Toronto Public Health could cut 423 staff as it shifts away from 'high-intensity' pandemic response

The public health unit in Canada's largest city appears set to cut hundreds of staff as it shifts its COVID-19 response — but several veteran city councillors warn settling on the unit's budget for next year will be complicated because of unknowns surrounding the virus.

Coun. Joe Mihevc, the chair of the Board of Health, said the preliminary budget submission Toronto Public Health (TPH) released Tuesday calls for a cut of more than $9 million in its COVID-19 budget, and the shedding of 423 jobs overall.  It's part of a shift away from the influx of resources needed at the height of the pandemic, he said.

"That represents the shift from a high-intensity response to COVID to a lower-intensity response to COVID," Mihevc said.

"And I think what the Board of Health will want to do at its meeting next week is check in on those numbers."

TPH's budget for 2022 was $370 million and it employed 2,700 people this year.

One of the largest proposed changes comes in funding for the health unit's general COVID-19 response, with $9.1 million and 209 positions cut. That includes staff who helped mobilize the mass vaccine rollout, Mihevc said.

"Toronto became an international model for how to do large numbers of vaccines in an efficient way," he said. 

"We are top of the class globally for having done it. That amount of work is no longer necessary so I can understand if we need to scale back."

Overall, TPH has proposed a $368-million budget submission in the document. In addition to the proposed cuts, the unit is asking for more money in other areas. Overall, that translates into a cut of $1.2 million for 2023. The proposed budget will be debated in the coming months ahead of final approvals in February by city council.

The health unit is asking for $37 million to continue its COVID-19 mass immunization efforts. The request for provincial pandemic funding could change if new waves of the virus call for a larger response, Mihevc said.

"If there is something that breaks in a dramatic way and requires us to step up beyond what that $37 million provides for, then you can bet your life that the medical officer of health and the Board of Health will be making a second attempt to right-size the budget," he said. 

Mihevc said the pandemic, and the complicated state of the funding for public health more generally, will make coming up with this year's budget difficult. Toronto shares the costs of many of its programs with the Ontario government and that funding is not always stable, he said.

"This is certainly one of the most complex budgets that I've seen in my over 20 years at city hall," he said. "And that's because we're still in the pandemic period."

'Unbelievable turbulence'

Coun. Gord Perks, who is also a member of the Board of Health, said funding of public health was a mess before the pandemic when the provincial government announced it would change those cost-sharing arrangements with local health units. While the pandemic postponed some of those plans, Perks said others have stuck and it further complicates the budget process.

"It has been three years of unbelievable turbulence at Toronto Public Health," he said. "And this budget doesn't yet bring us to a stable point."

Perks said in addition to questioning how the proposed staff reductions will affect operations, he's concerned about submissions that show key budget requests for the current fiscal year have been ignored by the province.

Toronto Public Health had asked for $2.8 million in 2022 for a variety of measures to address the opioid poisoning crisis  and that funding was never provided, he said.

"This is a devastating crisis and the province simply hasn't come through," he said. "That's something that the City of Toronto is going to have to speak up about loud and clear."

A spokesperson for Ontario Health Minister Sylvia Jones said the province provided $172.1 million to Toronto Public Health in 2022. That included funding for pandemic recovery, to address higher costs of service delivery and to help retain nurses. 

And since 2020, the province says it has spent $255.8 million to support COVID-19 monitoring, case and contact management and the vaccine program.   

"Provincial funding decisions for public health programs will be made once the Ministry of Health's budget is known and will be based upon available funding," Hannah Jensen said in a statement.  

"Our government will continue to work with public health and municipal sector partners to monitor capacity and funding requirements for the COVID-19 response and ensure critical public health services are maintained and delivered to protect the health and well-being of Ontarians," she added.

Mihevc said the budget also calls for some spending on key programs to address the needs of seniors and children, which come from provincial funding. The submission budgets $689,000 to expand the Ontario Seniors Dental Care Program and an increase of $827,000 for the Student Nutrition Program.

"If you spend a few pennies on public health today, you save big dollars later on with disease and hospitalizations," he said.

"So, it's a very smart economic investment."