THE REGIONAL MUNICIPALITY OF PEEL HEALTH SYSTEM INTEGRATION COMMITTEE

Transcription

1 THE REGIONAL MUNICIPALITY OF PEEL HEALTH SYSTEM INTEGRATION COMMITTEE REVISED AGENDA HSIC - 3/2017 DATE: Thursday, June 29, 2017 TIME: LOCATION: MEMBERS: 9:30 AM 11:00 AM Regional Council Chamber, 5th Floor Regional Administrative Headquarters 10 Peel Centre Drive, Suite A Brampton, Ontario F. Dale; A. Groves; E. Moore; M. Palleschi; C. Parrish; P. Saito; B. Shaughnessy ADVISORY MEMBERS: M. DiEmanuele; J. Flewwelling; 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. Kim Delahunt, Senior Director, Central West Local Health Integration Network and Odelia Andrea, Director, Strategy Management and Planning, Mississauga Halton Local Health Integration Network, Presenting an Update on the Implementation of the Patients First Act and the Dissolution of the Community Care Access Centres (Presentation material now available) 3.2. Patricia Li, Assistant Deputy Minister, Direct Services; Donna Piasentini, Director, Emergency Health Program Management and Delivery Branch; and, Steven Haddad, Executive Lead, Enhancing Emergency Services in Ontario Office, Ministry of Health and Long-Term Care, Presenting an Overview of Provincial Directions Related to Paramedic Services, Including the Enhancing Emergency Services in Ontario Initiative (See also Reports Item 4.1, and Communications Item 5.1) (Presentation material now available)

2 HSIC-3/ Thursday, June 29, REPORTS 4.1. Overview of Provincial Policy Reforms Related to Emergency Health Services in Ontario (For information) (See also Delegations Item 3.2 and Communications Item 5.1) 4.2. Update on Regional Mental Health Advocacy 5. COMMUNICATIONS 5.1. Association of Municipalities of Ontario (AMO), Policy Update dated June 5, 2017, Province Announces Emergency Services Changes Including Dispatch and Fire-Medic Pilots (Receipt recommended) (See also Delegations Item 3.2, and Reports Item 4.1) 6. IN CAMERA MATTERS 7. OTHER BUSINESS 8. NEXT MEETING Thursday, October 19, 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

3 JFRegion IIof Peel working with you Request for Delegation FOR OFFICE USE ONLY r MEETING DATEyyyyiMM/OO--MEETING 12017/06/29 HSIC 1. ~ _ REQUESTDATEYYYY/MM/DD /05 NAME OF INDIVIDUAL(S) Kim Delahunt POSITION/TITLE Senior Director NAME Attention: Regional Clerk Regional Municipality of Peel 10 Peel Centre Drive, Suite A Brampton, ON L6T 4B9 Phone: ext Fax: council@peelregion.ca NAME OF ORGANIZATION Central West Local Health Integration Network (LHIN) TELEPHONENUMBER EXTENSION FAX NUMBER NAME OF INDIVIDUAL(S) Odelia Andrea POSITION/TITLE Director, Strategy Management and Planning NAME OF ORGANIZATION Mississauga Halton Local Health Integration Network (LHIN) TELEPHONENUMBER EXTENSION FAX NUMBER REASON(S) FOR DELEGATIONREQUEST(SUBJECTMATTER TO BE DISCUSSED) Providing an update regarding the implementation of the Patients First Act and the Dissolution of the Community Care Access I AM SUBMITIING A FORMAL PRESENTATION TO ACCOMPANY MY DELEGATION IZI YES 0 NO IF YES, PLEASE ADVISE OF THE FORMAT OF YOUR PRESENTATION (ie POWERPOINTj Powerpoint ----~ Note: Delegates are requested to provide an electronic copy of all background material/presentations to the Clerk's Division at least seven (7) business days prior to the meeting date so that it can be included with the agenda package. In accordance with Procedure By-law , as amended, delegates appearing before Regional Councilor Committee are requested to limit their remarks to 5 minutes and 10 minutes respectively (approximately 5/10 slides). Delegates should make every effort to ensure their presentation material is prepared in an accessible format. Once the above information is received in the Clerk's Division, you will be contacted by Legislative Services staff to confirm your 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 as amended, for the purpose of contacting individuals and/or organizations requesting an opportunity to appear as a delegation before Regional Councilor a Committee of Council. The Delegation 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. All Regional Council meetings are audio broadcast via the internet and will be video broadcast on the local cable television network where video files will be posted and available for viewing subsequent to those meetings. Questions about collection may be directed to the Manager of Legislative Services, 10 Peel Centre Drive, Suite A, 5th floor, Brampton, ON L6T 4B9, (905) ext V /04

4 3.1-2 Patients First Region of Peel Health System Integration Committee Presented by: Kim Delahunt, Vice President, Health System Planning, Integration & Strategy, Central West LHIN Odelia Andrea, Director, Strategy Management & Planning, Mississauga Halton LHIN June 29, 2017

5 3.1-3 Background Why are we moving on this? What do we expect to improve? 2

6 3.1-4 The Patients First Journey First Mandate Letter September 2014 Bringing Care Home January 2015 Patients First: Action Plan for Health Care February 2015 Patients First: Roadmap to Strengthen Home and Community Care May 2015 Province-wide consultation January April 2016 Patients First: Discussion Paper December 2015 Auditor General Report on CCACs (Phase 2) December 2015 Auditor General Report on CCACs (Phase 1) August 2015 Price-Baker Report May 2015 Patients First: Reporting Back on the Proposal to Strengthen Patient- Centred Health Care in Ontario June 2016 Patients First Act, 2016 Introduction (Bill 210) June 2016 Mandate Letters Released September 2016 Patients First Act, 2016 Reintroduction (Bill 41) October 2016 Patients First Act, 2016 Passage December

7 3.1-5 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 4

8 3.1-6 How the Act Supports Transformation Goals Legislative enablers More Effective Service Integration, Greater Equity Establishment of sub-regions LHIN objects Timely Access to Primary Care, and Seamless Links Between Primary Care and Other Services Designation of new health service providers Establishment of sub-regions More Consistent and Accessible Home and Community Care Transfer of CCACs to LHINs Shared services entity to support backoffice functions Stronger Links Between Population & Public Health and other Health Services Formal linkages between LHINs and Boards of Health Establishment of Integrated Clinical Care Council Physician planning Expanded LHIN governance Establishment of sub-regions 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. 5

9 3.1-7 Transition to Transformation A multi-year plan to improve the performance of Ontario health care system. 6

10 3.1-8 Implementation Milestones: December Summer

11 3.1-9 Through Transition Towards Transformation 8

12 Changes Enabled by Patients First Act,

13 LHIN Mandate Letter 10

14 Health Shared Services Ontario To support the implementation of Patients First Act and LHINs beyond transition day. Health Shared Services Ontario (HSSO) 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 11

15 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 Total number of sub-regions with population size of less than 40,000 Number of sub-regions that have an acute care centre Estimated range of physicians in each sub-region Largest: 551,700 (HNHB LHIN) Median: 139,200 Smallest: 7,100 (NE LHIN) 5 (SE LHIN X 1, NE LHIN X 1, NW LHIN X 3). 73 out 76 Largest: 575 (Central Ottawa Champlain LHIN) Average: 153 Smallest: 12 (James Bay Coast NE LHIN) 12

16 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. 13

17 Mississauga Halton LHIN Sub-Region Map 14

18 Central West LHIN Sub-Region Map 15

19 Patients First: A Roadmap to Strengthen 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 In progress In progress In progress 6. Expand Caregiver Supports On May 13, 2015, Ontario announced a threeyear 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. 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 16

20 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 More bureaucracy No physician voice Access to specialists Privacy Care Coordinators / Primary Care 8% savings = $10.7M Response Which means 59 fewer executive and administrative/management staff Patient care is protected and maintained The integrated LHIN structure includes significantly expanded roles for physicians to support planning, priority-setting, and implementation at the LHIN and sub-region levels. Musculoskeletal strategy will support increased coordination and access Digital supports to link patients to specialists 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. Active collaboration with Ontario Primary Care Council to plan this work 17

21 Welcome to the Central West LHIN

22 Welcome to the Mississauga Halton LHIN We ve grown! Mississauga Halton LHIN May 31,

23 Thank you for your attention! Questions? Mississauga Halton Local Health Integration Network 700 Dorval Drive, Suite 500 Oakville ON L6K 3V3 Tel: or Fax: Central West Local Health Integration Network 8 Nelson Street West, Suite 300 Brampton, ON L6X 4J2 Tel Toll Free centralwest@lhins.on.ca 20

24 eregion IIIof Peel working with you Request for Delegation FOR OFFICE USE ONLY I MEETING DATE YYYY/MM/DD- I ~~17/0~1!~_ REQUESTDATE YYYY/MM/DD 2017/06/05 NAME OF INDIVIDUAL(S) Patricia Li MEETING NAME HSIC Attention: Regional Clerk Regional Municipality of Peel 10 Peel Centre Drive, Suite A Brampton, ON L6T 4B9 Phone: ext Fax: council@peelregion.ca POSITION/TITLE Assistant Deputy Minister, Direct Services NAME OF ORGANIZATION Ministry of Health and Long-Term Care (MOHL TC) TELEPHONENUMBER EXTENSION FAX NUMBER NAME OF INDIVIDUAL(S) Donna Piasentini and Steven Haddad POSITION/TITLE See Below NAME OF ORGANIZATION Ministry of Health and Long-Term Care (MOHL TC) TELEPHONENUMBER EXTENSION FAX NUMBER REASON(S)FORDELEGATION REQUEST(SUBJECTMATTER TO BE DISCUSSED) Second Presenter Organization: Director, Emergency Health Program Management and Delivery Branch, MOHL TC Third Presenter Organization: Executive Lead, Enhancing Emergency Services in Ontario Office, MOHL TC Providing an overview of provincial directions related to Paramedic Services, including the enhancing emergency services in Ontario initiative 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) _P_o_w_e_!rp_o_in_t _ Note: Delegates are requested to provide an electronic copy of all background material/presentations to the Clerk's Division at least seven (7) business days prior to the meeting date so that it can be included with the agenda package. In accordance with Procedure By-law , as amended, delegates appearing before Regional Councilor Committee are requested to limit their remarks to 5 minutes and 10 minutes respectively (approximately 5/10 slides). Delegates should make every effort to ensure their presentation material is prepared in an accessible format. Once the above information is received in the Clerk's Division, you will be contacted by Legislative Services staff to confirm your 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 as amended. for the purpose of contacting individuals and/or organizations requesting an opportunity to appear as a delegation before Regional Councilor a Committee of Council. The Delegation 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. All Regional Council meetings are audio broadcast via the internet and will be video broadcast on the local cable television network where video files will be posted and available for viewing subsequent to those meetings. Questions about collection may be directed to the Manager of Legislative Services, 10 Peel Centre Drive, Suite A, 5th floor, Brampton, ON L6T 4B9, (905) ext V

25 3.2-2 Update on Transforming Ontario s Emergency Health Services System Patricia Li Ministry of Health & Long-Term Care June 29, 2017

26 3.2-3 Presentation Overview A B Enhancing Emergency Services in Ontario (EESO) A System Transformation Report on Investments in Emergency Health Services Program Implementation 2

27 3.2-4 Presentation Overview A Enhancing Emergency Services in Ontario (EESO) A System Transformation Vision EESO is a strategic transformation of emergency health services to improve and sustain quality co-ordinated care across the patient s journey, and implement more effective medical transportation and paramedic services with all health care delivery partners and providers in Ontario. 3

28 3.2-5 Multi-Year Transformation Journey Ontario is enhancing and modernizing its emergency health services (EHS) system to provide people with increased flexibility and more options for medical transportation and paramedic services, to ensure they are receiving the right care when they need it. This is being facilitated through a multi-year vision under the umbrella of Enhancing Emergency Services in Ontario (EESO). There are several health sector reforms currently ongoing within the context of Patients First. The goals of these reforms are well aligned to the key objectives of EHS transformation, namely: Equitable access to care; Efficient service delivery of medical transportation; and, Better care coordination. EESO These reforms provide important opportunities for linkage and alignment. Refer to Appendix A1 for further details on pillars of work related to the multi-year vision. 4 4

29 EESO Mandate The Government s announcement on June 5, 2017, provides direction to design new patient care models for low acuity patients and to develop patient care and transportation standards (PCTS) for inter-facility critical care transports. As a first step in this multi-year journey, the ministry plans to update the Ambulance Act (the Act) through a transparent and inclusive consultation process in Summer The proposed changes, if passed, would enable the government to: o o o Allow paramedics to provide patient care options on the scene for low acuity patients for example appropriate on-scene treatment and refer patients to nonhospital options. Currently, paramedics are bound by law to transport patients to hospital facilities only. 1 Implement two pilots in interested municipalities that will enable certified paramedics to demonstrate the patient care options Develop new patient care and transportation standards to address critically ill patients in inter-facility patient transports by air ambulance and critical care land ambulance. 1 This requirement is referenced from the Health Insurance Act. Refer to Appendix A2 for further details on context for action. 5 5

30 3.2-7 EESO Key Deliverables in 2017/18 The EESO Office will be undertaking the following key activities pertaining to the patient s journey in the 2017/18 fiscal year: 911 Medical Emergencies Inter-Facility Patient Transports Legislative Amendments Create options in the oversight framework for: Low acuity patients who call 911 for a medical emergency., to allow for referral to non-hospital facilities, other health providers and services. Determining inter-facility transport of critically ill patients based on level of care needs. Program Design Through a transparent and inclusive stakeholder consultation process, design options for new patient care models (including alternate destination, Treat & Refer and Treat & Release), and develop new Patient Care and Transportation Standards for critically ill patients requiring interfacility transport to a higher or specialized level of care. Critical Care Services Review Scope and conduct with the support of a management consulting service a robust review of critical care services in Ontario, by designing model options that consider: Critical Care Land Ambulance program One-Number-to-Call Post Phase 1 evaluation Needs of specific patient populations (e.g. paeds). Non-Urgent Inter- Facility Transports Support demonstration projects in northern Ontario to test the feasibility of dedicated routes, followed by an evaluation of the outcomes to inform a broader system level solution. These important changes will ensure that patients are receiving access to the appropriate care at the right time, in the right place, and set the stage for further system transformation in 2018 and beyond. Refer to Appendix A3 and A4 for further details on future state patient s journey for 911 medical emergency calls. 6

31 3.2-8 Consultation Considerations The ministry is planning a two-staged approach to consultations, to enable the first phase of system transformation. This approach takes into account the feedback received from municipal partners and other stakeholders, to ensure that the review of the legislative framework and program design are appropriately informed by evidence and with due regard for potential impacts on delivery partners. Legislative Amendments Alternate Destinations Scope of Practice Standards for 911 Calls versus Inter-Facility Program Design Potential Liabilities and Risks Labour Relations Municipal Costs Non-Urgent Inter-Facility Patient Transports Title Protection Demonstration Pilots The diagram to the right illustrates the complexity of the current oversight regime, which points to pieces of legislation and regulations that may require amendments to enable the changes announced by the Government. 7

32 3.2-9 Consultation Staged Approach Over the coming weeks, the ministry will be focussing on targeted discussions related to the legislative amendments. Please see below the proposed consultation schedule for external partners: Stakeholders Association of Municipalities of Ontario (AMO) Level of Engagement Consult City of Toronto Consult Ontario Association of Paramedic Chiefs (OAPC) Consult Emergency Services Advisory Committee (ESAC) Consult Local Health Integration Networks (LHIN) Inform Ornge CritiCall Unions Consult Consult Inform * The ministry will come back to the AMO Health Task Force on further occasions as mutually deemed necessary. 8

33 Consultation Staged Approach (cont.) The ministry will be leveraging the existing EESO governance structure to engage with internal ministry partners and ensure alignment with other health sector reforms under Patients First. An inter-ministerial working group will also be struck to ensure that other ministry perspectives are taken into account. This will include: Ministry of Municipal Affairs Ministry of Labour Ministry of Advanced Education and Skills Development Ministry of Community Safety and Correctional Services Once the Ambulance Act and related legislation are amended, the ministry will focus on program design features of new patient care models and standards, which may include changes to regulations and standards. Working closely with our health partners, clients and caregivers, the ministry will proceed with broader stakeholder consultations starting in Winter

34 Presentation Overview B Investments in Emergency Health Services Program Implementation to: Improve patient outcomes Over three years ( ), the government is investing $60M in both technology and business processes to drive change and improve service Strong partnerships and municipal engagement are paramount to our shared responsibilities 10

35 Investing Emergency Health Services A Three-Year Outlook Investments of more than $60 million to improve patient outcomes A New Medical Dispatch System Upgrading the Computer Aided Dispatch System (5.7) Replacing the Digital Voice Recording and Retrieval System (the pre-work for modernizing the Public Safety Radio Network) Standardizing Operational Policies and Procedures Supporting our Dedicated Offload Nurses Program 11

36 Improving Patient Outcomes We made a commitment to improve patient outcomes To date we have: Putting Patients First Delivered a fleet of 16 vehicles to First Nations Emergency Response Teams for 16 communities in Northern Ontario Supported the Dedicated Offload Nurses Program with funding and new performance measures (see appendix B3) Introduced Basic Life Standards and Advanced Life Standards in 2016, which will be completed by December of 2017 Strong Partnerships Matter We continue to engage with municipalities and paramedic services early and often to find ways to improve how we deliver ambulance services to patients 12

37 Ambulance Dispatch Communications The ministry is currently implementing the following system improvements: New Medical Triage Algorithm First Implementation Site by March 2018, in Mississauga Upgrade of the Computer Aided Dispatch System 5.7 Will follow the upgrade of the new medical triage algorithm Investing in System Improvements Government Mobile Communications Project A multi-year project to replace Ontario s public safety radio network Note: See Appendix B1-B4 for details 13

38 Ambulance Dispatch Communications Investing in Business Transformation Revising Our Manual of Practice and Streamlining the Deployment Planning Process It s the starting point for everything we do, and determines how efficiently and effectively we operate Need to streamline our Manual of Practice and your Deployment Plans and planning process over the next 12 months Will be a Living Document to ensure updates can be made in a timely and standardized manner with an evidence-based approach and guiding principles that put the patient first Note: See Appendix B1-B4 for details 14

39 Ambulance Dispatch Communications Investing in Business Transformation Streamlining the Deployment Planning Process (cont d) Ensure municipal deployment plans are standardized, balanced and integrated for more effective use of resources Implement a standardized template for Deployment Plans in clear writing making it easier to implement Create a consistent approach with guiding principles to improve response times, reduce errors, and bring consistency to access to care Consult with paramedic services to streamline the deployment planning and approval process to eliminate inefficiencies Note: See Appendix B1-B4 for details 15

40 Ambulance Dispatch Communications Review of the Ambulance Dispatch Model in Ontario Deloitte Review Ambulance Dispatch Model Deloitte was retained to develop a series of options for the optimal delivery model for land and air ambulance communications in Ontario Review commended September 2016 and is now completed. The Deloitte Report noted that there is currently work underway to reform the emergency health system The work undertaken to inform the Deloitte Report will be used to identify next steps in the transformation of ambulance dispatch and emergency services The Deloitte Report will be shared with all participants by the Summer

41 Discussion 17

42 Appendices 18

43 A1. Multi-Year Transformation Journey The ministry s multi-year vision for change is based on the following four key pillars of work: Integrate Change Redesign patient interaction with the EMS system/ 911 by creating different clinical pathways while ensuring patients receive the right care at the right time in the right place. Build Develop a sustainable, system-level solution to non-urgent inter-facility transports, addressing the particular needs of Ontarians in northern and remote communities. + Provide seamless patient care for those who are critically ill and/or requiring higher level of care, by conducting a comprehensive review of critical care system in Ontario to better integrate services at the point of care. Oversee Establish an accountability structure with better utilization of system resources and supported by benchmarks to measure system performance

44 A2. Context for Action Patient transport volumes continue to rise, while an outdated legislative framework under the Ambulance Act focusses on patients who access care for medical emergencies via a 911 call, but does not address other patient journeys such as inter-facility transports. As a result, definitive patient triage, assessment, diagnosis, treatment/referral and discharge are all conducted in the emergency department (ED), which is not optimal for all patients. A future-facing EHS system will be timely, responsive and provide patients with a seamless, integrated journey to accessing care

45 A3. The Patient s Journey: 911 Medical Calls Today s 911 calls most often result in the dispatch of an ambulance. In the absence of other destination options for treatment/interventions, patients are taken to the ED. The multi-year vision involves redesigning the patient s interaction with the EHS system/ 911, enabling clinical pathways based on patient needs. This will help reduce inappropriate ED visits and get patients to the right care in the first instance, avoiding the need for future transfers. Phase 2 Phase 1 Legend Immediate Response Prompt Response Scheduled Response Diverted Response No Transport Will be informed by consultations 21

46 A4. The Patient s Journey: 911 Medical Calls (cont.) In the first phase, the ministry is interested in pursuing new patient care models in the Patient Assessment on Scene stage. This will enable certified paramedics, including firefighters who are certified paramedics, to respond to calls for low acuity patients with a broader range of treatments/interventions. Patient Assessment on Scene Certified Ontario Paramedics adhering to standards under the Ambulance Act will assess and treat patients at the point of care. The proposal aims to enhance medical response with alternative patient care models other than ED, post 911 response. Alternate Destination: Once on scene assessment by the paramedic is complete, it may be more appropriate to transport the patient to an alternate health facility other than an ED, such as an Urgent Care Centre, mental health and addictions crisis centre, etc. Patient Assessment Treatment Destination Decision Treat and Refer Alternate Destination Transport Transfer of Care Transfer of Care Treat & Refer: Paramedics could provide appropriate on scene treatment and referral options (e.g. into primary or home/communitybased care). Some Canadian and international jurisdictions have seen benefits in moving to this model. Treat and Release Discharge HCC Models Primary Care Home Care Community Paramedicine Transfer of Patient Record Treat & Release: Under appropriate conditions, paramedics would be able to assess, treat and release lower acuity patients when deemed safe and appropriate. This would also promote increased use of primary care and existing community resources

47 B1. Status Update June 2017 New Medical Algorithm Vendor orientation complete (business requirements documented) Vendor proposal being reviewed Project Governance in place, EHS Senior Business Lead identified Contract negotiations to be completed end of June/early July 2017 Implementation Planning Team and Structure under development On-boarding Project Manager, June 2017 Peel, Halton, Georgian, Toronto and Niagara Paramedic Services regularly consulted on Lessons Learned from Niagara and Toronto Business Impacts Implementation Plan Medical Director Oversight Training of Ambulance Communications Centre Staff Training of Paramedic Services Staff 23

48 B2. Status Update June 2017 The hub of a suite of applications Upgrade of the Computer Aided Dispatch System to 5.7 Supports advanced technologies that will allow us to manage our resources more effectively Will be implemented after the new medical algorithm Improves functionality for dispatchers to view, select and dispatch municipal ambulances Already implemented in Niagara (March 2017) and Toronto (May 2017) Paramedic Services The ministry is working with the vendor (TriTech) to address and resolve system issues and defects, and ensure the configuration of CAD 5.7 for provincial implementation. Once deployment-ready, a detailed CAD 5.7 roll-out and training plan will be developed 24

49 B3. Ambulance Dispatch Communications Investing in Business Transformation Dedicated Offload Nurses Program Since 2008, the ministry has provided 100% funding to municipalities to arrange for dedicated nurses to receive and triage ambulance patients at locally selected hospitals 20 (out of 50) municipalities receive a total of $16M, which represents almost 160 nursing FTEs For 2017/18, the ministry has enhanced accountability, improved performance measurement and better alignment with P4R(Pay-For-Results) principles, so that results can be more clearly and quantifiably defined 25

50 B4. Context for Action Initiative MPDS First Site (Mississauga) Remaining Sites Manual of Practice/Deployment Plans Phase 1: Consultation and development Phase 2: Training and deployment CAD 5.7 Upgrade Niagara and Toronto Province-wide Implementation Digital Voice Recording and Retrieval Developing Business Cases for provincewide sequencing and implementation Request For Bids issued Evaluation phase late July/August 2017 Review of the Ambulance Dispatch Model Release Deloitte Report Implementation Date March 2018 Schedule in development September to December 2017 Spring 2018 Completed Pending Vendor and User Adoption Readiness Underway Implementation begins in the Northern zone in Fall of 2017 Summer

51 4.1-1 REPORT Meeting Date: Health System Integration Committee For information DATE: June 15, 2017 REPORT TITLE: FROM: OVERVIEW OF PROVINCIAL POLICY REFORMS RELATED TO EMERGENCY HEALTH SERIVCES IN ONTARIO Nancy Polsinelli, Commissioner of Health Services OBJECTIVE To provide an overview of provincial directions related to paramedic services and their alignment with Regional priorities. REPORT HIGHLIGHTS Enhancing Emergency Services in Ontario (EESO) is a provincial multi-year transformational initiative to improve the coordination of care for patients across their journey within the emergency health services system. The EESO Office was established in 2016, with a three-year mandate to make strategic recommendations to an Executive Steering Committee within the Ministry of Health and Long-Term Care. EESO directions align with Regional priorities to address system issues, such as reforms to the ambulance dispatch system and Peel Paramedic Services ongoing work with Peel-area hospitals to reduce offload delay. Regional staff have established relationships with provincial colleagues to build a foundation for collaboration and engagement in discussions related to system transformation in the years ahead. DISCUSSION 1. Background Responsibility for paramedic services in Ontario is shared between the Ministry of Health and Long-Term Care (Ministry) and single and upper tier municipalities who deliver land ambulance services. The former Emergency Health Services Branch within the Direct Services Division of the Ministry, which provided oversight for land ambulances services, has recently been restructured into two new branches. The new Emergency Health Program Management and Delivery Branch sets standards, measures performance and oversees the seamless functioning of emergency ambulance services. The other new Emergency Health Regulatory and Accountability Branch provides strategic direction and program support on the operations of emergency ambulance services. In early 2016, a new office was also created within the Direct Services Division of the Ministry, called Enhancing Emergency Services in Ontario (EESO). The EESO Office has a three-year mandate to propose strategic reforms to improve coordinated care throughout

52 4.1-2 OVERVIEW OF PROVINCIAL POLICY REFORMS RELATED TO EMERGENCY HEALTH SERVICES IN ONTARIO the patient s journey within the emergency health services system. In this context, the term emergency health services includes paramedic services, ambulance dispatch centres, and regional base hospitals that provide medical direction to paramedics, air ambulance, as well as other key stakeholders, such as hospitals, police and fire services. This report provides a high level overview of the mandate and activities of the EESO from a Region of Peel perspective, and is meant to complement a delegation to today s meeting by Patricia Li, Assistant Deputy Minister of the Direct Services Division. 2. Findings Enhancing Emergency Health Services in Ontario is described by the Province as a multiyear transformation initiative to improve coordinated care throughout the patient s journey within the emergency health services system. To do this, the EESO works collaboratively with other Divisions and Branches within the Ministry (e.g. Emergency Health Program Management and Delivery Branch, Home and Community Care Branch) to identify more effective service delivery alternatives and better integrate all health care delivery partners and providers. a) Alignment between EESO and Regional Priorities and Directions The mandate and objectives of EESO acknowledges the contribution that paramedic services make within the health system, and that reforms related to the emergency health services system need to be aligned with ongoing transformation in other parts of the health system. As outlined in the report titled Patients First: A Proposal to Strengthen Patient-Centred Care in Ontario Region of Peel Response to the February 4, 2016 meeting of the Health System Integration Committee (HSIC), the Region of Peel has long advocated for greater recognition of the role paramedics play in the local health system, and for greater integration and coordination of paramedic services with other local health services. As such, Regional staff view the Ministry s direction with the creation of the EESO Office, and accompanying recognition that paramedics are a key player within the local health system, as positive and encouraging progress in relation to this advocacy ask. On June 5, 2017, the provincial government publicly committed to replacing the triage tool used in ambulance dispatch centres, with the Mississauga dispatch centre being the first site for implementation. This responds to over 10 years of Regional advocacy for such changes and also marks positive progress by the province to address system issues impacting municipal land ambulance operators in Peel. While further analysis is needed to determine the impact on municipal operators, consultations on the proposed changes to the Ambulance Act, which would expand the scope of paramedics to provide on-scene treatment and to refer patients to destinations other than hospitals, present an opportunity to work with the province to identify innovative solutions to system pressures. At the same time, the Province has also proposed two pilot projects to test the use of firefighters certified as paramedics to respond to low acuity calls in the community. Council has indicated in the past that it is not supportive of this direction, and staff will continue to monitor these proposed changes and identify opportunities to provide municipal feedback. Initial analysis on the implications of the provincial government s announcement by the Association of Municipalities of Ontario is included as a communication item on today s agenda for reference

53 4.1-3 OVERVIEW OF PROVINCIAL POLICY REFORMS RELATED TO EMERGENCY HEALTH SERVICES IN ONTARIO The work of EESO will build on these provincial announcements and explore other policy reforms within the paramedic services system, with a focus on redesigning patient s interaction with the emergency health services system and enabling appropriate pathways to care based on patient needs. As a result, the list of initiatives of focus for the EESO (see below), which are either led by, or conducted in collaboration with other Divisions and Branches within the Ministry, align with Regional priorities and directions, including our long-standing efforts to influence reforms to the provincial dispatch system. Introducing new technologies that improve the triaging of patients and enable better information sharing between dispatchers and paramedics; Reviewing Central Ambulance Communication Centre (CACC or dispatch centre) performance to identify areas for improvement; Continuing to support measures to reduce ambulance offload delay; Standardizing municipal deployment plans by updated operating policies and protocols; Developing a provincial community paramedicine framework to consider alternative ways to utilize paramedics in non-emergency settings; and Modernizing the existing telehealth system and considering options to reform the way that patient s currently interact with the 911 system. The EESO Office will use the findings and directions from these and other projects (e.g. non-urgent transport, critical care system review) conducted over their three-year mandate, together with research and sector insights, to make recommendations to Ministry leadership that will support long-term system change and ensure a more coordinated patient journey throughout the emergency health services system. As a result, Regional staff view the EESO Office as an important partner for ongoing Regional advocacy related to paramedic services, and have established relationships with provincial colleagues to build a foundation for collaboration and engagement in discussions related to system change. CONCLUSION The creation of the EESO Office within the Ministry of Health and Long-Term Care is viewed by Regional staff as a promising first step towards better recognizing the role that paramedics play in the local health system, and addressing important system issues that impact the daily operations of Peel Regional Paramedic Services and Peel s health system partners

54 4.1-4 OVERVIEW OF PROVINCIAL POLICY REFORMS RELATED TO EMERGENCY HEALTH SERVICES IN ONTARIO Continuing to build strong relationships with provincial staff, including those within the EESO Office, will help position the Region of Peel well to share knowledge from a local perspective and influence system change both locally and provincially. Nancy Polsinelli, Commissioner of Health Services Approved for Submission: D. Szwarc, Chief Administrative Officer For further information regarding this report, please contact Dawn Langtry, Director, Ext. 4138, dawn.langtry@peelregion.ca. Authored By: Liz Estey and Cullen Perry, Strategic Policy and Projects, Health Services - 4 -

55 4.2-1 REPORT Meeting Date: Health System Integration Committee DATE: June 15, 2017 REPORT TITLE: FROM: UPDATE ON REGIONAL MENTAL HEALTH ADVOCACY Nancy Polsinelli, Commissioner of Health Services RECOMMENDATION That the advocacy approach outlined in section 2 of the report of the Commissioner of Health Services titled, Update on Regional Mental Health Advocacy be endorsed; And further, that a copy of the subject report be shared with the Minister of Health and Long-Term Care, the Minister of Children and Youth Services, the Central West and Mississauga Halton Local Health Integration Networks, Peel Children s Centre, and Ontario s Mental Health and Addictions Leadership Advisory Council for information. REPORT HIGHLIGHTS A report and delegations received at the October 2016 meeting of the Health System Integration Committee (HSIC) outlined the complexity of the mental health system and challenges for local service delivery. As a result, HSIC identified two advocacy positions related to mental health and addictions funding and mental health system integration, which were subsequently endorsed by Regional Council as Regional advocacy priorities. Despite some positive provincial directions related to funding reform and integrated mental health service planning, further action from the Province is needed to ensure equitable funding for Peel and support coordinated service planning at the local level. Currently, Regional advocacy is focused on encouraging the Province to implement a needs-based funding model for mental health and addictions services across the lifespan, and supporting alignment of ongoing service planning for the child/youth and adult sectors, both locally and through advocacy for supportive processes at the provincial level. DISCUSSION 1. Background Funding, system planning, and coordination of mental health and addictions services are provincial responsibilities, shared between the Ministry of Health and Long-Term Care (adult services) and the Ministry of Children and Youth Services (child and youth services). At a local level, oversight is the responsibility of the Local Health Integration Networks (Central West and Mississauga Halton) for adult services, and the Peel Children s Centre for child and youth services.

56 4.2-2 UPDATE ON REGIONAL MENTAL HEALTH ADVOCACY In June 2011, the Ministry of Health and Long-Term Care (MOHLTC) released a ten-year strategy, Open Minds, Healthy Minds: Ontario s Comprehensive Mental Health and Addictions Strategy, which aims to enhance coordination of the mental health system and improve access to programs and services along a continuum of care. Recognizing the need for a more holistic and comprehensive approach to addressing mental health in Ontario, the implementation of the strategy involves 15 ministries, with both the MOHLTC and the Ministry of Children and Youth Services playing leadership roles. In 2014, Ontario s Mental Health and Addictions Leadership Advisory Council was established to support the implementation of the strategy and make recommendations regarding key priorities for action. At the October 20, 2016 meeting of the Health System Integration Committee (HSIC), a report and a number of delegations outlined the complexity of the mental health system, as well as the challenges and opportunities for mental health and addictions service delivery in Peel. An overview of the delegations provided at the October 20 th meeting is provided in Appendix I for reference. Challenges associated with funding and system integration were highlighted as key areas of concern in Peel. Funding is a key challenge, as allocations to both the Central West and Mississauga Halton Local Health Integration Networks (LHINs) for mental health and addictions services are well below the provincial average. Similarly, delegates shared that funding for Peel s children and youth mental health services is not equitable compared to other jurisdictions. Underfunding of mental health and addictions services contributes to lower service availability and higher wait times for core mental health and addictions services in Peel. From a system integration perspective, delegates spoke to the challenges associated with child and youth mental health being considered separately from all other health issues, and having two systems for mental health service funding and delivery one for adults and one for children and youth. Although the MOHLTC and the Ministry of Children and Youth Services are making efforts to improve integration, this is yet to translate into tangible improvements in coordination at the local level. As a result, services remain disjointed and residents continue to struggle with both accessing and navigating available services. System navigation is a particular issue for youth who need age-appropriate services as they transition into the adult system. Appendix II includes more specific examples and context to the issues of underfunding and system integration in Peel. Recognizing these challenges, the HSIC endorsed the following two advocacy positions at the October 20, 2016 meeting and referred them to the Government Relations Committee. In November 2016, they were endorsed by Regional Council as Regional advocacy priorities. Mental Health and Addictions Funding: The provincial government should address historical inequities in funding for mental health and addictions services in Peel to support improved access to services within the community and ensure that funding matches community needs and reflects demographic changes. Mental Health System Integration: The provincial government should integrate mental health system planning and service delivery to ensure seamless access to services across the entire age continuum (children to seniors) and work across ministries on the basic social needs required for mental health promotion and recovery, such as housing

57 4.2-3 UPDATE ON REGIONAL MENTAL HEALTH ADVOCACY 2. Regional Advocacy Efforts To facilitate action and leverage windows of opportunity for influence, staff have developed a strategic approach to advocacy for Council s two mental health related positions. An update on the current provincial and regional context related to each advocacy position, and an overview of the strategic approach to advocacy, including ongoing and proposed advocacy activities, is described below. a) Mental Health and Addictions Funding Current Context The provincial government has recently made commitments that demonstrate their understanding of the need to reform and enhance funding for mental health and addictions services. Recent funding announcements by the MOHLTC related to supportive housing, structured psychotherapy and youth wellness hubs, as well as the latest federal and provincial health transfer agreement (March 2017) that includes an additional $1.9B for mental health services over 10 years, are encouraging investments. Through Ontario s comprehensive mental health and addictions strategy, the Province has also committed to implementing needs-based funding for all mental health and addictions services across the lifespan. A needs-based funding model, which accounts for growing service needs associated with population growth, demographics, socioeconomic status and diversity, will help to ensure Peel residents receive their fair share of provincial dollars. The Province has made some positive progress toward this type of funding, with the Ministry of Children and Youth Services planning to roll out a needsbased funding model for children and youth services in the fiscal year. However, the MOHLTC has yet to announce that they are moving forward with a similar approach to adult mental health and addictions services funding. The Region of Peel advocated to the Province for a needs-based funding model across the lifespan within our 2017 provincial pre-budget submission and corresponding delegation at the prebudget consultation hosted by the Ontario Standing Committee on Finance and Economic Affairs. b) Mental Health System Integration Current Context Through its mental health and addictions strategy, the provincial government has acknowledged the need for improved cross-ministerial coordination and greater integration of mental health and addictions services with other types of services and supports, such as supportive housing and seniors services. Nevertheless, fundamental challenges still exist as a result of the provincial division of funding and service delivery by age and the disconnect of child and youth mental health from all other health services. Currently, with direction from the Ministry of Children and Youth Services, Peel Children s Centre (the lead agency for child and youth mental health services in Peel) is working through a community service planning process for children and youth mental health and addictions services. At the same time, both LHINs serving Peel (Central West and Mississauga Halton) are beginning to plan adult services at the sub-region level as a component of ongoing health system transformation under the Patients First Act. While these two localized system planning efforts are occurring in parallel, to our knowledge, there has been no direction or support from the Province to coordinate or - 3 -

58 4.2-4 UPDATE ON REGIONAL MENTAL HEALTH ADVOCACY align planning. To fill this gap, Regional staff have been working at the local level to support linkages between the Peel Children s Centre and the Central West and Mississauga Halton LHINs, and encourage alignment of service planning efforts. c) Future Advocacy Opportunities While work is ongoing at the provincial level to address mental health system issues, change is still required to ensure that Peel residents receive their fair share of funding and have more seamless and coordinated access to services across their lifespan. To help positively influence these changes, staff have identified the following actions as next steps for the Region s advocacy efforts: Continue to engage as a system partner in Peel Children s Centre s development of a community mental health plan through their community asset inventory working group (Spring 2017). Meet with the Chief Executive Officer of Peel Children s Centre to identify opportunities to leverage his provincial role in sector reform to support alignment of children and youth mental health planning with the adult mental health sector and gain insights about funding model changes (Spring 2017). Send letters to both the MOHLTC and the Ministry of Children and Youth Services asking the Province to move forward with a needs-based funding model for mental health services across the lifespan and to provide greater support and direction to lead agencies in order to enable and facilitate coordinated planning locally (Summer 2017). Send communication from the Commissioner of Health Services to the Associate Deputy Ministry (ADM) within the MOHLTC responsible for mental health issues, indicating the Region s support for needs-based funding reform and system integration efforts, with potential to invite the ADM to return to a future Health System Integration Committee meeting to provide an update on provincial progress (Summer 2017). Share information about mental health underfunding challenges in Peel at the Summit 4 Fair Funding, with the potential to identify collective messaging for the 905 regions following the Summit (Fall 2017). Continue to support and influence mental health system planning locally, including supporting collaboration between Peel Children s Centre and, both LHINs serving Peel, and identifying opportunities for coordinated planning with other system partners at a regional level (Ongoing). Identify opportunities to influence the province to support integration of mental health services with other supports across the lifespan, such as supportive housing, and ensure that the needs of seniors are adequately integrated with adult services (Ongoing). CONCLUSION While current provincial directions related to the mental health and addictions system are in alignment with the Region of Peel s overall vision for a better integrated and more accessible mental health system, significant change is still required to ensure that Peel receives its fair share of provincial dollars for mental health and addictions services, and that system and service planning is well coordinated to facilitate seamless transitions and improve access

59 4.2-5 UPDATE ON REGIONAL MENTAL HEALTH ADVOCACY By working through a multi-pronged approach to advocacy, including formal letters and strategic partnerships, the Region will continue to influence change both locally and provincially to improve the funding, functioning and performance of the mental health and addictions system in Peel. Nancy Polsinelli, Commissioner of Health Services Approved for Submission: D. Szwarc, Chief Administrative Officer APPENDICES 1. Appendix I Delegations at the October 20 Meeting of HSIC 2. Appendix II Evidence Supporting Council-Endorsed Advocacy Positions For further information regarding this report, please contact Dawn Langtry, Director, Ext. 4138, dawn.langtry@peelregion.ca. Authored By: Nicole Britten and Jessica Kwik, Strategic Policy and Projects, Health Services - 5 -

60 4.2-6 APPENDIX I UPDATE ON REGIONAL MENTAL HEALTH ADVOCACY Delegations at the October 20, 2016 Meeting of the Health System Integration Committee # DELEGATES PRESENTATION TOPIC 1 Dawn Langtry, Director, Strategic Policy, Planning and Initiatives, Region of Peel Providing an Overview of the Mental Health System in Peel 2 Sharon Lee Smith, Associate Deputy Minister, Policy & Transformation, Ministry of Health and Long-Term Care Regarding the Direction and Implementation of the Provincial Mental Health Strategy 3 Suzanne Robinson, Director, Health System Integration, Central West Local Health Integration Network (LHIN) and Monica Beltazzoni, Program Director, Program Director, Mental Health, Self- Management, Central Intake and Halton Diabetes Programs, Halton Healthcare 4 Humphrey Mitchell, Chief Executive Officer, Peel Children s Centre 5 David Smith, Chief Executive Officer, Canadian Mental Health Association (CMHA) Peel Dufferin Providing an Overview of the LHIN Role in the Mental Health and Addictions System and to Outline Key Funding Priorities and Areas of Focus, in Particular, the System Access Models and Health Links Providing an Overview of Peel Children s Centre s Role in the System as the Lead Agency for Child and Youth Mental Health Services in Peel and to Identify Current or Emerging Gaps or Challenges Providing an Overview of the Work of CMHA in Peel as well as the Interactions between CMHA Peel, the Human Services Outreach Team and Peel Regional Police Through the Crisis Support Team

61 4.2-7 APPENDIX II UPDATE ON REGIONAL MENTAL HEALTH ADVOCACY Evidence Supporting Council-Endorsed Advocacy Positions In 2016, Regional Council identified mental health and addictions funding and mental health system integration as Regional advocacy priorities. Underfunding and the lack of system integration are at the root of a number of challenges experienced by Peel residents, including difficulties accessing and navigating services and long wait times for mental health and addiction services. While these underfunding and system integration issues are interconnected, data that specifically speaks to each of the issues is summarized below for additional context and background information to Regional Council s current advocacy. i) Evidence Supporting Regional Advocacy related to Mental Health and Addictions Funding The current funding allocation model for mental health and addictions services does not account for demographic changes and population growth, which has resulted in underfunding of services in Peel. While Peel is growing faster than the provincial average, per capita funding for mental health and addictions services for both Local Health Integration Networks (LHINs) serving Peel (Central West and Mississauga Halton) are among the lowest in Ontario. This funding variation across jurisdictions is illustrated in the table below. Adult mental health and addictions funding in Peel compared to other jurisdictions (2015/16) Annual per capita funding for adult services Ontario average Local Health Integration Networks (LHINs) serving Peel Local Health Integration Networks similar to Peel Mental Health $65.70 Central West* $33 Mississauga Halton* $26 Addictions $18.60 Central West $6.10 Mississauga Halton $5.40. Supportive Housing (mental healthspecific) 9 units per 10,000 people *Lowest funded of LHINs in Ontario Central West units per 10,000 people Mississauga Halton* units per 10,000 people Central (York Region-area) $41.40 Champlain (Ottawa area) $52.30 Toronto Central $ Central $3.80 Champlain $18.40 Toronto Central $30.90 Central 7.1 units per 10,000 people Champlain 6.7 units per 10,000 people Toronto Central 31.1 units per 10,000 people Funding constraints can translate into limited community supports, leading to longer wait times for services or unmet needs that may show up as emergency department visits or interactions with the police. Some examples of these challenges within both the child and youth sector and adult sector in Peel include: As of May 2017, the median wait times in the Central West LHIN were greater than provincial values for the following services for adults: case management, centralized/coordination access and support within housing. i As of May 2017, the median wait times in the Mississauga Halton LHIN were greater than provincial values for the following services for adults: assertive community 1

62 4.2-8 APPENDIX II UPDATE ON REGIONAL MENTAL HEALTH ADVOCACY treatment team, case management, early psychosis intervention, inpatient services and primary day/night care. ii As of 2016, 1,100 people in Peel are waiting for one of the 252 mental health supportive housing units in the Region. Emergency departments and police are seeing increasing numbers of people with mental health issues. o Brampton Civic has seen a 32% increase in emergency visits for mental health issues and a 42% increase in emergency visits for substance abuse between 2012 and o Credit Valley and Mississauga Hospital have seen an increase of 15% and 13% respectively in emergency visits for mental health issues and a 35% increase in emergency visits for substance abuse between 2012 and o Peel Police report an 8% increase in mental health calls for assistance (not including suicide or suicide attempts) between 2013 and ii) Evidence Supporting Regional Advocacy related to Mental Health System Integration Fundamental system gaps stem from the provincial division of funding and service delivery, which is currently divided by child/youth services (Ministry of Children and Youth Services) and adult services (Ministry of Health and Long Term Care). Coordination between the child/youth and adult sectors is particularly important for older youth that must transition into the adult system. Examples that demonstrate a lack of coordination both at the provincial and local level include: Up to 52 per cent of young people engaging in the transition process disengage from services at a time of onset of mental health problems, and would benefit from early intervention. iii Lack of provincial guidance and support to enable integrated mental health system-wide planning across the child/youth and adult sectors at the local level. Lack of developmentally-appropriate and coordinated services for youth addictions, which the Ontario s Mental Health and Addictions Leadership Advisory Council has attributed to youth addictions not being transferred to the Ministry of Children and Youth Services with other youth-specific mental health services. Across the system, there are a range of different entry points, eligibility requirements, and intake processes that govern services, making system navigation challenging for residents. For example, according to 2015 Ontario Student Drug Use and Health Survey data, onethird of Peel students in grades 7-12 (32%) have perceived unmet mental health needs, defined as not knowing who to turn to when facing a mental health issue. iv i ConnexOntario eservices database. Accessed on May 15, ii ConnexOntario eservices database. Accessed on May 15, iii Mental Health Commission of Canada (2015). Taking the Next Step Forward: Building a Responsive Mental Health and Addictions System for Emerging Adults, Ottawa, ON: Mental Health Commission of Canada. Available from: iv Peel Public Health. A Look at Peel Youth in Grades 7-12: Physical Health and Mental Well-Being. Results from the Ontario Student Drug Use and Health Survey, , A Peel Health Technical Report

63 5.1-1 From: AMO Communications Sent: June 5, :28 PM To: Lockyer, Kathryn Subject: AMO Policy Update - Province Announces Emergency Services Changes Including Dispatch and Fire-Medic Pilots June 5, 2017 Province Announces Emergency Services Changes Including Dispatch and Fire-Medic Pilots Today, the Minister of Health and Long-Term Care announced proposed changes to emergency health services, including providing alternative options for medical treatment and paramedic services. We understand there will be a consultation process over the coming weeks with the intent to introduce legislative changes in the fall session. Firstly, the Ministry is investing in a new medical dispatch system for land ambulance 911 calls expected to roll out across the province over a period of two years starting in March The purpose is to better prioritize calls based on patient need and redirecting low acuity patients from emergency rooms, where appropriate and safe to do so. This initiative is timely and welcome. AMO has long called for improvements to the dispatch system. The government is also seeking to expand the scope of paramedics to provide alternate on-scene treatment and to refer patients to destinations other than hospitals as is currently required by law. Further information and analysis on the implications and benefits to patients, municipal governments, and District Social Service Administration Boards is needed. The Minister also announced that once the Act is changed and a regulation is in place, that two pilot projects could test the use of firefighters certified as paramedics to respond to low-acuity calls Given the legislative process, it is likely these pilots will not occur until 2018 at the earliest and there are willing municipal governments. There is still time for municipal input into this proposal. While the two pilots are to be voluntary, determined by the municipal employer, then interest arbitrators must be forbidden in law from replicating this idea. As happened with 24-hour shift pilots, interest arbitration settlements made it a practice, even in municipalities that did not adopt the policy. The government must address the labour