Board of Health Meeting Summary – April 18, 2019
The Leeds, Grenville and Lanark District Health Unit provides high quality public health programs and services in collaboration with local partners, including municipalities, to promote and protect health of the population. The governance structure with the Board of Health includes all obligated municipalities who provide funding and oversight along with Provincial appointees to the Health Unit, and this relationship extends to working with municipalities on important public health concerns.
The 2019 Ontario Budget includes significant new direction for public health in governance, organization, and funding which could have a major impact on public health programs and services in the community with an associated impact on the population’s health.
From the budget:
- In 2019–20 improve public health programs and back-office efficiency and sustainability while providing consistent, high-quality services, be responsive to local circumstances and needs by adjusting provincial-municipal cost-sharing of public health funding;
- By 2020–21 establish 10 regional public health entities and 10 new regional boards of health with one common governance model; and protect what matters most by ensuring public health agencies focus their efforts on providing better, more efficient front-line care by removing back-office inefficiencies through digitizing and streamlining processes.
- By 2021–22, modernizing public health units through regionalization and governance changes to achieve economies of scale, streamlined back-office functions and better-coordinated action by public health units, leading to annual savings of $200M by 2021–22.
Change in Provincial Funding
The Board of Health was notified on Thursday, April 16, 2019 that the Ministry of Health and Long-Term Care will unilaterally decrease the provincial/municipal funding ratio for Mandatory Public Health Programs from the current 75%/25% to 70%/30% in 2019 and then to 70%/30% or 60%/40% for subsequent years depending on the population size of the Regional Public Health Entity. The Related Public Health Programs like Smoke Free Ontario and Healthy Smiles which are currently 100% provincially funded will be funded at 70% provincial/30% municipal in 2019.
It is estimated that this provincial decision in the change in the provincial/municipal funding ratio will increase the overall municipal contribution for Public Health Programs and Services to meet the Ontario Public Health Standards in 2019 by about $1 million dollars. For the existing Leeds, Grenville and Lanark District Health Unit, the $1 million dollars would be apportioned among obligated municipalities based on population as follows (estimates):
- Brockville $126K
- Gananoque $30.5K
- Lanark County $354K
- Prescott $25K
- Smiths Falls $52K
- United Counties $412.5K
The Board of Health encourages all municipalities to write to the Minister of Health and Long-Term Care, Christine Elliot, copied to their riding Member of Provincial Parliament (MPPs) and the Association of Municipalities of Ontario (AMO), to request that the current provincial/municipal funding ratio be maintained for 2019 given municipal budgets are already set and a quarter of the year has passed. In addition, any change in the funding ratio between the province and municipalities be negotiated with the Association of Municipalities of Ontario rather than be set unilaterally.
Regional Public Health Entity
The government has not provided a description of the Regional Public Health Entity announced in the budget beyond saying that all current Boards of Health will be disbanded and new Regional Public Health Entities and Boards will be established.
The Board of Health will be sending a letter to Minister of Health and Long-Term Care Christine Elliott, copied to appropriate riding MPPs and AMO, recommending that the following be done prior to the implementation of the Regional Public Health Entity to ensure that the community continues to benefit from effective and efficient public health programs and services.
- Consultation with Public Health Ontario, the Association of Local Public Health Agencies (alPHa), the Council of Medical Officers of Health, and other experts in the field be undertaken before the Regional Public Health Entity is implemented to ensure it does improve the effectiveness and efficiency of public health services in the community.
- Include the following principles in the development of the Regional Public Health Entity:
- Appropriate municipal role in governance – The public expects that their municipal tax dollars are overseen by the municipal politicians they elect. For the municipal public health investment, this currently occurs through representatives from obligated municipalities on the Board of Health. It is important that obligated municipalities continue to have a significant governance role in the Regional Public Health Entity;
- No loss of service to our community – All current employees providing programs and services under the Foundational and Program Standards as listed in the 2019 Annual Service Plan continue to be funded within the Regional Public Health Entity to provide service in Lanark, Leeds, and Grenville;
- Meaningful involvement in planning – The needs and assets of the Lanark, Leeds and Grenville communities are considered in the planning of any public health programs and services for the community;
- Integrity of the Health Unit – The Health Unit functions as a unit and services and programs will be difficult to maintain if the health unit is divided between two Regional Public Health Entities;
- Like Health Unit Populations Grouped Together – Collaboration will be more effective and efficient if the populations are similar among the health units in the Regional Public Health Entity;
- Equitable access to positions – All Management and Administrative positions in the new Regional Public Health Entity must be open to all our current employees through a competition or other process; and,
- Effective “back office” support – All services included in the “back office” support provided by the Regional Public Health Entity be at the same quality or better than currently exist in the Health Unit.