Minutes - December 14, 2023 - Board of Health Meeting

Members Present: 

Matthew Newton-Reid (Chair)
Michael Steele (Vice-Chair)
Selomon Menghsha
Skylar Franke
Michelle Smibert
Aina DeViet
Peter Cuddy (entered at 7:31 p.m.)
Michael McGuire
Howard Shears
Emily Williams, Chief Executive Officer (ex-officio)
Dr. Alexander Summers, Medical Officer of Health (ex-officio)

Regrets:

Tino Kasi

Others Present:

Stephanie Egelton, Executive Assistant to the Board of Health (recorder)
Sarah Maaten, Director, Public Health Foundations
Jennifer Proulx, Acting Director, Healthy Start and Chief Nursing Officer
Dr. Joanne Kearon, Associate Medical Officer of Health
Cynthia Bos, Manager, Human Resources
David Jansseune, Assistant Director, Finance
Anita Cramp, Manager, Secondary School Team
Angela Armstrong, Program Assistant, Communications
Abha Solanki, End User Support Analyst, Information Technology
Morgan Lobzun, Communications Coordinator
Emily Van Kesteren, Acting Manager, Communications
Ryan Fawcett, Manager, Privacy, Risk and Client Relations

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

Disclosure of Conflict of Interest

Chair Newton-Reid inquired if there were any disclosures of conflicts of interest.

At 7:01 p.m., it was noted that Board Member Skylar Franke declared a conflict of interest related to Report No. 84-23. This declaration was made due to her partner being employed by the Thames Valley District School Board.

No other conflicts were declared.

Approval of Agenda

It was moved by M. Steele, seconded by A. DeViet, that the AGENDA of the December 14, 2023 Board of Health meeting be approved.
Carried

Approval of Minutes

It was moved by M. McGuire, seconded by S. Menghsha, that the MINUTES of the November 9, 2023 Special Board of Health meeting be approved.
Carried

It was moved by A. DeViet, seconded by M. Steele, that the MINUTES of the November 16, 2023 Board of Health meeting be approved.
Carried

It was moved by M. Smibert, seconded by S. Menghsha, that the MINUTES of the November 16, 2023 Governance Committee meeting be received.
Carried

New Business

Summary of Strategic Prioritization and Restructuring of the Middlesex-London Health Unit (Report No. 80-23)

Dr. Alexander Summers, Medical Officer of Health provided a summary and overview of the Middlesex-London Health Unit’s strategic prioritization work and new organizational structure effective January 1, 2024.

Dr. Summers noted that this report was in companion to the next report on the Health Unit’s 2024 budget. It was noted that in September, the Board approved the process that the Health Unit needed to undertake to reprioritize its work to decrease the budget shortfall that the Health Unit would experience for 2024.

Dr. Summers highlighted the investments and disinvestments that were made:
• Minor investments in vaccine preventable disease to ensure ongoing ability to maintain compliance with the Immunization of School Pupils Act (ISPA), as well as to support moderate vaccine administration (including COVID-19) to prioritized populations with minimal access to other health care sources. It was noted that that the COVID-19 Extraordinary Expense funding will be ending in 2024, and the Western Fair Vaccination Clinic will be closing as a result over the weekend of December 16.
• Minor investments in infectious disease control to ensure readiness and responsiveness to emerging threats.
• Minor strengthening of presence with health sector partners, notably the Middlesex-London Ontario Health Team.
• Significant reductions in comprehensive school health nursing, with a shift to supporting boards and ‘families’ of schools. Immunization and oral health programming in schools will continue.
• Significant reduction in public health nursing capacity in healthy public policy development and community mobilization, with a shift to prioritized issues and partners at the municipal level. It was noted that registered dietitian capacity has been reduced.
• Reduced and scoped social marketing work, particularly public awareness campaigns, with the exception of regional and sustained initiatives. Initiatives will be determined through the annual prioritization efforts of the agency.

Dr. Summers noted that labour and financial impacts of the final investments and disinvestments would be spoken to in the following report regarding the 2024 budget.

It was moved by S. Franke, seconded by S. Menghsha, that the Board of Health receive Report No. 80-23 re: “Summary of Strategic Prioritization and Restructuring of the Middlesex-London Health Unit” for information.
Carried

2024 Middlesex-London Health Unit Budget (Report No. 81-23)

Emily Williams, Chief Executive Officer reminded the Board of the labour relations impacts with reprioritization and restructuring of the Health Unit.

Position Changes
• Net reductions of 13.0 FTE (Full Time Equivalent) Registered Nurses, 2.0 FTE Registered Dietitians, 1.5 FTE Health Promoters and 1.0 FTE Director
• Other changes offset by investments of positions with lower salary bands such as reduction of 3.0 FTE Manager roles offset by addition of 3.0 Associate Manager roles.
• Investments in temporary positions for 2024 (3.6 FTE) in anticipation of a continued shortfall in 2025 funding to minimize further disruption. It was noted that the Province has committed to a 1% increase to funding for 2025.

People Impacts
• Voluntary Retirement Incentive Program (VRIP) was offered to reduce layoffs (6 positions)
• Reduction of already vacant positions (4 positions)
• Total layoffs anticipated at maximum 7 front-line staff; attempts to will extend employment by placing into temporary contract roles (such as permanent staff on leaves) will be utilized as well

David Jansseune, Assistant Director, Finance provided an overview of the 2024 budget.

Program Delivery
The Health Unit’s budget operates using two (2) companies (MLHU from January-December and MLHU2 from April to March). There are five (5) divisions, 38 departments (47 programs), and 288 FTE staffing at the base level. Funding and expenditures are tracked across 1,111 active accounts. This budget will need to be re-created into a program budget for the Ministry of Health called the Annual Service Plan.

Budgeting Procedures
Salaries & Wages includes zero-based budgeting of staff resources to match the new organizational structure, including contractually obligated wage and step increases.

Benefits include 2024 rates with Canada Life incorporated into the Budget, pending approval from the Board.

General Expenses include a thorough review with 7 years of trending data.

Extraordinary Expenses are COVID-19 expenses absorbed into Vaccine Preventable Disease and Infectious Disease Control budget. This funding will no longer be available in 2024 from the Province but includes a $1.3 million pressure absorbed in the 2024 budget planning process.

Budgeted Gap is calculated to generate a balance budget (no deficit and no surplus). The Health Unit’s 2024 budget includes a reduction in the the gap from $1.5 million to $1 million.

Funding Sources
Ontario Ministry of Health = 66% of funding
City of London = 20% of funding
Ministry of Children, Community and Social Services = 6.5% of funding
Middlesex County = 4% of funding
Miscellaneous Revenue, including IPAC = 2.5% of funding
Public Health Agency of Canada = 0.7% of funding
Public Health Ontario = 0.3% of funding

The percentage of funding is based on total funding envelope of $38.4 million. The Ministry of Health and Municipal funding ratio is 71% / 29% for programs in the cost-shared budget. In 2023, the funding envelope was $50 million, which included funding for COVID-19 and School Focused Nurses Initiative.

100% Funded Programs – 2024
Funders for these programs include the Ministry of Health, the City of London, the Public Health Agency of Canada, Public Health Ontario and the Ministry of Children, Community and Social Services.

COVID-19 = $0 (decrease of $10,655,019 from 2023)
School Focused Nurses Initiative = $0 (decrease of $1,415,572 from 2023)
Ontario Seniors’ Dental Care Program = $3,491,500 (decrease of $201,648 from 2023)
City of London Cannabis Legalization Fund = $208,984 (increase of $20,090 from 2023)
Smart Start for Babies = $152,430 (increase of $1,681 from 2023)
Best Beginnings/Healthy Babies Healthy Children = $2,483,313 (increase of $34,947 from 2023)
Library Shared Services = $108,414 (increase of $3,400 from 2023)
FoodNet Canada = $111,040 (decrease of $7,939 from 2023)

Total = $6,555,681 (decrease of $12,220,060 from 2023)

Shared Funding Programs
Shared funding programs are funded by the Ministry of Health, City of London, County of Middlesex and some internally generated revenue. This funding can be redistributed if needed and surplus is returned to funders. This section of funding includes grants, user fees and other income, salaries and wages, benefits and general expenses.

Grants, User Fees and Other Income = $31,853,279
• There will be a 2% funding increase in the 2024 budget, accounting for a 1% increase in 2023 and a 1% increase in 2024 from the Ministry of Health
• The Needle Exchange Program and Public Health Inspector Practicum Program are funded $39,000
• The City of London and Middlesex County will be contributing an additional 3% in funding
• Infection Prevention and Control (IPAC) funding increased $171,732 from 2023
• $80,000 in interest on bank accounts was earned
• There is a targeted 1% internal revenue increase

Salaries, Wages and Overtime = $20,955,463
• Cost of living increases are at a contractual 2%
• COVID-19 funding has been discontinued (related staffing costs are $846,722 and 11 FTE)
• Temporary contract positions for mitigation in 2025 ($245,701 and 3.6 FTE)
• $1,269,701 and 16.3 FTE in savings from the restructuring, impacted to shared funding only

Benefits = $5,523,838
• Integration of staffing for COVID-19 related work benefit costs at $188,016
• Benefits for temporary contract positions for mitigation in 2025 are $55,682
• $135,551 are the benefits-related savings from the restructuring

It was noted that there are increases in legislative benefits (CPP, EI, EHT and SWIB) of $98,000 and are being proposed to be offset by the decrease in benefits provided costs ($92,000 reduction).
General Expenses = a reduction of $119,249 from 2023, totaling $6,364,529
• A budgeted $100,000 for accelerated payment of the variable bank loan
• Occupancy costs increases for insurance and leases (insurance $34,000, Citi Plaza $56,000 and Strathroy $18,000)
• Cell phone increase of $11,000
• Professional services, development and travel increased for trending costs

The total consolidated budget for the Health Unit is $34,408,959.

It was moved by M. Steele, seconded by M. McGuire, that the Board of Health:
1) Receive Report No. 81-23 re: “2024 Middlesex-London Health Unit Budget” for information; and
2) Approve the 2024 Budget as outlined in Appendix A.
Carried

2024 Ontario Budget Consultation – Board of Heath Submission (Report No. 82-23)

E. Williams noted that the online portal for the 2024 Ontario Budget has been opened and is providing individuals and organizations the opportunity to provide submissions regarding budgetary priorities. This report is a timely discussion for the Board of Health as the Board can submit a letter of advocacy for sufficient base funding for public health. A draft response to the consultation has been provided to the Board and outlines specific program areas where sustained base funding is needed.

It was moved by S. Franke, seconded by A. DeViet, that the Board of Health:
1) Receive Report No. 82-23 re: “2024 Ontario Budget Consultation - Submission” for information; and
2) Approve the attached response as Appendix A.
Carried

Canada Life Benefits – 2024 Renewal Rates (Report No. 83-23)

D. Jansseune provided an overview on the 2024 Canada Life Benefits Renewal Rates.

The Health Unit has been insured by Canada Life, formerly Great West Life, to provide benefits to staff since 2013 and partnered with AON Hewitt to assist with negotiations with benefit providers. Premium rates were guaranteed and remained constant from 2019 to 2021 but were subject to review beginning 2022. Canada Life’s proposal was an increase to $1,978,076 or 11.3%. AON Hewitt successfully negotiated a lesser amount, and a decrease to the previous rates. Benefits will be tendered during the spring of 2024 to ensure value for money is maximized and rates remain competitive.

The Health Unit’s contract with Canada Life to provide group insurance will be renewed from January 1 to December 31, 2024. Based on the number of employees and benefits selected, the premium decrease for 2024 is estimated to be $54,039 (3%).

Board Member Howard Shears noted that the Canada Life had received the contract for benefits for employees working with the federal government, and there were reported concerned from insured individuals not receiving their benefits on time. H. Shears inquired if the Health Unit’s employees had reported any concerns. E. Williams noted that there have been no concerns reported.

It was moved by H. Shears, seconded by S. Franke, that the Board of Health approve the renewal of the group insurance rates administered by Canada Life as described in Report No. 83-23 re: “Canada Life Benefits – 2024 Renewal Rates”.
Carried

Signed School Board and Public Health Partnership Declaration (Report No. 84-23)

Chair Newton-Reid reminded that Board Member Skylar Franke declared a conflict of interest related to Report No. 84-23 due to her partner being employed by the Thames Valley District School Board. Board Member S. Franke excused herself from discussion and voting on this matter.

Anita Cramp, Manager, Secondary School Team provided an update on the partnership declarations between public health and the local school boards (Thames Valley District School Board and London District Catholic School Board).

A. Cramp noted that the Health Unit’s ongoing collaboration with local school boards holds immense significance and the recently signed partnership declarations are formal expressions of the commitment to working together. A partnership declaration is a formal agreement to acknowledge the shared commitment between public health and school boards to positively impact the health and wellbeing of children and youth in schools. Declarations are collaboratively developed through dialogue and outline the overarching process and expectations for the partnership. The specific declarations being discussed outline shared objectives, strategies for joint efforts (including assessing the need for public health services and resources in schools), communication strategies, processes for engaging in collaborative initiatives, and a mutual commitment to data and information sharing.

A. Cramp concluded that the signing of these declarations serves as testament that rapport with local school boards is deeply valued, and that both parties are dedicated to fostering continued collaboration. With the restructuring, there will be a new School Health team formed in 2024, and the Health Unit continues to be committed to working closely with school board partners to improve the health and wellbeing of youth.

Chair Newton-Reid added that public health nurses in schools are vital and the continued collaboration and positive working relationships are very much valued.

It was moved by M. Smibert, seconded by A. DeViet, that the Board of Health receive Report No. 84-23 re: “Signed School Board and Public Health Partnership Declaration” for information.
Carried

Changes to Committee Meeting Cadence (Report No. 85-23)

E. Williams in her capacity as Secretary and Treasurer of the Board of Health presented a proposal to the Board regarding changes to meeting cadences and the draft 2024 Board of Health and Committee meeting schedule.

E. Williams noted that it is the discretion of the Board of Health to establish standing committees under Governance Policy G-280 – Board Size and Composition and under Board of Health By-Law No. 3. It is proposed that the cadence of the standing committee meetings is changed for 2024. Reasons for reducing the frequency of standing committee meetings include providing more Board Member experience with financial and governance matters, less financial and opportunity costs, improved public awareness, and prevention of quorum issues.

A draft updated Terms of Reference for the Finance and Facilities and Governance Committees wereaffixed to the report, with minor housekeeping changes such as title changes, meeting frequency adjustments and amendments to the scope of committees. A draft 2024 meeting schedule was also provided to the Board, noting that Finance and Facilities Committee meetings would occur quarterly, 1 month after quarter closure, and Governance Committee meetings would occur biannually, with a focus on policy review. E. Williams concluded that there is also a proposal to have all Committee meetings begin at 6 p.m. before the 7 p.m. Board meetings.

Board Member Aina DeViet noted that streamlining was a good idea and if needed, an opportunity to call a meeting was available. A. DeViet inquired on how policy review logistics would work with the proposed biannual meetings. E. Williams noted that policies would continue to be split up for review by subject matter area (as started in early 2023) for Committee review and would be provided to the Committee earlier due to the amount of policies.

Chair Newton-Reid added that he had met with E. Williams to review this proposal and was supportive of these changes.

It was moved by M. Smibert, seconded by S. Franke, that the Board of Health:
1) Receive Report No. 85-23 re: “Change to Committee Meeting Cadence” for information;
2) Amend the Terms of Reference for the Finance and Facilities and Governance Committees (Appendix A); and
3) Approve the 2024 Board of Health meeting schedule (Appendix B).
Carried

Current Public Health Issues (Verbal)

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

Highlights included the topics of:

Respiratory Season Update
• The Western Fair COVID-19 Vaccination Clinic will be closing on December 16. The clinic opened in December 2020 in Western Fair District Agriplex and moved to Western Fair District Main Building in October 2022
• Between opening and the end of November 2023, there were 518 clinic days and 235,407 doses of COVID-19 vaccine given to the community
• Middlesex-London is currently in a high-risk category for respiratory illnesses (COVID-19 and influenza)
• COVID-19 laboratory confirmed cases have increased, along with outbreaks, with indicators similar to the overall provincial data
• Influenza laboratory confirmed cases have decreased, with a low positivity rate
• Rhinovirus, pneumonia, RSV and parainfluenza are also active in the region

2024 Budget Impacts on Public Health
• Windsor Essex County Health Unit’s (WECHU) safe consumption site has been put on hold
• The WEHU is also facing a funding shortfall and will be providing layoff notices to approximately two dozen staff

Substance Use in the News
• Two well-known physicians specializing in treatment of addiction in Middlesex-London (Dr. Andrea Sereda and Dr. Sharon Koivu) have been the center of media attention with providing opposite views on the safe supply debate
• People will be able to buy beer, cider, wine and ready to drink alcohol at convenience stores and big box stores. Public health has concerns with this for a number of reasons:
o Research confirms that increased alcohol availability leads to increased alcohol consumption and alcohol-related health and social harms.
o Some communities are disproportionately affected by policies that increase alcohol access in their neighbourhoods.
o Where government retail monopolies have been dismantled and partial or full privatization have been introduced, increases in alcohol consumption and harms have been observed.
o Alcohol consumption is estimated to contribute to 154 or 4.1% of all deaths, 842 or 2.4% of hospitalizations and 6,968 or 3.8% of emergency department visits in an average year, amongst those older than 15 years of age in Middlesex-London.
o Alcohol has been classified as a type 1 carcinogen by the International Agency for Research on Cancer since 1988 and has been causally related to 7 types of cancer.
o Alcohol cost Ontario taxpayers $7.109 billion in direct and indirect costs.

Life Expectancy Decreasing
• Statistics Canada has reported that life expectancy has decreased for a third year in a row, which is unprecedented in the last many decades
• Leading causes of death in 2022:
o Cancer and Heart Disease (41.8% of deaths)
o COVID-19, unintentional injuries, cerebrovascular disease (stroke), chronic lower respiratory diseases, diabetes mellitus, influenza & pneumonia, Alzheimer's disease, & chronic liver disease and cirrhosis (26.4% of deaths)

MLHU in the News
• COVID-19 outbreaks continuing in long term care
• The Health Unit’s Western Fair Vaccination Clinic closing
• Rise in COVID-19 cases
• NDP proposes plan to launch free contraception program for Ontario residents
• iHEAL: New app marks Canada 1st in helping women cope with partner violence
• MLHU’s budget impacts

Chair Newton-Reid asked why media coverage and public discourse regarding the increase of COVID-19 cases had been limited. Dr. Summers noted that one reason was likely the relative decline in morbidity and mortality. Severity was reduced because a majority of the population had some level of immunity from previous vaccination or infection. As a result, the health care system had not been overwhelmed this fall as a result of COVID-19, and therefore, less attention had been given to the rising cases.

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

Correspondence

It was moved by S. Franke, seconded by A. DeViet, that the Board of Health endorse the following item:
a) Ontario Dental Association (ODA), Ontario Dental Hygienists’ Association (ODHA), and Ontario Association of Public Health Dentistry (OAPHD) re: Considerations for Aligning Federal and Provincial Dental Programs to Improve Oral Health
Carried

It was moved by S. Franke, seconded by M. McGuire, that the Board of Health receive the following item for information:
b) Middlesex-London Board of Health External Landscape for December 2023
Carried

Other Business

The next meeting of the Middlesex-London Board of Health is on Thursday, January 18, 2024 at 7 p.m.

Closed Session

At 8 p.m., it was moved by S. Franke, seconded by M. McGuire, that the Board of Health will move into a closed session to consider matters regarding labour relations or employee negotiations, personal matters about identifiable individuals, including Board employees, advice that is subject to solicitor-client privilege, including communications necessary for that purpose, a trade secret or scientific, technical, commercial, financial or labour relations information, supplied in confidence to the municipality or local board, which, if disclosed, could reasonably be expected to prejudice significantly the competitive position or interfere significantly with the contractual or other negotiations of a person, group of persons, or organization and to approve previous confidential Board of Health minutes.
Carried

At 8:28 p.m., it was moved by S. Franke, seconded by P. Cuddy, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 8:29 p.m., it was moved by P. Cuddy, seconded by M. Smibert, that the meeting be adjourned.
Carried

Matthew Newton-Reid
Chair

Emily Williams
Secretary