COVID response has put Hamilton public health operations at ‘unprecedented’ risk

Hamilton public health reported an unprecedented" level of risk to operations as the COVID pandemic continues to consume the vast majority of the department's resources.

A total of 29 issues were identified that put the organization at risk of failing to meet its objectives.

Of these, 13 were considered high-risk as they had the highest likelihood of occurring and greatest potential impact on operations."

The number of high-risk issues was more than ever before," stated a report to Hamilton's board of health Nov. 15.

I do have concerns," medical officer of health Dr. Elizabeth Richardson told the board. We have an unprecedented number of risks ... and, of course, that's driven by COVID."

Also contributing to the situation is uncertainty over the province's planned overhaul of public health that could result in significantly less funding and a drastic reduction in the number of departments to as few as 10 in Ontario from 34. No timeline has been set yet for when this will go ahead.

In the meantime, nearly two-thirds of public health resources - 374 full-time equivalent (FTE) positions - are still being taken up by the pandemic more than 20 months after it started.

That number doesn't include the 100 FTEs that public health has been short for months now. It also excludes 75 FTEs sent in by the province to help.

In addition, Hamilton public health is losing one of its key epidemiologists as Stephanie Hughes has been recruited to the Public Health Agency of Canada. It comes at a time when epidemiologists are in demand across the country.

It's a very challenging environment in which to recruit," said Richardson while warning, the current structure ultimately isn't sustainable."

She described staff being redeployed from their jobs for nearly two years, excessive amounts of overtime and verbal abuse that those working on the COVID hotline and in contact tracing have endured from the public.

As a result, there are considerable mental health and wellness impacts" to the workforce, said Richardson.

Precarious staffing is among the high-risk items identified to the board, along with absenteeism and burn out.

Another area of high concern is the effect of the COVID response on the other programs normally provided by public health.

We continue to have a number of programs and services that are currently not up and running," said Richardson. We aren't meeting program targets that we would normally meet on a number of different levels."

There is also risk of community planning tables moving ahead without public health involvement. One example is the board creating Hamilton's Ontario Health Team, which will eventually oversee the local delivery of care as part of a provincewide overhaul of the health care system.

We're disengaged ... because of the attention of the organization to the COVID-19 response and to the highest-risk public health programs we have," said Richardson.

One barrier to recruitment is that the majority of Hamilton's postings are temporary because they're part of the COVID response at a time when applicants can get permanent jobs elsewhere.

We've essentially been on a continuous recruitment journey now for about two years," said Richardson.

Joanna Frketich reports on health for The Spectator. jfrketich@thespec.com