Sound check. 1 2 3 Welcome to the board of health for the city of Hamilton. I'm chair of the board of health, city councelor Cameron Crutch, joined today in council chambers by vice chair Neil Joseph, member Ryan Jansen, councilors Casar, Huang Wilson, Alex Wilson that is Member Kirkby and joining me online, member Denko and councelor Nan going to call this meeting to order as we do have a quorum for today's meeting and move to the first item which is approving the agenda. Can I please have a mover and a second to approve today's agenda? See councelor hang seconded by vice chair Joseph. Any amendments from board members to today's agenda? Not seeing any. All is in favor to approve the carried the agendas presented by uh raise of hand. That's everyone that carries. Thanks. On to declarations of interest. Are there any to declare? Not seeing any. Move to item five, which is the approval of the minutes of our previous meeting at the board of health on August 26, 2026. Can I please have a mover and a second to adopt the minutes of the previous meeting? Moved by councelor Hang, seconded by councelor Nan. Any discussion on the minutes from our last meeting? Okay. By show of hands, all those in favor to adopt those minutes. That's everybody and welcome to the meeting. Member Chung. Items for information is item seven. First one is board of health 26029 with the health evaluation and action through long-term trends and high impact modeling and analysis for prevention or health map initiative. Can I have a mover and a second to receive the report? Moved by councelor P. Seconded by councelor Alex Wilson. Is there any discussion on this report from members of the board of health? Member Jansen. Go ahead. >> Quick question. Um uh page 13 of the agenda just says that there will be information brought back year over year. In the second year the refined model will be applied. uh third-year outputs will be embedded. I'm just wondering if it will require a motion for this to come back to board of health annually. Uh that's just something we can verbally agree to. >> Yeah. >> Sorry, could you say that again? You're asking for if what has to come back as a motion. >> Sorry. Updates on the annual uh looks like there's sort of a phase to the this three-year cycle. I'm wondering if annual updates can be brought back if that will require a motion or just conversation. >> Sure. turn to the medical officer of health. >> Good morning. Elizabeth Fruitson, medical officer of health. So when it comes to individual data sources or projects that are being um carried out like this one with health map, we don't tend to bring the individual projects back to the board, we bring them back together through the community health status reporting and so we would see it coming in that way rather than um as a piece on its own. >> Okay, that's helpful. Thank you. >> Thank you. We don't see further questions at this time, so I'll move to the vote to receive this report. All in favor by show of hands. That's everyone. Thank you so much. We're now on to 7.2 Board of Health 26030. Unfortunately, the consultant for this report who was here to ask questions is not here at this moment. So, we're going to defer 7.2 till after 8.1 and hope that they've arrived by then. That doesn't mean you have to ask questions about 7.3 to delay us from getting to 8.1. I'm just letting you know that that's the the plan. Board of Health 26031 is Hamilton's public health budget variance report 2026 Q2. Can I have a mover and second to receive that report? Move by councelor Hang, seconded by councelor Tatison. Any discussion on this one? I'm not seeing discussion on this. So, all those in favor of this budget variance report, by show of hands, please. Thank you. That's everyone. And we're on to eight items for consideration. And there will be probably be some discussion on this. 8.1 Board of Health 26032 Hamilton Public Health 2027 Preliminary Budget. And Dr. Dr. Richardson, the medical officer of health, has a presentation for this item. Can I have a mover in second or two? Uh, we don't need to move in secondary yet. Sorry. We're just going to have um Dr. Richardson do the presentation, then we'll have a mover in secondary after that. Go ahead. Whenever you're ready. Are we waiting for the presentation to load? Okay, we're waiting for the presentation to load. Everyone, just so you know what the pause is. Pauses are fine. Uh but uh it's important to announce why. >> Yes. [clears throat] My apologies, chair. I do this almost every day at work, but of course, now that I'm here at the board, suddenly it's very [clears throat] difficult to do. All right, there we go. >> Great. >> Um, so, oh, and it's my touch pad's quite sensitive. I'll have to adjust for that. So, we thought we would bring you a preliminary budget rather than a budget overview at this point in time. Last year, we bought you the budget in three stages. We did an overview and then we did the preliminary budget and then we did the recommended budget. However, you know, a lot of the reason for the overview was just it was your first time going through a budget and so we had um some additional information for that and um we wanted to also this year get some endorsement of the priorities as we continue to plan as we go forward um to that recommended budget because that's the basis on which we do our uh our planning for the subsequent year. So, we thought we'd bring you a little bit more information. it's certainly not final information and then um bring a recommended budget um in December or January depending on the meeting timings um to uh for consideration of the board. So just going to go through here the budget pro uh process the context for our preliminary budget to date um how we've gone about focusing resources for maximum impact and um a little a few more details within it and then again just look at the budget process. So, um, here we are today at the board of health meeting with this preliminary budget. Throughout the fall, we will continue to refine the budget based on any feedback that we get today and any new information that we get as we go. Um, we do tend to get the allocations for the provincial programs later in the year. So, that's particularly uh something significant that we look forward to. Um most other adjustments that are city- based are now in the budget for us as we plan. So that's a good thing. We will bring back as I said in December or January the recommended budget. It does go to the general issues committee meeting. Right now projected to be in January of 2027 for um part of the city budget process for local boards and agencies. And then in March, of course, it gets submitted to our provincial funders, other funders who are considering it as part of their budget processes. Now, it doesn't want to change slides. There we go. So, um, in terms of context, I don't think I need to tell any of the members here that the world is a pretty dynamic place right now. And um we do have emerging public health issues that continue to arise as well as some pretty significant population health needs. Our mandate as well under the Ontario public health standards is evolving. Um we have I'll just uh remind you the new Ontario public health standards we now have in draft for all of the programs um and standards. Earlier we just still had some gaps. Now, those have been filled, but we don't yet have the word that these are the final standards um or exactly the implementation date. We were told January 1st and now the language has changed to early 2027 and there's still some work to be done with our colleagues at the provincial level getting to understand a little bit more deeply any changes that they that have been put in place. That said, is it a big change in what we see so far? No, it's not. There are some changes like the uh I was going to use the acronym CHIP but it's the comprehensive health pro promotion standard which um the ministry feels is the largest area of change for us um but there are other smaller ones that happen um in different areas of the standards. On top of that, of course, uh economically, we have uh a lot of pressures. Our workforce costs as well, contractual obligations, changes in technology in particular, uh really influence our service delivery and our financial planning. So within that context, we're expected to prioritize and hence why the prioritization process is important for you to look at today. So, as we prepare the budget, just a reminder of the process that we go through as as staff to the board, we go through and look at our 2026 expenditures. And so, you just looked at the um for example, budget variance report that we have to date to June of this year to look at, you know, where are the pressures uh right now? How are things going? And we look at all of our programs and services. Um we go through a process where we say, okay, is there anything more that we need to do in order to meet needs? And so we do continue to see and you'll have seen that in the BER a pressure from the immunization programs terms of the expectations of the province and the expanded vaccination programs that they are um bringing to bear which is a good thing. Um so we look at those pressures. We look at where perhaps you know some other change has happened. another community organization has taken over programming in that area and so there's not as much need for ours or the ministry has changed uh some details on what they're expecting us to do and expecting us to back off from something and so we we go through that process and look at you know where do we need to um to invest a little more in our priorities and where do we think that the we could reallocate some resources in order to do that. Of course uh population health data is key to that whole process. Um our organizational capacity is key to that uh process. You know what skills and competencies do we have in the organization? What do they need to do in terms of of evolving with the times? And of course we go through in the summer right now go through a process where we come to each of you and have a discussion about priorities and what you think about what where they were, what you think about where they um should go as we move forward. And that uh is a very big part of our community input and our board input into those priorities as we move forward um in uh October. And I know we only have a couple of items for that meeting. So we may not have that meeting ultimately, but we will be bringing forward a um something that is a strategic planning approach for our 28 budget development. And so it'll be a more robust um uh process of going through these things and getting full board input into those priorities. Um right now we're working towards that, moving earlier with the inputs and then moving forward with a more systematic uh method of achieving that. So our um three priorities that are recommended are child and youth healthy growth and development, climate related environmental risks, and preventing substance use and related harms. Um since these are the big issues that face our community, you don't see a lot of shift in these year-over-year. However, we do see small tweaks. And so, for example, talking about not just prevention of substance use, but also related harms was a key piece that came up as we were discussing these things that we still um would want to make clear that there's a focus on that as well. So, those are the the key um programmatic ones. And then we do continue to have you know some pieces around how can we make biggest impact inside the organization. So certainly we talked last year about shifting equitydriven um public health and upholding indigenous rights from being a priority unto itself to being spread across all of our programs and services as a foundation. And so that is maintained in um in this year's uh approach. And then again looking at organizational capacity and it served us very well looking at how we sustain that flexible and adaptable workforce that is part of what is allowing us to do as much as we possibly can on the immunization front in response to the community's needs. But because those come and go through the year, all of for example our public health nurses spend time doing immunizations during the year so that they can maintain their competence if we have another significant issue and need to stand up large um clinics. It also gives them some variability in the work which some people like a little better than others. Um but it allows us as well not to just mass reallocate resources as some health units had to do and cut some program programming. we get to maintain more breadth of programming by taking that approach. So we continue to look at sustaining that but also are there other uh parts of our workforce that would um also benefit from such an approach. The other big piece as I mentioned in terms of pressures is service delivery enhancing service delivery through technology. So a significant focus for us as we uh move forward as well and of course doing that in collaboration with other health units that are leaders in this area. In terms of um our budget planning principles, you know, we're here to maintain our core programs and services that we're mandated to do. Looking at alignment though with the priorities, preserving particularly those um programs for priority populations. We do go through CQI processes or continuous quality improvement, look at modernization of things and of course overall responsible resource management and you know today bring forward to you really a maintenance budget that looks at how we can preserve those essential services while doing some um shifts towards those high priority pieces. So overall and we've organized our budget by mandate. I do wonder at some point in the future if we should organize our budget by program area really by you know big areas of impact which you'll see in a moment. Um so at some point love feedback on that but our Ontario public hand health standards which are cost shared make up about $49 million worth of the 2027 budget with about a 2.8% increase overall. You've got the Ontario seniors dental care program. You see a big shift though on that federally funded initiatives line and if you saw that first draft we had a little transposition error in it and so please this is the right set of slides on the revised agenda um where the emergency treatment fund which is a fund from the federal government um that really has drawn our particular applications um have drawn to a close in terms of the programs that they were funding and there aren't really new dollars. We've been successful over a number of years of getting, you know, a couple of million dollars um in total at for funding that particularly was focused on opioids, but that source is now no longer open to us. So that's why you see that big shift there. Proincially funded programs sit at about $10.7 million and municipally funded programs. So those are things like the RCF programs, some out of the cold programs and um some other areas have a small increase there for an overall increase in our expenditures of 7%. From a revenue perspective, um there's that big shift in the uh federal grants that I mentioned. The provincial grants are overall up about $468,000. That includes the 1% funding that you heard announced at AMO by the Minister of Health. And so that's been quickly incorporated into our budgets and um good news. At this point in the year with the budget that we have gathered, we're sitting at about a million dollar increase or $19.5 million in municipal share, which is about a 5.9% increase. and fees and and uh other revenue have gone up by about 81,000 which is um I should mention that our user fees overall what we adapted in uh that case was an increase in user fees of 3 and a half% which is approximately the cost the increase in costs that we're seeing for the the services that are delivered that those fees go to help pay for. So um that's the rate at which we are meant to um recoup uh funding through fees and so that's what's been incorporated into it right now. So overall revenue has gone up slightly but because of the big shift in the federal funding not as quickly as it has um in other areas. I should note that those programs of course also end when those uh when the funding ends. So it's not that the the programming is continuing on, but that those programs come to an end. So our major drive drivers are always employee related costs. And you'll see in the the circle graph that shows you um why that's the case because 81% of our expenditures are uh employees. It's the people who provide the services. In our case, um we do have capital financing included in here. You might remember last year we needed a new air monitor uh which was funded last year through healthy and safe communities capital block. This year we don't have access to a block and so it does show up in our operational budget as capital finding for this second air quality monitor which now needs to be replaced as well. um cost allocations about a $77,000 pressure rent, materials and supplies and then offset of course by some other costs. So some of those contractual services are due to the changes in the federal grants that we're no longer um providing those services for but also looking for other savings as we go through. Here's just where again just looking at our budget. Yes, administration and facilities makes up the largest portion of our cost, but it would be healthy growth and development if we added healthy babies, healthy children into that piece that actually showed up top there. Um, but this goes you shows you where the dollars go. There is a subsequent graph or chart I should say. So, we present it in two ways. So, from an AODA perspective that it's more accessible to uh people who are able to interpret it in different ways. this chart just to say it's not that we're spending the same amount on immunization that we did on um our rent and whatnot. It's just that we continued with the graph over there. So you do have to pay attention to the numbers as we go through. This is that circle chart I've mentioned. So again, our employee related costs make up the greatest share at 81% followed by cost allocations which in essence are often uh employees in other parts of the city uh that we pay for like HR, IT, legal and others. Um and then our buildings and grounds and uh and so on. I skipped one in terms of where the revenues come from. Still the major source is provincial subsidies at 43.9 million or 67% overall. Um municipal share about 30% for both the programs that are directly delivered um on behalf of the municipality as well as shares to other programs that are funded by other funders and then fees and grants and our small amount of federal grants for this year. Don't know why it skips that. There's on the capital side that is the $135 $35,000 for the purchase of a second airpointer that I mentioned earlier is included under capital financing in the operating budget. And just a reminder then about the timetable of where we go from here. Happy to take any questions there might be. >> Thanks very much. Before we turn to questions, I know there was something come up that came up last year about the budget that I wondered if you could clarify for everybody before we get into questions with respect to the authority of the board of health with respect to its budget. So I remember that when we first had training about the subject of the budget, there was discussion especially during the council deliberations for the board of health that sort of council has approval 100% over the budget and we're kind of here in a prefuncter manner. But I don't think that's actually the case. So could you maybe expand on that so we understand what the sort of gravity of the decision- making around this table actually is? >> Absolutely. So um when it comes to the budget, it's a little bit if you it would be pretty much the opposite of what you just said in terms of the role of the board of health and so it is the board's responsibility to approve the budget and then subsequent to that it does go to city council. The the budget as you see here is made up of a number of different components. And so the components that are the mandatory programs, that's the short form we give them. Those are the Ontario public health standards. It's just that they started out called mandatory programs years ago. But in essence, it is the board that determines the budget for those. The province provides a grant to fund a portion of that and then the municipality needs to make up the remainder of it. And so in essence the board is sending that over to say to the municipality you need to fund us this much in order to provide those services for the remainder of the services that don't fall under that. So you'll know that for example in child and adolescent services because of the importance of children's mental health the municipality had decided that they would continue to fund additional service um or to maintain service levels. It wasn't even additional services, but to maintain service levels during times of provincial austerity, they kicked in more money to make up for the um increases in costs that were coming through inflation. And so that's happened for child and adolescent services, for um alcohol, drug and gambling services, for healthy babies, healthy children as well. And so for those ones that are not within the mandatory program scope, it's up to the municipality whether they want to continue to provide extra dollars or if they want to say um no, we'd like you to stick to the money the province gives you. Um and then of course there are those programs that are simply decided by the municipality. So things like the residential care facilities program, that's really up to them to decide if that's something they still want to fund and do. >> Thanks. Since I don't see other people on the list, I'm going to pass the chair to vice chair Joseph and ask a few questions. Um, and I'll come to folks after that. There's three things I think that are missing from this budget that I think are important before we can approve it. I think one thing we talked about in the last year, broadly speaking, was communications and we don't have a comm's plan in this budget. I think we need to have a costed ex uh option for the board in terms of investing in a communications plan for this board. I think that many people around here have asked for something similar to what Ottawa Public Health is doing. And we understand that we haven't funded our public health unit to do that kind of work. So this is the time to have that conversation about what's that look like. It's the only time we get to have that conversation actually is now. And I think it's essential we have that conversation about if what the plan needs to be around that. Number two, and this came out of the self assessment was scope. The number one piece of feedback I've had from board of health members is around the scope of the board of health. And I think when you look at other public health units and other boards of health, they're doing things we are not doing. We are also doing things they're not doing in some cases. We need a clear map of what that looks like and we need a clear sense of what our authority here is. And so are there areas actually that no board of health has explored um that that we have powers to do. For instance, what about implementing shelter standards? Why isn't that the job of the board of health when it comes to the health and well-being of people who are using our shelters? Why isn't it the board of health's responsibility to in some way mandate shelter standards like we do for food safety? What about the safety of our shelter system? I don't know the answer to that question, but the ball keeps bouncing around between various parties about who's responsible for that. What about our air quality? I understand the Ministry of Environment Conservation and Parks has a role to play in our air quality. What is the full extent of our authority under what we can do with air quality? Do we need to develop a local air quality program here? Like these are the questions we've been raply sort of wrestling with over this term and over the last year. year and I think we need to have options in front of us about you know what are some what are some things we could do to maybe analyze these things in 2027 come back with some full responses that are costed and funded and have a block set aside that we could actually use to spend on on some of these resources because right now the way the budget's presenting itself we're not going to have a chance to do that and I think we're already behind on this kind of work I think our first year here was setting up the board of health and getting everyone trained great I think we're all trained I think everyone understands that the job here and the role here and members have brought forward motions over the last year so everyone's kind of leged legislatively understands what they're doing, but we're missing that piece. Lastly, I think the thing missing from this budget is that we don't really have a clear understanding of what the projects are that are at risk. So, when we see federal funding that's changing or or things like that, what does that mean actually in terms of programs that are at risk, what are the options in front of us? So, if there are municipal programs in front of us, where there are options for us to invest in those programs, I think we have to have a clear line by line understanding of like what are all the specific municipal programs? What are the shortfalls in this budget? what are the areas that maybe we can contribute to? What are other options for the board of health in terms of the funding we want to put forward? I think that's really important for us just to make a wide an an eyesop decision because I think the way that we do talk about these things in terms of mandatory programs, fedally funded, provinially funded, those are helpful terms, but they don't drill down to the kind of impacts that we see in our community, right? So, if we're talking about um programs for children and babies, are there align items of the specific programs? What do those look like? How have those changed over the years? Is this an opportunity for us to do something about that? like what are the gaps you see? I think it's important to have conversations about fiscal responsibility and we want to make sure that our budget is very fiscally responsible. No one's debating that or discounting that. I think at the same time we have to understand what the pressures and needs are and we can't drive ourselves to a budget that says we're going to stick to a percentage or stick to a number without fully understanding what what the options on the table are. And I think as this board of health is now finally, I think in its first year to look at a budget in a really robust way, I think we need as much from you folks as possible in terms of being able to make those decisions so that we can ensure that when we bring this to council, we feel confident about it. Those are my uh thoughts and comments and if we could see in the next iteration something about that or some kind of cost or some costing or some some you know showing us some information about that so we can make decisions about it. I think we did a good job last year. We had a budget, we had an option, we made a decision, we put that decision forward, right? I think we always want to be in that position as a board of health is what are the what are the things we can do here >> on the list I see councelor Fang so I'll turn to you now >> thank you I really appreciate that line of questioning chair um I think for me I wanted to really get a better sense of understanding the capital financing because I think that um the chief medical officer made made mention that we that public health no longer has block funding meaning there's no more capital sort of finance like capital monies coming from the from the city. But we have identified on slide 1162,000 in capital financing. But then the one project that we have is an air pointer at 135,000. So where's that discrepancy? But also I think that that leads into what the chair was also saying is like where what are the different areas that we might need that those fundings for? Because when I think about air quality again and air pointer is exactly what we need. we just don't really have block finance block funding to do that. But then that's also not properly alloc like it doesn't show in the budget how we're going to be using that air pointer. How big of a sense is that I just it it it's a bit of a disconnect for me. We buy an air pointer because we need it but then that doesn't adequately reflect the kind of work that we need to do in terms of air pollution. So, I hope that's a roundabout query generalized question on just clearing up what is the capital financing that we need, but then also how does that relate back into actually our work? >> I think your question is how does purchasing a new airpinter connect to a program that we have here? And the answer is maybe it does or doesn't. Maybe this is a one-off, but I think that's the question. and as well as the capital financing. So if we also it it comes back to if the program requires us to have some more capital financing then how does the budget really reflect that? Thanks >> through the chair. I think you know one of the one of my things all through my career has been what is a budget and what's a plan and some people uh some organizations treat the budget as the beall and endall of what is the plan for the year. It's not something I think is particularly helpful because of the reasons that you're saying just now, right, is that the numbers and the allocations don't um don't tell us what's happening with the money. And so what you will see when we come back in December is a broader piece on the priority plans. And so, for example, with air quality, you'll see much more that comes through that way. I think the challenge that I'm hearing before you today and I'm trying to think of how we can bridge that for you the plan back to the budget is um the extent of detail for those elements that we're talking about and so I think we can definitely bring back for you from the priorities standpoint which will cover a number of issues you know that relate into those they're fairly obvious right the child and youth healthy growth and development you know will include immunization for example, as well as healthy growth and development elements because they're in there. The climate change one will include air quality as well as climate change elements. And the substance use piece will include substance use prevention programming, but it but they won't include other large sections of the services that we provide. And that's where the um program uh updates that we're providing to say okay these are the things that we're doing across and this is how much it's costing um is is to help meet that that gap between how much we're spending and what we're doing. I think for staff over the next couple of months to be ready for what we bring back in December and January knowing that this does need to go before GIC based on the current plan um in January is are there areas of focus um I'm assuming the ones that are the priority ones that that would be of great interest and so I think we'll be ready for that. Are there others, you know, the chair mentioned, um, you know, for example, programs at risk and so I think that's been one of the challenges for us in understanding the approach with things that are soft-funded, I'll call it funded on grants for short periods of time that we know are timelmited are, you know, what's the approach to do with those, but you mentioned also municipal programs. The chair also me mentioned municipal programs and so you know, is that an area of focus to bring back some more detail? I don't think we can bring you back fullome detail on everything because we would be here for a week um together to talk about them. So are those am I hitting the mark in terms of the areas of focus to talk about more so in December and January or is there something else that we need? [clears throat] >> Councelor Hoya did you want to respond to that with respect to your specific question and then I can respond with respect to the ones that I raised. I think that there is a real opportunity to come back with what chief medical officer said in December. I know that that's not we're never going to get the be all and end all line by line program descriptions that we're that but I think that there's I think that drawing the line between the budget and the plan I think is a very clear um gap that we need to bridge because a lot of the times when people anybody outside of this organization outside of this horseshoe when they look at the budget if they don't see a very clear line to the plan it just it ends up confusing a lot of people so I think I will wait for that December. But ultimately, I would like to still identify in [clears throat] the plan, do we need capital financing? And if so, what is that? Because you're really only asking for 162,000. I don't know other than buying the air pointer, I don't really know what other else there might be there. So, that's my very focused question is on the capital financing bit. So, I think I'm happy to wait for that to come back in December, but ultimately um if we do need to ask for dollars, I'd like to understand what is the plan for capital financing and what is it what is it what that we're financing. Thank you. >> Okay. Thanks. I think that's understood. Yeah. To clarify what I'm saying, I think what we need to be set up to do in 2027 is tackle these issues. And I'm worried that the budget doesn't contemplate how we're going to do that yet. So, for instance, if we want to tackle a robust communications plan, do we need to set some funding aside to make sure we do that and and what that looks like and come with a costed plan to the board of health at some point in 2027, but that's going to require money in the plan for the board of health's budget to pay for someone to do that work and come in and do it. That's my concern. So, when it comes to the scope, yes, those are great priorities to have and inside those buckets. We want to make sure we're identifying things inside those buckets that are our scope. But, are there things that the board of health has wanted to take on in this term of council? Are there things that um public health staff have wanted to take on or wanted to look at? Are there things other boards of health are doing, other public health units are doing that we're not really taking on? Like that example, the shelter system, which is one example, but there are many ways to approach public health. And so I feel like this is an opportunity because we have a semi- autonomous board of health to change the direction of the board of health and public health unit in some ways. I'm not saying in in you know fantastic major ways, but maybe in some nuanced ways that are important to the members of the board of health. And then lastly, I think we do need not maybe program descriptions. I think everyone understands what the program areas are at this point, but we don't have, as Councelor Hang was saying, a map between those programs, how they're being funded, which ones are at risk, uh, municipal programs that maybe need attention. For instance, we had reports throughout this entire year that would show us that this program was extremely effective, and then we had staff say things like it would be more effective if, and then there was a dot dot dot, and some things were said there. Okay. And a lot of those things were ellipsies that needed funding at the end of them. So that's I guess my question is that if we spent $10,000 in an area here and that $10,000 had a really high impact in terms of turning the results over, how is that delivering on public health outcomes for people? So I mean that's I think the stuff that we need to know about here because I think we don't have the ability to understand all of that and see the links between the budget, the plan, and the outcomes at the same time. So that we're relying on you to kind of say here are here are the opportunities in front of you. here's where the funding can go. Here's where we think there's some further things you might think about funding and so on. So, hope that makes sense. On that note, I don't I see a couple more folks here. Got councelor Casar, Vice Chair Joseph, and then member Denko, and we'll get to all of you right now. And then I see uh councelor Alex Wilson. Councelor Casar. >> Okay. Thank you, Chair Crutch. Um, so I'm going to kind of build on what you were just asking about there or commenting on, but specifically to the numbers as presented here because on the surface the city uh the board of health through the city's budget is contributing it seems on the surface more than its fair share with the 5.9% increase. There's a lot of things happening here with the decrease as Dr. Richardson said in federal money for 2027 and then the provin provincial grants and subsidies of 1.1%. So I also heard in the presentation that when we don't have federal money that those programs and services would stop. So whether it's can be explained a little more here or it's a followup in the next presentation is why is the municipal share here so much larger than um the senior levels of government and what are we getting for that? So I think that just needs a little more a little drill down to explain because it's a significant number when we know the city is dealing with cost pressures from every direction and would need to really be able to justify what we're getting out of that if that is clear through your chair. >> So in terms I just wasn't sure if this was another piece to come forward or if this was a question for now but I'm assuming it's a question for now. >> Yeah. If you can answer part of it now, that'd be helpful, but certainly it's probably a little deeper and we need some more work, I think. >> So, through the chair, um, essentially what the province, there's sort of two two things that are going on. So, each of the program areas gets funded at different levels. So, as I mentioned for the Ontario public health standards, the approach to funding is you set out your budget, province decides on a grant, municipality pays the rest, and user fees for us pay a significant portion as well. Um however um you know and then and for the last while they've been giving us 1% per year and they've extended that for another year from the province. And so the share that the municipality pays picks up when you have a overall pressure of say 3.2% 3.5% in terms of staffing costs those pressures tend to fall to the levy um instead of to uh instead of the province providing dollars for those. in other programs right now where we sit is um that we don't have all the funding allocations from those programs yet. Sometimes we don't get those funding allocations until well into the into sit on a different budget year than we do. So we have to make assumptions and make room and say okay if if this is all we know right now which is that we don't know if there'll be any increase you know what this would be the levy increase to maintain service levels and you know if there's a funding increase the following year then it gets absorbed into the analysis and and brought back and and uh incorporated in that way. So generally speaking, what you're getting for the extra dollars from a municipal perspective is maintenance is maintaining the programs and services where they are um but at present day values, present- day costs of what those are. So that's why I say in this in this presentation that this is a maintenance budget. We haven't built in any, you know, increases in programming, additional service levels, any of that sort of thing in the budget that you're seeing today. >> Right. Thank you for elaborating on that. And I think the key takeaway there is there are [clears throat] provincial health standards that are over time not funded adequately to maintain. Therefore, what I heard from uh Dr. Richardson is that this the municipal budget needs to compensate for that. So, in a sense, it's a form of provincial downloading if we want to continue to offer the same service. Uh or we can make the decision that we'll let the service decline with the amount of revenue that's allocated to the city. And the choice has been these are valuable public health services. therefore we should maintain them um because there's consequences if we don't therefore ask the municipal levy for that money. That that's my key takeaway and I've seen some nods from the bench. So just wanted that to you know be elaborated on so that we understand that and can continue that thread as we go through the budget process. So that's the only question I had. Thanks. >> Thanks so much Councelor Casar. Next up is Vice Chair Joseph. Take it away whenever you're ready. Your microphone's on. >> Thanks. Yeah, when I um read the report and heard the presentation um I guess I was looking for a plan as well. Um you know reading the report if you know you single spaced it it probably be about three pages I don't know five. Um so it seemed quite brief to me. Um I think you know the some of the points raised already including those by the chair um included uh maybe a request for some analysis in the reporting. Uh I I understand that the the cycles and the timelines don't necessarily add up that the this budget process has to uh kind of proceed while the planning is also uh being orchestrated and um developed. Mhm. >> I think for me uh as a community member, board member, I think I would need a little bit of connection uh from how the operational visioning is happening alongside this kind of budget reporting and communication to us, to me personally. um particularly so that we could have the generative conversations you know that were uh something um identified in the evaluation [clears throat] report. I think we could have conversations that attach some of the conversations that we've had at this board around air quality, around opioid use, around changes in in programming at different political levels such that we could identify priorities inside of these conversations around budget. Right now, it looks like uh some machinery that uh is aimed at keeping the machine running, which is great. But also I think we have passed motions around health equity data and like the chair mentioned uh around communications in particular it was misinformation and disinformation and I think we need the opportunity to put those conversations back into these ones and it would be helpful [sighs and gasps] if uh you know the the background parts weren't you know blank um if there was the analysis and the attachments inside of this to help us with that analysis. My question is, is that possible? Is it possible to uh provide some more background in this type of reporting even though the timelines don't add up such that we could have these generative conversations uh and attach what's happened throughout the year, the feedback that been brought to us um in uh concert with with how this rolls out such that we could provide the kind of an analysis and feedback on the budget and generate priorities. uh and you know wield our authorities to do so. There was a question in there. [laughter] >> Yep. Medical officer of health >> through the chair. Uh so you'll remember as well that I referenced this sort of movement that we've had from you know trying to get the board involved earlier and earlier in the planning and and uh from both the planning planning and the budget planning perspective as we go forward particularly around priorities. And so I think I think the sweet spot will come next summer. Um I don't think the sweet spot's going to come in December if I'm frank. It won't come in December or January because we haven't got time yet to talk about all those pieces and the priorities. And so in the strategic planning process, you know, we're meant to bring together again the public health data, the population health data, I should say, you know, the evidence and the strategic conversations with the board in order to look at priorities over the next four years and and where do we want those to go? And so I think that's designing that sweet spot and looking at how that that conversation will go will help us get further enough far enough in advance that we're more properly doing what it what it's asked to be done here. I think what we can do for December and January and that's why I was asking can you tell us some these are the areas that I see coming back that will give you more of that detail with the priorities that we come back with. Um, and so I think that will help in those areas. There are some pieces though that are difficult to come back and cost and quite frankly communications is one of them because communications really is built into all of our programs and services. And so to try and pull out a budget specific to those um activities, we don't budget at that level. We don't do activity based costing in our organization more broadly. We don't have the systems. we don't have the platforms to do that. Um, and so to bring back costing that is, you know, on the simple piece of how much of every employees time is spent doing communications of various sorts that contributes to those plans is difficult to do. Are there some pieces for example around branding that um we've had some conversations about that would be easier to cost and say you know if we want to do some more specific branding around the board and Hamilton public health that would take these amount of resources to do that's easier to sort of chunk off and say how do we move that forward. So I that's just to give you an example of where some things are easier to pull out from a budgeting perspective and other things are so integrated into all of our programming that they're very hard to pull forward. >> Well, thank you. That's helpful. I think the the conversations around communications are necessary and important. I would argue that uh we are in a kind of neo uh transition in terms of information as an age and people talk about it in terms of intelligence and artificial or not. uh but I think having those conversations around what we're talking about in terms of communication could be uh broad and less specific such that asks could be made and the board could support uh public health in making those asks in terms of broad sweeping budget because it will be the case that addressing misinformation and disinformation um at maybe a uh larger scale will be uh priority to respond to health risks as a consequence of an information communication debacle or um event. I consider those public health events as well. Uh influx of harmful health, public health misinformation or disinformation. I think those things can be costed specifically without looking at everybody's individual acts of communication as a part of a budget consideration. Um so like I'm just um alluding to my earlier point which is uh some specifics around connecting the planning ideas and prioritization to these more gross budget numbers uh will might be helpful to other members of the board as well as they are for me. Thanks uh Vice Chair Joseph and just again because we're referring back sometimes to my comments I'll just clarify that I think the ask is yes we have identified through the motions that have been passed in the last year some of the key areas around communications we want to focus on the question is from more practical perspective do we need to hire people I don't think it's an analysis of the organization's communications that we're looking for but more so if we want to meet objectives like dealing with misinformation and disinformation if we want to meet objectives with uh new branding if we want to meet objective ives with getting out there more than we are now in terms of advancing that branding and having public messages around everything that we do um annual messages around certain campaigns that happen every year around flu season and how we do that the likely answer is we're going to need people to do that work I presume and so what does that look like how can we be prepared for that how can we make sure that when we are in a position where we understand what's necessary we can act without waiting for the 2028 and 2029 budgets to do it that's my concern so I'll now turn to member Denko. Go ahead when you're ready. >> Thank you. I think my my thoughts and questions. >> Unfortunately, for reasons that I'm not sure of, it's a little bit hard to hear you. So, you may have to speak up a little bit or move the microphone your computer closer to you. We could hear you earlier when you were doing your sound check, but it's difficult now. So, why don't you try again? >> Okay. Just testing my sound. Is that working better? >> That's okay. Thank you. >> Uh, thank you. and through the chair. Just my my questions and and thinking aligns with what has been already been said. So just to to add to the conversation, I think some of the the pieces that I'm missing uh as we look to approve priorities um and in a preliminary budget understanding things will change over time. Um I don't have a sense of what the alternatives are. So if we don't increase municipal funding for example, what are the consequences and the measurable measurable impacts um in Hamilton on public health services? And I think the the importance of highlighting that um it is important because it was mentioned provincial funding is not keeping up with something as basic as increased um staffing costs. And so to maintain services, we're relying on the municipal levy uh and and we're not getting our our share of of provincial funding that that's necessary. And and that's that's creating a gap over time. So that would be really helpful to understand what the consequences would be if we didn't see that increase at the municipal levy or if we aligned it with perhaps what the increase was approved for last year overall for the um municipal increase. Um I'm also interested to understand with the the loss of federal funding that was specific you mentioned to opioid work. Um given one of our priorities is substance prevention um and looking at the impacts of that. What are we losing by losing that funding? And is that service that we we feel should be prioritized as part of one of our budget priorities? uh what would it cost to to to bridge that gap or are there other opportunities to look for that type of funding? Um and I also, you know, recognize that we have climate related environmental um risks as part of our priorities, but I don't actually see funding related to that and some explicit descriptors of what would our our level of service be, what are we focusing in on um with regards to that priority. So those are all pieces of information that I think would be uh very helpful for me to to make an informed decision as we go forward. And so I I think overall I'm looking at uh understanding more about you know what is our baseline service level for the different major public health programs and what service levels are we budgeting to deliver in 2027. So it's looking for some measurable impacts if we approve funding or if we do not approve funding. Um, you know, you mentioned increased demand, like what does that look like? What is the five-year trend? Those would all be really helpful, tangible pieces of information. Um, and then last piece is around technology and efficiencies. So, it's referenced, but there's often a cost to initiating new technologies that then find us efficiencies. Uh, I think there's a reference to the fact that there there's an increased cost for it and technology um just based on what we're we're leveraging from the city. So how much of that is owned by public health and do we have to do on our own? How much of that is linked to what the city services provide? Um and we are there efficiencies that we can find there. What is the investment that needs to happen to get us to that point of efficiency? So those are just my like my feedback comments. If there's a a response, I'm happy to to hear that as well. So perhaps my response will be quite short but you'll remember when we when I was going through the presentation I pointed out about the the charts with the numbers and then I showed you the charts with the the bar graphs with like this is how much goes in each area and I said I think we should shift how we budget. Um, and so I really really enjoy the conversation today because this is this piece about, you know, not numbers aren't the king piece. It's the impact of what we can do and that this is the funding that follows it up. I think we're, you know, with the greatest respect to David and Miriam who are sitting behind me and are the great supports that help us put our finances together. I think they know too um just how much we want to show that connection between the costs and where they're going and what it is that's being funded. We will need your patience. Um because as you've heard me say earlier, we have this is a a significant shift in the way that things have been done. Um and we've been trying to move towards that as we also because as much as there's the training that has gone on as the chair referenced for the board around the role, there's also been a significant shift for staff in uh making an adjustment to this way of doing business and figuring out how best to support this work. So as I said earlier, I think you know the the strategic discussion that's planned for next summer once the new board is you know fully ensconced after the election and the transition process if any that happens from there um that we will um be in a better place to really discuss from a priority setting standpoint and a strategic connection. But we can certainly make steps towards the sorts of things that are being asked and start to explore what level of drawing together the plan and the budget um would be most helpful to the board. So know that we're excited about it. Um but it's just going to take us a bit of time to continue to get there and evolve. Thanks very much. And one piece I'll tease out before I pass on to the next speaker is that the city housing Hamilton board for example, we share procurement with the city of Hamilton over the years. City Housing Hamilton has been re-evaluating the effectiveness of doing that and discussing whether or not it thinks the procurement division should have have its own sort of arm. We should have our own arm of procurement at city housing Hamilton because of how much we're procuring. Are there things like that that are happening at the board of health that may be efficiencies that may actually end up saving us money in the end? I think was one of the things that was being being driven at, right? Is is if we have someone internally who's willing to do certain kinds because we're so heavily dependent upon the city for X. if we had our own person doing that thing, would we be able to save money doing it? And so I think those are things people are concerned about, too. And from that, I'll move on to councelor Alex Wilson. Go ahead when you're ready. >> Thank you through you, Chair. I think just a couple comments knitting together some of the things I heard. So one of the ones just I think on uh budget to program, like how are we spending money? Where is it going? How do we know if $10,000 here could really have a huge impact to an overdemand program budget? Um, also appreciating uh some of the comments from the bench about the journey that that path is on and we're at a point in time. Um, I think maybe just some comments from me around what could early steps in that process look like because I think there's been some comments about maybe maybe further in the process or where we'd like to end up or where we'd like to kind of get there when we're done the transition. Um, I think the program overviews that were done as trainings all listed most of the key programs in every division. Um generally on each slide there was KPIs that were relative to that program. One of the issues I think I can imagine in pulling everything up is that um say a program in healthy families healthy babies has different KPIs than um in some of our environmental climate vectorbor diseases. But in the context of that reporting the KPIs were identified for the program. Um I think some comments about demand were also identified. And so I think even just a summary of some of that information that's already been identified already been pulled out. um some of those pieces just in bullet form would have really helped I think tie in and that could have been some of that the beginnings of that analysis work so I don't think that's the finishing of piece of that but just I think we're closer maybe in some of those areas or some of that work has already been done in terms of at least what are the programs um what are the drivers uh but it's not it's not current to this report it's been kind of about a year ago when we are trained on some of those things and so linking that information is sometimes difficult so that was kind of piece one piece two specific to communications Um just helping me understand is there someone in Hamilton public health whose job is communication specifically or what I heard from the previous answer is that different roles may have 5% of their role is communication 10% 15% maybe you're even getting up to 25 30 but is there anyone who's kind of like a comm's officer or kind of taking comms across all social media accounts or is it more distributed is maybe a fair way to talk about it >> through the chair. So, um, communications, uh, in terms of a central coordinating group, shall we say, we have a communications, uh, steering committee. Kevin will help me in just one moment. Um, internally, who is overseeing the plan and how we evolve it and what we do. From the standpoint of staffing, we have two communications FTEES that we uh have a service level agreement with the municipality to come from the centralized comms pool. Those FTEES are um are not two single individuals. They're spread out over and I'm going to turn it over to Kevin in just one moment, but spread over a couple of individuals or more than a couple of individuals in order to provide us services across social media, responsive media, proactive media. >> I don't want to cut off an answer, but I just want to say like that does answer there's two FDs, but they're housed in the city of Hamilton's comms there and then otherwise staff may have a distributed role, but is that fair just as a very high level? That's how communications kind of responsibilities get divided is people may have a bit of it but the kind of the high level or the strategic things are maybe coming from management plus maybe in consultation with some of the staff that have to inform the communication specifics. Is that a very rough >> That's a rough Yeah, I would say. So, Kevin, >> um I would really appreciate if some of the folks who are maybe steering that could come back with December with a recommendation about what their needs are because I think what we've heard from the board is what we think as people not doing that work every day. Um what the end result of that is. What I've heard is, oh, that's maybe faster than we can go or further than we go. I've heard some um to borrow a word used in the Bay Observer recently, some tension uh between those two things, but I don't think that tension or that friction was necessarily negative. I think it was just we're needing to maybe hear more specifics or a suggestion I think maybe to help us understand so it's not oh we have to wait till June of next year before we can move this forward. Um if what we're hearing from board members is maybe further or too too different than where we are today, I think it's because of our lack of familiarity with operations. And so if those more familiar with operations could maybe make a suggestion about a step forward to still walk towards that path of the fur vision, I think that'd be helpful. Um my very final point, I'll make it quick because I heard the ding. Um is Ottawa Public Health having a very similar meeting today. um about their budget. They includes a financial sustainability piece uh where I think they my understanding is they reported in the terms of a deficit, but what they're doing is essentially they're just looking at hey our mandatory pieces that we have to do staffing mainly is going up, but the provincial funding is not going up. And they've predicted a 10-year deficit um of if that trend continues, are we getting 75% provincial funding really in this budget? And could you talk about um would we be able to kind of forecast what that trend looks like? I we don't talk about it in terms of deficit here. So there's some language differences, but just is provincial funding keeping up and what does that look like over time and could some of that information be brought back in a future update? >> Ruth the chair. Um so couple of different things. We didn't bring you a full budget book today. You're going to have a full budget book in December which will give you a lot more detail as well. And in that is multi-year budget uh numbers that lay out um where the overall budget is at for this the group that is the 7525 cost shared historically. You know the province is quite clear. It's it's no longer that. It may have been that in history but it is a grant you know of provincial and municipal ones. We can outline for you specifically within that multi-year budget where it would sit today and where it would sit you know with assumptions going forward. The assumption would be 0% funding increases. >> Thank you. So maybe just to clear at a point in time there was 75% 25% but since that point in time as inflation other things have happened the provinces maybe offered zero or 1% um are the varying numbers but that number has always been higher than 0 1% and so that's created a a deficit of some form or a need for the municip as as Ottawa would say a deficit as we would say a need for an increased municipal contribution. um and that challenge if that could be kind of projected out over a 10 year so we get that shortfall over what does this look like over the next 10 year I don't think that's necessarily helpful from the how do we balance our budget perspective as much as it is helpful from the advocacy perspective or identifying um really what's changing over the long term and what are the risks of uh the provincial funding not changing um especially as we kind of project this not just in a one year or a two-year cycle but you know we're we're now multi many years into this and many years ahead uh does that change some of the pressures we Thank you so much for uh the time. Thank you. >> Thanks very much. And now we're on to Councelor Mark Tatterson. Take it away whenever you're ready. Councelor Jison. >> Thank you, Chair. Um I think my question for Dr. Richardson, our chief medical officer, is sort of related to what everyone's getting at here, but for me the big number is employee related costs. And I'm just wondering in my, you know, putting it, I think, in my own and using my own vocabulary, when we look at things like infectious disease control and we see say $8 million being used, what percentage of that, what amount of that is being used to for salaries, benefits, you know, costs, employee related costs. So, so will that be detailed out in the forthcoming budgets? I guess that's my comment and just wondering um that and I think that's similar to what other people are asking. >> So, I can give you a through the chair I can give you a high level answer. I just turned to Jordan and said does he have those precise numbers? He doesn't have them today. we would you could abstract those numbers uh from it um as we in what we bring forward usually generally 81% um which is the overall number that we have for Hamilton public health is kind of the lowest end the reason for that is that um it is probably dental services is the only program that has significant uh costs that are non-employee related because they would have more related to taking x-rays to doing dental work uh the equipment and all those sorts of things that are that are needed for dental. But so everybody's programs uh across the board or all the programs across the board would be in that 85 plus percent that is employee employee related. So we could we could detail that but I'll tell you you'll not see much variance um across the programs. >> Okay, I understand that. So I I guess basically what I'm trying to understand is like well how again I get you say it's not going to be much. How what are the people doing? What's their job descriptions inside of healthy and growth development? Is that something that comes forth or is that more of the plan that you're talking about as opposed to the budget >> through the chair? Um at some point we move from the strategic level discussion into an operational level discussion. So when you talk about job descriptions and all those sorts of things, those would not come to the board. Those would be things that are worked out by staff with HR um in detailing those sorts of pieces. But sorting out um employee related costs from operational costs, those do come forward in the uh in the budget books. >> Okay. Thanks very much. >> Thanks. At this time, I'm not seeing any further speakers, but I didn't know if based on the feedback we had here, if there's anything that we wanted to solidify in the form of a motion or if the feedback you think you understand where we're going for December and January. I think it's hard to craft motions on the floor and so I don't want to put people in that position. So I thought I would just ask that before we move forward. >> That's much appreciated, very much so with the the discussion that we've heard today. Um I would say that we have some really good guidance on what is needed. I I we don't always need everything through a motion. In fact, it is this more workshopppy conversation. I think that it was contemplated shall I say in the self-evaluation uh process that uh that we that has been gone through and that staff are looking for quite frankly from the board this more of a dialogue more ideas more input so this is as I said this is exciting and helpful to us um I think we've got lots of good things as I said earlier we'll take our best step forward in doing bringing some additional detail additional parts and continue to do that improvement as we So if we have questions along the way, I think when we get to sort of that um post October um timeline to sort of come back to the chair and vice chair and get a little bit of insight on, you know, is there anything else that would be helpful to bring forward to those December and January meetings? That would be very helpful for um a couple of us at least from PHLT to do. Sounds good. So on that uh we need a vote and this vote is going to be through our electronic system because it's a recommendation for consideration. We need a mover and seconder on these recommendations that are there. Moved by councelor Kasar, seconded by councelor hang. That vote is populated now and you can vote electronically. Member Deno, I just need your vote. Thank you. >> In favor. Okay. Thank you. >> Member Jensen in favor. >> Also in favor. Okay. Thank you. And that carries 11 to zero. At this point, we're now going to return back to item for information 7.1, Board of Health 26029, health evaluation and action through long-term trends and high impact modeling. Just give me one second here as I pull up document. Do we have a mover in second at this point? I wasn't sure if we did. >> Yes. Oh, sorry. 7.2. I lied. Look at that. I just talked right off the sheet like I wasn't even here. So it's 7.1 I apologize or 7.2 sorry I apologize [snorts] which is the 2026 board of health self-evaluation results and there will also be a presentation for this and so I'll turn to the presenter at this time. >> So through the chair just to introduce Peter as he comes down to the podium. Um many of you will have met him through the interview process but as you know a self-evaluation by the board is required under the standards every couple of years. We've been very fortunate I think in the way we've done it to marry it up with the way that things were done with the transition for the board with having Peter come discuss um with the individuals of council and um subsequently now with all of the individuals around this table how the governance has gone through the transition and then you know what are some ideas about moving forward. So he heads up an organization which I think only Peter can introduce. Well, so I will let him tell what Mass LBP is. >> Thanks. >> Just one second. Your microphone is on. Also, before you begin, on the left hand side of you, there's a little thing that you can use to adjust the desktop. >> Wow. >> So, >> thank you very much. uh and uh thanks very much for uh inviting me not only to present to you today but to be part of what I know has been such a significant change uh for uh for the city and for the board of health. Certainly was a pleasure to speak with many of you during the course of the interview process and as Dr. Richardson has just explained uh this is a a mandatory uh process that boards of health need to undertake uh periodically to satisfy provincial requirements. Um I'm just going to quickly go through a few slides uh to take you through some of the highlights of the report that will have been uh shared with you and then I'm happy to entertain any questions. Uh Dr. Richardson did allude to my organization. We've been working for almost 20 years to strengthen uh democracy across Canada and we're frequently involved in conversations about governance. It's called mass LBP and the LBP stands for led by people. Um, now as I'm clicking ahead here, >> presentation, >> I'm not Is this >> Yes, we've got the wrong presentation. The former one up. I'll just ask Matt. >> It's okay. We're just going to switch the presentations around. We have the wrong one up. It's okay. That was probably my fault. I announced the wrong item, so you can blame me. Now perhaps while those slides appear I can just continue um sure >> with the presentation. Uh so uh this is the first self- evaluation obviously since Hamilton adopted its semi-autonomous board of health model. I was able to speak with 10 of its 13 members that's five counselors for citizen members and the education representative. uh for those of you who participated in it, all of this will be review. We spoke about generative, fudiciary and strategic questions of governance and really spent um the bulk of that discussion concerning the culture uh of this new entity. Um, I uh recorded those uh conversations confidentially um uh analyzed thematically looking for some uh similarities and differences from what I heard that was shared with two of my colleagues uh to validate uh the findings that we then shared in the report and um we'll go to the next slide then is that within my power uh so broadly I want to say that I think most people would agree that this new model is working well. Um, anything that's new of course entails a kind of settling out period. It entails important changes, but uh I heard consistent and broad support from both counselors and citizen members. I think uh everyone appreciated who I spoke to uh that now the board of health contains greater community and clinical expertise. that was one of the major objectives of switching to this model. Uh and that people are bringing more lived experience and diverse perspectives. Um many people pointed to the fact that even though you're figuring out exactly how to do it, there is more questioning of colleagues at the uh board of health and engagement with the materials that they're bringing forward. People observe that broadly speaking um there's good camaraderie. It's a constructive culture and there's been little interpersonal conflict. So, uh I think uh members see that the model can work and is working. Next slide. Um I mentioned a moment ago, however, that change takes time to adjust to um and while we might know the rules as a board, it doesn't mean that everyone knows how to use them effectively. And um I heard uh recurring observation that the citizen members of course they don't get to practice being a part of a council uh as frequently as those who are elected might especially those who've been here for several terms. And so knowing when to initiate a motion or how to amend that motion or whether even a motion is necessary um these are all elements of the governance process that will come with time. Um uh when we think about the orientation of future members, they'll come to some recommendations in the end. People talked about opportunities to practice some of the things that they might find themselves doing um almost roleplaying uh uh elements of uh their function. Um and I think a number of people recognized as well that the there's an evolving dynamic uh with staff at the board of health uh and members of the rather with public health and members of the board of health. Next slide. Um I I think this is probably true of just about every governing board um in history and of all time, right? people would prefer to have less time spent on the administrative oversight matters, more time talking about the big issues and thinking about some of the uh emerging priorities in the community. Um not surprisingly as people have been figuring out this new model, a lot of its focus has been um on responding to uh reports uh and materials that the uh public health is bringing forward and thinking of course about um your fidiciary responsibilities. You haven't had the opportunity to establish a new set of priorities and I heard Dr. Richardson just now alluding to a coming cycle when that might be more possible. Um, you're also trying to accomplish a lot in the course of the monthly meetings that you have. A number of individuals suggested that maybe there might be the opportunity to have some standide sessions for the purpose of education or even some kind of a retreat. Um and obviously there are some uh important uh considerations given the structure uh and public reporting um responsibilities of the board. Uh and of course uh to the conversation that I think I overheard just now clarifying um how the budget process is to work. Clarifying uh some of the reporting pathways between the board and council remain elements that were noted uh not as a problem but as something that uh will continue to u be better articulated and evolve. Next slide. So um uh before I u finish with uh just six or so recommendations um again observing that there is a quite a necessary I think an understandable differential between those who are elected members of council and participating on the board and those um who uh are community uh based members. Um, interestingly, many of the electeds said, "We'd like to hear more from the selecteds." And many of the selecteds said, "We're not quite sure when, and we don't want to um uh not interfere, but we don't we're not quite sure of the timing. We're not quite sure whether this would be fair to ask. Would we be putting too much pressure on public health or other entities?" Again, these are all issues that come with both practice but also reassurance from elected colleagues. Um and uh it was suggested as well that perhaps there can be an informal mentoring um relationship between some of the electeds and selecteds at least in so far as they feel like they're able to get their hands on the reigns. Um for those uh elected members of council who are no longer part of the board, uh there was a suggestion that um perhaps in the next cycle more can be done to ensure that elected members of council are better aware of the deliberations of the board so that they're able to explain to their constituents um why decisions may or may not have been taken. Um for those elected members who are not part of the board um many residents will still believe that they are part of the board and uh so figuring out ways to to communicate this change communicate responsibility is something several people observed as being important. So finally uh to conclude with a few recommendations on the last slide if that can be advanced. There we go. Um first uh thinking about the orientation I expect everybody would have some very practical suggestions at this table when the time comes to invite new people to be seated at the board of health. Also ensuring that there is good continuity between uh any members who are leaving and those coming in. uh I think there'd be strong support uh for finding that time to have a half-day governance or priority setting session in sync with both uh the electoral cycle and the other planning cycles of which you're a part working to build and strengthen those relationships deliberately uh uh deliberately create a pathway for member-led issues. So, uh, inevitably people hear things, they pick things up from, uh, the residents, they hear about other jurisdictions. Maybe there's a way to triage these issues with a designated uh, board of health or rather public health staff member who could say, "All right, here's how you might try and advance this." And then to speak with other members of the board to determine whether that's going to be sufficient and how best to proceed. All of this speaks to the fifth point about clarifying mutual expectations between board and staff. I think as everybody well appreciates so many of your activities and responsibilities are highly constrained by the province and so understanding exactly how much staff time there is to designate beyond that or how many uh initiatives or issues it's feasible for public health to take up in a given year or cycle. These are important almost rules of thumb that I think need to be established by convention uh rather than by uh statute. Uh and then lastly uh to return to the point from the previous slide, strengthening um continuity and strengthening the relationship with those counselors who no longer serve on the board are all things to consider um as uh the board of health continues its good work. So, I'm going to conclude there. Um, I hope you've had a chance to review highlights of the report as well. Happy to take any questions. >> Going to look around now for folks to indicate that they're interested in speaking. And I'll first turn to councelor Alex Wilson. Go ahead. >> Thank you. Um, I think your presentation was really clear. Uh, there's also been some reporting on your presentation that I think is a little different than how I understood. So, I'm just asking some questions maybe to get right into it, but I I appreciate these may sound like obvious. I'm just framing that that they may sound a little obvious given your presentation. Um, I took away from your presentation that we asked folks to have more participation and that was one of the reasons for having a change in structure, but just having different people at a table and not changing the structure didn't magically allow for things to be more generative. And so, you've talked about what's worked, but you've also made some recommendations about how we can continue to realize that. Are you able to comment on the various times that you noticed tension between whether it was counselors and non-counselor- elected members, tension between anyone on the board and staff? And maybe just comment on was that tension good tension, bad tension? Is this like a a constructive move so far? Not a constructive move given, you know, some of the commentary you have about governance generally speaking. Um I thought I heard you say right track, here's some room for improvement, but I'm just wondering if you could expand on that. I think if there was uh one single takeaway from the report and the findings, it's absolutely the right track and as always room for improvement when you're doing something new with new people uh at the table as well. Um I didn't observe any of your sessions. The findings of the report are exclusively based on those conversations that I had. Uh no one pointed to particular moments or flare-ups um either between members of the board or with staff. Um u so I I I refrain from um uh elaborating any further. Uh everyone pointed to it being a uh constructive collaborative environment but recognizing a differential between community members and elected members knowing the ropes. >> Perfect. Yeah. And needing to be accountable to that um and actually have a plan to make it work. Um no, thank you. I really appreciate that. if we were to do this again in two more years as we legally have to. Uh what are you hoping that if we acted on some of these things would change? How would that feedback be different? Would there still be tension and what would that tension look like in two years even if we got everything right? >> Well, I I just want to observe that of course tension isn't necessarily a bad thing. Um the purpose of having any kind of governing body is that it um it provides a place for people with different views, different perspectives, and different priorities. And inevitably those perspectives uh um will come into conflict with each other. The question is whether it's productive conflict or whether it creates a climate where people feel less able to then speak their peace and advance their agenda constructively with others. So I don't think um anyone should take the findings of this report to say uh-oh there are tensions and tensions are bad. Not at all. It's all about how do we disagree agreeably when there are disagreements that can be productively addressed and resolved through the board's work. >> Thank you. And so in terms of the two years from now, just where you're hoping we'd be on with that respect, >> um I think uh that community members would feel uh increasingly confident about their ability to participate. uh that um all members of the board would feel more confident about when to seek the guidance of public health to address an emerging issue or priority. Uh that there would be um a kind of settled convention about the timing with respect to the budget um the establishing of priorities, the onboarding of members that these cycles would feel known uh to people. And that lastly that there might be some annual session of some type where people in a slightly more relaxed uh setting may be able to workshop and share what they see going on in the community while also learning more uh about um everything that public health is encountering and learning from this community and other jurisdictions as well. >> Thank you uh through you chair not a question just a very brief comment from me finishing up. I've certainly felt since the transition um there's been less politicization of issues. There's been questioning around the reason of the evidence or how did we get here as opposed to the why is this in front of us or um kind of some of the social media circuit on an issue and it's been much more focused on hey what is the healthcare evidence base. So I personally um have noticed some of those changes already and look forward to kind of that continued cultural investment in a good governance. Thank you. >> Thanks very much. Now to Vice Chair Joseph. >> Go ahead when you're ready. >> Yeah. Um uh my question is, you know, well um the counselor earlier raised the comment the idea that you can, you know, change who's around a table, but it doesn't necessarily impact the structure automatically. I think, you know, setting the table, changing the table, the arrangements of where the table is and how it gets there and who's around it is are all pieces of the puzzle. Um, I've thought about, you know, uh, those of us who are citizen members, who have day jobs, uh, who those who might work in healthcare industries or institutions, um, and accessibility and equity and how those land in terms of structure, did it come up at all? uh the timing of these meetings um you know that they're they're in the morning at 9:30 during a weekday and whether it was an impediment to participation for uh folks because of that and would you know moving a a meeting like this to say uh an evening we rarely go over two hours uh be beneficial? Were there were there specific pieces of structural feedback like that that uh spoke to issues of access or equity in terms of participation >> other than uh a few mild comments about some frustrations with laptops and technology. Uh there was nothing with respect to the the timing of the meetings. Uh although it sounds like something very much worth considering. Um and of course you know there are many people who chose not to put their names forward uh for a community seat and that might be one of the uh the the you know most common reasons why. Uh but again uh my work in evaluating this wasn't to talk to people who uh chose not to um put their names forward. It was only those who were seated. >> Oh, thank you. That's helpful. I think, you know, when I'm thinking about how something changes in such a way that it engages community differently, I think having a evening meeting changes that in a number of ways. The ways that people view and see these things live and who gets to participate and who comes forward as a potential candidate for citizen member and um anyways, I just want to raise that particular piece. Thank you. Thank you very much. And now to member Jansen. Go ahead when you're ready. >> Awesome. Thanks. I think there's a lot to celebrate in this report. As I was reading it over, I think this is a a great news story and so I appreciate uh the feedback to the board and in this self-evaluation process. Um I know a lot of it was focused on composition and relational dynamics and and again a lot to celebrate there. I wonder if you have any comment on uh structure specifically with respect to more specialized tasks. I don't know if this came up in any of the conversations, but our board of health doesn't have, for example, uh specific uh structures to focus on risk or u finance or um quality, you know, things like that. Um I it's a a bit of a broad question, but yeah, do you have any comment about um the structure specifically with respect to those? Um I I can't recall uh anyone I spoke to mentioning the idea of creating subcommittees potentially to to look at questions of risk or finance. Um and offhand I'm I'm not um uh I can't speak confidently about how other uh boards of health uh may create uh small delegations to examine these issues. Um but again I I think there's an opportunity uh on the uh with the receipt of this report uh to use it as a springboard for exactly these discussions. >> Fantastic. Thanks. >> Thanks very much. And now to member Kirkby. Go ahead when you're ready. >> Great. Uh thanks so much for the report. It was really helpful. Um it's good to reflect back on our first go at this. Um and I guess my question is um I think it's directed at the more seasoned folks around the table. Um just around um what's recommended in terms of turning these recommendations into action and making some of these things happen. So what the process for that would be because I think there's some good ideas in here and things that we can do to um create a space and a structure that um does allow for that more generative discussion and um ability to bring forward important pieces to the group. >> Thanks very much. And I'm going to take the chair briefly. There's a question in that. Sorry I I missed that part of it. Go ahead. The question is just what does anyone have any idea of how to turn the recommendations into actions >> for received for information? >> Right. Fair enough. It's being received for information. So yeah, I'll turn to the medical officer of health. Sorry, I missed the question implied there. Apologies. >> Yeah, that's good. It's >> through the chair. So, I think this is one of the things with doing it this way is um you get to hear more about the report uh first and discuss it and then typically what happens is staff go away and by staff I mean Matt and uh and our staff from within Hamilton Public Health go away and look at those elements that have put forward those recommendations and look at some things we can bring back. So some things that we're thinking about already are, you know, how are we going to arrange orientation for the new board of health once it is struck after the election and thinking a quicker deeper immersion into things um makes more sense than the sort of longer drawn out sort of process over several meetings that uh that we have u done in the first cycle. Um, you know, we're looking at I know that they're working on within clerks changes to some of the uh the bylaws like the procedural bylaw. And so, you know, that's happening both at council. We've always talked about this. It helps to be somewhat similar between council and the board because it does lead to people not going, okay, which meeting am I in now? Um, but you know, are there changes to that that could be brought forward? So, we're looking at the elements that are a little easier for us to quantify. The questions though, I think around what time should meetings be? um you know other elements of those are things that we need more direction on. So that's just where my thinking is. I'll turn it to Matt to add from a clerk's perspective. >> So through the chair, I don't really have anything further to add only um if the board wanted us to report back on anything specific then a motion would be helpful. Yeah, I'll add as the chair to that to that saying that that's an important distinction and takeaway from this entire conversation and reflects exactly on what has been discussed in the self-evaluation is people aren't really sure always what to do and so it's important to ask this question. The answer is you can do whatever you want. I want to say that like you are here as a member of the board of health do as you wish in terms of emotions. Now, if the motion's out of order or wild and we're saying things like we're, you know, we're going to release 750,000 cats into the downtown core, that may not be within our power, but what you can say is, I think we should have a report come back from staff to analyze whether or not it's better to have meetings at a different time. You could have one-on-one conversations with board members and say, what about having the meeting later and see what people think? You could suggest we strike some working groups or subcommittees. We just strike them. We people them with people. We see how it goes for a year. We evaluate it after the year is done. There's no harm in trying some things out too, right? So, if we see some things that you want to try doing, we can try doing them on a pilot basis. Uh this is not a right or wrong answer space in terms of trying things that don't have necessarily a direct financial or other kinds of community impacts. If they're just going to impact the body that's here and the work that we're doing, we can we can put those things forward anytime we want to. So, I think it's worthy of reflection. This is our last board of health meeting for this term. And so I think think about this as you are transitioning because no matter what the citizen members here will remain as board of health members just so you know that no matter what happens with the election you will remain members of the board of health until you're replaced by an application process in the future. So I think it's a good thing to think about as people come on to this after the election sit with them have that conversation there. I think making those decisions now today may be a little bit premature, but I think it's important for those remaining members especially to think about what you want. Come up with a laundry list of items, bring forward a motion, just do it. Uh back to member Jansen. >> Yeah, thanks. Um, just looking at the standards here, I see that the OPHs says uh or includes completion includes uh an analysis of the results, board of health discussion, an implementation of feasible recommendations for improvement if any. Um, I love the distinction between the elected and the selected. Uh, as one of the selected, I'm going to try something new. Uh just in terms of creating a motion on the fly, is there the ability for staff [snorts] to come back um with a an action plan on the implementation of feasible recommendations for improvement uh with respect to this this report and my apologies if I'm doing something wrong there. >> Yeah. So I would generally say having motions on the floor for during a meeting is not a great idea except this one's extremely straightforward and so I don't think requires any special word smithing. I think what you're asking is for staff to come back back with an action plan with respect to the recommendations and identifying in that right if you think that a recommendation is not for you to make you can also just say that's for the board to make or that's guidance we need from the board on this but areas where perhaps it is up for staff to to do that including legislative coordinator perhaps if there's legislative things that are there. So if that makes sense that you're asking for a report back and um we have a secondary in councelor Alex Wilson since report back on staff on the recommendations in the report in terms of an action plan and when is the most important thing. So when do you think you'd like to have that back and when is reasonable for staff to get that back is more an appropriate question. There are different quarters in the year. Is it going to be quarter 1 of 2027 or quarter two? >> I think we can do this for quarter one. the the big next step will be the budget and uh and that planning piece we've talked about, but then this for Q1. >> Okay, so Q1 that's been moved by member Jansen, seconded by councelor Alex Wilson. Again, very straightforward. We didn't need to board Smith anything. Does anybody have any questions about the motion that's now on the floor? I'm not seeing questions from folks. This is an electronic vote because it's a recommendation. So, we'll have you turn to the electronic system. I briefly lost connection to the electronic system, so I can't tell if it's up yet. It is up. Okay, the vote is up. And that carries 11 to zero. On that, I'm not seeing further questions from members about this report. Thank you so much for being here today. >> Thank you. >> We'll need a mover and second to receive the report and approve the recommendations in the report. Moved by councelor Alex Wilson, seconded by member Kirkby. And that will also be No, that's a show of hands because it's an item for information. So there's no recommendations there. Apologies. That's everybody that carries. Thank you so much. On that note, we have a couple last items of business before we adjourn. Draw your attention to both of them. One is the uh rather prefuncter bill that says we met today. Good for us. And then the other one is not. The other one is still somewhat preuncter, but it basically says it's for the purposes of the municipal freedom and you know personal information act like FOIS essentially, right? Who's going to conduct that business with FOIS here? And the answer is it'll be the secretary for the board of health, which is the legislative coordinator for the board of health. Um, which is the city clerk ultimately is how it works out in the situation. But if there's something that needs to come to our attention, it would, but we're deferring the authority. Otherwise, the board of health would have to manage FOI requests itself, which is of course ridiculous. Um, that's why there's a whole process and and uh department for that. So on those two bills, you have a mover and second to approve them. Moved by councelor Kasar, seconded by councelor Alex Wilson, and this will also require an electronic vote and that should be up shortly. [snorts] It's up. Member Denko, are you in favor? We can't see your hand at this time. member Denos if you could audibly say if that's possible. >> In favor. >> Thank you. >> Thank you so much. >> And that carries 11 to zero. And that being the end of our official business today. Shay's meeting is adjourned. This is the last meeting for this term of council for the board of health as there wasn't sufficient business to hold one for October the 5th. See you after the election, folks. Meeting adjourned. >> Thank you, chair.