By Anish Abraham
JOBURG'S emergency management services (EMS) unit may be facing a shake up. In its efforts to improve service delivery in health care, the Gauteng provincial government has decided to take over ambulance running functions from local authorities.
The local authorities, however, want the process reviewed.
In 2001 Johannesburg's fire and ambulance services were merged to form the EMS. However, fire and ambulance services continue to operate off separate budgets.
Now a mayoral committee report has put forward the pros and cons for the current integrated model the Metro uses, as well as the proposed separate service delivery model.
It states that under the Constitution, the provision of emergency medical services should fall under the provincial government, while the provision of fire brigade services is the competency of municipalities.
"Chapter 3 of the Constitution, as well as the Local Government: Municipal Systems Act of 2000, provides for co-operative governance with respect to efficient and effective service delivery by the three spheres of government."
Based on the legislation, provincial governments can use municipalities as agents to render ambulance services on a subsidy basis.
The mayoral committee report states that it will be difficult for municipalities to comply with the province's wishes as the subsidy amounts, based on provincial salary scales, are lower than those used by local authorities.
Integrated services are found in the United States; Germany, England and Australia have separate services for ambulance and fire. France and the Netherlands have reverted to an integrated service, after a period of separation.
Gauteng has proposed a Government Owned Entity model for ambulance services in which a wholly owned company has some autonomy when it comes to service conditions. It may also be a parastatal with some private shareholding.
The mayoral committee report lists the advantages of an integrated ambulance and fire service as maximising available skilled manpower and resources such as vehicles and buildings; collective response management and administration; centralised top management; co-ordinated response; co-ordinated centralised emergency communication; and facilitation of volunteer participation.
A separated service would be advantageous because of dedicated norms and standards enforcement; professional career development; and dedicated, specific budget control.
The disadvantages of a separation of services are that economy-of-scale principles and the benefits of multi-skilled services will be lost; an increase in service expenditure; response and mission times could be compromised; and there could be a decline in service levels as a result of fragmented service structures.
The City has raised several concerns, namely:
- The negative effect on service delivery;
- The City would loose out on its dual benefit qualification;
- Issues regarding staff transfers and retrenchments;
- Disposal of moveable and immoveable property;
- Going concern principle as per the Labour Relations Act;
- EMS contracts with private companies for oxygen, equipment repair and waste removal would be affected;
- A Service Level Agreement with Joburg Connect would be affected; and
- The City would have to fund an extra R57-million for its staff because of a cut in provincial subsidies.
As such, the mayoral committee report states that the Public Safety Section 80 Committee has resolved not to support the transfer of ambulance services to the province.
"There is a strong belief by all the involved municipalities that an integrated service model provides a better service than a separate service model will, and it should be retained," it states.
"However, it is not the intention of this report to ignore the order of the MEC or to refuse implementing the order, but to provide sufficient hidden facts and critical information that should be taken into consideration during the process."
Joburg's mayoral committee has since recommended consultation with all stakeholders and labour between January and February 2006, establishing a transitional structure that will be jointly managed by the City and the provincial government by March 2006, and de-link services and management by the end of June 2006.
After a policy meeting in October, the Public Health Committee said it preferred the government entity rather than the province taking over ambulance functions, as long as it was done in a way that avoided duplication and competition.
It also said the new entity should consolidate the principle of co-operative governance and maintain professional collaboration.
A technical task team that included the provincial health department, Salga, senior managers of metros and district municipalities and the department of local government should be set up, and that communication of the matter should be managed jointly.
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