1. Ministry of Health and Long-Term Care Update Presentation to alPHa Board of Health General Meeting October 23, 2009 Allison J. Stuart, Assistant Deputy Minister (A) Public Health Division

2. Agenda 1.2009 Program Based Grants 2.Funding Review 3.Procurement 4.H1N1

3. 3 2009 Program-Based Grants MOHLTC/MHP invested a total $553.0 million for mandatory and related public health programs and services. Mandatory Programs (75%) - $509.3 million 5% increase in 2009 included a 3% across-the-board increase for common cost drivers to all public health units, 1% for population growth and 1% for low income populations. Related Programs: $43.7 million Infectious Diseases Control (100%) - $18.7 million Infection Prevention and Control Nurses (100%) - $2.9 million Public Health Research, Education and Development - $1.8 million Small Drinking Water Systems (100%) – $4.1 million Unorganized Territories (100%) - $4.8 million Vector-Borne Diseases (75%) - $8.6 million Other Program Grants (including one-time grants) - $2.8 million Since 2003, funding has more than doubled, including both uploaded costs and increased investments in public health capacity. 110.6% increase ($290.3 million), of which 52.4% ($152.2 million) is due to upload and 47.6% ($138.1 million) is due to growth.

4. 4 Summary of Approved Funding Mandatory and Related Programs Provincial Cost Share of Mandatory Programs Year Provincial Share 2003 50% 2004 50% 2005 55% 2006 65% 2007 75% 200875% 200975%

5. 5 Funding Review - Overview The Public Health Division is at the very early stages of developing a process and proposal for reviewing the provincial funding provided to public health units. The funding review is expected to take a holistic approach to public health unit funding and will examine the funding for mandatory and related programs (i.e., Unorganized Territories, Vaccination Subsidies, Infectious Diseases Control, and Capital). This review, which will examine a number of funding models and options, will take some time and the process will include stakeholder engagement.

6. 6 Funding Review – Setting the Stage Inequities in all likelihood exist due to historical funding patterns and are maintained through across-the-board increases Economic climate No new funding is available as a consequence of this review No confirmation that increases available in recent years will continue in the future Other considerations Changing demographics Capital – recognition within MOHLTC of need for process to address Performance Management Framework

7. 7 Funding Review – Next Steps Verify historical data Confirm scope of the funding review e.g. MOHLTC funded programs, all funded programs, or a combination Identify cost pressures through information gathering salaries and benefits, capital issues, information technology, funding challenges in mandated programs, revenue Charge-Backs Identify potential models for funding, cost reductions, risk/impact analysis and implementation approaches

8. 8 Procurement The new Procurement Directive is available on the Ministry of Government Services (MGS) website and includes changes related to the use of non- competitive procurement processes for consulting services and procurement approval authorities; changes have also been made to directives related to travel, meal and hospitality expenses. A risk assessment of autonomous health units’ purchasing practices took place in August to assess their purchasing approval authority framework; procurement planning as an integral part of purchasing policy; and use of competitive processes when purchasing consulting services. Public health units are not required to comply with the government’s new Procurement Directive. However, as public health units receive substantial funding from the province, best practice and fiscal prudence would align the public health units’ procurement policies with the new procurement directive and with that of the relevant municipality as appropriate.

9. 9 H1N1 Planning Current Status – What we Know pH1N1 is currently the predominant circulating influenza virus Most illness has been mild, with low rates of hospitalizations and deaths Ontario is no longer reporting case –level information: little utility once influenza is established in the community ­Community activity levels for influenza-like illness available at www.ontario.ca/flu (Ontario Influenza Bulletin)www.ontario.ca/flu Severe disease causing hospitalization occurs most frequently in children and young adults Risk factors for severe outcomes also include chronic medical conditions; people over 65; children under 5; pregnant women; people living in remote/isolated communities; residents of long-term care homes Health system busy but coping

10. 10 H1N1 Planning Current Status – What we Know Ontario Health Plan for an Influenza Pandemic is based on a set of assumptions that anticipated a pandemic with a moderate to severe impact: ­Attack rate of 35% (approx 4.5M over the course of the pandemic) ­12,635 fatalities ­54,572 hospitalizations So far, pH1N1 has shown a mild impact (understanding that this MAY WELL increase in the Fall and Winter): ­4,221 confirmed cases: a general indicator, given lab tests are not routinely required ­27 fatalities ­431 total hospitalizations (with approximately 26 currently in hospital) Although the assumptions of the OHPIP have not been met, we are adapting our strategies rather than doing away with them altogether

11. 11 H1N1 Planning Central Role of Public Health Largest immunization effort ever in Canada, requiring mobilization of entire public health sector Impacts on numerous other sectors; looking to public health for leadership ­Elementary and secondary schools ­Colleges and universities ­Faith groups ­Shelters and community service providers ­Front-line healthcare providers: such as hospitals, long-term care, family physicians Communication is key: balanced approach – this is a different flu season