this announcement however, a senior manager in TPH  asserted that the Board of Health really has no say and it is going just  for information purposes.  Since when has the function of the Board of Health been reduced to a ceremonial role?  The same manager told all of the providers of speech and language services in Toronto, that we would soon  be getting a letter from the province to that affect.

Sure enough  we all received a letter co-signed by the assistant deputy ministers of MOH and MCYS saying they fully support what TPH  is doing and resistance,  as Jean-Luc Picard would say, is futile whether it comes  from the providers, parents or now apparently the Toronto Board of Health as well.

I do  not know how exactly the bureaucracy at Queen`s Park works,  but to get a letter co-signed by two ADMs is highly unusual and must have taken multiple approvals.   A friend of mine referred to it as a &?%$%? and die letter.

I suppose bringing out their biggest guns would  resign all of us to the notion that the TPH`s  plan to  take resources out of the community  and then reinvest it  in their bureaucracy was a fait accompli.  No doubt it did make some feel that way.  But clearly for TPH  to bring in their biggest brothers to fight their battle, indicates that as nerve has been touched.  It indicates they know their actions cannot stand up to public scrutiny so let`s try to shut down the opposition.  We plan to continue to try to touch the nerve.

So what is this all about.  Well to begin to answer  that you first have to understand the current structure of speech and language services in Toronto.  Money for speech services comes from the Government of Ontario via MCYS. 

In Toronto,  and not in every city the money then flows to TPH  which then distributes it to four geographically based organizations.  Those four then have contracts with community service agencies like LAMP to provide services.  Added to the mix is that some  of the community based organizations and  

LAMP is one of them, have speech money coming from the Ministry of Health.  That money predates  TPH`s  involvement in the program.  LAMP has always taken the two pots of money and acted as if they are one as do many of the others who have MOH money.

TPH  has always had the role of coordinating service delivery at the city wide level.  For the vast majority of time that this program has been in operation, TPH`s performance as a coordinating body could be charitably described as largely either absent of disinterested.

That changed a couple of years ago when they  initiated an administrative review of the program.  A consultant was hired,  paid for and only reported to TPH.  His report did not comment on how TPH management had been absent  for most of the history of this project, but it concluded  the system would be best served if TPH had total control.  So to be clear, TPH hired a consultant who said TPH should have total control.  Clearly my notion of conflict of interest is very different from the one at TPH.

Needless  to say service providers were upset  not only at the outcome but the process by which the report was developed.  It went well beyond its terms of reference  and got into areas of program service and delivery.  The consultant was not a speech pathologist and neither is anyone sitting at the management table of TPH.

The management of TPH will now say it was not just an administrative review but a program review. I guess if you cannot justify a previous action, you just rewrite history.

Providers were of course upset at the lack of clinical involvement in the administrative review and many openly asked how you could change a service without consulting parents.  How do you know what is working and what is not if you do not talk to parents.  Since then and on more than one occasion TPH has said there will be parental input.  It never happened and now they are going to the Board of Health for what appears to be a ceremonial  endorsement.

So why are they acting this way.  I cannot be the one to answer that question but it is clearly contrary to the image they have tried to create for themselves.  They like to be seen as client centered ( as long as the client agrees with them) and the like to say they work in partnership with the community (but  only when the community succumbs to them).

TPH management has said there are problems in the current system with some yet to be named providers.   They argue they need the authority to bring some organizations in line.  While I do not know who these organizations are and what transgressions they have performed, there is nothing in the current structure  that would stop TPH with dealing with a non performing organization. 

But rather than do that, rather than address current issues, they are going to the tried and true bureaucratic response- change the whole system to address a few problem members.  This doesn't speak to a problem in the service delivery model , it speaks to the neglectful management of this program by TPH.  They are trying to create a crisis to promote change, yet  for the vast majority of us the program is working very well providing needed services  to families.

As for the parents these changes will result in chaos.  All of the therapeutic relationships we now have with families will end because under their plan as services will no longer be provided by LAMP.  Services may be providedin LAMP by some other organization but there is no guarantee of that and even if it is,  it  likely won`t be the same provider that is currently giving your child service.

So  LAMP and other community organizations will have to fire all of its staff.  People who have committed their lives to serving these children will be losing their jobs because TPH wants total  control.  Despite many requests TPH will not say they or the ministries involved will pay severance costs. Legally, that is our responsibility but the question is where will we get that money.  We cannot take it from other funders, they would not agree to that so are we left to fund it with donations.  Would our donors think that is a good use of their money. 

Would they continue to donate to an organization that uses its money in this fashion.  I would not.

The origin of the severance is not the only issue.  The very fact that we have to pay severance is the bigger one.  No matter who pays it, it is a tremendous waste of public money.  That is money  we will be paying  highly qualified clinical staff  not to work when the need for the service is so critical.

It is of course possible that our fired staff will be reemployed in the new model but there are no guarantees.  Even if they are, it does not negate our severance obligations.  So you could have a scenario  where we fire staff, we pay them severance and they get hired to do the same job the next day by the new lead agency. Such a waste of public money.

At its essence what we have is a backroom deal that has been struck between the staff at TPH and the staff at the ministry.  They will of course throw out the cliché of accountability.  Anytime the government wants to do something they say it is about improving accountability which of course neuters any arguments to the contrary.

But when governments use that word, it does not mean what you think it means.  Accountability really means more government control.  There is a great amount of accountability as we would define it in the current program.  But the current program allows for the use of discretion in the delivery of services to communities and that is something that governments  loathe.  Everything has to be exactly the same.  That is their real world definition of accountability.

 I think it is finally  time we exercised the demons from the Mike Harris`  government. Amalgamation was a  Harris initiative despite the fact that over 80% of Torontonians voted in a city run plebiscite against it. We know the strength of this city is based in it communities. That is how Toronto works on the ground.

Fully amalgamating speech and language services at the city level is quite different if you live in Thunder Bay or Cornwall than it is in a diverse city of 2.7 million people like Toronto.  No other program is even close to this size.

A more cost effective and responsive option would be to eliminate TPH entirely from the program.  Let MYCS contract with four or five service providers who will then contract with community based organizations in their community.  We do not need the expensive middle man.  That is money that could be used for services.

LAMP is fully committed to stopping this initiative although we acknowledge the heavy hitters  are lined up on the other side of the fence.  We will oppose it because we fundamentally believe that diverting money out of the community  to TPH is setting the stage for the further erosion  of  the funding of community based services.  Margaret Thatcher would indeed be proud of TPH right now as this is from her playbook.  All you have to do is substitute the word  Toronto for London and Thatcherism will continue  to live.

We will oppose it because it is bad for children and we believe in a democratic society parents should be given a voice. And we actually plan to give it to them.  This week we will be sending out a letter to all parents in the program asking them if they wish to express their opinions to the medical officer of health.  We will video their comments and post them on line.

At least they will get a say but at this point it is doubtful anyone is listening

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