1. Regular Board Meeting:  February 15, 2018

1. Information Report - Shared Calendar Project (N. Dupuis)
2. Information Report –Windsor-Essex Community Housing Corporation Smoke-Free Policy (N. Dupuis)
3. Information Report – Immunization of Schools Pupils Act Implementation Update (T. Marentette)
4. Information Report – Windsor-Essex County Living Wage Program (N. Dupuis/K. McBeth)
5. Media Coverage Summary Report

1. Reserves (G. McNamara)

1. Annual Service Plan - Handout (T. Marentette)
2. Annual Service Plan – Resolution and Recommendation Report - Handout (T. Marentette/L. Gregg)

1. Regular Board Meeting: February 15, 2018.
   It was moved
   That the minutes be approved.
   CARRIED

1. Information Report – Shared Calendar Project
2. Information Report – Windsor-Essex Community Housing Corporation Smoke-Free Policy
3. Information Report – Immunization of Schools Pupils Act Implementation Update
4. Information Report –Windsor-Essex County Living Wage Program
5. Media Coverage Summary Report
   It was moved
   That the consent agenda be received.
   CARRIED

1. Reserves

   At the last Board meeting, the topic of Reserves was briefly discussed and materials were subsequently distributed, at the request of the Chair, to the Board.

   Other public health units within the Province have reserves funded through contributions from their respective obligated municipalities as the Province of Ontario does not permit grant monies to be contributed to a reserve.   The Board Chair provided background on Health Unit funding, indicating that the WECHU receives a grant from the Ministry of Health and Long-Term Care (“the Ministry”) to a maximum of 75% for the Cost-Shared Program and that the Municipalities are obligated to fund public health.  Furthermore, the timing of budget approvals by the Ministry presents a challenge for public health units to spend their budget in a given year.

   Establishing municipal reserves would allow for the use of unspent municipal dollars already allocated to the Health Unit through the annual budget process.

   It was decided that the Board’s position be stated in the form of a resolution. Administration will bring forward a resolution recommendation to the April board meeting.  It was further requested that Administration’s report include information regarding the need for a reserve fund by the WECHU as well as a brief chronology of what has happened in the past for the benefit of new members and a refresh for past members.

   The Board discussed taking a more assertive approach to increasing Windsor-Essex’s base budget.

   In 2015, there was lobbying to increase this health unit’s base budget. As a result, approximately 1.2 million dollars was received. This additional funding translated to an 8% base budget increase. The Province did agree that Windsor-Essex received 80% of what it should be receiving in comparison to other health units. Of the 36 health units, this health unit still remains one of the lowest funded health units.

   It is the full responsibility of municipalities to pay for public health. The Ministry provides a grant of up to 75% of individual health unit budget requests while the municipalities are responsible for the remaining percentage. The Board has agreed that the funding model for health units is flawed. Furthermore, the Board needs to look at what is needed for to address public health needs in this community rather than getting fixated on the 75/25 funding formula. This Health Unit has different needs than some others because of its geographic location being a border community.

   With the recent introduction of the 2018 Standards, some of the mandates will require more resources and dollars.

   The Board Chair would like to see continued dialogue with the Province. It was further proposed by the Board that the WECHU needs to develop a three to four-year plan for increasing the base budget in advance so that the municipalities are aware of the plan and the strategies for moving forward.

1. Annual Service Plan
   Further to the WECHU’s 2018 budget submissions, the Ministry requested completion of an annual service plan. Public health units were asked to link relevant funding with program activities and staffing. The Annual Service Plan and Budget Submission was submitted to the Ministry by the March 1, 2018 deadline. Seventy-three program plans were submitted.

   The CEO reviewed the WECHU Annual Service Plan and Budget Submission 2018 document as distributed highlighting the ten base funding requests and ten one-time funding requests submitted.

2. Annual Service Plan – Resolution and Recommendation Report
   Public Health Units are required to have a board resolution to support the submission of Annual Service Plan and Budget Submission.

    

   As presented by the WECHU in January of 2018, the 2018 Cost-Shared budget contemplated a base funding request of 3.23% or $429,974.  Of that, $355,528 related funding to address operational pressures allowing the WECHU to maintain current service levels in Windsor and Essex County.  The remaining $74,446 represented a staff augment relating to mental health requirements within the modernized OPHS.  The $74,446 request is included as part of the Mental Health Specialist full-time equivalent base funding request.  The $355,528 increase is included as part of the General Base Funding request of $1,026,092.  The remainder of the General Base Funding request or $670,574, represents an ask to help reduce the funding disparity that was highlighted in the global funding formula review of 2015.  The funding review indicated that the WECHU was not receiving its model share of public health funding.  Base funding requests put forward in the 2018 Annual Service Plan and Budget submission outside of the $429,974 contemplated in the January 2018 budget presentation, will not be operationalized until such time as approval is received from the Ministry of Health and Long-Term Care (“the Ministry”).

   L. Gregg provided a summary of the base funding and one-time funding requests. One-time funding request are typically funded at a rate of 100% by the Ministry.  Base funding requests can be funded to a maximum of 75% by the Ministry or at a rate of 100% depending upon their nature. In the budget presented in January of 2018, the Ministry’s funded share of the 2018 budget was 71.51%.  If the General Base Funding, Mental Health Specialist, School Screening, and Public Health Inspector full time equivalents base funding requests are approved, the Ministry’s funded shared of the 2018 budget would increase to 72.81%.

   A question was raised by the Board regarding the expected timing of Ministry approvals.  L. Gregg responded that approvals could be expected in late summer or early fall but reminded the Board that 2017 approvals were received as late as November of 2017.

   A motion to support the following 2018 budget requests (the first three were approved as part of the 2018 budget) is needed for submission to the Ministry.
   It was moved
   That the Windsor-Essex County Board of Health approve the following:

   i) Budget for Mandatory Cost-Shared Program of $19,222,184.
   ii) Budget for Vector-Borne Disease Cost-Shared Program of $128,000.
   iii) Budget for Small Drinking Water Systems Program of $13,733.
   iv) Budget for Mandatory 100% Funded Programs of $3,357,033.
   v) Additional Base Funding Requests of $1,678, 924.
   vi) One-Time Funding Requests of $724,888.

   CARRIED

That the Board move out of Committee of the Whole at 5:40 p.m.
CARRIED

1. Regular Board Meeting:  January 18, 2018

1. Opioid Overview (Dr. W. Ahmed)

1. Information Report – Opioid Strategy
2. Information Report – Naloxone Distribution
3. Media Coverage Summary Report

1. Reserves (G. McNamara)
2. 2017 Strategic Plan Progress Update – Report  (K. McBeth)
3. 2017 WECHU Operational Plan Annual Summary (K. McBeth)

1. Regular Board Meeting: January 18, 2018.
   It was moved
   That the minutes be approved - CARRIED

1. Opioid Overview

   Opioid misuse is a significant problem in our community that includes visits to emergency rooms and an increase in hospitalization over the years. Windsor-Essex is higher than the provincial average for overdoses. The number of fatalities from overdoses continue to increase.

   Dr. Ahmed discussed the Cycle of Addiction, Experimentation – Prescriptions – Dependence – Recovery – Abuse. Family history of addiction predisposes individuals to become addicted. Prevention is needed.  Individuals need to be directed to services. Better reporting is also required to identify areas to target and enhance harm reduction to reduce the transmission of disease. 

   The Windsor-Essex Community Opioid Strategy (WECOS) is based on 4 pillars and there are 4 sub-committees or working groups that have been formed to work on outcomes for these pillars. 

   Public health’s role is to form partnerships--do our part, avoid duplication, share data, develop early warning system(s), health promotion and disease prevention, harm reduction (support other agencies through naloxone distribution and training) and advocacy. 

   Windsor-Essex is working with our community partners to explore the idea of an Overdose Prevention Site (OPS). Any agency focused on harm reduction can apply for a temporary OPS through the Ministry of Health and Long-Term Care. The Ministry can fund an OPS site for a period of 3-6 months. Staff must be properly trained and must have a registered healthcare provider available to help users if needed. It is not the same as a safe injection site (SIS). 

   Next steps in the WECOS is to train and distribute naloxone to community agencies. The board asked questions about the idea of mobile supervised injection sites. Dr. Ahmed responded that in the absence of central supervised injection service, mobile sites may not be effective. The solution is comprised of many components and supervised injection is part of the solution not the only solution.

   Dr. Ahmed’s report will be forwarded to the Board.

1. Information Report – Opioid Strategy
   It was moved
   That the Opioid Strategy Information Report be received - CARRIED
2. Information Report – Naloxone Distribution
   It was moved
   That the Naloxone Distribution Information Report be received - CARRIED
3. Media Coverage Summary Report
   It was moved
   That the Media Coverage Summary Report be received - CARRIED

1. Reserves
   This was discussed at JBEC.

   The Health Unit meets the challenges of its budget every year. When the Health Unit does not have the ability to spend its budget allocation, funds are returned to the Ministry. The Province is not responsible for funding; however, municipalities are obligated to deliver dollars as required for public health services. What is received from the province is a grant which is always based on the previous year. The WECHU has 5-6 weeks to spend the money from the last budget. Because the agency was unable, monies had to be returned, otherwise they could have been held in a reserve to address specific needs.

   L. Damphouse will send the Board background information. Reserves will be brought forward to the next meeting for discussion. The Board was asked to consider the Health Unit having the ability. This reserve piece would good for strategic planning.

   H. Payne left 4:52 pm

2. 2017 Strategic Plan Progress Update—Report

   Board members B. Marra and Dr. Ken Blanchette are members of the Strategic Planning Committee.   

   The committee met in January to look at goals and measures, and made revisions to the plan as needed.  

   Goals related to the Health Unit’s strategic priorities of Communication and Awareness, Partnerships, Organizational Development, and Evidence-Based Public Health Practice were reviewed. 

   Health equity education will be provided to the Board which came up in the board evaluation survey. 

   K. McBeth discussed the colour coded legend on page 3 of the update.  Red means there is more work needed towards achieving that objective and some of that work has been incorporated into operational plans for 2018. The agency continues to work on green and yellow to– enforce ongoing corporate dialogue to keep the strategic plan alive, develop a corporate tracking system so managers incorporate the objectives as appropriate and link it back to our strategic plan. Board will receive quarterly updates that is not redundant. 

   Dr. Blanchette congratulated K. McBeth for her leadership and everyone that was involved in the process.

   The strategic plan is a living document that is updated annually.

   It was moved
   That the report be received - CARRIED

3. 2017 WECHU Operational Plan Annual Summary

   The agency continues to look at continuous quality improvement and also looks at whether we are achieving our activities as per the Ontario Public Health Standards. The focus is on project management. The report does not contain an exhaustive list of every activities, nor will it illustrate day to day activities. It will illustrate high level project activities with a focus on accountability, project management, and minimal resources required to perform these activities. M. Watters questioned benchmarking with other health units. K. McBeth explained that health units right now are at different stages in their planning and are very different in their planning system and it would be difficult to compare. Health units in the future will see a much more comparable system with the institution of the annual service plan.

   Seventy percent of activities identified in our operational plan were either completed or on target for 2017.  With the new electronic planning system (M-Files), the agency can be better aligned with operational activities.

   K. McBeth will forward her presentation to the Board.

   It was moved
   That the report be received - CARRIED

1. Regular Board Meeting:  December 21, 2017

1. 2018 Budget (L. Gregg)
2. Influenza Update (Dr. W. Ahmed)

1. Report Number 2018-R001-HPROT/HPROMO – 0118-TM/ND from Theresa Marentette, Acting CEO, Director, Health Protection and Chief Nursing Officer and Nicole Dupuis, Director, Health Promotion dated January 18, 2018; Health Protection and Promotion Divisions Report to the Board of Health
2.  
3. Report Number 2018-R002-KNMGMT– 0118-KM from Kristy McBeth, Director, Knowledge Management dated January 18, 2018; Knowledge Management Division Report to the Board of Health

Moved by
Seconded by
That the reports listed on the Consent Agenda as items 7a) to 7b) be received for
information.

1. Financial Controls Checklist (L Gregg) 26
2. 2017 Q4 Operational Plan Report (K. McBeth) Handout
3. Board of Health Reports – New templates for 2018 (T. Marentette)

1. Regular Board Meeting: December 21, 2017
   It was moved
   That the meeting minutes presented be approved.
   CARRIED

1. 2018 Budget (L. Gregg)

   L. Gregg provided an overview of the 2018 Budget for the Board.  The WECHU had received a zero increase from the Ministry and is asking for 4% from each of the municipalities and 3.23% from the province.  If funding approval is less than 3.23%, more funding from the municipalities would be required.  Items briefly discussed were professional development, program supplies, professional fees, building occupancy, and an increase in cost to staff parking. Regarding the Capital Project, WECHU has applied for a planning grant and are awaiting approval (likely April 2018 timeline).  The Ministry will determine the sum of the grant approval.
   It was moved
   That the Board move into Committee of the Whole at 4:04 pm
   CARRIED
   It was moved
   That the Board move out of Committee of the Whole at 4:13 pm
   CARRIED
   Board of Health members briefly discussed the Ministry’s funding process.  WECHU is recommending a request of 3.23% funding from the Ministry and 4% from the municipalities
   It was moved
   That the recommendation be approved and the 2018 Budget be accepted as presented.
   CARRIED
   Bill Marra arrived at 4:15 pm

2. Influenza Update (Dr. W. Ahmed)
   Dr. W. Ahmed provided the Board with a brief overview of this year’s influenza season noting symptoms, how influenza is spread and the number of current outbreaks.  The province is seeing more Influenza A outbreaks, but our community is seeing more Influenza B.  Each year the vaccine is based on the circulating strain of the virus.
   It was moved
   That the presentation be received for information.
   CARRIED

1. Financial Controls Checklist (L. Gregg)
   L. Gregg provided a brief overview of the Financial Controls Checklist, the most common deficiency being the lack of segregation of duties.  The Organization does its best to segregate the initiation of purchasing from ordering and receipt. There are instances as a result of vacations, illnesses and other unplanned absence, that impact the Organization’s ability to segregate. To mitigate risk, the Organization segregates the approval function (both for purchase and for payment) from the purchasing and receipt function. The action plan for 2018 and going forward, the Organization will continue to look for different strategies to mitigate risks associated with the segregation of incompatible duties.
   The tracking of aging of accounts receivable is a manual function. As a result, risk exists that invoices may not be followed up on a timely manner.  The action plan for 2018, commencing in the 2nd quarter and moving forward, it is anticipated that the volume of invoicing prepared by the Organization will be reduced.  Manual tracking of aged invoices will remain until such time as a better systems solution can be identified.
   It was moved
   That the Financial Controls Checklist be received for information.
   CARRIED
2. 2017 Q4 Operational Plan Report (K. McBeth)
   K. McBeth advised that the Board will receive the 2017 Annual Report at the February Board meeting as well as the Operational Plan.
   It was moved
   That the information be received.
   CARRIED
3. Board of Health Reports – New Templates for 2018 (T. Marentette)
   T. Marentette noted that commencing in February that Board Reports will be AODA compliant and more useful to the Board.  The biggest change will be in the Consent Agenda section with the Leadership Team noting relevant topics which may or may not be aligned with presentations.
   It was moved
   That the information be received.
   CARRIED