Department of publichealth, its programs and its clients. He sought humane and Lasting Solutions to the issues at homelessness, untreated mental illness, and Substance Abuse in San Francisco. He supported and funded the creation of the citys first Behavior Health Navigation Center at humming bird place on on the campus. And he was an avid supporter of the getting to zero initiative and backfield h. I. V. Funding for the sfph programs. He launched an Innovative Program in 2016 to help San Franciscoance afford Health Insurance through the San Francisco covered m. R. A. Under the city options. He was a champion for the vision zero collective Impact Initiative which increases safety for pedestrians and bicycleists while reducing injuries and death. He supported the implementation of assisted outpatient treatment in San Francisco giving families a chance at connection to treatment for loved ones suffering from mental illness. He put a generous amount of funds and reserve in the fiscal year 1718 and 1819 budget to protect the city against potential federal threats to the Affordable Care act and healthcare funding. He supported the San Francisco department of publichealth developments of an integrated Electronic Health record system through funding of the project and approved innovative funding mechanisms which the San Francisco department of publichealth could fund the initiative through safe revenue. He ushered in the rebuild of the sucker burg San Francisco General Hospital and spent time with patients at the General Hospital and laguna honda hospital in addition to visiting the sfdph Heath Centers where mayor lee created the department of homelessness in support of housing to focus efforts to prevent homelessness and assist those who are homeless. Where as, mayor lee advocated for Affordable Housing and many ways including pledgeing to build and rehabilitate buildings intended for lowworking and middleclass joining the board president david chew to reeight the Housing Preference program to assist tenants evicted through the ellis act sponsoring Funding Initiatives where mayor lee died december 12th, 2017 at San Francisco General Hospital and be it resolved the San Francisco Health Commission acknowledges and honours mayor lee for his lifelong commitment and dedication to improving the lives of others through his invaluable public service. His enormous compassion for others and his effective and thoughtful leadership and be it further resolved that the San Francisco Health Commission conveys its heartfelt condolences to his family, friends and colleagues. I hear by certify this San Francisco Health Commission at its hearing at its meeting of december 19th, 2017 adopted the foregoing resolution. Any comments on the resolution . Otherwise we prepare for the vote. All those in favor the resolution please say aye. Aye. All those opposed. Resolution has been approved. Thank you, i will make sure they get a copy of that resolution. Item 7 is resolution in honor of colleen, ill note this resolution was read and presented at the december 5th information meeting and that today is the day foray approval. Motion foray approval of the resolution for colleen is in order. All those in favor. Second. Ok. Further discussion. If not all those in favor of the resolution, please a aye. Aye. Those opposed and the resolution has been approved. Thank you. I will make sure that she gets a copy of the framed resolution. Thank you. Item 7 is resolution support of vision zero and automated Speed Enforcement and cindy will explain and the version you have in your packet has tracked changes because it is a version you all passed recently last year, im sorry, this year and this is a revised version. Ok. Please, thank you. Good afternoon commissioners, here with the updated resolution for automated Speed Enforcement for your consideration. The original resolution was passed in may of 2016 for vision zero and automated Speed Enforcement and i want to give you background on the automated Speed Enforcement and why were asking for your consideration for an updated version so the version original version was passed in may of 2016 and fortunately that year we were unable to get an automated Speed Enforcement bill introduced but fortunately in february of 2017, the General Hospital with Assembly Member chew mayor ed lee and the mayor from san jose, the streets act of 2017 was introduced and this bill would allow for both San Francisco and san jose to have a fiveyear pilot pharoah program of automated see enforcement. And the bill after it was introduced it was double referred so it was referred both to the Privacy Committee and to the Transportation Committee the bill passed through the priv committee and when it got to the Transportation Committee. They thought it was best to turn it to a twoyear bill was we werent sure we had the votes for it to move forward and the department of publichealth has been working closely with the m. T. A. For the past nine months trying to gather support and do more out reach and education not only automated Speed Enforcement but our Vision Zero Initiative in San Francisco. The bill is schedule for the Transportation Committee hearing on january 9th and we are seeking for commissions and constituencys that supported this bill to renew their support as we go in to this Transportation Committee meeting in the againing of next year beginning of next year. So the resolution is very similar to the original resolution that was passed and there were a couple updates and the most notable the National Transportation board came out with a study that really sum enter theed correlation between speed and fatalities, traffic fatalities and also recommended that all states removed barriers of having for automated and this was a really necessary tool to achieve our vision zero goals. Im happy to answer questions but our Vision Zero Team is on vacation for the holidays but i can try to answer questions or get back to you with information thank you. Thank you. If not the resolution a motion before us. I want to make one comment in the last year ive noticed on the buses the adds about speed and the vision zero desk i find them effective. I slowed down and people around me are slowing down so i wholeheartedly support any campaign to get us there, thank you, very much. Yes, please, commissioner. Hi, how are you. Quick question about a a assemblyman chew, it creates a Pilot Program for those two jurisdictions san jose and San Francisco that with the intention of it bringing results that would then help create a statewide program . Thats correct. There was pretty wide opposition throughout the state and so having the two pilot projects that have local support we thought it would be more effective trying to introduce this new technology and move it forward. Thank you. Further discussion. If not were prepared for the vote. All those in favor. Please say aye. Aye. All those opposed. So good luck. Thank you, very much. Commissioners item 9 is the s fph budget. Theres a long presentation from mr. Wagner. Very informative and interesting presentation. Get some coffee. [laughter] as we go in to this we normally would have a less format setting for the ability to have a dialogue around the subject that we have at hand as in our past planning sessions. However, so for today, we are going to try to do something that would allow everyone to have input and make their thoughts known and prepare for the future by going through each of the sections and stopping at each of the sections for commission and other comments that may come from staff and then proceed onto the next session knowing barbara has to go to a Department Meeting during part of this if there are questions we wanted to reserve for her well wait for her to return. And well set those aside. You can make the comment and we would then present those to her when she got back to put them back in to the context. Its not totally ideal as a set up but i think what those of us who plan this one to do is to begin top layout just before we go in to the budget for the coming year and this may be even more important with the potential transition and changes of leadership and government, where we stand in terms of our resources and how we are planning for the future. So this is a background a year ago we went in to a good part of it where we got in to the details of parts of the pools of funding and hopefully then today one can look at and see how those actually effect programs and what one with do about programs that are related to our budget. And so we will ask for is there any Public Comment on this topic first . I received no request for Public Comment. Ok, so, from this point on then well have accepted there were no Public Comments and dialogue will be between therefore the department and the commission and certainly if Staff Members also have something they want to weigh in on that could help they just sort of raise their hands because this is not really a roundtable and well call on them in order to add to the dialogue. I would encourage that well need to try this format for right now. So with that, mr. Wagner. Thank you dr. Chow. I think the overview and the context he gave is exactly right we did this last year for the first time and the item was as the city goes through its five year Financial Outlook weve tried to kind of piggy back on that process and look within the department of publichealth and see where we fit in to that broader outlook to try to give ourselves some background and some context for the budget that were going to enter in to for the next two years but then also to start thinking beyond that and imagine what the next four to five years will look like in types of decisions that we have to be thinking about now in order to impact our trajectory over the next five years. So as dr. Chow said, weve got five sections, i do want to try to kind of plow through this but i do want to make this useful to all of you so ill let the discussion and questions to the extent that you have them guide where we spend time. So, first section is just to go through where we are in terms of the citys financial picture and the instructions from the mayor s office as you know, this year, this time each year we get the official projection from the Mayors Office which is sort of a kickoff of the formal departmental budget process and the Mayors Office working with the other city stakeholders as a projection of revenues and expenditures for the general fund and uses that to develop policy instructions for the departments to guide the submission of the budget to the Mayors Office and in february. So the slides that im walking through right now are borrowed from the Mayors Office presentation to us so ill just recap what that presentation looks like and well dive in to more d. P. H. Specific numbers. So there are two things going on , the short term and the medium to longer term and in the short term, the fiscal picture is close to last year. Theres a deficit but not what we experienced in the years following the recession and so the deficit is not huge but it is significant and it is going to require some financial restraint to get threw this two year budget and in the medium and longer term the picture looks different and there are slowing of Revenue Growth compared to what weve seen in the last five or six kind of super charged years of Economic Growth and were still growth but not at the rates we have been and expenditures are growing faster than revenues, a couple of those areas are employee costs which is always a factor for city budgets and our budget and there are state policy changes including a big one one on ihss in Home Support Services which is shifting a significant portion of that program onto the countys from the state and we have voter approved baseline set asides which are carving outgrowing share of general fund dollars dedicating those dollars to a specific mandated services approved by the voters. We also of course are doing this in the context of what is happening at the federal level so that is something that is area of uncertainty and of course the economic climate is something that is perpetually worth watching. So the high level snapshot of the approach on the budget is to continue to do Financial Planning with an eye towards the future of building reserves and limiting the growth in our on going costs and being strategic about where the money goes so that when we have dollars were putting them towards investments that will payoff over many years and so those are all things that are very well aligned with our approach at d. P. H. And a lot of our focus for the last two years and our Financial Planning. The instructions to city departments are to reduce our level of general fund support by 2. 5 in the first year and 2. 5 in the next year so its relatively similar to last year and last year it was 3 and another 3 so were on the same order of magnitude. Just well get to if a little bit more later but the dollar value of those changes is about 16 and 32 million in each of the two years of the budget for us and in addition to covering all of our other new costs. The other significant instructions and well see, ill explain to you the reasoning for this but again no new f. T. E. S that was an instruction last year were expected to accommodate our needs and operating new to the budget. So, the Mayors Office financial projection again for the update from the fiveyear Financial Plan covering four years and it looks at the Revenue Growth and again the economy is still strong and in certain areas the rate of growth is slowing so were getting back to a normal, stable rate of growth as you remember during those few years after the recession ended in the city started a recovering and were really seeing astronomical rates of growth by historical standards in the city economy and jobs started coming back and Property Values escalated business taxes, hotel taxes were all coming in at highlights of growth and salary and benefits of course are continued cost growth but projection assumes we have inflationary increases in those rates and some other calculated rates for benefits and pensions and then other city wide costs. So here is the high level picture from the financial projection, these are millions of dollars by the fiscal years of the projection so you can see at the top total sources thats the growth in the revenues for the city and then below is the growth in the uses if you look at fiscal year 21, 22 you have Revenue Growth but then compare that to what you see in the uses which is 1. 1 billion of expenditure growth and you can see how that imbalances growing overtime to the point where the fouryear outlook shows 709 million deficit which is a very sizable deficit now that of course is projection that says if we just let present trends continue doing nothing about it, that is what will happen but of course, were not going to do nothing about it were going to do lots of things about it and that is what subject of the financial work were doing now. One other item to note on this slide in particular is if you look at the salary and benefits line in fiscal year 2122 that number is 559 million of growth and that number alone is greater than the growth in the total revenues. So all of that projected Revenue Growth is being consumed by the rate of growth in our employee costs. That is the reason for the instruction about no new f. G. E. S the city is historic high in the number as the Health Department and so the idea here is because of the rate of that growth every time you add new f. F. D. E. S you compound that cost to the future and its exacerbateing the gap between expenditure and revenues so theres a strong instruction for us to limit our f. D. E. Growth for that reason. Here is a high level break down of how the Cost Increases shake out so half of them again are salaries and benefits were half the salaries and benefits and then other operating costs and growth and baselines and set aside as i mentioned earlier. On personnel, the number of factors that are pushing on those personnel costs upward, pension is a big one, the picture on the amount the city needs to contribute to the pension costs has changed for the worse for a number of reasons over the last couple of years and it was expected the contributions the pension fund would decline at this point in time but a number of things including a loves a lawsuit, the level of returns on the Pension Funds investment and demographic of retire res has changed and pushed the forecast of those costs upwards and it has a big impact on ours in the citys total expenditures. We of course have continuing growth in wages which is reflection of the labor market and the economic climate in the region and then our health costs for employees are also continuing to grow at a faster rate than the economy. This is another illustration of the effect of our employee costs on the bottom line for the department and for the city and this is a history since 2007 2008 of the rate of the growth and employee costs versus normal inflation so the bottom green line is normal inflation and the economy and the Consumer Price index and the top line is the rate of growth in our employee costs so you can see that our employee costs are going much faster than you would have normal inflation in the economy and thats i couldnt see those costs really pushing the gap between expenditures and revenues and driving the deficit and again the reason for the no f. T. E. Instruction. I will pass on that slide and move to the next one. The same concept which the mayor s office and Controllers Office always use to remind us and i find a helpful reminder but these are the bars is the length of the time between recessions so if you have a period of one year of recessions its a bar graph of one so each year shows the starting point of an economic expansion so you can see that in 1991 for example, we began a period of economic expansions so no recessions consecutive periods of growth that lasted about ten years and the dark blueline which is the third from the right is the current economic expansion that were experiencing so thats been going on since 2009 and were at a little over eight years and that tells us that if we go through this upcoming two year budget cycle, without experiencing a recession we will then be in the longest continuous period of economic expansion since we really have reliable economics data so the city is not forecasting a recession but you keep this context in mind its a helpful reminder we should keep at the front of the mind its certainly possible from the Historical Perspective that we can have an economic change in the Economic Cycle within our planning horizon and we should start to act in ways that create cushion for ourselves if thats the case another kind of caution on the horizon is when you look at the way that the city has balanced its budget and how were using different sources to pay for our operating costs, this graph those you a couple of big one time Revenue Sources that had been used to balance the budget and first this fund balance that is the dollars and the surplus we end the year with and spend forward coming the two year budget and the blue at the top is the property transfer tax and the property transfer tax is when a property changes hands it comes in to the citys general fund you can see how it has grown dramatically over the period of the economic expansion thats due to the rise in Property Values and you can see also kind of what happens to that revenue in prior periods of downturns. Its susceptible to the economy so a lot of citys financial projections and our current budget is balanceed on the assumptions that we will be able to continue to see that high rate of revenue from property transfer taxes if theres a change in the economy that significantly effects Property Values that can drop significantly its a risk to the citys budget. So looking forward i wont go in to these in detail but risks from the federal you are familiar with most of the number of different area were policy changes that could effect income to the city the biggest and there was to be a change to the medicate funding have been proposed earlier in the year in congress that did not go through and its something we need to be mindful of that could have a significant change to our Financial Outlook. So again, instructions from the Mayors Office on going reduction of 2. 5 and another 2. 5 in the second year and dont grow budgeted f. T. E. S we need to submit a budget to the Controllers Office by february 21st could combine with those instructions and our numbers are 16 and a half million in 1819 growing to 33. 1 in 19 and 20 so those are numbers that are big numbers but they are within the range of instructions that we have met in the past. So that is a summary of what the Mayors Office presented to us and ill take a moment and see if there are any questions or conversations on it. Questions from any commission ers . See how clear you were. Well troy to keep the streak going. What is our total budget now . Our total budget is a little over 2 billion. Ok. So were putting the 16 milliondollar in to that context . Yeah and so the 16 million, the 16 million is not total reduction to our budget but it will be after you take going from the current year to next year you build in all those increases that we know will happen so pension costs and labor contracts, inflation an our pharmaceutical thats will push our budget up and were being asked to reduce that higher number by 16. 5 million so in actuality the mayors budget instructions is really not a cut to us and this is been the case in the past several years where essentially its saying you are going to grow but please restrain the rate at which you are growing so we can keep expenditure growth closer in mind with revenues and so why want to get the impression its like a nominal like you have to reduce your budget compared to the current year so well grow and trim back on that growth. So next commissioner. I just wanted to thank you, this is its an excellent protocol of what happened and it all changes even the last week the votes with congress our mayor and its interesting when you look at it and you shared it especially the draft from 1945 we had this period of growth compared to where we are now and you think about what happened from 45 on and you think built investment i. E. In hospitals and education and rebuilding this station and building schools thats institutions of Higher Learning and the g. I. Bill providing all of these services so we can make quote really what the nation is all about and we take a look at where we are within the last whatever and you think about west longest war ever 16 years and you look at the industrial military complex and how many billions were spent and our schools are, Everything Else that was built before were education was free and we invested in education and all of our people and now its astounding its like were two different worlds and the other variable where theres a shift even locally in administration i cannot remember closely when they were killed and dianne came in and george had his own way and we are going to zero base budgeting and all of a sudden we had it revised and our staff went through a whole top see topsyturvy and weve had outstanding input and we were able to track the best of the best and you folks have been fantastic but again all these variables are its like really watching two nations that are totally different and what were about and thank god for the city but i mean, were going to be hit as we all know i mean, the variables brings us back to there was a out beat client but i think about the leadership over the years and as our president has said our mayor was such an exceptional person and there was a thing called men to match our mountains and they looked at yo sem tee and so fourth and you think about we had a mayor that not only match people went through mountains building those railroads, Building Access here and all those Clinical Trials that went through and look what he went over the mound and his commitment to what our institutions were, what our democracy was is unparallel and then here we are in this other world dismantleing everything, we all know its every day and you think where are we as a nation but thank god were still here in the city county still navigateing that we have a lot of challenges but you staff have been through so many challenges and whatever and theres going to be more challenges coming in but as was mentioned in the services, they wanted to thank all the staff city and county who have really pulled together to go through where we are now and why we have the ability to do some things and some things will be challenged on but its a team effort and anyway, the leadership you just had will feel never get again and restore dignity to public service, to what our mission is and what our values are as the city and hopefully as a nation at one point. Im sorry, but again this budget was a budget designed by this crew. The crew and the mayors crew and that may shift and well hold stead fast. Thank you. And i will say to one of mayor lees legacy is investment where maybe not everybody was stepping up but the city stepping up to make those investments and Public Infrastructure going back to a city administrator he was one of the authors of the First Capital plan and the first new version of the capitol plan and it included the rebuild of San Francisco General Hospital and it included the bonds that were currently spending on and it included parks a lot of that infrastructure and so i think that has been one of the f. We look at the world that were in right now thats a big piece of that context is where we have had resources locally and we have made an effort over the last many years to invest those is in Public Infrastructure that hopefully will payoff over many years to come. Thank you. Thank you. Commissioners, any other comments on this and we appreciate the perspective commissioner sanchez put us in to in terms of these arent just mayors instructions. Well move forward to the next item getting more directly in to our general fund. All right. So i am included here as the request of president chow and others a slide we did at last years presentation for some context and clarity on the general fund because as you know the general fund and the level of general fund support is what really driving our budget process is what were balancing to throughout the process and there are a couple of words that we get tripped up on often times in our financial and Planning Committee and other contacts which is the general fund and our level of general fund support which is what were balancing to so the general fund is an Accounting Fund in the city and i think ive got some old lingo up there since weve changed our Accounting System but its app Accounting Fund and it contains a lot of things and it contains general tax revenues and it also contains revenues that come from the state and federal and it contains fee revenues and its used to pay for a lot of Different Things in the city and a lot of different departments including d. P. H. So within the general fund, which is an Accounting Fund, there is concept called general fund support and within the general fund theres a pool of tax dollars that comes in their local tax dollar and those local tax dollars are available to be allocated by policy decisions from the board of supervisorors and the Mayors Office so you can see i have a graphic here showing theres the general fund within it and theres a pool of unallocated general fund dollars that can be spread around to diffuses at the discretion of our elected officials so d. P. H. Received dollars and general supports those are the dollars that are between our revenues and our expenditures and we also receive dollars that are federal grants and we earned federal and state and commercial revenue through a services that they provide to patients throughout the network and we have a significant portion of our budget which comes from that un allocate general fund dollars and its our general fund support so the graphic up here say little convoluted and im happy to dive in to it if its useful to refresh the ideas is theres that general fund un allocated dollars those have to be spread around to fund a whole bunch of city and county services and Police Department, Fire Department, rec and park department, Health Department, Human Services department the whole range of services and so in a sense we are competing with all of those other departments maybe competition is the wrong word but theyre competing demands on that pool of un allocated general fund dollars from those Important Services that the mayor and board need to weigh each year to balance the budget and because the demands on that pool of funds is larger than the available funds every year, thats why were asked to take actions that restrain our rate of growth and our draw on those funds. So just to give you a little bit of a sense of perspective on how we fit in to that picture, this is a table from the citys approved budget our adopted budget you can see for example on fiscal year 17 and 18 each department and it shows how many revenues is generating and how much allocated general fund support it is receiving so that column is important and that is the amount that theyre receiving from the mayor and the board of supervisors through the budget process through that pool of local tax dollars and then theyre total sources and so you can see how the dollars flow for example and theres the Police Department in this first section which earns 128 million per year in revenue but it receives a subsidy 460 million from the citys general fund and so on and so fourth. The department of publichealth is highlighted in blue. We earn 1. 5 billion in revenues from sources but we receive 715 so we draw the pool of local tax dollars that gets allocated for us for our services. The total in the box is 4. 2 billion so we receive a substantial amount of that but not the per ponderance when you look closer however, there are a lot of constraints on the discretion over the funds with the mayor and the board of supervisors have to make decisions and this is an example from fiscal year 17 and 18 so of that 4. 2 billion that is legally available for the mayor and board to allocate out to city departments theres about three quarters of a billion of that amount that is locked in and mandates so for example, the voter say were going to require in the charter that x dollars gets to this specific service those dollars must be allocated and the mayor and the board have no discretion to allocate them otherwise and there is about a billion of that 4. 2 that goes to pay for general city responsibilities which is things like Retiree Health subsidiaries , Health Service Administration Costs and those dollars that we must spend keep City Services running and were obligated do not have a policy choice to make to reduce them without other action and that leaves about 2. 5 billion that is available that is truly a matter of policy addition correction so in that light our 715 million is much larger share puts us at about 30 of the total discretionary dollars that are available to allocate and so that is a big portion its a much bigger portion than when you look at the higher level numbers and that is one of the reasons that our budget is a major factor for the citys general Fund Balancing plan and vice versa when the general fund is in trouble were in trouble and when were in trouble the general fund is in trouble so thats why were always working very carefully to coordinate with Mayors Office and Controllers Office on our Financial Planning so that it alliance with the citys approach. So any questions on that piece of it . Commissioner. With regards to our 715 million general fund support at 29 how did that compare to other departments, what are the next top three perhaps . All right, here we go. Lets see. So if you look in the second column of numbers you can see the general fund support so just to kick a couple off theyre on the prior page so you can see Police Department at 459 and weve got the Municipal Transportation Agency received 313 million and Human Services agency 241 million so the biggest general Fund Recipients are are the core city and county functions so those are the Public Safety so Police Department Fire Department and sheriff those are all big general fund draws primarily because of the large Core Functions that dont generate their own revenue and on the traditional county side its us and the Human Services agency so those safety net Human Services programs socom bine those five departments and you get a pretty large share of what the the general fund dollars are used for. Any questions . Please have empathy for mr. Wagner to stand during the presentation. Im trying to go fast. With regards to other departments and their financial staff us, the other departments as far as you know and the most general way healthy do they have reserves like we have reserves and i guess this is if theres a battle for an apple pie how hungry are they. [laughter] yeah, um, its a big question and its a lexture so a lot of people are True Enterprise departments they have their own reserves and so if you particularly want the ones that are receiving the vast majority of their revenues are earned revenue which are general fund most have their own reserve like the Public Utility Commission and the airport building inspection and financial Transportation Agency and they have reserve policies and they built their own reserves and the flip side of that is that there is no general fund to bail them out if they get in to financial trouble because they are responsible for generating their own revenues. For general Fund Departments, most do not center a reserve and the general fund itself theres a general fund reserve for the city and that is health and appropriateed in the budget each year we started the policy about three years ago and working with the Mayors Office and the Controllers Office of creating a management reserve for d. P. H. Done through the budget appropriate ordinance that allows us to as you know, when we know that there are potential volatility in our federal revenues to set aside dollars in a reserve to account for that future liabilitys that we might have and that is a pretty new policy that something that is again about threeyearsold and i dont think that it is replicated in any other general Fund Department and the reason for that is we had a lot of experience with especially when we get these big pieces of federal revenue theyre funded through an i. G. T. And they take forever to get the red tape done to get us paid so you have a short fall one year and a payment the next year and maybe you get paid twice this year and zero times next year and that fluctuation of revenue was hard to manage and caused a lot of volatility on the citys general Fund Balancing so that was one of the steps that we had taken as part of the Health Commission s kind of Financial Sustainability direction is to put that reserve in place to weather some of that volatility but for the most part aside from that so that is a big positive for us and for the citys general fund for the most part, the general fund does not have other general Fund Departments dont have their own reserves and ill talk about it a little bit later in the presentation but the city has over the the last seven or eight years worked hard to buildup those general Fund Reserves and do better Contingency Planning for future downturns than had been done in the past and i think thats another Financial Management legacy of the past administration. Thank you. Any other questions at this point . No, well, are you able to continue. Yes. I keep plugging away. All right, so i want to re visit what we talked about last year which was the approach that we had adopted going in to our last fiveyear Financial Planning cycle and so as you may recall what we talked about last year and this is after a historical period where the department of publichealths rate of growth in general fund was high where our general fund support levels were growing at a rate that was faster than tractortrailer rest of the city and so at last years Financial Planning session, we kind of took the view of saying what would happen if we sort of planned for ourselves to grow but grow no faster than the rate of growth as the general fund as a whole and so essentially we would be taking no more than our share of that growth in the tomb total city revenues and that was the principle to set some longterm Financial Planning targets for ourselves. The illustration is here where this is sort of saying if we start out with 30 of the numbered and hold ourselves and say were going to grow but were not going to grow more than our share were not going to eat in to the share of other departments, at the end of the planning cycle, as it looks on the bottom, were still at 30 . We grew but were still at 30 of the discretionary general Fund Revenues. The top is where were growing faster than the general fund as a whole when we do that overtime we eat up a greater and greater share of the general fund dollars that are available and that leaves a smaller pool available for other general funded services and puts pressure on the general fund that ultimately comes back to us when theyre a large deficits and were asked to reduce our share of those deficits. So were trying to say lets try to grow at the pace that the general fund dollars are growing that will prevent us from being in a deficit in the city it comes back as a largecut targets and were growing services, shrinking and growing and were just going to keep at a slow and modest but steady rate of growth in our inflation. So last year this is kind of recaping at what we looked at last year when we went through this exercise, we had used that principle and said, lets look at what the projections are for the rate of growth in the citys general fund and say if we grow no faster than that rate of growth so we just keep to our share what would our level of support would be to accomplish that and so at the top of the page for 17 and 18 those were our targets we calculate inside that way and 711 million and 740 million for 19 and 18 and below that is the adopted budget for the 17 and 18 you can see that theres the level of general fund support and its 715 and 770 so its over the target but that difference was funded because as you saw at the presentation three or four months ago we ended fiscal year 16 and 17 with a large surplus due to Revenue Growth and those dollars were programmed in the mayors budget to fund our d. H. R. Contributions some of the items in the mayors budget such as the humming bird, the saint marys some of those other prioritys so our net general fund when you factor in the surplus is 682 million and 704 million over the two years so were doing better than that target that was adopted by the Health Commission last year. Thats a recap before we ended up compared to our discussions last year. So now what im going to show you is we have updated this projection and im noticing the column might need to be widened. I see theres a little bit of a all right. So ill do this and ill scroll back and fourth and this is an updated version of what we looked at last year at Financial Planning session and this is essentially taking the mayors financial forecast and isolating the d. P. H. Only portion of it and so you can see at the top there there are expenditures and those are broken out by the large catagories, salary and Fringe Benefits and contracts and other items Electronic Health reports or materials and supplies, equipment, and facilities. On the bottom is our revenue projection again this is the revenue projection that is assumed in the mayors fiveyear projection and general fund support and between our expenditures our revenue how much general fund support will we need to kind of and baseline projections and so to provide a little bit of context on what these are showing us, you can see where the growth is and where the changes are so for example, salaries and the line below that accounts for 250 million of expendsture growth so its the single largest driver of our expenditure growth over the five year projection. Other items driving Cost Increases are inflation on our non personnel costs so our contracts are purchases particularly our pharmaceuticals and our growing at a rate thats much faster than inflation and to all those if they continue at their rate of growth will drive up our expenditures and when you a five correction protection we projected if can he continue at this pace our general fund support will grow to 1 billion n. Should read 22 and 23 fiscal year 22 and 23 so that would be a pretty significant rate of growth and this, what you are seeing here is mirrored in the larger and it shows the city deficit growing to 700 million by the end of the fiveyear time line. What were doing similar to the past if we look at fiveyear projection and say how do we expect the rate of those general Fund Revenues to grow, and then lets hold ourselves to that same rate of growth what would we have to do to get our general fund down to that level so ill walk through this spread sheet and show you what that kind of projects out to and at the top line, those are the numbers taken from the last page so and in the next section we take the 1820 budget so this is the upcoming two year budget and and savings proposal so that target and our general fund targets and 19 and looking out in to the following three years, were saying ok after that adjusted total after we kind of do what were going to do in this two year budget what will the years look like and in those areas what were doing here is the same thing that we did last year were looking at the rate of growth in the general f
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