September 2021 Board of Health Meeting - Q2 Financial Results Information Report

PREPARED BY:

Lorie Gregg, Director of Corporate Services

DATE:

September, 2021

• Mandatory and related programs funded to a maximum of 70% (“Cost-Shared”) by the Ministry of Health (“MOH”) and 30% by  the Corporation of the City of Windsor, the Corporation of the County of Essex and the Corporation of the Township of Pelee (hereinafter referred to as the “Obligated Municipalities”).
• Related programs funded 100% by the MOH.  More specifically, this includes the Ontario Seniors Dental Care program and the AMOH/MOH Compensation Initiative.
• Related programs funded 100% by the Ministry of Children, Community and Social Services (“MCCSS”). 
• One-time business cases funded 100% by the MOH.

The second quarter financial report to the Board includes a budget to actual comparison and narrative for material variances for all programs listed above, except related programs funded 100% by the Ministry of Children Community and Social Services (MCCSS).  Forecasted financial results will be provided with the Q3 and Q4 financial report.

Related programs funded 100% by the MCCSS will be reported on in November of 2021.

COST-SHARED PROGRAM FINANCIAL RESULTS

At June 30, 2021, the variance from budget to actual total expenses amounts to $810,141. Specific variances are as follows:

• Salaries and Benefits:  Expenditures in these financial captions relate to salaries and benefits paid to the WECHU staff in service of the Mandatory Cost-Shared Program. Cumulatively, these financial captions are $519,587.  Substantial human resources were deployed to support COVID-19 Response and COVID-19 Vaccination Programs.  Salaries and benefits allocated to the Mandatory Program are not entirely an accurate depiction of the human resources working on Mandatory Programs at June 30, 2021.  A secondary analysis is being compiled for the purposes of Q2 reporting to the MOH delineating resources in a more granular fashion.  This report will be brought to the Board in October of 2021.
• Mileage, Professional development, and Travel and meetings:  Expenditures in these financial captions support WECHU staff in the completion of their public health responsibilities.  Cumulatively, these financial captions are $97,640 underspent at June 30, 2021. Mandatory program activities continue to be impacted by COVID-19 Pandemic.  A substantial portion of the WECHU staff continue to work-from-home and employ virtual means to interact with clients, partners, etc.  Professional development is completed on an “as needed basis” taking into consideration staff capacity.
• Association and Membership Fees:  Expenditures in this financial caption relate to memberships in an association or other group by virtue of professional requirements or to support initiatives associated with Public Health.  The majority of Association and Membership Fees are paid in the early in the fiscal year.  While overspent at June 30, 2021, the WECHU anticipates that this financial statement caption will remain within its overall budget for fiscal 2021.
• Program supplies:   Expenditures in this financial caption support the functions of departments, those that directly support public health programs as well as those that support corporate service departments such as Information Technology and Communications.  Cumulatively the Program supplies financial caption is underspent $93,385.  Program related expenditures continue to be underspent due to the on-going focus on the COVID-19 Pandemic (underspent $186,196).  Corporately, the budget is overspent $93,111, which is primarily to the prepayment of Information Technology software licensing for calendar years 2021 and 2022. 
• Professional fees:  Expenditures in this financial caption include legal, audit, consulting fees and dentistry services.  At June 30, 2021, this caption is underspent $83,004.  This variance is primarily associated with the variance in dentistry fees paid on account of the Healthy Smiles Ontario Program (HSO).  In February of 2021, the WECHU successfully recruited a second dentist FTE, whose time would be allocated evenly between the ODSCP and the HSO Program, reducing the requirement subcontracted dentistry services.
• Building Maintenance:  Expenditures in this financial caption include costs to maintain Windsor, Essex and Leamington locations.  More specifically, these costs relate to building and equipment maintenance, grounds keeping and housekeeping supplies.  The variance here relates primarily to:  i) Costs incurred to install electrical for 12 desks in the Leamington office in the amount of $5,662;  ii)  Prepayment of certain maintenance costs for calendar years 2021 and 2022. 
• Insurance:  Expenditures in this financial caption include costs associated with general liability insurance, property insurance, director and office insurance coverage as well as cyber coverage.   Insurance premiums are paid at the beginning of the year.  The WECHU anticipates that the budget for this financial statement caption will remain underspent for 2021. 
• Utilities:  Expenditures in this financial caption include utility costs for the Windsor and Leamington offices.  Utilities are underspent $29,462 due to lower than anticipated utilization (i.e. staff working from home; environmental factors).
• Vehicle:  Expenditures in this financial caption include vehicle maintenance, repair and fuel.  The WECHU incurred augmented fuel costs on account of: 1. Vaccine delivery to retirement homes, long-term care homes, pharmacies and physicians; 2. Supplies delivery to mass vaccination sites. It is anticipated that this financial caption will remain within budget for 2021.
• Offset revenue:  Revenues included in the financial caption relate to interest, proceeds on sale of tangible capital assets, parking revenue, vaccine recoveries, sales of contraceptives as well as course fees relating to the food handler course and examination.  At June 30, 2021, offset revenue is under budget by $21,165.  More specifically:  i) nil interest was earned (under budget $2,500).  ii) Nil was earned on account of food handler courses (under budget $5,000).  iii) Nil was earned on account of vaccine recoveries (under budget $18,844).  iv)  $618 was earned on account of the sale of contraceptives (under budget $6,382). v)  $14,186 was earned on account of parking revenues (over budget $686).  vi)  $34,708 was earned on account of seasonal housing inspections (over budget $7,622).  vii)  Sale of tangible capital assets of $4,759 (over budget $4,259). viii)  $1,280 in user fees (under budget $970).

COVID-19 RESPONSE PROGRAM

The COVID-19 Response Program was established to respond to the on-going impact of the COVID-19 Pandemic in Windsor and Essex County.  The budget for this program included 30 FTEs, more specifically: one (1) director FTE, five (5) Manager FTEs, nine (9) Registered Practical Nurse FTEs, seven (7) Public Health Nurse FTEs, four (4) Public Health Inspector FTEs, one (1) Epidemiologist FTE and three (3) Support Staff FTEs.

Variances from budget at June 30, 2021 are as follows:

• Salaries and benefits are underspent $382,882:  The staffing complement of this program has evolved from January to June of 2021, in response to the changes in local case counts.  Additionally, the Province of Ontario provided human resource support for case and contact management at no cost.  This provided the WECHU the opportunity to deploy nursing resources to support COVID-19 Vaccinations in March of 2021.

Programs supplies

• Communication and awareness is underspent $23,100: At June 30, 2021, $ nil was spent on communication and awareness campaigns associated with the COVID-19 Pandemic (excluding vaccine).  The WECHU has determined that there is a greater need for human resource capacity to support the Communications Department and, by extension, the messaging and media associated with public health measures as well as COVID-19 vaccination efforts.  As such, these financial resources will be expended on staffing to support this area.  Recruitment will occur in Q3 of 2021.

Purchased services

• Case and contact management support is overspent $132,884:  At June 30, 2021, 6,645 hours were acquired from Global Excel Management to support case and contact management.   The budget for case and contact management support of $549,504 was intended for a 6-month period. While on a pro-rata basis, the budget for case in contact management is overspent, the amount expended at June 30, 2021, is within the budgeted amount for the initial term of the contract.
• Translation and interpretation is underspent $34,600:  Translation and interpretation costs were lower than anticipated in the area of case and contact management.  Higher than anticipated translation and interpretation costs were experienced as for the COVID-19 Vaccination Program.

COVID-19 VACCINE PROGRAM

As per the approved budget (March of 2021), the COVID-19 Vaccine Program supports 63 FTEs comprised of two (2) manager FTEs, one (1) health promotion specialist FTE, ten (10) public health nurse FTEs, forty (40) registered practical nurses FTEs and ten (10) support staff FTEs.  Similar to the COVID-19 Response Program, the composition of the COVID-19 Vaccination Program evolved with vaccination requirements, as well as the availability of vaccine within Windsor and Essex County. 

Variance from budget at June 30, 2021 are as follows:

• Salaries and benefits are overspent $471,784: Additional human resource capacity was added at all levels to support three mass immunization clinics, mobile vaccination events as well as vaccine distribution to physicians and pharmacies in Windsor and Essex County. 
• Mileage is overspent $24,297:  The budget for this financial caption did not contemplate the additional human resource capacity (in excess of 63 FTEs) as well as the length of time mass vaccination sites would remain in operation.

Program supplies

• Communications and awareness is underspent $33,937:  At June 30, 2021, a nominal amount was expended on account of communication and awareness campaigns associated with COVID-19 Vaccinations.  The WECHU leveraged its YouTube broadcasts, media releases, website and social media (relatively in expensive), for communicating messaging.  Similar to the discussion noted under the COVID-19 Response Program, the WECHU has determined that there is a greater need for human resource capacity to support the Communications Department and, by extension, the messaging and media associated with public health measures as well as COVID-19 vaccination efforts. As such, these financial resources will be expended on staffing to support this area.  Recruitment will occur in Q3 of 2021.
• Information technology is overspent $75,773: Additional hardware was acquired to support COVID-19 Vaccination staff.  Computer hardware such as laptops, monitors, keyboards, mice, printers and cables were acquired ($97,721).  Tablets were acquired to support the check-in and queuing process at each of the mass clinics ($10,137).  Upgraded temperature control and monitoring equipment was acquired for the WECHU vaccine fridges and freezers ($4,975).
• Medical equipment is overspent $32,076:  This financial caption includes the cost of acquiring medical equipment and supplies to support COVID-19 vaccinations in various settings (i.e. long-term care and retirement homes; mobile events; mass clinics; physician offices).    Supplies included: Epi pens, needles, syringes, drape sheets, bandages, alcohol swabs, etc.  In the latter part of Q1, the Province of Ontario included vaccine administration supplies with its shipment of vaccine.  The WECHU continued to acquire and use its own needles and syringes for the administration of Moderna up to June 30, 2021, as our vaccination supplies more consistently drew additional doses per vial of Moderna.  This was critical at this time due to the limited supply of vaccine in Windsor and Essex County.
• Personal protective equipment is underspent $ 31,875:  This financial caption includes costs associated with rental and or purchase of isolation gowns, the purchase of N95 masks, and the purchase of nitrile gloves, hand sanitizer and similar supplies to support COVID-19 Vaccinations in various settings.  In the latter part of March 2021, certain personal protective equipment were distributed with vaccine shipments, eliminating the need for the WECHU to continue to acquire these supplies.
• Other is overspent $69,892:  This financial caption included:  Tents, generator and security for pop-up events ($6,080); Office supplies ($19,570); Licensing for scheduling application ($35,839); Copier/printer charges for printing resources ($9,388); Calibration and electrical for vaccines freezers ($5,418); other general supplies ($6,317).

Purchased services

• Other is overspent $224,250:  This financial caption includes amounts paid to independent contractors and paid volunteers (immunizers) augmenting the WECHU capacity to administer COVID-19 Vaccinations in various settings.  More specifically:
  • Total hours incurred on account of direct client service at a mass vaccination clinic were 7,109 hours or $199,937. 
  • Total hours incurred on account of call centre activities, support booking vaccination appointments were 1,637 hours or $100,681. 
  • Total hours incurred on account of other activities associated with planning were 216 hours or $6,520.
    In addition, costs were incurred on account of legal, namely the writing and review of legal agreements with the COVID-19 Vaccination Program totaling $33,075.
• Transportation is underspent $115,187:  The budget for this financial caption was developed based on the WECHU’s COVID-19 Vaccination plan submitted to the Ministry of Health in January of 2021.  The WECHU plan focused on the distribution and administration of vaccines through physicians and pharmacies thus resulting in the WECHU incurring additional costs associated with transportation (couriers).  The provincial vaccination plan varied from the WECHU plan, with a focus on vaccine administration at mass vaccination clinics.  Physicians and pharmacists were on-boarded later on in the process.
• Translation and interpretation was overspent $38,699:  This financial caption includes translation and interpretation costs to support mass vaccination clinics and mobile clinics.  The budget did not appropriately contemplate the volume of vaccinations to be delivered in a mass vaccination setting.

ONTARIO SENIORS DENTAL CARE PROGRAM

The Ontario Seniors Dental Care Program (OSDCP) supports eleven and one-half (11.5) FTEs comprised of one and one-half (1.5) manager FTEs, one and one-half (1.5) dentist FTEs, three (3.0) dental hygienist FTEs, three (3.0) dental assistant FTEs, one (1) health promotion specialist FTE and two (2) support staff FTEs.

Variances from budget at June 30, 2021 are as follows:

• Salaries and benefits are underspent $69,813 - This variance predominantly relates to: i) Deployment of one (1) manager FTE for the period January 1, 2021 to April 30, 2021, to support COVID-19 Response, representing a decrease in salaries and benefits of $43,571; ii) Delay in the recruitment of a second dentist supporting the OSDCP, and Healthy Smiles Ontario Program, representing a decrease in salaries and benefits of $8,600.
• Mileage, Travel and meetings, Professional Development are underspent $6,317 - These financial captions continue to be underutilized due to the on-going impact of the COVID-19 Pandemic.   Virtual or telephone conferencing continues to be leveraged to engage with clients and/or partners.  Professional development is completed on an “as needed basis”.
• Clinical supplies and other are underspent $57,747 - This financial caption is directly impacted by client volumes/visits.  For the period January to June 2020, the WECHU dental clinic had 272 visits from 148 OSDCP clients.  For the period January to June 2021, the WECHU dental clinic had 1,590 visits from 582 OSDCP clients.  Year-over-year increase in expenses is reasonable.  In terms of the variance from budget, the WECHU is relatively early in its experience administering the OSDCP.  The WECHU will continue to collect data on the experience/utilization of supplies to support a more accurate estimate of expenditures in future budget processes.
• Professional services are overspent by $7,746 - This financial caption includes translation and interpretation costs, fees paid on account of a denturist and dentist, lab fees and fees paid on account of oral surgery referrals.  In terms of the variance from budget, and similar to clinical supplies and other, the WECHU is still relatively early in its experience administering the OSDCP.  The WECHU will continue to collect data and experience to support more accurate estimates of professional services expenditures in subsequent budgeting processes.  Details of Professional services as at June 30, 2021 are as follows:

FINANCIAL INFORMATION FOR RELATED PROGRAMS FUNDED 100% BY THE MOHLTC

Note:  All funding approvals are for the period April 1, 2021 to March 31, 2022.

Public Health Inspector Practicum Program:  This one-time funding supports the hiring of two Public Health Inspector Practicum positions.  Eligible costs include student salaries, wages and benefits, transportation expenses associated with practicum positions.  At June 30, 2021, a recruitment for public health inspector practicum students had not yet been completed.

School-Focused Nurses Initiative:  This funding supports the hiring of 19 nurses to creating additional capacity to provide rapid-response support to school boards and schools, facilitating public health and preventative measures related to the COVID-19 Pandemic.  At June 30, 2021, $339,892 were incurred on account of salaries and benefits. The WECHU anticipates being on-budget for this program initiative at March 31, 2022.

Approved by: Nicole Dupuis