1. alPHa Conference Allison J. Stuart Assistant Deputy Minister Public Health Division Ministry of Health and Long Term Care February 11, 2011

2. Today... Public Health Accountability Agreements Organizational Standards Funding Healthy Smiles Ontario

3. Performance Management Components Objectives: Alignment with MOHLTC strategic objectives; improved organizational and programmatic performance; continuous quality improvement and enhanced accountability. Indicators Public Reporting Accountability Agreements Risk Management Framework Assessment Policy Completed Nearing completion In development Voluntary accreditatio n OPHS Organization al Standards

4. Public Health Accountability Agreements (AA)

5. Background: Accountability Agreements The Public Health Accountability Agreement (AA) is built on performance management principles accepted as management best practice. Uses measurement and monitoring strategies to provide evidence for decision making and continuous quality improvement. The AA template is currently under development:  led by Public Health Division (MOHLTC) and Ministry of Health Promotion and Sport  Informed by Joint Ministries/Boards of Health Committee, performance Management Working Group and Technical Advisory Committee Sets out obligations of the boards of health AND the ministries for a 3-year period (January 1, 2011 – December 31, 2013). Finances and performance expectations outlined in schedules will be amended annually. The AA template uses the Ontario Government Transfer Payment Agreement template as its starting point, and incorporates existing PBG Terms & Conditions, and new performance management expectations. Much of the content of the AAs has been used by the ministries and boards of health in the past, and will be familiar to boards of health.

6. Accountability Agreements – Indicators An initial set of potential accountability agreement indicators has been developed in consultation with the Indicator Technical Advisory Committee (InTAC), and received input from the Performance Management Working Group and the Joint Ministries/Boards of Health Committee. A small number of performance indicators will be common across all boards of health and will reflect provincial priorities for performance improvement. In the first year baselines will be established for each indicator for each board of health. Years 2 and 3: targets for performance improvement will be established in consultation with each board of health, relative to its baseline level of achievement.  No provincial level targets. A consultation and communication strategy is under development Examples – to demonstrate progress on provincial priorities and program effectiveness:  % of Class A & B pool & spas with repeat closures, by class..  % population under 18 years that wear a helmet when biking.  % tobacco vendor compliance with legislation by infraction type.  % of expectant mothers who report the intention to breastfeed.

7. Public Health Organizational Standards

8. Organizational Standards: Development Process Ontario Public Health Organizational Standards developed with the guidance of the Performance Management Working Group.  A two stage consultation process to gather advice and input from public health in Ontario. Reflect government’s expectations for governance and administrative practices.  Based on generally accepted principles of good governance and management excellence. Document includes:  Expectations noted in the general text of the Ontario Public Health Standards,  Sections of the Health Protection and Promotion Act,  Consideration of the requirements in the Program-Based Grants Terms and Conditions; and  New requirements identified from literature and standards in use in other jurisdictions.

9. Organizational Standards: Content Expectations of the board of health as the governing body (first 5 categories) and the public health unit as the administrative body (one category). Supports delineation of each board’s responsibilities as a governing body from the health unit staff responsibilities for day to day organizational management. The categories of the Organizational Standards are as follows:  Board Structure:8 requirements  Board Operations:10 requirements  Leadership: 2 requirements  Trusteeship: 3 requirements  Community Engagement & Responsiveness:5 requirements  Management Operations:16 requirements

10. Organizational Standards: Implementation Mature, well functioning boards of health are likely to be adhering to practices that are in line with the standards. Orientation on Organizational Standards and Accountability Agreements will be provided for boards of health and public health unit senior management during the coming months. There will be many different ways that boards of health can meet the requirements, and this will be acknowledged within the measurement strategy.  Understanding these differences will also be useful in identifying best practice approaches, which can then be shared within the sector. Work continues in partnership with the Ontario Council of Community Health Accreditation (OCCHA) on the development of measurement tools and processes to support the ministries’ Organizational Standards.

11. Relationship with Accountability Agreements The Organizational Standards will be enabled through Accountability Agreements. Boards of Health are encouraged to use 2011 to plan for local implementation of the Organizational Standards. Reporting on achievement of the Organizational Standards will begin in 2012. January – March 2011 April – June 2011 July – September 2011 October – December 2011 January – December 2012 - 2013 Organisational Standards released Organisational Standards – Planning and ImplementationOrg Standards Measurement AA Template & Indicators Drafted Consultation with BOHs & PHUs Finalize AA Template & Performance Indicators BOH signing of AAs Initiate Baseline Data Collection Monitoring and Measurement Begins Identify Board- specific indicators as needed. Negotiate targets on all performance indicators for Years 2 & 3.

12. Public Health Funding

13. (1) Grants For 2011, the government expects that board of health budgets will continue to recognize and incorporate the identified needs of their communities and will balance local priorities with the Ministry’s clear direction for fiscal restraint. Taking into account the fiscal reality facing the province, and in order to sustain public health funding, the Ministry will be reviewing 2011 board of health grant requests for mandatory programs within a provincial funding envelope that provides up to 3% growth funding. 2011 funding decisions for mandatory programs will be made once the Ministry’s budget is known and will be based upon available funding.

14. (1) Grants: Important Dates/Changes The 2011 budget submission package for mandatory and related programs will be released to the sector in mid-February, 2011 for completion and return to the ministry by April 1, 2011. New features: consolidation of funding to expedite process and accountability; increasing alignment among the three ministries. Target for release of grants to field: June 2011!

15. (2) Public Health Funding Review The government is currently undertaking a review of the funding provided to boards of health in an effort to ensure a more equitable and transparent method of funding. The Public Health Funding Review Working Group (FRWG):  Includes government and public health representation.  Provides advice on the development and implementation of a needs-based methodology for allocating funding increases for mandatory and related programs, including unorganized territories grants. Next steps for FRWG:  Confirmation of the components and indicators to be included in the funding formula and determination of their respective weighting;  Identification of options and risk/impact analysis of proposed model(s);  Field consultation; and  Preparation of the report and recommendations, and identification of potential implementation approaches. Recommendations respecting a new funding model likely to be released in 2012.

16. Healthy Smiles Ontario Program

17. HSO: Background Healthy Smiles Ontario was launched on October 1, 2010 with local announcements across the province.  THANK YOU! Provides preventive and early access to dental treatment for children and youth who do not otherwise have dental coverage (private or public) Administered locally by the 36 public health units. t is estimated to be able to provide services to an additional ~ 130,000 low- income children and youth. Program eligibility is assessed by local public health units based on specific criteria.  residency in Ontario  17 years of age or under  household Adjusted Family Net Income of $20,000 or below  no access to any form of dental coverage.

18. HSO: Program Service Delivery Depending on the public health unit’s business case/proposal, local service delivery options include:  Private (fee-for-service) practitioners: this is a component of all PHU proposals  Public health unit-community clinics: included in 30 proposals  Community Health Centre clinics: 35 were proposed including Aboriginal and Francophone CHCs  Other community provider clinics: e.g., universities / colleges / schools, hospitals, Family Health Teams, Ontario Early Years Centres  Mobile clinics: in 5 PHUs: Niagara, Northwestern, Peterborough, Simcoe-Muskoka, Toronto  Portable clinics: in a variety of community locations

19. HSO: Program Implementation and Roll-out 35 of 36 public health units began some level of service delivery (e.g., through private practitioners) starting on October 1, 2010. Public health units will continue to expand their service delivery models throughout 2011 until all components of each health unit model are fully operational. Public health units will not be developing a list of dental care providers or providing contact information for individual dental providers. This approach is in alignment with that of other provincial dental programs.

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