Accountability: Understanding the effect of governance structures on land ambulance services in Ontario, connected by Consolidated Municipal Services Management (CMSM) agreements

Ontario has seen significant changes across the municipal landscape, including the realignment of service responsibilities. One of the products of this realignment was the introduction of the CMSM program in 1998, which saw local municipalities take on the responsibilities for many services, including land ambulance. Land ambulance is an important life-saving service (Aringhieri et al. 2017). Decision-makers must ensure that such services must be delivered with optimal performance. As a public service in Ontario, this includes democratic performance. Crucial to the anchorage of democratic performance is accountability. Accountability is a transaction of information, dialogue, and rewards/sanctions (Brandsma and Schillemans 2012). It is an important component of democracy. While much attention has been paid to accountability at the provincial and federal levels, there is a growing body of research into accountability at the local level (Spicer 2017; Arnbuckle 2018). This study aims to contribute to this growing body of literature by considering the vital service of land ambulance and the unique institutions of city-county separation along with the imposed CMSM program. By asking the question “In areas where city-county institutions are established, to what extent is the accountability gap in land ambulance services agreements effected by the governance model of the service provider”, this study contributes to the empirical data around accountability, inter-municipal agreements, and SPBs. Through a quantitative test and description, this paper first quantifies the extent of accountability in 13 city-county services, confirming that while land-ambulance services generally perform well, governance structures do correlate with improved performance. Additionally, using a comparative case study, this study qualitatively describes the findings in two similar municipalities with different governance structures, supporting the GAT findings and describing how municipalities can improve their accountability. In sum, this paper finds that in the 13 agreements/services studied, SPB governance structures have superior performance to direct and contract delivery. However, partnerships that have or can produce annual reports, create clear complaints processes, establish joint committees (or boards) with representation from all partner municipalities, do correlate with a strong performance in accountability