meeting documents health system integration committee hsic ...€¦ · –depression care...

THE REGIONAL MUNICIPALITY OF PEEL

HEALTH SYSTEM INTEGRATION COMMITTEE AGENDA HSIC - 2/2017 DATE: Thursday, April 20, 2017 TIME: 9:30 AM – 11:00 AM LOCATION: Regional Council Chamber, 5th Floor Regional Administrative Headquarters 10 Peel Centre Drive, Suite A Brampton, Ontario MEMBERS: F. Dale; A. Groves; E. Moore; M. Palleschi; C. Parrish;

P. Saito; B. Shaughnessy ADVISORY MEMBERS: C. Brereton; M. DiEmanuele; J. Flewwelling; C. Hecimovich;

B. MacLeod; S. McLeod Chaired by Councillor P. Saito or Vice-Chair Councillor B. Shaughnessy 1.

DECLARATIONS OF CONFLICTS OF INTEREST

2.

APPROVAL OF AGENDA

3.

DELEGATIONS

3.1 Peter Dundas, Chief and Director, Peel Region Paramedic Services, Providing an Overview of the Key Challenges and Opportunities Facing Peel Paramedic Services (See also Item 4.1)

3.2 Dave Wakely, President, OPSEU Local 277, Peter Dundas, Chief and Director, Dan Paterson, Superintendent, Jill Ferras, Paramedic, Peel Regional Paramedic Services, Providing an Update on the Psychological Health and Safety Initiatives that are being Implemented in Paramedic Services to Support Staff Wellbeing

3.3 Bill MacLeod, CEO, Mississauga Halton LHIN & Kim Delahunt, Senior Director, Health System Integration, Central West LHIN, Providing an Update on the Implementation of the Patients First Act and its Implications for Peel

HSIC-2/2017 -2- Thursday, April 20, 2017 4.

REPORTS

4.1 Paramedic Services - System Pressures Update (For information) (See also Item 3.1)

4.2. Update on Provincial Dispatch Reform Advocacy (For information)

5.

COMMUNICATIONS

6.

IN CAMERA MATTERS

7.

OTHER BUSINESS

8.

NEXT MEETING Thursday, June 29, 2017, 9:30 a.m. – 11:00 a.m. Regional Council Chamber, 5th Floor Regional Administrative Headquarters 10 Peel Centre Drive, Suite A Brampton, Ontario

9.

ADJOURNMENT

, Region d PeelWOltkLttq tOIt qOIl

FOR OFFICE USE ONLY,- - -- --- l

MEETING DATE YYYY/MM/DD I MEETING NAME

REQUEST DATE YYYY/MM/DD

2017103/24

Request for DelegationAttention: Regional Clerk

Regional Municipality of Peel10 Peel Centre Drive, Suite A

Brampton, ON L6T 4B9Phone: 905-791-7800 ext. 4582 Fax: 905-791-1693

E-mail: [email protected]

NAME OF INDIVIDUAL(S)Peter Dundas

POSITION/TITLEChief and Director

NAME OF ORGANIZATIONPeel Paramedic Services

E-MAIL TELEPHONE NUMBER EXTENSION FAX NUMBER

NAME OF INDIVIDUAL(S)

: POSITION/TITLE NAME OF ORGANIZATION


REASON(S) FOR DELEGATION REQUEST (SUBJECT MAnER TO BE DISCUSSED)Regarding system pressures in Paramedics

I AM SUBMITIING A FORMAL PRESENTATION TO ACCOMPANY MY DELEGATION

IF YES, PLEASE ADVISE OF THE FORMAT OF YOUR PRESENTATION (ie POWERPOINTj

IZI YES 0 NO

Note:Delegates are requested to provide an electronic copy of all background material/presentations to the Clerk's Division atleast seven (7) business days prior to the meeting date so that it can be included with the agenda package. In accordancewith Procedure By-law 100-2012, as amended, delegates appearing before Regional Councilor Committee are requestedto limit their remarks to 5 minutes and 10 minutes respectively (approximately 5/10 slides).

Once the above information is received in the Clerk's Division, you will be contacted by Legislative Services staff to confirmyour placement on the appropriate agenda. Thank you.

Notice with Respect to the Collection of Personal Information(Municipal Freedom of Information and Protection of Privacy Act)

Personal information contained on this form is authorized under Section IV-4 of the Region of Peel Procedure By-law 100-2012 as amended, for the purpose ofcontacting individuals and/or organizations requesting an opportunity to appear as a delegation before Regional Councilor a Committee of Council. TheDelegation Request Form will be published in its entirety with the public agenda. The Procedure By-law is a requirement of Section 238(2) of the Municipal Act,2001, as amended. Please note that all meetings are open to the public except where permitted to be closed to the public under legislated authority. AllRegional Council meetings are audio broadcast via the internet and will be video broadcast on the local cable television network where video files will beposted and available for viewing subsequent to those meetings. Questions about collection may be directed to the Manager of Legislative Services, 10 PeelCentre Drive, Suite A, 5th floor, Brampton, ON L6T 4B9, (905) 791-7800 ext. 4462.

V-01-100 2015/10

3.1-1

mailto:[email protected]

Presented to Health Services

Integration Committee

April 20, 2017

Paramedic Services 2016

System Pressures Update

1

3.1-2

System Activity “On average,

the system initiates

a vehicle movement

every 2 minutes.”

“On average,

Paramedic Services

receives a call

every 4.5 minutes.”

2

3.1-3

Legislated Response Time

Framework • Meet time for Sudden Cardiac Arrest

– Target – 6:00 minutes 70% of time

– PRPS meets 6:00 minute target 71% of time

• Canadian Triage Acuity Scale 1 through 5

– Paramedic Services meets targets except Canadian Triage

Acuity Scale 2

– 35 seconds over 10:00 minute target 90% of time

• System Pressures strains system

– Increase risk of not meeting response times

3

3.1-4

Average Paramedic Shift

4

1.6

3.7

6.7

Paramedic Shift - 12 Hours

Available Response Time Coverage for Calls Vehicle Movement Meals/Breaks

Time on Calls

Offload Delay

3.1-5

Shift – Peak Periods - 2016

5

2.2

5.2

4.6

Paramedic Shift - 12 Hours (Peak Period)

Time on Calls

Offload Delay Available Response Time Coverage for Calls Vehicle Movement Meals/Breaks

3.1-6

System Pressures Drive Activity

Principal system pressures of

Paramedic Services

1. Land Ambulance Dispatch

2. Call Volume Growth

3. Staffing

4. Offload Delay

6

3.1-7

Call Volume and Population

Growth

4.9%

7.9%

2.1%

5.0%

2.2%

5.8%

7.6%

2.8%

6.0%

1.4%

9.3%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Region of Peel - Average Population and Paramedic Call Growth

Annual Call Growth Average Population Growth - 2.0% Average Call Growth - 5.0%

Avg Population Growth

Avg Call Growth

7

3.1-8

Staffing to Council Approved Level

• Challenge in 2016

– Fewer vehicles on road than budgeted

• Result . . .

– Increased pressure on system due to less

coverage

– Impacts availability for calls

8

3.1-9

Average Paramedic Call

‘Improvement in Offload Delay’ 0:0

3:0

9

0:0

6:5

6

0:0

8:2

6

0:0

8:3

1

0:1

7:3

4

0:1

9:0

9

0:1

2:1

1

0:1

4:3

1

0:2

9:1

1

0:1

9:0

0

1:0

0:5

1

0:4

7:0

0

0:00:00 0:28:48 0:57:36 1:26:24 1:55:12 2:24:00

20

08

20

16

Dispatch Call Handling

Travel to Scene

Scene Time

Travel to Hospital

Hospital Time (non-offload)

Offload Delay

Total – 2:11:22

Total – 1:55:07

9

3.1-10

Next Steps

• Continue dispatch advocacy

• Adjust recruitment strategy to meet

demands

• Support work with hospital partners

• Monitor call volume drivers and adjust

coverage

10

3.1-11

Questions . . . Discussion

11

3.1-12

, Region dPeelWOltklklf lolt qOIl

lOR OFFICE USE QNLY r

MEETING DATE YYYY/MM/DD IMEETING NAME

I


2017/04/20



Brampton, ON L6T4B9Phone: 905-791-7800 ext. 4582 Fax: 905-791-1693


NAME OF INDIVIDUAL(S)Peter F.Dundas

POSITION/TITLE

:Chief and Director, Peel Regional Paramedic ServicesNAME OF ORGANIZATIONRegion of Peel

E-MAIL TELEPHONE [email protected] (905) 791-7800

EXTENSION3921

FAX NUMBER

NAME OF INDIVIDUAL(S)Dave Wakely

: POSITION/TITLE

President, OPSEULocal 277NAME OF ORGANIZATION


REASON(S) FOR DELEGATION REQUEST (SUBJECT MAnER TO BE DISCUSSED)Additional individuals -Dan Paterson, Superintendent, Peel Regional Paramedic ServicesJill Ferras, Paramedic, Peel Regional Paramedic Services

To participate in the presentation of - 'Psychological Health Initiatives' at April 20, 2017 Health Services Integration Comm.

I AM SUBMITIING A FORMAL PRESENTATIONTO ACCOMPANY MY DELEGATION rg] YES 0 NO

IF YES,PLEASEADVISEOFTHE FORMAT OFYOUR PRESENTATION(ie POWERPOINTj POWERPOINT(in eAgenda)

Note:Delegates are requested to provide an electronic copy of all background material/presentations to the Clerk's Division atleast seven (7) business days prior to the meeting date so that it can be included with the agenda package. In accordancewith Procedure By-law 100-2012, as amended, delegates appearing before Regional Councilor Committee are requestedto limit their remarks to 5 minutes and 10 minutes respectively (approximately 5/10 slides).




V-01-100 2015/10

3.2-1



Health Services Integration

Committee

April 20, 2017

Psychological Health Initiatives

Peel Regional Paramedic Services

1

3.2-2

Collaboration with Regional Staff

• Psychological health initiatives are a collaborative effort

– Paramedic Services working with Human Resources and Ontario

Public Service Employees Union Local 277

• Paramedic Services’ first initiatives . . .

– Road to Mental Readiness

– Peer Support Program

– Psychological Risk Assessment and Action Plan

– Critical Incident Response Review

2

3.2-3

Road to Mental Readiness – R2MR

• Developed by Canadian Armed Forces

• Adapted for first responders in partnership with . . .

– Mental Health Commission of Canada

– Centre for Addiction and Mental Health

• Implemented by PRPS in fall of 2016 -

– Psychologist from CAMH part of every training session

– Full-day training for leadership

– Half-day training for front-line

3

3.2-4

Elements of R2MR

• I. Raise awareness and reduce stigma

• II. Introduce ‘Mental Health Continuum Model’

– Scale to understand severity

• HEALTHY

• REACTING

• INJURED

• ILL

4

3.2-5

Other Elements of R2MR

• III. Provide practical tools

– Goal Setting

– Visualization

– Self Talk

– Tactical Breathing

5

3.2-6

Peer Support Program

• Program Design

– Peer Support Accreditation and Certification Canada

• Recruit Paramedic Services staff

– Volunteers bringing their lived experience

• Training for Volunteers

– Confidential, non-clinical, volunteer, mental health support

program for PRPS employees

6

3.2-7

Psychological Risk Assessment

• Survey conducted in 2016

– Over 60% of paramedic staff participated

– Based on Canadian Standards Association Standard

• Report received

• Oversight/Steering Committee being finalized

• Development of Action Plan focusing on top three risk factors:

– Organizational Culture

– Psychological Support

– Psychological Job Demands

7

3.2-8

Employee & Family Assistance Program and

Collective Agreement Support

• Expanded services for Paramedic Services staff

– WorkAssist

• Help resolve psychological barriers to support remaining at

work

– Depression Care

• Counsellor can assess severity and extend duration of care

– Trauma Assist

• Individual needs assessed by an experienced trauma

counsellor

• Additional benefit

– $1,000 per year for psychological counselling for employee

– $500 per year for family

8

3.2-9

Still Ahead

• Critical Incident Response

– Working with Mental Health Innovations

– Review/refine existing policies and practices

• Sustaining psychological health initiatives within Peel Paramedic

Services

9

3.2-10

Questions/Discussion

10

3.2-11

• Region dPooWOllkLttq fOil qOl!

FOR OFFICE USE ONLY

MEETING DATE YYYY/MM/DD MEETING NAME2017/04/20 HSIC


2017/04/20



Brampton, ON L6T 4B9Phone: 905-791-7800 ext. 4582 Fax: 905-791-1693


NAME OF INDIVIDUAL(S)Bill MacLeod

POSITION/TITLEChief Executive Office

NAME OF ORGANIZATIONMississauga Halton Local Health Integration Netowrk

[email protected]

TELEPHONE NUMBER(905) 337-7131

EXTENSION212

FAX NUMBER

NAME OF INDIVIDUAL(S)Kim Delahunt

POSITION/TITLESenior Director, Health System Integration

NAME OF ORGANIZATIONCentral West Local Health Integration Network

[email protected]

TELEPHONE NUMBER(905) 452-6974

EXTENSION FAX NUMBER

REASON(S) FOR DELEGATION REQUEST (SUBJECT MADER TO BE DISCUSSED)Providing an update on the implementation of the Patients First Act and its implications for Peel.

I AM SUBMITIING A FORMAL PRESENTATION TO ACCOMPANY MY DELEGATION ~ YES 0 NO

IF YES, PLEASE ADVISE OF THE FORMAT OF YOUR PRESENTATION (ie POWERPOINT) Powerpoint----~-----------------------Note:Delegates are requested to provide an electronic copy of all background material/presentations to the Clerk's Division atleast seven (7) business days prior to the meeting date so that it can be included with the agenda package. In accordancewith Procedure By-law 100-2012, as amended, delegates appearing before Regional Councilor Committee are requestedto limit their remarks to 5 minutes and 10 minutes respectively (approximately 5/10 slides).




V-01-100 2015/10

3.3-1


Patients First

Region of Peel Health System Integration Committee Presented by: Bill MacLeod, Chief Executive Officer, Mississauga Halton LHIN Kim Delahunt, Senior Director, Health System Integration, Central West LHIN April 20, 2017

3.3-2

Background

• Why are we moving on this?

• What do we expect to improve?

3.3-3

The Patients First Journey

Patients First: Action Plan for

Health Care

February 2015

Patients First: Reporting Back on the Proposal to

Strengthen Patient-Centred Health Care in

Ontario June 2016

Patients First: Roadmap to Strengthen Home and Community

Care May 2015

Patients First: Discussion

Paper

December 2015

Patients First Act, 2016 Reintroduction

(Bill 41)

October 2016

Patients First Act, 2016 Introduction (Bill 210)

June 2016

Mandate Letters Released

September 2016

Province-wide consultation

January – April

2016

Bringing Care

Home

January 2015

Auditor General Report on CCACs

(Phase 2)

December 2015

Auditor General Report on CCACs

(Phase 1)

August 2015

First Mandate

Letter

September 2014

Price-Baker

Report

May 2015

Patients First Act, 2016 Passage

December 2016

3.3-4

Achievements of Ontario’s Health System

4

Over the past decade, Ontario’s health care system has improved in a number of important ways:

Community

Services

Patients

Physicians and Nurse Practitioners

Long-Term Care

LHINs Care Providers

Hospitals

Collaboration Sustained Commitment Change & Adaptation

Established in 2006, LHINs have

demonstrated success in integrating local

health care systems.

94% of Ontarians now have a

regular family health care provider.

92% of home and community care

clients say their care experience has been good, very good or

excellent.

36 public health units in Ontario delivering

its programs and services using a

population health approach.

Public Health Units

Community Mental Health

Organizations

3.3-5

The Case for Change

5

Health services are fragmented in the way they are planned and delivered; fragmentation can affect the patient experience and can result in poorer health outcomes.

Some Ontarians are not always well-served by the health care system.

Many Ontarians have difficulty seeing their primary care provider when they need to, especially during evenings or weekends.

Some families find home and community care services inconsistent and hard to navigate; family caregivers can experience high levels of stress.

Public health services are disconnected from parts of the health care system; population health not a consistent part of system planning.

Despite significant progress over the past ten years, we still need to do more to ensure that the health care system is meeting the needs of Ontarians.

1

2

3

4

5

3.3-6

What We Are Trying to Achieve Expanded Role of LHINs for More Effective Service Integration, Greater Equity

• Care delivered based on community needs • Appropriate care options enhanced within communities • Easier access to a range of care services • Better connections between care providers in offices, clinics, home and

hospital

Timely Access to Primary Care, and Seamless Links Between Primary Care and Other Services

• All patients who want a primary care provider have one • More same-day, next-day, after-hours and weekend care • Lower rates of hospital readmissions; lower emergency department use • Higher patient satisfaction

More Consistent and Accessible Home and Community Care • Easier transitions from acute, primary and home and community care and

long-term care • Clear standards for home and community care • Greater consistency and transparency around the province • Better patient and caregiver experience

Stronger Links Between Population & Public Health and other Health Services • Health service delivery better reflects population needs • Public health and health service delivery better integrated • Social determinants of health and health equity incorporated into care

planning • Stronger linkages between disease prevention, health promotion and care

Services that Address Needs of Indigenous

People Across Ontario • Strong Indigenous

voices in system planning and service delivery

• Better health outcomes for Indigenous peoples

• Social determinants of health unique to Indigenous populations is incorporated into care planning

• Culturally competent

care delivery, incorporating traditional approaches to healing and wellness

3.3-7

Consultation and Engagement: Key Themes

Engagement sessions were held with stakeholders, and gathered feedback and ideas on the proposal. In response to the Patients First proposal, the over 1,100 emails and 187 formal written submissions from stakeholder organizations were received.

3.3-8

Summary of the Patients First Act, 2016

•Amends LHIN objects to reflect LHIN role in home and community care, health promotion, equity •Requires LHINs to establish sub-regions •Allows for establishment of entity to support LHINs with shared services, e.g. payroll •Requires each LHIN to have one or more Patient and Family Advisory Committees

LHIN Governance and Mandate

•Adds primary care models (not physicians) as health service providers funded by LHINs •Allows LHINs to collect information about practice and service capacity from primary care

Primary Care

•Provides for transfer of CCAC staff and functions to LHINs Home and Community Care

•Establishes a formal relationship between LHINs and local boards of health Public Health

•Gives LHINs accountability mechanisms for health service providers and long-term care homes •Gives Minister accountability mechanisms for LHINs and ability to set standards

Accountability

•Allows for integrated clinical care council to be established to advise on clinical standards •Gives Patient Ombudsman oversight of complaints for health services provided/arranged by LHINs •Allows for provincial Patient and Family Advisory Council

Complementary Legislative Changes

3.3-9

Continuity of Labour and Contracts • The employees of the CCACs will be integrated into the LHINs. This was first stated in the December 2015

Patients First paper and has been confirmed consistently through consultations to date.

• Our foremost priority is to maintain continuity of patient care and to continue to support those involved in delivering high quality patient care. All services will continue as currently planned.

• The work that CCAC employees perform will continue in the LHINs.

• CCAC contracts with service providers will be transferred to the LHINs, meaning home care services will continue to be provided by current service providers. This will ensure that patients receiving care continue to receive it from familiar faces—from providers that know their stories, their preferences, and their needs.

• To support the seamless transfer of operations, there will be continuity of employment for the unionized CCAC employees, along with the continuity of collective agreements and union representation.

• Salaries, benefits, pensions, seniority and other collective agreement provisions will continue in the LHINs, per the collective agreements.

• Continuity of Human Resources (HR) and Labour Relations (LR) functions, both at the local level and provincially as supported by the new HSSO, will support a smooth workforce transition.

• The LHINs and CCACs have developed a range of resources to enable LHIN HR and LR staff to welcome CCAC employees into the LHINs, including a welcome package and training on public service requirements.

• Continuing good union-management relations are a focus of the transition.

• The ministry has met regularly with the 5 unions (ONA, CUPE, OPSEU, COPE, and Unifor) that have bargaining units in the CCACs to provide them with updates on implementation planning for Patients First and address any concerns they may have.

3.3-10

How the Act Supports Transformation

More Effective Service Integration,

Greater Equity

Establishment of sub-regions

LHIN objects

Establishment of Integrated

Clinical Care Council

Timely Access to Primary Care, and

Seamless Links Between Primary Care and Other

Services Designation of

new health service

providers


Physician planning

More Consistent and Accessible Home and

Community Care

Transfer of CCACs to LHINs

Shared services entity to

support back-office functions

Expanded LHIN governance

Stronger Links Between Population & Public Health and

other Health Services

Formal linkages between LHINs and Boards of

Health


Goals

Legislative enablers

Services that Address Needs of Indigenous People Across Ontario

Ontario is engaging Indigenous partners through a parallel process that will collaboratively identify the requirements necessary to achieve responsive and

transformative change.

3.3-11

Transition to Transformation

A multi-year plan to improve the

performance of Ontario health care system.

3.3-12

Implementation Milestones: December 2016 - Summer 2017

3.3-13

Accomplishments: Building LHINs’ Capacity

Health Shared Services Ontario

Health Shared Services Ontario (HSSO) was established in December 2016 and began operations on March 1, 2017. It provides shared services to LHINs, including finance, IT, HR and procurement.

Governance and Organization

Each LHIN has developed an integrated leadership structure, including home and community care and clinical leadership functions. LHIN boards are being expanded from 9 to up to 12 members.

Knowledge-Building

Detailed information from CCACs is informing the LHIN knowledge-building process, focusing on the current state of home and community care and on gaps and opportunities in the sector.

Transition Readiness

Deloitte (vendor) has assessed and is supporting readiness at each LHIN in advance of transition day. Individual transitions of CCACs into LHINs will occur following a public order from the Minister.

• LHINs are being supported to build their capacity and to successfully execute their enhanced role in the health care system.

• Transition to the “new LHINs”, which integrate the functions and staff of the CCACs, will occur in a staged manner in May-June 2017.

Tran

sitio

n Da

ys (

May

– Ju

ne 2

017)

3.3-14

Through Transition Towards Transformation

3.3-15

Changes Enabled by Patients First Act, 2016

3.3-16

Health Shared Services Ontario To support the implementation of Patients First Act and LHINs beyond transition day.

Hea

lth S

hare

d Se

rvic

es O

ntar

io

(HSS

O) A provincial agency that will

facilitate health system integration and provide LHINs with essential supports for key business functions, including:

Health Shared Services Ontario will also drive health system:

Standardization and consistency, leading to a more common

patient experience

Sustainability and efficiency, through economies of scales for

common services

Innovation through the expanded use of technology assets and

supports

3.3-17

Sub-Regions

Characteristic Description

• Total number of sub-regions • 76 • Average number of sub-regions • 5.4 • Range of number of sub-regions • 4 (WW LHIN) – 7 (MH LHIN; CE LHIN)

• Range of population size • Largest: 551,700 (HNHB LHIN) • Median: 139,200 • Smallest: 7,100 (NE LHIN)

• Total number of sub-regions with population size of less than 40,000

• 5 (SE LHIN X 1, NE LHIN X 1, NW LHIN X 3).

• Number of sub-regions that have an acute care centre • 73 out 76

• Estimated range of physicians in each sub-region

• Largest: 575 (Central Ottawa – Champlain LHIN)

• Average: 153 • Smallest: 12 (James Bay Coast – NE

LHIN)

3.3-18

Sub-Regions by LHIN • The proposed LHIN sub-regions were approved by the LHIN Renewal Steering Committee (a

joint MOHLTC and LHINs executive table) on Dec 15, 2016.

• Total number of sub-regions: 76

• See appendix for sub-region maps.

6

5

4

6

5

7 5

6

7

5

5

5 5

5

3.3-19

Summary: Sub-Region ‘Wills’ and ‘Won’ts’ LHIN Sub-Regions Will… LHIN Sub-Regions Won’t…

Enable a more focused and granular approach to assessing population health need and service capacity.

x Result in barriers to access; patient care is a priority

Help to better identify variation across the province in health disparities, health system performance and the ability of service to meet the needs of the population.

x Result in more bureaucracy; sub-regions are to enable better planning and performance improvement, not the creation of new organizations or administration.

Assist in identifying local factors that inhibit health system improvement.

x Come into conflict with ministry or LHIN obligations to engage with provincial or regional partners. These will continue.

Enable more focused community and provider engagement in a manner more aligned with local circumstance.

x Be exclusionary. Flexibility will be applied for communities or agencies whose people or jurisdictions extend beyond a sub-region geography.

Provide an organizational structure to enable clinical leadership, as well as provider and public engagement in health system planning and improvement.

x Infringe on traditions or established jurisdictions in the planning, delivery or improvement of health services.

3.3-20

Mississauga Halton LHIN Sub-Region Map 3.3-21

Central West LHIN Sub-Region Map 3.3-22

Home and Community Care Client Profile

In 2015/16, Ontario’s 14 Community Care Access Centres (CCACs) provided services to 842,000 clients of which 646,000 received home care. Short-stay: 60 % of clients served were short-stay (acute, rehab and end of life clients); 7% of short-stay clients were palliative Long-stay: 40% of clients served were long-stay. 14% of Long-stay clients had very high needs, equivalent to those of clients in LTC Homes. 3% of these clients were medically complex children.

Home care services received • 28.7 million hours in personal

support and home-making visits; • 6.9 million nursing visits; • 1.7 million physiotherapy,

occupational therapy and speech language therapy visits.

Referral source • In FY 2015/16 largest proportion of

clients receiving home care services were referred from hospitals (50%).

• Referrals from primary care were 14%. • Smallest proportion was from schools

(13%). • Remainder were community self-

referrals.

3.3-23

Patients First: A Roadmap to Strengthen Home and Community Care

• On May 13, 2015, Ontario announced a three-year plan to improve and expand home and community care.

• Based on recommendations from the Expert Group on Home and Community Care, the plan includes 10 steps toward transforming home and community care.

1. Develop a Statement of Home and Community Care Values

2. Create a Levels of Care Framework

3. Increase Funding for Home and Community Care

4. Move Forward with Bundled Care

5. Offer Self-Directed Care

6. Expand Caregiver Supports

7. Enhance Support for Personal Support Workers

8. Increase Nursing Services for Patients with Complex Needs

9. Provide Greater Choice for Palliative and End-of- Life Care

10. Develop a Capacity Plan

In progress

In progress

In progress

In progress

3.3-24

Roadmap Goals and Linkages with LHIN Renewal Put Clients and Caregivers First - The planning and delivery of home and community care is client and caregiver-centred. LHIN Renewal Linkage: The Patients First Act, 2016, supports this objective by providing a structure and mandate more focused on the patient and client experience.

Improve Client and Caregiver Experience - Clients and caregivers understand the support they can expect and experience a timely, responsive system. LHIN Renewal Linkage: The Act creates a structure focused on access to and integration and transparency of care.

Drive Greater Quality, Consistency and Transparency - Clients receive consistent, high quality care throughout the province. LHIN Renewal Linkage: Expanded LHIN mandates will strengthen consistency of home care and the Integrated Clinical Care Council and clinical leadership will drive quality standards.

Plan for and Expand Capacity - Investments focus on increasing capacity and improving performance in the home and community care system. LHIN Renewal Linkage: The Act supports planning and delivery at the sub-region level.

Modernize Delivery - Updated funding models, consistent assessment approaches, flexible contracting, workforce stabilization and improved technology are used throughout the sector. LHIN Renewal Linkage: Expanded LHINs have a platform and mandate for ongoing system modernization.

3.3-25

Communications and Myth-Busting

• To ensure a seamless transition for patients and health care providers, the ministry has developed a comprehensive stakeholder communications plan and will engage a third party expert to provide change management and communications supports to the LHINs throughout the transitional period.

• In February-March, communications have focused on the LHIN and CCAC workforce and stakeholders (650+ direct recipients).

• Local, LHIN-led communications to workforce and local stakeholders • Webinars (Five since June 2016; average 3,000+ viewers)

• The ministry and LHINs continue to respond, with consistent messages, to concerns raised by stakeholders:

Myth/Criticism Response

More bureaucracy

8% savings = $10.7M • Which means 59 fewer executive and administrative/management staff • Patient care is protected and maintained

No physician voice The integrated LHIN structure includes significantly expanded roles for physicians to support planning, priority-setting, and implementation at the LHIN and sub-region levels.

Access to specialists • Musculoskeletal strategy will support increased coordination and access • Digital supports to link patients to specialists

Privacy Patient privacy in Ontario has never been stronger; amendments to the Act before passage removed access to personal health information by investigators unless it is obtained with patient consent.

Care Coordinators / Primary Care Active collaboration with Ontario Primary Care Council to plan this work

3.3-26

Thank you for your attention! Questions? Mississauga Halton Local Health Integration Network 700 Dorval Drive, Suite 500 Oakville ON L6K 3V3 Tel: 905-337-7131 or 1-866-371-5446 Fax: 905-337-8330 Email: [email protected] www.mississaugahaltonlhin.on.ca Central West Local Health Integration Network 8 Nelson Street West, Suite 300 Brampton, ON L6X 4J2 Tel. | 905.455.1281 Toll Free | 1.866.370.5446 Email | [email protected] www.centralwestlhin.on.ca

3.3-27


http://www.mississaugahaltonlhin.on.ca/


http://www.centralwestlhin.on.ca/

REPORT Meeting Date: 2017-04-20

Health System Integration Committee

For Information

DATE: April 11, 2017

REPORT TITLE: PARAMEDIC SERVICES - SYSTEM PRESSURES UPDATE

FROM: Nancy Polsinelli, Commissioner of Health Services

OBJECTIVE

To provide an overview of the system pressures impacting paramedic services and the work that Peel Regional Paramedic Services is doing to mitigate the impacts. REPORT HIGHLIGHTS

Peel Regional Paramedic Services is impacted by a number of system pressures, including increasing call volume, inefficiencies with the ambulance dispatch system, ongoing challenges with offload delay and staffing issues.

Over the past ten years, population growth in Peel has increased by an average of two per pent annually. Over the same time period, call volume has, on average, grown by five per cent annually.

As outlined in the report, titled “Update on Provincial Dispatch Reform Advocacy,” the Region has been advocating for changes to the provincial dispatch system since 2006 to improve the efficiency and effectiveness of ambulance deployment. Recent advocacy efforts have resulted in positive discussions with the Ministry, including verbal commitments to implement updated technology and a new triage tool, with the Mississauga dispatch centre being the first site for implementation.

Offload delay continues to put pressure on Paramedic Services. In the past, strong partnerships have helped to mitigate the impacts of offload delay. Continued engagement with our hospital partners will be essential to continuing to address offload delay and other system pressures in the future.

A key challenge for Peel Paramedics is recruiting the right number of skilled paramedics to respond to the growing and changing demands of our community. To help ensure that we are able to staff to Council-approved levels, management will be developing a long-term staffing strategy.

1. Background

The Region of Peel is responsible for the provision, oversight and partial funding (50-50 cost shared with the provincial government) for the delivery of 24/7 pre-hospital medical care and transport to area hospitals for residents and visitors to Peel. Growing pressures on the local health system due to demographic changes (i.e. population growth and an aging population) and changing health needs (e.g. increasing incidence of chronic disease), have resulted in increasing service demands. Paramedic Services is not immune to these pressures, and the impact is most evident through increasing emergency

4.1-1

PARAMEDIC SERVICES - SYSTEM PRESSURES UPDATE

- 2 -

call volumes. Inefficient ambulance deployment through provincial dispatch centres continues to place additional pressures on service, despite Regional advocacy for reforms to the dispatch system for over 11 years. Further, staffing and the ongoing challenges with offload delay continue to impact the ability of Peel paramedics to respond to the emergency health needs of Peel residents.

2. System Pressures

As described above, Paramedic Services is impacted by a number of pressures, including increasing call volume, inefficiencies with the ambulance dispatch system, ongoing challenges with offload delay and staffing issues. Information about these four issues and their impact in Peel are described in greater detail below. a) Call Volume

Call volume growth in Peel currently exceeds population growth, placing pressure on Paramedic Services and hospital emergency departments. For instance, over the past ten years, population growth in Peel has increased by an average of two per cent annually. Over the same time period, call volume has, on average, grown by five per cent annually. Table 1 below provides actual call volume numbers in Peel and year-over-year growth over a five year period. Table 1 – Increasing Paramedic Call Volume

Year Call Volume Increase to Prior Year

2012 95,212 7.6% 2013 97,881 2.8%

2014 103,771 6.0% 2015 105,230 1.4%

2016 115,029 9.3%

b) Ambulance Dispatch System

The Ministry of Health and Long Term Care operates the Mississauga Central Ambulance Communication Centre (CACC or dispatch centre), which dispatches and coordinates ambulances and other resources (i.e., Rapid Response Units) operated by Peel Regional Paramedic Services. The current triage tool used to classify the severity of incoming ambulance calls (coding them as urgent ‘lights and sirens’ calls or of lesser priority) assigns more calls as lights and sirens calls than necessary, leaving fewer ambulances available to respond to new calls that are truly urgent. Growing pressure on paramedic services requires that ambulance resources be deployed as efficiently as possible. As described in the staff report on today’s agenda, titled “Update on Provincial Dispatch Reform Advocacy”, improvements to ambulance dispatch will enable Peel to better deploy resources across the Region to ensure residents receive care within a time

period that more accurately reflects their needs.

c) Offload Delay

Under normal circumstances it should take a paramedic about 30 minutes to transfer the care of a patient to a hospital emergency department, complete paperwork, clean

4.1-2


- 3 -

equipment and restock supplies. Time spent at a hospital beyond 30 minutes is referred to as offload delay. As the Health System Integration Committee is aware, Peel Regional Paramedic Services works collaboratively with the three hospital emergency departments in Peel to address and improve offload delay on a regular basis. Process improvement work, initiated in 2011, and provincial funding for the Hospital Nursing Program that allows for dedicated offload nurses to assume the care of low acuity patients arriving by ambulance, have helped to recover paramedic hours previously lost to offload delay. Staff have been advised that the Hospital Nursing Program will be continuing in 2017/2018 and have submitted a proposal for consideration by the Ministry. In 2016, offload delay accounted for 38,035 hours, which is 9.4 per cent lower than 2011 (42,002 hours) despite the fact that the number of patients increased by 31 per cent during this same time period (from 46,470 to 60,922). This is a significant achievement. Despite these efficiencies, paramedic hours lost to offload delay increased from 2015 to 2016. In the context of a 9.3 per cent increase in call volume, total offload delay hours increased by 4.6 per cent (from 36,369 to 38,035 hours). The ability of Peel Regional Paramedic Services and their hospital partners to continue to make improvements is challenged by increasing call volumes and, in recent months (December 2016 to February 2017), higher than normal hospital emergency department volumes.

d) Staffing Levels

Identifying, recruiting and retaining the appropriate level and mix of staff is essential for any business. This has become particularly important and challenging for the Paramedic Services sector in the Greater Toronto Area. Peel Regional Paramedic Services has been able to keep up with demands; however, current trends and system pressures identified in this report, together with limited supply and competition for qualified candidates, indicate that current staffing levels may not be sustainable to address the current and future needs of the community. One key issue is a reduced pool of part-time paramedics. To staff to Council approved levels, it is necessary to have a sufficiently large pool of employees (part-time and temporary) to fill vacant shifts. This is because part-time staff are used to fill shifts that full-time paramedics are not available to work. Having flexibility to pull from a group of part-time and temporary paramedics allows Paramedic Services to respond quickly to vacant shifts and demands due to call volume.

3. Responding to System Pressures

Demands on Paramedic Services are not new and Regional Council has been supportive of Peel Regional Paramedic Services efforts in the past to find new and innovative ways to manage system pressures, including the development of the Divisional Model. In addition, with direction from the Aging Population Steering Committee, staff completed a review of the Peel’s Community Referrals by Emergency Medical Services (CREMS) program. The review resulted in new processes and tools to help better connect patients to appropriate services to help reduce dependencies on the 911 system. In addition to continuing to build on these historical efforts, Peel Regional Paramedic Services is working to maximize existing resources and continue to find efficiencies within the current system to keep up with demand. Some of the areas of current focus are described below.

4.1-3


- 4 -

a. Partnership

Many of the successes achieved by Peel Regional Paramedic Services in managing system pressures is attributable to strong partnerships and relationships with the two hospital corporations serving Peel (William Osler Health System and Trillium Health Partners). In recent months, our hospital partners have continued to work collaboratively with Paramedic Services to prioritize the offload of ambulances at their emergency departments, despite having emergency department volumes at surge levels. This support and ongoing engagement on system-wide issues helps Paramedic Services to continue to respond to community needs, manage costs and respond to new challenges. Continuing to build on and strengthen these partnerships is essential.

b. Advocacy

Advocacy is another tool that has been used by the Region to help mitigate system pressures in the past. Previous Regional advocacy related to offload delay has helped to identify the importance of the provincial Hospital Nursing Program and has supported the addition of offload delay times as part of the provincial Pay for Performance program. Reforms to the provincial dispatch system has been a priority for the Region of Peel since 2006, as efficient deployment of ambulances would greatly support Peel Paramedics to better respond to need in the community. More details about advocacy efforts by the Region of Peel are included in the staff report titled, “Update on Provincial Dispatch Reform Advocacy,” also included on today’s agenda. At a high level, our advocacy to date has placed an emphasis on:

Replacing the existing triage tool used in provincially operated dispatch centres with a more accurate tool;

Improving access to real-time data; and

Developing an accountability framework between the dispatch centres and municipal land ambulance operators.

Recent advocacy efforts have resulted in positive discussions with the Ministry, and verbal commitments from the province to implement updated technology and a new triage tool, with the Mississauga dispatch centre being the first site for implementation. While this is considered positive progress, the Region will continue to advocate until evidence-informed changes are implemented.

c. Staffing and Recruitment Strategy

Monitoring the impact of system pressures on workload and its effects on staff wellbeing and morale is essential to maintaining an efficient and effective workforce. Simultaneously, it is important to develop the right mix and level of skilled paramedics to be able to respond to the growing and changing demands of our community. To address these challenges, management will be conducting further analysis and developing a broader staffing strategy, which will include enhanced recruitment and scheduling. For example, additional recruitment sessions will be planned for this year.

4.1-4


- 5 -

CONCLUSION Paramedic Services is impacted by a number of system pressures, including increasing call volume, inefficiencies with the ambulance dispatch system, ongoing offload delay and staffing issues. While most of these challenges are not new, they are growing and accumulative. As a result, they continue to put pressure on emergency health services, requiring Peel Regional Paramedic Services to identify new and innovative ways to continue to meet the needs of Peel residents. Building on successful partnerships, continuing to actively advocate for system changes and developing a strong approach to recruitment will help to position the Region of Peel to manage and mitigate the impacts of system pressures now and in the future.

Nancy Polsinelli, Commissioner of Health Services Approved for Submission:

D. Szwarc, Chief Administrative Officer For further information regarding this report, please contact Peter F. Dundas, [email protected], Ext 3921. Authored By: Lincoln Bryant

4.1-5

REPORT Meeting Date: 2017-04-20

Health System Integration Committee

For Information

DATE: April 7, 2017

REPORT TITLE: UPDATE ON PROVINCIAL DISPATCH REFORM ADVOCACY

FROM: Nancy Polsinelli, Commissioner of Health Services

OBJECTIVE

To provide an update on Regional advocacy efforts to make evidence-informed improvements to the provincial dispatch system, including implementation of a new triage tool and prioritization of the Mississauga Central Ambulance Communications Centre for these improvements. REPORT HIGHLIGHTS

The Region of Peel has been advocating to the Province for evidence-informed improvements to the dispatch system since 2006.

Current Regional advocacy is focused on implementing a new triage tool used in provincially operated dispatch centres and confirming prioritization of the Mississauga Central Ambulance Communication Centre for implementation.

Recent advocacy efforts, including a meeting with the Minister of Health and Long-Term Care’s Parliamentary Assistant, have led to positive conversations with the Ministry about achieving dispatch reform.

Despite promising direction, the Ministry has yet to publicly commit to implementing the more accurate Medical Priority Dispatch System triage tool, or prioritizing the Mississauga Central Ambulance Communication Centre for implementation.

DISCUSSION 1. Background

The Ministry of Health and Long-Term Care is responsible for the oversight of land ambulance services in Ontario, which includes direct operation of half of the 22 ambulance dispatch centres across the province. Among the provincially operated dispatch centres is the Mississauga Central Ambulance Communication Centre (CACC or dispatch centre), that deploys and coordinates ambulances and other resources operated by Peel Regional Paramedic Services and Halton Region Paramedic Services. Since 2006, the Region of Peel in collaboration with other municipal land ambulance operators in the Greater Toronto Area (Halton, Durham, York and the County of Simcoe), has been advocating to the Province to make improvements to the dispatch system. Regional advocacy has focused on encouraging the province to replace the triage tool used to classify the severity of incoming ambulance calls (code them as life threatening or not), improve access to data in real time, and develop an accountability framework.

4.2-1

UPDATE ON PROVINCIAL DISPATCH REFORM ADVOCACY

- 2 -

In February 2016, Regional Council approved the report to the Health System Integration Committee titled, “Ambulance Communications and Dispatch Services Advocacy,” which included the following renewed advocacy position:

That the Ministry of Health and Long-Term Care expedite the improvements related to ambulance dispatch by implementing the Medical Priority Dispatch System, and further that given call volumes, the Mississauga Dispatch Centre be given priority for implementation (Resolution 2016-144).

In June 2016, the Premier announced proposed consultations on expanding medical response through fire services. Regional staff viewed these consultations as a distraction from urgently needed reforms to the paramedic dispatch system. As a result, the report to Regional Council dated October 27, 2016, titled; “Proposed Provincial Consultation on Expanding Medical Response through Fire Services” included the following recommendation:

That the Region of Peel does not support further exploration of alternative models of emergency medical response and to advocate that the Province initiate dispatch reforms to lead to improved emergency medical response times and patient outcomes (Resolution 2016-815).

Regional Council approved the October 27, 2016 report, and referred the issue to the Government Relations Committee, who identified provincial dispatch reform as a Regional advocacy priority in November 2016. The Association of Municipalities Ontario (AMO) also holds the position that improvements to the dispatch system should be the focus of provincial and municipal efforts to address demand for paramedic services.

2. Regional Advocacy Positions

In Peel, we continue to experience challenges with the dispatch system related to inaccurate triaging, a lack of access to real-time data, and accountability between dispatch centres and municipal land ambulance operators. Most recently, concerns about staffing levels at the Mississauga Central Ambulance Communication Centre (CACC or dispatch centre) have also been raised. Since February 2016, when Regional Council endorsed the renewed advocacy position, advocacy efforts have focused on encouraging the provincial government to implement the more accurate Medical Priority Dispatch System (triage tool) across the province, and prioritize the Mississauga CACC for implementation of the new tool as a necessary first step toward dispatch reform. a) Implementing the Medical Priority Dispatch System across the Province

Evidence indicates that the Dispatch Priority Card Index II (DPCI II) triage tool currently used in provincially operated dispatch centres over-prioritizes ambulance calls, meaning that more ambulances are assigned as life-threatening (red lights and siren calls) than necessary. This leaves fewer ambulances available to respond to new calls that are truly urgent. In 2015, Ontario’s Auditor General reported that the Medical Priority Dispatch System (MPDS), a different triage tool already used in Toronto and Niagara, is a more detailed and accurate tool than DPCI II. For example, 72 per cent of total calls in 2015 were coded through the current DPCI II tool as life-threatening, with only 20 per cent of these calls resulting in transport to hospital in life-threatening condition. Using the MPDS tool, approximately 40 per cent of those original total calls would have been

4.2-2


- 3 -

coded as life-threatening. This data demonstrates an increased accuracy in the triaging of calls received by the dispatch centre, thereby reducing demand on Paramedic Services. Implementing MPDS across the provincially operated dispatch centres will: increase accuracy with recognizing life-threatening situations and calls that require tiered response; reduce paramedic response time; and, enable more efficient allocation of resources across ambulance fleets to ensure residents receive care within a time period that more accurately reflects their needs.

b) Prioritization of the Mississauga Central Ambulance Communication Centre

Growing pressure on paramedic services requires that ambulances be deployed as efficiently as possible. The Mississauga Central Ambulance Communication Centre serving Peel and Halton is the busiest of the provincially operated dispatch centres, receiving over 320,000 calls in 2015. Improvements to the current systems are urgently needed to mitigate service challenges associated with rapid growth and an aging population. In 2016, Peel Regional Paramedic Services responded to an estimated 115,029 emergency and non-emergency calls and the number of calls is expected to increase annually by more than five per cent. To respond to these pressures, Peel’s 2017 budget includes an additional $1.34M, to simply maintain service levels. With the provincial share of operating costs included (shared on a 50:50 basis), the total cost to maintain service levels is 2.68M.

3. Recent Regional Advocacy Efforts

For the past eleven years (since 2006), the Region has advocated for evidence-informed improvements to the provincial dispatch system. Appendix I provides a chronology of these advocacy efforts. Some recent advocacy activities include:

Sharing relevant Regional Council reports and recommendations with all land ambulance delivery agents in Ontario, our local system partners, the Association of Municipalities of Ontario, the Ontario Association of Paramedic Chiefs for endorsement, and local MPPs for their information.

Staff level meetings with Peel, Halton and Ministry staff, including Patricia Li, Assistant Deputy Minister responsible for paramedic issues.

Letters from Regional Chair Dale to the Minister of Health and Long-Term Care (Dr. Eric Hoskins) requesting a meeting to discuss dispatch reform.

Advocacy for paramedic dispatch reform as part of the 2017 provincial pre-budget submission and delegation at the pre-budget consultation hosted by the Ontario Standing Committee on Finance and Economic Affairs.

Meeting between Councillor Saito, Chair of the Health System Integration Committee, the Commissioner of Health Services, the Chief and Director of Paramedic Services and the Parliamentary Assistant to the Minister of Health and Long-Term Care, MPP John Fraser, to discuss dispatch reform.

To date, these efforts have resulted in positive discussions with the province, including verbal commitments to replace the current triage tool and prioritize the Mississauga dispatch centre for these changes.

4.2-3


- 4 -

4. Current Provincial Response to Regional Advocacy In December 2016, commitments to replace the triage tool were supported by a Notice of Proposed Procurement on behalf of the Ministry of Health and Long-Term Care seeking a triage tool to be delivered in the spring of 2017 with implementation by the spring of 2018. Further, Ministry staff have verbally committed to prioritizing the Mississauga dispatch centre for new triage technology, which they have also noted will be implemented by 2018.

While these commitments are promising, the Province has yet to publicly commit to implementing the more accurate Medical Priority Dispatch System tool or engage municipal operators regarding implementation of these improvements. The Region of Peel is looking for the Province to:

Publicly announce their commitment to implement the Medical Priority Dispatch System (MPDS) triage tool across the province;

Share their implementation plan, including a prioritization schedule for provincially operated dispatch centres, with land ambulance operators;

Prioritize dispatch centres with the highest volume and those facing rapid growth, such as the Mississauga Central Ambulance Communication Centre that serves Halton and Peel; and

Formally engage municipal operators in the planning and implementation process.

These outcomes will be considered positive progress toward provincial dispatch reform in Ontario, and the Region of Peel will continue to advocate for these actions until they are achieved. The Region will continue to take a strategic approach to advocacy activities, and explore opportunities to work with Ministry staff to implement the new triage tool, as well as other dispatch reforms, such as improving the accessibility of real time data and enhancing accountability between dispatch centres and municipal land ambulance operators.

4.2-4


- 5 -

CONCLUSION Improvements to ambulance dispatch will enable Peel to better allocate resources across its ambulance fleet and ensure residents receive care within a time period that more accurately reflects their needs. While recent provincial commitments are encouraging, the Region will continue to advocate until the province takes further action supporting their commitments to replacing the tool and ensure that, given call demands, the Mississauga dispatch centre is a priority for implementation.

Nancy Polsinelli, Commissioner of Health Services Approved for Submission:

D. Szwarc, Chief Administrative Officer APPENDICES

1. Appendix I - Chronology of Regional Ambulance Dispatch Advocacy For further information regarding this report, please contact Dawn Langtry, Director Strategic Policy Planning and Initiatives, extension 4138, [email protected]. Authored By: Nicole Britten, Advisor, Policy & Advocacy

4.2-5

APPENDIX I – UPDATE ON PROVINCIAL DISPATCH REFORM ADVOCACY

Chronology of Regional Ambulance Dispatch Advocacy (November 2006 – Present) INITIATION OF REGIONAL DISPATCH ADVOCACY (Fall 2006- Spring 2007)

October 12, 2006

Report (oral) to Emergency and Protective Services Committee (EPSC) “Evaluation and Recommendations for Capital Planning and Development of the Peel Regional Paramedic Service

HealthAnalytics report (oral) presented to EPSC including recommendations concerning needed changes to ambulance dispatch. October 26, 2006 Regional Council creates first advocacy position related to ambulance dispatch reform

Regional Council approves HealthAnalytics report to EPSC (Approved 2006-1120) as well as Peel’s first council-endorsed advocacy position related to ambulance dispatch.

Council Resolution 2006- 1149: “That the Province of Ontario, in consultation with Peel staff be requested to make improvements to its call triaging process at CACC; And further, that the Province be requested to expedite the Provincial Task force recommendations made related to offload delay; And further, that the Province be requested to establish a media campaign to prevent the misuse of Paramedic Services for calls which can be addressed through other healthcare agencies; And further, that the Province be requested to enter into discussions with the Region of Peel to allow the Region to directly operate the CACC.”

February 22, 2007 Report to EPSC “Evaluation and Recommendations for Capital Planning and Development of the Peel Regional Paramedic Service- Feasibility Study” (linked)

Report proposes feasibility studies from the report by HealthAnalytics, including one project regarding ‘System oversight and reporting’ that proposes that an EMS System Board be formed to oversee Peel’s pre-hospital system (including oversight of the CACC).

The committee endorses the report and proposed studies, and recommends a special meeting of Regional Council in the second quarter of 2007 to receive study findings.

June 7, 2007 HealthAnalytics Study report presented to EPSC

Report includes recommendations calling on the Ministry of Health and Long-Term Care (Ministry) to implement new ambulance call triaging system presented to EPSC.

Recommendation EPSC-8-2007: “ … And further, that the Ministry of Health and Long-Term Care implement a new call triage protocol based on the Medical Priority and Dispatch System (MPDS) model that will allow improved call triaging; And further, that the Regional Chair contact the Minister of Health and Long-Term Care to express the need for the Ministry to act expeditiously in this regard; And further, that the implementation of any revised EMS or ambulance response time targets for the Region of Peel be established upon the implementation of the new call triaging and vehicle dispatch system which accurately delineates and triages emergency calls, and effectively integrates the call intake and vehicle dispatch functions; And further, that in the context of developing an effective call triaging system, the Region work towards, and provide the resources necessary to achieve response times of five (5:00) minutes at the 90th percentile for EMS system first response…”

June 21, 2007 Report from June 7, 2011 EPSC meeting and minutes to Regional Council

Regional Council approves report and minutes from June 7, 2007 EPSC. (Approved 2007-831)

JOINT ADVOCACY WITH GTA LAND AMBULANCE OPERATORS (Late 2009 – December 2015)

Fall 2009 Staff receive POMAX report, “GTA Ambulance Communications and Dispatch Services Review”

Report highlights a number of challenges with ambulance dispatch and communications, and puts forward a number of recommendations to improve the dispatch system in the GTA including improvements to the triage tool, governance and operational accountability, and access to up-to-date dispatch information.

January 27, 2010

Joint letter from Regional Chairs/Warden (with copy of POMAX report) sent to the Minister of Health and Long-Term Care (Deb Matthews)

Initiates joint advocacy with GTA partners (Halton, York, Durham, and Simcoe), with the Region of Peel playing a leadership role.

4.2-6

https://www.peelregion.ca/paramedics/pdfs/feb-12-2007-report.pdf


June 2010 GTA Chiefs/Directors of Paramedic Services meet with Director, Emergency Health Services Branch

Joint meeting GTA Chiefs/Directors with Ministry staff, who advise that they had read the POMAX report but currently have direction not to explore any other options at this time. No approval or authority to move ahead.

September 9, 2010 Regional Council endorses POMAX Review (2009), “GTA Ambulance Communications and Dispatch Services Review” (linked)

Region of Peel continues to play leadership role in joint advocacy with GTA partners.

Recommendations from the POMAX report inform further advocacy through AMO meetings, budget consultations (2011-2015) as well as the Region of Peel’s 2011 Election Campaign platform.

August 23, 2011 Annual AMO Meeting with Minister Matthews and Ministry staff

Minister indicates that they are looking at a province-wide solution to find efficiencies, and suggested that this particular issue be taken up by AMO.

Minister instructs staff to follow-up.

December 13, 2011

Regional staff meet with AMO senior policy staff

Regional staff brief AMO on the POMAX report, including recommendations.

While AMO was receptive to the report, Regional staff are told that the AMO board is unlikely to take on ambulance dispatch as a priority given the minority government status.

March 2012 – May 2012

Letters from Chair Kolb to Minister Matthews

Three letters sent to Minister Matthews, all including a copy of the POMAX report and requesting a meeting between the Minister and Regional Chairs/Warden to discuss dispatch reform.

August 1, 2012 Meeting of Chairs/Warden and staff with Minister Matthews regarding ambulance dispatch.

Minister acknowledges CACC issues, but EHSB currently has other priorities. Directs staff to work with the GTA group to find some solutions related to the issues.

October 2012 Region of Peel receives copy of Evaluation of Niagara Ambulance Communications Services (NACS)

NACS evaluation (completed in 2010) validates many of the concerns re CACC in GTA, including enhanced accuracy of the MPDS triage tool.

December 2013 Ontario’s Auditor General releases 2013 Report highlighting issues with dispatch system.

Report highlights the current triage tool as an issue within the ambulance dispatch system.

Ministry directs Sunnybrook Centre for Pre-hospital Medicine to assess effectiveness of the two triage tools used in Ontario.

February 3, 2014 Regional staff meet with staff from the Premier’s Office

Chairs and Warden reiterate their desire to see reforms to the ambulance dispatch system in relation to issues like governance, technology and triage (as outlined in the POMAX study).

Premier’s staff commits to review the information and follow-up with Minister Matthews’ staff to see if progress could be made on concerns.

February 20, 2014 EPSC Report “Auditor General Report on Land Ambulance” (linked) Report provides an overview of the Auditor General findings and recommendations regarding ambulance dispatch and other system issues.

August 19, 2014 Annual AMO Meeting with Minister of Health and Long-Term Care (Eric Hoskins) and Ministry staff Ministry staff instructed to work with Ontario Association of Paramedic Chiefs and AMO to get moving on a mandate and terms of reference for Land Ambulance Dispatch working group.

November 2014 to May 2015

Chief Dundas serves on Ministry Land Ambulance Dispatch Working Group

Ministry forms the Land Ambulance Dispatch Working Group to provide advice on improving the dispatch process and prioritization of emergency calls.

Final report (linked) to the Ministry of Health and Long-Term Care provided in May 2015 includes key recommendations to improve dispatch.

No response to Working Group recommendations from the Ministry.

August 17, 2015 Annual AMO Meetings with Parliamentary Assistant to the Minister of Health Minister Indira Naidoo-Harris, and Ministry staff

In follow up, Minister Hoskins sends a letter to David Szwarc (November 18, 2015), stating the Ministry’s commitment to improve ambulance services and notes that any changes to dispatch must be evidence-based and contribute to improving patient outcomes, financial stability and government priorities.

4.2-7

http://www.peelregion.ca/council/agendas/pdf/rc-20100909/report-he-b1.pdf

https://www.peelregion.ca/council/agendas/pdf/2014/2014-02-20/epsc-4b.pdf

https://www.oapc.ca/wp-content/uploads/2016/11/Land-Ambulance-Working-Group.pdf


December 2015 Auditor General releases Report with 2-Year Follow-Up Report

2 Year Follow-Up Report to 2013 Audit highlights little progress has been made to improve the dispatch issue in Ontario.

Report indicates that research commissioned by the Ministry has shown that the Medical Priority Dispatch System tool is more accurate than the Dispatch Priority Card Index II(DPCI II) tool currently used in provincial dispatch centres.

Ministry indicates that it will take until late 2018 to plan and complete improvements.

REGIONAL ADVOCACY FOCUSED ON EXPEDITING IMPROVEMENTS AND PRIORITIZATION OF THE MISSISSAUGA CACC (Feb 2016-Present)

February 4, 2016 Health System Integration Committee (HSIC) reports, “ Patients First: A Proposal to Strengthen Patient-Centre Health Care in Ontario – Region of Peel Response” and “Ambulance Communications and Dispatch Services Advocacy” (linked)

HSIC endorses both reports, which identify a renewed advocacy position:“That the Ministry of Health and Long-Term Care be requested to expedite the improvements related to the ambulance dispatch system by implementing the Medical PriorityDispatch System, as described in the report of the Commissioner of Health Services titled “Ambulance Communications and Dispatch Services Advocacy”, across the Provinceof Ontario;And further, that the Mississauga Dispatch Centre, given the call volumes, be given priority for implementation.”

Feb 25, 2016 HSIC Reports (and recommendation) approved by Regional Council

Council Resolutions 2016-143 and 2016-144: Recommendations from February 4, 2016 Reports to HSIC approved. Both reports are shared with Ministry, and report titled, Ambulance Communications and Dispatch Services Advocacy, is distributed to ambulance operators, local system

partners, AMO and Ontario Association of Paramedic Chiefs for endorsement.o Responses to report tabled at June 2, 2016 HSIC from Durham, Hamilton, Kawartha Lakes and Lennox and Addington.

April 2016 Chair Dale meeting with Associate Minister D. Damerla

Meeting with Minister Damerla to discuss top issues for Peel, including dispatch reform.

May 4, 2016 Halton and Peel joint meeting with Assistant Deputy Minister, Direct Services (oversees Emergency Health Services Branch)

Meeting with ADM Patricia Li (responsible for Paramedic issues) to discuss issues with the dispatch system and triage tool and advocate for Mississauga CACC to beprioritized.

Province committed to further discussion with municipal staff and indicated commitment to dispatch reform.

June 2016 Premier Wynne announces intention to consult on new fire-paramedic model

Premier Wynne announces the government’s intention to consult on expanding medical response through fire services.

AMO issues a News Release (linked) expressing concerns with the proposed consultations, and pointing to dispatch as a more important priority.

July 7 2016 Report to Regional Council, “Update on Regional Ambulance Communications Centre Advocacy” (linked)

Update on Regional advocacy efforts and provincial progress highlighting challenges with the triage tool, access-to-real time data and lack of an accountability framework asongoing concerns related to dispatch.

Council indicates its continued support for Paramedic dispatch reform as an advocacy priority for the Region.

August 17, 2016 Annual AMO Meeting with Parliamentary Assistant John Fraser and Ministry staff

Dispatch reform is highlighted as a top of mind issue for Peel.

Region of Peel delegate is unable to ask question regarding why the Ministry plans to consult on expanding medical response through fire services, when evidence-informed dispatch reforms have yet to be implemented during the session with PA John Fraser.

September 7, 2016 Teleconference with EESO 2.0 Office within the Ministry and Director, Emergency Health Services Branch Staff receive verbal commitment from Director that they are moving forward with changes to the provincial triage tool and that the Mississauga CACC (which serves Halton and Peel) will be first site for implementation of new tool.

4.2-8

http://www.peelregion.ca/council/agendas/2016/2016-02-04-hsic-agenda.pdf

http://www.peelregion.ca/council/agendas/2016/2016-02-04-hsic-agenda.pdf

https://www.amo.on.ca/AMO-Content/Policy-Updates/2016/Government-to-Consult-on-Expanding-Medical-Respons

http://www.peelregion.ca/council/agendas/2016/2016-07-07-rc-agenda.pdf


October 27, 2016 Recommendation report to Regional Council, “Proposed Provincial Consultation on Expanding Medical Response through Fire Services” (linked)

Rationale for not moving forward with proposed consultation includes the fact that consultations will distract from ambulance dispatch reform, an evidence-informed strategy to improve the provincial emergency response system.

Report shared with local system partners for endorsement, as well as AMO, and Peel area MPPs for information.

Report referred to Government Relations Committee to include dispatch advocacy as a Regional advocacy priority.

Council Resolution 2016-815: “That the Regional Chair and the Chair of the Health System Integration Committee request to meet with the Minister of Health and Long-Term Care to indicate that the Region of Peel does not support further exploration of alternative models of emergency medical response and to advocate that the Province initiate dispatch reforms to lead to improved emergency medical response times and patient outcomes”.

November 14, 2016

Letter from Chair Dale to Minister Hoskins requesting a meeting to discuss Dispatch Reform

Letter to Minister Hoskins from Chair Dale advising that Regional Council passed resolution 2016-815 (above) and requesting that the Minister meet with Chair Dale, and Councillor Pat Saito (Chair of the Health System Integration Committee) to discuss dispatch reform as a provincial priority.

A copy of the report, “Proposed Provincial Consultation on Expanding Medical Response through Fire Services” is included for review.

Email response from Patricia Li, Assistant Deputy responsible for paramedic issues denying a meeting and inviting the Region to provide their feedback on ongoing consultations regarding expanding medical response through fire services.

January 9, 2017 Regional Response to Consultations on Expanding Medical Response through Fire Services submitted to Minister Hoskins

Formal letter submitted to Minister Hoskins reiterating Council Resolution from October 27th as the Region’s formal response to Ministry consultations.

Regional response to consultations (supporting AMO’s coordinated response) is also submitted via email to Patricia Li, Assistant Deputy Minister response for paramedic issues.

Letter also sent to the Minister on behalf of MARCO LUMCO (December 23, 2016) indicating that they do not support the consultations and encouraging a focus on dispatch reform.

January 9, 2017 Letter to Minister Hoskins reiterating request for meeting re: Dispatch Reform

Letter reiterates request for in-person meeting and clarifies that the meeting request was to discuss dispatch and not the fire-paramedic proposal.

In response, a meeting is scheduled with Minister Hoskins’ Parliamentary Assistant, John Fraser, Chair Dale, Councillor Saito for February 27, 2017.

January 19, 2017 Dispatch reform included in 2017 provincial pre-budget submission

Dispatch reform included in the Region’s 2017 provincial pre-budget submission, as well as the delegation at the pre-budget consultation hosted by the Ontario Standing Committee on Finance and Economic Affairs.

In response to a question by MPP Sylvia Jones wanting further clarification on how the Region wants the dispatch system to be reformed, Janice Sheehy specifies that there is immediate need for the province to implement a new triage tool.

February 27, 2017 Meeting with Parliamentary Assistant John Fraser

Councillor Saito (Chair of HSIC), Nancy Polsinelli (Commissioner, Health Services) and Peter Dundas (Chief and Director, Paramedic services), met with John Fraser, Parliamentary Assistant to the Minister of Health and Long-Term Care.

PA confirmed provincial commitment to replacing the triage tool.

4.2-9

http://www.peelregion.ca/council/agendas/2016/2016-10-27-agenda.pdf

meeting documents health system integration committee hsic ...€¦ · –depression care...

Documents