Presentation on theme: "Changing Landscape of Public Health in Ontario"— Presentation transcript:
1Changing Landscape of Public Health in Ontario Dr. George PasutChief Medical Officer of Health (A)May 14, 2007
2CMOH Update Provide an update on the following items: Ministry Organization and RestructuringCMOH Recruitment ProcessCreation of Ontario Agency for Health Protection & PromotionThe Health Protection and Promotion Act (HPPA) AmendmentsThe Capacity Review Committee (CRC)Public Health Human Resources InitiativePublic Health Network (PHN) – FPTPublic Health Program Standards
4MOHLTC Restructuring Local Health Integration Networks (LHINs) In March 2006, the government passed the Local Health Integration Act, 2006.The legislation gives the LHINs the power to plan health care services in each communityFuture Role of the MOHLTC will be as “Stewards of the Health Care System“Strengthen accountability frameworks and mechanismsEstablish strategic directions and provincial priorities for the health systemDevelop legislation, regulations, standards, policies and directivesMonitor and report on the performance of the health care systemPlan and establish funding models and levels of funding for the health system
5MOHLTC Strategic Directions VISION“A health care system that helps people stay healthy, delivers good care when they need it, and will be there for their children and grandchildren.”STRATEGIC DIRECTIONSMOHLTC has adopted the following strategic directions:Renewed community engagement and partnerships in and about the health care system;Improve the health status of Ontarians;Ontarians will have equitable access to the care and services they need no matter where they live or their socio/cultural/economic status;Improve the quality of health outcomes; andEstablish a framework for sustainability of the health care system that achieves the best results for consumers and the community.In Spring 2007, MOHLTC will be releasing a 10-year Health Strategy Plan.
8Mandate of Public Health In 2002, the F/P/T Advisory Committee on Population Health defined five core functions for public health in Canada:Population Health Assessment;Health Surveillance;Health Promotion;Disease and Injury Prevention; andHealth Protection.Discussion has occurred as to whether emergency response and preparedness as well as population health advocacy should be added to the core functions for public health.
9CMOH Recruitment Process Dr. Basrur resigned for health reasons in the fall of 2006.Appointed as Acting Chief Medical Officer of Health on December 13, 2006Ruth Hawkins appointed Acting Assistant Deputy Minister (ADM), Public Health Division.There is currently a recruitment team composed of an all-party Legislative Committee with support from the Deputy Minister of the Ministry of Health and Long-Term Care and the Deputy of Health Promotion.Application period closes today!
10Health System Improvements Act (Bill 171) December 12, 2006 the Health System Improvements Act (Bill 171) was introduced in the House. Bill 171 includes the Ontario Agency for Health Protection and Promotion Act.HSIBReceived Second Reading on March 20-26, 2007.Went to the Standing Committee on Social Policy April 23-24, 2007.Received Clause-by-Clause Reading on May 7, 8 and 14Third Reading May 31Awaiting Royal Assent and Proclamation of components (different timing)
11Health Protection and Promotion Act (HPPA) Amendments Emergency powers when there is an immediate and serious, or immediate risk to the health of persons anywhere in Ontario (e.g., directives re: precautions and procedures; supply chain powers).Strengthening, streamlining and clarifying the control and management of infectious diseases (e.g., providing MOH powers to issue orders re: outbreak of communicable diseases in hospitals or institutions).Strengthening public health service delivery (e.g., streamlining lab results reporting, enabling nurse practitioners to work with their full scope of practice).
12Capacity Review Committee Final CRC report, Revitalizing Ontario’s Public Health Capacity, received May 2006Comprehensive government response in development50 recommendations in 7 key areas on how to improve the function and configuration of the Public Health system:Ensuring quality governanceBuilding stronger public health unitsRevitalizing the public health work forceStable and predictable fundingDemonstrating accountability and measuring performanceResearch and knowledge exchangeStrategic partnershipsReport calls for major transformation of governance and configuration of public health units; these issues are under review by government and require policy approval.Government is interested in engaging stakeholders to discuss feasibility of other recommendations that do not require government approval to proceed:e.g. development of mutual aid agreements, enhancement of strategic partnerships with LHINs and Primary Care and facilitation of one time salary strategy development.Some recommendations are dependent upon creation of Agency for Health Protection and Promotion:e.g. development of province-wide public health research and knowledge exchange agenda.Report is being carefully reviewed by government and a response can be expected in a couple of months.We look forward to receiving comments and feedback on the report recommendations from this conference.
13Public Health Human Resources Initiatives Consistent with the recently announced HealthForceOntario Strategy, PHD is working with the Health Human Resources Strategy Division on the following areas:A Health Human Resources marketing and recruitment centre, including a comprehensive websiteOpportunities to increase enrolment in public health programs e.g., five new Physician Re-Entry program positions created for 2007 for physicians interested in pursuing community medicine or master’s in public health (MPH) or equivalent)PHD supports Medical Officer of Health in Training Bursary Program for physicians currently working in public health to pursue master’s educationThe province-wide job registry and vacancy portal is an example of information sharing through the health work force website.Particular attention is being made to help increase enrollment in northern and rural public health programs.
14Origins of the Public Health Network (PHN) HistoryRecommended by the F/P/T Special Task Force on Public Health (Partners in Public Health Report)A commitment by First Ministers in the 10-Year Plan to Strengthen Health CarePublicly announced & launched by F/P/T Ministers of Health on April 22, 2005Fulfills a critical gap identified in the Naylor ReportFirst Council Meeting – June 6 -7, 2005
15Origins of the Public Health Network (PHN) Early PHAC Activities to Support Network Start-UpJune 2005 – brainstorming between Healthy Living and the CCDPC on the emerging network and what the issue groups might be for the new Health Promotion and Non-Communicable Disease and Injury Prevention and Control Expert Groups.Environmental scan on various issue areas to help us better understand the work being done
16Mandate The Public Health Network will: Support the public health challenges jurisdictions face during emergenciesCollaborate on day-to-day operations of public healthProvide advice and regular reporting to CDMH on public health matters and the activities of the NetworkFacilitate information sharing among all jurisdictions and disseminate information regarding best practices in public healthRespect jurisdictional responsibilities in public healthBe accountable to the CDMHLaunched April 22, 2005, the Network will function as a mechanism for intergovernmental collaboration and coordination on public health issues.The mandate for the Network is two-fold: first, to promote and facilitate F/P/T collaboration on public health issues when needed, and second, to respond to direction from the Conference of Deputy Ministers of Health on any public health matter.The Public Health Network will allow all governments to work together in public health –resulting in the best use of resources and enhanced responsiveness for Canadians.
17Conference of F/P/T Deputy Ministers of Health Network StructureExpert Groups(permanent expertise)Communicable Disease ControlIssue GroupsEmergency Preparedness & ResponseCanadian Public Health LaboratoryReporting through respective Expert Groups on key issuesConference of F/P/T Deputy Ministers of HealthCouncilF/P/T membersPublic Health Surveillance & InformationIs accountable toChronic Disease & Injury Prevention & ControlFunctionally, the Network, through the Council, gets its mandate from and is accountable to the Conference of F/P/T Deputy Ministers of Health. It will report on an annual, and on as needed basis during public health emergencies. The Council provides leadership and oversees the day-to-day business of the Network.The vast majority of the work of the Network will be executed through a series of Expert Groups and Issue Groups on various public health topics. The Task Force has recommended six initial Expert Groups.Three of these Expert Groups (e.g. Lab Network and EPR and to a lesser extent, Communicable Disease) already exist and will be integrated into the Network, building on existing expertise and collaborative efforts that are working well.Population Health PromotionCCMOHTask Groups(time limited)Public Health Human Resources Task GroupTask Groups
18Revised Structure of the Pan-Canadian Public Health Network as of August 2006
19Environmental Health Branch Director of Environmental Health position – recently created.New Director (Brenda Mitchell) - began Jan 2007.Environmental Health BranchFormally created in Feb 2007.To provide strategic and policy leadership for environmental issues with human health impact.Mandate includes:Public health policy re: air quality, drinking water, adaptation to climate change.Enhance capacity of medical officers of heath to respond to environmental hazards.Support implementation of mandatory programs (food, water, health hazards).Coordinate with federal, provincial and municipal agencies / governments.
20Ontario Public Health Standards Presentation to Ontario Society of Nutrition Professionals in Public HealthDr. George PasutJune 1, 2007
21PurposeOn Monday, April 30, 2007, the Program Standards Technical Review Committee (TRC) submitted its final draft of the proposed Ontario Public Health Standards (OPHS), to the Acting Chief Medical Officer of Health.The purpose of the following presentation is to:Provide an overview of the process to develop the proposed standardsHighlight proposed scope for Infectious Diseases standards
23Review Process Overview MinistersActing CMOHInter-Ministry Committee(15 members)Technical Review CommitteeProgram Standards Development TeamsExpert AdviceReportAdviseTechnical SupportProposed Standards
24Review Process Overview – Key Components TECHNICAL REVIEW COMMITTEE (TRC)Established to guide the development of renewed standards for public health (term: September April 2007)Co-chaired by Dr. George Pasut and Dr. Bob Nosal (Medical Officer of Health for Halton Region)- following Dr. Pasut’s appointment as Acting Chief Medical Officer of Health, Ms. Monika Turner (Director, Public Health Standards Branch, MOHLTC) served as co-chairComprised of 21 additional members from public health units, academia, the Association of Municipalities of Ontario and government (MOHLTC, MHP and MCYS)PROGRAM STANDARDS DEVELOPMENT TEAMS (PSDT)10 PSDTs established in late October 2006 to develop initial drafts of standards for consideration by the TRC (IDPC, VPD, SH/STI, TB and 3 for EH)The PSDTs were comprised of representatives from local boards of health and government (Public Health Division and Ministries of Health Promotion and Children and Youth Services).
25Consultation Activities 8 Workshops in Summer and Fall with public health unit staff (~15-20 health units per workshop) to discuss challenges and opportunities for renewalEnvironmental Health workshop (June 20)Extensive consultation on first draft of Standards (February 19 – March 9, 2007)141 stakeholders (public health units, health and social organizations, education and Aboriginal organizations) invited to complete an electronic survey (E-survey) on draft Standards9 MOHLTC divisions and 15 Ministries invited to complete policy questions (alignment of Standards with legislation/regulations/policies, suggestions for revisions and identification of implementation challenges)
26Communication Activities TRC Field Communiqués (8) sent to MOHs and other stakeholdersWebinar with all 36 public health units to provide background on the review process and the E-surveyInformation Notice on Environmental Bill of Rights regarding the review processMeeting with key public health stakeholder associationsPosting on MOHLTC & PH e-Portal websites (Terms of Reference, membership, communiqués, E-survey summary)
27Submission and Approval Timelines APRIL 30Submission of Standards to A/CMOHMAYMHP, MCYS & MOHLTC ReviewTBCMinisters’ ApprovalTBCRelease of StandardsImplementationDevelopment of Protocols*Development of Implementation Resource ManualDevelopment of roll-out strategyDevelopment of performance management framework* Protocols would be developed based on current scientific evidence, and would likely entail consultation with boards of health and would seek input from key stakeholders, including ASPHIO
29Key Approach and Directions The approach for developing the proposed public health standards included:Moving towards standards that are measurable and linked with specific performance measures for increased accountabilityIntegrating the standards into an overall performance management framework for public healthIncorporating technical revisions to reflect new science, evidence and best practices in public healthBalancing the need for provincial standardization of a number of program functions with the need to offer local flexibilityEstablishing ongoing review, enhancement and support processes so that the standards are continually evolving
31Proposed Structure and Format The Ontario Public Health Standards are organized as follows:Introductory Section – which outlines the purpose, scope and accountability, statutory basis and format for the proposed standardsFoundations:Principles – which encompass Need, Impact, Capacity as well as Partnership and CollaborationFoundational Standard – which addresses population health assessment, surveillance, research and knowledge exchange and program evaluation; andThirteen Program Standards – which address Chronic Diseases and Injuries, Family Health, Infectious Diseases, Environmental Health and Emergency Preparedness.
32Proposed Structure and Format (cont’d) The proposed standards have adopted the following format for each of the programs:Goal – a statement that reflects the broadest level of results to be achieved in a specific standard. The work of boards of health, in addition to community partners, non-governmental organizations and governmental bodies, contribute to the achievement of the goalEffects – the changes in health status, organizations, systems, norms, policies, environments and practices. The effects result from the outcomes and include the contributions made by public health and many organizations to the overall health of the population. Boards of health shall not be held directly accountable for effectsOutcomes – the immediate results of activities or requirements that often focus on changes in awareness, knowledge, attitudes, skills, practices, environments and policies. Boards of health shall direct their efforts towards, and be held accountable for, outcomesRequirements – the specific statements of action
33Proposed Structure and Format (cont’d) Further, the requirements have been organized into four groupings based on key public health functions:Surveillance and Assessment – use of surveillance, epidemiological analysis and surveillance data for program planning and implementation;Health Promotion and Policy Development – work with community partners to influence the development and implementation of healthy public policies, create/enhance supportive environments and increase awareness;Disease Prevention – management and provision of services including preventive measures, reporting and responding to diseases; andHealth Protection – including enforcement of applicable legislation, regulations and inspection.In addition, many of the requirements will be accompanied by protocols to further articulate the “how” of the standards – and thus, will be quite specificThe TRC has recommended the review of existing protocols as well as the development of new protocols
34Ministry/Board of Health Accountability Framework for Mandatory Public Health Programs Mandatory Health Programs & Services Guidelines (1997)Planning &EvaluationSettingExpectationsMonitoring PerformanceAssessmentEnforcementHealth Protection & Promotion ActEducation & Consultation
35Performance Management Build a performance management framework that:Links standards with specific performance measures to meet multiple information needs,Allows for continuous quality improvement, andCaptures and reports on Board of Health performance and that of the overall public health system.Public Health Performance Management FrameworkSource: Final CRC Report, May 2006
36Silos to Systems: U.S. Public Health Foundation’s Turning Point Performance Management Framework
37From Compliance to Performance… 19972007Compliance MeasurementDid we do what wesaid we would do?Performance MeasurementDid the program have theimpact we expected?Understanding the Performance Culture Shift:Measuring performance is about using data/information for assessing the gap between ministry expectations and Board of Health achievement and then identifying and implementing strategies for improvementKey difference is a subtle shift FROM measuring what we said we would do TO measuring outcomes--are we having the impact we want? And, if not, what do we need to do differently?