Minutes - September 21, 2023 - Board of Health Meeting

Members Present: 

Matthew Newton-Reid (Chair)
Michael Steele (Vice-Chair)
Selomon Menghsha
Skylar Franke (attended virtually)
Michelle Smibert
Aina DeViet
Emily Williams, Chief Executive Officer (ex-officio)
Dr. Alexander Summers, Medical Officer of Health (ex-officio)

Regrets:

Peter Cuddy
Tino Kasi
Michael McGuire

Others Present:

Carolynne Gabriel, Executive Assistant to the Medical Officer of Health (recorder)
Sarah Maaten, Director, Office of the Medical Officer of Health
Mary Lou Albanese, Director, Environmental Health and Infectious Disease
Jennifer Proulx, Acting Director, Healthy Start
Dr. Joanne Kearon, Associate Medical Officer of Health
Cynthia Bos, Manager, Human Resources
Marc Resendes, Acting Manager, Strategy, Planning and Performance
Alison Locker, Manager, Population, Health, Assessment and Surveillance
Shaya Dhinsa, Manager, Sexual Health
Donna Kosmack, Manager, Oral Health
Warren Dallin, Manager, Procurement and Operations
Emily Van Kesteren, Acting Manager, Communications
Lilka Young, Human Resources Advisor, Health & Safety
Morgan Lobzun, Communications Coordinator, Communications
Alex Tyml, Online Communications Coordinator, Communications
Parthiv Panchal, End User Support Analyst, Information Technology

Chair Matthew Newton-Reid called the meeting to order at 7:00 p.m.

Chair Newton-Reid read a statement from the Middlesex-London Health Unit regarding support for the LGBTQ2S+ community.

Chair Newton-Reid announced that Michael Steele has been re-appointed to the Board of Health for another three years.

Sarah Maaten introduced Marc Resendes, Acting Manager, Strategy, Planning and Performance.

Disclosure of Conflict of Interest

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

Approval of Agenda

It was moved by Aina DeViet, seconded by Michelle Smibert, that the AGENDA of the September 21, 2023 Board of Health meeting be approved.
Carried

Approval of Minutes

It was moved by M. Smibert, seconded by Selomon Menghsha, that the MINUTES of the July 20, 2023 Board of Health meeting be approved.
Carried

It was moved by M. Steele, seconded by A. DeViet, that:
• the MINUTES of the July 20, 2023 Performance Appraisal Committee meeting be received,
• the MINUTES of the July 20, 2023 Governance Committee meeting be received,
• the MINUTES of the August 10, 2023 Finance and Facilities Committee meeting be received, and
• the MINUTES of the September 14, 2023 Finance and Facilities Committee meeting be received.
Carried

New Business

Finance and Facilities Committee Meeting Summary (Report No. 49-23)

M. Steele provided this report.

It was moved by M. Steele, seconded by S. Menghsha, that the Board of Health receive Report No. 10-23FFC re: “2023 Q2 Financial Update and Factual Certificate” for information.
Carried

It was moved by M. Steele, seconded by A. DeViet, that the Board of Health receive Report No. 11-23FFC re: “City of London Budget: Assessment Growth Proposals” for information.
Carried
It was moved by M. Steele, seconded by M. Smibert, that the Board of Health receive Report No. 12-23FFC re: “Annual 2022 Surplus – Alternate Use” for information.
Carried

It was moved by M. Steele, seconded by S. Menghsha, that the Board of Health approve that the municipal portions of 2022 surplus funds be applied as payment on the Middlesex-London Health Unit’s variable loan.
Carried

Regarding the recommendation for staff to engage in required proceedings with the City of London and County of Middlesex to enable surplus funds to be redirected for payment of the Health Unit’s variable loan, Skylar Franke inquired what would happen if the Board of Health approves the motion but the City and County Councils do not agree to the redirection. Emily Williams, CEO advised that MLHU staff will follow the process provided by the City and County, which is as of yet unknown. If the City and County are not supportive, this information will be brought back to the Board of Health for direction.

It was moved by M. Steele, seconded by M. Smibert, that the Board of Health direct staff to engage in required proceedings with the City of London and the County of Middlesex to enable surplus funds to be redirected to the Canadian Imperial Bank of Commerce (CIBC) for payment to the Health Unit’s variable loan in the following amounts: City of London: $611,898 and The County of Middlesex: $116,552.
Carried

It was moved by M. Steele, seconded by M. Smibert, that the Board of Health direct staff to prepare a briefing note for the County of Middlesex and City of London Council regarding the alternate use of municipal surplus funds.
Carried

M. Steele advised the Board of Health that the Middlesex-London Health Unit works under two separate financial structures: MLHU1 and MLHU2. MLHU1, as partially funded by the municipalities, operates on the municipal fiscal year of January to December. MLHU2 consists of four (4) programs which are fully funded at the provincial level and operate on their fiscal year of April to March. As a result, they are reported separately and the auditing process for MLHU2 takes three (3) months longer to complete. Therefore, their audited financial statements are presented at this meeting.

It was moved by M. Steele, seconded by A. DeViet, that the Board of Health approve the audited Financial Statements of Middlesex-London Health Unit for programs ended March 31, 2023.
Carried

It was moved by M. Steele, seconded by M. Smibert, that the Board of Health receive Report No. 14-23FFC re: “2023 Funding Update” for information.
Carried

It was moved by M. Steele, seconded by M. Smibert, that the Board of Health receive Report No. 15-23FFC re “2023 Financial Update” for information.
Carried

Governance Committee Meeting Summary from September 21, 2023 (Verbal)

This report was presented by M. Smibert.

It was moved by M. Smibert, seconded by M. Steele, that the Board of Health receive Report No. 08-23GC re: “Board of Health Member Self-Assessment - 2023” for information.
Carried

It was moved by M. Smibert, seconded by S. Menghsha, that the Board of Health:
1) Approve the Board of Health Member Self-Assessment Tool as Appendix A; and,
2) Direct staff to initiate the Board of Health Member Self-Assessment for 2023.
Carried

It was moved by M. Smibert, seconded by S. Franke, that the Board of Health:
1) Receive Report No. 09-23GC re: “Governance Policy Review” for information; and,
2) Approve the governance policies as amended in Appendix B.
Carried

It was moved by M. Smibert, seconded by A. DeViet, that the Board of Health:
1) Receive Report No. 10-23GC re: “MLHU Q2 2023 Risk Register” for information; and,
2) Approve the Q2 2023 Risk Register (Appendix A).
Carried

It was moved by M. Smibert, seconded by M. Steele, that the Board of Health receive Report No. 11-23GC, re: “2021-2022 Provisional Plan Final Update” for information.
Carried

2022 Annual Report and Attestation (Report No. 50-23)

This report was introduced by A. Summers. The Annual Report and Attestation is a report required by the Ministry of Health to outline how the Health Unit has, or has not, achieved the requirements of the Ontario Public Health Standards (OPHS). Typically, the report is due in April; however, due to the pandemic, the 2022 report was due August 31. It has been submitted, but the attestation of the Board of Health is still required. It was noted that not all work has resumed due to the redeployment to baseline work, and as a result, not all components of the OPHS were achieved. This is similar to other health units.

It was moved by M. Smibert, seconded by S. Menghsha, that the Board of Health:
1) Receive Report No. 50-23 re: “2022 Annual Report and Attestation” for information; and
2) Approve the Middlesex-London Health Unit 2022 Annual Report and Attestation.
Carried

Sexually Transmitted Infection Strategy (Report No. 51-23)

This report was introduced by A. Summers who introduced Shaya Dhinsa, Manager, Sexual Health and Alison Locker, Manager, Population Health Assessment and Surveillance.

Highlights of this report included:
• There has been a substantial increase in the rates of bacterial sexually transmitted infections in the past 10 years.
o The rates of Chlamydia in Middlesex-London have both increased and been above the rates of peer groups and the province.
o The rates of Gonorrhea in Middlesex-London have tracked with provincial trends but have more than tripled in the past 10 years.
o The rates of infectious Syphilis have tracked with provincial trends and have increased more than six-fold over the past 10 years.
• Local case data identified priority populations including:
o Those who have unprotected sex
o Those who have new sexual partners
o Those who engage in anonymous sex
o Men who have sex with men and women who have sex with women
o Marginalized sexually active females
o Sexually active females and males: Chlamydia, 15-29 year olds; Gonorrhea, 15-44 year olds; Syphilis, 20-59 year olds
• Effective strategies identified to address the rates of bacterial sexually transmitted infections include:
o Distributing relevant up-to-date epidemiological data
o Expanding efforts to mobilize community partnerships
o Providing screening and treatment information
o Offering additional testing options
o Assessing the potential for expanding MLHU outreach services
o Continuing to support sexual health programming in schools
o Having an ongoing commitment to community-wide initiatives to address the social determinants of health

Chair Newton-Reid inquired about access to testing and other strategies for rural populations, especially youth who may not have transportation to get into a clinic. A. Summers advised that the broad expansion of testing access is critical and may include expansion of services in schools, such as submitting testing samples, and potentially partnering with community services like libraries and community centres. There will also be advocacy with the province to expand access to testing.

It was moved by M. Steele, seconded by A. DeViet, that the Board of Health receive Report No. 51-23 re: “Sexually Transmitted Infection Strategy” for information.
Carried

MLHU Strathroy Dental Clinic – Final Project Update (Report No. 52-23)

This report was introduced by E. Williams who introduced Donna Kosmack and Warren Dallin. The work of M. Resendes was also recognized.

Highlights of this report included:
• MLHU Strathroy Dental Clinic was completed $49,000 under budget.
• Contributing to success were frequent project team meetings, maintaining a contingency for unexpected costs, and having a cross-functional team.
• The Clinic currently sees approximately 12 patients each day with the capacity of 20 per day once all staff are onboarded.
• Patients in London are willing to travel to Strathroy to receive treatment sooner.
• From opening day to September 20, 592 patients have been seen in Strathroy and the waiting list has decreased from 700 to 588, even as names are added to the waiting list daily.
• The province has granted $145,400 in capital funding for the Seniors Dental Care Program to be used by March 31, 2024. This will be used to expand the operatories in Citi Plaza.

Board members had received questions from local MPPs about residents becoming disqualified for the program due to temporary increases in government social security payments. D. Kosmack acknowledged some patients have lost coverage due to receiving additional funds which put their income just over the threshold. The program has received permission from the Ministry to continue to extend services to individuals who were in the middle of treatment but have since lost coverage; however, this extension is only to the end of the year. Coverage renewals occur August 1, so some individuals may become eligible again in August 2024.

It was advised there is an intercommunity bus which connects communities throughout the county. The bus is $10 each way and stops at both Citi Plaza and the Shops on Sydenham in Strathroy, providing a public transit option for patients between the MLHU London and Strathroy offices.

It was moved by A. DeViet, seconded by S. Menghsha, that the Board of Health receive Report No. 52-23 re: “MLHU Strathroy Dental Clinic – Final Project Update” for information.
Carried

Updates from Ontario’s Ministry of Health in August 2023 (Report No. 53-23)

This report was presented by A. Summers and E. Williams. It was advised that Report No. 53-23 and Report No. 54-23 are companion reports related to the 2024 budget season.

Highlights of this report include:
• MLHU received a funding letter on August 29 advising of a 1% increase to the base funding for 2023, operating funding for the Seniors Dental Care Program, and additional capital funding for updates to the Citi Plaza dental operatories.
• At the Association of Municipalities in Ontario (AMO) meeting in August 2023, the ministry announced a 1% annual increase to the cost-shared budget for the next 3 years, starting in 2024 and reversed the proposed changes to the cost-shared funding formula back to 75:25. The funding amount associated with the changes to the cost-shared budget is at Q2 2018 levels. No additional COVID-19 funding was announced.
• The province has announced a “Strengthening Public Health” initiative which includes a review of the OPHS to clarify roles and responsibilities of public health at the local and provincial/regional level, encouraging voluntary mergers of health units, and reviewing the public health funding formula. The criteria for voluntary mergers is not yet known and the review of the OPHS will not be complete until 2025.
• MLHU is facing a budget shortfall of between $2.6 million and $2.8 million for 2024. The range in shortfall is because corporate inflation is not yet known (e.g., utility and insurance costs). To address the deficit, current service levels cannot be maintained and decisions to balance the budget cannot wait until the review of the OPHS is completed. Using a budgeted gap planning for vacancies and delays in recruiting is not a solution. It has reached $1.5 million and is a challenge to achieve in 2023, resulting in positions being gapped which would be of value to have filled.
• The shortfall is due in part to a structural deficit in that funding has not kept pace with inflation and population growth. In 2011, funding amounted to $57.93 per capita. In 2021, this had decreased to $55.60 per capita.

Strategic Prioritization for the Middlesex-London Health Unit (Report No. 54-23)

This report is the second of the companion reports, along with Report No. 53-23.

To address the budget shortfall in 2024, a process for strategic prioritization was proposed, based on the following principles:
• MLHU will focus on the core work of local public health.
• The work MLHU does must be definable and clearly articulated.
• The work must have an impact on the community.
• MLHU will consolidate its resources to the core work to ensure the programs and services provided are done well.
• As the work fits within the core work of local public health, MLHU will adjust the work to meet the gaps, needs, and expectations of its funders and community.
Based on the strategic priorities, the organization may be restructured to align form with function.

Historically, leadership has consulted teams and leaders to develop solutions to budgetary constraints; however, the magnitude of the shortfall would make it unfair to request the same now. As such A. Summers and E. Williams will be leading the process. The proposed timeline is:
• Board approval of the process and principles at the September Board of Health meeting.
• Board approval of prioritized programs and interventions at the October Board of Health meeting.
• Board approval of the organizational structure, including financial and labour relations at the November or December Board of Health meeting.

Chair Newton-Reid highlighted the work the Health Unit has done over the past six years to find savings and efficiencies.

A. Summers advised about strategies being used to mitigate the risks of moving forward with changes in advance of knowing the changes to the OPHS. He is in constant communication with ministry leadership, outlining the approach MLHU is taking. Additionally, if the reorganization is misaligned with the revised OPHS, staff will be reassigned rather than disinvested.

Chair Newton-Reid commented there may be potential downloading to municipal funders to address some of the shortfalls.

It was moved by M. Steele, seconded by S. Menghsha, that the Board of Health receive Report No. 53-23 re: “Updates from Ontario’s Ministry of Health in August 2023” for information.
Carried

It was moved by M. Smibert, seconded by S. Menghsha, that the Board of Health:
1) Receive Report No. 54-23 re: “Strategic Prioritization for the Middlesex-London Health Unit” for information; and
2) Approve the recommended principles and the methodology for prioritization.
Carried

Current Public Health Issues (Verbal)

This report was presented by A. Summers who provided a verbal update on current public health issues in the region.

Highlights included:
Respiratory Season
• Middlesex-London is not yet in a high-risk respiratory season.
• There are increased rates of COVID-19 in Middlesex-London and across the province, including increased outbreaks in long-term care homes and hospitals. Wastewater data and test percent positivity are also trending upwards.
• Health Canada has recently approved Moderna’s monovalent COVID-19 vaccine which targets the most prevalent variant. It is anticipated this vaccine will be available for high-risk individuals in October and to the general public in later October or November.
• The annual influenza vaccine will be available soon, prioritized for higher risk individuals. It can be co-administered with the COVID-19 vaccine. MLHU will be focused on administering within long-term care and retirement homes.
• The first vaccine for RSV has been approved. The Ministry of Health has indicated it will be offered to select at-risk populations, notably in long-term care homes.
• Vaccination for respiratory illnesses will be critical and widely promoted. Masking continues to be helpful, especially in high density settings. While it is unlikely there will be a resumption of mandatory masking in the general population, it is likely to be required in clinical areas.
Health and Homelessness
• Recent success in the Whole of Community System Response for health and homelessness includes the selection of three lead agencies and hub locations. These will be presented to the Strategic Priorities and Policy Committee on September 25 and then to full City Council on October 5.
• The federal government recently announced $74million in funds to build 2,000 new homes in the next three years through the Housing Accelerator Fund.
Substance Use Trends
• A report was recently published by the Ontario Drug Policy Research Network presenting data on the characteristics of deaths related to substance use. This data provides context for a report coming to the Board of Health in October regarding local opioid use.

It was moved by M. Smibert, seconded by S. Franke, that the Board of Health receive the verbal report re: “Current Public Health Issues” for information.
Carried

Medical Officer of Health Activity Report for July and August (Report No. 55-23)

A. Summers presented this report which highlights that the summer was busy with external meetings, including supporting the health and homelessness response and advocating regarding funding challenges. There were also many efforts to meet internally with staff and to understand the work of the agency.

Chair Newton-Reid noted that he, A. Summers, and E. Williams attended AMO and were granted five delegations.

It was moved by M. Smibert, seconded by M. Steele, that the Board of Health receive Report No. 55-23 re: “Medical Officer of Health Activity Report for July and August” for information.
Carried

Chief Executive Officer Activity Report for July and August (Report No. 56-23)

E. Williams presented this report. She recognized Chair Newton-Reid and Vice Chair Steele for attending advocacy meetings with local MPPs.

It was moved by S. Franke, seconded by A. DeViet, that the Board of Health receive Report No. 56-23 re: “Chief Executive Officer Activity Report for July and August” for information.
Carried

Correspondence

It was moved by M. Smibert, seconded by S. Franke, that the Board of Health receive items a) through g) for information:
a) Thunder Bay District Health Unit re: Physical Literacy for Healthy Active Children
b) Timiskaming Health Unit re: Request for Air Quality Monitoring Stations in the Timiskaming District
c) Public Health Sudbury & Districts re: Bill 103, Smoke-Free Ontario Amendment Act (Vaping is not for Kids), 2023
d) Association of Local Public Health Agencies re: Public Health Funding and Capacity Announcement
e) Simcoe-Muskoka District Health Unit re: Bill 103, Smoke-Free Ontario Amendment Act (Vaping is not for Kids), 2023
f) Middlesex-London Board of Health External Landscape for August and September
g) Algoma Public Health re: Income-based policy interventions to reduce household food insecurity
Carried

Other Business

The next meeting of the Middlesex-London Board of Health is on Thursday, October 19 at 7 p.m.

Closed Session

At 8:25 p.m., it was moved by M. Steele, seconded by A. DeViet, that the Board of Health will move into a closed session to consider matters regarding labour relations or employee negotiations, personal matters about an identifiable individual, including Board employees, litigation or potential litigation, including matters before administrative tribunals, affecting the municipality or local board, advice that is subject to solicitor-client privilege, including communications necessary for that purpose, and to approve previous confidential Board of Health minutes.
Carried

At 9:14 p.m., it was moved by S. Menghsha, seconded by S. Franke, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 9:15 p.m., it was moved by M. Smibert, seconded by S. Franke, that the meeting be adjourned.
Carried

Matthew Newton-Reid
Chair

Emily Williams
Secretary