By Kaitlyn Clark
The Haldimand Press
HALDIMAND—The Haldimand Norfolk Health Unit (HNHU) requested the two counties fund the hiring of 30.2 temporary full-time equivalent (FTE) employees until June 2022, along with the purchasing of an electronic medical record (EMR) program, to continue containment efforts for COVID-19. This is expected to cost $4,324,700 between November 1, 2020 to December 31, 2021.
“Response to the COVID-19 pandemic has been unprecedented and is expected to remain as the major focus for public heath for the next 18-24 months,” said the report. “HNHU has managed this pandemic utilizing redeployed County and public health staff…. This is not sustainable in the long term.”
The report noted that over the past six months the staffing complement has included about 80 current public health staff, 17 redeployed County staff, and 10 new staff. This cost $4.2 million, with $1.4 million being additional costs to the budget.
From March to September staff managed 25,832 tasks related to COVID, including hotline calls (9,333), managing persons under investigation (5,956), Environmental Health Team calls (4,405), and COVID-19 test booking (3,947). The report notes that while these tasks can be quantified, “time spent in meetings, trainings, huddles, (and) case conferences are not captured.” While the hotline has taken up considerable resources, Medical Officer of Health Dr. Shanker Nesathurai said “it has made a difference” in ensuring residents have access to the correct information and that it acts as “an early warning” of any issues in the community.
In five months, significant hours were also seen from supporting departments to handle COVID-19, including 1,645 hours for human resources, 2,027 hours for financial services, and 1,475 hours for the IT department. The report noted that 1,820 hours is considered to be an FTE for one entire year based on 35 hours per week.
Additionally, the data shows that while outbreaks can prompt increases in workloads, a steady workload has remained even with cases being lowered. At its peak after the outbreak on a Vittoria farm, nearly 93 FTEs were deployed from May 30 to June 12 to handle COVID-19 containment, including nearly 40 FTEs mobilized specifically for the outbreak. In comparison, from August 22 to September 4 there was just under 43 FTEs deployed with no outbreak.
“Upon declaration of the emergency within the counties, the health unit was overwhelmed in managing the COVID-19 response with its staffing complement,” said the report, noting that many staff members were utilized from over a dozen program areas that are normally mandatory but were put on hold or reduced. “The health unit will need to restart the provision of mandatory programs and services to address all the drivers of population health. Therefore, with the current staffing resources the health unit is unable to concurrently manage COVID-19 pandemic activities while also providing mandatory programs and services.”
The report noted the importance of having those mandatory programs back up and running, particularly considering the adverse effects of COVID-19 outside of the direct illness, such as increased risk of alcohol and drug use, and increased mental health concerns such as depression and anxiety.
“The team recognizes the magnitude of this specific ask,” said Marlene Miranda of Health and Social Services in her presentation to the Board of Health on October 6. “It is imperative that the health unit continue to address drivers of community health and not just COVID-19.”
Miranda also noted that the team started the year with 11.2 fewer FTEs than last year due to the Province downloading costs and Norfolk voting to remove or reduce programming to make up the shortfall.
Nesathurai has also repeatedly shared concerns that their containment strategy to use contact tracing for the identification, isolation, and testing of individuals at risk of COVID-19 could become infeasible should resources be oversaturated due to an outbreak. This has already been seen in endemic areas like Toronto, who have given up on contact tracing altogether.
HNHU staff are also experiencing “adverse consequences of COVID-19. The shift to a seven-day work week, extended hours, additional on-call response, and cancelling of vacation has been challenging…. The human impact over the past six months is palpable. Staff must balance competing priorities at home; which may include child care concerns, and caregiving concerns for aging parents. These challenges lead to extra stressors which significantly impact staff overall health, wellbeing, and resilience.”
To date, public health staff have taken approximately 2,400 fewer hours of vacation compared to the same period in 2019, but sick time has increased by about 378 hours.
Having a team focused on COVID-19 is expected to relieve some of this stress. The proposed team is comprised of 26.2 FTEs for core staff members such as public health inspectors (10) and registered practical nurses (seven), along with one FTE for a program manager and three FTEs for support staff (IT, finance, and human resources).
Additionally, the EMR system allows for digital storage of client medical records, which are currently kept in paper format. This would allow remote access, and therefore reduced numbers of staff in the office at one time, along with better service and data management.
The report claims that HNHU should have made the switch years ago, and that sticking to paper formats creates “a high risk that our COVID-19 response would be crippled” and puts residents “at risk.” Miranda noted that this is the only health unit she is aware of that does not currently have an EMR in Ontario. While the EMR creates an increased up-front cost for implementation, the report notes that avoiding it would require $247,000 annually for an additional four FTEs to support the team versus $130,000 to operate the EMR annually.
Staff have submitted requests to the Ministry of Health to offset the costs outlined in the report. An updated report outlining the financial impacts of COVID-19 is to be provided in the future. Should the two counties have to take on the entire cost of the new team and EMR system, it would cost Haldimand $427,200 and Norfolk $617,300 for the remainder of 2020, which would include set up costs like new equipment. The following year would cost $1,341,600 for Haldimand and $1,938,600 for Norfolk for a full year of service.
“The inability to hire the COVID-19 response team will pose a challenge to the HNHU’s ability to contain the virus and potentially lead to an increase in confirmed cases, clusters, and outbreaks within the communities; including death,” said the report. “The impact on staff will be cumulative over time, and without the additional support could lead to battle fatigue with the attendant negative effects on overall health, wellbeing, and resilience.”
Health and Social Services has begun the six to eight week process of hiring new staff, but cannot move forward until given approval by the Board of Health.
Board of Health defers decision
Ultimately Haldimand County does not get a vote in matters related to Health and Social Services, which is shared by the two counties but run by Norfolk. However, Haldimand requested the Board of Health defer the decision until more information can be provided and discussed among staff of both counties.
Haldimand Council also asked that staff explore the potential for cost recoveries, such as by charging farmers more for bunkhouse inspections.
Norfolk Councillor Ian Rabbitts put forward the motion as requested in the report, with an addition to explore cost recovery options, but did not get a seconder to move forward with a vote.
Norfolk Councillor Chris Van Paassen then put forward a potential motion to grant eight new employees.
Miranda said in that case, “I would have to come back to the board on what programs we will not be able to provide.”
Miranda estimated that 40-50% of programs, including those that are mandatory by the Province, would not be possible to continue with only eight new staff members.
Councillors began discussing particulars of the motion, such as if it would apply to any positions as chosen by staff or only public health nurses, or what limits should be set for total budget allowances.
This was cut short as a third councillor raised concerns that they were making decisions on the fly. She motioned for the decision to be deferred, which was seconded and then passed. Rabbitts was the only vote against the deferral.
“There is a number and what that number looks like is somewhere between where they’re at today and the 30 they have in the report,” said Haldimand Mayor Ken Hewitt. “We do support the idea that we need to move forward with bringing on some FTEs to support this process. We want to see (health services staff) supported, but at this stage can’t support this ask.”