7.             OTTAWA BOARD OF HEALTH - GOVERNANCE

 

CONSEIL DE LA SANTÉ D’OTTAWA − GESTION PUBLIQUE

 

 

 

Committee RecommendationS as amended

 

That Council:

 

1.                  Approve, in principle, an independent Board of Health governance model with features similar to Toronto’s current model (authorized by Section 405 of the City of Toronto Act) as described below:

a)                  A Board of Health comprised of eleven members appointed by the City, six councillors and five citizen representatives;

b)                  The Board of Health appoints the Medical Officer of Health and the Associate Medical Officers of Health who are employees of the Board of Health;

c)                  The Medical Officer of Health reports directly to the Board of Health;

d)                  The City of Ottawa provides to the Board, public health unit employees, who shall remain City of Ottawa employees;

e)                  The Board of Health makes recommendations to City Council on any issues within City Council’s jurisdiction that involve public health considerations (e.g., non-smoking by-laws); and;

f)                   The Board of Health reports annually to City Council on its operations.

 

2.                  Refer the recommended model to the mid-term governance review for consideration as part of that review process.

 

3.                  Direct the City Solicitor to prepare an application to the province for special legislation amending the City of Ottawa Act to authorize the City to implement a governance model in keeping with the final model approved by Council.

 

4.         Approve that after the first term appointments of the Board of Health are made by Council that subsequent citizen board members be recruited and be appointed by the Board of Health, similarly to OCH and that the composition of the Board be reviewed at the time to ensure that necessary skills and abilities are reflected;

 

5.         Approve that the majority of the Board of Health citizen representatives be from the Board Health constituency and knowledge.


 

RecommandationS modifiÉeS du Comité

 

Que le Conseil

 

1.                  approuve, en principe, un modèle de gestion publique du conseil de la santé publique autonome comportant des caractéristiques similaires à celles du modèle actuel de Toronto (autorisé par l’article 405 de la Loi de 2006 sur la cité de Toronto), comme il est décrit ci-dessous :

a)         le Conseil de la santé comprend onze membres nommés par la Ville, soit six conseillers et cinq résidents; 

b)         le Conseil de la santé nomme le médecin chef en santé publique ainsi que les médecins adjoints en santé publique, qui sont des employés du Conseil de la santé; 

c)         le médecin chef en santé publique fait directement rapport au Conseil de la santé;

d)         la Ville d’Ottawa détache au Conseil des employés du service de santé publique, qui resteront à l’emploi de la Ville d’Ottawa;

e)         le Conseil de la santé fait des recommandations au Conseil municipal sur des enjeux compris dans le secteur de compétence du Conseil municipal et qui suscitent des considérations sur la santé publique (p. ex., règlements antitabac);

f)          le Conseil de la santé fait rapport chaque année au Conseil municipal sur ses activités.

 

2.                  renvoye le modèle recommandé à l’examen de la gestion publique au milieu du mandat pour étude dans le cadre de ce processus d’examen.

 

3.                  charge le chef du contentieux de présenter à la province une demande de mesures législatives spéciales qui modifieraient la Loi de 1999 sur la ville d’Ottawa afin d’autoriser la Ville à mettre en œuvre  un modèle de gestion publique conforme à la version définitive du modèle approuvé par le Conseil.

 

4.         approuve que, une fois les nominations au Conseil de la santé faites par le Conseil municipal venues à terme, les résidents siégeant au Conseil soient dès lors nommés par le Conseil de la santé, comme cela se fait à la Société de logement communautaire d’Ottawa, et que l’on procède alors à une réévaluation de la composition du Conseil afin de s’assurer que les membres possèdent les qualifications et les aptitudes requises;

 

5.         approuve que la représentativité et les connaissances de la majorité des résidents siégeant au Conseil de la santé s’harmonisent avec celles des autres membres du Conseil.

 


 

 

Documentation

 

1.         Deputy City Manager's report Community and Protective Services, dated 23 September 2008 (ACS2008-CPS-OPH-0010).

 

2.         Extract of Draft Minutes, 2 October 2008.


Report to/Rapport au:

 

Community and Protective Services Committee

Comité des services communautaires et de protection

 

and Council / et au Conseil

 

23 September 2008 / le 23 septembre 2008

 

Submitted by/Soumis par :

Steve Kanellakos, Deputy City Manager/Directeur municipal adjoint,

Community and Protective Services/Services communautaires et de protection

 

Contact Person/Personne ressource :

Dr. Isra Levy, Medical Officer of Health / médecin chef en santé publique

Ottawa Public Health / Santé publique Ottawa

(613) 580-2424 x 23675 

 

City Wide/à l'échelle de la Ville

Ref N°: ACS2008-CPS-OPH-0010

 

 

SUBJECT:

ottawa Board of Health - governance

 

 

OBJET :

Conseil de la santé d’Ottawa − gestion publique

 

 

REPORT RECOMMENDATIONS

 

That the Community and Protective Services Committee recommend that Council:

1.         Approve, in principle, an independent Board of Health governance model with features similar to Toronto’s current model (authorized by Section 405 of the City of Toronto Act) as described below:

a)                  A Board of Health comprised of nine members appointed by the City, four councillors and five citizen representatives;

b)                  The Board of Health appoints the Medical Officer of Health and the Associate Medical Officers of Health who are employees of the Board of Health;

c)                  The Medical Officer of Health reports directly to the Board of Health;

d)                  The City of Ottawa provides to the Board, public health unit employees, who shall remain City of Ottawa employees;

e)                  The Board of Health makes recommendations to City Council on any issues within City Council’s jurisdiction that involve public health considerations (e.g., non-smoking by-laws); and;

f)                   The Board of Health reports annually to City Council on its operations.

 

2.         Refer the recommended model to the mid-term governance review for consideration as part of that review process.

 

3.         Direct the City Solicitor to prepare an application to the province for special legislation amending the City of Ottawa Act, 1999  to authorize the City to implement a governance model in keeping with the final model approved by Council.

 

RECOMMANDATIONS DU RAPPORT

 

Que le Comité des services communautaires et de protection recommande au Conseil :

 

1.                  D’approuver, en principe, un modèle de gestion publique du conseil de la santé publique autonome comportant des caractéristiques similaires à celles du modèle actuel de Toronto (autorisé par l’article 405 de la Loi de 2006 sur la cité de Toronto), comme il est décrit ci-dessous :

a)         Le Conseil de la santé comprend neuf membres nommés par la Ville, soit quatre conseillers et cinq résidents; 

b)         Le Conseil de la santé nomme le médecin chef en santé publique ainsi que les médecins adjoints en santé publique, qui sont des employés du Conseil de la santé; 

c)         Le médecin chef en santé publique fait directement rapport au Conseil de la santé;

d)         La Ville d’Ottawa détache au Conseil des employés du service de santé publique, qui resteront à l’emploi de la Ville d’Ottawa;

e)         Le Conseil de la santé fait des recommandations au Conseil municipal sur des enjeux compris dans le secteur de compétence du Conseil municipal et qui suscitent des considérations sur la santé publique (p. ex., règlements antitabac);

f)          Le Conseil de la santé fait rapport chaque année au Conseil municipal sur ses activités.

 

2.                  De renvoyer le modèle recommandé à l’examen de la gestion publique au milieu du mandat pour étude dans le cadre de ce processus d’examen.

 

3.                  De charger le chef du contentieux de présenter à la province une demande de mesures législatives spéciales qui modifieraient la Loi de 1999 sur la ville d’Ottawa afin d’autoriser la Ville à mettre en œuvre un modèle de gestion publique conforme à la version définitive du modèle approuvé par le Conseil.

 

 

EXECUTIVE SUMMARY

 

In December of 2007, as part of budget deliberations, Council approved a motion which provided that the 2008 Public Health budget ($9.792M) be approved from one-time sources and that the base budget funding be removed from the 2008 budget and that the Minister of Health and Long Term Care be advised that the Province of Ontario will be required to provide funding for public health services in 2009 and beyond.

 

It was further resolved, that the Medical Officer of Health be directed to bring forward organizational structures, such as an independent Board of Health (BOH), to facilitate the uploading of the financial responsibility for this service and that the Deputy City Manager of Community and Protective Services (CPS) be directed to engage the public and community partners in support of Council’s uploading goals.

 

At its meeting of May 15, 2008 the Community and Protective Services Committee (CPSC) received a report with a proposed model similar to the Toronto Board of Health model. CPSC directed staff to consult with the public on this independent Board of Health governance model, and report back to CPSC and Council with the recommended model to be referred to the mid-term governance review. The mid-term governance review is a comprehensive review of the City’s governance structure, being led by the City Solicitor’s office in conjunction with the City Clerk’s office, to facilitate an efficient and effective decision-making process for City Council. This review will identify recommendations and options to improve the City’s governance structure, enhance accountability and transparency, and promote effective citizen engagement.  CPSC directed that an underpinning principle of a proposed governance model be that it be functional and suitable in any fiscal arrangement (i.e. whether or not the City’s uploading goals are met).

 

The overarching objective of Public Health governance reform must be to improve service delivery and health outcomes of Ottawa’s citizens and to operate Ottawa Public Health in accordance with exemplary public health governance practices. In short, the new governance model must improve focus on public heath stewardship and organisational responsiveness to community health needs, and simultaneously remove the “municipal dilemma”, wherein municipal council risks conflict between its interests as manager and funder of City services, and the statutory responsibility of the Board of Health to protect public health as provided for under the Health Promotion and Protection Act.

 

In keeping with direction received from CPSC, the consultation process consisted of a combination of facilitated focus group sessions, interviews with key stakeholders and a public opinion survey.  Altogether, almost 450 participants provided feedback on the proposed model.

 

Survey, focus group and interview results were unanimously supportive of a more autonomous Board of Health. Feedback has been used to amend the proposed model.

 

The recommended model outlined in this report is consistent with the recommendations emanating from the 2006 Ontario Capacity Review Committee (CRC) as well as the cost uploading goals of City Council.  In January 2005, the provincial Capacity Review Committee was established to examine public health governance, funding and accountability. The report of the Committee, Revitalizing Ontario’s Public Health Capacity: The Final Report of the Capacity Review Committee, May 2006, identified the governance elements that are necessary to ensure a strong and resilient province-wide system that can react quickly and effectively to the challenges of the 21st century.


 

The proposed model meets the principles of focus on public health and responsiveness to local needs by creating a more autonomous board with a mixed membership of community and Councillor members. It removes the inherent conflict of interest for Councillors described by Justice Campbell in the analysis of the “two hats” of municipal politicians and public health stewards. It maintains administrative integration with the municipality by proposing that the City provide staff to the public health unit with the Board of Health. It provides a greater degree of autonomy for the Board of Health to respond to emerging public health issues/threats in which the mixed membership Board of Health sets public health policy and the MOH reports directly to the Board of Health.

 

It provides for Council appointment of Board of Health members and Council approval of recommendations with citywide implications and approval of the overall budget for the Board of Health. It also provides for a regular reporting relationship from the Board of Health to City Council.

 

RÉSUMÉ

 

Pendant les délibérations budgétaires en décembre 2007, le Conseil a approuvé une motion précisant que le budget de la santé publique 2008 (9,792 M$) sera approuvé et tiré de sources ponctuelles, que le financement de base du budget sera retiré du budget 2008 et que le ministère de la Santé et des Soins de longue durée sera informé que la province de l’Ontario devra financer les services de santé publique en 2009 et par la suite.

 

Il a été en outre résolu de demander au médecin chef en santé publique de présenter des structures organisationnelles, par exemple un conseil de la santé autonome, pour faciliter le transfert en amont de la responsabilité financière de ce service, et de demander au directeur municipal adjoint des Services communautaires et de protection (SCP) d’engager des partenaires communautaires et le public pour soutenir les buts du transfert en amont du Conseil.

 

À l'occasion de la réunion du 15 mai 2008, le Comité des services communautaires et de protection a reçu un rapport dans lequel on présentait un modèle semblable à celui du Conseil de la santé de Toronto. Le Comité a demandé au personnel de mener des consultations publiques au sujet de ce modèle de gestion publique du Conseil de la santé autonome et de présenter ses conclusions au Comité et au Conseil municipal à l’aide du modèle recommandé qui sera envoyé à l’examen de la gestion publique au milieu du mandat. Il s'agit d'un examen approfondi de la structure de gestion publique de la Ville mené par le bureau du chef du contentieux et le bureau du greffier municipal afin d’améliorer l’efficience et l’efficacité du processus de prise de décisions du Conseil municipal. Il permettra de cerner des recommandations et des suggestions qui viseront à améliorer la structure de gestion publique de la Ville, l'obligation de rendre compte et la transparence, de même qu’à favoriser l'engagement des résidents. Le Comité a indiqué que le modèle de gestion publique proposé devait être avant tout fonctionnel et adapté aux divers accords fiscaux (c’est-à-dire que la Ville atteigne ou non ses objectifs en matière de transferts en amont).

 

L'objectif principal de la réforme de la gouvernance de la santé publique doit être l'amélioration de la prestation des services et de la santé des résidents d'Ottawa, de même que la gestion de Santé publique Ottawa conformément aux pratiques exemplaires de gouvernance de la santé publique. Bref, le nouveau modèle de gouvernance doit être davantage axé sur la gestion de la santé publique et sur l'aptitude des organisations à répondre aux besoins de la collectivité en matière de santé. De plus, il doit résoudre le « dilemme municipal » selon lequel le Conseil municipal risque de se trouver en situation de conflit d'intérêts en raison de son rôle de gestionnaire et de bailleur de fonds des services de la Ville et de la responsabilité législative du Conseil de la santé qui consiste à protéger la santé publique, en vertu de la Loi sur la protection et la promotion de la santé. 

 

Conformément aux directives formulées par le Comité, le processus de consultation comprenait des séances de discussion en groupe, d'entretiens avec les principaux intervenants ainsi qu’un sondage d'opinion. Au total, presque 450 participants ont formulé des commentaires sur le modèle proposé.

 

Les résultats du sondage, des groupes de discussion et des entretiens ont révélé que tous souhaitent que l'on accorde davantage d'autonomie au Conseil de la santé. On s'est fondé sur les commentaires reçus pour modifier le modèle proposé.

 

Le modèle proposé décrit dans le présent rapport cadre bien avec les recommandations du rapport de 2006 du Comité d'examen de la capacité d'intervention de l'Ontario et les objectifs du Conseil municipal en matière de transfert en amont des coûts. En janvier 2005, on a formé le Comité d'examen de la capacité d'intervention pour qu’il examine la gouvernance de la santé publique, le financement et l'obligation de rendre compte. Le rapport du Comité d'examen de la capacité d'intervention intitulé Revitalisation de la capacité d'intervention des services de santé publique de l'Ontario : rapport final du Comité d'examen de la capacité d'intervention et publié en mai 2006 présente les éléments de gestion publique essentiels à l'établissement d'un système provincial solide que l'on peut adapter rapidement et efficacement aux enjeux du XXIe siècle.  

 

Le modèle proposé est conforme aux principes de gestion axée sur la santé publique et à l'aptitude à répondre aux besoins locaux grâce à la création d'un conseil plus autonome composé à parts égales de membres de la collectivité et de conseillers municipaux. Il permet de régler la question du conflit d’intérêts propre aux conseillers et décrite par le juge Campbell dans son analyse des deux rôles que doivent jouer les politiciens municipaux et les responsables de la gestion de la santé publique. Le modèle permet une intégration administrative avec la municipalité en proposant à la Ville de fournir du personnel au bureau de santé par l’intermédiaire du Conseil de la santé. Ce modèle accorde une plus grande autonomie au Conseil de la santé pour qu’il puisse mieux affronter les enjeux émergents en matière de santé publique et les menaces à la santé publique, et prévoit que ce dernier sera responsable de l’élaboration des politiques de santé publique et que le médecin chef en santé publique sera sous la supervision directe du Conseil de la santé. Le Conseil municipal serait responsable de la nomination des membres du Conseil de la santé et de l’approbation des recommandations ayant des incidences pour l’ensemble de la Ville et du budget général du Conseil de la santé. Il prévoit également la présentation de rapports réguliers par le Conseil de la santé au Conseil municipal.

 

 

BACKGROUND

 

Chronology of Developments Impacting Ottawa Public Health Governance

Over the past decade, concern about the public health system arose due to a number of events, including concerns about oversight (e.g. dangerous bacteria in the drinking water in Walkerton) and about the capacity to adequately respond to public health events (e.g. the response to West Nile disease and Severe Acute Respiratory Syndrome (SARS)).

 

In January 2005, the provincial Capacity Review Committee (CRC) was established to examine public health governance, funding and accountability. 

 

The report of the Committee, Revitalizing Ontario’s Public Health Capacity: The Final Report of the Capacity Review Committee, May 2006, identified the governance elements that are necessary to ensure a strong and resilient province-wide system that can react quickly and effectively to the challenges of the 21st century. These elements were: 

·        Local – Local boards of health to ensure that programs are tailored to local needs and relationships are maintained with other locally-governed bodies and agencies that are primary partners in the delivery of services (e.g., school boards). 

·      Autonomous - Autonomous boards allow for the recruitment of members with specific skills and interest in public health, to add to the perspective brought by municipal councillors. Autonomous boards also ensure the independence of the Medical Officer of Health (MOH) and direct MOH reporting to the board without having to work through other bureaucratic layers.

·      Primary focus on public health - Boards with a primary focus on public health ensure that appropriate attention is paid to its mandate.

 

The CRC report included the following three recommendations respecting governance: 

·        A consistent governance structure of autonomous, locally based boards of health within a province-wide system (recommendation 19);

·        That where local health units are currently integrated into the municipal structure, the boards of health and municipalities should jointly agree on their degree of future integration (Recommendation 20), and; 

·        That there be an equal balance between municipal appointees and local citizens representatives appointed by the board (Recommendation 21).

 

To date, the Province has not formally dealt with the Capacity Review Committee (CRC) recommendations.

 

On January 1, 2007, Bill 130, the Municipal Statute Law Amendment Act, 2006, came into effect, giving municipal governments more autonomy to determine local governance structures.


 

In December of 2007, as part of budget deliberations, Council approved Motion 26/25, which provided that the 2008 Public Health budget ($9.792M) be approved from one-time sources and that the base budget funding be removed from the 2008 budget with the Minister of Health and Long Term Care being advised that the Province of Ontario will be required to provide funding for public health services in 2009 and beyond.

 

It was further resolved, that the Medical Officer of Health be directed to bring forward organizational structures, such as an independent Board of Health, to facilitate the uploading of the financial responsibility for this service and that the Deputy City Manager of Community and Protective Services (CPS) be directed to engage the public and community partners in support of Council’s uploading goals.

 

The primary challenge to be met in the process of developing a new governance model was to achieve a better balance of the three key accountabilities of the Medical Officer of Health, to the:

·        Province to ensure the requirements of the Health Protection and Promotion Act are met;

·        Board of Health for the effective delivery of Ottawa Public Health programs and services; and

·        City for efficient fiscal management and adherence to corporate administrative policies and procedures.

 

The report presented to Community and Protective Services Committee (CPSC) on May 15 (ACS2008-CPS-OPH-0006) proposed a model of governance consistent with the recommendations of the 2006 Ontario Capacity Review Committee as well as the cost uploading goals of the City of Ottawa.

 

The following principles guided the development of the proposed governance structure:

·        Accountability

·        Responsive to local needs

·        Focus on public health

·        Works well under current or uploaded fiscal arrangements

·        Maintains a functional relationship with the operational leadership of the health unit

·        No additional cost to the City of Ottawa.

 

Further to the report, CPSC requested that public consultations be done on the proposed model.  Results of the consultation process, including amendments to the proposed model based on feedback received through the consultation process, are set out in the following sections.

 

To date the Province has not formally responded to the City’s request to upload the entire cost of public health. On August 26, 2008, members of the CPS Committee (Councillors Deans, Feltmate and Cullen) along with the Medical Officer of Health had the opportunity to raise Council’s funding concerns directly with the Minister of Health and Long Term Care at a meeting in conjunction with a meeting of the Association of Municipalities of Ontario.


It was clear from that meeting, and from the Ministry’s continuation of its traditional funding formula for Ottawa Public Health (OPH) in the 2008 public health budget cycle, that the province has no current plans to accept 100% financial uploading for public health programming.

 

DISCUSSION

 

Board of Health Roles and Responsibilities

In its orientation manual for Board of Health members, Ontario’s Association of Local Public Health Agencies outlines the mandates of boards of health including the:

·        Responsibility to uphold provincial legislation under the Health Protection and Promotion Act and others;

·        Accountability to the community to protect and promote health, prevent disease and monitor community health through the appropriate programs; and

·        Establishment of overall objectives and priorities for the organization in its provision of health programs and services. 

 

Given that the potential consequences of a Board of Health that is unable or unwilling to meet its responsibilities includes risk to human health and life, the Health Protection and Promotion Act includes provisions for legal action by the province including re-appointment of the Board members, and financial penalty. 

 

Section 95 of the Health Promotion and Protection Act provides protection from liability for Board of Health members’ acts or omissions provided they act in “good faith” in the execution of their respective duties.  In light of this “good faith” proviso, the City Solicitor, in Memo ACS2008-CMR-LEG-0011-IPD, to the Coordinator, Community and Protective Services Committee, February 2008, submitted that it is recommended that the City’s Board of Health ensure that all health programs and services are “evidence-based” and the evidence in support of program policies and procedures be carefully documented.

 

The City’s policy of indemnification of City Council members as a result of any action or other proceeding brought against them is also subject to the “good faith” proviso.

 

Municipal Dilemma

Justice Campbell, in his Second Interim Report, “SARS and Public Health in Ontario”, 2005, used the phrase “municipal funding dilemma” to describe a potential conflict for municipal councillors. He argued that there is a fundamental difference in the duties of elected representatives as managers of municipal affairs who have a mandate to keep taxes down and the duties of Board of Health members in fulfilling requirements under the Health Protection and Act (HPPA).  A municipal councillor on a Board of Health has two “hats”:

·        Municipal politician hat – manage municipal priorities and the municipal budget; and

·        Public health hat – steward of delivery of public health services that adequately protect the public.

 

This separation of hats is particularly difficult when council is the Board of Health and does not meet separately. Having unelected representatives on a Board of Health ameliorates this conflict.

 

Justice Campbell contends that separating the two hats through an independent Board of Health does not diminish the importance of the Board of Health or the requirement to ensure that the budget is well managed and appropriate for the services delivered. However, only one hat, which is bound by legal duty under Health Protection and Promotion Act, should be worn while deliberating as the Board of Health.  The Board of Health has the time and expertise to focus on public health matters and the statutory duty to ensure the budget is sufficient to carry out mandatory programs while also assuring that the budget is managed efficiently and effectively. 

 

Ontario Boards of Health Structures

Currently, 36 boards of health in Ontario are divided among three distinct governance structures (attached as Document 1), which are provided for under the HPPA:

 

1.      Autonomous - The Board of Health is independent from local government. The MOH reports directly to the Board of Health. Health unit staff operates separately from the municipal administrative structure. There are 21 autonomous boards of health in Ontario.

2.      Regional/Single Tier - Staff operates under the administration of regional government or a single-tier municipality. Regional or city councils are the Boards of Health and make final decisions. However, detailed review is often delegated to a standing committee, which then makes recommendations to full council.  There are 10 regional/single-tier boards of health.

3.      MunicipalIn municipal boards, the staff of the health unit operates under the municipal administrative structure. Presently, there are 5 municipal boards of health.

 

Ottawa’s Municipal Model

Ottawa Public Heath operates under the municipal model. The Community and Protective Services Committee first considers reports before they rise to the full Board of Health (Ottawa City Council).  Council does not meet separately as the Board of Health and neither CPSC nor Council structure its agenda to focus uniquely on public health issues. The Medical Officer of Health does not have direct access to the Board of Health and usually communication is provided through the City Manager or Deputy City Manager.

 

The MOH reports to the Deputy City Manager of the Community and Protective Services department. Public health staff is employed by, and operates under, the City of Ottawa’s administrative structure. Ottawa Public Health is completely integrated within the City’s administration.

 

Proposed Governance Model

The proposed made in Ottawa model is based on a “hybrid” model already in place in the City of Toronto (see City of Toronto Act attached as Document 2) that combines aspects of the municipal model and the autonomous model.

The model:

·        Fulfills the governance requirements of the HPPA;

·        Fulfills the governance recommendations of the Capacity Review Committee, discussed earlier in the report (including the principles of focus on public health and mixed membership);

·        Retains administrative integration with the municipality (no significant new costs);

·        Provides autonomy for the Board of Health while leaving key responsibilities with Council including approval of the budget envelope and approval of recommendations with citywide and financial implications; and

·        Supports the possible future upload of public health costs by delegating the setting of public health policy to an independent Board of Health.

 

In addition to the above noted principles, an extensive literature review was conducted to determine the key principles defining good governance practices (attached as Document 3).

 

Consultation Process

The public and key stakeholders were consulted on the proposed Board of Health model. Delegates of all City advisory committees were also invited to attend facilitated sessions.  Ottawa Public Health staff and affiliated unions were also consulted. Details of consulted stakeholders are included in the Consultation section of this report. 

 

The facilitated sessions, key informant interviews and the survey were all structured to obtain feedback on each of the features of the proposed model as well as to capture general comments or suggestions not reflected in the proposed model.

 

Consultation Results

Consultations were conducted on the proposed new governance model during July and August. Almost 450 people representing the general public and key informants, as well as various organizations and professional groups participated in the consultations through a methodology that included an online survey, focus group discussions, and interviews. 

 

Key Themes

Support for change – There was strong support for change. A large majority of survey respondents expressed satisfaction with the proposed governance model, all wanted change from the status quo, and most focus group participants wanted adjustments to the proposed model.  

 

More independence for the Board of Health – There was overwhelming support for a Board of Health that has more autonomy. This was shown through several indicators, including a large majority who want: 1) the Board of Health to have responsibility for appointing the Medical Officer of Health; and, 2) the Medical Officer of Health to report directly to the Board of Health.  There were very frequent references in the consultations to the need for greater autonomy for the Board of Health and for more independence in its decision-making.    

 

Mixed representation on the Board – There was strong support for a Board of Health with a mixed representation and a variety of skills and experience among its members.  Those consulted want the board to include health and public health experts, community representatives, and elected officials. 

 

Other Findings on Specific Recommendations

Size of the Board of Health – Most agreed with the proposal as presented during the consultations for a Board of Health with 13 board members. Many also indicated they would either accept or prefer a smaller board with nine or 10 members.

 

Composition of the Board – A majority of focus group participants, and many of those commenting in the survey, expressed a preference for more public health experts and community representatives and fewer councillors on the Board of Health.  

 

Board selection criteria – The most important considerations for choosing board members were knowledge of health/health care, knowledge and experience in public health, impartiality/objectivity, strong ties to the community, and representing the entire community. 

 

Employment Status – There was support for the Medical Officer of Health and Associate Medical Officers of Health to be employees of the Board of Health.  As a practical and administrative matter, there was support for staff of the board to be employees of the City of Ottawa.  There were questions about how these employment arrangements would work, and whether there would be confusion in the lines of reporting and responsibility.

 

Reporting – There was strong support for having the Medical Officer of Health report directly to the Board of Health. There was also strong support for the Board of Health to report annually to City Council, with accountability cited most frequently as the rationale.  

 

Made in Ottawa Board of Health Model Recommended

The following section outlines the made in Ottawa model being recommended to CPS Committee and Council. It includes details of the amendments to the model features as well as an explanation and summary of the feedback received as part of the consultation process. A summary table comparing the model presented to CPS Committee on May 15, 2008 with the amended model presented in this report is attached as Document 4.

 

A large majority of respondents indicated that the City should proceed with the new governance model for public health regardless of whether or not the Province provides 100% funding.

 

Recommendation 1 – Ottawa Board of Health - Recommended Model

 

a)      A Board of Health comprised of nine members appointed by the City, four councillors and five citizen representatives.

 

This recommendation has changed. The original model proposed a Board of Health comprised of thirteen members: six city councillors and six citizen representatives and one school board representative all appointed by City Council.

 

Staff received a great deal of feedback with respect to the composition of the Board of Health. As a general comment, stakeholders were concerned that councillors were over-represented. 

At the same time, the Capacity Review Committee in its report recommended that there should be equal representation between municipal councillors and appointed board members. 

 

As a comparison both the Ottawa Public Library Board and the Police Services Board were examined and noted to have councillors in the minority. There is a mix of six councillors and eight community members for the Library Board and three councillors, three council appointed public members and one provincially appointed member for the Police Services Board. Document 5 attached, has more details regarding the two boards.

 

There was diverse opinion regarding inclusion of a school representative in the board composition. Some participants wondered how one member could represent the interests of the different school boards, with corresponding comments about the need for a mechanism to ensure that views of all school boards are taken into account. A key informant interview with the Ottawa Public Library revealed that their board no longer held a board position for a school representative for these reasons.

 

Some focus groups had strong opinions that the Board of Health should play a role in appointing members rather than vesting this process entirely in City Council. This report is not recommending any particular process for board member recruitment and appointments.

 

b)      The Board of Health appoints the Medical Officer of Health and the Associate Medical Officers of Health who are employees of the Board of Health.

 

This recommendation has changed. The original model proposed that Council appoint the Medical Officer of Health and Associate MOHs to the Board.

 

There was broad consensus from both the survey respondents and focus group participants that a qualified board, once appointed by Council, should have the authority to appoint the MOH and Associate MOHs to ensure clear lines of accountability. This reporting structure would be consistent with the provision under the Health Protection and Promotion Act; “Every Board of Health, (a) shall appoint a full-time medical officer of health; and (b) may appoint one or more associate medical officers of health, of the Board of Health.” Appointments approved by the Board of Health would have to be subsequently approved by the Ministry of Health and Long Term Care (MOHLTC) as is presently the case under the HPPA.

 

The Associate MOHs would report directly to the MOH as is the current situation.

 

Survey respondents were divided on the issue of whether the Medical Officer and the Associate Medical Officers of Health should become employees of the Board of Health. Overall, a slight majority agreed with this proposal, including many who strongly agreed.


 

c)      The Medical Officer of Health reports directly to the Board of Health.

 

This recommendation remains as originally proposed. 

 

The majority of survey respondents agreed with this proposal. Focus group participants also identified a number of benefits of having the Medical Officer of Health report directly to the Board of Health including the following:

·          allows for more focus on public health issues and more independence of management;

·          MOH would report to a group that has expertise; and, 

·          the process would be more dynamic and responsive to emerging and emergent public health issues.

 

Having the MOH report directly to the Board of Health so as to ensure the independence of the MOH and the focus on public health is similar to the reporting relationship that the Chief Librarian has with the Ottawa Library Board and that of the Police Chief has with the Police Services Board.

 

Presently the MOH reports through the Deputy City Manager of Community and Protective Services. If this model is adopted then the Deputy City Manager, Community and Protective Services could invite the MOH to attend meetings of the CPS Management Team to maintain and facilitate ongoing initiatives and partnerships between OPH and the CPS department, as is presently the case with the Library.

 

d)      The City of Ottawa provides to the Board, public health unit employees, who shall remain City of Ottawa employees.

 

This recommendation remains mainly as originally proposed.

 

After consultation with the City Solicitor it was determined that no service agreement is required to maintain public health staffs’ employment with the City under the proposed new structure. The recommendation as proposed, is consistent with the authority contained in the City of Toronto Act.

 

There was broad consensus amongst both the survey respondents and the focus groups that the retention of public health employees as City employees would provide the least disruption during the transition to the new model and would contain the costs of establishing a new and separate entity.

 

e)      The Board of Health makes recommendations to City Council on any issues within City Council’s jurisdiction that involve public health considerations (e.g., non-smoking by-laws).


This recommendation remains as originally proposed. 

 

There was broad consensus on this recommendation once it was appropriately explained and clarified to consultation participants.  The recommendation proposes that the Board of Health would approve policies, programs and activities for which it is responsible under the Health Protection and Promotion Act without recourse to Council.

 

For initiatives that fall within the jurisdiction of City of Ottawa Council (e.g., Smoking by-laws; Pesticide by-laws; Idling by-laws) the MOH, through the Board of Health, would have to make recommendations to City Council.

 

f)        The Board of Health shall report annually to City Council on its operations.

 

This recommendation remains as originally proposed. 

 

A large majority of survey and focus group respondents agreed with this recommendation. Clarification was provided that the BOH could report to Council as often as required but that it would do so no less than once annually.  Currently Ottawa Public Health (OPH) provides an annual report to the Ministry of Health and Long Term Care and to Council. The recommended model would require the same annual report while inviting any additional reports that the BOH wishes to forward to Council for its information or approval.

 

It is proposed that the City Council would approve the OPH budget envelope until such time as the full cost of public health may be uploaded to the Province.

 

Under this model the MOH remains accountable to the Province to ensure the requirements of the HPPA are met, accountable to the BOH for the effective management of the Ottawa Public Health Unit and its programs and accountable to the City for efficient fiscal management of the budget and adherence to administrative policies and procedures.

 

Recommendation 2 – Referral of Recommended Model to the Mid-Term Governance Review

 

The mid-term governance review is a comprehensive review of the City’s governance structure, being led by the City Solicitor’s office in conjunction with the City Clerk’s office, to facilitate an efficient and effective decision-making process for City Council. This review will identify recommendations and options to improve the City’s governance structure, enhance accountability and transparency, and promote effective citizen engagement.

 

At the same time, the Mayor’s office has struck a Citizen’s Taskforce on Governance to provide recommendations on governance to the Mayor and Council. 

 

This report recommends that the model proposed by Recommendation 1 of this report, including the results of the consultation strategy be referred to the mid-term governance review to form part of the comprehensive governance package to be considered by Council in the fall.

 

Recommendation 3 – Application for Special Legislation to Amend the City of Ottawa Act

 

It is recommended that, in view of possible delays in process, the City should request of the Province the same authority as provided to the City of Toronto in the City of Toronto Act, which would permit the City of Ottawa to establish a Board of Health, in accordance with Health Protection and Promotion Act. Such authority would provide the City the flexibility to incorporate the made in Ottawa proposals advanced in this report, once the enabling legislation has been approved by the province of Ontario.

 

Currently section 12 of the City of Ottawa Act, 1999 provides that the City has the rights, powers and duties of a Board of Health under the Health Protection and Promotion Act. 

 

Subject to approval of the features of a Board of Health governance model, Corporate Legal Services will prepare an application for special legislation from the province to amend the City of Ottawa Act similar to the City of Toronto Act (attached as Document 2). 

 

Furthermore, subject to approval of that legislation by the Province, staff would prepare a final report to Committee and Council recommending implementation details.

 

CONSULTATION

 

In keeping with direction received from CPS Committee, consultations with the public and key stakeholders were conducted.  In order to reach as many people as possible several methods were used simultaneously.  The following consultation activities took place over the summer of 2008.

·        The proposed model and consultation strategy was presented to the Health and Social Services Advisory Committee (HSSAC) at its meeting of May 27. 

·        A 21-day governance survey was posted on Ottawa.ca and the Ottawa Public Health website. (July 9 to July 30)

·        Advertisements were placed on two occasions in the Ottawa Citizen and Le Droit newspapers to inform the general public about the survey.  

·        Personalized emails inviting stakeholders to complete the survey and to participate in consultation sessions were sent from both the Deputy City Manager’s office and the Office of the Medical Officer of Health.

·        A public service announcement (PSA) was distributed to radio stations.

·        Key informant interviews were conducted with 12 individuals, including the Civic Institute of Professional Personnel and the Canadian Union of Public Employees.

·        Three information and consultation sessions were conducted with staff from Ottawa Public Health.

·        Four public consultation sessions were held concurrently at Ottawa City Hall on July 22. Thirty-four (34) participants attended the sessions including members of City Advisory Committees including delegates from:  Health and Social Services Advisory Committee; Environmental Advisory Committee; Equity and Diversity Advisory Committee; Accessibility Advisory Committee; Seniors Advisory Committee. All of the City’s Advisory Committees were invited to attend the sessions.

 

Almost 450 people including the general public and various organizations and professional groups participated in the consultations. Stakeholder names were gathered from several existing distribution and contact lists so as to have a cross section of representation from community partners and affiliated groups. The emails encouraged the individuals to forward the invitation to participate in the survey and consultation sessions to colleagues and partner agencies that may have been missed. Representatives from Community Health and Resources Centres, the health sector, school boards, population specific (youth, seniors, women, multicultural) organization participated.

 

Legal Services and Clerk’s branches were consulted during the preparation of this report.

 

A summary and analysis of key findings will be held on file with the City Clerk.

 

Health and Social Services Advisory Committee

 

On September 16, 2008 OPH staff provided a verbal briefing to the Health and Social Services Advisory Committee (HSSAC) to outline the results of the consultation process, along with the amendments to the proposed Board of Health governance structure.

 

Some HSSAC members expressed a preference for a larger number of Board members (11) with a mix of seven community representatives and 4 Councillors. However the majority of the HSSAC members were satisfied with the amended proposal going forward for consideration.

 

FINANCIAL IMPLICATIONS

 

There are no financial implications associated with this report.

 

SUPPORTING DOCUMENTATION

 

Document 1 – Types of Board of Health Structures

Document 2 – City of Toronto Act

Document 3 – Principles for Board of Health Governance

Document 4 – Comparison Table – Governance Model Recommendations

Document 5 – Ottawa Police Services Board and Ottawa Public Library Board Comparators

 

DISPOSITION

 

The Community and Protective Services Department will coordinate implementation of any direction received as part of consideration of this report.


Document 1

 

Types of Board of Health Structures

(from the Manual for Board of Health Members, Association of Local Public Health Agencies, 2007)

 

Autonomous

 

In autonomous boards of health, the health unit staff operates separately from the municipal administrative structure. There are 21 autonomous boards of health in Ontario:

 

·        Algoma

·        Brant County

·        Eastern Ontario

·        Elgin-St. Thomas

·        Grey Bruce

·        Haliburton-Kawartha-Pine Ridge

·        Hastings-Prince Edward

·        Kingston, Frontenac, Lennox & Addington

·        Leeds, Grenville, Lanark

·        Middlesex-London

·        North Bay Parry Sound

·        Northwestern

·        Perth

·        Peterborough

·        Porcupine

·        Renfrew

·        Sudbury

·        Thunder Bay

·        Timiskaming

·        Wellington-Dufferin-Guelph

·        Windsor-Essex

 

Regional/Single-Tier

 

In this type of Board of Health, staff operates under the administration of regional government or a single-tier municipality. According to the Association of Municipalities of Ontario, a regional government is a federation of the local municipalities within its boundaries, and a single-tier municipality is defined as an area where there is only one level of municipal government. The 10 regional/single-tier boards of health in Ontario include:

 

·        Durham (regional)

·        Haldimand-Norfolk

·        Halton (regional)

·        Lambton

·        Niagara (regional)

·        Oxford

·        Peel (regional)

·        Simcoe Muskoka

·        Waterloo (regional)

·        York (regional)

 

Municipal

 

In municipal boards, the staff of the health unit operates under the municipal administrative structure. Presently, there are 5 municipal boards of health:

·        Chatham-Kent

·        Hamilton

·        Huron

·         Ottawa

·         Toronto

 

Document 2

 

City of Toronto Act, 2006

S.O. 2006, CHAPTER 11
Schedule A

 

Board of Health

Board of Health continued

405.  (1) The Board of Health for the City of Toronto Health Unit is continued as a Board of Health for the City and is deemed to be a Board of Health established under the Health Protection and Promotion Act. 2006, c. 11, Sched. A, s. 405 (1).

Size

(2) The City shall, by by-law, establish the Board’s size in accordance with subsection 49 (2) of the Health Protection and Promotion Act. 2006, c. 11, Sched. A, s. 405 (2).

Appointment

(3) Despite subsections 49 (1) and (3) of the Health Protection and Promotion Act, all the members of the Board shall be appointed by the City. 2006, c. 11, Sched. A, s. 405 (3).

Area of jurisdiction

(4) The Board’s area of jurisdiction is the City. 2006, c. 11, Sched. A, s. 405 (4).

Functions of city council

(5) Despite the Health Protection and Promotion Act, the City has the following functions with respect to the Board:

1. The functions that the Board would otherwise have in respect of the appointment, reappointment and dismissal of its medical officer of health and associate medical officers of health.

2. The duty of providing to the Board the city employees, including public health nurses, that the City considers necessary to carry out the Board’s functions, including its duties in respect of mandatory health programs and services.

3. The duty of appointing the Board’s auditor. 2006, c. 11, Sched. A, s. 405 (5).


 

Document 3

Principles for Board of Health Governance Structure

 

The key principles defining good governance used in this review of the literature were first categorized by the United Nations, but have quickly spread into evaluation of municipal, non-profit and institutional governance.  These principles of performance, accountability and transparency, legitimacy and voice, direction and fairness, provide the framework used to categorise the best practices assembled here. 

 

The literature reviewed for best governance practices included several national reports for non-profit organisations, the governance review for the Canadian Medical Association, the Ontario Agency for Health Protection and Promotion, and several provincial reviews of governance.  Other Ontario specific reports outlining suggestions for governance were consulted, including the SARS Commission report, the assessors report on the Muskoka-Parry Sound Health Unit, and the Capacity Review Committee.  Understanding that local needs must be taken into account, we included the audit criteria used by the Office of the Auditor General for the audits of the Ottawa Polices Services Board and the Ottawa Public Library Board.

 

These best practices do not provide prescriptive instructions on how to assemble a Board of Health, but rather present a holistic framework built on principles shown to be valued not just in the general health care arena, but on a continuing basis by Ottawa City Council.  Using these principles, we have assembled best practice guidelines for processes and policies that will inform operations for the new Board of Health, which can be seen in the table below.

 

Key Principles

Application

Performance

·        Responsiveness

·        Effectiveness

·        Efficiency

·        Ability to formulate and implement sound policies

·        Evidence based practice

·        Established qualification needs of board members:

          Interest in health issues or willingness to learn

          Complement existing BOH skill set

          Leadership in the community

          Appreciation of the standards of care and role of MOH in protecting public health

          Willingness to accept the responsibility and accountability involved with being a member of the BOH

          Ability to work effectively as a team, and with a variety of people

          Demonstrated integrity

          Capacity to think and act strategically

          Demonstrated high level of performance

·        Orientation for all board members

·        Continuing education for all board members

·        Comprehensive policies and procedures

·        Defined, staggered terms for BOH members

·        Regular board meetings

·        Effective leadership from the chair

·        Regular evaluation of BOH members.

Accountability and Transparency

·        Accountability to stakeholders:

       Citizens

       Province

       Council

       OPH staff

·        Autonomy of Medical Officer of Health, and Board of Health

·        Ethics

·        Independent voice (free from conflict of interest)

·        “The MOH should report directly to the Board of Health and have the independence to be fully accountable for fulfilling the legislative requirements of the HPPA and its regulations.” (Capacity Review Committee Report)

·        “Public health staff and programs must be accountable via the health unit leadership to the Board of Health.” (Capacity Review Committee Report)

·        Adhere to provincial requirements (Health Protection and Promotion Act)

·        Fiscal accountability

·        Established process for regular reports to City Council

·        City of Ottawa’s Transparency and Accountability policy followed

·        Established code of conduct and conflict of interest policy

·        Selection and replacement practices for BOH members: transparent, non-partisan, involving external expert advice

·        Nominating committee responsible for board member selection

·        Formal process for application to the board

·        Clearly defined board member roles and responsibilities

·        Established policy and procedures for performance measurement

·        Established protocols for meetings

·        Public encouraged to attend & participate

Legitimacy and Voice

·        Public participation

·        Atmosphere of openness and trust

·        Effective team dynamics

 

·        Number of board members (8-13 members)

·        Composition of the board (at least 50% citizen representation)

·        Established rules of engagement for board meetings

·        Effective leadership from the chair

·        Meetings well attended, with a high level of participation

·        Board members have passion for public health and able to advocate on behalf of public health

·        Public encouraged to attend & participate

Direction

·        Strategic plan

·        Long-term vision

·        Visual identity

·        Established strategic planning process

·        Identified short and long term budget needs

·        Monitor progress of strategic plan

·        Meetings focused on strategic, substantive issues

·        Conduct environmental scan (keep abreast of federal, provincial and local trends)

·        Board members have passion for public health and able to advocate on behalf of public health


Key Principles

Application

Fairness

·        Equity

·        Inclusiveness

·        Respect

·        Ethics

·        Accessibility

·        Composition of the board with representation of:

       Genders

       Geographic areas of the City

       Official languages

       Cultures

·        Ensure ease/access to participation for all

 

 

Bibliography

Agency Implementation Task Force. 2006. From Vision to Action: A Plan for the Ontario Agency for Health Protection and Promotion. The Final Report of the Agency Implementation Task Force. Available at: http://www.health.gov.on.ca/english/public/pub/ministry_reports/agency_06/agency_06.pdf Accessed August 7, 2008.

 

Association of Local Public Health Agencies. 2007. Orientation Manual for Board of Health Members. Toronto: Association of Local Public Health Agencies. pp.77.

 

Bugg G, Dallhoff S, Speevak-Sladowski P. 2006. National Study of Board Governance Practices in the Non-profit and Voluntary Sector in Canada: Strategic Leverage Partners Inc. & Centre for Voluntary Research and Development. pp.106.

 

Canadian Association of Police Boards. 2005 Best Practices - A Framework for Professionalism and Success. Available at: http://www.jibc.ca/police/publications/police_boards/bestpractices_governance.pdf Accessed August 7, 2008.

 

Canadian Medical Association. 2008. A Balanced Blueprint for the Future. Available at: http://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Advocacy/governance_review/CMA_Balance_FINAL_WEB_Engl.pdf Accessed on August 7, 2008.

 

City of Ottawa. Accountability and Transparency Policy. 2007. City of Ottawa. Available at: http://ottawa.ca/city_hall/policies/accountability_en.html Accessed June 27, 2008.

 

City of Ottawa. 2006. Appointment Policy (Advisory Committees, Boards, Task Forces and External Agencies, Boards and Commissions) City of Ottawa. Available at: http://ottawa.ca/calendar/ottawa/citycouncil/occ/2006/12-06/Doc%203%20-%20Appointment%20Policy%20November%20222006%20version.htm Accessed August 7, 2008.

 

City of Ottawa. 2008. Governance Committee Report: Ottawa Public Library Board; pp 10.

 

City of Ottawa, Office of the Auditor General. 2005. Governance Audit of the Ottawa Police Services Board: Final report. 

 

Dunkley G. 2007 Public Health Governance in the City of Ottawa: A Review of Current Context and Options. Ottawa. pp.16.

 

Edgar L, Marshall C, and Bassett M. 2006. Partnerships: Putting Good Governance Principles in Practice. Institute On Governance. Available at: http://www.iog.ca/publications/2006_partnerships.pdf. Accessed on Aug 5 2008.

 

Ministry of Health and Long Term Care, Ontario. 2006. Revitalizing Ontario's Public Health Capacity, Final report of the Capacity Review Committee Available at: http://www.health.gov.on.ca/english/public/pub/ministry_reports/capacity_review06/capacity_review06.pdf Accessed July 23, 2008.

 

Nova Scotia Executive Council Office. 2008. Board Selection Criteria:  Capital District Health Authority.  Available at: http://www.gov.ns.ca/exec_council/pdf/non-adjudicative/DHA9-Capital.pdf Accessed on July 23, 2008.

 

Prybil, L et al. 2008. Governance in Nonprofit Community Health Systems : An initial report on CEO perspectives. Grant Thornton LLP, Chicago, USA.  Available at: http://www.public-health.uiowa.edu/news/pdf/021508-release.pdf Accessed on July 22, 2008.

 

Scott GWS. 2004.  Assessors Report on the Muskoka-Parry Sound Health Unit. Available at: http://www.health.gov.on.ca/english/public/pub/ministry_reports/assessorrep04/assessor_report04.pdf Accessed July 14, 2008.

 

State Government of Victoria, Australia. 2008. Appointments to Health Practitioner Registration Boards:  Statement Addressing Key Selection Criteria.  Available at: http://www.health.vic.gov.au/pracreg/pdf/board/board-ksc.doc  Accessed July 23, 2008.

 

The Honourable Mr. Justice Archie Campbell. The SARS Commission, second interim report: SARS and Public Health Legislation 2005. Volume 5. Available at: http://www.sarscommission.ca/report/v5.html. Accessed on July 14, 2008.

 

United Nations Development Program (UNDP). 1997. Good Governance and Sustainable Development. Available at: http://www.pogar.org/publications/other/undp/governance/undppolicydoc97-e.pdf. Accessed on July 23, 2008.


 

Document 4

 

Model Proposed May 15

Proposed Model After Consultations

That the Community and Protective Services Committee direct staff:

1. To consult with the public, as described in this report, on an independent Board of Health Governance model with the following features:

That the Community and Protective Services Committee recommend that Council:

1.  Approve, in principle, an independent Board of Health governance model with features similar to Toronto’s current model (authorized by Section 405 of the City of Toronto Act) as described below:

a) A Board of Health comprised of thirteen members:  six City councillors and six citizen representatives and one school board representative all appointed by City Council;

a) A Board of Health comprised of nine members appointed by the City four councillors and five citizen representatives;

b) City Council appoints the Medical Officer of Health and the Associate Medical Officers of Health to the Board who are employees of the Board of Health;

b) The Board of Health appoints the Medical Officer of Health and the Associate Medical Officers of Health who are employees of the Board of Health;

c) The Medical Officer of Health reports directly to the Board of Health;

c) The Medical Officer of Health reports directly to the Board of Health;

d) The City of Ottawa provides to the Board, public health unit employees, who shall remain City of Ottawa employees, through service agreements with the Board of Health

d) The City of Ottawa provides to the Board, public health unit employees, who shall remain City of Ottawa employees;

e) The Board of Health makes recommendations to City Council on any issues within City Council’s jurisdiction that involve public health considerations (e.g., non-smoking by-laws); and

e) The Board of Health makes recommendations to City Council on any issues within City Council’s jurisdiction that involve public health considerations (e.g., non-smoking by-laws); and;

f) The Board of Health shall report annually to City Council on its operations.

f) The Board of Health shall report annually to City Council on its operations.

2. To report back to Community and Protective Services Committee and Council with the recommended model to be referred to the mid-term governance review.

2. Refer the recommended model to the mid-term governance review for consideration as part of that review process.

 

3. Direct the City Solicitor to prepare an application to the province for special legislation amending the City of Ottawa Act to authorize the City to implement a governance model in keeping with the final model approved by Council.

 


Document 5

Ottawa Police Services Board and Ottawa Public Library Board Comparators

 

 

Legislation

Board Membership / Composition

Autonomous

Funding Formula

Council Approval

Board FTEs & Budget

Chief  / CEO

 

Ottawa Public Library Board

Public Libraries Act, 1990

Mixed-Membership 14 members in total

(14 appointed by City Council)

·         6 City Councillors

·         8 members of the public

Yes

·         Board is autonomous from Council

·         Staff of the Library are not City Staff

·         Board is accountable to the Ontario Minister of Culture

80 % of funding for the Ottawa Public Library is from City of Ottawa ($26m)

Yes - Council

approves OPL’s annual budget requirements and its annual audited financial statements

 

$28k with 0 FTE

(However, support provided by the office of the Chief Librarian)

A board shall appoint a chief executive officer (CEO) who shall have general supervision over and direction of the operations of the public library and its staff, shall attend all board meetings and shall have the other powers and duties that the board assigns to him or her from time to time. R.S.O. 1990, c. P.44, s. 15 (2). 

·         In Ottawa the Chief Librarian is also the CEO of the OPL

 

Ottawa Police Services Board

Police Services Act of Ontario, 1990

Mixed-Membership of 7 members in total *

·         3 City Councillors & 1 member of the public (not an employee of the municipality) appointed by Council 

·         3 members of the public * appointed by the Lieutenant Governor in Council

Yes

·         Board is autonomous from Council

·         Staff of the Police are not City Staff

·         Board is accountable to the Solicitor General of Ontario

 

100% of funding for the Ottawa Police Service is from the City of Ottawa

Yes - Council

approves overall OPS budget requirements, but cannot approve or disapprove of specific items

$665k includes 2 FTEs of the Board

·         Executive Director

·         Admin. Assistant

The chief of police reports to the board and shall obey its lawful orders and directions. R.S.O. 1990, c. P.15, s. 41 (2).

 


OTTAWA BOARD OF HEALTH – GOVERNANCE

CONSEIL DE LA SANTÉ D’OTTAWA - GESTION PUBLIQUE

ACS2008-CPS-OPH-0010                                 CITY WIDE / À L'ÉCHELLE DE LA VILLE

 

Councillor Chiarelli advised the Committee that he would propose a motion and requested that the committee put it on the top of the list.  The intent if the motion is to change the composition of the existing board of health to majority of 5 council members and 4 appointed citizen members for the first round of the board.

 

Dr. Isra Levy, Medical Officer of Health, gave a brief introduction to his report and thanked the Councillors and the Advisory Committees for their input and comments leading up to this report.  As well he stated that much work had been done on this project by staff and his predecessor before he became the Medical Officer of Health.  Dr. Levy gave a PowerPoint presentation on the report, which is held on file with the City Clerk’s office.

 

Councillor Leadman inquired on the structure of the board and if there had been any input or direction to get some kind of youth representation or a group that represent youth.  It is not mentioned anywhere.

 

Dr. Levy responded by saying that there were a number of comments in the consultation process regarding different stakeholder groups.  The idea was to limit that source of representation and look for individuals to fit a job description as a member of board of health.  There would not be representation for a specific stakeholder or interest group.

 

Councillor Leadman was concerned that a segment of society, youth, would not be represented.

 

Dr. Levy said that children and youth are a critically important segment of the population and would form an important element of the Board’s work.  The life cycle approach to programming would recognize that and it would recognize other segments of the population such as the aged and other cultural groups. 

 

There was thought of having a school board representative but ultimately the overwhelming opinion was that it would be difficult to find a single representative from a single constituency such a children that would carry the burden of bringing this forward but perhaps most importantly there would have been one stakeholder for a group ahead of many others with just as much importance.

 

Councillor Leadman asked if there would be an opportunity to change the make up of the board in the future.

 

Dr. Levy stated that the implementation details have not been laid out yet such as the precise skills and criteria of a board member as well as the appointment of the board members themselves.  There will be an opportunity in the future to make amendments and there would be an evaluation component on the effectiveness of the Board and its make up.

 

Councillor Qadri commented that Dr. Levy had mentioned 4 or 5 community members.  He noted that they would probably be individuals involved in health related matters. He wanted to know who is to decide on the qualification of those members.

 

Chair Deans advised that there would be a motion coming forward from Councillor Feltmate proposing that that City Council appoint the first board and subsequent boards would be appointed by the Board of health.

 

The Committee then heard from the following delegation:

 

Sally Rutherford, Health and Social Services Advisory Committee, stated the HSSAC are relatively new members and met for the first time in earlier May this year. She said that Dr. Levy was one of their first guests and he explained the system and the process underway for the new Board of Health. There are 14 members on the advisory committee and their comments are reflected in the report and their minutes as well as the memorandum circulated.  A copy of the memorandum is held on file with the City Clerk. At the meeting of September 16, the Health and Social Service Advisory Committee reviewed the report of the Community and Protective Services Committee and Council concerning the Ottawa Board of Health Governance Plan.  The committee strongly and unanimously supports the general model of an independent Board of Health and the proposed structure.  They agree that City Council appoints the initial board and that the Board of Health makes subsequent appointments.  She said that HSSAC believes it has an important role to play in the establishment of the new Board of Health and would like to continue to be engaged in its ongoing development.  They really believe as well that the Board of Health have autonomy similar to that of the Police Services Board.  HSSAC was very clear that there needs to be a very thoughtful list of qualifications; essentially, a job description, for board members, and that the qualifications be at a fairly high level, so that we have people who know what they are dealing with and do so in an appropriate way.

 

Chair Deans wanted to follow up on one issue that was raised dealing with the number of seats on the board. HSSAC has suggested that they preferred 11, as opposed to the 9 members that had been recommended.

 

Ms. Sutherland responded by stating that they believe the workload is going to be considerable, and we know how hard Councillors work; the amount of time that is considered from a City Councillor is enormous, and they wanted to spread the workload amongst Councillors, and amongst the citizen representatives. 

 

Chair Deans asked Dr. Levy if he had any objection to making the number of members 11.  Dr. Levy responded saying he had no objections.

 

Councillor Holmes asks if Councillor Chiarelli could amend his motion so that the number of members is raised from 9 to 11.  There is agreement.

 

Councillor Holmes inquired if the citizen members would be experienced in public health matters.  This was a recommendation by HSSAC as well.

 

Dr. Levy responded by saying that there was strong opinion expressed during the consultations, that there should at least be individuals who can bring to bear on the debate significant background and expertise.

 

Councillor Holmes commented that part of her voting for this report is that we will move to a more specialized kind of board.  For example a Board that will have a doctor from a community health centre; someone teaching nursing at U of O; people who know something about public health. She will make a motion to that effect.  She asked if Dr. Levy would be comfortable with that motion.

 

Dr. Levy stated that he does not want to inadvertently create or have created a box that I think the consultations wanted, he wants to see a higher level of expertise brought to bear on the discussions and the debate, than might exist without some individuals with a background or an expertise. However, he also thinks that by moving in the direction where you contain every member of the BOH in terms of their background and educational or professional background, specifically to the health field, you might be losing some of the other sectoral expertise.

 

Councillor Holmes if he would be more comfortable if the motion stated a majority.  Dr. Levy responded in the affirmative.

 

Councillor Feltmate asked how the process of a board works; Council sets up a BOH and they hire the Dr. Levy and the associate, but staff are from the City? As well, how is the budget managed or purchasing services? Who does staff report to?

 

Dr. Levy responded by stating that the original proposal said there would be a service agreement between the BOH and the City.  However, what was learned within the Toronto context, is there is no need for a service agreement, there is, it’s easily incorporated into the hybrid integrated model that with minimal disruption which is the kind of disruption we may have if we try and take the staff outside of the existing City structure. The Medical Officer of Health is essentially the CEO of the organization, and interacts with the BOH. As the CEO he is responsible for, and accountable for, the direction of all staff resources. The staff of Ottawa Public Health, while administratively structured within the City, would be functionally and professionally accountable, as they are today, through management layers, to the CEO of the organization, which is the Medical Officer of Health (MOH).

 

Councillor Feltmate understands that staff report to the MOH and the MOH to the Board. As for the funding that comes from the Province, the 75%, and the other 25% that comes from Council, that funding would go to the Board of Health (BOH), to be managed, and is done internally or through the City?

 

Dr. Levy stated that the funding would flow to the BOH, and the BOH may choose to use an alternative financial service management structure to the City’s, but that is not what’s envisaged; what’s envisaged is that there is economy of scales that would be realized, and that’s part of the reason for leaving staff integrated within the City. Technically, it would be possible for a board to instruct the MOH to find alternative ways of managing the budget, but ultimately, with the proposal as suggested, the budget envelope would still be presented to Council for approval.

 

Chair Deans stated that the Committee would now move to the motions starting with Councillor Chiarelli’s.

 

Councillor Chiarelli said that he has listened to the arguments over the past year and heard now from two consecutive MOHs that one of the things they would like to see most improved is the attention span of the BOH between major issues. That on the smaller day to day, week to week issues, or smaller in terms of public attention, that they would have the focus of the board a little better than they do with Council. He appreciates that argument, and he thinks everyone would admit that Council does not give as much time to its role as a BOH, in the sort of non-crisis periods that you might expect.

Having said that, there is a reason for the current system’s design, being that in public health, there are often issues that have direct impact on the community, where the public expects that the people making those decisions will be accountable and representative and that they will be able to get in contact with them, and ultimately hold them accountable for any decisions that they happen to reach. As a sort of compromise, he is moving this motion, to allow for the independent board that will be able to devote more time to the minor issues but still will retain control or oversight by people who are elected, or who can be held accountable by the communities who will be affected by their decisions. He believes this is a good compromise because it allows the focus that you want on the day-today, week-to-week issues, and at the same time maintains that level of accountability that people expect, and they are the people paying the bills.

 

Councillor Holmes was concerned that the discussion would concentrate on dirty needles since it is only a small percentage of the responsibility of the public health department, compared to communicable diseases, sexual health, all the other health matters that the health department deals with, that are much more important than dirty needles.

 

Councillor Chiarelli on a point of order stated he never mentioned dirty needles but safe injection sites.

 

Councillor Holmes commented that the reason that she likes this report so much is because there are more City representatives, public representatives, than Councillors. People who will have the public health of the citizens as a top priority. The spread of disease will be a top priority for this new board. Councillors are busy with Ottawa Community Housing, Library Board, and there are more public representatives there and that is good since Councillors cannot get to every meeting that is held. She is very pleased that more public representatives will be sitting on this board and I want them to be more knowledgeable about health.  She wants to see the majority of the BOH be people who are really knowledgeable in this field.

 

Chair Deans said that she had a few points to make. One is, Justice Campbell and his post-SARS review suggested that it be 50/50 representation on the board be elected representatives and members of the public and what was recommended was tipping the balance in favour of one community representative and Councillor Chiarelli’s motion tips the balance in the other direction. Councillor Feltmate has a follow-up motion suggesting that we review that after one term; and at the same time, we allow the BOH to pick future members.


She believes this is reasonable, in terms of a transition that we would start having the balance slightly tipped in favour of City Council, we have a chance to review it, see how it works, then in the future tip the balance slightly the other way after there’s a review. She personally thinks this is a fairly good solution. She will support both motions.

 

Councillor Chiarelli stated that Councillor Holmes is correct on the assertion that the majority of citizen members should come from the health field, however he also sees value in the remaining citizen appointees possessing other skills, such as communications, maybe teachers. He believes his motion is as good a compromise as you will get. He urges members of committee to vote for it.

 

Moved by Councillor Feltmate

 

That after the first term appointments of the Board of Health are made by Council that subsequent citizen board members be recruited and be appointed by the Board of Health, similarly to OCH;

 

And furthermore that the composition of the Board be reviewed at the time to ensure that necessary skills and abilities are reflected.

 

                                                                                                            CARRIED

(Dissent: Councillor Chiarelli)

 

Moved by Councillor Chiarelli

 

Be It Resolved that the recommended composition of the proposed independent Board of Health be 6 council members and 5 members of the public appointed by Council.

                                                                                                            CARRIED

 

YEAS (7):  A. Cullen, R. Chiarelli, M. Bellemare, P. Feltmate, C. Leadman, S. Qadri,    D. Deans

NAYS (2): G. Bédard, D. Holmes

 

Moved by Councillor Holmes

 

That the majority of the Board of Health citizen representatives be from the Board Health constituency and knowledge.

                                                                                                            CARRIED

That the Community and Protective Services Committee recommend that Council:

 

1.         Approve, in principle, an independent Board of Health governance model with features similar to Toronto’s current model (authorized by Section 405 of the City of Toronto Act) as described below:

a)                  A Board of Health comprised of eleven members appointed by the City, six councillors and five citizen representatives;

b)                  The Board of Health appoints the Medical Officer of Health and the Associate Medical Officers of Health who are employees of the Board of Health;

c)                  The Medical Officer of Health reports directly to the Board of Health;

d)                  The City of Ottawa provides to the Board, public health unit employees, who shall remain City of Ottawa employees;

e)                  The Board of Health makes recommendations to City Council on any issues within City Council’s jurisdiction that involve public health considerations (e.g., non-smoking by-laws); and;

f)                   The Board of Health reports annually to City Council on its operations.

 

2.         Refer the recommended model to the mid-term governance review for consideration as part of that review process.

 

3.         Direct the City Solicitor to prepare an application to the province for special legislation amending the City of Ottawa Act to authorize the City to implement a governance model in keeping with the final model approved by Council.

 

4.         Approve that after the first term appointments of the Board of Health are made by Council that subsequent citizen board members be recruited and be appointed by the Board of Health, similarly to OCH and that the composition of the Board be reviewed at the time to ensure that necessary skills and abilities are reflected;

 

5.         Approve that the majority of the Board of Health citizen representatives be from the Board Health constituency and knowledge.

 

                                                                                                CARRIED as amended