Minutes - October 20, 2022 - Board of Health Meeting

Members Present:

Mr. Matt Reid (Chair)
Ms. Kelly Elliott (Vice-Chair)
Mr. John Brennan
Mr. Selomon Menghsha
Ms. Maureen Cassidy
Ms. Aina DeViet
Mr. Michael Steele
Ms. Tino Kasi

Regrets:

Ms. Mariam Hamou

Others Present:

Ms. Carolynne Gabriel, Executive Assistant to the Board of Health and Communications Coordinator (Recorder)
Dr. Alexander Summers, Medical Officer of Health
Dr. Karalyn Dueck, Acting Associate Medical Officer of Health
Ms. Emily Williams, Chief Executive Officer
Ms. Maureen MacCormick, Director, Healthy Living
Ms. Mary Lou Albanese, Director, Environmental Health and Infectious Disease
Ms. Jennifer Proulx, Acting Director, Healthy Start/Chief Nursing Officer
Mr. David Jansseune, Assistant Director, Finance
Ms. Ronda Manning, Manager, Early Years Community Health Promotion
Mr. Darrell Jutzi, Manager, Child Health
Mr. Jordan Banninga, Manager, Infectious Disease Control
Ms. Cynthia Bos, Manager, Human Resources
Mr. Dan Flaherty, Manager, Communications
Ms. Laura Dueck, Public Health Nurse
Ms. Deneen Langis, Human Resources Coordinator
Mr. Alex Tyml, Online Communications Coordinator
Ms. Sejal Shah, Information Technology, Desktop and Applications 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 Mr. Michael Steele, seconded by Ms. Aina DeViet, that the AGENDA for the October 20, 2022 Board of Health meeting be approved.
Carried

Approval of Minutes

It was moved by Ms. Maureen Cassidy, seconded by Mr. Selomon Menghsha, that the Board of Health approve the MINUTES of the September 15, 2022 Board of Health meeting.
Carried

It was moved by Mr. Steele, seconded by Ms. Cassidy, that the Board of Health receive the:

Carried

Reports and Agenda Items

Finance & Facilities Committee Meeting – October 6, 2022 (Report No. 57-22)

This report was introduced by Mr. Michael Steele, Chair of the Finance and Facilities Committee who indicated that two reports were considered.

Mr. Steele introduced Mr. David Jansseune, Assistant Director, Finance, to present upon the first report considered, MLHU2 Financial Statements, Fiscal 2022 from April 1, 2021 to March 31, 2022. Mr. Jansseune shared Appendix A to Report No. 15-22FFC, Consolidated Financial Statements of Middlesex-London Health Unit March 31st Programs and Independent Auditors’ Report thereon, Year ended March 31, 2022.

Highlights of the presentation included:

The five programs itemized in the financial statements are 100% funded and have a fiscal year from April 1 to March 31. The funders include the Ministry of Children, Community & Social Services, the Public Health Agency of Canada, and Public Health Ontario.
The consolidated statement of financial position has seen little change between 2020-2021 and 2021-2022.
The Shared Library Services Partnership ran a deficit of approximately $6,000, spent on program resources.
The five programs represent approximately $2,900,000 of the Health Unit’s total operating budget of $65,300,000. The majority of costs are related to staffing.
The amounts owing to the funders decreased from $41,683 (2021) to $35,676 (2022).

It was moved by Mr. Steele, seconded by Ms. Cassidy, that the Board of Health approve the audited Financial Statements of Middlesex-London Health Unit for programs ended March 31, 2022.
Carried

The second report considered was Proposed 2023 Budget Planning Process (Report No. 16-22FFC). Mr. Steele introduced Ms. Emily Williams, Chief Executive Officer who shared a PowerPoint presentation providing an overview of the proposed 2023 budget process.

Ms. Williams noted that the 2023 budget process is being adjusted at MLHU due to the continued uncertainty around COVID-19 requirements, a lack of visibility on 2023 base funding, and significant inflationary pressures. Due to this context, the previous process of PBMA will no longer be sufficient and instead, a strategic review of programs and a modified zero-based budgeting process is being proposed.

Funding assumptions being used for budgeting for 2023 include:

Funding will be flat to 2022 levels, with MLHU covering all inflationary pressures and with Ministry funding information to be available in January 2023.
Mitigation funding will be continued for 2023.
COVID-19 expenses remain as a separate “extraordinary expense” with funding confirmed for 2023 on September 29, 2022.

Ms. Williams noted that the Health Unit is facing two inflationary pressures, $596,000 for salaries, benefits, and step increases and $300,000 for corporate expenses, totaling $896,000. Additional budgetary pressures include a plan to reduce gapping to 2021 levels, resulting in an additional pressure of $330,000, and a plan to increase payment of the variable portion of the bank loan, from $75,000 to $200,000 in 2023. The payment of the variable portion of the bank loan would only occur if there were surplus operating dollars at year end. These total inflationary pressures result in a total organizational target of $1,200,000.

Ms. Williams summarized the proposed budget planning process for 2023 which includes the use of zero-based budgeting of general expenses and program reviews using one of two frameworks: Public Health Program Pyramid or Critical Business Infrastructure, depending upon the program being reviewed.

Highlights of zero-based budgeting include:

The exclusion of COVID-19 funds.
Keeping 100% funded programs at 2022 levels.
Finance providing allocations based on a four-year history of actuals.
Senior Leadership providing rationale for any increase to the Senior Leadership Team (SLT) for approval.

Dr. Alexander Summers, Medical Officer of Health provided an overview of the Public Health Program Pyramid framework:

The objective of the framework is to provide an approach for SLT and the Board of Health to review and understand the programs being provided by the Health Unit and assist with prioritization of the programs, within the context of resource constraints.
The pyramid has different levels with the levels closer to the bottom being prioritized.
The bottom level is “Critical (preserved),” which contains mandatory programs which are clearly defined in the Health Protection and Promotion Act (HPPA) or Ontario Public Health Standards (OPHS) and which align with the Health Unit’s core understanding of the role of public health units. These are the programs which are maintained during office closures or public health emergencies.
The next level is “Essential (maintained),” which contains programs which are aligned with the OPHS or are legislated under the HPPA and are considered a part of organizational strategy and effective interventions.
The third level is “Aspirational (reviewed),” which contains programs which are optional that could fill a need in the community, but which are not mandated or under the core understanding of public health work.
The top level is “Legacy (disinvested),” which contains programs which have been moved into different sectors or are no longer deemed impactful. MLHU does not have many legacy programs remaining.

Dr. Summers commented that the vast majority of the work currently done by MLHU fits within the Critical and Essential levels; however, within the context of budgetary pressures, leadership must consider the “opportunity costs” of providing one program instead of another. He also commented that attention will be given to the resources necessary to provide a program with the intensity required to yield impactful outcomes.

Ms. Williams provided an overview of the Critical Business Infrastructure framework which will inform decisions regarding corporate services. Components of the framework include:

Cross organizational services that impact all staff, support all divisions equally, and provide consultative or problem-solving services to other parts of the organization.
Support legislated requirements.
Provide business continuity or critical infrastructure that includes support to emergency response and ensures the protection of the organization’s assets.
Support external stakeholders; provide information and support stakeholder relations.

Next steps include obtaining Board of Health approval, engaging with staff, notifying union partners, presenting at staff town hall, and following up with divisions.

Chair Reid commented that the Board of Health appreciates Senior Leadership looking for savings, but that at some point the Board will need to go to the funders of the Health Unit and ask for additional funds in order for the Health Unit to continue delivering its mandate.

It was moved by Mr. Steele, seconded by Ms. DeViet, that the Board of Health:

Approve the revised budget planning process for 2023 outlined herein;
Approve the modified zero-base budgeting approach to General Expenses; and
Receive the Public Health Program Pyramid and Critical Business Infrastructure frameworks outlined in Appendix A and Appendix B to Report No 16-22FFC for information.

Carried

Performance Appraisal Committee Meeting – September 28, 2022 (Verbal Update)

This report was introduced by Ms. Cassidy, Chair, Performance Appraisal Committee. Ms. Cassidy noted that the majority of the work of the committee is confidential and cannot be updated in public, but that the committee is on track to complete the performance appraisal process by early November 2022.

It was moved by Ms. Cassidy, seconded by Mr. Menghsha, that the Board of Health receive the verbal report, re: “Performance Appraisal Committee Meeting – September 28, 2022” for information.

Carried

Baby-Friendly Initiative Update (Report No. 58-22)

This report was introduced by Ms. Jennifer Proulx, Acting Director, Healthy Start/Chief Nursing Officer who introduced Ms. Ronda Manning, Manager, Early Years Community Health Promotion Team, and Ms. Laura Dueck, Public Health Nurse.

Ms. Dueck shared a PowerPoint presentation.

Highlights of this report include:

In 2011, the Ontario government made obtaining Baby-Friendly Initiative (BFI) designation an accountability indicator for public health units. In 2015, MLHU received its BFI designation.
In 2020, as MLHU’s designation came up for renewal, the organization decided not to renew as designation is no longer an accountability indicator.
MLHU continues its commitment to maintaining best practices in infant feeding, operationalized through a Baby-Friendly Practice Lead and a Baby-Friendly Practices Committee within the Healthy Start division. The Committee is focusing internally and revising the Baby-Friendly Policy, reviewing related policies and guidelines, revising new staff learning modules, supporting best practices through staff education and resource review, and continuing surveillance of infant feeding practices within the community to support program planning.
Policy 2-070 Baby Friendly Policy was updated due to revised guidance documents from the World Health Organization and the Breastfeeding Committee for Canada and included a shift in the organization of the “ten steps to successful breastfeeding,” edits to clinical practices, use of more inclusive language to reflect the diverse nature of individuals having and feeding babies, and updating responsibilities within the policy to align with recent organizational restructuring.
Recent external activities have included promoting Canadian Breastfeeding Week (October 1 to 7) and holding “Baby-Friendly” workshops with community healthcare partners, with additional workshops planned for 2023.

It was moved by Ms. Cassidy, seconded by Ms. Kelly Elliott, that the Board of Health receive Report No. 58-22, re: “Baby-Friendly Initiative Update,” for information.

Carried

Healthy Relationships Plus Program (Report No. 59-22)

This report was introduced by Ms. Maureen MacCormick, Director, Healthy Living who introduced Mr. Darrell Jutzi, Manager, Child Health Team.

Highlights of this report include:

The Child Health Team (CHT) implements a proportionate universalism approach when working with schools, which results in school communities most at risk for increased health inequities and negative health outcomes receiving a more intense level of service. The Ministry of Education’s Education Opportunities Index is used to categorize schools as Priority or Universal.
Public Health Nurses (PHNs) assigned to priority schools serve approximately seven schools each and provide intensive programs and services, for example frequent school visits, comprehensive school health assessments and plans, class or small group facilitation and training, and engaging with students, families, and school staff.
PHNs assigned to universal schools provide support through a centralized model which includes offering high-level planning and consultation with school administration and staff, providing communication support for all schools, participating in community partnerships, engaging in local policy development and community-level assessment, and supporting service evaluation and continuous quality improvement with school health programs and services.
Early adolescence (grades six to eight) is an important developmental period with peer and dating relationships becoming very important influences. It is also a time when many mental health challenges and health-compromising behaviours emerge.
The Healthy Relationships Plus Program will be offered in elementary schools through an ongoing collaboration with Southwestern Public Health, the Thames Valley District School Board, and the London District Catholic School Board.
The Healthy Relationships Plus Program is an evidence-informed small groups program developed at Western University and designed to promote healthy relationships, increase positive mental health, target unhealthy substance use, and promote skills and protective factors. It is a universal, competency enhancement program focusing on prevention, rather than treatment, and involves all adolescents in the class rather than just those in whom concerns are identified. This approach develops the capacities and resiliency all youth require to be well adjusted and succeed in school.
The format includes short games and activities that allow the students to practice skills and role play effective responses to everyday situations. As the session progress, information will be sent to parents/caregivers to assist with facilitating practice at home.
MLHU’s school health approach is being recognized across the province and other health units are seeking to adapt it.

Chair Reid inquired how many schools are considered priority schools. Mr. Jutzi indicated that of the 150 elementary schools in the Middlesex-London region, approximately 70 are considered priority schools based on provincial data. This is a fairly high proportion compared to neighbouring communities.

It was moved by Ms. DeViet, seconded by Ms. Elliott, that the Board of Health receive Report No. 59-22, re: “Healthy Relationships Plus Program,” for information.

Carried

2021-2022 Influenza Season in Middlesex-London and 2022-2023 Influenza Vaccine Distribution (Report No. 60-22)

This report was introduced by Ms. Mary Lou Albanese, Director, Environmental Health and Infectious Disease Control who introduced Mr. Jordan Banninga, Manager, Infectious Disease Control. Ms. Albanese mentioned that the influenza program is a collaborative program involving the Vaccine-Preventable Diseases Team which distributes the influenza vaccine to physicians and long-term care homes in the region, the Infectious Disease Control Team which does outbreak management, and the Population Health Assessment and Surveillance Team which analyzes surveillance data.

Mr. Banninga provided the following highlights:

Over the past two years the Middlesex-London region has experienced influenza seasons with decreased activity than previous years.
The 2021-2022 influenza season demonstrated the impact of public health measures deployed during the start of the COVID-19 pandemic on other, less contagious respiratory viruses, like influenza. During the 2020 and 2021 seasons when COVID-19 public health measures, including masking, physical distancing, enhanced infection prevention and control (IPAC) practices, were most strongly implemented, there were zero laboratory confirmed cases of influenza in the region. Towards the the end of the 2021-2022 influenza season, which coincided with the easing of public health measures, there was an increase in laboratory confirmed cases, hospitalizations, and deaths due to influenza, as well as one outbreak in a long-term care home.
The Health Unit is anticipating an increase in influenza activity during the 2022-2023 season based on trends observed in the Southern hemisphere, which traditionally is looked to for projecting the influenza season in this region. For example, Australia experienced a pronounced influenza season around June, 2022, which coincided with the circulation of COVID-19.
The Infectious Disease Control Team is prepared for increased influenza activity. The outbreak and IPAC measures on which the team has been advising institutions are aligning with COVID-19 and influenza. Potentially the increased emphasis on respiratory and hand hygiene, which has occurred during the pandemic, will reduce the burden of influenza in the community going forward.

It was moved by Ms. Cassidy, seconded by Ms. Tino Kasi, that the Board of Health receive Report No. 60-22, re: “2021-2022 Influenza Season in Middlesex-London and 2022-2023 Influenza Vaccine Distribution,” for information.

Carried

Middlesex-London Health Unit Leadership Development Program Update (Report No. 61-22)

This report was introduced by Ms. Williams who introduced Ms. Cynthia Bos, Manager, Human Resources, and Ms. Deneen Langis, Human Resources Coordinator.

Ms. Langis shared a PowerPoint presentation. Highlights of this report included:

The Leading MLHU Framework was developed in 2015 resulting from surveys, academic literature, and external scans. The Framework remains the foundation for the current Leadership Development Program, which focusses on the on-going need for leadership development for MLHU managers, directors, supervisors, and future leaders.
The Framework is based on seven domains for public health: leadership, effective management, strategic awareness, critical thinking and problem solving, leading change, high performance teams, and public health foundations.
The Leadership Development Program aims to identify leaders at various stages in their professional career and proactively provide training opportunities that align with the public health core competencies.
The Leadership Development Program consists of several learning streams: MLHU Specifics, Future Leaders, Leading MLHU – Level 1 for New Leaders, and Leading MLHU – Level 2 for Existing Leaders. Within each stream there are programs and learning opportunities geared to that level of leadership development, along with recommended timelines.
Courses and programs MLHU is committed to including as part of the Leadership Development Program include: San’yas ICS Core Health training; From Bystander to Ally training; Vital Learning programs, including Crucial Conversations and Crucial Accountability; Myers Briggs Type Indicator; Managing in a Unionized Environment; and LEADS learning series.
Next steps include identifying and enrolling leaders. Employees who have demonstrated the ability to lead or who have expressed an interest in developing leadership skills will be identified and supported by enrolling them in course offerings at the Future Leaders level.
The Leadership Development Program will continue to be reviewed, evaluated, and strengthened based on evolving changes, challenges, strategies, and organizational vision and values.

It was moved by Mr. Menghsha, seconded by Mr. Steele, that the Board of Health receive Report No. 61-22, re: “Middlesex-London Health Unit Leadership Development Program Update,” for information.

Carried

Current Public Health Issues (Verbal Update)

This report was provided by Dr. Summers, who shared a PowerPoint presentation.

Highlights of this report included:

The COVID-19 “dashboard” which summarizes local COVID-19 surveillance data has shifted to reporting once a week to align with current provincial reporting practices.
COVID-19 case counts continue to be high and reflect only a portion of actual cases in the community due to limits on COVID-19 testing eligibility.
It is anticipated that COVID-19 cases will increase throughout winter.
The Health Unit will be monitoring closely percent positivity, outbreaks in long-term care homes, and potentially waste-water indicators.
Bivalent COVID-19 vaccines are available in the region for booster doses. Everyone over the age of 12 is recommended to receive a fall COVID-19 booster dose at a minimum interval of three months and a recommended interval of six months.
There has been a gradual increase in the percentage of Middlesex-London residents who have received a booster dose in the past six months, to approximately 22% of the eligible population. COVID-19 vaccine will continue to be available through MLHU mass vaccination clinics and community mobile clinics, pharmacies, and primary care partners. How the vaccine is provided throughout the County will also be reviewed throughout the fall and winter.
COVID-19 will remain a risk through the fall and winter, and for many years to come. The population is no longer “naïve” to the virus with the majority of the population having some degree of immunity either from immunization, past infections, or both. This means that the relative mortality within the population and the risk of severe illness is decreased; however, it does not mean that individuals will not have symptoms nor that there are not potential long-term impacts.
The Health Unit’s messaging, regardless of the fluctuations in COVID-19 cases, remains using the familiar tools to reduce the risk of COVID-19 including: being up to date with vaccinations, masking in crowded indoor environments, and supporting yourself and others to stay home if sick. A new vaccine-resistant variant would change this response.
The Middlesex-London Health Unit is participating in a community summit on health and homelessness with community partners including London Health Sciences Centre, St. Joseph’s Health Care, the Canadian Mental Health Association Thames Valley Addiction and Mental Health Services, City of London, Middlesex London Paramedic Services, and London Police Services.

Chair Reid inquired about the changes in self-isolation periods and requirements, shifting from 14 days for those with COVID-19 and their close contacts, to being able to leave self-isolation while symptomatic but provided symptoms have been improving for 24 hours.

Dr. Summers indicated that a contributing factor to the change in self-isolation requirements is that the population now has some baseline immunity to the COVID-19 virus, which decreases the risk of severe outcomes, even as the risk of infection is increasing. The guidance from the Health Unit can be simplified to:

“If you have symptoms of COVID-19, stay home.”
Individuals can leave self-isolation if their symptoms have been improving for 24 hours and they have no fever..
Additionally, even if no longer self-isolating, those who have COVID-19 symptoms or who have tested positive for COVID-19 should continue to wear a mask in public and avoid high-risk settings for 10 days following their symptoms starting or testing positive.
Close contacts should also follow this guidance for 10 days after their exposure.

It was moved by Ms. DeViet, seconded by Ms. Elliott, that the Board of Health receive the verbal update re: “Current Public Health Issues” for information.

Carried

Medical Officer of Health Activity Report for September (Report No. 62-22)

It was moved by Ms. Elliott, seconded by Ms. Cassidy, that the Board of Health receive Report No. 62-22, re: “Medical Officer of Health Activity Report for September,” for information.
Carried

Chief Executive Officer Activity Report for September (Report No. 63-22)

It was moved by Mr. John Brennan, seconded by Mr. Menghsha, that the Board of Health receive Report No. 63-22, re: “Chief Executive Officer Activity Report for September,” for information.
Carried

Correspondence

It was moved by Mr. Brennan, seconded by Ms. Elliott, that the Board of Health receive items a) and b).
Carried

Other Business

The next meeting of the Middlesex-London Board of Health is Thursday, November 10 at 7:00 p.m.
Carried

Confidential

At 8:20 p.m., it was moved by Mr. Steele, seconded by Ms. Elliott, that the Board of Health will move in-camera to approve previous confidential Board of Health and Committee minutes, to consider matters regarding personal matters about an identifiable individual, including municipal or local board employees, labour relations or employee negotiations, and advice that is subject to solicitor-client privilege, including communications necessary for that purpose.
Carried

At 9:18 p.m., it was moved by Ms. DeViet, seconded by Mr. Brennan, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 9:18 p.m., it was moved by Mr. Brennan, seconded by Mr. Menghsha, that the meeting be adjourned.
Carried

Matt Reid
Chair

Emily Williams
Secretary

Date of creation: November 4, 2022
Last modified on: February 7, 2023