December 2019 Board Meeting

Prepared By:

Communications Department

Date:

December 3, 2019

Subject:

November Media Relations Recap Report

November Media Coverage

Media Coverage

News Release, Media Advisories and Media Statements

Stories Reported by the Media

AM 800

Blackburn News

CBC News

Note: Digital stories were not available for nine of CBC’s requests.

CTV Windsor News

Note: Digital stories were not available for two of CTV’s requests.

St. Clair College/Mediaplex

Note: Digital stories were not available for five of St. Clair College’s requests.

University of Windsor News​​​​​​​

Windsor Star

Note: Digital stories were not available for three of Windsor Star’s requests.

Windsorite.ca

Note: Digital stories were not available for the Lakeshore News request (1), or Radio-Canada’s requests (2),

The following individuals contributed to this report: Jennifer Jershy, Marc Tortola, and Michael Janisse.

Prepared By:

Darcie Renaud, Performance Improvement & Accountability Coordinator (PIAC), Planning & Strategic Initiatives Department

Date:

December 19, 2019

Subject:

2019 Operational Plan Reporting Q3 Status 

BACKGROUND

In 2018, the Ministry of Health, introduced a new Annual Service Plan (ASP) that Health Units are required to submit each year. An electronic planning and reporting system was created to support the development of the ASP and to monitor operational plan progress throughout the year. In this system, work plans are developed for all public health interventions. These interventions directly address the programs provided by the WECHU. The WECHU’s ASP provides details about planned expenditures and program plans for 2019, including 268 initially planned interventions tied to 61 programs. The Ministry of Health requires program activity and financial reports in Q2 and Q4 of the implementation year, and an annual summary report. In addition, status updates are provided for interventions quarterly. 

CURRENT INITIATIVES

The appended report reflects the quarterly Board of Health summary report for Q3 of 2019. This report includes overall status information for the 223 interventions that were in progress in Q3 of 2019. A majority of the interventions were either on target or completed, though some interventions were cancelled or deferred until the following year. Proposed changes to public health operations and the 2019 labour disruption continued to influence the progress of some interventions, though to a lesser degree than in Q2. The most common reason given for deferral, cancellation, or variance was human resource issues (35%), followed by adjusted program priorities (27%), and the 2019 labour disruption (18%). Further detail is provided about the status of programs based on the related interventions that were planned for in Q3 of 2019.

CONSULTATION

The following individuals contributed to this report:

• Marc Frey, Manager, Planning & Strategic Initiatives

APPROVED BY:

Theresa Marentette, CEO

WECHU Strategic Plan Progress - At a Glance

Communication and Awareness

Organizational Development

Partnerships

Evidence-based Public Health Practice

Communication and Awareness

Partnerships

Organizational Development

Evidence-Based Public Health Practice

Prepared By:

Darcie Renaud, Performance Improvement & Accountability Coordinator (PIAC), Planning & Strategic Initiatives Department

Date:

December 19, 2019

Subject:

Q3 Strategic Plan Report

BACKGROUND

The 2017-2021 WECHU Strategic Plan sets out our plan to enhance our delivery of quality public health programs and services to all residents in Windsor and Essex County. The current strategic plan details our organization’s vision, mission, values, and our four strategic priorities. Each quarter, the Board of Health (BoH) receives a report on the status of progress made towards the Strategic Priorities in that quarter.

CURRENT INITIATIVES

The 2019 Q3 Strategic Plan Progress Report provides the objectives under each strategic priority with corresponding updates to measure our advancement towards achieving the goal. Progress has continued on many of the strategic objectives, however, uncertainty around the proposed merger of public health units by the Ontario government has resulted in the delay and/or deferral of a number of plans related to the WECHU’s strategic objectives.

CONSULTATION

The following individuals contributed to this report:

• Marc Frey, Manager, Planning & Strategic Initiatives 
• Michael Janisse, Manager, Communications
• Ramsay D’Souza, Manager, Evaluation & Epidemiology

APPROVED BY:

Theresa Marentette, CEO

Reporting Structure

This report provides a status summary for all of the 2019 Annual Service Plan program interventions that were in progress in Q3 (July 1st to September 30th).

All active interventions received a status update using the following categories:

• On Target (the intervention is progressing at the planned pace)
• Variance (the intervention is behind the planned pace)
• Complete (the intervention has been completed)
• Deferred (current work on the intervention has been stopped – with potential to continue next year)
• Cancelled (the intervention will no longer occur)

If the intervention was identified as ‘Variance’, ‘Deferred’, or ‘Cancelled’, a reason was provided. In these cases, the most relevant reason was selected from the following list:

• 2019 Labour Disruption (the labour disruption resulted in changes to the intervention)
• Adjusted Program Priorities (program priority alterations resulted in changes to the intervention)
• Human Resource Issue (staffing circumstances resulted in changes to the intervention)
• Partnership Limitations (external partner(s) did not to meet their obligations)
• Public Health Emergency (a significant public health emergency resulted in changes to the intervention)
• Resource Limitation (financial, material, or internal support limitations resulted in changes to the intervention)

It is important to note that reporting reflects a summary of progress made on interventions based on the predetermined milestones for the intervention. This does not necessarily represent the amount or scope of work captured under each program.

Overall Quarterly Status Summary

There were 223 interventions in progress in Q3 2019. Figure 1 displays the percentage of interventions that were on target, reported a variance, were deferred, were cancelled, or were completed. A majority of interventions (64%) were either completed or on target. This is a slight increase from Q2, when 63% of plans were reported as completed or on target. 

Of the 223 interventions in progress, 36% (79) were deferred, cancelled, or reported a variance. Figure 2 provides a summary of the reasons for variances, deferrals, or cancellations as a percentage of the total number of variances, deferrals, and cancellations. 

Proposed changes to public health operations and the 2019 labour disruption continued to influence the progress of some interventions, though to a lesser degree than in Q2. The most common reason given for deferral, cancellation, or variance was human resource issues (35%), followed by adjusted program priorities (27%), and the 2019 labour disruption (18%). Combined, the labour disruption, program priority adjustments, and human resource issues accounted for 80% of the variances, deferrals, or cancellations of interventions. 

In some cases, managers and staff provided comments to further explain the reason for deferral, cancellation, or variance. Examples of human resources issues that affected the status of work plans included expected and unexpected leaves of absence and general staff turnover. When adjusted program priorities were cited, examples provided included the service delivery model change in the Healthy Schools department, changing priorities of partners and partnerships, and a need to focus more staff time than expected on other interventions. 

Program Quarterly Status Summary

All interventions are directly tied to programs and program objectives; Figure 3 displays a summary of the status updates for each WECHU program based on the number of interventions that were on target, varied from target, were completed, were deferred, or were cancelled. 

Prepared By:

Phil Wong, Environmental Health Manager

Date:

December 19, 2019

Subject:

Lead in Drinking Water

BACKGROUND

According to Health Canada, lead in drinking water should be kept as low as reasonably achievable. The most significant contribution of lead in drinking water is generally from lead service lines that supply drinking water to your home. The best approach to eliminate lead exposure is to remove and replace the full lead service line. Lead service lines have not been used for many years but older homes and buildings (pre-1948) may still have lead pipes and service lines. Lead solder and brass fittings/fixtures are also common sources of lead exposure. This report will highlight some of the key regulations and provide some clarification on how lead exceedances are handled in the province of Ontario.

Standards vs. Guidelines and Duty to Report

The Canadian guideline for lead in drinking water was lowered in June 2019 to 5ppb (0.005mg/L) or as low as reasonably achievable. In Ontario, the Drinking Water Quality Standards Reg. 169/03 and the Safe Drinking Water Act, 2002, have the maximum acceptable concentration (MAC) for lead in drinking water as 10ppb (0.010mg/L). All municipal drinking water systems and designated facilities are legally required to meet the 10ppb MAC. Under the Act, all drinking water system operators have a duty to report microbiological, chemical and radiological exceedances to their local public health unit and the Ministry of Environment, Conservation and Parks (MECP). The WECHU’s role is to give direction, in the event of an exceedance, on corrective action to eliminate/reduce any health effects.

Municipal Systems

The Drinking Water Systems Reg. 170/03 outlines the sampling protocol and testing requirements for municipal drinking water systems. The MECP regulates these systems and calls for the implementation of an extended lead testing-program. Targeted testing and sampling is conducted by municipal drinking water operators in each municipality, and any lead service lines are replaced when identified. Homeowners on municipal systems are encouraged to contact their local providers for options on lead sampling and other services. Homeowners are notified by the municipal drinking water operator and the health unit if lead is identified through operator sampling. 

Schools and Child Care Centres

Schools and child care centres are required to sample their water for lead as per Ontario Regulation 243/07: Schools, Private Schools and Child Care Centres. This regulation, recently amended in 2017, increased lead sampling requirements in these facilities. There is a requirement for annual sampling and testing of lead in drinking water to ensure lead levels are below the provincial Ontario Drinking Water Quality Standards Reg. 169/03. It also requires flushing of plumbing in schools to help reduce lead levels in drinking water. Flushing has been shown to reduce lead levels in water and is a recognized lead reduction strategy. Schools and child care centres have replaced service lines, decommissioned fountains, installed NSF POU filters and have bottle filling stations when lead exceedances have been identified. The regulation is enforced by the MECP as schools and child care centres are designated facilities, and the health unit takes a lead role to provide guidance on health related issues.

Private Water Supplies

Homeowners using private water supplies within Ontario can send water samples for lead testing to an accredited private laboratory from the MECP list. There is a cost associated with lead testing at a private laboratory. Private homeowners can submit water samples to the Public Health Ontario Laboratory for bacteriological testing (E. coli and total coliforms) and this service is free for all private drinking water systems.

CURRENT INITIATIVES

Under the Ontario Public Health Standard’s Safe Drinking Water and Fluoride Monitoring Protocol, the health unit is mandated to provide 24/7 on-call support and response to all adverse drinking water events. Where water intended for human consumption may not be safe to consume, the health unit is required under the Health Protection Promotion Act to respond. The health unit initiates a response within 24 hours of receiving notification of any adverse event in the region. Boil Water and Drinking Water advisories, as well as legal orders to drinking water system operators, are issued regularly to prevent exposures to any microbiological, chemical or radiological exceedances. The health unit continues to work with municipal drinking water system operators, school boards and private well owners to provide awareness and education on safe drinking water.  

For more information on safe drinking water please visit the sites below:

• Lead in Drinking Water
• Lead in Schools and Child Care
• Private Well Water
• Enforcement
• Windsor Utilities Commission

APPROVED BY

Theresa Marentette

Prepared By:

Neil Mackenzie, Manager, Chronic Disease and Injury Prevention

Date:

December 19, 2019

Subject:

2019 Nutritious Food Basket and the Real Cost of Eating Well in Windsor-Essex

BACKGROUND

Nutritious Food Basket – Description

As part of the Population Health Assessment and Surveillance Protocol, 2018, under the modernized Ontario Public Health Standards (OPHS), boards of health are required to monitor food affordability at a local level. The Ministry of Health and Long Term Care provides guidance for determining the Nutritious Food Basket in its guidance document: Monitoring Food Affordability Reference Document, 2018 (MOHLTC, 2018).

Each year, the WECHU releases its calculation for the Nutritious Food Basket. Food costing tools, such as the Nutritious Food Basket (MOHLTC, 2008), measure the cost of basic healthy eating representing current nutrition recommendations and average food purchasing patterns. It allows for improved understanding of the real cost of eating a basic nutritious diet for a reference family and those of different ages, gender, and physiological status (i.e., pregnant, breast feeding) within Windsor-Essex County. 

Over a two-week period in May 2019, the WECHU’s Registered Dietitians (RD) surveyed nine different grocery stores within the city and county. Stores are selected following the NFB protocol, ensuring representation of all types of grocery stores (i.e., high-end, discount, community based). Using the NFB costing tool, the average cost of the lowest price available for 67 different food items is calculated. Once the average price is determined, different income and family scenarios for our local community are calculated.

Nutritious Food Basket – 2019 Reality

The cost of healthy eating for a family of four in Windsor and Essex County was calculated to be $211.20 per week. This represents an increase of $17.16/week (8.8 %) over the previous year’s calculation. The 2019 Nutritious Food Basket cost ($211.20/week) is 12.3% higher than the cost in 2014 ($188.04/week). Over that same period, rental costs in WEC have increased by 18.9%, and Ontario Works benefits have only increased by 7.8%.  Households who are reliant on social assistance as their main source of income are at a greater risk for food insecurity than households who receive income from employment (PROOF Food Insecurity Policy Research, 2017).

Note: The NFB does not include items such as spices, sauces, condiments, processed and ready-to-eat foods, baby food and formula, personal hygiene, and cleaning products.

The increase in the cost of the Nutritious Food Basket for 2019 has a real impact, in that healthy eating will continue to be unattainable by many in our community. For example, a family of four* receiving Ontario Works has an average monthly household income of $2,623. When rent is accounted for, the family would be left with only $1,533 to cover the cost of food ($914.50) and all other remaining expenses, including utilities, transportation costs, medical expenses, clothing, etc. The reality is much worse for a single adult male receiving Ontario Works. After accounting for rent, the individual is left with only $225 to cover all remaining expenses, including food. This amount is less than the cost of the Nutritious Food Basket for an adult male ($306.93/month). Indeed, the individual would be left with no money at all for other basic expenses. With less money for food, the quality and quantity of foods purchased are compromised, causing individuals to turn to other options such as food banks or missing meals to make ends meet. 

CURRENT INITIATIVES

The NFB data is intended to raise awareness about the cost of basic healthy eating in our community.  This data can be used to assist policy and decision makers to advocate for improved social assistance rates, living wage uptake, more affordable housing availability, accessible and affordable child care, affordable and flexible utility costs, and other supports to ensure everyone has enough money available to meet their family’s basic nutrition needs.

The NFB has been used as an essential local component in the calculation of the Windsor-Essex County Living Wage for 2020.

A plan is in place to disseminate the 2019 NFB results and the Real Cost of Eating Well in Windsor-Essex to a variety of partners, organizations, and municipal councils who can use the information to support the most vulnerable individuals in our community. The information provided will help inform an urgent discussion on short and longer-term measures required to support individuals and families in having sufficient funds for a basic healthy diet. 

CONSULTATION:

The following individuals were contributed to this report:

• Heather Nadon, Public Health Dietitian
• Noura Jabbour, Public Health Dietitian
• Neil Makenzie, Manager, Chronic Disease and Injury Prevention

APPENDICES

• Appendix A - The Real Cost of Eating Well in Windsor-Essex, 2019 Report

APPROVED BY

Theresa Marentette

Prepared By:

Neil Mackenzie, Manager, Chronic Disease and Injury Prevention

Date:

December 19, 2019

Subject:

Windsor and Essex County Living Wage Program

BACKGROUND

Income inequality has been recognized as one of the most significant social determinants contributing to poorer population health outcomes. As such, many communities across Ontario, nationally, and internationally have implemented living wage programs aimed to raise awareness, encourage adoption, and advance healthy public policy. In 2017, the Windsor-Essex County Health Unit (WECHU) agreed to take over the administration of the Windsor and Essex County Living Wage program from Pathway to Potential; Windsor and Essex County’s Social Investment Plan. The program re-launched in March 2018, and as of November 2019, there are 27 Certified Living Wage Employers.

CURRENT INITIATIVES

The 2020 Living Wage calculated for Windsor and Essex County is $15.52/hour for full and part time employees that do not receive health benefits from their employer. This represents a .37 cent per hour (2.4%) increase over the 2019 Living Wage. The 2020 Living Wage for full and part time employees who receive health benefits from their employer remains at $14.00/hour (current provincial minimum wage).

Purpose: To raise awareness about the minimum salary required to increase the likelihood of having a basic standard of living in Windsor and Essex County, and to advance policies, partnerships, and practices that promote health and well-being for our community.

Key Program Deliverables

Each year the living wage calculation is updated and shared with the community. See the attached Calculating a Living Wage for Windsor and Essex County 2020 report (Appendix A). The report is intended to provide an overview of the Living Wage, how it’s calculated, and assumptions that are made in the calculations. It is anticipated that the report will help raise awareness about the importance of paying at least a Living wage to all employees, in order to increase the likelihood that they can meet the basic cost of living in Windsor and Essex County.

The Living Wage Certification Program includes:

• Promotion and recruitment activities;
• An online intake and enrollment process;
• Verification that applicants meet program eligibility criteria;
• Support for employer implementation;
• An employer Living Wage Certification package;
• Program evaluation and reporting activities to support quality improvement; and,
• Recognition at the annual Gord Smith Healthy Workplace and Bike Friendly Awards.

KEY CALCULATION CHANGES FOR 2020

In order to better support local communities in the Living Wage Calculation process, the Ontario Living Wage Network (OLWN) reviewed and updated the living wage calculation methodology in 2018.  This change allows local communities to spend less time calculating the living wage and helps standardize calculations throughout the province.

CONSULTATION

Members of the CAC serve in a consultative capacity, providing recommendations and advice to the WECHU Living Wage program administration team.  The most recent CAC meeting was held on October 24, 2019. At that meeting, the WECHU team delivered a presentation outlining the 2020 Living Wage calculation and relevant changes. They also shared the 2019 Living Wage evaluation report. The plan for promoting and recruiting Living Wage employers for 2020 was discussed.  Group feedback and discussion resulted in valuable input and advice that will be incorporated into the 2020 Living Wage Program.

Note: not all members of the CAC attended the meetings referred to above.

Community Advisory Committee Membership

• Judy Lund (Working Toward Wellness Committee)
• Michelle Suchiu (Executive Director, Workforce WindsorEssex)
• Stephen Lynn (Coordinator of Social Planning, City of Windsor)
• Jelena Payne (The Community Development and Health Commissioner, City of Windsor)
• Luciano Carlone (Director of Finance and Corporate Services, Canadian Mental Health Association - Windsor-Essex County Branch)
• Lorraine Goddard (CEO, United Way/Centraide Windsor-Essex County)
• Robert Ross (Windsor-Essex Food Policy Council)
• Greg Schlosser (Director, Human Resources, County of Essex)

The following individuals contributed to this report: Nicole Dupuis, Marc Frey, Neil MacKenzie, Ramsey D’Souza, Saamir Pasha, and Cathy Bennett.

APPENDICES

• Appendix A – Calculating a Living Wage for Windsor and Essex County 2020 - Report coming soon

APPROVED BY:

Theresa Marentette, CEO

Prepared By:

Lorie Gregg, Director of Corporate Services

Date:

December 19, 2019

Subject:

Q3 Financial Results

BACKGROUND

The Leadership Team of the Windsor-Essex County Health Unit (“the WECHU”) monitors financial results on an on-going basis for the following programs:

• Mandatory programs funded to a maximum of 75% (“Cost-Shared”) by the Ministry of Health and 25% by  the Corporation of the City of Windsor, the Corporation of the County of Essex and the Corporation of the Township of Pelee (hereinafter referred to as the “Obligated Municipalities”);
• Related programs funded 100% by the Ministry of Health;
• Related programs funded 100% by the Ministry of Children, Community and Social Services (“MCCSS”).
• One-time business cases funded 100% by the Ministry of Health.

The third quarter financial report to the Board includes a budget to actual comparison and narrative for material variances for all programs listed above, as well as forecasted financial results for the year-ending December 31, 2019.

COST-SHARED PROGRAM FINANCIAL RESULTS

The following is the financial information for the Cost-Shared programs including Vector-Borne Diseases and Small Drinking Water Systems for the period January 1, 2019 to September 30, 2019 with forecasted financial results for the year-ending December 31, 2019.

For the period January 1, 2019 to September 30, 2019, cash flows relating to the 2019 program year are as follows:

At September 30, 2019, the variance from budget to actual total expenditures amounted to $2,033,408. Specific variances are as follows:

• Salaries and Employee benefits:  Expenditures in these financial captions relate to salaries and benefits paid to the WECHU staff in service of the Mandatory Cost-Shared Program.  The combined variance from budget of $1,847,854 is attributed to: 
  • Labour disruption involving the WECHU staff represented by the Ontario Nurses Association (“ONA”) for the period March 8th, 2019 to May 8th, 2019 (approximate savings of $996,000);
  • Given the uncertainty that arose with the April 11th, 2019, Ontario Provincial Budget, certain positions, predominantly non-union, remained unfilled (approximate savings of $450,000 );
  • Gapping resulting from vacancies (i.e. extended recruitment processes; voluntary departures; unpaid leaves; back-filling positions for unpaid leaves); 
  • Gapping due to under utilization of certain other compensation related provisions (i.e. overtime, benefits, etc.) (approximate savings of $110,441).
• Travel and meetings, Mileage, Professional Development:  The combined variance associated with these financial captions was $117,151.  The aforementioned labour disruption had an impact on these financial captions, causing the WECHU to reprioritize certain less essential activities for those more critical to client service delivery, both during and subsequent to the labour disruption.   Adding to this was the release of the Ontario Provincial Budget, and the austerity measures that the WECHU put in place to ensure that financial resources would only be directed to mandatory travel, meetings and professional development (similar to those put in place by the Province of Ontario).
• Program supplies:   Expenditures in this financial caption support the activities of the departments, those that directly support Public Health Programs as well as those “support” departments such as Information Technology and Communications.  At September 30, 2019, the variance compared to budget amounted to $78,210 and can be attributed to:  i) The aforementioned labour disruption; ii) Timing of program activities. 
• Professional fees:  Expenditures in this financial caption include legal, audit and consulting fees paid to third parties.  The budget variance in Professional fees relates to an increase in legal costs to support the WECHU with collective bargaining (ONA only) and during the labour disruption (approximate impact $114,090). 
• Office equipment rental:  Expenditures in this financial caption include the WECHU’s contractual lease payments on account of multi-function copiers and a large format printer used to support client service delivery.  While the monthly contractual lease payments are consistent (approximately 44% of the 2019 annual budget or $62,480) the overage costs (the term used to describe utilization) vary depending upon the print volume. 
• Utilities and Telephone:  Expenditures in these financial statement captions include utilities for the Windsor and Leamington offices as well as all telecommunication (mobile, broadband, etc.).  The variance at September 30, 2019 of $43,544 is due to lower than anticipated usage coupled with certain cost-saving measures undertaken by the WECHU.
• Security:  Expenditures in this financial caption include security costs contracted on an as needed basis for after-hours events at our Windsor office location.  The WECHU incurred additional security costs of $46,984 for the period March 8, 2019 to May 8th, 2019, on account of the labour disruption.

In addition to the budget to actual analysis above, the WECHU has provided forecasted financial results for the year-ending December 31, 2019.  These forecasted financial results consider actual year-to-date results at November 30, 2019, as well as estimates of expenditures for the remaining 31-day period.  Total forecasted expenditures for the year-ending December 31, 2019 are anticipated to be $1,424,558 underspent when compared to budget.  Material variances between forecast to budgeted financial results are detailed below:

• Salaries and Employee benefits: For the year-ended December 31, 2019, Salaries and Employee benefits are forecasted to be $1,592,568 underspent.  This is attributed to:
  • The aforementioned labour disruption (approximate savings of $996,000);
  • Austerity measures taken by the WECHU resulting from the release of the 2019 Ontario Provincial Budget (approximate savings of $617,526);
  • Gapping resulting from vacancies (i.e. extended recruitment processes; voluntary departures; unpaid leaves; back-filling positions for unpaid leaves); 
  • Finalization of negotiations with the WECHU employees represented by the Canadian Union of Public Sector Employees (“CUPE”) resulting in a one-time bonus to said staff.  The Board of Health approved a one-time bonus to the non-union group of the same amount (approximate impact of $126,000).
• Program supplies:  For the year-ended December 31, 2019, Program supplies are forecasted to be overspent by $223,576.  This is primarily attributed to:
  • Costs associated with translation of the WECHU’s food handler courses into multiple languages (approximate impact of $17,000).
  • Implementation costs associated with the Ceridian Dayforce Project (approximate impact of $26,000).
  • Acquisition of two vaccine fridges to replace existing vaccine fridges nearing “end of life” (approximate impact of $21,042).
  • Acquisition of nicotine replacement therapy/tobacco cessation supports (approximate impact of $50,000).
  • Acquisition of information technology hardware (i.e. computers, servers, etc.) to replace existing equipment before “end of life” due to hardware defects (approximate impact of $30,000) and accelerating replacement to reduce budgetary pressures in 2020 (approximate impact of $20,000).
• Professional fees:  For the year-ended December 31, 2019, Professional fees are forecasted to be overspent by $116,612.  The forecasted variance in Professional fees is attributed to the labour disruption. 
• Security:  For the year-ended December 31, 2019, Security is forecasted to be overspent $35,896.  The forecasted variance in Security is attributed to the labour disruption.

HEALTHY BABIES HEALTHY CHILDREN PROGRAM FINANCIAL RESULTS

The Healthy Babies/Healthy Children Program is funded through the Ministry of Children, Community and Social Services.  This Program supports 27.0 FTEs comprised of managers (2), nurses (17), family home visitors (4), social worker (1), and support staff (3).  The objective of the Program is to ensure a healthy future for children and their families. 

For the period January 1, 2019 to September 30, 2019, the HBHC program underspent compared to budget in the amount of $384,202.  Factors contributing this include:  i) Labour disruption involving the WECHU staff represented by the ONA for the period March 8th, 2019 to May 8th, 2019.  This resulted in a variance in Salaries and benefits of approximately $280,000 and Mileage of $6,000 and likely attributed to under utilization of Professional development of $6,580 and Program supplies of $15,692;  ii)  Lower than anticipated Purchased services (i.e. translation) because of our use of an Arabic speaking nurse to address the needs of our community.

As reported at the November 4th, 2019, Budget meeting, the MCCSS modified the funding year for this Program from the calendar year to an April to March timeframe, aligning the funding year to the Province of Ontario’s fiscal year.  It is the WECHU’s understanding that reporting for this Program will be for the 15-months ending, March 31, 2020.  Administration will report forecasted financial results in February of 2020 for this program.

NURSE PRACTITIONER PROGRAMS

The Nurse Practitioner Program is funded through the Ministry of Children, Community and Social Services.  This Program supports 1 FTE (nurse practitioner).  The objectives of the Program are to promote healthy pregnancy, birth and infancy for children, improve parenting and family supports, strengthen early childhood development, learning and care.

At September 30, 2019, this Program is underspent by $24,569 due to the labour disruption involving the WECHU staff represented by the ONA for the period March 8th, 2019 to May 8th, 2019.

As reported at the November 4th, 2019, Budget meeting, the MCCSS modified the funding year for this Program from the calendar year to an April to March timeframe, aligning the funding year to the Province of Ontario’s fiscal year.  It is the WECHU’s understanding that reporting for this Program will be for the 15-months ending, March 31, 2020.  Administration will report forecasted financial results in February of 2020 for this program.

FINANCIAL INFORMATION FOR RELATED PROGRAMS FUNDED 100% BY THE MINISTRY OF HEALTH

The Healthy Smiles Ontario (“HSO”) program is funded through the Ministry of Health.  This program supports 14.25 FTEs comprised of a manager (0.75), dental assistants (5.5), dental hygienists (5.5), a health promotion specialist (0.5), and support staff (2).  This program provides preventative, routine, and emergency and essential dental treatment for children and youth, from low-income families, who are 17 years of age and under.

For the period January 1, 2019 to September 30, 2019, the HSO budget is underspent $44,426.  The most notable variances are as follows:

• A variance of $39,104 related to Salaries and benefits.  This is due to the reallocation of FTE resources to other program initiatives such as the Ontario Seniors Dental Program (approximate savings of $21,645) as well as gapping resulting from timing of recruitment (approximate savings of $7,500).
• A variance of $32,809 related to Program supplies.  The timing of the acquisition of Program supplies varies annually. 
• A variance of $30,725 related to Purchased Services, which includes professional services provided by dentists as well as translation.  As reported in at Q1 of 2019, there were fewer available dentists’ hours in the months of February and March.  Subsequent to March 31, 2019, additional dentists’ hours are available. 

Forecasted financial results for the year-ending December 31, 2019, indicate that the HSO program budget will be fully expended with amounts from Salaries and benefits being redirected to fund operating expenditures (more specifically Program supplies).

Base funding for the Smoke-Free Ontario Strategy Initiative must be used in the planning and implementation of comprehensive tobacco control activities across prevention, cessation, prosecution, and protection and enforcement at the local and regional levels.  Boards of Health must comply and adhere to the Smoke-Free Ontario Strategy: Public Health Unit Tobacco Control Program Guidelines and the Directives:  Enforcement of the Smoke-Free Ontario Act. 

At September 30, 2019, this program is underspent by $17,757.   In May of 2019, the Ministry of Health approved certain one-time funding up to March 31, 2019 for cannabis related activities.  The total one-time funding approval amounted to $96,700, of which, $37,656 was expended in fiscal 2018, and $44,158 was expended in Q1 of 2019, thus taking pressure off the calendar 2019 budget for this program initiative.  

Forecasted financial results for the year-ending December 31, 2019, indicate that this program budget will be overspent $38,150.  This overage relates to an additional FTE resource (Tobacco Enforcement Officer) added for fiscal 2019 only, to assist with increased work load with the legalization of cannabis in October of 2018.  The overage for this program will be funded from the Cost-Shared Mandatory Program Budget.

A description of other related programs is included below:

Nursing Initiative: The Amending Agreement for 2019 received August 20, 2019, aggregates the following program initiatives under “Nursing Initiatives”.  These include:  the Chief Nursing Officer Initiative; the Infection Prevention and Control Nursing Initiative; and the Social Determinants of Health Nursing Initiative.  Base funding for these initiatives support the salaries and benefits of 4 nursing FTE’s or greater, with certain specific qualifications.  At September 30, 2019, the aggregate underspent budget amounted to $63,442, which resulted from the labour disruption involving the WECHU staff represented by the ONA for the period of March 8th, 2019 to May 8th, 2019.  At December 31, 2019, this program initiative is forecasted to be underspent by $45,153.  The 2019 budget for this initiative included salary and benefit overages ($45,153) associated with three of the four assigned FTEs, which, subsequent to the labour disruption, are forecasted to be negated.

Enhanced Food Safety – Haines Initiative:  This initiative was established to support implementing the Food Safety Program Standard under the Ontario Public Health Standards (“OPHS”).  At September 30, 2019, there is a minor negative variance of $1,919 due to timing of purchases.  This program initiative is not forecasted to be overspent at December 31, 2019.   

Enhanced Safe Water:  This initiative was established to increase the Board of Health’s capacity to meet the requirements of the Safe Water Program Standard under the OPHS.  At September 30, 2019, there is no negative variance to report on.   This program initiative is not forecasted to be overspent at December 31, 2019.

Harm Reduction Program Enhancement:  Base funding for this initiative supports the Board of Health in the activities associated with its Local Opioid Strategy.  More specifically it supports 2.5 FTEs dedicated to working on activities associated with:  i) Our local opioid response; ii) Naloxone Distribution and Training;  iii)  Opioid Overdose Early Warning and Surveillance.   At September 30, 2019, the budget for this program initiative is underspent by $17,122, which resulted from the labour disruption involving employees represented by the ONA (approximately $15,000) for the period March 8th, 2019 to May 8th, 2019.  At December 31, 2019, this program initiative is forecasted to be underspent $21,240.  In addition to the labour disruption noted above, gapping associated with certain other positions resulted.  Recruitment is currently underway but is not anticipated to be concluded before year-end.

Infectious Disease Control Initiative:  This initiative was established to support the hiring of infectious diseases control positions (4.5 FTEs) and supporting these staff to monitor and control infectious diseases.  They serve to enhance the Board of Health’s ability to handle and coordinate increased activities related to outbreak management.  At September 30, 2019, the budget for this program initiative is underspent by $22,964, which resulted from the labour disruption involving employees represented by the ONA for the period March 8th, 2019 to May 8th, 2019.  The 2019 budget for this initiative included salary and benefit overages ($4,817) associated with the 4.5 FTEs allocated to this program, which, subsequent to the labour disruption, are forecasted to be negated.

Needle Exchange Program Initiative:  This initiative was established to support the purchase of needles and syringes, and their associated disposal costs, for the Board of Health’s Needle Exchange Program.  At September 30, 2019, there are no negative variances to report on. This program initiative is not forecasted to be overspent at December 31, 2019.

FINANCIAL INFORMATION FOR RELATED PROGRAMS FUNDED 100% BY THE MINISTRY OF HEALTH

Mandatory Programs - Enhanced Mosquito Surveillance: 

This one-time funding supports an enhanced surveillance program.  Eligible costs include salaries for students, supplies and additional equipment, identification and testing expenses, promotional costs and mileage.  At September 30, 2019, there are no negative variances to report on. 

New Purpose-Built Vaccine Refrigerators: 

This one-time funding supports the acquisition of one new twenty-five (25) cubic foot purpose-built refrigerator used to store publicly funded vaccines.  At September 30, 2019, the new purpose-built vaccine refrigerator has been acquired.  No additional costs are anticipated.

Public Health Inspector Practicum Program: 

This one-time funding supports the hiring of approved Public Health Inspector Practicum positions.  Eligible costs include student salaries, wages and benefits, transportation expenses associated with practicum positions, equipment and educational expenses.  This funding relates to practicum placements for the four-month period, which commenced May of 2019 and concluded in August of 2019.  At September 30, 2019, the funding has been expended.

APPROVED BY

Theresa Marentette, CEO

Board Members Present:

Gary McNamara, Joe Bachetti, Rino Bortolin, Fabio Costante, Gary Kaschak, Judy Lund, John Scott, Ed Sleiman, Larry Snively  ​​​​​​

Board Member Regrets:

Tracey Bailey, Dr. Debbie Kane

Administration Present:

Theresa Marentette, Dr. Wajid Ahmed, Lorie Gregg, Nicole Dupuis, Kristy McBeth, Dan Sibley, Lee Anne Damphouse 

Staff Present:

Kim Casier, Eric Nadalin, Neil MacKenzie, Jen Jershey, Nicole Trajkovski, Denise Barbour, Barb Deter, Nancy Dumouchelle, Heather Gartner, Denise Hryniuk, Dawnice Kavanaugh

QUORUM:  Confirmed

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

ISSUE

Healthy Smiles Ontario (HSO) is a publically funded dental care program for children and youth 17 years old and under from low-income households. The Ministry of Health introduced HSO in 2010 as a 100% provincially funded mandatory program for local health units, providing $1,529,700 in funding for children in Windsor-Essex (2019). HSO covers regular visits to a licensed dental provider within the community or through public health units.

In April 2019, the provincial government introduced its 2019 Budget Protecting What Matters Most (Minister of Finance, 2019). Following the release of the provincial budget, the Ministry of Health introduced changes to the funding models for health units effective January 2020. The changes in funding for local health units include a change from a 25% municipal share, 75% provincial cost-shared budget for mandatory programs to 30% and 70% respectively. In addition, the Ministry notified health units that formerly 100% provincially funded mandatory programs such as HSO would now share these costs with municipalities at the rate of 30%, a download of approximately $458,910.00 to local municipalities.

BACKGROUND

Oral health is vital to our general health and overall well-being at every stage of life. Most oral health conditions are largely preventable and share common risk factors with other chronic diseases, as well as the social determinants of health, such as income, employment and education, whereby those in the lowest income categories have the poorest oral health outcomes. Approximately 26% of children (0-5 yrs) and 22.6% of children and youth (0-17yrs) in Windsor-Essex County live in low-income households, compared to 19.8% and 18.4% in Ontario (Windsor-Essex County Health Unit, 2019). Tooth decay is one of the most prevalent and preventable chronic disease, particularly among children. In Windsor-Essex from 2011 to 2016, the number of children screened in school with decay and/or urgent dental needs increased by 51%.  Tooth decay is also the leading cause of day surgeries for children ages one to five. The rate of day surgeries in Windsor-Essex in 2016 was 300.6/100K compared to 104.0/100K for Ontario, representing a significant cost and burden to the healthcare system (WECHU Oral Health Report, 2018). For children, untreated oral health issues can lead to trouble eating and sleeping, affect healthy growth and development, speech and contribute to school absenteeism.

In 2016, the MOHLTC integrated six publicly funding dental programs into one 100% funded program, providing a simplified enrolment process and making it easier for eligible children to get the care they need. The HSO program was part of Ontario’s Poverty Reduction Strategy commitment to build community capacity to deliver oral health prevention and treatment services to children and youth from low-income families in Ontario. Windsor-Essex Health Unit operates two dental clinics, one in Windsor and one clinic in Leamington. The WECHU provides preventative and restorative services with a team of registered dental hygienists, general dentists and a pediatric dentist. There is about a six-month wait list for services in our current clinics. The number of preventative oral health services provided through the WECHU dental clinics has increased year over year from 1,931 in 2011 to 7,973 in 2017 (WECHU Oral Health Report, 2018).

Community dentists are not required to take patients under the Healthy Smiles Ontario program which can create barriers to accessing services. Changes to the funding model for HSO will not affect the services provided by local dentists and is only applied to local health units. Mixed model funding for public health units and private fee-for-service dental providers, poses a risk to the delivery of the HSO program in Ontario. Based on the data and analysis in the 2018 Oral Health report, the Windsor-Essex County Health Unit proposed recommendations to improve the oral health status in Windsor-Essex including: Improve access to oral health services within Windsor-Essex and advocate for improved funding for oral health services and expansion of public dental programs such as Healthy Smiles Ontario to priority populations. Given the growing urgent need and increase in dental decay among vulnerable children in Windsor-Essex and recognizing the existing barriers to access to care, the WECHU recommends that HSO retain its current funding and structure as 100% funded, merging it with the Ontario Seniors Dental Care Program to be a comprehensive dental care program for vulnerable children and seniors in Ontario.

PROPOSED MOTION

Whereas the WECHU operates a dental clinic in Leamington and Windsor for HSO eligible children with wait times for services exceeding 6 months, and

Whereas one in four children under five years (26.0%), one in five children under 17 years (22.6%), and one in ten seniors (11.4%) in Windsor and Essex County live in poverty, and

Whereas inadequate access and cost remain barriers to dental care for Windsor and Essex County residents, 23.7% report that they lack dental insurance that covered all or part of the cost of seeing a dental professional, and

Whereas indicators show an overall trend of declining oral health status among children in Windsor and Essex County compared to Ontario, and

Whereas the rate of oral health day surgeries for children in Windsor and Essex County (300.6/100K) far exceeds that of Ontario (100.4/100K), and

Whereas there is an increased difficulty in obtaining operating room time for dental procedures in Windsor-Essex with wait times exceeding 1 year for children in need of treatment, and

Whereas there is a chronic underfunding of the Healthy Smiles Ontario program creating barriers to accessing services among local dentists, and

Now therefore be it resolved that the Windsor-Essex County Board of Health recognizes the critical importance of oral health for vulnerable children and youth, and

FURTHER THAT, urges the Ministry of Health to reconsider its decision to download 30% of the funding of the Healthy Smiles Ontario Program to local municipalities, and

FURTHER THAT this resolution be shared with the Ontario Minister of Health, the Chief Medical Officer of Health, the Association of Municipalities of Ontario, local MPP’s, the Association of Public Health Agencies, Ontario Boards of Health, the Essex County Dental Society, the Ontario Association of Public Health Dentistry, the Ontario Dental Association and local municipalities and stakeholders.