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December XX 2016
Toronto Public Health (TPH) 2017 Preliminary Operating Budget and
2017 - 2026 Preliminary Capital Budget amp Plan
Budget Committee
December 20 2016
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Agenda
bull Agency Overview Agency Services and Resources
bull Operating Overview Service Performance Key Issues amp Priority Actions 2017 - 2019 Preliminary Operating Budget amp Plan
bull Capital Overview Capital Performance Key Issues amp Priority Actions 2017 ndash 2026 Preliminary Capital Budget amp Plan
2
Agency Overview
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Program Map Bu
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Toronto Public Health TPH reduces health inequities and improves the health of the whole population
Family Health Infectious Diseases
Chronic Diseases amp Injuries
Environmental Health
Public Health Foundations
Emergency Preparedness
Purpose To ensure effective public health programs responding to the health needs of the population
Purpose To reduce the burden of preventable chronic diseases and injuries of public health importance and reduce the frequency and severity of preventable injury and of substance misuse
Purpose To enable Purpose To prevent or Purpose To prevent and individuals and families to reduce the burden reduce the burden of achieve optimal infectious diseases of illness from health hazards preconception health public health importance in the physical experience a healthy environment pregnancy have the healthiest newborn(s) possible and be prepared for parenthood and all children to attain and sustain optimal health and developmental potential
Purpose To ensure a consistent and effective response to public health emergencies and emergencies with public health impacts
6
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Public Health Funding Overview
bull 2016 Budget - $2441M bull Cost shared mandatory programs and services (most
programs) bull 71 of total budget bull 75 Provincial $1276M 25 City $431M
bull 100 City Funded ($168M) bull 7 of total budget bull Low income dental bull Student nutrition program
bull 100 Provincial Funded ($485M) bull 20 of total budget bull Early Childhood programs (Ministry of Children and Youth Services) bull Healthy Smiles Ontario (Ministry of Health and Long-Term Care) bull Tobacco ControlEnforcement (Ministry of Health and Long-Term Care) bull CDLU amp AIDS amp Sexual Health Info Line
7
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nch 2017 Organizational Chart for TPH
Medical Officer of Health
(183046)
Communicable Chronic Disease Healthy Finance amp Healthy Dental amp Oral Disease Control amp Injury Communities Administration Families Health
(39509) Prevention (15800) (14486) (47260) Services (18175) (16150)
Office of the MOH amp Healthy Performance Healthy Strategic Support Public Policy amp Standards Environments
(2060) (4000) (5875) (19731)
Category Senior Management Management Exempt Professional
amp Clerical Union Total
Permanent Pos 10 2418 20 15477 17925 Temporary Pos 00 25 00 355 380
Total 10 2443 20 15832 18305
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Staffing Trend (Excludes Capital Positions)
Key Points bull In 2017 there is a net reduction of -240 FTE from efficiency reduction options bull BOH Recommended position changes include 135 FTErsquos for Immunization and Food Safety
Inspections bull These are not included in the 2017 Preliminary Operating Budget
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nch Vacancy Analysis
of Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent of
Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent
of Vacancies
as at Sep 30
of Vacancies
Projections to Dec 31
Vacancies of Total
Approved Pos
Approved Pos
Equivalent
Operating 1116 61 18381 997 54 18418 1313 1249 68 184093
Capital 100 256 389 63 186 335 31 11 48 2365
Total 1216 65 18770 1059 56 18753 1344 1260 68 186458
Agency
2014 2015 2016 Year-End Projections
Vacancy Drivers Vacancies were purposely held in latter part of 2015 to achieve 51 gapping target Delays in processing organization complement changes
Hiring Strategies Ongoing monitoring and analysis of vacancy status and achievement of gapping target PHN open house was held in September followed by a posting to pre-qualify and create a pool of
PHNs for future hiring
10
Service Performance
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Operating Budget Variance as of Sep 30 2016
City ProgramAgency Quarter
Year to Date Year-End Projection
Gross Expenditures Revenue Net Variance Alert
Gross Expenditures Revenue Net Variance Alert
$M trend $M trend $M trend $M trend $M trend $M trend
3-Month (12) (11) (01) (24) (22) (03) Toronto Public Health 6-Month (41) (38) (03) (92) (86) (06)
9-Month (64) (57) (07) (74) (65) (09)
Key Points bull Under-spending is primarily in salaries and benefits bull 1344 positions below approved complement which is equivalent to a 21
vacancy rate after gapping bull At year-end TPH expects to have 1260 positions below approved complement
which is equivalent to 17 vacancy rate after gapping
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Infectious Diseases
bull Responded to approximately 40500 cases and contacts of reportablecommunicable diseases(eg Meningitis TB Salmonella)
bull Responded to 350 outbreaks of communicable diseases in the community and institutional facilities
bull Investigated amp followed up on over 16000 confirmed cases of chlamydia gonorrhea syphilis and HIV
bull Delivered 1350 immunization clinics provided 88000 doses of vaccines
Environmental Health
bull Conducted approx 27026 food premise inspections Inspected 90 (9938) of High Risk food premises (3x per year) 91 (14363) medium risk (2x per year) and 60 (2725) low risk food premises (1x per year) as per the provincial Food Safety Protocol
bull Inspected 1748 recreational facilities by completing 4550 inspections (inspected 3809 (86) indoor poolsspas (4 x year) 661 (699) outdoor poolsspas (2 x year) and 80 (479) non-regulated recreational water facilities (1 x year)
bull Conducted 369191 catch basin treatments (over 3 rounds) with larvicide for West Nile Virus Prevention
Emergency Preparedness
bull Designed amp implemented a full-scale emergency exercise to test TPHrsquos Mass Immunization Clinic Plan
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Chronic Diseases bull Provided Chronic Disease amp Injury Prevention services to 207 priority elementary schools (eg amp Injury nutrition physical activity promotion tobacco prevention road safety) Prevention
bull Achieved 98 compliance rate of tobacco vendors through Tobacco Enforcement as per the Smoke Free Ontario Act
bull Provided dental care to 18760 children 17 yrs amp younger from low income families and treated Family Health 11050 seniors (65+) in the Cityrsquos dental program
bull Delivered 130000 individual interventions to children and families to improve child development outcomes and increase parenting capacity to sustain and optimize child health and development
bull TPH in partnership with Toronto Central LHIN supported the development of the Toronto Public Health Indigenous Health Strategy Foundations
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Key Service Issues amp Priority Actions for 2017
Core Public Health Requirements Not Met
New Funding Recommended by Board of Health
Not meeting existing and new legislated requirements of the Immunization of School Pupils Act (ISPA) Assess the immunization records of all students in both publicly funded and
private schools by the 201819 school year
High risk sexual and substance misuse behaviours among vulnerable youth in underserved areas of the city Implement year 3 of 5 year enhancement plan of Toronto Urban Health Fund
Not meeting existing and new provincially prescribed service levels in Health Hazard and Food Safety programs Increase food and safe water inspections to achieve provincially prescribed
service levels
Emerging Issue
Increasing opioid use and overdose 15 Develop an Overdose Prevention Action Plan for Toronto
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Business Modernization amp Transformation Initiatives
bull TB Nurses will use Wireless Surface Pros to promote more timely information and improved continuity of care for TB clients on Directly Observed Therapy
bull Vaccine Preventable Diseases nurses will use wireless technology to conduct cold-chain inspections in physician offices
bull Public Health Inspectors will roll out wireless technology to enter Food and Water Safety results and for Personal Services Settings (PSS) inspections (eg tattoo parlour body piercings) to provide real-time access to inspection results and faster posting to our Dine Safe Swim Safe and BodySafe Inspection disclosure websites
16
2017 ndash 2019 Preliminary Operating Budget amp Plan
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
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(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
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Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
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2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
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Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
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nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
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Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
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Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
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Bu
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Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
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nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
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Agenda
bull Agency Overview Agency Services and Resources
bull Operating Overview Service Performance Key Issues amp Priority Actions 2017 - 2019 Preliminary Operating Budget amp Plan
bull Capital Overview Capital Performance Key Issues amp Priority Actions 2017 ndash 2026 Preliminary Capital Budget amp Plan
2
Agency Overview
5
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Program Map Bu
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7 Ta
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h
Toronto Public Health TPH reduces health inequities and improves the health of the whole population
Family Health Infectious Diseases
Chronic Diseases amp Injuries
Environmental Health
Public Health Foundations
Emergency Preparedness
Purpose To ensure effective public health programs responding to the health needs of the population
Purpose To reduce the burden of preventable chronic diseases and injuries of public health importance and reduce the frequency and severity of preventable injury and of substance misuse
Purpose To enable Purpose To prevent or Purpose To prevent and individuals and families to reduce the burden reduce the burden of achieve optimal infectious diseases of illness from health hazards preconception health public health importance in the physical experience a healthy environment pregnancy have the healthiest newborn(s) possible and be prepared for parenthood and all children to attain and sustain optimal health and developmental potential
Purpose To ensure a consistent and effective response to public health emergencies and emergencies with public health impacts
6
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Public Health Funding Overview
bull 2016 Budget - $2441M bull Cost shared mandatory programs and services (most
programs) bull 71 of total budget bull 75 Provincial $1276M 25 City $431M
bull 100 City Funded ($168M) bull 7 of total budget bull Low income dental bull Student nutrition program
bull 100 Provincial Funded ($485M) bull 20 of total budget bull Early Childhood programs (Ministry of Children and Youth Services) bull Healthy Smiles Ontario (Ministry of Health and Long-Term Care) bull Tobacco ControlEnforcement (Ministry of Health and Long-Term Care) bull CDLU amp AIDS amp Sexual Health Info Line
7
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nch 2017 Organizational Chart for TPH
Medical Officer of Health
(183046)
Communicable Chronic Disease Healthy Finance amp Healthy Dental amp Oral Disease Control amp Injury Communities Administration Families Health
(39509) Prevention (15800) (14486) (47260) Services (18175) (16150)
Office of the MOH amp Healthy Performance Healthy Strategic Support Public Policy amp Standards Environments
(2060) (4000) (5875) (19731)
Category Senior Management Management Exempt Professional
amp Clerical Union Total
Permanent Pos 10 2418 20 15477 17925 Temporary Pos 00 25 00 355 380
Total 10 2443 20 15832 18305
8
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Staffing Trend (Excludes Capital Positions)
Key Points bull In 2017 there is a net reduction of -240 FTE from efficiency reduction options bull BOH Recommended position changes include 135 FTErsquos for Immunization and Food Safety
Inspections bull These are not included in the 2017 Preliminary Operating Budget
9
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nch Vacancy Analysis
of Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent of
Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent
of Vacancies
as at Sep 30
of Vacancies
Projections to Dec 31
Vacancies of Total
Approved Pos
Approved Pos
Equivalent
Operating 1116 61 18381 997 54 18418 1313 1249 68 184093
Capital 100 256 389 63 186 335 31 11 48 2365
Total 1216 65 18770 1059 56 18753 1344 1260 68 186458
Agency
2014 2015 2016 Year-End Projections
Vacancy Drivers Vacancies were purposely held in latter part of 2015 to achieve 51 gapping target Delays in processing organization complement changes
Hiring Strategies Ongoing monitoring and analysis of vacancy status and achievement of gapping target PHN open house was held in September followed by a posting to pre-qualify and create a pool of
PHNs for future hiring
10
Service Performance
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Operating Budget Variance as of Sep 30 2016
City ProgramAgency Quarter
Year to Date Year-End Projection
Gross Expenditures Revenue Net Variance Alert
Gross Expenditures Revenue Net Variance Alert
$M trend $M trend $M trend $M trend $M trend $M trend
3-Month (12) (11) (01) (24) (22) (03) Toronto Public Health 6-Month (41) (38) (03) (92) (86) (06)
9-Month (64) (57) (07) (74) (65) (09)
Key Points bull Under-spending is primarily in salaries and benefits bull 1344 positions below approved complement which is equivalent to a 21
vacancy rate after gapping bull At year-end TPH expects to have 1260 positions below approved complement
which is equivalent to 17 vacancy rate after gapping
12
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Infectious Diseases
bull Responded to approximately 40500 cases and contacts of reportablecommunicable diseases(eg Meningitis TB Salmonella)
bull Responded to 350 outbreaks of communicable diseases in the community and institutional facilities
bull Investigated amp followed up on over 16000 confirmed cases of chlamydia gonorrhea syphilis and HIV
bull Delivered 1350 immunization clinics provided 88000 doses of vaccines
Environmental Health
bull Conducted approx 27026 food premise inspections Inspected 90 (9938) of High Risk food premises (3x per year) 91 (14363) medium risk (2x per year) and 60 (2725) low risk food premises (1x per year) as per the provincial Food Safety Protocol
bull Inspected 1748 recreational facilities by completing 4550 inspections (inspected 3809 (86) indoor poolsspas (4 x year) 661 (699) outdoor poolsspas (2 x year) and 80 (479) non-regulated recreational water facilities (1 x year)
bull Conducted 369191 catch basin treatments (over 3 rounds) with larvicide for West Nile Virus Prevention
Emergency Preparedness
bull Designed amp implemented a full-scale emergency exercise to test TPHrsquos Mass Immunization Clinic Plan
13
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Chronic Diseases bull Provided Chronic Disease amp Injury Prevention services to 207 priority elementary schools (eg amp Injury nutrition physical activity promotion tobacco prevention road safety) Prevention
bull Achieved 98 compliance rate of tobacco vendors through Tobacco Enforcement as per the Smoke Free Ontario Act
bull Provided dental care to 18760 children 17 yrs amp younger from low income families and treated Family Health 11050 seniors (65+) in the Cityrsquos dental program
bull Delivered 130000 individual interventions to children and families to improve child development outcomes and increase parenting capacity to sustain and optimize child health and development
bull TPH in partnership with Toronto Central LHIN supported the development of the Toronto Public Health Indigenous Health Strategy Foundations
14
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Key Service Issues amp Priority Actions for 2017
Core Public Health Requirements Not Met
New Funding Recommended by Board of Health
Not meeting existing and new legislated requirements of the Immunization of School Pupils Act (ISPA) Assess the immunization records of all students in both publicly funded and
private schools by the 201819 school year
High risk sexual and substance misuse behaviours among vulnerable youth in underserved areas of the city Implement year 3 of 5 year enhancement plan of Toronto Urban Health Fund
Not meeting existing and new provincially prescribed service levels in Health Hazard and Food Safety programs Increase food and safe water inspections to achieve provincially prescribed
service levels
Emerging Issue
Increasing opioid use and overdose 15 Develop an Overdose Prevention Action Plan for Toronto
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Business Modernization amp Transformation Initiatives
bull TB Nurses will use Wireless Surface Pros to promote more timely information and improved continuity of care for TB clients on Directly Observed Therapy
bull Vaccine Preventable Diseases nurses will use wireless technology to conduct cold-chain inspections in physician offices
bull Public Health Inspectors will roll out wireless technology to enter Food and Water Safety results and for Personal Services Settings (PSS) inspections (eg tattoo parlour body piercings) to provide real-time access to inspection results and faster posting to our Dine Safe Swim Safe and BodySafe Inspection disclosure websites
16
2017 ndash 2019 Preliminary Operating Budget amp Plan
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
18
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
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nch Base Changes
(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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nch 2018 amp 2019 Plan
Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
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nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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Instruction No more than 2 Pages
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Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
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Instruction No more than 2 Pages
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Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
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7 Ta
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ted
Budg
et L
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h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
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nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Agency Overview
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Toronto Public Health TPH reduces health inequities and improves the health of the whole population
Family Health Infectious Diseases
Chronic Diseases amp Injuries
Environmental Health
Public Health Foundations
Emergency Preparedness
Purpose To ensure effective public health programs responding to the health needs of the population
Purpose To reduce the burden of preventable chronic diseases and injuries of public health importance and reduce the frequency and severity of preventable injury and of substance misuse
Purpose To enable Purpose To prevent or Purpose To prevent and individuals and families to reduce the burden reduce the burden of achieve optimal infectious diseases of illness from health hazards preconception health public health importance in the physical experience a healthy environment pregnancy have the healthiest newborn(s) possible and be prepared for parenthood and all children to attain and sustain optimal health and developmental potential
Purpose To ensure a consistent and effective response to public health emergencies and emergencies with public health impacts
6
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Public Health Funding Overview
bull 2016 Budget - $2441M bull Cost shared mandatory programs and services (most
programs) bull 71 of total budget bull 75 Provincial $1276M 25 City $431M
bull 100 City Funded ($168M) bull 7 of total budget bull Low income dental bull Student nutrition program
bull 100 Provincial Funded ($485M) bull 20 of total budget bull Early Childhood programs (Ministry of Children and Youth Services) bull Healthy Smiles Ontario (Ministry of Health and Long-Term Care) bull Tobacco ControlEnforcement (Ministry of Health and Long-Term Care) bull CDLU amp AIDS amp Sexual Health Info Line
7
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nch 2017 Organizational Chart for TPH
Medical Officer of Health
(183046)
Communicable Chronic Disease Healthy Finance amp Healthy Dental amp Oral Disease Control amp Injury Communities Administration Families Health
(39509) Prevention (15800) (14486) (47260) Services (18175) (16150)
Office of the MOH amp Healthy Performance Healthy Strategic Support Public Policy amp Standards Environments
(2060) (4000) (5875) (19731)
Category Senior Management Management Exempt Professional
amp Clerical Union Total
Permanent Pos 10 2418 20 15477 17925 Temporary Pos 00 25 00 355 380
Total 10 2443 20 15832 18305
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Staffing Trend (Excludes Capital Positions)
Key Points bull In 2017 there is a net reduction of -240 FTE from efficiency reduction options bull BOH Recommended position changes include 135 FTErsquos for Immunization and Food Safety
Inspections bull These are not included in the 2017 Preliminary Operating Budget
9
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nch Vacancy Analysis
of Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent of
Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent
of Vacancies
as at Sep 30
of Vacancies
Projections to Dec 31
Vacancies of Total
Approved Pos
Approved Pos
Equivalent
Operating 1116 61 18381 997 54 18418 1313 1249 68 184093
Capital 100 256 389 63 186 335 31 11 48 2365
Total 1216 65 18770 1059 56 18753 1344 1260 68 186458
Agency
2014 2015 2016 Year-End Projections
Vacancy Drivers Vacancies were purposely held in latter part of 2015 to achieve 51 gapping target Delays in processing organization complement changes
Hiring Strategies Ongoing monitoring and analysis of vacancy status and achievement of gapping target PHN open house was held in September followed by a posting to pre-qualify and create a pool of
PHNs for future hiring
10
Service Performance
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Operating Budget Variance as of Sep 30 2016
City ProgramAgency Quarter
Year to Date Year-End Projection
Gross Expenditures Revenue Net Variance Alert
Gross Expenditures Revenue Net Variance Alert
$M trend $M trend $M trend $M trend $M trend $M trend
3-Month (12) (11) (01) (24) (22) (03) Toronto Public Health 6-Month (41) (38) (03) (92) (86) (06)
9-Month (64) (57) (07) (74) (65) (09)
Key Points bull Under-spending is primarily in salaries and benefits bull 1344 positions below approved complement which is equivalent to a 21
vacancy rate after gapping bull At year-end TPH expects to have 1260 positions below approved complement
which is equivalent to 17 vacancy rate after gapping
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Infectious Diseases
bull Responded to approximately 40500 cases and contacts of reportablecommunicable diseases(eg Meningitis TB Salmonella)
bull Responded to 350 outbreaks of communicable diseases in the community and institutional facilities
bull Investigated amp followed up on over 16000 confirmed cases of chlamydia gonorrhea syphilis and HIV
bull Delivered 1350 immunization clinics provided 88000 doses of vaccines
Environmental Health
bull Conducted approx 27026 food premise inspections Inspected 90 (9938) of High Risk food premises (3x per year) 91 (14363) medium risk (2x per year) and 60 (2725) low risk food premises (1x per year) as per the provincial Food Safety Protocol
bull Inspected 1748 recreational facilities by completing 4550 inspections (inspected 3809 (86) indoor poolsspas (4 x year) 661 (699) outdoor poolsspas (2 x year) and 80 (479) non-regulated recreational water facilities (1 x year)
bull Conducted 369191 catch basin treatments (over 3 rounds) with larvicide for West Nile Virus Prevention
Emergency Preparedness
bull Designed amp implemented a full-scale emergency exercise to test TPHrsquos Mass Immunization Clinic Plan
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Chronic Diseases bull Provided Chronic Disease amp Injury Prevention services to 207 priority elementary schools (eg amp Injury nutrition physical activity promotion tobacco prevention road safety) Prevention
bull Achieved 98 compliance rate of tobacco vendors through Tobacco Enforcement as per the Smoke Free Ontario Act
bull Provided dental care to 18760 children 17 yrs amp younger from low income families and treated Family Health 11050 seniors (65+) in the Cityrsquos dental program
bull Delivered 130000 individual interventions to children and families to improve child development outcomes and increase parenting capacity to sustain and optimize child health and development
bull TPH in partnership with Toronto Central LHIN supported the development of the Toronto Public Health Indigenous Health Strategy Foundations
14
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Key Service Issues amp Priority Actions for 2017
Core Public Health Requirements Not Met
New Funding Recommended by Board of Health
Not meeting existing and new legislated requirements of the Immunization of School Pupils Act (ISPA) Assess the immunization records of all students in both publicly funded and
private schools by the 201819 school year
High risk sexual and substance misuse behaviours among vulnerable youth in underserved areas of the city Implement year 3 of 5 year enhancement plan of Toronto Urban Health Fund
Not meeting existing and new provincially prescribed service levels in Health Hazard and Food Safety programs Increase food and safe water inspections to achieve provincially prescribed
service levels
Emerging Issue
Increasing opioid use and overdose 15 Develop an Overdose Prevention Action Plan for Toronto
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Business Modernization amp Transformation Initiatives
bull TB Nurses will use Wireless Surface Pros to promote more timely information and improved continuity of care for TB clients on Directly Observed Therapy
bull Vaccine Preventable Diseases nurses will use wireless technology to conduct cold-chain inspections in physician offices
bull Public Health Inspectors will roll out wireless technology to enter Food and Water Safety results and for Personal Services Settings (PSS) inspections (eg tattoo parlour body piercings) to provide real-time access to inspection results and faster posting to our Dine Safe Swim Safe and BodySafe Inspection disclosure websites
16
2017 ndash 2019 Preliminary Operating Budget amp Plan
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
18
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
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nch Base Changes
(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
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Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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nch 2018 amp 2019 Plan
Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
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nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
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Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
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Bu
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Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
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nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
5
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Program Map Bu
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Com
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ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h
Toronto Public Health TPH reduces health inequities and improves the health of the whole population
Family Health Infectious Diseases
Chronic Diseases amp Injuries
Environmental Health
Public Health Foundations
Emergency Preparedness
Purpose To ensure effective public health programs responding to the health needs of the population
Purpose To reduce the burden of preventable chronic diseases and injuries of public health importance and reduce the frequency and severity of preventable injury and of substance misuse
Purpose To enable Purpose To prevent or Purpose To prevent and individuals and families to reduce the burden reduce the burden of achieve optimal infectious diseases of illness from health hazards preconception health public health importance in the physical experience a healthy environment pregnancy have the healthiest newborn(s) possible and be prepared for parenthood and all children to attain and sustain optimal health and developmental potential
Purpose To ensure a consistent and effective response to public health emergencies and emergencies with public health impacts
6
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Public Health Funding Overview
bull 2016 Budget - $2441M bull Cost shared mandatory programs and services (most
programs) bull 71 of total budget bull 75 Provincial $1276M 25 City $431M
bull 100 City Funded ($168M) bull 7 of total budget bull Low income dental bull Student nutrition program
bull 100 Provincial Funded ($485M) bull 20 of total budget bull Early Childhood programs (Ministry of Children and Youth Services) bull Healthy Smiles Ontario (Ministry of Health and Long-Term Care) bull Tobacco ControlEnforcement (Ministry of Health and Long-Term Care) bull CDLU amp AIDS amp Sexual Health Info Line
7
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nch 2017 Organizational Chart for TPH
Medical Officer of Health
(183046)
Communicable Chronic Disease Healthy Finance amp Healthy Dental amp Oral Disease Control amp Injury Communities Administration Families Health
(39509) Prevention (15800) (14486) (47260) Services (18175) (16150)
Office of the MOH amp Healthy Performance Healthy Strategic Support Public Policy amp Standards Environments
(2060) (4000) (5875) (19731)
Category Senior Management Management Exempt Professional
amp Clerical Union Total
Permanent Pos 10 2418 20 15477 17925 Temporary Pos 00 25 00 355 380
Total 10 2443 20 15832 18305
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Staffing Trend (Excludes Capital Positions)
Key Points bull In 2017 there is a net reduction of -240 FTE from efficiency reduction options bull BOH Recommended position changes include 135 FTErsquos for Immunization and Food Safety
Inspections bull These are not included in the 2017 Preliminary Operating Budget
9
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nch Vacancy Analysis
of Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent of
Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent
of Vacancies
as at Sep 30
of Vacancies
Projections to Dec 31
Vacancies of Total
Approved Pos
Approved Pos
Equivalent
Operating 1116 61 18381 997 54 18418 1313 1249 68 184093
Capital 100 256 389 63 186 335 31 11 48 2365
Total 1216 65 18770 1059 56 18753 1344 1260 68 186458
Agency
2014 2015 2016 Year-End Projections
Vacancy Drivers Vacancies were purposely held in latter part of 2015 to achieve 51 gapping target Delays in processing organization complement changes
Hiring Strategies Ongoing monitoring and analysis of vacancy status and achievement of gapping target PHN open house was held in September followed by a posting to pre-qualify and create a pool of
PHNs for future hiring
10
Service Performance
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Operating Budget Variance as of Sep 30 2016
City ProgramAgency Quarter
Year to Date Year-End Projection
Gross Expenditures Revenue Net Variance Alert
Gross Expenditures Revenue Net Variance Alert
$M trend $M trend $M trend $M trend $M trend $M trend
3-Month (12) (11) (01) (24) (22) (03) Toronto Public Health 6-Month (41) (38) (03) (92) (86) (06)
9-Month (64) (57) (07) (74) (65) (09)
Key Points bull Under-spending is primarily in salaries and benefits bull 1344 positions below approved complement which is equivalent to a 21
vacancy rate after gapping bull At year-end TPH expects to have 1260 positions below approved complement
which is equivalent to 17 vacancy rate after gapping
12
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Infectious Diseases
bull Responded to approximately 40500 cases and contacts of reportablecommunicable diseases(eg Meningitis TB Salmonella)
bull Responded to 350 outbreaks of communicable diseases in the community and institutional facilities
bull Investigated amp followed up on over 16000 confirmed cases of chlamydia gonorrhea syphilis and HIV
bull Delivered 1350 immunization clinics provided 88000 doses of vaccines
Environmental Health
bull Conducted approx 27026 food premise inspections Inspected 90 (9938) of High Risk food premises (3x per year) 91 (14363) medium risk (2x per year) and 60 (2725) low risk food premises (1x per year) as per the provincial Food Safety Protocol
bull Inspected 1748 recreational facilities by completing 4550 inspections (inspected 3809 (86) indoor poolsspas (4 x year) 661 (699) outdoor poolsspas (2 x year) and 80 (479) non-regulated recreational water facilities (1 x year)
bull Conducted 369191 catch basin treatments (over 3 rounds) with larvicide for West Nile Virus Prevention
Emergency Preparedness
bull Designed amp implemented a full-scale emergency exercise to test TPHrsquos Mass Immunization Clinic Plan
13
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Chronic Diseases bull Provided Chronic Disease amp Injury Prevention services to 207 priority elementary schools (eg amp Injury nutrition physical activity promotion tobacco prevention road safety) Prevention
bull Achieved 98 compliance rate of tobacco vendors through Tobacco Enforcement as per the Smoke Free Ontario Act
bull Provided dental care to 18760 children 17 yrs amp younger from low income families and treated Family Health 11050 seniors (65+) in the Cityrsquos dental program
bull Delivered 130000 individual interventions to children and families to improve child development outcomes and increase parenting capacity to sustain and optimize child health and development
bull TPH in partnership with Toronto Central LHIN supported the development of the Toronto Public Health Indigenous Health Strategy Foundations
14
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Key Service Issues amp Priority Actions for 2017
Core Public Health Requirements Not Met
New Funding Recommended by Board of Health
Not meeting existing and new legislated requirements of the Immunization of School Pupils Act (ISPA) Assess the immunization records of all students in both publicly funded and
private schools by the 201819 school year
High risk sexual and substance misuse behaviours among vulnerable youth in underserved areas of the city Implement year 3 of 5 year enhancement plan of Toronto Urban Health Fund
Not meeting existing and new provincially prescribed service levels in Health Hazard and Food Safety programs Increase food and safe water inspections to achieve provincially prescribed
service levels
Emerging Issue
Increasing opioid use and overdose 15 Develop an Overdose Prevention Action Plan for Toronto
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Business Modernization amp Transformation Initiatives
bull TB Nurses will use Wireless Surface Pros to promote more timely information and improved continuity of care for TB clients on Directly Observed Therapy
bull Vaccine Preventable Diseases nurses will use wireless technology to conduct cold-chain inspections in physician offices
bull Public Health Inspectors will roll out wireless technology to enter Food and Water Safety results and for Personal Services Settings (PSS) inspections (eg tattoo parlour body piercings) to provide real-time access to inspection results and faster posting to our Dine Safe Swim Safe and BodySafe Inspection disclosure websites
16
2017 ndash 2019 Preliminary Operating Budget amp Plan
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
18
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
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(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
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nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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Instruction No more than 2 Pages
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nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
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nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
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Bu
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Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
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nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
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Program Map Bu
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Com
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ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h
Toronto Public Health TPH reduces health inequities and improves the health of the whole population
Family Health Infectious Diseases
Chronic Diseases amp Injuries
Environmental Health
Public Health Foundations
Emergency Preparedness
Purpose To ensure effective public health programs responding to the health needs of the population
Purpose To reduce the burden of preventable chronic diseases and injuries of public health importance and reduce the frequency and severity of preventable injury and of substance misuse
Purpose To enable Purpose To prevent or Purpose To prevent and individuals and families to reduce the burden reduce the burden of achieve optimal infectious diseases of illness from health hazards preconception health public health importance in the physical experience a healthy environment pregnancy have the healthiest newborn(s) possible and be prepared for parenthood and all children to attain and sustain optimal health and developmental potential
Purpose To ensure a consistent and effective response to public health emergencies and emergencies with public health impacts
6
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Public Health Funding Overview
bull 2016 Budget - $2441M bull Cost shared mandatory programs and services (most
programs) bull 71 of total budget bull 75 Provincial $1276M 25 City $431M
bull 100 City Funded ($168M) bull 7 of total budget bull Low income dental bull Student nutrition program
bull 100 Provincial Funded ($485M) bull 20 of total budget bull Early Childhood programs (Ministry of Children and Youth Services) bull Healthy Smiles Ontario (Ministry of Health and Long-Term Care) bull Tobacco ControlEnforcement (Ministry of Health and Long-Term Care) bull CDLU amp AIDS amp Sexual Health Info Line
7
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nch 2017 Organizational Chart for TPH
Medical Officer of Health
(183046)
Communicable Chronic Disease Healthy Finance amp Healthy Dental amp Oral Disease Control amp Injury Communities Administration Families Health
(39509) Prevention (15800) (14486) (47260) Services (18175) (16150)
Office of the MOH amp Healthy Performance Healthy Strategic Support Public Policy amp Standards Environments
(2060) (4000) (5875) (19731)
Category Senior Management Management Exempt Professional
amp Clerical Union Total
Permanent Pos 10 2418 20 15477 17925 Temporary Pos 00 25 00 355 380
Total 10 2443 20 15832 18305
8
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Staffing Trend (Excludes Capital Positions)
Key Points bull In 2017 there is a net reduction of -240 FTE from efficiency reduction options bull BOH Recommended position changes include 135 FTErsquos for Immunization and Food Safety
Inspections bull These are not included in the 2017 Preliminary Operating Budget
9
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nch Vacancy Analysis
of Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent of
Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent
of Vacancies
as at Sep 30
of Vacancies
Projections to Dec 31
Vacancies of Total
Approved Pos
Approved Pos
Equivalent
Operating 1116 61 18381 997 54 18418 1313 1249 68 184093
Capital 100 256 389 63 186 335 31 11 48 2365
Total 1216 65 18770 1059 56 18753 1344 1260 68 186458
Agency
2014 2015 2016 Year-End Projections
Vacancy Drivers Vacancies were purposely held in latter part of 2015 to achieve 51 gapping target Delays in processing organization complement changes
Hiring Strategies Ongoing monitoring and analysis of vacancy status and achievement of gapping target PHN open house was held in September followed by a posting to pre-qualify and create a pool of
PHNs for future hiring
10
Service Performance
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Operating Budget Variance as of Sep 30 2016
City ProgramAgency Quarter
Year to Date Year-End Projection
Gross Expenditures Revenue Net Variance Alert
Gross Expenditures Revenue Net Variance Alert
$M trend $M trend $M trend $M trend $M trend $M trend
3-Month (12) (11) (01) (24) (22) (03) Toronto Public Health 6-Month (41) (38) (03) (92) (86) (06)
9-Month (64) (57) (07) (74) (65) (09)
Key Points bull Under-spending is primarily in salaries and benefits bull 1344 positions below approved complement which is equivalent to a 21
vacancy rate after gapping bull At year-end TPH expects to have 1260 positions below approved complement
which is equivalent to 17 vacancy rate after gapping
12
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Infectious Diseases
bull Responded to approximately 40500 cases and contacts of reportablecommunicable diseases(eg Meningitis TB Salmonella)
bull Responded to 350 outbreaks of communicable diseases in the community and institutional facilities
bull Investigated amp followed up on over 16000 confirmed cases of chlamydia gonorrhea syphilis and HIV
bull Delivered 1350 immunization clinics provided 88000 doses of vaccines
Environmental Health
bull Conducted approx 27026 food premise inspections Inspected 90 (9938) of High Risk food premises (3x per year) 91 (14363) medium risk (2x per year) and 60 (2725) low risk food premises (1x per year) as per the provincial Food Safety Protocol
bull Inspected 1748 recreational facilities by completing 4550 inspections (inspected 3809 (86) indoor poolsspas (4 x year) 661 (699) outdoor poolsspas (2 x year) and 80 (479) non-regulated recreational water facilities (1 x year)
bull Conducted 369191 catch basin treatments (over 3 rounds) with larvicide for West Nile Virus Prevention
Emergency Preparedness
bull Designed amp implemented a full-scale emergency exercise to test TPHrsquos Mass Immunization Clinic Plan
13
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Chronic Diseases bull Provided Chronic Disease amp Injury Prevention services to 207 priority elementary schools (eg amp Injury nutrition physical activity promotion tobacco prevention road safety) Prevention
bull Achieved 98 compliance rate of tobacco vendors through Tobacco Enforcement as per the Smoke Free Ontario Act
bull Provided dental care to 18760 children 17 yrs amp younger from low income families and treated Family Health 11050 seniors (65+) in the Cityrsquos dental program
bull Delivered 130000 individual interventions to children and families to improve child development outcomes and increase parenting capacity to sustain and optimize child health and development
bull TPH in partnership with Toronto Central LHIN supported the development of the Toronto Public Health Indigenous Health Strategy Foundations
14
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Key Service Issues amp Priority Actions for 2017
Core Public Health Requirements Not Met
New Funding Recommended by Board of Health
Not meeting existing and new legislated requirements of the Immunization of School Pupils Act (ISPA) Assess the immunization records of all students in both publicly funded and
private schools by the 201819 school year
High risk sexual and substance misuse behaviours among vulnerable youth in underserved areas of the city Implement year 3 of 5 year enhancement plan of Toronto Urban Health Fund
Not meeting existing and new provincially prescribed service levels in Health Hazard and Food Safety programs Increase food and safe water inspections to achieve provincially prescribed
service levels
Emerging Issue
Increasing opioid use and overdose 15 Develop an Overdose Prevention Action Plan for Toronto
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Business Modernization amp Transformation Initiatives
bull TB Nurses will use Wireless Surface Pros to promote more timely information and improved continuity of care for TB clients on Directly Observed Therapy
bull Vaccine Preventable Diseases nurses will use wireless technology to conduct cold-chain inspections in physician offices
bull Public Health Inspectors will roll out wireless technology to enter Food and Water Safety results and for Personal Services Settings (PSS) inspections (eg tattoo parlour body piercings) to provide real-time access to inspection results and faster posting to our Dine Safe Swim Safe and BodySafe Inspection disclosure websites
16
2017 ndash 2019 Preliminary Operating Budget amp Plan
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
18
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
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nch Base Changes
(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
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nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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Instruction No more than 2 Pages
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nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
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nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
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Bu
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Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
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nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
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Public Health Funding Overview
bull 2016 Budget - $2441M bull Cost shared mandatory programs and services (most
programs) bull 71 of total budget bull 75 Provincial $1276M 25 City $431M
bull 100 City Funded ($168M) bull 7 of total budget bull Low income dental bull Student nutrition program
bull 100 Provincial Funded ($485M) bull 20 of total budget bull Early Childhood programs (Ministry of Children and Youth Services) bull Healthy Smiles Ontario (Ministry of Health and Long-Term Care) bull Tobacco ControlEnforcement (Ministry of Health and Long-Term Care) bull CDLU amp AIDS amp Sexual Health Info Line
7
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nch 2017 Organizational Chart for TPH
Medical Officer of Health
(183046)
Communicable Chronic Disease Healthy Finance amp Healthy Dental amp Oral Disease Control amp Injury Communities Administration Families Health
(39509) Prevention (15800) (14486) (47260) Services (18175) (16150)
Office of the MOH amp Healthy Performance Healthy Strategic Support Public Policy amp Standards Environments
(2060) (4000) (5875) (19731)
Category Senior Management Management Exempt Professional
amp Clerical Union Total
Permanent Pos 10 2418 20 15477 17925 Temporary Pos 00 25 00 355 380
Total 10 2443 20 15832 18305
8
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Staffing Trend (Excludes Capital Positions)
Key Points bull In 2017 there is a net reduction of -240 FTE from efficiency reduction options bull BOH Recommended position changes include 135 FTErsquos for Immunization and Food Safety
Inspections bull These are not included in the 2017 Preliminary Operating Budget
9
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nch Vacancy Analysis
of Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent of
Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent
of Vacancies
as at Sep 30
of Vacancies
Projections to Dec 31
Vacancies of Total
Approved Pos
Approved Pos
Equivalent
Operating 1116 61 18381 997 54 18418 1313 1249 68 184093
Capital 100 256 389 63 186 335 31 11 48 2365
Total 1216 65 18770 1059 56 18753 1344 1260 68 186458
Agency
2014 2015 2016 Year-End Projections
Vacancy Drivers Vacancies were purposely held in latter part of 2015 to achieve 51 gapping target Delays in processing organization complement changes
Hiring Strategies Ongoing monitoring and analysis of vacancy status and achievement of gapping target PHN open house was held in September followed by a posting to pre-qualify and create a pool of
PHNs for future hiring
10
Service Performance
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Operating Budget Variance as of Sep 30 2016
City ProgramAgency Quarter
Year to Date Year-End Projection
Gross Expenditures Revenue Net Variance Alert
Gross Expenditures Revenue Net Variance Alert
$M trend $M trend $M trend $M trend $M trend $M trend
3-Month (12) (11) (01) (24) (22) (03) Toronto Public Health 6-Month (41) (38) (03) (92) (86) (06)
9-Month (64) (57) (07) (74) (65) (09)
Key Points bull Under-spending is primarily in salaries and benefits bull 1344 positions below approved complement which is equivalent to a 21
vacancy rate after gapping bull At year-end TPH expects to have 1260 positions below approved complement
which is equivalent to 17 vacancy rate after gapping
12
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Infectious Diseases
bull Responded to approximately 40500 cases and contacts of reportablecommunicable diseases(eg Meningitis TB Salmonella)
bull Responded to 350 outbreaks of communicable diseases in the community and institutional facilities
bull Investigated amp followed up on over 16000 confirmed cases of chlamydia gonorrhea syphilis and HIV
bull Delivered 1350 immunization clinics provided 88000 doses of vaccines
Environmental Health
bull Conducted approx 27026 food premise inspections Inspected 90 (9938) of High Risk food premises (3x per year) 91 (14363) medium risk (2x per year) and 60 (2725) low risk food premises (1x per year) as per the provincial Food Safety Protocol
bull Inspected 1748 recreational facilities by completing 4550 inspections (inspected 3809 (86) indoor poolsspas (4 x year) 661 (699) outdoor poolsspas (2 x year) and 80 (479) non-regulated recreational water facilities (1 x year)
bull Conducted 369191 catch basin treatments (over 3 rounds) with larvicide for West Nile Virus Prevention
Emergency Preparedness
bull Designed amp implemented a full-scale emergency exercise to test TPHrsquos Mass Immunization Clinic Plan
13
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Chronic Diseases bull Provided Chronic Disease amp Injury Prevention services to 207 priority elementary schools (eg amp Injury nutrition physical activity promotion tobacco prevention road safety) Prevention
bull Achieved 98 compliance rate of tobacco vendors through Tobacco Enforcement as per the Smoke Free Ontario Act
bull Provided dental care to 18760 children 17 yrs amp younger from low income families and treated Family Health 11050 seniors (65+) in the Cityrsquos dental program
bull Delivered 130000 individual interventions to children and families to improve child development outcomes and increase parenting capacity to sustain and optimize child health and development
bull TPH in partnership with Toronto Central LHIN supported the development of the Toronto Public Health Indigenous Health Strategy Foundations
14
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Key Service Issues amp Priority Actions for 2017
Core Public Health Requirements Not Met
New Funding Recommended by Board of Health
Not meeting existing and new legislated requirements of the Immunization of School Pupils Act (ISPA) Assess the immunization records of all students in both publicly funded and
private schools by the 201819 school year
High risk sexual and substance misuse behaviours among vulnerable youth in underserved areas of the city Implement year 3 of 5 year enhancement plan of Toronto Urban Health Fund
Not meeting existing and new provincially prescribed service levels in Health Hazard and Food Safety programs Increase food and safe water inspections to achieve provincially prescribed
service levels
Emerging Issue
Increasing opioid use and overdose 15 Develop an Overdose Prevention Action Plan for Toronto
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Business Modernization amp Transformation Initiatives
bull TB Nurses will use Wireless Surface Pros to promote more timely information and improved continuity of care for TB clients on Directly Observed Therapy
bull Vaccine Preventable Diseases nurses will use wireless technology to conduct cold-chain inspections in physician offices
bull Public Health Inspectors will roll out wireless technology to enter Food and Water Safety results and for Personal Services Settings (PSS) inspections (eg tattoo parlour body piercings) to provide real-time access to inspection results and faster posting to our Dine Safe Swim Safe and BodySafe Inspection disclosure websites
16
2017 ndash 2019 Preliminary Operating Budget amp Plan
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
18
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
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nch Base Changes
(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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nch
2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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nch 2018 amp 2019 Plan
Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
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nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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Instruction No more than 2 Pages
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nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
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nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
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Bu
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Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
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nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
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nch 2017 Organizational Chart for TPH
Medical Officer of Health
(183046)
Communicable Chronic Disease Healthy Finance amp Healthy Dental amp Oral Disease Control amp Injury Communities Administration Families Health
(39509) Prevention (15800) (14486) (47260) Services (18175) (16150)
Office of the MOH amp Healthy Performance Healthy Strategic Support Public Policy amp Standards Environments
(2060) (4000) (5875) (19731)
Category Senior Management Management Exempt Professional
amp Clerical Union Total
Permanent Pos 10 2418 20 15477 17925 Temporary Pos 00 25 00 355 380
Total 10 2443 20 15832 18305
8
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Staffing Trend (Excludes Capital Positions)
Key Points bull In 2017 there is a net reduction of -240 FTE from efficiency reduction options bull BOH Recommended position changes include 135 FTErsquos for Immunization and Food Safety
Inspections bull These are not included in the 2017 Preliminary Operating Budget
9
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nch Vacancy Analysis
of Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent of
Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent
of Vacancies
as at Sep 30
of Vacancies
Projections to Dec 31
Vacancies of Total
Approved Pos
Approved Pos
Equivalent
Operating 1116 61 18381 997 54 18418 1313 1249 68 184093
Capital 100 256 389 63 186 335 31 11 48 2365
Total 1216 65 18770 1059 56 18753 1344 1260 68 186458
Agency
2014 2015 2016 Year-End Projections
Vacancy Drivers Vacancies were purposely held in latter part of 2015 to achieve 51 gapping target Delays in processing organization complement changes
Hiring Strategies Ongoing monitoring and analysis of vacancy status and achievement of gapping target PHN open house was held in September followed by a posting to pre-qualify and create a pool of
PHNs for future hiring
10
Service Performance
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Operating Budget Variance as of Sep 30 2016
City ProgramAgency Quarter
Year to Date Year-End Projection
Gross Expenditures Revenue Net Variance Alert
Gross Expenditures Revenue Net Variance Alert
$M trend $M trend $M trend $M trend $M trend $M trend
3-Month (12) (11) (01) (24) (22) (03) Toronto Public Health 6-Month (41) (38) (03) (92) (86) (06)
9-Month (64) (57) (07) (74) (65) (09)
Key Points bull Under-spending is primarily in salaries and benefits bull 1344 positions below approved complement which is equivalent to a 21
vacancy rate after gapping bull At year-end TPH expects to have 1260 positions below approved complement
which is equivalent to 17 vacancy rate after gapping
12
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Infectious Diseases
bull Responded to approximately 40500 cases and contacts of reportablecommunicable diseases(eg Meningitis TB Salmonella)
bull Responded to 350 outbreaks of communicable diseases in the community and institutional facilities
bull Investigated amp followed up on over 16000 confirmed cases of chlamydia gonorrhea syphilis and HIV
bull Delivered 1350 immunization clinics provided 88000 doses of vaccines
Environmental Health
bull Conducted approx 27026 food premise inspections Inspected 90 (9938) of High Risk food premises (3x per year) 91 (14363) medium risk (2x per year) and 60 (2725) low risk food premises (1x per year) as per the provincial Food Safety Protocol
bull Inspected 1748 recreational facilities by completing 4550 inspections (inspected 3809 (86) indoor poolsspas (4 x year) 661 (699) outdoor poolsspas (2 x year) and 80 (479) non-regulated recreational water facilities (1 x year)
bull Conducted 369191 catch basin treatments (over 3 rounds) with larvicide for West Nile Virus Prevention
Emergency Preparedness
bull Designed amp implemented a full-scale emergency exercise to test TPHrsquos Mass Immunization Clinic Plan
13
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Chronic Diseases bull Provided Chronic Disease amp Injury Prevention services to 207 priority elementary schools (eg amp Injury nutrition physical activity promotion tobacco prevention road safety) Prevention
bull Achieved 98 compliance rate of tobacco vendors through Tobacco Enforcement as per the Smoke Free Ontario Act
bull Provided dental care to 18760 children 17 yrs amp younger from low income families and treated Family Health 11050 seniors (65+) in the Cityrsquos dental program
bull Delivered 130000 individual interventions to children and families to improve child development outcomes and increase parenting capacity to sustain and optimize child health and development
bull TPH in partnership with Toronto Central LHIN supported the development of the Toronto Public Health Indigenous Health Strategy Foundations
14
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Key Service Issues amp Priority Actions for 2017
Core Public Health Requirements Not Met
New Funding Recommended by Board of Health
Not meeting existing and new legislated requirements of the Immunization of School Pupils Act (ISPA) Assess the immunization records of all students in both publicly funded and
private schools by the 201819 school year
High risk sexual and substance misuse behaviours among vulnerable youth in underserved areas of the city Implement year 3 of 5 year enhancement plan of Toronto Urban Health Fund
Not meeting existing and new provincially prescribed service levels in Health Hazard and Food Safety programs Increase food and safe water inspections to achieve provincially prescribed
service levels
Emerging Issue
Increasing opioid use and overdose 15 Develop an Overdose Prevention Action Plan for Toronto
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Business Modernization amp Transformation Initiatives
bull TB Nurses will use Wireless Surface Pros to promote more timely information and improved continuity of care for TB clients on Directly Observed Therapy
bull Vaccine Preventable Diseases nurses will use wireless technology to conduct cold-chain inspections in physician offices
bull Public Health Inspectors will roll out wireless technology to enter Food and Water Safety results and for Personal Services Settings (PSS) inspections (eg tattoo parlour body piercings) to provide real-time access to inspection results and faster posting to our Dine Safe Swim Safe and BodySafe Inspection disclosure websites
16
2017 ndash 2019 Preliminary Operating Budget amp Plan
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
18
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
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nch Base Changes
(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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017
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nch
Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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Supp
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nch
2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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nch 2018 amp 2019 Plan
Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
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Lau
nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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nch
Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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Instruction No more than 2 Pages
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orte
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nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
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nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
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ded
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Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
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nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
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Staffing Trend (Excludes Capital Positions)
Key Points bull In 2017 there is a net reduction of -240 FTE from efficiency reduction options bull BOH Recommended position changes include 135 FTErsquos for Immunization and Food Safety
Inspections bull These are not included in the 2017 Preliminary Operating Budget
9
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nch Vacancy Analysis
of Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent of
Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent
of Vacancies
as at Sep 30
of Vacancies
Projections to Dec 31
Vacancies of Total
Approved Pos
Approved Pos
Equivalent
Operating 1116 61 18381 997 54 18418 1313 1249 68 184093
Capital 100 256 389 63 186 335 31 11 48 2365
Total 1216 65 18770 1059 56 18753 1344 1260 68 186458
Agency
2014 2015 2016 Year-End Projections
Vacancy Drivers Vacancies were purposely held in latter part of 2015 to achieve 51 gapping target Delays in processing organization complement changes
Hiring Strategies Ongoing monitoring and analysis of vacancy status and achievement of gapping target PHN open house was held in September followed by a posting to pre-qualify and create a pool of
PHNs for future hiring
10
Service Performance
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Operating Budget Variance as of Sep 30 2016
City ProgramAgency Quarter
Year to Date Year-End Projection
Gross Expenditures Revenue Net Variance Alert
Gross Expenditures Revenue Net Variance Alert
$M trend $M trend $M trend $M trend $M trend $M trend
3-Month (12) (11) (01) (24) (22) (03) Toronto Public Health 6-Month (41) (38) (03) (92) (86) (06)
9-Month (64) (57) (07) (74) (65) (09)
Key Points bull Under-spending is primarily in salaries and benefits bull 1344 positions below approved complement which is equivalent to a 21
vacancy rate after gapping bull At year-end TPH expects to have 1260 positions below approved complement
which is equivalent to 17 vacancy rate after gapping
12
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Infectious Diseases
bull Responded to approximately 40500 cases and contacts of reportablecommunicable diseases(eg Meningitis TB Salmonella)
bull Responded to 350 outbreaks of communicable diseases in the community and institutional facilities
bull Investigated amp followed up on over 16000 confirmed cases of chlamydia gonorrhea syphilis and HIV
bull Delivered 1350 immunization clinics provided 88000 doses of vaccines
Environmental Health
bull Conducted approx 27026 food premise inspections Inspected 90 (9938) of High Risk food premises (3x per year) 91 (14363) medium risk (2x per year) and 60 (2725) low risk food premises (1x per year) as per the provincial Food Safety Protocol
bull Inspected 1748 recreational facilities by completing 4550 inspections (inspected 3809 (86) indoor poolsspas (4 x year) 661 (699) outdoor poolsspas (2 x year) and 80 (479) non-regulated recreational water facilities (1 x year)
bull Conducted 369191 catch basin treatments (over 3 rounds) with larvicide for West Nile Virus Prevention
Emergency Preparedness
bull Designed amp implemented a full-scale emergency exercise to test TPHrsquos Mass Immunization Clinic Plan
13
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Chronic Diseases bull Provided Chronic Disease amp Injury Prevention services to 207 priority elementary schools (eg amp Injury nutrition physical activity promotion tobacco prevention road safety) Prevention
bull Achieved 98 compliance rate of tobacco vendors through Tobacco Enforcement as per the Smoke Free Ontario Act
bull Provided dental care to 18760 children 17 yrs amp younger from low income families and treated Family Health 11050 seniors (65+) in the Cityrsquos dental program
bull Delivered 130000 individual interventions to children and families to improve child development outcomes and increase parenting capacity to sustain and optimize child health and development
bull TPH in partnership with Toronto Central LHIN supported the development of the Toronto Public Health Indigenous Health Strategy Foundations
14
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Key Service Issues amp Priority Actions for 2017
Core Public Health Requirements Not Met
New Funding Recommended by Board of Health
Not meeting existing and new legislated requirements of the Immunization of School Pupils Act (ISPA) Assess the immunization records of all students in both publicly funded and
private schools by the 201819 school year
High risk sexual and substance misuse behaviours among vulnerable youth in underserved areas of the city Implement year 3 of 5 year enhancement plan of Toronto Urban Health Fund
Not meeting existing and new provincially prescribed service levels in Health Hazard and Food Safety programs Increase food and safe water inspections to achieve provincially prescribed
service levels
Emerging Issue
Increasing opioid use and overdose 15 Develop an Overdose Prevention Action Plan for Toronto
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Business Modernization amp Transformation Initiatives
bull TB Nurses will use Wireless Surface Pros to promote more timely information and improved continuity of care for TB clients on Directly Observed Therapy
bull Vaccine Preventable Diseases nurses will use wireless technology to conduct cold-chain inspections in physician offices
bull Public Health Inspectors will roll out wireless technology to enter Food and Water Safety results and for Personal Services Settings (PSS) inspections (eg tattoo parlour body piercings) to provide real-time access to inspection results and faster posting to our Dine Safe Swim Safe and BodySafe Inspection disclosure websites
16
2017 ndash 2019 Preliminary Operating Budget amp Plan
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
18
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
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nch Base Changes
(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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nch
Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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nch 2018 amp 2019 Plan
Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
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nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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Instruction No more than 2 Pages
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nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
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nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
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Bu
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Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
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nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
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nch Vacancy Analysis
of Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent of
Vacancies
Vacancies of Total Approved
Pos
Approved Pos
Equivalent
of Vacancies
as at Sep 30
of Vacancies
Projections to Dec 31
Vacancies of Total
Approved Pos
Approved Pos
Equivalent
Operating 1116 61 18381 997 54 18418 1313 1249 68 184093
Capital 100 256 389 63 186 335 31 11 48 2365
Total 1216 65 18770 1059 56 18753 1344 1260 68 186458
Agency
2014 2015 2016 Year-End Projections
Vacancy Drivers Vacancies were purposely held in latter part of 2015 to achieve 51 gapping target Delays in processing organization complement changes
Hiring Strategies Ongoing monitoring and analysis of vacancy status and achievement of gapping target PHN open house was held in September followed by a posting to pre-qualify and create a pool of
PHNs for future hiring
10
Service Performance
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Operating Budget Variance as of Sep 30 2016
City ProgramAgency Quarter
Year to Date Year-End Projection
Gross Expenditures Revenue Net Variance Alert
Gross Expenditures Revenue Net Variance Alert
$M trend $M trend $M trend $M trend $M trend $M trend
3-Month (12) (11) (01) (24) (22) (03) Toronto Public Health 6-Month (41) (38) (03) (92) (86) (06)
9-Month (64) (57) (07) (74) (65) (09)
Key Points bull Under-spending is primarily in salaries and benefits bull 1344 positions below approved complement which is equivalent to a 21
vacancy rate after gapping bull At year-end TPH expects to have 1260 positions below approved complement
which is equivalent to 17 vacancy rate after gapping
12
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Infectious Diseases
bull Responded to approximately 40500 cases and contacts of reportablecommunicable diseases(eg Meningitis TB Salmonella)
bull Responded to 350 outbreaks of communicable diseases in the community and institutional facilities
bull Investigated amp followed up on over 16000 confirmed cases of chlamydia gonorrhea syphilis and HIV
bull Delivered 1350 immunization clinics provided 88000 doses of vaccines
Environmental Health
bull Conducted approx 27026 food premise inspections Inspected 90 (9938) of High Risk food premises (3x per year) 91 (14363) medium risk (2x per year) and 60 (2725) low risk food premises (1x per year) as per the provincial Food Safety Protocol
bull Inspected 1748 recreational facilities by completing 4550 inspections (inspected 3809 (86) indoor poolsspas (4 x year) 661 (699) outdoor poolsspas (2 x year) and 80 (479) non-regulated recreational water facilities (1 x year)
bull Conducted 369191 catch basin treatments (over 3 rounds) with larvicide for West Nile Virus Prevention
Emergency Preparedness
bull Designed amp implemented a full-scale emergency exercise to test TPHrsquos Mass Immunization Clinic Plan
13
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Chronic Diseases bull Provided Chronic Disease amp Injury Prevention services to 207 priority elementary schools (eg amp Injury nutrition physical activity promotion tobacco prevention road safety) Prevention
bull Achieved 98 compliance rate of tobacco vendors through Tobacco Enforcement as per the Smoke Free Ontario Act
bull Provided dental care to 18760 children 17 yrs amp younger from low income families and treated Family Health 11050 seniors (65+) in the Cityrsquos dental program
bull Delivered 130000 individual interventions to children and families to improve child development outcomes and increase parenting capacity to sustain and optimize child health and development
bull TPH in partnership with Toronto Central LHIN supported the development of the Toronto Public Health Indigenous Health Strategy Foundations
14
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Key Service Issues amp Priority Actions for 2017
Core Public Health Requirements Not Met
New Funding Recommended by Board of Health
Not meeting existing and new legislated requirements of the Immunization of School Pupils Act (ISPA) Assess the immunization records of all students in both publicly funded and
private schools by the 201819 school year
High risk sexual and substance misuse behaviours among vulnerable youth in underserved areas of the city Implement year 3 of 5 year enhancement plan of Toronto Urban Health Fund
Not meeting existing and new provincially prescribed service levels in Health Hazard and Food Safety programs Increase food and safe water inspections to achieve provincially prescribed
service levels
Emerging Issue
Increasing opioid use and overdose 15 Develop an Overdose Prevention Action Plan for Toronto
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Business Modernization amp Transformation Initiatives
bull TB Nurses will use Wireless Surface Pros to promote more timely information and improved continuity of care for TB clients on Directly Observed Therapy
bull Vaccine Preventable Diseases nurses will use wireless technology to conduct cold-chain inspections in physician offices
bull Public Health Inspectors will roll out wireless technology to enter Food and Water Safety results and for Personal Services Settings (PSS) inspections (eg tattoo parlour body piercings) to provide real-time access to inspection results and faster posting to our Dine Safe Swim Safe and BodySafe Inspection disclosure websites
16
2017 ndash 2019 Preliminary Operating Budget amp Plan
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
18
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
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nch Base Changes
(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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ndash 2
017
Tax
Supp
orte
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dget
Lau
nch
Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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nch
2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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nch 2018 amp 2019 Plan
Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
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nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
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nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
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Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
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nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Service Performance
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Operating Budget Variance as of Sep 30 2016
City ProgramAgency Quarter
Year to Date Year-End Projection
Gross Expenditures Revenue Net Variance Alert
Gross Expenditures Revenue Net Variance Alert
$M trend $M trend $M trend $M trend $M trend $M trend
3-Month (12) (11) (01) (24) (22) (03) Toronto Public Health 6-Month (41) (38) (03) (92) (86) (06)
9-Month (64) (57) (07) (74) (65) (09)
Key Points bull Under-spending is primarily in salaries and benefits bull 1344 positions below approved complement which is equivalent to a 21
vacancy rate after gapping bull At year-end TPH expects to have 1260 positions below approved complement
which is equivalent to 17 vacancy rate after gapping
12
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Infectious Diseases
bull Responded to approximately 40500 cases and contacts of reportablecommunicable diseases(eg Meningitis TB Salmonella)
bull Responded to 350 outbreaks of communicable diseases in the community and institutional facilities
bull Investigated amp followed up on over 16000 confirmed cases of chlamydia gonorrhea syphilis and HIV
bull Delivered 1350 immunization clinics provided 88000 doses of vaccines
Environmental Health
bull Conducted approx 27026 food premise inspections Inspected 90 (9938) of High Risk food premises (3x per year) 91 (14363) medium risk (2x per year) and 60 (2725) low risk food premises (1x per year) as per the provincial Food Safety Protocol
bull Inspected 1748 recreational facilities by completing 4550 inspections (inspected 3809 (86) indoor poolsspas (4 x year) 661 (699) outdoor poolsspas (2 x year) and 80 (479) non-regulated recreational water facilities (1 x year)
bull Conducted 369191 catch basin treatments (over 3 rounds) with larvicide for West Nile Virus Prevention
Emergency Preparedness
bull Designed amp implemented a full-scale emergency exercise to test TPHrsquos Mass Immunization Clinic Plan
13
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Chronic Diseases bull Provided Chronic Disease amp Injury Prevention services to 207 priority elementary schools (eg amp Injury nutrition physical activity promotion tobacco prevention road safety) Prevention
bull Achieved 98 compliance rate of tobacco vendors through Tobacco Enforcement as per the Smoke Free Ontario Act
bull Provided dental care to 18760 children 17 yrs amp younger from low income families and treated Family Health 11050 seniors (65+) in the Cityrsquos dental program
bull Delivered 130000 individual interventions to children and families to improve child development outcomes and increase parenting capacity to sustain and optimize child health and development
bull TPH in partnership with Toronto Central LHIN supported the development of the Toronto Public Health Indigenous Health Strategy Foundations
14
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Key Service Issues amp Priority Actions for 2017
Core Public Health Requirements Not Met
New Funding Recommended by Board of Health
Not meeting existing and new legislated requirements of the Immunization of School Pupils Act (ISPA) Assess the immunization records of all students in both publicly funded and
private schools by the 201819 school year
High risk sexual and substance misuse behaviours among vulnerable youth in underserved areas of the city Implement year 3 of 5 year enhancement plan of Toronto Urban Health Fund
Not meeting existing and new provincially prescribed service levels in Health Hazard and Food Safety programs Increase food and safe water inspections to achieve provincially prescribed
service levels
Emerging Issue
Increasing opioid use and overdose 15 Develop an Overdose Prevention Action Plan for Toronto
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Business Modernization amp Transformation Initiatives
bull TB Nurses will use Wireless Surface Pros to promote more timely information and improved continuity of care for TB clients on Directly Observed Therapy
bull Vaccine Preventable Diseases nurses will use wireless technology to conduct cold-chain inspections in physician offices
bull Public Health Inspectors will roll out wireless technology to enter Food and Water Safety results and for Personal Services Settings (PSS) inspections (eg tattoo parlour body piercings) to provide real-time access to inspection results and faster posting to our Dine Safe Swim Safe and BodySafe Inspection disclosure websites
16
2017 ndash 2019 Preliminary Operating Budget amp Plan
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
18
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
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nch Base Changes
(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
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nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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Instruction No more than 2 Pages
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nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
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nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
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Bu
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Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
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nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
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Operating Budget Variance as of Sep 30 2016
City ProgramAgency Quarter
Year to Date Year-End Projection
Gross Expenditures Revenue Net Variance Alert
Gross Expenditures Revenue Net Variance Alert
$M trend $M trend $M trend $M trend $M trend $M trend
3-Month (12) (11) (01) (24) (22) (03) Toronto Public Health 6-Month (41) (38) (03) (92) (86) (06)
9-Month (64) (57) (07) (74) (65) (09)
Key Points bull Under-spending is primarily in salaries and benefits bull 1344 positions below approved complement which is equivalent to a 21
vacancy rate after gapping bull At year-end TPH expects to have 1260 positions below approved complement
which is equivalent to 17 vacancy rate after gapping
12
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Infectious Diseases
bull Responded to approximately 40500 cases and contacts of reportablecommunicable diseases(eg Meningitis TB Salmonella)
bull Responded to 350 outbreaks of communicable diseases in the community and institutional facilities
bull Investigated amp followed up on over 16000 confirmed cases of chlamydia gonorrhea syphilis and HIV
bull Delivered 1350 immunization clinics provided 88000 doses of vaccines
Environmental Health
bull Conducted approx 27026 food premise inspections Inspected 90 (9938) of High Risk food premises (3x per year) 91 (14363) medium risk (2x per year) and 60 (2725) low risk food premises (1x per year) as per the provincial Food Safety Protocol
bull Inspected 1748 recreational facilities by completing 4550 inspections (inspected 3809 (86) indoor poolsspas (4 x year) 661 (699) outdoor poolsspas (2 x year) and 80 (479) non-regulated recreational water facilities (1 x year)
bull Conducted 369191 catch basin treatments (over 3 rounds) with larvicide for West Nile Virus Prevention
Emergency Preparedness
bull Designed amp implemented a full-scale emergency exercise to test TPHrsquos Mass Immunization Clinic Plan
13
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Chronic Diseases bull Provided Chronic Disease amp Injury Prevention services to 207 priority elementary schools (eg amp Injury nutrition physical activity promotion tobacco prevention road safety) Prevention
bull Achieved 98 compliance rate of tobacco vendors through Tobacco Enforcement as per the Smoke Free Ontario Act
bull Provided dental care to 18760 children 17 yrs amp younger from low income families and treated Family Health 11050 seniors (65+) in the Cityrsquos dental program
bull Delivered 130000 individual interventions to children and families to improve child development outcomes and increase parenting capacity to sustain and optimize child health and development
bull TPH in partnership with Toronto Central LHIN supported the development of the Toronto Public Health Indigenous Health Strategy Foundations
14
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Key Service Issues amp Priority Actions for 2017
Core Public Health Requirements Not Met
New Funding Recommended by Board of Health
Not meeting existing and new legislated requirements of the Immunization of School Pupils Act (ISPA) Assess the immunization records of all students in both publicly funded and
private schools by the 201819 school year
High risk sexual and substance misuse behaviours among vulnerable youth in underserved areas of the city Implement year 3 of 5 year enhancement plan of Toronto Urban Health Fund
Not meeting existing and new provincially prescribed service levels in Health Hazard and Food Safety programs Increase food and safe water inspections to achieve provincially prescribed
service levels
Emerging Issue
Increasing opioid use and overdose 15 Develop an Overdose Prevention Action Plan for Toronto
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Business Modernization amp Transformation Initiatives
bull TB Nurses will use Wireless Surface Pros to promote more timely information and improved continuity of care for TB clients on Directly Observed Therapy
bull Vaccine Preventable Diseases nurses will use wireless technology to conduct cold-chain inspections in physician offices
bull Public Health Inspectors will roll out wireless technology to enter Food and Water Safety results and for Personal Services Settings (PSS) inspections (eg tattoo parlour body piercings) to provide real-time access to inspection results and faster posting to our Dine Safe Swim Safe and BodySafe Inspection disclosure websites
16
2017 ndash 2019 Preliminary Operating Budget amp Plan
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
18
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
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nch Base Changes
(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
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Supp
orte
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Lau
nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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Instruction No more than 2 Pages
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orte
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nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
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nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
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Bu
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Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
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nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Infectious Diseases
bull Responded to approximately 40500 cases and contacts of reportablecommunicable diseases(eg Meningitis TB Salmonella)
bull Responded to 350 outbreaks of communicable diseases in the community and institutional facilities
bull Investigated amp followed up on over 16000 confirmed cases of chlamydia gonorrhea syphilis and HIV
bull Delivered 1350 immunization clinics provided 88000 doses of vaccines
Environmental Health
bull Conducted approx 27026 food premise inspections Inspected 90 (9938) of High Risk food premises (3x per year) 91 (14363) medium risk (2x per year) and 60 (2725) low risk food premises (1x per year) as per the provincial Food Safety Protocol
bull Inspected 1748 recreational facilities by completing 4550 inspections (inspected 3809 (86) indoor poolsspas (4 x year) 661 (699) outdoor poolsspas (2 x year) and 80 (479) non-regulated recreational water facilities (1 x year)
bull Conducted 369191 catch basin treatments (over 3 rounds) with larvicide for West Nile Virus Prevention
Emergency Preparedness
bull Designed amp implemented a full-scale emergency exercise to test TPHrsquos Mass Immunization Clinic Plan
13
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Chronic Diseases bull Provided Chronic Disease amp Injury Prevention services to 207 priority elementary schools (eg amp Injury nutrition physical activity promotion tobacco prevention road safety) Prevention
bull Achieved 98 compliance rate of tobacco vendors through Tobacco Enforcement as per the Smoke Free Ontario Act
bull Provided dental care to 18760 children 17 yrs amp younger from low income families and treated Family Health 11050 seniors (65+) in the Cityrsquos dental program
bull Delivered 130000 individual interventions to children and families to improve child development outcomes and increase parenting capacity to sustain and optimize child health and development
bull TPH in partnership with Toronto Central LHIN supported the development of the Toronto Public Health Indigenous Health Strategy Foundations
14
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Key Service Issues amp Priority Actions for 2017
Core Public Health Requirements Not Met
New Funding Recommended by Board of Health
Not meeting existing and new legislated requirements of the Immunization of School Pupils Act (ISPA) Assess the immunization records of all students in both publicly funded and
private schools by the 201819 school year
High risk sexual and substance misuse behaviours among vulnerable youth in underserved areas of the city Implement year 3 of 5 year enhancement plan of Toronto Urban Health Fund
Not meeting existing and new provincially prescribed service levels in Health Hazard and Food Safety programs Increase food and safe water inspections to achieve provincially prescribed
service levels
Emerging Issue
Increasing opioid use and overdose 15 Develop an Overdose Prevention Action Plan for Toronto
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Business Modernization amp Transformation Initiatives
bull TB Nurses will use Wireless Surface Pros to promote more timely information and improved continuity of care for TB clients on Directly Observed Therapy
bull Vaccine Preventable Diseases nurses will use wireless technology to conduct cold-chain inspections in physician offices
bull Public Health Inspectors will roll out wireless technology to enter Food and Water Safety results and for Personal Services Settings (PSS) inspections (eg tattoo parlour body piercings) to provide real-time access to inspection results and faster posting to our Dine Safe Swim Safe and BodySafe Inspection disclosure websites
16
2017 ndash 2019 Preliminary Operating Budget amp Plan
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
18
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
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nch Base Changes
(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
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nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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Instruction No more than 2 Pages
Budg
et C
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ittee
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orte
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Lau
nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
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ded
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Instruction No more than 2 Pages
Budg
et C
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ittee
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Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
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Bu
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Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
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nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
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nch 2016 Key Service Accomplishments
Service Key Accomplishments
Chronic Diseases bull Provided Chronic Disease amp Injury Prevention services to 207 priority elementary schools (eg amp Injury nutrition physical activity promotion tobacco prevention road safety) Prevention
bull Achieved 98 compliance rate of tobacco vendors through Tobacco Enforcement as per the Smoke Free Ontario Act
bull Provided dental care to 18760 children 17 yrs amp younger from low income families and treated Family Health 11050 seniors (65+) in the Cityrsquos dental program
bull Delivered 130000 individual interventions to children and families to improve child development outcomes and increase parenting capacity to sustain and optimize child health and development
bull TPH in partnership with Toronto Central LHIN supported the development of the Toronto Public Health Indigenous Health Strategy Foundations
14
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Key Service Issues amp Priority Actions for 2017
Core Public Health Requirements Not Met
New Funding Recommended by Board of Health
Not meeting existing and new legislated requirements of the Immunization of School Pupils Act (ISPA) Assess the immunization records of all students in both publicly funded and
private schools by the 201819 school year
High risk sexual and substance misuse behaviours among vulnerable youth in underserved areas of the city Implement year 3 of 5 year enhancement plan of Toronto Urban Health Fund
Not meeting existing and new provincially prescribed service levels in Health Hazard and Food Safety programs Increase food and safe water inspections to achieve provincially prescribed
service levels
Emerging Issue
Increasing opioid use and overdose 15 Develop an Overdose Prevention Action Plan for Toronto
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Business Modernization amp Transformation Initiatives
bull TB Nurses will use Wireless Surface Pros to promote more timely information and improved continuity of care for TB clients on Directly Observed Therapy
bull Vaccine Preventable Diseases nurses will use wireless technology to conduct cold-chain inspections in physician offices
bull Public Health Inspectors will roll out wireless technology to enter Food and Water Safety results and for Personal Services Settings (PSS) inspections (eg tattoo parlour body piercings) to provide real-time access to inspection results and faster posting to our Dine Safe Swim Safe and BodySafe Inspection disclosure websites
16
2017 ndash 2019 Preliminary Operating Budget amp Plan
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
18
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
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nch Base Changes
(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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nch 2018 amp 2019 Plan
Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
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nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
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Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
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Bu
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Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
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nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
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Key Service Issues amp Priority Actions for 2017
Core Public Health Requirements Not Met
New Funding Recommended by Board of Health
Not meeting existing and new legislated requirements of the Immunization of School Pupils Act (ISPA) Assess the immunization records of all students in both publicly funded and
private schools by the 201819 school year
High risk sexual and substance misuse behaviours among vulnerable youth in underserved areas of the city Implement year 3 of 5 year enhancement plan of Toronto Urban Health Fund
Not meeting existing and new provincially prescribed service levels in Health Hazard and Food Safety programs Increase food and safe water inspections to achieve provincially prescribed
service levels
Emerging Issue
Increasing opioid use and overdose 15 Develop an Overdose Prevention Action Plan for Toronto
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Business Modernization amp Transformation Initiatives
bull TB Nurses will use Wireless Surface Pros to promote more timely information and improved continuity of care for TB clients on Directly Observed Therapy
bull Vaccine Preventable Diseases nurses will use wireless technology to conduct cold-chain inspections in physician offices
bull Public Health Inspectors will roll out wireless technology to enter Food and Water Safety results and for Personal Services Settings (PSS) inspections (eg tattoo parlour body piercings) to provide real-time access to inspection results and faster posting to our Dine Safe Swim Safe and BodySafe Inspection disclosure websites
16
2017 ndash 2019 Preliminary Operating Budget amp Plan
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
18
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
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nch Base Changes
(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
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nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
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nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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Tax
Supp
orte
d Bu
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nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
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Bu
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Com
mitt
ee ndash
201
7 Ta
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ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
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nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
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Business Modernization amp Transformation Initiatives
bull TB Nurses will use Wireless Surface Pros to promote more timely information and improved continuity of care for TB clients on Directly Observed Therapy
bull Vaccine Preventable Diseases nurses will use wireless technology to conduct cold-chain inspections in physician offices
bull Public Health Inspectors will roll out wireless technology to enter Food and Water Safety results and for Personal Services Settings (PSS) inspections (eg tattoo parlour body piercings) to provide real-time access to inspection results and faster posting to our Dine Safe Swim Safe and BodySafe Inspection disclosure websites
16
2017 ndash 2019 Preliminary Operating Budget amp Plan
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
18
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
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nch Base Changes
(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
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nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
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Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
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Com
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201
7 Ta
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h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
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Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
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2017 ndash 2019 Preliminary Operating Budget amp Plan
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
18
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
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(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
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2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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nch 2018 amp 2019 Plan
Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
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nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
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Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
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Com
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201
7 Ta
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Budg
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aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
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Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
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2017 Preliminary Operating Budget
Key Points Base pressures include salaries and COLA increases for $11 million
(19) Efficiency reduction options will not affect service levels Preliminary budget is 04 below the 2016 Net Operating Budget 2017 Preliminary Operating Budget does not include the New amp Enhanced
services recommended by the Board of Health 2017 Preliminary Operating Budget and BOH Recommended budget have
the same base budget and reduction options BOH recommended New amp Enhanced proposals are required to meet key
service issues and OPHS standards
18
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BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
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(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
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nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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ded
2010
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Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
Staf
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com
men
ded
2010
Ope
ratin
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dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
Staf
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ded
2010
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ratin
g Bu
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Budg
et C
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ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
Staf
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ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
Staf
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com
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ded
2010
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ratin
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omm
ittee
ndash 2
017
Tax
Supp
orte
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Lau
nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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017
Tax
Supp
orte
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Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
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ded
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Budg
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ittee
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Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Staf
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ded
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ratin
g Bu
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Budg
et C
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ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
BOH Recommended New and Enhanced
New Enhanced Service Description ($000s)
2017 Impact Net Incremental Impact
Gross Revenue Net Positions 2018 Plan 2019 Plan
Net Positions Net Positions Not Included Referred to the Budget Process Toronto Urban Health Fund (TUHF) - Year 3 ISPA (Immunization of School Pupils Act) Health Hazard and Food Safety Inspections
1500 6000 1658
1125 4500 1244
375 1500 415
110 25
1500 639
40 307
Total NewEnhanced Services (Not Included) 9158 6869 2290 135 2139 40 307 00
bull The Inclusion of Immunization TUHF and Food Safety Inspections results in 2017 Operating Budget Request to be 002 lower than the 2016 net approved budget
19
Staf
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ittee
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Tax
Supp
orte
d Bu
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Lau
nch
2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
Staf
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nch
2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
Staf
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Lau
nch Base Changes
(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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nch
Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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nch
2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
Staf
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nch 2018 amp 2019 Plan
Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
Staf
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Lau
nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
Staf
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Supp
orte
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Lau
nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
Staf
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ded
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Tax
Supp
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nch
Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
Staf
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ded
2010
Ope
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Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
Staf
f Re
com
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ded
2010
Ope
ratin
g Bu
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Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
Staf
f Re
com
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ded
2010
Ope
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ittee
ndash 2
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Tax
Supp
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d Bu
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nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
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nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
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2017 Preliminary Operating Budget -Gross Expenditures by Program amp Funding Source
Where the Where the Money Money Goes Comes From $2425 Million $2425 Million
20
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
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nch Base Changes
(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
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nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
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Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
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Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
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Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
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nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
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Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
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2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
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Bu
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Com
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ee ndash
201
7 Ta
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ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
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nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
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2017 Preliminary Operating Budget Summary
Incremental Change
(In $000s) Budget Projected
Actual Base New
Enhanced Total
Budget By Service $ $ $ $ $ $ $ $ Chronic Diseases amp Injuries Gross Expenditures 387452 379277 444418 444418 56967 147 9511 21 10306 23 Revenue 276158 268427 321111 321111 44953 163 5998 19 6988 21 Net Expenditures 111294 110850 123307 123307 12013 108 3513 28 3318 26 Emergency Preparedness Gross Expenditures 31323 23705 23590 23590 (7733) (247) 447 19 615 26 Revenue 23528 17895 17814 17814 (5715) (243) 221 12 502 28 Net Expenditures 7795 5810 5776 5776 (2019) (259) 226 39 113 19 Environmental Health Gross Expenditures 241878 237048 240473 240473 (1404) (06) 5662 24 5916 24 Revenue 186620 178951 185309 185309 (1310) (07) 3763 20 5346 28 Net Expenditures 55258 58097 55164 55164 (94) (02) 1899 34 569 10 Family Health Gross Expenditures 873956 853372 924870 924870 50913 58 19722 21 19012 20 Revenue 711411 697910 723588 723588 12176 17 13166 18 12783 17 Net Expenditures 162545 155462 201282 201282 38737 238 6556 33 6230 30 Infectious Diseases Gross Expenditures 643653 616324 630497 630497 (13155) (20) 11629 18 8049 13 Revenue 505075 483168 493554 493554 (11521) (23) 8169 17 5399 11 Net Expenditures 138577 133156 136943 136943 (1634) (12) 3459 25 2649 19 Public Health Foundations Gross Expenditures 262524 260753 161329 161329 (101195) (385) 4788 30 4771 29 Revenue 148765 143161 96983 96983 (51782) (348) 2787 29 2555 26 Net Expenditures 113759 117592 64345 64345 (49414) (434) 2000 31 2216 33
Total Gross Expenditures 2440785 1493401 2425177 2425177 (15608) (06) 51758 21 48668 20 Revenue 1851557 1163183 1838359 1838359 (13198) (07) 34103 19 33573 18 Total Net Expenditures 589228 330218 586818 586818 (2410) (04) 17655 30 15095 25 Approved Positions 18646 18305 18305 (341) (18) (17) (01) (20) (01)
2016 2017 Preliminary Operating Budget 2017 Preliminary vs 2016 Budget
Change 2018 Plan
2019 Plan
21
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(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
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Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
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2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
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nch 2018 amp 2019 Plan
Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
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nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
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ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Base Changes
(In $000s) $ Position Net Expenditure Changes (Net Impact of Gross Chgs)
Prior Year Impacts Reversal of one-time 2016 COLA Allocation (4783) SNP Inflation funded from Reserve in 2016 1089
Salaries and Benefits COLA Progression Pay Step Increases and Realignments 11131 (35)
Other Base Changes Various Inflationary Increases 1563 Other Adjustments (IDCIDR 100 Funded Programs) 10 (67)
Total Net Expenditure Changes (Net Impact of Gross Chgs) 9010 (102) Revenue Changes
User Fee 14 VPD UIIP Pharmacy Inspections to Cost Shared (397) Dental Revenue Change due to Provincial Upload 6258
Total Revenue Changes 5875 Net Expenditure Changes 3135 (102)
Total
22
Staf
f Re
com
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ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
Staf
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com
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ded
2010
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ratin
g Bu
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Budg
et C
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ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch 2018 amp 2019 Plan
Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
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ded
2010
Ope
ratin
g Bu
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Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Actions to Achieve Budget Reduction Target 2017 Preliminary Service Change Summary
Description ($000s)
Total Service Changes Incremental Change
$ $ 2018 Plan 2019 Plan
Gross Net Pos Net Pos Net Pos Base Changes Base Expenditure Changes
Line by Line Review (730) (182) Base Expenditure Change (730) (182) 00 00 00 00 00
Service Efficiencies
311 Call Support Services (2189) (547) (182)
Confidential Operational and Support Efficiencies 1 - 6 (19220) (4805) (240) (627)
Facilities and Fleet IDCs Reduction (45) (11) Sub-Total (21453) (5363) (240) (809) 00 00 00
Revenue Adjustments Price Change to Recover Full costs in Food Handler Certification 572 00 (11) (13)
Sub-Total 572 00 00 (11) 00 (13) 00
Total Changes (21611) (5545) (240) (820) 00 (13) 00
23
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch 2018 amp 2019 Plan
Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 User Fee Changes
bull User Fee increases for Inflation $14 thousand net
bull Food Handler Certification fee increase for full cost recovery $572 thousand
24
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch 2018 amp 2019 Plan
Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch 2018 amp 2019 Plan
Description ($000s) Gross
Expense Revenue Net
Expense
Change Position Gross
Expense Revenue Net
Expense
Change Position
Known Impacts Prior Year Impact Reversal of One-Time PHAC Strategy (195) (195) Annualized Impact of 2017 Efficiency Savings (3239) (2419) (821) (01) 13 (13) Salaries and Benefits Related to Capital Projects Salaries and Benefits Related to Capital Projects 4423 4423 (17) (2494) (2494) (20) Salaries and Benefits 49223 34757 14466 25 45892 35437 10455 17 Other Base Changes (specify) Other Adjustments (IDCIDR 100 Funded Programs) (2768) (3110) 342 98 (40) 138 Various Inflationary Increases 2062 475 1586 03 2089 481 1609 03 Revenue (specify) User Fees 172 (172) 176 (176) Sub-Total 49505 34104 15402 26 (17) 45585 33573 12013 20 (20)
2018 shy Incremental Increase 2019 shy Incremental Increase
25
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch BOH Recommended vs 2017 Preliminary
Operating Budget Description ($000s)
BOH Recommended 2017 Preliminary Operating Budget
Comments
Position Change Gross Exp Net Expense
Position Change Gross Exp
Net Expense
$ $ $ $
2016 Approved Budget 18721 2432077 586224 18721 2432077 586224
In Year Adjustments (860) 16334 3004 (751) 8708 3004
2016 Adjusted Approved Budget 186349 2448411 589228 186458 2440785 589228
Additional in-year adjustments
Base Changes Base Expenditure Changes
Prior Year Impacts (20620) (3734) (25895) (3734)
Changes to 100 Funded Programs due to announced funding (59) (23186) (53) (9221) Additional in-year adjustments
Impact of Capital Changes (56) (10367) (35) (8522) IDCIS Capital Project received funding from the Province for a 2017 Incremental Impact of $1845K
COLA Progression Pay Step Increase Benefits Gapping and Starting Salary Adjustment
46153 11173 46153 11173
Economic Factors - Non Payroll 170 42 170 42 IDC IDR (19) (12336) 11 (14) (7625) 11 Reversal of in-year adjustments for IDCIDR entries
Other Base Changes Inflation Increases
Healthy Apartment Neighbourhoods
Base Revenue Changes
1851 1519 1851 1519 SNP TUHF Sexual Health Clinics and Dental Street Youth
9186 Received funding from the federal government for PHAC Healthy Apartment Neighbourhoods for a 5 year project It was approved in 2016 - HL 1412
User Fees (14) (14)
Dental Revenue due to Provincial upload (5304) (6258) $0095 mill ion net swapped with l ine by l ine review reductions
VPD UIIP Pharmacy Inspections to Cost Shared (93) 397 (93) 397 Base Savings Sub-Total (134) (18427) 4090 (102) 6004 3137
2016 Preliminary Base Budget 18501 2429984 593318 18544 2446790 592365
Service Changes Service Efficiencies
Line by Line Review (4475) (1136)
(2189) (547)
(240) (19220) (4806) (45) (11)
(730) (182)
(2189) (547)
(240) (19220) (4806) (45) (11)
Swapped with Dental Revenue changes and additional savings
311 IDC - Value-Based Reduction Reduced 311 IDC total to effective date of April 2017 from January 2017 Offset is the l ine by l i ne revi ew
Confidential Operational and Support Efficiencies 1-6 IDC Reductions for Fuel amp Facilities
(240) (25929) (6500) (240) (22184) (5547) Revenue Adjustments
572 572 Price Change to Recover Full costs in FHC
2017 Preliminary Budget 18261 2404627 586818 18304 2425178 586818 Change over 2016 Budget -04 -04 New Enhanced
1500 375 110 6000 1500
25 1658 415
Staff Initiated Toronto Urban Health Fund - Year 3
Not included in the 2017 Preliminary Budget Available for Budget Committees consideration
Immunization of School Pupils Act (ISPA) Health Hazard and Food Safety Inspections
Sub-Total 135 9158 2289 BOH Recommended before SNP enhancements 18396 2413785 589107 18304 2425178 586818 Change over 2016 Budget -002 -04
26
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Enhancement 100 City Funded
Other New amp Enhanced Services Approved Positions
Gross Expenditures Revenues Net
($000s) $ $ $
SNP Increase Financial Stability of Currently Funded Programs 000 11453 000 11453
SNP Increase - Expand to 49 New Schools 000 9584 000 9584
Total Student Nutrition Program 000 21037 00 21037
bull Student Nutrition Program bull Year 5 (of 6) City Council approved municipal funding plan bull 4 FTEs are discretionary cost-shared
27
Capital Overview
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Capital Overview
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Major Projects in the 2017 ndash 2026 Preliminary Capital Plan
($000s) 2017
Budget 2018 Plan
2019 Plan
2020 Plan
2021 Plan
2022 Plan
2023 Plan
2024 Plan
2025 Plan
2026 Plan
2017 -2026 Total
Legislated Infectious Disease Control System 334 334
Sub-Total 334 - - - - - - - - - 334 State of Good Repair (SOGR)
Inspection Management 1595 1498 1490 254 4837 Reporting Environment Enhancement 267 349 616 Early abilities Information System 329 774 1103 Chemical Tracking Information system 303 604 907 Community Health Information System 900 1199 755 2854
Sub-Total 900 1502 1359 1595 1498 1757 603 - 329 774 10317 Service Improvements
Datamart Data Warehouse - Phase 2 815 815 Datamart Data Warehouse - Phase 3 911 700 1611 Multilingual Website 270 268 538 Electronic Medical Record 418 1306 1724 Public eLearning 365 610 617 1592 Geographic Information Enablement 190 265 286 741 Socio-Demographic Data collection and Reporting 348 721 779 811 2659 Common Geographical Interface 700 300 1000 Mobile Enablement 391 378 527 550 528 2374 Dental amp Oral Health Information Systems Project 84 166 154 404 Correspondence and Communications Tracking System 439 326 765 Call Centre Revitalization 452 452 Public Notifications amp Advisories 557 474 1031 Expansion of Scarborough Dental Clinic 965 965
Sub-Total 2282 2731 2014 1805 1502 16671 Total Expenditures by Category (excluding carry forward) 3516 4233 3373 3400 3000 1757 603 - 329 774 27322
29
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Family Health
Issues The Scarborough Dental Clinic is experiencing over-crowding resulting in health and safety concerns and inability to satisfy demand
Priority Actions Expansion of Scarborough Dental Clinic (year 2 of 2 year project) bull To increase access to dental services for adults on social assistance (OW) adults with disabilities
(ODSP) and Refugees (IFHP) and decrease wait times as a result of improved service delivery bull To be compliant with Accessibility for Ontarians with Disabilities Act (AODA) and address the health
and safety concerns created from overcrowding
Family Health
Issues Dental clinics use manual processes for booking patients
Priority Actions Dental and Oral Health Information System (year 1 of 2 year project) bull To implement an integrated Oral Health Information System to provide access to meaningful real
time dental and oral health practice management information bull To improve the operational efficiency and effectiveness of providing Dental and Oral Health Services
Family Health and Chronic
Issues System has reached its end of life due to obsolete technology and does not conform to current standards resulting in service degradations
Priority Actions Community Health Information System (year 1 of 3 year project) Diseases bull Enhance the Toronto Community Health Information System (TCHIS) to improve system reliability and comply with legal requirements (including Accessibility for Ontarians with Disabilities Act (AODA) and Injuries Personal Health (PHIPA) legislation) and industry standards
bull Improve workflows and reduce errors so that program staff can continue to efficiently deliver public health service to a growing public health client base
30
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Instruction No more than 2 Pages
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Key Capital Issues amp Priority Actions for 2017 Infectious Diseases
Issues Canada Health Infoway and the province is developing a pan-Canadian interoperable information system for the surveillance and management of infectious diseases and TPH assistance is required to ensure TPH requirements are satisfied
Priority Actions Infectious Disease Control Information System (year 5 of 5 year project) bull This provincially funded project will utilize TPH expertise to assist in the on-going development and
implementation of the pan-Canadian Panorama System for infectious disease control
Infectious Diseases
Issues System used by the Sexual Health Clinic program is obsolete and does not meet program requirements The Needle Exchange program utilizes manual inefficient tools to manage and track service delivery and manage patient records
Priority Actions The Electronic Medical Records Phase 2 (year 1 of 2 year project) bull Deliver a client information system to provide a comprehensive electronic record of patients
health-related information for people attending sexual health and needle exchange clinics bull Create efficiencies in business processes and improved client care
Public Health Foundations
Issues Service metrics and reporting with real time quality data are an increasing expectation Difficulty obtaining quality clientpatient information and management information for service and decision-making in a timely manner
Priority Actions Datamart Data Warehouse Phase 2 (year 3 of 3 year project) bull Improve reporting trend analysis and performance measurement to meet mandatory Ministry of Health
and Long-Term Care reporting requirements
31
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Major Projects Completed in 2016
Service Area Key Projects
Infectious Diseases
Family Health and Chronic Diseases and Injuries
Communicable Disease Control (CDC) Wireless Rollout This project enabled staff in the Vaccine Preventable Disease (VPD) TB and Personal Service Settings (PSS) components of the Control of Infectious Disease Infection Control (CIDIC) program to enter and access data directly from health information management systems while in the field Wireless technology was used to improve Communicable Disease Control (CDC) business processes and service to clients
HFHL Point of Care project The purpose of this project was to implement wireless devices which communicate securely with the Toronto Community Health Information System (TCHIS) and synchronize data between the mobile units and the TCHIS database This project increased quality of care by providing professional staff access to materials documents health promotion literature and related policies and procedures on-site during a home visit improved accuracy of documentation by reducing the time gap between client interaction and documentation of these interactions improved compliance with documentation guidelines standards and policies and provided increased accountability with information contained within the customer record
32
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
Capital Budget Variance as of Sep 30 2016
Agencies ($000s)
2016 Approved Cash Flow
2016 Expenditure Trending
Alert (Benchmark 70 spending rate)
YTD Spending
Year-End Projection
at Year End
TPH Q3 4246 2995 4140 936 gt70 between 50 and 70 lt 50 or gt 100
Key Points bull Projects are being implemented as scheduled The projected under spending is attributable
to the following projects ndash The Healthy Environment Inspection System (Mobile) project based on the review of
sequencing of future rollouts it has been determined that some planned enhancements and the acquisition of required contracted developer resources will be deferred to 2017
ndash The Electronic Medical Record - Phase 1 as a result of unexpected project team vacancies some project activities will be deferred to 2017
33
2017 ndash 2026 Preliminary Capital Budget amp Plan
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
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2017 ndash 2026 Preliminary Capital Budget amp Plan
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
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omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
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2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget amp Plan Spending amp Funding Sources
35
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Bu
dget
Com
mitt
ee ndash
201
7 Ta
x Su
ppor
ted
Budg
et L
aunc
h 2017 ndash 2026 Preliminary Capital Budget amp Plan
by Project Category
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Health amp Safety - - - - - - - - - -Legislated 334 - - - - - - - - -SOGR 900 1502 1359 1595 1498 1757 603 - 329 774 Service Improvements 2282 2731 2014 1805 1502 743 1597 1700 1371 926 Growth Related - - - - - - - - - -
2017 - 2026 Preliminary Capital Budget and Plan by Category ($000s)
36
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch
2017 ndash 2026 Preliminary Capital Budget and Plan by Funding Source
4500
4000
3500
3000
2500
2000
1500
1000
500
0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
DebtCFC ReservesReserve Funds Development Charges ProvincialFederal Others
($000s) 2017 - 2026 Preliminary Capital Budget and Plan by Funding Source
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 DebtCFC 2217 4233 3373 3400 3000 2500 2200 1700 1700 1700 ReservesReserve Funds 334 - - - - - - - - -Development Charges 397 - - - - - - - - -ProvincialFederal 568 - - - - - - - - -Others - - - - - - - - - -
37
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
Staf
f Re
com
men
ded
2010
Ope
ratin
g Bu
dget
Budg
et C
omm
ittee
ndash 2
017
Tax
Supp
orte
d Bu
dget
Lau
nch Unfunded Capital Projects
Project Description ($000s)
Total Project Expenditure 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Community Collaboration Strategy 255 255 Community Collaboration 1571 485 476 610 Venue and Agency Scheduling 1173 330 843 Collaboration 1150 345 805 Documents and Records System 2349
Total - 1415 2124 610 - - - - - -
38
~TORONTO ~TORONTO
~TORONTO
~TORONTO ~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO
~TORONTO ~TORONTO 39
~TORONTO ~TORONTO
~TORONTO
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~TORONTO ~TORONTO 39
