li;- Region d Ped Wohkittq foh you

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1 li;- Region d Ped Wohkittq foh you REPORT Regional Council For Information DATE: August 16, REPORT TITLE: FROM: Janette Smith, Commissioner of Health Services David L. Mowat, MBChB, MPH, FRCPC, Medical Officer of Health OBJECTIVE The objective of this report is to provide Regional Council with an update on Provincial funding for public health. The Ministry of Health and Long-Term Care announced that Peel's 2010 operating grant was approved at $40,037,252. The Province placed a global 3 per cent cap on growth funding for mandatory programs on all boards of health. MOHLTC will provide Peel Public Health with $2,194,629 in 2010 for a 100 per cent provincially funded low income dental program. 0 Provincial funding for Peel Public Health's Smoke Free Ontario Act enforcement and education program is expected to be frozen at just over $650,000. A provincial funding announcement for a new youth engagement program totaling up to $150,000 is forthcoming. Peel Public Health is working with the Province on the details of a diabetes prevention program of up to two years duration. The Province enacted the Public Sector Compensation Restraint to Protect Public Services Act 2010, which freezes compensation plans for all non-bargaining employees in the public sector for two years. Current collective agreements of bargaining staff will be honored, but when they expire the Province will seek new contracts that include no net compensation increases for at least two years. Full implementation of the first year of the Public Health 4 Year Plan will need to be delayed until additional provincial funding becomes available. DISCUSSION 1. Background As reported previously to Council, the Ministry of Health and Long-Term Care (MOHLTC) has been committed to renewing Ontario's public health system through the implementation of Operation Health Protection. Provincial investments included the launch of the new Ontario Public Health Standards (OPHS), which set out the minimum requirements for Ontario health units1 programs and services.

2 #6-~2-2- August 16, Peel Public Health's provincial per capita funding is one of the lowest of all boards of health. This is primarily due to the pressures of rapid population growth and the lack of a provincial needs-based funding formula. Given Peel's population growth has been largely driven by new immigrants, this places an additional stress on service delivery, as newcomers have particular public health needs. As a result of provincial funding shortfalls, Peel Public Health has been unable to meet its obligations under the Ontario Public Health Standards. To address these gaps, the 4 Year Public Health Plan, was approved by Council on April 15, As part of this service improvement plan, 13 Full-Time Equivalents (FTE) were approved in the 2010 budget, pending announcements for the provincial portion of the funding. However, to avoid falling behind in the implementation of the 4 Year Plan, Council approved the immediate hiring of 4 of the I3 FTEs, which represents the 25 per cent Regionally funded portion of the total costs. 1. Funding Update a) 2010 Mandatory and Related Programs Funding Announcement On July 29, 2010 the Ministry of Health and Long-Term Care announced that Peel's 2010 operating grant (Appendix I) was approved at $40,037,252, as per the table below: Mandatory and Related Programs Mandatory Programs (75%) Infectious Diseases Control (1 00%) Infection Prevention and Control Nurse (100%) Small Drinking water Systems (1 00%) Vector-Borne Diseases (75%) Su b-total MOHLTC Approved Funding $38,024,046 $1,081,379 $82,400 $27,525 $761,902 $39,977,252 One-Time Funding (75%) Tier Two Electronic Documentation Su b-total $60, $60,000 Total $40,037,252 1 Peel demonstrated a solid business case for increasing provincial funding to address low per capita public health funding, rapid population growth and the needs of new immigrant groups. However, the Province opted to place a global 3 per cent cap on growth funding for mandatory programs on all boards of health. The Province has also enacted the Public Sector Compensation Restraint to Protect Public Senices Act 2010, which freezes compensation plans for all non-bargaining employees in the public sector for two years. Future public health funding may not include funding for increases to employee compensation. This is being reviewed as part of the budget preparation. For bargaining employees, the Province will honor all current collective agreements; however when they expire, the government will seek new contracts that include no net compensation increases for at least two years.

3 N8-c~ -3- August 16,201 0 b) Additional Funding Announcements The MOHLTC announced a 100 per cent provincially funded low income dental program totaling $2,194,629 for 2010 capital and operational costs. As described in a previous Council report, this program will expand access to dental services for low-income children from 0-18 years. It will be delivered in collaboration with the Bramalea and East Mississauga Community Health Centres, with MOHLTC funding flowed to these partners through Peel Public Health. Peel Public Health operates an enforcement and education program to support the Smoke Free Ontario Act. The Province's funding announcement for this program is forthcoming; however they have indicated it will be frozen at 2009 rates, which stands at just over $650,000. A new public health youth engagement program has been announced by the Ministry of Health Promotion (MHP), which focuses on tobacco prevention and other correlated risk factors for chronic diseases. When further details are known, a report will be tabled with Council. Peel Public Health is also working with the MHP on the details of a diabetes prevention program of up to two years duration. 2. Proposed Direction a) Deferred Implementation of the Public Health 4 Year Plan Full implementation of the first year of the Public Health 4 Year Plan will need to be delayed until additional provincial funding becomes available. The 2010 operating grant provided by the Province does not allow for the hiring of the remaining 9 FTEs approved in the 2010 budget. Peel Public Health will phase these resource improvements to mirror the funding enhancements provided by the Province, and will work to mitigate the impacts of the funding shortfall in the delivery of services. b) Provincial Advocacy As previously reported to Council, Peel Public Health is involved in the MOHLTC's working group to develop a needs-based funding formula, which is scheduled for implementation in This formula aims to recognize and respond to the variances in per capita funding among boards of health across the Province. Given Peel's position as one of the lowest per capita provincially funded health units in Ontario, this may result in funding increases. However, the MOHLTC's position is that relative adjustments will require incremental funding increases, which will not necessarily become available in any given year. Meanwhile, advocacy to the Province highlighting Peel's growing demand for public health services will continue.

4 HE-c Q -4- August 16,201 0 CONCLUSION Peel Public Health will continue to advocate to the Province for adequate levels of funding. Service improvements for 2010 identified in the Public Health 4 Year Plan will be deferred and reflected in the proposed budget for Janette Smith Commissioner of Health Services David L. Mowat, MBChB, MPH, FRCPC Medical Officer of Health Approved for Submission: D. Szwarc, Chief Administrative Officer For further information regarding this report, please contact Dr. David Mowat at extension 2566 or via at david.mowat@peelregion. ca Authored By: lnge Roosendaal, Office of the Medical Officer of Healthf c. Legislative Services Manager, Financial Support Unit (FSU)

5 August 16,2010 Ministry of Health and Long-Term Care Assistant Deputy Minister Minist&re de la Santi! et des Soins de Iongue duree Sous-ministr* adjoint p, LP Ontario Publlo Health Division Dlvislon de la sante publique 5" Floor, Hepburn Block kdifice Hepburn, 50 citage Queen's Park Queen's Park Toronto ON M7A lr3 Toronto ON M7A 'tr3 Telephone: (416) T6llphone :(416) Facsimile: (416) T6I6copieur :(416) JUL Dr. David Mowat Medical Officer of Health Peel Public Health 44 Peel Centre Drive, Suite 102 Brampton ON L6T 4B5, Dear D d a t w Further to the letter from the Honourable Deb Matthews, Minister of Health and Long-Term Care, I am pleased to confirm that, for 2010, Peel Public Health will receive $40,037,252 (including a one-time grant of $60,000) for the provision of mandatory and related public health programs in your community. I am enclosing a breakdown of the 2010 Program-Based Grants for your public health unit and a signed copy of the 2010 Program-Based Grants Terms and Conditions. This year, the government is allocating 3% growth funding for mandatory programs to all boards of health, or less if requested. Within the approved funding, each board of health is expected to deliver programs and services that meet the Ontario Public Health Standards and other requirements of the Health Protection and Promotion Act.... Over and above the growth funding for mandatory programs, the ministry is continuing to provide funding for other public health programs such as Infectious Diseases Control, Infection Prevention and Control Nurses, Small Drinking Water Systems, Unorganized Territories and Vector-Borne Diseases. The ministry reviewed all one-time requests against defined criteria and proposals were approved based on the results of this review and within the limited amount of funding available. We are unable to approve Peel Public Health's one-time funding request for public health facility planning and design costs at this time, due to the limited availability of funding. In the event that funding becomes available before the end of.our fiscal year, this decision may change. If you have any questions and/or require further clarification, please contact your program advisor at the Public Health Practice Branch.

6 August 16, Dr. David Mowat As you are aware, the government is currently undertaking adetijew of the funding provided,to boards of health in an effort to ensure a fair, transparent and consistent method of funding.,.we are also in the process of implementing a performance management framework for public health in Ontario. The framework will include the development of Organizational Standards for boards of health that will reflect best practices, and introduce accountability agreements which will enable performance measurement and monitoring. As you are aware, Ontario has felt the effects of the global recession and is running a deficit,in order to create jobs and protect public services. While the contributions of those who deliver ' public services are valued and appreciated, the public also expects those who are paid bv tax dollars to do their part to help sustain pubiic services. The government has passed the Public Sector Compensation Restraint to Protect Public Services Act, 2010, which freezes compensation plans for all non-bargaining employees in the broader, public sector, including the Ontario Public Service, for two years. For employees who Bargain, collectively, the government will respect all current collective agreements. When these " agreements expire and new contracts are negotiated, the government will work with transfer'" payment partners and bargaining agents to seek agreements of at least two years' duration that do not include net compensation increases. The fiscal plan provides no funding for compensation increases for future collective agreements. Funding provided by the province to transfer payment partners and agencies is for the purpose of providing and protecting public services and is not to be diverted to fund increases in emoloyee compensation. I) q In closing, as we continue to work towards an effective and sustainable public health system, 1' a would like to thank you for your ongoing commitment and support. I,i. I I Yours truly, I ', L I I Allison J. Stuart Assistant Deputy Minister Attachment c: Hon. Deb Matthews, Minister of Health and Long-Term Care Hon. Margarett R. Best, Minister of Health Promotion Dr. Arlene King, Chief Medical Officer of Health, Public Health Division Jean Lam, Assistant Deputy Mihister, Ministry of Health Promotion Mark Critch, Manager, Finance Support Unit - Health Services, Peel Public Health *, Valerie Sterling, President, Association of Local Public Health Agencies Liz Haugh, President, Ontario Public Health Association Peter Hume, President, Association of Municipalities of Ontario

7 August 16,

8 August 16, PROGRAM-BASED GRANTS TERMS AM) CONDITIONS Between Boards of Health and the Government of Ontario.. Public Health Division, on'behalf of Ministry of Health and Long-Term'Caie and Ministry of Health Promotion, hereby offers the board of health a grant under section 76 of the Health Protection and Promotion Act for the provision of pubiic health programs and services. According to section 76, the Ministers may make grants for the purposes of the Act on such conditions as the Ministers consider appropriate. With a view to establishing an accountability framework for the use of the grant by the board of health, Program-Based Grants (PBG) Terms and Conditions, effective January 1,2010 are attached as Schedule "A". Please note that a prerequisite to receiving the grant is acceptance of the Grant Terms and Conditions by the board of health. If you have any questions respecting the PBG Terms and Conditions agreement, please contact: Brent Feeney, Lead, Program Advisor Performance Management Unit Public Health Practice Branch Public Health Division, MOHLTC 393 University Avenue, 21" Floor Toronto ON M5G 1E6 I hereby accept the terms and conditions of the grant as specified in the 2010 PBG Terms and Conditions and attached Schedule "A".,434 <A: Chair, Board of Heal ~?ZEL P&L Name of Health Unit I&/fL \ HER MAJESTY?HE QUEEN IN RIGHT OFONTARTO. As represented by the Ministry of Health and s. Long-Term Care and the Ministry of Health Promotion Date Per: Allison J. Stuart Assistant Deputy Minister Public Health Division

9 August 16, Ministry of Health and Long-Term Care Office of the Minister loth lo or, Hepburn Block 80 Grosvenor Street Toronto ON M7A 2C4 Tel Fax Ministere de la Sant6 et des Soins de longue dur6e Bureau du mlnistre 70' Btage, Cdiflce Hepbum 80, rue Grosvenor Toronto ON M7A 2C4 TCI TBlBc Ontario JUL Mr. Emil Kolb Chair Peel Regional Board of Health 10 Peel Centre Drive Brampton ON L6T 469 Dear-: Lili 1 On behalf of the McGuinty government, I would like to take this opportunity to express my appreciation for the important work you do in support of Ontario's public health system. For 201 0, 1 am pleased to advise you that the province is providing the Peel Regional Board of Health with $40,037,252 (including a one-time grant of $60,000) for the provision of mandatory and related public health programs and services in your community. Even in times of considerable fiscal constraint, this government continues to make significant investments to support the public health system. In 201 0, for mandatory and related public health programs and services, the government is investing an additional $10.2 million over 2009 for a total of $563.2 million. Since 2003, funding has more than doubled, including both uploaded costs and increased investments in public health capacity. As part of our continuing commitment to Ontario's public health system, we are currently undertaking a review of the funding provided to boards of health in an effort to develop a more responsive, needs based approach to incremental funding that will result in greater equity over time in the public health system. As well, the government is continuing to move forward with the development of a performance management framework that will build a public health system with a greater focus on performance, accountability, and sustainability. You will receive correspondence shortly from Allison J. Stuart, Assistant Deputy Minister, Public Health Division, that will include specific information regarding your 2010 allocations for mandatory and related public health programs.

10 August 16, Mr. Emil Kolb In closing, please accept my sincere thanks for the ongoing contributions you and your staff make in an effort to provide Ontarians with the strong public health system they deserve. Yours sincerely, Deb Matthews Minister c: Hon. Margarett R. Best, Minister of Health Promotion I Hon. Laurel Broten, Minister of Children and Youth Services ' Hon. James J. Bradley, Minister of Municipal Affairs and Housing Dr. David Mowat, Medical Officer of Health, Peel Public Health A Sylvia Jones, MPP, Dufferin--Caledon.,, - Kuldip Kular, MPP, Bramalea--Gore--Malton Hon. Linda Jeffrey, MPP, Brampton--Springdale \/ic Dhillon, MPP, Brampton West '" Amrit Mangat, MPP, Mississauga--Brampton South Hon. Harinder S. Takhar, MPP, Mississauga--Erindale Hon. Peter Fonseca, MPP, Mississauga East--Cooksville Charles Sousa, MPP, Mississauga South Bob Delaney, MPP, Mississauga--Streetsville Valerie Sterling, President, Association of Local Public Health Agencies. Liz Haugh, President, Ontario Public Health Association Peter Hume, President, Association of Municipalities of Ontario ',,,