Good morning. We're just waiting for one more member uh for quum and then we'll begin. Uh so good morning. Uh camera rolling. >> Okay, good. Good morning. Uh my name is councelor Chris Moes and I am the chair of the board of health. The clerk has confirmed that we have quorum. So I'll call meeting 33 of the board of health to order. This meeting is being held by video conference and in person at city hall in committee room number one. Because we are meeting in person and remotely, we ask everyone for their patience with any delays and technical issues. If you're registered to speak at today's meeting, please listen for me to call your name. I will call speakers in the order they appear on the list. The list of speakers can be viewed online by visiting the board of health page at toronto.c/counsel and clicking the speakers box for today's meeting. The clerk has provided all agenda materials on toronto.csil and via CMP the clerk's meeting portal. Directors, please make sure that your video is turned on. Please keep your mic muted unless you wish to question staff or to speak on an item. As part of each agenda item, I will ask directors to raise their hand or unmute their mic if they wish to question staff or to speak. I will then create a speaker list and will call on directors when it is their turn to speak. When voting on an item or motion, I ask that directors raise their hand to indicate their vote. Directors, I want to remind you that you must submit and approve your motion by email. Staff available at boh toronto.ch with motions. All righty. The board of health acknowledges the land we are meeting on is the traditional territories of many nations including the miss of the credit, the anosbec, the chipoab, the hoses and the woodna peoples and is now home to many diverse first nations, Inuit and Matei peoples. We also acknowledge that Toronto is covered by Treaty 13 with the Missagas of the credit. The city of Toronto acknowledges all treaty peoples, including those who came here as settlers, as migrants, and either in this generation or in generations past, and those of us who came here involuntarily, particularly those brought to these lands as a result of transatlantic slave trade and slavery. We pay tribute to those ancestors of African origin and descent. Are there any declarations of interest under the mutual complex interest act? If you have an interest, please raise your hand or unmute your mic and indicate the item number and the nature of the interest. Seeing none, uh we need a motion to confirm the minutes from our last board of board meeting on May 4th, 2026. Uh director Trenabal. All those in favor carried. Thank you. All righty. Um, so again, good morning. Today is the 1st of June. I can't believe half the year is over. Where has it gone? Uh, which means I can officially wish everyone a happy pride month. I know that progress uh pride flag have already gone up in some corners of the city and today we'll be marking the start of Pride with a flag raising right here at city hall. So, if you're in the building, come on over and let's raise a flag. We won't stop. The theme of for this year's festival is a testament to the strength and resilience of the 2SLGQ plus community that has persisted since long before Pride was a celebration. June is always one of my favorite months in Toronto. It's also my birth month, by the way. With warm weather finally setting in and the vibrancy of pride festivities this year we have the added excitement of being one of the host cities of for the 2026 FIFA World Cup which means thousands of soccer fans will be here to cheer on their teams and of course I'll be cheering team Canada. Toronto Public Health has been actively engaged with our city divisions in the preparations for this global event, working hard to ensure that everyone can stay safe and healthy while enjoying the events. You may have seen the latest condom te campaign which features six limited edition soccer inspired condom designs that celebrate the energy of the World Cup while promoting sexual health. You can pick up uh these free condoms at TPH operated uh sexual health clinics while supplies last, of course. In other exciting news, today we're receiving a report that recommends the annual funding allocations for the student student nutrition program. Uh with this round of funding, the final phase of the expansion will be complete, meaning that the city's goal of having a universal student nutrition program across all public schools communities by the 2026 2027 school year will be fully realized. The delivery of a universal student nutrition program is something we've been working towards since 2024. Behind the scenes, the team of Toronto Public Health and their partners have been laying the groundwork to ensure that all schools are ready to implement the program. Each program is locally developed and operated within individual school communities according to program operating guidelines that allow for service delivery approaches to reflect the unique needs, resources, infrastructure, and demographics of each school community. I'd like to thank everyone who has worked with us to make universal student decision a reality, including representatives from the school boards, Angel Foundation for learning, Toronto Foundation for Student Success, and especially the volunteers at each school who are on the ground feeding our students each and every day. This morning, we have also have an update on the Toronto Urban Health Fund. Since the creation of the tough uh preventing the spread of HIV has been a central goal of the program. Over the years, it has expanded to support grassroots and community- based organizations through a total of four funding streams. More recently, staff have been work looking at ways to streamline the program to examine impact and minimize administrative burden while remaining true to TU's core values. As Toronto remains committed to our targeted as a fasttrack city working towards our zero new HIV case targets, our medical our medical office of health is recommending that while funding continues for 21 previously approved projects. We also enter into agreement with the Ontario HIV treatment network for pilot program, a project to advance the Toronto to zero initiative under the tough umbrella. Today, we'll have an opportunity to learn more about this proposed funding breakdown. Finally, we'll also be discussing the Toronto public health nursing recruitment and retention strategy. At TPH, nurses represent at least well the largest regulated health professional workforce. They are central to the delivery of public health programs and services across the city, including sexual health, communicable diseases control, immunization, school health, healthy babies, healthy children, and harm reduction services. I'm looking forward to hearing from our chief nursing officer, Joan Filano Scott, about how we are actively attracting new public health nurses and supporting our existing workforce. Before I pass it to Dr. Murdy, I do want to acknowledge that on June 13th, the consumption and treatment services at Fred Victor and Moss Park OPS are set to wind down. As the result of a provincial decision to stop funding these services, this board has been steadfast in our commitment to supporting harm reduction and safe consumption sites since the province first launched the attack on safe consumption sites through the community care and recovery act nearly two years ago. When the two additional sites close, Kensington Market, Ops, and Street Health will be the only remaining public safety consumption sites left in the city of Toronto. To say that I am concerned about the impacts on our communities is an understatement. We have already been experiencing the consequences of the first round of closures, the increase in public drug use, and discarded uh paraphilia. and most concerning, the increase in suspected overdoses and burnout among the frontline staff who respond. These are uncertain and upsetting times, but we will continue to work with the remaining safe consumption sites and other community organizations who serve people who use drugs to monitor this situation and allocate the resources we have set we have as best we can. And with that, I will turn now to Dr. Murdy for her remarks. >> Thank you, Chair Moyes. We appreciate your recognition of Toronto Public Health's efforts and how we work every day to protect the health of Torononians, support communities, and build a healthier city for everyone. And as you so kindly and clearly explained, our teams are often faced with multiple critical public health issues that require our care, attention, and rapid response. As a public health organization, we have shown time and again that we are flexible, responsive, and resilient. While issues like Ebola, which is now a public health emergency of international concern, rise to the top of what people imagine as public health, there are many more issues that are not as apparent to the average Torononian. This is why we launched this year the This is public health campaign to deepen our understanding of the diverse programs and services available to those who live, work, play, and study in the city and how we work as part of a larger health system. Local public health is part of everyday life in Toronto, even when you don't see it. In recent years, the rapid spread of false information online has also made it more difficult for individuals to tell the difference between credible health information and inaccurate or misleading content. This has led to confusion about public health guidance and at times has weakened trust in evidence-based advice. Launching a year-round public education initiative, the This is Public Health campaign features seasonally focused content and real life examples that highlight how public health supports communities every day and reinforces Toronto Public Health as a reliable source of information. As you've heard from Chair Moyes just now, we're recently launching the latest edition of Toronto Public Health's award-winning condom to campaign, unveiling six soccer inspired condoms ahead of the 2026 FIFA World Cup. These clever and a little cheeky uh health promotion campaigns have already garnered significant local, national, and international media attention. More importantly, it's opening the conversation about sexual health as being part of the overall health and well-being of people and breaking down the stigma associated with talking about sexual health and helping people access sexual harm reduction services and health services. Creative concepts arrive alongside a recent celebration and participation in newcomer day, welcoming people from around the world as they make their way to this wonderful city. Newcomers to Toronto enrich our lives through culture, language, and a shared appreciation for all that our city has to offer. Public health is present not just on newcomer day, but all year round to help and support newcomers as they establish their new lives in Toronto. As we return to our agenda, we see these actions and intentions reflected in the four reports being considered today. The reports show the breadth of our work across the public health space. We're also pleased to present on our nursing recruitment and retention strategy where we showcase the important work of Toronto Public Health nurses. Our nurses are one of the essential pillars of our public health work. They provide care, education, prevention, and support in communities across the city. Toronto Public Health is committed to supporting a strong, skilled, and engaged nursing workforce through ongoing recruitment, mentorship, professional development, and workplace initiatives that help nurses thrive in their roles and continue delivering highquality public health services. For this board meeting, we're also bringing forward a report for financial authorities to proceed with our continued expansion of the student nutrition program that will bring us to the city's vision of a universal morning meal program by the 202627 school year. The city is investing over $31 million towards student nutrition programs in the upcoming year. This includes funding for 78 new student nutrition programs as part of the phase 4 expansion of the program. This will mean that more than 325,000 students at all Toronto public schools will have access to a student nutrition program. We're also bringing forward an update on Toronto Urban Health Fund allocations based on board of health direction from the fall of 2025. This report includes a pilot for increasing our support towards HIV prevention, treatment, and care, which is a foundational goal of the Toronto Urban Health Fund and a priority for Toronto Public Health as we continue to see the impact of HIV infection in our community. Finally, our last report highlights the importance of food safety for special events and the ways that Toronto Public Health is working with city partners to improve the safety of food served during the thousands of special events that occur across the city. and June board chair's birth month, but also several other important events and milestones in Toronto. Today is the beginning of Pride Month, a time in which we celebrate our two spirit, lesbian, gay, bisexual, transgender, queer, and questioning communities in the city. Later today, Mayor Chow, members of council, representatives from Pride Toronto will raise the pride flag here at city hall to open the city's festivities. Today is also the start of National Indigenous History Month, a time in which we're reminded of our shared responsibility in recognizing and honoring the culture, history, and ongoing contributions of First Nations, Inuit, and Matei peoples. As part of our commitment to truth, justice, and reconciliation, we'll be hosting a session for Toronto Public Health staff on June 18th with a guest speaker, Dr. Evan Adams, as well as inviting staff to participate in a variety of events over the month. It is also the beginning of our FIFA 2026 World Cup in Toronto. As you know, Toronto is hosting the first of six games at Toronto Stadium starting on Friday, June the 12th. We'll also host four more games through June and the knockout match in July 2nd. This will be a very busy and lively time for our city. And lastly, on a more summer note, June 13th will mark the closure of Moss Park and Fred Victor supervised consumption sites. the closure of these sites. There will only be three supervised consumption sites left in the city when we had 10 locations at the start of 2025. Closures are happening at a time when we had 485 non-fatal suspected opioid overdoses calls to paramedics in April of this year. That was the highest number of calls that we've seen in a month since 2021. April was also a rise in fatal suspected opioid overdose calls to paramedics with 19 calls that month. This is also the highest number of deaths we've seen in a month since July of 2024. Our hospital partners are seeing similar trends in their emergency departments and our community partners are seeing it every day in the care they're providing to their clients. rise in overdose outcomes is being driven by a changing nature of the toxic substances in our drug supply, but is also being driven by the lack of locations where people can go, where they can use safely, where they can access the other medical and social care that they need. At a time when the toxicity of the supply is increasing, having even fewer sites where people can access low barrier care and be supported in their use will result in continued strain on our emergency services, hospitals, outreach teams, and other substance use support services. Public Health is actively working with our city and healthcare partners to mitigate the impacts of these closures and find other ways of providing services. And I would like to thank our many partners in this work for their ongoing commitment to serving some of the most vulnerable people in our city. I'd also like to thank all of our teams at Toronto Public Health for the range of work that is happening every day and to support the health and being well-being of our city. Thank you so much for being here today. I'll turn it back to Chair Moyes. >> And thank you Dr. Marty. Um so we have four items on the agenda today. Uh the first item is HL 33.1 Toronto Public Health's nursing recruitment and retention strategy. Uh there is a presentation so I will hold this item down. Uh also the item has a confidential attachment. If a director would like to speak or ask questions on the confidential portions of this item, a motion to move into close session will be required. Uh the next item is HL 33.2 two, achieving universal student nutrition uh 2026 service uh subsidies. Would anyone like to hold this down? >> I think council Chang has a motion, so hold it down. >> Yes, I would like to hold it down, please. Thank you. >> H 33.3 2026 and 2027 Toronto Urban Health Fund allocations and review process. Uh there is a speaker on this item, so I'll hold it down. HL 33.4 four, implementation of the food safety management plan for special events. Would anyone like to hold this down? >> I'd also like to hold that down, please. >> All righty. >> Thank you, chair. >> Um, one second. So we will now consider well I'm going to ask that we moved item HL 33.1 to the last item on the agenda uh because we may go into private for that item. So rather than going in and going out we'll just move it to the last if that's okay for everybody. The next item is item HL 33.2. Two, achieving university student nutrition program. >> That's correct. Right. >> 2026 service subsidies. One second. Thank you. Just getting my bearings here. HL 33.2 achieving university student nutrition 2026 services subsidies. Um councelor Chang, you held it. >> Yes, I have a few questions. Thank you, Chair. Uh my first question is what metrics are currently being tracked as this many money money is allocated? Are we tracking number of students fed, types of food being fed? What kind of leftovers are are resulting from the program? >> Thank you councelor to you the chair. We do have uh many metrics from the program area. Um just to remind everyone that the city works in partnership with other um not forprofit foundations and school boards. So the the metrics that we do track are mostly related from applications data. The application data indicates number of participants, how many programs a day the how many days per week a program will run. For example, some are at three days a week and some are at five. Uh the different types of programs offered. Some have um a morning snack program, something around recess time and some have grandfather programs that are beyond that. We also have >> Sorry, sorry that so my question is more about if there are any requirements. So as we work with these not for profofits that work for many schools, are we asking for some kind of feedback loop that once the money is allocated, we have a better understanding of how it's landing? So again through the to the chair what we're tracking now is to say that there are application data but we have not gone further beyond that based on our current expansion model. The plan is to of course move forward post expansion to look into more detailed data analysis. >> Great. And do we know how much the our funding results in per student? Is it like 75 cents per day$150 per day? Do we have a metric of how much money is being spent on average per student per day? >> Uh to the chair. Again, we do have a baseline model where we look at uh the average cost per student and the city contributes roughly 20% of that cost. >> So, schools are invited to or required to do some pitching in into funding the program. Is that correct >> to the chair? That is correct. We have a model whereby initially it was modeled after a 20% um funding source uh from five different sources. One being the city, two being the province, three being federal, four being from general donations, philanthropic efforts uh and other school means and five being from parent support. >> And do we know how successful that has been? Are are schools able to achieve the desired amount of money needed to run the program or are some depending entirely on whatever the city is providing? >> Again to the chair um like every school is different in the models that they have programs designed and how they are working and similarly they do have different models of fundraising. As you can imagine, some schools are more successful in fundraising efforts and others have experienced challenges. >> Is there a concern of the heavy dependence on parent volunteers to execute this program? I've heard from some parents where they have to hand out thousands of food items per day and uh you know for volunteers it's quite a heavy load in terms of the amount of time and logistics whereas other schools have been able to fund raise to pay for a coordinator. So is there is there some concern about schools falling through the g cracks because they can't raise the money to pay for this and it's then on parent volunteers shoulders. >> Uh to the chair again again again as every school model is different in how they deliver the program and also the type of resources they may have. Some schools do have uh staffing support, whether it's a teacher or uh an administrative staff that is kind of leading the charge. Some have um a wide available source of volunteers in the community that are actively helping their own children who are at the school participate and others may have one or two. It is different across the board. It is a challenge that we have looked at and something we want to explore further together with the city >> and overall as we look at the metrics what is the percentage of funding are we achieving that 20% is the city and that 80% is coming from other sources do we know of all the grants and donations that have been made to round out the total amount that uh funds student nutrition across all funding sources >> the chair Again, uh currently we do not have um exact amounts of what each source of funding is. We are aware from the federal and provincial contribution what that figure is. It is less than the city's contribution. City is the largest funer of this initiative and continues to be for the last few years. There are uh means where the foundation partners do have access to some uh data that relates to uh finances but it is not something that TPH is actively collecting right at this moment. So if we cover 22% of question the amount >> that of the amount what is the percentage covered by province and federal government what >> is it 10% 5% u to chair sorry I don't have that exact uh percentage breakdown it's about um to our 31 million about 20 million um from the federal and provincial combined >> so we contribute 44 million and they contribute you combined 20 million. Is that right? Does that sound correct? >> Uh, a little bit. Um, less than that. >> Less than that. Okay. Thank you. >> I didn't have any questions, but now I do. Um so the you mentioned that again it's been four years since I've left the TSB but um before I had left I recall that the more prominent schools the wealthy schools when they collect uh fund raise that a percentage of that is allocated to more marginalized schools. Is that correct to you the chair? To be honest, I'm not sure how that model has worked and how the distribution of funds collected, whether it's shared amongst other schools or whether that's kept to schools just for themselves. Some schools do have active poster campaigns that are related strictly for the S&P fundraising, which I understand those funds are kept within those schools that did raise those funds. I just add to that um both the Angel Foundation and the Toronto Foundation for School Success do their own fundraising and as the largest implementers they will allocate uh funds that they've raised centrally to schools that are struggling to to generate local um uh donations as well to be able to support I did start the student nutrition program in schools with the highest need for these programs. Uh so it was started at a time when you know majority of the delivery was through um either the local provincial or national uh contributions to the program. Very little reliance on um the local schools to be able to help fund it. Uh maybe more so volunteer it but but it's um was really trying to deliver those schools in the highest need. As we've expanded to all schools, there will be schools we've added now to getting to a universal program where they have a differential uh ability to contribute to that program either through volunteerism or through financial donations. Those should be going through especially if they're collected through the the two foundations to be reallocated to be able to help harmonize the need for cities schools across the city. >> Okay. And just lastly, so the learning operative index, LOI, uh, initially, prior to this program, the schools with the lowest LOIs were did have a food program, but now every school has one. Is that correct? >> Yes, correct. When we started the program, it was targeted to schools um with the highest need and then now as we move to universal program, it is all schools. >> Thank you. I see uh Director Gourd has her hands up. Go ahead. >> Yes, thank you for this report. I I know the great work that's done by Toronto Public Health staff and student nutrition program staff and volunteer to manage these programs. And I remember when there was interest in moving student nutrition programs into high schools. And I'm just curious if any of these 77 new school communities include high schools or what how many high schools are being served um programs of this kind whether it's breakfast or snack. Thank you. >> Thank you for the question to you chair. When we look at schools we we look at all public schools from elementary to high school. Um there are some variances in how the programs are run. For example, on the elementary side, we're looking at delivering uh snacks per classroom each time we we visit. Sorry, when the volunteers visit. Whereas in a high school, most high schools have a model where it's kind of a grab and go where there's an option to grab whatever snacks the student may feel that they require as opposed to delivering individually based on different needs. >> Any further questions? >> Okay. Thank you. Uh, director uh Madori, go ahead. >> You chair. Um, I'm curious to hear more about um how students, families, and communities are being engaged in ensuring that the food that's being provided is culturally relevant. Um, and those kinds of pieces, not just that it's sort of I'm just thinking about the concept of universal and how it's not just about providing food, but also thinking um beyond that. and if you could speak a little bit to those pieces. >> Yeah, thank you for the question to the chair. Uh it is a bit dependent on you know the the resources available to the schools. Some schools take this very seriously and and have a very engaged program. One of the recent schools we visited um in East View and Scorboroough has a very active um uh volunteer population as well as a vice principal who's taken this on. They also have a very large indigenous student population. And as they're preparing the morning strawberries, they left half the strawberries with their tops cut off and half the strawberries with the tops cut on left on because they know the indigenous children liked having the stems as part of their strawberries. So, a real embedding of that um ideology of of what what would be culturally relevant to students and being able to serve that food. So, I think there are some schools where that's that's taken um very much so. We do know that there are still some schools where um you know space and volunteers and and the types of food that they're able to to deliver is is more limited just because the the room in the school they don't necessarily have a prep space to be able to cut up fresh food or or have that kind of offering. Uh and so they might be more limited in terms of having that that input as to what they're able to to serve because it not because of a lack of interest in the cultural competency but also just what they're physically able to serve um in the space that they have in the school. And I'm thank you so much. I'm curious also about whether or not we're able to capture um there was an earlier question about indicators and if we're able to capture the extent to which this program is addressing equity and advancing equity. Um can you speak a little bit to that? >> Uh to the chair I you know I think that the the biggest getting to to equity now is that all schools have it um to the universal program. So certainly when it was started um and it was targeted to to lower income or other needs schools that was the focus to sort of help level but but we know that individual children um at any given school might be in need and so getting to the universal aspect to that program is the leveler of equity to try to make sure all students um have access to that program. You don't have to you know qualify for it. you don't have to sort of um you know ask for it that this is now available to to all children uh through that programming. So that's the the universalism part of the equity that we're trying to address. And then I think the harmonization about you know where we're able to have um extended funds to stu schools who need more um and then being able to uh offer less. So each school as they are applying to be part of the program have put in what they need to be able to be a be part of that program. So, uh, being able to give more or less depending on that need for that school. >> Thank you. Uh, seeing no others, uh, questions. >> I have got a I've got a question, please. >> Was there go ahead? >> Yes. Yeah. Thank you so much for this update. And I guess my question is a combination of um, councelor Chans and the board and the board chair. Um, is TPH using any indicators by itself or with its partners to make sure that the the universal morning meal approach is improving access and reducing inequities across all the school communities. >> Uh, thank you for the question to the chair. One of the uh, as Dr. Dr. Mertie mentioned earlier one of the key measures for us is to ensure that we have a universality and ensuring that all schools have equal access to these programs. Once once that is completed, there's some definitely some surveying we can do. But you know, sometimes there are not sometimes all these programs do have uh local level support that that dictate how it's to be run and how to address local needs whether through the parents or some of the local parenting um uh working groups that they have or local programming local program operating committees. So these kind of ensure that we are meeting the local equity needs that are required. Okay. So, so is that a yes that there are indicators that are being used to understand how it's improving access and reducing equities? >> I I would I wouldn't say indicators in the more traditional sense. I would say that we're addressing on a individual basis on each school community. >> Okay. um is there some level of um I don't know evaluation to actually see if it's having the impact that we require it to have >> to the chair. One of the uh items that we would like to tackle on once we complete phase 4 successfully is to look at building those kind of indicators to determine what are good measures of this program and how we can use those measures to improve and meet the community needs. >> Okay. Thank you. >> Dr. Chair, just add to say that I think we know the value of student nutrition programs. I mean many um research evaluations has shown that the provision of this of this kind of uh food programming to students helps them set up for a better day, being able to be more ready to learn, have um uh significant health outcomes and certainly not our intention to re-evaluate that very good evidence about those positive outcomes. Um as we move to a universal program where we are aiming to really focus on the evaluation is around the efficiency and the effect of of that delivery of that program. you know, are we having um as much value for money in terms of um the models that we're using? Are we making sure that we're trying to uh improve the way the schools are doing that? Are we trying to reduce that burden for for parent volunteer where we know that's a significant um contribution to this program? So, I think we're not looking to reevaluate the very good evidence around the benefits of this program, but really looking at to say how can we make sure we're delivering this in the best way possible. Any further questions? >> I just have one question, chair. >> Go ahead, council bravo. >> Thank you. On the question of universality, um is it accurate to say that the measures that we've been using, even the learning opportunities index that for example that can that the Toronto District School Board has tracked or neighborhood improvement areas or social development profiles, it they sometimes miss um pockets of poverty in communities that otherwise are affluent. And is that is that accurate? And secondly, that there even in a situation where there's a few children that are um not being um are are living in households with serious uh um economic challenges and may not be receiving a meal in the morning for a v variety of reasons that we're trying to ensure that no child is left unattended to. Um, is that accurate to >> the chair? That that is accurate. We know that the um indices per school are at an aggregate level and don't necessarily speak to individuals within that school. Um, and and may uh we also seen that there's been significant shifts in our Toronto landscape over time with um housing instability and changes in terms of where people are living. So, some of these indices are not necessarily as up-to-date um or as reflective of the neighborhoods that they're serving. So certainly reaching that universal offer to schools is one of the most equitable ways we can be offering this program to make sure that every child has access to it doesn't have to ask for it or or be identified as being in need for it. >> Yeah. Thank you. And I think that um well as you indicated that through you the medical officer of health has indicated that this intervention has been studied globally for a long time and in terms of what it does for population level um health improvements and the the challenge that I've noted and the 10 or so years that I was very active at my local school but also um the Tdsb and our city advisory committee is that the permission piece is very problematic. Um, so this would is what you're saying is this gets rid of the need for a parent to sign uh, you know, an a form at the beginning of the year saying they'll allow their uh, child to participate and by the way make this donation which in the schools that I observed sometimes acted as a deterrent. So sometimes a a child would be have had breakfast, had a snack, had lunch packed, was in the snack program and a child who hadn't had breakfast and didn't have uh sufficient meals for the day would be excluded and teachers were breaking the rules and handing out food to those kids in need. This gets rid of all that kind of confusion and the burden of identifying and administratively tracking who's in and who's out. Is that correct? to the chair. That that is correct. The idea of a universal offer would be to to harmonize and make sure that that is available without those barriers to access. >> Thank you, chair. >> Thank you. Um okay, seeing no other uh questions for staff, we'll go to speakers. Uh we'll go to Council Chang first because I know she has a motion. >> Yes, I have a motion. Put it up. So this is a motion to just to gather feedback on the expansion that we have undertaken and to where possible overlay with socioeconomic data because this I heard a lot of fellow board members asking about the data and I think it's important to just see the effectiveness of what is happening. Uh, as you all know, Toronto is the child poverty center of Canada and this is a very important program. So, I don't think there's any debate about whether or not we should be investing in such an important initiative. But I think we have to just take a moment and get some feedback. I have heard from different school parents that some of the challenges that they've encountered and even the clarity of the messaging. So, we heard today that this is supposed to be 20 22% of the total amount of funding towards the program, but parents might not know that. In fact, I have a feeling a lot of parents think whatever the city provides or whatever is provided, that's the total amount that should be contributed to the program. So, there isn't even a goal of what they should be raising money towards. And I've also heard of parents saying, "We have to unload huge amounts of food. Like, we're Costco and it takes so much time and I didn't know how much time this was going to take." And often these are women and it is unpaid labor. So, not to say that these aren't amazing volunteers who are willing. Some of these schools have parents who have the time and the willingness, but other schools are really struggling to find the people to to do the handing out of this food. So we're not going to be able to solve all the problems, but we should at least be able to capture what is happening to better understand and then to see where we need to step in in terms of making sure that that equity is happening. It is really complicated. Poverty is not only there's no boundaries or borders for poverty and we have you know in many neighborhoods like mine we have areas of need that are surrounded by affluence and therefore we don't get the neighborhood improvement area designation but I know kids who've gone to school with a bag of chips as their lunch in this neighborhood and so that determination of who needs and who doesn't need is not always clear. So that's why this universality is important. Um but I think understanding how the people who are executing this program are experiencing it is important and namely that those are the parents. What is the expectation that they are given when they are provided this funding? how do they need to supplement it? How can they supplement it? And what avenues are there available if their school is unable to supplement? So, I think those are answers that we can find when we send out the questions. So, I look forward to the survey um and feedback being launched so that we can get a better understanding of how this is landing. And just like you know any plane that has to fly somewhere, you have to continually course correct uh in order to get to your destination. So I think we've set a good path by making this investment. Um and I think the messaging can also be strengthened that we hope our provincial and federal partners would at least match if not exceed what we're investing. but then also just ensuring how this program is delivered to make sure that it is making the difference that we hope it does in our city. Thank you. >> Thank you. Any other speakers? I'll speak briefly. Um again, I was a school trustee for six years and I know the program at the public school board very well. uh you know all my schools in Toronto center are on the low end of an LOI. I think the lowest one in my ward is I think two. Lord Duffin was at nine. But um yeah, so they were all fortunate to be to take part in the uh the the food program, nutrition food program. And I'm happy to see that it's expanded to other schools across the city as well, which is really important. It's it to councelor Bravo's point, you know, there's a lot of data already, but it's also important to note that we at the city don't ne necessarily run the program. Again, you have the angel program at the Catholic board, TFS at the public board. So, you know, it is a kind of a mix and match. And so, um, and a lot of these people who actually help in these programs are volunteers as well to your point, councelor Chang. And so that's really important to note, but um we're heading in the right direction. Um you know, I want to thank the mayor for actually, you know, investing in this program. I know when she was a school trustee herself and the council, that's something that she championed and now as mayor, she's actually put in, you know, I think $10 million more into the program. So, which is really great and we will see the benefits of fruits of that uh soon rather than later. And with councelor Chang's motion, I'm hoping that the report will will reflect that, which I'm sure it will. So, thank you once again. Um, I will put the motion on the on the screen. We could vote on it. >> All those in favor? Carried. Item is amended. Tell All those in favor carried. Okay. One down. The next item is HL 33.3 2026 and 2027 Toronto Urban Health Fund allocations and review process. There are two speakers on the item. Um, sorry, one speaker on the item. Arnold Armagulis, are you here? >> Arnold online. Arnold. in the room. No. Going once. Going twice. Okay. And third time. Arnold's not here. All righty. So, um any uh questions of staff on this item? Councelor Chang, go ahead. >> Great. Um I noted that it mentions that there's a cost share between the Ministry of Health and Toronto for this fund and I'm wondering what is that mix? >> The chair that's it's the same as per uh usual allocation. So approximately 7525 in terms of all of our cost share programs >> and we see that there is a decline uh from 2026 to 2027. Why is that decline in funding happening and what do we expect for 2028? >> The chair, the decline is a timing matter. The timing relates to the 2026 funding actually ends in June and the the year goes from July to July. So that's one year. Then the remainder of the six months is a 2028 sorry 2027 period. It's only because of the 18month split. It's not a decrease per se. So the organizations that are funded won't shouldn't be preparing for in some cases a relatively substantial decrease and and the 2028 budget would balance it out >> to the chair. The current funding that they're already receiving will expire end of this month. So they will not be losing anything because the rema the next year's funding will go from July 1st to June 30th next year with another six more months at which time they'll be able to apply to the reformatted or restructured uh tough program >> and the restructuring is that defined by the ministry or by the city or or in partnership >> to the chair again there are some restrictions or guidelines within our Ontario public standards that will define this. There's also a component where um TPH or the city will have some say as well. >> Great. Thank you so much. Those are all my questions. >> Okay. Thank you. Uh any other questions of staff? >> I have got a question. So, thank you so much for this um for this item. So, from what I'm seeing, it's not just about grants. It's also about how we can support um community based public health infrastructure. So I'm curious if there's anything that staff has learned so far about the most significant forms of admin burden that company based organizations are facing >> to the chair. uh the evaluation that we brought forward and and the report in 2020 um November 2025 on re-evaluating was that we did hear um the length of application the amount of reporting back by funded um organizations for the amount of money that they were receiving was a significant burden and uh felt that that was an inappropriate amount of of um application and report back required. So we're definitely taking that back and why we are doing the further evaluation to say how can we restructure this to have a more flexible and nimble approach to be able to flow funds to appropriate agencies have the insured accountability and oversight of that funding but also make it a little bit easier recognizing some of these smaller community agencies don't have the infrastructure to um to be able to support the the level of um report back that was required previously. >> Mhm. Thank you. Uh so given that how will the board be able to understand if the interim approach and the proposal for the for the OTM pilot, how we're going to understand if it's actually going to improve the model going into the 2020 2028 cycle. So to the chair, um we're we're really leaning heavily on on the success that we've had in the indigenous um Toron urban health fund model where we've been able to look at it as a basket of um funding to a larger central organization that's then able to look at how to disperse that funding to individual community agencies um to do the work in a broader um goals-based and and more self-determined way to do that. So that's the approach that's being provided um or proposed as this pilot um for advancing the work on Toronto to zero um getting towards uh an HIV elimination goals and targets. This is an existing organization that um is working within Toronto that the mayor signed on to in 2023 for Toronto to become a fasttrack cities toward HIV elimination and looking at that again as a as a as a basket of funding to a larger entity which includes many community organizations who are working towards those goals and being able to flow an initiative as opposed to an individual individual organization and being able to evaluate that and say is that a more efficient way of flowing that money because we're funding now an organization that different community partners can be part of um without having to have each of them apply for that funding individually. So we'll be able to look back at after this sort of model and pilot to say you know feedback from from the individual funders feedback from our flowthrough agency through the Ontario HIV treatment network um and be able to say is that we're able to achieve uh better successes through that funding and more um more impact by having this this flow through funding as opposed to um individual funding of agencies. >> Okay. Thank you. Um, I don't know if there's any questions uh from the board, but I have a motion for this particular item. Thanks. And I would need staff assistance. >> Okay. We haven't seen it. Normally, we it should be sent in advance so it can be reviewed, but >> uh are you are you sending it now or >> uh Okay, I'll email it to to the clerk >> because Okay. Because it may need some uh finessing. So, Okay. Yeah. Go ahead. Uh, Director Mador, >> it's a follow-up question. Actually, I have a couple questions. Um, I'm curious to learn more about um how Toronto Public Health is going to learn from the indigenous community basket model. um totally appreciate uh the importance of reducing burden and supporting community-led decision-m and I've also been you know at the same time that's a particular uh that model is uh was developed and implemented within a particular context right around governance uh with particular worldviews and values and I'm wondering if staff could speak to how you're going to identify lessons who's guiding that learning um and how TPH will ensure that it doesn't, you know, dilute a separate indigenousled funding stream. Those kinds of pieces >> to the chair. You know, one of the things we've already heard from the community ambassador approach is we've heard from our indigenous partners and leaders that they did have uh self-governance and the right to work amongst their own communities. And what we're doing is we're working with them to kind of understand what really went well for them which we've already heard but where are some areas that we can definitely improve upon. Uh as one of the counselors mentioned earlier you know we do we can course correct as we go along and early on we've heard that it is a more preferred approach and it did reduce um both administrative economic burdens on these recipients who may not have the infrastructure to uh do grant writing apply for grants hiring staff. So these kind of community based models do help with a coordinated approach from the center. >> Great. So if I'm understanding correctly, um, indigenous communities and organizations are contributing to that learning and part of that process then in informing those >> to the chair. Yes, indeed. >> Um, and then I have another question about uh the renewal only process. So, I'm wondering to what extent TPH is keeping track of new needs that might emerge um for organizations that aren't currently funded um between now and 2028 when the when the new approach will be launched. How is that going to work >> to the chair? Um as as with board direction in the fall when we we put a pause on the current uh tough funding program to we extended anyone who was being currently funded. So the funds that are being allocated through this report are to extend all of the agencies that did um put forward and say they would like to continue the projects either one year up to three year projects that they were continuing um until we can have that renewal process and renewed um application. There may be other ones who are coming forward who who did not who initially did not and I think we would you know entertain requests um as they come up uh to that. We have not received um other ones in there. They recognize that we're in a transition process, too. Um, you know, I think to first to say this is not a guaranteed funding. So, so there's not um a requirement on the Ontario Public Health standards for us to have Toronto Urban Health funding as part of it. What this funding does is allow us to extend the work of Toronto Public Health with community partners for things that are part of the Ontario public health standards, but where we are not the most um best situated uh deliverer of those those services. So, it's a way of extending the services of Toronto Public Health through those ones. So, it is something we do need to review um annually to say, you know, are the things that we're funding still in line and within our mandates of Ontario public health standards? We're going to need to refresh that once the new standards do come out to make sure that what we are investing in is that extension of public health work in the community. Um, and so I think that we're we're also part of the evaluation is to help reset expectations that people um some organizations have been funded year-over-year for many years and and have become somewhat reliant on that funding and we we don't want to leave them in the lurch in terms of transitions, but we I think we also have to recognize that that we might need to reevaluate our needs and and as new process goes to make sure we're funding the right things. >> Thank you. Um I have one or two questions. So the tough funding was isn't it was initially for HIV and AIDS. Is that correct? And we're going and so we've kind of lost uh I would say the loss but we've deviated over the years from that and now we're kind of heading back in that direction. Is that accurate or somewhat accurate? >> Yeah, that is one of the uh original goals for the Toronto Urban Health Fund was to help um support HIV AIDS as one of a primary goal and target of that funding. It has been expanded over time um to related areas like substance use and harm reduction which are obviously very closely related to to the prevention of HIV um as well as to to other areas that has been been looked at in terms of how that that funding has been allocated. Uh certainly re bringing back and and the refocus um with this current pilot project on HIV and AIDS is to help um increase that investment in this area. It's become one of the the smaller proportions of the current tough funding programs that we have and certainly feel for where we are in the epidemic and how close we are in terms of potentially achieving um elimination status that this investment is is an important way to get back to the goals of that original tough funding as well as the goals of Toronto Public Health as HIV is an disease of public health significance that we are have mandates to prevent, treat and care for. >> Okay. and talking to some of our community partners over the last uh year or two, it I was informed that HIV uh infection rates are actually up in the city of Toronto. Can you speak to that >> to the chair? We we have had fluctuating um numbers in terms of HIV in the last couple years. We did see declines through COVID and that was probably largely due to an under testing because people were not didn't have the same access to care. Um since COVID we have had some increases in in HIV rates and again part of that may have been missed diagnoses that would have happened otherwise as we've increased it. We also have seen um increasing in um new importations of people um from other countries who with HIV infections known infections but new to Toronto in terms of being um individuals who require care in their city. But we also seen you know with um ongoing uh drug crisis with ongoing um homelessness crisis that there are individuals who are continuing to become infected with HIV either through introvenous drug sharing or other um mechanisms um associated with those those uh epidemics happening and really the the need for renewal and refocus on that. So, you know, two of the the um primary target areas of Toronto to zero is in care for newcomers uh because we know that this is a significant area where we have many um people coming to the city with HIV infection as well as care for people with complex needs and that complex needs can include things like substance use or homelessness and those are some certainly focus areas for us in terms of wanting to invest in HIV care. >> Okay. Thank you. Going to ask a question. you don't have to answer it. So with the closures of SCSI, do you anticipate that uh there'll be an increase in HIV um uh cases in the city? >> Um that's a challenging question. I mean I think we you know we're certainly doing our best to try to uh increase our delivery of harm reduction supplies that does prevent that transmission. Um we have seen people have shifted somewhat more so to inhalation instead of introvenous drug use. Um but we and we do hand out harm reduction supplies for both of those. But you know as as we are limited in places that we can offer those services then there can be more risk for individuals if they're not um you know finding regular ways to be able to access those supplies if we're we're kind of more limited through some of our partners or outreach services. >> Okay. Thank you. Um, seeing no other questions, um, we're going to go to speakers. Uh, Deputy Director Oz, do you have your motion? >> I have I emailed it to the clerk. >> Did you receive it? >> We'll have to hold it down because uh, it might need some >> Oh, yeah. I see the respondent. Yes. Yes. Gina, you can share the motion with the public health. >> Is the wording okay, though? You have to Um, I will hold this item down while staff is uh looking at it. So, we'll go over to item HL 33.4, Four, implementation of a food safety management plan for special events. Uh, who held that item down? Councelor Chang, go ahead. Ask a question. >> Thank you. Just have a few questions. So, I'm just wondering how often are large events inspected and how big is the team on public health that does these inspections? the chair. Um, in 202 in 2025, we inspected approximately 21 uh large special events. In 2026, we are anticipating to inspect uh 26 uh large special events. The the key thing is is that not all special events are the same. Um, special events will range anywhere from like a charity bike ride that occurred over the Gardener and Dawn Valley Parkway this past weekend. Um, all the way up to large street v uh venues. Um, and so there's a lot of uh preventative measures that are taken in well in advance of the events themselves. um looking at uh the types of vendors and that and having those discussions with vendors and having that preventative approach is part of the key approaches that Toronto Public Health has implemented uh to help with the surge of special events in the city of Toronto. >> And so is the staff team the same staff as Dine Safe or is it a separate team? >> Um you are correct, counselor. It is these same um food safety inspectors that are out every day um conducting inspections at restaurants under the dine safe inspection system um that um do the on call work over the weekend or the overtime work over the weekend to inspect those food premises. Fortunately, there are a number of special events that do occur on um begin on the weekdays. So we will get out to those during regular office hours. But again, it is the same group of staff that are conducting the routine inspections. >> And how many uh food inspectors do we have? >> So currently right now we have approximately 72 um inspectors working in the field uh conducting inspections on a daily basis. Um, and that's to account for the um over 18,000 food premises that we have in the city and not including all the special events and seasonal events or seasonal uh food premises that often operate every year in the city of Toronto. >> And how were the uh special event organizers invited to participate in the food safety management plan tool? Was it through the permitting office uh for the locations that hold these large events or was there another mechanism that triggered this invitation? >> Yep. So in late 2024 um with our colleagues at economic and development, we actually met with a number of special event organizers and introduced them to the tool and the electronic uh components that make it easy for them to um partake in in completing the food safety management plan. Um, last year in 2025, we did reach out to a number of our our regular events that happened across the city of Toronto uh to invite them to to try out the tool to see what they thought about it and to provide any feedback. Um, and there was a survey done of those individuals at the end of the at the end of this uh special event season. And we also had a number because this information was actually posted live on our website for all special events happening in the city of Toronto. We did have a number of organizers that just voluntarily undertook um the the participated in in the food safety management plan without any encouragement or knowledge of it being in place. >> And so are we then the next step is extending it into the permitting system so that there is a more formal invitation as organizers permit locations in the city. that that is the goal is to work with our colleagues um that offer uh permits across the city for for a city property um for events held on city property. And so our goal is to um have further discussions with them to see about implementing this as one of the requirements for those permits. Um the the key component is is that this is really only focusing on events that happen on city property, but the tool itself is very useful for all special events, whether they're public, private, um events that are held on city property or on private property. >> And do we inspect large events that are not on city property? >> Yes, those those happen regularly every year. um large events even things like um uh events that happen at the distillery market um things that happen at Metro Toronto Convention Center. We have a number of events at Enterare where we're con constantly in there conducting um inspections during the business days of those events. >> Great. Thank you. Those are all my questions. >> Thank you. Any other questions of staff? Seeing none. Okay. So I will ask director Mador to move that item approval. Yep. All those in favor? Those carried. Thank you. We'll go back to item HL 33.3. Um Director Oay. Um we'll put your motion on the screen and you can speak to it. Here we go. Okay. That's a blank page. >> I can confirm I didn't send a blank motion. Oh, it's coming blizzard as some people call it. >> It's coming. There it is. Go ahead. >> Okay. Thank you so much and thank you so much to the clerk for accommodating the late motion. Um yeah, this motion is really about uh accountability as we move through this interim tough approach and the OM pilot and I feel it'll be um like as we're approving this uh funding and the new pilot as well. It would be great for the board to also understand what we'll be learning from it. Um I also want to make sure that we hear back from the we have back on the experience of the community based organizations um that we work with uh especially OTN uh around the administrative burdens and whether the model is actually working for them. And so it just helps that when it's going to help us when staff come back in 2027 that we have a clearer picture of you know what the outcomes are, what the lessons learned are and what was what would shape the uh 2028 cycle. Okay. Okay. Great. Uh any other speakers on the item? None. Okay. We'll put the motion back on the screen and we can vote on it. All those in favor? Those carried. Item as amended. All those in favor? Those carried. Wonderful. Okay, we're going to go back to item number one. Uh, HL 31.1 Toronto Public Health Nursing Recruitment and Retention Strategy. I'm going to ask Dr. Murdy to introduce the U presenters. >> Thank you so much. We have today speaking on this item Joanne Figaniano Scott who is director of community health and well-being as well as our chief nursing officer and Myron Palisandrin who's our director of operations and business support. Thank you. Good morning, chair and members of the board. This presentation is in response to a board of health motion requesting an update on the Toronto Public Health's nursing workforce and the development of a nursing recruitment and retention strategy. Slide, please. We will provide an overview of Toronto Public Health's nursing workforce, highlight key workforce trends and pressures, and outline the nursing recruitment and retention strategy. Nurses are central to delivering TPH's programs and services, and contribute to improved population health outcomes. They work in close collaboration and interdisiplinary colleagues to advance the organization's mandate to improve the health and well-being of Torononians and advance population health outcomes. Next slide, please. Toronto Public Health has developed a nursing recruitment strategy. The strategy is organized across these six pillars which reflect key areas of focus for recruitment, retention, and nursing workforce development. We'll now walk you through each of these pillars. Next slide, please. The first pillar focus on monitoring nursing workforce across TPH. Understanding the composition of our nurses workforce in a is an important foundation for workforce planning, sustainability, and future service delivery. All nurses at TPH who are regulated who are regulated health professionals practice in accordance with provincial legislation and the standards set by the college of nurses of Ontario. There are two public health nurses classifications at TPH. Public health nurses and registered practical nurses. Public health public health nurse positions at TPH are held by registered nurses who have a bachelorette degree in nursing and meet legislative requirements to use this title. The PHN's practice with a high level of professional responsibility and are skilled in adapting to complex and changing environments. Their roles include assessing individual, community and population health needs, planning and delivering high quality public health programs. Registered practical nurses or RPNs hold a practical nursing degree, sorry, diploma and are also licensed and regulated in Ontario. The RPN's practice within a defined scope of practice that is appropriate for stable and predictable care needs with consultation or collaboration with RNs as complexity increases. Both PHN's and RPN roles at TPH deliver public health programs and services, promote health, prevent disease, support emergency response and community well-being. Next slide, please. It is also to it is also important to note that health human resource pressures exist across the health sector. Toronto Public Health has strong recruitment outcomes and we continue to stabilize our nursing workforce. Another important component for the nursing workforce is compensation. Compensation for Toronto Public Health nurses is determined through the city of Toronto's collective bargaining process. This process is led by corporate labor relations and is conducted with QP local 79 which represents public health nurses and registered practical nurses. The most recent collective agreement includes a 6.14% wage increase for 2025 for public health nurses as part of a total increase of approximately 17.9% over the 4-year collective agreement period. This agreement also includes enhancements for benefits. These outcomes contribute to recruitment and retention of nurses at Toronto Public Health. Toronto Public Health monitors key indicators to understand and support the nursing workforce. As of 2025, the workforce includes 585 nurses comprised of 376 public health nurses, 94 registered practical nurses, 54 specialists, and 61 staff in leadership and other roles. Nurses represent the largest regulated health profession workforce at Toronto Public Health. Recruitment remains strong, supported by a high volume of applications, including both internal and external candidates. Turnover has declined from 2024 2025 for both PHNs and RPNs, indicating improved workforce stability. The decrease in RN turnover reflects temporary COVID related positions and 2025 over half of nursing turnover was a result of retirements. It is important to note that the level of retirement is consistent with what's being reported across the health care system. This is not unique to TPH. Recognizing the current retirement eligible eligibility rate for nurses, we are actively planning for future workforce transitions with approximately 16% of PHN's eligible to retire within the next 5 years. TPH is also strengthening our workforce by successfully recruiting nurses, converting more roles to permanent positions, reducing turnover, and proactively planning for upcoming retirements. Building on these workforce trends, the next pillar of the recruitment and retention strategy focuses on promoting public health nursing and strengthening the pipeline into the workforce. This includes engagement across the education pathway from early outreach through to nursing education, student placements, and consolidation opportunities. TPH is working in partnership with academic institutions to increase student placements and increase consolidation opportunities which support students to transitioning to practice. These efforts strengthen the pipeline of nurses entering public health and position public health nursing as a career of choice. Next slide, please. Building on efforts to strengthen the pipeline, the third pillar focuses on recruitment, including Toronto Public Health's efforts to attract and hire nurses to meet current and future service needs to support program and service delivery. Recruitment remains strong with over 2,400 applications received in 2025 across both internal and external candidates. Toronto Public Health continues to recruit for both permanent and temporary positions to address current vacancies. At the same time, targeted efforts are underway to address specific recruitment challenges, particularly in attracting French-speaking nurses. These efforts support both immediate staffing needs and longerterm workforce planning. Once recruited, Toronto Public Health is also focused on supporting nurses through onboarding, mentorship, and professional development. Next slide, please. In addition to recruitment efforts, the fourth pillar focuses on strengthening nursing practice through onboarding, mentorship, and professional professional development. This includes both corporate and program level onboarding as well as mentorship through peer and team-based supports. Training and uh professional development opportunities are provided to support ongoing learning. Recent examples include trauma-informed care and skills development. Toronto Public Health is also a best practice spotlight organization. Best practice spotlight organizations are selected for demonstrating leadership and excellence in the implementation, evaluation, and ongoing monitoring of RNAO best practice guidelines. Implementation of these guidelines is supported through 275 trained champions across the organization. The majority of these whom are nurses. Together, these efforts strengthen nursing practice, support engagement, and contri and contribute to retention across the workforce. Next slide, please. The fifth pillar recognizes and celebrates the contributions of nursing of its nursing workforce as part of fostering a positive workplace culture. Recognition programs includes initiatives such as cheers to peers, employee shoutouts, and and the above and beyond recognition program. Nurses are also recognized annually through through nursing week events held in May. This year's theme was the power of nurses to transform health and multiple activities occurred across the organization including uh professional development and nursing practice webinars, team- based activities and office celebrations. Ongoing acknowledgement is supported through leadership communication including regular messaging from the medical officer of health and other internal communication channels. These efforts contribute to a positive workplace culture and support engagement across Toronto Public Health. Beyond internal efforts to foster a positive workplace culture, Toronto Public Health works closely with strategic partners to advance nursing practice and support the broader public health system. Next slide, please. The final pillar of our recruitment and retention strategy focuses on strategic partnerships to advance nursing practice and workforce planning. Toronto Public Health is a leader in public health nursing practice and works closely with strategic partners at the local, provincial, and national levels. TPH aligns with provincial and national strategies for recruitment and retention. And as mentioned previously, Toronto Public Health is recognized as a best practice spotlight organization and has held this designation since 2009, refle reflecting Toronto Public Health's strong commitment to implementing best practices. Toronto Public Health is one of only five health units that has received this designation. Public health nursing leadership is also represented across key organizations including the Ontario Association of Public Health Nursing Leaders, the Community Health Nurses of Canada Association and the Canadian Nurses Association. Through participation in these organization, Toronto Public Health shares and receives information on the broader public health, nursing, and nursing landscape to inform internal policies, workforce strategies, and nursing practice. Most recently, we have provided feedback on the uh community health nursing associ association of Canada's public health nursing competencies. Toronto Public Health continues to monitor workforce trends to remain responsive to broader system pressures and we are proactively responding while continuing to lead. Next slide, please. We want to take this opportunity to thank our nurses working at Toronto Public Health. They make incredible contributions daily to advancing health across the Toronto AC to advancing health across Toronto and we thank them very much for their efforts. Thank you. Thank you Joanne. Thank you Myin. Um we do have two speakers on the item. First up is uh Arlene Dus and then Marie Moody. Okay, you have five minutes. Uh, swipe and the green light should be on. >> Good morning, councelor Moyes, Dr. Murdy, and members of the board of health. My name is Arlene Diaz and I'm a public health nurse working in the investing in families program with families receiving Ontario Works. Last year, my colleagues and I made a few deputations to the board of health and budget committee about recruitment and retention in issues at Toronto Public Health. We appreciated that counselors Lily Chang, Anthony Brutza, Jamal Meyers, and Dr. Stephanie Xiao all asked important questions regarding our concerns. Over the past eight months, our chief nursing officer, Joanne Figliano Scott, and her team have been working tirelessly to recruit more staff and students and fill temporary positions with permanent ones. I'd like to thank her for her efforts to improve transparency with staff and inviting us to share ideas with leadership. While recruitment is the process of attracting, selecting, and hiring external candidates, retention is the practice of keeping your existing employees engaged, satisfied, and employed long term. As outlined in the report, workplace culture, opportunities for career development, work life balance, and recognition are all key retention strategies. However, the most important one right now in this age of inflation is salary competitiveness. Let me tell you why. When I decided to become a nurse, I went to a three-year college program in Scar Bro. My mother encouraged me to continue my studies and complete the 2-year postr university degree program, which I did. In college, I didn't know much about community or population health at the time. Fortunately, all my placements in university were at Toronto Public Health. Upon graduation and after studying nursing for 5 years, all with unpaid placements, I was hired to work at Toronto Public Health in 2003. I started on the Danforth with many senior nurses who mentored and trained me and taught me the foundational knowledge that I know today. It's been 23 years and many of those nurses have since retired, many spanning careers over 30 years. Because of our competitive salary at the time, I was able to buy my first detached house in Scar Bro with my husband at 25 years old. We raised our family, two kids, and two cats, all remaining close to my parents' home. Unfortunately, during COVID, I got a divorce, had to sell my matrimonial home, and because of our current low salary and inflation, I could not afford to stay in Scar Bro and had to move to Whitby. Can you believe after 23 years of working at the city of Toronto as a public health nurse, I couldn't even qualify for a mortgage to buy another home? Since then, I've been working at the hospital on the weekends to make ends meet. To think at nearly 50 years old, I have to work two jobs 7 days a week as a single mom. I have more I have seven more years to go until retirement. And instead of winding down, I've had to wind up looking for part-time jobs to earn extra money. This is the sad reality of many of my nursing colleagues at Toronto Public Health and even in long-term care. Nursing is one of the most trusted professions. We are not requiring or requesting a wage adjustment outside of contract negotiations just for greed. Similar to the counselors, we are requesting this out of necessity. Although we secured a wage increase during contract negotiations, it was not at par with inflation. And this was not because our union didn't ask for it. Our division was not classified as having a retention and recruit recruitment issue at the time. Retirements and resignations are happening now. Baby boomers are retiring. Students are choosing hospital-based positions where they can work overtime and have higher earning potential for their degrees and for positions held such as being team leaders. While our starting wages are similar, the union union's report shows how this gap widens with years of service where the shortfall is the most dramatic for the most experienced workers like me. Weightless are present, burnout and low morale are a constant and additional work and inflexible work schedules are our present-day realities. In closing, we would like the board to consider conducting a formal wage comparability review and report with our surrounding health units, hospitals, provincial agencies, and other municipalities to analyze our current wage compression. Our job profile was written 22 years ago in 2004. A lot has changed with our roles since then. We serve a growing and diverse population and deserve fair compensation for the care and responsibility we carry to serve the constituents and residents of the city of Toronto now because they are worth it and so are we. Thank you for your attention. >> Thank you. Any questions for the deputent? >> I I just may have one. So your um contract was negotiated through QP79 and I think that's for four years, >> right? >> So how how how are we to work outside of those uh um contract negotiations? Again, it it it's negotiated through 79 with the city and now you're locked in to my understanding. So how How are we supposed to work around that? >> I believe that as the board of health, you have the power to work outside of the contract and be able to make adjustments just like was done with the paramedical department. Uh the 911 dispatchers um they had a recruitment and retention issue and um there was adjustments that was made. So, >> but again, even through that, they hadn't signed on. They my understanding um that came after the fact within the negotiations but I may be wrong. I guess I could ask about that. >> I don't know all your powers but I believe in you and so I I I I participate in the elections. Our team of nurses is actually we're doing adopt a poll. I don't know if any other polling site will have a team of all nurses. So I believe in the political process and I think anything's possible. So that's why we're asking. >> Okay. Thank you. I think I saw director Oz has hands up. You have a question director? >> No, no, no. I didn't have hands up. Thanks. >> Thank you. Uh next up is uh Marne Moody. >> Uh thank you councelor Moyes and the board for allowing me to speak today. My name is Marne Moody and I'm a public health nurse that has been with the city for 24 years now. Um I'm here to discuss the role that low compensation plays in recruitment and retention. I want to first thank Dr. Murdy, Joanne, and all the other staff for all their hard work on the formalized recruitment and retention strategy. Um I've always found Joanne to be receptive to feedback and encouraged us to share our concerns. Uh even though sometimes I'm sure we tire you out. Um but um I believe she is sincere in her concern for staff well-being and the quality of our programs. Um our time allotted does not give us time to share more than our concerns. That's the reality. Um so I want to make sure that it's clear that I do appreciate those in management that try to make our workplace better, which in turn allows us to provide a better service to our clients and the constituents that we are accountable to. I want to thank you for acknowledging the complex, challenging, diverse, and often emotionally draining work we do. And as you see, it takes a document to just provide a highle summary. I want to also acknowledge and thank you for the recruitment and retention efforts because the summary does actually not do justice to all the hard work being done. As for the data, I'm happy to see we don't seem to have a retention issue at this time. I believe the perception of a current retention issue was a result of there being almost 15 to 20% less PHN's early 2025 compared to prepandemic levels. Uh we'd still like to see some more transparency around the data to have a better understanding of the decrease in PHN's that has led to mass hiring. Um I know it is partly due to more staff taking specialists and management positions. Um but we do need uh PHNS to do the direct client work. Um in terms of the document and and nursing hires, I would would like to see a breakdown of the designations of the new hires because there's some distinguishment in the document for PHNS and then some things are lumped together. Um we would like to see uh some more detailed data over the last 10 years of the number of PHNs employed at the beginning of the comparison period versus today. um number of specialists, number of management with varied backgrounds, population size of Toronto at those same time points, the ratio of PHNS to population over time, vacancy rates and turnover rates over time, and the number of experienced nurses leaving for other health units or even if we're losing them out of nursing into other sectors. I think the more transparency on staffing uh would be helpful to decrease false information ideas and it would also help provide evidence to the province and constituents why the health unit needs more appropriate funding. Uh the board was also provided with a petition demonstrating clear dissatisfaction among existing staff regarding compensation and 99% of PHN's signed that petition. I'm also unsure where the 17.9% increase is from. We are receiving the same percentage increase as other union members with the exception of we were given an extra dollar. This increase did not address the long-standing wage disparity of Toronto PHNS. As a result, the wage gap remains a significance concern despite the general increases. Currently, Waterlue and Chadam are being paid $8 more an hour than our senior PHNS. And if you're comparing current contracts, we are actually we're not senet anymore at the lowest. We've been bumped second uh up to third place as the lowest PHNS uh paid PHNS in Ontario and across Canada, Quebec excluded. They have their own system. An aside, I also want to make sure everyone here knows over the last eight years, fire services, Toronto Police Services, and actually even TTC has received almost a 10% wage increase higher than local 79 members. Um, all of those are male dominated unions where ours is about 66 to 69% female and that is just wage, forget benefit comparison, etc. Not that I am begrudging them. in their increase cuz some of them are also not receiving proper compensation. But why the difference? Something to ponder. I still argue that as PHN vacancies occur across uh the province with retirements will lose many talented experienced uh staff. Uh when reviewing other business sectors, chronic low compensation has shown to led to low low morale, decreased engagement and productivity and decreased interest in mentoring students and training staff. I hope the city and the board of health does not wait until the nursing program is in crisis like happened with 911 dispatch before rectifying the issue. I am happy to see Dr. Mury has wants this to remain as an agenda item and I also hope that Dr. Murdy will meet with public health workers and QP79 leadership to discuss the role that compensation changes can play in improving retention and recruitment. And thank you for letting me go over time. >> Welcome. Thank you for your deputation. Any questions for deputent? Uh, council Chang, go ahead. >> Thank you for your deputation. Can you just repeat again the metric points that you hope to see included in future updates? >> Uh, so you talked about Yeah, P, you had a whole list of metrics. to just I I would like to see uh maybe a analysis over the last 10 years because I know CO skews the numbers. Um but it would be good to see the number of PHNs employed at the beginning of the comparison period versus today. Um the number of specialists cuz we know that some of the nurses have moved to specialist positions and there has been some increase. um the number of management with varied backgrounds because I know it's important to encourage nurses into more management positions and I think some some of that's been lost over time. the population size of Toronto at the same time points because in previous deputation we brought up that uh our PHN ratio is um lower in compared comparison to some other health units for the population. uh the ratio of P ph PHN's sorry uh the ratio of PHNS to population over time, vacancy rates and turnover rates over time and the number of experienced nurses leaving for other health units or other sectors. >> Great. Thank you very much. It's very helpful. Those are all my questions. >> Thank you. Uh Councelor Thompson, go ahead. >> Thank you very much, Mr. Chair through you. Um thank you for your presentation. Um I want to just before I ask you my question I'm fairly biased towards nurses. My mother was a nurse so I can tell you that um I understand and uh for many years during the 70s they went through a whole issue with the hospitals in terms of not providing a wage increase for them and then know the impact on families and so on. So I just wanted to set the table with that particular perspective and so on. Um, so can you tell me just situate for me, are you connected with local 79 as a member of the bargaining team or you just a nurse who's actually here to give us your perspective on the wage disparity? >> I I am a nurse. I'm not part of the bargaining committee in in in Arleene. Yeah, we're just providing our perspectives what we've seen. We've both been with the city for a long time and we've seen our wages like we were originally one of the higher paid PHNs in the province and now we're one of the lowest. So that has our percentage is if you look at because we're under the full union contracts with negotiations we get the same as everybody else. As I was saying we got an extra dollar this time. Uh, and uh, that's not compounded. That just goes on each year. We just get an extra dollar. So that's the extra dollar for senior staff versus an extra dollar for for new staff or maybe novice staff. >> Um, and >> you don't really get an extra dollar though. I mean, you have to pay taxes as well, right? Doesn't keep up with the rate of inflation and so on. Um, okay. Thank you very much for that. Um I I'm curious then with respect to the conversation that we're having, which is important that the reports reflect that. Tell me about the conversation you're having with respect to local uh 79 and that leadership with respect to its bargaining on your behalf. help me to understand that because seems to me that there is a bit of a disconnect and this is not the first time we've actually had nurses come forward to us to say that they're not satisfied and it gives us the comparators and so on so forth but I've never asked the question before in terms of what is the relationship and how are you transacting this conversation and concern with respect to the union leadership because when you have these agreements it's very challenging for us as a body to look at intervening in that until next time with respect to the contractual goaround. >> Um the union is here with us and they're very aware of the wage disparity that we are having. Um that was at the brought forward during negotiations. We are 400 of 30,000 people. So uh if we even if we may have not been happy with what may have been negotiated uh if it was good for the other people then we we have we're we're brought along with the tide. So um but they are aware I know um and they are very willing to meet with management about addressing the issue. >> All right. So I'm confused. During negotiation they're addressing your issue, >> but you've said to me now obviously they are aware of your issues. >> Now they're going to potentially based on your answer meet with management to basically discuss your issue. One would presume that at the start irrespective of whether or not you're of a 400 number unit within the complex of a larger group. So if I look at paramedics, a similar situation with respect to paramedics that they've gone through over the years and I know I've been around for that. I'm just wondering though as part of the discussion with your union leadership. >> Mhm. >> Do you not then take out the value added because you're saying to me there's a particular value additive to that 400 unit that is different in terms of how they're treated in terms of salaries. >> That's not what I'm I'm No. >> Well, it has to be because you said >> sorry. Okay, let me clarify then if if you misunderstood. >> Uh they're negotiating for all of us >> and there's back and forth between the union and the city >> and this is what they were able to achieve at that time and negotiate with the city. There is the ability of adjusting outside of the contract. It has been done with MLS and other departments. uh a lot of other departments are going through the same process. So at this time, so there is the ability to negotiate a different wage out of contract. >> Okay, that's very helpful. Thank you. Thank you very much. Thank you, Mr. Chair. >> Thank you, Council Thompson brought up an important point. Um I'd like to tease out a little bit. So 79 have negotiated a contract. Is does the nursing does does TPH nurses is there a subset within 79 to actually negotiate for you? >> We don't have a separate contract. >> I understand that. But again be like you mentioned uh term paramedic they had a a special I guess uh >> so there's paramedics which are a separate contract 416 and then there's the dispatchers which is under our local 79. >> So paramedic is part of 416. Is that is that what you just >> I believe paramedics but dispatchers >> the 91 dispatchers are under local 79. >> Okay. internal >> internal but going forward though I mean like it seems to me that just based what I'm hearing that I think uh nurses should actually have a special seat at the table when it comes to negotiations because your needs are different than everybody else's. >> Would you agree with that? Is that something you'd work towards perhaps with next contract? Um, it would be awesome if we could have a seat at the table, too. Uh, it's the the you're I'm trying to clarify if you're wanting me to defend the efforts of our union and the efforts that they put towards for us at the table. um you would have to talk them to them directly about how much they did or did not discuss at the table, but they have been representing us and our concerns even if they were not was not a nurse. We had other public health individuals at the table. >> Okay. Thank you. I think I saw someone else's hands up. Uh Director Gourd, go ahead. >> Yes. Um, I wanted to start by thanking Joanne and the two deputants for the information that you've given us and uh, they've both been excellent. I really appreciate hearing about some of the concerns that the nurses have uh, as well as the financial compensation, the other concerns you've expressed. That was one of my questions. What are nurses asking for outside of financial compensation that have to do with service access and quality and public health preparedness? Perhaps I'm curious if the public health nurses in the neighboring health units are part of QP or are they part of OA and do you know what union is representing those nurses in the neighboring health units? Um, most of the public health nurses are represented by ONA, their contracts. I think there's about five of us that are under QP. I don't count, don't like quote me on that, though. I know there's some other health units that are QP. Okay. All righty. Seeing no other questions of the deputent. Thank you for except taking our questions. Um, all righty. We'll take it in-house now. Questions of staff. Director Tangerbal. >> Um, thank you to the deputens and thank you to Murin and uh Joanne as well. I had a quick question on I think slide six. Um, for the turnover declining report, uh, public health nurses was 9.8 9.8% to 8.7%. But for the RPNs, it was 27% to 3.4%. I know we kind of glazed over it. there was reference to maybe might be because of COVID, but I was just wondering if you can give us the years that this is compared to and what the reason may have been for the 27% in specific. >> Thank you. And to the chair, I think you're asking a slide six where I mentioned that RPN's reduced from 27% to 3.4. Is that the right >> that was mostly related to the large significance we had in COVID the number of nursing positions and in 2025 the drop then reduced further as a result of retirement so 24 to 25 >> um and then I'll ask a quick question in relation to um something that the deputants had mentioned do we have any data on um how many nurses go to other public health units I know that's a hard thing to ask or if there's any change if there's been any uh transition from nursing roles to other roles within public health or within the city. >> Thank you again to the chair. We do do exit interviews uh and it's based on that data collection. It's not an official of where they're going. Some candidates may not be as forthcoming where others may be. So I wouldn't say it's a reliable data point for us to have that kind of information. Do we have a data point on just how many people have left like mid-career like not retirement but how many public health nurses have left period? >> Thank you for the question. I'd had to check on that. I'm not sure what data is available on that because it'll be a factor of one is age but does not necessarily represent the number of years of service or experience level. >> Okay. Thank you. I uh just a little bit of context. The reason I'm asking is if we can try to make an educated guess on where people may have going or like what kind of trends we can be seeing if we saw how many people were exiting and where in their career they were when they were exiting. But thank you. >> Thank you. Uh any further questions of staff d um councelor Thompson? >> Uh yes. Thank you Mr. Chair through you. I think maybe this is for I don't know Dr. you want to take this but um what are the resources that we allocate for um to support sort of recruitment for nurses? >> The chair uh as the the presentation outlined we are investing quite a bit right now um in our pipeline for nursing recruitment. Uh we were very successful in terms of the numbers we've just hired in terms of over um 70 permanent and another 40 forthcoming um in 2026. We do recognize that um nursing curriculum has changed and so we've been reinvesting that time with many of our nursing uh colleges. Uh our nursing practice leadership was just at a conference where they met with many of the nursing colleges across the country and particularly those locally in Toronto to help look at what they're providing in terms of exposure to public health nursing as a career pathway. We've tried to um increase the number of placements for student nurses to have that practicum experience at public health nursing so that they get more exposed to that as a career option um and being able to to bring them forward uh as as hiring now. So I think certainly with the volume of retirements that we're anticipating over the next 5 years, this is certainly a key initiative for us to be able to have more student nurses thinking about public health nursing going forward. So you have a strong recruitment and retention strategy that's actually in place or it's being I guess it continues to evolve and you change and implement and improve on an ongoing basis. >> The chair that's correct and I think it's been fairly successful. I mean we've had I've had a number of hiring um through 2025 and now into 2026 as well. So um seeing the volume of applicants, seeing the quality of applicants, seeing that we are able to fill positions, um through the applicants that we have, I think is a a good success factor. >> Right. So we're talking about a number of things here today and it's a very complex issue of course um recruitment retention um dissatisfaction um and concern about uh wages and what's being paid and comparators and so on. What's the average hourly rate for one of your Toronto Public Health nurses? Do I don't know if you have that information. >> Uh, that would be an inc camera question. I'm >> Well, that's funny because Google has it. >> Google has it? >> Of course. So, I just wanted to compare it and see if it was Google correct. Um, Google says, cuz I Googled it, it says here that the average hourly wages is between uh $42 of to $46, which according to Google, it says it's higher than the national average for public health. I don't know. Can you tell me yay or nay on that one? You don't have to give me that specific. Yes, >> perhaps through the chair, counselor, uh, the entry wage rate for 2025 is $46 an hour. >> I got you. >> Pops out at about $50 an hour. That's for 2025 and it will continue to increase for the remainder of the collect >> based on experience on the agreement. Okay. Gotcha. Then and and thank you. Thank you Dr. Mur. So through you just staff. Um can you then help me to understand then as it relates to uh a breakout on a separation in an agreement? Let's say they're standard four years. Are they standard agreement for our >> varying? Yes. For the chair. Typically collective agreements are about four years, but they can be longer or shorter. >> Gotcha. Thank you. How do you kind of separate or break out a specific unit as part of bargaining and as part of a union representing a specific unit within the organization? We've seen this years ago with respect to the paramedics and they had a view. They would come in similar to some of the nurses that were coming in. they felt that they were being utilized in a way to create opportunities that were not in their best interest because it seems to be somewhat that's being intimated here. I'm curious then in terms of how do we as this body intervene with respect to a contract that has been signed and approved by membership. How do we change that >> through the chair councelor? Uh the city negotiated the most recent collective agreement with QP local 79. The board does not have the power to unilaterally intervene in that respect. Uh of course the public health nurses work for the city, >> right? >> So we are in charge of of that collective bargaining process. Uh but there is no ability for the board itself to have a seat at the table or to unilaterally amend the terms. >> Right. and and and and in addition to that, there would be no opportunity for an individual as part of the nurse's group to be brought to the table to negotiate their interest because they have a a union that's actually doing that on their behalf. Would that be correct >> to the chair? Yes. I would say it's up to the union to assign individuals to the bargaining team, >> right? >> So, whoever the union chooses to bring to the table is of course up to them, >> right? And just to just follow through, I know we're at five minutes, but if the nurs's group, the 400 plus or 400, if they're unhappy and dissatisfied with respect to the process in terms of bargaining, they would need to take that out with respect to the interest that is the local that that's representing their interest in order to advocate for much more in terms of benefits and wages and so on. That would be the the normal practice. Would that be correct? to the chair. I would say individual groups of employees within the bargaining unit are free to bring their concerns to the elected uh representatives at QP local 79. >> Right. >> Okay. Thank you. Thank you, Mr. Chair. Any other questions of staff? I guess >> Oh, I'll just I think there were other hands ahead of me, but I just put me on list. >> Go ahead, councelor Bev. >> No, please. I saw uh councelor Chang and director Zad ahead of me. I'll just wait. I don't know who was first, but sure. Councelor Chang, go ahead. >> Thank you. Through the chair. Does the funding that we get from the province grow with our population or any wage increases that are negotiated to the chair. um the funding that we have proincially uh for it in the last three years we've received a 1% increase of base funding um for 24 25 and 26. We do not currently have information for 2027 and therefore the provincial percentage is decreasing over time because we are increasing in terms of our population and in terms of our negotiated collective agreement. Is that correct >> the chair? Yes. Uh in terms of maintaining uh the collective bargaining agreement that there is a differential uh supplement by the city um or we have to maintain uh as part of our overall city budget the the total amount that we are um being allocated and looking being asked to find different kinds of efficiencies within that as well. Is there a survey that is done of public health nurses to capture morale and identify challenges to the chair? The employee engagement survey provides an opportunity for public health staff including nurses to share some feedback. Uh TPH leadership also has had monthly nursing practice council meetings, hosted special meetings to discuss nursing recruitment and retention and invited guest nurses from across program areas to attend. Uh over the last year, my colleague Joanne and I have had the chance to make a couple of visits on site as well to the various seven offices where nurses do work and we've tried to create multiple touch points and opportunities to hear directly from staff outside of the actual survey itself. How often is the survey done and does the board have an opportunity to look at the results of those surveys? >> Uh to the chair, I I'm not certain how often the survey is done. We have about three or four touch points throughout the year. Um with regards to sharing the survey results, um I'll have to get back to you on that. I I'm I'm thinking maybe not sure. >> Okay. And there was a mention of the uh ratio of residents to public health nurses. So how do we compare with other regions? The chair um we've moved away from looking at population size as being the the main factor. We know that there are many other determinants of um needs across public health units. Um especially the 29 health units across Ontario. Some are more urban, some are more mixed, urban, rural, some are more rural. Uh so true population size doesn't necessarily take into account other aspects of equity. The way we deliver programs. Um the types of staff that we are using. For example, Toronto Public Health is one of the few uh public health units that uses RPNs. Um other public health units only have PHNS. So certainly that that that exact ratio is not probably our best comparator. I think we're really looking at, you know, how efficiently and effectively are we delivering the programs of the Ontario public health standards. >> But wouldn't Toronto be more complex and require more support because of how diverse our city is compared to uh other municipalities that are less complex and diverse? the chair. Um certainly the the number of equity deserving populations is is a greater complexity. Um however, other factors like geography in terms of how much time nurses are spending traveling to different appointments is different in other health units. Uh so there are many different factors I think that we're looking at it. I think we're also being encouraged to really think differently about how we're delivering our services. Um we've seen that we've had you know essentially flat growth from the province in terms of our public health funding. We are still waiting on Ontario public health standards, but we know that there are changes within that that are asking us to look at how the way we're doing our work is different. Uh, and I think that those are all reasons that we can't necessarily be static and say that, you know, the number of nurses we had 10 years ago or 20 years ago is the number of nurses we need now because we need to be flexible and adaptive to the changing needs of our services and the way we're delivering those services now. >> And and my last question um is about the wages. So, could the board of health request the city to explore opportunities to renegotiate a more competitive wage through the 2027 budget process? Is that even possible? >> Through the chair, there's nothing preventing the board from asking the city to do that. >> Okay. Thank you. That that's all my questions. >> Uh, thank you. Um, where's my list? Uh, Director Oz, thank you. >> Uh, thank you all so much for the presentation. Um, Joan and team, and I want to say thank you as well to the deputendants. So, um, as we've been going through the conversations, there's a couple of things that have come up. uh cost of living, the gender nature of nursing, um recruitment, retention, perhaps burnout, collective agreement, growing service complexity. So my question or my first question is do we know for sure what is the biggest drivers of retention right now? Is it recruitment, competition? Is it culture? Do we know? Thank you for the question to the chair. You know what we've seen as I displayed earlier in our presentation is we do not have a recruitment um issue in the sense of there are numerous applicants both internally and externally who are applying for the roles based on the current structure as it is. So I do not think that is a factor. Um but I will pass it on to my colleagues that want to speak about other aspects. uh through you chair and thank you for the question. Um in terms of retention, we're also uh the data shows that we're also not seeing a retention um challenge at Toronto Public Health. Uh currently we do anticipate a high number of um retirements over the next 5 years, which is in line with what the rest of the um the um the health is experiencing. And I think there's a number of ways we're continuing to um engage with staff to collect information around um the workplace environment. Uh we're looking at new uh technologies uh to reduce the administrative burden in terms of uh that sometimes can uh contribute to workplace wellness. So, we're exploring different types of ways of delivering services, introducing new technologies, and um in introducing new programs in terms of professional uh development opportunities to to um support the nurses in dealing with the changing complexity of community needs. >> Great. Thank you so much. Um and again, back to the presentation. uh I think it was slide five or six that showed that there was strong application volumes and improvement in turnover figures. So how's TPH thinking about what parts of the strategy are having the greatest impact? That way it would help the board understand um what is really driving long-term stability >> to the chair. Um, I think our long-term stability, one of the numbers we're looking at most significantly is the retirements. And again, this is not um, unique to Toronto Public Health. This is across the healthcare sector. We have um, many healthcare professionals who are eligible to retire uh, across the next five years. So really building that pipeline um of newer nurses who would be coming in to fill those roles and ensuring we have um a strong recruitment base to to be able to look from in terms of being that uh preferred employer where nurses who have those choices upon graduation are choosing Toronto. And I think we've we've shown that at least this year in terms of the recruitment efforts that we have. We had a number of um applicants and successful applicants who have been placed into permanent positions within Toronto Public Health and we're only looking to to see how we can continue to to strengthen those. We certainly recognize um you know the the number of new new nurses and certain placements does play a burden on existing staff who have to help train those new staff or help train um nursing placements. Uh so we do recognize that you know getting up to levels of having full complement um is important so that that workload can be shared. Uh we do know we're we're asking you know senior nurses to take on those roles in terms of mentoring and supporting new nurses. But hopefully they also see the benefit of bringing on those nurses and having fuller staff. We've now had in a number of program areas um significant reductions almost to the point where we have no weight list in a number of our programs where we used to have significant weight list um because of the nursing shortages. So I think it's the combination of efforts. We have to look across all of the pillars of recruitment and retention strategy continue to place effort into all those streams and and continue to keep those eyes on on the the retirements. Um you know we certainly hope uh nurses will stay as long as they would like to and is working but um as they occur that we will be filling those positions. >> Okay. Thank you. And my final question is um well I really like the six pillar structure for retention and recruitment. So the the update we're expecting in 2027 uh second quarter um will that distinguish between recruitment success, retention success and workplace culture so that we can see where progress is strong is strongest and where we need more work >> the chair. Yes, I think certainly we can absolutely include those aspects to to have more detailed. I think we heard um through the presentations and some questions today in terms of having some more specifics that we're able to share in terms of um additional new hires by next year um those retentions through different phases of career progression of staff into leadership roles um uh as well as the the ongoing um internal engagement efforts as well and any results of engagement surveys that we have. >> Wonderful. Thank you so much for the work you do. >> Thank you. and then council bravo is the next speaker. >> Yeah, thank you uh chair through you. Um so I just wanted to go back to the question of uh the collective agreements and um the role that the board has to play in the city the uh I heard from uh Dr. Merty that while our the the provincial increase has been 1% um but the relative wage increases and pressures have far exceeded that. Is that correct >> to the chair? Yes. the collective agreement is higher than 1% that we are receiving um through the the provincial contribution increases >> and that means therefore that um the where does the money then come to uh bridge the gap between those two so far at this time the chair uh the overall budget that has been approved by um the city for Toronto Public Health um has uh in some places been able to offset that we've been able to to look at holding positions to be able to um make budget for this year and and certainly uh you know if we continued on the same trajectory in terms of uh similar 1% growth from the province it will mean have to look at um potential reductions in staffing to be able to uh make budget if we're at the same level in terms of staffing. So, oh, so the the city of Toronto uh so the property tax base has been bridging the gap between the real cost of um having the the services that we need um delivered by nurses and with respect to what the actual costs are in terms of um councelor Thompson was was uh asking about that there is the collective bargaining process. We have a collective agreement. I heard a suggestion from my colleague um on the board that perhaps we should be making statements about u making requests through the budget process. Um is it fair to say that um the this uh unit QP79 represents a lot of care workers? Um, you know, I think from the, you know, shel workers in shelters, workers in childare centers, um, is it accurate to say that these kinds of pressures because of all, um, insufficient provincial funding are creating pressures across the board in terms of care work in our city. >> To the chair, councelor, that would depend on the funding arrangements for each individual service. I'm not intimately familiar with the funding arrangements for shelters or child care, but uh most of those from my understanding are subsidized at some level from the province. >> Yeah, they're subsidized by the province. But I think my point here is that they're all members of the same they're inside workers, members of the same bargaining unit, all doing care work. And um we have challenges. I think that we recognize um in children's services and the shelter division and the broader uh uh space that we are that this provincial government the provincial governments are underfunding this kind of work and they all um belong to the same bargaining unit which I think to me is um uh just wanted to speak to the to the question of the the you know this the suggestion that we would be somehow participating or or making our voice heard through it around collective bargaining issues that belong um you know with the union and uh when they're negotiating agreement is that um an answer you said that there's nothing preventing us from doing that but is is this uh a practice that you see in other parts of the city I'm not sure if anybody here can answer that because I think we're talking specifically about public health but there is to my mind implications for how there are a lot of collective um bargaining conversations that will take place when the new agreement comes up and we're kind of spot focusing on a group of workers that certainly deserve increased wages. But I'm concerned that we're directing our request here to the wrong funer, the funer that's already making, you know, uh filling the gap um and uh and not the provincial government. through the chair. I would say that the purview for setting the collective bargaining mandate is with the executive committee. They set aside the funding envelope for each round of negotiations. The request that forms part of the mandate and that funding envelope uh we obtain that by consulting with all of the city's individual divisions to see where their pressure points are and where their special uh funding requirements or special adjustments are are needed. So I would say that it would not be typical for an individual board to express support or to intervene in a collective bargaining process. That's a process that staff undertake on a division by division basis. We collect all the information then we come and we present it uh cohesively to the executive board to get the total financial mandate. >> Thank you. So it's not impossible for us to make a statement but it's not the way that the practice occurs in terms of building up um the uh the budget. Uh, thank you. >> I think that's fair. >> Thank you, councelor Po. Um, I have one question. So, looking at slide six and the preparing for retirements. Um, 16% for public health nurses and 20% for registered practical nurses. Um, people are allowed to stay on beyond the retirement years, right? >> Yes, certainly. we're able to >> okay >> keep working. >> Okay, that's good. And um if people decide to retire, for example, teachers for example, they retire and they're allowed to work x amount of days in a year. I think it's 90 or 120 days, I don't remember. Um could that happen here as well? I'm I'm just asking. I don't know. through the chair. An individual's ability to work postretirement, it may be impacted by the individual pension plans. So it would depend on the rules in terms of their income and their ability to continue working for the same employer they just retired from. >> Okay. So So my question though is that they even though they can retire and still continue working if they so choose for Toronto Public Health. >> I'm not intimately familiar with the pension rules. Okay. So, I can't tell you for sure, but I can say that they would have an impact on the ability for someone to retire from the city and then continue to work for public health. >> And all our nurses, are they all full-time or part-time or a combination of both? I assuming >> Sorry, can you repeat the question, please? >> Our public health nurses, are they all full-time or they're part-time members there, too? >> The majority of the positions are full-time positions. >> Okay. And um I know working at the hospital for many many years to fill the gap um they often brought on agency nurses. Do we do that here at public health >> through the chair? Currently we do not bring on agency nurses. >> Okay. So the reason I'm asking so if we were to have a shortage of nurses a result of retire early retirement or retirement and we have issues with recruitment can we then go to agency nurses is that something that we have done in the past or something that's considered >> to sorry go ahead >> I'll add but if you want to add um we have in the past um particularly the RPN's um we have used contract nurses to help support um the fall and school immunization campaign. So through RPN's and previous model was to have a contract agency who supported that process. We have not recently used that. Um we've moved away from that model now uh currently for our vaccine delivery. If that was to happen that we were in a shortfall of of nurses um and we weren't able to recruit uh I think we could look at it. The challenge would be there's not many agency nurses who are specialized in public health nursing. Um, so having that kind of competency to be able to bring those nurses on, I think it would only be for very um specialized functions like like vaccines where they're able to kind of come in and and and vaccine in a clinic and and leave um those types of services, but the full role of the public health nurse would be challenging to fill. >> Okay. Thank you. Um seeing no other questions of staff, any speakers on the item? I I had sent a motion. I believe uh clerk is just reviewing it. >> Yeah. I really wish you'd send that in advance to us because it needs to be reviewed. >> Um Okay. Do we need have a need to go into close Okay. Do we have a need to go into close session at all to ask any questions? Okay. Seeing none. Okay. >> Chair, >> sorry. I have submitted uh also a a couple motions and I think staff are working on it. Would it be possible we take a few minutes break and I think staff are processing uh member ozade's motion and my motions as well. Is it possible we just take a few minutes? >> Sure. That's just for just for members of >> of the board to be aware. If you have motions, submitting motions, please do so in advance so it can be reviewed by staff and myself. >> I think we try to except sometimes deputations also impact. So, but yes, thank you. >> I I do want to remind people and I think we try to really be careful. We'll take a five minute break, but I just want to state that um this is a very sensitive issue and I hope the motions that we brought forth reflect the sensitivity of that. I will take a five minutes break. Thank you. >> U go ahead council bravo. Sorry. >> Uh thank you. Uh, sorry. I know we're taking a break, but um I guess if if the motions require us to ask questions um like how if we haven't seen the motions, you asked if we need to go on camera, but since we haven't seen the motions, they haven't been shared with the committee. How do we know? Well, I just procedurally want to know what happens in terms of >> Yeah. Once I see the motions, then we can go in in camera to discuss it if need be. >> Thanks. >> Thank you. >> Um, we need a motion to recess for five minutes. So, we'll come back in five minutes. All those in favor opposed. Okay, if everybody uh can come back into the meeting, those online, please turn your camera back on and we can resume. Yeah, wonderful. So, I think we've covered everyone that uh asked questions. Then we're going to go to uh speakers. We'll start with Director O who has a motion. >> Go ahead, Charles. >> Oh, is the motion going to be put on the screen? >> Yep, it's on the screen. >> Speak to it. >> Okay. Yes. Give me a second. Sorry, I'm just working on my screen. Yes. So, thank you so much again to the clerk for the just for editing the motion. Um, yeah, this motion is meant to be just a simple and supportive addition to the report that's already strong. Um, I like the strategy is quite thoughtful and this motion just helps make sure that the board has some measurable indicators when the update returns in 2027. I believe it's Q2. And I feel that it would be really helpful for us to see the picture around um recruitment, retention, vacancies, turnover, but also staff experience in a in a more concrete way. So this is just for clarity and so that the board will understand better what's working over time. Um I anticipate nurses are going to be here for the next century. So um this will just help us get a better picture. Thanks. Sorry, I Charles, Dr. O. Um, staff is suggesting a slight friend amendment. Uh, rather than staff experience, can we change it to staff engagement because experience is hard to measure? >> Uh, sure. >> Okay. Thank you. So, before we vote on it, we'll make the change. Um, next up is councelor uh Chang. Thank you. I have a motion and thank you to all the staff who helped make it happen so quickly. So, uh basically it it's actually kind of similar to director ozade um in terms of just trying to deepening our uh information that is reported to us. So in future staff retention updates that we include uh public health nurse to population ratio comparison analysis of the last 10 years um in terms of number of nurses employed, number of specialists and um these were all the metrics that were shared by our deputent and just trying to get that broader understanding to help inform our staff retention um policies. And then the second one is uh a motion to request the Ontario Ministry of Health to increase their support of Toronto Public Health uh that it would grow with population and negotiated wage increases because every time we have to negotiate our cost of operating Toronto Public Health goes up and in order for the programs that we have to continue, we have to be able to grow that support from the ministry. Otherwise, the city has to bear that burden. And so, I just want to say that, you know, this is a very difficult subject and we know that our public health nurses did so much heavy lifting during the pandemic. It did result in burnout and a significant turnover. And now we're kind of settling a new um we have a new medical director and we have a new recruitment strategy. And it's good to hear that we have new nurses coming on board. Um, and it's a favorable hiring environment right now, I think. So, that is helping. But retention is important because experienced nurses bring something that um you can't get easily with new hires, which is supervisory capacity as well as the knowledge of the system and the challenges. And the city of Toronto has significant uh responsibilities that I think are larger than other municipalities just like our population. We do have more complexity and our population is growing over time I think more than a lot of other municipalities. So to for our public health to have to keep adapting to the growing changes in our city without parallel support and growth from our province is a problem. And I don't think we should keep just adapting our programs to fit into the mold that the province gives us in terms of the funding that they give us. Um and so really having a a good discussion with the Ministry of Health in terms of their expectations and maybe they're not growing our funding because they're shrinking uh what they aspire to do through public health, which is concerning because this is where upstream investments are made and it can save overall spending on health if we fund public health adequately. So, I hope that members will support these motions. Thank you. >> Thank you. Go ahead. Councelor um Thompson has a question for you. Councelor Chang. >> Yes. Through you, Mr. Chair. To councelor Chang. I'm just wondering whether or not uh your motion wouldn't be strengthened if in fact you were to request the city so the council would make this request visav um what you want to achieve. uh just coming from the board of health alone I think that the magn the magnitude of the weight of city of Toronto emphasizes the importance you talk about the population mix and so on so I'm just wondering if you would just amend it to reflect that >> I am happy to take that friendly amendment and so the wording >> so it's essentially to for the uh board of health to request the city city council to >> Yes. Yes. I'm I'm happy if staff could amend my motion to reflect that. That would be great. >> Um I was told by staff this is going to go to council anyway. Is it not going to council? You want Sorry. You want to speak to this Vanessa? >> This report is currently staying at the board of health. It sounds like the motion would be bringing the report to city council. >> Well, that's fine. um if that's how we get to get council's voice and its position on it so it can go to council um normally would stay here I don't see a problem with that I mean at the end of the day I think Dr. Dr. Dr. Merchie, you and your team be negotiating with the um the Ministry of Health anyways, but I think just having council's endorsement, I think it's significant. >> We can make that uh friend amendment. Is that okay? Okay, we'll make that adjustment. So, it goes to the council can vote on it to request the province to >> and I think you'll probably have some more voices from council as well who actually endorse and support this. Thank you. Thank you for the suggestion. Much appreciated. Welcome. So for clarity, uh, councelor Chang, it's number two that's being uh amended, right? Yes. >> Yes, that's that's correct. Council Chang and councelor Thompson. So based I just got some feedback from staff in that if this goes to council the entire things goes to council including the confidential attachment. >> What's wrong with that? >> Because the board health has its own processes you know especially in regards to >> prevent them from actually working in a parallel. >> It just means that we're kind of delegating some of this stuff to counselor right rather than staying at the board of health. You want to speak to this maybe just for clarif clarification. >> So we sorry just can we take that one item out and send that to council and allow the board of health to do what they do? We can't. Okay. All right. So tell me what the complications are. I'm just curious. >> All right. So can I suggest this then? >> Yeah. >> If councelor Chang is supportive of it then Okay. So this goes and it stays in the process of the board of health. And then can we maybe just add to that? Maybe ask the mayor to write a letter in support. >> Yeah, perhaps maybe a separate motion. >> Yes. I mean, so that would simply what it's in support of the requests of councelor Chang's uh desire to ask the uh province for additional support because I think it just really needs a city's emphasis on this and I think it just shining the light on it and maybe ask the mayor to write a letter. >> Maybe a standalone motion to do that rather than uh tagging it on to >> Okay. I I I don't want to complicate things. That's not my intention. The suggestion that's being made to me is that perhaps we can bring a motion forth at council to request that the mayor engage the province. >> But bring a motion on what when an item is not at council is a member. >> So would it be a member's motion? a walk. I'm happy to move a a walk- on members motion. >> Sure. I mean, that's fine. I'm happy to second it if you wish or No, maybe the chair seconds it >> uh Yes. Yeah, it could be a walk on motion. >> I just think it's extremely important because it's a political thing, right? >> Yeah. I I agree. We just trying to find the best way to actually do it. >> Okay. Got I got you. Yeah. I >> sure do that sentiment. So, do you know leave it? >> I will move a member's motion. Thank you. Thank you. the messiness messiness of politics right before your eyes. Local government, >> but it works. >> But it works. Yes. Um, it does take a village, doesn't it? Okay. So, we're going to put up uh Director Oz's uh motion first. Oh, sorry. My apologies. Are there any other speakers on this item? Councelor Thompson. >> Okay, go ahead. >> Thank you. I I just wanted to speak. Um thank you and and thank you to Dr. Merchie and and team for the report and um I think it's really super important. I mean all sectors in our city and society are facing these challenges quite frankly in terms of um people retiring um you know I was talking to some uh folks in the union recently and they're talking about carpenters, construction workers, electricians, plumbers and all of these things are happening. So this is not unique to public health. Um let me say I have immense respect for people in this profession. um having had a mother who was a um operating room nurse who was hired from the UK to come to this country to work and basically that's the only job she had in this country and a an uncle who was a doctor in this country as well and so and so medical um health and that sort of field uh goes um you know deep in my family I've got a cousin who is a surgeon in G etc etc ETA. So I I speak to it from that particular basis of understanding and having seen my mother's own experience in terms of going through what the speakers were talking about and I realize that's not the essence of the report as such in terms of salaries and union um negotiation and so on but it is important from a perspective of the satisfaction of people working in the sector. And I would say that when you compare our Toronto Public Health nurses to other um uh places, I think that they're number one. They're the cream of the crop quite frankly. uh when they are involved and engaged and we've seen through the experiences of not simply co but I saw it through SARS and you know um all the the medical officers of health who have led this organization have been strong leaders and strong in their discipline and so on and I see that here I see the efforts that's actually being made to address this particular issue and I think that we need to not only celebrate it but We need to support it in a significant way. Public health is human health. In my view, public health is an essential part of who we are as a society. And when we went through the co experience, the outreaches that we did with respect to bringing people into the tent and connecting with um individuals across this city was just phenomenal. And so, I mean, I think that we celebrate the workers in public health. We obviously are the beneficiary of their expertise, their wisdom and uh the the the efforts that they take in order to make uh us healthier and as as a community and as a city. So it's important for us to be aware as to issues and conditions around uh their um not simply feelings about the practitioner uh sort of experience but also just their well-being and and and welfare um as it relates to their positions coming to work. How they feel about that is extremely important. The retention aspect is something that is um not simply timely, but it's something that you do on an ongoing basis to make sure that you're staffed up, you're ready to respond to any of the pandemic, endemics or things that would uh would come to this great city of Toronto. And so that work is actually being done. And I do think it's important for us to have the different voices and the input with respect to the concerns that people have. And I do think we need to point out to the province what the disparities are and the gaps and so on with respect to funding because that's an important piece as to the exercise. It's also important with respect to the sustainability for those who are working in this area. Um I would say if I were to ask the question of public health workers would say is money the number one reasons why you're here? I would actually bet they would tell me no. But is it important? I'd say that it is. And they would say yes, it is. They're here because this is a vocation. This is an advocation. This is a profession that they've all aspired to be involved in. And yes, they should be treated uh fairly. But I also will say this to the local who's representing this group of people. Well, you understand what their needs are. Make sure you voice it as at the appropriate time. And so the wait isn't on them to come to us and say, "Well, augment and make the changes to the contract." I suspect that um obviously you've heard a lot and I suspect as we move into the next round of negotiation, obviously these issues will be on the table and I'm hoping that they're successful for their members and again um this report is significant and it's very helpful. Thank you, Mr. Chair. >> Thank you. Any other speakers on the item? >> Okay, seeing none. Okay. >> Oh, sorry. real quick. I wasn't thinking of speaking, but um I really appreciate it. >> Actually, you spoke you spoke already when you brought your motion forth. >> Oh, okay. >> Okay. >> Okay. >> In that case, thank you. >> Yes. I in the interest of time, I'll just be very quick and say that u I'm sympathetic to what the nurses uh just said and I spent 22 years working, you know, in the healthcare field. I've seen firsthand, you know, how important nurses are to our society and they should be compensated and give the resources that they need uh to continue doing the great job that they do. And you know, it was not on my radar prior to this negotiations that just passed, but not that it is. I can say to you that in the next three years when this uh comes about again, we will all will pay close attention and make sure that uh you're given the tools that you need to make sure you're success successful, especially around the the the wage gap that we know that exists. And I hope that councelor Chang's motion and councelor Ozay's um director Oz's motion will help in that direction. And as we've committed as well to bring a motion forth that council asking the province to actually um provide more funding to public health to support our nurses. And with that, I'm going to ask that uh director of today's motion be put on the screen so we can vote on it. Okay. All those in favor? Those carried council chang second come on the screen first. All those in favor carried item as amended. All those in favor oppose carried. Wonderful. Thank you and thank you staff. Thank you everybody. Thank you deput for being here and staying for the entire thing and we'll see you at the next meeting and come to the flag raising later on. Thank you. >> Thank you everyone. Bye-bye. >> Bye everybody. >> Meetings adjourned.