The merger of health units in Ontario is not a provincial cost-saving exercise that will result in the loss of front-line jobs, reductions in public health services, or additional costs for municipalities.
That was the word from provincial health officials at a meeting on Thursday (February 15) of the board of health for the Haliburton Kawartha Pine Ridge (HKPR) District Health Unit, which is considering a merger with the neighbouring Peterborough Public Health.
Ontario chief medical officer of health Dr. Kieran Moore attended the virtual meeting along with two of his staff — public health division executive lead Elizabeth Walker and accountability and liaison branch director Brent Feeney — to answer questions from board members.
“The merger is a means by which we can enhance your funding, cover costs, and help smaller health units build competencies and capacities that maybe they haven’t had,” Dr. Moore said. “Realistically, this is the only means by which we can help you fiscally.”
While Dr. Moore said he couldn’t reveal the total amount of funding to support health unit mergers, “the amalgamation pool of funding that has been given to us is significant to cover costs.”
The boards of health for the HKPR District Health Unit and Peterborough Public Health announced last November they were moving ahead with a process to explore the impacts of a voluntary merger in the communities they serve.
Peterborough Public Health serves the city and county of Peterborough as well as Curve Lake and Hiawatha First Nations, and the Haliburton, Kawartha, Pine Ridge District Health Unit serves the City of Kawartha Lakes, Northumberland County, and Haliburton County.
In 2019, the two health units first explored opportunities for shared service delivery after the Ontario government announced a budget that included plans to slash the number of public health units in the province from 35 to 10 and cut public health funding by $200 million.
The government put those plans on hold when the COVID-19 pandemic hit in 2020 and, in August last year, announced it was reversing course on the planned reductions, instead offering funding, resources, and supports to health units that voluntarily merged and reinvested any savings from the merger into programs and services.
To explore the feasibility of a merger, the two health units hired Sense and Nous, a Toronto-based consultancy that specializes in the process of amalgamations and mergers.
“The Sense and Nous team has worked with many public health units in a variety of projects,” reads the Sense and Nous website. “A comprehensive feasibility analysis of the health units, including IT, marketing, and governance, can result in a compelling business case for a potential amalgamation, if supported by the analysis. ”
Sense and Nous presented its final report to the health units in early February during in-camera sessions at the respective board of health meetings. The sessions were not open to the public as the report includes legal and human resources considerations.
As part of the process of considering the report, the board of health for the HKPR District Health Unit invited provincial health officials to its February 15 meeting. The board of health for Peterborough Public Health has also invited the officials to attend its next meeting on February 21.
“With respect to mergers, this is not intended to result in a loss of front-line jobs,” said Feeney during the February 15 meeting. “This is not a provincial savings exercise as it was in 2019 so, if there are savings made at the local level, the local health unit can keep those savings and reinvest in enhancing public health services. We don’t expect any reduction in local presence. This is about building capacity across the health units, utilizing savings to advance services, and not see an impact to municipalities in terms of costing.”
Nine health units in Ontario have expressed an interest in merging. The health units have until April 2 to provide the provincial health ministry with proposals for mergers, as part of a business plan with a three-year budget. The ministry will announce decisions about mergers in August and approved health units will merge as of January 1, 2025.
“This funding will require minister approval, and then we will have to do some regulation changes as well,” Feeney said. “So approval of those business cases will occur as soon as possible, and that will include a three-year funding commitment for the merger.”
Board member and Port Hope mayor Olena Hankivsky expressed concerns with the merger timeline, given the health units would only have four months to complete a merger after approval.
“We understand that mergers like this will take a while to work through, so that January date is really to initiate and lock in the process,” Walker said. “There will be some time following that, where a lot of the actions will actually unfold and the work starts to begin.”
“The minister (of health) and others in government are very interested in this process and want to see it succeed,” Dr. Moore added. “If you’re saying the timelines aren’t quick enough for approval, we will relay that information back to them.”
Board member and Kawartha Lakes city councillor Tracy Richardson questioned the benefits of the health units merging, pointing out “we’ve got great leadership structures in place.”
Moore said mergers will allow health units to find efficiencies, such as union negotiations, cybersecurity, and informatics data and analytics.
“You have two very terrific leaders,” Walker added, referring to medical officers of health Dr. Natalie Bocking and Dr. Thomas Piggott. “We’re also looking at opportunities to deepen our public health leadership across the province. So where we have opportunities to not just have (a medical officer of health) in place in an agency, but also an associate (medical officer of health) and physician consultants, so there’s a successor pathway for our public health leadership.”
Another question raised by the board was how mergers would be financed, especially if health units have upfront costs.
“We are asking for a three-year budget,” Feeney said. “We would approve three year, multi-year funding and then do adjustments as we go through the years. It would not be based on a process like we did throughout COVID, which was more of a COVID extraordinary cost reimbursement process.”
“We know that health units are going to need advanced funding approvals in order to move forward with the work. We’ve got a three-year funding commitment here, which in my time is the first of its kind, so we’re going to be able to approve multi-year funding on this, which I think is so important to ensure success of the merger.”
Moore added that a merged health unit could also apply for additional one-time funding, as health units have done in the past.
