October 18, 2012 - Minutes
Members Present
Ms. Viola Poletes Montgomery (Chair)
Mr. David Bolton
Ms. Denise Brown
Ms. Patricia Coderre
Mr. Al Edmondson
Mr. Marcel Meyer (Vice Chair)
Ms. Nancy Poole
Mr. Mark Studenny
Regrets
Mr. Stephen Orser
Others Present
Mr. Wally Adams, Director, Environmental Health and Chronic Disease Prevention Services
Ms. Michelle Alvey, Health Promoter
Ms. Diane Bewick, Director, Family Health Services
Ms. Laura Dueck, Public Health Nurse
Ms. McKenzie Dumoulin, Youth Leader
Mr. Dan Flaherty, Manager, Communications
His Worship Joe Fontana, Mayor, City of London
Mr. Ross Graham, Manager, Special Projects
Ms. Alison Locker, Epidemiologist
Ms. Heather Lokko, Manager, Family Health Services
Ms. Kaylene McKinnon, Public Health Nurse
His Worship Jim Maudsley, Warden, County of Middlesex
Mr. John Millson, Director, Finance and Operations
Ms. Jessica Pacheco, Youth Leader
Ms. Sherri Sanders, Executive Assistant to the Board of Health (Recorder)
Ms. Deb Shugar, Manager, Family Health Services
Mr. Rick Shantz, Director, Information Technology
Ms. Trudy Sweetzir, Communications Assistant
Ms. Louise Tyler, Director, Human Resources and Labour Relations Services
Mr. Alex Tyml, Online Communications Coordinator
Dr. Bryna Warshawsky, Acting Medical Officer of Health & CEO and Director, Oral Health, Communicable Disease & Sexual Health Services
Media Outlets
Mr. Andrew Forbes, Western News
Ms. Cristina Howorun, CTV London
Mr. Wayne Jennings, CTV London
Ms. Emily Leighton, Western News
Mr. Jonathan Sher, London Free Press
Ms. Viola Poletes Montgomery, Chair, Board of Health, called the meeting to order at 7:00 p.m. Chair Poletes Montgomery announced that Board of Health meetings will be audio taped to ensure the accuracy of the minutes. The tape will be destroyed after the minutes are approved at the following Board of Health meeting.
Disclosures of Conflict(s) of Interest
Chair Poletes Montgomery inquired if there were any disclosures of conflict of interest to be declared. None were declared.
Approval of Agenda
It was moved by Ms. Coderre, seconded by Mr. Studenny that the Revised October 18, 2012, Agenda be approved. Carried
Approval of Minutes
It was moved by Ms. Poole, seconded by Mr. Edmondson that the Minutes of the September 13, 2012, Board of Health meeting be approved. Carried
It was moved by Mr. Edmondson, seconded by Ms. Brown that the Confidential Minutes of the September 13, 2012, Board of Health meeting be approved. Carried
Reports With Delegations
Item #6) Report No. 122-12 re ‘One Life One You’ Hosts Successful Smoke-Free Outdoor Movie Event in Victoria Park
Mr. Wally Adams, Director, Environmental Health and Chronic Disease Prevention Services, introduced Ms. Michelle Alvey, Health Promoter, and Youth Leaders, Ms. McKenzie Dumoulin and Ms. Jessica Pacheco, students at Beal Secondary School. Ms. Alvey also introduced the rest of the Youth Leaders: Ms. Nour Irani, Ms. Alexis Sylvester, Mr. Scott Navarro, Ms. AndreaHanke, and Ms. Eleane Paguaga.
Ms. Alvey, Ms. Dumoulin and Ms. Pacheco assisted Board members with their understanding of this report. They highlighted the smoke-free, outdoor movie event at Victoria Park in London that was attended by over 1300 people and showed a video clip of the media coverage of the event.
It was moved by Ms. Brown, seconded by Mr. Meyer that Report No. 122-12 re ‘One Life One You’ Hosts Successful Smoke-Free Outdoor Movie Event in Victoria Park be received for information. Carried
Item #7) Report No. 123-12 re Middlesex-London’s Community Health Status Resource
Dr. Bryna Warshawsky, Acting Medical Officer & CEO, assisted Board members with their understanding of this report. A copy of Dr. Warshawsky’s PowerPoint presentation is filed with the minutes. Dr. Warshawsky explained that the Foundational Standard of the Ontario Public Health Standards requires the Health Unit to compile data about the population’s health. Instead of a written report, an on-line Community Health Status Resource has been developed to provide this information. Dr. Warshawsky acknowledged the significant amount of work conducted by the Health Unit Epidemiologists, Ms. Sarah Maaten, Ms. Alison Locker and Ms. Evelyn Crosse, as well as the Health Unit Data Analyst, Mr. Bernie Lueskie, in the development of this resource.
Dr. Warshawsky introduced Ms. Alison Locker, Epidemiologist. Ms. Locker demonstrated the online resource. Ms. Locker noted that if Board of Health members would like to access the Resource, it can be found at www.communityhealthstats.healthunit.com . If they have questions about the Resource, contact information can be found on the home page of the Resource.
It was moved by Ms. Brown, seconded by Ms. Coderre that Report No. 123-12 re Middlesex-London’s Community Health Status Resource be received for information. Carried
Item #3) Report No. 119-12 re Baby Friendly Organization Policy
Ms. Diane Bewick, Director, Family Health Services, introduced Ms. Laura Dueck, Public Health Nurse, and Ms. Heather Lokko, Manager, Reproductive Health Team. Ms. Lokko and Ms. Dueck assisted Board members with their understanding of this report using a PowerPoint presentation (filed with the minutes). Ms. Lokko explained the Baby Friendly Organization Policy for the Health Unit. Ms. Lokko and Ms. Dueck also discussed each of the Ten Steps outlined in the policy to provide orientation to Board of Health members as required under the Ontario Public Health Accountability Agreement. Board members are required to do the following:
1. Acquire knowledge about the Baby Friendly Initiative (BFI)
2. Formally endorse the Baby Friendly Organization policy
3. Participate in initial and on-going orientation. This orientation includes the following:
a. Report No. 060-12 – from April 19, 2012 Board of Health meeting;
b. Report No. 119-12 – from October 18, 2012 Board of Health meeting;
c. The presentation at the October 18, 2012 Board of Health meeting;
d. Regular reports at future Board of Health meetings.
In response to a question about how the Health Unit can ensure that the Baby Friendly Initiative is happening in the hospitals, Ms. Lokko replied that Health Unit staff members are partnering with hospital staff to achieve the BFI requirements.
In response to a question about how the Health Unit supports new mothers whether or not they choose to breast feed their infants, Ms. Dueck explained that services such as Healthline, Infantline, Well Baby Clinics, and information in physicians’ offices and hospitals about Health Unit programs are available to everyone. Although Health Unit staff members will not provide group information about formula feeding, they will provide one on one help, when needed.
It was moved by Ms. Coderre, seconded by Mr. Bolton that the Board of Health endorse the Baby-Friendly Organization policy attached as Appendix A to Report No. 119-12. Carried
Item # 13) Report 129-12 Current Status of 2013 Budget Considerations (which also relates to Report No. 116-12 re City of London and Middlesex County Exploration of Options for Municipal Administration of Public Health from September agenda)
Dr. Warshawsky introduced the report using a PowerPoint presentation (filed with the minutes). Dr. Warshawsky reviewed the concept of shared services. She explained that Dr. Graham Pollett and Mr. John Millson met with City of London staff on June 29, 2012, to discuss a review of shared services with the City of London. On July 17, Health Unit staff members prepared a draft Terms of Reference and presented the draft to the City. The Terms of Reference will be the subject of a Board Report at a future meeting.
Dr. Warshawsky reminded Board of Health members that the Mayor and Warden sent a letter to the Ministry of Health and Long-Term Care on May 30, 2012, to ask what would be involved in administering public health at the municipal level. A response from the Minister of Health and Long-Term Care stated that the authority for public health administration rested with the Board of Health. On September 11th, Mr. Bill Rayburn, Chief Administrative Officer, County of Middlesex, made a presentation to County Council about the exploration of municipal administration of public health. On September 13th, the Board of Health was provided with Report 116-12 in which the implications of municipal administration of public health were discussed. As Board members began to explore Report 116-12, clarification was needed as to what Warden Maudsley and Mayor Fontana were proposing, and a request was made to the Mayor and to the Warden to make a presentation to the Board of Health.
Dr. Warshawsky then introduced His Worship Mayor Joe Fontana, Mayor, City of London, and His Worship Warden Jim Maudsley, Warden, County of Middlesex.
Warden Maudsley thanked the Board of Health for the invitation to make a presentation. He introduced the presentation by stating that he and Mayor Fontana believe that a reduction in administrative costs is required to support the growth of public health programs and services and reduce municipal budgets. He also stated that he and the Mayor believe they were elected to ensure services for which they are responsible are delivered in the most efficient and effective manner possible.
Warden Maudsley explained that he and the Mayor approached the Minister of Health and Long-Term Care earlier in 2012 to ask about municipally administered public health and what decision making protocol was required to make changes. Warden Maudsley also explained that Mr. Bill Rayburn’s presentation to Middlesex County indicated that it was best to try and provide administrative efficiencies as opposed to governance changes or service cuts. With this direction in mind, the administration of the three parties (Middlesex County, City of London and the Health Unit) are working on the development of a Terms of Reference for a third party review of current administrative services to determine the most efficient method for administrating public health programs and services.
Warden Maudsley then turned the presentation over to Mayor Fontana.
Mayor Fontana opened by thanking the Board for its commitment to public health and emphasized that collectively all three agencies are here to serve the citizens. He stated that he wants to work in partnership to deliver services; not to reduce public health services. The City of London wants to achieve the desired 75/25% cost-shared arrangement. The Mayor stated that he and the Warden have ideas as to how they can help the Health Unit reduce operating costs.
The Mayor explained that the City is aiming for another year of 0% budget increases. To achieve this, the Middlesex Health Unit would receive a $731,000 decrease in funding from the City for London. This would result in an estimated 71.7% provincial and a 28.3% municipal cost-shared split. Mayor Fontana appreciates the cost savings realized by the Health in the 2012 budget, but he feels more is required.
The Mayor outlined the cost containing methods that the City has used including wage freezes for management staff and outside workers, personnel gapping and vacancy management,freezes to group benefit plan rates, budget reductions and efficiencies and new user fees. He acknowledged that the Middlesex Health Unit is already a member of the Elgin Middlesex Oxford Purchasing Consortium. He believes that the City could find administrative cost savings for the Health Unit that would not impact the delivery of public health services, including the administration of human resources, payroll and information technology. The City already shares services with a number of Boards and Commissions.
Mayor Fontana apologized that the review of the draft Terms of Reference is taking a little longer than he would have liked and that he hopes to have it delivered to the Health Unit by Friday, October 19, 2012. The Mayor stated that he looks forward to continuing the dialogue between administrations so that the review project can move forward as quickly as possible.
The Mayor and Warden then opened the presentation up to questions.
In response to a question about the May 30th letter from the Mayor and Warden to the Minister of Health and Long-Term Care, Dr. Warshawsky informed Board members that a copy of the letter could be found as Appendix A to Report No. 116-12. Chair Poletes Montgomery also clarified that the Board of Health was not copied on the initial letter; however, it was copied on the response from Minister Deb Matthews.
In response to a question about whether or not the City’s wage freezes were part of the provincial Wage Restraint Act or something specific to the City, Mayor Fontana reported they were not part of the Act and were initiated by the City. Board member Ms. Pat Coderre reported that the Board of Health Unit was required to freeze wages, as dictated by the provincial Wage Restraint Act.
In response to a question about the shared services the City provides to its Boards and Commissions, the Mayor explained that the City provides payroll services for London Police and Tourism London. City staff members also currently offer some Information Technology (IT) support to all Boards and Commissions in terms of emails, network server management and telephone systems.
It was highlighted by Board member Mr. Mark Studenny that the Board of Health has had a 0% increase in its funding from the City of London and the County of Middlesex for the past eight years. In response to a question as to whether the London Police Board has maintained a similar 0% increase in funding in the past few years, the Mayor responded that the Police budget has not come in at 0% in the past number of years and that they will be asked to come in at zero this budget year.
In response to a question about the selection of Price Waterhouse Cooper to conduct the third party review of the shared services model, Mayor Fontana replied that the company has experience and expertise in this area.
Mr. John Millson clarified that the City of London, Middlesex County and the Health Unit have the same external auditor, KPMG LLP. He offered to explain the difference between an internal audit and an external audit when the Terms of Reference are discussed at a future Board of Health meeting. Mr. Millson explained that the firm of Price Waterhouse Cooper currently is used to conducting the internal audit process for the City of London. Because the company already has information about the City’s internal processes, they were suggested to do the third party review.
In response to a question about whether or not the shared services model was intended to include all parts of the Health Unit’s budget (cost-shared programs and 100% funded programs), Mayor Fontana replied that it was.
Board member Mr. Al Edmondson summarized that the Health Unit’s intent is to offer cost efficient public health programs and services. The shared-services review is intended to explore if there are efficiencies to be gained.
Chair Poletes Montgomery thanked the Mayor and Warden for their presentation.
Item #1 Report No. 117-12 re 2013 Budget – “Protecting the Gains”
Dr. Bryna Warshawsky and Mr. John Millson, Director, Finance and Operations, assisted Board members with their understanding of this report by means of a PowerPoint presentation (filed with the minutes).
Dr. Warshawsky presented information from the Ministry of Health and Long-Term Care (MOHLTC) that acknowledges that there are many obligated municipalities within the Province that provide funding to Boards of Health that exceeds 25% of the cost-shared budget.
Dr. Warshawsky explained that if this Health Unit receives a 2% increase from the province in 2013 and a 0% increase from the municipalities, there will be at $477, 682 shortfall. The Public Health Accountability Agreement expects Boards of Health to meet the Ontario Public Health Standards. The municipalities are obligated to cover the costs the Board of Health deems necessary that are not covered by the provincial grants. Therefore, the Board of Health has three options to consider in order to direct Health Unit staff to prepare the 2013 Cost-Shared Budget. These options include the following:
A) Assume a 2% increase in the grant from the province and ask obligated municipalities for an increase to cover the anticipated costs.
B) Assume a 2% increase in the grant from the province and continue the 2005 Business Plan which asks municipalities for no increase in funds. This would result in a $466,682 shortfall.
C) Move more quickly to a 75/25 cost-sharing arrangement which would result in additional cuts.
Mr. Millson discussed Option B and the possibilities of finding the anticipated $477,682 shortfall. He also noted that the possibility of creating reserves would be discussed in a future Board of Health report. Reserves need to be considered because of the constraints on the Health Unit’s budget under Option B. Reserves would enable the Health Unit to deal with unbudgeted and one-time needs that previously were dealt with by gapping that would no longer be available under Option B.
It was noted that any cost efficiencies identified in the Shared Services Review would not be known in time for the 2013 budget. It was also noted that Option B would not meet the City of London’s budget targets and would not move the Health Unit any closer to a 75/25 cost-sharing arrangement. If the $477,682 shortfall was passed on to the obligated municipalities, it would result in greater than a 3% increases to the City and County above what they are paying now (Note: this increase was subsequently determined to be 6.6%).
In response to a question about the impacts of Option C, Mr. Millson replied that the Health Unit Budget would be reduced by $1.5 to $1.7 million to move to 75/25, in addition to the $477,682 shortfall. Significant cuts to programs, services and staffing would be required.
It was moved by Ms. Poole, seconded by Mr. Edmondson that the Board of Health endorse Option B as outlined in the presentation related to Report No. 117-12 re 2013 Budget – “Protecting the Gains” that assumes a 2% increase in grant from the Ministry of Health and Long-Term Care and continuation of the Health Unit’s 2005 Business Plan which asks the City of London and the County of Middlesex for a 0% increase over 2012. 4 for 3 against. Carried
Action Required
Item #2 Report No. 118-12 re Provincial Government Announcement to Regulate Indoor Tanning: Call for Support & Endorsement of Bill 74
Mr. Wally Adams assisted Board members with their understanding of this report. He explained that since Cabinet is now prorogued, the status of this Private Member’s bill is unknown.
It was moved by Ms. Brown, seconded by Mr. Studenny:
1. That the Board of Health endorse the Ontario Government announcement to enact provincial tanning industry legislation by sending a letter (attached as Appendix A to Report No. 118-12) to The Right Honourable Dalton McGuinty, Premier of Ontario; and further
2. That the Board of Health communicates its support for provincial tanning industry legislation to The Honourable Deb Matthews, Minister of Health and Long-Term Care; the Association of Local Public Agencies (alPHa); local Members of Provincial Parliament and all Boards of Health in Ontario.
Carried
Item #4 Report No. 120-12 re London Children and Youth Network: Endorsement of London’s Child and Youth Agenda to 2015
A draft letter of endorsement was circulated to Board of Health members via email on October, 17, 2012. A copy of the draft letter is filed with the minutes. Ms. Diane Bewick, Director, Family Health Services, and Ms. Debbie Shugar, Manager, Family Health Services, were available to answer questions about this report. Ms. Shugar reminded Board members that more information about London’s Child and Youth Network is available at www.londoncyn.ca .
It was moved by Ms. Coderre, seconded by Ms. Brown that the Board of Health send the letter that was circulated to Board members on October 17, 2012, to Ms. Lynne Livingstone, Chair, Child and Youth Network, endorsing London’s Children and Youth Network Agenda to 2015. Carried
Item #14 Report No. 130-12 re Questions and Answers about the Health Unit Budget
Dr. Warshawsky reported that several articles have appeared in the media regarding the Health Unit budget that affect the reputation of Health Unit and its staff. She highlighted that the Health Unit is a very effective and efficient organization with a complex budget. Dr. Warshawsky also reported that Health Unit staff members are being asked questions by their partners in the community and colleagues at other health units. Therefore, staff members propose to send a series of questions and answers to provide succinct, factual information about the Health Unit’s budget to community partners via list serves and Twitter and to post on the Health Unit’s website. This document will be circulated to Board of Health members before it is distributed in the community.
Further discussion ensued regarding the concept of the 75/25 cost-sharing arrangement. Councillor Denise Brown agreed to provide information that supports the 75/25 cost-sharing arrangement to Board of Health members.
It was moved by Mr. Studenny, seconded by Ms. Coderre that the Board of Health endorse the dissemination of a series of Questions and Answers explaining the Health Unit’s budget and related organizational matters, and that the initial communication be sent by the Board Chair on behalf of the Board of Health. 6 for 2 against. Carried
Ms. Poole left the meeting at 9:25 p.m.
For Information
Item #5 Report No. 121-12 re Acting Medical Officer of Health Activity Report – September 14 – October 10, 2012
Item #8 Report No. 124-12 re Accreditation – 2012 Annual Questionnaire and Site Visit
Item #9 Report No. 125-12 re Informing the Development of a Middlesex-London Sodium Campaign
Item #10 Report No. 126-12 re Intersectoral Action for Immigrant Population: London & Middlesex Local Immigration Partnership
Item #11 Report No. 127-12 re Influenza Season in Middlesex-London
Item #12 Report No. 128-12 re Program Evaluation for the Althouse College Sexual Health Education Sessions, 2011 & 2012
Item #13 Report No. 129-12 re Current Status of 2013 Budget Considerations
Item #16 Verbal Report re Medical Officer of Health and Chief Executive Officer Recruitment Process
Ms. Poletes Montgomery, Chair of the Medical Officer of Health Selection Committee, reported that the Search Committee met with Four Corners Group and was presented with a short list of four candidates. The Committee is moving onto the next step which will be interviews.
It was moved by Ms. Brown, seconded by Mr. Bolton that Reports listed as Items #5, #8 through #13 and #16 be received for information. Carried
Other Business
Next scheduled Board of Health Meeting – Thursday, November 15, 2012 at 7:00 p.m.
Correspondence
Chair Poletes Montgomery highlighted the first item of correspondence which was Dr. Francine Lortie-Monette’s letter of resignation from the Board of Health. Chair Poletes Montgomery expressed her gratitude to Dr. Lortie-Monette for her dedication to the Board of Health and reported that a letter of thanks had been sent to Dr. Lortie-Monette on behalf of the Board. The Chair reported that staff members have been in contact with the Public Appointments Secretariat about the need for two provincial appointees to the Board and whether there will be any delays in these appointments because the legislature has been prorogued.
Chair Poletes Montgomery also reminded Board members that the Fall alPHa Symposium is scheduled for November 7-8, 2012, in Toronto. If any Board member is interested in attending, s/he should contact Ms. Sherri Sanders, Executive Assistant to the Board of Health, who can make the arrangements.
Mr. Edmondson requested to be added to the November 15, 2012, Board of Health agenda re a proposal for a pilot project with a local Board of Education.
Adjournment
At 9:31 p.m., it was moved by Mr. Bolton, seconded by Mr. Studenny that the meeting be adjourned. Carried
VIOLA POLETES MONTGOMERY
Chair
BRYNA WARSHAWSKY
Secretary-Treasurer
Last modified on: February 25, 2013