What happened to public health under regionalization: Fears vs. Realities Saskatoon Health Region Chief Medical Health Officer Dr. Cory Neudorf

Fear 1 – PHS Split Apart Reality - A few program changes, but we have mostly stayed intact as a unit –Lost High risk prenatal program, Early Maternity Discharge program, podiatry, but we were included in the decisions, and agreed due to the care group model being formed (Maternal-Child Health portfolio) –Gained a Population Health Research Unit, a Community Developer, and are able to influence on many other parts of the system

Fear 2 – Becoming too insular Reality 2 – By actively engaging staff to think of Public Health as both a service delivery dept. and a support dept., we have been able to become more integrated and are not seen as elitist –The first few years we tended to be too protectionist and lost opportunities for influence and engagement, but since 2000, this has turned around and has been gradually getting better

Fear 3 – Decreased Funding Reality 3 - Our funding has stayed stable, while acute care budgets had cuts in the mid 90’s –While we do not have a larger share of total health spending, we have seen some innovative prevention and promotion programming performed with Corporate dollars outside of Public Health’s budget (Population health thinking is widespread, therefore others assist with our mandate) for a net increase in funding and services –Acute care deficits and funding pressures still threaten, but Regional Strategic Plan and goals include a commitment to do more prevention and health promotion, reduce health inequalities. Funding pools protect Community Services somewhat.

Fear 4 – No Board Access Reality 4 - Continued access to the RHA Board –The MOH makes Quarterly reports to the Board, orientates new members to the services of PHS and the Public Health Act, and has access to the Board upon request at any meeting if needed. –The MOH reports to the Board directly according to the PH Act, and to the CEO directly for administrative purposes

Fear 5 – Unpopular Programs Cut Reality 5 - Core programming for vulnerable populations has grown, and is more protected than when we reported to the Municipality. –Includes harm reduction programming and targeted interventions to reduce health disparity and improve immunization rates.

Fear 6 – Shift to More Individual Care Reality 6 - We have been allowed to focus more on Population level work as we are able to work with other parts of the system to do individual health education –CHC’s, primary health care, –chronic disease management and prevention, –engagement of all parts of the system to reduce health inequalities

Fear 7 – Loss of MOH Authority Reality 7 - The MOH now acts as a Chief MOH/VP for the region (analogous to the Physician VP or Chief of Staff on the acute side), and sits as a member of the Sr. Leadership Team. The PHS GM reports jointly to the MOH and the Community Services VP, while the Deputy MOH’s who act as consultants to the system report to the MOH solely. PHS in same portfolio as other community services and is working very closely with the Primary Health Care GM to forge a Community Oriented Primary Care Model MOH asked to be co-VP over Public Health, and has provided VP oversight to Corporate Support (Information Technology, Utilization Management, and Research (SHIPS) over the years. The MOH provides consultative roles with all other parts of the Region’s services.

Fear 8 – Loss of Provincial Ties Reality 8 - PHS staff continue to meet provincially to set program priorities and set consistent standards for programs and policy within each discipline (MOH’s, nurses, PHI’s, etc) with all groups reporting to the Council of MOH’s. –The provincial PHS Dept does program support, surveillance, policy work, advocacy, monitoring, etc, but no longer supervises regional staff directly.

Fear 9 – Being “Swallowed Up” Reality 9 – With the CMHO at the senior table and with access to the Board, public health issues continue to get the necessary attention. –Acute care crises can certainly consume an inordinate amount of discussion and planning time, but the chance to spend time discussing proactive, upstream initiatives in the areas of Population Health and Public Health items are well received by the Senior team and therefore get positive, focused responses. –Budget requests do not get preferential treatment, but do not seem to fair any worse than under the previous local board of health model. At times, requests are so minor compared to the large requests and pressures from other areas that they are easier to approve. There are also infrastructure benefits from being part of a corporate support department response (capital improvements, inflation cost adjustments, equipment purchases, etc)