pH1N1 Implications for the Ministry

The overall consensus of opinion that formed at the symposium represents a set of decisions reached by a diverse group of healthcare professionals. Clearly, there are systemic issues that, if addressed thoughtfully, would improve the ability of healthcare providers, at all levels, to better respond to future pandemics. The implications of the consensus opinions from the symposium can be broadly categorized into three areas: those that would apply either to Public Health or to Primary Care, provincially or locally; and, those that would apply to both, again, both provincially and/or locally.

The main directives to the Ministry, to Public Health and to Primary Care derived from the symposium consensus building process are as follow:

• Many local plans for influenza pandemic (PIPs) need to be more fully operationalized - that is, expand the written document so that, rather than being a broad strategic statement, it becomes a comprehensive and detailed policy & procedures manual that includes memoranda of understanding negotiated with local stakeholders, a priori, which define authority, assign roles, detail responsibilities, and identify triggers that signal when to implement plan elements.
• An improved strategy for communication is required across all levels. This includes reducing the number of 'authoritative' information sources and improving message coordination and message consistency across all sources. At the very least, inter-agency cooperation should ensure messages from different sources are not contradictory.
• Improve healthcare system integration at both provincial and local levels.  Incentives are needed to facilitate formal, local-level partnerships between Primary Care and Public Health. There are roles for the LHINs, NGOs, medical organizations and the Ministry to help smooth and coordinate this process if it is to be a province-wide initiative.
• LHINs need to be more involved in facilitating pandemic response activities at the local level - this implies better integration of Primary Care and Public Health at the level of a LHIN's jurisdiction.
• The mismatch between the legal authority and the policy responsibility to operate Influenza Assessment Centres (FACs) needs to be resolved. If a PHU wants to hire a physician away from his or her practice during a period of public emergency, such as a pandemic, appropriate funding needs be to in place to properly compensate the physician's time.
• Decisions / guidelines should be evidence based and information on the decision-making process should be available - and should be minimally influenced by political considerations.
• There is a need to improve the gathering, processing and dissemination of local and provincial surveillance information - real time data from a variety of sources, including emergency department syndromic surveillance (EDSS).