Budget crunch forces health unit to scale down school nurse program

Facing budget pressures, London's health unit will no longer provide a team of dedicated public health nurses to work in high schools. The decision essentially ends one-on-one student contact with nurses who provide help with a long list of health issues, including sexual health and mental health. 

"The services that are ending are the ability to do individual-level, staff-to-student, situational supports," said Dr. Joanne Kearon, associate medical officer of health for the Middlesex London Health Unit (MLHU). 

Kearon said the health unit will continue to send nurses in schools for vaccinations, and help school staff with tobacco and vaping enforcement. Health unit nurses will also teach group information sessions to students on issues such as bullying, substance abuse and building healthy relationships.   

"It definitely represents a loss of our ability to do those services and a lot to our community," said Kearon. "We'd like to be able to continue to provide those services but we can't do it at a meaningful population-level way moving forward." 

In a statement to CBC News by Thames Valley District School Board superintendent Andrew Canham said the board "deeply values" the support by health unit nurses. 

"The Thames Valley looks forward to continuing our partnership and collaborating with the Health Unit in relation to the impact any service changes may have on schools and students," the statement said. 

The London District Catholic School Board did not respond to requests for comment. 

The move to eliminate dedicated public health nursing teams in school began last year when the health unit eliminated staff positions while dealing with a $2.6 million budget shortfall.

At that time the school health team went down from 19 to 10 nursing positions. Now the remaining 10 nursing positions will be redeployed outside of schools, Keaton said. Two other vacant positions, a dietitian and marketing coordinator, have been eliminated. 

Emily Williams, the health unit's CEO, said MLHU has found savings in other areas but can't cut more without cutting services the health unit's board considers essential. 

"The only thing available to us is to decrease programming further and reduce more positions," said Williams. "We were not recommending that to the board and they were not supporting dropping their service levels any further."

MLHU will also go back to the funding municipalities it services — the City of London and Middlesex County — for a budget boost above what was included in those municipalities most recent budgets. The health unit has a submission to London's budget committee that seeks an increase of just under $227,000 in the city's budget update. The ask to the county is for $43,410. 

Increased ask to municipalities

In the City of London's four-year budget approved in the spring, London taxpayers will contribute an average of $8 million a year to the health unit, an increase of three per cent from the previous budget.

In a submission to the city's budget committee, the health unit said despite a series of cost-cutting measures — including eliminating 20 positions last year and another two this year — they  remain about $950,000 in deficit. 

The province increased the health unit's budget by $1 million last year, which Williams said wasn't enough to cover inflationary increases. 

So what's creating the health unit's budget pressures?

Williams said in addition to inflation, the health unit is working to clear a backlog of child vaccinations that accumulated during the COVID-19 pandemic. Because of that backlog, there's been an increase in the diseases that vaccinations help control, including measles and chicken pox. 

The health unit has also spent more to deal with outbreaks of communicable diseases that require contact tracing, including a legionnaires' outbreak last fall that killed two people. Another factor is the need to vaccinate an increasing number of newcomers to the London area. 

The request for the budget increase will come before London city council at Thursday's budget committee meeting. Meanwhile, the changes to the school nursing program will begin in 2025.