The District Municipality of Muskoka

Health Services Committee

Meeting HS-4-2019

Minutes

Place: Council Chamber, District Administration Building

Time: 9:00 a.m.

Date: March 21, 2019

Present: Committee Chair S. Clement; District Chair J. Klinck; Members S. Cairns, T. Glover, R. Nishikawa, T. Withey

Absent: Member P. Cooper

Officials Present: M. Duben, Chief Administrative Officer; N. Barrette, Commissioner of Health Services

Also Present: C. Faber, Director, Programs; J. McWilliam, Chief, Paramedic Services and Emergency Planning; S. McKinnon, Deputy Chief, Paramedic Services and Emergency Planning; R. Jackson, Administrative Assistant; T. Guthrie, Deputy Clerk

Call to Order

Committee Chair Clement called the meeting to order at 9:05 a.m.

Declaration of Pecuniary Interests

None were declared.

Orientation

a) Orientation – Muskoka Paramedic Services Overview Presentation Presentation HS-4-2019-3

Chief McWilliam provided a digital presentation regarding Muskoka Paramedic Services and answered questions regarding the opioid situation in Muskoka; eastern Muskoka ambulance deployment and Algonquin Park coverage; ambulance service billing and new paramedic hiring.

To access the presentation, click on the following link: https://muskoka.civicweb.net/document/33460

Councillor Nishikawa arrived at 9:12 a.m. Muskoka Paramedic Services a) Muskoka Paramedic Services (MPS) Short-Term Deployment Recommendation Results Report HS-4-2019-1 b) Retaining Ambulance 5172 to be operated as a Support Unit Report HS-4-2019-2

Moved by T. Glover and seconded by J. Klinck R12/2019-HS

THAT ambulance 5172 be declared surplus and rebranded to a Support Unit;

AND THAT the fleet complement for Paramedic Services be increased for this Support Unit;

AND THAT the operation of the Support Unit be maintained within the 2019 approved operating budget for Paramedic Services.

Carried.

Health Services a) Verbal Update on the Local Ontario Health Team

Mr. Barrette provided a verbal update on the Province’s initiatives to create health care teams across the Province. He noted that the current government’s recommendation is to consolidate all health care organizations in Ontario into one agency called Ontario Health. He added that the intent is to have one agency responsible for the delivery of all health services in the Province; to create regional health teams to ensure that local presence in health care is maintained and to have a strong reliance on the use of digital technology for health care delivery.

Mr. Barrette advised information would be provided on a regular basis to the Committee as information is released related to this initiative. b) Establishment of a Health Initiatives Fund Working Group Report HS-4-2019-4

This item was deferred to a future meeting due to changes being made by the Provincial Health Care Programs and Initiatives.

Information Items a) Correspondence received from the Ministry of Health and Long-Term Care dated February 26, 2019 regarding Ontario’s Government for the People to Break Down Barriers to Better Patient Care HS-4-2019-INFO-A b) Correspondence received from the Simcoe Muskoka District Health Unit dated February 20, 2019 regarding Public and Environmental Health Implications of Bill 66, Restoring Ontario’s Competitiveness Act, 2018 HS-3-2019-INFO-B c) Correspondence received from the Ministry of Health and Long-Term Care dated March 8, 2019 regarding Ontario Health Board of Directors HS-3-2019-INFO-C

New Business a) Simcoe Muskoka District Health Unit Board update

Councillor Cairns highlighted the minutes of the February 20, 2019 Simcoe Muskoka District Health Unit Board meeting and recommended that the Health Unit be invited to a future Committee meeting to discuss climate change and its impact on public health issues.

To access the Board Meeting Notes, click on the following link: https://muskoka.civicweb.net/document/33462

Adjournment

Moved by T. Withey and seconded by J. Klinck P13/2019-HS

THAT the Health Services Committee adjourns to meet again on Thursday, April 18, 2019 or at the call of the Chair.

Carried.

The meeting adjourned at 10:27 a.m.

______Deputy Clerk 70 PINE STREET, BRACEBRIDGE, ONTARIO P1L 1N3 Telephone (705) 645-2231 / Fax (705) 645-5319 / 1-800-461-4210 (705 area code) www.muskoka.on.ca

To: Chair and Members Health Services Committee

From: Stuart McKinnon Deputy Chief, Paramedic Services and Emergency Planning

Date: March 21, 2019

Subject: Muskoka Paramedic Services (MPS) Short-Term Deployment Recommendation Results

Report: HS-4-2019-1 ______

Recommendation

This report is provided for information.

Origin

In 2017, Operational Research in Health Limited (ORH) was retained to conduct a Comprehensive Deployment Review of Muskoka Paramedic Services (MPS) in the District. The company specializes in operational planning for emergency and health services and has completed hundreds of similar projects globally. The company uses analytical and modeling techniques to address resource planning problems employing a sophisticated simulation process.

For the Comprehensive Deployment Review, the company collected paramedic service call data, population growth and demographics projections, community development planning data and traffic data. From the collected data, the consultant determined the District’s future Paramedic Service call demands through to 2028. The consultant then ran a series of iterative simulated operational models to determine the most efficient and effective paramedic resource deployment to meet the future call demands. With the resulting modelling, the consultant provided recommendations over the short, medium and long term.

ORH’s presentation and final report can be found in staff report CES-11-2017-1.

Page 1

Analysis

All of the consultant’s short-term recommendations have been successfully implemented.

The consultant’s short-term recommendations were fully implemented in 2018 and included:

A. Updating the Current Deployment Plan to be more effective and efficient B. Optimizing Station Deployment by moving the 12 hour weekend evening staffing from MacTier to Port Carling C. Improving seasonal coverage with an additional ambulance in East Muskoka & the Highway 11 Corridor

A. The MPS deployment plan was optimized for call demand coverage.

A deployment plan is a written set of directives that MPS provides to the Ministry of Health and Long-Term Care’s Ambulance Communication Service. The directives state how to deploy MPS personnel to meet response time performance and operational objectives. This plan also directs standby deployments to reposition personnel from one area of the District to another in order to provide balanced emergency coverage, in an effort to maximize overall performance.

Updating the deployment plan was a lengthy process and was carried out by a team comprised of front line paramedics, union representatives, Muskoka Ambulance Communications Service staff and the management team. Efficiencies were identified by seeking feedback from front line staff, analyzing neighbouring services’ deployment plans, consulting with allied agencies, and implementing changes informed by the Comprehensive Deployment Review.

The revised plan aimed to improve response time performance, through reducing non- productive vehicle movements and standby deployments, and control non-urgent transfers during times of limited resources. The expected results of these changes were reductions in the duration and frequency of critical low paramedic availability and reductions in paramedic shift overrun.

As some of the considered changes to the deployment plan may have had an impact on the hospitals in Muskoka relating to non-urgent medical transportation for patients, multiple education sessions with hospitals were held prior to rollout to allow for feedback, and preparation ahead of the final roll out.

The revised deployment plan was implemented on June 4, 2018. Following the roll out, staff worked with management staff from the hospitals as the deployment plan changes limiting the number and time-of-day acceptance of non-urgent medical transfers caused some operational concerns from the hospitals. Subsequently, following the deployment plan roll out, the hospital has been using private medical transportation companies to complete their non-urgent patient transfers. Staff learned that the hospitals had service contracts in place with private medical transportation companies before the deployment plan changes were made but were not generally utilizing the companies as Paramedic Services were being utilized in this capacity. Page 2

B. Staff rostering was adjusted to match patient call demands.

The legacy staffing pattern of the MacTier station was 12-hour daytime coverage Monday to Thursday and 24-hour staffing from Friday to Sunday. In Port Carling, staffing was 24-hours Monday to Thursday and 12-hour daytime coverage Friday to Sunday.

Consistent with the recommendation from ORH, staffing for the 12-hour night was shifted from the MacTier station to the Port Carling Station resulting in 24-hour staffing seven days per week in Port Carling and 12-hour daytime staffing 7-days per week in MacTier.

C. Seasonal coverage was improved in East Muskoka and the Highway 11 corridor.

Two 12-hour 7-day per week daytime paramedic ambulances were staffed during the peak seasonal period from June 29, 2018 to September 3, 2018. One paramedic ambulance was assigned to patrol the Township of Lake of Bays and a second paramedic ambulance was deployed from the Town of Bracebridge Paramedic Services Headquarters.

As a result of implementing the consultant’s recommendations, there were outcomes that are highlighted throughout the remainder of this analysis section.

Implementing consultant’s recommendations resulted in improved operational efficiency, and balanced coverage, while maintaining response time performance in 2018.

The response time performance targets set for 2017 and 2018 were all met or exceeded for year over year. A detailed report on the 2018 response time performance plan results will be presented in April, 2019.

Seasonal and year-over-year changes in call volumes were managed with the addition of seasonal staffing, controlling non-productive vehicle movements which resulted in fewer periods of low paramedic availability. These factors contributed to response time performance being maintained in 2018. Secondary benefits were achieved including reduced shift-overrun which has positive impacts on staff work/life balance, reduced staffing cost, as well as reduced ambulance mileage and fuel consumption.

Periods of low paramedic availability were reduced.

Status Critical is an operational term used to describe times where high call volume levels result in 1 to 3 paramedic resources being available in the District. Code Red is an operational term used to describe times where high call volume levels result in 0 to 1 paramedic resource being available in the District.

The addition of 2 seasonal paramedic ambulances contributed to a reduced time spent in Status Critical and Code Red during the seasonal period. As shown in the table below, Status Critical occurrences dropped by 48% and Code Red by 34%.

Status Critical and Code Red - Seasonal Period

2017 2018 % Change from 2017 - 2018 Status Critical 95 hrs. 50 hrs. -48% Code Red 5 hrs. 3 hrs. -34% Page 3

Updates to the MPS Deployment Plan helped improve paramedic resource availability during the June to Year-End period, by reducing the time spent in Status Critical or Code Red situations as shown below.

Status Critical and Code Red – June to Year-End

2017 2018 % Change from 2017 - 2018 Status Critical 189 hrs. 126 hrs. -33% Code Red 7 hrs. 4 hrs. -41%

Controlling non-urgent out of the District transfers improved paramedic availability especially during peak periods.

Controlling non-urgent patient transfers contributed to fewer standby deployments. During the seasonal period, the need to bring paramedic ambulances from the west to Bracebridge decreased by 49%. During evening periods where staffing levels are lowest, time spent at low paramedic availability was slightly reduced. During the seasonal period in 2017 Status Critical between the hours of 22:00 and 07:00 was 35 hours compared to nearly 31 hours for the same period in 2018. 60% of time spent at status critical in 2018 was between 22:00-07:00 indicating that resources are low during evening hours, but some improvements have been made.

The seasonal paramedic ambulance in East Muskoka was highly mobile and utilized for patient calls.

Of the 804 hours of coverage provided by additional paramedic ambulances, 70% was spent responding to calls or roaming the East Muskoka coverage area, with the remainder spent at the seasonal posts. Below is a distribution of time spent at each post. Note, almost half of the time was spent in Hillside, consistent with the recommendation brought forward during the Comprehensive Deployment Review. Fire Stations were used in Hillside, Dwight, and Baysville, and an OPP Office in Dorset to provide space for paramedics to have meals and complete documentation. Data was collected through a paramedic sign in/sign out process at each location.

Seasonal Paramedic Ambulance Distribution of time spent at each post

Page 4

The addition of a seasonal paramedic ambulance in Bracebridge reduced standby deployments by 11% overall increasing paramedic geographic availability District-wide.

The addition of a seasonal paramedic ambulance in Bracebridge helped reduce standby deployments from Port Carling and MacTier by 49% during the Seasonal Period, allowing resources to remain in the west end of the District. From June to Year-End, service-wide standby deployments reduced by 11%, resulting in fewer vehicle movements. For Port Carling/MacTier from June to Year-End was reduced by 32%.

Standby Deployments - Seasonal Period

2017 2018 % Change from 2017 to 2018 Port Carling/MacTier 718 363 -49%

Standby Deployments – June to Year-End

2017 2018 % Change from 2017 to 2018 Port Carling/MacTier 1,698 1,157 -32%

Operational benefits were achieved resulting in cost-avoidance in staffing and fleet.

Although not the primary purpose of the Comprehensive Deployment Review, some operational efficiencies resulting from more efficient deployment strategies have been realized resulting in cost-avoidance in the areas of staffing and fleet operations.

Paramedic shift overrun was reduced by 23% during the seasonal period.

Changes implemented in the Deployment Plan were aimed at reducing shift overrun by restricting lower priority transfers near the end of shift, and ensuring staff are back to their station on time whenever possible. The benefits are improved work/life balance for paramedics and reduced expenditures related to overtime. The changes were designed to have no impact on emergency coverage and response performance.

Shift Overrun – Seasonal Period

2017 2018 % Change from 2017 - 2018 Shift Overrun 412 hrs. 317 hrs. -23%

Shift Overrun - Updated Deployment Plan Period

2017 2018 % Change from 2017 - 2018 Shift Overrun 894 hrs. 763 hrs. -15%

A 23% decrease in shift overrun during the Seasonal Period can be partially attributed to the addition of 2 seasonal resources. A 15% reduction in overrun for the June to Year-End period demonstrates that changes to the Deployment Plan also contributed to a reduction in overrun resulting in a net cost-avoidance of approximately $9,800. Page 5

Fleet fuel consumption was reduced by 7% and mileage was reduced by 4% year over year.

Fuel consumption and mileage were both less in 2018 during the seasonal period compared to 2017. Fuel consumption and mileage were also lower for 2018 June to Year-End period compared to 2017. 2018 Variance from 2017 with 2017 2018 2 Seasonal Ambulances Kilometers (Seasonal) 193,285 186,761 -4% Litres (Seasonal) 48,882 46,847 -4% Kilometers (June – Year-End) 560,491 536,695 -4% Litres (June-Year-End) 134,389 124,835 -7%

A reduction in mileage, fuel consumption, and subsequent maintenance for the June to Year- End period resulted in a net-cost avoidance of approximately $14,000.

Financial Considerations

The financial considerations are noted in the Analysis section of this staff report.

Communications

In future reports to Committee, details of the 2018 response time performance results will be presented. In addition, subsequent reports will outline further components of the Comprehensive Deployment Review’s medium and long-term recommendations as below:

Medium-term recommendations (over the next 5-years) include:

1. Introducing a low priority transfer ambulance 2. Optimizing station locations in West Muskoka 3. Adding new staff support positions for management and administration

Long-term recommendations (over the next 10-years) include:

1. Adding additional 12-hour 7 day per week staffing for night shift resulting in two 24-hour seven day per week ambulances in Gravenhurst 2. Developing a capital plan to align with all recommendations

Page 6

Strategic Priorities

Click on icons below to view strategies under each priority area:

s 1.1, 1.5, s 2.2, 2.4, s 5.2, 5.4 1.6 2.9

Respectfully submitted,

Original signed by Original signed by

Stuart McKinnon Jeff McWilliam Deputy Chief, Paramedic Services Chief, Paramedic Services and Emergency Planning and Emergency Planning

Original signed by

Norm Barrette Commissioner of Health Services

Page 7 70 PINE STREET, BRACEBRIDGE, ONTARIO P1L 1N3 Telephone (705) 645-2231 / Fax (705) 645-5319 / 1-800-461-4210 (705 area code) www.muskoka.on.ca

To: Chair and Members Health Services Committee

From: Stuart McKinnon Deputy Chief, Paramedic Services and Emergency Planning

Date: March 21, 2019

Subject: Retaining Ambulance 5172 to be operated as a Support Unit

Report: HS-4-2019-2 ______

Recommendation

THAT ambulance 5172 be declared surplus and rebranded to a Support Unit;

AND THAT the fleet complement for Paramedic Services be increased for this Support Unit;

AND THAT the operation of the Support Unit be maintained within the 2019 approved operating budget for Paramedic Services.

Origin

The current 10-year capital budget plan for ambulance vehicle replacements is two (2) new ambulances annually. The expected life-cycle of an ambulance is 4 years or 300,000 kms, and Paramedic Response Units are replaced every five (5) years or as required.

Analysis

Supporting community programs, focused prevention, education and awareness of health related emergencies is an integral part of contemporary paramedic services.

A holistic approach to providing paramedic services includes education and prevention programming. Education in the form of public awareness, CPR courses, AED training, and targeted presentations help to support better patient outcomes, while preventative health presentations and activities help improve the overall health of the community. Professional recognition within the service and between area services has become an integral component of a modern paramedic service.

Page 1

There is currently no dedicated Muskoka Paramedic Service (MPS) vehicle for community programs or logistics.

Current community relations programs and Honour Guard activities are supported using front line vehicles, District vehicles when possible, or personal vehicles. Spare ambulance resources are strategically placed at each station to support operations in the event of a breakdown or scheduled maintenance. However when spare ambulances are relied upon for community programs and special events, operational requirements have impacted the completion of some of the planned activities.

Operational challenges result from the current process.

The Muskoka Paramedic Services (MPS) Management Team, Community Relations Coordinators, Honour Guard, and Community Paramedics have identified the shared challenge of finding appropriate transportation for personnel and equipment/materials for various community events. Front line ambulances and Paramedic Response Units (PRUs) have been made available for community events and logistical tasks, however removing these resources from a station, even for a short time, may cause a delay in resource replacement in the event of a vehicle breakdown. This challenge is much more apparent during the Seasonal Deployment period where there are fewer spare resources available.

The use of an in-service vehicle is not ideal for use by staff that are not on active-duty (Honour Guard, Community Relations, Community Paramedicine, and Modified Work Staff). When a vehicle is used for these activities, signs that are labelled “Not in Service,” are place in the front windshield and the rear doors of the vehicle, however the overall appearance of the vehicle is not distinguishable to members of the public and may lead the community to expect them to respond as any on-duty paramedic would.

Retaining an ambulance scheduled for decommissioning and disposal to be used as a support unit for community program and logistics use will achieve a number of benefits.

A support unit is a non-emergency vehicle that is used by paramedic services for administrative and community work. A support unit is not governed by the Ambulance Act. Internal policies apply to the use of the support unit and the vehicle may not be used for emergency responses.

The vehicle will be re-branded in such a way so that is clearly identifiable as a District/MPS vehicle but not one that performs emergency responses.

The support unit will provide staff transportation to support:

• Community events such as group visits, public relations (PR) displays, Flu Clinics, parades, and food drives; • Equipment, inventory, and the retrieval of equipment from neighbouring services; • Paramedic staff on modified/restricted duties, who have medical restrictions and should not be performing regular paramedic duties while travelling the District; • Honour Guard travel and preparation. Storage of uniforms during travel, and locating a climate controlled place to prepare events; and

Page 2

• Community Paramedicine clinics/visits.

The support unit may be utilized during a large scale event, in a non-emergency capacity. The vehicle may provide additional space for planning or site management, in tandem with the Emergency Support Unit (ESU). The ESU is a trailer that carries additional equipment, provides admin space, and logistical supplies to certain emergency scenes. Further, if additional supplies and /or staff were required at an incident related to emergency management the support unit could be utilized.

Ambulance 5172 is currently identified to be surplus and disposed in accordance with the current vehicle capital plan and is capable of operating as a support unit.

Ambulance 5172 was purchased and put into service in June of 2014 and its servicing followed a preventative maintenance program, with further comprehensive inspections every 48,000 kms. The vehicle is in good working order, with all mechanical and electrical features working properly. Current mileage is 290,500 kms which makes it no longer suitable for front-line emergency operations; however its current condition makes it an ideal resource to be repurposed as a support unit.

Financial Considerations

Estimated annual mileage and costs for the Support Unit has been developed based on 2018 historical data.

Use Annual Mileage (km) Special Education and Community Events 3,500 Flu Shot Clinics 500 Community Paramedicine Visits 8,000 Logistics Support 9,000 Honour Guard Functions 2,500 Total 23,500

One-Time Estimated Expenses Cost Lost Revenue from Auction $ 7,000 Rebranding $ 4,500 Total Initial Expenses $11,500 Estimated Annual Operating Expenses Cost Licensing $ 360 Insurance $ 1,070 Maintenance $ 5,000 Estimated Total Annual Cost $ 6,430

There are no additional anticipated operating costs as fuel consumption for vehicle travel was previously spread across other fleet vehicles.

Staff anticipate one-time and operating costs for the support unit may be absorbed in the current operating budget.

Page 3

Staff anticipates the one-time cost of lost revenue and rebranding of $11,500 and the annual operating cost of $6,430 can be absorbed in the approved 2019 Tax Supported Operating Budget. The use of a support unit will also minimize personal mileage paid to staff attending events.

It is anticipated that the lifecycle of the support unit will be 3-4 years, at which point a future surplused/decommissioned vehicle may be reclassified as a support unit. The future budget in 2020 will include the funds to support the ongoing operation of a support unit.

While the Community Paramedicine initiative operates outside the MPS Operational Budget, the nature of sharing this resource between programs (Community Paramedicine, Logistics, Community Relations and Honour Guard) means that usage of the support unit for the Community Paramedicine program will have a small impact on operating, fuel, and maintenance costs.

Communications

Staff will work with Corporate Communications to develop awareness messaging for the community as well as inform fleet asset management staff internally.

Strategic Priorities

Click on icons below to view strategies under each priority area:

s 1.1, 1.5 s 2.2, 2.5 s 5.1, 5.4

Respectfully submitted,

Original signed by Original signed by

Stuart McKinnon Jeff McWilliam, CMM III Executive Deputy Chief, Paramedic Services Chief, Paramedic Services and and Emergency Planning Emergency Planning

Original signed by

Norm Barrette Commissioner of Health Services

Page 4

70 PINE STREET, BRACEBRIDGE, ONTARIO P1L 1N3 Telephone (705) 645-2231 / Fax (705) 645-5319 / 1-800-461-4210 (705 area code) www.muskoka.on.ca

To: Chair and Members Health Services Committee

From: Norm Barrette Commissioner of Health Services and Julie Stevens Commissioner of Finance and Corporate Services

Date: March 21, 2019

Subject: Establishment of a Health Initiatives Fund Working Group

Report: HS-4-2019-4 ______

Recommendation

THAT The District Municipality of Muskoka establish a Health Initiatives Fund Working Group as outlined in staff report HS-4-2019-4;

AND THAT the Terms of Reference for the Health Initiatives Fund Working Group be approved as outlined in Appendix “I” to staff report HS-4-2019-4.

Origin

On January 31, 2018 a resolution was passed (R33/2018) at Committee of the Whole Council. Staff were directed to support the formation of a joint committee of Muskoka Algonquin Health Care (MAHC) representatives and Muskoka District Councillors to review future expenditures and that the hospital levy be dedicated only to existing MAHC facility needs or other projects as identified.

At the February 21, 2019 meeting of the Health Services Committee, staff presented a staff report HS-3-2019-1 for the formation of a committee and terms of reference based on the terms of the resolution R33/2018. Following a debate of the committee pertaining to the intent of the motion and the desired outcomes, the Health Services Committee passed the following motion (R8/2019-HS) “THAT staff be directed to report back to the Committee regarding the protocol and formation of a Health Initiatives Fund Working Group to provide alternatives to the proposed framework and membership, which aligns with Councils desire to consider other potential fund recipients.”

Page 1 This staff report provides Committee and Council with various elements to consider that will form the framework for evaluating funding requests.

Background

Further to Committee’s direction, staff commenced the development of framework options for consideration. As the various iterations of possible frameworks were determined, several hundred different iterations of final frameworks are possible. To that end, rather than presenting several framework options, staff are presenting a single framework that provides for a wide range of possible initiatives to consider while minimizing the administrative effort to manage the entire funding and reporting process.

Analysis

The key decision points required to finalize a governance and decision making framework have been itemized. These decision points may be combined in a multitude of ways by Committee and Council. In order to establish a base framework as a starting point, staff have provided recommendations with its rationale for each framework component.

General Criteria:

1. Is there a geographic boundary for initiatives?

• MAHC initiatives only • Initiatives for providers physically located within the District • Initiatives for providers physically located both in the District and outside the District that provide essential health services for District residents

In order to support the greatest number of Muskoka residents with funding initiatives, staff recommend the general criteria of:

Initiatives for providers physically located both in the District and outside the District that provide essential health services for District residents.

2. Is there a community result that initiatives must support?

• No specific community result • General – initiatives must support the social determinants of health • Focused – initiatives must support a focused community result (broadly i.e. poverty reduction, seniors) • Targeted – indicatives must support a targeted community result (i.e. Crisis mental health, palliative care)

Page 2

In order to maintain practices consistent with the previously established funding approach, staff recommend the community result criteria of:

No specific community result.

Funding Options Criteria:

1. What types of initiatives are eligible for funding?

• Capital – facility and equipment expenses only • One time operating costs – to support start-up expenses other than capital • Annual recurring operating costs – other than start-up costs • Any combination of capital, start up and annual operating costs

In order to maintain practices consistent with the previously established funding approach, staff recommends eligible funding for:

Capital – facility and equipment expenses only.

2. What duration of funding may be considered for initiatives?

• Single year commitment • Multi-year commitments subject to annual budget approval of Council

In order to maintain practices consistent with the previously established funding approach, staff recommends funding may be considered for:

Multi-year commitments subject to annual budget approval of Council.

Funding Request Evaluation Process:

1. By whom should funding requests be assessed and subsequent recommendations advanced to the Health Services Committee?

• District staff (with external staff consulted as required) • District staff along with a representative selection of agency staff • Sub-committee of the Health Services Committee • Health Services Committee

Page 3

In order to streamline the development of funding criteria, communicate with stakeholders, review and evaluate funding requests and advance recommendations to the Health Services Committee, staff recommends the process be administered by:

District staff (with external staff consulted as required).

Appendix “I” outlines the proposed terms of reference based on the framework recommendations of staff.

Financial Considerations

There is approximately $805,000 available for distribution to identified projects. This balance is comprised of approximately $205,000 from the 2018 allocation, including interest earned, and $600,000 from the approved 2019 budget.

Communications

This report will be circulated to all health service providers within the District and to health service providers in adjacent communities surrounding the District.

Strategic Priorities

Click on icons below to view strategies under each priority area:

s 5.1, 5.2, s 2.2, 2.3, s 3.1 5.3, 5.4, 2.5, 2.7 5.6

Respectfully submitted,

Original signed by Original signed by

Norm Barrette Julie Stevens Commissioner of Health Services Commissioner of Finance and Corporate Services

Page 4

Appendix “I” for Committee’s Consideration

Membership: Proposed Working Group Responsibilities:

The membership of the In order to identify the best allocation of funds, it is proposed Health Initiatives Fund that the Working Group develop evaluation criteria, issue calls Working Group will be made for proposals, evaluate the proposals received against the up of District staff and on an established criteria and then advance the recommended as needed basis, external allocation to the Health Services Committee on an annual staff to provide basis. technical/professional advice.

Initial Membership: Working Group’s Scope:

• Commissioner of • Develop criteria to inform calls for proposals from Health Services interested health care partners to ensure that the expenditures service the residents of Muskoka • Commissioner of Finance and • Issue a notification of the call for proposal process and Corporate Services ensure broad awareness of the initiative • Support Staff • Evaluate proposals based on the established review criteria to optimize the best use of available funding by • External staff to measuring the capital requests submitted against the provide medical needs of Muskoka technical/professional advice on an as • Make recommendations to Muskoka District Council via needed basis the Health Services Committee on the allocation of funding based on proposal criteria including a description of the proposed projects, the individual project’s cost and funding sources, justification for the project and a description (recommendations of the Health Initiatives Fund Working Group are not binding on the decisions made by Muskoka District Council) • Make presentations to the Health Services Committee as required

Page 5

HS-4-2019-INFO-A

NEWS Ministry of Health and Long-Term Care

Ontario's Government for the People to Break Down Barriers to Better Patient Care Renewed, connected and sustainable health care system will reduce hallway health care by focusing resources on patient needs February 26, 2019 9:00 A.M.

TORONTO — Today, Christine Elliott, Deputy Premier and Minister of Health and Long-Term Care, delivered the Government of Ontario's long-term plan to fix and strengthen the public health care system by focusing directly on the needs of Ontario's patients and families.

"The people of Ontario deserve a connected health care system that puts their needs first," said Elliott. "At the same time the people of Ontario deserve peace of mind that this system is sustainable and accessible for all patients and their families, regardless of where you live, how much you make, or the kind of care you require."

Ontario's new plan would improve access to services and patient experience by:

• Organizing health care providers to work as one coordinated team, focused on patients and specific local needs. Patients would experience easy transitions from one health provider to another (for example, between hospitals and home care providers, with one patient story, one patient record and one care plan). • Providing patients, families and caregivers help in navigating the public health care system, 24/7. • Integrating multiple provincial agencies and specialized provincial programs into a single agency to provide a central point of accountability and oversight for the health care system. This would improve clinical guidance and support for providers and enable better quality care for patients. • Improving access to secure digital tools, including online health records and virtual care options for patients - a 21st-century approach to health care.

"If we expect real improvements that patients will experience first-hand, we must better coordinate the public health care system, so it is organized around people's needs and outcomes. This will enable local teams of health care providers to know and understand each patient's needs and provide the appropriate, high-quality connected care Ontarians expect and deserve," said Elliott.

Ontario's renewed patient-centric approach is paired with historic investments in long-term care for seniors and improved mental health and addictions services for families. Ontario is investing $3.8 billion over 10 years to establish a comprehensive and connected system for mental health

Page 1 HS-4-2019-INFO-A and addictions treatment, and adding 15,000 new long-term care beds over five years and 30,000 beds over 10 years.

"Our government is taking a comprehensive, pragmatic approach to addressing the public health care system," said Elliott. "By relentlessly focusing on patient experience, and on better connected care, we will reduce wait times and end hallway health care. Ontarians can be confident that there will be a sustainable health care system for them when and where they need it."

QUICK FACTS

• The government intends to introduce legislation that would, if passed, support the establishment of local Ontario Health Teams that connect health care providers and services around patients and families, and integrate multiple existing provincial agencies into a single health agency – Ontario Health. • The entire process will be seamlessly phased in to ensure that Ontarians can continue to contact their health care providers as usual throughout the transition process. • The government has consulted with patients, families, nurses, doctors and others who provide direct patient care, including the Premier’s Council on Improving Healthcare and Ending Hallway Medicine and its working groups, the Minister’s Patient and Family Advisory Council, and health system and academic experts. • Ontario currently has a large network of provincial and regional agencies, clinical oversight bodies and 1,800 health service provider organizations. This creates confusion for both patients and providers trying to navigate the health care system.

LEARN MORE

• Read the Premier’s Council report: Hallway Health Care: A System Under Strain • Ontario’s plan to build a connected public health care system. Learn more.

Media Line Toll-free: 1-888-414-4774 Available Online [email protected] Disponible en Français GTA: 416-314-6197 David Jensen Communications Branch [email protected] 416-314-6197 For public inquiries call ServiceOntario (Toll-free in Ontario only) 1-866-532-3161 Hayley Chazan Deputy Premier & Minister of Health and Long-Term Care’s Office [email protected] 416-726-9941

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February 20, 2019

The Honourable Doug Ford Premier of Ontario Legislative Building Queens’s Park Toronto, ON M7A 1A1

Dear Premier Ford:

Re: Public and Environmental Health Implications of Bill 66, Restoring Ontario’s Competitiveness Act, 2018

On behalf of the Simcoe Muskoka District Health Unit (SMDHU) Board of Health, I am writing to express concern about the Government of Ontario’s decision to enact Bill 66, Restoring Ontario’s Competitiveness Act, 2018.

We appreciate the intention to enhance employment opportunities throughout Ontario, and recognize good quality employment as a key element which influences health. Individuals who are unemployed, have precarious employment, or experience poor working conditions are at higher risk of stress, injury, high blood pressure and heart disease. However, the proposed bill will amend a number of acts and regulations intended to protect and promote public and environmental health.

In consideration of the proposed amendments, Bill 66 was assessed by SMDHU staff for implications to public and environmental health. We are apprehensive of unintended negative consequences which may arise from the implementation of this bill. The attached appendices outline concerns related to Schedule 3 (Appendix 1) and Schedule 5 (Appendix 2). Schedule 10 (Appendix 3) is also included, though the Board of Health is aware of media reports and social media remarks made by Honourable Minister Clark indicating “when the legislature returns in February, (the Government) will not proceed with Schedule 10 of the Bill.” This is welcomed, however, from our assessment of Bill 66 as it is presently written, its implementation to amend and repeal current legislation will potentially result in:

• Negative impacts to Ontario’s natural and built environment; • Degradation of important water sources; • Decreased preservation of greenspaces including agricultural lands, forests, parks and natural heritage features; • Decreased opportunities for physical activity; • Impacts to child safety; and • Increased risk of the spread of infectious diseases.

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We request the government consider the impacts on the public health and safety of residents of Ontario prior to Bill 66 proceeding through the legislative process. We thank you for the opportunity to provide comment and your consideration of our feedback.

Sincerely,

ORIGINAL Signed By:

Anita Dubeau Chair, Board of Health

AD:BA:cm cc. Honorable Christine Elliot, Minister of Health and Long-Term Care Honorable Steve Clark, Minister of Municipal Affairs Honorable Lisa Thompson, Minister of Education Honorable Rod Phillips, Minister of the Environment, Conservation and Parks Dr. David Williams, Chief Medical Officer of Health Members of Provincial Parliament for Simcoe and Muskoka Ontario Boards of Health Ms. Loretta Ryan, Association of Local Public Health Agencies Association of Municipalities of Ontario Ontario Public Health Association Members of Provincial Parliament Municipal Councils Central Local Health Integration Network North Simcoe Muskoka Local Health Integration Network

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Appendix 1: Concerns and considerations related to Schedule 3 – Ministry of Education

SMDHU recognizes the efforts to enhance child care availability to families by increasing the total number of children under the age of two that can be cared for by home child care providers. Though evidence on optimal infant to caregiver ratios is inconclusive, the current limits in Child Care and Early Year’s Act, 2014, were chosen to ensure child safety1. We urge the government to evaluate the effects of this legislation on child safety and developmental outcomes if implemented. The proposed changes will not adequately address issues of access, affordability, and quality child care for families. Similar to our high quality education system, a child care strategy that prioritizes accessibility, affordability and quality is best addressed through a government system that ensures universal access to high quality care.

In addition, there may be implications to infection prevention and control due to the proposed amendment to paragraph 4 subsection 6 (4) of the Child Care and Early Years Act, 2014, which recommends the reduction of the age restriction from six years of age to four for registration in authorized recreation and skill building programs. Authorized recreational and skill building programs are not proactively inspected for food safety nor infection prevention and control by local public health units. With immunization follow-up doses for several diseases (e.g. measles, pertussis, and chickenpox) not occurring until a child is between 4 – 6 years, coupled with the potential for decreased hygienic practices and larger numbers of children congregating in one location2, there is the potential for the spread of vaccine-preventable diseases. Facilities that are not required to be inspected may not have the administrative (e.g. policies on when to exclude ill children) or physical (e.g. appropriate disinfectants) infrastructure to prevent infections. By lowering the age from six years to four, a potential increased infectious disease risk will occur for children 4-6 years attending these programs.

1 Ontario Ombudsman. 2014. Ombudsman Report: “Careless about Childcare” Investigation into how the Ministry of Education responds to complaints and concerns relating to unlicensed daycare providers .Available at: www.ombudsman.on.ca/Files/sitemedia/Documents/Investigations/SORT%20Investigations/Careless AboutChildCareEN-2.pdf 2 Canadian Paediatric Society. 2015. Well Beings: A Guide to Health in Child Care – 3rd edition.

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Appendix 2: Concerns and considerations related to Schedule 5 - Ministry of Environment, Conservation and Parks

The purpose of the Toxics Reductions Act (TRA) is to prevent pollution and protect human health and the environment, through reducing the use and creation of toxic substances within Ontario. While SMDHU supports efforts to avoid duplication of existing provincial and federal regulations, it is important to recognize the need to reduce the availability of toxic substances within Ontario. Existing federal requirements through the National Pollutant Release Inventory and the Chemical Management Plan have limitations to supporting further reduction of toxic substances that the province of Ontario hoped to address. The TRA can provide important economic benefits which lead to potential cost savings, creating new markets, and supporting employee health and safety. Similar legislation has shown to be effective in other jurisdictions in the United States that have required toxic reduction plans. Thus, SMDHU encourages the province to not eliminate the TRA, but to evaluate more effective opportunities for toxics reduction in Ontario that can support creating healthy environments while reducing barriers for business

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Appendix 3: Concerns and considerations related to Schedule 10 - Ministry of Municipal Affairs and Housing

The Planning Act and associated provincial regulations support effective planning, by ensuring development meets community needs, allows for sustainable economic growth, while protecting green spaces such as agricultural lands, forests, parks and natural heritage features which provide multiple health, economic and environmental benefits. The health benefits of well-designed communities based on provincial policies include better air quality, protected drinking water supplies, availability of locally grown foods, reduced urban heat islands, increased climate resiliency, mitigation of vector-borne diseases, increased opportunities for physical activity, general wellbeing and lower health care costs. Conservation of natural heritage features such as the Greenbelt addresses climate change mitigation (carbon sequestration) and adaptation (mitigating flood risks). For example, the Greenbelt actively stores carbon, with an estimated value of $4.5 billion over 20 years; annual carbon sequestration is valued at 10.7 million per year1. Benefits of greenspaces are communicated within the ‘Preserving and Protecting our Environment for Future Generations: a Made in Ontario Environment Plan’ which identifies the government’s commitment to protect the Greenbelt for future generations2.

SMDHU is concerned that the proposed amendment to the Planning Act will allow the use of Open for Business planning by-laws to permit the use of these important lands for alternative purposes without adhering to existing local planning requirements, such as official plans. Employment land needs are explicitly identified within local planning documents, and thus the use of the by-law will compromise long-term planning decisions. While the by-law may provide short-term economic benefit through the expansion of employment lands, this will be at the expense of long-term, sustainable economic development and protection of green space currently prescribed by the Planning Act.

In addition, Bill 66 allows municipalities to bypass important environmental legislation and discount protections for clean water and environmentally sensitive areas across Ontario. After the events of 2000 in Walkerton, where seven people died and thousands were ill3, Ontario put legislation in place to protect the over 80% of Ontarians who get their drinking water from municipal sources. The Clean Water Act, which directly addresses 22 of the 121 recommendations made following the Walkerton Inquiry, supports the adoption of a watershed based planning process, and serves as the instrument for the creation of source water protection plans.

Current legislation protects drinking water sources and greenspace. The changes proposed in Bill 66 will weaken a number of noteworthy acts including the Clean Water Act, the Great Lakes Protection Act, the Lake Simcoe Protection Act, the Greenbelt Act, the Oak Ridges Moraine Conservation Act, and the Places to Grow Act. Currently these acts prevail in the case of conflict between a municipal plan and the noted act; under the proposed changes this would no longer be the case.

1 Tomalty, R. 2012. Carbon in the Bank: Ontario’s Greenbelt and its role in mitigating climate change. [Vancouver]: David Suzuki Foundation 2 Ministry of the Environment, Conservation and Parks. 2018. Preserving and protecting our environment for future generations: A Made-in-Ontario environment plan. [Toronto]: Ontario Ministry of the Environment, Conservation and Parks. 3 Walkerton Inquiry (Ont.) and Dennis R. O’Connor. 2002. Report of the Walkerton Inquiry: A strategy for safe drinking water. [Toronto]: Ontario Ministry of the Attorney General.

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Notably, Section 39 of the Clean Water Act currently requires all Planning Act decisions to conform to policies in approved source protection plans that address significant drinking water threats prescribed by the Clean Water Acti. This important provision must remain applicable to all municipal planning and zoning decisions in order to protect public health and safety.

Bill 66 not only impacts drinking water, but also moves back progress made on protecting Lake Simcoe. The Lake Simcoe Protection Act was created to safeguard the watershed and protect our Great Lakes and Lake Simcoe from environmental damage. Lake Simcoe attracts 9 million visitors on an annual basis and accounts for approximately $1 billion dollars in annual spending. Due to the economic, environmental and health impacts that the Open for Business planning bylaw will present, we urge the government to remove the amendment to the Planning Act, from Bill 66. At minimum, public health authorities should be granted the ability under the Planning Act to review and comment on open for business bylaw applications, due to potential risk and hazards to health and for the protection and promotion of public health and safety.

i Threats identified in the act include landfills, sewage systems, and the storage or handling of fuel, fertilizers, manure, pesticides, road salt, organic solvents and other substances on lands near wells or surface water intake pipes used by municipal drinking water systems

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NEWS Ministry of Health and Long-Term Care

Ontario Health Board of Directors March 8, 2019 2:00 P.M.

The government has proposed legislation that would, if passed, enable the transfer of multiple existing provincial agencies into Ontario Health over a number of years.

The Ontario Health Board of Directors will take on a number of critical responsibilities, most importantly, ensuring the continuity of patient care throughout the transition process.

The composition of the early slate of Ontario Health Board of Directors is as follows:

Bill Hatanaka, Chair Nominee of the Ontario Health Board of Directors, serves on the Fund Advisory Board of Invesco Canada and is a member of the Independent Review Committee of RP Investment Advisors. He is Vice-Chair of ICE NGX Canada Ltd. and Chair of their Risk Management Committee. Additionally he sits on the Board of Governors of York University, and serves as Chair, Finance and Audit. He has previously served on other public boards including TMX (Chair HRC, Derivatives), and TD Ameritrade (Risk Committee). He is the Past Chair of the Investment Industry Association of Canada (IIAC).

Mr. Hatanaka is the past President and CEO, OPSEU Pension Trust (OPTRUST), a defined benefit pension plan, jointly sponsored by the Government of Ontario and the Ontario Public Service Employees Union. He is former Group Head, Wealth Management, TD Bank Group, where he was a member of the senior executive team of the Bank with responsibility for building the Bank's global Wealth and Asset Management business. He was the inaugural Chair of the TD Bank's Diversity Leadership Council. His community involvement has included work with Canadian Centre for Diversity, The United Way and the Japanese Canadian Cultural Centre.

Elyse Allan, Vice Chair Nominee of the Ontario Health Board of Directors, currently serves as a Director of Brookfield Asset Management, a Fellow at the C.D. Howe Institute and member of its National Advisory Council, an advisor to the Eco-Fiscal Commission, and as a Director of MaRS Discovery District. Until recently she participated on the Board of Directors of the Conference Board of Canada, The Royal Ontario Museum, and the Business Council of Canada. Previously she served as Chair of the Board for the Canadian Chamber of Commerce, and Chair of Providence Healthcare. Prior to her retirement, Ms. Allan was the President and CEO of GE

Page 1 HS-4-2019-INFO-C Canada and Vice-President of the GE Company. She led a Canadian multi-billion dollar digital, manufacturing, financial and industrial services company. She was appointed to the Order of Canada in 2014.

Jay Aspin's career has included key roles with the Ontario Northland Transportation Commission, the North Bay and District Chamber of Commerce, the Ministry of Economic Development and Trade and as federal Member of Parliament for Nipissing-Timiskaming. Mr. Aspin holds the Corporate Director (ICD.D) designation, and served on a variety of boards including the North Bay Civic Hospital Corporation, Certified Management Consultants of Canada, Canadian Space Advisory Board, Near North District Schools, Association of Municipalities of Ontario and the Federation of Canadian Municipalities.

Andrea Barrack is the Global Head, Sustainability and Corporate Citizenship at TD Bank Group. Previously, she was the CEO of the Ontario Trillium Foundation. Ms. Barrack is the current Chair of the Dean's Council for the Ted Rogers School of Management at Ryerson University, and an advisory member of the Impact Canada Initiative. Her previous board work includes serving as the Vice-Chair with the Scarborough Health Network.

Dr. Alexander Barron is a physician who has specialized in General Pediatrics, Pediatric Emergency Medicine and Pediatric Hematology, and has practiced at the Hospital for Sick Children, St. Joseph's Health Centre in Toronto, North York General Hospital and the Grand River Hospital. He has been a consulting physician on the Afghanistan Task Force with the Canadian International Development Agency. Dr. Barron has also served on the board of the Ontario Medical Association, as well as The Canadian Medical Protective Association, where he has been on the Executive, Case Review and Investment Committees.

Dr. Adalsteinn (Steini) Brown is the Dean of the Dalla Lana School of Public Health at the University of Toronto. Prior to becoming Dean, he was the Director of the Institute of Health Policy, Management and Evaluation and the Dalla Lana Chair of Public Health Policy at the university. Dr. Brown is a member of the Premier's Council on Improving Healthcare and Ending Hallway Medicine. Dr. Brown's other past roles include senior leadership positions in policy and strategy within the Ontario government, founding roles in startup companies, and extensive work on performance measurement.

Rob Devitt retired in 2015 after serving 11 years as President and CEO of the Toronto East General Hospital. He has been appointed to assist a number of other hospitals in Ontario, including serving as a Supervisor and Peer Reviewer. Over the years, Mr. Devitt has served on numerous boards including the Ontario Hospital Association, the Canadian College of Health

Page 2 HS-4-2019-INFO-C Care Leaders and the Post-Secondary Education Quality Assessment Board. He was an original board member of Plexxus and HDIRS.

Garry Foster currently sits on the boards of SmartREIT and Real Matters Inc., where he chairs the Audit Committees. He also serves on the Presto Fare Card sub-committee of Metrolinx, and Payments Canada. He has chaired the board of Cogniciti, the commercialization arm of Baycrest Health Sciences, and is the Chair of the Board of the Baycrest Foundation. Mr. Foster had a long career at Deloitte, where he led the Technology, Media and Telecommunications Practice and was Vice-Chair of the firm. He is a Fellow of the Chartered Professional Accountants.

Shelly Jamieson retired in 2017 as the CEO of the Canadian Partnership Against Cancer (CPAC), an independent organization funded by Health Canada to accelerate action on cancer control for all Canadians. Prior to joining CPAC, she held Ontario's highest-ranking civil servant role as Secretary of Cabinet, Head of the Ontario Public Service and Clerk of the Executive Council. Ms. Jamieson serves on the Board of Directors of High Liner Foods, and is Chair of the Human Resources and Corporate Governance Committee. She is also Chair of the Governance Committee of The Gordon Foundation.

Jackie Moss was a senior executive at CIBC for over 16 years where she ran the Human Resources, Strategy and Corporate Development functions and was the General Counsel in Canada. Prior to this, she was a partner at Blake, Cassels and Graydon. Ms. Moss now serves on the board of IMCO and Minto REIT and is chair of their Human Resources and Nominations and Governance Committees, respectively. She is the Founder and CEO of Giftgowns.

Paul Tsaparis is currently Chair of the Board of Governors at York University, and a board member at Teranet, Humber River Hospital, Metrolinx and Indspire. He is Past Chair of the Information Technology Association of Canada (ITAC) and the ITAC Board of Governors. Mr. Tsaparis' over 30-year career in technology included being appointed Hewlett-Packard's Vice- President of Technology Support, Americas in May 2010. Before taking on the Americas leadership role, he was President and CEO of Hewlett-Packard (Canada).

Anju Virmani is the Chief Information Officer at Cargojet, Canada's leading supplier of time- sensitive air cargo services. Her professional career includes acting as a senior advisor to many technology startups. She is currently on the Board of CentrePort Canada, based in Winnipeg. Previously, Ms. Virmani has served on the boards of the Toronto Transit Commission and the Toronto Central Local Health Integration Network. Her other appointments include the Advisory

Page 3 HS-4-2019-INFO-C Council for National Security (ACNS), the Cross-Cultural Roundtable on National Security (CCRS) and the Schulich School of Business Advisory Committee.

The members of the board of directors for Ontario Health will also be appointed to the boards for each of the Local Health Integration Networks, as well as the following provincial health service agencies: Cancer Care Ontario, eHealth Ontario, HealthForceOntario, Health Shared Services Ontario, Health Quality Ontario and Trillium Gift of Life Network.

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