There is a possibility that Kingston, Frontenac, and Lennox & Addington (KFL&A) Public Health could merge with other nearby public health units in the near future.
At a meeting of the KFL&A Board of Health (BOH) on Wednesday, Nov. 22, 2023, Medical Officer of Health Dr. Piotr Oglaza made a presentation prepared by the provincial Ministry of Health called Strengthening Public Health: Outcomes and Objectives to Support Voluntary Mergers. This presentation described rationale and objectives and laid out the merger proposal submission process.
The vision, according to Oglaza, is for Local Public Health Agencies (LPHAs) to “have the critical mass and capacity, skilled personnel and competencies needed to deliver core Public Health services and address public health emergencies within a cohesive system that better aligns with community and system partners.”
The province, he said, “has explicitly indicated that they expect local Public Health service delivery to be maintained, front-line jobs be maintained, and that cost savings is not the goal — any cost efficiencies would be retained by the LPHA for further service delivery.”
Oglaza then explained the province’s six objectives. Each LPHA would have a minimum population base of 500,000, improve organizational performance, sustain leadership structure, sustain competencies and capacities for specialized positions, support alignment and coordination with partners, and develop partnerships within communities and priority populations.
Dr. Oglaza told the BOH, “We haven’t yet been engaged in the discussion, but I believe this is something that’s coming, and next it will be a formal process for Public Health Units to participate in that work. The main topic here at today’s meeting is the voluntary mergers.”
Oglaza explained that the timeline for these discussions is a tight one: “The expectations for exploring feasibility is throughout the month of November into December, and then it’s a very short timeline for once the decisions are made based on that feasibility exploration.”
A decision on the mergers, he said, would need to be accompanied by a business case, due by “the ambitious timeline” of the end of March 2024 “for the annual service plan… That’s the minister’s mechanism to submit costs to the province and then get reimbursement for next year.”
Merger and transition costs will be funded by the province outside of the LPHA’s base budget, starting in 2024. LPHAs can jointly apply for a feasibility assessment in 2023-24.
Currently, Oglaza said, KFL&A Public Health is a LPHA governed by an autonomous board serving a population of approximately 210,000 residents — “below the Ministry’s stated goal of local Public Health systems with larger LPHAs serving a minimum of 500,000 residents.”
“While capacity issues — such as a shortage of staff to fill critical positions within KFL&A Public Health — have not been as acute in comparison to other parts of the province, our agency is subject to the same gradual erosion of funding and resulting impacts on capacity in the future due to inflation… and cost increases,” he noted.
Further to a motion passed by the BOH on September 27, 2023, to explore options for merging with other LPHAs, Oglaza said he and board chair Wes Garrod met on October 30, 2023 with their counterparts from two neighbouring agencies — Leeds, Grenville and Lanark District Health Unit (LGLDHU) and Hastings Prince Edward Public Health (HPEPH) — whose boards of health have already passed a similar motion to explore voluntary mergers.
At that meeting, Oglaza said, “all three parties expressed interest in considering moving forward with further exploration of mergers… subject to endorsement by each individual Board of Health.”
The combined population of the three LPHAs was 571,009 in 2022 — already exceeding the ministry’s criteria for a minimum size of population served — and is projected to grow to 601,322 by 2028. Oglaza pointed out that all three Health Units have mixed urban-rural geographies (the largest urban centre in HPE is Belleville; for LGL it is Brockville). There are two main roadway corridors connecting the LPHAs’ geographies: Highway 7 runs through the north and Highway 401 to the south.
Current service delivery in the three LPHAs occurs in the North-South direction, whereas, Oglaza noted, residents and clients seek services in both North-South and East-West directions. Residents from the region typically seek specialized health care in Kingston, with some residents in LGL going to Ottawa and some in HPE going to Peterborough. Some KFL&A residents, especially around Sharbot Lake, seek services in Perth in LGL, whereas some residents east of Belleville have been known to seek services in Napanee.
As well, he pointed out that there is already a history of collaboration of LPHA programs, from leadership to front-line staff and joint delivery of Public Health services, such as the Nurse Family Partnership, which is delivered jointly by the HPE and KFL&A Health Units.
Given the anticipated mutual support for further exploratory discussions between the boards of health, Oglaza recommended that the KFL&A Board of Health “endorse, in principle, further investigation of the feasibility of a potential voluntary merger between the three LPHAs.”
Board Chair Wes Garrod stated, “We will do everything regarding mergers in public session and will not do anything in private session. I think the public deserves that, and that’s exactly what’s going on. So that’s number one.”
“Number two,” he said, “I’m very proud of KFL&A Public Health… and the level of service we provide. And that service is provided because of the good staff that we have… We have to be able to improve the service delivery and I guess, in some cases, be more efficient — but overall, for me, it’s improving service delivery — and in order to do that, we have to maintain staff.”
After a discussion, the KFL&A Board of Health voted to endorse, in principle, further investigation of the feasibility of a potential voluntary merger between KFL&A Public Health; Leeds, Grenville and Lanark District Health Unit; and Hastings Prince Edward Public Health. The board also struck a voluntary merger committee to investigate potential voluntary mergers, work with other boards of health, and report back to the KFL&A Board of Health with recommendations.