Budget Debate to Include Health Department Staffing Options


The Finance Committee and the Board of Selectmen are considering a few staff increases as part of the FY23 budget that voters will ultimately debate and approve, with or without amendments, at this spring’s annual town meeting.  In addition to new requests from the Police and Fire Departments, the Board of Health is requesting additional staff for the Health Department.

Currently our Health Department consists of an Administrator who works 26 hours a week and a Public Health Nurse scheduled for 10 hours a week.  We rely on outside contracted services for the Board’s Title V septic system regulatory work as well as for food establishment and housing inspection requirements.  Certainly, during the peaks of the COVID pandemic we had to significantly increase the hours of the Public Health Nurse and the BOH Administrator.  Fortunately, we were able to draw on state and federal funding to pay for the needed additional hours which staff conscientiously and without complaint provided. 

Most towns have a Health Agent, either part-time or full-time.  It has been since the ‘90’s since Manchester has had an agent, either shared with Essex, or on our own.  While the pandemic will eventually recede, COVID is likely to become endemic with annual ebbs and flows perhaps similar to the flu.  And it is likely we will see new viruses and other communicable disease challenges in the future.  Having a Health Agent means we can reduce the number of contracted services we need, gain a department head leader to assist the Board of Health, and maintain a stronger presence for public health needs both in-town and with the various regional collaborative efforts that are and will likely be in place. 

The BOH has proposed two different models going forward.  One option is to seek a new part-time Health Agent, keeping the current hours of the administrative position, and reducing the number of contracted services we rely on.  Another option is to seek a full-time agent, maintaining the hours of the administrative position and all but eliminate contracted services.  Both options are similar in cost depending on the final number of hours a new health agent works each week.  Under either option we could use a portion of our federal American Rescue Plan Act (ARPA) funds for the first four years of the higher cost.

The BOH favors moving forward with the part-time health agent model as they feel it will be easier to hire a part-time agent who has either the food and housing inspection skills or the Title 5 skills.  If we choose the full-time agent route, we would be looking for someone with all the requisite skills/training which may prove difficult.

The pandemic has exposed many shortcomings in our health system, including how under-resourced many local health agencies are.  The State is embarking on an effort to bolster the training and certification requirements of health agents and is also investing in more regional efforts.  There are good examples of regional collaborative supplying the needed expertise and assistance to local communities.  Some of our neighbors are in the early stages of exploring possibilities along these lines.  Our Board of Health feels our in-house capabilities are a priority for now.

This and other pressures for increased staffing are emerging.  Some, like the Police Department, are a result of new state laws.  Others, like the Fire Department, are a result of societal changes and a decline in volunteerism.  In the case of the Health Department, we have gotten by with a bare bone staffing model that simply is not sufficient given today’s growing threats of communicable diseases.  Crafting a reasonable budget that meets these numerous service provision challenges is on-going.  Agreeing to all the requests will mean a tax increase above the usual 2 ½ percent once any grant funds are exhausted.  Voter choices come Town Meeting will provide the ultimate answers.

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