Minutes - June 16, 2022 - Board of Health Meeting

Members Present: 

Mr. Matt Reid (Chair)
Ms. Kelly Elliott (Vice-Chair)
Mr. John Brennan
Mr. Selomon Menghsha (attended Virtually)
Ms. Mariam Hamou
Ms. Maureen Cassidy (arrived 7:08 p.m.)
Ms. Aina DeViet

Regrets:

Ms. Tino Kasi
Mr. Michael Steele

Others Present:

Ms. Carolynne Gabriel, Executive Assistant to the Board of Health and Communications Coordinator (Recorder)
Dr. Alexander Summers, Medical Officer of Health
Ms. Emily Williams, Chief Executive Officer
Ms. Stephanie Egelton, Executive Assistant, Medical Officer of Health and Associate Medical Officer of Health
Ms. Mary Lou Albanese, Director, Environmental Health and Infectious Diseases
Ms. Cynthia Bos, Manager, Human Resources
Ms. Ronda Manning, Manager, Early Years
Mr. David Jansseune, Assistant Director, Finance
Mr. Dan Flaherty, Manager, Communications
Ms. Lilka Young, Health and Safety Advisor
Ms. Heather Bywaters, Public Health Nurse
Ms. Nathalie Vandenheuvel, Public Health Nurse
Mr. Alex Tyml, Online Communications Coordinator
Mr. Parthiv Panchal, Information Technology, End User Support Analyst

Chair Matt Reid called the meeting to order at 7:00 p.m.

Disclosure of Conflict of Interest

Chair Reid inquired if there were any disclosures of conflicts of interest. None were declared.

Approval of Agenda

It was moved by Ms. Kelly Elliott, seconded by Ms. Aina DeViet, that the AGENDA for the June 16, 2022 Board of Health meeting be approved.
Carried

Approval of Minutes

It was moved by Ms. Mariam Hamou, seconded by Ms. DeViet, that the MINUTES of the May 19, 2022 Board of Health meeting be approved.
Carried

It was moved by Ms. Elliott, seconded by Mr. John Brennan, that the MINUTES of the June 2, 2022 Finance and Facilities Committee meeting be received.
Carried

Reports and Agenda Items

Finance & Facilities Committee Meeting – June 2, 2022 (Report No. 36-22)

This report was introduced by Ms. Elliott. Mr. David Jansseune, Associate Director, Finance was present to assist with answering any questions.

It was moved by Ms. Elliott, seconded by Ms. Hamou, that the Board of Health receive Report No. 11-22FFC, re: Information Technology Services - Asset Management for information.
Carried

It was moved by Ms. Elliott, seconded by Ms. Hamou, that the Board of Health receive Report No. 12-22FFC, re: Q1 Financial Update and Factual Certificate for information.
Carried

Verbal Governance Committee Meeting Summary from June 16, 2022

Ms. DeViet, Chair, Governance Committee provided a summary about the proceedings of the June 16, 2022 Governance Committee meeting, which had three (3) reports presented.

It was moved by Ms. DeViet, seconded by Ms. Elliott, that the Board of Health
1. Receive Report No. 10-22GC, re: “Governance By-law and Policy Review” for information; and
2. Approve the governance policies appended to this report (Appendix B) as amended.
Carried

It was moved by Ms. DeViet, seconded by Ms. Elliott, that the Board of Health receive Report No. 11-22GC, re: “2021-22 Provisional Plan Progress Update” for information.
Carried

It was moved by Ms. DeViet, seconded by Mr. Brennan, that the Board of Health strike the Performance Appraisal Committee for 2022.
Carried

Chair Reid indicated that, due to the number of Board Members unable to attend, or not yet in attendance, at the meeting, he would not invite members to express interest in joining the Performance Appraisal Committee and move to appoint the membership at this meeting. He instructed Ms. Carolynne Gabriel, Executive Assistant to the Board of Health, to email members of the Board of Health to solicit interest for membership in the Performance Appraisal Committee and, in doing so, adhere to the Terms of Reference for the Committee in beginning the work of the Committee in a timely manner.

Ms. DeViet provided a summary of the proposed changes to the Board of Health By-law #3 and indicated that these changes would provide flexibility for members of the Board to attend meetings virtually or in person.

It was moved by Ms. DeViet, seconded by Ms. Maureen Cassidy, that the Board of Health By-law #3 be now read for the first time.
Carried

It was moved by Ms. Elliott, seconded by Mr. Brennan, that the Board of Health By-law #3 be now read for a second time.
Carried

It was moved by Ms. Hamou, seconded by Ms. DeViet, that the Board of Health By-law #3 be now read for a third time and adopted.
Carried

Middlesex-London Health Unit Be Well Program Update (Report No. 37-22)

This report was introduced by Ms. Emily Williams, CEO who introduced Ms. Cynthia Bos, Manager Human Resources. Ms. Bos introduced Ms. Lilka Young, Health and Safety Advisor who is co-chair of the Be Well Committee.

Highlights of this report included:

• In response to the COVID-19 pandemic, the Be Well Committee pivoted to virtual programming in order to keep staff engaged in its programming. As MLHU staff begin returning to the office in a hybrid model, Be Well will continue offering hybrid programming.
• Examples of programs provided by Be Well include: live virtual exercise classes, which were also recorded and made available on the Be Well website for staff to view when convenient; access to fitness videos on demand through Employee Wellness Solutions Network (EWSN); mental health workshops through Homewood Health, MLHU’s employee and family assistance program (EFAP); nutrition sessions; group blood donations; and monthly virtual coffee breaks, which provide an opportunity for staff to gather virtually on Microsoft Teams and play games or have discussions.
• The EFAP program has been promoted frequently through townhalls and usage has seen an uptake in both telephonic counselling and proactive programming.
• The organization will continue to solicit feedback from staff on Be Well programming and incorporate the feedback into program offerings.

Ms. Hamou inquired if there were supports for those cycling to work. Ms. Young outlined the following:

• Staff with a parking pass at Citi Plaza also have access to a secure bike cage located in the parking garage.
• Staff without a parking pass at Citi Plaza can receive an access pass to the secure bike cage subsidized completely by Be Well. Those who would prefer to take the bus can submit for $20.00 per month subsidized by Be Well.
• These options and local cycling infrastructure were promoted by Be Well on townhalls and through Wellness Wednesday emails.
• Showers are available in the MLHU’s basement at Citi Plaza.

Ms. Cassidy inquired about the participation rate of the survey outlined in the report and whether it was indicative of staff participation in Be Well programming. Ms. Young indicated that the survey was a new personal health assessment tool which was promoted to staff but participation in which is completely voluntary.

Ms. Cassidy inquired how Ms. Young would gauge overall participation. Ms. Young indicated that because Be Well provides such a variety of different activities, it is hard to speak to participation rates as some staff prefer passive activities such as reading articles, while others prefer more active, social activities like exercise classes and virtual coffee breaks. The testimonials included in the report speak to feedback provided to Be Well expressing appreciation for Be Well, especially during the pandemic.

Ms. DeViet commented on the utilization rate for Homewood Health included in the report, noting that it exceeds the 20 per cent originally budgeted. She commented that this increased use indicates that staff are comfortable requesting help when they need it, but inquired how exceeding the contracted 20 per cent affects the organization and the contract. Ms. Bos responded that MLHU’s contract with them elapsed during the pandemic and Homewood Health renewed the contract at the same rate without another request for proposal. The cost in the contract is based on the number of potential users. Given the increase in staffing, it is expected that the contract will be more next renewal.

It was moved by Ms. Hamou, seconded by Ms. Cassidy, that the Board of Health receive Report No. 37-22 re: “Middlesex-London Health Unit (MLHU) Be Well Program Update” for information.
Carried

Joy In Work Update (Report No. 38-22)

This report was introduced by Ms. Emily Williams, CEO who shared a PowerPoint presentation.

Highlights of this report included:

• Burnout has taken a toll on MLHU staff and leaders.
• Leadership turnover has increased at MLHU with leaders citing heavy workload, struggles with work-life balance, and stress as contributing factors to their decision to leave the organization.
• Burnout negatively impacts staff engagement and subsequently client experience, quality, and safety.
• Supporting staff to deliver public health services while addressing staff well-being and mental health was made a strategic direction within the provisional strategic plan. Initiatives have included regular communications through townhalls, enhanced mental health benefits, and implementing the Joy In Work framework.
• The Joy In Work Framework will address the priorities of developing strategies to mitigate or address staff stress and/or burnout and executing a plan to value and recognize staff contributions in all MLHU programs, including opportunities to enhance staff connectedness and belonging.
• Joy In Work is a framework developed by the Institute for Healthcare Improvement. The framework includes the drivers found to improve Joy In Work as well as a high-level methodology for engaging staff in discussion. The tool serves as a conversation guide with staff. Staff must define “joy in work” for themselves. Staff engage in identifying what makes a good day at work and what impedes them from having a good day at work, and that feedback is refined into action items for implementation, which are then subject to daily improvement and real-time measurements to determine whether the interventions are having a positive impact.
• The framework has seven (7) main domains and two (2) methodology domains for quality improvement. The seven (7) main domains are: physical and psychological safety, meaning and purpose, choice and autonomy, recognition and rewards, participative management, camaraderie and teamwork, and wellness and resilience. Improvement in all domains has been shown to improve joy in work.
• Steps to date to solicit feedback to inform mitigating staff burnout include: a staff survey which yielded fifty-four (54) recommendations related to organizational and individual wellness and sustaining positive organizational changes; intentional debriefing sessions with a third-party consultant and members of the leadership team which used the Joy In Work framework as a guide; “all feelings welcomed” session offered to staff during the Omicron wave and facilitated by a psychotherapist-trained leader within the organization; and structured and formal debriefing sessions offered to leaders through Homewood Health. All this feedback was mapped to the Joy In Work framework and validated by the leadership team.
• The Senior Leadership Team (SLT) determined that the leadership team (MLT) would be the first cohort to engage in the Joy In Work framework because leaders have significant influence over their direct reports’ levels of engagement. Multiple sessions with the leadership team were held to clarify and theme the feedback received to align with the domains of the framework. This resulted in a comprehensive list of action items which would improve joy in work for leaders at MLHU. Directors worked with their divisions to further define approaches for engagement of leaders in each of the action items and to clarify realistic timing for implementation to ensure the required work does not further contribute to burnout. This resulted in a 12-month work plan.
• The Joy In Work framework will be rolled out to all staff in September.

It was moved by Ms. Elliott, seconded by Ms. DeViet, that the Board of Health receive Report No. 38-22, re: “Joy in Work Update” for information.
Carried

Implementation of the Early Years Outreach (EYO) Initiative (Report No. 39-22)

This report was introduced by Dr. Alexander Summers, Medical Officer of Health, who introduced Ms. Jennifer Proulx, the Acting Director for Healthy Start for the remainder of the year as Ms. Heather Lokko is seconded to the Chief Nursing Officer position full time.

Ms. Proulx introduced Ms. Ronda Manning, Manager, Early Years Community Health Promotion team. Ms. Manning thanked the Board for the opportunity to provide an update on the implementation of the Early Years Outreach Initiative. She then introduced Ms. Heather Bywaters, Public Health Nurse and Ms. Nathalie Vandenheuvel, Public Health Nurse.

Highlights of this report included:

• The relationship, experiences, and environment for children in their early years impacts their development long into adulthood. The protective factors in early years can improve the trajectory for them throughout their lives and for society as a whole. Childcare centres are key environments for early year development.
• It was identified that childcare providers needed more support during the pandemic. This led to the introduction of the Early Years Outreach Initiative.
• One activity of the initiative is an Early Years Outreach email which made it easier for early childhood educators to contact the Health Unit with questions. COVID-19 was a prominent topic, but questions were also received about child abuse, appropriate food, child development, etc.
• Another activity was the Childcare Educators webpage which provided a single location for information specific to early childhood educators as opposed to some information being included on webpages meant for schools.
• An e-newsletter was also developed and sent out monthly in both English and French. Alerts were sent out as needed as well as.
• An additional outcome from these initiatives is increased direct contact with childcare centres which has resulted in increased invitations to join community discussions.

Ms. Cassidy commented that there has been much dialog at City Hall about childcare, especially since the announcement of the National Child Care Strategy. It is anticipated that demand for childcare centres will increase when the funding comes into effect; however, it is unknown if there are sufficient childcare spaces in London to meet that demand. Similar to the health care field, early childhood educators have also been leaving the industry over the course of the pandemic. Ms. Bywaters indicated she has attended several meetings which have discussed this issue. She commented that early childhood educators are leaving the industry, and this has been exacerbated after the National Child Care Strategy was signed because they were expecting recognition as vital frontline workers and this did not happen. If they do not get more support and investment, early childhood educators could continue to leave the industry. London and Middlesex County have increased financial support for childcare centres; however, this means they will not get as much support through the National Child Care agreement. There is a lot of pressure for childcare centres to sign onto the agreement, but some are unsure.

Ms. Bywaters commented that she is grateful to be working in London and Middlesex because there is a network in London which provides advocacy as well as a recruitment and retention group in the county. MLHU is involved with both to provide support.

Ms. Elliott commented that Middlesex County falls well below the provincial average for licensed childcare sports. As a result, unlicensed and home daycares are used more. She inquired if any outreach to unlicensed providers had been done to provide them with information and add them to the e-newsletter distribution list. Ms. Bywaters responded that when the Early Years Initiative was started, the goals were kept small due to the size of the team. Outreach to unlicensed and home daycares has been identified as a next step of the initiative. COVID-19 prevented the team from conducting outreach in the community. Such outreach can be important for reaching unlicensed places as some do not like to be known to the Health Unit because they are unlicensed. Ms. Vandenheuvel added that word of mouth through community partnership meetings has resulted in some unlicensed centres signing up for the e-newsletter.

It was moved by Ms. Elliott, seconded by Ms. Cassidy, that the Board of Health receive Report No. 39-22, re: “Implementation of the Early Years Outreach (EYO) Initiative)” for information.
Carried

FoodNet Canada Ontario Sentinel Site Update and Memorandum of Agreement (Report No. 40-22)

This report was introduced by Ms. Mary Lou Albanese, Director, Environmental Health and Infectious Diseases.

Highlights of this report included:

• The Middlesex-London Health Unit has been involved with FoodNet Canada since 2014 and is the Ontario sentinel site. British Columbia, Alberta, and Quebec also have sentinel sites.
• The goal of the program is to monitor enteric illnesses and their associated risks. The program includes testing retail food, sampling manure and surface water, and following up with human cases. MLHU participates in all but manure sampling.
• MLHU is moving forward with renewing the memorandum of understanding for another two years. The partnership has been productive. An example is the investigations into human outbreaks of salmonella. It was determined that frozen chicken nuggets which were not fully cooked were the source of the salmonella. This evidence was presented to the Federal Government, and it is now required that the product has been fully cooked in order to be sold.

It was moved by Ms. Cassidy, seconded by Ms. Hamou, that the Board of Health receive Report No. 40-22, re: “FoodNet Canada Ontario Sentinel Site Update and Memorandum of Agreement” for information.
Carried

Verbal COVID-19 Disease Spread and Vaccine Campaign Update

This verbal report was presented by Dr. Summers. Highlights included:

• COVID-19 data continues to show a persistent decline although wastewater data is denoting an increase. Due to immunization coverage and natural immunity, which have decoupled severity of outcomes from the number of cases, hospitalization and ICU numbers continue to decline.
• The number of reported cases reflect the numbers seen in July of last year; however, in July 2021 testing eligibility was much more broad so the numbers cannot be directly compared, but they are showing a persistent decline.
• With warmer weather limiting indoor activities as well as high immunization rates and natural immunity, the rate of COVID-19 and risks are likely to be as low as they will ever be.
• COVID-19 is endemic, but its impact on the healthcare system will likely be less than in the past. It is likely that COVID-19 will be seasonal in the future along with influenza; how the healthcare system and society adjusts to this remains to be seen.
• With the shift into summer and being mindful that rates and risks are as low as they are likely to get, MLHU has changed its recommendations on masking. Universal masking is still recommended in high-risk settings such as healthcare settings, clinical spaces, and facilities with immunocompromised individuals. Universal eye protection is not required at this time.
• In the community, masking is becoming a personal decision relative to an individual’s risk. Masking remains protective, but given the low rates of COVID-19, it is a personal choice. Vaccination remains the best way to reduce personal risk to adverse outcome from COVID-19.
• Businesses may continue to require masking, and this should be respected.
• When autumn comes or a new variant rises, masking recommendations may need to be altered.
• At MLHU, internal policies have been aligned with community recommendations. Medical masks are still required in clinical spaces, but masks are optional in non-clinical spaces. Active screening of all staff and clients remains required.
• Vaccination efforts continue. It is anticipated that there will be a fall booster campaign in which MLHU will play a significant role along with pharmacies and primary care providers. The timeline for second booster doses for those under the age of 60 is not yet clear but is not anticipated during the summer unless there is a new variant or a change in trends. The timeline for vaccinations for those under the age of five is unclear. Moderna has submitted an application to Health Canada.
• MLHU plans on having the capacity to meet the anticipated vaccination needs in the fall and winter, as outlined in Report No. 29-22, “MLHU 2022 Infectious Disease Control Operational Update.”

Ms. Cassidy inquired if the wastewater data is a lagging indicator. Dr. Summers replied that in the Middlesex-London region, the wastewater data has historically followed the case trends, this is not happening now, likely due to the decoupling of the number of cases from those cases which are severe enough to require testing, hospitalization, and ICU admission. Wastewater data needs to be contextualized by other indicators as it can be affected by natural factors such as drought or heavy rains.

Ms. Cassidy inquired if Dr. Summers anticipates new variants of concern will increase locally due to the increase in international travel. Dr. Summers responded that the variants currently being seen in Ontario are sub-lineages of the Omicron variant. What these sub-lineages mean for the population is not yet clear, although it is likely that some variants may increase the risk of re-infection. At this time, a truly new variant which will completely change the population response due to immune variation has not been detected. Travel does affect the mixing of populations across the globe so hypothetically the risk of new variant spread could go up; however, travel restrictions are only effective if they are a true lockdown. Restrictions at a softer level have not appeared to impact the spread of new variants.

Ms. Cassidy inquired if there is any indication of a change in the rate of childhood vaccination. Prior to the pandemic there had been an increase in vaccine hesitancy among parents. Are parents more willing due to COVID-19? Dr. Summers responded that prior to the pandemic the Middlesex-London community continued to see a fairly robust vaccine uptake. There is a lack of a comprehensive vaccine registry prior to children attending school. There is currently such a register for the COVID-19 vaccine but not for other childhood vaccines. This lack of a comprehensive registry for children under the age of five is a gap. With regards to whether vaccination rates in children have increased, it is too early to say. There has been little opportunity to update vaccination information as a Health Unit and families have not had as many opportunities to get vaccinated. MLHU has been screening every child enrolled in schools in the region to determine if their vaccines are up to date, and if they are not, letters are being sent to provide parents with an opportunity to submit vaccine records or to have children vaccinated at “catch-up clinics.” There has been tremendous response to these letters with the “catch-up clinics” being fully booked. Additionally, in the next school year, the Health Unit can use the Immunization Schools Pupil Act to suspend those who do not have the required vaccinations. MLHU is one of a few Health Units which has had the capacity to do this work during the COVID-19 pandemic.

Ms. DeViet inquired if the second booster dose, anticipated to be available in the fall for the general public, would provide protection against any future variant which may arrive in Ontario. Dr. Summers indicated that the fall booster dose campaign could go in one of two directions. If the predominant variant continues to be Omicron and Omicron-specific vaccines have been approved, those vaccines would be provided during the campaign. Otherwise, existing vaccines will be provided. Existing vaccines provide some protection against Omicron and much better protection against severe outcomes. While they were originally developed to protect against the Alpha strain, they have been effective against the subsequent strains, so existing vaccines could be effective against any future variants as well.

Ms. DeViet commented that she knows individuals who are eligible for a second booster dose but who have not received it yet because it is summer and they want to put it off until the fall when there is potentially higher risks. She inquired what Dr. Summers advise would be. Dr. Summers indicated that he continues to advise that those who are eligible get the vaccine when they become eligible. COVID-19 is still in the community and if individuals wait to get the vaccine, they are still at risk during that delay. Those who are eligible are so because they are at a higher risk of severe outcomes and so should be up to date with their vaccines.

It was moved by Ms. Cassidy, seconded by Ms. DeViet, that the Board of Health receive the Verbal update re: “COVID-19 Disease Spread and Vaccine Campaign” for information.
Carried

Medical Officer of Health Activity Report for May (Report No. 41-22)

This report was introduced by Dr. Summers. In addition to the content of the report he apprised the Board that as of two days ago, he is now the COMOH Representative, South West Region.

It was moved by Mr. Brennan, seconded by Ms. Hamou, that the Board of Health receive Report No. 41-22 re: “Medical Officer of Health Activity Report for May” for information.
Carried

Chief Executive Officer Activity Report for May (Report No. 42-22)

This report was introduced by Ms. Williams. In addition to the content of the report she apprised the Board that the collective agreement negotiated with CUPE has now been ratified.

It was moved by Ms. Cassidy, seconded by Ms. Elliott, that the Board of Health receive Report No. 42-22 re: “Chief Executive Officer Activity Report for May” for information.
Carried

Correspondence

No correspondence was received in May.

Other Business

The next meeting of the Middlesex-London Board of Health is Thursday, July 14 at 6:00 p.m.

Confidential

At 8:17 p.m., it was moved by Ms. Elliott, seconded by Ms. Cassidy, that the Board of Health will move in-camera to approve previous confidential Board of Health minutes, and to consider matters regarding personal matters about an identifiable individual, including municipal or local board employees, labour relations or employee negotiations, and litigation or potential litigation, including matters before administrative tribunals, affecting the municipality or local board.
Carried

At 8:24 p.m., it was moved by Ms. Elliott, seconded by Ms. DeViet, that the Board of Health rise and return to public session.
Carried

Adjournment

At 8:25 p.m., it was moved by Ms. Elliott, seconded by Ms. Cassidy, that the meeting be adjourned.
Carried

Matt Reid
Chair

Emily Williams
Secretary