July 20, 2017

Today the Minister of Health and Long-Term Care, the Honourable Dr. Eric Hoskins, released the Report of the Minister’s Expert Panel on Public Health entitled “Public Health within an Integrated Health System.”

The MOHLTC Bulletin, that accompanied the Expert Panel Report, said that the report recommends strengthening public health’s relationships with primary care, community care and other partners, so that all health care services are more responsive to community needs. The report has been released without provincial comments or indication as to whether the report’s recommendations will be accepted, however, the bulletin states, “that the Ministry is now reviewing the recommendations provided by the panel, and exploring options for further engagement in order to achieve our government’s plan to deliver a stronger and more integrated health care system for the people of Ontario.”

The key recommendation proposes an end state for Public Health within an Integrated Health System that would have Ontario establish 14 regional public health entities—that are consistent with the LHIN boundaries except for a new Toronto Central LHIN/Regional Public Health entity.

Other Expert Panel Report recommendations include:
  • Proposed Leadership Structure consisting of:
    • Regional public health entity with a CEO that reports to the Board and a Regional Medical Officer of Health (MOH) who reports to the Board on matters of public health and safety.
      • Under each regional entity would be a Local Public Health Service Delivery Area with a Local Medical Officer of Health (reporting to the Regional MOH), local public health programs and services.
  • Proposed Board of Health Governance would be freestanding autonomous boards:
    • appointees would be municipal members (with formula defined by regulation), provincial appointees, citizen members (municipal appointees), and other representatives (e.g. education, LHIN, social sector, etc.) 
    • varied member numbers of 12-15
    • diversity and inclusion - board should reflect the communities they serve
    • qualifications - skills-based and experience
    • Board to have the right mix of skills, competencies, and diverse populations
    • “Municipalities should also be encouraged to appoint a mix of elected officials and members of the community to ensure diversity and continuity and to reduce challenges elected officials may experience balancing their municipal responsibilities with their responsibilities for public health”.
The Expert Panel was not asked to make specific recommendations on implementation; however, they did identify elements that should be considered in developing an implementation plan. These elements include:
  • Legislation
  • Funding – it was noted that “as part of implementation planning the Ministry will need to revisit funding constructs in order to implement the recommendations”
  • Transition planning/change management- with wording that says:
    • “The transition from the current 36 local boards of health to a smaller number of regional boards of health will have particular implications for municipalities and municipal members.  It is important that the new board structure recognizes and protects municipal interests, while recognizing the potential for competition for municipal seats.”
    • “To ensure greater consistency across the province, it may be helpful to work with the Association of Ontario Municipalities to develop the criteria for municipal representation on the new regional boards.”
  • Effective Linkages with LHINs and the Health System.
Although engagement details are pending, we do understand that there will likely be a reasonable amount of time for review and discussion. AMO will be convening its Health Task Force in early September to fully consider this report and assist the development of the AMO Board’s response at the September Board meeting. At the upcoming AMO Conference, there will be a concurrent session on the future of public health on Tuesday, August 15th.